Home versus in-hospital treatment of outpatients with acute deep venous thrombosis of the lower limbs.

BACKGROUND: Some physicians are still concerned about the safety of treatment at home of patients with acute deep venous thrombosis (DVT). METHODS: We used data from the RIETE (Registro Informatizado de la Enfermedad TromboEmbólica) registry to compare the outcomes in consecutive outpatients with acute lower limb DVT according to initial treatment at home or in the hospital. A propensity score-matching analysis was carried out with a logistic regression model. RESULTS: As of December 2012, 13,493 patients had been enrolled. Of these, 4456 (31%) were treated at home. Patients treated at home were more likely to be male and younger and to weigh more; they were less likely than those treated in the hospital to have chronic heart failure, lung disease, renal insufficiency, anemia, recent bleeding, immobilization, or cancer. During the first week of anticoagulation, 27 patients (0.20%) suffered pulmonary embolism (PE), 12 (0.09%) recurrent DVT, and 51 (0.38%) major bleeding; 80 (0.59%) died. When only patients treated at home were considered, 12 (0.27%) had PE, 4 (0.09%) had recurrent DVT, 6 (0.13%) bled, and 4 (0.09%) died (no fatal PE, 3 fatal bleeds). After propensity analysis, patients treated at home had a similar rate of venous thromboembolism recurrences and a lower rate of major bleeding (odds ratio, 0.4; 95% confidence interval, 0.1-1.0) or death (odds ratio, 0.2; 95% confidence interval, 0.1-0.7) within the first week compared with those treated in the hospital. CONCLUSIONS: In outpatients with DVT, home treatment was associated with a better outcome than treatment in the hospital. These data may help safely treat more DVT patients at home.

Positional therapy for obstructive sleep apnea: an objective measurement of patients' usage and efficacy at home.

BACKGROUND: Positional therapy that prevents patients from sleeping supine has been used for many years to manage positional obstructive sleep apnea (OSA). However, patients' usage at home and the long term efficacy of this therapy have never been objectively assessed. METHODS: Sixteen patients with positional OSA who refused or could not tolerate continuous positive airway pressure (CPAP) were enrolled after a test night study (T0) to test the efficacy of the positional therapy device. The patients who had a successful test night were instructed to use the device every night for three months. Nightly usage was monitored by an actigraphic recorder placed inside the positional device. A follow-up night study (T3) was performed after three months of positional therapy. RESULTS: Patients used the device on average 73.7 ± 29.3% (mean ± SD) of the nights for 8.0 ± 2.0 h/night. 10/16 patients used the device more than 80% of the nights. Compared to the baseline (diagnostic) night, mean apnea-hypopnea index (AHI) decreased from 26.7 ± 17.5 to 6.0 ± 3.4 with the positional device (p<0.0001) during T0 night. Oxygen desaturation (3%) index also fell from 18.4 ± 11.1 to 7.1 ± 5.7 (p = 0.001). Time spent supine fell from 42.8 ± 26.2% to 5.8 ± 7.2% (p < 0.0001). At three months (T3), the benefits persisted with no difference in AHI (p = 0.58) or in time spent supine (p = 0.98) compared to T0 night. The Epworth sleepiness scale showed a significant decrease from 9.4 ± 4.5 to 6.6 ± 4.7 (p = 0.02) after three months. CONCLUSIONS: Selected patients with positional OSA can be effectively treated by a positional therapy with an objective compliance of 73.7% of the nights and a persistent efficacy after three months.

