To analyze clinical presentation, modes of detection, growth pattern, operative findings, and results of surgery in children 3 years old or older who had extensive congenital cholesteatoma ...(keratoma).
Survey, case series.
Two academically affiliated medical centers: a children's hospital and an eye, ear, and throat hospital, both located in major metropolitan cities.
Twenty-five children selected according to specified criteria.
Tympanomastoid surgery, ie, canal wall up and canal wall down, some with ossicular reconstructive surgery.
Audiologic assessment (speech reception threshold) and recurrence (recidivism) of cholesteatoma.
Incidence of recidivism, 52%. Hearing maintained within the range of normal to mild hearing impairment postoperatively in 91% of the patients for whom complete data are available.
Congenital cholesteatoma may grow for years without causing signs or symptoms and, having grown without early detection, can extend to involve the epitympanum and mastoid antrum, cause ossicular erosion, and even extend to the middle cranial fossa. To adequately remove a congenital cholesteatoma that has gone undetected for many years, exposure of the anterior epitympanum is often necessary and removal of both the body of the incus and the head of the malleus often is required. Since congenital cholesteatoma usually develops in a child with a well-pneumatized mastoid that would create a large mastoid bowl if exteriorized, the otologic surgeon is likely to hesitate in using the canal wall down mastoidectomy technique. Alternatives to the canal wall down mastoidectomy technique, which can achieve reasonably good hearing results and avoid creation of a large mastoid bowl, include planned two-stage canal wall up surgery or canal preservation with primary reconstruction and close follow-up with otomicroscopy and serial computed tomographic scans.
Predicting the future risks of stroke for patients is in high demands. In this paper, we proposed a model predictive of risks of stroke in future 1 year's period for patients across all age, all ...payor, and all disease groups in Maine, using demographics and clinical histories extracted from Electronic Medical Record (EMR) and clinical notes provided by Health Information Exchange (HIE). A retrospective cohort of 180,196 patients and a prospective cohort of 347,504 patients were constructed for model development and validation, respectively. A logistic regression model based on multivariate analysis was built for risk prediction. The model had a c-statistic of 0.887 in prospective testing, resulting in a sensitivity of 0.410 at a positive predictive value (PPV) of 0.262. Integration of this early-warning system into online patient monitoring platforms enables better management of population with chronic conditions.
Chronic kidney disease (CKD) is a major public health concern in the United States with high prevalence, growing incidence, and serious adverse outcomes.
We aimed to develop and validate a model to ...identify patients at risk of receiving a new diagnosis of CKD (incident CKD) during the next 1 year in a general population.
The study population consisted of patients who had visited any care facility in the Maine Health Information Exchange network any time between January 1, 2013, and December 31, 2015, and had no history of CKD diagnosis. Two retrospective cohorts of electronic medical records (EMRs) were constructed for model derivation (N=1,310,363) and validation (N=1,430,772). The model was derived using a gradient tree-based boost algorithm to assign a score to each individual that measured the probability of receiving a new diagnosis of CKD from January 1, 2014, to December 31, 2014, based on the preceding 1-year clinical profile. A feature selection process was conducted to reduce the dimension of the data from 14,680 EMR features to 146 as predictors in the final model. Relative risk was calculated by the model to gauge the risk ratio of the individual to population mean of receiving a CKD diagnosis in next 1 year. The model was tested on the validation cohort to predict risk of CKD diagnosis in the period from January 1, 2015, to December 31, 2015, using the preceding 1-year clinical profile.
The final model had a c-statistic of 0.871 in the validation cohort. It stratified patients into low-risk (score 0-0.005), intermediate-risk (score 0.005-0.05), and high-risk (score ≥ 0.05) levels. The incidence of CKD in the high-risk patient group was 7.94%, 13.7 times higher than the incidence in the overall cohort (0.58%). Survival analysis showed that patients in the 3 risk categories had significantly different CKD outcomes as a function of time (P<.001), indicating an effective classification of patients by the model.
