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Objective To review and update the conceptual framework, indicator content and research priorities of the Organisation for Economic Cooperation and Development's (OECD) Health Care Quality Indicators (HCQI) project, after a decade of collaborative work. Design A structured assessment was carried out using a modified Delphi approach, followed by a consensus meeting, to assess the suite of HCQI for international comparisons, agree on revisions to the original framework and set priorities for research and development. Setting International group of countries participating to OECD projects. Participants Members of the OECD HCQI expert group. Results A reference matrix, based on a revised performance framework, was used to map and assess all seventy HCQI routinely calculated by the OECD expert group. A total of 21 indicators were agreed to be excluded, due to the following concerns: (i) relevance, (ii) international comparability, particularly where heterogeneous coding practices might induce bias, (iii) feasibility, when the number of countries able to report was limited and the added value did not justify sustained effort and (iv) actionability, for indicators that were unlikely to improve on the basis of targeted policy interventions. Conclusions The revised OECD framework for HCQI represents a new milestone of a long-standing international collaboration among a group of countries committed to building common ground for performance measurement. The expert group believes that the continuation of this work is paramount to provide decision makers with a validated toolbox to directly act on quality improvement strategies

BACKGROUND: Clostridium difficile is the most common cause of infectious diarrhea in hospitalized patients. Recurrences are common after antibiotic therapy. Actoxumab and bezlotoxumab are human monoclonal antibodies against C. difficile toxins A and B, respectively.METHODS: We conducted two double-blind, randomized, placebo-controlled, phase 3 trials, MODIFY I and MODIFY II, involving 2655 adults receiving oral standard-of-care antibiotics for primary or recurrent C. difficile infection. Participants received an infusion of bezlotoxumab (10 mg per kilogram of body weight), actoxumab plus bezlotoxumab (10 mg per kilogram each), or placebo; actoxumab alone (10 mg per kilogram) was given in MODIFY I but discontinued after a planned interim analysis. The primary end point was recurrent infection (new episode after initial clinical cure) within 12 weeks after infusion in the modified intention-to-treat population.RESULTS: In both trials, the rate of recurrent C. difficile infection was significantly lower with bezlotoxumab alone than with placebo (MODIFY I: 17% [67 of 386] vs. 28% [109 of 395]; adjusted difference, -10.1 percentage points; 95% confidence interval [CI], -15.9 to -4.3; PCONCLUSIONS: Among participants receiving antibiotic treatment for primary or recurrent C. difficile infection, bezlotoxumab was associated with a substantially lower rate of recurrent infection than placebo and had a safety profile similar to that of placebo. The addition of actoxumab did not improve efficacy. (Funded by Merck; MODIFY I and MODIFY II ClinicalTrials.gov numbers, NCT01241552 and NCT01513239 .).

Objective: This study evaluated the effects of extensive motor training in a finger-to-thumb opposition sequence task on performance and automaticity of patients at early and intermediate stages of Parkinson’s disease (PD). Methods: Fifteen PD patients in stage 1 of Hoehn and Yahr classification, 15 patients in stages 2 and 3, and 20 healthy matched control individuals, were extensively exposed to a 5-element finger-to-thumb opposition sequence task, 2 sessions per week, along 5 weeks. On session 1 the participants performed a specified sequence of movements along 60 seconds in a single-task condition; the number of sequences completed correctly was recorded. On sessions 2 to 9 the subjects were exposed to 600 repetitions per session of the same sequence of movements. On session 10 the participants performed 4 different 60-second-duration trials including (1) the trained sequence and (2) a novel sequence, both in a single-task condition, and (3) the trained sequence and (4) a novel sequence, both concurrently with a verbal fluency task, therefore in a dual-task condition. The number of sequences completed correctly was recorded. Results: All groups exhibited improvement of performance for the trained sequence. However, as expected, this improvement was relatively greater for the control subjects as compared to that seen for PD patients. Performance in the dual-task condition disrupted performance of all groups. However, while for control subjects this disruption was smaller for the trained as compared to the novel sequence, thus indicating automaticity for the trained sequence, for PD patients disruption was equivalent for trained and novel sequences. Conclusion: Extensive motor training promotes improvement of performance in PD patients at different stages of the disease. However, this improvement is not associated with development of automaticity for the trained sequence. It seems important to take this information into account when planning therapeutic training approaches for PD patients.

