A proposed novel adaptive DC technique for non-stationary data removal.

The stationarity of a time series is an important assumption in the Box-Jenkins methodology. Removing the non-stationary feature from the time series can be done using a differencing technique or a logarithmic transformation approach, but it is not guaranteed from the first step. This paper proposes a new adaptive DC technique, a novel technique for removing a non-stationary time series from the first step. The technique involves transferring non-stationary data into another domain that deals with it as a stationary time series, as it is much easier to be forecasted in that domain. The adaptive DC technique has been applied to different time series, including gasoline and diesel fuel prices, temperature, demand side, inflation rate and number of internet users time series. The performance of the proposed technique is evaluated using different statistical tests, including Augmented Dickey-Fuller (ADF), Kwiatkowski-Phillips-Schmidt-Shin (KPSS), and Phillips Perron (PP). Additionally, the technique is validated by comparing it with a differencing technique, and the results show that the proposed technique slightly outperforms the differencing method. The importance of the proposed technique is its capability to get the stationarity data from the first step, whereas the differencing technique sometimes needs more than one step.

Preformulation Studies with Phenylalanine Ammonia Lyase: Essential Prelude to a Microcapsule Formulation for the Management of Phenylketonuria.

Phenylalanine ammonia lyase (PAL) metabolizes phenylalanine to transcinnamic acid (TCA). Our eventual goal is to develop a PAL microcapsule formulation to deplete phenylalanine in the gastrointestinal tract (g.i.t). The focus of this research is pre-formulation studies with PAL. PAL exhibited undesirable time dependent decrease in activity due to TCA mediated product inhibition. Addition of bovine serum albumin (BSA) completely relieved product inhibition. Ultrafiltration experiments revealed that BSA acted by binding and sequestering TCA. PAL exhibits maximum activity at a pH of 8.5 and will need to be buffered to retain activity in the g.i.t. Buffer studies showed that a pH 8.5, 0.4 M Bicine buffer containing BSA was able to maintain maximal PAL activity against simulated gastric and intestinal fluid additions. Buffered PAL with BSA was able to rapidly and completely deplete phenylalanine in simulated mouse g.i.t conditions. A small fraction of phenylalanine in the g.i.t is present as dipeptides. Our studies established for the first time that PAL cannot metabolize phenylalanine dipeptides. Our results explain why previous trials with PAL in the management of phenylketonuria produced low efficacy. They will guide design of a PAL microcapsule formulation that maintains maximal PAL activity during its transit through the g.i.t.

Use of conditional medical orders to minimize moral, ethical, and legal risk in critical care.

Risk managers and ethicists monitor adherence to codes of conduct in the delivery of medical services and proactively participate with providers to create protocols that minimize the moral, ethical, and legal risks inherent in many commonly used medical protocols. "Code/no code" medical orders work well for patients at the extremes who always or never want to undergo a procedure, but they create troubling uncertainties for others by preventing them from expressly requesting procedures under some circumstances but not others. Obeying binary orders such as DNAR (Do Not Attempt Resuscitation) can allow deaths that a patient might want to delay or can expose patients to prolonged suffering they wish to avoid. These risks can be reduced by: (1) fully explaining the nature of proposed interventions and their possible beneficial and adverse effects in varying circumstances; and (2) replacing the traditional dichotomy with a continuum of options from always, through conditionally sometime, to never orders adapted to a range of situations and preferences. The Conditional Medical Orders (CMO) form summarizes patients' preferences regarding resuscitation, ventilation, and artificial hydration and nutrition (ANH) is an efficient way to increases the chance that patients will undergo only the treatments they want.

Analysis of pir gene expression across the Plasmodium life cycle.

BACKGROUND: Plasmodium interspersed repeat (pir) is the largest multigene family in the genomes of most Plasmodium species. A variety of functions for the PIR proteins which they encode have been proposed, including antigenic variation, immune evasion, sequestration and rosetting. However, direct evidence for these is lacking. The repetitive nature of the family has made it difficult to determine function experimentally. However, there has been some success in using gene expression studies to suggest roles for some members in virulence and chronic infection. METHODS: Here pir gene expression was examined across the life cycle of Plasmodium berghei using publicly available RNAseq data-sets, and at high resolution in the intraerythrocytic development cycle using new data from Plasmodium chabaudi. RESULTS: Expression of pir genes is greatest in stages of the parasite which invade and reside in red blood cells. The marked exception is that liver merozoites and male gametocytes produce a very large number of pir gene transcripts, notably compared to female gametocytes, which produce relatively few. Within the asexual blood stages different subfamilies peak at different times, suggesting further functional distinctions. Representing a subfamily of its own, the highly conserved ancestral pir gene warrants further investigation due to its potential tractability for functional investigation. It is highly transcribed in multiple life cycle stages and across most studied Plasmodium species and thus is likely to play an important role in parasite biology. CONCLUSIONS: The identification of distinct expression patterns for different pir genes and subfamilies is likely to provide a basis for the design of future experiments to uncover their function.

Evaluation of website information provided by paediatric surgery centres in Australia and New Zealand.