We developed and validated a model that is able to identify patients at high risk of having CKD in the next 1 year by statistically learning from the EMR-based clinical history in the preceding 1 year. Identification of these patients indicates care opportunities such as monitoring and adopting intervention plans that may benefit the quality of care and outcomes in the long term.
Understanding the future costs of the healthcare service utilization in patients can benefit the resource allocation management. The aim of this study is to develop a risk stratification model for ...healthcare resource utilization in future 6 months of patients in the state of Maine. A retrospective cohort of 1,273,114 patients was constructed to derive a decision-tree-based model to estimate the risk of resource utilization between January 1, 2013 and June 30, 2013, using the preceding 12-month clinical historical data. The model was validated with a prospective cohort of 1,358,153 patients by testing total costs between July 1, 2013 and December 31, 2013. Prospective results showed that the sensitivities of the model varied between 0.057 and 0.800, with confidence levels varying between 0.858 and 0.937 at all risk levels. Potential economic impacts of the model on healthcare resource utilization were explored. Future applications of our model will enable a more efficient resource allocation and targeted care intervention.
Eleven morphological variables were measured or scored on 12 groups belonging to Elphidium and two belonging to Haynesina. The 14 groups were compared along canonical axes. The mean canonical ...variates for the groups E. cf. mexicanum and E. mexicanum are so close we consider them conspecific. E. discoidale, E. gunteri, E. advenum, and E. mexicanum are clearly discriminated from the other groups. E. margaritaceum, E. excavatum, and H. orbiculare are fairly well discriminated from the others. The remaining six groups form two overlapping sets. One set contains E. bartletti, E. frigidum, and E. subarcticum, while the other contains E. williamsoni, E. excavatum (deep), and H. germanica. Two more analyses were made on these overlapping sets and the results indicate each of the groups can be discriminated. We conclude each group is a separate species, with the exception of E. excavatum (deep) which we regard as conspecific with E. excavatum. The specimens from 1,530 m depth simply do not exhibit as much variation as the specimens from shallower water used in the group E. excavatum. This suggests that not only species, but also some morphological groups can be used as ecological indicators.
Geographic Origin of Benthic Foraminiferal Species Buzas, Martin A.; Culver, Stephen J.
Science (American Association for the Advancement of Science),
05/1986, Letnik:
232, Številka:
4751
Journal Article
Recenzirano
Museum collections were used to document the worldwide Pliocene and Pleistocene fossil record of 59 species that now occur on the Atlantic continental margin of North America. Tabulation of these ...data indicates that benthic foraminifera evolve at all latitudes and in all parts of the world ocean rather than from some center or centers of origin. Dispersal in geologic time is very rapid.
The North Carolina barrier islands, a 325-mile-long string of narrow sand islands that forms the coast of North Carolina, are one of the most beloved areas to live and visit in the United States. ...However, extensive barrier island segments and their associated wetlands are in jeopardy. In The Battle for North Carolina's Coast, four experts on coastal dynamics examine issues that threaten this national treasure. According to the authors, the North Carolina barrier islands are not permanent. Rather, they are highly mobile piles of sand that are impacted by sea-level rise and major storms and hurricanes. Our present development and management policies for these changing islands are in direct conflict with their natural dynamics. Revealing the urgency of the environmental and economic problems facing coastal North Carolina, this essential book offers a hopeful vision for the coast's future if we are willing to adapt to the barriers' ongoing and natural processes. This will require a radical change in our thinking about development and new approaches to the way we visit and use the coast. Ultimately, we cannot afford to lose these unique and valuable islands of opportunity. This book is an urgent call to protect our coastal resources and preserve our coastal economy.
Species duration data for living benthic foraminifera derived from an extensive literature search have been compiled and analyzed to investigate rates and patterns of species origination. The same ...data subjected to taxonomic standardization through examination of many specimens lodged in museum collections indicate strikingly different, and more realistic, rates and patterns. Evolutionary generalizations based on data generated from the literature only are often unreliable and may be directly in opposition to reality. Extensive attempts at taxonomic standardization should be the norm in paleobiological investigations.
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