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The optimal dosing strategy for infliximab in steroid-refractory acute severe ulcerative colitis (ASUC) is unknown. We compared intensified and standard dose infliximab rescue strategies and explored maintenance therapies following infliximab induction in ASUC.

We propose a method, a model, and a form of presenting model results for condition monitoring of a small set of wind turbines with rare failures. The main new ingredient of the method is to sample failure thresholds according to the profit they give to an operating company. The model is a multiple linear regression with seasonal components and external regressors, representing all sensor components except for the selected one. To overcome the scarcity of the training data, we use the median sensor values from all available turbines in their healthy state. The cumulated deviation from the normal behavior model obtained for this median turbine is calibrated for each turbine at the beginning of the test period and after known failures. The proposed form of presenting results is to set a scale for possible costs, control for random maintenance, and show a whole distribution of costs depending on the free model parameters. We make a case study on an open dataset with SCADA data from multiple sensors and show that considering the influence of turbine components is more critical than seasonality. The distribution, the average, and the standard deviation of maintenance costs can be very different for similar minimal costs. Random maintenance can be more profitable than reactive maintenance and other approaches. Our predictive maintenance model outperforms random maintenance and competitors for the whole set of considered turbines, giving substantial savings.

Diagnostic imaging using CT enterography, magnetic resonance enterography, and intestinal ultrasound are important tools in evaluating stricturing Crohn's disease. Definitions of strictures have been developed for CT enterography and magnetic resonance enterography. However, expert recommendations for definitions and treatment response of strictures on intestinal ultrasound are not available. The aim of this study was to standardise definitions, diagnosis, and treatment response criteria in small bowel stricturing Crohn's disease on intestinal ultrasound.

Let's take a moment to celebrate cruciferous veggies. These mighty members of the Brassica family are rich in glucosinolates, plant chemicals with anticancer properties. Plus, eating them often may help [...]

Objective. To evaluate the association of improved patient safety practices with medical malpractice claims and costs in the perinatal units of acute care hospitals. Data Sources. Malpractice and harm data from participating hospitals; litigation records and medical malpractice claims data from American Excess Insurance Exchange, RRG, whose data are managed by Premier Insurance Management Services, Inc. (owned by Premier Inc., a health care improvement company). Study Design. A quasi-experimental prospective design to compare baseline and postintervention data. Statistical significance tests for differences were performed using chi-square, Wilcoxon signed-rank test, and i-test. Data Collection. Claims data were collected and evaluated by experienced senior claims managers through on-site claim audits to evaluate claim frequency, severity, and financial information. Data were provided to the analyzing institution through confidentiality contracts. Principal Findings. There is a significant reduction in the number of perinatal malpractice claims paid, losses paid, and indemnity payments (43.9 percent, 77.6 percent, and 84.6 percent, respectively) following interventions to improve perinatal patient safety and reduce perinatal harm. This compares with no significant reductions in the nonperinatal claims in the same hospitals during the same time period. Conclusions. The number of perinatal malpractice claims and dollar amount of claims payments decreased significantly in the participating hospitals, while there was no significant decrease in nonperinatal malpractice claims activity in the same hospitals. Key Words. Perinatal malpractice claims, patient safety, perinatal outcomes, care bundles, in situ simulation training, There is a recognized link between perinatal harm, malpractice claims, and malpractice payments. However, few studies have quantified this relationship and even fewer studies have undertaken efforts to improve perinatal [...]

