Percent Of Events Research Articles

Disks of Stars in the Galactic Center Triggered by Tidal Disruption Events

In addition to a supermassive black hole (SMBH), the central parsec of the Milky Way hosts over 100 massive, high-velocity young stars whose existence, and organization of a subset of them in one, or possibly two, misaligned disks, is puzzling. Due to a combination of low medium density and strong tidal forces in the vicinity of Sgr A*, stars are not expected to form. Here we propose a novel scenario for their in situ formation: a jetted tidal disruption event (TDE) from an older wandering star triggers an episode of positive feedback of star formation in the plane perpendicular to the jet, as demonstrated via numerical simulations in the context of jet-induced feedback in galactic outflows. An overpressured cocoon surrounding the jet shock-compresses clumps to densities high enough to resist the SMBH tidal field. The TDE rate of 10−5–10−4 yr−1 per galaxy, out of which a few percent of events are jetted, implies a jetted TDE event per galaxy to occur every few million years. This timescale is interestingly of the same order of the age of the disk stars. The mass function predicted by our mechanism is top heavy. Additionally, since TDEs are isotropic, our model predicts a random orientation for the disk of stars with respect to the plane of the galaxy and, due to the relatively high TDE rate, can account for multiple disks of stars with uncorrelated orientations.

Recurrence and Metachronous Disease in Children with Benign Ovarian Tumors: A Systematic Review of the Literature.

The majority of ovarian tumors in children are benign, with good prognosis following complete resection. Little is published on the incidence of tumor recurrence and metachronous disease, and follow-up management of children with benign ovarian tumors (BOTs) remains a matter of debate. This systematic review aimed to evaluate the incidence and timing of recurrence and metachronous disease in children with BOTs in pediatric literature. Comprehensive literature searches of the English literature (PubMed, OVID, EMBASE databases) from inception to present according to the Preferred Reporting Items for Systematic Review and Meta-analysis guidelines. Outcomes for tumor recurrence and metachronous disease were synthesized. Nineteen studies comprising 1,069 patients with BOTs were included in the analysis. All studies were retrospective cohort studies of children less than 18 years old. A total of 56 events of recurrence or metachronous disease were reported in these patients. The overall risk of recurrence/metachronous event occurrence was 5.2%/2.9%. Seventy-five percent of events occurred within the first 4 years following resection. Although the studies identified are few and heterogeneous, they demonstrate a significant risk of tumor recurrence and metachronous disease for children following resection of a BOT.Especially following total unilateral oophorectomy, these children are at risk of losing the contralateral ovary in case of metachronous disease.Immediate discharge from follow-up, therefore, does not appear safe. The majority of events occurred within the first 4 years following resection. Follow-up for children following resection of a BOT should, therefore, be continued for a minimum of 4 years following surgery. Larger, long-term prospective studies are required to more accurately determine the true incidence and long-term outcomes for children and adolescents with these tumors.

Comparing malaria early detection methods in a declining transmission setting in northwestern Ethiopia

BackgroundDespite remarkable progress in the reduction of malaria incidence, this disease remains a public health threat to a significant portion of the world’s population. Surveillance, combined with early detection algorithms, can be an effective intervention strategy to inform timely public health responses to potential outbreaks. Our main objective was to compare the potential for detecting malaria outbreaks by selected event detection methods.MethodsWe used historical surveillance data with weekly counts of confirmed Plasmodium falciparum (including mixed) cases from the Amhara region of Ethiopia, where there was a resurgence of malaria in 2019 following several years of declining cases. We evaluated three methods for early detection of the 2019 malaria events: 1) the Centers for Disease Prevention and Control (CDC) Early Aberration Reporting System (EARS), 2) methods based on weekly statistical thresholds, including the WHO and Cullen methods, and 3) the Farrington methods.ResultsAll of the methods evaluated performed better than a naïve random alarm generator. We also found distinct trade-offs between the percent of events detected and the percent of true positive alarms. CDC EARS and weekly statistical threshold methods had high event sensitivities (80–100% CDC; 57–100% weekly statistical) and low to moderate alarm specificities (25–40% CDC; 16–61% weekly statistical). Farrington variants had a wide range of scores (20–100% sensitivities; 16–100% specificities) and could achieve various balances between sensitivity and specificity.ConclusionsOf the methods tested, we found that the Farrington improved method was most effective at maximizing both the percent of events detected and true positive alarms for our dataset (> 70% sensitivity and > 70% specificity). This method uses statistical models to establish thresholds while controlling for seasonality and multi-year trends, and we suggest that it and other model-based approaches should be considered more broadly for malaria early detection.

