Analyzing associations in multivariate binary time series

We analyze multivariate binary time series using a mixed parameterization in terms of the conditional expectations given the past and the pairwise canonical interactions among contemporaneous variables. This allows consistent inference on the influence of past variables even if the contemporaneous associations are misspecified. Particularly, we can detect and test Granger non­-causalities since they correspond to zero parameter values

Entwicklung einer Eingabemaske für die Erfassung klinischer Annotationen

Im Rahmen des Projektes ”Zeitreihenanalytische Methoden zur Behandlung von Online-Monitoring-Daten aus der Intensivmedizin“ im Sonderforschungsbereich 475 wird eine klinische Studie zur Evaluierung und zum Vergleich von Alarm-Algorithmen für die Patientenüberwachung auf Intensivstationen durchgeführt. Die Studie erhebt klinisch annotierte Daten. Die durch ein Monitoringgerät aufgezeichneten Patientendaten für die Vitalparameter und die aufgetretenen Alarme werden dazu retrospektiv analysiert. Alle Annotationen werden mit Hilfe einer speziell zu diesem Zweck entwickelten Eingabemaske erfasst, die in dieser Arbeit beschrieben wird

Hispanic Ethnicity, Male Gender and Age Predict Restraint Use and Hospital Resource Utilization in Pediatric Trauma

Child restraint reduces the severity of injuries in motor vehicle crashes. Racial/ethnic groups appear to have differing restraint use rates. The objective of this study was to identify restraint use differences between ethnic and other demographic subgroups of pediatric trauma patients. Prospective data were analyzed for 1072 consecutive pediatric patients aged 19 or less who were involved in motor vehicle crashes and brought to our Trauma Center over a 42 month period. The demographic breakdown of this study cohort was 55.3% male, 21.4% Hispanic, 9.7% African American, 64.5% Caucasian, 2.2% Asian and 2.2% other. The highest rates of restraint use (56.1%) were reported for children ages 0 to 3 years, and the lowest for those 12-15 years (p=.0001). Restraint use rates were lower among males than females (OR=0.72; 95% CI = 0.55, 0.93), and lower among Hispanic than non-Hispanic pediatric patients (OR=0.52; 95% CI = 0.37, 073). Restrained patients were more likely than unrestrained patients to be discharged to home. Restrained patients were less severely injured than unrestrained patients as measured by Revised Trauma Score, the Glasgow Coma Score, Injury Severity Score, ICU days and length of hospital stay. Low restraint use is associated with Hispanic ethnicity, male gender and the age group 12-15 years. Measures of injury severity consistently indicate more severe injuries among unrestrained than restrained patients

Leishmania donovani populations in Eastern Sudan: temporal structuring and a link between human and canine transmission.

BACKGROUND: Visceral leishmaniasis (VL), caused by the members of the Leishmania donovani complex, has been responsible for devastating VL epidemics in the Sudan. Multilocus microsatellite and sequence typing studies can provide valuable insights into the molecular epidemiology of leishmaniasis, when applied at local scales. Here we present population genetic data for a large panel of strains and clones collected in endemic Sudan between 1993 and 2001. METHODS: Genetic diversity was evaluated at fourteen microsatellite markers and eleven nuclear sequence loci across 124 strains and clones. RESULTS: Microsatellite data defined six genetic subpopulations with which the nuclear sequence data were broadly congruent. Pairwise estimates of FST (microsatellite) and KST (sequence) indicated small but significant shifts among the allelic repertoires of circulating strains year on year. Furthermore, we noted the co-occurrence of human and canine L. donovani strains in three of the six clusters defined. Finally, we identified widespread deficit in heterozygosity in all four years tested but strong deviation from inter-locus linkage equilibrium in two years. CONCLUSIONS: Significant genetic diversity is present among L. donovani in Sudan, and minor population structuring between years is characteristic of entrenched, endemic disease transmission. Seasonality in vector abundance and transmission may, to an extent, explain the shallow temporal clines in allelic frequency that we observed. Genetically similar canine and human strains highlight the role of dogs as important local reservoirs of visceral leishmaniasis