Objective. To improve safety practices and reduce adverse events in perinatal units of acute care hospitals. Data Sources. Primary data collected from perinatal units of 14 hospitals participating in the intervention between 2008 and 2012. Baseline secondary data collected from the same hospitals between 2006 and 2007. Study Design. A prospective study involving 342,754 deliveries was conducted using a quality improvement collaborative that supported three primary interventions. Primary measures include adoption of three standardized care processes and four measures of outcomes. Data Collection Methods. Chart audits were conducted to measure the implementation of standardized care processes. Outcome measures were collected and validated by the National Perinatal Information Center. Principal Findings. The hospital perinatal units increased use of all three care processes, raising consolidated overall use from 38 to 81 percent between 2008 and 2012. The harms measured by the Adverse Outcome Index decreased 14 percent, and a run chart analysis revealed two special causes associated with the interventions. Conclusions. This study demonstrates the ability of hospital perinatal staff to implement efforts to reduce perinatal harm using a quality improvement collaborative. Findings help inform the relationship between the use of standardized care processes, teamwork training, and improved perinatal outcomes, and suggest that a multiplicity of integrated strategies, rather than a single intervention, may be essential to achieve high reliability. Key Words. High reliability, perinatal outcomes, quality improvement collaborative, standardized care processes, in situ simulation team training, Labor and delivery pose substantial risk for unintended harm to mothers and newborns. Perinatal complications are reported from 3 to 10.7 percent of all deliveries, ranging from catastrophic events, including [...]

About 17 to 17.5 million years ago, an instant in geological time after Afropithecus appeared in the northern part of Kenya, its possible descendants appeared on a new stage of [...]

Despite the introduction of new monoclonal antibodies and oral therapies for the treatment of ulcerative colitis, clinical remission rates remain low, underscoring the need for innovative treatment approaches. We assessed whether guselkumab plus golimumab combination therapy was more effective for ulcerative colitis than either monotherapy.

For the first time in the Kruglaya Bay of the Black Sea, 25 taxa of Bacillariophyta from 17 genera were found, three of them were new for the Crimea and the Black Sea Halamphora tenerrima, Amphora tenuissima, and Navicula antonii. Marine (40%), coastalbrackish (32%) and boreal-tropical (32%), arctic-boreal-tropical (24%), boreal and cosmopolitan (20% and 16%, respectively) prevailed. The morphological characteristics of the species in the SEM (scanning electronic microscope) and LM (light microscope), as well as the occurrence, ecology, phytogeography, and general distribution in various regions of the World Ocean are given.

Active-comparator trials are important to inform patient and physician choice. We aimed to evaluate the efficacy and safety of monotherapy with either ustekinumab or adalimumab in biologic-naive patients with moderately to severely active Crohn's disease.

EXECUTIVE SUMMARY Many common management practices in healthcare organizations, including the practice of strategic planning, have not been subject to widespread assessment through empirical research. If management practice is to [...]

This study explores organizational and market characteristics associated with superior hospital performance in both quality and cost of care, using the Healthcare Cost and Utilization Project State Inpatient Databases for [...]

EXECUTIVE SUMMARY Today, healthcare organizations are faced with the growing realization that functional and professional silos within the organization are counter to the provision of efficient and effective patient care [...]

EXECUTIVE SUMMARY Little is known about empirical variation in the extent to which healthcare organizations conduct formal strategic planning or the extent to which strategic planning affects performance. Structural contingency [...]

Studies of allele-specific expression in interspecific hybrids have provided important insights into gene-regulatory divergence and hybrid incompatibilities. Many such investigations in Drosophila have used transcriptome data from complex mixtures of many tissues or from gonads, however, regulatory divergence may vary widely among species, sexes, and tissues. Thus, we lack sufficiently broad sampling to be confident about the general biological principles of regulatory divergence. Here, we seek to fill some of these gaps in the literature by characterizing regulatory evolution and hybrid misexpression in a somatic male sex organ, the accessory gland, in F1 hybrids between Drosophila melanogasterand D. simulans.The accessory gland produces seminal fluid proteins, which play an important role in male and female fertility and may be subject to adaptive divergence due to male–male or male–female interactions. We find that transdifferences are relatively more abundant than cis, in contrast to most of the interspecific hybrid literature, though large effect-size transdifferences are rare. Seminal fluid protein genes have significantly elevated levels of expression divergence and tend to be regulated through both cisand transdivergence. We find limited misexpression (over- or underexpression relative to both parents) in this organ compared to most other Drosophila studies. As in previous studies, male-biased genes are overrepresented among misexpressed genes and are much more likely to be underexpressed. ATAC-Seq data show that chromatin accessibility is correlated with expression differences among species and hybrid allele-specific expression. This work identifies unique regulatory evolution and hybrid misexpression properties of the accessory gland and suggests the importance of tissue-specific allele-specific expression studies.

