Rapid Administration of Antibiotics for Reducing Fever Days in Patients Receiving Hematopoietic Stem Cell Transplantation.

Background and Objectives: Neutropenic fever (NF) is a major cause of mortality and morbidity in patients undergoing hematopoietic stem cell transplantation (HSCT). To date, no study has discussed the relationship of fever days in HSCT with the time between recording the fever and administering antibiotics. This study aimed to examine the association between fever days in HSCT and the time interval between recording the fever and intravenous (IV) antibiotics to the febrile neutropenia patient. Materials and Methods: A total of 22 patients who developed NF after HSCT in one hospital were analyzed. Patients who received IV antibiotics injection within 30 min were categorized in group A and those who received the injection after 30 min were categorized in group B. Fever was defined by an attack with an oral temperature of 38.3 °C. Patients' characteristics and possible risk factors were recorded and analyzed. Results: Groups A and B had 14 and 8 patients, respectively. Patient characteristics, including age, diagnosis, sex, and antibiotics level, were similar between the two groups. The median duration of fever days was 1.5 (range, 1−5) in group A and 6.5 (range, 1−14) in group B (p = 0.003). Multivariant analysis of possible independent impact factors of "fever days in HSCT" was performed. The odds ratio of "antibiotics given time" was 4.00 (95% confidence interval [CI] = 2.26 to 7.22, p = 0.001). The "antibiotics level" did not affect the NF period (odds ratio = −0.80, 95% CI = −2.40 to 1.07, p = 0.453). Conclusions: Rapid IV administration of antibiotics (<30 min after fever attack) can reduce the fever days in patients undergoing HSCT.

Factors related to the prevention and management of pressure ulcers.

Pressure ulcers (a type of skin failure) have served as an indicator of care quality. The purpose of this study was to utilize data-mining techniques as a means of identifying risk factors related to different stages of pressure ulcers to demonstrate how this means of analysis might be used as a vehicle to guide improved care quality. Data were obtained from a Web-based incident reporting system at a regional hospital in Taiwan. A total of 4301 cases dating from March 2005 to May 2009 were collected. For data-cleaning purposes, data within 3 SDs were kept for further analysis. Data-mining techniques were applied to identify the predictors, and a logistic regression analysis was used for result comparison purposes. The results revealed that sacral ulcer was the most prevalent, and most ulcers were in stage I, followed by stages II to IV. Five predictors were identified including hemoglobin, weight, sex, height, and use of repositioning sheet. The study concluded that nurses could use data-mining technique to identify predictors to assist in guiding ulcer interventions such as those based on a patient's demographic profile and application of a repositioning sheet to prevent ulcer occurrence to minimize harm.

The evaluation of a web-based incident reporting system.

A Web-based reporting system is essential to report incident events anonymously and confidentially. The purpose of this study was to evaluate a Web-based reporting system in Taiwan. User satisfaction and impact of system use were evaluated through a survey answered by 249 nurses. Incident events reported in paper and electronic systems were collected for comparison purposes. Study variables included system user satisfaction, willingness to report, number of reports, severity of the events, and efficiency of the reporting process. Results revealed that senior nurses were less willing to report events, nurses on internal medicine units had higher satisfaction than others, and lowest satisfaction was related to the time it took to file a report. In addition, the Web-based reporting system was used more often than the paper system. The percentages of events reported were significantly higher in the Web-based system in laboratory, environment/device, and incidents occurring in other units, whereas the proportions of reports involving bedsores and dislocation of endotracheal tubes were decreased. Finally, moderate injury event reporting decreased, whereas minor or minimal injury event reporting increased. The study recommends that the data entry process be simplified and the network system be improved to increase user satisfaction and reporting rates.

The retail brand personality-Behavioral outcomes framework: Applications to identity and social identity theories.