Surface-dependent strategies and energy flux in benthic marine communities or, why corals do not exist in the Mediterranean

Most structure-building organisms in rocky benthic communities are surface-dependent because their energy inputs depend mainly on the surface they expose to water. Two photosynthetic strategies, divided into calcareous and non calcareous algae, strict suspension-feeders and photosynthetic suspension feeders (e.g. hermatypic corals) are the four main strategies evolutively acquired by benthic organisms. Competition between those strategies occur in relation to productivity of the different species, in such a way that, for given environmental conditions, species with a higher growth (P/B ratio) would dominate. At a worldwide scale, littoral marine benthos can he considered to fit into the four fields defined by two main axes: the first, relates to productivity and relies atrophic and oligotrophic waters and the second is defined by the degree of environmental variability or seasonality (from high to low). Coral reefs (marine ecosystems dominated by photosynthetic suspension feeders) develop in the space of oligotrophic areas with low variability, while kelp beds (marine ecosystem dominated by large, non calcareous algae) are to be found only in eutrophic places with a high variability. The space of eutrophic waters with a low variability do not has specially adapted, high structured, benthic marine ecosystems, and in these conditions opportunistic algae and animals predominate. Finally, photophilic mediterranean benthos -devoid of kelps and without hermatypic corals- typifies the field of oligotrophic areas with high variability; in its more genuine aspect, Mediterranean benthos is represented by small algae with a high percentage of calcareous thallii. In all cases strict suspension-feeders compete successfully with photosynthetic organisms only in situations of low irradiances or very high inputs of POM. In its turn, Mediterranean rocky benthos, in spite of its relative uniformity, is geographically organized along the same axes. The Gulf of Lions and the insular bottoms (Balearic Islands, for example) would correspond to the extremes of eutrophic-high variability areas and oligotrophic-low variability areas, respectively. Irradiance, nutrient and POM concentration, and hydrodynamism are the three variables which mainly affect the distribution of the different surface-dependent strategies, and thus, these parameters are of paramount interest for understanding the trophic structure of Mediterranean benthic communities. In environments non limited by light, nutrient availability, defined as the product between nutrient -POM concentration and hydrodynamism, states the dominance of calcareous versus non calcareous algae. Calcareous algae dominate in oligotrophic waters while non-calcareous algae dominate in moderately eutrophic waters. In light-limited environments, passive suspension feeders (octocorallaria, gorgonians) become dominant species if POM availability is enhanced by a high hydrodynamism (strong currents); in waters with a low charge of POM organisms of other groups, mainly active suspension feeders, predominate (sponges, bryozoans, scleractiniarians). In any case, there always exists a very variable bathymetric zone, depending on light attenuation and nutrient-POM availability, where encrusting calcareous algae strongly compete with suspension feeders (coralligenous).

Influence of weather, rank, and home advantage on football outcomes in the gulf region.

PURPOSE: The objective of this study was to investigate the effects of weather, rank, and home advantage on international football match results and scores in the Gulf Cooperation Council (GCC) region. METHODS: Football matches (n = 2008) in six GCC countries were analyzed. To determine the weather influence on the likelihood of favorable outcome and goal difference, generalized linear model with a logit link function and multiple regression analysis were performed. RESULTS: In the GCC region, home teams tend to have greater likelihood of a favorable outcome (P < 0.001) and higher goal difference (P < 0.001). Temperature difference was identified as a significant explanatory variable when used independently (P < 0.001) or after adjustment for home advantage and team ranking (P < 0.001). The likelihood of favorable outcome for GCC teams increases by 3% for every 1-unit increase in temperature difference. After inclusion of interaction with opposition, this advantage remains significant only when playing against non-GCC opponents. While home advantage increased the odds of favorable outcome (P < 0.001) and goal difference (P < 0.001) after inclusion of interaction term, the likelihood of favorable outcome for a GCC team decreased (P < 0.001) when playing against a stronger opponent. Finally, the temperature and wet bulb globe temperature approximation were found as better indicators of the effect of environmental conditions than absolute and relative humidity or heat index on match outcomes. CONCLUSIONS: In GCC region, higher temperature increased the likelihood of a favorable outcome when playing against non-GCC teams. However, international ranking should be considered because an opponent with a higher rank reduced, but did not eliminate, the likelihood of a favorable outcome.

