Journal articles on the topic 'Episodes'
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Yang, Hao, Lei Chen, Hong Liao, Jia Zhu, Wenjie Wang, and Xin Li. "Impacts of aerosol–photolysis interaction and aerosol–radiation feedback on surface-layer ozone in North China during multi-pollutant air pollution episodes." Atmospheric Chemistry and Physics 22, no. 6 (March 29, 2022): 4101–16. http://dx.doi.org/10.5194/acp-22-4101-2022.
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Abstract. We examined the impacts of aerosol–radiation interactions, including the effects of aerosol–photolysis interaction (API) and aerosol–radiation feedback (ARF), on surface-layer ozone (O3) concentrations during four multi-pollutant air pollution episodes characterized by high O3 and PM2.5 levels during 28 July to 3 August 2014 (Episode1), 8–13 July 2015 (Episode2), 5–11 June 2016 (Episode3), and 28 June to 3 July 2017 (Episode4) in North China, by using the Weather Research and Forecasting with Chemistry (WRF-Chem) model embedded with an integrated process analysis scheme. Our results show that API and ARF reduced the daytime shortwave radiative fluxes at the surface by 92.4–102.9 W m−2 and increased daytime shortwave radiative fluxes in the atmosphere by 72.8–85.2 W m−2, as the values were averaged over the complex air pollution areas (CAPAs) in each of the four episodes. As a result, the stabilized atmosphere decreased the daytime planetary boundary layer height and 10 m wind speed by 129.0–249.0 m and 0.05–0.15 m s−1, respectively, in CAPAs in the four episodes. Aerosols were simulated to reduce the daytime near-surface photolysis rates of J[NO2] and J[O1D] by 1.8 × 10−3–2.0 × 10−3 and 5.7 × 10−6–6.4 × 10−6 s−1, respectively, in CAPAs in the four episodes. All of the four episodes show the same conclusion, which is that the reduction in O3 by API is larger than that by ARF. API (ARF) was simulated to change daytime surface-layer O3 concentrations by −8.5 ppb (parts per billion; −2.9 ppb), −10.3 ppb (−1.0 ppb), −9.1 ppb (−0.9 ppb), and −11.4 ppb (+0.7 ppb) in CAPAs of the four episodes, respectively. Process analysis indicated that the weakened O3 chemical production made the greatest contribution to API effect, while the reduced vertical mixing was the key process for ARF effect. Our conclusions suggest that future PM2.5 reductions may lead to O3 increases due to the weakened aerosol–radiation interactions, which should be considered in air quality planning.
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Sabharwal, Alka, Sakshi Kaushik, and Gurprit Grover. "PREDICTION OF INTER EPISODIC TIME FOR RECURRING MENTAL ILLNESS USING ORDER STATISTICS." Malaysian Journal of Public Health Medicine 21, no. 2 (August 28, 2021): 52–60. http://dx.doi.org/10.37268/mjphm/vol.21/no.2/art.720.
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Recurrent episodes are common across various mental disorders. Information on time to next episode, also referred as inter episodic times, provides a valuable tool for planning and evaluating the health outcomes of treatment in patients and developing effective preventive maintenance therapy. The objective is to obtain the prediction interval for the future inter episodic time when the number of previous episodes for a patient is small and inter episodic times are dependent. A data of 28 patients with a history of 3 or more recurring episodes of illness is extracted from a retrospective data of 146 patients diagnosed with mental and behavioral disorders. The prediction interval for time to occurrence of next episode is obtained using order statistics assuming that it will follow the order followed by previous inter episodic times. The validity of the results is verified using simulation studies with data generated using covariance structure of the real dataset. From the simulation studies, we found that more than 80% of the simulated inter episodic times lie in the simulated prediction intervals. This paper is highly beneficial to medical health professionals to predict time to next episode for patients with few previously known episodes of the concerned disease. The study has an implication to rare diseases where generally small database (patients) is available.
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Wilton, James, Mei Chong, Younathan Abdia, Roy Purssell, Aaron MacInnes, Tara Gomes, Richard C. Dart, et al. "Cohort profile: development and characteristics of a retrospective cohort of individuals dispensed prescription opioids for non-cancer pain in British Columbia, Canada." BMJ Open 11, no. 4 (April 2021): e043586. http://dx.doi.org/10.1136/bmjopen-2020-043586.
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PurposePrescription opioids (POs) are widely prescribed for chronic non-cancer pain but are associated with several risks and limited long-term benefit. Large, linked data sources are needed to monitor their harmful effects. We developed and characterised a retrospective cohort of people dispensed POs.ParticipantsWe used a large linked administrative database to create the Opioid Prescribing Evaluation and Research Activities cohort of individuals dispensed POs for non-cancer pain in British Columbia (BC), Canada (1996–2015). We created definitions to categorise episodes of PO use based on a review of the literature (acute, episodic, chronic), developed an algorithm for inferring clinical indication and assessed patterns of PO use across a range of characteristics.Findings to dateThe current cohort includes 1.1 million individuals and 3.4 million PO episodes (estimated to capture 40%–50% of PO use in BC). The majority of episodes were acute (81%), with most prescribed for dental or surgical pain. Chronic use made up 3% of episodes but 88% of morphine equivalents (MEQ). Across the acute to episodic to chronic episode gradient, there was an increasing prevalence of higher potency POs (hydromorphone, oxycodone, fentanyl, morphine), long-acting formulations and chronic pain related indications (eg, back, neck, joint pain). Average daily dose (MEQ) was similar for acute/episodic but higher for chronic episodes. Approximately 7% of the cohort had a chronic episode and chronic pain was the characteristic most strongly associated with chronic PO use. Individuals initiating a chronic episode were also more likely to have higher social/material deprivation and previous experience with a mental health condition or a problem related to alcohol or opioid use. Overall, these findings suggest our episode definitions have face validity and also provide insight into characteristics of people initiating chronic PO therapy.Future plansThe cohort will be refreshed every 2 years. Future analyses will explore the association between POs and adverse outcomes.
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Song, Andrew Jehyun, Arianna Kee, Jared Minetola, Karen Walsh, Valerie P. Csik, Amy Leader, and Vittorio Maio. "Pursuit of performance: An exploration of predictors associated with achieving performance based payments for breast cancer episodes under the Oncology Care Model." Journal of Clinical Oncology 37, no. 15_suppl (May 20, 2019): e18035-e18035. http://dx.doi.org/10.1200/jco.2019.37.15_suppl.e18035.
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e18035 Background: The Oncology Care Model (OCM) captures patient costs in a 6-month episode triggered by administration of systemic therapy. Most breast cancer (BC) patients will receive systemic therapy, with variations depending on stage and hormonal status, which makes BC an ideal indication to study costs in the OCM. Practices earn performance based payments (PBP) if aggregate episodic expenditures are managed below set target prices. We investigated predictors for episodic expenditures exceeding target prices, thus reducing potential for PBP. Methods: We identified BC episodes with non-decedent beneficiaries attributable to our academic medical center from OCM Reconciliation Reports during 7/1/16-6/30/17. Cohorts were defined as episodes whose costs were above target (Cohort 1) and those below (Cohort 2). The Wilcoxon Rank-Sum test was used to compare actual and target episode expenditure between cohorts. Multivariable logistic regression models were used to assess association of maintaining costs below target due to various predictors. Results: A total of 369 episodes were included in the study, with 124 episodes in Cohort 1 and 245 in Cohort 2. Median actual and target episode expenditures were higher in Cohort 1 (actual: $23,466 vs. $2,691, p < 0.0001; target: $8,425 vs. $5,870, p < 0.0001). In multivariable logistic regression, episodes were more likely to be below target if novel therapies, Part B drugs, or inpatient admissions were not utilized, controlling for other predictors (see Table). Conclusions: Large disparities exist for both actual expenditures and target prices for BC episodes in the OCM. Novel therapies, Part B drugs, and inpatient admissions are negatively associated with maintaining episode expenditures below target. Risk-adjustments for these expenditures need to be overhauled in OCM to accurately capture costs associated with management of cancer patients, and provide practical target prices for institutions to continue delivery of value based care. [Table: see text]
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Newell, William James. "How buyer roles and critical times affect buyer-supplier exchange episodes." IMP Journal 11, no. 3 (October 16, 2017): 376–97. http://dx.doi.org/10.1108/imp-03-2017-0013.
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Purpose The purpose of this paper is threefold: first, to examine how buyer-supplier episodes are characterised by their dimensions of time and social space, and how these dimensions interact to impact the criticality of an episode; second, to explore how time and social space create patterns of episodes that lead to buyer-supplier relationship change and continuity; and third, to examine the social space by the different roles that the buyer assumes among their episodes, while focusing on the concept of critical time to denote the temporal context. Design/methodology/approach A case study of a small retailer and five suppliers is employed. The primary data are e-mail communications between the buying and selling firms, along with a two-week field study at the retailer’s location. A total of 2,000 e-mails are coded to yield 75 episodes for the analysis. Findings The criticality of episodes differs depending on the role that the buyer assumes, and whether the episode occurs within a critical time period. The social space affects the type of criticality, while critical times enhance an episode’s criticality. This study outlines five different patterns of episodes occurring within critical times and across social spaces that characterise each of the buyer-supplier relationships. Research limitations/implications This paper focuses on e-mail communication, with little data on interactions occurring outside of this medium. Originality/value To the researcher’s knowledge, this paper is the first to link specific patterns of episode characteristics to the concept of buyer roles. It also examines episodes using e-mail communication, which is not a common source within the IMP research stream.
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Olszewski, Thomas D., and Mark E. Patzkowsky. "Evaluating taxonomic turnover: Pennsylvanian–Permian brachiopods and bivalves of the North American Midcontinent." Paleobiology 27, no. 4 (2001): 646–68. http://dx.doi.org/10.1666/0094-8373(2001)027<0646:ettppb>2.0.co;2.
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Using museum and literature data, we characterize faunal turnover in bivalves and brachiopods of the North American Midcontinent over approximately 12.5 Myr spanning the Pennsylvanian/Permian boundary. The two groups experienced indistinguishable rates of background faunal turnover but differed in the type and timing of elevated turnover episodes. Bivalves underwent an episode of elevated first appearance in the Missourian Series whereas brachiopods underwent an episode of elevated disappearance in the Wolfcampian Series. In neither group does turnover history strongly correlate to long-term changes in basinal lithofacies, which reflect evolution of regional climate. Comparison with other time intervals and basins suggests that magnitude and frequency of turnover episodes during the late Paleozoic was intermediate between the more episodic early Paleozoic and less episodic Mesozoic.
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Sutherland, Amanda, Emily Boudreau, Andy Bowe, Qian Huang, Joshua M. Liao, Matthew Flagg, Deborah Cousins, et al. "Association Between a Bundled Payment Program for Lower Extremity Joint Replacement and Patient Outcomes Among Medicare Advantage Beneficiaries." JAMA Health Forum 4, no. 6 (June 25, 2023): e231495. http://dx.doi.org/10.1001/jamahealthforum.2023.1495.
