Risk prediction of fever in neutropenia in children with cancer: a step towards individually tailored supportive therapy?

BACKGROUND: Fever in severe chemotherapy-induced neutropenia (FN) is the most frequent manifestation of a potentially lethal complication of current intensive chemotherapy regimens. This study aimed at establishing models predicting the risk of FN, and of FN with bacteremia, in pediatric cancer patients. METHODS: In a single-centre cohort study, characteristics potentially associated with FN and episodes of FN were retrospectively extracted from charts. Poisson regression accounting for chemotherapy exposure time was used for analysis. Prediction models were constructed based on a derivation set of two thirds of observations, and validated based on the remaining third of observations. RESULTS: In 360 pediatric cancer patients diagnosed and treated for a cumulative chemotherapy exposure time of 424 years, 629 FN were recorded (1.48 FN per patient per year, 95% confidence interval (CI), 1.37-1.61), 145 of them with bacteremia (23% of FN; 0.34; 0.29-0.40). More intensive chemotherapy, shorter time since diagnosis, bone marrow involvement, central venous access device (CVAD), and prior FN were significantly and independently associated with a higher risk to develop both FN and FN with bacteremia. The prediction models explained more than 30% of the respective risks. CONCLUSIONS: The two models predicting FN and FN with bacteremia were based on five easily accessible clinical variables. Before clinical application, they need to be validated by prospective studies.

AGENT BASED, DISTRIBUTED CONTROL STRATEGIES AND OPTIMIZATION OF PLUG-IN ELECTRIC VEHICLES ON SMART/MICROGRID ARCHITECTURES

This thesis will present strategies for the use of plug-in electric vehicles on smart and microgrids. MATLAB is used as the design tool for all models and simulations. First, a scenario will be explored using the dispatchable loads of electric vehicles to stabilize a microgrid with a high penetration of renewable power generation. Grid components for a microgrid with 50% photovoltaic solar production will be sized through an optimization routine to maintain storage system, load, and vehicle states over a 24-hour period. The findings of this portion are that the dispatchable loads can be used to guard against unpredictable losses in renewable generation output. Second, the use of distributed control strategies for the charging of electric vehicles utilizing an agent-based approach on a smart grid will be studied. The vehicles are regarded as additional loads to a primary forecasted load and use information transfer with the grid to make their charging decisions. Three lightweight control strategies and their effects on the power grid will be presented. The findings are that the charging behavior and peak loads on the grid can be reduced through the use of distributed control strategies.

CD4(+) T cell count decreases by ethnicity among untreated patients with HIV infection in South Africa and Switzerland

BACKGROUND: Estimates of the decrease in CD4(+) cell counts in untreated patients with human immunodeficiency virus (HIV) infection are important for patient care and public health. We analyzed CD4(+) cell count decreases in the Cape Town AIDS Cohort and the Swiss HIV Cohort Study. METHODS: We used mixed-effects models and joint models that allowed for the correlation between CD4(+) cell count decreases and survival and stratified analyses by the initial cell count (50-199, 200-349, 350-499, and 500-750 cells/microL). Results are presented as the mean decrease in CD4(+) cell count with 95% confidence intervals (CIs) during the first year after the initial CD4(+) cell count. RESULTS: A total of 784 South African (629 nonwhite) and 2030 Swiss (218 nonwhite) patients with HIV infection contributed 13,388 CD4(+) cell counts. Decreases in CD4(+) cell count were steeper in white patients, patients with higher initial CD4(+) cell counts, and older patients. Decreases ranged from a mean of 38 cells/microL (95% CI, 24-54 cells/microL) in nonwhite patients from the Swiss HIV Cohort Study 15-39 years of age with an initial CD4(+) cell count of 200-349 cells/microL to a mean of 210 cells/microL (95% CI, 143-268 cells/microL) in white patients in the Cape Town AIDS Cohort > or =40 years of age with an initial CD4(+) cell count of 500-750 cells/microL. CONCLUSIONS: Among both patients from Switzerland and patients from South Africa, CD4(+) cell count decreases were greater in white patients with HIV infection than they were in nonwhite patients with HIV infection.

