Results of first stage brachiobasilic and brachiobrachial fistula creation: Implications for staged versus single procedure decision making

2021 ◽  
pp. 112972982110052
Author(s):  
Mary Ottinger ◽  
Desiree Picone ◽  
Katrina Hseih ◽  
Mathew Wooster ◽  
Mark J London ◽  
...  
Keyword(s):  
Decision Making ◽  
Operating Room ◽  
Senior Author ◽  
Two Stage ◽  
Second Stage ◽  
Single Procedure ◽  
Av Fistulas ◽  
Two Stages ◽  
Lost To Follow Up

Introduction: Transposed brachiobasilic AV fistulas (BVT) have increasingly been performed in two stages. Published reports give conflicting results, perhaps in part as many reports of staged procedures eliminate those patients who “fail” the first stage (i.e. are lost to follow-up in addition to anatomic failure). Methods: A prospectively maintained database was reviewed to identify all patients at two institutions who underwent the first stage of planned two-stage BVT by the senior author. Success in this context was defined as patients who eventually underwent second stage fistula creation, leaving the operating room after the second stage with a patent, transposed fistula. Results: From October 2012 to June 2020, 218 patients underwent first-stage procedures. At the first visit, 185 (85%) of fistulas were patent, 23 (11%) were occluded, 8 (4%) of patients were lost to follow-up, and 2 (1%) died. In the interval before the second operation, another eight (4%) patients were lost to follow-up, two were cancelled for medical reasons, and two declined surgery, leaving a total of 173 patients who made it to the second stage (80%). At operation, four patients were found to have unusable veins, leaving a total of 169 patients who completed both stages. If all patients who underwent first stage are included, 77% of patients entering this pathway left the OR after their second stage with patent access. If those lost to follow-up are excluded, this number increases to 84%, while if all those lost to follow-up are assumed to mature, success increases to 85%. Conclusions: Depending on results in patients lost to follow-up, between 77% and 85% of patients undergoing first stage brachiobasilic fistulae undergo successful second stage transposition. These numbers are equivalent or slightly lower than published maturation rates for single-stage BVT, so there is little margin for failure at the second stage.

A novel two-stage method of plant seedlings classification based on deep learning

2021 ◽  
pp. 1-11
Author(s):  
Tianhong Dai ◽  
Shijie Cong ◽  
Jianping Huang ◽  
Yanwen Zhang ◽  
Xinwang Huang ◽  
...  
Keyword(s):  
Deep Learning ◽  
Learning Technology ◽  
Two Stage ◽  
Second Stage ◽  
Stage Classification ◽  
Different Types ◽  
Two Stages ◽  
Plant Seedlings

In agricultural production, weed removal is an important part of crop cultivation, but inevitably, other plants compete with crops for nutrients. Only by identifying and removing weeds can the quality of the harvest be guaranteed. Therefore, the distinction between weeds and crops is particularly important. Recently, deep learning technology has also been applied to the field of botany, and achieved good results. Convolutional neural networks are widely used in deep learning because of their excellent classification effects. The purpose of this article is to find a new method of plant seedling classification. This method includes two stages: image segmentation and image classification. The first stage is to use the improved U-Net to segment the dataset, and the second stage is to use six classification networks to classify the seedlings of the segmented dataset. The dataset used for the experiment contained 12 different types of plants, namely, 3 crops and 9 weeds. The model was evaluated by the multi-class statistical analysis of accuracy, recall, precision, and F1-score. The results show that the two-stage classification method combining the improved U-Net segmentation network and the classification network was more conducive to the classification of plant seedlings, and the classification accuracy reaches 97.7%.

Validating the Excision of Cholesteatoma

1985 ◽  
Vol 93 (3) ◽  
pp. 288-292 ◽  
Author(s):  
Arnold G. Schuring ◽  
William H. Lippy
Keyword(s):  
Surgical Procedures ◽  
Radical Mastoidectomy ◽  
Hearing Results ◽  
Second Stage ◽  
Retraction Pockets ◽  
Third Stage ◽  
Second Procedure ◽  
Lost To Follow Up

In lieu of a radical mastoidectomy, 138 patients underwent a closed tympanomastoidectomy with subsequent staged surgical procedures until the excision of cholesteatoma could be validated. All the patients underwent two surgical procedures, 29% underwent three procedures, and 4% underwent four procedures. The surgical findings at the second procedure were: negative, 41.5%; retraction pockets, 7%; squamous pearls, 14%; recurrent cholesteatoma, 12%; and residual cholesteatoma, 25.5%. At each stage the likelihood of finding any form of cholesteatoma lessens. A conversion from a closed to an open mastoidectomy was necessary for 9% of the patients, and 4% were lost to follow-up. The opportunity to adjust the reconstructed ossicular assembly exists at each stage. With the use of semibiologic prostheses (ossicle cup and columella), the hearing results were: first stage, 67% within 20 dB, 84% within 30 dB; second stage, 77% and 90%; third stage, 77% and 96%.

