Long-term results of endoscopic third ventriculostomy: an outcome analysis.

OBJECT Endoscopic third ventriculostomy (ETV) is the procedure of choice in the treatment of obstructive hydrocephalus. The excellent clinical and radiological success rates are well known. Nevertheless, very few papers have addressed the very long term outcomes of the procedure in very large series. The authors present a large case series of 113 patients who underwent 126 ETVs, and they highlight the initial postoperative outcome after 3 months and long-term follow-up with an average of 7 years. METHODS All patients who underwent ETV at the Department of Neurosurgery, Mainz University Hospital, between 1993 and 1999 were evaluated. Obstructive hydrocephalus was the causative pathology in all cases. RESULTS The initial clinical success rate was 82% and decreased slightly to 78% during long-term follow-up. Long-term success was analyzed using Kaplan-Meier curves. Overall, ETV failed in 31 patients. These patients underwent a second ETV or shunt treatment. A positive impact on long-term success was seen for age older than 6 months, and for obstruction due to cysts or benign aqueductal stenosis. The complication rate was 9% with 5 intraoperative and 5 postoperative events. CONCLUSIONS The high clinical success rate in short-term and long-term follow-up confirms ETV's status as the gold standard for the treatment of obstructive hydrocephalus, especially for distinct pathologies. The patient's age and underlying pathology may influence the outcome. These factors should be considered carefully preoperatively by the surgeon.

Small-diameter titanium grade IV and titanium-zirconium implants in edentulous mandibles: five-year results from a double-blind, randomized controlled trial.

BACKGROUND The aim of this study was to compare the 5-year survival and success rates of 3.3 mm dental implants either made from titanium-zirconium (TiZr) alloy or from Grade IV titanium (Ti Grade IV) in mandibular implant-based removable overdentures. METHODS The core study had a follow-up period of 36 months and was designed as a randomized, controlled, double-blind, split-mouth multicenter clinical trial. Patients with edentulous mandibles received two Straumann Bone Level implants (diameter 3.3 mm, SLActive®), one of TiZr (test) and one of Ti Grade IV (control), in the interforaminal region. This follow-up study recruited patients from the core study and evaluated the plaque and sulcus bleeding indices, radiographic crestal bone level, as well as implant survival and success 60 months after implant placement. RESULTS Of the 91 patients who initially received implants, 75 completed the 36 month follow-up and 49 were available for the 60 month examination. Two patients were excluded so that a total of 47 patients with an average age of 72 ± 8 years were analysed. The characteristics and 36-month performance of the present study cohort did not differ from the non-included initial participants (p > 0.05). In the period since the 36-month follow-up examination, no implant was lost. The cumulative implant survival rate was 98.9 % for the TiZr group and 97.8 % for the Ti Grade IV group. Crestal bone level changes at 60 months were not different in the test and control group (TiZr -0.60 ± 0.69 mm and Ti Grade IV -0.61 ± 0.83 mm; p = 0.96). The cumulative implant success rate after 60 months was 95.8 and 92.6 % for TiZr and Ti Grade IV, respectively. CONCLUSIONS After 60 months, the positive outcomes of the 36 month results for TiZr and Ti Grade IV implants were confirmed, with no significant differences with regard to crestal bone level change, clinical parameters and survival or success rates. TiZr implants performed equally well compared to conventional Ti Grade IV 3.3 mm diameter-reduced implants for mandibular removable overdentures. TRIAL REGISTRATION Registered on www.clinicaltrials.gov: NCT01878331.

