Energy-Efficient Wireless Sensor Network with an Unequal Clustering Protocol Based on a Balanced Energy Method (EEUCB).

A hot spot problem is a problem where cluster nodes near to the base station (BS) tend to drain their energy much faster than other nodes due to the need to perform more communication. Unequal clustering methods such as unequal clustering routing (UDCH) and energy-efficient fuzzy logic for unequal clustering (EEFUC) have been proposed to address this problem. However, these methods only concentrate on utilizing residual energy and the distance of sensor nodes to the base station, while limited attention is given to enhancing the data transmission process. Therefore, this paper proposes an energy-efficient unequal clustering scheme based on a balanced energy method (EEUCB) that utilizes minimum and maximum distance to reduce energy wastage. Apart from that, the proposed EEUCB also utilizes the maximum capacity of node energy and double cluster head technique with a sleep-awake mechanism. Furthermore, EEUCB has devised a clustering rotation strategy based on two sub-phases, namely intra- and inter-clustering techniques, that considers the average energy threshold, average distance threshold, and BS layering node. The performance of the proposed EEUCB protocol is then compared with various prior techniques. From the result, it can be observed that the proposed EEUCB protocol shows lifetime improvements of 57.75%, 19.63%, 14.7%, and 13.06% against low-energy adaptive clustering hierarchy (LEACH), factor-based LEACH FLEACH, EEFUC, and UDCH, respectively.

Validation of the NFL-225 test for predicting 1-RM bench press performance in college football players.

BACKGROUND: The purpose of this study was to evaluate the accuracy of repetitions-to-fatigue (RTF) using an absolute load of 102.3 kg (225 lbs) to estimate one-repetition maximum (1-RM) bench press performance in college football players using various prediction equations. EXPERIMENTAL DESIGN: a prospective study on the association between muscular endurance and muscular strength. PARTICIPANTS: 260 players from NCAA Division IA (n=43), IAA (n=63), II (n=129), and red-shirts (n=25) were evaluated at the conclusion of a minimum of eight weeks of heavy-resistance training during the off-season. MEASURES: all subjects performed a 1-RM bench press and RTF using an absolute load of 102.3 kg. RESULTS: The Mayhew et al. NFL-225 equation nonsignificantly overestimated 1-RM from RTF by 0.5 kg, while the Chapman et al. NFL-225 equation significantly underpredicted by 3.2 kg, although both equations were comparable in the number of players predicted within +/-4.5 kg of actual 1-RM (52% vs 51%, respectively). Only two of nine RTF equations currently in use produced predicted 1-RM values that were not significantly different from actual 1-RM performance. CONCLUSIONS: Specific NFL-225 equations are more accurate in estimating 1-RM bench press from absolute muscle endurance in college football players than previous published RTF equations. The accuracy of prediction decreases at higher repetitions.

Optic neuropathy and chiasmopathy in the diagnosis of systemic lupus erythematosus.

PURPOSE: To report the clinical presentation of acute visual loss in six patients who were ultimately diagnosed with systemic lupus erythematosus (SLE). METHODS: Retrospective case series. RESULTS: All patients had a positive antinuclear antibody and elevated anti-double stranded DNA titers. Five of six patients demonstrated gadolinium enhancement of the optic nerve and/or chiasm on magnetic resonance imaging (MRI). Most patients showed initial improvement after treatment with high-dose systemic corticosteroids, but five experienced recrudescences during steroid taper, requiring further treatment with immunosuppressive or cytotoxic medications. CONCLUSIONS: Visual loss owing to optic neuropathy or chiasmopathy may be the presenting sign of SLE or the event that leads to this diagnosis. Gadolinium-enhanced MRI is useful for identifying anterior visual pathway lesions in these patients. Corticosteroids are effective in the treatment of this condition; however, relapses requiring further treatment are common.

Neuroma as a cause of oculomotor palsy in infancy and early childhood.

