Repetitive Attempts Research Articles

An inferential spatiotemporal approach for knowledge synthesis to identify trends in public health research

BackgroundDecisions follow patterns that are introduced by human perception. Research and development (R&D) are influenced by these patterns. Furthermore, R&D publications can represent repetitive attempts to solve similar, or the same problems. Literature reviews serve as an important tool for identifying these trends, but they are time consuming. The time commitment of a literature review can be reduced by using a sample of research. This will allow an infinite population of research to be generalized. Additionally, spatiotemporal analysis is most appropriate for fields that follow time and geographic trends, such as public health. Also, using research locations to perform this analysis potentially captures the social return of R&D, as knowledge gained. As a result, an inferential spatiotemporal methodological framework is introduced to quickly identify research trends using public health research. This was applied to a childhood Pb exposure case study. MethodsA body of more than 1000 childhood elevated blood lead (Pb) level (EBLL) research articles were used to extract publication years, research locations, and subtopics. These publications were grouped into research locations (i.e., U.S. states where research was conducted; not publication location) and averaged over years published (i.e., 29 years). Binary indicator variables were derived using the subtopics extracted and the periods identified in time trend analyses. Explanatory variables were used to conduct hypothesis testing. Significant variables were used to generalize the population of the annual average EBLL articles written per state. ResultsThe range of the annual average of EBLL research articles by state was 0–1.7 articles, with a mean of 0.3 articles. Thirty-eight explanatory variables suggested a significant effect on research article production. These included temporal, sociodemographic, education, structure age, environmental, and economic variables. The strongest effect on research production for U.S. states came from the number of structures built before 1950. A predictive model was selected to generalize the population of articles using time-periods 1990-95, environmental subtopic, and structures built before 1950. The locations with the most research production for this topic were California and New York. The locations with the least research production for this topic were Alaska, Hawaii, Nevada, Wyoming, North Dakota, South Dakota, Mississippi, Delaware, and New Hampshire. ConclusionIf the trend for R&D is to make fast decisions, more human bias will be introduced into the decision-making process. Analytical tools that enable researchers to identify trends and ask more questions about their field will mitigate these biases. This hypothesis testing and predictive modeling methodology provide researchers and other decision makers with analytical tools they can use to quickly identify research trends and narrow their field of research. Additionally, this analysis potentially captures the impact of discovered ideas, as a social return spillover, for this topic.

Conventional outcome reporting per IVF cycle/embryo transfer may systematically underestimate chances of success for women undergoing ART: relevant biases in registries, epidemiological studies, and guidelines.

Pre-conception counselling and management of expectations about chance of success of IVF/ICSI treatments is an integral part of fertility care. Registry data are usually used to inform patients about expected success rates of IVF/ICSI treatment, as these data should best represent real-world populations and clinical practice. In registries, the success rate of IVF/ICSI treatments is conventionally reported per treatment cycle or per embryo transfer and estimated from data for which several treatment attempts per subject have been pooled (e.g. repetitive IVF/ICSI attempts or repetitive attempts of cryotransfer). This, however, may underestimate the true mean chance of success per treatment attempt, because treatment attempts of women with a poor prognosis will usually be over-represented in a pool of treatment cycle data compared to treatment events of women with a good prognosis. Of note, this phenomenon is also a source of potential bias when comparing outcomes between fresh transfers and cryotransfers, since women can undergo a maximum of only one fresh transfer after each IVF/ICSI treatment, but potentially several cryotransfers. Herein, we use a trial dataset from 619 women, who underwent one cycle of ovarian stimulation and ICSI, a Day 5 fresh transfer and/or subsequent cryotransfers (follow-up of all cryotransfers up to 1 year after the start of stimulation), to exemplify the underestimation of the live birth rate, when not accounting for repeated transfers in the same woman. Using mixed-effect logistic regression modelling, we show that the mean live birth rate per transfer per woman in cryocycles is underestimated by the factor 0.69 (e.g. live birth rate per cryotransfer of 36% after adjustment versus 25% unadjusted). We conclude that the average chance of success of treatment cycles of women of a given age, treated in a given centre, etc., when conventionally calculated per cycle or per embryo transfer from a pool of treatment events, do not apply to an individual woman. We suggest that patients are, especially at the outset of treatment, systematically confronted with mean estimates of success per attempt that are too low. Live birth rates per transfer from datasets encompassing multiple transfers from single individuals could be more accurately reported using statistical models accounting for the correlation between cycle outcomes within women.

