4-digit Code Research Articles

3-dimensional Analysis and Literature Review of the Root Canal Morphology and Physiological Foramen Geometry of 125 Mandibular Incisors by Means of Micro–Computed Tomography in a German Population

IntroductionThe aim of this study was to examine the root canal system morphology of mandibular incisors by means of micro–computed tomographic imaging. MethodsThe root canal configuration, physiological foramina, frequency of accessory and connecting canals, and the size and shape of the physiological foramina of 125 mandibular incisors were investigated by means of micro-CT and 3-dimensional imaging software. Root canal configuration of the coronal, middle, and apical thirds and the physiological foramina number are described by a 4-digit system code. ResultsThe most frequent root canal configurations were 1-1-1/1 (56%), 1-2-1/1 (17.6%), and 1-1-1/2 (10.4%); 9 additional different root canal configurations were observed. Single-rooted incisors showed in 80% 1, in 16% 2, and in 4% 3 physiological foramina, respectively. Accessory canals were found in only 13.6% of the investigated teeth. Connecting canals were observed in 36% of the sample, most often in root canal configurations 1-2-1/1 (12.8%) and 2-2-1/1 (7.2%). The morphologic dimensions of a total of 146 physiological foramina were measured. Their mean wide and narrow diameters were 0.24 mm (standard deviation = 0.1 mm) and 0.23 mm (standard deviation = 0.08 mm) when only 1 physiological foramen was present. The physiological foramen shapes observed were oval (56%), round (28.8%), and irregular (15.2%). ConclusionsThe study provides detailed information about the root canal morphology of anterior teeth in a German population. Within the limitations of the study, the authors recommend according to results obtained in this investigation a final physiological foramen preparation size of ISO 30-35; yet, such a decision should be carefully considered on an individual basis.

Are Low-to-Moderate Average Alcohol Consumption and Isolated Episodes of Binge Drinking in Early Pregnancy Associated with Facial Features Related to Fetal Alcohol Syndrome in 5-Year-Old Children?

Fetal alcohol syndrome (FAS) typically is observed among individuals with high prenatal alcohol exposures (PAE), but exposure histories obtained in clinical diagnostic settings are often inaccurate. The present analysis used the Lifestyle During Pregnancy Study (LDPS) to assess the potential effects of low-to-moderate average weekly alcohol consumption and binge drinking in early pregnancy on facial features associated with FAS among children 5years of age. The analysis is a prospective follow-up study of 670 women and their children sampled from the LDPS cohort based on maternal alcohol consumption during pregnancy. The 4-Digit Code FAS Facial Photographic Analysis Software was used to measure the magnitude of expression of the 3 diagnostic facial features of FAS from standardized digital photographs. Logistic regression was used to estimate the odds of presenting with the FAS/partial fetal alcohol syndrome (PFAS) facial phenotypes relative to different patterns of prenatal alcohol exposure. Ten children presented with the FAS/PFAS facial phenotypes. None of the children sampled met the central nervous system (CNS) criteria for FAS or PFAS at age 5years. All remained at risk for PFAS since some types of CNS dysfunction associated with this diagnosis may only be assessed at older ages. The FAS/PFAS facial phenotypes were 8.5-fold more likely among children exposed to an average of 1 to 4 drinks/wk and 2.5-fold more likely among children with a single binge exposure in gestational weeks 3 to 4 compared to children with no such exposures. The magnitude of expression of the FAS facial phenotype was significantly correlated with all other diagnostic features of FAS: growth deficiency, microcephaly, and measures of CNS dysfunction. These findings suggest that low-to-moderate levels of PAE or isolated binge exposures may place some fetuses at risk for FAS/PFAS. Thus, conservative advice is still for women to abstain from alcohol consumption during pregnancy.

Comparison of the 4-Digit Code, Canadian 2015, Australian 2016 and Hoyme 2016 fetal alcohol spectrum disorder diagnostic guidelines.

