55,494 research outputs found
The UN-SUSTAINABLE Match in HCV Recipients. Evidences from the Italian D-MELD Study on Balancing Donor-Recipient Risk Factors
No full textThe UN-SUSTAINABLE Match in HCV Recipients. Evidences from the Italian D-MELD Study on Balancing Donor-Recipient Risk Factor
Public Private Partnership for Equitable Provision of Quality Health Services
No full textThis report presents the findings of an independent Technical Review that focused on the promotion of Public Private Partnership (PPP) for equitable provision of quality health services in Tanzania. The report is meant to contribute to the Annual Joint Health Sector Review 2005. The ToR has been broadly defined, signifying the interest that many stakeholders currently take in PPP. The Review Team (RT), with two international and three national consultants, undertook efforts to consult stakeholders for prioritisation of the issues included in the ToR. The RT had access to a large number of official documents such as laws, by-laws, policy documents, guidelines, etc. and a wide range of studies on PPP set in Tanzania complemented by international literature. The RT undertook efforts to interview relevant persons and committees, associations, organisations, ministries, donors, etc. at the national level as well as in four districts, two rural and two urban. Nevertheless, time constraints did force the RT to limit itself and consequently not all actors that constitute the private health sector could be contacted. It is hoped that the Annual Joint Health Sector Review 2005 will allow a representative participation of all actors in the field of PPP to discuss this review and compensate for any issue or actor that was left out unintended
Physics with polarized protons at HERA
No full textThe operation of HERA with polarized proton and electron beams will allow to study a wide variety of observables in polarized electron-proton collisions at #sq root#(s)=300 GeV. The physics prospects of this project have been elaborated in detail in a dedicated working group, whose results we summarize in this report. We show that several important and often unique measurements in spin physics could be made at HERA. These include measurements of the polarized structure function g_1(x,Q"2) at low x, a direct determination of the polarized gluon distribution #DELTA#G(x,Q"2) for the region 0.002<x<0.2 from polarized di-jet rates and hadrons with high p_t, polarized quark distributions from weak structure functions and semi-inclusive asymmetries, parton distributions in the polarized photon and information on the helicity structure of possible new physics at large Q"2. HERA could therefore make a significant contribution to our understanding of spin effects in high energy collisions and to the spin structure of the nucleon. (orig.)Available from TIB Hannover: RR 2999(97-233) / FIZ - Fachinformationszzentrum Karlsruhe / TIB - Technische InformationsbibliothekSIGLEDEGerman
Parton distributions
No full textParton distributions, α(χ,μ(^₂) are essential ingredients for almost all theoretical calculations at hadron colliders. They give the number densities of the colliding par- tons (quarks and gluons) inside their parent hadrons at a given momentum fraction χand scale μ(^₂). The scale dependence of the parton distributions is given by DGLAP evolution, while the X dependence must be determined from a global analysis of deep-inelastic scattering (DIS) and related hard-scattering data. In Part I we introduce ‘doubly-unintegrateď parton distributions, fa(x, z, k(^₂),μ(^₂)), which additionally depend on the splitting fraction z and the transverse momentum (k) associated with the last evolution step. We show how these distributions can be used to calculate cross sections for inclusive jet production in DIS and compare the predictions to data taken at the HERA ep collider. We then calculate the transverse momentum distributions of พ and z bosons at the Tevatron pp collider and of Standard Model Higgs bosons at the forthcoming LHC. In Part II we study diffractive DIS, which is characterised by a large rapidity gap between the slightly deflected proton and the products of the virtual photon dissociation. We perform a novel QCD analysis of recent HERA data and extract diffractive parton distributions. The results of this analysis are used to investigate the effect of absorptive corrections in inclusive DIS. These absorptive corrections are due to the recombination of partons within the proton and are found to enhance the size of the gluon distribution at small X. We discuss the problem that the gluon distribution decreases with decreasing X at low scales while the sea quark distribution increases with decreasing X, whereas Regge theory predicts that both should have the same small-X behaviour. Our study hints at the possible importance of power corrections at low scales of around 1 GeV
Photoproduction of multi-jet events at HERA: a Monte Carlo simulation
No full textWe study the regime of high-energy photoproduction, currently under exploration at the DESY ep Collider, HERA. In particular we discuss the possible production of more than one pair of 'back-to-back' jets which may occur at reasonably high-p_T as a consequence of the high parton density regime opened up at HERA centre-of-mass energies. We describe the construction of a multi-jet event generator based upon leading order QCD perturbation theory and an eikonal formalism, and show that the effect of multiple parton interactions on event shapes at HERA could indeed be significant. (orig.)Available from TIB Hannover: RA 2999(93-107) / FIZ - Fachinformationszzentrum Karlsruhe / TIB - Technische InformationsbibliothekSIGLEDEGerman
Sudden unexpected deaths and vaccinations during the first two years of life in Italy: a case series study.