This study applies identity and social identity theories to develop and test a framework in which retail brand personality influences consumer outcomes [i.e., positive word-of-mouth (WOM) about and patronage intention toward the retailer] through public and/or private self-congruity, strengthened by shopping conspicuousness situation, and retail brand identification (RBI). This is the first study to include social shopping situations to study brand personality and self-congruity. A questionnaire with a 2 (retailer image format) × 2 (shopping situation conspicuousness) between-subjects design was conducted on a sample of US consumers. Structural equation modeling was used to test the hypotheses. The findings suggest a framework in which Genuine, the most influential dimension of retail brand personality, predicted outcome behaviors both directly and indirectly through self-congruities and RBI. The high shopping conspicuousness situation strengthened the relationship between public self-congruity and the overall RBI. The concept of RBI provides an additional theoretical perspective for guiding future research on shopper-brand relationships. In addition, this framework provides practical implications for retail environment design and customer-brand relationship management.

Endophthalmitis caused by Pseudomonas aeruginosa in Taiwan.

PURPOSE: To investigate the clinical settings, treatment given, and visual outcomes for eyes with Pseudomonas aeruginosa endophthalmitis in Taiwan. METHODS: This is a retrospective, noncomparative, consecutive case series. Medical records were reviewed in 72 eyes of 71 patients with culture-proven P. aeruginosa endophthalmitis between January 1997 and December 2007. RESULTS: The clinical settings included keratitis/scleritis (44.4%), cataract surgery (15.3%), penetrating keratoplasty (13.9%), endogenous source (12.5%), trauma (6.9%), penetrating keratoplasty with cataract surgery (2.8%), trabeculectomy with cataract surgery (1.4%), trabeculectomy (1.4%), and secondary implant (1.4%). Initial visual acuity ranged from counting fingers to no light perception. Final visual acuity was better than 5/200 in 6 of 72 eyes (8.3%), 4/200 to hand motions in 4 eyes (5.6%), and light perception to no light perception in 62 eyes (86.1%). In vitro testing, the susceptibility patterns of organisms isolated were as follows: ceftazidime (100%), cefepime (100%), aztreonam (100%), imipenem (99%), amikacin (94%), and gentamicin (86%). Five of 16 eyes (31.3%) that underwent primary or secondary pars plana vitrectomy with intravitreal antibiotics achieved a final visual acuity of 5/200 or better compared with 1 of 45 eyes (2.2%) treated with 1 or multiple vitreous tap(s) and intravitreal antibiotics (Fisher's exact test, P = 0.004). CONCLUSION: Despite early diagnosis and treatment with intravitreal antibiotics, visual acuity outcomes were generally poor.

Intravitreal loading injection of ganciclovir with or without adjunctive oral valganciclovir for cytomegalovirus anterior uveitis.

BACKGROUND: A pilot study was conducted to evaluate the therapeutic results of intravitreal ganciclovir injection as a loading dose with or without the following oral valganciclovir for the treatment of cytomegalovirus (CMV) anterior uveitis in immunocompetent patients. METHODS: Six consecutive patients in whom active CMV anterior uveitis was detected by polymerase chain reaction assay of the aqueous humor were enrolled between January 2006 and December 2008. These patients received an intravitreal injection of ganciclovir (2 mg/0.05 ml) as a loading dose. Subsequent use of oral valganciclovir (900 mg twice a day) was determined according to the severity of the post-injection aqueous inflammation. Immune status and anterior chamber reaction of individual patients, visual acuity, intraocular pressure (IOP) at study entry, and follow-up intervals were examined. RESULTS: The mean patient-month follow-up period after intravitreal injection was 14.7 months (range, 12-22 months). Two patients received only the intravitreal ganciclovir injection once and four patients had received the following oral valganciclovir for average 2.3 months (range, 1-4 months). With this treatment strategy, the best-corrected visual acuity of the patients improved or stabilized; the IOP and the inflammation of anterior chamber of the patients were well controlled at all time points and there were no treatment-associated complications by the end of follow-up. CONCLUSIONS: In patients with CMV anterior uveitis, intravitreal ganciclovir injection as a loading dose with or without the following oral valganciclovir can control the inflammation and IOP well.

Ghost cell glaucoma after intravitreal bevacizumab for postoperative vitreous hemorrhage following vitrectomy for proliferative diabetic retinopathy.