Two-stage flexible warranty decision-making considering downtime loss

2019 ◽  
Vol 234 (3) ◽  
pp. 527-535
Author(s):  
Rui Zheng ◽  
Chun Su ◽  
Yuqiao Zheng
Keyword(s):  
Decision Making ◽  
Preventive Maintenance ◽  
Maintenance Cost ◽  
Service Cost ◽  
Decision Framework ◽  
Two Stage ◽  
Warranty Period ◽  
Second Stage ◽  
Warranty Service ◽  
Warranty Policies

Most existing warranty policies are rigid, and the downtime loss is also not taken into account. This study develops a two-stage decision framework to design flexible warranty policies, where the downtime loss is considered. In the first stage, by minimizing the warranty service cost, a fixed warranty policy is provided to determine the baseline of preventive maintenance’s times and effort. In the second stage, customers have three options to increase preventive maintenance times, preventive maintenance effort, or both of them, which results in three types of flexible warranty policies. The additional maintenance cost for the increased preventive maintenance times and/or preventive maintenance effort is paid by the customers. Besides, the flexible policies are optimized to minimize customer’s cost, which is the sum of the downtime loss and shared maintenance cost. A practical example is provided to illustrate the effectiveness of the proposed flexible warranty policies. The results indicate that compared with the fixed warranty policies, both the manufacturer and customers can benefit from the proposed flexible policies, especially when the downtime loss is substantial. Moreover, the proposed policy is more effective when the warranty period is longer.

Integrated Model for MCDM: Selection Contractor in Malaysian Construction Industry

2014 ◽  
Vol 548-549 ◽  
pp. 1587-1595
Author(s):  
Waled Alzober ◽  
Abdul Razak Yaakub
Keyword(s):  
Decision Making ◽  
Construction Industry ◽  
Construction Projects ◽  
Integrated Model ◽  
Decision Making Process ◽  
Contractor Selection ◽  
Second Stage ◽  
Proposed Model ◽  
Two Stages ◽  
Selection Of

A complex or unstructured problem is based on multi criteria not on a single criterion. A contractor selection problem is a multi-criteria problem. A correct decision-making is required for selecting the appropriate contractor for a construction project. Selection of a contractor is a key decision made by clients and the process of selection a contractor has become an important issue in construction projects. Many multi-criteria techniques have been proposed and applied to such problems solution. This paper aims to propose integrated model for MCDM. The integrated model contains two stages. First stage integrates two MCDM methods are AHP and ANN to prepare a shortlist of the best alternatives. Second stage apply statistical model COP to choose the optimum alternative from the best alternatives in a shortlist. Proposed model for tendering system provides automated a decision-making process that reduces the time and manpower requirements for processing tender

Hydroxyapatite-Coated Femoral Stem Survivorship at 10 Years

2005 ◽  
Vol 284-286 ◽  
pp. 1069-0 ◽  
Author(s):  
Gregory Y. Lee ◽  
Ajay Srivastava ◽  
Darryl D. D'Lima ◽  
Pam Pulido ◽  
Clifford W. Colwell
Keyword(s):  
Polyethylene Wear ◽  
Femoral Stem ◽  
Senior Author ◽  
Independent Observer ◽  
Long Term Follow Up ◽  
The Mean ◽  
Lost To Follow Up ◽  
Hip Arthroplasties

The Omnifit-HA femoral stem component has shown excellent results in early clinical studies. This is an independent prospective study of the outcome of a ydroxyapatite-coated femoral component implanted by one surgeon with an intermediate-term follow up. The senior author performed 103 consecutive uncemented total hip arthroplasties in 96 patients from July 1991 to December 1996. The components implanted were the Omnifit-HA femoral stem and the Omnifit PSL porous-coated acetabular shell. The mean age at the time of the index procedure was 52 years old (range, 27–78) and male:female ratio was 54:42. Three patients were deceased and four patients were lost to follow-up. The mean follow up was 10.3 years (range, 7.3–12.7 years). Clinical and radiographic evaluations were performed by an independent observer. The average preoperative and postoperative Harris Hip Scores were 55 and 92, respectively. The overall survivorship of the Omnifit-HA stem was 100% with no femoral revisions. The survivorship of the Omnifit PSL cup was 89.7% with 4 acetabular revisions for aseptic loosening and 6 polyethelene liner exchanges for osteolysis or late instability. The mean polyethylene wear rate was 0.24 mm per year. This long-term follow up shows that the use of circumferentially coated hydroxyapatite stems can protect against the migration of wear debris along the femoral stem.

