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Women living with HIV (WLHIV) are at increased risk for human papillomavirus (HPV)-associated anal cancer. Given the “field effect” of HPV pathogenesis, some recommend that anal cancer screening should be limited to WLHIV with prior genital disease. This study aimed to characterize the relationship between anal and genital disease in WLHIV in order to better inform anal cancer screening guidelines. We retrospectively studied 153 WLHIV with biopsy-proven anal high-grade squamous intraepithelial lesions (AHSIL) and long-term evaluable cervical/vaginal/vulvar histopathology. Based on the absence or presence of genital HSIL, subjects were categorized as having isolated AHSIL or multicentric HSIL. Demographics, HIV parameters and cervical/anal HPV status were recorded. Chi-square test was used for bivariate analyses. Of 153 WLHIV with AHSIL, 110 (72%) had isolated AHSIL, while 43 (28%) had multicentric HSIL (28 cervical, 16 vulvar, and 8 vaginal HSIL). The median genital surveillance was 8 years (range 1–27). Cervical HPV16/18 infection was associated with multicentric disease (P = 0.001). Overall, 53% of multicentric cases presented genital HSIL preceding AHSIL with median interval 13 years (range 2–23). Paired anal and cervical high-risk HPV results were available for 60 women within 12 months of AHSIL diagnosis: 30 (50%) had anal infection alone, while 30 (50%) had anal/cervical coinfection by 16/18 (15%), non-16/18 (13%), or different types (22%). In conclusion, WLHIV frequently develop AHSILs without pre-existing genital disease or after long latency following a genital HSIL diagnosis. Our findings support anal cancer screening for WLHIV irrespective of prior genital disease.

The concept of functional groups (set of species having similar physiological, ecological or life-history traits) has been largely used for plants, microorganisms, nematodes or insects in agroecosystems. However, this concept has been rarely applied to describe assemblages of plant pathogens. Yet, classification systems in plant pathology resemble this functional approach, as they address different disease processes or life history traits. In this review, we discuss advantages and drawbacks of current classification systems in relation to their application to the ecological management of crop diseases. Then, we propose to reorganize one of the classical plant-pathogen systems in a dichotomous key of functional groups obtained by combining two life-history traits: dispersal and survival strategies. The six functional groups proposed here are soil inhabitants; soil survivors; debris-seed-borne; air-borne; seed-borne, and vector-borne pathogens. We applied these groups to characterize pathogens of two major crops, wheat and tomato, grown in temperate climate regions. Our contribution intends to provide a comprehensive conceptual framework for the design of crop disease management strategies based on ecological principles, as well as to facilitate the interpretation of the occurrence of epidemics in response to the agricultural practices applied in real-world agroecosystems.

Purpose: Prior studies have identified a racial disparity in incidence and survival of squamous cell carcinoma of the anus (SCCA) in the young African American male population. We aim to determine whether racial disparities are independent of income and urban location. Methods: The National Cancer Institute's Surveillance of Epidemiology and End Results database was queried for data on patients with SCCA for the years of 2000–2013. Cox regression was used to determine the effect of race, county median family income, rural–urban continuum, and stage of disease on overall survival. Results: The incidence rate of SCCA was significantly higher in black men

Diverticular colitis, also known as segmental colitis associated with diverticulosis, is a colonic inflammatory disorder on the spectrum of inflammatory bowel disease (IBD). The disease consists of macroscopic and microscopic inflammation affecting inter-diverticular mucosa, sparing peri-diverticular mucosa, with inflammation confined to the descending and sigmoid colon. The disease likely arises from the altered immune response of an individual, genetically susceptible to the IBD spectrum of diseases. Patients with segmental colitis associated with diverticulosis (SCAD) are typically older, and likely represent a subgroup of IBD—susceptible patients who lacked an environmental trigger until that point in their life. Most patients remain in remission with initial treatments of mesalamine or topical steroids, and maintenance mesalamine afterwards. Only the most severe form of the disease necessitates immunomodulatory therapy and the consideration of surgery.

IntroductionGynecologic oncology patients represent a distinct patient population with a variety of surgical risks. The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database provides an opportunity to analyze large cohorts of patients over extended periods with high accuracy. Our goal was to develop a postoperative risk assessment calculator capable of providing a standardized, objective means of preoperatively identifying high-risk patients in the gynecologic oncology population.MethodsWe queried the ACS NSQIP database for gynecologic oncology patients from 2005 to 2013. Multivariate logistic regression was performed to generate predictive models specific for 30-day postoperative mortality and major morbidity.ResultsThere were 12,831 patients with a primary gynecologic malignancy identified: 7847 uterine, 3366 adnexal, 1051 cervical, and 567 perineum cancers. In this cohort, 125 (0.97%) patients died, and 784 (6.11%) major morbidity events were recorded within 30 days of their surgery. For 30-day mortality, the mean calculated predictive probability was 0.128 (SD, 0.219) compared with 0.009 (SD, 0.027) in patients alive 30 days postoperatively (P< 0.0001). The mean predictive probability of major morbidity was 0.097 (SD, 0.095) compared with 0.059 (SD, 0.043) in patients who did not experience major morbidity 30 days postoperatively (P< 0.0001).ConclusionsUsing NSQIP data, these predictive models will help to determine patients at risk for 30-day mortality and major morbidity. Further clinical validation of these models is required.