P-755 Conventional outcome reporting per embryo-transfer cycle systematically underestimates the chance of success of women undergoing ART: a source of bias in registries, trials and guidelines

Abstract Study question How should ART treatment success be estimated from data consisting of several treatment attempts per subject (e.g., fresh transfer followed by cryotransfer[s] and/or repetitive attempts)? Summary answer Live birth rate estimates per transfer cycle will be substantially higher when accounting for differences in the number of embryo transfers between subjects. What is known already Preconception counselling and expectation management is an integral part of fertility care. In the course of IVF-treatment, the majority of women undergo several embryo transfers (ET). The live birth rate per ET cycle may be severely underestimated since women with a poor prognosis will be overrepresented in the population compared to women with a good prognosis. This is because women achieving a live birth early will contribute few ETs, whereas women without live births will contribute several ETs to the pool of observations. This phenomenon does also add bias when comparing the live birth rates between fresh- transfers and cryo-transfers. Study design, size, duration The complete data set from the RAINBOW trial (NCT03564509) was applied to exemplify the underestimation of live birth chance of individual women in cryo-cycles. In total 557 women underwent treatment in a fixed, individualized daily- dose of follitropin delta in a long GnRH agonist protocol, IVF/ICSI and blastocyst transfer. Surplus blastocysts were cryopreserved on day 5/6 and subsequently used for cryo-transfers up to one year after start of the stimulation. Participants/materials, setting, methods Live birth rate was analyzed using a mixed effect logistic regression model where the log-odds of achieving a live birth was assumed to be normally distributed in the trial population. Type of transfer (fresh or cryo) was included as a factor in the model. The delta method was used to transform estimated mean log-odds from the model into estimated live birth rates per transfer, and to estimate the difference between fresh- and cryo-transfers. Main results and the role of chance Of the 619 women starting stimulation, 557 had at least one fresh- or cryo-transfer. A total of 927 embryo transfers were performed whereof 520 fresh- and 407 cryo-transfers. In total, 252 subjects had at least one cryotransfer, 102 had a second cryotransfer, 37 a third, 12 a fourth, three a fifth, and one had a sixth cryotransfer, respectively. Of the 520 fresh transfers, 212 (41%) resulted in a live birth, whereas for the 407 cryo-transfers 100 (25%) resulted in a live birth (unadjusted difference 16%). When using the mixed effect logistic regression model to adjust for repeated transfers in the same women, the live birth rates were estimated to be 41% for fresh transfers and 36% per transfer for cryo-transfers. The difference between rates for fresh transfer and per cryo-transfer was estimated to be 5.3% with 95% confidence interval ranging from -6.6% to 17.1% and with no statistically significant difference (p = 0.3827). Limitations, reasons for caution Comparison between live birth rate after fresh transfer and per cryotransfer in the same group of women will already be biased in favour of the fresh transfer. This is because the fresh transfer will normally use the embryo of highest quality, leaving embryos of lower quality for cryo-transfers. Wider implications of the findings Average chance of success reported per cycle or per embryo-transfer (e.g. registry reports) do not apply to individual couples, especially not at the outset of treatment. Live birth rates per transfer from datasets encompassing multiple transfers from single individuals can be more accurately reported using mixed effect logistic regression models. Trial registration number NCT03564509

Analysis of psycho-sociodemographic features in referred male psychiatric patients with suicidal ideation

Abstract Suicide is defined by the World Health Organization as an act in which an individual ends his or her own life. Suicidal behavior is a major public health problem worldwide. According to the World Health Organization, the global suicide rate is 10,5/100.000 – 13,5/100.000 in case of men and 7,7/100 000 in case of women and is the 2nd most common cause of violent death. Suicide is a multifactorial phenomenon that can be approached from different perspectives. In Romania, this rate is similar to the global rate: in 2016, the estimated suicide rate was 10.4/100,000, well below the European average. Suicide rates vary by region, age group, gender, ethnicity, and registration of mortality statistics. The aim of the present study is to investigate the psycho-socio-demographic indicators of a cohort of patients with suicidal thoughts emergency referred to a particular psychiatric ward in one year. In our research, we performed a case-control, analytical, randomized, observational study at the Clinical Hospital of Neurology and Psychiatry Brasov among adult psychiatric patients admitted during 2014. The following data on patients were processed: demographic data (age, gender, place of residence), psychosocial data (social background, marital status, education), chronic somatic comorbidities, family history of psychiatric illness, pre-existing psychiatric illnesses, previous suicide attempts and their characteristics. The risk of suicide was assessed by the Modified Scale for Suicide Ideation - Miller et al. Questionnaire and distinguished 3 categories. In our sample of 77 cases we identified 14 patients with low suicide risk, 17 with moderate risk and 46 with high suicide risk. The focus of our study was on suicidal behavior. Suicide attempt, as a complex clinical problem with a waste complexity of ethiology, has high demands on psychiatric care. Being familiar with the different psycho-socio-demographic profiles by gender is proved to be a useful tool in both “screening” and in subsequent case management. These principles can facilitate decision-making, can increase adherence to treatment, and reduce the risk of repetitive attempts.