No full textBACKGROUND: The signal of an association between vaccination in the second year of life with a hexavalent vaccine and sudden unexpected deaths (SUD) in the two days following vaccination was reported in Germany in 2003. A study to establish whether the immunisation with hexavalent vaccines increased the short term risk of SUD in infants was conducted in Italy.
METHODOLOGY/PRINCIPAL FINDINGS: The reference population comprises around 3 million infants vaccinated in Italy in the study period 1999-2004 (1.5 million received hexavalent vaccines). Events of SUD in infants aged 1-23 months were identified through the death certificates. Vaccination history was retrieved from immunisation registries. Association between immunisation and death was assessed adopting a case series design focusing on the risk periods 0-1, 0-7, and 0-14 days after immunisation. Among the 604 infants who died of SUD, 244 (40%) had received at least one vaccination. Four deaths occurred within two days from vaccination with the hexavalent vaccines (RR = 1.5; 95% CI 0.6 to 4.2). The RRs for the risk periods 0-7 and 0-14 were 2.0 (95% CI 1.2 to 3.5) and 1.5 (95% CI 0.9 to 2.4). The increased risk was limited to the first dose (RR = 2.2; 95% CI 1.1 to 4.4), whereas no increase was observed for the second and third doses combined.
CONCLUSIONS: The RRs of SUD for any vaccines and any risk periods, even when greater than 1, were almost an order of magnitude lower than the estimates in Germany. The limited increase in RRs found in Italy appears confined to the first dose and may be partly explained by a residual uncontrolled confounding effect of age
All repair and reconstruction. Techniques from the SANTI study group
No full textBackground: Combining an anterior cruciate ligament (ACL) reconstruction with an anterolateral ligament (ALL) reconstruction results in significant advantages including reduced graft rupture rates, a lower risk of reoperation for secondary meniscectomy, improved knee stability, and higher rates of return to preinjury levels of sport. Indications: The previously reported indications for combined ACL and ALL reconstruction are as follows: ACL reconstruction revision; high-grade pivot shift test; long-term ACL rupture; young patients; pivoting activities; concomitant medial meniscus repair, and, specifically, regarding the ALL repair, it must be an acute surgery (within 15 days from injury). Technique Description: Several modern techniques have been described to repair and reconstruct the ALL. This technical note details a number of these techniques performed by the Scientific Anterior Cruciate Ligament Network International (SANTI) Study Group. Results: First, we describe a combined ACL reconstruction and double-bundle ALL reconstruction using hamstring autograft. Secondly, we describe a single-bundle ALL reconstruction using gracilis autograft. Thirdly, we describe an ALL reconstruction technique using a knotless soft anchor, which provides shallow fixation and prevents tunnel convergence. Finally, we describe a technique for ALL repair. Conclusion: Several techniques have been described to repair and reconstruct the ALL, all offering significant advantages over an isolated ACL reconstruction. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication
Robust automated detection of microstructural white matter degeneration in Alzheimer’s disease using machine learning classification of multicenter DTI data
No full textDiffusion tensor imaging (DTI) based assessment of white matter fiber tract integrity can support the diagnosis of Alzheimer’s disease (AD). The use of DTI as a biomarker, however, depends on its applicability in a multicenter setting accounting for effects of different MRI scanners. We applied multivariate machine learning (ML) to a large multicenter sample from the recently created framework of the European DTI study on Dementia (EDSD). We hypothesized that ML approaches may amend effects of multicenter acquisition. We included a sample of 137 patients with clinically probable AD (MMSE 20.6±5.3) and 143 healthy elderly controls, scanned in nine different scanners. For diagnostic classification we used the DTI indices fractional anisotropy (FA) and mean diffusivity (MD) and, for comparison, gray matter and white matter density maps from anatomical MRI. Data were classified using a Support Vector Machine (SVM) and a Naïve Bayes (NB) classifier. We used two cross-validation approaches, (i) test and training samples randomly drawn from the entire data set (pooled cross-validation) and (ii) data from each scanner as test set, and the data from the remaining scanners as training set (scanner-specific cross-validation). In the pooled cross-validation, SVM achieved an accuracy of 80% for FA