The semiarid Espinal in central Argentina, being recently transformed from natural semiarid grasslands into agriculture, represents an interesting scenario to understand the early stages of weed community assembly and its relationship with crop identity and management. Our aim was to characterize the weed communities in corn (Zea mays L.) and soybean [Glycine max (L.) Merr.], the main crops of the Espinal region, under the dominant rainfed conditions. Weed surveys were carried out in 53 fields, and farmers were interviewed to collect information about crop management. Floristic composition was compared within and between crops by calculating the additive partition of the abundance-based Bray-Curtis dissimilarity. We compared the frequency and mean cover of functional groups between crops through generalized linear models. Finally, canonical correspondence analysis was carried out to analyze the associations between floristic composition and agronomic variables. Mean alpha and gamma diversity was greater in corn (10.0 and 80 species, respectively) than in soybean (7.6 and 46 species, respectively). Furthermore, species composition of weed communities was more similar among soybean fields than among either cornfields or fields of both crops. Hence, floristic differences between crops are potentially the result of different microenvironmental heterogeneity above- and belowground, with corn likely to be more permissive to weed establishment compared with soybean. The higher frequency of annual, dicotyledonous, and native species, and the high proportion of rare species, mostly native, suggest a strong legacy of the original vegetation that thrived in these recently cultivated systems. The functional composition was also affected by agronomic management, with sulfur, nitrogen, and grass herbicide application being the most important factors related to the floristic composition of weed communities. This early description can be used as a starting point for studies concerning trajectories, mechanisms, and processes of weed communities related to environment and management. Fil: Rauber, Ruth Bibiana. Instituto Nacional de Tecnología Agropecuaria; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina Fil: Demaría, Manuel R.. Instituto Nacional de Tecnología Agropecuaria; Argentina Fil: Jobbagy Gampel, Esteban Gabriel. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - San Luis. Instituto de Matemática Aplicada de San Luis "Prof. Ezio Marchi". Universidad Nacional de San Luis. Facultad de Ciencias Físico, Matemáticas y Naturales. Instituto de Matemática Aplicada de San Luis "Prof. Ezio Marchi"; Argentina Fil: Arroyo, Daniel N.. Instituto Nacional de Tecnología Agropecuaria; Argentina Fil: Poggio, Santiago Luis. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Instituto de Investigaciones Fisiológicas y Ecológicas Vinculadas a la Agricultura. Universidad de Buenos Aires. Facultad de Agronomía. Instituto de Investigaciones Fisiológicas y Ecológicas Vinculadas a la Agricultura; Argentina

Background Timing of surgery has been shown to affect outcomes in many forms of cancer, but definitive national data do not exist to determine the effect of time to surgery on survival in colon cancer. Objective This study aimed to determine whether a delay in definitive surgery in colon cancer significantly affects survival. Data sources A retrospective cohort study using 2 independent population-based databases, The Surveillance, Epidemiology, and End Results Medicare-linked database and the National Cancer Database, was performed. Study selection All patients had American Joint Committee on Cancer stage 1 through 3 colon cancer. Patients were more than 18 years of age in the National Cancer Database cohort and older than 66 years of age in the Medicare cohort. Patients had a minimum of 3 years of follow-up. Main outcome measures The main outcome was overall survival as a function of time between diagnosis and surgery in 4 intervals (1-2, 3-4, 5-6, >6 weeks). Results The Medicare cohort demonstrated an adjusted 5-year survival of 8% to 14% higher in patients with a surgical delay between 3 and 6 weeks, with significantly lower hazard ratios in that interval. The National Cancer Database cohort demonstrated an adjusted 5-year survival of 9% to 16% higher in patients with surgery 3 to 6 weeks after diagnosis, with comparatively similar improvements in survival hazard. Limitations Because this was a retrospective study of administrative databases, with Medicare data limited to billing data, the causality of outcomes must be interpreted with caution. Conclusions The ideal timing of definitive resection in colon cancer is between 3 and 6 weeks after initial diagnosis. All efforts should be made for patients to obtain definitive surgery within this interval to achieve a modest but significant improvement in overall survival. See Video Abstract at http://links.lww.com/DCR/B76. ?CUANDO DEBEN SOMETERSE LOS PACIENTES CON CANCER DE COLON A UNA RESECCION DEFINITIVA?: Se ha demostrado que el momento de la cirugia afecta los resultados en muchas formas de cancer, pero no existen datos nacionales definitivos para determinar el efecto del tiempo hasta la cirugia en la supervivencia en el cancer de colon.Determinar si un retraso en la cirugia definitiva en el cancer de colon afecta significativamente la supervivencia.Un estudio de cohorte retrospectivo que utiliza dos bases de datos independientes basadas en la poblacion; Se realizo la base de datos vinculada a la vigilancia, la epidemiologia y los resultados finales y la base de datos nacional del cancer.Pacientes con cancer de colon en estadios 1 a 3 del Comite Estadounidense Conjunto sobre el Cancer. Los pacientes tenian mas de 18 anos en la cohorte de la National Cancer Database y mas de 66 anos en la cohorte de Medicare. Los pacientes tuvieron un minimo de 3 anos de seguimiento.El resultado principal fue la supervivencia general en funcion del tiempo entre el diagnostico y la cirugia en 4 intervalos (1-2, 3-4, 5-6, y mas de 6 semanas).La cohorte de Medicare demostro una supervivencia ajustada de 5 anos de 8 a 14% mas en pacientes con un retraso quirurgico entre 3 a 6 semanas, con razones de riesgo significativamente mas bajas en ese intervalo. La cohorte de la National Cancer Database demostro una supervivencia ajustada a 5 anos de 9 a 16% mas en pacientes con cirugia de 3 a 6 semanas despues del diagnostico, con mejoras comparativamente similares en el riesgo de supervivencia.Dado que este fue un estudio retrospectivo de bases de datos administrativas, con datos de Medicare limitados a datos de facturacion, la causalidad de los resultados debe interpretarse con precaucion.El momento ideal para la reseccion definitiva en el cancer de colon es entre tres y seis semanas despues del diagnostico inicial. Se deben hacer todos los esfuerzos para que los pacientes obtengan una cirugia definitiva dentro de este intervalo para lograr una mejora modesta pero significativa en la supervivencia general. Consulte Video Resumen en http://links.lww.com/DCR/B76.

Background Nursing home residents undergoing surgery have a higher rate of postoperative adverse outcomes than nonnursing home patients. This study seeks to determine what contribution nursing home status makes to theses occurrences, independent of comorbid conditions. Methods Using the American College of Surgeons-National Surgical Quality Improvement Program (ACS-NSQIP) database, the 30-day postoperative outcomes of the 5 commonest nonemergent inpatient procedures performed on nursing home residents were compared with those in nonnursing home residents using logistic regression analysis. Results Nursing home status was found to be an independent risk factor for septic complications in all procedures, for blood transfusion requirement after lower leg amputation, for pneumonia and stroke/cerebrovascular accident after thromboendarterectomy, and for mortality after partial colectomy with primary anastomosis. Conclusions These data suggest that, in addition to serving as a surrogate indicator of health status and current morbidity, residence in a nursing home makes an independent contribution to adverse postoperative outcomes.