Performance evaluation in Bayesian adaptive randomization

Bayesian adaptive randomization (BAR) is an attractive approach to allocate more patients to the putatively superior arm based on the interim data while maintains good statistical properties attributed to randomization. Under this approach, patients are adaptively assigned to a treatment group based on the probability that the treatment is better. The basic randomization scheme can be modified by introducing a tuning parameter, replacing the posterior estimated response probability, setting a boundary to randomization probabilities. Under randomization settings comprised of the above modifications, operating characteristics, including type I error, power, sample size, imbalance of sample size, interim success rate, and overall success rate, were evaluated through simulation. All randomization settings have low and comparable type I errors. Increasing tuning parameter decreases power, but increases imbalance of sample size and interim success rate. Compared with settings using the posterior probability, settings using the estimated response rates have higher power and overall success rate, but less imbalance of sample size and lower interim success rate. Bounded settings have higher power but less imbalance of sample size than unbounded settings. All settings have better performance in the Bayesian design than in the frequentist design. This simulation study provided practical guidance on the choice of how to implement the adaptive design. ^

Children with acute leukemia: A comparison of outcomes and cost-effectiveness from allogeneic blood stem cell and bone marrow transplantation

The relative merits of PBSCT versus BMT for children with standard and high risk hematologic malignancies remain unclear. In a retrospective single center study, we compared allogeneic peripheral blood stem cell transplantation (PBSCT) (n=30) with bone marrow transplantation (BMT) (n=110) in children with acute leukemia. We studied recipients of HLA matched sibling stem cells, and of stem cells from alternative donors (HLA mismatched and/or unrelated) and determined whether sourcing the stem cells from PB or marrow affected engraftment, incidence of acute and chronic GvHD, and disease-free survival at 1 year. Our results show a modest reduction in time to engraftment from PB stem cells and no greater risk of GvHD, but illustrate that the severity of the underlying disease is by far the greatest determinant of 1 year survival. Patients in the BMT group had a higher treatment success rate and lower costs than the recipients of the PBSCT within the standard but not the high risk disease group, where the treatment success rate and the cumulative costs were lower in the PBSCT group compared to the BMT group. Our current incremental cost-effectiveness ratio and analysis of uncertainty suggest that allogeneic transplantation of bone marrow grafts was a more cost-effective treatment option compared to peripheral blood stem cells in patients with standard risk childhood acute leukemia disease. For high risk disease our data are less prescriptive, since the differences were more limited and the range of costs much larger. Neither option demonstrated a clear advantage from a cost-effectiveness standpoint.^

Effectiveness of medical abortion with mifepristone and buccal misoprostol through 59 gestational days

BACKGROUND: From 2001 to March 2006, Planned Parenthood Federation of America (Planned Parenthood) health centers throughout the United States provided medical abortions principally by a regimen of oral mifepristone, followed 24-48 h later by vaginal misoprostol. In late March 2006, analyses of serious uterine infections following medical abortions led Planned Parenthood to change the route of misoprostol administration and to employ additional measures to minimize subsequent serious uterine infections. In August 2006, we conducted an extensive audit of medical abortions with the new buccal misoprostol regimen so that patients could be given accurate information about the success rate of the new regimen. OBJECTIVES: We sought to evaluate the effectiveness of the buccal medical abortion regimen and to examine correlates of its success during routine service delivery. METHODS: In 2006, audits were conducted in 10 large urban service points to estimate the success rates of the buccal regimen. Success was defined as medical abortion without vacuum aspiration. These audits also permitted estimates of success rates with oral misoprostol following mifepristone in a subset in which 98% of the subjects stemmed from two sites. RESULTS: The effectiveness of the buccal misoprostol-mifepristone regimen was 98.3% for women with gestational ages below 60 days. The oral misoprostol-mifepristone regimen, used by 278 women with a gestational age below 50 days, had a success rate of 96.8%. CONCLUSION: In conjunction with 200 mg of mifepristone, use of 800 mcg of buccal misoprostol up to 59 days of gestation is as effective as the use of 800 mcg of vaginal misoprostol up to 63 days of gestation.

