Probability of mortality of critically ill cancer patients at 72?h of intensive care unit (ICU) management

Goals To develop and validate a model for probability of hospital mortality for cancer patients at 72 h of intensive care unit (ICU) management.Patients and methods This is an inception cohort study performed at four ICUs of academic medical centers in the United States. Defined continuous and categorical variables were collected on consecutive patients with cancer admitted to the ICU. A preliminary model was developed from 827 patients and then validated on an additional 415 patients. Multiple logistic regression modeling was used to develop the models, which were subsequently evaluated for discrimination and calibration. The main outcome measure is in-hospital death.Results A probability of mortality model, which incorporates ten discrete categorical variables, was developed and validated. All variables were collected at 72 h of ICU care. Variables included evidence of disease progression, performance status before hospitalization, heart rate >100 beats/min, Glasgow coma score 5, mechanical ventilation, arterial oxygen pressure/fractional inspiratory oxygen (PaO₂/FiO₂) ratio <250, platelets <100 k/µl, serum bicarbonate (HCO₃)<20 mEq/l, blood urea nitrogen (BUN) >40 mg/dl, and a urine output of <150 ml for any 8 h in the previous 24 h. The p values for the fit of the preliminary and validation models were 0.535 and 0.354 respectively, and the areas under the receiver operating characteristic (ROC) curves were 0.809 and 0.820.Conclusions We report a multivariable logistic regression model to estimate the probability of hospital mortality in critically ill cancer patients at 72 h of ICU care. The model is comprised of ten unambiguous and readily available variables. When used in conjunction with clinical judgment, this model should improve discussions about goals of care of these patients. Additional validation in a community hospital setting is warranted.Funding for initiation and coordination of this project was provided by Memorial Sloan Kettering Cancer Center. Participating institutions providing resources for site-specific data collection. This paper was presented in part at the annual meeting of the American Society of Clinical Oncology in May, 2001 held in San Francisco, CA, USA     

Slot Machine Structural Characteristics: Creating Near Misses Using High Award Symbol Ratios

A near miss is a failure that was close to a win. In this paper we analyze the primary documents associated with a case that was brought before the Nevada Gaming Commission in 1988. This case resulted in the 1989 ruling that the proprietary computer algorithms used by one slot machine manufacturer to create a high number of near misses on the payline are “unacceptable,” whereas the use of virtual reel mapping to create near misses above and below the payline is acceptable. We show how, before and after 1989, slot machine manufacturers use virtual reels and a technique called “award symbol ratio” to create a high number of near misses above and below the payline and how this acceptable practice has the unintended effect of also creating near misses on the payline which can be explained by a software concept called feature interaction. The paper concludes with a discussion of the implications of near misses for problem gambling.     

血红蛋白测定室内质控方法的设计

目的 从临床或医学实用性质量要求的角度，设计血红蛋白测定中的质控方法，即确定质控规则和质控测定值的个数。方法 设计质控方法的步骤：(1)以“允许总误差”形式规定质量要求；(2)确定该测定方法稳定操作下的不精密度或标准差(s)和不准确度(偏差)；(3)计算试验的临界系统误差和随机误差；(4)评价候选质控方法的误差检出概率(Ped)和假失控概率(Pfr)。结果 将这一设计方法应用于血红蛋白测定，结果表明用13a质控规则(N=1)能容易地达到90％以上的误差检出目标。结论 本质控方法对于临床检验项目具有广泛的适用性。     