In these days of 3GHz powerhouses, DVD burners, and wireless computing, mining the depths of vendors' value lines might not sound terribly appealing. But the budget systems we've seen so […]

American golfer Tiger Woods is only twenty-five, but his achievements make him the greatest in the world in 2001 with the potential to do more. Opinions on his prowess are presented by some of the world's other great sports stars including Pele.

Information on the performance of health care services at local level by regions from 1982 to 1995 in US is offered. Additional information on organizational forms of health care delivery in local markets is included.

Issues related to proposed regulations regarding 'vulture' charitable lead trusts (CLTs) are examined, focusing on the legitimate intentions of the regulations and disadvantages if enacted. 'Vulture' CLT's use an unrelated donor, often seriously ill, as the measuring life for defining the charitable term, but proposed regulations may prevent legitimate trusts involving unrelated people.

Byline: -BRET BEGUN AMSTERDAM Noord Out Until recently, there wasn't much incentive to cross the IJ River and visit North Amsterdam (Noord)-unless you were really into Dutch movies (the spaceship-like [...]

Byline: BY BRET BEGUN, JOSH CONDON, MATT DUCKOR, KEVIN PIRES, JON ROTH, AND DAVID SWANSON PHOTOGRAPHS BY JEREMY LIEBMAN 10 Rules for Hosting the Ultimate Holiday Party* *Without Doing That [...]

Product Listing Akia Tornado TX266 Akia Corp. 11406 Metric Blvd., Ste. 190 Austin, TX 78758 800-936-5481; 512-339-4804 Fax: 512-339-4886 www.akia.com Direct Price: $4,299 Dell Inspiron 3000 M266XT Dell Computer Corp. […]

Ten hardware-laden 266MHz systems shoot for the mainstream with prices of $2,399 or less. Product Listing CompUSA American A266L-SE CompUSA 14951 N. Dallas Pkwy. Dallas, TX 75240 800-266-7872 www.compusa.com Direct […]

Nurses and nursing must face widespread change in health care as the 20th century ends, and an entrepreneurial stance is probably the best view to take. The nursing profession and individual nurses must increasingly act as proactive innovators to meet the expectations of the new health care marketplace. Once the profession recognizes the crucial importance of entrepreneurship, it can develop strategies and resources to assist nurse entrepreneurs.

Product Listing Digital HiNote Ultra 2000 Digital Equipment Corp. 111 Powder Mill Rd. Maynard, MA 01754-1418 800-344-4825; 508-624-6400 Fax: 508-480-8583 www.windows.digital.com Mfr. Est. Price: $5,999 (beta) Not final BIOS, drivers, […]

Product Listing Chicago Map Compass Chicago Map Corp. 15419 127th St. Lemont, IL 60439 800-257-9244; 630-257-7616 Fax: 630-257-9678 www.chicagomap.com Requires: 8MB RAM; 10MB hard drive space; CD-ROM drive; Windows 3.x, […]

Product Listing CyberMax Max A4-PR166 CyberMax Computer 133 N. Fifth St. Allentown, PA 18102 800-443-9868; 610-770-1808 www.cybmax.com Direct Price: $1,599 DirectWave MVP C-166 DirectWave 4260 E. Brickell St. Ontario, CA […]

Product Listing Amquest HyperModem AM3314E-HY Amquest Corp. 1650 Manheim Pike Lancaster, PA 17601 800-577-3335; 717-569-8030 http://www.amquestcorp.com Avg. Mail-Order Price: $183 Archtek SmartLink 3334-A Archtek America Corp. 18549 Gale Ave. City […]