Smoking cessation after coronary angiography

Abstract Funding Acknowledgements Type of funding sources: Public Institution(s). Main funding source(s): Centre of Postgraduate Medical Education Background Smoking cessation is crucial for risk reduction among patients with coronary artery disease (CAD). Effective support in smoking cessation (SC) and data regarding factors related to SC are still a matter of concern. Purpose To assess SC rates and factors related to effective smoking cessation in patients after coronary angiography (CA) Methods Patients scheduled to CA between 01.2014 and 11.2018 were screened for active smoking. Patients were contacted by phone after at least 6 months after procedure and investigated about current smoking, history of smoking and nicotine dependence. Results 3719 consecutive patients were screened, overall 921 (24.8%) patients declared active smoking within the last month before CA. 241 patients were contacted and questionnaired after at least 6 months. The mean age of patients was 61.2 ± 9.3, 168 (69.7%) patients were men, 115 (47,7%) patients had acute coronary syndrome (ACS). Mean hospitalization time was 6 ± 4.4 days, 67 (27.8%) patients were scheduled for the second stage procedure. 80 (33.2%) patients declared SC during follow-up. In multivariate logistic regression analysis hospitalization time ≥4 days (OR 3.62; 95% CI 1.9-6.89), Fagerstrome score ≤4 (OR 1.96; 95%CI 1.01-3.79), scheduled second hospitalization (OR 2.54; 95%CI 1.32-4.86), and unexpectedly smoking load with ≥51 pack-years (OR 2.28; 95%CI 1.16-4.47) increased the chance of SC. Conclusion Substantial group of patients scheduled to CA are current smokers. Self-reported SC rates after procedure are higher than in general population but still reasonably low. Prolonged in-hospital stay and repeated hospitalization increase chances for smoking cessation as well as low measured nicotine dependence. Paradoxically high load of packing-years also increase the chances of SC which may support repetitive attempts to SC in this group of patients.

Extensor mechanism tendinopathy in patients with lateral patellar maltracking.

Patellar maltracking is an important subset of patellofemoral pain syndrome. We hypothesize that maltracking patients have an increased incidence of extensor mechanism dysfunction due to repetitive attempts at stabilization of the patella. Our purpose is to delineate imaging features to identify maltracking patients at risk for extensor mechanism tendinopathy. Retrospective review of knee MRIs performed for anterior knee pain over a year was conducted to identify 218 studies with imaging findings of maltracking. The cases were evaluated for the presence and degree of patellar and quadriceps tendinopathy, tibial tuberosity-trochlear groove distance (TT-TG) and the distribution and grade of patellofemoral chondrosis. Cases were compared to 100 healthy, age-matched control knee MRIs. The mean age of maltracking patients with either patellar or quadriceps tendinosis was 41.2years versus 48.2years in the control population (p = 0.037). The TT-TG was significantly higher in maltracking patients with either patellar or quadriceps tendinosis at 16.49mm versus 14.99mm (p = 0.006). Maltrackers with isolated lateral patellofemoral chondrosis had a higher mean TT-TG at 17.4mm versus 15.4mm (p = 0.007). Extensor mechanism tendinosis was increased in the maltracking population compared to the controls at 57.8% versus 27.3% (p = 0.004). Extensor mechanism tendinosis is more common in the maltracking population and occurs at a younger age. TT-TG distance is significantly increased in patients with extensor mechanism dysfunction and in patients with isolated lateral patellofemoral chondrosis. TT-TG measurement can be used independently to identifying maltrackers who may be at risk for future complications.