BACKGROUND AND OBJECTIVE: To report the occurrence of ghost cell glaucoma after intravitreal injection of bevacizumab for the treatment of postoperative vitreous hemorrhage after vitrectomy for proliferative diabetic retinopathy (PDR). PATIENTS AND METHODS: Retrospective chart review from August 2006 to December 2007. Patients who had postoperative vitreous hemorrhage after vitrectomy for PDR and received an intravitreal injection of bevacizumab were enrolled in the study. RESULTS: Eight eyes of 8 patients (mean age: 46 years) were included. After intravitreal injection of bevacizumab, 4 (50%) eyes had clearance of vitreous hemorrhage. Three eyes developed ghost cell glaucoma within 1 week after intravitreal injection of bevacizumab. Of these, intraocular pressure was controlled in 1 eye through the use of anti-glaucoma medication, whereas the other 2 eyes needed surgical intervention to lower intraocular pressure and subsequently clear the vitreous hemorrhage. CONCLUSION: Intravitreal injection of bevacizumab may accelerate the clearance of postoperative vitreous hemorrhage in cases of PDR. However, a high incidence of ghost cell glaucoma was observed. Caution should be exercised when administering an intravitreal injection of bevacizumab for a postoperative vitreous hemorrhage after vitrectomy for PDR.

Chronic postoperative Roseomonas endophthalmitis.

We report one case with chronic postoperative endophthalmitis caused by Roseomonas species. Roseomonas spp. induced chronic endophthalmitis, which might result in misdiagnosis and delayed treatment and causes ocular damage and severe visual loss. This report is the first one related to a case with postoperative endophthalmitis secondary to Roseomonas infection.

Clinical characteristics and surgical outcomes of pediatric retinal detachments with lens disorders.

PURPOSE: To describe the clinical characteristics and outcomes of eyes with retinal detachments with lens disorders and compare them to eyes with retinal detachments without lens disorders. METHODS: A retrospective chart review of 42 eyes of 37 children who had retinal detachments with lens disorders was performed. Eyes were compared based on epidemiological data, characteristics of retinal detachment, and anatomical and functional surgical outcomes and were then compared to 254 eyes with retinal detachment without lens disorders. RESULTS: In eyes with lens disorders, the retina was reattached after the first operation in 13 (31%) eyes and at the end of the intervention in 22 (52%) eyes. Surgical and visual outcomes appeared to be slightly better in the subluxation and dislocation group compared with cataract and aphakia or pseudophakia groups. In eyes without lens disorders, the retina was reattached in 202 (80%) eyes after the first intervention and in 228 (90%) eyes at the end of the intervention. CONCLUSION: Pediatric retinal detachment with a lens disorder is associated with unsatisfactory surgical and visual outcomes compared to those without lens disorders. Primary internal and external approaches are suggested in children with complicated retinal detachment with lens disorders.

Cancer Impact, Complementary/Alternative Medicine Beliefs, and Quality of Life in Cancer Patients.

OBJECTIVES: The purpose of this study was to explore the relationships among cancer impact, belief in complementary and alternative medicine (CAM), CAM use, and quality of life (QOL). DESIGN: The study used a cross-sectional, descriptive correlational design with convenience sampling. A total of 122 cancer patients participated. Data were collected at a medical center in Chunghua, Taiwan. The questionnaires included the Chinese version of the Cancer Problem in Living Scale (CPILS), Complementary and Alternative Medicine Belief Inventory (CAMBI), Complementary and Alternative Medicine scale, and Chinese versions of QOL scales, including the Functional Assessment of Cancer Therapy-General (FACT-G). RESULTS: The mean age was 56.5 years, and most participants were male (n = 69, 56.6%), had completed high school or above (n = 56, 45.9%), and were married (n = 109, 89.3%). The most common type of cancer was oral (n = 17, 13.9%), followed by esophageal (n = 15, 12.3%) and colorectal (n = 13, 10.7%). Cancer patients, on average, use one or two types of CAM. The impact of cancer is significantly related to age (F = 7.12, p < 0.05), and income is related to QOL (F = 3.61, p < 0.05). Pearson correlations showed that the use of CAM was positively associated with belief in CAM (CAMBI) (r = 0.26, p = 0.01), and the impact of cancer was highly negatively associated with QOL (r = -0.71, p = 0.001). The predictors of QOL were the impact of cancer and use of CAM, and the impact of cancer accounted for 51% of the variance in QOL. CONCLUSION: This study supports research on the impact of cancer, belief in CAM, and use of CAM as related to QOL in cancer patients. These results can be used to provide options to clinicians and cancer patients.