This study was performed to investigate factors determining tumor pressure (TP) in hepatocellular carcinoma (HCC) and a correlation of pressure gradient between TP and portal vein pressure (PVP) with tumor spread. TP and hepatic tissue pressure (HTP) were measured in 70 patients who underwent hepatic resection for HCC. Changes in TP after hepatic artery occlusion (HAO) or portal vein occlusion (PVO) were observed. HTP was elevated with worsening chronic liver disease, and exhibited a significant positive correlation with PVP. The TP was significantly higher in the encapsulated and the nonnecrotic HCCs. The pressure gradient (TP-PVP) was significantly greater in the encapsulated HCCs, especially in those with microscopic portal vein invasion (vp) or intrahepatic metastasis (im). HAO caused a greater decrease in TP than did PVO, with the decrease being particularly marked in the encapsulated HCCs. The TP of HCC was found to be regulated mainly by the presence or absence of a tumor capsule or necrosis, and partly by the hepatic arterial flow and PVP. Our study suggests that TP increases with capsule formation and that the pressure gradient between TP and PVP may be a causal factor in the dispersement of tumor cells into the portal vein.

The c-met proto-oncogene encodes the tyrosine kinase receptor for hepatocyte growth factor (HGF), a potent mitogen and motogen for epithelial cells. Because of its profound effects on cell growth and motility, HGF may be important in the development of cancer metastases in hepatocellular carcinoma (HCC). In this study, we examined HGF concentration and expression of the c-met proto-oncogene product (c-Met) in 62 patients with HCC to determine the relationship between the level of expression and clinicopathological features, and patient outcome following hepatectomy. Western blotting was used to examine the c-Met expression, and HGF concentration in tumors was measured using an enzyme-linked immunosorbent assay. c-Met was found to be overexpressed in HCC compared with nontumorous liver tissue (P < .01), and correlated with an increased incidence of intrahepatic metastases (P = .039). Patients were divided into two groups: low c-Met HCC and high c-Met HCC. Patients with high c-Met HCC had a significantly shorter 5-year survival than patients with low c-Met HCC (33.5% vs. 80.3%, respectively; P < .05). However, there was no correlation between HGF concentration in the tumor tissue and clinicopathological factors and patient survival. These results indicate that the expression of c-Met played an important role in tumor growth and metastases in patients who underwent hepatectomy for HCC.

我々は,検診にてCA19-9の軽度上昇を指摘され,超音波にて偶然発見された成人の肝間葉性過誤腫を経験したので報告する.症例は47歳の女性である.超音波やCTにて肝のS6より肝外性に発育する大きさ7cmの腫瘍を認め,腫瘍は充実性の部分と嚢胞性の部分にて構成されていた.血管造影では腫瘍全体に濃染像が見られた,良性腫瘍を最も疑ったが,悪性腫瘍も否定できず手術を施行した.切除標本では大きさ7.5cm×7.5cmの境界明瞭で光沢のある充実性腫瘍で,内部に大小の嚢胞を認めた.組織像では主に豊富な線維結合織よりなり,その間に大小の血管あるいはリンパ管や,小胆管の増生を認めた.現在,術後3年であるが,再発兆候はない.肝間葉性過誤腫の本邦報告例は64例であり,このうち15歳以下の小児例が52例と大部分を占め,成人例はわずか12例に過ぎない.小児例では腫瘍の発育速度は早く,成人例では発育速度は緩慢であるも悪性腫瘍との鑑別も困難で,共に切除が第一選択の治療である.悪性化や転移例はなく予後良好であるが,3例の再発例があり注意を要する.

In order to decide on advertisement fees for web servers, Naor and Pinkas introduced (threshold) metering schemes secure against coalitions of corrupt servers and clients. They show that one should be able to detect illegal behavior of clients, i.e., one needs to verify the shares received from clients. Most metering schemes do not offer this feature. But Ogata and Kurosawa pointed out a minor flaw in the extension protocol by Naor and Pinkas providing detection of such illegal behavior and propose a correction. In this paper we extend the linear algebra approach from Nikov et al. in order to build robust unconditionally secure general metering schemes. As a tool to achieve this goal we introduce doubly-labelled matrices and an operation on such matrices. Certain properties of this operation are proven.

Determination of acetylcholine esterase in serum (S-AChE) and erythrocytes (E-AChE) was carried out in nine patients with Hirschsprung's disease and 16 normal controls. S-AChE was significantly elevated in patients with Hirschsprung's disease, while no significant difference was observed in E-AChE in these two groups. In 17 patients with Hirschsprung's disease, S-AChE and E-AChE were determined after definitive operation. Twelve of these patients underwent a Duhamel type procedure in which a small part of the aganglionic bowel segment remained unresected. Five patients were treated by Swenson's procedure performing complete resection of the aganglionic bowel segment. S-AChE in patients treated by the Duhamel type procedure remained elevated, while it was as low as that in normal controls in patients who underwent Swenson's procedure. There was no significance in E-AChE in both groups. This study suggests a close relation of the level of S-AChE to the extent of the aganglionic bowel segment in Hirschsprung's disease.

