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Water Science and Technology : a... Feb 2019This study has been carried out to evaluate the applicability of the pilot scale hybrid type of stormwater runoff treatment system for treatment of combined sewer...
This study has been carried out to evaluate the applicability of the pilot scale hybrid type of stormwater runoff treatment system for treatment of combined sewer overflow. Also, to determine the optimum operation parameter such as coagulation dosage concentration, effectiveness of coagulant usage, surface loading rate and backwashing conditions. The pilot scale stormwater filtration system (SFS) was installed at the municipal wastewater plant serving the city of Cheongju (CWTP), Korea. CWTP has a capacity of 280,000 m/day. The SFS consists of a hydrocyclone coagulation/flocculation with polyaluminium chloride silicate (PACS) and an upflow filter to treat combined sewer overflows. There are two modes (without PACS use and with PACS use) of operation for the SFS. In case of no coagulant use, the range of suspended solids (SS) and turbidity removal efficiency were 72.0-86.6% (mean 80.0%) and 30.9-71.1% (mean 49.3%), respectively. And, the recovery rate of filter was 79.2-83.6% (mean 81.2%); the rate of remaining solid loading in filter media was 16.4-20.8% (mean 18.8%) after backwashing. The influent turbidity, SS concentrations were 59.0-90.7 NTU (mean 72.0 NTU), 194.0-320.0 mg/L (mean 246.7 mg/L), respectively. The range of PACS dosage concentration was 6.0-7.1 mg/L (mean 6.7 mg/L). The range of SS and turbidity removal efficiency was 84.9-98.2 (mean 91.4%) and 70.7-96.3 (mean 84.0%), respectively. It was found that removal efficiency was enhanced with PACS dosage. The recovery rate of filter was 92.0-92.5% (mean 92.3%) the rate of remaining solid loading in filter media was 6.1-8.2% (mean 7.2%) after backwashing. In the case of coagulant use, the particle size of the effluent is bigger than influent particle size. The results showed that SFS with PACS use more effective than without PACS use in SS and turbidity removal efficiency and recovery rate of filter.
Topics: Drainage, Sanitary; Filtration; Flocculation; Rain; Republic of Korea; Waste Disposal, Fluid; Wastewater; Water Purification
PubMed: 30975943
DOI: 10.2166/wst.2019.097 -
AJR. American Journal of Roentgenology May 2018The purpose of this study is to assess the utility of texture analysis of multiple MRI sequences for the differentiation of uterine leiomyomas and leiomyosarcomas.
OBJECTIVE
The purpose of this study is to assess the utility of texture analysis of multiple MRI sequences for the differentiation of uterine leiomyomas and leiomyosarcomas.
MATERIALS AND METHODS
Seventeen leiomyosarcomas and 51 leiomyomas undergoing MRI before resection were included. Whole-lesion volumes of interest were placed on T2-weighted images, contrast-enhanced T1-weighted images, and apparent diffusion coefficient (ADC) maps. The diagnostic performance of histogram metrics was assessed.
RESULTS
For T2-weighted images, significant differences were observed for mean, skewness, entropy, mean of the bottom 10th percentile (mean), mean of the 10th through 25th percentiles (mean), and mean of the 25th through 50th percentiles (mean) (p ≤ 0.010). For T1-weighted contrast-enhanced images, significant differences were observed for mean, mean, and mean (p ≤ 0.045). For the ADC maps, no metrics showed a significant difference (p ≥ 0.067). Metrics with AUC greater than 0.8 were the mean (0.875), mean (0.863), mean (0.839), and mean (0.802) for T2-weighted imaging. The mean, mean, and mean for T2-weighted imaging all achieved greater AUCs than did the standard mean (p ≤ 0.038). Patients with leiomyosarcoma were significantly older than those with leiomyoma (p < 0.001; AUC = 0.866). At multivariable regression, significant independent predictors of leiomyosarcoma were patient age (p = 0.002) and T2-weighted imaging mean (p = 0.004), with a combined AUC of 0.955. Patient age achieved sensitivity of 82.4% and specificity of 92.2%; T2-weighted imaging mean achieved sensitivity of 82.4% and specificity of 74.5%.