Induction of cytochrome P450-dependent monooxygenase by extracts of the medicinal herb Salvia miltiorrhiza.

The herbal medicine Salvia miltiorrhiza (Danshen) is currently used for the treatment of cardiovascular and cerebrovascular diseases. To assess possible herb-drug interactions, the effects of the aqueous and ethyl acetate extracts of S. miltiorrhiza on cytochrome P450 (CYP) were studied. Oral treatment of C57BL/6J mice with the ethyl acetate extract caused a dose-dependent increase in liver microsomal 7-methoxyresorufin O-demethylation (MROD) activity. The ethyl acetate extract caused an 8-, 2-, 3- and 3-fold increase in hepatic MROD, tolbutamide hydroxylation, nifedipine oxidation and warfarin 7-hydroxylation activity, respectively. However, the aqueous extract had no effects on any of the activities determined. Pharmaceutical product of S. miltiorrhiza extract caused a dose-dependent increase in MROD activity without affecting other activity. Immunoblot analysis of microsomal proteins showed that ethyl acetate extract-treatment elevated the protein levels of CYP1A and CYP3A. Tanshinone IIA was the main diterpene quinone in S. miltiorrhiza. At the dose corresponding to its content in ethyl acetate extract, tanshinone IIA-treatment increased mouse liver microsomal MROD activity. These results demonstrated that there were mouse CYP1A, CYP2C and CYP3A-inducing agents present in the ethyl acetate extract, but not in the aqueous extract, of S. miltiorrhiza. Tanshinone IIA played a role in the induction of CYP1A by S. miltiorrhiza. The CYP induction by the ethyl acetate extract and pharmaceutical product suggested that possible drug interactions between S. miltiorrhiza and CYP substrates should be noticed.

Temperature-dependent development and population growth of Tetraneura nigriabdominalis (Homoptera: Pemphigidae) on three host plants.

The root aphid Tetraneura nigriabdominalis (Sasaki) (Homoptera: Pemphigidae) is a pest of many Gramineae species; however, little is known about its biology and relationships with host plants. The objectives of this study were to quantify the effects of temperature on development, longevity, fecundity, and population growth of T. nigriabdominalis and to assess the effects of host plant on development of T. nigriabdominalis. The effects of temperature on performance of this root aphid were determined at 10, 15, 20, 25, 30, and 35 +/- 1 degrees C on rice roots, Oryza sativa L. Nymphal stages from birth to adult decreased from 46.3 d at 10 degrees C to 8.5 d at 30 degrees C. Aphid survival and development were lowest at 35 degrees C, and no aphid produced progeny at this temperature. Average adult longevity decreased from 23.3 d at 15 degrees C to 8.2 d at temperatures up to 35 degrees C. Average number of nymphs produced per female was highest at 25 degrees C; averaging near 30 nymphs per female, but it dropped to near zero at both 10 and 35 degrees C. The highest intrinsic rate of increase (r(m)) was 0.241 at 30 degrees C. Net reproductive rate (R(0)) ranged from 29.8 at 25 degrees C to 0.2 at 10 degrees C. The generation time (GT) decreased with increasing temperatures from 60.3 d at 10 degrees C to 13.8 d at 30 degrees C. In addition, root aphids reared at 30 degrees C on three host plants [O. sativa, Zea mays L. and Sorghum bicolor (L.) Moench] revealed that the developmental time of the nymphal stages averaged 6.9 d when reared on O. sativa and 10.7 d when reared on Z. mays. Comparison of the nitrogen content of the three host plants indicated that the root nitrogen content was highest in O. sativa. The effect of nitrogen content on aphid performance, however, is still not clear. Other factors, such as plant secondary chemistry, may play a role in affecting aphid performance.