The decline of bees is a major concern due to their vital role inpollinating many crops and wild plants. Some regions in SouthAmerica, and especially the Pampas, are amongst those parts ofthe world where stressors of bee populations have been littlestudied. The Pampas has been intensively transformed for agriculture,being presently one of the most productive areas of agriculturalcommodities in the world. Here, we aim to provide firstinsights on the taxonomic and functional composition of beeassemblages in the Rolling Pampa, the most intensively managedpart of the Pampas. Soybean (herbicide-tolerant genetically modifiedvarieties) is the predominant crop in this region. Bees weresampled with coloured pan traps. Sampling points were locatedon field margins in either the cropped or the semi-natural grasslandarea of a farmland site devoted to annual cropping. A total of2384 individuals were caught, representing 33 taxa [mainly (morpho)species]. The subgenus Lasioglossum (Dialictus) largely dominatedcaptures (78% of the total abundance) and was relativelyabundant in the entire study area, suggesting that some speciesare likely to reach their ecological requirements in cropped areas.No-till fields and field margins may provide large areas for thesebelow-ground nesting species, while their polylectic food preferencesallow them to collect pollen on a wide range of plantspecies, among them possibly soybean. On the contrary, the richnessand the abundance of other taxa were higher in the seminaturalarea than in the cropped area. Among them, abovegroundnesting or oil-collecting species, which have more specialisednesting and floral requirements, were highly associated withthe semi-natural area. Our findings highlight the large dominanceof L. (Dialictus) species in this highly intensively managed landscape,and the urgent need of preserving semi-natural habitats tomaintain species-rich and functionally diverse bee communities inthe Pampas. Fil: Le Féon, Violette. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Instituto de Investigaciones Fisiológicas y Ecológicas Vinculadas a la Agricultura. Universidad de Buenos Aires. Facultad de Agronomía. Instituto de Investigaciones Fisiológicas y Ecológicas Vinculadas a la Agricultura; Argentina. Institut National de la Recherche Agronomique; Francia Fil: Poggio, Santiago Luis. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Instituto de Investigaciones Fisiológicas y Ecológicas Vinculadas a la Agricultura. Universidad de Buenos Aires. Facultad de Agronomía. Instituto de Investigaciones Fisiológicas y Ecológicas Vinculadas a la Agricultura; Argentina Fil: Torretta, Juan Pablo. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario; Argentina. Universidad de Buenos Aires. Facultad de Agronomía. Departamento de Recursos Naturales y Ambiente. Cátedra de Botánica Agrícola; Argentina Fil: Bertrand, Colette. Institut National de la Recherche Agronomique; Francia Fil: Molina, Gonzalo Alberto Roman. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Instituto de Investigaciones Fisiológicas y Ecológicas Vinculadas a la Agricultura. Universidad de Buenos Aires. Facultad de Agronomía. Instituto de Investigaciones Fisiológicas y Ecológicas Vinculadas a la Agricultura; Argentina Fil: Burel, Françoise. Universite de Rennes I; Francia. Centre National de la Recherche Scientifique; Francia Fil: Baudry, Jacques. Institut National de la Recherche Agronomique; Francia Fil: Ghersa, Claudio Marco. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Instituto de Investigaciones Fisiológicas y Ecológicas Vinculadas a la Agricultura. Universidad de Buenos Aires. Facultad de Agronomía. Instituto de Investigaciones Fisiológicas y Ecológicas Vinculadas a la Agricultura; Argentina

The incidence of anal squamous cell carcinoma (ASCC) in the U.S. is increasing, particularly in immunocompromised patients. Preventative screening is used to monitor precancerous dysplasia known as anal intraepithelial neoplasia (AIN), which can progress to ASCC. High Resolution Anoscopy (HRA) is one screening procedure that uses a colposcope with acetic acid and Lugol's iodine solution to visualize the anal epithelium for AIN. HRA has offered potential in managing AIN, but as more evidence emerges it is unclear whether HRA provides definitive benefit. This narrative review updates readers on the efficacy of HRA in screening AIN, compares HRA to other techniques, compares the use of HRA in various high-risk populations, and offers practical information on the use of HRA. Keyword searches were conducted using MEDLINE, Web of Science, and Cochrane Library. Current literature is mixed regarding the utility of HRA. Further randomized controlled trials are needed to definitively assess the role of HRA.

Obesity currently affects more than a third of the United States population and is associated with increased surgical complications. Compared to all other subspecialties, colorectal surgery is the most affected by the increasing trend in obese surgical patients. Operative time has been found to have the greatest impact on hospital costs and physician workload. This study was conducted to determine whether obesity has a direct impact on operative time in elective colorectal procedures using a high-powered, nationally representative patient sample.A retrospective analysis was conducted on 45,362 patients who underwent open and laparoscopic ileocolic resections, partial colectomies, and low pelvic anastomoses using American College of Surgeons National Surgical Quality Improvement Program data from 2005-2009. Operative time was the main outcome variable, whereas body mass index (BMI) was the main independent variable. BMI was divided into three classes as follows: normal (25), overweight and/or obese (25-35), and morbidly obese (35). A univariate linear model was used to analyze the relationship while controlling for confounding factors such as demographics and preoperative conditions. Statistical significance was established at P ≤ 0.05.Morbidly obese patients were found to have longer operative times than did normal patients across each individual colorectal procedure (P0.001), ranging from a mean difference of 17.8 min for open ileocolic resections to 56.6 min for laparoscopic low pelvic anastomoses with colostomies.BMI, as an objective measure of obesity, is a direct, statistically significant independent predictor of operative time across elective colorectal procedures.

Squamous cell carcinoma of the anal canal is preceded by a spectrum of premalignant lesions known as anal intraepithelial neoplasia (AIN). AIN is caused by infection with the human papilloma virus (HPV), and the pathogenesis mimics that of cervical cancer. It is most commonly associated with HIV infection and high-risk sexual behavior. Symptoms of AIN may mimic benign processes. Multiple screening approaches exist for detecting HPV and dysplasia, but so far there is no standard algorithm. Several treatment options for AIN exist, although recurrence remains high. Regular surveillance by a surgeon is key after successful treatment. Extramammary perianal Paget׳s disease (EMPD) is another premalignant lesion. It is an intraepithelial adenocarcinoma that may or may not be associated with underlying malignancy. There are limited cases reported in the literature, and a staging method has been proposed. Both AIN and EMPD will be discussed in the following chapter.

