Using data from an enumerated network of worldwide flight connections between airports, we examine how sampling designs and sample size influence network metrics. Specifically, we apply three types of sampling designs: simple random sampling, nonrandom strategic sampling (i.e., selection of the largest airports), and a variation of snowball sampling. For the latter sampling method, we design what we refer to as a controlled snowball sampling design, which selects nodes in a manner analogous to a respondent-driven sampling design. For each design, we evaluate five commonly used measures of network structure and examine the percentage of total air traffic accounted for by each design. The empirical application shows that (1) the random and controlled snowball sampling designs give rise to more efficient estimates of the true underlying structure, and (2) the strategic sampling method can account for a greater proportion of the total number of passenger movements occurring in the network.
The dynamic coupling between cardiac pump performance and vascular arterial-venous capacitive and resistive properties was examined analytically and experimentally to determine the feasibility of maintaining systemic and pulmonary circulation, devoid of the right heart. Analysis of the cardiovascular system (excluding neurohumoral factors), used a mathematical representation of the major determinants involved in cardiac output and demonstrated that change in pump flow output has reciprocal effects on the venous and arterial pressures. Independent of the pump's performance characteristics, cardiac output reserve was restricted, reaching a critical plateau (50% of normal) because of the rapidly depleting pulmonary venous pressure, concurrent with the translocation of the venous stressed volume to the arterial side of the circulation. Animal experiments aided by computer modeling confirmed that near normal flow can be sustained by actively mobilizing or augmenting blood volume, or by reducing selectively the unstressed volume and venous pooling. A single blood pump, in a form of a mechanical substitute, or the biologic left heart acting alone, can support the entire circulation. The right heart is not essential for normal pulmonary circulation, but serves to maintain low systemic venous pressure and a relatively high left heart flow reserve state. Peripheral vascular parameters, i.e., stressed volume and venous capacitance, serve a vital role in preserving the mechanical self regulation of cardiac output.
Abstract Diabetes self-management programmes can improve clinical and healthy lifestyle outcomes. Research has demonstrated that improved engagement with type 2 diabetes (T2D) care is associated with greater empowerment beliefs and a perceived internal control over their illness. As part of the DWELL evaluation study, an interim subset of 139 participants in the UK and 53 participants in France were assessed pre- and post-intervention on measures of weight, BMI, waist circumference and glycated haemoglobin (HbA1c), as well as self-efficacy beliefs (DES-SF), healthy eating behaviours (DEBQ) and perceptions of illness (IPQ-R). Pre-post comparisons in both countries demonstrated statistically significant decreases in weight (UK: Z = 6.71, p<.001, FR: Z = 3.33, p<.05), BMI (UK: Z = 6.70, p<.001, FR: Z = 3.21, p<.05), waist circumference (UK: Z = 6.71, p<.001, FR: Z = 3.24, p<.05),and HbA1c (UK: Z = 6.29, p<.001, FR: Z = 4.18, p <.001). Importantly, participation in the DWELL programme was associated with increased self-efficacy beliefs (UK: Z = 5.63, p<.001, FR: Z = 5.54, p<.001), greater perceived personal control over their diabetes (UK: Z = 3.17, p<.05, FR: Z = 2.20, p<.05), reduced negative feelings about their illness (UK: Z = 3.01, p <.05, FR: Z = 2.19, p<.05) and decreased eating in response to external food cues (UK: Z = 3.79, p<.001, FR: Z = 2.34, p<.05). In the UK, participants also reported an increased optimism for treatment control of their diabetes (Z = 3.06, p <.05) and for their long-term prognosis (Z = 1.99, p<.05).These preliminary findings support the efficacy of the DWELL programme in improving diabetes-related biomedical outcomes, as well as improvements in patient empowerment, healthy eating habits and increased perceived illness control. Further analysis, available at a later date, will include a larger sample of participants, including longitudinal data with follow-ups six- and 12- months post participation in the DWELL programme.
Two patients who presented with compensatory head postures and diplopia are described. They both had marked unilateral superior oblique overaction, in one patient due to a large, incomitant skew deviation. Each underwent a superior oblique tendon lengthening procedure using a segment of silicone 240 retinal band as an expander, in combination with a contralateral superior rectus recession. Both achieved an excellent result with an improvement of the compensatory head posture and an increase in the field of binocular single vision. This surgical procedure is proposed as an option in the management of superior oblique overaction, including certain cases of skew deviation.
In the past 13 years, total expenditures for nursing home care under the Medicaid program have increased drastically. They show no signs of abating. Government, therefore, has become aware of the need to control this rapid increase. Families, who currently provide a large amount of informal, long-term care for their disabled elderly, are seen as a potential resource to maintain people in the community. Although demographic elements appear to mitigate against increased family responsibility, governmental incentives may be able to reverse the trend. While demographic variables cannot be modified by public policies, programs can be developed to modify family situations, increasing family capacity--and willingness--to care for disabled, elderly adults.
