An artificial neural network stratifies the risks of reintervention and mortality after endovascular aneurysm repair:a retrospective observational study

Background Lifelong surveillance after endovascular repair (EVAR) of abdominal aortic aneurysms (AAA) is considered mandatory to detect potentially life-threatening endograft complications. A minority of patients require reintervention but cannot be predictively identified by existing methods. This study aimed to improve the prediction of endograft complications and mortality, through the application of machine-learning techniques. Methods Patients undergoing EVAR at 2 centres were studied from 2004-2010. Pre-operative aneurysm morphology was quantified and endograft complications were recorded up to 5 years following surgery. An artificial neural networks (ANN) approach was used to predict whether patients would be at low- or high-risk of endograft complications (aortic/limb) or mortality. Centre 1 data were used for training and centre 2 data for validation. ANN performance was assessed by Kaplan-Meier analysis to compare the incidence of aortic complications, limb complications, and mortality; in patients predicted to be low-risk, versus those predicted to be high-risk. Results 761 patients aged 75 +/- 7 years underwent EVAR. Mean follow-up was 36+/- 20 months. An ANN was created from morphological features including angulation/length/areas/diameters/ volume/tortuosity of the aneurysm neck/sac/iliac segments. ANN models predicted endograft complications and mortality with excellent discrimination between a low-risk and high-risk group. In external validation, the 5-year rates of freedom from aortic complications, limb complications and mortality were 95.9% vs 67.9%; 99.3% vs 92.0%; and 87.9% vs 79.3% respectively (p0.001) Conclusion This study presents ANN models that stratify the 5-year risk of endograft complications or mortality using routinely available pre-operative data.

A Bayesian neural network algorithm identifies patients in whom post-EVAR surveillance may be unnecessary

Lifelong surveillance is not cost-effective after endovascular aneurysm repair (EVAR), but is required to detect aortic complications which are fatal if untreated (type 1/3 endoleak, sac expansion, device migration). Aneurysm morphology determines the probability of aortic complications and therefore the need for surveillance, but existing analyses have proven incapable of identifying patients at sufficiently low risk to justify abandoning surveillance. This study aimed to improve the prediction of aortic complications, through the application of machine-learning techniques. Patients undergoing EVAR at 2 centres were studied from 2004–2010. Aneurysm morphology had previously been studied to derive the SGVI Score for predicting aortic complications. Bayesian Neural Networks were designed using the same data, to dichotomise patients into groups at low- or high-risk of aortic complications. Network training was performed only on patients treated at centre 1. External validation was performed by assessing network performance independently of network training, on patients treated at centre 2. Discrimination was assessed by Kaplan-Meier analysis to compare aortic complications in predicted low-risk versus predicted high-risk patients. 761 patients aged 75 +/− 7 years underwent EVAR in 2 centres. Mean follow-up was 36+/− 20 months. Neural networks were created incorporating neck angu- lation/length/diameter/volume; AAA diameter/area/volume/length/tortuosity; and common iliac tortuosity/diameter. A 19-feature network predicted aor- tic complications with excellent discrimination and external validation (5-year freedom from aortic complications in predicted low-risk vs predicted high-risk patients: 97.9% vs. 63%; p < 0.0001). A Bayesian Neural-Network algorithm can identify patients in whom it may be safe to abandon surveillance after EVAR. This proposal requires prospective study.

Survival in the pre-senile dementia frontotemporal lobar degeneration with TDP-43 proteinopathy:effects of genetic, demographic and neuropathological variables