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ImportanceMuch of the evidence for bundled payments has been drawn from models in the traditional Medicare program. Although private insurers are increasingly offering bundled payment programs, it is not known whether they are associated with changes in episode spending and quality.ObjectiveTo evaluate whether a voluntary bundled payment program offered by a national Medicare Advantage insurer was associated with changes in episode spending or quality of care for beneficiaries receiving lower extremity joint replacement (LEJR) surgery.Design, Setting, and ParticipantsCross-sectional study of 23 034 LEJR surgical episodes that emulated a stepped-wedge design by using the time-varying, geographically staggered rollout of the bundled payment program from January 1, 2012, to September 30, 2019. Episode-level multivariable regression models were estimated within practice to compare changes before and after program participation, using episodes at physician practices that had not yet begun participating in the program during a given time period (but would go on to do so) as the control. Data analyses were performed from July 1, 2021, to June 30, 2022.ExposuresPhysician practice participation in the bundled payment program.Main Outcomes and MeasuresThe primary outcome was episode spending (plan and beneficiary). Secondary outcomes included postacute care use (skilled nursing facility and home health care), surgical setting (inpatient vs outpatient), and quality (90-day complications [including deep vein thrombosis, wound infection, fracture, or dislocation] and readmissions).ResultsThe final analytic sample included 23 034 LEJR episodes (6355 bundled episodes and 16 679 control episodes) from 109 physician practices participating in the program. Of the beneficiaries, 7730 were male and 15 304 were female, 3057 were Black, 19 351 were White, 447 were of other race or ethnicity (assessed according to the Centers for Medicare &amp; Medicaid Services beneficiary race and ethnicity code, which reflects data reported to the Social Security Administration), and 179 were of unknown race and ethnicity. The mean (SD) age was 70.9 (7.2) years. Participation in the bundled payment program was associated with a 2.7% (95% CI, 1.3%-4.1%) decrease in spending per episode (mean episodic spending, $21 964 [95% CI, $21 636-$22 296] vs $22 562 [95% CI, $22 346-$22 779]), as well as reductions in skilled nursing facility use after discharge (21.3% for bundled episodes vs 25.0% for control episodes; odds ratio [OR], 0.81 [95% CI, 0.67-0.98]) and increased use of the outpatient surgical setting (14.1% for bundled episodes vs 8.4% for control episodes; OR, 1.79 [95% CI, 1.53-2.09]). The program was not associated with changes in quality outcomes, including 90-day complications (8.8% for bundled episodes vs 8.6% for control episodes; OR, 1.02 [95% CI, 0.86-1.20]) and readmissions (4.3% for bundled episodes vs 4.6% for control episodes; OR, 0.92 [95% CI, 0.75-1.13]).Conclusions and RelevanceIn this study of an LEJR bundled payment program offered by a national Medicare Advantage insurer, findings suggest that physician practice participation in the program was associated with a decrease in episode spending without changes in quality. Bundled payments offered by private insurers, including Medicare Advantage plans, are an alternate payment option to fee for service that may reduce spending for LEJR episodes while maintaining quality of care.
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Xiong, Jennifer, Puneeth Indurlal, Hope Ives, Judi Payne-De Bock, Chad Adams, Ramzi Abujamra, Brian Turnwald, Stuart Staggs, Jason Altieri, and Rajini Manjunath. "The impact of seasonality with hierarchical condition category coding on Oncology Care Model performance for the U.S. Oncology Network." Journal of Clinical Oncology 40, no. 28_suppl (October 1, 2022): 66. http://dx.doi.org/10.1200/jco.2022.40.28_suppl.066.
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66 Background: The Oncology Care Model (OCM) is a 6-month, episode-based, Medicare value-based care program, which rewards practices for decreasing the total cost of care (TCOC) compared to a trend adjusted predicted baseline called the benchmark price. The predicted baseline and trend factor are a function of 14 covariates in a generalized linear model with a log link and gamma distribution. Select non-cancer comorbidities, represented by a subset of Hierarchical Condition Category (HCC) flags assigned to the episode in the calendar year when the episode initiates, is a major covariate of the linear model. Patient episodes with one or more HCC flags are expected to have higher episode expenditures and receive a higher adjustment to the benchmark. Here, we seek to describe the seasonality of HCC flags and its impact on the benchmark for OCM episodes in The US Oncology Network (The Network). Methods: All eligible OCM episodes data from 14 practices in The Network participating in the OCM for performance periods (PP) 3-9 were analyzed to measure the average number of HCC flags per episode. The relative contribution of HCC flags to the benchmark was calculated by unraveling the linear model. The difference of the average HCC flags, benchmark, and relative contribution of HCC flags to the benchmark for episodes starting in different quarters of the calendar year were evaluated. Results: Average HCC flags for episodes showed a seasonal decline during each calendar year, with episodes initiating during the first quarter of a calendar year having 16.25% higher HCC flags, compared to those in the last quarter (1.93 vs 1.66 flags). The benchmark and the relative contribution of the HCC flags to the episode benchmark were lower in the last quarter of the year (4% and 16.5% respectively) compared to the first quarter. Episode expenditures did not show a similar seasonality pattern. Conclusions: The assignment of HCC flags based on the episode initiation date, leads to a seasonality effect on the average HCC flags and benchmark for episodes initiating in different parts of the calendar year. The seasonality results from a progressively abbreviated period available to assign HCC flags for episodes initiating later in the calendar year. We also hypothesize that the annual reporting requirement for HCC flags, and risk adjustment coding by professionals at the start of each new calendar year, contributes to this seasonality. The financial impact of seasonality on episodic value-based care model benchmarks necessitates a modified, non-seasonal approach to comorbidity-based risk adjustment.
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Aldridge, Anthony E. "Brachiopod outline and episodic growth." Paleobiology 25, no. 4 (1999): 471–82. http://dx.doi.org/10.1017/s0094837300020339.
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Accretionary outlines of many brachiopods are closely matched by one or more episodes of logarithmic spiral growth where each episode has a constant growth gradient. An episodic model supports the observations of abrupt change, but not that of gradual change in accretionary growth. A reliable guide to the number of growth episodes is given by the pattern of residuals after fitting a single spiral to an outline. An episodic model exposes subtle variations in growth that are not easily described by visual examination. A three-episode model clarifies a shape difference between two species of the endemic New Zealand genus Neothyris. Direct observation, along with linear measurements and their ratios, was unable to pinpoint that the well-documented dorsoventral compression in one species arises from a growth episode in the ventral valve. Logarithmic spirals about a single coiling axis are not suited for large, disjunct changes in outline for which the moving-frame methods or aperture-deposition models are applicable.
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Chagani, Hasina Suleman, and Kalimuddin Aziz. "Clinical profile of acute rheumatic fever in Pakistan." Cardiology in the Young 13, no. 1 (February 2003): 28–35. http://dx.doi.org/10.1017/s1047951103000064.
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We designed a multi-hospital prospective study of children less than 12 years to determine the comparative clinical profile, severity of carditis, and outcome on follow up of patients suffering an initial and recurrent episodes of acute rheumatic fever. The study extended over a period of 3 years, with diagnosis based on the Jones criteria. We included 161 children in the study, 57 having only one episode and 104 with recurrent episodes. Those seen in the first episode were differentiated from those with recurrent episodes on the basis of the history. The severity of carditis was graded by clinical and echocardiographic means. In those suffering their first episode, carditis was significantly less frequent (61.4%) compared to those having recurrent episodes (96.2%). Arthritis was more marked in the first episode (61.4%) compared to recurrent episodes (36.5%). Chorea was also significantly higher in the first episode (15.8%) compared to recurrent episodes (3.8%). Sub-cutaneous nodules were more-or-less the same in those suffering the first (7%) as opposed to recurrent episodes (5.8%), but Erythema marginatum was more marked during the first episode (3.5%), being rare in recurrent episodes at 0.9%. Fever was recorded in approximately the same numbers in first (45.6%) and recurrent episodes (48.1%). Arthralgia, in contrast, was less frequent in first (21.1%) compared to recurrent episodes (32.7%). A history of sore throat was significantly increased amongst those suffering the first episode (54.4%) compared to recurrent episodes (21.2%). When we compared the severity of carditis in the first versus recurrent episodes, at the start of study mild carditis was found in 29.8% versus 10.6%, moderate carditis in 26.3% versus 53.8%, and severe carditis in 5.3% versus 31.8% of cases, respectively. At the end of study, 30.3% of patients suffering their first episode were completely cured of carditis, and all others showed significant improvement compared to those with recurrent episodes, where only 6.8% were cured, little improvement or deterioration being noted in the remainder of the patients. We conclude that the clinical profile of acute rheumatic fever, especially that of carditis, is milder in those suffering their first attack compared to those with recurrent episodes.
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Léotard, Antoine, Elisabeth Groos, Charlotte Chaumereuil, Laure Peter-Derex, Andrea O. Rossetti, Smaranda Leu-Semenescu, and Isabelle Arnulf. "IV steroids during long episodes of Kleine-Levin syndrome." Neurology 90, no. 17 (March 23, 2018): e1488-e1492. http://dx.doi.org/10.1212/wnl.0000000000005349.
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ObjectiveTo retrospectively compare the benefits (episode cessation) and risks of IV methylprednisolone (IV-MP) vs abstention during prolonged Kleine-Levin syndrome (KLS) episodes.MethodsA total of 26 patients with KLS received 1 g/d IV-MP for 3 days during 1 to 6 episodes each (totaling 43 IV-MP sessions). The change of episode duration with IV-MP (vs previous episode duration) was compared with the change duration between 2 consecutive episodes in 48 untreated patients matched for age, sex, age at KLS onset, number of episodes, and disease duration (more treated than untreated patients had long episodes).ResultsEleven patients (42.3%) had an episode that was at least 1 week shorter than the preceding one when they received IV-MP therapy, whereas shorter episodes were significantly less frequent (10.4%) in the untreated group. This benefit was more marked (65.5% responders, 12 fewer days in an episode vs 0 days in the untreated patients) when IV-MP was infused before the 10th day of the episode. Mild, transient adverse effects (insomnia, muscle pain, nervousness/restlessness, but no manic switching) were reported by 61.3% of patients. No specific responder profile was identified.ConclusionIn this open-labeled, naturalistic study, early IV-MP (following the protocol for multiple sclerosis relapses) had a good benefit/risk ratio during KLS episodes in patients with long episodes (with half of the patients having an early cessation of episodes).Classification of evidenceThis study provides Class IV evidence that for patients with long episodes of KLS, IV steroids decrease the duration of KLS episodes.
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Holmes, Jennifer, John Geen, John D. Williams, and Aled O. Phillips. "Recurrent acute kidney injury: predictors and impact in a large population-based cohort." Nephrology Dialysis Transplantation 35, no. 8 (August 3, 2019): 1361–69. http://dx.doi.org/10.1093/ndt/gfz155.
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Abstract Background This study examined the impact of recurrent episodes of acute kidney injury (AKI) on patient outcomes. Methods The Welsh National electronic AKI reporting system was used to identify all cases of AKI in patients ≥18 years of age between April 2015 and September 2018. Patients were grouped according to the number of AKI episodes they experienced with each patient’s first episode described as their index episode. We compared the demography and patient outcomes of those patients with a single AKI episode with those patients with multiple AKI episodes. Analysis included 153 776 AKI episodes in 111 528 patients. Results Of those who experienced AKI and survived their index episode, 29.3% experienced a second episode, 9.9% a third episode and 4.0% experienced fourth or more episodes. Thirty-day mortality for those patients with multiple episodes of AKI was significantly higher than for those patients with a single episode (31.3% versus 24.9%, P < 0.001). Following a single episode, recovery to baseline renal function at 30 days was achieved in 83.6% of patients and was significantly higher than for patients who had repeated episodes (77.8%, P < 0.001). For surviving patients, non-recovery of renal function following any AKI episode was significantly associated with a higher probability of a further AKI episode (33.4% versus 41.0%, P < 0.001). Furthermore, with each episode of AKI the likelihood of a subsequent episode also increased (31.0% versus 43.2% versus 51.2% versus 51.7% following a first, second, third and fourth episode, P < 0.001 for all comparisons). Conclusions The results of this study provide an important contribution to the debate regarding the need for risk stratification for recurrent AKI. The data suggest that such a tool would be useful given the poor patient and renal outcomes associated with recurrent AKI episodes as highlighted by this study.