1433 A 13 Year Review of Uterine Endometrial Ablation Device Events Using Categorization of Reports to the Manufacturer and User Facility Device Experience (Maude) Data Base

Study Objective Usefully categorize reports on endometrial ablation device events using the FDA MAUDE database. Design The FDA MAUDE database was reviewed using brand name searches: Novasure, Genesys HTA, Thermachoice, Minerva, and HerOption. Reported events were categorized as follows: Type I , non-injury equipment malfunction; Type II , an injury event not requiring hospitalization; Type III , an injury requiring hospitalization. Setting 13-year FDA MAUDE database review (2005-2018). Patients or Participants N/A. Interventions N/A. Measurements and Main Results 1518 MAUDE reports were categorized as follows: Novasure: Type I: 92/550 (16.7%), Type II: 273/550 (49.6%), Type III: 185/550 (33.6%); Genesys HTA: Type I: 140/432(32.40%), Type II: 259/432 (58.1%), Type III: 42/432 (9.49%); Thermachoice: Type I: 315/466 (67.60%), Type II: 78/466 (16.74%), and Type III: 73/466 (15.67%); Minerva: Type I: 13/56 (23.21%), Type II: 9/56 (16.07%), and Type III: 34/56 (60.71%); Her Option: Type I: 4/14 (28.57%), Type II: 0 (0%), and Type III:10/14 (71.43%). Novasure, Minerva, and Her Option had a greater percent of events due to bowel injury while Genesys HTA and Thermachoice had a greater percent of events due to vaginal/cervical/external thermal injuries. Over 50% of HTA Geneysis events were due to vaginal/cervical/external thermal injuries while greater than 50% of Novasure events were due to uterine perforation. Thermachoice had greater than 60% of events due to balloon rupture device malfunction. Conclusion The MAUDE database serves as a valuable tool for physicians to evaluate the safety and possible complications from existing and new technologies. Categorizing events as described here may improve clinicians’ ability to interpret MAUDE data. Large differences in report type were noted between brands of endometrial ablation devices. The percentage of Type III events by device were highest for HerOption, Minerva, and Novasure. Caution must be made when interpreting the data from the MAUDE database due to potential subjective and incomplete narrative, lack of outcome details, and erroneous or duplicate submissions.

The Multi-messenger Matrix: The Future of Neutron Star Merger Constraints on the Nuclear Equation of State

Abstract The electromagnetic (EM) signal of a binary neutron star (BNS) merger depends sensitively on the total binary mass, M tot, relative to various threshold masses set by the neutron star (NS) equation of state (EOS), parameterized through the neutron star (NS) maximum mass, M TOV, and characteristic radius, R 1.6. EM observations of a BNS merger detected through its gravitational-wave (GW) emission, which are of sufficient quality to ascertain the identity of the merger remnant, can therefore constrain the values of M TOV and R 1.6, given the tight connection between M tot and the well-measured chirp mass. We elucidate the present and future landscape of EOS constraints from BNS mergers, introducing the “Multi-Messenger Matrix,” a mapping between GW and EM measurables that defines the ranges of event chirp masses that provide the most leverage on constraining the EOS. By simulating a population of BNS mergers drawn from the Galactic double NS mass distribution we show that ∼10 joint detections can constrain M TOV and R 1.6 to several percent level where systematic uncertainties may become significant. Current EOS constraints imply that most mergers will produce supramassive or hypermassive remnants, a smaller minority (possibly zero) will undergo prompt collapse, while at most only a few percent of events will form indefinitely stable NSs. In support of the envisioned program, we advocate in favor of Laser Interferometer Gravitational-Wave Observatory (LIGO)/Virgo releasing chirp mass estimates as early as possible to the scientific community, enabling observational resources to be allocated in the most efficient way to maximize the scientific gain from multi-messenger discoveries.