Factors associated with survival were studied in 84 neuropathologically documented cases of the pre-senile dementia frontotemporal dementia lobar degeneration (FTLD) with transactive response (TAR) DNA-binding protein of 43 kDa (TDP-43) proteinopathy (FTLD-TDP). Kaplan-Meier survival analysis estimated mean survival as 7.9 years (range: 1-19 years, SD = 4.64). Familial and sporadic cases exhibited similar survival, including progranulin (GRN) gene mutation cases. No significant differences in survival were associated with sex, disease onset, Braak disease stage, or disease subtype, but higher survival was associated with lower post-mortem brain weight. Survival was significantly reduced in cases with associated motor neuron disease (FTLD-MND) but increased with Alzheimer's disease (AD) or hippocampal sclerosis (HS) co-morbidity. Cox regression analysis suggested that reduced survival was associated with increased densities of neuronal cytoplasmic inclusions (NCI) while increased survival was associated with greater densities of enlarged neurons (EN) in the frontal and temporal lobes. The data suggest that: (1) survival in FTLD-TDP is more prolonged than typical in pre-senile dementia but shorter than some clinical subtypes such as the semantic variant of primary progressive aphasia (svPPA), (2) MND co-morbidity predicts poor survival, and (3) NCI may develop early and EN later in the disease. The data have implications for both neuropathological characterization and subtyping of FTLD-TDP.

Measuring effectiveness in international financial crime prevention: Can we agree on a performance metric?

The attempts at carrying out terrorist attacks have become more prevalent. As a result, an increasing number of countries have become particularly vigilant against the means by which terrorists raise funds to finance their draconian acts against human life and property. Among the many counter-terrorism agencies in operation, governments have set up financial intelligence units (FIUs) within their borders for the purpose of tracking down terrorists’ funds. By investigating reported suspicious transactions, FIUs attempt to weed out financial criminals who use these illegal funds to finance terrorist activity. The prominent role played by FIUs means that their performance is always under the spotlight. By interviewing experts and conducting surveys of those associated with the fight against financial crime, this study investigated perceptions of FIU performance on a comparative basis between American and non-American FIUs. The target group of experts included financial institution personnel, civilian agents, law enforcement personnel, academicians, and consultants. Questions for the interview and surveys were based on the Kaplan and Norton’s Balanced Scorecard (BSC) methodology. One of the objectives of this study was to help determine the suitability of the BSC to this arena. While FIUs in this study have concentrated on performance by measuring outputs such as the number of suspicious transaction reports investigated, this study calls for a focus on outcomes involving all the parties responsible for financial criminal investigations. It is only through such an integrated approach that these various entities will be able to improve performance in solving financial crime. Experts in financial intelligence strongly believed that the quality and timeliness of intelligence was more important than keeping track of the number of suspicious transaction reports. Finally, this study concluded that the BSC could be appropriately applied to the arena of financial crime prevention even though the emphasis is markedly different from that in the private sector. While priority in the private sector is given to financial outcomes, in this arena employee growth and internal processes were perceived as most important in achieving a satisfactory outcome.

A comprehensive assessment of self -report experiences of adoptive parents of special needs children in Florida

Adoption of special needs children is now seen as a life long event whereby the adoptive child and family have unique needs. The need for postplacement resources throughout the life cycle of the adoption process is evident. This exploratory-descriptive research employed a random stratified cross-sectional design. The purpose of the study was to describe, identify, examine, and assess the relative influence of identified empirically and conceptually relevant variables of self-report experiences of adoptive parents of special needs children. Primary areas of exploration included: (1) adoptive children and families' characteristics, (2) postplacement service needs, utilization and satisfaction, and (3) adoptive parents' perceptions of their adoption experiences. A proportionate stratified random mail survey was used to obtain 474 families who had adopted special needs children from the 15 geographic districts which make up the state adoption social service agency in Florida. A 144-item survey questionnaire was used to collect basic information on demographic data, service provision, and adoption experiences. Four research questions were analyzed to test the effect the predictor variables had on willingness to adopt another special needs child, successful adoption, satisfying experience, and realism about problems. All four research questions revealed that the full model and the child's antecedent and the adoptive parents' intervening variable blocks were significant in explaining the variance in the dependent variables. The child's intervening variables alone were only significant in explaining the variance for one of the dependent variables. The results of the statistical analysis on the fifth research question and the three hypotheses determined that (1) only one postplacement service, crisis intervention, had a statistically significant impact on the adoptive parents' perceived level of satisfaction with the adoption experience; (2) adoptive parents who rate their adoption as successful are more likely to express a desire to adopt another special needs child; (3) the more adequate information on the child the adoptive parents perceived that they had prior to placement, the more they perceived they were realistic about the problems they would encounter; and (4) six specific postplacement services were found to be significant in predicting successful adoptions--crisis intervention, outpatient drug/alcohol treatment, maintenance subsidy, physical therapy, special medical equipment, and family counseling. Implications for the social work field and future research are discussed. ^