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Kalokyri, Varvara, Alexander Borgida, and Amelie Marian. "Supporting Human Memory by Reconstructing Personal Episodic Narratives from Digital Traces." Proceedings of the International AAAI Conference on Web and Social Media 16 (May 31, 2022): 453–64. http://dx.doi.org/10.1609/icwsm.v16i1.19306.
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Numerous applications capture in digital form aspects of people’s lives. The resulting data, which we call Personal Digital Traces - PDTs, can be used to help reconstruct people’s episodic memories and connect to their past personal events. This may have several applications, from helping the recall of patients with neurodegenerative diseases to gathering clues from multiple sources to identify recent contacts and places visited – a critical new application for the recent health crisis. This paper takes steps towards integrating, connecting and summarizing the heterogeneous collection of data into episodic narratives using scripts – prototypical plans for everyday activities. Specifically, we propose a matching algorithm that groups PDTs from many different sources into script instances (episodes), and we provide a technique for ranking the likelihood of candidate episodes. We report on the results of a study based on the personal data of real users, which gives evidence that our episode reconstruction 1) integrates well PDTs from different sources into coherent episodes, and 2) augments users’ memory of their past actions.
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Taylor, Susan, Katie Minor, Cindy L. Shmon, G. Diane Shelton, Edward E. Patterson, and James R. Mickelson. "Border Collie Collapse: Owner Survey Results and Veterinary Description of Videotaped Episodes." Journal of the American Animal Hospital Association 52, no. 6 (November 1, 2016): 364–70. http://dx.doi.org/10.5326/jaaha-ms-6436.
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ABSTRACT Completed surveys were obtained from owners of 165 border collies experiencing repeated episodes of abnormal gait or collapse during strenuous exercise. Unremarkable veterinary evaluation and lack of disease progression over time made common systemic, cardiac, and neurologic causes of exercise intolerance unlikely. Survey questions addressed signalment, age of onset, description of episodes, and owner perception of factors associated with collapse. Most dogs were young adults (median 2 yr) when episodes began, and they had experienced from 2 to more than 100 episodes (median 6) prior to their owners completing the survey. Retrieving was the activity most commonly associated with episodes (112/165 dogs, 68%), followed by herding stock (39/165 dogs, 24%). Owners reported that high environmental temperatures (111/165 dogs, 67%) and excitement (67/165 dogs, 41%) increased the likelihood of their dog having an episode during strenuous activity. Veterinary evaluation of videotapes of presumed border collie collapse (BCC) episodes (40 dogs) were used to provide a description of the typical features of BCC episodes. Altered mentation, symmetrical ataxia affecting all four limbs, increased pelvic limb extensor tone and toe scuffing or knuckling, truncal swaying, and falling to the side were common features, suggesting that BCC may be an episodic diffuse central nervous system disorder.
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Laudon, H. "Recovery from episodic acidification delayed by drought and high sea salt deposition." Hydrology and Earth System Sciences Discussions 4, no. 5 (September 11, 2007): 2975–96. http://dx.doi.org/10.5194/hessd-4-2975-2007.
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Abstract. For the prediction of episodic acidification large uncertainties are connected to climatic variability and its effect on drought conditions and sea-salt episodes. In this study data on 342 hydrological episodes in 25 Swedish streams, sampled over 10 years, have been analyzed using a recently developed episode model. The results demonstrate that drought is the most important factor modulating the magnitude of the anthropogenic influence on pH and ANC during episodes. These modulating effects are especially pronounced in southern and central Sweden, where the historically high acid deposition has resulted in significant S pools in catchment soils. The results also suggest that the effects of episodic acidification are becoming less severe in many streams, but this amelioration is less clear in coastal streams subject to high levels of sea-salt deposition. Concurrently with the amelioration of the effects of episodic acidification, regional climate models predict that temperatures will increase in Sweden during the coming decades, accompanied by reductions in summer precipitation and more frequent storms during fall and winter in large areas of the country. If these predictions are realized delays in streams' recovery from episodic acidification events can be expected.
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Laudon, H. "Recovery from episodic acidification delayed by drought and high sea salt deposition." Hydrology and Earth System Sciences 12, no. 2 (March 5, 2008): 363–70. http://dx.doi.org/10.5194/hess-12-363-2008.
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Abstract. For the prediction of episodic acidification large uncertainties are connected to climatic variability and its effect on drought conditions and sea-salt episodes. In this study data on 342 hydrological episodes in 25 Swedish streams, sampled over 10 years, have been analyzed using a recently developed episode model. The results demonstrate that drought is the most important factor modulating the magnitude of the anthropogenic influence on pH and ANC during episodes. These modulating effects are especially pronounced in southern and central Sweden, where the historically high acid deposition has resulted in significant S pools in catchment soils. The results also suggest that the effects of episodic acidification are becoming less severe in many streams, but this amelioration is less clear in coastal streams subject to high levels of sea-salt deposition. Concurrently with the amelioration of the effects of episodic acidification, regional climate models predict that temperatures will increase in Sweden during the coming decades, accompanied by reductions in summer precipitation and more frequent storms during fall and winter in large areas of the country. If these predictions are realized delays in streams' recovery from episodic acidification events can be expected.
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Kessing, Lars Vedel. "Severity of depressive episodes during the course of depressive disorder." British Journal of Psychiatry 192, no. 4 (April 2008): 290–93. http://dx.doi.org/10.1192/bjp.bp.107.038935.
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BackgroundIt is not clear whether the severity of depressive episodes changes during the course of depressive disorder.AimsTo investigate whether the severity of depressive episodes increases during the course of illness.MethodUsing a Danish nationwide case register, all psychiatric inpatients and out-patients with a main ICD-10 diagnosis of a single mild, moderate or severe depressive episode at the end of first contact were identified. Patients included in the study were from the period 1994–2003.ResultsA total of 19 392 patients received a diagnosis of a single depressive episode at first contact. The prevalence of severe depressive episodes increased from 25.5% at the first episode to 50.0% at the 15th episode and the prevalence of psychotic episodes increased from 8.7% at the first episode to 25.0% at the 15th episode. The same pattern was found regardless of gender, age at first contact and calendar year.ConclusionsThe increasing severity of depressive episodes emphasises the importance of early and sustained prophylactic treatment.
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Susanti, Ani, Utami Widiati, Bambang Yudi Cahyono, and Tengku Intan Suzila Tengku Sharif. "Assessing episodes in verbalization process of EFL students’ collaborative writing." Studies in English Language and Education 9, no. 2 (May 23, 2022): 539–53. http://dx.doi.org/10.24815/siele.v9i2.20165.
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One of the ways to engage EFL students in writing is to assign them to work collaboratively. Collaborative writing requires a verbalization process resulting in episodes related to language, texts, and scaffolds. This study examined the use of episodes in collaborative writing of EFL students set in pairs by the teacher. It identified the most productive type of episodes which include language-related episodes (LREs), text-related episodes (TREs), and scaffolding episodes (SEs). It also scrutinized the categories of episodes within each type of episode. The study involved 20 pairs of Indonesian students from the English Department of a reputable university in Yogyakarta, Indonesia. The students were given an integrated reading-writing task and asked to work in pairs. The results of the study showed that SEs were the most productive type of episode, followed by LREs in the moderate occurrence, and TREs, which were the least productive type of episode. The results also revealed that among the categories in each type of episode, lexis-focused (LREs), organization-focused (TREs), and repetition (SEs) were more productive than the other categories of episodes. These results imply that the most productive categories of episodes could be catalysts in the teaching of writing, which employs collaborative writing tasks either in pairs or in small groups. This study offers insights into creating activities to encourage writing activities that especially involve types of pairings.
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Adelson, Kerin B., Maureen Canavan, Sophia Mun, Cary Philip Gross, Naralys Sinanis, and Amy J. Davidoff. "The association between clinical trial (CT) participation, pharmaceutical costs, and savings performance in the Oncology Care Model (OCM)." Journal of Clinical Oncology 38, no. 29_suppl (October 10, 2020): 2. http://dx.doi.org/10.1200/jco.2020.38.29_suppl.2.
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2 Background: The OCM is a Centers for Medicare and Medicaid Services (CMS) alternative payment model, which seeks to curb costs while improving care for patients receiving systemic cancer therapy. CMS models the expected spending target for each 6-month episode using historical, geographic and clinical factors, including CTr participation. We evaluated the relationship between CTr participation, drug costs and performance in the OCM. Methods: We used claims for OCM episodes attributed to the Yale Cancer Center between July 2016 and July 2018. We stratified episodes by CTr participation and used t-tests and chi-square tests to compare total cost, drug costs (Part B, Part D and novel cancer therapies) and whether observed episode costs were above or below CMS targets. Analyses were conducted for the total sample and among the most common cancer types. Results: Among 9,387 OCM episodes (5,270 unique patients), 815 (8.7%) episodes involved a CTr. Among non-CTr patients, the mean Medicare cost per episode ($32,909) was modestly higher than the mean episode spending target ($31,746; p < 0.001), while in the CTr group, the mean Medicare cost per episode ($36,590) was substantially lower than the mean episode spending target ($48,124 p < 0.001). CTr episode costs were more likely to be under spending targets than non-CTr episodes (66% vs 56%, p < 0.001) overall and in breast, lung, and myeloma cancers, although only statistically significant for lung cancer (76% CTr vs 48% non-CTr, p < .001). Overall, non-CTr had significantly higher mean Part D drug costs per episode ($8,441 vs $3,893, p < 0.001), which was also noted among patients with lung cancer, ovarian cancer and lymphoma. Non-CTr episodes were also associated with higher mean novel therapies cost ($5,736) compared with CTr patient episodes ($4,346, p = 0.013). When comparing the sum of all other expenditures, CTr episodes were significantly associated with higher non-pharmaceutical expenditures than non-CTr episodes ($20,940 vs. $13,323, p < 0.001) overall. Conclusions: Episodes with CTr participation out-performed non-CTr episodes in achieving savings relative to CMS spending targets. Savings were driven by lower drug costs for the CTr episodes, particularly in the categories of Part D and novel cancer therapies. This suggests that CTr enrollment shifts costs for expensive pharmaceuticals away from CMS and toward the CTr study sponsor. Further research should explore whether this finding is generalizable to other cancer centers and payment models.
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Hirsch, Jared, Gabriela Dieguez, and Paul Cockrum. "Comparing total cost of care for Medicare FFS patients with pancreatic cancer by chemotherapy regimen." Journal of Clinical Oncology 38, no. 15_suppl (May 20, 2020): e19394-e19394. http://dx.doi.org/10.1200/jco.2020.38.15_suppl.e19394.