CONCLUSION
For whole-lesion histogram metrics obtained on various MRI sequences, T2-weighted images provided the highest, and ADC maps the lowest, performance for differentiating uterine leiomyomas and leiomyosarcomas. Metrics reflecting percentiles from the bottom half of the histogram distribution outperformed the standard mean. Models combining the T2-weighted imaging whole-lesion metrics and patient age achieved particularly high diagnostic performance. Although these findings require validation in larger studies, they have implications for facilitating improved treatment selection for these two entities.
Topics: Adult; Contrast Media; Diagnosis, Differential; Diffusion Magnetic Resonance Imaging; Female; Humans; Leiomyoma; Leiomyosarcoma; Magnetic Resonance Imaging; Retrospective Studies; Sensitivity and Specificity; Uterine Neoplasms
PubMed: 29547053
DOI: 10.2214/AJR.17.18605 -
Journal of Cancer Research and... Dec 2022The aim was to assess the potential reduction in the doses to organs at risk (OARs) and target organ volume by doing replanning on repeat computed tomography (CT) scan...
AIM OF STUDY
The aim was to assess the potential reduction in the doses to organs at risk (OARs) and target organ volume by doing replanning on repeat computed tomography (CT) scan during the 4 week of radiation therapy (RT).
MATERIALS AND METHODS
Twenty-four histologically proven patients of inoperable esophagus carcinoma were studied. All patients received induction chemotherapy followed by concurrent chemotherapy and radiotherapy. CT simulation with proper immobilization was done, and images were transferred to the treatment planning system. Delineation of target volumes and OARs was done, and two plans were generated for 60 Gy in 30 fractions and 40 Gy in 20 fractions with intensity-modulated RT keeping the doses to OARs within the tolerance limits. Replanning for 20 Gy in 10 fractions was done on repeat CT scan during the 4 week of radiotherapy treatment, and potential reduction in doses to OARs and target organ volume was assessed.
RESULTS
A total of 24 cases were analyzed for the adaptive plan with the coverage of the 95% prescription isodose for planning target volume. Statistical analysis was done by t-test. The difference in the doses received by the OARs was analyzed and was seen that due to re CT scan, the doses were reduced to the left lung V (mean 19.23 Gy vs. 17.35 Gy) and D (mean 16.03 Gy vs. 14.25 Gy), right lung V (mean 18.38 Gy vs. 16.66 Gy) and D (mean 15.70 Gy vs. 13.97 Gy), heart V (mean 38.72 Gy vs. 35.32 Gy) and D (mean 26.40 Gy vs. 22.74 Gy), and spine 1% volume (mean 36.54 Gy vs. 33.39 Gy) and D (mean 39.81 Gy vs. 34.34 Gy), gross tumor volume (GTV) (mean 67.37 cm vs. 24.58 cm ) and were all significantly smaller for the adaptive plan.
CONCLUSION
By doing adaptive radiotherapy in the 4 week of treatment using repeat CT scan, along with the response evaluation, there is a significant reduction in the volume of GTV, and replanning of treatment on repeat CT scan also helps us in reducing doses to the OARs resulting in reduced toxicity.
Topics: Humans; Radiotherapy Planning, Computer-Assisted; Radiotherapy Dosage; Radiotherapy, Intensity-Modulated; Organs at Risk; Tomography, X-Ray Computed; Carcinoma; Lung Neoplasms
PubMed: 36510979
DOI: 10.4103/jcrt.JCRT_162_20 -
Journal of Insurance Medicine (New... 2006[corrected] In a previous article, it was demonstrated that use of mean age to enter a life table to obtain a mean expected mortality rate of a cohort with a wide age...
BACKGROUND
[corrected] In a previous article, it was demonstrated that use of mean age to enter a life table to obtain a mean expected mortality rate of a cohort with a wide age range invariably underestimates the true mean expected mortality rate, q'. This is due to the bias introduced by the average 10% annual increase in q' in the approximate age range of 45 to 90 years (rates in the population life table, ages 0-109 years were analyzed to illustrate this). The magnitude of the error was demonstrated in various examples. All of these data were limited to the first year of FU (follow-up) duration. In this article, we analyze progression of mean age, x, and mean expected mortality rate, q', with FU duration in cohorts with all ages combined. When the age range is only 5 or 10 years, the mean age of the survivors does increase very nearly a full year with each year of FU duration.