A Decade of Changes in Family Caregivers' Preferences for Life-Sustaining Treatments for Terminally Ill Cancer Patients at End of Life in the Context of a Family-Oriented Society.

CONTEXT: Temporal changes in different family caregiver cohorts' preferences for life-sustaining treatments (LSTs) at end of life (EOL) have not been examined nor have the concept of whether caregivers' LST preferences represent a homogeneous or heterogeneous construct. Furthermore, LST preferences are frequently assessed from multiple treatments, making clinical applications difficult/infeasible. OBJECTIVES: To identify parsimonious patterns and changes in the pattern of LST preferences for two independent cohorts of family caregivers for terminally ill Taiwanese cancer patients. METHODS: Preferences for cardiopulmonary resuscitation, intensive care unit care, cardiac massage, intubation with mechanical ventilation, intravenous nutritional support, tube feeding, and dialysis were assessed among 1617 and 2056 family caregivers in 2003-2004 and 2011-2012, respectively. Patterns and changes in LST preferences were examined by multigroup latent class analysis. RESULTS: Five distinct classes were identified: uniformly preferring, uniformly rejecting, uniformly uncertain, and favoring nutritional support but rejecting or uncertain about other treatments. Class probability significantly decreased from 29.3% to 23.7% for the uniformly rejecting class, remained largely unchanged for the uniformly preferring (16.9%-18.6%), and favoring nutritional support but rejecting (37.1%-37.5%) or uncertain about other treatments (8.0%-10.4%) classes, but significantly increased from 7.0% to 11.5% for the uniformly uncertain class over time. CONCLUSION: Family caregivers' LST preferences for terminally ill cancer patients are a heterogeneous construct and shifted from uniformly rejecting all LSTs toward greater uncertainty. Surrogate EOL-care decision making may be facilitated by earlier and thorough assessments of caregivers' LST preferences and tailoring interventions to the unique needs of caregivers in each class identified in this study.

Age-related changes in human RPE cell density and apoptosis proportion in situ.

PURPOSE: To determine the effect of age on the proportion of apoptotic cells in the RPE and cellular density in human eyes in situ. METHODS: RPE flatmounts prepared from 22 adult human cadaver eyes (11 pairs; ages 19-87) were stained for apoptotic cells by a TUNEL technique. The density of RPE cells was also measured. The flatmount was divided into four concentric regions centered on the fovea (zone 1, 0-1.5 mm radius; zone 2, 1.5-3.0 mm; zone 3, 3.0-12.5 mm; and zone 4, >12.5 mm). RESULTS: There was a positive correlation between the donor's age and the proportion of apoptotic RPE cells per eye (r = 0.63; P = 0.04), which increased during the sixth decade and was higher in older (age range, 56-87 years) than in younger (age range, 19-48 years) eyes (0.56 +/- 0.14 vs. 0.07 +/- 0.07 cells per 100,000 cells, respectively; P = 0.03). Apoptotic RPE cells were located mainly in zone 1 in older eyes. Cell density decreased in the RPE as the distance from the fovea increased (r = 0.66, P < 0.05). The decrease was most prominent in zone 4 (r = -0.76, P = 0.007). CONCLUSIONS: The proportion of apoptotic human RPE increased significantly with age. Apoptotic RPE cells are confined mainly to the macula of older human eyes. The observation that RPE cell death occurs in the macula but the density of RPE cells remains unchanged in the macula and decreases in the periphery suggests that migration of peripheral RPE cells may compensate for the death of macular RPE cells.

Nuclear sclerotic cataract in young patients in Taiwan.