Mixed dentition space analysis in Egyptian children

This study was done to examine the applicability of the Tanaka and Johnston and Moyers’ methods of prediction in Egyptian population and to develop a new prediction method for this specific population if necessary. A total of 325 Egyptian students 145 female, 180 male, mean age 14.4 years, SD±1.1 years were randomly selected from 10 preparatory and secondary schools in Mansoura city, Dakahlia governorate, Egypt during the academic year 2008–2009. The mesiodistal crown diameters of the permanent teeth were measured and compared with the predicted values derived from the Tanaka and Johnston's equations and from Moyers’ probability tables at 35%, 50% and 75%. Significant sexual dimorphism was found in tooth sizes. There were significant differences between the actual measurements and that derived from the Tanaka and Johnston's equation and Moyers’ tables. New linear regression equations were derived for both genders to allow accurate tooth size prediction in Egyptians. The correlation coefficients between the total mesiodistal width of the mandibular permanent incisors and that of the maxillary and mandibular canines and premolars were found to be 0.78 and 0.89 in male and 0.63 and 0.87 in female, respectively. It can be concluded that there is a limitation in the application of the Tanaka and Johnston's and Moyers’ prediction methods to Egyptian population. The developed prediction equation is more accurate for predicting the mesiodistal widths of unerupted canine and premolars of Egyptian population.     

输血感染艾滋病病毒1型母婴传播概率回顾性定群研究

目的 研究HIV-1型母婴传播率.方法 对某市8个乡全部居民普查出的63例一次性输血感染HIV的母亲及其子女进行研究,调查母亲的受血时间、子女的出生时间、出生方式、母乳喂养等情况.母亲输血感染HIV的84名子女作为母婴传播的观察对象,采集的血清标本用ELISA法进行HIV抗体初筛,用Western-blot法进行确证.结果 存在母婴传播危险因素的子女母婴感染率为32.1%(27/84).存在宫内、分娩、母乳3个因素和存在分娩、母乳2个因素的感染率分别为36.8%(7/19)和35.7%(5/14),存在宫内、分娩2个因素的感染率为14.3%(2/14);单纯母乳喂养感染率为37.9%(11/29).经合并分析,存在母乳喂养因素的母婴传播组HIV-1感染率(36.9%,24/65)显著高于人工喂养的母婴传播组(11.8%,2/17).结论 一次性输血感染HIV的母亲,母婴感染率因传播危险因素不同而有所不同,母乳喂养在母婴传播HIV中具有重要作用.     

An investigation of whether patients with post-traumatic stress disorder overestimate the probability and cost of future negative events

This study compared estimations of the probability and cost of negative events occurring made by patients with post-traumatic stress disorder (PTSD) (n=43), patients with other anxiety disorders (n=29) and non-patients' (n=35). Prior to treatment PTSD patients overestimated the probability and cost of all types of traumatic events occurring relative to non-patients, and overestimated the probability and cost of the specific type of traumatic event that they had been traumatized by relative to the anxious controls as well as non-patients. These judgment biases were specific to traumatic events and did not generalise to all negative events. PTSD patients' estimations of the probability and cost of traumatic events were significantly reduced following treatment, and were no longer significantly different from those of non-patients. Results suggest that patients with PTSD show specific judgment biases in the estimation of probability and cost, which can be successfully modified by cognitive therapy.     

儿童疫苗接种率调查抽样方法的评价

目的比较三种接种率调查抽样方法的结果,以期选择最适宜现阶段的接种率调查抽样方法。方法分别采用PPS法、系统抽样法和分层整群抽样法对天津市1～2岁儿童建卡率、建证率、卡证符合率、计划免疫疫苗接种率,以及乙肝首针及时接种率、麻疹疫苗及时接种率进行调查比较,计算率进行χ2检验。结果 PPS法调查适龄儿童2 695人、系统抽样法调查适龄儿童1 073人、分层整群抽样法调查适龄儿童192人。PPS法、系统抽样法和分层整群抽样法调查的建证率两两比较差异无统计学意义(χ2=0.794,P>0.05;χ2=0.003,P>0.05;χ2值=0.15,P>0.05),建卡率比较差异有统计学意义(χ2=12.25,P<0.05;χ2=194.85,P<0.05;χ2=24.652,P<0.05)。系统抽样法调查的儿童建卡率、建证率、卡证符合率、五苗合格接种率、卡介苗接种率、脊灰疫苗接种率、百白破疫苗接种率、麻疹疫苗接种率、乙肝疫苗接种率、乙肝首针及时接种率、麻疹疫苗及时接种率与PPS法结果进行比较,除脊灰疫苗接种率差异有统计学意义外,其他差异均无统计学意义。而分层整群抽样法调查的结果与PPS法相比较,除百白破疫苗接种率和麻疹疫苗首针及时接种率差异无统计学意义以外,其他差异均有统计学意义。系统抽样法和分层整群抽样法调查结果比较,除脊灰疫苗接种率、百白破疫苗接种率和麻疹疫苗首针及时接种率差异无统计学意义意外,其他差异均有统计学意义。PPS法和系统抽样法调查的结果一致率达到87.5%。结论与抗体水平监测相比接种率调查也能相对客观的反映儿童的接种水平。在高接种率状态下,系统抽样法和PPS法所得结果一致,为节省人力物力能用系统抽样法替代PPS法。分层整群抽样法更能发现工作中存在的问题和不足,可用于考核基层工作。     