Product Listing ACT ND-5123DE All Computer Technology 224 S. 5th Ave. City of Industry, CA 91746 800-775-1953; 818-369-4181 Fax: 818-961-7462 http://www.allcomp.com/acw Support: Live, toll-free phone support, 9 a.m. to 5 […]

Nursing must relinquish its traditional strategies for building the profession and replace them with a contemporary plan of action. Changes in the health care system have altered its sources of power and means for gaining this power. Major themes in a contemporary framework for achieving professional power for nursing include collaboration with other health care professionals, accountability to stakeholders, commitment to continual change and recruitment of more men. Flexibility is vital to making the right strategic changes.

Byline: BY BRET BEGUN, LAURA BOLT, AND JON ROTH * PHOTOGRAPH BY ADAM VOORHES Face It: There's No Escaping Emoji They're ubiquitous, addictive, and not the domain of teenage girls [...]

Immunopathology and intestinal stem cell (ISC) loss in the gastrointestinal (GI) tract is the prima facie manifestation of graft-versus-host disease (GVHD) and is responsible for significant mortality after allogeneic bone marrow transplantation (BMT). Approaches to prevent GVHD to date focus on immune suppression. Here, we identify interferon-λ (IFN-λ; interleukin-28 [IL-28]/IL-29) as a key protector of GI GVHD immunopathology, notably within the ISC compartment. Ifnlr1−/− mice displayed exaggerated GI GVHD and mortality independent of Paneth cells and alterations to the microbiome. Ifnlr1−/− intestinal organoid growth was significantly impaired, and targeted Ifnlr1 deficiency exhibited effects intrinsic to recipient Lgr5+ ISCs and natural killer cells. PEGylated recombinant IL-29 (PEG-rIL-29) treatment of naive mice enhanced Lgr5+ ISC numbers and organoid growth independent of both IL-22 and type I IFN and modulated proliferative and apoptosis gene sets in Lgr5+ ISCs. PEG-rIL-29 treatment improved survival, reduced GVHD severity, and enhanced epithelial proliferation and ISC-derived organoid growth after BMT. The preservation of ISC numbers in response to PEG-rIL-29 after BMT occurred both in the presence and absence of IFN-λ–signaling in recipient natural killer cells. IFN-λ is therefore an attractive and rapidly testable approach to prevent ISC loss and immunopathology during GVHD.

Magnesium metal (Mg) is a promising material for stent applications due to its biocompatibility and ability to be resorbed by the body. Manufacturing of stents by laser cutting has become an industry standard. Our alternative approach uses photo-chemical etching to transfer a pattern of the stent onto a Mg sheet. In this study, we present three stages of creating and validating a stent prototype, which includes design and simulation using finite element analysis (FEA), followed by fabrication based on AZ31 alloy and, finally, in vivo testing in peripheral arteries of domestic pigs. Due to the preliminary character of this study, only six stents were implanted in two domestic farm pigs weighing 25–28 kg and they were evaluated after 28 days, with an interim follow-up on day 14. The left and right superficial femoral, the left iliac, and the right renal artery were selected for this study. The diameters of the stented artery segments were evaluated at the time of implantation, on day 14 and then, finally, on day 28, by quantitative vessel analysis (QVA) using fluoroscopic imaging. Optical Coherence Tomography (OCT) imaging displayed some malposition, breaks, stacking, and protrusion into the lumen at the proximal, distal, and mid-sections of the stented arteries. The stents degraded with time, but simultaneously became embedded in the intima. After 28 days, the animals were euthanized, and explanted vessels were fixed for micro-CT imaging and histology studies. Micro-CT imaging revealed stent morphological and volumetric changes due to the in-body degradation. An in vivo corrosion rate of 0.75 mm/year was obtained by the CT evaluation. The histology suggested no-life threatening effects, although moderate injury, inflammation, and endothelialization scores were observed.