PURPOSE: To document the clinical features of discrete nuclear sclerosis in young patients. SETTING: Chang-Gung Memorial Hospital, Taoyuan, Taiwan, Republic of China. METHODS: The medical records of all patients younger than 45 years with nuclear sclerosis who had cataract surgery at 1 hospital were retrospectively reviewed. Patients with congenital cataract, ocular trauma, ocular disease in addition to myopia, and systemic disease associated with cataract were excluded. The patients' age, sex, bilateral lens status, axial length, original and preoperative refractive status, and preoperative and postoperative best corrected visual acuities (BCVAs) were recorded. RESULTS: Fifty-five eyes of 35 patients aged 32 to 45 years met the study criteria. Nuclear sclerotic cataract was bilateral in 20 patients. The mean age at surgery was 40.64 years +/- 3.63 (SD). The mean refraction before the development of cataract was -7.80 +/- 3.57 diopters (D) and the mean preoperative refraction, -17.40 +/- 6.05 D. The mean axial length was 28.09 +/- 2.31 mm. The postoperative BCVA was 20/22 or better in 53 eyes (96.4%). CONCLUSIONS; In patients younger than 45 years with cataract in Taiwan, nuclear sclerosis was not a rare cause of visual loss and axial myopia was strongly associated with the formation of nuclear sclerosis. Bilateral sclerosis was observed in most cases. Patients with an axial length greater than 27.0 mm had the greatest risk. Surgical treatment was therapeutic.

Induction of CYP1A by a diterpene quinone tanshinone IIA isolated from a medicinal herb Salvia miltiorrhiza in C57BL/6J but not in DBA/2J mice.

Effects of tanshinone IIA, an active diterpene quinone of the herbal medicine Salvia miltiorrhiza (Danshen), on cytochrome P450 (CYP), UDP-glucuronosyl transferase (UGT), and glutathione S-transferase (GST) were studied in the arylhydrocarbon (Ah)-responsive C57BL/6J (B6) and nonresponsive DBA/2J (D2) mice. Oral treatment of tanshinone IIA caused a dose-dependent increase of liver microsomal 7-methoxyresorufin O-demethylation (MROD) activity in B6 but not in D2 mice. In B6 mice, tanshinone IIA increased hepatic benzo(a)pyrene hydroxylation (AHH), 7-ethoxyresorufin O-deethylation, MROD, and 7-ethoxycoumarin O-deethylation activities. The levels of Cyp1A2 protein and mRNA were elevated. On the contrary, in D2 mice, tanshinone IIA decreased hepatic AHH and nifedipine oxidation activities and the CYP3A protein level without affecting other activities determined. Cyp1A2 protein and mRNA levels were not affected by tanshinone IIA in D2 mice. Tanshinone IIA had no effects on UGT and GST activities in both B6 and D2 mice. These results demonstrated that induction of CYP1A2 by tanshinone IIA depended on the Ah-responsiveness and occurred at pre-translational level.

Retinal function and histologic changes following intravitreal injection of indocyanine green in a rabbit model.

The aim of this animal study was to investigate the effects of intravitreal injection of indocyanine green (ICG) applied in macular hole surgery on retinal functional, morphology, and histologic changes. Eighteen (18) New Zealand albino rabbits were divided equally into three groups (6 rabbits in each). In Group A, both eyes of each rabbit were vitrectomized by perflouropropane gas compression. One (1) month later, 0.1 cc of different doses of ICG was injected into the vitreous in the left eyes. In the right eyes, 0.1 cc of balanced salt solution was injected intravitreally, allowing them to serve as control eyes. In Group B, the same doses of ICG were injected intravitreally. ICG was washed out by fluid-fluid exchange 3 minutes after injection. In Group C, the same doses of ICG were injected intravitreally in nonvitectomized eyes. Scotopic and photopic electroretinogram (ERG) recordings and indirect ophthalmoscopy examinations were performed to detect any functional and morphologic changes. Rabbit eyes were enucleated 4 months after ICG injections to observe histologic changes. Significant decreased of scotopic and photopic ERG amplitude and marked histologic changes were noted in eyes injected with 0.5 mg/cc and 0.1 mg/cc of ICG in nonvitrectomized eyes (Group C). In vitrectomized eyes (Group A), decreased scotopic and photopic ERGs and mild histologic changes were noted in eyes injected with 0.5 mg/cc, but no histologic changes were noted in eyes injected with 0.1 mg/cc. There was a transient, mild decrease in scotopic and photopic ERGs and no morphologic changes were noted in the eyes with fluid-fluid exchange (Group B). The toxicity of intravitreous ICG is dose- and time-dependent. ICG at 0.5 mg/cc, with short exposure time, is recommended in macular hole surgery.