Building hippocampal circuits to learn and remember: insights into the development of human memory

The hippocampal formation is essential for the processing of episodic memories for autobiographical events that happen in unique spatiotemporal contexts. Interestingly, before 2 years of age, children are unable to form or store episodic memories for recall later in life, a phenomenon known as infantile amnesia. From 2 to 7 years of age, there are fewer memories than predicted based on a forgetting function alone, a phenomenon known as childhood amnesia. Here, we discuss the postnatal maturation of the primate hippocampal formation with the goal of characterizing the development of the neurobiological substrates thought to subserve the emergence of episodic memory. Distinct regions, layers and cells of the hippocampal formation exhibit different profiles of structural and molecular development during early postnatal life. The protracted period of neuronal addition and maturation in the dentate gyrus is accompanied by the late maturation of specific layers in different hippocampal regions that are located downstream from the dentate gyrus, particularly CA3. In contrast, distinct layers in several hippocampal regions, particularly CA1, which receive direct projections from the entorhinal cortex, exhibit an early maturation. In addition, hippocampal regions that are more highly interconnected with subcortical structures, including the subiculum, presubiculum, parasubiculum and CA2, mature even earlier. These findings, together with our studies of the development of human spatial memory, support the hypothesis that the differential maturation of distinct hippocampal circuits might underlie the differential emergence of specific "hippocampus-dependent" memory processes, culminating in the emergence of episodic memory concomitant with the maturation of all hippocampal circuits.

Looking Back: Historical Hall, 1899-1904; State Historical, Memorial and Art Building, 1905-1999; Ola Babcock Miller Building, 1999-Present, June 2013

For more than 80 years, visitors to the Iowa State Historical, Memorial, and Art Building were treated to the state’s collection of historic documents, literature, portraits, and historical, geological, and archeological artifacts. Those who visited might have memories of the spectacular sand paintings by Iowan Andrew Clemens, the variety of taxidermy Iowa animals, the pioneer Conestoga wagon in the basement, the biplane hanging from the dome ceiling, the odd display by the medical library of things removed from stomachs, or the Native American display on the third floor. This booklet is a look back at the origins of the museum. It includes some of the Historical Department reports, legislation passed by the general assembly, newspaper and magazine articles, and photographs pertaining to the museum and library. It is not intended to be an exhaustive review and documentation of displays and exhibits. It is a brief overview of the building’s history and some photographs that may bring back memories, for some, of a field trip as a student. This booklet has been created from a variety of source materials: photographs, newspaper articles, and various reports. The following have contributed: State Library of Iowa, Iowa State Historical Society, the Iowa Judicial Branch, Susan Wallace, Helen Dagley, Barb Corson, Jerome Thompson, Pam Rees, Georgiann Fischer, and Jason Mrachina.

Are You Prepared? A Guide to Emergency Preparedness, October 24, 2013

Being prepared means making an emergency plan, building an emergency kit and being aware of the hazards that can impact you. Whether you are at home or at work, emergencies like tornadoes, flooding or winter storms can occur quickly and without warning. We can’t prevent emergencies, but we can prepare for them.

Construcción de un índice de calidad ocupacional (ICO) para el análisis de la inserción profesional de los graduados universitarios = Building an employment quality index (EQI) to analyse graduates’ access to the labour market