and 83% for MD. Accuracies for NB were significantly lower, ranging between 68% and 75%. Removing variance components arising from scanners using principal component analysis did not significantly change the classification results for both classifiers. For the scanner-specific cross-validation, the classification accuracy was reduced for both SVM and NB. After mean correction, classification accuracy reached a level comparable to the results obtained from the pooled cross-validation. Our findings support the notion that machine learning classification allows robust classification of DTI data sets arising from multiple scanners, even if a new data set comes from a scanner that was not part of the training sample
Effectiveness of brief schema group therapy for borderline personality disorder symptoms : a randomized pilot study
No full textBackground and objectives Schema group therapy is a potentially cost-effective treatment for borderline personality disorder (BPD). We piloted the feasibility and effectiveness of a 20-session schema group therapy without individual therapy among psychiatric BPD outpatients in a randomized pilot study registered as a clinical trial (ISRCTN76381242). Methods Altogether 42 psychiatric outpatients diagnosed with BPD were randomized 2:1 to a 20-session weekly schema group therapy plus treatment as usual (TAU) (n = 28) vs. a control group with TAU alone (n = 14). The primary outcome was decline of BPD symptoms in the short Borderline Symptom List (BSL-23) score. Secondary outcomes were decline in symptoms of anxiety, depression, alcohol use, and improvement in functioning and schema modes. Two external experts evaluated validity of the intervention based on videotaped sessions. Results Overall, 23 schema group therapy patients (82%) and 12 controls (86%) completed their treatment. Treatment validity good or very good. However, no significant differences emerged in the primary outcome mean BSL-23 decline (6.95 [SE 5.91] in group schema therapy vs. 12.55 [4.85] in TAU) or in any of the secondary outcome measures. Limitations Despite randomization, the TAU subgroup had non-significantly higher baseline scores in most measures. Small sample size predisposing to type II errors; reliance on self-reported outcomes. Conclusions Schema group therapy was feasible for psychiatric outpatients with BPD. However, in this small pilot study we did not find it more effective than TAU. Effectiveness of this short intervention remains open.Peer reviewe
Pulse oximetry adoption and oxygen orders at paediatric admission over 7 years in Kenya: a multihospital retrospective cohort study
No full textObjectives To characterise adoption and explore specific clinical and patient factors that might influence pulse oximetry and oxygen use in low-income and middle-income countries (LMICs) over time; to highlight useful considerations for entities working on programmes to improve access to pulse oximetry and oxygen.
Design A multihospital retrospective cohort study.
Settings All admissions (n=132 737) to paediatric wards of 18 purposely selected public hospitals in Kenya that joined a Clinical Information Network (CIN) between March 2014 and December 2020.
Outcomes Pulse oximetry use and oxygen prescription on admission; we performed growth-curve modelling to investigate the association of patient factors with study outcomes over time while adjusting for hospital factors.
Results Overall, pulse oximetry was used in 48.8% (64 722/132 737) of all admission cases. Use rose on average with each month of participation in the CIN (OR: 1.11, 95% CI 1.05 to 1.18) but patterns of adoption were highly variable across hospitals suggesting important factors at hospital level influence use of pulse oximetry. Of those with pulse oximetry measurement, 7% (4510/64 722) had hypoxaemia (SpO2 <90%). Across the same period, 8.6% (11 428/132 737) had oxygen prescribed but in 87%, pulse oximetry was either not done or the hypoxaemia threshold (SpO2 <90%) was not met. Lower chest-wall indrawing and other respiratory symptoms were associated with pulse oximetry use at admission and were also associated with oxygen prescription in the absence of pulse oximetry or hypoxaemia.
Conclusion The adoption of pulse oximetry recommended in international guidelines for assessing children with severe illness has been slow and erratic, reflecting system and organisational weaknesses. Most oxygen orders at admission seem driven by clinical and situational factors other than the presence of hypoxaemia. Programmes aiming to implement pulse oximetry and oxygen systems will likely need a long-term vision to promote adoption, guideline development and adherence and continuously examine impact
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