Background The gold standard for surveillance of patients with anal lesions is unclear. Objective The aim of this study was to stratify patients for risk of progression of disease and to determine appropriate intervals for surveillance of patients with anal disease. Design This was a retrospective chart review for patients treated for anal lesions between 2007 and 2014. Only patients with ≥1 year of follow-up from index evaluation, pathology, documented physical examination, and anoscopy findings were included for analysis. Settings The study was conducted at an urban university hospital. Patients HIV-positive patients with anal lesions treated with excision and fulguration were included. Main outcome measures Recurrence of anal lesions, progression of disease, and progression to cancer were measured. Results Ninety-one patients met inclusion criteria. The mean age was 41.6 years, and mean follow-up was 38.6 months (range, 11.0-106.0 mo). On initial pathology, 8 patients (8.8%) had a diagnosis of condyloma acuminatum without dysplasia, 20 patients (22%) had anal intraepithelial neoplasia I, 32 (35.2%) had anal intraepithelial neoplasia II, and 31 (34.1%) had anal intraepithelial neoplasia III. Sixty-nine patients (75.8%) had repeat procedures. Seven (87.5%) of 8 patients with condyloma and 6 (30%) of 20 patients with anal intraepithelial neoplasia I progressed to high-grade lesions. Five (15.6%) of 32 patients progressed from anal intraepithelial neoplasia II to III, and 2 patients with anal intraepithelial neoplasia III (6.5%) developed squamous cell carcinoma (2.3% for the entire cohort). Limitations This was a single institution study. High-resolution anoscopy was not used. Conclusions All of the HIV-positive patients with condyloma or anal intraepithelial neoplasia, regardless of the presence of dysplasia, should be surveyed at equivalent 3-month time intervals, because their risk of progression of disease is high. Video Abstract at http://links.lww.com/DCR/A389.

Trophic guilds of epigeal arthropods regulating insect pest populations may be affected by factors act-ing across spatial scales. Although the influence of landscape factors associated with farming effects onarthropod assemblages has received increasing attention in the last decades, most research was carriedout in fine-grain landscapes by comparing conventional and organic cropping systems. Here, we aimedat identifying the role of fencerows and crop heterogeneity in defining arthropod diversity in intensivelyfarmed, coarse-grain landscapes. Hence, we developed a multi-scale heterogeneity approach based onfitting linear-mixed models to elucidate the effects of three spatial scales (local, neighbouring crop types,and landscape) on arthropod diversity. Mixed models were fitted to arthropod data obtained by pitfalltrap samplings in 22 field pairs. Field position was a major determinant of arthropod species diversityat local scale, due to the contrasting disturbance regimes of fencerows and adjoining field edges. Fencedensity at landscape scale contributed to retain diverse arthropod assemblages in farmland mosaics bysupplying habitats and refuges. In addition, extended fence network may function as corridors for dis-persal, increasing connectivity between dissimilar habitats. Fence habitats, as well as their density in thelandscapes, enhance both richness and abundance of beneficial arthropods. Our findings indicate that theoverall arthropod diversity was benefited by landscape complexity, being the presence and density offencerows key landscape attributes. Contrasting disturbance regimes at different field positions emergedas a major driver modulating arthropod species diversity in intensively managed farmland mosaics. Non-cropped habitats associated with fencerows and field margins play key ecological functions that are ofvital importance for providing ecosystem services in agro-ecosystems. Complex landscapes may help toconserve overall plant diversity in agro-ecosystems, as well as the spillover of arthropod species fromfencerows towards crop fields. Even in heavily intensified landscapes, where crop diversity is the mainsource of heterogeneity, promoting measures intended for both restoring and managing fencerow andnon-cropped habitats through landscape planning will contribute to maintain arthropod richness (almost 70% of total richness) across the entire landscape. Fil: Molina, Gonzalo Alberto Roman. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Instituto de Investigaciones Fisiológicas y Ecológicas Vinculadas a la Agricultura; Argentina. Universidad de Buenos Aires. Facultad de Agronomia. Departamento de Recursos Naturales y Ambiente; Argentina Fil: Poggio, Santiago Luis. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Instituto de Investigaciones Fisiológicas y Ecológicas Vinculadas a la Agricultura; Argentina. Universidad de Buenos Aires. Facultad de Agronomía. Departamento de Producción Vegetal; Argentina Fil: Ghersa, Claudio Marco. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Instituto de Investigaciones Fisiológicas y Ecológicas Vinculadas a la Agricultura; Argentina. Universidad de Buenos Aires. Facultad de Agronomia. Departamento de Recursos Naturales y Ambiente; Argentina

The aim of this study was to identify unique risk factors for mortality in patients with end-stage renal disease undergoing nonemergent colorectal surgery.A multivariate logistic regression model predicting 30-day mortality was constructed for patients with end-stage renal disease undergoing nonemergent colorectal procedures. Data were obtained from the National Surgical Quality Improvement Program (2005-2010).Among the 394 patients analyzed, those with serum creatinine levels7.5 mg/dL had .07 times the adjusted mortality risk of those with levels3.5 mg/dL. For colorectal surgery patients, the average serum creatinine level was 5.52 ± 2.6 mg/dL, and mortality was 13% (n = 50).High serum creatinine was associated with a lower risk for mortality in patients with end-stage renal disease, even though creatinine is often considered a risk factor for surgery. These results show how variables from a patient-centered subpopulation can differ in meaning from the general population.

Colon and rectal resections are among the most common surgical procedures performed in the United States. Complication rates of up to 25% have been reported and result in a substantial impact on quality of life and cost of care. Recently, the Surgical Care Improvement Program (SCIP) has promoted guidelines to prevent postoperative and potentially preventable complications. A comprehensive evidenced-based review of these guidelines and other perioperative strategies for practicing colorectal surgeons is the basis of this review.

Biodiversity ecosystem services in agroecosystems are negatively affected by farmland homogenisation due to intensive agriculture. The Pampas, an important worldwide region producing commodity crops, have been greatly homogenised with the expansion no-tillage and herbicide-tolerant transgenic soybeans since the 1990s. Here, we tested the hypothesis of that dietary changes in barn owls will be associated with the loss of semi-natural habitats derived from farming intensification. We characterised the dietary habits of western barn owls by analysing their pellets between two sampling periods (2004-2005 and 2010-2012). We also assessed the habitat loss due to cropping intensification through fencerow removal and pasture conversion to annual crops during the same period. We observed that barn owls shifted from eating mostly rodents in the first sampling period to eating a higher proportion of anurans in the second sampling period. Between sampling, rodent proportion in pellets decreased from 80% to 61.6%, while anuran proportion increased from 20% to 37.7%. A rapid farming intensification occurred on the farm between both sampling periods. Pastures were ploughed to grow annual crops. Thus, the annually cropped area increased by 60% from 2004 to 2012, while the area with pastures was reduced in about 80%. During the same period, nearly two-thirds of fences on the farm were removed to enlarge the cropped area. Our findings suggest that dietary habits of barn owls may shift to consume more anurans when rodent availability declines in association with the loss of semi-natural habitats, which resulted from rapid farming intensification on the studied farm. We suggest monitoring the population size and diet of barn owls for evaluating environmental changes produced in agroecosystems by farming intensification, as well as the adaptive responses of different rodent and anuran species to such changes. Fil: Hodara, Karina. Universidad de Buenos Aires. Facultad de Agronomía. Departamento de Métodos Cuantitativos y Sistemas de Información; Argentina Fil: Poggio, Santiago Luis. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Instituto de Investigaciones Fisiológicas y Ecológicas Vinculadas a la Agricultura. Universidad de Buenos Aires. Facultad de Agronomía. ; Argentina