ToJugaador Not? How Mumbai’s Gig Workers Thrive Against Psychological Contract Discrepancies

As gig economy based firms increasingly rely upon algorithmic management to regulate their gig workers, we explore how driver-partners’ psychological contacts working for two major ridesharing platforms based on Mumbai evolve. The gig workers’ responses in how they adapt and thrive to the challenges posed by the information asymmetry brought about by the app’s algorithms are qualitatively captured using semi-structured interviews. From the thematic analysis that follows, we learn that the gig workers perceive psychological contract violation when repetitive attempts via problem-focused coping fail to resolve the psychological contract breach induced discrepancies. Though functional coping responses are persisted initially, we find that a collective influenced employee reaction follows soon. This collective attempt at resetting the power asymmetry leads the drivers to disengage with their organisations and resort to counterproductive work behaviour hacks. These temporary and significant quick fixes (identified as jugaad in the local culture) help the gig workers thrive amidst their disengagement states.

Understanding umbilical venous catheter insertion practices through a prospective multicenter observational study

Objective To understand practices of umbilical venous catheter (UVC) insertion in tertiary level neonatal intensive care units (NICU) and investigate the outcomes of subsequent attempts following a failed initial attempt. Study design Prospective, multi-center observational study of UVC insertions at tertiary level NICUs between March 2019 and January 2020. Results Of the 101 UVCs inserted at 4 centers, seventy-two (71%) were central at the first attempt and 50% were central at subsequent attempts. Patients with at least 1 failed attempt at insertion were less likely to have a centrally placed UVC (p = .009). Manipulations were less likely to be required when UVC was centrally placed during the first attempt. Maneuvers such as posterior liver mobilization used during insertion were likely to be associated with successful central placement of UVC (p = .0243). The time to complete the procedure was significantly less when the UVC was central at the first attempt (34.2 ± 20.2 vs 46.9 ± 33.8) (p = .0292). Gestational age, birth weight, and age of the baby at the insertion of the UVC, experience of the provider, and type of catheter were comparable among groups. The Shukla formula was most commonly used by providers to measure the depth of UVC placement. Conclusion Repetitive attempts and manipulations were less likely to be beneficial in the successful central placement of UVC in neonates. Additionally, repetitive attempts at insertion prolonged the overall duration of the procedure.

Communication-based suicide prevention after the first attempt. A systematic review.

Previous suicide attempts are the strongest risk factor for a new suicide attempt, suicide death, the development of recurrent suicide behavior and even the development of suicidal ideation in the general population. Primary prevention aims to reduce new suicide attempts in the general population, while secondary prevention tries to reduce the chance of suicide attempts in patients with high risk. Tertiary interventions are targeted at individuals who have already made one or more suicide attempts and aim to prevent second or repetitive attempts and to suppress suicidal behavior. Communication with patients and family is a very effective way of preventing a second suicide attempt. The aim of this paper is to present an overview of tertiary suicide prevention interventions focusing on communication with the patient and their family and study their effectiveness. This systematic review was based on the PRISMA checklist and was conducted using the databases Pubmed, Scopus and Google Scholar for articles published between 2000 and 2020 focus in go communication with family and patient. All studies concerning at least one previous suicide attempt were included. The interventions described in the studies concerned: [1] face-to-face and telephone contacts, [2] communication with greeting cards and letters, [3]telephone contact with the patient and record keeping to facilitate the implementation of the action plan, [4] telephone contacts only, and [5] technology-based communication. Our investigation brought up9 studies on interventions focusing on communication with the patient and their family. Family and patient communication interventions, with a particular emphasis on telephone and written communication, have shown a good level of effectiveness in the prevention of a new suicide attempt, especially if the intervention has been completed according to the schedule and the patient has not abandoned the treatment early. The generalization of the results is limited due to the inclusion of other types of studies jointly with randomized controlled trials and the variability among the samples of the studies. In conclusion, family and patient communication interventions have shown a positive effect on preventing a second suicide attempt. More studies are needed to investigate the effectiveness of different prevention approaches at hand and clarify in which patient populations each intervention could be more effective.Previous suicide attempts are the strongest risk factor for a new suicide attempt, suicide death, the development of recurrent suicide behavior and even the development of suicidal ideation in the general population. Primary prevention aims to reduce new suicide attempts in the general population, while secondary prevention tries to reduce the chance of suicide attempts in patients with high risk. Tertiary interventions are targeted at individuals who have already made one or more suicide attempts and aim to prevent second or repetitive attempts and to suppress suicidal behavior. Communication with patients and family is a very effective way of preventing a second suicide attempt. The aim of this paper is to present an overview of tertiary suicide prevention interventions focusing on communication with the patient and their family and study their effectiveness. This systematic review was based on the PRISMA checklist and was conducted using the databases Pubmed, Scopus and Google Scholar for articles published between 2000 and 2020 focus in go communication with family and patient. All studies concerning at least one previous suicide attempt were included. The interventions described in the studies concerned: [1] face-to-face and telephone contacts, [2] communication with greeting cards and letters, [3]telephone contact with the patient and record keeping to facilitate the implementation of the action plan, [4] telephone contacts only, and [5] technology-based communication. Our investigation brought up9 studies on interventions focusing on communication with the patient and their family. Family and patient communication interventions, with a particular emphasis on telephone and written communication, have shown a good level of effectiveness in the prevention of a new suicide attempt, especially if the intervention has been completed according to the schedule and the patient has not abandoned the treatment early. The generalization of the results is limited due to the inclusion of other types of studies jointly with randomized controlled trials and the variability among the samples of the studies. In conclusion, family and patient communication interventions have shown a positive effect on preventing a second suicide attempt. More studies are needed to investigate the effectiveness of different prevention approaches at hand and clarify in which patient populations each intervention could be more effective.