INTRODUCTION: Third nerve palsy in infancy and early childhood is rare. We present 5 children with isolated monocular oculomotor palsy originally believed to be idiopathic but subsequently documented to be secondary to a presumed neuroma of the third nerve, distal to the mesencephalon. METHODS: Retrospective case review of patient charts from 1995 through 1999 was performed. RESULTS: Mean age at initial presentation was 14.4 months (range, 2-36 months). Two patients were male. Initial manifestation was an incomplete paresis in all 5 cases; 2 patients presented initially with exotropia, 2 with ptosis, and 3 with anisocoria. The pupil was ultimately involved in all cases. Progression to total paresis occurred in 4 of 5 patients over a mean of 13 months (range, 4-22 months). Findings of initial neuroimaging were believed to be normal in all cases but further thin-section gadolinium-enhanced magnetic resonance imaging studies, including coronal views, revealed enlargement and/or enhancement of the subarachnoid or intracavernous portion of the oculomotor nerve. Aberrant regeneration did not develop in any case throughout follow-up (mean, 49.4 months). Visual acuity was decreased on the ipsilateral side in all cases, consistent with amblyopia. No patient had neurofibromatosis. CONCLUSIONS: Suspicion for neuroma should be high in infants and young children with acquired, isolated, apparently idiopathic third nerve palsy. Serial gadolinium-enhanced, 1- to 2-mm thin-section magnetic resonance imaging with coronal views is essential for proper diagnosis.

Pseudotumor cerebri and optic nerve sheath decompression.

OBJECTIVE: To determine the efficacy and safety of optic nerve sheath decompression in a large population of patients with pseudotumor cerebri with visual loss despite medical treatment and to suggest a treatment algorithm on the basis of these data. DESIGN: Retrospective, noncomparative, interventional case series. PARTICIPANTS: One hundred fifty-eight eyes in 86 patients with pseudotumor cerebri. INTERVENTION: Optic nerve sheath decompression. MAIN OUTCOME MEASURES: Visual acuity, visual fields, and surgical complications. RESULTS: After optic nerve sheath decompression for pseudotumor cerebri, visual acuity stabilized or improved in 148 of 158 (94%) eyes, and visual fields stabilized or improved in 71 of 81 (88%) eyes. Surgical complications, most of which were transient and benign, were seen in 39 of 86 patients. Only one eye in one patient had permanent severe visual loss secondary to an operative complication. CONCLUSIONS: In patients with pseudotumor cerebri with progressive visual loss despite maximum medical therapy, optic nerve sheath decompression is a safe and effective means of stabilizing visual acuity and the visual fields of those tested.

Microbiological confirmation of tuberculosis cases at diagnosis and at the end of treatment in Italy.

Microbiological findings at diagnosis and at the end of treatment are relevant for evaluating tuberculosis (TB) treatment programmes. The objectives of this study were to describe the microbiological findings at diagnosis and at the end of treatment in pulmonary and extrapulmonary TB patients treated under programme conditions in Italy. The study was a prospective monitoring activity based on the collection of standard recording and reporting forms from a representative sample of Italian TB Units. The forms with individual data were reviewed and analysed on a quarterly basis, 9 months after enrolment. The complete bacteriological profile of patients was analysed at diagnosis and at the completion of treatment. Individual data on 992 patients were analysed. At diagnosis 320 (32.2%) of cases were pulmonary sputum smear positive, 361 (36.4%) pulmonary smear negative or not done and 311 (33.4%) extrapulmonary; 424 (42.7%) of all TB cases were culture confirmed at diagnosis (368, 50.2%, of pulmonary cases); 575 (84.4%) of pulmonary cases had a culture done at diagnosis and 156 (22.9%) at the end of treatment (p < 0.001); 572 (84%) had a sputum smear done at diagnosis and 164 (24.1%) at the end of treatment (p < 0.001). Although the rate of bacteriologically confirmed cases is similar to that of other European countries, the bacteriological confirmation at diagnosis and, particularly, at the end of treatment, is sub-optimal. The importance of further disseminating national guidelines among physicians managing TB is emphasized, in order to achieve a higher proportion of TB cases bacteriologically confirmed at diagnosis and monitored at the end of treatment.