Fistula-in-ano and perianal abscess is a very common pathology encountered in a colorectal surgery practice. Surgical therapy is the main form of treatment. The goal is to eliminate the formation of abscess and achieve healing while preserving anal sphincter function. However, recurrence rates are significant, and postoperative stool incontinence can be present. To maximize operative results and minimize recurrence and complications, accurate preoperative assessment of the fistula is necessary. It is now increasingly recognized that preoperative imaging can help identify infection that would have otherwise gone unidentified. Magnetic resonance imaging and endoanal ultrasound findings preoperatively, especially in patients with complex or recurrent fistulas or persistent abscess, have been shown to influence surgery and reduce the change of recurrence. In this article, we will describe the imaging of fistula-in-ano, with an emphasis on magnetic resonance imaging and endoanal ultrasound diagnostic modalities.

Background and Objectives: The objectives of this study were to determine morbidity and mortality rates of ambulatory anorectal surgeries in prone jackknife position. Patients and Methods: Retrospective chart analysis on 210 patients undergoing ambulatory anorectal surgery in the prone jackknife position. The primary endpoint studied was mortality and complication rates. Other factors analyzed were age, sex, clinical diagnosis, procedure, past medical history, American Society of Anesthesiologists physical status classification, current smoking status, mean pre- and post-operative mean arterial pressure (MAP), mean minimum intraoperative MAP, minimum intraoperative O2saturation, estimated blood loss, fluids given, anesthesia duration, antibiotic administration, and days to discharge and whether there were any readmissions within 30 days. To assess significant differences between pre-, intra-, and post-operative mean arterial pressure, one-way ANOVA was used. Results: There was no mortality within 30 days of surgery. Complication rate was 3.3% with urinary retention being the most common, comprising 42% of all complications. Thirty-day readmission rate from surgery was 1%. Mean pre- and post-operative MAP was 88.4 ± 11.4 and 90.6 ± 11.9, respectively. Mean minimum intraoperative MAP and O2saturation was 70.6 ± 9.5 and 98.7% ± 1.6%, respectively. Mean minimum intraoperative MAP was significantly decreased compared to mean pre- and post-operative MAP (P

Increasing cropland productivity is critical to meet future global demand of food, fibers and biofuels. Recent innovations in grain crop management are aimed at designing more ecologically complex cropping systems by growing double crop sequences comprising a great variety of crop species. The objectives of this study were to compare (i) the pattern of resource use and the productivity in cool-season crop sand their influence on the following warm-season second crops, and (ii) the overall resource capture, resource use efficiency, and productivity of various single and double cropping systems. Hence, three field experiments under rainfed conditions and computer-simulated experiments were conducted in contrasting sites in the Rolling Pampa. Seven cropping systems were evaluated, which included five double crop sequences (rapeseed/soybean, wheat/soybean, barley/soybean, field pea/soybean, and field pea/maize) and maize and soybean as single crops. Cool-season crops differed in resource use, which therefore affected differently the following second crop. The highest and the lowest yields with double cropped soybean were produced after field pea and wheat, respectively. Soybean single crop was the least productive treatment because of low resource capture and moderate resource use efficiency. Double cropping systems including soybean as second crop outperformed soybean single crop productivity due to larger resource use. Comparatively, maize single crop used fewer resources but with higher efficiency than the cropping systems including soybean, which led to higher yields when water was not limiting. Field pea/maize double crop was the most productive system, since field pea allowed for long resource use periods, while maintaining similar resource use efficiency as maize single crops. Field experiment results were confirmed by crop yield simulations based on 39 years of environmental data from the same sites. Wheat/soybean double crops expanded and contributed to raise productivity in the Pampas with available farming technologies. However, novel crop type combinations appeared as feasible ways for improving resource use balance in the growing season among the component crops. This may raise the total annual productivity or, at least, increase the grain yield of soybean, the more profitable component at present. These findings have important implications regarding the ecological intensification of commodity grain cropping systems, which can be implemented by proactive farmers in the short-term in various regions of the world. Fil: Andrade, José Francisco. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Instituto de Investigaciones Fisiológicas y Ecológicas Vinculadas a la Agricultura; Argentina. Universidad de Buenos Aires. Facultad de Agronomía. Departamento de Producción Vegetal. Cátedra de Cerealicultura; Argentina Fil: Poggio, Santiago Luis. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Instituto de Investigaciones Fisiológicas y Ecológicas Vinculadas a la Agricultura; Argentina. Universidad de Buenos Aires. Facultad de Agronomía. Departamento de Producción Vegetal; Argentina Fil: Ermacora, Mario Roberto. Asociación Argentina de Consorcios Regionales de Experimentación Agrícola; Argentina Fil: Satorre, Emilio Horacio. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Instituto de Investigaciones Fisiológicas y Ecológicas Vinculadas a la Agricultura; Argentina. Universidad de Buenos Aires. Facultad de Agronomía. Departamento de Producción Vegetal. Cátedra de Cerealicultura; Argentina. Asociación Argentina de Consorcios Regionales de Experimentación Agrícola; Argentina