Evaluation of automated capillary complete blood counts for routine clinical decision making in a large cohort of hematological patients, using Mindray BC-3000 Plus Auto and Sysmex XE-5000 hematology analyzers.

Venous blood (VB) sampling for complete blood count (CBC) via venipuncture is the basic method for the daily evaluation of hematological patients. However, several issues during this process, such as venipuncture difficulty and repetitive attempts, may cause pain, phlebitis, hematomas, inadequate sampling, and patient discomfort. Capillary blood (CB) sampling could be an alternative and less painful solution for the patient. The purpose of this study was the comparative evaluation of basic CBC parameters, as counted from venous and capillary blood samples. During the period 06/2016-06/2019 in which the study was conducted, 1634 automated counts of VB or CB were performed, derived from 425 hematological hospitalized patients. Bland-Altman plots were performed to show the agreement of VB and CB counts of common hematological parameters (Hb, Hct, WBC, absolute neutrophil count-[ANC], RBC, Plt, MCV, MCH), using two different hematology analyzers (Mindray BC-3000 Plus Auto and Sysmex XE-5000). Clinical significance of CB sampling was assessed by applying specific clinically significant cutoffs for Hb, ANC, and Plt. All measured parameters revealed a significant correlation (r>.9) between CB and VB samples, irrelatively of the hematology analyzer used. CB measurements of Hb, ANC, and Plt, at different clinically important cutoff levels, showed excellent sensitivity (87%-100%), specificity (95%-100%), positive predictive value, and negative predictive value (87%-100% and 90%-100%, respectively). Capillary blood and VB counts in hematological patients were equivalent for most basic hematological parameters. Hb, ANC, and Plt CB counts revealed clinically significant performance, indicating that they can reliably substitute VB sampling in the day work.

Crosslinked on novel nanofibers with thermophilic carbonic anhydrase for carbon dioxide sequestration

The recombinant Sulfurihydrogenibium yellowstonense carbonic anhydrase (SyCA) was covalently bonded on novel polyacrylonitrile (PAN) and polyethylene terephthalate (PET) nanofibers (PAN-PET-PAN donated as AEA) that was first fabricated by electrospinning. The resulting composite materials further crosslinked by the glutaraldehyde, which significantly increased thermostability up to 89.8% and 18.0% after heating at 60 °C for 1 h for immobilized crude and pure SyCA, respectively. After four repetitive attempts in the demonstration of CO2 sequestration, immobilized crude and pure SyCA on AEA also effectively improved the total CaCO3 yields to be 5.8 folds and 2.2 folds compared to free enzyme. Furthermore, the endurance of immobilized crude was investigated on flue gasses, which was retained its activity up to 57% on 50 mM NOx and 61% on 50 mM SOx presence. This is the first report of immobilized thermophilic SyCA on a novel nanofiber at the reusability, durability, sequestration of carbon dioxide, tolerant to sulfur oxides (SOx) and nitrogen oxides (NOx) toxic gases and to prevent air pollution.

Short-Term Effects of Healthy Eating Pattern Cycling on Cardiovascular Disease Risk Factors: Pooled Results from Two Randomized Controlled Trials.