Use of 2-color flow cytometry to assess radiation-induced genotoxic damage on CHO-KI cells

The micronucleus assay is an important technique used to evaluate genotoxic damage of chemical or physical agents (as ionizing radiations) on cells, based on quantification of cells bearing micronuclei, which are fragments derived from damage (breakage) of the DNA. Currently, this technique was updated to an automated approach that relies on plasma membrane dissolution to analyze fluorescent dye-labelled nuclei and micronuclei by flow cytometry. Cell suspensions were irradiated in PBS by a 60Co source in doses between 0 and 16 Gy, and incubated by 72h. Cell membranes were lysed in the presence of SYTOX Green and EMA dyes, so EMA-stained nuclei could be discriminated as from dead cells, and nuclei and micronuclei could be quantified. Amounts of micronuclei (percent of events) in the samples, were found to be proportional to radiation doses, and could be fitted to a linear-quadratic model (R² = 0.993). Only higher doses (8 and 16 Gy) and positive control could induce relevant increases in micronucleus amounts. The incorporation EMA showed an increase in irradiated cells. Mid- to high doses (4, 8 and 16 Gy) induced reduction of cell proliferation. Experiments showed the suitability of the technique to replace traditional microscopy analysis in evaluation of the effects of ionizing radiations on cells, with possibility to use in biological dosimetry.

Failure Analysis and Prediction for Big-Data Systems

Motivated by the high complexity of today’s datacenters, a large body of studies tries to understand workloads and resource utilization in datacenters. However, there is little work on exploring unsuccessful job and task executions. In this article, we study and predict three types of unsuccessful executions in traces of a Google datacenter, namely $\sf {fail}$ , $\sf {kill}$ , and $\sf {eviction}$ . We first quantitatively show their strongly negative impact on machine time and the resulting task slowdown. We analyze patterns of unsuccessful jobs and tasks, particularly focusing on their interdependencies, and we uncover their root causes by inspecting key workload and system attributes. Furthermore, we develop three on-line prediction models that can classify jobs and events into four classes upon arrival time, using independent or nested Neural Networks. We explore different combinations of feature sets and techniques to reduce the computational overhead. Our evaluation results show that the proposed models can accurately classify 94.4 percent of jobs and 76.8 percent of events into four classes.

A Death in the Family: Lessons From a Tragedy.

A Death in the Family: Lessons From a Tragedy.

The Timing of Susceptibility to Post-Fire Debris Flows in the Western United States

Watersheds recently burned by wildfires can be susceptible to debris flow, although little is known about how long this susceptibility persists and how it changes over time. We use a compilation of 75 debris-flow response and fire-ignition dates, vegetation and bedrock class, rainfall regime, and initiation process from throughout the western United States to address these issues. The great majority (85 percent) of debris flows occurred within the first 12 months following wildfire, with 71 percent occurring within the first 6 months. Seven percent of the debris flows occurred between 1 and 1.5 years after a fire, or during the second rainy season to impact an area. Within the first 1.5 years following fires, all but one of the debris flows initiated through runoff-dominated processes, and debris flows occurred in similar proportions in forested and non-forested landscapes. Underlying geologic materials affected how long debris-flow activity persisted, and the timing of debris flows varied within different rainfall regimes. A second, later period of increased debris flow susceptibility between 2.2 and 10 years after fires is indicated by the remaining 8 percent of events, which occurred primarily in forested terrains and initiated largely through landslide processes. The short time period between fire and debris-flow response within the first 1.5 years after ignition and the longer-term response between 2.2 and 10 years after fire demonstrate the necessity of both rapid and long-term reactions by land managers and emergency-response agencies to mitigate hazards from debris flows from recently burned areas in the western United States.

Timing of Susceptibility to Post-fire Debris Flows in the Western USA

Watersheds recently burned by wildfires can have an increased susceptibility to debris flow, although little is known about how long this susceptibility persists, and how it changes over time. We here use a compilation of 75 debris-flow response and fire-ignition dates, vegetation and bedrock class, rainfall regime, and initiation process from throughout the western U.S. to address these issues. The great majority (85 percent) of debris flows occurred within the first 12 months following wildfire, with 71 percent within the first six months. Seven percent of the debris flows occurred between 1 and 1.5 years after a fire, or during the second rainy season to impact an area. Within the first 1.5 years following fires, all but one of the debris flows initiated through runoff-dominated processes, and debris flows occurred in similar proportions in forested and non-forested landscapes. Geologic materials affected how long debris-flow activity persisted, and the timing of debris flows varied within different rainfall regimes. A second, later period of increased debris flow susceptibility between 2.2 and 10 years after fires is indicated by the remaining 8 percent of events, which occurred primarily in forested terrains and initiated largely through landslide processes. The short time period between fire and debris-flow response within the first 1.5 years after ignition, and the longer-term response between 2.2 and 10 years after fire, demonstrate the necessity of both rapid and long-term reactions by land managers and emergency-response agencies to mitigate hazards from debris flows from recently burned areas in the western U.S.