Four thousand years of vegetation and fire history in the spruce forests of northern Kyrgyzstan (Kungey Alatau, Central Asia)

Analyses of pollen, macrofossils and microscopic charcoal in the sediment of a small sub-alpine lake (Karakol, Kyrgyzstan) provide new data to reconstruct the vegetation history of the Kungey Alatau spruce forest during the late-Holocene, i.e. the past 4,000 years. The pollen data suggest that Picea schrenkiana F. and M. was the dominant tree in this region from the beginning of the record. The pollen record of pronounced die-backs of the forests, along with lithostratigraphical evidence, points to possible climatic cooling (and/or drying) around 3,800 cal year B.P., and between 3,350 and 2,520 cal year B.P., with a culmination at 2,800-2,600 cal B.P., although stable climatic conditions are reported for this region for the past 3,000-4,000 years in previous studies. From 2,500 to 190 cal year B.P. high pollen values of P. schrenkiana suggest rather closed and dense forests under the environmental conditions of that time. A marked decline in spruce forests occurred with the onset of modern human activities in the region from 190 cal year B.P. These results show that the present forests are anthropogenically reduced and represent only about half of their potential natural extent. As P. schrenkiana is a species endemic to the western Tien Shan, it is most likely that its refugium was confined to this region. However, our palaeoecological record is too recent to address this hypothesis thoroughly.

Verfügbarkeit intralogistischer Systeme

Bei der Entwicklung und Auslegung komplexer Materialflusssysteme bilden heutzutage die Erreichung einer hohen Leistungsfähigkeit bei vergleichsweise niedrigen Kosten und einem hohen Servicegrad die maßgeblichen Zielkriterien. In zweiter Reihe eng damit verbunden ist der Kennwert Verfügbarkeit, der das Verhältnis zwischen der Ausfall- und der theoretischen Nutzungszeit dieser Systeme beschreibt. Der Kennwert Verfügbarkeit wird für technische Systeme allgemein in einer Vielzahl unterschiedlicher Richtlinien und Normen definiert. Einige davon sind speziell auf den Bereich der Materialflusssysteme ausgerichtet und dokumentieren auch Berechnungsansätze für die Verfügbarkeit. Trotz dieser Anleitungen ist die Analyse und Bewertung von Verfügbarkeitskennwerten bei der Entwicklung und Inbetriebnahme von Materialflusssystemen wiederholt Gegenstand von Auseinandersetzungen zwischen Kunden und Lieferanten. Der vorliegende Beitrag analysiert diese Situation und skizziert Lösungsansätze.

Erfahrbares Programmieren durch den zielgerichten Einsatz von Flugdrohnen im Informatikunterricht

Informatik- und insbesondere Programmierunterricht sind heute ein wichtiger Bestandteil der schulischen Ausbildung. Vereinfachte Entwicklungsumgebungen, die auf die Abstraktion typischer Programmierkonzepte in Form von grafischen Bausteinen setzen, unterstützen diesen Trend. Zusätzliche Attraktivität wird durch die Verwendung exotischer Laufzeitumgebungen (z. B. Roboter) geschaffen. Die in diesem Paper vorgestellte Plattform “ScratchDrone” führt ergänzend zu diesen Angeboten eine moderne Flugdrohne als innovative Laufzeitumgebung für Scratch-Programme ein. Die Programmierung kann dabei dank modularer Systemarchitektur auf verschiedenen Abstraktionsebenen erfolgen, abhängig vom Lernfortschritt der Schüler. Kombiniert mit einem mehrstufigen didaktischen Modell, der Herausforderung der Bewegung im 3D-Raum sowie der natürlichen menschlichen Faszination für das Fliegen wird so eine hohe Lernmotivation bei jungen Programmieranfängern erreicht.

