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Sample records for center mskcc experience

  1. Options for Breast Reconstruction after Mastectomy for Carcinoma of the Breast: An Observational Experience at MSKCC, New York under UICC Fellowship.

    PubMed

    Das, Prafulla Kumar; Cordeiro, Peter G

    2015-12-01

    The first Author went to visit The Memorial Sloan Kettering Cancer Center (MSKCC), New York, USA on UICC ICRETT Fellowship to observe as many clinical situations of options of breast reconstruction after mastectomy for carcinoma breast during a period of 1 month in June 2014. The second Author was the Supervisor for such clinical observation at the Plastic and Reconstructive Service, Department of Surgery at MSKCC. The main objective of this project was to gain a deeper understanding of the various options for reconstruction and specific operative skills and techniques needed for reconstruction after surgical resections for breast carcinoma. The gained experience would benefit our Regional Cancer Center's physicians, patients, and families. All patients treated by the Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center (MSKCC) who underwent surgical resection and reconstruction of their breast mounds were observed during the period between June 1, 2014 and June 30, 2014. It was observed that a vast majority of patients who underwent a mastectomy at MSKCC were offered primary breast reconstruction. They underwent thorough counseling and teaching about the various options, and feasibility with regard to their specific case. Patients eventually made the final choice on type of reconstruction, type of implant, and type of nipple/areola reconstruction. A majority of patients underwent implant reconstruction at MSKCC. This was partly related to the high rate of bilateral mastectomies (close to 50 %) as well as a significant rate of post mastectomy radiation (15 to 20 %). PMID:27065656

  2. Intensity-modulated Radiation Therapy (IMRT) for Inoperable Non-small Cell Lung Cancer: the Memorial Sloan-Kettering Cancer Center (MSKCC) Experience

    PubMed Central

    Sura, Sonal; Gupta, Vishal; Yorke, Ellen; Jackson, Andrew; Amols, Howard; Rosenzweig, Kenneth E.

    2009-01-01

    Introduction Intensity-modulated radiation therapy (IMRT) is an advanced treatment delivery technique that can improve the therapeutic dose ratio. Its use in the treatment of inoperable non-small cell lung cancer (NSCLC) has not been well studied. This report reviews our experience with IMRT for patients with inoperable NSCLC. Methods and Materials We performed a retrospective review of fifty-five patients with stage I–IIIB inoperable NSCLC treated with IMRT at our institution between 2001–2005. The study endpoints were toxicity, local control, and overall survival. Results With a median follow-up of 26 months, the 2-year local control and overall survival rates for stage I/II patients were 50% and 55% respectively. For the stage III patients, 2-year local control and overall survival rates were 58% and 58% respectively with median survival time of 25 months. Six patients (11%) experienced grade 3 acute pulmonary toxicity. There were no acute treatment-related deaths. Two patients (4%) had grade 3 or worse late treatment-related pulmonary toxicity. Conclusions IMRT treatment resulted in promising outcomes for inoperable NSCLC patients. PMID:18343515

  3. Contemporary Management of Penile Cancer: Greater than 15-Year MSKCC Experience

    PubMed Central

    Moses, Kelvin A.; Winer, Andrew; Sfakianos, John P.; Poon, Stephen A.; Kent, Matthew; Bernstein, Melanie; Russo, Paul; Dalbagni, Guido

    2014-01-01

    Introduction Penile cancer is a rare malignancy, and few guidelines are available to define treatment paradigms. For greater understanding of the natural history of surgically treated penile cancer, we analyzed experience at our institution. Materials and Methods Using an institutional database, we identified 127 patients treated for squamous cell carcinoma of the penis from 1995 – 2011. Cancer-specific survival (CSS) was calculated using the Kaplan-Meier method. Survival data were compared using the log-rank test. The difference in risk of cancer-specific death by lymph node status and histological grade was determined by univariate Cox regression analysis. Results Five-year CSS for pTis, pT1, pT2, and pT3/4 was 100%, 84% (95% CI 58%-95%), 54% (95% CI 33%-71%), and 54% (95% CI 25%-76%), respectively (P ≤ .005). Three-year CSS for patients with N0, N+, and Nx disease was 90% (95% CI 47%-99%), 65% (95% CI 47%-79%), and 86% (95% CI 73%-93%), respectively (P = .03). The receipt of neoadjuvant chemotherapy did not change per 5 year period over the 16 years of our study. Median follow-up was 2.8 years. Conclusions Penile cancer patients with advanced disease had poor survival. Tumor stage and nodal status were significant predictors of CSS. Penis-sparing approaches may be considered for most patients; however, pathological stage and grade dictate the management and ultimate outcome. Further studies are necessary to clarify the benefits of chemotherapy in this disease. PMID:24775572

  4. Treatment of nasal cavity and paranasal sinus cancer with modern radiotherapy techniques in the postoperative setting-the MSKCC experience

    SciTech Connect

    Hoppe, Bradford S.; Stegman, Lauren D.; Zelefsky, Michael J.; Rosenzweig, Kenneth E.; Wolden, Suzanne L.; Patel, Snehal G.; Shah, Jatin P.; Kraus, Dennis H.; Lee, Nancy Y. . E-mail: leen2@mskcc.org

    2007-03-01

    Purpose: To perform a retrospective analysis of patients with paranasal sinus (PNS) cancer treated with postoperative radiotherapy (RT) at Memorial Sloan-Kettering Cancer Center. Methods and Materials: Between January 1987 and July 2005, 85 patients with PNS and nasal cavity cancer underwent postoperative RT. Most patients had squamous cell carcinoma (49%; n = 42), T4 tumors (52%; n = 36), and the maxillary sinus (53%; n = 45) as the primary disease site. The median radiation dose was 63 Gy. Of the 85 patients, 76 underwent CT simulation and 53 were treated with either three-dimensional conformal RT (27%; n = 23) or intensity-modulated RT (35%; n = 30). Acute and late toxicities were scored according to the Radiation Therapy Oncology Group radiation morbidity scoring criteria. Results: With a median follow-up for surviving patients of 60 months, the 5-year estimates of local progression-free, regional progression-free, distant metastasis-free, disease-free, and overall survival rates were 62%, 87%, 82%, 55%, and 67%, respectively. On multivariate analysis, squamous cell histology and cribriform plate involvement predicted for an increased likelihood of local recurrence, and squamous cell histologic features predicted for worse overall survival. None of the patients who underwent CT simulation and were treated with modern techniques developed a Grade 3-4 late complication of the eye. Conclusion: Complete surgical resection followed by adjuvant RT is an effective and safe approach in the treatment of PNS cancer. Emerging tools, such as three-dimensional conformal treatment and, in particular, intensity-modulated RT for PNS tumors, may minimize the occurrence of late complications associated with conventional RT techniques. Local recurrence remains a significant problem.

  5. A Personal Reflection on the History of Radiation Oncology at Memorial Sloan-Kettering Cancer Center

    SciTech Connect

    Chu, Florence C.H.

    2011-07-01

    Purpose: To provide a historical and personal narrative of the development of radiation oncology at Memorial Sloan-Kettering Cancer Center (MSKCC), from its founding more than 100 years ago to the present day. Methods and Materials: Historical sources include the Archives of MSKCC, publications by members of MSKCC, the author's personal records and recollections, and her communications with former colleagues, particularly Dr. Basil Hilaris, Dr. Zvi Fuks, and Dr. Beryl McCormick. Conclusions: The author, who spent 38 years at MSKCC, presents the challenges and triumphs of MSKCC's Radiation Oncology Department and details MSKCC's breakthroughs in radiation oncology. She also describes MSKCC's involvement in the founding of the American Society for Therapeutic Radiology and Oncology.

  6. Chemical & RNAi screening at MSKCC: a collaborative platform to discover & repurpose drugs to fight disease

    PubMed Central

    Bhinder, Bhavneet; Antczak, Christophe; Shum, David; Radu, Constantin; Mahida, Jeni P.; Liu-Sullivan, Nancy; Ibáñez, Glorymar; Raja, Balajee Somalinga; Calder, Paul A.; Djaballah, Hakim

    2014-01-01

    Memorial Sloan-Kettering Cancer Center (MSKCC) has implemented the creation of a full service state-of-the-art High-throughput Screening Core Facility (HTSCF) equipped with modern robotics and custom-built screening data management resources to rapidly store and query chemical and RNAi screening data outputs. The mission of the facility is to provide oncology clinicians and researchers alike with access to cost-effective HTS solutions for both chemical and RNAi screening, with an ultimate goal of novel target identification and drug discovery. HTSCF was established in 2003 to support the institution’s commitment to growth in molecular pharmacology and in the realm of therapeutic agents to fight chronic diseases such as cancer. This endeavor required broad range of expertise in technology development to establish robust and innovative assays, large collections of diverse chemical and RNAi duplexes to probe specific cellular events, sophisticated compound and data handling capabilities, and a profound knowledge in assay development, hit validation, and characterization. Our goal has been to strive for constant innovation, and we strongly believe in shifting the paradigm from traditional drug discovery towards translational research now, making allowance for unmet clinical needs in patients. Our efforts towards repurposing FDA-approved drugs fructified when digoxin, identified through primary HTS, was administered in the clinic for treatment of stage Vb retinoblastoma. In summary, the overall aim of our facility is to identify novel chemical probes, to study cellular processes relevant to investigator’s research interest in chemical biology and functional genomics, and to be instrumental in accelerating the process of drug discovery in academia. PMID:24661215

  7. Advanced Unilateral Retinoblastoma: The Impact of Ophthalmic Artery Chemosurgery on Enucleation Rate and Patient Survival at MSKCC

    PubMed Central

    Abramson, David H.; Fabius, Armida W. M.; Issa, Reda; Francis, Jasmine H.; Marr, Brian P.; Dunkel, Ira J.; Gobin, Y. Pierre

    2015-01-01

    Purpose To report on the influence of ophthalmic artery chemosurgery (OAC) on enucleation rates, ocular and patient survival from metastasis and impact on practice patterns at Memorial Sloan Kettering for children with advanced intraocular unilateral retinoblastoma. Patients and Methods Single-center retrospective review of all unilateral retinoblastoma patients with advanced intraocular retinoblastoma treated at MSKCC between our introduction of OAC (May 2006) and December 2014. End points were ocular survival, patient survival from metastases and enucleation rates. Results 156 eyes of 156 retinoblastoma patients were included. Primary enucleation rates have progressively decreased from a rate of >95% before OAC to 66.7% in the first year of OAC use to the present rate of 7.4%. The percent of patients receiving OAC has progressively increased from 33.3% in 2006 to 92.6% in 2014. Overall, ocular survival was significantly better in eyes treated with OAC in the years 2010–2014 compared to 2006–2009 (p = 0.023, 92.7% vs 68.0% ocular survival at 48 months). There have been no metastatic deaths in the OAC group but two patients treated with primary enucleation have died of metastatic disease. Conclusion OAC was introduced in 2006 and its impact on patient management is profound. Enucleation rates have decreased from over 95% to less than 10%. Our ocular survival rate has also significantly and progressively improved since May 2006. Despite treating more advanced eyes rather then enucleating them patient survival has not been compromised (there have been no metastatic deaths in the OAC group). In our institution, enucleation is no longer the most common treatment for advanced unilateral retinoblastoma. PMID:26709699

  8. Patient Experience in Health Center Medical Homes.

    PubMed

    Cook, Nicole; Hollar, Lucas; Isaac, Emmanuel; Paul, Ludmilla; Amofah, Anthony; Shi, Leiyu

    2015-12-01

    The Human Resource and Services Administration, Bureau of Primary Health Care Health Center program was developed to provide comprehensive, community-based quality primary care services, with an emphasis on meeting the needs of medically underserved populations. Health Centers have been leaders in adopting innovative approaches to improve quality care delivery, including the patient centered medical home (PCMH) model. Engaging patients through patient experience assessment is an important component of PCMH evaluation and a vital activity that can help drive patient-centered quality improvement initiatives. A total of 488 patients from five Health Center PCMHs in south Florida were surveyed in order to improve understanding of patient experience in Health Center PCMHs and to identify quality improvement opportunities. Overall patients reported very positive experience with patient-centeredness including being treated with courtesy and respect (85 % responded "always") and communication with their provider in a way that was easy to understand (87.7 % responded "always"). Opportunities for improvement included patient goal setting, referrals for patients with health conditions to workshops or educational programs, contact with the Health Center via phone and appointment availability. After adjusting for patient characteristics, results suggest that some patient experience components may be modified by educational attainment, years of care and race/ethnicity of patients. Findings are useful for informing quality improvement initiatives that, in conjunction with other patient engagement strategies, support Health Centers' ongoing transformation as PCMHs. PMID:26026275

  9. Intermediate load-center photovoltaic application experiments

    SciTech Connect

    Burgess, E. L.

    1980-01-01

    A total of nine intermediate load-center photovoltaic systems were carried into the construction phase this year. These nine systems range in size from 20 to 225 kW/sub p/ electrical output and total almost 1 MW/sub p/. They are being installed in a diverse set of applications and locations and represent the bulk of the photovoltaic initial system evaluation experiments (ISEE) for the intermediate load-center sector. Each of these experiments are briefly described and the status of the construction phase is given for each project.

  10. NASA Lewis Research Center photovoltaic application experiments

    NASA Technical Reports Server (NTRS)

    Ratajczak, A.; Bifano, W.; Martz, J.; Odonnell, P.

    1978-01-01

    The NASA Lewis Research Center has installed 16 geographically dispersed terrestrial photovoltaic systems as part of the DOE National Photovoltaic Program. Four additional experiments are in progress. Currently, operating systems are powering refrigerators, a highway warning sign, forest lookout towers, remote weather stations, a water chiller and insect survey traps. Experiments in progress include the world's first village power system, an air pollution monitor and seismic sensors. Under a separate activity, funded by the U.S. Agency for International Development, a PV-powered water pump and grain grinder is being prepared for an African village. System descriptions and status are included in this report.

  11. NASA Lewis Research Center combustion MHD experiment

    NASA Technical Reports Server (NTRS)

    Smith, J. M.

    1982-01-01

    The MHD power generation experiments were conducted in a high field strength cryomagnet which was adapted from an existing facility. In its original construction, it consisted of 12 high purity aluminum coils pool cooled in a bath of liquid neon. In this configuration, a peak field of 15 tesla was produced. For the present experiments, the center four coils were removed and a 23 cm diameter transverse warm bore tube was inserted to allow the placement of the MHD experiment between the remaining eight coils. In this configuration, a peak field of 6 tesla should be obtainable. The time duration of the experiment is limited by the neon supply which allows on the order of 1 minute of total operating time followed by an 18-hour reliquefaction period. As a result, the experiments are run in a pulsed mode. The run duration for the data presented here was 5 sec. The magnetic field profile along the MHD duct is shown. Since the working fluid is in essence superheated steam, it is easily water quenched at the exit of the diffuser and the components are designed vacuum tight so that the exhaust pipe and demister an be pumped down to simulate the vacuum of outer space.

  12. The Deep Impact Network Experiment Operations Center

    NASA Technical Reports Server (NTRS)

    Torgerson, J. Leigh; Clare, Loren; Wang, Shin-Ywan

    2009-01-01

    Delay/Disruption Tolerant Networking (DTN) promises solutions in solving space communications challenges arising from disconnections as orbiters lose line-of-sight with landers, long propagation delays over interplanetary links, and other phenomena. DTN has been identified as the basis for the future NASA space communications network backbone, and international standardization is progressing through both the Consultative Committee for Space Data Systems (CCSDS) and the Internet Engineering Task Force (IETF). JPL has developed an implementation of the DTN architecture, called the Interplanetary Overlay Network (ION). ION is specifically implemented for space use, including design for use in a real-time operating system environment and high processing efficiency. In order to raise the Technology Readiness Level of ION, the first deep space flight demonstration of DTN is underway, using the Deep Impact (DI) spacecraft. Called the Deep Impact Network (DINET), operations are planned for Fall 2008. An essential component of the DINET project is the Experiment Operations Center (EOC), which will generate and receive the test communications traffic as well as "out-of-DTN band" command and control of the DTN experiment, store DTN flight test information in a database, provide display systems for monitoring DTN operations status and statistics (e.g., bundle throughput), and support query and analyses of the data collected. This paper describes the DINET EOC and its value in the DTN flight experiment and potential for further DTN testing.

  13. Melanoma and non-melanoma skin cancers in hairy cell leukaemia: a Surveillance, Epidemiology and End Results population analysis and the 30-year experience at Memorial Sloan Kettering Cancer Center.