Replication Forks Restarted by Homologous Recombination Display a High Frequency of Errors at Inverted Repeats

Replication restart by HR at the sites of a collapsed replication fork promotes cell survival, but at the expense of increasing the potential for genome rearrangement. We have previously shown that, when a replication fork collapses within a small (~900bp) inverted repeat, homologous recombination is required to restart the collapsed fork. In the majority of cases, the restart event is effective and promotes cell survival. However, the presence of a nearby repeat (homologous sequence) results in an inappropriate template exchange in a few percent of events, producing dicentric and acentric giant palindromic chromosomes.We also studied the consequence of restarted replication fork progression through a small palindrome. We observed that restarted forks are prone to generate errors when they replicate through small inverted repeats. Thus, two distinct mechanisms can result in gross chromosomal rearrangements: 1. When replication forks collapse within a repeated sequence, incorrect homologous recombination can occur that results in repeat fusion. 2. The restarted replication fork is itself error prone, and is particularly sensitive to making errors when replicating closely spaced inverted repeats.

FACS Analysis of Stat3/5 Signaling Reveals Ligand Sensitivity As a Significant Prognostic Factor in Pediatric AML: A Children's Oncology Group Report

Abstract 938Pediatric acute myeloid leukemia (AML) remains a devastating disease with a relapse rate near 50%. Kinase inhibitors are being incorporated into treatments, yet the signaling abnormalities targeted by these drugs remain poorly understood. Pathways involving Stat3 and Stat5 are known to be aberrantly active in AML, and increased activity has been associated with chemoresistant disease and poor outcome. Our hypothesis is that analysis of Stat3/5 activation patterns will delineate signaling abnormalities, and thereby guide the development of targeted therapies. We performed FACS analysis of the Stat3/5 signaling pathways in 140 diagnostic bone marrow samples from patients on the AML study CCG 2961. After thawing, cells were rested in serum-free medium for 2 hr. We measured tyrosine-phosphorylated Stat3 (pY-Stat3), serine-phosphorylated Stat3 (pS-Stat3) and pY-Stat5 in unstimulated cells, cells stimulated with low (1 ng/ml), intermediate (10 ng/ml), or high (100 ng/ml) dose G-CSF, and cells stimulated with low (0.5 + 1), intermediate (5 + 10), or high (50 + 100) dose IL-6 + soluble IL-6 receptor alpha. Constitutively phosphorylated proteins were quantified as the percent of events in the positive gate in unstimulated cells. Constitutive pY-Stat3 and pY-Stat5 were found to be common and highly variable. The median percent of pY-Stat3+ events was 37.3% (range 0.1–91.8%); the median %pY-Stat5+ was 18.6% (range 0.5–86.5%). In contrast, pS-Stat3 was generally low (median 3.63%, range 0.1–78.2%). There was non-significant correlation between %pY-Stat3+ and %pY-Stat5+. There was a significant correlation between %pY-Stat3+ and %total Stat3+, with Pearson correlation coefficient R=0.523 (p<0.001). Constitutively activated Src (pY-Src) was generally low (median 4.2%), although there was a population with 20–40 %pY-Src+, which also had high constitutive %pY-Stat3, suggesting that aberrant Src activation may account for high basal pY-Stat3 in some cases. Ligand responses were expressed as the fold increase in mean fluorescence intensity over unstimulated cells (δMFI). There was a strong correlation between pY-Stat3 and pY-Stat5 δMFIs to G-CSF (R=0.91, p<0.001), suggesting overlap of the pathways from G-CSF to each STAT. Likewise, the pY-Stat3 δMFI to G-CSF significantly correlated with the pY-Stat3 δMFI to IL-6 (R=0.343, p<0.001), suggesting convergence of the pathways from each receptor to Stat3. G-CSF receptor expression positively correlated with the GCSF-induced pY-Stat3 δMFI (R=0.396, p<0.001), whereas gp130 (IL-6 receptor) expression negatively correlated with the IL-6-induced pY-Stat3 δMFI (R=-0.262, p<0.005). None of the constitutive or ligand-induced pStat measurements, pY-Src, total Stat3, or receptor expression alone were significant predictors of survival. However, we did identify patterns of ligand sensitivity that predicted outcome. Patients with G-CSF-sensitive AML cells, defined as a pY-Stat3 δMFI > 2 in response to the low or intermediate G-CSF dose (33% of patients in the cohort), had a superior 5 year event-free survival (EFS; 57.8 ± 15% v. 37.2 ± 10%, p=0.025). A similar trend was observed for IL-6 sensitivity (p=0.1). When pY-Stat3 sensitivities to G-CSF and IL-6 were considered together, patients whose blasts were equally sensitive to both ligands had the best 5 yr EFS (69 ± 20%). Patients whose blasts responded to G-CSF only, or were unresponsive to both, had intermediate outcomes (5 yr EFS 38.5 ± 16% and 41.8 ± 14%, respectively). Surprisingly, patients whose blasts responded to IL-6 only had the worst outcome, with a 5 yr EFS of 25 ± 22% (p=0.047). These ligand sensitivity results highlight the importance of understanding not only molecular changes in AML, but also functional aberrancies. For example, cases with low constitutive and ligand-induced Stat3 activation may be resistant to Stat3 pathway inhibitors, whereas cases with high basal pY-Src or aberrant IL-6 sensitivity may be effectively treated with inhibitors of these pathways. In summary, multiparameter FACS analysis of Stat3 and Stat5 activities provides biologic and prognostic insight into the role of signaling aberrancies in AML, and this knowledge will promote rational implementation of new therapies. Disclosures:No relevant conflicts of interest to declare.