A Bookman's View on the Humanities

Mitchell Kaplan, founder of the Books and Books bookstore chain and of the Miami International Book Festival lectures on the evolution of books and writing. Lecture held at Green Library, Modesto Maidique Campus, Florida International University on March 21, 2012

Data compilation on the biological response to ocean acidification: environmental and experimental context of data sets and related literature

The exponential growth of studies on the biological response to ocean acidification over the last few decades has generated a large amount of data. To facilitate data comparison, a data compilation hosted at the data publisher PANGAEA was initiated in 2008 and is updated on a regular basis (doi:10.1594/PANGAEA.149999). By January 2015, a total of 581 data sets (over 4 000 000 data points) from 539 papers had been archived. Here we present the developments of this data compilation five years since its first description by Nisumaa et al. (2010). Most of study sites from which data archived are still in the Northern Hemisphere and the number of archived data from studies from the Southern Hemisphere and polar oceans are still relatively low. Data from 60 studies that investigated the response of a mix of organisms or natural communities were all added after 2010, indicating a welcomed shift from the study of individual organisms to communities and ecosystems. The initial imbalance of considerably more data archived on calcification and primary production than on other processes has improved. There is also a clear tendency towards more data archived from multifactorial studies after 2010. For easier and more effective access to ocean acidification data, the ocean acidification community is strongly encouraged to contribute to the data archiving effort, and help develop standard vocabularies describing the variables and define best practices for archiving ocean acidification data.

Estrutura e desempenho organizacional: uma análise na Universidade Federal do Rio Grande do Norte

This research analyses the components of the organizational structure of the UFRN (Rio Grande do Norte Federal University) and to what extent they affect organizational performance. The study, classified as exploratory and descriptive, was conducted in two phases. The first phase consists of a pilot test to refine the research instrument and to identify the latent components of the organizational structure, and the second to characterize these components and thereby establish relationships with organizational performance. In the first phase, the research was conducted in 20 UFRN organizational units with the participation of 84 employees between technical-administrative and teachers, after considering missing values and outliers, while the second phase occurred in two stages: one conducted with 279 valid cases, consisting of technical-administrative and teachers of 37 UFRN units, and another with 112 managers of the institution in the 49 units identified in this research. The instrument adopted in the first phase was composed of 36 indicators of organizational structure, with six extracted and adapted from the instrument developed by Medeiros (2003) and 30 prepared based on the literature review, from Mintzberg (2012), Hall (1984), Vasconcellos and Hemsley (1997) and Seiffert and Costa (2007) and 7 performance indicators adapted from Fleury and Mills (2006), Vieira and Vieira (2003) and Kaplan and Norton (1997) from the self-assessment instrument in use by the university. In this stage the data were analyzed using the techniques of factor analysis and reliability analysis by means of Cronbach’s alpha, aiming to extract the factors representing the components of the organizational structure. In step 1 of the second phase, the instrument, refined and reduced in the previous phase, with 24 variables of organizational structure and 6 for performance was used, while in step 2, a semi-structured interview guide with questions, organized into nine organizational structure elements, was adopted aiming to gather information to understand the relationship of structure to performance of the UFRN. The techniques used in the second phase, as a whole, were factor analysis and reliability analysis to characterize the components extracted in the previous phase and to validate the performance variables and correlation analysis, regression and content analysis to establish and understand the relationship between structure and performance. The results showed, in the two stages, six latent components of organizational structure in the context under study: training and internalization, communication, hierarchy, decentralization, formalization and departmentalization - with high levels of Cronbach's alpha indexes - which can thereby be characterized as components of UFRN structure. Six performance indicators were validated in this study, showing them as efficient and highly reliable. Finally, it was found that the formalization, communication, decentralization, training and internalization components positively affect UFRN performance, while departmentalization has an adverse affect and hierarchy did not show a significant relationship. The results achieved in this work are important in future studies to support the development of a model structure that represents the specifics of the university

