56 research outputs found

    Optimizing care for patients with symptomatic carotid disease

    Get PDF

    Prey removal in cotton crops next to woodland reveals periodic diurnal and nocturnal invertebrate predation gradients from the crop edge by birds and bats

    Get PDF
    Factors influencing the efficacy of insectivorous vertebrates in providing natural pest control services inside crops at increasing distances from the crop edge are poorly understood. We investigated the identity of vertebrate predators (birds and bats) and removal of sentinel prey (mealworms and beetles) from experimental feeding trays in cotton crops using prey removal trials, camera traps and observations. More prey was removed during the day than at night, but prey removal was variable at the crop edge and dependent on the month (reflecting crop growth and cover) and time of day. Overall, the predation of mealworms and beetles was 1-times and 13-times greater during the day than night, respectively, with predation on mealworms 3-5 times greater during the day than night at the crop edge compared to 95 m inside the crop. Camera traps identified many insectivorous birds and bats over crops near the feeding trays, but there was no evidence of bats or small passerines removing experimental prey. A predation gradient from the crop edge was evident, but only in some months. This corresponded to the foraging preferences of open-space generalist predators (magpies) in low crop cover versus the shrubby habitat preferred by small passerines, likely facilitating foraging away from the crop edge later in the season. Our results are in line with Optimal Foraging Theory and suggest that predators trade-off foraging behaviour with predation risk at different distances from the crop edge and levels of crop cover. Understanding the optimal farm configuration to support insectivorous bird and bat populations can assist farmers to make informed decisions regarding in-crop natural pest control and maximise the predation services provided by farm biodiversity

    Cost-Effectiveness of Two Decision Strategies for Shunt Use During Carotid Endarterectomy

    Get PDF
    Background: Arterial shunting during carotid endarterectomy (CEA) is essential in some patients because of insufficient cerebral perfusion during cross-clamping. However, the optimal diagnostic modality identifying these patients is still debated. None of the currently used modalities has been proved superior to another. The aim of this study was to assess the cost-effectiveness of two modalities, stump pressure measurement (SPM) versus electroencephalography (EEG) combined with transcranial Doppler (TCD) during CEA. Methods: Two retrospective cohorts of consecutive patients undergoing CEA with different intraoperative neuromonitoring strategies (SPM vs. EEG/TCD) were analyzed. Clinical data were collected from patient hospital records. Primary clinical outcome was in-hospital stroke or death. Total admission costs were calculated based on volumes of healthcare resources. Analyses of effects and costs were adjusted for clinical differences between patients by means of a propensity score, and cost-effectiveness was estimated. Results: A total of 503 (239 SPM; 264 EEG/TCD) patients were included, of whom 19 sustained a stroke or died during admission (3.3 vs. 4.2%, respectively, adjusted risk difference 1.3% (95% CI −2.3–4.8%)). Median total costs were €4946 (IQR 4424–6173) in the SPM group versus €7447 (IQR 6890–8675) in the EEG/TCD group. Costs for neurophysiologic assessments were the main determinant for the difference. Conclusions: Given the evidence provided by this small retrospective study, SPM would be the favored strategy for intraoperative neuromonitoring if cost-effectiveness was taken into account when deciding which strategy to adopt

    Growth of uniform solid solutions of naphthalene and 2-naphthol by repeated pass zone-leveling

    No full text
    Abstract The construction of a zone-leveling apparatus is described. The apparatus was tested with the binary system naphthalene and 2-naphthol. The experimental concentration distribution profiles in the zone-leveled ingots are compared with profiles calculated by the theory of Kirgintsev and Kudrin. The concentration distribution measured in the polycrystalline zone-leveled ingots shows a variation of 0.01 mole fraction in the uniform part of the ingot. The isothermal initial melting behaviour of uniform solid solutions of naphthalene and 2-naphtol is described

    Optimizing care for patients with symptomatic carotid disease

    Get PDF
    The first part of this thesis reviews new developments in medical and invasive treatment options in patients with symptomatic carotid disease. Improvements in medical treatment have led to a decline in annual stroke risk, affecting the indication for carotid endarterectomy (CEA). CEA is further challenged by the introduction of carotid angioplasty and stenting. However, CEA continues being the golden standard. These developments necessitate proper patient selection. A potential further role for duplex ultrasound in improving patient selection was subsequently investigated. Its role seems however to be limited in the event of the presence bilateral significant carotid stenosis, when the degree of stenosis may erroneously be estimated too high. Also, the gray-scale median, a quantification method of plaque echolucency which theoretically might indicate plaques prone for rupture and embolisation, could not be validated as predictor for plaque vulnerability. In order to optimize the care chain and, consequently, patient outcome, the clinical treatment course of these patients was analysed. Its durations showed to be significantly shortened over the past decade, however, improvements can be made in those patients who had been externally referred. In the era of centralization, this issue might be of importance. Health care costs rise uncontrollably while resources are constrained by budget cuts. The last chapter provides an insight into the structure of costs made during admission for CEA and studies the cost-effectiveness of two different intraoperative neuromonitoring modalities in order to seek a possibility to reduce costs and re-allocate resources to those patients who need them most
    • …
    corecore