BACKGROUND: Hospital websites are an important source of information for patients, parents and healthcare providers. There are currently no standardized recommendations for the information provided on paediatric surgery websites. We aimed to assess the information available on each hospital website, in Australia and New Zealand, which provides paediatric surgical care. METHODS: Google search was performed of the 16 paediatric surgical centres in Australia and New Zealand to determine whether they had a hospital website and to assess its contents. The presence of patient fact sheets and clinical practice guidelines was recorded. Access to contact information, hospital Facebook page and Twitter handles were noted. RESULTS: We found that 11 (69%) centres had a specific paediatric surgical section to the hospital website, all provided contact information. Five centres (31%) had paediatric-specific guidelines available for health professionals. Six websites (37.5%) provided health information sheets on common paediatric surgical conditions. Facebook and Twitter facilities were present on the majority of the websites (75%). CONCLUSION: The internet presence of paediatric surgery in Australia and New Zealand is sparse. One-third of centres do not have hospital web presence. The availability of clinical guidelines and patient information sheets on hospital websites is limited. Our findings would suggest that improvement and increase in the internet presence of paediatric surgery in Australia and New Zealand is needed.

Paediatric testicular tumours in a New Zealand centre.

AIM: This is a 12-year, single-centre retrospective review of paediatric testicular tumours and review of the world literature on paediatric testicular tumours. The aim was to identify presenting features, the range of pathology and management of such tumours in comparison with other published series. METHODS: The hospital's pathology database was searched for all testicular and paratesticular tissue submitted for patients younger than 16 years of age during the 12-year study period January 2000 to December 2011, and patients with testicular tumours identified. A detailed review of clinical records was then completed and summary statistics calculated. RESULTS: There were 33 tumours and 22 (66.7%) were malignant. The most common tumour was mature teratoma. No tumours presented with a twisted gonad. The mean incidence per year was 2.75 cases. This is comparable to other reported series worldwide (median 1.92, range 1.7-6.3). CONCLUSION: Testicular tumours in children are rare. In our centre, mature teratoma was the most common tumour, and malignant testicular tumours did not present with torsion. Our experience in managing gonadal tumours is similar to that published by major centres for paediatric surgery across the world. There is scope to develop the practice of testis-sparing surgery.

Extreme hydrothermal conditions at an active plate-bounding fault.

Temperature and fluid pressure conditions control rock deformation and mineralization on geological faults, and hence the distribution of earthquakes. Typical intraplate continental crust has hydrostatic fluid pressure and a near-surface thermal gradient of 31 ± 15 degrees Celsius per kilometre. At temperatures above 300-450 degrees Celsius, usually found at depths greater than 10-15 kilometres, the intra-crystalline plasticity of quartz and feldspar relieves stress by aseismic creep and earthquakes are infrequent. Hydrothermal conditions control the stability of mineral phases and hence frictional-mechanical processes associated with earthquake rupture cycles, but there are few temperature and fluid pressure data from active plate-bounding faults. Here we report results from a borehole drilled into the upper part of the Alpine Fault, which is late in its cycle of stress accumulation and expected to rupture in a magnitude 8 earthquake in the coming decades. The borehole (depth 893 metres) revealed a pore fluid pressure gradient exceeding 9 ± 1 per cent above hydrostatic levels and an average geothermal gradient of 125 ± 55 degrees Celsius per kilometre within the hanging wall of the fault. These extreme hydrothermal conditions result from rapid fault movement, which transports rock and heat from depth, and topographically driven fluid movement that concentrates heat into valleys. Shear heating may occur within the fault but is not required to explain our observations. Our data and models show that highly anomalous fluid pressure and temperature gradients in the upper part of the seismogenic zone can be created by positive feedbacks between processes of fault slip, rock fracturing and alteration, and landscape development at plate-bounding faults.

Honor Thy Parents: An Ethnic Multigroup Analysis of Filial Responsibility, Health Perceptions, and Caregiving Decisions.

The present study explores patterns of parity and disparity in the effect of filial responsibility on health-related evaluations and caregiving decisions. Participants who identified as White, Black, Hispanic, or Asian/Pacific Islander read a vignette about an older man needing medical care. They were asked to imagine that they were the man's son and answer questions regarding their likelihood of hiring a health care advocate (HCA) for services related to the father's care. A multigroup (ethnicity) path analysis was performed, and an intercept invariant multigroup model fits the data best. Direct and indirect effect estimation showed that filial responsibility mediated the relationship between both the perceived severity of the father's medical condition and the perceived need for medical assistance and the likelihood of hiring an HCA only for White and Hispanic participants, albeit differently. The findings demonstrate that culture and ethnicity affect health evaluations and caregiving decision making.

Intramedullary fixation of pertrochanteric fractures after hip resurfacing arthroplasty - Do we have the answer? Case report and literature review.

OBJECTIVE: To report a case of a peri-prosthetic hip fracture fixed using a previously unreported technique of intramedullary nailing with dual proximal fixation. CASE SUMMARY: An 81-year-old nursing home resident suffered a multi-fragmentary peri-prosthetic hip fracture around a Birmingham Hip Resurfacing arthroplasty (BHR), which was fixed using a novel technique. DISCUSSION: Such fractures pose a significant surgical dilemma with regards to the optimal method of treatment. The increasing popularity of these implants suggests that these fractures will become increasingly common. CONCLUSION: We believe that our technique provides a practical and satisfactory solution to these fractures.