Time For Different Levels Research Articles

The impact of anemia on the mortality of COPD patients hospitalized for acute exacerbation resulting in respiratory failure.

Anemia increases mortality in patients with chronic obstructive pulmonary disease (COPD), but its effects on mortality and survival time for different levels of airflow limitation severity are unclear. Our goal was to investigate the effects of anemia on survival time and mortality in COPD patients with varying degrees of airflow limitation. We looked at 300 consecutive COPD patients in the past. Their demographic information, Charlson comorbidity index, previous early (30 days) and late (>30 days) hospitalizations, blood counts, and post-bronchodilator spirometric values were all recorded. They were contacted by phone to check on their vital status, and their mortality rates were calculated. Anemic patients had a mean overall survival time of 31.9 2.8 months and normal patients had a mean overall survival time of 41.7 2.1 months (p=0.001). Their 1-year and 2-year mortality rates are higher. Age, Charlson comorbidity index, BMI, FEV1%, anemia, MCV, hemoglobin, serum creatinin, and early and late hospitalizations all had an impact on mortality. BMI, anemia, and FEV1% remained risk factors for death. Anemic group 2 patients had a higher mortality rate than groups 3 and 4. Anemic patients in groups 2 and 4 had shorter survival times. Anemic COPD patients have higher 1-year and 2-year mortality rates. Mortality is affected by age, Charlson comorbidity index, BMI, FEV1%, anemia, MCV, hemoglobin, serum creatinin, and early and late hospitalizations. BMI, anemia, and FEV1% remained risk factors for death. Anemic group 2 patients have a higher mortality rate than groups 3 and 4. Anemic patients in groups 2 and 4 have shorter survival times.

Experience and Impact of a Locally-Based Peer, Volunteer Cancer Support Programme in Hospital Melaka, Melaka Malaysia

Background: Melaka is a small southern state in Peninsular Malaysia. On average, the state has an annual incidence of 200 odd breast cancer patients, largely treated out of its public, subsidized, single tertiary treatment center of Hospital Melaka. Hospital Melaka is an 800-bedded hospital with multiple specialties including surgery and radiology. Though the hospital does not have a dedicated oncology department, cancer treatment is carried out via phone consultations and visiting oncologists as well as a team of on-site nursing staff who are trained to initiate and monitor treatment. Feedback from Hospital Melaka staff highlighted that there was a drop-out rate of about 30% of patients from the treatment journey. Qualitative interviews with different stakeholders including patient revealed that the drop-out may be driven by factors such as: i) fear of surgery, ii) fear of chemotherapy, iii) fear of disfigurement, iv) loss of spouse v) emotional distress and shock; and vi) delay in waiting times for different levels of diagnostics and treatment. Aim: The aim of the initiative was to reduce the rate of patients who defaulted out from the cancer treatment journey via a three-pronged approach: a) improving understanding about cancer and treatment by patients and family members; b) integrating peer-support into the clinical treatment pathway at the hospital and reduction of waiting times; and c) maintaining a continuous interaction with the patient throughout the treatment journey. Methods: The inception and deployment of a locally-based peer, volunteer support program for breast cancer patients and families as part of the formal cancer treatment process in Hospital Melaka. Volunteers were consisted of a trained mix of cancer survivors, current and retired healthcare practitioners and provided information pertaining to treatment and care aspects of breast cancer as well as emotional support and follow-up of patients via phone or in person to ensure compliance to treatment. In this study, we engaged with various stakeholders including hospital management and clinicians. Then, support group's services were formalized into the care pathway for all patients with breast cancer; with both volunteers able to send and receive patient referrals. Results: Statistically significant reductions in patient delays in decision-making to seek treatment as well as a significant decrease of 12.5% in the number of defaulters. Conclusion: A support program built with support from all stakeholders and run by volunteers and embedded within the formal care process acts as a catalyst to enhance both service delivery as well as keeping patients engaged on the cancer care journey.

Impact of the feedback provided by a gastric electrical stimulation system on eating behavior and physical activity levels.