Septic peritonitis from pyloric and non-pyloric gastrointestinal perforation: prognostic factors in 44 dogs and 11 cats

OBJECTIVES To identify potential prognostic factors affecting outcome in septic peritonitis caused by gastrointestinal perforation in dogs and cats. METHODS A retrospective study. Animals operated on for septic peritonitis because of gastrointestinal perforation were evaluated. Risk factors assessed included age, duration of clinical signs, recent prior abdominal surgery, recent prior anti-inflammatory drug administration, placement of a closed-suction drain and location of perforation. RESULTS Fifty-five animals (44 dogs and 11 cats) were included. The overall mortality was 63·6%. No association was found between age, duration of clinical signs or prior abdominal surgery and outcome. Animals with a history of prior anti-inflammatory drugs were significantly (P=0·0011) more likely to have perforation of the pylorus (73·3%). No significant difference in outcome was found between animals treated with closed-suction drains and those treated with primary closure or between pyloric perforation and perforation at other gastrointestinal sites. CLINICAL SIGNIFICANCE Administration of anti-inflammatory drugs in dogs and cats is a significant risk factor for pyloric perforation. Pyloric perforation was not associated with a poorer outcome than perforation at other gastrointestinal sites. Placement of a closed suction drain did not improve outcome compared to primary closure.

Efficacy of Grazing Stockpiled Perennial Forages for Winter Maintenance of Beef Cows

In a three year study, wintering systems utilizing the grazing of stockpiled perennial hay crop forages or corn crop residues were compared to maintaining cows in a drylot. In the summer of 1992, two cuttings of hay were harvested (June 22 and August 2) from three 10-acre fields containing “Johnstone” endophyte-free tall fescue and “Spreador II” alfalfa, and one cutting of hay was harvested from three 10- acre fields of smooth brome grass. “Arlington” red clover was frost-seeded into the smooth bromegrass fields in 1993 and into tall fescue-alfalfa and smooth bromegrass fields into 1994. Two cuttings of hay were harvested from all fields in subsequent years, and three-year average hay yields for tall fescue-alfalfa and smooth bromegrass-red clover were 4,336 and 3,481 pounds per acre, respectively. Regrowth of the forage following the August hay harvest of each year was accumulated for winter grazing. Following a killing frost in each year, two fields of each stockpiled forage were stocked with cows in midgestation at two acres per cow. Two 10-acre fields of corn crop residues were also stocked at two acres per cow, following the grain harvest. Mean dry matter forage yields at the initiation of grazing were 1,853, 2,173 and 5,797 pounds per acre for fields containing tall fescue-alfalfa, smooth bromegrass-red clover, and cornstalks, respectively. A drylot was stocked with 18 cows in 1992 and 1993 and 10 cows in 1994. All cows were fed hay as necessary to maintain a body condition score of five. During grazing, mean losses of organic matter were -6.4, -7.6, and -10.7 pounds per acre per cow from tall fescue-alfalfa, smooth bromegrass-red clover, and cornstalk fields. Average organic matter loss rates from stockpiled forages due to weathering alone were equal to only 30% of the weathering losses of the corn crop residues. In vitro digestibility of both stockpiled forages and cornstalks decreased at equal rates during grazing each year, with respective annual loss rates of .14, .08, and .06% per day. Cows grazing corn crop residues required an average of 1,321 pounds per cow less hay than cows maintained in the drylot to maintain equivalent body condition during the grazing season. Cows grazing tall fescue-alfalfa or smooth bromegrass-red clover had body weight gains and condition score changes equal to cows maintained in a drylot but required 64% and 62% less harvested hay than cows in the drylot during the grazing season. Over the entire stored forage cows grazing tall fescue-alfalfa and smooth bromegrass-red clover required an average of 2,390 and 2,337 pounds per cow less than those maintained in the drylot. Because less hay was needed to maintain cows grazing stockpiled forages, average annual excesses of 5,629 and 3,868 pounds of hay dry matter per cow remained in the stockpiled tall fescue-alfalfa and smooth bromegrass-red clover systems.