As clinicians strive to achieve consensus worldwide on how best to diagnose fetal alcohol spectrum disorders (FASD), the most recent FASD diagnostic systems show convergence and divergence. Applying these systems to a single clinical population illustrates the contrasts between them, but validation studies are ultimately required to identify the best system. The 4-Digit-Code, Hoyme 2016, Canadian 2015 and Australian 2016 FASD diagnostic systems were applied to 1,392 patient records evaluated for FASD at the University of Washington. The diagnostic criteria and tools, the prevalence and concordance of diagnostic outcomes, and validity measures were compared between the systems. The proportion diagnosed with fetal alcohol syndrome (FAS) and FASD varied significantly (4-Digit-Code 2.1%, ≤79%; Hoyme 6.4%, 44%, Australian 1.8%, 29%; Canadian 1.8%, 16%). Eighty-two percent were diagnosed FASD by at least one system; only 11% by all four systems. Key factors contributing to discordance include: requiring high alcohol exposure; excluding growth deficiency; relaxing the facial criteria; requiring brain criteria that prevent diagnosis of infants/toddlers; and excluding moderate dysfunction from the spectrum. Primate research confirms moderate dysfunction (1-2 domains ≤-2 standard deviations) is the most prevalent outcome caused by PAE (FAS 5%, severe dysfunction 31%, moderate dysfunction 59%). Only the 4-Digit-Code replicated this diagnostic pattern. The needs of individuals with FASD are best met when diagnostic systems provide accurate, validated diagnoses across the lifespan, the full spectrum of outcome, the full continuum of alcohol exposure; and utilize diagnostic nomenclature that accurately reflects the association between outcome and alcohol exposure.

INTERNATIONAL SPECIALIZATION OF THE REPUBLIC OF BELARUS IN THE EAEU: OPPORTUNITIES FORI NVESTMENT INTEGRATION

The article presents the possibility of using a country's bilateral trade analysis as the informational basis for identifying priority areas and industries in manufacturing from which outward direct investment (ODI) could be promoted to the host countries that are trading partners within the integration area. There has been elaborated a methodology for determining priority industries and types of ODI strategies. It includes eight stages of a dynamic assessment of the country's international specialization change in bilateral trade. The methodology comprises the evaluation of the following indicators: comparative advantages in international trade between the country and partners in order to determine the priority sectors for ODI identify the types of ODI strategies; the nature of intra-industry trade of the country and partner countries to determine the possibilities for global and regional value chains creation. The methodology has been applied to the case of theRepublicofBelarus. There have been evaluated the dynamic changes in its international specialization in bilateral trade with the EAEU partner countries on the basis of the 4-digit UN Standard International Trade Classification code. Static and dynamic effects of integration were identified, on the basis of which the types of potential ODI strategies fromBelarusto the EAEU partner countries were revealed.

Validating occupational coding indexes for use in multi-country surveys

Occupational coding in multi-country surveys is mostly a black box: have national survey agencies classified the same occupational titles into the same category across countries? This paper attempts to validate the coding from 5-digit occupational titles into the 4-digit occupational units of the international ISCO-08 classification, based on a comparison of coding indexes from national statistical offices. Two research objectives are central. To what extent are occupational titles in the coding indexes similar, when comparing their English translations? What percentage of similar occupational titles is coded similarly across countries? To answer these questions, we merged titles from 20 coding indexes (18 non- English), resulting in 70,489 records. We translated the titles in English, using online dictionaries and Google translate (4.2% could not be translated). We checked for existent codes of the titles, using ILO’s ISCO-08 coding index (10.3% non-existent). The remaining database had 60,559 records, of which 32% had at least one duplicate title (19,044 records). These duplicate records could be aggregated into 5,350 occupational titles. Only 64% of these titles had the same ISCO-08 4-digit code, 70% at 3-digit, 74% at 2 digit, and 80% at 1-digit. Users of multi-country surveys should be cautious when using the 4-digit ISCO-08 codes.