    PubMed

    Watts, Justin M; Kishtagari, Ashwin; Hsu, Meier; Lacouture, Mario E; Postow, Michael A; Park, Jae H; Stein, Eytan M; Teruya-Feldstein, Julie; Abdel-Wahab, Omar; Devlin, Sean M; Tallman, Martin S

    2015-10-01

    Few studies have examined melanoma and non-melanoma skin cancer (NMSC) incidence rates after a diagnosis of hairy cell leukaemia (HCL). We assessed 267 HCL patients treated at Memorial Sloan Kettering Cancer Center (MSKCC) and Surveillance, Epidemiology and End Results (SEER) data for melanoma and NMSC incidence rates after HCL. Incidence data from MSKCC patients demonstrated a 10-year combined melanoma and NMSC skin cancer rate of 11·3%, melanoma 4·4% and NMSC 6·9%. Molecular analysis of skin cancers from MSKCC patients revealed activating RAS mutations in 3/9 patients, including one patient with melanoma. Of 4750 SEER patients with HCL, 55 (1·2%) had a subsequent diagnosis of melanoma. Standardized incidence ratios (SIRs) did not show that melanoma was more common in HCL patients versus the general population (SIR 1·3, 95% CI 0·78-2·03). Analysis of SEER HCL patients diagnosed before and after 1990 (approximately before and after purine analogue therapy was introduced) showed no evidence of an increased incidence after 1990. A better understanding of any potential association between HCL and skin cancer is highly relevant given ongoing trials using BRAF inhibitors, such as vemurafenib, for relapsed HCL, as RAS-mutant skin cancers could be paradoxically activated in these patients. PMID:26115047

  14. Implementing Teacher Education Centers: The Florida Experience.

    ERIC Educational Resources Information Center

    Van Fleet, Alanson A.; And Others

    1976-01-01

    This monograph is an historical document portraying the problems of starting Florida's first ten teacher education centers (1974-75). Its aim is to provide information to individuals and groups considering active participation in teacher education centers. The document is organized as four sections followed by a bibliography and appendix. The…

  15. Increasing Counseling Center Utilization: Yeshiva University's Experience

    ERIC Educational Resources Information Center

    Schwartz, Victor; Nissel, Chaim; Eisenberg, Daniel; Kay, Jerald; Brown, Joshua T.

    2012-01-01

    Yeshiva University established a counseling center during the 2004-2005 academic year. As a religiously based institution, the administration recognized that there would likely be significant impediments to utilization of on-campus mental health services as a result of negative attitudes about mental illness and its treatment--stigma. To combat…

  16. Pregnancy during hemodialysis: a single center experience.

    PubMed

    Bahadi, Abdelali; El Kabbaj, Driss; Guelzim, Khalid; Kouach, Jaouad; Hassani, Mohammed; Maoujoud, Omar; Aattif, Mohammed; Kadiri, Mouncif; Montassir, Dina; Zajjari, Yassir; Alayoud, Ahmed; Benyahia, Mohammed; Elallam, Mostapha; Oualim, Zouhir

    2010-07-01

    Successful pregnancy outcome is an uncommon occurrence in women requiring chronic dialysis treatment. We reviewed the course and outcome of 9 pregnancies occurred in women on chronic hemodialysis in our center from 1999-2007; 5 of them ended with delivery of alive newborns, 2 with fetal deaths in-utero, and 2 with abortions. The average age of patients was 34 years. The etiology of the original kidney disease was unknown in 44.4% of the cases, and only 22.2% of the patients maintained diuresis. Dialysis started in 8 cases before the diagnosis of pregnancy. The average gestational age at diagnosis was 14 weeks. We modified the prescription of dialysis in 4 patients by increasing the frequency of the dialysis sessions to 6 per week and in 3 by increasing the duration of each session to 6 hours. Anemia was present in all the cases; 3 patients received erythropoietin and 4 patients required transfusion. The pregnancy was com-plicated in 44% of the cases by a polyhydramnios. The average time at delivery was 33 weeks and it was achieved in 80% of pregnancies through vaginal route. The average weight of newborns was to 2380 g. We conclude that pregnancy in women on hemodialysis is possible. The success of pregnancy may be influenced by the residual diuresis and early diagnosis to improve the quality of dialysis by increasing the dialysis dose. PMID:20587867

  17. Prior Experiences Shaping Family Science Conversations at a Nature Center

    ERIC Educational Resources Information Center

    McClain, Lucy R.; Zimmerman, Heather Toomey

    2014-01-01

    Using families as the analytical focus, this study informs the field of informal science education with a focus on the role of prior experiences in family science conversations during nature walks at an outdoor-based nature center. Through video-based research, the team analyzed 16 families during walks at a nature center. Each family's prior…

  18. Ambulatory laparoscopic cholecystectomy: A single center experience

    PubMed Central

    Tiryaki, Cagri; Bayhan, Zülfü; Kargi, Ertugrul; Alponat, Ahmet

    2016-01-01

    AIM: To evaluate the demographic and clinical parameters affecting the outcomes of ambulatory laparoscopic cholecystectomy (ALC) in terms of pain, nausea, anxiety level, and satisfaction of patients in a tertiary health center. MATERIALS AND METHODS: ALC was offered to 60 patients who met the inclusion criteria. Follow-up (questioning for postoperative pain or discomfort, nausea or vomiting, overall satisfaction) was done by telephone contact on the same day at 22:00 p.m. and the first day after surgery at 8: 00 a.m. and by clinical examination one week after operation. STAI I and II data were used for proceeding to the level of anxiety of patients before and/or after the operation. RESULTS: Sixty consecutive patients, with a mean age of 40.6 ± 8.1 years underwent ALC. Fifty-five (92%) patients could be sent to their homes on the same day but five patients could not be sent due to anxiety, pain, or social indications. Nausea was reported in four (6.7%) cases and not associated with any demographic or clinical features of patients. On the other hand, pain has been reported in 28 (46.7%) cases, and obesity and shorter duration of gallbladder disease were associated with the increased pain perception (P = 0.009 and 0.004, respectively). Preopereative anxiety level was significantly higher among patients who could not complete the ALC procedure (P = 0.018). CONCLUSION: Correct management of these possible adverse effects results in the increased satisfaction of patients and may encourage this more cost-effective and safe method of laparoscopic cholecystectomy. PMID:26917919

  19. Johnson Space Center Flight Medicine Clinic Experience

    NASA Technical Reports Server (NTRS)

    Landry, Trela

    2006-01-01

    Being a member of the Flight Medicine Clinic (FMC) Staff is a great experience. I joined the FMC staff 2 years ago when I became part of the Kelsey-Seybold team. The FMC staff consists of Flight Surgeons, Family Clinic Physician, Nursing staff, Wellness Coordinator and Support staff. We serve as the Primary Care Physicians for the astronauts and their families and provide annual physicals for the retired astronauts. We have approximately 800 patients in the FMC. As the Family Clinic Physician, I care for the astronaut spouses and children and provide annual physicals for the retired astronauts. Since we have a small patient population, we have the opportunity to spend increased personal time with our patients, which I enjoy. We have a pretty healthy patient population, who are very interested in their overall health and preventive care. In preparation for a shuttle launch, our nursing staff assists the flight surgeons with the astronaut physical exams, which occur 10 days prior to launch and again 3 days after their return. We also provide Primary Contact physicals for the families and guests, who will be in close contact with shuttle crew members. During these physicals, we provide education, emphasizing the importance of preventing the spread of communicable diseases to shuttle crew members. Being a part of the Space Medicine Program is an honor. To know that you contribute in some way to our nation s Space Program is very special. (This article was prepared by Dr. Trela Landry, M.D. for inclusion in a Kelsey-Seybold newsletter on 25 OCT 2006.)

  20. New Counselors' Experiences of Community Health Centers

    ERIC Educational Resources Information Center

    Freadling, Amy H.; Foss-Kelly, Louisa L.

    2014-01-01

    This phenomenological study explored 6 new counselors' experiences working in community mental health centers and their experiences of the Council for Accreditation of Counseling and Related Educational Programs-accredited training received in preparation for such work. Three themes from the interviews were identified to provide implications…

  1. NASA Glenn Research Center Experience with "LENR Phenomenon"

    NASA Technical Reports Server (NTRS)

    Wrbanek, Susan Y.; Fralick, Gustave C.; Wrbanek, John D.; Niedra, Janis M.

    2012-01-01

    Since 1989 NASA Glenn Research Center (GRC) has performed some small-scale limited experiments that show evidence of effects claimed by some to be evidence of Low Energy Nuclear Reactions (LENR). The research at GRC has involved observations and work on measurement techniques for observing the temperature effects in reactions of isotopes of hydrogen with palladium hydrides. The various experiments performed involved loading Pd with gaseous H2 and D2, and exposing Pd thin films to multi-bubble sonoluminescence in regular and deuterated water. An overview of these experiments and their results will be presented.

  2. NASA Glenn Research Center Experience with LENR Phenomenon

    NASA Technical Reports Server (NTRS)

    Wrbanek, Susan Y.; Fralick, Gustave C.; Wrbanek, John D.; Niedra, Janis M.

    2012-01-01

    Since 1989 NASA Glenn Research Center (GRC) has performed some small-scale limited experiments that show evidence of effects claimed by some to be evidence of Low Energy Nuclear Reactions (LENR). The research at GRC has involved observations and work on measurement techniques for observing the temperature effects in reactions of isotopes of hydrogen with palladium hydrides. The various experiments performed involved loading Pd with gaseous H2 and D2, and exposing Pd thin films to multi-bubble sonoluminescence in regular and deuterated water. An overview of these experiments and their results will be presented.

  3. Simulations of Validation Platform Experiments by the PSI-Center

    NASA Astrophysics Data System (ADS)

    Nelson, B. A.; Akcay, C.; Glasser, A. H.; Hansen, C. J.; Jarboe, T. R.; Kim, C. C.; Marklin, G. J.; Milroy, R. D.; Shumlak, U.; Sovinec, C. R.; O'Bryan, J. B.; Held, E.; Ji, J.-Y.; Lukin, V. S.

    2012-10-01

    The Plasma Science and Innovation Center (PSI-Center - http://www.psicenter.org) assists collaborating validation platform experiments with extended MHD simulations. Collaborators include the Bellan Plasma Group (Caltech), CTH (Auburn U), FRX-L (Los Alamos National Laboratory), HIT-SI (U Wash - UW), LDX (M.I.T.), MST & Pegasus (U Wisc-Madison), PHD (UW), PFRC (PPPL), SSX (Swarthmore College), TCS (UW), and ZaP (UW). Modifications have been made to the NIMROD, HiFi, and PSI-Tet codes to specifically model these experiments, including mesh generation/refinement, appropriate boundary conditions (external fields, insulating BCs, etc.), and kinetic and neutral particle interactions. The PSI-Center is planning to add neutrals to NIMROD. When implemented in NIMROD, these results will be compared to the neutral particle physics in the 2D version of HiFi. Coaxial helicity injection BCs will be specified in HiFi to simulate the Caltech co-planar experiment, for verification with previous and ongoing NIMROD simulations. Results from these simulations, as well as an overview of the PSI-Center status will be presented.

  4. PSI-Center Simulations of Validation Platform Experiments

    NASA Astrophysics Data System (ADS)

    Nelson, B. A.; Akcay, C.; Glasser, A. H.; Hansen, C. J.; Jarboe, T. R.; Marklin, G. J.; Milroy, R. D.; Morgan, K. D.; Norgaard, P. C.; Shumlak, U.; Victor, B. S.; Sovinec, C. R.; O'Bryan, J. B.; Held, E. D.; Ji, J.-Y.; Lukin, V. S.

    2013-10-01

    The Plasma Science and Innovation Center (PSI-Center - http://www.psicenter.org) supports collaborating validation platform experiments with extended MHD simulations. Collaborators include the Bellan Plasma Group (Caltech), CTH (Auburn U), FRX-L (Los Alamos National Laboratory), HIT-SI (U Wash - UW), LTX (PPPL), MAST (Culham), Pegasus (U Wisc-Madison), PHD/ELF (UW/MSNW), SSX (Swarthmore College), TCSU (UW), and ZaP/ZaP-HD (UW). Modifications have been made to the NIMROD, HiFi, and PSI-Tet codes to specifically model these experiments, including mesh generation/refinement, non-local closures, appropriate boundary conditions (external fields, insulating BCs, etc.), and kinetic and neutral particle interactions. The PSI-Center is exploring application of validation metrics between experimental data and simulations results. Biorthogonal decomposition is proving to be a powerful method to compare global temporal and spatial structures for validation. Results from these simulation and validation studies, as well as an overview of the PSI-Center status will be presented.

  5. Simulations of ICC Experiments by the PSI-Center

    NASA Astrophysics Data System (ADS)

    Nelson, Brian; Glasser, A. H.; Jarboe, T. R.; Kim, C. C.; Marklin, G. J.; Lowrie, W.; Meier, E. T.; Milroy, R. D.; Shumlak, U.; Sovinec, C. R.; O'Bryan, J. B.; Held, E.; Ji, J.-Y.; Lukin, V. S.

    2011-10-01

    The Plasma Science and Innovation Center (PSI-Center - http://www.psicenter.org) assists collaborating innovative confinement concept (ICC) experiments with extended MHD simulations. Collaborators include the Bellan Plasma Group (Caltech), CTH (Auburn U), FRX-L (Los Alamos National Laboratory), HIT-SI (U Wash - UW), LDX (M.I.T.), MST & Pegasus (U Wisc-Madison), PHD (UW), PFRC (PPPL), SSX (Swarthmore College), TCS (UW), and ZaP (UW). Modifications have been made to the NIMROD, HiFi, and PSI-Tet codes to specifically model these ICC experiments, including mesh generation/refinement, appropriate boundary conditions (external fields, insulating BCs, etc.), and kinetic and neutral particle interactions. Interfaces of these codes to the powerful 3-D visualization program, VisIt (http://www.llnl.gov/visit) have been developed and implemented. Results from these simulations, as well as an overview of the Interfacing Group status will be presented.

  6. Legacy data center integration into distributed data federations: The World Data Center for Climate (WDCC) experience

    NASA Astrophysics Data System (ADS)

    Kindermann, Stephan; Berger, Katharina; Toussaint, Frank

    2014-05-01

    The integration of well-established legacy data centers into newly developed data federation infrastructures is a key requirement to enhance climate data access based on widely agreed interfaces. We present the approach taken to integrate the ICSU World Data Center for Climate (WDCC) located in Hamburg, Germany into the European ENES climate data Federation which is part of the international ESGF data federation. The ENES / ESGF data federation hosts petabytes of climate model data and provides scalable data search and access services across the worldwide distributed data centers. Parts of the data provided by the ENES / ESGF data federation is also long term archived and curated at the WDCC data archive, allowing e.g. for DOI based data citation. An integration of the WDCC into the ENES / ESGF federation allows end users to search and access WDCC data using consistent interfaces worldwide. We will summarize the integration approach we have taken for WDCC legacy system and ESGF infrastructure integration. On the technical side we describe the provisioning of ESGF consistent metadata and data interfaces as well as the security infrastructure adoption. On the non-technical side we describe our experiences in integrating a long-term archival center with costly quality assurance procedures with an integrated distributed data federation putting emphasis on providing early and consistent data search and access services to scientists. The experiences were gained in the process of curating ESGF hosted CMIP5 data at the WDCC. Approximately one petabyte of CMIP5 data which was used for the IPCC climate report is being replicated and archived at the WDCC.

  7. The Dresden Apheresis Center - experience with LDL apheresis and immunoadsorption.

    PubMed

    Julius, Ulrich; Tselmin, Sergey; Fischer, Sabine; Passauer, Jens; Bornstein, Stefan R

    2009-12-29

    The first apheresis center in former German Democratic Republic was established in Dresden November 1990 following the reunification of Germany. We here summarize the activities of this center to date. From the center's establishment until the end of July 2009 13,291 sessions of therapeutic apheresis have been performed. Four LDL apheresis methods, namely DALI, Therasorb LDL, HELP and lipidfiltration, are available and several comparative studies of these methods have been published. In addition, we have established the Therasorb IG method and two rheophoresis methods (Rheofilter SR 20; TheraSorb-Rheo Adsorber). Currently we treat 53 high-risk patients with LDL apheresis, including 6 post- heart transplant patients and 5 patients with immunoadsorption. Since November 1990 we have seen a marked reduction in the number of new cardiovascular events by apheresis intervention, but they could not be totally prevented and 2 patients died despite LDL apheresis treatment. In our clinical experience all 4 LDL apheresis methods appear equally effective. However, it is an advantage to have the ability to switch methods in patients in whom one method was less effective or less well tolerated. We also successfully treated patients suffering from Evans' syndrome, pemphigus, urticaria vasculitis with monoclonal gammopathy IgM Type Kappa, lichen myxoedematosus or lupus erythematodes with immunoadsorption. The rheophoresis approach has been used in patients with age-dependent degeneration of the macula, sudden hearing loss, leg ulcers, and diabetic foot syndrome. PMID:20129367

  8. National Criticality Experiments Research Center: Capability and Status

    SciTech Connect

    Hayes, David K.; Myers, William L.

    2012-07-12

    After seven years, the former Los Alamos Critical Experiments Facility (LACEF), or Pajarito Site, has reopened for business as the National Criticality Experiments Research Center (NCERC) at the Nevada National Security Site (NNSS). Four critical assembly machines (Comet, Planet, Flat-Top, and Godiva-IV) made the journey from Los Alamos to the NNSS. All four machines received safety system upgrades along with new digital control systems. Between these machines, systems ranging from the thermal through the intermediate to the fast spectrum may be assembled. Steady-State, transient, and super-prompt critical conditions may be explored. NCERC is the sole remaining facility in the United States capable of conducting general-purpose nuclear materials handling including the construction and operation of high-multiplication assemblies, delayed critical assemblies, and prompt critical assemblies. Reconstitution of the unique capabilities at NCERC ensures the viability of (1) The Nuclear Renaissance, (2) Stockpile Stewardship, and (3) and the next generation of criticality experimentalists.