Avaliação de polimorfismos funcionais nos genes de reparo XRCC1, APEX1, XPD e XPF em carcinomas de células escamosas orais

Base excision repair (BER) and nucleotide excision repair (NER) pathways play critical role in maintaining genome integrity. Polymorphisms in BER and NER genes which modulate the DNA repair capacity may affect the susceptibility and prognosis of oral cancer. This study was conducted with genomic DNA from 92 patients with oral squamous cell carcinomas (OSCC) and 130 controls. The cases were followed up to explore the associations between BER and NER genes polymorphisms and the risk and prognosis of OSCC. Four single-nucleotide polymorphisms (SNPs) in XRCC1 (rs25487), APEX1 (rs1130409), XPD (rs13181) and XPF (rs1799797) genes were tested by polymerase chain reaction – quantitative real time method. The GraphPad Prism version 6.0.1 statistical software was applied for statistical analysis of association. Odds ratio (OR), hazard ratio (HR), and their 95 % confidence intervals (CIs) were calculated by logistic regression. Kaplan-Meier curve and Cox proportional hazard model were used for prognostic analysis. The presence of polymorphic variants in XRCC1, APEX1, XPD and XPF genes were not associated with an increased risk of OSCC. Gene-environment interactions with smoking were not significant for any polymorphism. The presence of polymorphic variants of the XPD gene in association with alcohol consumption conferred an increased risk of 1.86 (95% CI: 0.86 – 4.01, p=0.03) for OSCC. Only APEX1 was associated with decreased specific survival (HR 3.94, 95% CI: 1.31 – 11.88, p=0.01). These results suggest an interaction between polymorphic variants of the XPF gene and alcohol consumption. Additionally APEX1 may represent a prognostic marker for OSCC.

Estudo da correlação das características clínico-patológicas do câncer colorretal com a expressão imunohistoquímica de proteínas da progressão tumoral