Effects of ocean acidification caused by rising CO2 on the early development of three mollusks

Increasing atmospheric CO2 can decrease seawater pH and carbonate ions, which may adversely affect the larval survival of calcareous animals. In this study, we simulated future atmospheric CO2 concentrations (800, 1500, 2000 and 3000 ppm) and examined the effects of ocean acidification on the early development of 3 mollusks (the abalones Haliotis diversicolor and H. discus hannai and the oyster Crassostrea angulata). We showed that fertilization rate, hatching rate, larval shell length, trochophore development, veliger survival and metamorphosis all decreased significantly at different pCO2 levels (except oyster hatching). H. discus hannai were more tolerant of high CO2 compared to H. diversicolor. At 2000 ppm CO2, 79.2% of H. discus hannai veliger larvae developed normally, but only 13.3% of H. diversicolor veliger larvae. Tolerance of C. angulata to ocean acidification was greater than the 2 abalone species; 50.5% of its D-larvae developed normally at 3000 ppm CO2. This apparent resistance of C. angulata to ocean acidification may be attributed to their adaptability to estuarine environments. Mechanisms underlying the resistance to ocean acidification of both abalones requires further investigation. Our results suggest that ocean acidification may decrease the yield of these 3 economically important shellfish if increasing CO2 is a future trend.

Effects of seawater acidification on early development of the intertidal sea urchin Paracentrotus lividus, seawater carbonate chemistry and biological processes

The effect of pH ranging from 8.0 to 6.8 (total scale - pHT) on fertilization, cleavage and larval development until pluteus stage was assessed in an intertidal temperate sea urchin. Gametes were obtained from adults collected in two contrasting tide pools, one showing a significant nocturnal pH decrease (lowest pHT = 7.4) and another where pH was more stable (lowest pHT = 7.8). The highest pHT at which significant effects on fertilization and cleavage were recorded was 7.6. On the contrary, larval development was only affected below pHT 7.4, a value equal or lower than that reported for several subtidal species. This suggests that sea urchins inhabiting stressful intertidal environments produce offspring that may better resist future ocean acidification. Moreover, at pHT 7.4, the fertilization rate of gametes whose progenitors came from the tide pool with higher pH decrease was significantly higher, indicating a possible acclimatization or adaptation of gametes to pH stress.

Impact of CO2-driven acidification on the development of the sea cucumber Apostichopus japonicus (Selenka) (Echinodermata: Holothuroidea)

We evaluated the impact of ocean acidification on the early development of sea cucumber Apostichopus japonicus. The effect of pH-levels (pH 8.04, 7.85, 7.70 and 7.42) were tested on post-fertilization success, developmental (stage duration) and growth rates. Post-fertilization success decreased linearly with pH leading to a 6% decrease at pH 7.42 as compared to pH 8.1. The impact of pH on developmental time was stage-dependent: (1) stage duration increased linearly with decreasing pH in early-auricularia stage; (2) decreased linearly with decreasing pH in the mid-auricularia stage; but (3) pH decline had no effect on the late-auricularia stage. At the end of the experiment, the size of doliolaria larvae linearly increased with decreasing pH. In conclusion, a 0.62 unit decrease in pH had relatively small effects on A. japonicus early life-history compared to other echinoderms, leading to a maximum of 6% decrease in post-fertilization success and subtle effects on growth and development.

Seawater carbonate chemistry, fertilization and early development of the coral eating crown-of-thorns starfish, Acanthaster planci in a laboratory experiment

Outbreaks of crown-of-thorns starfish (COTS), Acanthaster planci, contribute to major declines of coral reef ecosystems throughout the Indo-Pacific. As the oceans warm and decrease in pH due to increased anthropogenic CO2 production, coral reefs are also susceptible to bleaching, disease and reduced calcification. The impacts of ocean acidification and warming may be exacerbated by COTS predation, but it is not known how this major predator will fare in a changing ocean. Because larval success is a key driver of population outbreaks, we investigated the sensitivities of larval A. planci to increased temperature (2-4 °C above ambient) and acidification (0.3-0.5 pH units below ambient) in flow-through cross-factorial experiments (3 temperature × 3 pH/pCO2 levels). There was no effect of increased temperature or acidification on fertilization or very early development. Larvae reared in the optimal temperature (28 °C) were the largest across all pH treatments. Development to advanced larva was negatively affected by the high temperature treatment (30 °C) and by both experimental pH levels (pH 7.6, 7.8). Thus, planktonic life stages of A. planci may be negatively impacted by near-future global change. Increased temperature and reduced pH had an additive negative effect on reducing larval size. The 30 °C treatment exceeded larval tolerance regardless of pH. As 30 °C sea surface temperatures may become the norm in low latitude tropical regions, poleward migration of A. planci may be expected as they follow optimal isotherms. In the absence of acclimation or adaptation, declines in low latitude populations may occur. Poleward migration will be facilitated by strong western boundary currents, with possible negative flow-on effects on high latitude coral reefs. The contrasting responses of the larvae of A. planci and those of its coral prey to ocean acidification and warming are considered in context with potential future change in tropical reef ecosystems.