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e19394 Background: To analyze total cost of care for patients with pancreatic cancer by common therapeutic regimens. Methods: Cancer episodes were identified using a methodology similar to the Medicare Oncology Care Model (OCM) in the 2014-2016 100% Medicare Limited Data Set (LDS) claims files. Index dates for chemotherapy claims could not occur within 6 months of another chemotherapy claim for all Medicare FFS beneficiaries. Cancer episodes were defined as the 6-month period following an index date. Each episode was assigned a cancer type based on the plurality of cancer ICD 9/10 diagnosis codes that occurred on chemotherapy claims in the episode. Episode costs were calculated from claims paid amounts. DME and other Part B spending was estimated using episodes from the 5% Medicare LDS files using the same methodology. We analyzed total episode costs for five pancreatic cancer treatment regimens: gemcitabine plus nab-paclitaxel (gem-nab), FOLFIRINOX, liposomal irinotecan, FOLFOX, and FOLFIRI. Results: We identified 110,618 cancer episodes in 2016, of which 4,018 were pancreatic cancer. Pancreatic cancer patients in these episodes were treated with gem-nab (45% of episodes), FOLFIRINOX (14%), FOLFOX (8%), FOLFIRI (6%), and liposomal irinotecan (4%). The main drivers of episode costs among regimens were Part B chemotherapy, other Part B drugs, and inpatient services. Episode costs were $41,749, $42,086, $35,601, $36,169, and $45,851 for patients receiving gem-nab, FOLFIRINOX, FOLFOX, FOLFIRI, and liposomal irinotecan, respectively. Part B chemotherapy costs were $13,065 (gem-nab), $3,095 (FOLFIRINOX), $4,853 (FOLFOX), $3,204 (FOLFIRI), and $18,474 (liposomal irinotecan); other Part B drug costs were $7,343 (gem-nab), $17,013 (FOLFIRINOX), $11,131 (FOLFOX), $15,377 (FOLFIRI), and $10,479 (liposomal irinotecan); and inpatient service costs were $9,044 (gem-nab), $9,069 (FOLFIRINOX), $7,701 (FOLFOX), $5,838 (FOLFIRI), and $5,108 (liposomal irinotecan). Conclusions: Total episode costs for pancreatic cancer care ranged from $35,601 (FOLFOX) to $45,851 (liposomal irinotecan), but the cost components varied by regimen. Episodes with liposomal irinotecan had the largest Part B chemotherapy costs but the lowest inpatient service costs. Episodes with FOLFIRINOX and gem-nab had similar inpatient service costs, which were higher than episodes with liposomal irinotecan, FOLFOX, or FOLFIRI. Episodes with FOLFIRINOX and FOLFIRI had higher other Part B drug costs than episodes with FOLFOX, liposomal irinotecan, or gem-nab.
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Thaker, Nikhil G., Joshua Holloway, Chas Hodapp, Michael Mellen, David Fryefield, Rehman Meghani, Kathryn Tong, and Christopher M. Rose. "Automated Big Data Analytics for the Radiation Oncology Alternative Payment Model Proposal Using a Novel Health Care Software Technology." JCO Oncology Practice 16, no. 4 (April 2020): e333-e340. http://dx.doi.org/10.1200/jop.19.00692.
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INTRODUCTION: The proposed Radiation Oncology Alternative Payment Model (RO-APM) aims to test prospective episode-based payments for radiotherapy episodes. Practices will need a tool that can calculate historical episode reimbursements to succeed in this new model. An automated software-based technology was created to calculate historical episode reimbursements within a large Network of community oncology practices. MATERIALS AND METHODS: Claims data between January 1, 2017, and July 31, 2019, were cleaned, organized into episodes, and analyzed with a series of Python computer programs per proposed RO-APM methodology. Averaged Winsorized historical episode reimbursements were first calculated over the entire Network, then over 24 of the largest Practices, and then rerun after application of Clinical Rules to remove misattributed episodes. RESULTS: A total of 79,418 RO-APM–defined episodes were generated from 6,512,375 claims lines. A total of 7,086 episodes (8.9%) were removed because of no treatment delivery code within 28 days of treatment planning. The Network of practices had more bone metastases, and breast, cervical, and uterine cancers but less lung and prostate cancer than the RO-APM dataset. Combination-modality episodes were more costly and required more providers than single-modality episodes. Clinical Rules reattributed 2,495 episodes (3.4%) and increased episode reimbursement by +5.8% over all disease sites (+3.7% using volume weighting; P = .001). CONCLUSION: As payment models continue to shift from volume to value, practices will need an automated analytics technology to measure historical costs and prepare for operational and financial transformation. This automated approach can be adapted to future versions of the RO-APM. Our analysis suggests that future iterations of the RO-APM could incorporate Clinical Rules to remove misattributed palliative care episodes and could implement a separate payment for episodes with multiple radiation therapy modalities.
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Adelson, Kerin B., Maureen Canavan, Sophia Mun, Cary Philip Gross, Naralys Sinanis, and Amy J. Davidoff. "The impact of clinical trial (CTr) participation on savings performance in the oncology care model (OCM)." Journal of Clinical Oncology 38, no. 15_suppl (May 20, 2020): e19367-e19367. http://dx.doi.org/10.1200/jco.2020.38.15_suppl.e19367.
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e19367 Background: The OCM is a Centers for Medicare and Medicaid Services (CMS) alternative payment model, which seeks to curb costs while improving care for patients receiving systemic cancer therapy. CMS models the expected total cost (spending target) for each 6-month episode using historical, geographic and clinical factors including CTr participation. We evaluated the relationship between CTr participation, actual cost of care and performance in the OCM. Methods: We used claims for OCM episodes attributed to the Yale Cancer Center between July 2016 and July 2018. We stratified episodes by CTr participation and used t-tests and chi-square tests to compare total cost, drug costs (Part B and D) and whether actual episode costs were above or below CMS targets. Analyses were conducted for the total sample, and among the most common cancer types. Results: Among 9,387 OCM episodes (5,270 unique patients), 815 (8.7%) episodes involved a CTr. Among non-CTr patients, the mean Medicare cost per episode ($32,909) was modestly higher than the mean episode spending target ($31,746; p < 0.001), while in the CTr group, the mean Medicare cost per episode ($36,590) was substantially lower than the mean episode spending target ($48,124 p < 0.001). Mean drug cost was lower with CTr vs without ($15,650 vs $19,587, p < 0.001). Drug costs also accounted for a lower percentage of total costs for episodes with CTr vs not (41% vs 57%). CTr episodes were more likely to meet spending targets than non-CTr episodes (66% vs 56%, p < 0.001) overall and in breast, lung, and myeloma cancers, although only statistically significant for lung cancer (76% CTr vs 48% non-CTr, p < 0.001). Mean difference between target and actual costs was greater for episodes with CTr (- $11,534) than for episodes without CTr (+ $1,163) (p < 0.001). Conclusions: On average, episodes with CTr participation had substantially lower costs compared with their spending targets, while non-CTr episodes had slightly higher costs compared with their spending targets. While total cost of care was higher for episodes with CTr (as the CMS model predicts), drug costs were significantly lower. As drugs comprise a large proportion of total cost, lower drug costs in CTr episodes likely contribute to savings. Additional research should explore whether other OCM centers with higher rates of CTr participation are more likely to meet spending targets in value-based payment models.
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Rahman, Khiratul, Nurizzati Nurizzati, and Zulfadhli Zulfadhli. "EKRANISASI CERITA NOVEL WINTER IN TOKYO ILANA TAN KE FILM WINTER IN TOKYO SUTRADARA FAJAR BUSTOMI." Jurnal Bahasa dan Sastra 6, no. 3 (February 15, 2019): 362. http://dx.doi.org/10.24036/81037280.
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This study aims to: (a) describe the episode of Ilana Tan's novel Winter In Tokyo; (b) describe the movie episode of Winter In Tokyo by director Fajar Bustomi; (c) describe the episode of Ilana Tan's novel Winter In Tokyonovel with Winter In Tokyo directed by Fajar Bustomi. This research type is qualitative research with descriptive method. This research data is the episode of novelty novel Winter In Tokyo by Ilana Tan and Winter In Tokyo film directed by Fajar Bustomi. Data collection techniques have three stages. First, read Ilana Tan's Winter In Tokyo novel, and then follow Winter In Tokyo directed by Fajar Bustomi. Second, the data collection phase of the novel episode of Winter In Tokyo by Ilana Tan and Winter In Tokyo film by director Fajar Bustomi were collected through recording and observation techniques. Third, the stage of inventorying data into data inventory format. The research findings are episodes of 24 novel episodes, while in the film there are 24 episodes. In the film there are 6 additional episodes, and a reduction of 14 episodes, while the episode of a novel story that changes varies after being turned into a movie, found 7 episodes. It happens because of the creativity of the director while adapting the novel to the movie.Keywords: novel, movie, ekranisasi, episode
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McIntosh, R. P., and J. E. A. McIntosh. "Amplitude of episodic release of LH as a measure of pituitary function analysed from the time-course of hormone levels in the blood: comparison of four menstrual cycles in an individual." Journal of Endocrinology 107, no. 2 (November 1985): 231–39. http://dx.doi.org/10.1677/joe.0.1070231.
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ABSTRACT Pulse amplitude and frequency are often used to describe measurements of LH in blood. Such analyses are compatible with models of LH being released from the pituitary in episodes that are controlled by pulses of hypothalamic gonadotrophin-releasing hormone. The amplitudes of these secretory episodes as seen in blood are usually defined as the net heights of peaks above a baseline. As a measure of each pituitary secretory episode, this is valid only if peaks are regularly and widely spaced, making overlap negligible. When episodes are erratic and frequent so that only fractions of peaks have been cleared from the circulation before others follow, nadirs between peaks include output from previous episodes and do not define a physiologically meaningful baseline. Applied to overlapping peaks, such measures of amplitude usually underestimate pituitary secretory episodes and imply a tonic mode of LH secretion in addition to pulsatile release. Using the additional information of fitted LH clearance coefficients to define the shapes of LH peaks, a simple method based on an episodic mode of release alone is described, for estimating more accurately the relative sizes of secretory episodes as observed in blood, free of the effects of overlapping peaks. Using this analysis we have described the variation in amplitude, interval and clearance rates of LH secretory episodes within and between four normal menstrual cycles of a single individual. Thirteen, 3–6 h blood sampling sessions were performed during early follicular growth at the transition from luteal to follicular phases when the frequencies of LH peaks, LH/FSH ratios and progesterone concentrations were changing markedly. Our secretory episode model described all data well without the need to introduce a tonic mode of release. When frequent pulses overlapped we found that amplitudes of episodes were usually higher than peaks estimated by conventional methods, but a decrease in both amplitude and pulse interval occurred after the start of menstruation. Highly variable patterns of LH release were demonstrated in the late luteal phase of this normal individual while FSH levels rose consistently. J. Endocr. (1985) 107, 231–239
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Swann, Alan C. "Pharmacologic Mood Destabilization: Case Vignettes." CNS Spectrums 14, S11 (November 2009): 9–11. http://dx.doi.org/10.1017/s1092852900003898.
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Bipolar disorder is an illness characterized by inherent mood instability that produces a predisposition to depressive, hypomanic, or manic episodes. This predisposition to affective episodes, rather than the episodes themselves (which can have many causes), is arguably the hallmark of bipolar disorder.Most episodes of bipolar disorder, including the first episode, are depressive. This exposes an inherent flaw in our nosological system, which requires a manic or hypomanic episode for diagnosis of bipolar disorder. Treatment of a depressive episode in undiagnosed bipolar disorder can entail the use of medications that were developed to treat a different disorder (major depressive illness) and that may have mood-destabilizing or activating properties.
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Campbell, Jennifer, Krishnan Bhaskaran, Sara Thomas, Rachael Williams, Helen I. McDonald, and Caroline Minassian. "Investigating the optimal handling of uncertain pregnancy episodes in the CPRD GOLD Pregnancy Register: a methodological study using UK primary care data." BMJ Open 12, no. 2 (February 2022): e055773. http://dx.doi.org/10.1136/bmjopen-2021-055773.