Non-Gaussian heart rate as an independent predictor of mortality in patients with chronic heart failure

BACKGROUND: Morbidity and mortality due to chronic heart failure remain unacceptably high despite effective drug therapies, and the search for a better risk predictor is ongoing. Statistics derived from beat-to-beat fluctuations in heart rate or heart rate variability (HRV) have been used for this purpose, but the current predictability level is low or moderate at best. OBJECTIVE: The purpose of this study was to evaluate whether a recently proposed non-Gaussian index of HRV is a significant and independent mortality predictor in patients with congestive heart failure (CHF). METHODS: Twenty-four-hour Holter ECGs from 108 CHF patients were evaluated. Thirty-nine (36.1%) of the patients died during the follow-up period of 33 +/- 17 months. Cox proportional hazards regression analysis was performed to determine factors related to all-cause mortality. The factors evaluated derived from clinical information, including plasma brain natriuretic peptide, conventional time- and frequency-domain and fractal HRV measures, and a recently proposed non-Gaussian index lambda of HRV. RESULTS: The short-term (<40 beats) non-Gaussian index lambda(40) (hazard ratio per increment of unit standard deviation 1.64, 95% confidence interval [1.23, 2.18], P <.001) and the long-term (<1,000 beats) index lambda(1000) (hazard ratio 1.42, 95% confidence interval [1.07, 2.18], P <.02), together with brain natriuretic peptide (hazard ratio 2.26, 95% confidence interval [1.45, 3.53], P <.001), are significant univariate risk predictors of mortality. In a multivariate model, lambda(40) (1.49, [1.13, 1.96], P <.005) and brain natriuretic peptide (2.39, [1.53, 3.75], P <.001) are independent predictors of the survival statistics of patients. None of the conventional HRV measures have predicted the mortality of patients in a significant and independent manner. CONCLUSION: The results of this study indicate the usefulness of the short-term non-Gaussian index of HRV for risk prediction in patients with CHF.     

Influence of neurotransplantation on rats'' behavior with different conditions of reinforcement

Recently, we have reported a marked rat lateralization in the T-maze choice. Embryonic rat tissue from neocortex, hippocampus, hypothalamus and amygdala was transplanted into intact rat brains in various combinations: 1) neocortex and hypothalamus (Neo + Hyp); 2) hippocampus and amygdala (Hipp + Amyg); 3) neocortex and hippocampus (Neo + Hipp); and 4) hypothalamus and amygdala (Hyp + Amyg). Once under conditions in which reinforcement was equally qualitative and equally probable, rats in all groups chose the T-maze arm contralateral to the side of implantation. In a second set of experiments, rats were presented a choice between quality and probability of reinforcement. The right arm of the T-maze contained a cup of water 33% of the time (high-quality but low-probability reinforcement). The left sleeve contained a solution of 0.15% quinine in water 100% of the time (low quality but high probability of reinforcement). Rats that received Neo + Hyp transplants chose the T-maze arm that always contained a drink cup with water significantly more often than they chose the arm that always contained the drink cup with quinine solution. Rats that received Hipp + Amyg transplants chose the arm containing the drink cup with quinine solution much more often than the arm that sometimes contained a cup of water. Rats with transplanted Neo + Hyp generally were more active than rats with transplanted Hipp + Amyg. These data suggest that the behavior of rats can be affected by selective transplantation of different brain tissue.