A shift from oral to intravenous iron supplementation therapy is observed over time in a large swiss cohort of patients with inflammatory bowel disease

BACKGROUND In 2007, leading international experts in the field of inflammatory bowel disease (IBD) recommended intravenous (IV) iron supplements over oral (PO) ones because of superior effectiveness and better tolerance. We aimed to determine the percentage of patients with IBD undergoing iron therapy and to assess the dynamics of iron prescription habits (IV versus PO). METHODS We analyzed anonymized data on patients with Crohn's disease and ulcerative colitis extracted from the Helsana database. Helsana is a Swiss health insurance company providing coverage for 18% of the Swiss population (1.2 million individuals). RESULTS In total, 629 patients with Crohn's disease (61% female) and 398 patients with ulcerative colitis (57% female) were identified; mean observation time was 31.8 months for Crohn's disease and 31.0 months for ulcerative colitis patients. Of all patients with IBD, 27.1% were prescribed iron (21.1% in males; 31.1% in females). Patients treated with steroids, immunomodulators, and/or anti-tumor necrosis factor drugs were more frequently treated with iron supplements when compared with those not treated with any medications (35.0% versus 20.9%, odds ratio, 1.94; P < 0.001). The frequency of IV iron prescriptions increased significantly from 2006 to 2009 for both genders (males: from 2.6% to 10.1%, odds ratio = 3.84, P < 0.001; females: from 5.3% to 12.1%, odds ratio = 2.26, P = 0.002), whereas the percentage of PO iron prescriptions did not change. CONCLUSIONS Twenty-seven percent of patients with IBD were treated with iron supplements. Iron supplements administered IV were prescribed more frequently over time. These prescription habits are consistent with the implementation of guidelines on the management of iron deficiency in IBD.

Herbrand Theorems for Substructural Logics

Herbrand and Skolemization theorems are obtained for a broad family of first-order substructural logics. These logics typically lack equivalent prenex forms, a deduction theorem, and reductions of semantic consequence to satisfiability. The Herbrand and Skolemization theorems therefore take various forms, applying either to the left or right of the consequence relation, and to restricted classes of formulas.

Post-Mortem Cardiac 3T Magnetic Resonance Imaging. Visualization of Sudden Cardiac Death?

OBJECTIVES: This study aimed to investigate post-mortem magnetic resonance imaging (pmMRI) for the assessment of myocardial infarction and hypointensities on post-mortem T2-weighted images as a possible method for visualizing the myocardial origin of arrhythmic sudden cardiac death. BACKGROUND: Sudden cardiac death has challenged clinical and forensic pathologists for decades because verification on post-mortem autopsy is not possible. pmMRI as an autopsy-supporting examination technique has been shown to visualize different stages of myocardial infarction. METHODS: In 136 human forensic corpses, a post-mortem cardiac MR examination was carried out prior to forensic autopsy. Short-axis and horizontal long-axis Images were acquired in situ on a 3-T system. RESULTS: In 76 cases, myocardial findings could be documented and correlated to the autopsy findings. Within these 76 study cases, a total of 124 myocardial lesions were detected on pmMRI (chronic: 25; subacute: 16; acute: 30; and peracute: 53). Chronic, subacute, and acute infarction cases correlated excellently to the myocardial findings on autopsy. Peracute infarctions (age range: minutes to approximately 1 h) were not visible on macroscopic autopsy or histological examination. Peracute infarction areas detected on pmMRI could be verified in targeted histological investigations in 62.3% of cases and could be related to a matching coronary finding in 84.9%. A total of 15.1% of peracute lesions on pmMRI lacked a matching coronary finding but presented with severe myocardial hypertrophy or cocaine intoxication facilitating a cardiac death without verifiable coronary stenosis. CONCLUSIONS: 3-T pmMRI visualizes chronic, subacute, and acute myocardial infarction in situ. In peracute infarction as a possible cause of sudden cardiac death, it demonstrates affected myocardial areas not visible on autopsy. pmMRI should be considered as a feasible post-mortem investigation technique for the deceased patient if no consent for a clinical autopsy is obtained.