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ObjectivesTo investigate why episodes of pregnancy identified from electronic health records may be incomplete or conflicting (overlapping), and provide guidance on how to handle them.SettingPregnancy Register generated from the Clinical Practice Research Datalink (CPRD) GOLD UK primary care database.ParticipantsFemale patients with at least one pregnancy episode in the Register (01 January 1937−31 December 2017) which had no recorded outcome or conflicted with another episode.DesignWe identified multiple scenarios potentially explaining why uncertain episodes occur. Criteria were established and systematically applied to determine whether episodes had evidence of each scenario. Linked Hospital Episode Statistics were used to identify pregnancy events not captured in primary care.ResultsOf 5.8 million pregnancy episodes in the Register, 932 604 (16%) had no recorded outcome, and 478 341 (8.5%) conflicted with another episode (251 026 distinct conflicting pairs of episodes among 210 593 women). 826 146 (89%) of the episodes without outcome recorded in primary care and 215 577 (86%) of the conflicting pairs were consistent with one or more of our proposed scenarios. For 689 737 (74%) episodes with recorded outcome missing and 215 544 (86%) of the conflicting pairs (at least one episode), supportive evidence (eg, antenatal records, linked hospital records) suggested they were true and current pregnancies. Furthermore, 516 818 (55 %) and 160 936 (64%), respectively, were during research quality follow-up time. For a sizeable proportion of uncertain episode, there is evidence to suggest that historical outcomes being recorded by the general practitioner during an ongoing pregnancy may offer explanation (73 208 (29.2%) and 349 874 (37.5%)).ConclusionsThis work provides insight to users of the CPRD Pregnancy Register on why uncertain pregnancy episodes exist and indicates that most of these episodes are likely to be real pregnancies. Guidance is given to help researchers consider whether to include/exclude uncertain pregnancies from their studies, and how to tailor approaches to minimise underestimation and bias.
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Gunawan, Debi, Yenni Hayati, and Muhammad Ismail Nasution. "ALIH WAHANA NOVEL RONGGENG DUKUH PARUK KARYA AHMAD TOHARI KE FILM SANG PENARI KARYA SUTRADARA IFA ISFANSYAH: DITINJAU DARI EPISODE CERITA." Jurnal Bahasa dan Sastra 6, no. 4 (June 25, 2019): 525. http://dx.doi.org/10.24036/81046000.
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This research aims to; (a) describe the episode of Ahmad Tohari's Ronggeng Dukuh Paruk novel; (b) describing the film episode of the Dancer by director Ifa Isfansyah; (c) describes a comparison of the story of Ronggeng Dukuh Paruk novel by Ahmad Tohari with the film The Dancer Director by Ifa Isfansyah, this type of research is a qualitative research with descriptive methods. The data of this study are episodes of the story of Ronggeng Dukuh Paruk's novel by Ahmad Tohari and the film Sang Penari Director by Ifa Isfansyah. Data collection techniques are carried out in three stages. The first stage was reading Ahmad Tohari's Ronggeng Dukuh Paruk karya novel, then proceeding to watch the film The Dancer's Director Ifa Isfansyah. The second stage is the data collection stage about the episode story of Ronggeng Dukuh Paruk novel by Ahmad Tohari and the film Sang Penari directed by Ifa Isfansyah's work collected through recording and observation techniques. The third stage is the stage of inventorying data into a data inventory format. Based on the results of research episodes in novels and films found a number of different episodes. The story episodes in the novel are found in 51 episodes, while in the film there are 46 episodes of the story. In the film there are 9 episodes of story episodes added, and 24 episodes of story episodes reduction, while novel episodes that experience varied changes after being screened as a film, found in 7 episodes. This happened because of the creativity of the director when adapting the novel to the film. Keywords: ecranization, novel, film
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Hirsch, Jared, Gabriela Dieguez, and Paul Cockrum. "Comparing total cost of care for Medicare FFS patients with pancreatic cancer by chemotherapy regimen." Journal of Clinical Oncology 38, no. 4_suppl (February 1, 2020): 721. http://dx.doi.org/10.1200/jco.2020.38.4_suppl.721.
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721 Background: To analyze total cost of care for patients with pancreatic cancer by FDA-Approved/NCCN Category 1 regimen. Methods: Cancer episodes were identified using a methodology similar to the Medicare Oncology Care Model (OCM) in the 2014-2016 100% Medicare Limited Data Set (LDS) claims files. Index dates were established for chemotherapy claims that did not occur within 6 months of another chemotherapy claim for all Medicare fee-for-service beneficiaries. Cancer episodes were defined as the 6-month period following an index date. Each episode was assigned a cancer type based on the plurality of cancer ICD 9/10 diagnosis codes that occurred on chemotherapy claims in the episode. Episode costs were calculated from claim paid amounts, and DME and other Part B spending was estimated using episodes created in the 5% Medicare LDS files using the same methodology. We analyzed total episode costs for three FDA-Approved/NCCN Category 1 pancreatic cancer regimens: gemcitabine plus nab-paclitaxel (gem-nab), FOLFIRINOX (FFX), and liposomal irinotecan (nal-IRI). Results: We identified 110,618 cancer episodes in 2016, of which 4,018 were for pancreatic cancer (average age at index: 71.3 years). Pancreatic cancer patients in these episodes were treated with gem-nab (45% of episodes), FFX (14%), and nal-IRI (4%). The main cost drivers across all regimens were Part B chemotherapy, other Part B drugs and inpatient services. Episode costs were $41,749, $42,086, and $45,851 for patients receiving gem-nab, FFX, and nal-IRI, respectively. Part B chemotherapy costs were $13,065 (gem-nab), $3,095 (FFX), and $18,472 (nal-IRI); other Part B drug costs were $7,343 (gem-nab), $17,013 (FFX), and $10,479 (nal-IRI); and inpatient service costs were $9,044 (gem-nab), $9,069 (FFX), and $5,108 (nal-IRI). Conclusions: Total episode costs for pancreatic cancer care were similar among three FDA-Approved/NCCN Category 1 regimens, but the components of cost varied. Episodes with Nal-IRI had the largest Part B chemotherapy costs and the lowest inpatient service costs. Episodes with FFX and gem-nab had similar inpatient service costs, which were higher than episodes with nal-IRI. Episodes with FFX had the highest other Part B drug costs.
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Fekete, Robert. "Paroxysmal Nonkinesigenic Dyskinesia with Tremor." Case Reports in Neurological Medicine 2013 (2013): 1–2. http://dx.doi.org/10.1155/2013/927587.
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Introduction. Paroxysmal nonkinesigenic dyskinesia (PNKD) consists of episodes of chorea, athetosis, or dystonia which are not triggered by movement, with complete remission between episodes. A case of genetically confirmed PNKD with simultaneous tremor has not been previously reported.Case Report. The patient is an 86-year-old right-handed female who presented with episodic stiffness, with onset at age 9. Attacks have a prodrome of difficulty in speaking, followed by abnormal sensation in extremities. Episodes consist of dystonia of trunk associated with upper and lower extremity chorea. There is complete resolution between attacks except for persistent mild head tremor and action tremor of both extremities. Attack frequency and duration as well as tremor amplitude escalated two and a half years ago, in correlation with development of breast carcinoma. Episodes improved after successful cancer treatment, but higher amplitude tremor persisted. There is an autosomal dominant family history of similar episodes but not tremor. Genetic diagnosis was confirmed via A7V mutation of the myofibrillogenesis regulator (MR-1) gene.Conclusion. Exacerbation due to another medical or psychiatric condition should be considered if there is unexpected deterioration in episode frequency or length. PNKD due to MR-1 mutation may exist even in the presence of action tremor.
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Blakely, L. Johnetta, Zsolt Hepp, Rupali Fuldeore, Samantha Tomicki, Jared Hirsch, Gabriela Dieguez, and Heidi Wirtz. "Healthcare resource utilization, quality metrics, and costs of bladder cancer within the oncology care model." Journal of Clinical Oncology 39, no. 28_suppl (October 1, 2021): 54. http://dx.doi.org/10.1200/jco.2020.39.28_suppl.54.
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54 Background: The Oncology Care Model (OCM) incentivizes practices to provide higher quality, lower cost care for Medicare beneficiaries through payment arrangements that include financial and performance accountability for 6-month care episodes. We sought to describe the existing experience with bladder cancer (BC) for OCM practices, in the context of all OCM cancer types, given the dynamic treatment landscape in which new and emerging therapies will impact spending and patient care in this payment model. Objective: To estimate healthcare resource utilization (HRU), OCM quality metrics, and costs for OCM episodes among Medicare beneficiaries with BC. Methods: OCM episodes triggered by receipt of cancer therapy (index event) were identified among Medicare beneficiaries (100% Research Identifiable Files) from 2016-18. Other inclusion criteria were enrollment in Parts A & B for the entire OCM episode (6 months or until death) and 6 months pre-index date, Medicare as primary payer, and ≥1 qualifying Evaluation & Management visit during the episode. A cancer type was assigned to each episode. BC episodes were stratified as low- (defined by receipt of BCG and/or mitomycin without other systemic therapy) or high-risk (receipt of systemic therapy other than BCG or mitomycin) based on OCM definitions. Results: Of the 2.2 million OCM cancer episodes identified among 1 million beneficiaries, 60,099 (̃3%) were BC episodes. Our analytic cohort consisted of 43,621 BC episodes (69% low-risk and 31% high-risk) among 33,497 beneficiaries. Across BC episodes, average patient age was 76.6 years and 77% were male. Relative to low-risk episodes, high-risk episodes included higher metastatic cases (40 vs 2%), and more comorbidity burden (7.4 vs 4.3 Charlson comorbidity score). High-risk episodes had more hospital admissions (0.7 vs 0.2) and intensive care unit use (17 vs 5%), longer length of stay (5.9 vs 4.9 days), and higher rates of surgery (7 vs 1%) and mortality (17 vs 2%). Among OCM quality metrics, high-risk episodes had higher inpatient admissions (42 vs 15%) and emergency department visits (37 vs 20%) relative to low-risk episodes. Average spending per high-risk BC episode was ̃$38,000 (vs $9,204 for low-risk), with ̃$11,000 spent on systemic therapies and ̃$7,000 on inpatient services. Conclusions: High-risk OCM episodes of BC, which included 40% metastatic BC, had higher HRU and costs, and lower quality performance, than low-risk episodes. Novel therapies offer a significant opportunity to optimize BC management and improve quality of care, particularly for high-risk episodes. Further, as < 3% of OCM episodes were attributed to BC, and only one-third of BC episodes were classified as high-risk, controlling expenditure on novel therapies in BC episodes is unlikely to impact overall performance for practices participating in OCM.
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Kuehny, Jeff S., William B. Miller, and Dennis R. Decoteau. "Changes in Carbohydrate and Nitrogen Relationships during Episodic Growth of Ligustrum japonicum Thunb." Journal of the American Society for Horticultural Science 122, no. 5 (September 1997): 634–41. http://dx.doi.org/10.21273/jashs.122.5.634.