  9. Mars Pathfinder Rover-Lewis Research Center Technology Experiments Program

    NASA Technical Reports Server (NTRS)

    Stevenson, Steven M.

    1997-01-01

    An overview of NASA's Mars Pathfinder Program is given and the development and role of three technology experiments from NASA's Lewis Research Center and carried on the Mars Pathfinder rover is described. Two recent missions to Mars were developed and managed by the Jet Propulsion Laboratory, and launched late last year: Mars Global Surveyor in November 1996 and Mars Pathfinder in December 1996. Mars Global Surveyor is an orbiter which will survey the planet with a number of different instruments, and will arrive in September 1997, and Mars Pathfinder which consists of a lander and a small rover, landing on Mars July 4, 1997. These are the first two missions of the Mars Exploration Program consisting of a ten year series of small robotic martian probes to be launched every 26 months. The Pathfinder rover will perform a number of technology and operational experiments which will provide the engineering information necessary to design and operate more complex, scientifically oriented surface missions involving roving vehicles and other machinery operating in the martian environment. Because of its expertise in space power systems and technologies, space mechanisms and tribology, Lewis Research Center was asked by the Jet Propulsion Laboratory, which is heading the Mars Pathfinder Program, to contribute three experiments concerning the effects of the martian environment on surface solar power systems and the abrasive qualities of the Mars surface material. In addition, rover static charging was investigated and a static discharge system of several fine Tungsten points was developed and fixed to the rover. These experiments and current findings are described herein.

  10. Installation of center disk baffle into Madison Dynamo Experiment vessel

    NASA Astrophysics Data System (ADS)

    Clark, M. M.; Nornberg, M. D.; Taylor, N. Z.; Wallace, J. P.; Forest, C. B.

    2013-10-01

    The Madison Dynamo Experiment (MDE) comprises a 1 m diameter spherical chamber that contains a turbulent flow of liquid sodium driven by two counter rotating impellers. One of the goals of the MDE is to observe a magnetic field grow at the expense of kinetic energy in the liquid sodium flow. It has been found that turbulence in the MDE plays a significant and solely detrimental role in the generation of magnetic fields. The installation of an equatorial baffle and the three rotatable vanes in each hemisphere resulted in a reduction of large scale eddies in the flow and enhanced field generation. However, no self-excited field was observed. This Poster will present recent modifications made to the experiment consisting of installing a copper disk baffle in the center of the spherical vessel. The design and installation of the structure will be illustrated and discussed. Results from before and after the center disk baffle installation will be shown. Supported by NSF and DoE.

  11. Advanced Life Support Project: Crop Experiments at Kennedy Space Center

    NASA Technical Reports Server (NTRS)

    Sager, John C.; Stutte, Gary W.; Wheeler, Raymond M.; Yorio, Neil

    2004-01-01

    Crop production systems provide bioregenerative technologies to complement human crew life support requirements on long duration space missions. Kennedy Space Center has lead NASA's research on crop production systems that produce high value fresh foods, provide atmospheric regeneration, and perform water processing. As the emphasis on early missions to Mars has developed, our research focused on modular, scalable systems for transit missions, which can be developed into larger autonomous, bioregenerative systems for subsequent surface missions. Components of these scalable systems will include development of efficient light generating or collecting technologies, low mass plant growth chambers, and capability to operate in the high energy background radiation and reduced atmospheric pressures of space. These systems will be integrated with air, water, and thermal subsystems in an operational system. Extensive crop testing has been done for both staple and salad crops, but limited data is available on specific cultivar selection and breadboard testing to meet nominal Mars mission profiles of a 500-600 day surface mission. The recent research emphasis at Kennedy Space Center has shifted from staple crops, such as wheat, soybean and rice, toward short cycle salad crops such as lettuce, onion, radish, tomato, pepper, and strawberry. This paper will review the results of crop experiments to support the Exploration Initiative and the ongoing development of supporting technologies, and give an overview of capabilities of the newly opened Space Life Science (SLS) Lab at Kennedy Space Center. The 9662 square m (104,000 square ft) SLS Lab was built by the State of Florida and supports all NASA research that had been performed in Hanger-L. In addition to NASA research, the SLS Lab houses the Florida Space Research Institute (FSRI), responsible for co-managing the facility, and the University of Florida (UF) has established the Space Agriculture and Biotechnology Research and

  12. Joint Langley Research Center/Jet Propulsion Laboratory CSI experiment

    NASA Technical Reports Server (NTRS)

    Neat, Gregory W.; O'Brien, John F.; Lurie, Boris J.; Garnica, Angel; Belvin, W. K.; Sulla, Jeff; Won, John

    1992-01-01

    This paper describes a joint Control Structure Interaction (CSI) experiment in which Jet Propulsion Laboratory (JPL) damping devices were incorporated into the Langley Research Center (LaRC) Phase 0 Testbed. The goals of the effort were twofold: (1) test the effectiveness of the JPL structural damping methods in a new structure and (2) assess the feasibility of combining JPL local control methods with the LaRC multiple input multiple output global control methods. Six dampers (2 piezoelectric active members, 4 viscous dampers), placed in three different regions of the structure, produced up to 26 dB attenuation in target modes. The combined control strategy in which the JPL damping methods contributed local control action and the LaRC control scheme provided global control action, produced and overall control scheme with increased stability margins and improved performance. This paper presents an overview of the technologies contributed from the two centers, the strategies used to combine them, and results demonstrating the success of the damping and cooperative control efforts.

  13. CCSDS telemetry systems experience at the Goddard Space Flight Center

    NASA Technical Reports Server (NTRS)

    Carper, Richard D.; Stallings, William H., III

    1990-01-01

    NASA Goddard Space Flight Center (GSFC) designs, builds, manages, and operates science and applications spacecraft in near-earth orbit, and provides data capture, data processing, and flight control services for these spacecraft. In addition, GSFC has the responsibility of providing space-ground and ground-ground communications for near-earth orbiting spacecraft, including those of the manned spaceflight programs. The goal of reducing both the developmental and operating costs of the end-to-end information system has led the GSFC to support and participate in the standardization activities of the Consultative Committee for Space Data Systems (CCSDS), including those for packet telemetry. The environment in which such systems function is described, and the GSFC experience with CCSDS packet telemetry in the context of the Gamma-Ray Observatory project is discussed.

  14. Single-center experience in double kidney transplantation.

    PubMed

    Fontana, I; Magoni Rossi, A; Gasloli, G; Santori, G; Giannone, A; Bertocchi, M; Piaggio, F; Bocci, E; Valente, Umberto

    2010-05-01

    Use of organs from marginal donors for transplantation is a current strategy to expand the organ donor pool. Its efficacy is universally accepted among data from multicenter studies. Herein, we have reviewed outcomes of double kidney transplantation (DKT) over an 9-year experience in our center. The aim of this study was to evaluate possible important differences between a monocenter versus multicenter studies. Between 1999 and 2008, we performed 59 DKT. Recipient mean age was 63 +/- 5 years. Mean HLA-A, -B, and -DR mismatches were 3.69 +/- 0.922. Donor mean age was 69 +/- 7 years and mean creatinine clearance was 69.8 +/- 30.8 mL/min. Proteinuria was detected in three donors (5%). Mean cold ischemia and warm ischemia times were 1130 +/- 216 and 48 +/- 11 minutes, respectively. The right and left kidney scores were 4.18 +/- 2 and 4.21 +/- 2, respectively. Thirty patients (51%) displayed good postoperative renal function; 22 (37%), acute tubular necrosis with postoperative dialysis; 3 (5%), acute rejection episodes; 4 (7%), single-graft transplantectomy due to vascular thrombosis; 1 (2%), a retransplantation; 5 (8%), a lymphocele; 3 (5%) vescicoureteral reflux or stenosis requiring surgical correction. Cytomegalovirus infection was detected in five patients (8%). In three patients (5%) displayed de novo neoplasia. Three patients showed chronic rejection (5%), whereas we observed a cyclosporine-related toxicity in 7 (12%). Nine patients (15%) developed iatrogenic diabetes. Patient and graft survivals after 3 years from DKT were 93% and 86.3%, respectively. In this study, we applied successfully a widespread score to allocate organs to single kidney transplantation or DKT. In our experience, the score is suitable for the organ allocation but it may be overprotective, excluding potentially suitable organs for a single transplantation. PMID:20534235

  15. Penile lichen sclerosus: An urologist's nightmare! - A single center experience

    PubMed Central

    Singh, Jitendra Pratap; Priyadarshi, Vinod; Goel, Hemant Kumar; Vijay, Mukesh Kumar; Pal, Dilip Kumar; Chakraborty, Sudip; Kundu, Anup Kumar

    2015-01-01

    Purpose: Penile lichen sclerosus (LS) is a nagging condition and its progression result in devastating urinary and sexual problems and reduction in the quality-of-life. This study has been carried out to present our experience about this disease with simultaneous review of the available literature. Materials and Methods: This retrospective study has been done at a tertiary care center of eastern India. The data of 306 patients affected with LS were analyzed for clinical presentation, physical examination, investigations, and treatment offered. Results: Presenting symptoms were non-specific. The prepuce was most commonly involved location followed by glans and meatus. Urethral involvement was not isolated as the primary site. Circumcision was done in 237 patients, while 63 patients underwent meatotomy. Thirty-six of 39 cases of LS induced stricture were treated with buccal mucosal graft (BMG) either in one stage or in two stages. Conclusion: LS varies from being a highly aggressive disease of the penis and anterior urethra to a burnt out condition affecting just the meatus and surrounding glans. Early diagnosis and treatment are required to prevent its complication and associated morbidity. Management depends on the anatomical location of lesion, extent of involvement, rapidity of progression and its severity. Use of BMG in LS induced urethral stricture has shown encouraging results. PMID:26229314

  16. Railgun experiments at the University of Texas Center for Electromechanics

    NASA Astrophysics Data System (ADS)

    Hayes, R. J.

    1991-05-01

    The Center for Electromechanics at the University of Texas at Austin (CEM-UT) presently has five experimental electromagnetic (e.m.) launchers or railguns in operation. An additional ten fully operational railguns are presently decommissioned and five new launchers are being fabricated. Several different parallel rail configurations and geometries are being studied as well as augmented rails and coaxial launchers. Recent tests utilizing the magnetic flux generated in a coil have produced promising results for work with coilgun launchers. Electromagnetic launchers at CEM-UT have been used in a wide variety of experiments. Particles of 50-500 μm in diameter have been accelerated up to 11 km/s to determine the effects of micrometeorite impacts on materials used in space applications and 2.5-kg packages have been launched to 2.6 km/s (8.1 MJ muzzle energy) in ballistic tests. Paper studies on launching 100-kg payloads at 10 km/s have also been conducted to determine the feasibility of launching satellites with e.m. launchers.

  17. Endovascular Treatment of Dural Arteriovenous Fistulas: Single Center Experience

    PubMed Central

    Oh, Jae-Sang; Oh, Hyuk-Jin; Shim, Jai-Joon; Bae, Hack-Gun; Lee, Kyeong-Seok

    2016-01-01

    Objective Treatment of intracranial dural arteriovenous fistulas (dAVFs) remains a challenge. However, after introduction of Onyx, transarterial approach is the preferred treatment option in many centers. We report our experience of dAVFs embolization with special emphasis on transarterial approach. Methods Seventeen embolization procedures were performed in 13 patients with dAVFs between Jan 2009 and Oct 2014. Clinical symptoms, location and type of fistulas, embolization methods, complications, radiological and clinical outcomes were evaluated using charts and PACS images. Results All 13 patients had symptomatic lesions. The locations of fistulas were transverse-sigmoid sinus in 6, middle fossa dura in 4, cavernous sinus in 2, and superior sagittal sinus in 1 patient. Cognard types were as follows : I in 4, IIa in 2, IIa+IIb in 5, and IV in 2. Embolization procedures were performed ≥2 times in 3 patients. Nine patients were treated with transarterial Onyx embolization alone. One of these required direct surgical puncture of middle meningeal artery. Complete obliteration of fistulas was achieved in 11/13 (85%) patients. There were no complications except for 1 case of Onyx migration in cavernous dAVF. Modified Rankin scale score at post-operative 3 months were 0 in 11, and 3 in 2 patients. Conclusion Transarterial Onyx embolization can be a first line therapeutic option in patients with dAVFs. However, transvenous approach should be tried first in cavernous sinus dAVF because of the risk of intracranial migration of liquid embolic materials. Furthermore, combined surgical endovascular approach can be considered as a useful option in inaccessible route. PMID:26885282

  18. An Exploration of Hispanic Mothers' Culturally Sustaining Experiences at an Informal Science Center

    ERIC Educational Resources Information Center

    Weiland, Ingrid

    2015-01-01

    Science education reform focuses on learner-centered instruction within contexts that support learners' sociocultural experiences. The purpose of this study was to explore Hispanic mothers' experiences as accompanying adults at an informal science center within the context of culturally sustaining experiences, which include the fluidity…

  19. Ghana's experience in the establishment of a national data center

    NASA Astrophysics Data System (ADS)

    Ekua, Amponsah Paulina; Yaw, Serfor-Armah

    2012-08-01

    The government of Ghana in a bilateral agreement with the Preparatory Commission for the Comprehensive Nuclear Test-Ban Treaty Organization (CTBTO) has established a National Data Center in Ghana with the aim of monitoring the testing of nuclear explosions. Seismic, hydroacoustic, radionuclide and infrasound methods are used for the monitoring. The data center was commissioned on 3 February, 2010 at the Ghana Atomic Energy Commission. At present Ghana does not have any operational, centralised data (seismic, hydroacoustic, radionuclide and infrasound) acquisition system with the capability of accessing data from other international stations. Hence, the need of setting up the National Data Center which would enable us constantly monitor, manage and coordinate both natural and man-made seismic activities in the country and around the globe, upload data to the International Data Center (IDC) as well as receive and use International Monitoring System (IMS) data and IDC products for treaty verification and compliance. Apart from these, the center also accesses and analyzes seismic waveforms relevant to its needs from the International Data Center; makes data available to its stakeholder institutions for earthquake disaster mitigation; reports on all aspects of disasters related to earthquake to the relevant government agencies that deal with disasters; makes recommendations to the government of Ghana on earthquake safety measures; provides information to assist government institutions to develop appropriate land and building policies. The center in collaboration with stakeholder agencies periodically organises public lectures on earthquake disaster risk mitigation.

  20. Hemoglobin H Disease in Turkey: Experience from Eight Centers

    PubMed Central

    Ünal, Selma; Oktay, Gönül; Acıpayam, Can; İlhan, Gül; Gali, Edip; Celkan, Tiraje; Bay, Ali; Malbora, Barış; Akar, Nejat; Oymak, Yeşim; Toptaş, Tayfur

    2016-01-01

    The purpose of this study was to research the problem of hemoglobin H (HbH) disease, to reveal the distribution patterns among different health centers, and to emphasize the importance of this disease for Turkey. A total of 273 patients were included from 8 hemoglobinopathy centers. The Antakya Hemoglobinopathy Center reported 232 patients and the remaining 7 centers reported 41 patients. PubMed was also searched for published articles related to Turkish patients with HbH disease, and we found 16 articles involving a total of 198 HbH patients. Most of the patients were reported from Antakya; thus, special attention should be paid to this region. This is a preliminary study to investigate the extent of the problem of HbH disease and it emphasizes the need for hematology associations or the Ministry of Health to record all cases of HbH disease in Turkey. PMID:26376738

  1. National Spherical Torus Experiment (NSTX) Center Stack Upgrade

    SciTech Connect

    Neumeyer, C; Chrzanowski, J; Dudek, L; Fan, H; Hatcher, R; Heitzenroeder, P; Menard, J; Ono, M; Ramakrishnan, S; Titus, P; Woolley, R; Zhan, H

    2009-09-24

    The purpose of the NSTX Center Stack Upgrade project is to expand the NSTX operational space and thereby the physics basis for next-step ST facilities. The plasma aspect ratio (ratio of plasma major to minor radius) of the upgrade is increased to 1.5 from the original value of 1.26, which increases the cross sectional area of the center stack by a factor of ~ 3 and makes possible higher levels of performance and pulse duration.

  2. Making Experience Count: Career Centers Staffed by Retired Volunteer Paraprofessionals.

    ERIC Educational Resources Information Center

    Dutro, Kenneth R.