2282 - Area Variations in People's Cycling Duration in the Netherlands: The Role of the Natural and the Built Environment

Highest Scoring Abstract: Doctoral Background Cycling for transportation has the potential to contribute to an increase in people's physical activity levels. A growing body of evidence links the natural and the built environment to cycling. Whereas previous studies were mostly done within one city or one region, the present study covered the whole of the Netherlands, giving the opportunity to investigate whether associations between environmental characteristics and cycling are context-specific. The study examined the extent to which objectively measured natural and built environment characteristics contribute to differences in cycling between 4-digit postal code areas (“PC4 areas”) and between municipalities in the Netherlands, as well as the differential effect of environmental characteristics on cycling by municipality size. Methods Our sample from the Dutch National Travel Survey 2010–2014 comprised 110,027 people aged 20–89 years, residing in 3,163 PC4 areas, nested within 387 municipalities. Multilevel Tobit regression models were fitted to assess the associations between the natural and the built environment with average daily cycling duration (in minutes), while adjusting for individual and household characteristics. Interaction effects of natural and built environment characteristics and municipality size on cycling duration were also investigated. Results After adjustment for individual and household characteristics, 3.4% of the variance on cycling duration could be explained by environmental factors. Higher address density, more bus stops, and shorter distance from home to the nearest train station were positively related to cycling duration. Respondents were more likely to cycle on days with higher temperatures, less wind, and less precipitation. Interaction tests showed that increased street density and address density appeared to be less cycling-promotive in small urban areas compared to medium or large cities. On the other hand, the positive associate between number of bus stops and cycling duration was weaker in the four largest cities and medium-sized cities compared to small urban and rural areas. Conclusions Higher address density, more bus stops, and shorter distance from home to nearest train station were positively related to cycling duration. Interactions suggest that relations between environmental characteristics and cycling duration are context-specific (e.g. dependent on circumstances that differ between highly urbanized and less urbanized areas). The findings confirm that the emphasis in Dutch policies on compact, development and good public transport has helped achieve a high level of cycling at both the city and the national level.

Twin study confirms virtually identical prenatal alcohol exposures can lead to markedly different fetal alcohol spectrum disorder outcomes-fetal genetics influences fetal vulnerability.

Risk of fetal alcohol spectrum disorder (FASD) is not based solely on the timing and level of prenatal alcohol exposure (PAE). The effects of teratogens can be modified by genetic differences in fetal susceptibility and resistance. This is best illustrated in twins. To compare the prevalence and magnitude of pairwise discordance in FASD diagnoses across monozygotic twins, dizygotic twins, full-siblings, and half-siblings sharing a common birth mother. Data from the Fetal Alcohol Syndrome Diagnostic & Prevention Network clinical database was used. Sibling pairs were matched on age and PAE, raised together, and diagnosed by the same University of Washington interdisciplinary team using the FASD 4-Digit Code. This design sought to assess and isolate the role of genetics on fetal vulnerability/resistance to the teratogenic effects of PAE by eliminating or minimizing pairwise discordance in PAE and other prenatal/postnatal risk factors. As genetic relatedness between siblings decreased from 100% to 50% to 50% to 25% across the four groups (9 monozygotic, 39 dizygotic, 27 full-sibling and 9 half-sibling pairs, respectively), the prevalence of pairwise discordance in FASD diagnoses increased from 0% to 44% to 59% to 78%. Despite virtually identical PAE, 4 pairs of dizygotic twins had FASD diagnoses at opposite ends of the fetal alcohol spectrum-Partial Fetal Alcohol Syndrome versus Neurobehavioral Disorder/Alcohol-Exposed. Despite virtually identical PAE, fetuses can experience vastly different FASD outcomes. Thus, to protect all fetuses, especially the most genetically vulnerable, the only safe amount to drink is none at all.