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Rooted cuttings of Ligustrum japonicum Thunb., an episodically growing species, were grown hydroponically in a controlled-environment growth chamber to determine allocation of glucose, mannitol, total soluble sugars, and total protein in mature leaves, flush leaves, stems, and roots. During the 65 days of episodic growth, 43% of the total soluble sugars was glucose and 33% mannitol. Glucose concentrations of mature leaves decreased during the first root growth episode, increased in almost all plant tissue during a shoot growth episode and decreased in all plant tissue at initiation of a second root growth episode. Mannitol concentrations in the roots and stems decreased during episodes of root growth and increased during a shoot growth episode when leaf flush mannitol concentrations increased. Radiolabeled C applied to leaves before the initiation of the first period of shoot elongation was translocated to the roots. After shoot elongation, just before a root growth episode, most labeled C was translocated to new shoots and roots. Autoradiographs indicated that subsequent episodes of shoot growth were supported by photosynthate from the previous shoot flush. Protein concentrations decreased in all plant tissues during shoot growth but increased in roots and mature leaves during root growth. Concentrations of 15N in leaf and stem tissue indicated retranslocated N supported each episode of shoot growth. Changes in endogenous C and N concentrations and allocation patterns in ligustrum were linked to the control of episodic shoot and root growth.
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Black, Rachel M., Richard Stanford, and Dan Gratie. "765. The Burden of Illness Associated with Recurrent Clostridioides difficile Infection: A Claims-based Analysis." Open Forum Infectious Diseases 8, Supplement_1 (November 1, 2021): S479—S480. http://dx.doi.org/10.1093/ofid/ofab466.962.
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Abstract Background Clostridioides difficile infection (CDI) is a significant public health concern and the leading cause of infection related healthcare utilizations in adults in the United States. A considerable proportion of CDI patients suffer recurrent episodes of CDI (rCDI). The objective of this study was to describe the impact of CDI on healthcare resource utilization (HCRU) and patient burden. Methods A retrospective analysis of patients with a CDI diagnosis claim was conducted using the HealthVerity database. Continuous enrollment with medical and pharmacy benefits was required for 12 months before and after the first occurrence of CDI diagnosis (index date). Patients were stratified by total number of CDI episodes. rCDI episodes were defined as episodes that occurred within 12 weeks of the previous episode. Baseline demographics, treatment by episode, and HCRU data were captured. Results 5,964 patients with a CDI episode were identified. The average age was 56.6 years with 30.2% of the population being ≥ 65 years old. 65.7% of patients were female and 61.2% had a claim for ≥ 1 antibiotic in the 90 days leading up to the index date. Vancomycin was the predominant treatment used across all episodes (54-67%). Use of fecal microbiota transplant (FMT) increased with number of CDI episodes (12.6% for the 3rd episode; 20.7% for 5th episode). Fidaxomicin was used for initial CDI treatment in 7.5% of cases. Prior to the initial CDI episode, 24% of patients had ≥ 1 emergency department (ED) visit, 64% had an outpatient office visit and 49% had an inpatient admission due to any cause. In the post-index period, 73% of patients experienced ≥ 1 ED visits, 95% had an outpatient office visit and 72% were admitted to the hospital for any cause. As the number of CDI episodes increased, the number of ED visits, inpatient admissions and ICU admissions trended upwards. Conclusion Results from this observational analysis suggest that the presence of CDI seems to lead to a considerable increase in HCRU after the initial episode. Despite variation in treatment patterns by episode, some HCRU seems to increase with additional episodes. Disclosures Rachel M. Black, PharmD, Seres Therapeutics (Consultant) Richard Stanford, PharmD, MS, AbbVie (Consultant)Sanofi-Genzyme (Consultant)Seres Therapeutics (Consultant) Dan Gratie, PharmD, MS, Seres Therapeutics (Consultant)
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ter Horst, Liora, Matthijs C. Brouwer, Arie van der Ende, and Diederik van de Beek. "Community-acquired Bacterial Meningitis in Adults With Cerebrospinal Fluid Leakage." Clinical Infectious Diseases 70, no. 11 (July 12, 2019): 2256–61. http://dx.doi.org/10.1093/cid/ciz649.
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Abstract Background Cerebrospinal fluid (CSF) leakage is a risk factor for developing bacterial meningitis. Methods We analyzed episodes of community-acquired bacterial meningitis associated with CSF leakage from a prospective nationwide cohort study. Results CSF leakage was identified in 65 episodes of 2022 episodes (3%) in 53 patients. The cause of CSF leakage was identified in 49 of 65 episodes (75%), which most commonly consisted of ear-nose-throat surgery (19 of 49 episodes [29%]) and remote head trauma (15 of 49 episodes [23%]). The episode was a recurrent meningitis episode in 38 patients (59%). Of the recurrent episodes, 27 had known CSF leakage (71%) of whom 20 (53%) had previous surgery aiming to close the leak. Nine patients (38%) with known CSF leakage had been vaccinated (23-valent pneumococcal vaccine in 9 patients, meningococcal serogroup C vaccine in 2, meningococcal serogroup A and Haemophilus influenzae type b vaccine each in 1 patient). Streptococcus pneumoniae was cultured in 33 episodes (51%) and H. influenzae in 11 episodes (17%). The most common pneumococcal serotypes were 3 (4 episodes), 35B, 9N, 38, and 15C (each 2 episodes). Haemophilus influenzae was unencapsulated in all 10 episodes with known capsule type. The outcome was unfavorable in 8 episodes (12%) and no patient died. Conclusions Bacterial meningitis in patients with CSF leakage has a high recurrence rate, despite surgical repair or vaccination, and outcome is generally favorable. CSF leakage should be suspected in patients with bacterial meningitis presenting with liquorrhea, recurrent meningitis, or with disease caused by H. influenzae.
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Shin, Hye Jung, Seung-Myung Park, Jong Sung Park, In Ho Song, and You Deog Hong. "Chemical Characteristics of High PM Episodes Occurring in Spring 2014, Seoul, Korea." Advances in Meteorology 2016 (2016): 1–11. http://dx.doi.org/10.1155/2016/2424875.
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This study was conducted for understanding of characteristics of two different high PM episodes occurred during the spring of 2014 in Seoul, Korea. Case 1 was the phenomenon by complex of long range transport and following domestic stagnation. Case 2 was caused by the Asian dust event. During high PM episodes, atmospheric condition became more acidic. The equivalent concentration ratio of nitrate to sulfate decreased to 0.75 and 0.95 in Case 1 and Case 2, respectively, implying that sulfate concentration increase was greater than nitrate concentration increase in high PM episode possibly caused by long range transport. In high PM episodes, SOR and NOR increased with steeper rate for NOR. Considering correlation between temperature and SOR, it was suggested that the homogeneous formation of sulfate was not active in the Korean Peninsula, especially in high PM episodic periods. On the other hand, heterogeneous sulfate formation reaction was dominant for high PM episodes. Considering NOR and its correlation with temperature and humidity, it was suggested that NO2oxidation was mainly caused by homogeneous oxidation in Case 1. For Case 2, heterogeneous oxidation mainly contributed to forming the nitrate due to the extremely high particle concentrations in Asian dust.
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Al-Allak, A., R. Jones, R. Stiff, D. Dharmasena, and G. Morris-Stiff. "Long-Term Outcome of Continuous Ambulatory Peritoneal Dialysis (CAPD) Peritonitis: Surgery can be Avoided." Annals of The Royal College of Surgeons of England 91, no. 2 (March 2009): 118–22. http://dx.doi.org/10.1308/003588409x359088.
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INTRODUCTION Continuous ambulatory peritoneal dialysis (CAPD) has become the preferred method of home dialysis for patients with end-stage renal failure. Peritonitis is a common and serious complication and requires prompt diagnosis and treatment. The aim of this study was to assess what proportion of patients with CAPD peritonitis that required surgical intervention for on-going sepsis or for peritonitis-related bowel obstruction. PATIENTS AND METHODS All patients presenting with a first episode of CAPD peritonitis during the 5-year period from 1994–1998 were identified from a prospectively maintained database. Data collected included patient demographics, details of peritonitis episodes and their treatment, and details of any surgical intervention undertaken. RESULTS A total of 500 episodes were identified in 168 patients of whom 162 had complete follow-up representing 488 peritonitis episodes. Sixty-three patients experienced one episode of peritonitis, 33 two episodes, 20 had three episodes, and 46 had more than three episodes. None of the patients underwent surgery either primarily or for complications of the infective episode. A total of 465 episodes were due to a single organism (95%) and the remainder were due to multiple organisms (5%). The most common causative organisms were Gram-positive cocci (308 episodes; 71%) followed by Gram-negative bacilli (106 episodes; 24%). In 55 patients (34%), the same organism was implicated in consecutive admissions. Patients with autosomal dominant polycystic kidney disease (ADPKD), whilst accounting for 12 of 169 (7%) patients in the cohort, experienced 23 of 125 (18.4%) episodes of peritonitis by Gram-negative cocci. Such infections were seen in 8 of 12 (66.7%) ADPKD patients and accounted for 23 of 40 (57.5%) infections experienced by the ADPKD patients. CONCLUSIONS Whilst CAPD peritonitis is a common problem in the renal failure population, with almost 100 episodes per year, it would appear that most episodes can be managed using intraperitoneal antibiotics without the need for surgical intervention.
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Stanier, C. O., A. Singh, W. Adamski, J. Baek, M. Caughey, G. Carmichael, E. Edgerton, et al. "Overview of the LADCO winter nitrate study: hourly ammonia, nitric acid and PM<sub>2.5</sub> composition at an urban and rural site pair during PM<sub>2.5</sub> episodes in the US Great Lakes region." Atmospheric Chemistry and Physics Discussions 12, no. 6 (June 6, 2012): 14115–67. http://dx.doi.org/10.5194/acpd-12-14115-2012.
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Abstract. An overview of the LADCO (Lake Michigan Air Directors Consortium) Winter Nitrate Study (WNS) is presented. Sampling was conducted at ground level at an urban-rural pair of sites during January–March 2009 in eastern Wisconsin, toward the Western edge of the US Great Lakes region. Areas surrounding these sites experience multiday episodes of wintertime PM2.5 pollution characterized by high fractions of ammonium nitrate in PM, low wind speeds, and air mass stagnation. Hourly surface monitoring of inorganic gases and aerosols supplemented long-term 24-h aerosol chemistry monitoring at these locations. The urban site (Milwaukee, WI) experienced 13 PM2.5 episodes, defined as periods where the seven-hour moving average PM2.5 concentration exceeded 27 μg m−3 for at least four consecutive hours. The rural site experienced seven episodes by the same metric, and all rural episodes coincided with urban episodes. Episodes were characterized by low pressure systems, shallow/stable boundary layer, light winds, and increased temperature and relative humidity relative to climatological mean conditions. They often occurred in the presence of regional snow cover at temperatures near freezing, when snow melt and sublimation could generate fog and strengthen the boundary layer inversion. Substantial contribution to nitrate production from nighttime chemistry of ozone and NO2 to N2O5 and nitric acid is likely and requires further investigation. Pollutant-specific urban excess during episode and non-episode conditions is presented. The largest remaining uncertainties in the conceptual model of the wintertime episodes are the variability from episode-to-episode in ammonia emissions, the balance of daytime and nighttime nitrate production, the relationship between ammonia controls, NOx controls and ammonium nitrate reductions, and the extent to which snow and fog are causal (either through meteorological or chemical processes) rather than just correlated with episodes because of similar synoptic meteorology.
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Stanier, C., A. Singh, W. Adamski, J. Baek, M. Caughey, G. Carmichael, E. Edgerton, et al. "Overview of the LADCO winter nitrate study: hourly ammonia, nitric acid and PM<sub>2.5</sub> composition at an urban and rural site pair during PM<sub>2.5</sub> episodes in the US Great Lakes region." Atmospheric Chemistry and Physics 12, no. 22 (November 22, 2012): 11037–56. http://dx.doi.org/10.5194/acp-12-11037-2012.