The Italian AIPO study on tuberculosis treatment results, report 1996. National AIPO "Tuberculosis" Study Group. Associazione Italiana Pneumologi Ospedalieri.

In Italy, no national data on tuberculosis (TB) treatment results were available. In 1995, the AIPO (Italian Association of Hospital Pneumologists) TB Study Group, in collaboration with the Istituto Superiore di Sanità (technical branch of the Ministry of Health), started a prospective monitoring activity based on World Health Organization (WHO) and International Union against Tuberculosis and Lung Disease (IUATLD) recommendations. Data were collected from a nationwide network of 41 TB units, managing a significant proportion of all the TB cases notified in Italy each year. The aim of this study was to analyse the case findings and treatment results for the year 1996. Eight hundred and thirty eight TB cases were reported (56% males; 26% immigrants), 708 (84%) being new cases. Of these cases, 565 (67%) were pulmonary, 235 (28%) extrapulmonary and 38 (5%) both pulmonary and extrapulmonary. The main risk factors for TB were a history of recent contact and diabetes among native Italians and recent contact and human immunodeficiency virus-seropositive status among immigrants. The majority of immigrants were from Africa and Asia, and had been in Italy > 24 months before diagnosis of TB. Thirty-six per cent of patients had a positive direct sputum smear examination for alcohol acid-fast bacilli; 37% were resistant to any drug (monoresistance to isoniazid 4.4%; multidrug resistance 10.4%). In 96% of cases, the duration of treatment was < 12 months. The overall success rate (cured plus treatment completed) was 84.1%. A significantly higher percentage of deaths was found in native Italians (being age-related), whereas immigrants had a higher default rate.

Cost-comparison of different management policies for tuberculosis patients in Italy. AIPO TB Study Group.

Although in developing countries the treatment of tuberculosis (TB) cases is among the most cost-effective health interventions, few studies have evaluated the cost-effectiveness of TB control in low-prevalence countries. The aim of the present study was to carry out an economic analysis in Italy that takes into account both the perspective of the resource-allocating authority (i.e. the Ministry of Health) and the broader social perspective, including a cost description based on current outcomes applied to a representative sample of TB patients nationwide (admission and directly observed treatment (DOT) during the initial intensive phase of treatment); a cost-comparison analysis of two alternative programmes: current policy based on available data (scenario 1) and an hypothetical policy oriented more towards outpatient care (scenario 2) (both scenarios included the option of including or not including DOT outside hospital admission, and incentives) were compared in terms of cost per case treated successfully. Indirect costs (such as loss of productivity) were included in considerations of the broader social perspective. The study was designed as a prospective monitoring activity based on the supervised collection of forms from a representative sample of Italian TB units. Individual data were collected and analysed to obtain a complete economic profile of the patients enrolled and to evaluate the effectiveness of the intervention. A separate analysis was done for each scenario to determine the end-point at different levels of cure rate (50-90%). The mean length of treatment was 6.6 months (i.e. patients hospitalized during the intensive phase; length of stay was significantly higher in smear-positive patients and in human immunodeficiency virus (HIV) seropositive patients). Roughly six direct smear and culture examinations were performed during hospital admission and three during ambulatory treatment. The cost of a single bed day was US$186.90, whereas that of a single outpatient visit ranged, according to the different options, from US$2.50 to US$11. Scenario 2 was consistently less costly than scenario 1. The cost per case cured for smear-positive cases was US$16,703 in scenario 1 and US$5946 in scenario 2. The difference in cost between the cheapest option (no DOT) and the more expensive option (DOT, additional staff, incentives) ranged from US$1407 (scenario 1, smear-negative and extrapulmonary cases) to US$1814 (scenario 2, smear-positive cases). The additional cost to society including indirect costs ranged from US$1800 to US$4200. The possible savings at the national level were in the order of US$50 million per year. In conclusion, cost-comparison analysis showed that a relatively minor change in policy can result in significant savings and that the adoption of DOT will represent a relatively modest economic burden, although the real gain in effectiveness resulting from DOT in Italy requires further evaluation.