Presumed choroidal atypical tuberculosis superinfected with cytomegalovirus retinitis in an acquired immunodeficiency syndrome patient: a case report.

BACKGROUND: To report an unusual case of multifocal choroidopathy with uveitis and cytomegalovirus (CMV) retinitis in a patient with acquired immunodeficiency syndrome (AIDS) after initially presenting with pulmonary tuberculosis (Mycobacterium kansasii). CASE: Slit-lamp biomicroscopy and indirect ophthalmoscopic examination were done. Vitreous biopsy, pars plana vitrectomy, and retinal biopsy were performed. Computer tomography scan, magnetic resonance imaging and biopsy of the brain were also carried out. OBSERVATIONS: Multiple yellowish-white, round, slightly elevated subretinal pigment epithelium lesions were noted in areas devoid of the atrophic retina of previous CMV infection. Anterior uveitis and vitritis were also noted. Vitreous, retina, and brain biopsy did not offer any clue for diagnosis. The visual acuity improved later, along with recovered immunity under the anti-tuberculosis medications and the cocktail therapy for AIDS. CONCLUSIONS: Combined CMV retinitis and atypical tuberculosis chorioretinitis, although rare, can develop in the patients with AIDS. Systemic dissemination of atypical tuberculosis infection should be responsible for the choroidopathy in this patient.

Optimal policies of non-cross-resistant chemotherapy on Goldie and Coldman's cancer model.

Mathematical models can be used to study the chemotherapy on tumor cells. Especially, in 1979, Goldie and Coldman proposed the first mathematical model to relate the drug sensitivity of tumors to their mutation rates. Many scientists have since referred to this pioneering work because of its simplicity and elegance. Its original idea has also been extended and further investigated in massive follow-up studies of cancer modeling and optimal treatment. Goldie and Coldman, together with Guaduskas, later used their model to explain why an alternating non-cross-resistant chemotherapy is optimal with a simulation approach. Subsequently in 1983, Goldie and Coldman proposed an extended stochastic based model and provided a rigorous mathematical proof to their earlier simulation work when the extended model is approximated by its quasi-approximation. However, Goldie and Coldman's analytic study of optimal treatments majorly focused on a process with symmetrical parameter settings, and presented few theoretical results for asymmetrical settings. In this paper, we recast and restate Goldie, Coldman, and Guaduskas' model as a multi-stage optimization problem. Under an asymmetrical assumption, the conditions under which a treatment policy can be optimal are derived. The proposed framework enables us to consider some optimal policies on the model analytically. In addition, Goldie, Coldman and Guaduskas' work with symmetrical settings can be treated as a special case of our framework. Based on the derived conditions, this study provides an alternative proof to Goldie and Coldman's work. In addition to the theoretical derivation, numerical results are included to justify the correctness of our work.

Application of data mining to the identification of critical factors in patient falls using a web-based reporting system.

PURPOSE: The implementation of an information system has become a trend in healthcare institutions. How to identify variables related to patient safety among accumulated data has been viewed as a main issue. The purpose of this study was to identify critical factors related to patient falls through the application of data mining to available data through a hospital information system. METHOD: Data on a total of 725 patient falls were obtained from a web-based nursing incident reporting system at a medical center in Taiwan. In the process of data mining, feature selection was applied as the first step, after which 10 critical factors were selected to predict the dependent variables (injury versus non-injury). An artificial neural network (ANN) analysis was applied to develop a predictive model and a multivariate stepwise logistic regression was performed for comparison purposes. RESULTS: The ANN model produced the following results: a Receiver-Operating-Character (ROC) curve indicated 77% accuracy, the positive predictive value (PPV) was 68%, and the negative predictive value (NPV) was 72%; while the multivariate stepwise logistic regression only identified 3 variables (fall assessment, anti-psychosis medication and diuretics) as significant predictors with ROC curve of 42%, PPV of 26.24%, and NPV of 87.12%. CONCLUSION: In addition to medication use such as anti-psychotic and diuretics, nursing intervention where a fall assessment is conducted could represent a critical factor related to outcomes of fall incidence.