Development and validation of prediction rules to target care intensification in veteran patients with diabetes

BackgroundDiabetes affects 30.3 million people in the USA. Among these people, a major risk factor for microvascular complications is having a glycated haemoglobin (HbA1c) value of ≥75 mmol/mol; therefore, it would be helpful to identify patients who will obtain future HbA1c values of <75 mmol/mol.ObjectivesTo develop and validate two prediction rules among patients with diabetes having a baseline HbA1c value of ≥75 mmol/mol: (1) HbA1c measurement ever <75 mmol/mol and (2) final HbA1c measurement of <75 mmol/mol.MethodsRetrospective cohort study using a registry extracting data from the Department of Veterans Affairs’s (VA’s) electronic health records system. Baseline was 1 Jul 2013–30 June 2014; patients were followed up until 31 July 2016.ResultsOur population consisted of 145 659 patients. Across models, predictors were age, sex, minority status, baseline HbA1c value, time, HbA1c≥75 mmol/mol, receiving insulin treatment and consecutive number of HbA1c values of 75 mmol/mol. The overall likelihood of a patient ever having an HbA1c<75 mmol/mol was 73.65%; with the rule, predicted probabilities were 38.94%, 50.75% and 78.88%. The overall likelihood of patients having a final HbA1c measurement of <75 mmol/mol was 55.35%; the rule provided predicted probabilities of 29.93%, 50.17% and 68.58%.ConclusionsWithin each rule, there were similar observed and predicted tertile probabilities; maintaining HbA1c values of <75 mmol/mol resulted in probability shifts in the majority of patients. We recommend psychosocial screening for 15% of patients for whom there is less than one-third chance of maintaining HbA1c<75 mmol/mol. We plan to conduct additional research to see whether this approach helps.

Effect of Radiofrequency Ablation (RFA) on Cutaneous Manifestations of Varicose Vein

Introduction: The varicose vein is a common chronic vascular disease affecting people with predisposing factors like restricted mobility, pregnancy, obesity, and long-standing jobs. According to CEAP (Clinical, Etiological, Anatomical, and Pathological) classification, there are six categories of CEAP ranging from C0 or no sign to C6 or active ulceration of the vein. Radiofrequency Ablation (RFA) is the minimally invasive procedure to manage varicose vein. This study aims to assess cutaneous manifestation and quality of life among participants who underwent RFA in the Dhulikhel Hospital. Methodology: This study is retrospective review of the clinical and surgical report of 171 consecutive number of patients admitted with varicose veins and treated with Radio Frequency Ablation from January 2015 to December 2016. The cutaneous manifestation of all the patients were noted prior to surgery and were followed up in two months to note the manifestation again. Results: The total number of patients were171 with 79 male (46.2%) and 92 female (53.8%). The mean age was 48.9 years (S.D. 6.8). In pre-ablative stage, there were 42.1% patients in C4 stage, 30.4% patients in C3 stage, 16.4% in C2 stage. In post-ablative stage, there were 39.8% patients in C4 stage, 16.4% in C1 and 11.7% in C2 stage. In 53.8% of patients, there was a decrease in C stage postoperatively. Findings of this study are encouraging in terms of C staging after RFA, and it paves the way for further exploration of RFA.

A statistical analysis on the effect of preceding dry weather on sewer blockages in South Wales

Water and sewerage companies (WaSC) in the UK are under increasing pressures to improve customer satisfaction. The biggest cause for customer dissatisfaction in the wastewater sector is a service failure caused by a blockage. There is therefore a need to understand the factors which influence blockage processes in order to prevent them. This work demonstrates how preceding rainfall impacts the sewer system of two highly populated regions within South Wales that have differing gradients. The total rainfall, number of dry days and consecutive number of dry days prior to a blockage were investigated using statistical analysis in order to determine the impact that rainfall has on blockages. The results obtained demonstrate the importance that dry weather has on blockage rates in both steep and flat catchments. Future work will incorporate predicted rainfall impact into a proactive maintenance scheduling model.

Instantaneous Quantum Description of Photonic Wavefronts and Applications

By imposing the condition of non-vanishing expectation values for the amplitude and phase of field operators, pure quantum states are identified composed of two consecutive number states.&nbsp; These pure states also deliver noise-free radiation modes restricting the &ldquo;half-photon noise&rdquo; to the expectation value of the lowest level of dynamic and coherent number states. As a result, instantaneous phase-sensitive amplification of photons is easily controlled&nbsp;&nbsp; and&nbsp;&nbsp; direct evaluation of time or distance - varying wavefront distributions of photons and phases can be carried out for sub-Poissonian distributions of photons without the need for quasi-probabilities.