Except the non-melanoma skin tumors, colorectal cancer is the second most common in the Southeastern Region of Brazil, the third most common in the Southern and Central Regions. It is also the forth most common in the Northern Region and it is the fifth one in the Northeastern. To assess pathological and clinical variables of colorectal Cancer is crucial to know the possible conclusions for the survival of patients and point out the characteristics in the progress of tumor, such as the profile of tumor invasion and its angiogenesis. This work focuses on analyzing clinically and pathologically some settings in colorectal cancer patients (CRC) in the city of Natal and its countryside through those variables as parameters of prognosis and determine the level of protein expression, for instance: E-cadherin (E-cad), beta- -catenin (β-cat), galectin-3 (gal-3), matrix metalloproteinases (MMP) 2 and 9 and vascular-endothelial growth factor alpha (α VEGF) in the tumor tissues. A retrospective study was done in colorectal cancer cases in the regions of Rio Grande do Norte state from 1995 to 2005, specifically in Natal city/RN/Brazil. The pathological and clinical variables, such as: age, gender, ethnicity, lifestyle, family history, the location of the primary tumor, level of differentiation, TDM staging, modified Dukes’, treatment and survival were analyzed. The pathological and clinical data were collected from medical records through a specific form and were filed on Excel. A total of 534 patients were selected from the Pathology Department file in this institution, however, 176 patients were excluded. 358 patients were included for Epidemiological analysis and its clinical and pathological correlations were selected. 180 patients were also selected for histological and immunohistochemical studies. The tumor progression of these selected proteins mentioned before were analyzed. The Paraffin blocks of these samples were treated by Microarray Tissue technique and its blades subjected to immunohistochemistry to test the intensity of these proteins in tumor tissues. The results of this analysis were correlated with clinicopathologic variables of patients. Statistical analysis using the chi-frame Pearson test and analysis of midlife by Kaplan-Meier curve was also utilized. P values < 0.05 were considered statistically significant. The average age of our sample was 58.8 years and 51.7 % were female. Alcohol consumption has increased by 1.71 time the risk of death by CCR (p = 0.034) and tobacco consumption increased 2.7 times the chance of developing tumors of high TNM stage (p = 0.001). Cancer patients had a family history of 3,833 times the chance of developing the CCR (p = 0.002). The expression of MMP-2 showed a significant association with tumors of high TNM stage (p <0.046) and mortality (p = 0.041). The α VEGF expression had statistically significant correlation with high TNM stage (p <0.009), degree of cell indifferentiation (p <0.025) and mortality (p <0.035). Expressions of E-cadherin and beta-catetina demonstrated tumor linked to high TNM stage (p = 0.0001) and Dukes› modified (p = 0.05), lesions in the rectum (p = 0.03 and p = 0.007, respectively), smoking (p = 0.05) and indifferentiation (p = 0.001). The expression of Gal-3 showed statistical significance with high TNM stage of patients (p = 0.01), smokers (p = 0.01), alcohol drinking (p = 0.03), indifferentiation (p = 0.0001) and mortality (p = 0.0001). Based on the results, therefore, we could realize that lifestyle and family history had correlation in the CCR prognosis, as well as MMP-2 expression, MMP-9, VEGF alpha, E-cadherin, Beta-catenin and Galectin-3 were important prognostic markers in tumor progression in colorectal cancer.

Study of Periodic and Quasi-Periodic Structures in Silicon-on-Insulator

In this thesis, a numerical design approach has been proposed and developed based on the transmission matrix method in order to characterize periodic and quasi-periodic photonic structures in silicon-on-insulator. The approach and its performance have been extensively tested with specific structures in 2D and its validity has been verified in 3D.

LPJ-LMfire simulations for Europe for the Last Glacial Maximum and preindustrial control, link to netCDF files

This data sets contains LPJ-LMfire dynamic global vegetation model output covering Europe and the Mediterranean for the Last Glacial Maximum (LGM; 21 ka) and for a preindustrial control simulation (20th century detrended climate). The netCDF data files are time averages of the final 30 years of the model simulation. Each netCDF file contains four or five variables: fractional cover of 9 plant functional types (PFTs; cover), total fractional coverage of trees (treecover), population density of hunter-gatherers (foragerPD; only for the "people" simulations), fraction of the gridcell burned on 30-year average (burnedf), and vegetation net primary productivity (NPP). The model spatial resolution is 0.5-degrees For the LGM simulations, LPJ-LMfire was driven by the PMIP3 suite of eight GCMs for which LGM climate simulations were available. Also provided in this archive is the result of an LPJ-LMfire run that was forced by the average climate of all GCMs (the "GCM-mean" files), and the average of each of the individual LPJ-LMfire runs over the eight LGM scenarios individually (the "LPJ-mean" files). The model simulations are provided that include the influence of human presence on the landscape (the "people" files), and in a "world without humans" scenario (the "natural" files). Finally this archive contains the preindustrial reference simulation with and without human influence ("PI_reference_people" and "PI_reference_nat", respectively). There are therefore 22 netCDF files in this archive: 8 each of LGM simulations with and without people (total 16) and the "GCM mean" simulation (2 files) and the "LPJ mean" aggregate (2 files), and finally the two preindustrial "control" simulations ("PI"), with and without humans (2 files). In addition to the LPJ-LMfire model output (netCDF files), this archive also contains a table of arboreal pollen percent calculated from pollen samples dated to the LGM at sites throughout (lgmAP.txt), and a table containing the location of archaeological sites dated to the LGM (LGM_archaeological_site_locations.txt).