Towards the Use of Brain–Computer Interface and Gestural Technologies as a Potential Alternative to PIN Authentication

ABSTRACTThis article describes an exploratory study which examined the use of Brain–Computer Interface (BCI) and gestural technologies generated from a BCI headset as a novel potential alternative to a 4-digit PIN code for authentication. Unlike other input modalities, many of these tokens (i.e., “push,” “lift,” “excitement”), can overcome some of the security vulnerabilities associated with PIN authentication (e.g., observations from third parties). Participants engaged in a controlled study where they performed five, 4-token authentication tasks on a simulated authentication screen. The percentage of completed BCI and gestural input tasks, as well as input time and accuracy, was compared to the 4-digit PIN task. The results showed that while authentication using a BCI headset is currently not as complete, fast, or accurate as that of a 4-digit PIN code, users felt that such a system would represent greater security over PIN-based authentication. In addition, mental commands, which might be perceived as the most secure from the standpoint of inconspicuous detection, were found to offer disappointing results both in terms of completion percentage and completion time.

An investigation of intra-individual variability in children with fetal alcohol spectrum disorder (FASD)

ABSTRACTIntra-individual variability (IIV) is defined as systematic within-person variation in performance either across test sessions (e.g., test/retest performance on the same task) or in one session (e.g., variations in performance on multiple trials of a single task). Higher levels of IIV have been noted as a characteristic of neurodevelopmental disorders such as attention deficit/hyperactivity disorder​ (ADHD), but IIV is yet to be investigated in fetal alcohol spectrum disorder (FASD). FASD is a term used to describe a range of conditions resulting from prenatal exposure to alcohol. As part of a comprehensive neuropsychological battery, four study groups (1. fetal alcohol syndrome/partial fetal alcohol syndrome; 2. static encephalopathy/alcohol exposed; 3. neurobehavioral disorder/alcohol exposed as diagnosed using the University of Washington FASD 4-Digit Code; 4. typically-developing (TD) age-matched children with no prenatal alcohol exposure) were administered measures of motor response and inhibitory control, attention, and adaptive behavior. The results indicate increased levels of IIV in those with FASD compared to the TD controls. It was found that IIV uniquely contributes to predicting adaptive behavior above and beyond attention, while attention partially mediates the relationship between IIV and adaptive behavior. This is the first study to the authors’ knowledge to show the presence of increased IIV in children with FASD. It additionally provides evidence that IIV measures some inherent variability in performance independent of poor attention in children with FASD.

Comparison of the FASD 4-Digit Code and Hoyme et al. 2016 FASD diagnostic guidelines.

Background:As clinicians strive to achieve consensus worldwide on how best to diagnose fetal alcohol spectrum disorders (FASD), the most recent FASD diagnosstic systems exhibit convergence and divergence. Applying these systems to a single clinical population illustrates contrasts between them, but validation studies are ultimately required to identify the best system. Currently, only the 4-Digit Code has published comprehensive validation studies.Methods:The 4-Digit Code and Hoyme 2016 FASD systems were applied to the records of 1,392 patients evaluated for FASD at the University of Washington to: 1) Compare the diagnostic criteria and tools used by each system, 2) Compare the prevalence and concordance of diagnostic outcomes and assess measures of validity.Results:Only 38% of patients received concordant diagnoses. The Hoyme criteria rendered half as many diagnoses under the umbrella of FASD (n=558) as the 4-Digit Code (n=1,092) and diagnosed a much higher proportion (53%) as fetal alcohol syndrome/partial fetal alcohol syndrome (FAS/PFAS) than the 4-Digit Code (7%). Key Hoyme factors contributing to discordance included relaxation of facial criteria (40% had the Hoyme FAS face, including patients with confirmed absence of alcohol exposure); setting alcohol exposure thresholds prevented 1/3 with confirmed exposure from receiving FAS/FASD diagnoses; and setting minimum age limits for Alcohol-Related Neurodevelopmental Disorder prevented 79% of alcohol-exposed infants with neurodevelopmental impairment a FASD diagnosis. The Hoyme Lip/Philtrum Guides differ substantively from the 4-Digit Lip-Philtrum Guides and thus are not valid for use with the 4-Digit Code.Conclusions:All FASD diagnostic systems need to publish comprehensive validation studies to identify which is the most accurate, reproducible, and medically valid.