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Abstract. An overview of the LADCO (Lake Michigan Air Directors Consortium) Winter Nitrate Study (WNS) is presented. Sampling was conducted at ground level at an urban-rural pair of sites during January–March 2009 in eastern Wisconsin, toward the western edge of the US Great Lakes region. Areas surrounding these sites experience multiday episodes of wintertime PM2.5 pollution characterized by high fractions of ammonium nitrate in PM, low wind speeds, and air mass stagnation. Hourly surface monitoring of inorganic gases and aerosols supplemented long-term 24-h aerosol chemistry monitoring at these locations. The urban site (Milwaukee, WI) experienced 13 PM2.5 episodes, defined as periods where the seven-hour moving average PM2.5 concentration exceeded 27 μg m−3 for at least four consecutive hours. The rural site experienced seven episodes by the same metric, and all rural episodes coincided with urban episodes. Episodes were characterized by low pressure systems, shallow/stable boundary layer, light winds, and increased temperature and relative humidity relative to climatological mean conditions. They often occurred in the presence of regional snow cover at temperatures near freezing, when snow melt and sublimation could generate fog and strengthen the boundary layer inversion. Substantial contribution to nitrate production from nighttime chemistry of ozone and NO2 to N2O5 and nitric acid is likely and requires further investigation. Pollutant-specific urban excess during episode and non-episode conditions is presented. The largest remaining uncertainties in the conceptual model of the wintertime episodes are the variability from episode-to-episode in ammonia emissions, the balance of daytime and nighttime nitrate production, the relationship between ammonia controls, NOx controls and ammonium nitrate reductions, and the extent to which snow and fog are causal (either through meteorological or chemical processes) rather than just correlated with episodes because of similar synoptic meteorology.
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Anderst, J. "Subsequent Episodes of Abuse More Deadly Than Initial Episode." AAP Grand Rounds 30, no. 6 (December 1, 2013): 68. http://dx.doi.org/10.1542/gr.30-6-68.
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Madokoro, Hirokazu, Kazuhito Sato, and Nobuhiro Shimoi. "Category Maps Describe Driving Episodes Recorded with Event Data Recorders." Machine Learning and Knowledge Extraction 1, no. 1 (March 12, 2018): 43–63. http://dx.doi.org/10.3390/make1010003.
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This study was conducted to create driving episodes using machine-learning-based algorithms that address long-term memory (LTM) and topological mapping. This paper presents a novel episodic memory model for driving safety according to traffic scenes. The model incorporates three important features: adaptive resonance theory (ART), which learns time-series features incrementally while maintaining stability and plasticity; self-organizing maps (SOMs), which represent input data as a map with topological relations using self-mapping characteristics; and counter propagation networks (CPNs), which label category maps using input features and counter signals. Category maps represent driving episode information that includes driving contexts and facial expressions. The bursting states of respective maps produce LTM created on ART as episodic memory. For a preliminary experiment using a driving simulator (DS), we measure gazes and face orientations of drivers as their internal information to create driving episodes. Moreover, we measure cognitive distraction according to effects on facial features shown in reaction to simulated near-misses. Evaluation of the experimentally obtained results show the possibility of using recorded driving episodes with image datasets obtained using an event data recorder (EDR) with two cameras. Using category maps, we visualize driving features according to driving scenes on a public road and an expressway.
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Sakamoto, Shinji, Atsuko Tomoda, and Nobuhiko Kijima. "Association of Self-Preoccupation and Self-Reported Duration and Severity of Depressive Episodes." Psychological Reports 90, no. 3 (June 2002): 861–68. http://dx.doi.org/10.2466/pr0.2002.90.3.861.
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The present study investigated the relation of self-preoccupation, i.e., the tendency to focus more on the self than on external objects and to maintain this self-focused attention, with the duration and severity of depressive episodes. The hypotheses were that, compared with people low on self-preoccupation, people scoring higher on self-preoccupation may experience more long-lasting depressive episodes and during such episodes they may experience a greater number of depressive symptoms. The present study examined association of self-esteem with the severity or duration of depressive episodes. A total of 1,076 undergraduates (361 men, 700 women, 15 unknown) from nine universities in the Tokyo metropolitan area participated. Of the total, 246 undergraduates (55 men and 191 women) reported that they had experienced a depressive episode continuing four or more days; these data were analyzed and are reported here. Self-preoccupation, self-esteem, and depressive episodes within 12 mo. were measured by a self-report questionnaire. The results tentatively supported the hypotheses. Specifically, rated self-esteem was significantly correlated with the number of depressive symptoms reported in a depressive episode but not with the duration of the episode. However, rated self-preoccupation was correlated with the severity and duration of the depressive episode, although the correlation of self-preoccupation scale scores with the duration of the episode was quite weak and requires further research.
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Aragno, E., G. Di Salvo, G. Rosso, and G. Maina. "Bipolar disorder and peripartum mood episodes: Epidemiology and clinical correlates." European Psychiatry 64, S1 (April 2021): S197. http://dx.doi.org/10.1192/j.eurpsy.2021.523.
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IntroductionIt is known that the peripartum period is a high-risk period of recurrence in bipolar disorder (BD). However, data on correlations between reproductive life events, such as age at menarche and peripartum period, are mixed in BD.ObjectivesThe aims of this retrospective study are to investigate the lifetime rate of peripartum mood episodes, the clinical correlates and the relationship between age at menarche and peripartum episode in a sample of women with BD.MethodsThe study focused on comparisons between women with vs. without peripartum mood episodes (n = 292). Socio-demographic and clinical characteristics between women with vs without BD peripartum episode were examined through descriptive statistics.Adjusted logistic regression analysis was run to examine the association between variables.ResultsIn our sample, 30% had at least one BD peripartum episode. Women with peripartum episode had significantly earlier age at menarche, earlier onset of BD and longer duration of untreated disorder compared to women without peripartum episode. After adjustment, the late menarche (>15 years) was associated with lower probability of BD episodes during the peripartum period compared to normal menarche (12-14 years).ConclusionsPeripartum mood episodes are common in BD and are correlated with early onset of BD and long duration of untreated disorder. Moreover, age at menarche may be related to the risk of peripartum mood episodes. The results deserve to be deepened in further studies.
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Tellapragada, Chaitanya, Helena Östlund, Christian Giske, Magnus Rasmussen, and Andreas Berge. "Recurrent bacteremia with Enterococcus faecalis, the clinical findings predicting endocarditis, and genomic characterization of the isolates: a retrospective cohort study." European Journal of Clinical Microbiology & Infectious Diseases 42, no. 8 (July 8, 2023): 1001–9. http://dx.doi.org/10.1007/s10096-023-04636-3.
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AbstractMultiple episodes of Enterococcus faecalis bacteremia (EfsB) may indicate a relapse and be due to an undiagnosed infective endocarditis (IE). The aims were to study the clinical presentation of patients with EfsB with focus on the risk of recurrent infection and IE, identify potential improvements of the management, and to investigate whether E. faecalis isolates from different episodes in the same patient were identical. In a retrospective study, a cohort of patients with monomicrobial (M) EfsB episodes was analyzed. Clinical data from medical records were collected. Furthermore, blood culture isolates from patients with multiple episodes were subjected to whole genome sequencing and multilocus sequence typing. In 666 episodes of MEfsB, 69 patients with IE and 43 with recurrent infections were found. Patients without IE, but with a following episode diagnosed as IE, were compared to those without a following episode. Variables significantly correlated with IE were long duration of symptoms, growth in all blood cultures, unknown origin of infection, heart murmur, and predisposition for IE. Transesophageal echocardiography, all negative, was done in 4 out of 11 episodes during the first episodes, later diagnosed with IE. In 28 of 31 patients with two or more EfsB episodes, isolates with identical sequence type were found. Episodes of EfsB in patients later diagnosed with IE showed features of IE already during the first episodes, were not adequately evaluated, are due to identical isolates, and most likely represent true relapses. Risk factor analysis should guide the use of echocardiography.
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Shipitsyna, Galina M. "EPISODES." Bulletin of the Moscow State Regional University (Russian philology), no. 5 (2019): 300–305. http://dx.doi.org/10.18384/2310-7278-2019-5-300-305.
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Seddon, Kathleen, Inmaculada Cerrada Serra, and Joonbum Seo. "Flash pulmonary oedema associated with paroxysmal supraventricular tachycardia: report of two cases." Journal of Feline Medicine and Surgery Open Reports 9, no. 1 (January 2023): 205511692311665. http://dx.doi.org/10.1177/20551169231166528.
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Case summary We describe two cats that had episodic tachypnoea and increased respiratory effort during periods of paroxysmal supraventricular tachycardia (SVT). Thoracic radiographs at the time of clinical signs were consistent with cardiogenic pulmonary oedema. Echocardiography following stabilisation revealed a hypertrophic cardiomyopathy phenotype with normal left atrial size in both cats. The first cat was initially treated with diltiazem, but this did not reduce the frequency of the clinical episodes. Diltiazem was switched to atenolol and the cat remained well without further recurrence. At the time of writing, the cat was reported to be well, 3 years after the initial diagnosis of SVT. The second cat was first managed with diltiazem and was then transitioned to atenolol due to recurrent clinical episodes. The episodes were less frequent with atenolol but still present. Therefore, atenolol was changed to sotalol. The cat remained well on sotalol for 2 years with only one recurrent episode during a painful event. The patient then suffered a sudden cardiac death, 5 years after the initial diagnosis of SVT. Relevance and novel information To our knowledge, this is the first report that describes flash pulmonary oedema developing secondary to episodic paroxysmal SVT in cats. Despite the severity and speed of respiratory compromise, prognosis may be good with an adequate arrhythmia control.
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Bramão, Inês, and Mikael Johansson. "Benefits and Costs of Context Reinstatement in Episodic Memory: An ERP Study." Journal of Cognitive Neuroscience 29, no. 1 (January 2017): 52–64. http://dx.doi.org/10.1162/jocn_a_01035.
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This study investigated context-dependent episodic memory retrieval. An influential idea in the memory literature is that performance benefits when the retrieval context overlaps with the original encoding context. However, such memory facilitation may not be driven by the encoding–retrieval overlap per se but by the presence of diagnostic features in the reinstated context that discriminate the target episode from competing episodes. To test this prediction, the encoding–retrieval overlap and the diagnostic value of the context were manipulated in a novel associative recognition memory task. Participants were asked to memorize word pairs presented together with diagnostic (unique) and nondiagnostic (shared) background scenes. At test, participants recognized the word pairs in the presence and absence of the previously encoded contexts. Behavioral data show facilitated memory performance in the presence of the original context but, importantly, only when the context was diagnostic of the target episode. The electrophysiological data reveal an early anterior ERP encoding–retrieval overlap effect that tracks the cost associated with having nondiagnostic contexts present at retrieval, that is, shared by multiple previous episodes, and a later posterior encoding–retrieval overlap effect that reflects facilitated access to the target episode during retrieval in diagnostic contexts. Taken together, our results underscore the importance of the diagnostic value of the context and suggest that context-dependent episodic memory effects are multiple determined.
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Cummings, Kevin J., Kathryn G. Commons, Julie C. Hewitt, John A. Daubenspeck, Aihua Li, Hannah C. Kinney, and Eugene E. Nattie. "Failed heart rate recovery at a critical age in 5-HT-deficient mice exposed to episodic anoxia: implications for SIDS." Journal of Applied Physiology 111, no. 3 (September 2011): 825–33. http://dx.doi.org/10.1152/japplphysiol.00336.2011.