U-Shaped Relationship Between Functional Outcome and Serum Uric Acid in Ischemic Stroke

Background/Aims: We sought to assess a consecutive number of patients with first-ever acute ischemic stroke (AIS), the clinical relevance in regard to functional outcome of the serum uric acid (SUA) measured at admission. Methods: In 2 prospective centers for observational study, serum concentrations of SUA were measured on admission in the serum of 710 consecutive patients with AIS. SUA concentrations were determined by high-performance liquid chromatography. SUA, NIH stroke scale (NIHSS), and conventional risk factors were evaluated to determine their value to predict functional outcome within 3 months. Results: During the follow-up, an unfavorable functional outcome (defined as a mRS score > 2) was found in 219 (30.8%) patients. The unfavorable functional outcome distribution across the SUA quartiles ranged between 12.4% (third quartile) and 50.6% (first quartile). After adjusting for all other significant outcome predictors, SUA concentration remained an independent unfavorable outcome predictor with an adjusted OR of 0.996 (95% CI, 0.993-0.998; P< 0.001). Conclusions: The data show that the U-shaped nature of the exposure-risk relationship was more prominent when the data were assessed in deciles (based on the SUA values). This model predicted the lowest relative risk of unfavorable outcome in the 67th percentile (corresponding to 309 µmol/L). SUA was significantly associated with the risk of poor functional outcomes in Chinese patients with stroke.

Variations on the Theme of Synaptic Filtering: A Comparison of Integrate-and-Express Models of Synaptic Plasticity for Memory Lifetimes

Integrate-and-express models of synaptic plasticity propose that synapses integrate plasticity induction signals before expressing synaptic plasticity. By discerning trends in their induction signals, synapses can control destabilizing fluctuations in synaptic strength. In a feedforward perceptron framework with binary-strength synapses for associative memory storage, we have previously shown that such a filter-based model outperforms other, nonintegrative, “cascade”-type models of memory storage in most regions of biologically relevant parameter space. Here, we consider some natural extensions of our earlier filter model, including one specifically tailored to binary-strength synapses and one that demands a fixed, consecutive number of same-type induction signals rather than merely an excess before expressing synaptic plasticity. With these extensions, we show that filter-based models outperform nonintegrative models in all regions of biologically relevant parameter space except for a small sliver in which all models encode memories only weakly. In this sliver, which model is superior depends on the metric used to gauge memory lifetimes (whether a signal-to-noise ratio or a mean first passage time). After comparing and contrasting these various filter models, we discuss the multiple mechanisms and timescales that underlie both synaptic plasticity and memory phenomena and suggest that multiple, different filtering mechanisms may operate at single synapses.

A set of free cross-platform authoring programs for flexible web-based CALL exercises

<p>The Mango Suite is a set of three freely downloadable cross-platform authoring programs for flexible network-based CALL exercises. They are Adobe Air applications, so they can be used on Windows, Macintosh, or Linux computers, provided the freely-available Adobe Air has been installed on the computer. The exercises which the programs generate are all Adobe Flash based. The three programs are: (1) Mango-multi, which constructs multiple-choice exercises with an optional sound and/or image; (2) Mango-match, which is for word/phrase matching exercises, and has an added feature intended to promote memorization, whereby an item must be matched correctly not once but an optional consecutive number of times; (3) Mango-gap, which produces seamless gap filling exercises, where the gaps can be as small as desired, down to the level of individual letters, and correction feedback is similarly detailed. Sounds may also be inserted at any desired points within the text, so that it is suitable for listening or dictation exercises. Each exercise generated by any of the programs is produced in the form of a folder containing all of the necessary files for immediate upload and deployment (except that if sound files are used in a Mango-gap exercise, they must be copied to the folder manually). The html file in which the flash exercise is embedded may be edited in any way to suit the user, and an xml file controlling the appearance of the exercise itself may be edited through a wysiwyg interface in the authoring program. The programs aim to combine ease of use with features not available in other authoring programs, toprovide a useful teaching and research tool.</p>