Ambivalenzen in der Beratung von Pflegeeltern

Infolge des gesellschaftlichen Wandels haben sich die Aufgaben und auch ihre Prioritätensetzung in der Pflegekinderhilfe verändert. Bspw. stellen sich die Ansprüche an erzieherische Fähigkeiten über die Pflegepersonen verfügen sollen, umfangreicher dar als noch vor Jahrzehnten. Zudem war eine Zusammenarbeit mit den Geburtseltern bis weit in das 20. Jahrhundert nicht vorgesehen. Gleichzeitig sind die bestehenden Beschreibungen der Pflegefamilie bis heute unscharf und in ständiger Veränderung darüber, wie eine (Pflege-) Familie aussehen soll, was sie charakterisiert, welche Aufgaben, welche Rollen vergeben werden. Die Forschung hat bisher zu wenig zur Weiterentwicklung beigetragen. Angesichts dessen bestehen Widersprüche für derartige Ausprägungen, wenn die sich wandelnden und als Norm festgelegten Lebensweisen nicht mit den sie umgebenden Umwelten harmonieren. Ihre Auswirkungen treten verstärkt auf der operativen Ebene hervor. Das vorliegende Forschungsprojekt hat Erstgespräche zwischen Fachkräften für Pflegekinder und Bewerbenden um ein Pflegekind evaluiert. Die in der Untersuchung freigelegten Ambivalenzen zeigen auf, dass sich einerseits die Anforderungen an den Pflegeauftrag gewandelt haben und andererseits diese veränderten Ansprüche offenbar in der Praxis noch nicht zufriedenstellend gelöst wurden. Deren Auftreten hat aber Auswirkungen u.a. auf die Herstellung eines gemeinsamen Arbeitsbündnisses in einem ersten Gespräch zur Aufnahme eines Pflegekindes sowie anschließend auf das Alltagsgeschehen während eines Pflegearrangements. Die Ergebnisse dieses Forschungsprojekts können als Grundlage dienen, ein transparentes und an den Bedarfen von Pflegefamilien orientiertes Vorgehen zu generieren

Selective Use of Pericardial Window and Drainage as Sole Treatment for Hemopericardium from Penetrating Chest Trauma

Background Penetrating cardiac injuries (PCIs) are highly lethal, and a sternotomy is considered mandatory for suspected PCI. Recent literature suggests pericardial window (PCW) may be sufficient for superficial cardiac injuries to drain hemopericardium and assess for continued bleeding and instability. This study objective is to review patients with PCI managed with sternotomy and PCW and compare outcomes. Methods All patients with penetrating chest trauma from 2000 to 2016 requiring PCW or sternotomy were reviewed. Data were collected for patients who had PCW for hemopericardium managed with only pericardial drain, or underwent sternotomy for cardiac injuries grade 1–3 according to the American Association for the Surgery of Trauma (AAST) Cardiac Organ Injury Scale (OIS). The PCW+drain group was compared with the Sternotomy group using Fisher’s exact and Wilcoxon rank-sum test with P\u3c0.05 considered statistically significant. Results Sternotomy was performed in 57 patients for suspected PCI, including 7 with AAST OIS grade 1–3 injuries (Sternotomy group). Four patients had pericardial injuries, three had partial thickness cardiac injuries, two of which were suture-repaired. Average blood drained was 285mL (100–500 mL). PCW was performed in 37 patients, and 21 had hemopericardium; 16 patients proceeded to sternotomy and 5 were treated with pericardial drainage (PCW+drain group). All PCW+drain patients had suction evacuation of hemopericardium, pericardial lavage, and verified bleeding cessation, followed by pericardial drain placement and admission to intensive care unit (ICU). Average blood drained was 240mL (40–600 mL), and pericardial drains were removed on postoperative day 3.6 (2–5). There was no significant difference in demographics, injury mechanism, Revised Trauma Score exploratory laparotomies, hospital or ICU length of stay, or ventilator days. No in-hospital mortality occurred in either group. Conclusions Hemodynamically stable patients with penetrating chest trauma and hemopericardium may be safely managed with PCW, lavage and drainage with documented cessation of bleeding, and postoperative ICU monitoring. Level of evidence Therapeutic study, level IV

Leishmania siamensis als Erreger von autochthoner kutaner Leishmaniose bei Pferden in Deutschland - eine neue Infektionskrankheit in Mitteleuropa?