RESULTS
We utilized a 1973-1987 cohort in the SEER database for prostate cancer, all ages and all stages combined, and from this derived a comparative mortality table. We first demonstrated the difference between cumulative expected survival rate, P', as calculated in the SEER database, and the actuarial calculation of P'. The SEER method results in a 5% underestimate of P' vs the actual P' at a duration 14-15 years, and a corresponding overestimate of Q' and q'. Second, we found that the annual mean age of the survivors in the prostate cancer cohort increased from 72.4 years at entry to 80.2 years in a FU of 15 years. Mean expected q' increased from 66.7 per 1000 in the first year to 93.1 per 1000 in the 15th year. The geometric mean annual increase in mean q' was only 2.4% per year, instead of the approximate 10% seen in the life table from about age 45 to 90. Progression patterns by duration for mean age and mean q' are very different in female thyroid cancer, all ages and all stages combined, again for a 1973-1987 cohort. In thyroid cancer, females outnumber males; in both sexes, the proportion of younger patients, under age 45, is much greater than in typical cancer sites, such as prostate cancer. In female thyroid cancer, both mean age and mean q' actually decreased from the mean values at entry for 5 years or more. At entry, mean age was 43.9 years, and mean q' was 8.2 per 1000. These values decreased to 43.5 years and 6.8 per 1000, respectively, at duration 1-2 years, then leveled off and began a gradual increase. At duration 14-15 years, mean age was 53.7 years, and mean q' was 11.4 deaths per 1000 per year.
CONCLUSION
Progression of mean q' is erratic and unpredictable, because annual mean age of survivors is highly dependent on the proportion of younger patients in the cohort being followed. If the proportion of patients under age 45 years is high enough, both mean age and mean q' may show an initial decrease from the values found in the year of entry, because, even though each survivor is a year older, the progression of mean age is so heavily biased by the slower progression of q' at the younger than at the older ages. However, with the SEER database, if annual expected survival rates are converted to annual expected mortality rates, the derivation of mean expected mortality rate, q' is accurate, regardless of the width of the age range in the cohort selected and being analyzed. The user of the SEER database is warned that the expected cumulative survival rate, P', is derived in the SEER survival tables on the basis of the first-year age distribution, not on the basis of the changing age distribution that is actuarially observed.
Topics: Adolescent; Adult; Age Factors; Aged; Bias; Child; Child, Preschool; Cohort Studies; Follow-Up Studies; Humans; Infant; Infant, Newborn; Life Tables; Male; Middle Aged; Mortality; Prostatic Neoplasms; SEER Program; United States
PubMed: 17076138
DOI: No ID Found -
Current Oncology (Toronto, Ont.) Dec 2018Communities of practice (cops) have been shown to be effective models for achieving quality outcomes in health care.
BACKGROUND
Communities of practice (cops) have been shown to be effective models for achieving quality outcomes in health care.
OBJECTIVE
Here, we describe the application of the cop model to the Canadian oncology context.
METHODS
We established an oncology cop at our urban community hospital and its networks. Goals were to decrease barriers to access, foster collaboration, and improve knowledge of guidelines in cancer care. We hosted 6 in-person multidisciplinary meetings, focusing on screening, diagnosis, and management of common solid tumours. Health care providers affiliated with our hospital were invited to attend and to complete post-meeting surveys. Likert scales assessed whether cop goals were realized.
RESULTS
Meetings attracted a mean of 57 attendees (range: 48-65 attendees), with a mean of 84% completing the surveys and consenting to the analysis. Attendees included family physicians (mean: 41%), specialist physicians (mean: 24%), nurses (mean: 10%), and allied health care providers (mean: 22%). Repeat attendance increased during the series, with 85% of attendees at the final meeting having attended 1 or more prior meetings. Across the series, most participants agreed or strongly agreed that the cop reduced barriers (mean: 76.0% ± 7.9%) and improved access to cancer care services (mean: 82.4% ± 8.1%) and subject matter experts (mean: 91.7% ± 4.2%); fostered teamwork (mean: 84.5% ± 6.8%) and a culture of collaboration (mean: 94.8% ± 4.2%); improved knowledge of cancer care services (mean: 93.3% ± 4.8%), standards of practice (mean: 92.3% ± 3.1%), and quality indicators (mean: 77.5% ± 6.3%); and improved cancer-related practice (mean: 88.8% ± 4.6%) and satisfaction in caring for cancer patients (mean: 82.9% ± 6.8%). Participant feedback carried a potential for bias.