En este trabajo se propone la construcción de un índice de calidad ocupacional (ICO) a partir de los datos de la Encuesta de Inserción Laboral de los Graduados de las Universidades Catalanas realizada por la Agencia para la Calidad del Sistema Universitario de Catalunya (AQU), que ha de permitir un mejor análisis de la información que proporciona la encuesta y facilitar su comparación con estudios similares. La encuesta se realiza tres años después de la graduación. En este artículo, se utiliza la segunda encuesta realizada el año 2005 entre 11.456 graduados (52,63%) de la promoción 2001 (AQU, 2005, Serra-Ramoneda, 2007). El índice se ha elaborado a partir de los indicadores objetivos ‘tipo y duración del contrato laboral’, ‘retribución económica’, ‘adecuación entre la formación universitaria y el empleo’ a los que se otorga una puntuación ponderada según las respuestas dadas por los graduados. La suma de las puntuaciones se matiza con un coeficiente derivado del indicador subjetivo ‘satisfacción con el trabajo en general’. A partir de la información proporcionada por el índice, se realiza un análisis comparativo del nivel de calidad ocupacional que han logrado los graduados de áreas de conocimiento, ámbitos de trabajo, ramas de actividad y ubicaciones territoriales del empleo diferentes. Los resultados obtenidos permiten observar que entre los graduados catalanes los siguientes hechos son buenos predictores de la calidad de la ocupación: haber estudiado una carrera que no sea de Humanidades, ser un hombre, haber desempeñado durante la carrera un trabajo relacionado con los estudios, estar ocupado en la construcción, en instituciones financieras o en servicios a empresas, haber tenido algún tipo de movilidad por motivos de trabajo, trabajar fuera de Cataluña y hacerlo en empresas grandes, especialmente con más de 500 trabajadores. Finalmente, se presentan algunas reflexiones y propuestas que pueden resultar de interés para la orientación de los estudiantes y la planificación universitaria

Infections and functionnal impairment in nursing home residents : a reciprocal relationship

RESUME: Contexte : l'objectif de cette étude de cohorte prospective était de déterminer la relation entre la survenue d'infections et la dépendance fonctionnelle chez des résidents d'établissements de long séjour durant une période de 6 mois. Population et méthode : les patients inclus (1324 résidents) étaient âgés de 65 ans et plus (âge moyen 85.7 ans, 76.6% de femmes), étaient des résidents de 39 EMS du canton de Vaud. Au baseline, des données démographiques, médicales, concernant les facteurs de risque et protecteurs des infections ont été récoltées. Au cours du suivi de 6 mois, les infirmières des EMS ont documenté la survenue de symptômes et signes d'infection en utilisant les critères développés spécifiquement par l'APIC pour les établissements de long séjour. Les mesures du status fonctionnel ont été évaluées au baseline, à 3 mois et à 6 mois. Deux outcomes différents ont été utilisés : a) le déclin fonctionnel défini comme le décès ou une diminution des capacités fonctionnelles au suivi, b) le status fonctionnel mesuré par une échelle standardisée. Résultats : à la fin du suivi, la mortalité était de 14.6%, similaire pour les résidents avec et sans infection (16.2% versus 13.1%, P .11). Durant les 2 périodes de suivi de 3 mois, les sujets ayant présenté une ou plusieurs infections avaient des odds de déclin fonctionnel plus élevés, y compris après ajustement pour les caractéristiques démographiques, médicales et fonctionnelles du baseline, ainsi que la survenue de nouvelles maladies (odds ratio ajustés (OR) = 1.6, intervalle de confiance à 95% (IC) = 1.2-2.2, P = .002 et OR = 1.5, 95% IC= 1.1-2.0, P= .008, respectivement). Comparés aux résidents non infectés, les odds de déclin fonctionnel augmentaient significativement et graduellement chez ceux ayant eu une, respectivement 2 infections ou plus. L'analyse prédisant le score fonctionnel (restreinte aux sujets ayant survécu) a donné des résultats similaires. Finalement, une analyse de survie prédisant le temps jusqu'à la première infection a confirmé une augmentation progressive de la probabilité d'infection chez les sujets avec dépendance fonctionnelle modérée, respectivement sévère, comparés aux sujets indépendants à la ligne de base. Conclusion : chez les résidents de long séjour, les infections sont à la fois cause et conséquence de la dépendance fonctionnelle. Des études futures devraient être entreprises pour investiguer si des programmes de prévention des infections peuvent également contribuer à prévenir le déclin fonctionnel, un facteur important pour la qualité de vie de ces résidents. ABSTRACT: Objectives: To determine the relationship between infections and functional impairment in nursing home residents. Design: Prospective cohort study (follow-up period, 6 months). Setting: Thirty-nine nursing homes in western Switzerland. Participants: A total of 1,324 residents aged 65 and older (mean age 85.7; 76.6% female) who agreed to participate, or their proxies, by oral informed consent. Measurements: Functional status measured every 3 months. Two different outcomes were used: (a) functional decline defined as death or decreased function at follow-up and (b) functional status score using a standardized measure. Results: At the end of follow-up, mortality was 14.6%, not different for those with and without infection (16.2% vs 13.1%, P= .11) During both 3-month periods, subjects with infection had higher odds of functional decline, even after adjustment for baseline characteristics and occurrence of a new illness (adjusted odds ratio (AOR) = 1.6, 95% confidence interval (CI) = 1.2-2.2, P = .002, and AOR 1.5, 95% CI 1.1-2.0, P .008, respectively). The odds of decline increased in a stepwise fashion in patients with zero, one, and two or more infections. The analyses predicting functional status score (restricted to subjects who survived) gave similar results. A survival analysis predicting time to first infection confirmed a stepwise greater likelihood of infection in subjects -with moderate and severe impairment at baseline than in subjects with no or mild functional impairment at baseline. Conclusion: Infections appear to be both a cause and a consequence of functional impairment in nursing home residents. Further studies should be undertaken to investigate whether effective infection control programs can also contribute to preventing functional decline, an important component of these residents' quality of life.