Cost-effectiveness of adjuvant systemic therapy in early-stage breast cancer patients with isolated tumor cells or micrometastases in regional lymph nodes.

614 Background: The MIRROR study has shown a negative prognostic impact of isolated tumor cells and micrometastases in regional lymph nodes in early-stage breast cancer patients who had not received adjuvant systemic therapy (endocrine and/or chemotherapy) compared to those who had received adjuvant therapy. The goal of the present study was to evaluate whether administering AST in those patients is cost-effective. Methods: The primary objective of this cost-effectiveness analysis was to determine the incremental cost-effectiveness ratio (ICER), expressed as the investment necessary to prevent one percent of events after 5 years of follow-up. The median costs of the adjuvant and nonadjuvant therapy cohort of the MIRROR study were compared using a log regression taking into account possible confounders. The costs of every treatment delivered for primary breast cancer, follow-up, and recurrence of disease were included in the analyses. The 5- year disease free survival was assessed using Cox regression analysis. To assess the robustness of the study results, we carried out one-way sensitivity analyses for several parameters. Results: In the non-adjuvant therapy cohort, 22.7% of patients with complete follow-up or an event (n = 366) had an event within 5 years, and the estimated mean costs per patient were €15,528 (95% CI, €13,832-€17,223). In the adjuvant therapy cohort, 15.3% of patients with complete follow-up or an event (n = 483) had an event within 5 years, and the estimated mean costs per patient were €17,773 (95% CI, €16,957-€18,588). The costs of the adjuvant therapy cohort were significantly higher (p < 0.0001), after correction for age, log tumor size, tumor grade, and axillary treatment. The ICER was €304 per % events prevented. Sensitivity analyses resulted in ICERs ranging from €31 and €406 per % event prevented. Conclusions: In the adjuvant therapy cohort with complete follow-up after 5 years, the disease event rate was 7.4% lower as compared to the nonadjuvant therapy cohort. To obtain this, €2,250 had to be invested per patient with early-stage breast cancer and isolated tumor cells or micrometastases in regional lymph nodes. No significant financial relationships to disclose.

Perioperative non-hypoxic bradycardia in pediatric patients: Thai anesthesia incident monitoring study (Thai AIMS)

Results: There were 49 cases of perioperative non-hypoxic bradycardia in pediatric patients (2.4% of all 1996 incident reports or 13.4% of all incident reports from pediatric patients). Anesthesia (71%) was a major factor that related to the bradycardia, wheareas 19% and 10% were surgical and patient factors, respectively. Sixty percent of cases occurred during induction, of which 80% (24 out of 30 cases) and 10% were considered as anesthesiarelated or combination of anesthesia and patient factors. Sixty percent (9 out of 15 cases) of bradycardia during the maintenance phase was surgery-related particularly in ophthalmologic surgery. Four cases (8.1%) of all bradycardia occurred during the emergence and recovery phase of which 78% was considered anesthesiarelated. All bradycardia had complete recovery. Sixty-three percent of events were preventable. Major contributing factors were lack of adequate knowledge (55%) and inappropriate decision-making (22%). Conclusion: Most perioperative non-hypoxic bradycardia incidences were anesthesia-related and most common during the induction phase. Improved supervision, additional training and vigilance were suggested corrective strategies.