Adherence to healthy eating patterns (HEPs) is often short-lived and can lead to repetitive attempts of adopting—but not maintaining—HEPs. We assessed effects of adopting, abandoning, and readopting HEPs (HEP cycling) on cardiovascular disease risk factors (CVD-RF). We hypothesized that HEP cycling would improve, worsen, and again improve CVD-RF. Data were retrospectively pooled for secondary analyses from two randomized, crossover, controlled feeding trials (n = 60, 52 ± 2 years, 30.6 ± 0.6 kg/m2) which included two 5–6 week HEP interventions (Dietary Approaches to Stop Hypertension-style or Mediterranean-style) separated by a four-week unrestricted eating period. Ambulatory and fasting blood pressures (BP), fasting serum lipids, lipoproteins, glucose, and insulin were measured before and during the last week of HEP interventions. Fasting systolic BP and total cholesterol decreased (−6 ± 1 mm Hg and −19 ± 3 mg/dL, respectively, p < 0.05), returned to baseline, then decreased again (−5 ± 1 mm Hg and −13 ± 3 mg/dL, respectively, p < 0.05) when adopting, abandoning, and readopting a HEP; magnitude of changes did not differ. Ambulatory and fasting diastolic BP and high-density lipoprotein cholesterol concentrations followed similar patterns; glucose and insulin remained unchanged. Low-density lipoprotein cholesterol concentrations decreased with initial adoption but not readoption (−13 ± 3 and −6 ± 3, respectively, interaction p = 0.020). Healthcare professionals should encourage individuals to consistently consume a HEP for cardiovascular health but also encourage them to try again if a first attempt is unsuccessful or short-lived.

Deviation and Restoration of Mundaneness and Mythological Nature in Chinese Cinema—Evolution of Chinese Directors of Different Generations over the Past Forty Years after the Reform and Opening-up Policy

ABSTRACTFilm is mundane both as an art form and as a myth. It is even considered a mundane art with a mythological nature; however, its mundaneness overshadows the mythological aspect. Over forty years after the reform and opening-up policy, the film industry in China has gone through a series of changes from obedience to reflection, inheritance to criticism, as well as rebellion to restoration. In the cycle of cultural representations from gradual recovery to restoration and transformation, and to international fame and diversification, directors of different generations (i.e., the Third, the Fourth, the Fifth, the New) have been hovering in confusion between mundane life and mythology. They have been moving back and forth from explaining and glorifying mythologies to weakening and challenging them, thus they have been marked with different shades and colors by the transitional age in their repetitive explorations and attempts. The latest generation of directors in mainland China, i.e., the aggressive generation, have ultimately returned to the reality of the coexistence of the mundane and mythical natures, and are trying to break through boundaries and combine various genres. The aggressive generation is likely to indicate the right direction and the inevitable course of future film creation in mainland China.

Hyper-frontality in an OCD patient – evidence from event-related potentials in a cued GO/NOGO task

The study aimed to evaluate the hyperactivity of the frontal lobes in a patient with obsessive-compulsive disorders. A 21-year-old female met the diagnostic criteria of DSM-5 since her behaviour was characterized by a preoccupations with negative thoughts and by repetitive attempts to decrease or stop those behaviours. Two working hypotheses were tested to find neuromarkers of OCD and anxiety in the patient described. In agreement with the 'OCD hypothesis' an increase of the frontal beta activity and an increase of the parietalalpha activity pattern was found. The 'anxiety' hypothesis found confirmation in an increased left temporal P1 wave in response to the visual stimuli observed in ERPs. In all three conditions (EO, EC, GO/NOGO task), two characteristics were deviant from the normative average data in EEG spectra. First, an increase of frontal beta activity and the increase of parietal alpha activity was noted. The independent component analysis applied for 700 ms EEG fragments in GO and NOGO conditions revealed a strong activation over the central areas. Specific patterns of QEEG and ERPs, the increase of beta activity frontally, and the increase of parietal alpha activity pattern which produce hyper-frontality, might be useful in the diagnosis of an OCD patient. ERPs in a GO/NOGO task can be used in the assessment of functional brain changes in OCD patients.