To examine the postoperative stability of inferior rectus recession, with particular reference to the incidence of progressive overcorrection.The results of consecutive patients undergoing inferior rectus recession over a 3 year period were reviewed.21 patients underwent inferior rectus recession, using an adjustable suture technique in all but three cases. In 16 patients additional vertical muscle surgery was performed at the time of the inferior rectus recession. All patients were followed for a minimum of 3 months postoperatively, with a mean follow up of 9.3 months. At the final postoperative visit 11 patients were well aligned, eight were undercorrected, and two were overcorrected. In five of the eight undercorrected cases, the residual deviation was the result of postoperative drift in the direction of the preoperative deviation, following an initially good alignment. Review of the results failed to reveal any factor predictive for this postoperative drift.The risk of postoperative overcorrection following inferior rectus recession should be considered, but in this study, undercorrection occurred more frequently than overcorrection. The possible reasons for overcorrection and undercorrection are discussed.
Home health services in Massachusetts, 1971: their role in care of the long-term sick. R Morris, and E HarrisCopyRight https://doi.org/10.2105/AJPH.62.8.1088 Published Online: October 07, 2011
Background: Acute phase reactants (erythrosedimentation rate [ESR], C-reactive protein [CRP]) have limited utility in GCA, even in patients treated with prednisone alone. Furthermore, the lack of reliable biomarkers in patients receiving interleukin (IL)-6 blockade therapy is a major unmet need. Objectives: To identify biomarkers of disease activity in GCA patients treated with prednisone monotherapy and with prednisone in combination with tocilizumab (TCZ). Methods: We mapped the serum proteome of GCA patients with active and inactive disease in an unbiased manner using high-throughput multiplexed mass spectrometry. Proteomic analyses were performed in 5 µl serum samples with 11-plexed tandem mass tag (TMT) technology using an Orbitrap Lumos mass spectrometer. A SEQUEST-based database search engine was employed for peptide identification. Quantification was based on TMT reporter ion intensities. All patients were sampled during their participation in the GiACTA trial, 1 in which they received TCZ plus 26 weeks of prednisone (TCZ group) or placebo plus 26 or 52 weeks of prednisone (PRED group). Active disease was defined as the presence of cranial or PMR symptoms requiring treatment intensification regardless of ESR and CRP levels. Samples were selected if patients were in clear states of active or inactive disease at GiACTA systematic sample collection timepoints (baseline and weeks 4, 12, 24, 48). An exhaustive leave-2-out strategy was used to identify classification markers. All possible pairs of samples were isolated as test samples and the remaining training samples were used to identify the protein markers. Proteins with an absolute log2 fold concentration difference ≥0.5 between active and inactive samples and a P-value <0.1 were retained and sorted based on the metric -log10(P-value)*absolute(log2 fold change). Top markers within each training set were selected to generate normalized ranks {0,1} across all samples. A mean rank was calculated for every sample. The set of normalized ranks for the test samples across all sets of top markers were bootstrapped for each test sample 100 times with replacement. The bootstrapped rankings were evaluated by determining areas under the curves (AUC) of receiver operator characteristic (ROC) curves. Results: The PRED group included 21 patients (active, n = 16; inactive, n = 5) and the TCZ group included 21 patients (active, n = 14; inactive, n = 7). Using high-throughput sample preparation methods without applying any depletion of known highly abundant serum proteins, we quantified 760 proteins across all samples and 344 proteins in at least half the samples. Compared to inactive PRED-treated patients, active PRED-treated patients showed significant overexpression of several acute phase reactants including serum amyloid A1 and 2 (SAA1, SAA2) and complement factor H (CFH) (Fig. 1a). The magnitude of concentration change and the level of statistical significance observed for SSA1, SSA2 and CFH in PRED-treated patients were higher than those of CRP (Fig. 1a). Compared to inactive TCZ-treated patients, active TCZ-treated patients demonstrated significant overexpression of multiple biomarkers including haptoglobin, haptoglobin precursor, SSA2 and complement factor 4A, and underexpression of peptidase inhibitor 16 (Fig. 1b), a protein involved in vascular and regulatory T cell biology. Sets of 10 biomarkers resulted in a classification of active versus inactive disease with ROC AUCs of 0.89 (95% CI 0.79-0.96) in the PRED group (Fig. 2a) and 0.97 (95% CI 0.95-0.97) in the TCZ group (Fig. 2b). Conclusion: We identified several differentially expressed serum proteins in GCA patients with active and inactive disease receiving prednisone monotherapy or TCZ-based treatment regimens. In both treatment groups, a signature of biomarkers classified disease activity status with high accuracy. Haptoglobin, a readily available laboratory test, may be useful in monitoring disease activity in GCA patients receiving IL-6 blockade therapy. References: [1]Stone et al . NEJM 2017 Disclosure of Interests: Sebastian Unizony Grant/research support from: Genentech, Inc., Robert Morris: None declared, Johannes Kreuzer: None declared, Wilhelm Haas: None declared, John H. Stone Grant/research support from: Roche, Consultant of: Roche
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