Six patients were treated with transcatheter arterial embolization (TAE). Three patients suffered from intractable genital bleeding; the other three patients were preoperative cases of a stage III adenocarcinoma of the uterine cervix and two of these had gestational trophoblastic disease. Bleeding was stopped in all three cases of intractable hemorrhage; one patient rebled after 6 days. In the three preoperative cases, transcatheter arterial embolization was thought to be effective in decreasing intraoperative blood loss. There are no other reports of application of this technique to preoperative cases to decrease intraoperative blood loss in gynecological cases.

Four cases of foreign bodies in the duodenum were treated using a flexible fibre-optic panendoscope. All the patients were boys and eight months to four years of age. The ingested foreign materials were an injection needle, a marking pin, a hairpin and a curtain hook. Endoscopic extraction was attempted, because the ingested objects might cause perforation or obstruction of the gastrointestinal tract. Until recently, they had to be carefully watched or prophylactic operation suggested. Under general anaesthesia, duodenal endoscopy was easily performed and extraction of foreign bodies was not found to be difficult during infancy. This is considered to be a safer and less hazardous way than careful watching or prophylactic operation.

Wireless Sensor Networks (WSN) are often deployed in hostile or difficult scenarios, such as military battlefields and disaster recovery, where it is crucial for the network to be highly fault tolerant, scalable and decentralized. For this reason, peer-to-peer primitives such as Distributed Hash Table (DHT), which can greatly enhance the scalability and resilience of a network, are increasingly being introduced in the design of WSN’s. Securing the communication within the WSN is also imperative in hostile settings. In particular, context information, such as the network topology and the location and identity of base stations (which collect data gathered by the sensors and are a central point of failure) can be protected using traffic encryption and anonymous routing. In this paper, we propose a protocol achieving a modified version of onion routing over wireless sensor networks based on the DHT paradigm. The protocol prevents adversaries from learning the network topology using traffic analysis, and therefore p reserves the context privacy of the network. Furthermore, the proposed scheme is designed to minimize the computational burden and power usage of the nodes, through a novel partitioning scheme and route selection algorithm.

Objective: To review and update the conceptual framework, indicator content and research priorities of the Organisation for Economic Cooperation and Development's (OECD) Health Care Quality Indicators (HCQI) project, after a decade of collaborative work. Design: A structured assessment was carried out using a modified Delphi approach, followed by a consensus meeting, to assess the suite of HCQI for international comparisons, agree on revisions to the original framework and set priorities for research and development. Setting: International group of countries participating to OECD projects. Participants: Members of the OECD HCQI expert group. Results: A reference matrix, based on a revised performance framework, was used to map and assess all seventy HCQI routinely calculated by the OECD expert group. A total of 21 indicators were agreed to be excluded, due to the following concerns: (i) relevance, (ii) international comparability, particularly where heterogeneous coding practices might induce bias, (iii) feasibility, when the number of countries able to report was limited and the added value did not justify sustained effort and (iv) actionability, for indicators that were unlikely to improve on the basis of targeted policy interventions. Conclusions: The revised OECD framework for HCQI represents a new milestone of a long-standing international collaboration among a group of countries committed to building common ground for performance measurement. The expert group believes that the continuation of this work is paramount to provide decision makers with a validated toolbox to directly act on quality improvement strategies.

This paper presents a weakness in the key schedule of the AES candidate HPC (Hasty Pudding Cipher). It is shown that for the HPC version with a 128-bit key, 1 in 256 keys is weak in the sense that it has 2(30) equivalent keys. An efficient algorithm is proposed to construct these weak keys and the corresponding equivalent keys. If a weak key is used, it can be recovered by exhaustive search trying only 2(89) keys on average. This is an improvement by a factor of 2(38) over a normal exhaustive key search, which requires on average 2(127) attempts. The weakness also implies that HPC cannot be used in standard constructions for hash functions based on block ciphers. The analysis is extended to HPC with a 192-bit key and a 256-bit key, with similar results. For some other key lengths, all keys are shown to be weak. An example of this is the HPC variant with a 56-bit user key and block length of 128 bits, which can be broken in 2(31) attempts on average. ispartof: pages:29-42 ispartof: Lecture Notes in Computer Science vol:1716 pages:29-42 ispartof: ASIACRYPT 1999 location:SINGAPORE, SINGAPORE date:14 Nov - 18 Nov 1999 status: published

This paper gives a survey of attacks on Message Authentication Codes (MACs). First it defines the required security properties. Next it describes generic forgery and key recovery attacks on MACs. Subsequently an overview is presented of most MAC constructions and on attacks on these algorithms. The MACs described include CBC-MAC and its variants, the MAC algorithms derived from cryptographic hash functions, and the ISO banking standard Message Authenticator Algorithm, also known as MAA. ispartof: pages:55-65 ispartof: Lecture Notes in Computer Science vol:1396 pages:55-65 ispartof: ISW 1997 location:JAPAN, JAPAN ADV INST SCI & TECHNOL, ISHIKAWA date:17 Sep - 19 Sep 1997 status: published