    This paper describes the planning and implementation of a veterans' hospital career center program that offers a comprehensive career counseling, vocational assessment, vocational rehabilitation planning, job placement, and follow-up program to inpatients and outpatients, under the direction of a counseling psychologist. Recruitment of volunteer…

  3. User-Centered Design in Practice: The Brown University Experience

    ERIC Educational Resources Information Center

    Bordac, Sarah; Rainwater, Jean

    2008-01-01

    This article presents a case study in user-centered design that explores the needs and preferences of undergraduate users. An analysis of LibQual+ and other user surveys, interviews with public service staff, and a formal American with Disabilities Act accessibility review served as the basis for planning a redesign of the Brown University…

  4. Lifelong Learning Center: An Experiment in Counseling Succeeds.

    ERIC Educational Resources Information Center

    Milner, Arthur

    1979-01-01

    Describes the evolution and program of Philadelphia's Lifelong Learning Center, which stresses helping individuals to overcome problems of unemployment due to job obsolescence, mid-life career change, women returning to the job market, and career education and planning. Both workshops and individual interviews are used in working with clients.…

  5. A center's experience: pulmonary function in spinal cord injury.

    PubMed

    Schilero, Gregory J; Radulovic, Miroslav; Wecht, Jill M; Spungen, Ann M; Bauman, William A; Lesser, Marvin

    2014-06-01

    Traumatic spinal cord injury (SCI) is associated with significant psychological and physical challenges. A multidisciplinary approach to management is essential to ensure recovery during the acute phase, and comprehensive rehabilitative strategies are necessary to foster independence and quality of life throughout the chronic phase of injury. Complications that beset these individuals are often a unique consequence of SCI, and knowledge of the effects of SCI upon organ systems is essential for appropriate management. According to the National SCI Statistical Center (NSCISC), as of 2010 there were an estimated 265,000 persons living with SCI in the United States, with approximately 12,000 incidence cases annually. Although life expectancy for newly injured individuals with SCI is markedly reduced, persons with chronic SCI are expected to live about as long as individuals without SCI; however, longevity varies inversely with level of injury. Since 2005, 56 % of persons with SCI are tetraplegic, and due to paralysis of respiratory muscles, these individuals may be especially prone to pulmonary complications, which remain a major cause of mortality among persons with chronic SCI. We at the VA Rehabilitation Research and Development Center of Excellence for the Medical Consequences of SCI at the James J. Peters VA Medical Center have devoted more than 25 years to the study of secondary medical conditions that complicate SCI. Herein, we review pulmonary research at the Center, both our past and future endeavors, which form an integral part of our multidisciplinary approach toward achieving a greater understanding of and improving care for veterans with SCI. PMID:24723067

  6. Observing system simulation experiments at NASA. Goddard Space Flight Center

    NASA Technical Reports Server (NTRS)

    Atlas, R.; Kalnay, E.; Baker, W. E.; Susskind, J.; Reuter, D.; Halem, M.

    1985-01-01

    A series of realistic simulation studies is being conducted as a cooperative effort between the European Centre for Medium Range Weather Forecasts (ECMWF), the National Meteorological Center (NMC), and the Goddard Laboratory for Atmospheres (GLA), to provide a quantitative assessment of the potential impact of future observing systems on large scale numerical weather prediction. A special objective is to avoid the unrealistic character of earlier simulation studies. Following a brief review of previous simulation studies and real data impact tests, the methodology for the current simulation system will be described. Results from an assessment of the realism of the simulation system and of the potential impact of advanced observing systems on numerical weather prediction and preliminary results utilizing this system will be presented at the conference.

  7. Docker experience at INFN-Pisa Grid Data Center

    NASA Astrophysics Data System (ADS)

    Mazzoni, E.; Arezzini, S.; Boccali, T.; Ciampa, A.; Coscetti, S.; Bonacorsi, D.

    2015-12-01

    Clouds and virtualization offer typical answers to the needs of large-scale computing centers to satisfy diverse sets of user communities in terms of architecture, OS, etc. On the other hand, solutions like Docker seems to emerge as a way to rely on Linux kernel capabilities to package only the applications and the development environment needed by the users, thus solving several resource management issues related to cloud-like solutions. In this paper, we present an exploratory (though well advanced) test done at a major Italian Tier2, at INFN-Pisa, where a considerable fraction of the resources and services has been moved to Docker. The results obtained are definitely encouraging, and Pisa is transitioning all of its Worker Nodes and services to Docker containers. Work is currently being expanded into the preparation of suitable images for a completely virtualized Tier2, with no dependency on local configurations.

  8. Common injuries in athletes' knee: experience of a specialized center

    PubMed Central

    Nicolini, Alexandre Pedro; de Carvalho, Rogério Teixeira; Matsuda, Marcelo Mitsuro; Sayum, Jorge; Cohen, Moisés

    2014-01-01

    OBJECTIVE: The present cross-sectional study aims to identify the most common knee injuries in athletes cared at a Specialized Outpatient Clinics. METHOD: Analysis of patients cared at the Knee Outpatient Clinics of a Sports Trauma Center, divided by gender, age and diagnosed injury. RESULTS: Initially 440 patients were divided into 33 types of sports; after excluding the less statistically significant practices, nine sports remained. The most frequently performed sports were football with almost 50% of total patients presenting anterior cruciate ligament (ACL) injury, and road runs with great frequency of meniscal injury. There was no correlation of the disorder with the type of sports performed but a correlation was found with patient's age/gender. CONCLUSION: The complete ACL rupture was the most common injury found in football, basketball and volleyball players, followed by meniscal injury in street runners. Level of Evidence IV, Study Transversal. PMID:25061417

  9. Blunt pancreatic trauma: experience at a rural referral center.

    PubMed

    Timberlake, G A

    1997-03-01

    The objective of this study was to compare mechanism of injury, treatment methods, and outcome of blunt pancreas trauma patients transferred from another hospital to those of patients brought directly from the scene. A retrospective review was conducted of 6078 patients treated at a Level I trauma center from 1/1/90 to 12/31/94. Blunt pancreas injury was found in 39 (0.64%) patients (mean age, 33.2 years). Mechanism of injury included 34 (87%) motor vehicle crashes, 3 (8%) motorcycle crashes, and 2 (5%) other injuries. There were 11 transfer patients (28%), and 28 (72%) admitted directly from the scene. Eighty-two per cent of the motor vehicle crash patients were unrestrained, and 35 per cent had ethanol intoxication. Exploratory laparotomy was performed on 32 (82%); eight (25%) required repair or resection; 22 (69%) had trivial injuries, at most requiring drainage; and two (6.3%) exsanguinated. No patients required Whipple resection or pancreatiocojejunostomy. At operation, an average of 2.5 associated intra-abdominal injuries were found. Overall survival was 35 of 39 (90%). Among the patients brought directly to the trauma center, 93 per cent survived, whereas survival among transferred patients was 82 per cent (chi2 = 0.19; P = 0.66). Blunt pancreatic injuries vary in severity, but radical resection is rarely required. Lack of safety restraint and ethanol use are major risk factors. Despite the high likelihood of associated injuries, survivability is high. No difference in outcome was seen between directly admitted and transferred patients. PMID:9036900

  10. Interventional Electrophysiology in Children: A Single-Center Experience

    PubMed Central

    Mosaed, Pasha; Dalili, Mohammad; Emkanjoo, Zahra

    2012-01-01

    Objective Ablation techniques of cardiac arrhythmia in children have significantly progressed in the past decade; however, the number of pediatric ablations is still significantly lower than that in adults. Accordingly, there is less information regarding the success rate and complications in this age group. Methods All pediatric ablations conducted between March 2005 and February 2011 at Rajaie Heart Center were studied. Abolishing the arrhythmia source by the end of procedure was considered as success. Recurrences before hospital discharge and those thereafter were named early recurrence and late recurrence, respectively. Findings A total of 125 catheter ablations were performed for 112 patients. Of them 118 (94.4%) procedures were successful. The success rate was significantly higher in the patients with atrioventricular nodal reentry tachycardia (AVNRT). Of 105 patients who continued follow-up program, 7 (6.7%) cases experienced recurrence; the recurrence rate was inversely dependent on the patients’ body size (P-value <0.05). There was no mortality. Five cases were complicated during or early after the procedure, all the complications were cured completely. Conclusion Therapeutic electrophysiology in children is an effective and relatively low-risk method. The recurrence and complication rates are similar to those reported in adults. Considering our results and the previous reports, pediatric patients with serious arrhythmia should not be deprived from ablation and should not be exposed to long-term toxic drugs. PMID:23399953

  11. Portal hypertensive biliopathy: A single center experience and literature review.

    PubMed

    Suárez, Vanessa; Puerta, Andrés; Santos, Luisa Fernanda; Pérez, Juan Manuel; Varón, Adriana; Botero, Rafael Claudino

    2013-03-27

    Portal hypertensive biliopathy (PHB) is characterized by anatomical and functional abnormalities of the intrahepatic, extrahepatic and pancreatic ducts, in patients with portal hypertension associated to extrahepatic portal vein obstruction and less frequently to cirrhosis. These morphological changes, consisting in dilatation and stenosis of the biliary tree, are due to extensive venous collaterals occurring in an attempt to decompress the portal venous blockage. It is usually asymptomatic until it progresses to more advanced stages with cholestasis, jaundice, biliary sludge, gallstones, cholangitis and finally biliary cirrhosis. Imaging modalities of the biliary tree such as Doppler ultrasound, computed tomography, magnetic resonance cholangiopancreatography and endoscopic retrograde cholangiopancreatography are essential to establish the diagnosis and the need of therapeutical interventions. Once the diagnosis is established, treatment with ursodesoxycholic acid seems to be beneficial. Decompression of the biliary tree to dilate, remove stones or implant biliary prosthesis by endoscopic or surgical procedures (hepato-yeyunostomy) usually resolves the cholestatic picture and prevents septic complications. The ideal treatment is the decompression of the portal system, with transjugular intrahepatic porto-systemic shunt or a surgical porto-systemic shunt. Unfortunately, few patients will be candidates for these procedures due to the extension of the thrombotic process. The purpose of this paper is to report the first 3 cases of PHB seen in a Colombian center and to review the literature. PMID:23556047

  12. Head and Neck Sarcomas: A Comprehensive Cancer Center Experience

    PubMed Central

    Tejani, Mohamedtaki A.; Galloway, Thomas J.; Lango, Miriam; Ridge, John A.; von Mehren, Margaret

    2013-01-01

    Head/neck sarcomas are rare, accounting for about 1% of head/neck malignancies and 5% of sarcomas. Outcomes have historically been worse in this group, due to anatomic constraints leading to difficulty in completely excising tumors, with high rates of local recurrence. We retrospectively analyzed cases of head/neck soft tissue sarcomas (STS) and osteogenic sarcomas managed in a multi-disciplinary setting at Fox Chase Cancer Center from 1999–2009 to describe clinicopathologic characteristics, treatment, outcomes, and prognostic factors for disease control and survival. Thirty patients with STS and seven patients with osteogenic sarcoma were identified. Most STS were high grade (23) and almost all were localized at presentation (28). Common histologies were synovial cell (6), rhabdomyosarcoma (5), angiosarcoma (4), liposarcoma (4) and leiomyosarcoma (3). The type of primary therapy and disease outcomes were analyzed. Cox proportional hazards regression analysis was performed to identify predictors of disease-free survival (DFS) and overall survival (OS). The HR and 95% CI for Cox model and median DFS/OS analyzed by Kaplan-Meier curves were calculated. PMID:24202325

  13. A Qualitative Examination of Connections between Learner-Centered Teaching and Past Significant Learning Experiences

    ERIC Educational Resources Information Center

    Brackenbury, Tim

    2012-01-01

    Learner-centered teaching is a collection of instructional practices that shift the emphasis of courses from the instructors' goals and methods of delivery to the knowledge and skills that the students develop. This study examined potential commonalities between features of learner-centered teaching and the past significant learning experiences of…

  14. Electronic Text Centers: Creating Research Collections on a Limited Budget, the Nebraska Experience.

    ERIC Educational Resources Information Center

    Giesecke, Joan R.; McNeil, Beth; Minks, Gina L. B.

    2000-01-01

    Defines electronic text centers as tools for digital collection development in the humanities and describes experiences at the University of Nebraska-Lincoln in developing an electronic text center. Considers staffing, standards for encoding and describing electronic texts, hardware and software selection, and partnerships with the University of…

  15. Do Children's Advocacy Centers Improve Families' Experiences of Child Sexual Abuse Investigations?

    ERIC Educational Resources Information Center

    Jones, Lisa M.; Cross, Theodore P.; Walsh, Wendy A.; Simone, Monique

    2007-01-01

    Objective: The Children's Advocacy Center (CAC) model of child abuse investigation is designed to be more child and family-friendly than traditional methods, but there have been no rigorous studies of their effect on children's and caregivers' experience. Data collected as part of the Multi-Site Evaluation of Children's Advocacy Centers were used…

  16. A cesium TELEC experiment at Lewis Research Center

    NASA Technical Reports Server (NTRS)

    Britt, E. J.

    1979-01-01

    The thermoelectronic laser energy converter (TELEC), was studied as a method of converting a 10.6 mm CO2 laser beam into electric power. The calculated characteristics of a TELEC seem to be well matched to the requirements of a spacecraft laser energy conversion system. The TELEC is a high power density plasma device which absorbs an intense laser beam by inverse bremsstrahlung with the plasma electrons. In the TELEC process, electromagnetic radiation is absorbed directly in the plasma electrons producing a high electron temperature. The energetic electrons diffuse out of the plasma striking two electrodes which are in contact with the plasma at the boundaries. These two electrodes have different areas: the larger one is designated as the collector, the smaller one is designated as the emitter. The smaller electrode functions as an electron emitter to provide continuity of the current. Waste heat is rejected from the collector electrode. An experiment was carried out with a high power laser using a cesium vapor TELEC cell with 30 cm active length. Laser supported plasma was produced in the TELEC device during a number of laser runs over a period of several days. Electric power from the TELEC was observed with currents in the range of several amperes and output potentials of less than 1 volt. The magnitudes of these electric outputs were smaller than anticipated but consistent with the power levels of the laser during this experiment.

  17. Endoscopic necrosectomy under fluoroscopic guidance – a single center experience

    PubMed Central

    Smoczyński, Marian; Jabłońska, Anna; Adrych, Krystian

    2015-01-01

    Introduction Our report presents a technique of necrotic tissue removal during transmural drainage of walled-off pancreatic necrosis (WOPN) that is an alternative to the one that has already been described in the literature. Aim To assess the effectiveness and safety of endoscopic necrosectomy performed during transmural drainage of symptomatic WOPN. Material and methods Within the years 2012–2013, 64 patients underwent endoscopic treatment of symptomatic WOPN in our center. Eight patients underwent endoscopic necrosectomy during transmural drainage. Fragments of necrotic tissues were removed from the collection's cavity under fluoroscopic guidance using a Dormia basket. The results and complications of treatment were compared retrospectively. Results Sixty-four patients with WOPN underwent transmural drainage under endoscopic ultrasonography (EUS) guidance. Eight patients (12.5%, 5 women and 3 men, mean age 57.25 years) were qualified for endoscopic necrosectomy. Transmural transgastric access was made in 7 patients and transduodenal access in 1 patient. Additional percutaneous drainage was used in 2 patients. Active drainage was continued for 24 days (11–44 days). The mean number of endoscopic procedures was 4.75 (3–9). The average number of necrosectomy procedures during drainage was 1.75 (1–4). Complications of endotherapy occurred in 2/8 (25%) patients, and they were not directly connected with necrosectomy. Therapeutic success after the end of active drainage was achieved in all patients. During a 6-month follow-up no recurrence of the collection was observed. Conclusions Endoscopic necrosectomy under fluoroscopic guidance is an effective and safe method of minimally invasive treatment in a selected group of patients with symptomatic WOPN. PMID:26240624

  18. Uncommon renal tumors in children: A single center experience

    PubMed Central

    Mandal, Kartik Chandra; Mukhopadhyay, Madhumita; Barman, Shibsankar; Halder, Pankaj; Mukhopadhyay, Biswanath; Kumar, Rajarshi

    2016-01-01

    Aims: Scrutiny over the clinical behaviors, management, and the final outcome of some rare renal neoplasm in order to find out some hidden facts about these tumors which are playing an important role in the disease course and its management. Materials and Methods: Retrospective evaluation of uncommon (non-Wilms’) renal neoplasm in the pediatric population in a tertiary care center. Fifteen cases of uncommon renal tumors were treated in our institution over the last 5 years (January 2008 to December 2012). The cases were tabulated in the form of age, sex, mode of presentation, preoperative investigations, intraoperative grading, pathological type, postoperative management and the final outcome. The patients were followed up for 2 years (clinically every 3 months and ultrasonography abdomen in every 6 months for first 2 years) in order to see any evidence of recurrence and complications related to postoperative chemotherapy. Results: Out of 15 cases, four cases were clear cell sarcoma (CCS) (26.6%), three cases were rhabdoid tumor (20%), three cases were congenital mesoblastic nephroma (20%), two cases were multilocular cystic nephroma (13.3%), two cases were renal teratoma (13.3%), and one case of teratoid Wilms’ tumor (6.6%). There were two deaths (one CCS and one rhabdoid tumor) due to chemotherapy-related toxicity but no recurrence. Three patients were lost during postoperative follow-up; ten patients are doing well and getting a regular visit in the follow-up clinic. Conclusion: The clinical presentations of these uncommon renal tumors are similar to that of Wilms’ tumor. Thus, preoperative diagnosis is difficult even with modern imaging techniques. Some of these tumors (CCS, rhabdoid tumor) are rapidly progressing and have a poor outcome. Hence, early intervention in the form of complete surgical resection of the tumor (whenever possible) and postoperative chemo/radiotherapy are imperative for fruitful outcome. PMID:27046976