A repository for integration of software artifacts with dependency resolution and federation support

While developing new IT products, reusability of existing components is a key aspect that can considerably improve the success rate. This fact has become even more important with the rise of the open source paradigm. However, integrating different products and technologies is not always an easy task. Different communities employ different standards and tools, and most times is not clear which dependencies a particular piece of software has. This is exacerbated by the transitive nature of these dependencies, making component integration a complicated affair. To help reducing this complexity we propose a model-based repository, capable of automatically resolve the required dependencies. This repository needs to be expandable, so new constraints can be analyzed, and also have federation support, for the integration with other sources of artifacts. The solution we propose achieves these working with OSGi components and using OSGi itself.

Simulation of academic performance rates, estimation of indicators of subjects and of a complete degree

The purpose of this paper is to present a program written in Matlab-Octave for the simulation of the time evolution of student curricula, i.e, how students pass their subjects along time until graduation. The program computes, from the simulations, the academic performance rates for the subjects of the study plan for each semester as well as the overall rates, which are a) the efficiency rate defined as the ratio of the number of students passing the exam to the number of students who registered for it and b) the success rate, defined as the ratio of the number of students passing the exam to the number of students who not only registered for it but also actually took it. Additionally, we compute the rates for the bachelor academic degree which are established for Spain by the National Quality Evaluation and Accreditation Agency (ANECA) and which are the graduation rate (measured as the percentage of students who finish as scheduled in the plan or taking an extra year) and the efficiency rate (measured as the percentage of credits which a student who graduated has really taken). The simulation is done in terms of the probabilities of passing all the subjects in their study plan. The application of the simulator to Polytech students in Madrid, where requirements for passing are specially stiff in first and second year subjects, is particularly relevant to analyze student cohorts and the probabilities of students finishing in the minimum of four years, or taking and extra year or two extra years, and so forth. It is a very useful tool when designing new study plans. The calculation of the probability distribution of the random variable "number of semesters a student has taken to complete the curricula and graduate" is difficult or even unfeasible to obtain analytically, and this is even truer when we incorporate uncertainty in parameter estimation. This is why we apply Monte Carlo simulation which not only provides illustration of the stochastic process but also a method for computation. The stochastic simulator is proving to be a useful tool for identification of the subjects most critical in the distribution of the number of semesters for curriculum vitae (CV) completion and subsequently for a decision making process in terms of CV planning and passing standards in the University. Simulations are performed through a graphical interface where also the results are presented in appropriate figures. The Project has been funded by the Call for Innovation in Education Projects of Universidad Politécnica de Madrid (UPM) through a Project of its school Escuela Técnica Superior de Ingenieros Industriales ETSII during the period September 2010-September 2011.

Results of the JET real-time disruption predictor in the ITER-like wall campaigns

The impact of disruptions in JET became even more important with the replacement of the previous Carbon Fiber Composite (CFC) wall with a more fragile full metal ITER-like wall (ILW). The development of robust disruption mitigation systems is crucial for JET (and also for ITER). Moreover, a reliable real-time (RT) disruption predictor is a pre-requisite to any mitigation method. The Advance Predictor Of DISruptions (APODIS) has been installed in the JET Real-Time Data Network (RTDN) for the RT recognition of disruptions. The predictor operates with the new ILW but it has been trained only with discharges belonging to campaigns with the CFC wall. 7 realtime signals are used to characterize the plasma status (disruptive or non-disruptive) at regular intervals of 1 ms. After the first 3 JET ILW campaigns (991 discharges), the success rate of the predictor is 98.36% (alarms are triggered in average 426 ms before the disruptions). The false alarm and missed alarm rates are 0.92% and 1.64%.