Two stage regression model with constraints; admissible second stage parameter estimation

2013 ◽  
Vol 63 (3) ◽  
Author(s):  
Lubomír Kubáček
Keyword(s):  
Parameter Estimation ◽  
Regression Model ◽  
Two Stage ◽  
Second Stage ◽  
Regression Experiment ◽  
Two Stages

AbstractIf a regression experiment is realized in two stages, then two possibilities can occur in the second stage. Estimates of the first stage parameters either may be corrected by use of second stage measurements or they must stay unchanged. In the latter case, this requirement must be taken into account when estimating the second stage parameters. The situation is a little more complicated when constraints on both groups of parameters are imposed.

scholarly journals Repeat two-stage exchange arthroplasty for recurrent periprosthetic hip or knee infection: what are the chances for success?

2022 ◽  
Author(s):  
A. C. Steinicke ◽  
J. Schwarze ◽  
G. Gosheger ◽  
B. Moellenbeck ◽  
T. Ackmann ◽  
...  
Keyword(s):  
Risk Factors ◽  
Periprosthetic Joint Infection ◽  
Joint Infection ◽  
Rank Test ◽  
Success Rates ◽  
Two Stage ◽  
Second Stage ◽  
Exchange Arthroplasty ◽  
Parametric Testing

Abstract Introduction Two-stage revision is a frequently chosen approach to treat chronic periprosthetic joint infection (PJI). However, management of recurrent infection after a two-stage exchange remains debated and the outcome of a repeat two-stage procedure is unclear. This study investigates the success rates of repeat two-stage exchange arthroplasty and analyzes possible risk factors for failure. Materials and methods We retrospectively identified 55 patients (23 hips, 32 knees) who were treated with repeat resection arthroplasty and planned delayed reimplantation for recurrent periprosthetic joint infection between 2010 and 2019 after a prior two-stage revision at the same institution. The minimum follow-up was 12 months with a median follow-up time of 34 months (IQR 22–51). The infection-free survival, associated revision surgeries, and potential risk factors for further revision were analyzed using Kaplan–Meier survival curves and comparative non-parametric testing. Results 78% (43/55) underwent reimplantation after a repeat implant removal. Of those who completed the second-stage surgery, 37% (16/43) underwent additional revision for infection and 14% (6/55) underwent amputation. The reinfection-free implant survivorship amounted to 77% (95% CI 64–89%) after 1 year and 38% (95% CI 18–57%) after 5 years. Patients with a higher comorbidity score were less likely to undergo second-stage reimplantation (median 5 vs. 3, p = 0.034). Furthermore, obese patients (p = 0.026, Fisher’s exact test) and diabetics (p < 0.001, log-rank test) had a higher risk for further infection. Most commonly cultures yielded polymicrobial growth at the repeat two-stage exchange (27%, 15/55) and at re-reinfection (32%, 9/28). Pathogen persistence was observed in 21% (6/28) of re-reinfected patients. Conclusion The success rates after repeat two-stage exchange arthroplasty are low. Patients must be counseled accordingly and different modes of treatment should be considered.

scholarly journals Efficacy of Two-Stage Treatment of Onychomycosis Using a Long-Pulsed Nd:YAG 1064-nm Laser

2019 ◽  
Vol 2019 ◽  
pp. 1-6
Author(s):  
Shan Zhong ◽  
Guan-ting Lin ◽  
Jun-ying Zhao
Keyword(s):  
Laser Treatment ◽  
Clinical Efficacy ◽  
Nail Plate ◽  
Efficacy Rate ◽  
Treatment Schedule ◽  
Two Stage ◽  
Second Stage ◽  
Controlled Treatment ◽  
Stage 1

Objectives. Onychomycosis is a fungal infection of the nail bed, nail matrix, and nail plate. Lasers have recently been studied as future clinical options for onychomycosis. We sought to evaluate the efficacy of the long-pulsed Nd:YAG 1064-nm laser on onychomycosis using a two-stage treatment. Methods. A total of 100 affected nails (88 toenails and 12 fingernails from 22 patients) were treated using a long-pulsed Nd:YAG 1064-nm laser. The self-controlled treatment schedule included the first stage (1 session per week for 8 weeks) and the second stage (1 session every 4 weeks for 16 weeks). Patients were followed up with for 12 weeks after the last laser treatment. Direct microscopy, cultures, and clinical assessments were performed at various time points. Results. Of the nails studied, 84% were infected by Trichophyton rubrum, while others were coinfected with T. rubrum and other fugal strains. The mycological clearance rate and the clinical efficacy rate of the nails were 29% and 21% after the first stage, 69% and 35% after the second stage, and 67% and 39% during follow-up, respectively. The second stage of laser treatment significantly improved the mycological clearance and clinical efficacy. Conclusion. Long-pulsed Nd:YAG 1064-nm laser two-stage treatment was effective for onychomycosis, with significantly improved mycological clearance and clinical efficacy. This trial is registered with ChiCTR 1900021669.