  19. Management of locoregional stage esophageal cancer: a single center experience.

    PubMed

    Javle, M M; Nwogu, C E; Donohue, K A; Iyer, R V; Brady, W E; Khemka, S V; Smith, J L; Demmy, T L; Yang, G Y; Nava, H R

    2006-01-01

    Therapeutic options for locoregional esophageal cancer (EC) include primary surgery, neoadjuvant or definitive chemoradiation and systemic chemotherapy. The role of surgery in these multimodal strategies has recently been debated and definitive chemoradiation is being offered as an alternative to surgery at many centers. We examined our results with multimodal therapy and surgery in this patient population. We conducted a retrospective analysis of 172 patients with locoregional (AJCC stages I-III) EC treated at RPCI between February 14, 1990 and September 20, 2002. Median age was 65 years (range, 36-95); there were 136 male patients. There were 100 regional (stages IIB-III), 69 local (stages I-IIA) and three in situ cases. Initial therapy was either combined modality (n = 122) or single modality (surgery) (n = 50). There was 0%, 30-day, postoperative mortality. Median survival for all patients was 25.3 months and was better for local stage with surgery alone (75 months) than with neoadjuvant (35.7 months) or definitive chemoradiation (19.1 months, P < 0.001). Survival for patients with regional disease treated with surgery alone, neoadjuvant or definitive chemoradiation was 21.5, 24.4 and 11.8 months, respectively (P = not significant). The associations of prognostic factors with overall survival were evaluated using Cox proportional hazards regression analysis and 2-sided Wald's chi-square test. On multivariate analysis, carefully selected patients treated with surgery alone had better outcomes compared with those treated with definitive chemoradiation (P < 0.001). Patients with locoregional esophageal cancer who are eligible for surgical resection either alone or as a part of multimodal therapy may have better outcomes than those treated with non-surgical approaches. PMID:16643174

  20. Carotid Artery Stenting: Single-Center Experience Over 11 Years

    SciTech Connect

    Nolz, Richard Schernthaner, Ruediger Egbert; Cejna, Manfred; Schernthaner, Melanie Lammer, Johannes Schoder, Maria

    2010-04-15

    This article reports the results of carotid artery stenting during an 11-year period. Data from 168 carotid artery stenting procedures (symptomatic, n = 55; asymptomatic, n = 101; symptoms not accessible, n = 12) were retrospectively collected. Primary technical success rate, neurological events in-hospital, access-site complications, and contrast-induced nephropathy (n = 118) were evaluated. To evaluate the influence of experience in carotid artery stenting on intraprocedural neurologic complications, patients were divided into two groups. Group 1 included the first 80 treated patients, and group 2 the remainder of the patients (n = 88). In-stent restenoses at last-follow-up examinations (n = 89) were assessed. The overall primary technical success rate was 95.8%. The in-hospital stroke-death rate was 3.0% (n = 5; symptomatic, 5.4%; asymptomatic, 2.0%; p = 0.346). Neurologic complications were markedly higher in group 1 (4.2%; three major strokes; symptomatic, 2.8%, asymptomatic, 1.4%) compared to group 2 (2.4%; one major and one minor stroke-symptomatic, 1.2%, asymptomatic 1.2%), but this was not statistically significant. Further complications were access-site complications in 12 (7.1%), with surgical revision required in 1 (0.6%) and mild contrast-induced nephropathy in 1 (0.85%). Twenty-one (23.6%) patients had >50% in-stent restenosis during a mean follow-up of 28.2 months. In conclusion, advanced experience in carotid artery stenting leads to an acceptable periprocedural stroke-death rate. In-stent restenosis could be a critical factor during the follow-up course.

  1. Progressive Transformation of Germinal Centers: Single-Center Experience of 33 Turkish Patients.

    PubMed

    Özkan, Melda Cömert; Özsan, Nazan; Hekimgil, Mine; Saydam, Güray; Töbü, Mahmut

    2016-08-01

    Progressive transformation of germinal centers (PTGCs) is a benign disease of the lymph nodes that is rarely associated with Hodgkin disease. We reviewed the clinical and pathologic features of PTGCs and the relationship of PTGCs with lymphoid neoplasia in an adult population. The data from 33 patients who were diagnosed with PTCGs were retrospectively analyzed. Of the 33 PTGC patients, 48.5% were men and 51.5% were women, with a mean age of 43.8 years at diagnosis. Most of the enlarged and excised lymph nodes were cervical and axillary. Diffuse large B-cell lymphoma and nodular lymphocyte predominant Hodgkin lymphoma was detected concurrent with PTGC in 2 patients. Also, PTGCs was detected 3 years after the diagnosis of diffuse large B-cell lymphoma, nodular lymphocyte predominant Hodgkin lymphoma, and T-cell-rich B-cell lymphoma in 3 patients. No relapse was found in the patients with lymphoma, and no progression to lymphoma was detected during the follow-up of the other patients. PTGCs is not considered a premalignant entity; however, the development of lymphoma has been reported rarely. If PTGCs occurs in the follow-up process of patients with lymphoma, the follow-up intervals should be shortened. PMID:27133958

  2. How the hydroelectric design center`s experience ensures new SCADA systems are successful

    SciTech Connect

    Gantenbein, C.

    1995-12-31

    An installed SCADA system doesn`t require age for obsolescence. Effective obsolescence can be a SCADA system, of any age, which no longer receives the manufacturer`s product support or it could be a new SCADA system which was never supplied with complete documentation for the delivered hardware or software. It could also be the system which was the state-of-the-market SCADA when designed and when the procurement documents were prepared but, by the time of final system acceptance, the hardware is two generations old in technology. The Hydroelectric Design Center (HDC) is aware of the many times these situations have occurred when SCADA systems have been purchased, not only by the Government, but by the hydroelectric industry in general. These situations can rapidly grow into significant and expensive problems as the Government`s needs change and expand. How can an applications software routine be modified when no source code was provided? How can a new device be added to the SCADA system`s communications ports when the communications protocol is unknown or is a vendor`s {open_quotes}proprietary{close_quotes} software. HDC is aggressively working on solutions to minimize the obsolescence of newly installed SCADA systems while still remaining within the boundaries of the Government`s procurement guidelines.

  3. A ventral visual stream reading center independent of visual experience.

    PubMed

    Reich, Lior; Szwed, Marcin; Cohen, Laurent; Amedi, Amir

    2011-03-01

    The visual word form area (VWFA) is a ventral stream visual area that develops expertise for visual reading. It is activated across writing systems and scripts and encodes letter strings irrespective of case, font, or location in the visual field with striking anatomical reproducibility across individuals. In the blind, comparable reading expertise can be achieved using Braille. This study investigated which area plays the role of the VWFA in the blind. One would expect this area to be at either parietal or bilateral occipital cortex, reflecting the tactile nature of the task and crossmodal plasticity, respectively. However, according to the metamodal theory, which suggests that brain areas are responsive to a specific representation or computation regardless of their input sensory modality, we predicted recruitment of the left-hemispheric VWFA, identically to the sighted. Using functional magnetic resonance imaging, we show that activation during Braille reading in blind individuals peaks in the VWFA, with striking anatomical consistency within and between blind and sighted. Furthermore, the VWFA is reading selective when contrasted to high-level language and low-level sensory controls. Thus, we propose that the VWFA is a metamodal reading area that develops specialization for reading regardless of visual experience. PMID:21333539

  4. Interventional Treatment of Pulmonary Valve Stenosis: A Single Center Experience

    PubMed Central

    Idrizi, Shpend; Milev, Ivan; Zafirovska, Planinka; Tosheski, Goce; Zimbakov, Zan; Ampova-Sokolov, Vilma; Angjuseva, Tanja; Mitrev, Zan

    2015-01-01

    BACKGROUND: Percutaneous pulmonary valvuloplasty is well established treatment of choice in pulmonary valve stenosis. AIM: The aim of our study was to present our experience with the interventional technique, its immediate and mid-term effectiveness as well as its complication rate. MATERIAL AND METHODS: The study included 43 patients, where 33 (74%) of them were children between the age of 1 month and 15 years. RESULTS: The procedure was successful in 38 patients or 90%. Mean peak to peak transvalvular gradient was reduced from 91.2 mmHg (55-150 mmHg) to 39.1 mmHg (20-80 mmHg). Follow- up of patients was between 2 and 13 years and included echocardiographic evaluation of pulmonary valve gradient, right heart dimensions and function as well as assessment of pulmonary regurgitation. We experienced one major complication pericardial effusion in a 5 months old child that required pericardiocenthesis. Six patients (13.9%) required a second intervention. During the follow up period there was significant improvement of right heart function and echocardiography parameters. Mild pulmonary regurgitation was noted in 24 (55%) patients, and four (9%) patients developed moderate regurgitation, without affecting the function of the right ventricle. CONCLUSIONS: Percutaneous pulmonary valvuloplasty is an effective procedure in treatment of pulmonary stenosis with good short and mid-term results. PMID:27275259

  5. Five years’ experience with capsule endoscopy in a single center

    PubMed Central

    Kav, Taylan; Bayraktar, Yusuf

    2009-01-01

    Capsule endoscopy (CE) is a novel technology that facilitates highly effective and noninvasive imaging of the small bowel. Although its efficacy in the evaluation of obscure gastrointestinal bleeding (OGIB) has been proven in several trials, data on uses of CE in different small bowel diseases are rapidly accumulating in the literature, and it has been found to be superior to alternative diagnostic tools in a range of such diseases. Based on literature evidence, CE is recommended as a first-line investigation for OGIB after negative bi-directional endoscopy. CE has gained an important role in the diagnosis and follow-up of Crohn’s disease and celiac disease and in the surveillance of small bowel tumors and polyps in selected patients. Capsule retention is the major complication, with a frequency of 1%-2%. The purpose of this review was to discuss the procedure, indications, contraindications and adverse effects associated with CE. We also review and share our five-year experience with CE in various small bowel diseases. The recently developed balloon-assisted enteroscopies have both diagnostic and therapeutic capability. At the present time, CE and balloon-assisted enteroscopies are complementary techniques in the diagnosis and management of small bowel diseases. PMID:19399924

  6. MRI-guided stereotactic amygdalohippocampectomy: a single center experience

    PubMed Central

    Vojtěch, Zdeněk; Malíková, Hana; Krámská, Lenka; Liščák, Roman; Vladyka, Vilibald

    2015-01-01

    Background This paper presents our experience of stereotactic radiofrequency amygdalohippocampectomy performed for intractable mesial temporal lobe epilepsy. Methods The article describes the cases of 61 patients who were treated during the period from 2004 to 2010. Mean postoperative follow-up was 5.3 years. Neuropsychological results were obtained for a subset of 31 patients. Results At their last postsurgical visit, 43 (70.5%) patients were Engel class I, six (9.8%) class II, nine (14.8%) class III, and three (4.9%) class IV. The surgery was complicated by four intracranial hematomas. One of them caused acute hydrocephalus and was treated by shunting and resolved without sequelae, while another caused transitory aphasia. The remaining hematomas were asymptomatic. There were two cases of meningitis which required antibiotic treatment. One patient committed suicide due to postoperative depression. After the procedure, we performed open epilepsy surgery and rethermolesions in three and two patients, respectively (8.2%). Patients showed increases in their mean full scale, verbal, and performance intelligence quotient (IQ) scores of 4, 3, and 4 IQ points, respectively (P<0.05). Five (17.2%), four (13.8%), and four (13.3%) patients improved their full scale, verbal, and performance IQ scores, respectively. No significant changes were found in memory performance, with a mean increase of 1, 3, and 0 memory quotient points in global, verbal, and visual memory, respectively (P<0.05). Global memory improved in three (10.3%) patients, verbal memory in one (3.4%), and one patient (3.3%) showed deterioration in visual memory. Conclusion Stereotactic radiofrequency amygdalohippocampectomy offers a safe, effective, and less aggressive treatment modality in cases of well-defined mesial temporal lobe epilepsy. Seizure outcome is comparable with the results of conventional epilepsy surgery and cognitive results could be even better. PMID:25709460

  7. Pediatric idiopathic dilated cardiomyopathy: A single center experience

    PubMed Central

    Azhar, Ahmad S.

    2013-01-01

    Context: Idiopathic dilated cardiomyopathy (IDCM) is a severe illness with high mortality in the pediatric population. AIMS: To highlight our experience about clinical course and outcome of IDCM. Settings and Design: Patients’ files were reviewed retrospectively for diagnosed cases of IDCM in the pediatric cardiology unit of King Abdul Aziz University Hospital, Jeddah, Saudi Arabia, from Jan 2003 to Jun 2011. Materials and Methods: Data about full history, clinical examination and investigations were recorded and grouped according to outcome as alive and well (group 1), alive and symptomatic (group 2) and worsened or dead (group 3). Statistical Analysis: Data was subjected to descriptive analysis. Chi-square and Student's paired t-test techniques were used where appropriate. Spearman rank correlation and survival analysis was done. Results: Eighty three patients were included with presenting age median (range), i.e.,14 (2 months–12 years) with females predominance 53 (63.9%). On presentation; cardiomegaly was noted in 72 (86.7%) with increased lung vascularity in 45 (54%). Sixty-one (74%) patients had ST segment and T-wave changes on electrocardiogram, while the same number had left ventricular hypertrophy, and 15 (18%) had arrhythmias. Echocardiography records on presentation and at last follow-up showed significant difference in several areas. Group 1 had 40 (48.2%), Group 2 had 23 (27.7%) while 20 (24.1%) were in Group 3 including nine cases who died. Survival rate over three years was 78%. Older the age, worse was the outcome (Spearman's rho = 0.3, P = 0.04). Conclusion: Majority of subjects were presented during first year of life; the three year survival rate was 78%. Favorable outcome was correlated with younger age at presentation. PMID:23633851

  8. Surgical Approach to Splenic Hydatid Cyst: Single Center Experience

    PubMed Central

    Eris, Cengiz; Akbulut, Sami; Yildiz, Mehmet Kamil; Abuoglu, Hasan; Odabasi, Mehmet; Ozkan, Erkan; Atalay, Suleyman; Gunay, Emre

    2013-01-01

    The benefits and risks of surgery for splenic hydatid cyst (SHC) remain controversial. We aimed to share our experience about a surgical approach for SHC. Sixteen consecutive patients with SHC disease who underwent open splenectomy at our hospital between January 2006 and July 2012 were retrospectively evaluated. Data on the patients' demographic features, clinical findings, radiological and serological diagnostic methods, and surgical and medicinal treatment options were collected and used to generate descriptive profiles of diagnosis, treatment course, and outcome. The patient population was composed of 6 females and 10 males, with an age range of 18 to 79 years (mean age: 47.0 ± 18.0). Radiological examinations detected hydatid cysts in spleen alone (n = 7) or both spleen and liver (n = 9). Preoperative serological testing identified 13 of the patients as IHA positive. All except 1 patient received a 10- to 21-day preoperative course of albendazole therapy and all patients received vaccination 1 week prior to surgery. Seven patients underwent splenectomy. The remaining patients underwent splenectomy with partial cystectomy and omentopexy (n = 6), partial cystectomy and unroofing (n = 1), pericystectomy (n = 1), or pericystectomy with partial nephrectomy (n = 1). All except one patient received a 10- to 45-day postoperative course of albendazole. No patients developed serious complications or signs of recurrence during the follow-up. The clinical profile of SHC disease at our hospital includes diagnosis by radiological methods, splenectomy treatment by simple or concomitant procedures according to the patient's symptoms, cyst size, number and localization, and compression of adjacent organs, and adjunct vaccination to decrease risk of postoperative septic complications. This profile is associated with low risk of complications and high therapeutic efficacy. PMID:24229022

  9. Ecology-centered experiences among children and adolescents: A qualitative and quantitative analysis

    NASA Astrophysics Data System (ADS)

    Orton, Judy

    The present research involved two studies that considered ecology-centered experiences (i.e., experiences with living things) as a factor in children's environmental attitudes and behaviors and adolescents' ecological understanding. The first study (Study 1) examined how a community garden provides children in an urban setting the opportunity to learn about ecology through ecology-centered experiences. To do this, I carried out a yearlong ethnographic study at an urban community garden located in a large city in the Southeastern United States. Through participant observations and informal interviews of community garden staff and participants, I found children had opportunities to learn about ecology through ecology-centered experiences (e.g., interaction with animals) along with other experiences (e.g., playing games, reading books). In light of previous research that shows urban children have diminished ecological thought---a pattern of thought that privileges the relationship between living things---because of their lack of ecology-centered experiences (Coley, 2012), the present study may have implications for urban children to learn about ecology. As an extension of Study 1, I carried out a second study (Study 2) to investigate how ecology-centered experiences contribute to adolescents' environmental attitudes and behaviors in light of other contextual factors, namely environmental responsibility support, ecological thought, age and gender. Study 2 addressed three research questions. First, does ecological thought---a pattern of thought that privileges the relationship between living things---predict environmental attitudes and behaviors (EAB)? Results showed ecological thought did not predict EAB, an important finding considering the latent assumptions of previous research about the relationship between these two factors (e.g., Brugger, Kaiser, & Roczen, 2011). Second, do two types of contextual support, ecology-centered experiences (i.e., experiences with

  10. Parents' Experiences with Childhood Deafness: Implications for Family-Centered Services

    ERIC Educational Resources Information Center

    Jackson, Carla Wood; Traub, Randi J.; Turnbull, Ann P.