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Mice deficient in the transcription factor Pet-1−/− have a ∼70% deficiency of brainstem serotonin [5-hydroxytryptamine (5-HT)] neurons and exhibit spontaneous bradycardias in room air at postnatal day (P)5 and P12 and delayed gasping in response to a single episode of anoxia at P4.5 and P9.5 (Cummings KJ, Li A, Deneris ES, Nattie EE. Am J Physiol Regul Integr Comp Physiol 298: R1333–R1342, 2010; and Erickson JT, Sposato BC. J Appl Physiol 106: 1785–1792, 2009). We hypothesized that at a critical age Pet-1−/− mice will fail to autoresuscitate during episodic anoxia, ultimately dying from a failure of gasping to restore heart rate (HR). We exposed P5, P8, and P12 Pet-1−/− mice and wild-type littermates (WT) to four 30-s episodes of anoxia (97% N2-3% CO2), separated by 5 min of room air. We observed excess mortality in Pet-1−/− only at P8: 43% of Pet-1−/− animals survived past the third episode of anoxia while ∼95% of WT survived all four episodes ( P = 0.004). No deaths occurred at P5 and at P12, and one of six Pet-1−/− mice died after the fourth episode, while all WT animals survived. At P8, dying Pet-1−/− animals had delayed gasping, recovery of HR, and eupnea after the first two episodes of anoxia ( P < 0.001 for each); death ultimately occurred when gasping failed to restore HR. Both high- and low-frequency components of HR variability were abnormally elevated in dying Pet-1−/− animals following the first episode of anoxia. Dying P8 Pet-1−/− animals had significantly fewer 5-HT neurons in the raphe magnus than surviving animals ( P < 0.001). Our data indicate a critical developmental window at which a brainstem 5-HT deficiency increases the risk of death during episodes of anoxia. They may apply to the sudden infant death syndrome, which occurs at a critical age and is associated with 5-HT deficiency.
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Pham, Christopher H., Sebastian Q. Vrouwe, Karen Tsai, Zachary J. Collier, Andrea C. Grote, Trevor E. Angell, Warren L. Garner, Justin Gillenwater, and Haig A. Yenikomshian. "10 Hypoglycemic Episodes Predict Length of Stay in Patients with Acute Burns." Journal of Burn Care & Research 41, Supplement_1 (March 2020): S9—S10. http://dx.doi.org/10.1093/jbcr/iraa024.014.
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Abstract Introduction Hypoglycemic episodes are associated with worse hospital outcomes, and their incidence varies by institution. We sought to define the prevalence of hypoglycemic episodes at our burn center and determine their association with hospital outcomes. Methods We retrospectively reviewed all consecutive adult and pediatric patients admitted to our burn center from 2015 to 2019. Patient demographics and burn characteristics were recorded. The primary outcome was mortality, and secondary outcomes were total length of stay (LOS) and intensive care unit LOS (ICU LOS). All patients experiencing hypoglycemic episodes were compared to patients who did not experience hypoglycemic episodes (controls) using two-tailed t, chi-squared, and multivariate logistic and multiple linear regression analyses. Results A total of 914 patients with acute burns were admitted during the study period. Thirty-three patients (4%) experienced hypoglycemic episodes (< 60 mg/dL). Of these, 17 patients (52%) experienced a single hypoglycemic episode, while the remainder (N=16) experienced multiple hypoglycemic episodes. There were no significant differences in age, sex, or presence of inhalation injury between hypoglycemic patients and controls. Patients that experienced a hypoglycemic episode had significantly greater TBSA involvement (23% vs. 11%, p< 0.00), higher prevalence of diabetes (48% vs. 20%, p< 0.00), higher mortality (18% vs. 7%, p=0.01), longer total LOS (39 vs. 13 days, p< 0.00), and longer ICU LOS (28 vs. 4 days, p< 0.00). A single hypoglycemic episode was associated with prolonging total LOS by 19 days (p< 0.00) and ICU LOS by 18 days (p< 0.00). Hypoglycemic episodes were not associated with higher odds of mortality (OR=0.9, 95% CI 0.3–3.0, p >0.05). There were no differences in outcomes between patients with single or multiple hypoglycemic episodes. Patients with multiple hypoglycemic episodes more frequently had a history of diabetes (81% vs. 18%, p< 0.00), and worse glucose control (HbA1c, 9% vs. 7%, p=0.04) compared to patients with single episodes. Conclusions Hypoglycemic episodes were associated with longer total and ICU LOS in our study but did not portend higher mortality. Applicability of Research to Practice Quality improvement efforts to prevent hypoglycemic episodes should focus efforts on known diabetics with high HbA1c levels.
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Poongodi, K., and Dhananjay Kumar. "Mining serial positioning episode rules by natural exponent inertia weight based swallow swarm optimization algorithm with constraint based event sequences." Journal of Intelligent & Fuzzy Systems 40, no. 3 (March 2, 2021): 4599–615. http://dx.doi.org/10.3233/jifs-201438.
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The Frequent Episode Mining (FEM) is a challenging framework to identify frequent episodes from a sequence database. In a sequence, an ordered collection of events defines an episode, and frequent episodes are only considered by the earlier studies. Also, it doesn’t support for the serial based episode rule mining. In this work, the episode rules are mined with precise and serial based rule mining considering the temporal factor, so that, the occurrence time of the consequent is specified in contrast to the traditional episode rule mining. The proposed work has a larger number of candidates and specific time constraints to generate the fixed-gap episodes, and mining such episodes from whole sequence where the time span between any two events is a constant which is utilized to improve the proposed framework’s performance. In order to improve the efficiency, an Optimal Fixed-gap Episode Occurrence (OFEO) is performed using the Natural Exponent Inertia Weight based Swallow Swarm Optimization (NEIWSSO) algorithm. The temporal constraints significantly evaluate the effectiveness of episode mining, and a noticeable advantage of the present work is to generate optimal fixed-gap episodes for better prediction. The effective use of memory consumption and performance enhancement is achieved by developing new trie-based data structure for Mining Serial Positioning Episode Rules (MSPER) using a pruning method. The position of frequent events is updated in the precise-positioning episode rule trie instead of frequent events to reduce the memory space. The benchmark datasets Retail, Kosarak, and MSNBC is used to evaluate the proposed algorithm’s efficiency. Eventually, it is found that it outperforms the existing techniques with respect to memory consumption and execution time. On an average, the proposed algorithm achieves 28 times lesser execution time and consumes 45.5% less memory space for the highest minimum support value on the Retail dataset compared to existing methods.
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McClish, Donna k., Wally R. Smith, Joshua J. Field, Samir K. Ballas, Claudia M. Campbell, Lori E. Crosby, Carlton Dampier, Deepika S. Darbari, and William Zempsky. "Defining Sickle Cell Disease Acute Painful Episodes: The Pisces Project." Blood 132, Supplement 1 (November 29, 2018): 3510. http://dx.doi.org/10.1182/blood-2018-99-114830.
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Abstract Background: For research purposes, painful crises in sickle cell disease (SCD) have either been self-defined by patients, or adjudicated by research experts, most often based on whether urgent care or hospital care was sought for pain related to SCD. The Pain in Sickle Cell Epidemiology Study (PiSCES) determined that three-fourths of self-defined crises days were not managed in urgent or hospital care. The Analgesic, Anesthetic, and Addiction Clinical Trial Translations, Innovations, Opportunities, and Networks (AAPT) published a taxonomy of chronic SCD pain, defined as pain on most days of 6 months duration, along with at least one clinical sign, and no better explanation for the pain. We served on a similar SCD consensus panel to propose a more expansive taxonomy of acute sickle cell pain or painful episodes, informed by the PiSCES dataset (manuscript under review). Here we present three PiSCES-derived definitions of acute painful episodes, and we analyze the impact of various definitions on pain outcome results potentially useful for research. Methods: PiSCES Patients (N=81) who completed at least 5 out of the expected 6 months of daily diaries and did not have gaps in their daily diary of 4 days or more were included. Patients self-reported their worst sickle cell pain intensity on a scale from 0 (none) to 9 (unbearable), and independently self-reported whether they were having a crisis that day, whether they went for an unscheduled physician visit, an Emergency Department visit, or whether they were hospitalized for sickle cell pain. Definitions of acute pain episodes compared here include self-reported crisis days, days with pain ≥ 5, and days with utilization of the ED or overnight hospitalization (other potential definitions not shown). To meet any definition, a crisis day (pain≥ 5, utilization) had to be reported for 2 or more consecutive days. Non-crisis intervals were 2 or more consecutive days without a self-reported crisis (pain ≥ 5, utilization). The average length of non-crisis intervals was considered to represent the time between crisis episodes. For <4 consecutive missing days, imputations were performed using non-missing data to calculate the probability that missing days were crisis days. We used PiSCES data to compare various pain outcomes (see Table) for patients with and without AAAPT-defined chronic pain, for the three definitions of an acute painful episode. We note that episode length, intensity, time between episodes and intensity of non-episodes were all estimated using only patients who had an acute painful episode. Results: (Table) For each definition of an acute painful episode, a larger percentage of patients with chronic pain had acute episodes than patients without chronic pain. Similarly, chronic pain patients had statistically significantly more episodes and higher mean pain intensity on non-episode days. For 2 of 3 definitions (but not ED or hospitalization use), chronic pain patients had longer episodes and shorter time between episodes. Only for the self-reported crisis definition, patients had higher mean pain intensity during episodes. Raising the pain intensity threshold from 5 to 6 to define an acute episode slightly decreased the absolute percentage with acute episodes, the number of episodes, and the length of episodes, but did not affect the relationships between outcomes for patients with and without chronic pain (results not shown in table). Conclusions: A comparison of various definitions of acute painful episodes using the PiSCES dataset yields slightly different pain outcome results. However, these differences are intuitive. For example, chronic pain patients still have more intense and more frequent acute painful episodes regardless of the definition used. The finding of more frequent acute pain in SCD adults with chronic pain has important implications for treatment and the design of SCD clinical trials. Table. Table. Disclosures Field: Ironwood: Consultancy, Research Funding; Prolong: Research Funding; Incyte: Research Funding. Dampier:Pfizer: Research Funding.
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Susanti, Ani, Utami Widiati, Bambang Yudi Cahyono, and Tengku Intan Suzila Tengku Sharif. "Indonesian EFL students’ verbal episodes in proficiency pairings." International Journal of Evaluation and Research in Education (IJERE) 11, no. 1 (March 1, 2022): 431. http://dx.doi.org/10.11591/ijere.v11i1.22025.
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The quality of collaborative writing process to some extent depends on the verbal episodes occurring during the collaboration. This study aimed to describe English as a foreign language (EFL) students’ verbal episodes in proficiency pairings. A case study design was used in this study. It involved 40 EFL students of the English department in an Indonesian university. They were divided into two groups based on the types of proficiency pairings: heterogeneous (20 students) and homogenous (20 students). Therefore, this study was also intended to identify which of the two types of proficiency pairings produces more verbal episodes than the other. The verbal processes were audio recorded and then transcribed. The audio transcriptions were analyzed for common themes related to episode categorization. To ensure the reliability of the episode analysis, inter-coder, and intra-coder checks were employed. The results showed that Indonesian EFL students used three major types of verbal episodes: language-related episodes (LREs), text-related episodes (TREs), and scaffolding episodes (SEs). The study also revealed that proficiency levels determined the categories of LREs and SEs most frequently produced by the heterogeneous and homogeneous pairs. Both the heterogeneous and homogeneous pairs were likely to produce almost the same frequencies of categories of TREs more particularly in terms of organization and content. Further research might explore the link between the number of episodes and the learning gains.