Factors associated with failure to receive oral anticancer drugs.

2021 ◽  
Vol 39 (28_suppl) ◽  
pp. 41-41
Author(s):  
Sahil D Doshi ◽  
Morgan RL Lichtenstein ◽  
Melissa Parsons Beauchemin ◽  
Rohit R. Raghunathan ◽  
Cynthia Law ◽  
...  
Keyword(s):  
Decision Making ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Prior Authorization ◽  
Transfer Of Care ◽  
Factors Associated ◽  
Lost To Follow Up ◽  
Directed Change ◽  
To Receive

41 Background: Oral anti-cancer drugs (OACDs) have become increasingly prescribed over the last 10 years and require a significant amount of care coordination. Preliminary administrative database studies have shown that 10-15% of prescriptions are never received by the patient, but the reasons behind this are poorly understood. In this study, we prospectively identified failure to receive (FR) cases in which OACD prescriptions were never received by patients, examined underlying reasons for FR, and assessed clinical and process-related factors associated with FR. Methods: We prospectively collected data on new OACD prescriptions for adult oncology patients at a large, urban academic cancer center from 1/1/2018 to 12/31/2019. We collected patient demographic, clinical, and insurance data, OACD delivery date, and interactions with payers and financial assistance groups. FR was defined as failure to receive a prescribed OACD. Reasons for FR were confirmed by manual chart review and classified into seven categories: clinical deterioration, financial access, provider-driven clinical decision making, patient-directed change, transfer of care, lost to follow up, and other. We calculated the relative proportion of each FR category and used multivariable logistic regression to identify factors associated with FR, including initiation of a prior authorization and drug class. Results: The cohort included 1,080 patients who were prescribed 1,269 new OACDs. Of these prescriptions, 13% (N=163) were categorized as FR. Among the 158 patients with FR, average patient age was 66 years, 55% identified as non-Hispanic white, 61% had any Medicare plan, 11% had Medicaid only, and 25% had commercial insurance. Overall, 18% of FR cases were attributed to clinical deterioration, 13% to financial access, 29% to provider-driven clinical decision making, 17% to patient-directed change, 13% to transfer of care, and 5% were lost to follow up. Univariate analysis showed that FR was less likely in cases where prior authorization was initiated (p < 0.001) and multivariate analysis confirmed this result (OR 0.47 [CI 0.33-0.66], p < 0.001). Conclusions: Though the majority of oncology patients prescribed OACDs received the drug, 13% of patients in our study experienced FR. FR is associated with a lack of prior authorization initiation, which may reflect barriers to access, a change in clinical decision-making, or patient choice. Ultimately, FR is multifactorial and may be appropriate in some cases. More work is needed to determine whether improved access would increase uptake in some patients. [Table: see text]

scholarly journals Stateless Two-Stage Multiple Criteria Scheduling in Nuclear Medicine

2014 ◽  
Vol 2014 ◽  
pp. 1-6
Author(s):  
Shu-Yen Wan ◽  
Che-Yao Chang ◽  
Chun-Ling Wang ◽  
Kun-Ju Lin
Keyword(s):  
Decision Making ◽  
Nuclear Medicine ◽  
Greedy Algorithm ◽  
Clinical Condition ◽  
Time Slot ◽  
Linear Time ◽  
Multiple Criteria Decision Making ◽  
Multiple Criteria ◽  
Two Stage ◽  
Second Stage

Examination in nuclear medicine exhibits scheduling difficulties due to its intricate clinical issues, such as varied radiopharmaceuticals for different diseases, machine preparation and length of scan, and patients’ and hospital’s criteria and/or limitations. Many scheduling methods exist but are limited for nuclear medicine. In this paper, we present stateless two-stage scheduling to cope with multiple criteria decision making. The first stage mostly deals with patients’ conditions. The second stage concerns more the clinical condition and its correlations with patients’ preference which presents more complicated intertwined configurations. A greedy algorithm is proposed in the second stage to determine the (time slot and patient) pair in linear time. The result shows practical and efficient scheduling for nuclear medicine.

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