Ecological intensification has been proposed as a paradigm for ensuring global food security while preserving biodiversity and ecosystem integrity. Ecologicalintensification was originally coined to promote precise site-specific farming practices aimed at reducing yield gaps, while avoiding negative environmental impacts (techno-simplicity). Recently, it has been extended to stress the importance of landscape complexity to preserve biodiversity and ecosystem services (eco-complexity). While these perspectives on ecological intensification may seem distinct, they are not incompatible and should be interwoven to create more comprehensive and practical solutions. Here, we argue that designing cropping systems to be more diverse, across space and time would be an effective route to accomplish environmentally-friendly intensification of crop production. Such a novel approach will require better integration of knowledge at the landscape level for increasing agro-biodiversity(focused on interventions outside fields) with strategies diversifying croppingsystems to manage weeds and pests (focused on interventions inside fields). Fil: Poggio, Santiago Luis. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Instituto de Investigaciones Fisiológicas y Ecológicas Vinculadas a la Agricultura. Universidad de Buenos Aires. Facultad de Agronomía. Instituto de Investigaciones Fisiológicas y Ecológicas Vinculadas a la Agricultura; Argentina. Universidad de Buenos Aires. Facultad de Agronomía. Departamento de Producción Vegetal. Cátedra de Producción Vegetal; Argentina Fil: Macfadyen, Sarina. CSIRO; Australia Fil: Bohan, David A.. Institut National de la Recherche Agronomique; Francia

IntroductionEncopresis is a not very common disorder. The prevalence of this disorder is about 1.5% after the age of 5 years old and decreased even more as age increased, being very rare in adolescence.AimHere we present a clinical case of an 11-year-old girl, with a diagnosis of functional encopresis with constipation and overflow incontinence for 4 years.MethodIn this case, we followed a program consisted of 12 sessions combining different techniques that are on experimental phase. The program we designed consist of toilet training, stablishment-token economy- of a diet high in fiber with a progressive remove of laxative medication and a family intervention with both parents that got divorced 4 years ago.ResultsHaving both parents the same frame the patient's problem easily started to decrease. In follow-up (6 and 12 months), we observed good toilet habits and not constipations episodes.ConclusionsEven though all the techniques used were in experimental phase, we considered that because of the chronicity of this problem a multidisciplinary approach was the best option.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Background Pay-for-performance measures incorporate surgical site infection rates into reimbursement algorithms without accounting for patient-specific risk factors predictive for surgical site infections and other adverse postoperative outcomes. Methods Using American College of Surgeons National Surgical Quality Improvement Program data of 67,445 colorectal patients, multivariable logistic regression was performed to determine independent risk factors associated with various measures of adverse postoperative outcomes. Results Notable patient-specific factors included (number of models containing predictor variable; range of odds ratios [ORs] from all models): American Society of Anesthesiologists class 3, 4, or 5 (7 of 7 models; OR 1.25 to 1.74), open procedures (7 of 7 models; OR .51 to 4.37), increased body mass index (6 of 7 models; OR 1.15 to 2.19), history of COPD (6 of 7 models; OR 1.19 to 1.64), smoking (6 of 7 models; OR 1.15 to 1.61), wound class 3 or 4 (6 of 7 models; OR 1.22 to 1.56), sepsis (6 of 7 models; OR 1.14 to 1.89), corticosteroid administration (5 of 7 models; OR 1.11 to 2.24), and operation duration more than 3 hours (5 of 7 models; OR 1.41 to 1.76). Conclusions These findings may be used to pre-emptively identify colorectal surgery patients at increased risk of experiencing adverse outcomes.

Long-term follow-up (>10 years) after vertical banded gastroplasty (VBG) is almost nonexistent. The aim of this study was to determine long-term outcome after VBG in a group of 71 patients studied prospectively. Seventy-one consecutive patients with morbid obesity (54 women and 17 men; mean age 40 years [range 22 to 71 years]) underwent VBG from 1985 to 1989 and were followed prospectively. Follow-up was obtained in 70 (99%) of the 71 patients. Weight (mean +/- standard error of the mean) preoperatively was 138 +/- 3 kg and decreased to 108 +/- 2 kg 10 or more years postoperatively. Body mass index decreased from 49 +/-1 to 39 +/- 1. Only 14 (20%) of 70 patients lost and maintained the loss of at least half of their excess body weight with the VBG anatomy. Vomiting one or more times per week continues to occur in 21% and heartburn in 16%. Fourteen patients have undergone conversion from VBG to Roux-en-Y gastric bypass (11 patients) or other procedures (3 patients) because of a combination of inadequate weight loss in 13 patients, gastroesophageal reflux in five, and frequent vomiting in four. Only 26% of patients after VBG have maintained a weight loss of at least 50% of their excess body weight; 17% underwent bariatric reoperation with good results. Thus VBG is not an effective, durable bariatric operation.

Throughout the Western world, the prevalence of obesity (body mass index [BMI] >30) is increasing in all age groups—low-income preschoolers, grade-school children, and adults. 1,9,15,20,26 A Belgian study showed a doubling in the proportion of working-class men with a BMI greater than 30 from 1978 to 1993 after adjusting for sociodemographic covariables. 31 Previous estimates from 1983 in the United States have suggested that 27% of women and 20% of men, based on Metropolitan Life Insurance Tables, are more than 20% above ideal body weight (IBW). 1 The National Health and Nutrition Examination Survey (1988–1991) suggested an increase to 31% for men and 35% for women. 15 Current estimates are that about 58 million Americans are obese. 18 Obesity has become a health care crisis in the United States, necessitating an ever-increasing financial expenditure secondary to weight-related morbidity. 10,37 In general, there is a U-shaped relationship between weight and risk of death. A 20% increase of weight above average increases mortality by 20% in men and 10% in women. 7 Although moderate obesity (BMI 28 to 35) has inconstant overt morbidity, severe forms of obesity (BMI >35) confer direct and consistent weight-related medical morbidity. Such severe obesity has been termed morbid obesity . Patients have morbid obesity, at least by strict weight-based criteria, when they are 100% or greater above IBW, are at least 100 lb above IBW, or have a BMI greater than 35; this usually includes women weighing greater than 240 to 250 lb and men weighing greater than 270 to 280 lb. A strictly weight-based definition is not appropriate, however, and a better definition of morbid obesity includes patients who have direct, weight-related serious morbidity, such as mechanical arthropathy, hypertension, type II diabetes mellitus, lipid-related cardiac disease, and sleep apnea. 6,15 An estimate of the prevalence of morbid obesity in the United States is about 2% in men and 6% in women. 18 Although the actual early mortality risk for women with morbid obesity is not well defined, men with a BMI greater than 40 between the ages of 25 and 34 years have a 12-fold increase in overall mortality compared with normal-weight men. 13 Add to this the nonlethal morbidity and the decreased quality of life related to obesity, and one easily sees the seriousness of the problem in today's society from a social and an economic vantage.