Latest developments in data analysis tools for disruption prediction and for the exploration of multimachine operational spaces.

In the last years significant efforts have been devoted to the development of advanced data analysis tools to both predict the occurrence of disruptions and to investigate the operational spaces of devices, with the long term goal of advancing the understanding of the physics of these events and to prepare for ITER. On JET the latest generation of the disruption predictor called APODIS has been deployed in the real time network during the last campaigns with the new metallic wall. Even if it was trained only with discharges with the carbon wall, it has reached very good performance, with both missed alarms and false alarms in the order of a few percent (and strategies to improve the performance have already been identified). Since for the optimisation of the mitigation measures, predicting also the type of disruption is considered to be also very important, a new clustering method, based on the geodesic distance on a probabilistic manifold, has been developed. This technique allows automatic classification of an incoming disruption with a success rate of better than 85%. Various other manifold learning tools, particularly Principal Component Analysis and Self Organised Maps, are also producing very interesting results in the comparative analysis of JET and ASDEX Upgrade (AUG) operational spaces, on the route to developing predictors capable of extrapolating from one device to another.

Diseño, fabricación, caracterización y aplicaciones constructivas de hormigones de consistencia seca con adiciones de materiales de procedencia orgánica e inorgánica de neumáticos fuera de uso (NFUs)

La siguiente investigación está centrada en establecer las diferencias en la reutilización, en los hormigones de consistencia seca, de dos tipos de caucho obtenidos en el proceso del reciclado del neumático, caucho reciclado del neumático (CRN): los tamaños del granulado (4-8 mm) de caucho reciclado de alta calidad (CR: Caucho Limpio) y el desecho del proceso del reciclado: fibra textil y de acero con trazas de caucho (desecho del caucho reciclado, IR: Caucho de impurezas). Ambos tipos fueron clasificados y añadidos como árido en sustitución del árido grueso (grava) desde el 20 al 100% del volumen. El comportamiento físico y mecánico del IR en los hormigones fue comparado con el hormigón de referencia y las series con el CR para el futuro uso en piezas de hormigón prefabricado. En ambos casos se aprecia una reducción de las resistencias mecánicas en proporción con las cantidades de caucho de sustitución, pero menos en series con IR con una combinación satisfactoria de fibra textil y metálica. El IR muestra mayores pérdidas en propiedades tales como trabajabilidad y densidad, pero también con un incremento de la porosidad. Estos hechos facilitan nuevas opciones para los desechos procedentes del CRN en los hormigones y por lo tanto menores gastos de energía, logrando una tasa de éxito en el proceso de reciclado cercano al 100%. The following research is focused on establishing the differences in the re-use as aggregate in dry consistency concretes of two types of rubber obtained in the process of tyre recycling, recycled rubber from tyres (RRT): granulated sizes (4–8 mm) of high quality recycled rubber (CR: Clean Rubber) and the waste of the recycling process: steel and textile fibers with rubber tracks (waste from recycled rubber, WRR). Both types were classified and added as aggregate in substitution of coarse aggregates from 20 to 100 % by volume. The physical and mechanical behavior of IR in concretes was compared with reference concrete and series with CR for a future use in precast concrete pieces. In both samples a reduction of mechanical resistance occurs in proportion with the amounts of rubber of substitution, but less in serials with IR with a successful combination of steel and textile fiber. IR shows furthermore a reduction in properties such as workability and density, but also an increment in porosity. These facts facilitate new options for waste from CRN in concretes and therefore lower energy costs, achieving a success rate in the recycling process close to 100 %.