The closed-loop gastric electrical stimulation (CLGES) abiliti® system provides tailored gastric electrical stimulation activated by food entry into the stomach and sensor-based data to medical professionals. The aim of this study was to analyze behavior changes using sensor-based food intake and activity data in participants treated with the CLGES system. Food intake and activity data (3D accelerometer) were downloaded at baseline and monthly/bimonthly for 12 months in a subset of patients with obesity (N = 45) participating in a multicenter trial with CLGES. Measured food intake parameters included the number of intakes during allowed and disallowed periods, nighttime intakes, and between-meal snacks (average/d). Activity parameters included time in different levels of physical activity (min/d), sleep/sedentary (h/d), and estimated energy expenditure (EE). Weight loss at 12 months averaged 15.7 ± 7.7% of the baseline body weight. Stable reduction in the number of disallowed meals and between-meal snacks (P < 0.05), an increase in all levels of physical activity (P < 0.001), and an increase in activity-based EE (303 ± 53 kcal/d on average, P < 0.001) were seen. Significant improvement in eating and activity was seen in participants. It is hypothesized that feedback of the sensor-based data induced behavioral changes and contributed to weight loss in patients treated with CLGES.

A simple equation for the melt elevation feedback of ice sheets

Abstract. In recent decades, the Greenland Ice Sheet has been losing mass and has thereby contributed to global sea-level rise. The rate of ice loss is highly relevant for coastal protection worldwide. The ice loss is likely to increase under future warming. Beyond a critical temperature threshold, a meltdown of the Greenland Ice Sheet is induced by the self-enforcing feedback between its lowering surface elevation and its increasing surface mass loss: the more ice that is lost, the lower the ice surface and the warmer the surface air temperature, which fosters further melting and ice loss. The computation of this rate so far relies on complex numerical models which are the appropriate tools for capturing the complexity of the problem. By contrast we aim here at gaining a conceptual understanding by deriving a purposefully simple equation for the self-enforcing feedback which is then used to estimate the melt time for different levels of warming using three observable characteristics of the ice sheet itself and its surroundings. The analysis is purely conceptual in nature. It is missing important processes like ice dynamics for it to be useful for applications to sea-level rise on centennial timescales, but if the volume loss is dominated by the feedback, the resulting logarithmic equation unifies existing numerical simulations and shows that the melt time depends strongly on the level of warming with a critical slowdown near the threshold: the median time to lose 10 % of the present-day ice volume varies between about 3500 years for a temperature level of 0.5 °C above the threshold and 500 years for 5 °C. Unless future observations show a significantly higher melting sensitivity than currently observed, a complete meltdown is unlikely within the next 2000 years without significant ice-dynamical contributions.

Resting heart rate on the decline: the Tromsø Study 1986-2007.

We examined secular changes in resting heart rate (RHR) and their relationship with changes in other cardiovascular risk factors in adult men and women over a 22-year period. A single-centre population-based longitudinal study comprised 30,699 men and women aged 30-89 years who participated in at least one of the 1986, 1994, 2001 and 2007 surveys of the Tromsø Study, Tromsø, Norway. During the study period, the age-adjusted means of RHR declined from 73.4 to 64.7 beats per minute (b.p.m.) in men, and from 78.3 to 66.4 b.p.m. in women. The decline was persistent from one survey to the next and was of similar size in both sexes and for all age groups and birth cohorts. RHR declined gradually over time for different levels of cardiovascular risk factors, and it declined more in those who moved from adverse to favourable values or categories of blood pressure, total and high-density lipoprotein cholesterol, triglycerides, body mass index, smoking and physical activity, and those who started to take blood pressure medication. The strongest predictors of individual decline in RHR were decrease in systolic blood pressure and triglycerides, increase in physical activity, taking blood pressure treatment and smoking cessation. A considerable decline in RHR has occurred in Tromsø over the past two decades in men and women of all ages. The decline is partly related to changes in several cardiovascular risk factors, and reasons behind this need to be further elucidated. The findings suggest that new definitions of normal RHR may be needed.

Drivers’ acceptance of delay time at different levels of service at signalised intersections

This study investigates the willingness of drivers, primarily motorcycle riders and car drivers, to accept delay time for different levels of service at signalised intersections. Videos of different levels of service were pre-recorded and presented to respondents in a survey. A contingent valuation method was employed to design scenarios corresponding to different levels of service. A spike model was subsequently employed to determine the acceptance of delay time. The results indicated a willingness to accept delay time ranging from 26 to 68s for motorcycle riders and from 34 to 81s for car drivers with different levels of service at signalised intersection. It is worth noting that the delay time is longer than that described in the Taiwan Highway Capacity Manual, thereby indicating that Taiwanese drivers are willing to accept longer delay time for different levels of service at signalised intersections.