Building the niche through time: using 13,000 years of data to predict the effects of climate change on three tree species in Europe

Aim Species distribution models (SDMs) based on current species ranges underestimate the potential distribution when projected in time and/or space. A multi-temporal model calibration approach has been suggested as an alternative, and we evaluate this using 13,000 years of data. Location Europe. Methods We used fossil-based records of presence for Picea abies, Abies alba and Fagus sylvatica and six climatic variables for the period 13,000 to 1000yr bp. To measure the contribution of each 1000-year time step to the total niche of each species (the niche measured by pooling all the data), we employed a principal components analysis (PCA) calibrated with data over the entire range of possible climates. Then we projected both the total niche and the partial niches from single time frames into the PCA space, and tested if the partial niches were more similar to the total niche than random. Using an ensemble forecasting approach, we calibrated SDMs for each time frame and for the pooled database. We projected each model to current climate and evaluated the results against current pollen data. We also projected all models into the future. Results Niche similarity between the partial and the total-SDMs was almost always statistically significant and increased through time. SDMs calibrated from single time frames gave different results when projected to current climate, providing evidence of a change in the species realized niches through time. Moreover, they predicted limited climate suitability when compared with the total-SDMs. The same results were obtained when projected to future climates. Main conclusions The realized climatic niche of species differed for current and future climates when SDMs were calibrated considering different past climates. Building the niche as an ensemble through time represents a way forward to a better understanding of a species' range and its ecology in a changing climate.

Wishes or Constraints? Mothers' Labour Force Participation and its Motivation in Switzerland

The aim of this article is to estimate the impact of various factors related to role conflict theory and preference theory on the reduction of women's labour force participation after their transition to parenthood. Objective and subjective dimensions of women's labour force participation are assessed. The empirical test is based on a survey of couples with children in Switzerland. Results show that compared to structural factors associated with role conflict reduction, preferences have little impact on mothers' labour force participation, but explain a good deal of their frustration if the factual situation does not correspond to their wishes. Structural factors, such as occupation, economic resources, childcare, and an urban environment, support mothers' labour force participation, whereas active networks and a home centred lifestyle preference help them to cope with frustrations.

Heart failure and community-acquired pneumonia: cases for home hospital?