Occupational self-coding and automatic recording (OSCAR): a novel web-based tool to collect and code lifetime job histories in large population-based studies.

Objectives The standard approach to the assessment of occupational exposures is through the manual collection and coding of job histories. This method is time-consuming and costly and makes it potentially unfeasible to perform high quality analyses on occupational exposures in large population-based studies. Our aim was to develop a novel, efficient web-based tool to collect and code lifetime job histories in the UK Biobank, a population-based cohort of over 500 000 participants. Methods We developed OSCAR (occupations self-coding automatic recording) based on the hierarchical structure of the UK Standard Occupational Classification (SOC) 2000, which allows individuals to collect and automatically code their lifetime job histories via a simple decision-tree model. Participants were asked to find each of their jobs by selecting appropriate job categories until they identified their job title, which was linked to a hidden 4-digit SOC code. For each occupation a job title in free text was also collected to estimate Cohen's kappa (κ) inter-rater agreement between SOC codes assigned by OSCAR and an expert manual coder. Results OSCAR was administered to 324 653 UK Biobank participants with an existing email address between June and September 2015. Complete 4-digit SOC-coded lifetime job histories were collected for 108 784 participants (response rate: 34%). Agreement between the 4-digit SOC codes assigned by OSCAR and the manual coder for a random sample of 400 job titles was moderately good [κ=0.45, 95% confidence interval (95% CI) 0.42-0.49], and improved when broader job categories were considered (κ=0.64, 95% CI 0.61-0.69 at a 1-digit SOC-code level). Conclusions OSCAR is a novel, efficient, and reasonably reliable web-based tool for collecting and automatically coding lifetime job histories in large population-based studies. Further application in other research projects for external validation purposes is warranted.

Smart ATM Access and Security System using RFID and GSM Technology

The aim of this paper is to implement smart ATM card. Now-a-days we use ATM card frequently for shopping , cash withdrawal etc..A single user may have different bank accounts, so the user obviously have many ATM cards .For user friendly access , instead of many ATM cards we compact all into a single ATM card with enhanced security by providing OTP. We also avoid the problem of skimming. The enhanced security of money transaction in ATM system is carried out by RFID. After getting entry customer has to place ATM smart card in ATM machine. Then ATM machine will automatically generates a 4-digit code i.e. OTP. And that code will be message to the customer’s registered mobile number through GSM modem which is connected to ARM 7. Here customer has to enter this code. After entering OTP, System will check whether entered code is a valid one or not. And if it is valid, a list of bank displays, select a bank and it will ask for 4-digit ATM pin, which is fixed. If that 4-digit code match with the entered pin code then system is allowed for further accessing. ATM will show options like cash withdrawal, cash deposit etc..

Magnetic Resonance Imaging-Based Radiomic Profiles Predict Patient Prognosis in Newly Diagnosed Glioblastoma Before Therapy

Magnetic resonance imaging (MRI) is used to diagnose and monitor brain tumors. Extracting additional information from medical imaging and relating it to a clinical variable of interest is broadly defined as radiomics. Here, multiparametric MRI radiomic profiles (RPs) of de novo glioblastoma (GBM) brain tumors is related with patient prognosis. Clinical imaging from 81 patients with GBM before surgery was analyzed. Four MRI contrasts were aligned, masked by margins defined by gadolinium contrast enhancement and T2/fluid attenuated inversion recovery hyperintensity, and contoured based on image intensity. These segmentations were combined for visualization and quantification by assigning a 4-digit numerical code to each voxel to indicate the segmented RP. Each RP volume was then compared with overall survival. A combined classifier was then generated on the basis of significant RPs and optimized volume thresholds. Five RPs were predictive of overall survival before therapy. Combining the RP classifiers into a single prognostic score predicted patient survival better than each alone (P < .005). Voxels coded with 1 RP associated with poor prognosis were pathologically confirmed to contain hypercellular tumor. This study applies radiomic profiling to de novo patients with GBM to determine imaging signatures associated with poor prognosis at tumor diagnosis. This tool may be useful for planning surgical resection or radiation treatment margins.