Crown-Plug Pulling Performed as Riserless Light Well Intervention in the Gulf of Mexico

This article, written by JPT Technology Editor Chris Carpenter, contains highlights of paper SPE 173647, ’Crown-Plug Pulling Performed as Riserless Light Well Intervention in the Gulf of Mexico - Overcoming the Challenges,’ by Garry Andrews and Angel Luviano, Welltec, prepared for the 2015 SPE/ICoTA Coiled Tubing and Well Intervention Conference and Exhibition, The Woodlands, Texas, USA, 24-25 March. The paper has not been peer reviewed. In a riserless-light-well-intervention (RLWI) operation in the Gulf of Mexico (GOM), a crown plug failed to release. Slickline (SL) was the first method to be put into action. It was believed that repetitive attempts had broken the seal, resulting in saltwater inflow that had created hydrates. Twenty-five percent methanol/ethanol/ glycol was pumped while jarring, but eventually the contingency plan was activated. This consisted of a hydraulic stroking tool, which managed to remove the upper crown plug successfully and allowed the operation to continue. Introduction Electric line (e-line) has become the preferred method of intervention in the industry for a number of tasks with a growing array of lightweight solutions available to operators as an alternative to the heavy-duty approach of coiled tubing (CT) or the limited approach of SL. With the growing number of subsea wells and the greater efficiency of RLWI, logic dictates that the industry will see more and more e-line interventions for subsea wells in place of heavier interventions. The Hydraulic Stroking Tool The hydraulic stroking tool used during the operation presented here provides the necessary force for most mechanical-intervention jobs. It can push or pull a number of times, in spite of well depth or lateral deviation, during the same run. The particular tool used for this operation was designed to pull with a force of 33,000 lbf. Since this operation was completed, this hydraulic stroking tool has been redesigned to apply up to 60,000 lbf of axial force downhole with its bidirectional hydraulic ram. When plugs or stuck tools need to be pulled, specific tools and adapters can be attached to the actuator piston. All mechanical operations are run from the surface, and operations begin after the stroking tool has anchored itself. The design of this particular hydraulic stroking tool presents operators with a number of advantages, including the ability to perform mechanical interventions without “killing” the well. Additionally, the tool contains fail-safe measures that allow the system to default to a safety mode if any operational problem occurs. The hydraulic stroking tool can be used for a number of services, including opening and closing valves and sliding sleeves, retrieving and setting gas lift valves and plugs, setting straddle packers, and fishing operations. The tool is deployed stand-alone in vertical wells or conveyed by tractor and can provide services to both horizontal and extended-reach wells onshore and subsea.

The LMA Classic™ as a conduit for tracheal intubation in adult patients: a review and practical guide

AbstractUnexpected difficulty in maintaining an open airway following induction of anaesthesia remains an ever-present hazard. Repetitive attempts at direct laryngoscopy and intubation are generally acknowledged to be inappropriate. The LMA ClassicTM is recognised as a rescue ventilation device in failed intubation scenarios and its specific role is well defined in international airway management protocols. Should clinical conditions dictate the need for tracheal intubation following placement of an LMA ClassicTM, it may be retained to serve as a conduit for intubation. Utilising the LMA ClassicTM as a conduit for intubation is considered a rescue manoeuvre, only resorted to when conventional methods such as direct laryngoscopy have failed. Therefore, it is important that this approach to intubation has a high success rate and that airway management specialists are familiar with the different available options, the relevant limitations and the pitfalls. A short description of the components of the LMA Cla...

Differential factors predicting first and repetitive suicide attempts among youth in Taiwan: a population-based study

Differential factors predicting first and repetitive suicide attempts among youth in Taiwan: a population-based study

Laceração traqueal pós-intubação: análise de três casos e revisão de literatura

Post-intubation tracheal injury is a rare and potentially fatal complication. Among the most common causes, cuff overinflation and repetitive attempts of orotracheal intubation in emergency situations are paramount. Diagnosis is based on clinical and radiological suspicion, confirmed by fiberoptic bronchoscopy. Both conservative and surgical management apply, and the decision-making process depends on the patient profile (comorbidities, respiratory stability), characteristics of the lesion (size and location) and the time elapsed between the occurrence of the injury and the diagnosis. We report the cases of three patients presenting tracheal laceration due to traumatic orotracheal intubation, two submitted to surgical treatment and one submitted to conservative treatment.