A Universal Reduced Rupture Creep Approach for Prediction of Long Term Failure Behavior of Aged Glass Polymers from the Short Term Test of Rupture Creep Compliance by the Unified Master Curved Extrapolation

The prediction of long term failure behaviors and lifetime of aged glass polymers from the short term tests of reduced rupture creep compliance (or strain) is one of difficult problems in polymer science and engineering. A new “universal reduced rupture creep approach" with exact theoretical analysis and computations is proposed in this work. Failure by creep for polymeric material is an important problem to be addressed in the engineering. A universal equation on reduced extensional failure creep compliance for PMMA has been derived. It is successful in relating the reduced extensional failure creep compliance with aging time, temperature, levels of stress, the average growth dimensional number and the parameter in K-W-W function. Based on the universal equation, a method for the prediction of failure behavior, failure strain criterion, failure time of PMMA has been developed which is named as a universal “reduced rupture creep approach". The results show that the predicted failure strain and failure time of PMMA at different aging times for different levels of stress are all in agreement with those obtained directly from experiments, and the proposed method is reliable and practical. The dependences of reduced extensional failure creep compliance on the conditions of aging time, failure creep stress, the structure of fluidized-domain constituent chains are discussed. The shifting factor, exponent for time-stress superposition at different levels of stress and the shifting factor, exponent for time-time aging superposition at different aging time are theoretically defined respectively.

TransGraph: Hierarchical Exploration of Transition Relationships in Time-Varying Volumetric Data

A fundamental challenge for time-varying volume data analysis and visualization is the lack of capability to observe and track data change or evolution in an occlusion-free, controllable, and adaptive fashion. In this paper, we propose to organize a timevarying data set into a hierarchy of states. By deriving transition probabilities among states, we construct a global map that captures the essential transition relationships in the time-varying data. We introduce the TransGraph, a graph-based representation to visualize hierarchical state transition relationships. The TransGraph not only provides a visual mapping that abstracts data evolution over time in different levels of detail, but also serves as a navigation tool that guides data exploration and tracking. The user interacts with the TransGraph and makes connection to the volumetric data through brushing and linking. A set of intuitive queries is provided to enable knowledge extraction from time-varying data. We test our approach with time-varying data sets of different characteristics and the results show that the TransGraph can effectively augment our ability in understanding time-varying data.

Calculation of Local Water Densities in Biological Systems: A Comparison of Molecular Dynamics Simulations and the 3D-RISM-KH Molecular Theory of Solvation

Water plays a unique role in all living organisms. Not only is it nature's ubiquitous solvent, but it also actively takes part in many cellular processes. In particular, the structure and properties of interfacial water near biomolecules such as proteins are often related to the function of the respective molecule. It can therefore be highly instructive to study the local water density around solutes in cellular systems, particularly when solvent-mediated forces such as the hydrophobic effect are relevant. Computational methods such as molecular dynamics (MD) simulations seem well suited to study these systems at the atomic level. However, due to sampling requirements, it is not clear that MD simulations are, indeed, the method of choice to obtain converged densities at a given level of precision. We here compare the calculation of local water densities with two different methods: MD simulations and the three-dimensional reference interaction site model with the Kovalenko-Hirata closure (3D-RISM-KH). In particular, we investigate the convergence of the local water density to assess the required simulation times for different levels of resolution. Moreover, we provide a quantitative comparison of the densities calculated with MD and with 3D-RISM-KH and investigate the effect of the choice of the water model for both methods. Our results show that 3D-RISM-KH yields density distributions that are very similar to those from MD up to a 0.5 Å resolution, but for significantly reduced computational cost. The combined use of MD and 3D-RISM-KH emerges as an auspicious perspective for efficient solvent sampling in dynamical systems.

Effects of Illegal Harvest of Eggs on the Population Decline of Leatherback Turtles in Las Baulas Marine National Park, Costa Rica

Within 19 years the nesting population of leatherback turtles (Dermochelys coriacea) at Parque Nacional Marino Las Baulas declined from 1500 turtles nesting per year to about 100. We analyzed the effects of fishery bycatch and illegal harvesting (poaching) of eggs on this population. We modeled the population response to different levels of egg harvest (90, 75, 50, and 25%) and the effect of eradicating poaching at different times during the population decline. We compared effects of 90% poaching with those of 20% adult mortality because both of these processes were present in the population at Las Baulas. There was a stepwise decline in number of nesting turtles at all levels of egg harvest. Extirpation times for different levels of poaching ranged from 45 to 282 years. The nesting population declined more slowly and survived longer with 20% adult mortality (146 years) than it did with 90% poaching (45 years). Time that elapsed until poaching stopped determined the average population size at which the population stabilized, ranging from 90 to 420 nesting turtles. Our model predicted that saving clutches lost naturally would restore the population when adult mortality rates were low and would contribute more to population recovery when there were short remigration intervals between nesting seasons and a large proportion of natural loss of clutches. Because the model indicated that poaching was the most important cause of the leatherback decline at Las Baulas, protecting nests on the beach and protecting the beach from development are critical for survival of this population. Nevertheless, the model predicted that current high mortality rates of adults will prevent population recovery. Therefore, protection of the beach habitat and nests must be continued and fishery bycatch must be reduced to save this population.