Surveillance of Vaccine Safety: Comparison of parental reports with routine surveillance and a clinical trial

One way to maintain confidence in vaccination programmes is to improve monitoring of immunisation safety. We studied active parental reporting of adverse events after a booster dose of diphtheria-tetanus toxoid (DT). 7193 children received the vaccine. Questionnaires were submitted by 84.2% of the parents, who reported reactions for 9.2% of the children. Four percent of events were classified as moderate/severe by interviews. Relative risk of redness and swelling reported was 0.24 (95% CI, 0.13–0.42) compared to a clinical trial, while it was 71.0 (44–114) compared to passive surveillance. Active surveillance by parental reports is a useful complement to passive surveillance of childhood immunisations to generate hypotheses for evaluation in controlled studies.

Characteristics of bleeding complications in patients with anticoagulant treatment.

Anticoagulation treatment is effective in the prevention of stroke as well as deep venous thrombosis (DVT) and pulmonary embolism (PE). Its preventive benefit has to be balanced against possible bleeding complications. We sought to assess risk factors for the severity of bleeding events in patients under anticoagulant treatment. Clinical characteristics, type of anticoagulant treatment, bleeding site, risk factors and additional medication taken were analysed in patients with bleeding complications during an observation period of 12 months. Eighty-seven bleeding complications in 84 patients (mean age, 79 years; 51% female) were observed from January to December 2005 at the Department of Internal Medicine of the Cantonal Hospital of Aargau. Most bleeding complications occurred in the gastrointestinal tract (54%). The median time interval from the beginning of the anticoagulant treatment to the bleeding event was 34 months. Forty-nine percent of events occurred after a treatment time above 36 months. Age was not found to influence the severity of bleeding but the duration of anticoagulant treatment before the occurrence of a complication was significantly longer for older patients (p = 0.001). Our study shows no influence of age on severity of bleeding complications. Furthermore, in patients with advanced age complications occurred later in the treatment course than in younger patients. Overall we assessed various bleeding events in patients treated for over three years. Therefore we emphasize the importance of closely controlling patients on anticoagulant treatment in the later course of treatment and to take account of the anticoagulation when ordering new medication.

Studying the human-computer-terminology interface.

To explore the use of an observational, cognitive-based approach for differentiating between successful, suboptimal, and failed entry of coded data by clinicians in actual practice, and to detect whether causes for unsuccessful attempts to capture true intended meaning were due to terminology content, terminology representation, or user interface problems. Observational study with videotaping and subsequent coding of data entry events in an outpatient clinic at New York Presbyterian Hospital. Eight attending physicians, 18 resident physicians, and 1 nurse practitioner, using the Medical Entities Dictionary (MED) to record patient problems, medications, and adverse reactions in an outpatient medical record system. Classification of data entry events as successful, suboptimal, or failed, and estimation of cause; recording of system response time and total event time. Two hundred thirty-eight data entry events were analyzed; 71.0 percent were successful, 6.3 percent suboptimal, and 22.7 percent failed; unsuccessful entries were due to problems with content in 13.0 percent of events, representation problems in 10.1 percent of events, and usability problems in 5.9 percent of events. Response time averaged 0.74 sec, and total event time averaged 40.4 sec. Of an additional 209 tasks related to drug dose and frequency terms, 94 percent were successful, 0.5 percent were suboptimal, and 6 percent failed, for an overall success rate of 82 percent. Data entry by clinicians using the outpatient system and the MED was generally successful and efficient. The cognitive-based observational approach permitted detection of false-positive (suboptimal) and false-negative (failed due to user interface) data entry.