Erratum.

Alcohol: Clinical and Experimental ResearchVolume 40, Issue 8 p. 1795-1795 ErratumFree Access Erratum This article corrects the following: A Comparison Among 5 Methods for the Clinical Diagnosis of Fetal Alcohol Spectrum Disorders Claire D. Coles, Amanda R. Gailey, Jennifer G. Mulle, Julie A. Kable, Mary Ellen Lynch, Kenneth Lyons Jones, Volume 40Issue 5Alcoholism: Clinical and Experimental Research pages: 1000-1009 First Published online: March 29, 2016 First published: 12 May 2016 https://doi.org/10.1111/acer.13117Citations: 1AboutSectionsPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat In the article by Coles and colleagues, “A Comparison Among 5 Methods for the Clinical Diagnosis of Fetal Alcohol Spectrum Disorders,” 2016, 40:1000–1009, an exception to the FASD 4-Digit Code in this study was not fully explained. Please note that the 4-Digit Code requires the Iosub et al. (1985) African American palpebral fissure length (PFL) normal growth charts be used for African Americans to control of the longer PFLs commonly found in African Americans. This study chose to use the Stromland et al. (1989) Scandinavian (Caucasian) PFL growth charts on all subjects because of limitations perceived in the applicability of the Iosub et al. (1985) norms. This decision may have affected the number of individuals meeting the 4-Digit Code diagnostic criteria for FAS. We apologize for omitting this explanation from the article. Reference Coles CD, Gailey AR, Mulle JG, Kable JA, Lynch ME, Jones KL (2016) A comparison among 5 methods for the clinical diagnosis of fetal alcohol spectrum disorders. Alcohol Clin Exp Res 40: 1000– 1009. doi: 10.1111/acer.13032. Citing Literature Volume40, Issue8August 2016Pages 1795-1795 ReferencesRelatedInformation

Energy Price Elasticity of Energy Intensity for Canadian Manufacturing Industries

This study analyses the roles that energy and other input prices play in reducing energy intensity of each of the 21 (according to the 4-digit code NAICS) manufacturing industries in Canada. A system of Generalized Leontief (GL) cost function and the derived factor intensity equations are estimated using the iterative seemingly unrelated regression (ISUR) and system generalized method of moments (GMM) estimation methods. Based on the GMM results, I find average energy price elasticity of -0.34 for the overall sector. Capital is complementary with energy in most cases while labour and energy are substitutes in about 50 % of the cases. Material and services inputs are mostly substitutable with energy. Technological change is energy-using in many industries. The policy implication is that a policy-induced permanent increase in energy costs may not contribute much to energy efficiency improvements in the manufacturing industries. Promoting investments in energy-saving technical change should be considered particularly for those industries exhibiting energy-using technological changes.

The Essential Role of Growth Deficiency in the Diagnosis of Fetal Alcohol Spectrum Disorder.

Background:Laboratory studies confirm prenatal alcohol exposure (PAE) causes growth deficiency (GD). GD has traditionally been a core diagnostic feature of fetal alcohol spectrum disorders (FASD), but was removed from the Canadian and Australian FASD diagnostic guidelines in 2016. This study aimed to empirically assess the clinical role and value of GD in FASD diagnosis.Methods:Data from 1814 patients with FASD from the University of Washington Fetal Alcohol Syndrome Diagnostic & Prevention dataset were analyzed to answer the following questions: 1) Is there evidence of a causal association between PAE and GD in our clinical population? 2) Is GD sufficiently prevalent among individuals with PAE to warrant its inclusion as a diagnostic criterion? 3) Does GD aid the diagnostic team in identifying and/or predicting which individuals will be most impaired by their PAE?Results:GD significantly correlated with PAE. GD was as prevalent as the other core diagnostic features (facial and CNS abnormalities). GD occurred in all FASD diagnoses and increased in prevalence with increasing severity of diagnosis. The most prevalent form of GD was postnatal short stature. GD was as highly correlated with, and predictive of, severe brain dysfunction as the FAS facial phenotype. Individuals with GD had a two to three-fold increased risk for severe brain dysfunction. Sixty percent of patients with severe GD had severe brain dysfunction. GD accurately predicted which infants presented with severe brain dysfunction later in childhoodConclusions:GD is an essential diagnostic criterion for FASD and will remain in the FASD 4-Digit Code.