    2008-01-01

    In response to the need for family-centered follow-up, this study examined parents' experiences with deafness after early identification. Qualitative inquiry methods were used to explore and describe the perceptions and experiences of nine parents of children identified with severe to profound deafness. Parents participated in face-to-face…

  11. Ecology-Centered Experiences among Children and Adolescents: A Qualitative and Quantitative Analysis

    ERIC Educational Resources Information Center

    Orton, Judy

    2013-01-01

    The present research involved two studies that considered "ecology-centered experiences" (i.e., experiences with living things) as a factor in children's environmental attitudes and behaviors and adolescents' ecological understanding. The first study (Study 1) examined how a community garden provides children in an urban setting the…

  12. Supporting flight data analysis for Space Shuttle Orbiter Experiments at NASA Ames Research Center

    NASA Technical Reports Server (NTRS)

    Green, M. J.; Budnick, M. P.; Yang, L.; Chiasson, M. P.

    1983-01-01

    The Space Shuttle Orbiter Experiments program in responsible for collecting flight data to extend the research and technology base for future aerospace vehicle design. The Infrared Imagery of Shuttle (IRIS), Catalytic Surface Effects, and Tile Gap Heating experiments sponsored by Ames Research Center are part of this program. The paper describes the software required to process the flight data which support these experiments. In addition, data analysis techniques, developed in support of the IRIS experiment, are discussed. Using the flight data base, the techniques have provided information useful in analyzing and correcting problems with the experiment, and in interpreting the IRIS image obtained during the entry of the third Shuttle mission.

  13. Supporting flight data analysis for Space Shuttle Orbiter experiments at NASA Ames Research Center

    NASA Technical Reports Server (NTRS)

    Green, M. J.; Budnick, M. P.; Yang, L.; Chiasson, M. P.

    1983-01-01

    The space shuttle orbiter experiments program is responsible for collecting flight data to extend the research and technology base for future aerospace vehicle design. The infrared imagery of shuttle (IRIS), catalytic surface effects, and tile gap heating experiments sponsored by Ames Research Center are part of this program. The software required to process the flight data which support these experiments is described. In addition, data analysis techniques, developed in support of the IRIS experiment, are discussed. Using the flight data base, the techniques provide information useful in analyzing and correcting problems with the experiment, and in interpreting the IRIS image obtained during the entry of the third shuttle mission.

  14. Core-centering of compound drops in capillary oscillations: Observations on USML-1 experiments in space

    NASA Technical Reports Server (NTRS)

    Wang, Taylor G.; Anikumar, A. V.; Lee, C. P.; Lin, K. C.

    1994-01-01

    AA Using the existing inviscid theories, an attempt is made to explain the centering of the oscillating liquid shell. Experiments on liquid shells and liquid-core compound drops were conducted using acoustic levitation, in a low-gravity environment during a Space Shuttle flight. It was observed that their inner and outer interfaces became concentric when excited into capillary oscillations. Using the existing inviscid theories, and attempt is made to explain the centering of the oscillating liquid shell. It is concluded that viscosity needs to be considered in order to provide a realistic description of the centering process.

  15. [The social experience of psychosis in the context of a Psychosocial Care Center].

    PubMed

    Dias, Marcelo Kimati

    2011-04-01

    This study discusses the relations existing between the institutional aspects of a Psychosocial Care Center (Caps) and the experience of psychotic patients. Using the referential base of the social experience of psychosis, which is broader in scope than a description of the experience of symptoms, while considering cultural aspects of the experience, three case studies were conducted at two different times. All of the patients studied were interviewed in 1995 and again in 2003. In addition to interviews with the subjects themselves, open interviews were conducted with their families and their professional carers, thereby taking the social relationship networks of the patients into consideration. Three central aspects were emphasized: (1) study of the history of the illness; (2) study of the representations of the disease; and (3) description of the everyday life and social relationships of the patients. Aspects with respect to the treatment of psychotic patients included in Psychosocial Care Centers were conducted using an anthropological approach. PMID:21584457

  16. Establishment and furnishing of the Photovoltaic Center for the Southwest Residential Experiment Station

    NASA Astrophysics Data System (ADS)

    Zwibel, H. S.; Schaefer, J. F.

    1982-04-01

    A building to serve as the operations, data gathering, and administrative complex and visitor center for the Southwest Residential Experiment Station (SW RES) was designed, constructed, and furnished as a cost-shared portion of a multiyear effort by the New Mexico Solar Energy Institute to establish and operate the SW RES for the Department of Energy National Photovoltaic Center Program. The 3000-square-foot building, called the Photovoltaic Center, houses a Visitor Center, shop area, offices, rest rooms, and a large data collection room. The passive solar design includes Earth berms, glazing along the southwest wall of the building and thermal mass in 55-gallon drums filled with water to store heat from solar radiation entering the building. The building is located on the New Mexico State University campus in Las Cruces.

  17. The Cispus Experience: A Curriculum Guide for the Cispus Learning Center.

    ERIC Educational Resources Information Center

    Association of Washington School Principals, Olympia.

    This curriculum guide presents lesson plans for outdoor and environmental education at the Cispus Learning Center, a camp in Randle, Washington. Objectives for the Cispus experience cover student learning of content, socialization as a team member, development of aesthetic awareness of nature and art, and increased physical wellness. Lesson plans…

  18. Individual Differences and the Conundrums of User-Centered Design: Two Experiments.

    ERIC Educational Resources Information Center

    Allen, Bryce

    2000-01-01

    Discusses individual differences between users of information systems that can influence search performance, and describes two experiments that addressed user-centered design of information systems. Highlights include interaction between cognitive abilities and design features; compensation and capitalization perspectives; recall and precision;…

  19. High School Students' Experiences of Bullying and Victimization and the Association with School Health Center Use

    ERIC Educational Resources Information Center

    Lewis, Catherine; Deardorff, Julianna; Lahiff, Maureen; Soleimanpour, Samira; Sakashita, Kimi; Brindis, Claire D.

    2015-01-01

    Background: Bullying and victimization are ongoing concerns in schools. School health centers (SHCs) are well situated to support affected students because they provide crisis intervention, mental health care, and broader interventions to improve school climate. This study examined the association between urban adolescents' experiences of…

  20. CENTER DIRECTOR RICHARD SMITH AND OTHER PERSONNEL OBSERVE SPACELAB 1 MODULE AND EXPERIMENT PALLET HO

    NASA Technical Reports Server (NTRS)

    1983-01-01

    CENTER DIRECTOR RICHARD SMITH AND OTHER PERSONNEL OBSERVE SPACELAB 1 MODULE AND EXPERIMENT PALLET HO KSC-383C-2860.02 P-16225,ARCHIVE-03951 Spacelab 1 module and its attached pallet are hoisted out of the payload canister, over the work stands and into the cargo bay of the Columbia.

  1. An Unsuccessful Experience with Computerized Medical Records in an Academic Medical Center.

    ERIC Educational Resources Information Center

    Dambro, Mark R.; And Others

    1988-01-01

    Experience with the Computer Stored Ambulatory Record (COSTAR), a computerized medical records system, installed at a large primary care clinic at a university medical center is reported. Use of the system was terminated because clinic revenues could not cover operating costs. (Author/MLW)

  2. Leaders' Experiences with High School-College Writing Center Collaborations: A Qualitative Multiple-Case Study

    ERIC Educational Resources Information Center

    Story, Julie A.

    2014-01-01

    The purpose of this qualitative multiple-case study was to explore academic leaders' experiences with the organizational elements of their own high school-college writing center collaborations. Conjoining theories framed this study: collaborative leadership theory, Kenneth Bruffee's notion of social constructionism and collaborative learning…

  3. Mass storage system experiences and future needs at the National Center for Atmospheric Research

    NASA Technical Reports Server (NTRS)

    Olear, Bernard T.

    1991-01-01

    A summary and viewgraphs of a discussion presented at the National Space Science Data Center (NSSDC) Mass Storage Workshop is included. Some of the experiences of the Scientific Computing Division at the National Center for Atmospheric Research (NCAR) dealing the the 'data problem' are discussed. A brief history and a development of some basic mass storage system (MSS) principles are given. An attempt is made to show how these principles apply to the integration of various components into NCAR's MSS. Future MSS needs for future computing environments is discussed.

  4. An Advanced Pharmacy Practice Experience in a Student-Staffed Medication Therapy Management Call Center

    PubMed Central

    Hall, Anna M.; Roane, Teresa E.; Mistry, Reena

    2012-01-01

    Objective. To describe the implementation of an advanced pharmacy practice experience (APPE) in medication therapy management (MTM) designed to contribute to student pharmacists’ confidence and abilities in providing MTM. Design. Sixty-four student pharmacists provided MTM services during an APPE in a communication and care center. Assessment. Students conducted 1,495 comprehensive medication reviews (CMRs) identifying 6,056 medication-related problems. Ninety-eight percent of the students who completed a survey instrument (52 of 53) following the APPE expressed that they had the necessary knowledge and skills to provide MTM services. Most respondents felt that pharmacist participation in providing Medicare MTM could move the profession of pharmacy forward and that pharmacists will have some role in deciding the specific provisions of the Medicare MTM program (92% and 91%, respectively). Conclusion. Students completing the MTM APPE received patient-centered experiences that supplemented their confidence, knowledge, and skill in providing MTM services in the future. PMID:22919086

  5. Preliminary Pioneer 10 encounter results from the Ames Research Center plasma analyzer experiment

    NASA Technical Reports Server (NTRS)

    Wolfe, J. H.; Collard, H. R.; Mihalov, J. D.; Intriligator, D. S.

    1974-01-01

    Preliminary results from the Ames Research Center plasma analyzer experiment for the Pioneer 10 Jupiter encounter indicate that Jupiter has a detached bow shock and magnetopause similar to the case at Earth but much larger in spatial extent. In contrast to Earth, Jupiter's outer magnetosphere appears to be highly inflated by thermal plasma and therefore highly responsive in size to changes in solar wind dynamic pressure.

  6. Nursing at ground zero: experiences during and after September 11 World Trade Center attack.

    PubMed

    Dickerson, Suzanne Steffan; Jezewski, Mary Ann; Nelson-Tuttle, Christine; Shipkey, Nancy; Wilk, Nancy; Crandall, Blythe

    2002-01-01

    The purpose of this study is to discover shared perceptions, feelings, and common experiences of nurses after the September 11th World Trade Center terrorist attack through interpretive analysis of narrative stories of seventeen nurses. Six themes and one constitutive pattern describe the experiences: (a) Loss of a symbol and regaining new meaning, (b) Disaster without patients, (c) Coordinating with and without organizations, (d) Rediscovering the pride in nursing, (e) Traumatic Stress, and (f) Preparing for the future. The constitutive pattern is that nursing enables a humanitarian disaster response. PMID:12146085

  7. A qualitative study of the experience of CenteringPregnancy group prenatal care for physicians

    PubMed Central

    2013-01-01

    Background This study sought to understand the central meaning of the experience of group prenatal care for physicians who were involved in providing CenteringPregnancy through a maternity clinic in Calgary, Canada. Method The study followed the phenomenological qualitative tradition. Three physicians involved in group prenatal care participated in a one-on-one interview between November and December 2009. Two physicians participated in verification sessions. Interviews followed an open ended general guide and were audio recorded and transcribed. The purpose of the analysis was to identify meaning themes and the core meaning experienced by the physicians. Results Six themes emerged: (1) having a greater exchange of information, (2) getting to knowing, (3) seeing women get to know and support each other, (4) sharing ownership of care, (5) having more time, and (6) experiencing enjoyment and satisfaction in providing care. These themes contributed to the core meaning for physicians of “providing richer care.” Conclusions Physicians perceived providing better care and a better professional experience through CenteringPregnancy compared to their experience of individual prenatal care. Thus, CenteringPregnancy could improve work place satisfaction, increase retention of providers in maternity care, and improve health care for women. PMID:23445867

  8. [The experience lived by clients' family members of a child psychosocial care center].

    PubMed

    Machineski, Gicelle Galvan; Schneider, Jacó Fernando; Camatta, Marcio Wagner

    2013-03-01

    The objective of this study was to understand the lived experiences of family members of children attending a Child Psychosocial Care Center. This study is a qualitative research with a phenomenological approach, developed at a Child Psychosocial Care Center (CAPSi as per its acronym in Portuguese) located in the municipality of Cascavel, State of Paraná. Participants were eleven family members of clients attending the above mentioned service and who, more actively, took part in the clients' care. Semi-structured interviews were performed and the gathered data were then analyzed by means of social phenomenology methodology The experience lived by the family members of children attending the Child Psychosocial Care Center included experiences in dealing with clients' behavior; seeking referrals to other services; waiting for treatment; hoping to see an improvement in the clinical profile of the patient and experiencing the service support provided to the family. Thus, this present study may contribute to a reflection on mental health nursing practice in caring for clients and their families. PMID:23781733

  9. NASA Glenn Research Center's Materials International Space Station Experiments (MISSE 1-7)

    NASA Technical Reports Server (NTRS)

    deGroh, Kim K.; Banks, Bruce a.; Dever, Joyce A.; Jaworske, Donald A.; Miller, Sharon K.; Sechkar, Edward A.; Panko, Scott R.

    2008-01-01

    NASA Glenn Research Center (Glenn) has 39 individual materials flight experiments (>540 samples) flown as part of the Materials International Space Station Experiment (MISSE) to address long duration environmental durability of spacecraft materials in low Earth orbit (LEO). MISSE is a series of materials flight experiments consisting of trays, called Passive Experiment Carriers (PECs) that are exposed to the space environment on the exterior of the International Space Station (ISS). MISSE 1-5 have been successfully flown and retrieved and were exposed to the space environment from one to four years. MISSE 6A & 6B were deployed during the STS-123 shuttle mission in March 2008, and MISSE 7A & 7B are being prepared for launch in 2009. The Glenn MISSE experiments address atomic oxygen (AO) effects such as erosion and undercutting of polymers, AO scattering, stress effects on AO erosion, and in-situ AO fluence monitoring. Experiments also address solar radiation effects such as radiation induced polymer shrinkage, stress effects on radiation degradation of polymers, and radiation degradation of indium tin oxide (ITO) coatings and spacesuit fabrics. Additional experiments address combined AO and solar radiation effects on thermal control films, paints and cermet coatings. Experiments with Orion Crew Exploration Vehicle (CEV) seals and UltraFlex solar array materials are also being flown. Several experiments were designed to provide ground-facility to in-space calibration data thus enabling more accurate in-space performance predictions based on ground-laboratory testing. This paper provides an overview of Glenn s MISSE 1-7 flight experiments along with a summary of results from Glenn s MISSE 1 & 2 experiments.

  10. Financial Planning for Military Child Care Centers: A Guidebook Based on the Experiences of the Fort Lewis Child Care Center.

    ERIC Educational Resources Information Center

    Office of the Assistant Secretary of Defense for Manpower and Reserve Affairs (DOD), Washington, DC.

    Good record keeping--along with a constant and detailed knowledge of expenses, income, profit, and loss--is the first step toward profitable management of a child care center. Good record keeping is especially important in a center that provides "drop-in" or occasional care because income may fluctuate greatly as a result of the variable number of…

  11. Establishment of a Comprehensive Epilepsy Center in Pakistan: Initial Experiences, Results, and Reflections

    PubMed Central

    Tahir, M. Zubair; Sobani, Zain A.; Quadri, S. A.; Ahmed, S. Nizam; Sheerani, Mughis; Siddiqui, Fowzia; Boling, Warren W.; Enam, Syed Ather

    2012-01-01

    Background. Developing countries, home to 80% of epilepsy patients, do not have comprehensive epilepsy surgery programs. Considering these needs we set up first epilepsy surgery center in Pakistan. Methods. Seventeen teleconferences focused on setting up an epilepsy center at the Aga Khan University (AKU), Karachi, Pakistan were arranged with experts from the University of Alberta Hospital, Alberta, Canada and the University of West Virginia, USA over a two-year period. Subsequently, the experts visited the proposed center to provide hands on training. During this period several interactive teaching sessions, a nationwide workshop, and various public awareness events were organized. Results. Sixteen patients underwent surgery, functional hemispherectomy (HS) was done in six, anterior temporal lobectomy (ATL) in six, and neuronavigation-guided selective amygdalohippocampectomy (SAH) using keyhole technique in four patients. Minimal morbidity was observed in ATL and, SAH groups. All patients in SAH group (100%) had Grade 1 control, while only 5 patients (83%) in ATL group, and 4 patients (66%) in HS group had Grade 1 control according to Engel's classification, in average followups of 12 months, 24 months and 48 months for SAH, ATL, and HS, respectively. Conclusion. As we share our experience we hope to set a practical example for economically constrained countries that successful epilepsy surgery centers can be managed with limited resources. PMID:22957232

  12. The L-SCAN Experiment: Mapping the Axial Magma Chamber Beneath the Eastern Lau Spreading Center

    NASA Astrophysics Data System (ADS)

    Allison, C. M.; Dunn, R.; Brooks, K.; Conder, J. A.; Martinez, F.; Conley, M. M.