Improving the appropriateness of referrals and waiting times for endoscopic procedures

There is a lack of standard methods for determining the clinical priority of patients referred by general practitioners (GPs) for specialist outpatient consultations. We introduced a system of progressive involvement by general practitioners and specialists with 80 diagnostic procedures. The aim of this study was to evaluate this new method of prioritization of patients suffering from significant gastroenterological disorders needing rapid access to diagnostic procedures. The study included 438 outpatients who were referred for and underwent a gastroscopy or colonoscopy. GPs used a ranking of waiting times for different levels of clinical priority, called 'homogeneous waiting groups'. Specialists also assigned a priority level for each patient as well as evaluating the appropriateness of the referral and the presence of significant endoscopic disorders. Agreement between GPs' and specialists' priority assessments was evaluated by the kappa statistic. Most referrals (74.4%) were deemed low priority by GPs, with no maximum waiting time assigned. The level of agreement between GPs and specialists as regards patients' priorities was poor or moderate: for gastroscopy the kappa was 0.31 (weighted kappa 0.47) and for colonoscopy 0.44 (weighted kappa 0.46). There was an association between the proportion of significant disorders identified with endoscopy and the priority assigned to the referral (chi2 = 18.9, 1 df, p < 0.001). The overall proportion of referrals deemed inappropriate by specialists was 22.1%. There is value in liaison between GPs and specialists for achieving timely referrals and avoiding delayed diagnosis though higher levels of agreement need to be achieved.

Patient and physician perspectives of maximum acceptable waiting times for cataract surgery

Background: Lengthy waiting times for cataract surgery are an important issue in countries with publicly funded health care systems. To improve the fairness, timeliness, and certainty of waiting-time management, the Western Canada Waiting List Project has developed priority criteria scores (PCSs) related to urgency and linked to maximum acceptable waiting times (MAWTs). The purpose of our study was to compare patient and physician perspectives of MAWT for different levels of urgency. A second aim was to assess the determinants of patient and surgeon perspectives on MAWT. Methods: Ophthalmologists assessed consecutive patients waitlisted for cataract surgery. Data included a MAWT, a visual analogue scale of urgency (VAS urgency), and the cataract PCS. Patients were mailed questionnaires to assess their perspectives of MAWT and VAS urgency. They were also sent a measure of visual function called the Visual Function Assessment. We used hierarchical linear regression to assess the determinants of MAWT. Results: The mean age of the 213 patients was 73.9 years; 56.8% were female and 71.8% were booked for first eye surgery. Physician-rated MAWT was significantly longer than patient-rated MAWT (mean 15.1 vs. 9.9 weeks). Median physician MAWTs ranged from 12 (most urgent) to 20 (least urgent) weeks, and patient MAWTs, from 4 to 8 weeks. A 3-step hierarchical linear regression model showed that, after adjusting for age and sex, the priority criteria added significantly to the surgeon model ( R 2 change = 0.22). Significant predictors were ocular comorbidity, impairment in visual function, and ability to work or live independently or care for dependents. After the addition of VAS urgency, the final model explained 42% of the variance in surgeon MAWT. Significant predictors were age-related macular degeneration and VAS urgency. A 4-step hierarchical regression model for patient MAWT showed that after step 2, sex and visual acuity in the nonsurgery eye were significant predictors. The final model accounted for 11% of the variance in patient MAWT. Significant predictors were sex (males had lower MAWT) and VAS urgency. Interpretation: Patient and physician views on MAWT differ, yet both are critical to a fair process for developing standardized waiting times related to levels of urgency. Results from this study provide initial inputs to the formulation of benchmark waiting times for different levels of the cataract PCS.