The Italian AIPO study on tuberculosis treatment results, report 1995. National AIPO "Tuberculosis" Study Group.

In Italy, no national data on tuberculosis (TB) treatment results were available. In 1995, the AIPO (Italian Association of Hospital Pneumologists) TB Study Group, in collaboration with the Istituto Superiore di Sanità (technical branch of the Ministry of Health), started a prospective monitoring activity based on World Health Organization (WHO) and International Union against Tuberculosis and Lung Disease (IUATLD) recommendations. Data were collected from a nationwide network of 41 TB units, managing a significant proportion of all TB cases notified in Italy each year. The aim of this study was to analyse the case findings and treatment results for the year 1995. Seven hundred and seventy eight TB cases were reported (59% males; 21% immigrants), 640 (82%) being new cases. Of these cases, 517 (66%) were pulmonary, 239 (31%) extrapulmonary and 22 (3%) both pulmonary and extrapulmonary. The main risk factors for TB were a history of recent contact and alcohol abuse among native Italians and human immunodeficiency virus-seropositive status among immigrants. The majority of immigrants were from Africa and South America, and had been in Italy > 24 months before diagnosis of TB. Thirty-seven per cent of patients had a positive direct sputum smear examination for alcohol acid-fast bacilli; 20% were resistant to any drug (monoresistance to isoniazid 3.5%; multidrug resistance 5.2%). In 95% of cases, the duration of treatment was < 12 months. The overall success rate (cured plus treatment completed) was 81.1%. A significantly higher percentage of deaths was found in native Italians (being age-related), whereas immigrants had a higher default rate.

The Italian AIPO study on tuberculosis treatment results, report 1997. National AIPO "Tuberculosis" Study Group.

In Italy no national data have been available on tuberculosis (TB) treatment results. In 1995 the AIPO (Italian Association of Hospital Pneumologists) TB Study Group, in collaboration with the Istituto Superiore di Sanità (technical branch of the Ministry of Health) started a prospective monitoring activity based on the recommendations of the World Health Organization and the International Union Against Tuberculosis and Lung Disease. The aim of this study was to analyse the case findings and treatment results during 1997. Data were collected from a representative network of TB units nation-wide, managing a significant proportion of all TB cases notified in Italy each year. A total of 715 TB cases were reported (56% males; 24% immigrants), of which 635 (89%) were new cases. Of these cases 493 (69%) were pulmonary, 187 (26%) extra-pulmonary cases and 35 (5%) both pulmonary and extrapulmonary. The main risk factors for TB were history of recent contact and diabetes among native Italians, human immunodeficiency virus-seropositive status and a history of recent contact among immigrants. The majority of immigrants came from Africa and Central and South America, and stayed in Italy for more than 24 months before the diagnosis of TB was made. Thirty-six per cent of patients had a positive direct sputum smear examination for alcohol acid-fast bacilli and 27% were resistant to any drug (monoresistance to isoniazid: 2.4%; multi-drug resistance: 7.5%). In 97% of cases the duration of treatment was < 12 months. The overall success rate (cured plus treatment completed) was 78.1%. A significantly higher percentage of deaths, which was age related, was found in native Italians, while immigrants had a higher default rate. In conclusion, case finding and treatment results in Italy in 1997 are similar to those described in 1995 and 1996.

"Mickey Mouse" aneurysm presenting with cranial bruit: case report.