    2009-12-01

    The L-SCAN (Lau Spreading Center Active-source Investigation) seismic experiment was designed to examine the relationship between melt supply and magmatic, tectonic, and hydrothermal processes along the Eastern Lau Spreading Center (a RIDGE2000 focus site). This 3-D active-source ocean-bottom-seismometer experiment covers a 100-km-long section of the spreading center, which exhibits significant along-strike variability in seafloor morphology, tectonics, crustal magma storage, and hydrothermal venting. Presumably these changes arise from variations in mantle melt supply. During the seismic experiment, we deployed 84 4-component ocean bottom seismometers (OBS), obtained from the OBSIP national instrument pool, over a 40 x 100 sq. km area centered on the ridge at 20°30'S. Sixty-five seismic lines (50-150 km in length) were shot using the R/V M. G. Langseth's 36-element airgun source, generating ~1 million seismic travel time observations. The experiment extends across three ridge segments, separated by two overlapping spreading centers. The southern segment exhibits an ‘inflated’ cross-sectional area and is underlain by an axial-magma-chamber seismic reflector (as detected by a previous MCS seismic study). We present a preliminary analysis of the L-SCAN refraction data collected along this ridge segment. Travel times of P-wave seismic energy were measured and compared for ray paths as a function of distance from the ridge axis, thereby allowing us to map, to first order, the location of the crustal low-velocity zone that extends beneath the AMC reflector. Only P-wave energy that has traveled within ~2-3 km of the ridge axis clearly exhibits the travel time delays indicative of a crustal low-velocity "mush” zone. We have not yet examined the deeper, Moho- and mantle-turning P-wave arrivals. It has been previously observed that high-temperature venting along this ridge segment is restricted to a narrow region at the ridge axis. We suggest a model in which a

  13. Forging successful academic-community partnerships with community health centers: the California statewide Area Health Education Center (AHEC) experience.

    PubMed

    Fowkes, Virginia; Blossom, H John; Mitchell, Brenda; Herrera-Mata, Lydia

    2014-01-01

    Increased access to insurance under the Affordable Care Act will increase demands for clinical services in community health centers (CHCs). CHCs also have an increasingly important educational role to train clinicians who will remain to practice in community clinics. CHCs and Area Health Education Centers (AHECs) are logical partners to prepare the health workforce for the future. Both are sponsored by the Health Resources and Services Administration, and they share a mission to improve quality of care in medically underserved communities. AHECs emphasize the educational side of the mission, and CHCs the service side. Building stronger partnerships between them can facilitate a balance between education and service needs.From 2004 to 2011, the California Statewide AHEC program and its 12 community AHECs (centers) reorganized to align training with CHC workforce priorities. Eight centers merged into CHC consortia; others established close partnerships with CHCs in their respective regions. The authors discuss issues considered and approaches taken to make these changes. Collaborative innovative processes with program leadership, staff, and center directors revised the program mission, developed common training objectives with an evaluation plan, and defined organizational, functional, and impact characteristics for successful AHECs in California. During this planning, centers gained confidence as educational arms for the safety net and began collaborations with statewide programs as well as among themselves. The AHEC reorganization and the processes used to develop, strengthen, and identify standards for centers forged the development of new partnerships and established academic-community trust in planning and implementing programs with CHCs. PMID:24280858

  14. A public health training center experience: professional continuing education at schools of public health.

    PubMed

    Potter, Margaret A; Fertman, Carl I; Eggleston, Molly M; Holtzhauer, Frank; Pearsol, Joanne

    2008-01-01

    The Public Health Training Center (PHTC) national program was first established at accredited schools of public health in 2000. The PHTC program used the US Health Resources and Services Administration's grants to build workforce development programs, attracting schools as training providers and the workforce as training clients. This article is a reflection on the experience of two schools, whose partnership supported one of the PHTCs, for the purpose of opening a conversation about the future of continuing education throughout schools and degree programs of public health. This partnership, the Pennsylvania & Ohio Public Health Training Center (POPHTC), concentrated its funding on more intensive training of public healthcare workers through a relatively narrow inventory of courses that were delivered typically in-person rather than by distance-learning technologies. This approach responded to the assessed needs and preferences of the POPHTC's workforce population. POPHTC's experience may not be typical among the PHTCs nationally, but the collective experience of all PHTCs is instructive to schools of public health as they work to meet an increasing demand for continuing education from the public health workforce. PMID:18552638

  15. An experience of liver transplantation in Latin America: a medical center in Colombia

    PubMed Central

    Londoño, Mauricio; Marín, Juan; Muñoz, Octavio; Mena, Álvaro; Guzmán, Carlos; Hoyos, Sergio; Restrepo, Juan; Arbeláez, María; Correa, Gonzalo

    2015-01-01

    Objectives: Liver transplantation is the treatment of choice for acute and chronic liver failure, for selected cases of tumors, and for conditions resulting from errors in metabolism. This paper reports the experience of a medical center in Latin America. Methods: Were conducted 305 orthotopic liver transplantations on 284 patients between 2004 and 2010. Of these patients, 241 were adults undergoing their first transplantation. Results: The average age of patients was 52 years old, and 62% of the individuals were male. The most common indication was alcoholic cirrhosis. The rate of patient survival after 1 and 5 years was 82 and 72% respectively. The rate of liver graft survival after 1 and 5 years was 78 and 68% respectively. The main cause of death was sepsis. Complications in the hepatic artery were documented for 5% of the patients. Additionally, 14.5% of the patients had complications in the biliary tract. Infections were found in 41% of the individuals. Acute rejection was observed in 30% of the subjects, and chronic rejection in 3%. Conclusion: In conclusion, liver transplantation at our medical center in Colombia offers good mid-term results, with a complication rate similar to that reported by other centers around the world. PMID:26019379

  16. Uncovering paradoxes from physicians' experiences of patient-centered ward-round.

    PubMed

    Bååthe, Fredrik; Ahlborg, Gunnar; Edgren, Lars; Lagström, Annica; Nilsson, Kerstin

    2016-05-01

    Purpose The purpose of this paper is to uncover paradoxes emerging from physicians' experiences of a patient-centered and team-based ward round, in an internal medicine department. Design/methodology/approach Abductive reasoning relates empirical material to complex responsive processes theory in a dialectical process to further understandings. Findings This paper found the response from physicians, to a patient-centered and team-based ward round, related to whether the new demands challenged or confirmed individual physician's professional identity. Two empirically divergent perspectives on enacting the role of physician during ward round emerged: We-perspective and I-perspective, based on where the physician's professional identity was centered. Physicians with more of a We-perspective experienced challenges with the new round, while physicians with more of an I-perspective experienced alignment with their professional identity and embraced the new round. When identity is challenged, anxiety is aroused, and if anxiety is not catered to, then resistance is likely to follow and changes are likely to be hampered. Practical implications For change processes affecting physicians' professional identity, it is important for managers and change leaders to acknowledge paradox and find a balance between new knowledge that needs to be learnt and who the physician is becoming in this new procedure. Originality/value This paper provides increased understanding about how physicians' professional identity is interacting with a patient-centered ward round. It adds to the knowledge about developing health care in line with recent societal requests and with sustainable physician engagement. PMID:27198705

  17. My personal experiences at the BEST Medical Center: A day in the clinic-the morning.

    PubMed

    Cohen, Philip R; Kurzrock, Razelle

    2016-01-01

    Dr. Ida Lystic is a gastroenterologist who trained at the OTHER (Owen T. Henry and Eugene Rutherford) Medical Center, after having completed her MD degree at the prestigious Harvey Medical School (recently renamed the Harvey Provider School). She accepted a faculty position at the BEST (Byron Edwards and Samuel Thompson) Medical Center. Dr. Lystic shares her experiences on a typical morning in gastroenterology clinic. Although her clinic start date was delayed by 2 months after becoming sick following a mandatory flu shot and having to complete more than 70 hours of compliance training modules, she is now familiar with the BEST system. Clinic scheduling priorities include ensuring that the staff can eat lunch together and depart at 5:00 pm. It is a continual challenge to find time to complete the electronic medical record after BEST changed from the SIMPLE (Succinct Input Making Patients Lives Electronic) system to LEGEND (referred to as Lengthy and Excessively Graded Evaluation and Nomenclature for Diagnosis by her colleagues). To maintain clinic punctuality, a compliance spreadsheet is e-mailed monthly to the Wait Time Committee. Their most recent corrective action plan for tardy physicians included placing egg timers on the doors and having nurses interrupt visits that exceed the allotted time. Administrative decisions have resulted in downsizing personnel. Patients are required to schedule their own tests and procedures and follow-up appointments-causing low patient satisfaction scores; however, the money saved lead to a large year-end bonus for the vice president of BEST Efficiency, who holds "providers" accountable for the poor patient experience. Although Dr. Ida Lystic and the gastroenterology clinic at "the BEST Medical Center" are creations of the authors' imagination, the majority of the anecdotes are based on actual events. PMID:27265082

  18. The challenges of transdisciplinary research in health disparities: the early experiences of the centers for population health and health disparities

    Technology Transfer Automated Retrieval System (TEKTRAN)

    In 2003, NIH funded 8 Centers for Population Health and Health Disparities (CPHHD). The mission of these centers is to understand and reduce health disparities using a transdisciplinary approach with community partners as co-investigators. The present study aims to identify early challenges experi...

  19. Group Violence and Migration Experience among Latin American Youths in Justice Enforcement Centers (Madrid, Spain).

    PubMed

    Martínez García, José Manuel; Martín López, María Jesús

    2015-01-01

    Group violence among Latin American immigrant youth has led to ongoing debates in political, legal, and media circles, yet none of those many perspectives has arrived at a solid, empirically supported definition for the phenomenon. This study aims to explore the relationship between the immigrant experience and violent group behavior in youths from Latin America serving prison sentences in Justice Enforcement Centers in the Community of Madrid. Semi-structured interviews were conducted with 19 juveniles, and content analysis was applied to the resulting transcripts, employing Grounded Theory to create an axial codification of intra- and inter-categorical contents, and Delphi panels for quality control. The research team delved into 62 topics, addressing participants' perceptions of the immigrant experience and its effects on five socialization settings (neighborhood, school, family, peer group, and significant other), and each one's relationship to violent behavior. The results led us to believe the young people's immigration experiences had been systematically examined. Their personal and social development was influenced by negative socioeconomic conditions, ineffective parental supervision, maladjustment and conflict at school, and experiences of marginalization and xenophobia. All those conditions favored affiliation with violent groups that provided them instrumental (economic and material), expressive, or affective support. PMID:26514376

  20. The Deep Impact Network Experiment Operations Center Monitor and Control System

    NASA Technical Reports Server (NTRS)

    Wang, Shin-Ywan (Cindy); Torgerson, J. Leigh; Schoolcraft, Joshua; Brenman, Yan

    2009-01-01

    The Interplanetary Overlay Network (ION) software at JPL is an implementation of Delay/Disruption Tolerant Networking (DTN) which has been proposed as an interplanetary protocol to support space communication. The JPL Deep Impact Network (DINET) is a technology development experiment intended to increase the technical readiness of the JPL implemented ION suite. The DINET Experiment Operations Center (EOC) developed by JPL's Protocol Technology Lab (PTL) was critical in accomplishing the experiment. EOC, containing all end nodes of simulated spaces and one administrative node, exercised publish and subscribe functions for payload data among all end nodes to verify the effectiveness of data exchange over ION protocol stacks. A Monitor and Control System was created and installed on the administrative node as a multi-tiered internet-based Web application to support the Deep Impact Network Experiment by allowing monitoring and analysis of the data delivery and statistics from ION. This Monitor and Control System includes the capability of receiving protocol status messages, classifying and storing status messages into a database from the ION simulation network, and providing web interfaces for viewing the live results in addition to interactive database queries.

  1. [Experience of extracorporeal membrane oxygenation in critical care of respiratory failure in newborn with congenital diaphragmatic hernia in perinatal center].

    PubMed

    Burov, A A; Nikiforov, D V; Podurovskaia, Iu L; Dorofeeva, E I; Abramian, M A; Makhalin, M V; Shatalov, K V; Nikiforov, V S; Degtiarev, D N

    2013-01-01

    The article deals with an experience of veno-arterial extracorporeal membrane oxygenation use in preterm infants with congenital diaphragmatic hernia during postoperative period in the perinatal center. PMID:24749262

  2. Atmospheric monitoring of a perfluorocarbon tracer at the 2009 ZERT Center experiment

    NASA Astrophysics Data System (ADS)

    Pekney, Natalie; Wells, Arthur; Rodney Diehl, J.; McNeil, Matthew; Lesko, Natalie; Armstrong, James; Ference, Robert

    2012-02-01

    Field experiments at Montana State University are conducted for the U.S. Department of Energy as part of the Zero Emissions Research and Technology Center (ZERT) to test and verify monitoring techniques for carbon capture and storage (CCS). A controlled release of CO 2 with an added perfluorocarbon tracer was conducted in July 2009 in a multi-laboratory study of atmospheric transport and detection technologies. Tracer plume dispersion was measured with various meteorological conditions using a tethered balloon system with Multi-Tube Remote Samplers (MTRS) at elevations of 10 m, 20 m, and 40 m above ground level (AGL), as well as a ground-based portable tower with monitors containing sorbent material to collect the tracer at 1 m, 2 m, 3 m, and 4 m AGL. Researchers designed a horizontal grid of sampling locations centered at the tracer plume source, with the tower positioned at 10 m and 30 m in both upwind and downwind directions, and the MTRS spaced at 50 m and 90 m downwind and 90 m upwind. Tracer was consistently detected at elevated concentrations at downwind sampling locations. With very few exceptions, higher tracer concentrations correlated with lower elevations. Researchers observed no statistical difference between sampling at 50 m and 90 m downwind at the same elevation. The US EPA AERMOD model applied using site-specific information predicted transport and dispersion of the tracer. Model results are compared to experimental data from the 2009 ZERT experiment. Successful characterization of the tracer plume simulated by the ZERT experiment is considered a step toward demonstrating the feasibility of remote sampling with unmanned aerial systems (UAS's) at future sequestration sites.

  3. The Manuel Lujan Jr. Neutron Scattering Center (LANSCE) experiment reports 1993 run cycle. Progress report

    SciTech Connect

    Farrer, R.; Longshore, A.

    1995-06-01

    This year the Manuel Lujan Jr. Neutron Scattering Center (LANSCE) ran an informal user program because the US Department of Energy planned to close LANSCE in FY1994. As a result, an advisory committee recommended that LANSCE scientists and their collaborators complete work in progress. At LANSCE, neutrons are produced by spallation when a pulsed, 800-MeV proton beam impinges on a tungsten target. The proton pulses are provided by the Clinton P. Anderson Meson Physics Facility (LAMPF) accelerator and a associated Proton Storage Ring (PSR), which can Iter the intensity, time structure, and repetition rate of the pulses. The LAMPF protons of Line D are shared between the LANSCE target and the Weapons Neutron Research (WNR) facility, which results in LANSCE spectrometers being available to external users for unclassified research about 80% of each annual LAMPF run cycle. Measurements of interest to the Los Alamos National Laboratory (LANL) may also be performed and may occupy up to an additional 20% of the available beam time. These experiments are reviewed by an internal program advisory committee. This year, a total of 127 proposals were submitted. The proposed experiments involved 229 scientists, 57 of whom visited LANSCE to participate in measurements. In addition, 3 (nuclear physics) participating research teams, comprising 44 scientists, carried out experiments at LANSCE. Instrument beam time was again oversubscribed, with 552 total days requested an 473 available for allocation.