Statin Use and Risk Of Recurrent Venous Thrombosis: Results From The MEGA Follow-Up Study

▪ IntroductionResults from randomized trials have indicated that statins may protect against a first venous thrombosis. Whether initiation of statin use after a first venous thrombosis reduces the risk of recurrence is uncertain. No randomized trial exists, and the few observational studies that have been conducted included both incident and prevalent statin users which may have led to overestimation of results due to a ‘healthy user effect'. Therefore, the aim of this study was to examine the risk of recurrent venous thrombosis in incident statin users versus non-users. MethodsWe used data from the MEGA follow-up study. Patients with a first venous thrombosis (n=4731) were recruited in the period 1999-2004 and followed for an average of 5.2 years. Information on statin use was obtained by linkage to the Dutch Foundation for Pharmaceutical Statistics (SFK) registry. The SFK gathers its data from a panel of non-hospital based pharmacies; more than 95 % of the community pharmacies in the Netherlands are represented on this panel. Linkage was based on a combination of age, sex, 4-digit postal code and vitamin K antagonist use within the first month after the initial venous thrombosis. Cox proportional hazard regression models with statin exposure as a time-dependent variable were used to estimate hazard ratios (HR) with 95% confidence intervals (CI95) for risk of recurrent venous thrombosis. Adjustments were conducted using two different approaches: a multivariable model that included age, sex, body mass index and smoking, and a propensity score model that was based on age (>50 years), sex, characteristics of the first event (provoked/unprovoked) and factor V Leiden. ResultsIn total, 2547 (53.2%) MEGA patients with a first venous thrombosis were uniquely linked to the SFK registry. Baseline characteristics did not differ between those who were and were not linked, which indicates low chance of selection bias in the linkage process. Prevalent statin users at baseline (n=153) were excluded from all analyses. During a total of 12844 person-years of follow-up, statin therapy was initiated in 233 (9.3%) patients. There were 347 definite recurrent venous thrombotic events, of which 16 occurred among statin users. Incident statin use was associated with 24% lower risk of recurrence (HR 0.76, CI95: 0.46-1.26) after adjustments for age and sex; with 17% lower risk after adjustments for age, sex, body mass index and smoking (HR 0.83, CI95: 0.52-1.31); and 15% lower risk when propensity score were taken into account (HR 0.85, CI95: 0.50-1.43). Statin use did not have any effect on recurrence in patients with an unprovoked first event (HR 1.04, CI95: 0.54-1.98), whereas a 37% lower risk was found in those with a provoked first event (HR 0.63 CI95: 0.26-1.53) after adjustment for propensity score. ConclusionOur findings imply that statins have only a modest effect on risk of recurrent venous thrombosis. Furthermore, we found no association between statin use and risk of recurrence in those with an unprovoked first event, which indicates that statins are likely to play only a minor role in secondary prevention of venous thrombosis. Disclosures:Off Label Use:Drug=statin Off-label use= whether or not statins prevent recurrent venous thrombosis.

Diagnostic outcomes of 27 children referred by pediatricians to a genetics clinic in the Netherlands with suspicion of fetal alcohol spectrum disorders