The production of a bruit associated with intracranial aneurysms is very rare. A patient with a bilobed aneurysm of the middle cerebral artery who was otherwise asymptomatic was admitted with both a subjective and an objective bruit. The bruit resolved with elective clipping of the aneurysm. After a thorough review of the literature, a total of 12 cases of proved intracranial aneurysms were found with associated bruit. Five of those were carotid artery aneurysms within the cavernous sinus. Most (67%) of those patients reviewed were admitted with hemorrhage that was present either into the cavernous sinus or in the form of subarachnoid hemorrhage, with the bruit only secondarily noted. A possible explanation for the production of bruits caused by intracranial aneurysms is discussed. We conclude that, although an audible bruit as the presenting symptom of an intracranial aneurysm is quite rare, it deserves serious surgical considerations.

Converting a unit to patient-focused care.

OBJECTIVE: St. Vincent Hospitals and Health Services, Indianapolis, implemented the patient-focused care concept, Care2001, to maintain or improve the quality of patient care and to reduce the overall complexity of delivering healthcare, which adversely affected St. Vincent's efficiency. With the streamlining possible using the patient-focused approach, St. Vincent hoped to realize cost savings as well. Pilot program: In January 1990 St. Vincent introduced the Seton Unit, a patient-focused care pilot program serving a homogeneous group of surgery patients. Program design: The Seton Unit required facility redesign, such as replacing the traditional central nurses' station with nurse substations,and job class reconfiguration, which established five job classifications: unit representative, unit support assistant, team care specialist, pharmacist, and clinical manager. RESULTS: The Seton Unit initially offered better quality care and increased patient, physician, and staff satisfaction; increased direct care; reduced length of stay; improved service; and reduced costs. After the initial impact of Care2001, satisfaction levels dropped somewhat, necessitating refinements. Satisfaction levels have since improved. IMPLICATIONS: The patient-focused care concept is succeeding at St. Vincent. The hospital has already expanded it to other units and is committed to implementing the concept hospital-wide.

Neuro-ophthalmological findings in closed head trauma.

Visual abnormalities following closed head trauma are common and can affect any part of the visual pathway. We reviewed 181 consecutive patients referred with visual complaints following closed head trauma. A motor vehicle accident was the most common etiology of trauma in 57% of cases, direct trauma to the head in 15%, and injuries sustained from a fall in 13%. Sixty-three percent of patients lost consciousness and 26% suffered a skull fracture. Thirty-five percent of all patients had visual field defects with functional (tunnel) fields the most common. Over 88% of eyes had 20/20 or better visual acuity. Thirty-three percent of patients suffered a cranial nerve palsy, with 75% resolving without intervention. The severity of head injury was directly related to the lack of proper seat belt and helmet use. Most visual complaints were improved with a simple refraction. Most binocular diplopia cleared with time, with only 15 cases requiring surgical correction.

Acetazolamide in the treatment of abnormal oculovestibular response.

We treated seven patients with incapacitating vertigo elicited by walking down a grocery store aisle or driving a car. Results of neurologic, neuro-ophthalmic, and neuroradiologic examinations were normal. Episodic vertigo secondary to an abnormal oculovestibular response was diagnosed. Each patient was given a trial of 250 to 500 mg of acetazolamide daily. Symptoms resolved completely in four patients, two patients had near resolution of symptoms, and one patient had no relief. Carbonic anhydrase activity has been demonstrated in the inner ear, and acetazolamide has been shown to affect the ion balance of the inner ear fluids.

Pupil-sparing oculomotor nerve palsy due to midbrain infarction.

Vasculopathic oculomotor nerve palsies with pupillary sparing are thought to be due to ischemic damage to the nerve in the subarachnoid space or the cavernous sinus. We present two cases of patients with isolated pupil-sparing oculomotor nerve palsies due to midbrain infarcts. Focal ischemic midbrain lesions should be considered in cases of pupil-sparing oculomotor nerve palsies.

Intracanalicular lipoma.

We present a patient with unilateral progressive painless loss of vision leading to optic atrophy and blindness. High-resolution computed tomography and magnetic resonance imaging demonstrated adipose tissue extending from the anterior portion of an enlarged optic canal posteriorly to involve the ipsilateral optic chiasm. To our knowledge, this is the first reported case of an intracanalicular lipoma.