Infecções por enterobacteriaceae resistente aos carbapenêmicos em hospital de ensino: epidemiologia e caracterização molecular

Introduction: The production of KPC (Klebsiella pneumoniae carbapenemase) has become an important mechanism of carbapenem-resistance among Enterobacteriaceae strains. In Brazil, KPC is already widespread and its incidence has increased significantly, reducing treatment options. The “perfect storm” combination of the absence of new drug developmentand the emergence of multidrug-resistant strains resulted in the need for the use of older drugs, with greater toxicity, such as polymyxins. Aims: To determine the occurrence of carbapenemase-producing strains in carbapenem-resistant Enterobacteriaceae isolated from patients with nosocomial infection/colonization during September/2014 to August/2015, to determine the risk factors associated with 30-day- mortality and the impact of inappropriate therapy. Materials and Methods: We performed a case control study to assess the risk factors (comorbidities, invasive procedures and inappropriate antimicrobial therapy) associated with 30-day-mortality, considering the first episode of infection in 111 patients. The resistance genes blaKPC, blaIMP, blaVIM and blaNDM-1 were detected by polymerase chain reaction technique. Molecular typing of the strains involved in the outbreak was performed by pulsed field gel electrophoresis technique. The polymyxin resistance was confirmed by the microdilution broth method. Results: 188 episodes of carbapenem-resistant Enterobacteriaceae infections/colonizations were detected; of these, 122 strains were recovered from the hospital laboratory. The presence of blaKPC gene were confirmed in the majority (74.59%) of these isolates. It was not found the presence of blaIMP , blaVIM and blaNDM-1 genes. K. pneumoniae was the most frequent microorganism (77,13%), primarily responsible for urinary tract infections (21,38%) and infections from patients of the Intensive Care Unit (ICU) (61,38%). Multivariate statistical analysis showed as predictors independently associated with mortality: dialysis and bloodstream infection. The Kaplan-Meier curve showed a lower probability of survival in the group of patients receiving antibiotic therapy inappropriately. Antimicrobial use in adult ICU varied during the study period, but positive correlation between increased incidence of strains and the consumption was not observed. In May and July 2015, the occurrence rates of carbapenem-resistant Enterobacteriaceae KPC-producing per 1000 patient-days were higher than the control limit established, confirming two outbreaks, the first caused by colistin-susceptible KPC-producing K. pneumoniae isolates, with a polyclonal profile and the second by a dominant clone of colistin-resistant (≥ 32 μg/mL) KPC-producing K. pneumoniae. The cross transmission between patients became clear by the temporal and spatial relationships observed in the second outbreak, since some patients occupied the same bed, showing problems in hand hygiene adherence among healthcare workers and inadequate terminal disinfection of environment. The outbreak was contained when the ICU was closed to new admissions. Conclusions: The study showed an endemicity of K. pneumoniae KPC-producing in adult ICU, progressing to an epidemic monoclonal expansion, resulted by a very high antibiotic consumption of carbapenems and polymyxins and facilitated by failures in control measures the unit.

Parallel and Streaming Truth Discovery in Large-Scale Quantitative Crowdsourcing

ACKNOWLEDGEMENTS This research is based upon work supported in part by the U.S. ARL and U.K. Ministry of Defense under Agreement Number W911NF-06-3-0001, and by the NSF under award CNS-1213140. Any opinions, findings and conclusions or recommendations expressed in this material are those of the author(s) and do not necessarily reflect the views or represent the official policies of the NSF, the U.S. ARL, the U.S. Government, the U.K. Ministry of Defense or the U.K. Government. The U.S. and U.K. Governments are authorized to reproduce and distribute reprints for Government purposes notwithstanding any copyright notation hereon.

The Role of the Sentence-Tokened

Peer reviewed