Evaluation of Color Parameters in a Machine Vision Analysis of Carbon Monoxide-Treated Fish—Part I

ABSTRACT The color of fresh tuna treated by 4% carbon monoxide +20% carbon dioxide +10% oxygen, or irradiated at 1 KGy or 2 KGy, or first gas treated then irradiated, was analyzed using the R, a* and hue parameters in a machine vision system. The percent of sample surface having R > Rthreshold, a* < a*threshold, or hue < huethreshold was associated with storage time for different levels of threshold values. Hue was selected as the best representative of the red color of tuna. A method was suggested to select the threshold value of a parameter. Irradiation did not change the color of fresh tuna. Exposure to CO increased the redness, and preserved it for up to 12 days in refrigerated storage. Microbial numbers for CO treated tuna were not different from control. Irradiation at 2 KGy was very effective in reducing microorganisms, while 1 KGy was ineffective.

Determinants of patient and surgeon perspectives on maximum acceptable waiting times for hip and knee arthroplasty

Lengthy waiting times for hip and knee arthroplasty have raised concerns about equitable and timely access to care. The Western Canada Waiting List project has developed priority criteria scores linked to maximum acceptable waiting times (MAWT) for different levels of priority. Our study purpose was to assess the determinants of patient- and surgeon-rated MAWT, and to test whether the anticipated waiting time has an independent influence after adjusting for age, sex and patient urgency. A second aim was to compare MAWT, waiting time and anticipated waiting time for different levels of urgency assessed using the priority criteria score. Orthopaedic surgeons assessed 233 consecutive patients waiting for arthroplasty in terms of their urgency (assessed using the priority criteria score and a visual analogue scale), MAWT and anticipated waiting time. Patient data included urgency (assessed by a visual analogue scale), MAWT and the Western Ontario McMaster Osteoarthritis index. We used hierarchical linear regression to test the models. After adjusting for age and sex, urgency (assessed by priority criteria score and visual analogue scale) and anticipated waiting time accounted for 40% of the variance in surgeon MAWT. The patient model accounted for 30% of the variance in patient MAWT. Older patients preferred signficantly shorter MAWTs (P <0.05). Anticipated waiting time added significantly to both the surgeon and patient MAWT models (R(2) change 0.11 and 0.07, respectively). Actual waiting time was weakly correlated with urgency assessed using the priority criteria score (r = -0.25, P <0.0001). Patients' and surgeons' views are critical to a fair process of establishing MAWT for elective procedures. Anticipated waiting time may influence the perspectives on MAWT and must be considered in their interpretation.

L'histoire Des Femmes Au Japon: L'histoire des femmes au Japon: La « maison », l'épouse et la maternité dans la société médiévale

Au Japon, les etudes sur l'histoire des femmes, dont les débuts remontent aux années 1920, ont toujours entretenu avec les etudes occidentales un rapport dual de proximité et d'indépendance : si ces etudes se sont souvent développées par référence à ce qui se faisait en Occident, il existe aussi tout un courant qui a pris naissance au coeur même des realites japonaises et qui connaît un essor original. Pour mettre en évidence les différences entre les approches occidentales et japonaises, je commencerai par examiner le volume qui traite du Moyen Age dans L'histoire des femmes en Occident public par des auteurs français, avant de presenter le developpement des etudes japonaises sur l'histoire des femmes, puis les differents domains que j ‘ a i moi-même defriches.

Age as a Factor in Combined Manual and Decision Tasks

A study was conducted to investigate the variation in speed of performance and decision making ability with age. The task performed involved decision making, hand movement, and positioning elements. The effects of age on decision and movement time were examined when information load, distance of move, and radial clearance (target width) were varied. In addition, heart rate was also monitored. Significant differences were detected in both decision and movement time for different levels of information load, distance of move, and radial clearance between the older (52 to 63 years) and younger (18 to 29 years) groups of subjects. Decision time differences between the two groups increased at higher levels of information load. The relationship between movement time and index of difficulty suggested that the older worker tends to exhibit a “start-up” lag in exercising movement control. Performance errors indicated that the slowing among the older workers was not observed at the expense of accuracy. The study provided no evidence that age has an effect on heart rate variability under different levels of information load and task difficulty.

Optimum scheduling of engineering design office work

A method is described for determining the optimum amount of design effort to employ on each project of a set of projects in engineering design office. For each project, the design time for different levels of design and the expected savings from the more detailed levels must be provided. Also, estimates of the market losses due to delayed start-up, and the probability of the project being completed must be supplied. A combinatorial program then selects the optimum level of design for each project. An example is given.