Aus mitteleuropäischer Sicht ist die durch Parasiten verursachte und von Sandmücken übertragene Leishmaniose eine in Ländern tropischer und subtropischer Regionen auftretende Infektionskrankheit. In zunehmendem Maße werden jedoch autochthone Fälle in Mitteleuropa, insbesondere in Süddeutschland, verzeichnet. Dies ist vermutlich auf die globale Erwärmung und die Ausdehnung des Verbreitungsgebietes der Sandmücken nach Norden zurückzuführen. Die vorliegende Arbeit befasst sich mit der Identifizierung und phylogenetischen Charakterisierung der Erreger dieser Fälle. Dazu wurden verschiedene Marker im Leishmaniengenom sequenziert und mit bekannten Arten verglichen. Die untersuchte DNA stammte von autochthonen kutanen Leishmaniosen bei Pferden und einem Rind, die in den letzten zehn Jahren in Deutschland und der Schweiz auftraten. Aufgrund identischer Sequenzen konnten die Parasiten als L. siamensis identifiziert bzw. verifiziert werden, eine erst im Jahr 2008 neu beschriebene Art, die in Thailand humane viszerale Leishmaniose verursacht. Die phylogenetischen Analysen zeigten die Ähnlichkeit von L. siamensis mit weiteren bisher nicht identifizierten Stämmen aus Martinique und Ghana, die kutane Leishmaniose bei Menschen verursachen. Um die Frage zu beantworten, ob sich die Leishmaniose zu einer in Mitteleuropa endemischen zoonotischen Krankheit entwickeln könnte, müssen weitere Studien über kompatible Vektoren, mögliche Reservoire und zur Virulenz durchgeführt werden

Emerging Disparities among Self-Pay Trauma Patients

Preliminary results from a study of trauma patients in Southern Nevada are yielding some unexpected findings with implications for both trauma centers and the growing Hispanic population. Hispanic patients are more likely to be self pay irrespective of income level and employment status when compared to non-Hispanic patient groups. Further, self pay Hispanics, unlike their non-Hispanic, self pay counterparts, tend to be employed, have families, and report stable living conditions. The implication is that the financial and social cost of traumatic injury may place a significant burden on trauma centers, patients, their families and the community

Evolutionary and geographical history of the Leishmania donovani complex with a revision of current taxonomy.

Leishmaniasis is a geographically widespread severe disease, with an increasing incidence of two million cases per year and 350 million people from 88 countries at risk. The causative agents are species of Leishmania, a protozoan flagellate. Visceral leishmaniasis, the most severe form of the disease, lethal if untreated, is caused by species of the Leishmania donovani complex. These species are morphologically indistinguishable but have been identified by molecular methods, predominantly multilocus enzyme electrophoresis. We have conducted a multifactorial genetic analysis that includes DNA sequences of protein-coding genes as well as noncoding segments, microsatellites, restriction-fragment length polymorphisms, and randomly amplified polymorphic DNAs, for a total of approximately 18,000 characters for each of 25 geographically representative strains. Genotype is strongly correlated with geographical (continental) origin, but not with current taxonomy or clinical outcome. We propose a new taxonomy, in which Leishmania infantum and L. donovani are the only recognized species of the L. donovani complex, and we present an evolutionary hypothesis for the origin and dispersal of the species. The genus Leishmania may have originated in South America, but diversified after migration into Asia. L. donovani and L. infantum diverged approximately 1 Mya, with further divergence of infraspecific genetic groups between 0.4 and 0.8 Mya. The prevailing mode of reproduction is clonal, but there is evidence of genetic exchange between strains, particularly in Africa

temporal structuring and a link between human and canine transmission

Background Visceral leishmaniasis (VL), caused by the members of the Leishmania donovani complex, has been responsible for devastating VL epidemics in the Sudan. Multilocus microsatellite and sequence typing studies can provide valuable insights into the molecular epidemiology of leishmaniasis, when applied at local scales. Here we present population genetic data for a large panel of strains and clones collected in endemic Sudan between 1993 and 2001. Methods Genetic diversity was evaluated at fourteen microsatellite markers and eleven nuclear sequence loci across 124 strains and clones. Results Microsatellite data defined six genetic subpopulations with which the nuclear sequence data were broadly congruent. Pairwise estimates of FST (microsatellite) and KST (sequence) indicated small but significant shifts among the allelic repertoires of circulating strains year on year. Furthermore, we noted the co-occurrence of human and canine L. donovani strains in three of the six clusters defined. Finally, we identified widespread deficit in heterozygosity in all four years tested but strong deviation from inter-locus linkage equilibrium in two years. Conclusions Significant genetic diversity is present among L. donovani in Sudan, and minor population structuring between years is characteristic of entrenched, endemic disease transmission. Seasonality in vector abundance and transmission may, to an extent, explain the shallow temporal clines in allelic frequency that we observed. Genetically similar canine and human strains highlight the role of dogs as important local reservoirs of visceral leishmaniasis