Characteristics of Texas Black Bass Fishing Tournaments

Abstract –We describe characteristics of Texas fishing tournaments for black bass Micropterus spp. based on voluntary reports for 2,418 tournaments held during 1993–1997. Most tournaments (99%) were 1–2 d in duration. An average of 35.1 anglers participated in each tournament, and most tournaments (84%) involved 20 or fewer boats. Ninety-seven percent of tournaments required live release of fish after weigh-in. Tournaments had a variety of formats and rules. The most common format (87.8% of tournaments) awarded prizes based on total weight, 26.9% awarded prizes based on team results, and 26.0% awarded prizes for big fish. Ten percent of events were paper tournaments, in which fish are captured, measured, and released immediately. In 23% of tournaments, the competition was held with self-imposed bag and minimum length limits that were more restrictive than those promulgated by the state. Comparison of our results with those from an earlier study suggests a compensatory relationship between tournament angle...

Predicting Postprocedure Bleeding in Liver Disease

Prophylactic transfusions of fresh frozen plasma and platelets are sometimes given to patients with mild elevations in prothrombin time (PT) and partial thromboplastin time (PTF) and mild thrombocytopenia before percutaneous liver biopsy. To determine whether PTs and PTFs 1.1-1.5 times midrange normal levels and platelet counts 50-99 × 109/L are associated with increased bleeding complications, hospital records of all patients who underwent percutaneous liver biopsy during 56 consecutive months (n = 291) were reviewed. Complete information was available for 177 inpatient procedures (155 standard, 22 fine needle). Overall, the frequency of bleeding complications in patients with platelet counts ± 50 × 109/L was 3.4% (6 of 175), with no significant difference between patients with mild hemostatic abnormalities and patients with normal parameters. These data suggest that prophylactic transfusions may not be necessary. One factor was highly associated with bleeding complications: a patient diagnosis of malignancy, 14% (7 of 50) compared with 0.8% (1 of 127) among other patients (P &lt; 0.001). These patients should be monitored closely after biopsy. To determine whether untreated mild coagulopathy in patients with no evidence of clinical bleeding is associated with an increased risk of hemorrhage after paracentesis or thoracentesis, retrospective examination was conducted of 608 consecutive procedures for which prothrombin time (PT), partial thromboplastin time (PTT), platelet (Plt) counts, and preprocedure and postprocedure hemoglobin concentrations were available. There was no increased bleeding in patients with mild to moderate coagulopathy (defined as PT or PTT up to twice the midpoint normal range or plt count of 50 to 99 × 103 per μL [50-99 × 109 L]). However, patients with markedly elevated serum creatinine levels (6.0 to 14.0 mg/dL [530-1240 μmol/L]) had a significantly greater average hemoglobin loss (–0.82 ± 1.3 g/dL [–8 ± 13 g/L], n = 11) than patients with normal serum creatinine levels (–0.12 ± 088 g/dL [–1 ± 9 g/L], n = 450) (p = 0.011). Overall, the frequency of bleeding complications requiring red cell transfusions was very low: 0.2 percent of events. The most common diagnosis for patients who had paracentesis was alcoholic liver disease (72%); for those having thoracentesis, it was infection (37%). It can be concluded that, for these patients, prophylactic plasma or platelet transfusions are not necessary. Patients with markedly elevated serum creatinine deserve close postprocedure observation.

Lack of increased bleeding after paracentesis and thoracentesis in patients with mild coagulation abnormalities

To determine whether untreated mild coagulopathy in patients with no evidence of clinical bleeding is associated with an increased risk of hemorrhage after paracentesis or thoracentesis, retrospective examination was conducted of 608 consecutive procedures for which prothrombin time (PT), partial thromboplastin time (PTT), platelet (Plt) counts, and preprocedure and postprocedure hemoglobin concentrations were available. There was no increased bleeding in patients with mild to moderate coagulopathy (defined as PT or PTT up to twice the midpoint normal range or pit count of 50 to 99 x 10(3) per microL [50-99 x 10(9)/L]). However, patients with markedly elevated serum creatinine levels (6.0 to 14.0 mg/dL [530-1240 mumol/L]) had a significantly greater average hemoglobin loss (-0.82 +/- 1.3 g/dL [-8 +/- 13 g/L], n = 11) than patients with normal serum creatinine levels (-0.12 +/- 0.88 g/dL [-1 +/- 9 g/L], n = 450) (p = 0.011). Overall, the frequency of bleeding complications requiring red cell transfusions was very low: 0.2 percent of events. The most common diagnosis for patients who had paracentesis was alcoholic liver disease (72%); for those having thoracentesis, it was infection (37%). It can be concluded that, for these patients, prophylactic plasma or platelet transfusions are not necessary. Patients with markedly elevated serum creatinine deserve close postprocedure observation.