Agriculture is mainly seen as a threat for biodiversity of agro-ecosystems. Intensification of agriculture and its expansion into marginal lands has substantially modified the physiognomy of rural landscapes through fragmentation and homogenisation, promoting the loss of both natural habitats and biodiversity (Benton et al., 2003). Nevertheless, agricultural landscapes harbour an important range of biodiversity, both within crops and in non-crop habitat (Storkey et al., 2012). The landscape level controls part of biodiversity structure and dynamics. In agricultural landscapes, emphasis has been put on the role of semi-natural elements for the fate of biodiversity (Tscharntke et al., 2005, Billeter et al., 2008). But it has been shown for many taxa that agricultural matrix matters (Kuroe et al., 2011, Anderson et al., 2007, Watling et al., 2010). In this special issue we address the role of semi natural areas at the landscape level, and consider the landscape effects on biodiversity for agriculture, e.g. weeds, pests and auxiliary organisms. Moreover, this issue comprises a wide variety of agricultural environments, which range from the millennial farming systems of China and Europe to the much more recent ones in the New World, as well as the contrasting levels of agricultural intensification, such as in Western and Eastern Europe....

Field margins are key landscape features sustaining biodiversity in farmland mosaics and through that, ecosystem services. However, agricultural intensification has encouraged fencerow removal to enlarge cropping areas, reducing farmland biodiversity and its associated ecosystems services. In the present work, we assess the role of field margins in retaining farmland biodiversity across the sunflower cropping area of Argentina. Flower-visiting insects and entomophilous plants were intensively sampled along the margins of sunflower fields, in eight locations across eastern Argentina. We recorded 149 species of flowering plants and 247 species of flower-visitors. Plants and arthropods were mostly natives. Most of the floral visitors captured provide ecosystem services to agriculture. Our results show that many species of beneficial insects and native plants occur in semi-natural linear features in the intensively managed farmland of Argentina. Field margins may constitute the last refugia of native plant species and their associated fauna in farmland mosaics. Conservation of field margins in Argentine farmland may therefore be essential for preserving biodiversity and associated ecosystem services. Fil: Torretta, Juan Pablo. Universidad de Buenos Aires. Facultad de Agronomía. Departamento de Recursos Naturales y Ambiente. Cátedra de Botánica Agrícola; Argentina Fil: Poggio, Santiago Luis. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Instituto de Investigaciones Fisiológicas y Ecológicas Vinculadas a la Agricultura; Argentina. Universidad de Buenos Aires. Facultad de Agronomía. Departamento de Producción Vegetal; Argentina

Squamous cell carcinoma of the anus (SCCA) is a rare tumor. However, its incidence has been increasing in men and women over the past 25 years worldwide. Risk factors associated with this cancer are those behaviors that predispose individuals to human papillomavirus (HPV) infection and immunosuppression. Anal cancer is generally preceded by high-grade anal intraepithelial neoplasia (HGAIN), which is most prevalent in human immunodeficiency virus-positive men who have sex with men. High-risk patients may benefit from screening. The most common presentation is rectal bleeding, which is present in nearly 50% of patients. Twenty percent of patients have no symptoms at the time of presentation. Clinical staging of anal cancer requires a digital rectal exam and a positron emission tomography/computed tomography scan of the chest, abdomen, and pelvis. Endorectal/endoanal ultrasound appears to add more-specific staging information when compared with digital rectal examination alone. Treatment of anal cancer prior to the 1970s involved an abdominoperineal resection. However, the current standard of care for localized anal cancer is concurrent chemoradiation therapy, primarily because of its sphincter-saving and colostomy-sparing potential. Studies have addressed alternative chemoradiation regimens to improve the standard protocol of fluorouracil, misogynic, and radiation, but no alternative regimen has proven superior. Surgery is reserved for those patients with residual disease or recurrence.

Agriculture intensification has drastically altered farmland mosaics, while semi-natural grasslands have been considerably reduced and fragmented. Bird declines in northern temperate latitudes are attributed to habitat loss and degradation in farmed landscapes. Conversely, landscape-modification effects on grassland/farmland bird communities are less studied in the South American temperate grasslands. We investigated how bird communities were influenced by landscape characteristics in the Rolling Pampa (Argentina). We sampled bird communities in 356 landscapes of 1-km radius that varied in cover and configuration of pastureland, flooding grassland and cropland. Using generalized linear models, we explored the relationship between both bird species richness and abundance, and landscape structure. Analyses were carried out for all species, and open-habitat, grassland and aquatic species. Pasture area was far the most important factor, followed by landscape composition, in predicting species richness and abundance, irrespective of specific habitat preferences, followed by partially-flooded grassland cover and its mean shape index. Grassland fragmentation did not affect species richness or abundance. When comparing the effects of landscape variables on bird richness and abundance (using mean model coefficients), pasture and grassland area effects were on average more than four times greater than those of compositional heterogeneity, and about ten times greater than shape effects. To conserve species-rich bird communities persisting in Rolling Pampa farmland, we recommend the preservation of pasture and grassland habitats, irrespective of their fragmentation level, in intensively managed farmland mosaics. © 2011 Springer Science+Business Media B.V. Fil: Cerezo, Alexis. Universidad de Buenos Aires. Facultad de Agronomía; Argentina Fil: Condes, María Cecilia. Universidad de Buenos Aires. Facultad de Agronomía; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina Fil: Poggio, Santiago Luis. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Instituto de Investigaciones Fisiológicas y Ecológicas Vinculadas a la Agricultura. Universidad de Buenos Aires. Facultad de Agronomía; Argentina

Introduction Changes in agricultural systems through the process of globalisation and the need to increase farm productivity over the past few decades have led to dramatic land-cover changes as well as the introduction of new technologies that are major threats to biodiversity in many parts of the world (Donald et al ., 2001; Norris, 2008). Loss of biodiversity is a global concern for many reasons. The first is that the loss of a species is a non-reversible process; this has led to Nature Conservation treaties and policies at world and national scales. The second reason is that species must be protected not only for their intrinsic value, but also because of the services they provide to society. The Millennium Ecosystem Assessment (www.millenniumassessment.org) has emphasised the latter aspect, and ‘ecosystem services’ (Carpenter et al ., 2007; Zhang et al ., 2007) is now a key word on many agendas, whether in the realm of nature protection or landscape management. From this perspective, the main cause of biodiversity loss is an overemphasis on production services (food and fibre) at the expense of other services such as water purification, pest control or pollination. The two main proximal causes that lead to loss of species are habitat loss (transformation of natural or semi-natural habitats to arable land) and heavy use of energy in the form of mineral fertilisers, especially nitrogen, pesticides and soil tillage (Matson et al ., 1997). All have adverse effects, though they may favour some species that become pests.