CONCLUSIONS
We demonstrated the feasibility of oncology cops and found that participants perceived their value in reducing barriers to access, fostering collaboration, and improving knowledge of guidelines in cancer care.
Topics: Canada; Community Health Services; Health Personnel; Humans; Medical Oncology; Patient Care Management; Patient Care Planning; Quality Improvement
PubMed: 30607111
DOI: 10.3747/co.25.4087 -
The Journal of Foot and Ankle Surgery :... Apr 2024The present study was to determine the characteristics of the ankle skeletal structure in patients with talus Hepple V type. We conducted a retrospective study on the...
The present study was to determine the characteristics of the ankle skeletal structure in patients with talus Hepple V type. We conducted a retrospective study on the skeletal structure of the talus in 110 patients with Hepple V osteochondral lesions of the talus and in control participants. The radiographic measurements taken include the following: in the coronal plane - depth of talus frontal curvature, length of the lateral and medial malleolus; in the sagittal plane - radius and height of talus, angle of tibial lateral surface, tibiotalar sector, and vertical neck angle. The osteochondral lesion of the talus showed a significantly larger mean radius (mean ± SD, 21.4 ± 2.5 mm; p < .001) and height (mean ± SD, 26.0 ± 2.7 mm; p < .005). It also demonstrated a longer mean medial malleolus length (mean ± SD, 15.7 ± 2.4 mm; p < .005), a larger mean vertical neck angle (mean ± SD, 86.2 ± 5.4°; p < .050), and a greater mean tibial lateral surface angle (mean ± SD, 80.0 ± 4.5°; p < .001). And there was a greater mean frontal curvature depth (mean ± SD, 3.9 ± 0.6 mm; p < .005). Overall, this study found that patients with Hepple V osteochondral lesions of the talus had a larger vertical neck angle and tibial lateral surface angle, a longer talus radius and medial malleolus length, a higher talus height, and a deeper frontal curvature depth. STUDY DESIGNS: Retrospective Case-Control Study.
PubMed: 38679411
DOI: 10.1053/j.jfas.2024.04.004 -
JAMA Network Open Jun 2019Nutrition during pregnancy is a critical dimension not only for women's health but also for the lifelong health of the offspring. Very limited national data exist on the... (Observational Study)
Observational Study
IMPORTANCE
Nutrition during pregnancy is a critical dimension not only for women's health but also for the lifelong health of the offspring. Very limited national data exist on the usual dietary intakes of pregnant women.
OBJECTIVE
To estimate total usual nutrient intakes (from foods and dietary supplements) and the population prevalence of meeting or exceeding the National Academies of Sciences, Engineering, and Medicine Dietary Reference Intake recommendations among pregnant US women.
DESIGN, SETTING, AND PARTICIPANTS
A cross-sectional analysis was performed of a nationally representative sample of 1003 pregnant US women aged 20 to 40 years from the 2001-2014 National Health and Nutrition Examination Survey.
EXPOSURE
Usual dietary intakes assessed by two 24-hour dietary recalls (including dietary supplements) adjusted for within-person variation using the National Cancer Institute method.
MAIN OUTCOMES AND MEASURES
The proportion of women at risk of inadequate dietary intake as determined by the Estimated Average Requirement, the proportion of women assumed to have adequate dietary intake as determined by the Adequate Intake, and the proportion of women at risk of excess dietary intake as determined by the Tolerable Upper Intake Level. Demographic differences between pregnant and nonpregnant women were compared with t tests.