Further Identification of CTX-M-2 Extended-Spectrum β-Lactamase in Pseudomonas aeruginosa

β-Lactamase production is the main mechanism for β-lactam resistance in gram-negative rods. The more threatening β-lactamases that have successfully emerged and are believed to spread only in Enterobacteriaceae are CTX-M-type extended-spectrum β-lactamases (ESBLs) (5). The acquired β-lactamases with wide activity spectra that are important in Pseudomonas aeruginosa include class B metallo-β-lactamases (mostly IMP and VIM types and especially SPM-1 in Brazil) and class A ESBLs, particularly VEB-, PER-, and GES-type enzymes (3, 8, 9). However, a single CTX-M-1-producing P. aeruginosa isolate has been reported from The Netherlands (1), as well as CTX-M-2- and CTX-M-43-positive P. aeruginosa isolates in Bolivia (2). This study reports the identification of a CTX-M-2-producing P. aeruginosa strain isolated from a Brazilian teaching hospital. During June 2005, a 63-year-old male patient with a recent hospitalization history was admitted to the intensive care unit for suspicion of pneumonia. He received ceftriaxone and clindamycin as first-line therapy. Four days later, he presented with septic shock and died. A blood culture grew P. aeruginosa (isolate P6208). Isolate P6208 was resistant to all β-lactams tested, except imipenem and ceftazidime. A double-disk synergy test was performed with ticarcillin-clavulanic acid- and cefotaxime-cefepime-containing disks. The production of an ESBL was evidenced only under unusual conditions (with a distance between the disks of 1.5 cm center to center) (Fig. ​(Fig.1).1). Isolate P6208 was also resistant to fluoroquinolones, amikacin, gentamicin, and tobramycin and was susceptible to colistin. The MICs of imipenem, ceftazidime, cefepime, and cefotaxime determined by using Etest strips (AB Biodisk, Solna, Sweden) were 1 μg/ml, 2 μg/ml, >256 μg/ml, and >32 μg/ml, respectively. FIG. 1. Double-disk synergy test with blaCTX-M-2-positive P. aeruginosa clinical isolate P6208. Arrows indicate double-disk synergy. Abbreviations: CAZ, ceftazidime; TCC, ticarcillin-clavulanic acid; CTX, cefotaxime; FEP, cefepime. HindIII-restricted total DNA from isolate P6208 as described previously (6) was used for cloning in pBK-CMV and was then transformed into Escherichia coli TOP10 and selected on agar plates containing ticarcillin (50 μg/ml) and kanamycin (30 μg/ml). The E. coli TOP10(p6208) recombinant strain displaying an ESBL phenotype was obtained. The sequencing of the 2,340-bp cloned DNA insert of recombinant plasmid p6208 identified a blaCTX-M-2 gene. It was preceded by an ISCR1 element located 498-bp upstream and followed by the qacEΔ1 gene cassette. This ISCR1-blaCTX-M-2 structure has already been identified in several enterobacterial species (7). Plasmid extraction performed by the Kieser method (4) did not evidence any plasmid. In addition, repetitive attempts to transfer the blaCTX-M-2 gene by electroporation failed, using both E. coli TOP10 and P. aeruginosa PAO1 as recipient strains. Thus, the blaCTX-M-2 gene might be likely chromosomally located in isolate P6208. This study identified a CTX-M-2-producing P. aeruginosa in Brazil. This finding is important since clinical laboratories may misidentify CTX-type enzymes in those nonfermenters, jeopardizing the choice of antimicrobial chemotherapy and the implementation of infection control measures. This report underlines that P. aeruginosa may become a hidden location for blaCTX-M genes.

Efficiency of diagnostic model to predict recurrent suicidal incidents in diverse world communities.

Suicidal attempts have a very significant effect on the society, and they also reflect on the efforts of the supporting health care and counseling facilities; and the mental health professionals involved. The impact of suicide is further magnified by the needs of persons who attempt suicide multiple times, requiring emergency health care and rehabilitation. Preventing such activities becomes a major task for the support providing agencies as soon as patient with such tendencies are identified. There are repetitive traits that can be observed during the entire therapeutic program among the high-risk group individuals, who are susceptible to this kind of activity and such traits indicate for specific profiling. The aim of the instrument is to prevent the occurrence of the repetitive suicidal attempts of the patients in various world regions, which may have significantly higher and concerning suicide rates. This profile has been constructed on the various parameters recognized in the statistical analysis of the patient population, which have been identified or can be under treatment for their suicidal behavior. This instrument is developed to predict the probability of population segments who may attempt suicide and repetitively, by matching the parameters of the profile with that of the patient pool. Building a profile for the purpose of predicting behavior of this kind can strengthen the intervention strategies more comprehensively and reduce such incidents and health care requirements and expenses.