Despite significant progress in the treatment of rectal cancer, local recurrence remains a difficult problem,1 resulting in considerable morbidity and high cancer-related mortality. Prevention of local recurrence should therefore be the chief goal of the operating surgeon and multidisciplinary management team. However, some patients are potential candidates for curative re-resection and therapy. This chapter addresses the issues involved in surgical management of patients with locally recurrent rectal cancer.

Background Primary sarcomas of the liver are extremely rare in adults. Optimal therapeutic approaches remain unclear. Methods Twenty consecutive adult patients who had surgical treatment for primary hepatic sarcomas were reviewed. Patient age ranged from 23 to 80 years. Other than one patient with primary hepatic angiosarcoma who had a history of thorium dioxide colloid (Thorotrast) exposure 23 years before diagnosis, no predisposing causes were apparent. Nineteen patients had hepatic resection and one patient had an orthotopic liver transplant. No patient received neoadjuvant chemotherapy or radiotherapy but radiotherapy was delivered intraoperatively in one patient. Results Leiomyosarcoma was the most common histological type of sarcoma diagnosed (five of 20 patients), followed by malignant solitary fibrous tumour (four) and epithelioid haemangioendothelioma (three). Fourteen tumours were high-grade sarcomas and six were low grade malignancies. Thirteen patients developed a recurrence. Distant metastases (ten patients) and intrahepatic recurrence (six) were the predominant sites of initial treatment failure. Six patients received salvage chemotherapy. Histological grade was the only factor significantly associated with overall patient survival (P = 0·03). With complete resection, patients with high-grade tumours had a 5-year survival rate of 18 (95 per cent confidence interval 5–62) per cent compared with 80 (52–100) per cent for patients with low-grade tumours. The 5-year survival rate for all 20 patients was 37 (20–60) per cent. Conclusion Surgical resection is the only effective therapy for primary hepatic sarcomas at present. Better adjuvant therapy is necessary, especially for high-grade malignancies, owing to the high failure rate with operation alone.

Efficient control of the electromechanical throttle body of internal combustion engines allows one to properly regulate the additional air flow provided to the engine in idle speed conditions. The behavior of the throttle is highly nonlinear, due to its mechanical characteristics and to significant friction forces. The systematic design of the control strategy calls for the availability of a reliable model, and of a related simulation tool. This paper presents the model and the simulation environment developed for and currently used by Magneti Marelli in order to characterize new throttle bodies, and to design the associated control algorithms.

Background Truvada, a fixed-dose combination of antiretroviral drugs (emtricitabine and tenofovir fumarate) indicated for HIV-1, was the 12th most expensive drug prescribed in Piedmont during 2009–2010, with a growth of 12%. Since July 2011 the School of Hospital Pharmacy in Turin has developed a two-year pharmacoeconomic project regarding high-cost drugs. Purpose To provide to the decision-makers with a management tool to evaluate the treatment costs of HIV patients. Materials and Methods The legislation and articles in epidemiology and pharmacoeconomic journals were reviewed. Drummond’s Weighted Checklist method was used to evaluate the pharmacoeconomic articles. A Budget Impact model, based only on the drug costs, was built. The treatment-naive population (290) was extrapolated from the incidence data in Piedmont in 2010. The treatment options relied on the US Department of Health and Human Services guidelines and on the pharmacoeconomic studies. The model suggested a combination of Truvada with: i) efavirenz (NNRTI, Sustiva), ii) atazanavir (PI, Reyataz)+ritonavir (PI booster, Norvir); iii) darunavir (PI, Prezista)+ritonavir (PI booster, Norvir). Results The daily treatment cost for a treatment-naive patient varies from €21.78 to €30.64, while the annual expenditure varies from €7,949.17 to €11,184.45. The Budget Impact was calculated assuming that the 290 new HIV cases had been treated for one year with one of the therapeutic strategies provided. The variation in comparison with association i) were respectively +24.64% for combination ii) and +40.70% for combination iii). Treatment iii) was the most expensive (€324,3491.37) and increased the annual expenditure by 40.70% (€938,233.23) as compared with treatment i) (€2305,258.14). Conclusions The Budget Impact analysis will be used to perform pre-assessments of expenditure in order to set up health care programmes for the allocation of the economic resources. A pharmacoeconomic analysis of cost-effectiveness will be performed between the associations Truvada + Reyataz and Truvada + Sustiva. No conflict of interest.

Prospective reimbursement (PR) programs were implemented in a number of states in the 1970s to reduce the rate of inflation in hospital costs. The associated savings have prompted concern about whether hospital administrators have been able to economize in ways that do not compromise patient care. This study examined the effects of PR on hospital mortality in 15 states. A quasi-experimental design was used to compare the 10-year trend in standardized mortality rates in hospitals in these states with those in a national sample of hospitals not receiving PR. Although the introduction of PR was associated with higher mortality on all patient groups studied, there was no indication that the level of cost saving in states under PR was correlated with patterns of mortality rates. We conclude that policymakers must be concerned that PR may be compromising the quality of patient care in hospitals, and that more definitive research is needed to improve understanding of the implied trade-off between cost containment and patient outcomes.

The aim of this paper is to present an identification procedure for NARX models describing the pressure inside the intake manifold and the crankshaft speed of Internal Combustion (IC) car engines. The proposed method is based on a stepwise regression approach and has been applied to real data collected on two commercial engines, namely a 1600cm3 and a 1200cm3. A number of experimental results witness the applicability of the proposed approach.

The paper presents a methodology for the pre-processing of the combustion time intervals, that is the basic signal used in misfire detection strategies, with the aim of increasing the signal-to-noise ratio to enable a more efficient misfire diagnosis, especially when the engine is running at high speeds and low loads. The performance of the basic misfire detection algorithm shows that in those engine operating conditions the background noise amplitude has approximately the same value of the information related to the misfire presence, thus hiding the misfire event that may not be detected. The proposed methodology is based on the correction of the combustion time signal cycle-by-cycle, using a vector of data that take into account the specific behavior of every cylinder combustion. For each engine running condition, the vector of data for the combustion time correction is stored in a map inside the control unit and could be continuously updated with an auto-adaptive learning technique. Some results of the methodology are reported in the paper, and compared with the basic misfire detection algorithm performance.