RESULTS
As representative of the US population, this sample of 1003 pregnant women had a mean (SE) age of 28.0 (0.3) years, was predominantly non-Hispanic white (mean [SE], 54.5% [3.1%]), and was at above 185% of the income to poverty ratio (mean [SE], 56.8% [3.0%]). Most pregnant women used a dietary supplement (mean [SE], 69.8% [2.3%]). A total of 10% or more of pregnant women had a total usual intake that is less than the Estimated Average Requirement for magnesium (mean [SE], 47.5% [2.8%]), vitamin D (mean [SE], 46.4% [2.7%]), vitamin E (mean [SE], 43.3% [2.7%]), iron (mean [SE], 36.2% [2.8%]), vitamin A (mean [SE], 15.5% [2.1%]), folate (mean [SE], 16.4% [1.6%]), calcium (mean [SE], 12.9% [2.4%]), vitamin C (mean [SE], 11.5% [1.9%]), vitamin B6 (mean [SE], 11.5% [1.5%]), and zinc (mean [SE], 10.9% [1.9%]). Some pregnant women exceeded the Adequate Intake for potassium (mean [SE], 41.7% [2.9%]), choline (mean [SE], 7.9% [3.2%]), and vitamin K (mean [SE], 47.9% [4.3%]). Most women exceeded the Tolerable Upper Intake Level for sodium (mean [SE], 95.0% [2.2%]), and some women exceeded the Tolerable Upper Intake Level of folic acid (mean [SE], 33.4% [2.8%]), iron (mean [SE], 27.9% [2.8%]), calcium (mean [SE], 3.0% [0.8%]), and zinc (mean [SE], 7.1% [1.6%]). For iron, the prevalence of an at-risk intake from foods alone was lower among women who used supplements (mean [SE], 80.3% [4.3%]) than those who did not use supplements (mean [SE], 95.3% [7.3%]); however, supplement use increased the risk of excessive iron and folic acid intakes given the amounts that are being consumed from supplemental products.
CONCLUSIONS AND RELEVANCE
This study suggests that a significant number of pregnant women are not meeting recommendations for vitamins D, C, A, B6, K, and E, as well as folate, choline, iron, calcium, potassium, magnesium, and zinc even with the use of dietary supplements. Almost all pregnant women in this study were at risk of excessive consumption of sodium, and many were at risk of excessive consumption of folic acid and iron. Improved dietary guidance to help pregnant women meet but not exceed dietary recommendations is warranted.
Topics: Adult; Cross-Sectional Studies; Diet; Dietary Supplements; Eating; Energy Intake; Female; Humans; Maternal Nutritional Physiological Phenomena; Nutrition Surveys; Pregnancy; Pregnant Women; Smoking; United States
PubMed: 31225890
DOI: 10.1001/jamanetworkopen.2019.5967 -
Sleep Medicine Jan 2023This study aimed to analyze the microstructural features of sleep in patients with vestibular migraine and migraine, and to hypothesize the pathophysiological mechanism...
OBJECTIVE
This study aimed to analyze the microstructural features of sleep in patients with vestibular migraine and migraine, and to hypothesize the pathophysiological mechanism between vestibular migraine and sleep disorders.
METHODS
From March 2021 to June 2022, 35 vestibular migraine patients, 35 migraine patients, and 30 controls were collected from the Vertigo Center & Sleep Center of the Second Affiliated Hospital of Zhengzhou University. The anxiety and depression status, sleep quality, and cyclic alternating pattern (CAP) of the three groups were analyzed and compared using the Pittsburgh Sleep Quality Index, Hamilton Anxiety and Depression Scale, and polysomnography (PSG).
RESULTS
The vestibular migraine group had a higher CAP time (mean 173.64 vs. 122.11, P < 0.001), CAP index (mean 54.25 vs. 37.50, P < 0.001), CAP rate (mean 48.41 vs. 32.31, P < 0.001), CAP sequences (mean 42.60 vs. 29.83, P < 0.001), A3% (mean 45.58 vs. 17.50, P < 0.001) and A2%+A3% (mean 68.87 vs. 38.83, P < 0.001) compared to the control group, with a lower A1 index (mean 16.68 vs. 23.87, P < 0.001) and A1% (mean 31.13% vs. 61.17, P < 0.001).
CONCLUSION
Patients with vestibular migraine have poor sleep quality, thalamic-cortical hyperfunction and active arousal system. In addition, high CAP rate and high A2 to A3 ratio make the sleep structure more fragmented.
Topics: Humans; Eye Movements; Sleep; Polysomnography; Migraine Disorders; Vertigo; Sleep Stages; Electroencephalography
PubMed: 36525848
DOI: 10.1016/j.sleep.2022.11.034 -
American Journal of Medical Genetics.... Mar 2024Research continues to demonstrate that the characteristics of one's social network could have an impact on the development of Alzheimer's disease. Given the...