BACKGROUND: Home hospital is advocated in many western countries in spite of limited evidence of its economic advantage over usual hospital care. Heart failure and community-acquired pneumonia are two medical conditions which are frequently targeted by home hospital programs. While recent trials were devoted to comparisons of safety and costs, the acceptance of home hospital for patients with these conditions remains poorly described. OBJECTIVE: To document the medical eligibility and final transfer decision to home hospital for patients hospitalized with a primary diagnosis of heart failure or community-acquired pneumonia. DESIGN: Longitudinal study of patients admitted to the medical ward of acute care hospitals, up to the final decision concerning their transfer. SETTING: Medical departments of one university hospital and two regional teaching Swiss hospitals. PATIENTS: All patients admitted over a 9 month period to the three settings with a primary diagnosis of heart failure (n= 301) or pneumonia (n=441). MEASUREMENTS: Presence of permanent exclusion criteria on admission; final decision of (in)eligibility based on medical criteria; final decision regarding the transfer, taking into account the opinions of the family physician, the patient and informal caregivers. RESULTS: While 27.9% of heart failure and 37.6% of pneumonia patients were considered to be eligible from a medical point of view, the program acceptance by family physicians, patients and informal caregivers was low and a transfer to home hospital was ultimately chosen for just 3.8% of heart failure and 9.6% of pneumonia patients. There were no major differences between the three settings. CONCLUSIONS: In the case of these two conditions, the potential economic advantage of home hospital over usual inpatient care is compromised by the low proportion of patients ultimately transferred.

A Framework for Building Hypercubes Using MapReduce

The European Space Agency's Gaia mission will create the largest and most precise three dimensional chart of our galaxy (the Milky Way), by providing unprecedented position, parallax, proper motion, and radial velocity measurements for about one billion stars. The resulting catalogue will be made available to the scientific community and will be analyzed in many different ways, including the production of a variety of statistics. The latter will often entail the generation of multidimensional histograms and hypercubes as part of the precomputed statistics for each data release, or for scientific analysis involving either the final data products or the raw data coming from the satellite instruments. In this paper we present and analyze a generic framework that allows the hypercube generation to be easily done within a MapReduce infrastructure, providing all the advantages of the new Big Data analysis paradigmbut without dealing with any specific interface to the lower level distributed system implementation (Hadoop). Furthermore, we show how executing the framework for different data storage model configurations (i.e. row or column oriented) and compression techniques can considerably improve the response time of this type of workload for the currently available simulated data of the mission. In addition, we put forward the advantages and shortcomings of the deployment of the framework on a public cloud provider, benchmark against other popular solutions available (that are not always the best for such ad-hoc applications), and describe some user experiences with the framework, which was employed for a number of dedicated astronomical data analysis techniques workshops.

A Framework for Building Hypercubes Using MapReduce

The European Space Agency's Gaia mission will create the largest and most precise three dimensional chart of our galaxy (the Milky Way), by providing unprecedented position, parallax, proper motion, and radial velocity measurements for about one billion stars. The resulting catalogue will be made available to the scientific community and will be analyzed in many different ways, including the production of a variety of statistics. The latter will often entail the generation of multidimensional histograms and hypercubes as part of the precomputed statistics for each data release, or for scientific analysis involving either the final data products or the raw data coming from the satellite instruments. In this paper we present and analyze a generic framework that allows the hypercube generation to be easily done within a MapReduce infrastructure, providing all the advantages of the new Big Data analysis paradigmbut without dealing with any specific interface to the lower level distributed system implementation (Hadoop). Furthermore, we show how executing the framework for different data storage model configurations (i.e. row or column oriented) and compression techniques can considerably improve the response time of this type of workload for the currently available simulated data of the mission. In addition, we put forward the advantages and shortcomings of the deployment of the framework on a public cloud provider, benchmark against other popular solutions available (that are not always the best for such ad-hoc applications), and describe some user experiences with the framework, which was employed for a number of dedicated astronomical data analysis techniques workshops.

Aging and Disability Resource Center and MHDS Commission Home Modification Assistance Program Plan, December 2015

This report was prepared as a directive to Aging and Disability Resource Centers and The Mental Health and Disability Commission to jointly develop a plan for a home modification assistance program to provide grants and individual income tax credits to assist with expenses related to the making or permanent home modifications that permit individual with a disability to remain in the homes.