The characteristics of fetal alcohol spectrum disorders (FASD) constitute a specific facial phenotype, growth failure and neurodevelopmental defects. Reported FASD prevalences vary widely from 0.08 per 1,000 up to 68.0-89.2 per 1,000. We aimed to evaluate to which extent children referred with a suspicion of FASD, indeed have FASD. We included all 27 children referred to our genetic department with a suspicion of FASD between 2005 and 2010. Nineteen children (70.3%) were of non-Dutch ancestry, and 24 (88.9%) had been adopted. We used both the 4-Digit Code and the Revised Institute of Medicine criteria. More than half of the children did not meet either criteria for the diagnosis of FASD. Of note, after evaluation 8/27 children appeared not to have confirmed prenatal alcohol exposure. Two children referred for suspicion of FASD (neither of which were exposed to alcohol or met the criteria for FASD) had a pathogenic microstructural chromosomal rearrangement (del16p11.2 of 542 KB and dup1q44 of 915 KB). In 22/24 children (91.7%) there were other factors that may have affected their intellectual abilities, such as familial intellectual disability and social deprivation. We recommend a critical approach towards the diagnosis FASD, and to investigate all patients suspected to have FASD for other causative factors including genetic abnormalities.

Sleep Problems in Children with Fetal Alcohol Spectrum Disorders

Sleep problems in children with fetal alcohol spectrum disorders (FASD) are reportedly common but not well characterized. Objectives were to: (1) assess sleep concerns in children with FASD using a caregiver-report survey, the Children's Sleep Habits Questionnaire (CSHQ); (2) compare CSHQ results with those of previously reported community sample; and (3) describe pilot polysomnography findings in children with FASD. Children with FASD were recruited from a behavioral intervention study, and participating caregivers completed the CSHQ. CSHQ results were compared with the original data from a previously published community sample of similar age. Participants with FASD and elevated CSHQ scores were offered overnight polysomnography. Thirty-three children with FASD (4.1-12.1 years) were enrolled; 85% of children with FASD scored above the clinical cutoff Total Score of 41, reflecting marked sleep disturbance. Elevated subdomain scores occurred primarily in areas concerning for pediatric insomnia. Those with comorbid ADHD had elevated CSHQ on additional subdomains with no difference in Total Scores. Compared with the community sample, children with FASD had higher Total Scores on the CSHQ (52 vs. 39, p < 0.001). Polysomnography, completed in 5 subjects, revealed mild sleep disordered breathing and fragmented sleep with elevated non-respiratory arousal indices. Clinically significant sleep problems are present in children with FASD on both subjective and objective measures. Further investigation is needed to better describe these sleep disturbances and their impact on overall health and daytime neurobehavioral problems in this clinical population.

Isolated Handwritten Digit Recognition using Adaptive Unsupervised Incremental Learning Technique

paper presents a new approach to off-line handwritten numeral recognition. From the concept of perturbation due to writing habits and instruments, we propose a recognition method which is able to account for a variety of distortions due to eccentric handwriting. The recognition of handwritten numerals is a challenging task in the field of image processing and pattern recognition. It can be considered as one of the benchmarks in evaluating feature extraction methods and the performance of classifiers. The performance of character recognition system depends heavily on what kind of features are being used. The objective of this paper is to provide efficient and reliable techniques for recognition of handwritten numerals. In this paper we propose Zoning based feature extraction system which calculates the densities of object pixels in each zone. Firstly the whole image is divided into 4 4 zones. Further in order to gain more accuracy these zones are divided into 6 6 zones. The division of zones carried out up to 8 8 zones. Hence 116 features are extracted in all. Nearest neighbour classifier is used for subsequent classification and recognition purpose. For the testing purpose an Award List has been used. Data has been collected from 200 users and extracted individual digits from these forms. These forms are filled out from different users in order to take different samples of handwriting. This Award List has 4-digit Roll no, 4-digit Code no and 3-digit Marks. The outcome of the research will be an automated system for recognition of awards. This automated system will recognize only digits. This procedure can also be done manually, but that is a tedious task and prone to error. This system's complexity lies in the different handwriting styles which vary from human to human. Thus automated system provides better recognition accuracy than manual system. The award list which is used in the automated system is shown below: The rest of the paper is organized into five sections. In the Section 2 we will briefly explain about the review of literature in which the feature extraction technique along with the classifier is discussed. Section 3 describes the proposed system. In section 4 we will discuss about Recognition Result and Comparisons among Different Zoning Techniques and finally conclusion is given in section 5.