Research continues to demonstrate that the characteristics of one's social network could have an impact on the development of Alzheimer's disease. Given the predisposition of people with Down syndrome to develop Alzheimer's disease, analysis of their social networks has become an emerging focus. Previous pilot research demonstrated that the personal networks of people with DS could be quantitatively analyzed, with no difference between self-report and parent-proxy report. This manuscript focuses on a 12-month follow-up period with the same original participants (24 adults with Down syndrome). Their social networks demonstrated sustainability, but not improvement, as reported by people with DS (mean network size: 8.88; mean density: 0.73; mean constraint: 0.44; mean effective size: 3.58; mean max degree: 6.04; mean degree: 4.78) and their proxies (mean network size: 7.90; mean density: 0.82; mean constraint: 53.13; mean effective size: 2.87; mean max degree: 5.19; mean degree: 4.30). Intentional and continued efforts are likely needed in order to improve the social network measures of people with Down syndrome.
Topics: Adult; Humans; Down Syndrome; Alzheimer Disease
PubMed: 37740458
DOI: 10.1002/ajmg.c.32064 -
Scientific Reports Mar 2022Accurate information on the sources of suspended sediment in riverine systems is essential to target mitigation. Accordingly, we applied a generalized likelihood...
Accurate information on the sources of suspended sediment in riverine systems is essential to target mitigation. Accordingly, we applied a generalized likelihood uncertainty estimation (GLUE) framework for quantifying contributions from three sub-basin spatial sediment sources in the Mehran River catchment draining into the Persian Gulf, Hormozgan province, southern Iran. A total of 28 sediment samples were collected from the three sub-basin sources and six from the overall outlet. 43 geochemical elements (e.g., major, trace and rare earth elements) were measured in the samples. Four different combinations of statistical tests comprising: (1) traditional range test (TRT), Kruskal-Wallis (KW) H-test and stepwise discriminant function analysis (DFA) (TRT + KW + DFA); (2) traditional range test using mean values (RTM) and two additional tests (RTM + KW + DFA); (3) TRT + KW + PCA (principle component analysis), and; 4) RTM + KW + PCA, were used to the spatial sediment source discrimination. Tracer bi-plots were used as an additional step to assess the tracers selected in the different final composite signatures for source discrimination. The predictions of spatial source contributions generated by GLUE were assessed using statistical tests and virtual sample mixtures. On this basis, TRT + KW + DFA and RTM + KW + DFA yielded the best source discrimination and the tracers in these composite signatures were shown by the biplots to be broadly conservative during transportation from source to sink. Using these final two composite signatures, the estimated mean contributions for the western, central and eastern sub-basins, respectively, ranged between 10-60% (overall mean contribution 36%), 0.3-16% (overall mean contribution 6%) and 38-77% (overall mean contribution 58%). In comparison, the final tracers selected using TRT + KW + PCA generated respective corresponding contributions of 1-42% (overall mean 20%), 0.5-30% (overall mean 12%) and 55-84% (overall mean 68%) compared with 17-69% (overall mean 41%), 0.2-12% (overall mean 5%) and 29-76% (overall mean 54%) using the final tracers selected by RTM + KW + PCA. Based on the mean absolute fit (MAF; ≥ 95% for all target sediment samples) and goodness-of-fit (GOF; ≥ 99% for all samples), GLUE with the final tracers selected using TRT + KW + PCA performed slightly better than GLUE with the final signatures selected by the three other combinations of statistical tests. Based on the virtual mixture tests, however, predictions provided by GLUE with the final tracers selected using TRT + KW + DFA and RTM + KW + DFA (mean MAE = 11% and mean RMSE = 13%) performed marginally better than GLUE with RTM + KW + PCA (mean MAE = 14% and mean RMSE = 16%) and GLUE with TRT + KW + PCA (mean MAE = 17% and mean RMSE = 19%). The estimated source proportions can help watershed engineers plan the targeting of conservation programmes for soil and water resources.
Topics: Environmental Monitoring; Geologic Sediments; Iran; Rivers; Soil
PubMed: 35273258
DOI: 10.1038/s41598-022-07882-1