  4. Assessing exploitation experiences of girls and boys seen at a Child Advocacy Center.

    PubMed

    Edinburgh, Laurel; Pape-Blabolil, Julie; Harpin, Scott B; Saewyc, Elizabeth

    2015-08-01

    The primary aim of this study was to describe the abuse experiences of sexually exploited runaway adolescents seen at a Child Advocacy Center (N=62). We also sought to identify risk behaviors, attributes of resiliency, laboratory results for sexually transmitted infection (STI) screens, and genital injuries from colposcopic exams. We used retrospective mixed-methods with in-depth forensic interviews, together with self-report survey responses, physical exams and chart data. Forensic interviews were analyzed using interpretive description analytical methods along domains of experience and meaning of sexual exploitation events. Univariate descriptive statistics characterized trauma responses and health risks. The first sexual exploitation events for many victims occurred as part of seemingly random encounters with procurers. Older adolescent or adult women recruited some youth working for a pimp. However, half the youth did not report a trafficker involved in setting up their exchange of sex for money, substances, or other types of consideration. 78% scored positive on the UCLA PTSD tool; 57% reported DSM IV criteria for problem substance use; 71% reported cutting behaviors, 75% suicidal ideation, and 50% had attempted suicide. Contrary to common depictions, youth may be solicited relatively quickly as runaways, yet exploitation is not always linked to having a pimp. Avoidant coping does not appear effective, as most patients exhibited significant symptoms of trauma. Awareness of variations in youth's sexual exploitation experiences may help researchers and clinicians understand potential differences in sequelae, design effective treatment plans, and develop community prevention programs. PMID:25982287

  5. Training for life science experiments in space at the NASA Ames Research Center

    NASA Technical Reports Server (NTRS)

    Rodrigues, Annette T.; Maese, A. Christopher

    1993-01-01

    As this country prepares for exploration to other planets, the need to understand the affects of long duration exposure to microgravity is evident. The National Aeronautics and Space Administration (NASA) Ames Research Center's Space Life Sciences Payloads Office is responsible for a number of non-human life sciences payloads on NASA's Space Shuttle's Spacelab. Included in this responsibility is the training of those individuals who will be conducting the experiments during flight, the astronauts. Preparing a crew to conduct such experiments requires training protocols that build on simple tasks. Once a defined degree of performance proficiency is met for each task, these tasks are combined to increase the complexity of the activities. As tasks are combined into in-flight operations, they are subjected to time constraints and the crew enhances their skills through repetition. The science objectives must be completely understood by the crew and are critical to the overall training program. Completion of the in-flight activities is proof of success. Because the crew is exposed to the background of early research and plans for post-flight analyses, they have a vested interest in the flight activities. The salient features of this training approach is that it allows for flexibility in implementation, consideration of individual differences, and a greater ability to retain experiment information. This training approach offers another effective alternative training tool to existing methodologies.

  6. Assessing exploitation experiences of girls and boys seen at a Child Advocacy Center

    PubMed Central

    Edinburgh, Laurel; Pape-Blabolil, Julie; Harpin, Scott B.; Saewyc, Elizabeth

    2015-01-01

    The primary aim of this study was to describe the abuse experiences of sexually exploited runaway adolescents seen at a Child Advocacy Center (N = 62). We also sought to identify risk behaviors, attributes of resiliency, laboratory results for sexually transmitted infection (STI) screens, and genital injuries from colposcopic exams. We used retrospective mixed-methods with in-depth forensic interviews, together with self-report survey responses, physical exams and chart data. Forensic interviews were analyzed using interpretive description analytical methods along domains of experience and meaning of sexual exploitation events. Univariate descriptive statistics characterized trauma responses and health risks. The first sexual exploitation events for many victims occurred as part of seemingly random encounters with procurers. Older adolescent or adult women recruited some youth working for a pimp. However, half the youth did not report a trafficker involved in setting up their exchange of sex for money, substances, or other types of consideration. 78% scored positive on the UCLA PTSD tool; 57% reported DSM IV criteria for problem substance use; 71% reported cutting behaviors, 75% suicidal ideation, and 50% had attempted suicide. Contrary to common depictions, youth may be solicited relatively quickly as runaways, yet exploitation is not always linked to having a pimp. Avoidant coping does not appear effective, as most patients exhibited significant symptoms of trauma. Awareness of variations in youth’s sexual exploitation experiences may help researchers and clinicians understand potential differences in sequelae, design effective treatment plans, and develop community prevention programs. PMID:25982287

  7. The Real Astronomy Experience: Making the IVO Effective for International Planetaria and Science Centers

    NASA Astrophysics Data System (ADS)

    Pennypacker, Carl

    The Real Astronomy Experience, or RAE, is a new exhibit just beginning development in the late fall of 2002, hopefully to be funded by the US National Science Foundation. RAE will allow public visitors in science centers, museums, and planetaria to operate and acquire images from a either a remote telescope in the southern hemisphere or from IVO data bases. RAE can operate from Europe and North America during daylight at the exhibit site. This project will be implemented also by international Global Hands-On Universe ("GHOU") collaborators. Greater international success will be facilitated by other GHOU nations joining the collaboration to build a viable network of small, inexpensive telescopes, and federating their data bases for the IVO.

  8. Assessing patient experiences in the pediatric patient-centered medical home: a comparison of two instruments.

    PubMed

    Knapp, Caprice; Chakravorty, Shourjo; Madden, Vanessa; Baron-Lee, Jacqueline; Gubernick, Ruth; Kairys, Steven; Pelaez-Velez, Cristina; Sanders, Lee M; Thompson, Lindsay

    2014-11-01

    The Patient-Centered Medical Home (PCMH) is a model of care that has been promoted as a way to transform a broken primary care system in the US. However, in order to convince more practices to make the transformation and to properly reimburse practices who are PCMHs, valid and reliable data are needed. Data that capture patient experiences in a PCMH is valuable, but which instrument should be used remains unclear. Our study aims to compare the validity and reliability of two national PCMH instruments. Telephone surveys were conducted with children who receive care from 20 pediatric practices across Florida (n = 990). All of the children are eligible for Medicaid or the Children's Health Insurance Program. Analyses were conducted to compare the Consumer Assessment of Health Plan Survey-Patient-Centered Medical Home (CAHPS-PCMH) and the National Survey of Children with Special Health Care Needs (NS-CSHCN) medical home domain. Respondents were mainly White non-Hispanic, female, under 35 years old, and from a two-parent household. The NS-CSHCN outperformed the CAHPS-PCMH in regard to scale reliability (Cronbach's alpha coefficients all ≥0.81 vs. 0.56-0.85, respectively). In regard to item-domain convergence and discriminant validity the CAHPS-PCMH fared better than the NS-CSHCN (range of convergence 0.66-0.93 vs. 0.32-1.00). The CAHPS-PCMH did not correspond to the scale structure in construct validity testing. Neither instrument performed well in the known-groups validity tests. No clear best instrument was determined. Further revision and calibration may be needed to accurately assess patient experiences in the PCMH. PMID:24585412

  9. Technology Transfer from University-Based Research Centers: The University of New Mexico Experience.

    ERIC Educational Resources Information Center

    Rogers, Everett M.; Hall, Brad; Hashimoto, Michio; Steffensen, Morten; Speakman, Kristen L.; Timko, Molly K.

    1999-01-01

    A study of 55 research centers at the University of New Mexico investigated the nature of the typical center, why funding has risen during the 1990s, reasons for founding the centers, the director's role, how university-based research centers transfer technology to private companies and other organizations, and what determines program…

  10. Glenn's Telescience Support Center Provided Around-the-Clock Operations Support for Space Experiments on the International Space Station

    NASA Technical Reports Server (NTRS)

    Malarik, Diane C.

    2005-01-01

    NASA Glenn Research Center s Telescience Support Center (TSC) allows researchers on Earth to operate experiments onboard the International Space Station (ISS) and the space shuttles. NASA s continuing investment in the required software, systems, and networks provides distributed ISS ground operations that enable payload developers and scientists to monitor and control their experiments from the Glenn TSC. The quality of scientific and engineering data is enhanced while the long-term operational costs of experiments are reduced because principal investigators and engineering teams can operate their payloads from their home institutions.

  11. Preliminary single center clinical experience of the use of a new implantable cardioverter defibrillator.

    PubMed

    Morgan, J M; Roberts, P R; Allen, S; Kallok, M J

    1998-12-01

    We report a single center's preliminary clinical experience of the Sentinel (Angeion, Minneapolis, MN) implantable cardioverter defibrillator (ICD), which employs novel technologies that offer the potential for significant reduction in ICD size. Thirty-three patients have received Sentinel ICDs with a mean follow-up of 450 (range 150-1023) days. Device shock therapy has been used to defibrillate/cardiovert 43 spontaneous episodes of malignant ventricular arrhythmia and 510 episodes of hemodynamically well tolerated ventricular arrhythmia have been pace-terminated (pace-termination failed in 6 episodes with subsequent delivery of appropriate shock therapy). There has been no arrhythmic death in this patient population. There have been 9 inappropriate shocks in 6 patients (in 2 patients for atrial fibrillation which had satisfied the algorithm detection criteria for high zone ventricular arrhythmia, in 3 for sinus tachycardia [rate greater than 180 beats per min] and in 1 due to device capacitor malfunction). Device replacement has been required for component malfunction in 3 patients. There have been no other major complications. Follow-up time to date is short and longterm device efficacy and performance remain unproven. However, our early clinical experience suggests that the innovations used to manufacture the Sentinel ICD have facilitated reduction in ICD size without compromising therapeutic efficacy. PMID:10027122

  12. Laparoscopy Versus Robotic Surgery for Colorectal Cancer: A Single-Center Initial Experience.

    PubMed

    Ferrara, Francesco; Piagnerelli, Riccardo; Scheiterle, Maximilian; Di Mare, Giulio; Gnoni, Pasquale; Marrelli, Daniele; Roviello, Franco

    2016-08-01

    Background Minimally invasive approach has gained interest in the treatment of patients with colorectal cancer. The purpose of this study is to analyze the differences between laparoscopy and robotics for colorectal cancer in terms of oncologic and clinical outcomes in an initial experience of a single center. Materials and Methods Clinico-pathological data of 100 patients surgically treated for colorectal cancer from March 2008 to April 2014 with laparoscopy and robotics were analyzed. The procedures were right colonic, left colonic, and rectal resections. A comparison between the laparoscopic and robotic resections was made and an analysis of the first and the last procedures in the 2 groups was performed. Results Forty-two patients underwent robotic resection and 58 underwent laparoscopic resection. The postoperative mortality was 1%. The number of harvested lymph nodes was higher in robotics. The conversion rate was 7.1% for robotics and 3.4% for laparoscopy. The operative time was lower in laparoscopy for all the procedures. No differences were found between the first and the last procedures in the 2 groups. Conclusions This initial experience has shown that robotic surgery for the treatment of colorectal adenocarcinoma is a feasible and safe procedure in terms of oncologic and clinical outcomes, although an appropriate learning curve is necessary. Further investigation is needed to demonstrate real advantages of robotics over laparoscopy. PMID:26721500

  13. Crack-Detection Experiments on Simulated Turbine Engine Disks in NASA Glenn Research Center's Rotordynamics Laboratory

    NASA Technical Reports Server (NTRS)

    Woike, Mark R.; Abdul-Aziz, Ali

    2010-01-01

    The development of new health-monitoring techniques requires the use of theoretical and experimental tools to allow new concepts to be demonstrated and validated prior to use on more complicated and expensive engine hardware. In order to meet this need, significant upgrades were made to NASA Glenn Research Center s Rotordynamics Laboratory and a series of tests were conducted on simulated turbine engine disks as a means of demonstrating potential crack-detection techniques. The Rotordynamics Laboratory consists of a high-precision spin rig that can rotate subscale engine disks at speeds up to 12,000 rpm. The crack-detection experiment involved introducing a notch on a subscale engine disk and measuring its vibration response using externally mounted blade-tip-clearance sensors as the disk was operated at speeds up to 12 000 rpm. Testing was accomplished on both a clean baseline disk and a disk with an artificial crack: a 50.8-mm- (2-in.-) long introduced notch. The disk s vibration responses were compared and evaluated against theoretical models to investigate how successful the technique was in detecting cracks. This paper presents the capabilities of the Rotordynamics Laboratory, the baseline theory and experimental setup for the crack-detection experiments, and the associated results from the latest test campaign.

  14. Early Clinical Experiences for Second-Year Student Pharmacists at an Academic Medical Center

    PubMed Central

    Amerine, Lindsey B.; Chen, Sheh-Li; Luter, David N.; Arnall, Justin; Smith, Shayna; Roth, Mary T.; Rodgers, Philip T.; Williams, Dennis M.; Pinelli, Nicole R.

    2015-01-01

    Objective. To examine student outcomes associated with the Student Medication and Reconciliation Team (SMART) program, which was designed to provide second-year student pharmacists at the University of North Carolina (UNC) Eshelman School of Pharmacy direct patient care experience at UNC Medical Center. Design. Twenty-two second-year student pharmacists were randomly selected from volunteers, given program training, and scheduled for three 5-hour evening shifts in 2013-2014. Pre/post surveys and reflection statements were collected from 19 students. Data were analyzed with a mixed methods approach. Assessment. Survey results revealed an increase in student self-efficacy (p<0.05) and positive perceptions of SMART. Qualitative findings suggest the program provided opportunities for students to develop strategies for practice, promoted an appreciation for the various roles pharmacists play in health care, and fostered an appreciation for the complexity of real-world practice. Conclusion. Early clinical experiences can enhance student learning and development while fostering an appreciation for pharmacy practice. PMID:26839428

  15. Assessment of the Patient-Centered and Family-Centered Care Experience of Total Joint Replacement Patients Using a Shadowing Technique.

    PubMed

    Marcus-Aiyeku, Ulanda; DeBari, Margaret; Salmond, Susan

    2015-01-01

    In 2030, when baby boomers reach 65 years of age and represent 18% of the population, it is anticipated that 67 million adults will have a diagnosis of arthritis increasing the demand for total hip and knee arthroplasty. With the growing emphasis on patient- and family-centered care, the aim of this project was to assess the patient experience of patients and families throughout the entire spectrum of the total joint replacement service line care at a university regional trauma hospital. A shadowing methodology as defined by the Institute for Health Improvement was utilized. Eight patient/family groups undergoing total joint replacements were shadowed. The mapped care experience included time, caregiver, activity, shadower observations, and impressions. Findings revealed inconsistencies in the delivery of patient- and family-centered care. Communication and interactions were predominantly provider-centric, with a focus on care routines versus the patient and family, and anticipation that care would be medically directed. PMID:26375835

  16. OPEN PELVIC FRACTURES: THE UNIVERSITY OF TENNESSEE MEDICAL CENTER AT KNOXVILLE EXPERIENCE OVER TEN YEARS

    PubMed Central

    Black, Emily Anne; Lawson, Christy M; Smith, Scott; Daley, Brian J

    2011-01-01

    Introduction Open fractures of the pelvis remain a devastating injury with a high mortality and morbidity. Such injuries require an aggressive treatment plan and the coordination of trauma and orthopaedic surgeons to achieve the best outcomes. We report our experience at the University of Tennessee Medical Center at Knoxville with open pelvic fractures over the last ten years. Methods After IRB and institutional approval, we reviewed patients admitted with a diagnosis of open fracture of the pelvis from 1999 to 2009. Demographic and admission data were recorded in the trauma registry (TRACS) of the Level I Trauma Center, serving the 1.2 million people living in the regions of east Tennessee, western North Carolina and southeastern Kentucky. Data on fractures were obtained from review of the medical records and radiographs within the chart Results There were 3053 pelvic fractures from January 1999 to December 2009. There were 231 deaths in this group (6%) and ages ranged from 18 to 89 years old and Injury Severity Scores ranged from 4 to 75, with a mean of 18.3. Seventy five percent of patients were able to be discharged home. Fifty-two fractures were open. There were 43 men and the mean age was 39 years old. Average ISS was 23 and ranged from 5 to 50. There were 10 deaths (19%) and eight patients underwent an-gioembolization for control of bleeding (3 deaths). Motorcycle crashes were the most frequent cause of an open fracture, with lateral compression injuries representing 71%. A defined algorithm for fracture management has been in place and employed to assure adequate resuscitation and fracture care and is presented. Discussion Open pelvic fractures are usually the result of a high energy transfer, and convey a high morbidity and mortality. A defined resuscitation and fixation strategy improves outcome from historical reports. Injuries from penetrating mechanisms are associated with less morbidity and lower mortality. PMID:22096441

  17. Evaluating Quality in Clinical Cancer Research: The M.D. Anderson Cancer Center Experience

    PubMed Central

    Cox, James D.; Giralt, Sergio A.; Veazie, Mary L.; Ajani, Jaffer A.; Bruner, Janet M.; Chan, Ka Wah; Hittelman, Walter N.; Hunt, Kelly K.; Iyer, Revathy B.; Karp, Daniel D.; Kuban, Deborah A.; Lippman, Scott M.; Raad, Issam I.; Rodriguez-Bigas, Miguel A.; Zwelling, Leonard A.; Markman, Maurie

    2009-01-01

    Background Despite the unquestionable importance of clinically oriented research designed to test the safety and efficacy of new therapies in patients with malignant disease, there is limited information regarding strategies to evaluate the quality of such efforts at academic institutions. Methods To address this issue, a committee of senior faculty at the University of Texas M.D. Anderson Cancer Center established specific criteria by which investigators from all departments engaged in clinical research could be formally evaluated. Scoring criteria were established and revised based on the results of a pilot study. Beginning in January 2004, the committee evaluated all faculty involved in clinical research within 35 departments. Scores for individual faculty members were assigned on a scale of 1 (outstanding) to 5; a score of 3 was set as the standard for the institution. Each department also received a score. The results of the evaluation were shared with departmental chairs and the Chief Academic Officer. Results 392 faculty were evaluated. The median score was 3. Full professors more frequently received a score of 1, but all faculty ranks received scores of 4 and 5. As a group, tenure/tenure track faculty achieved superior scores compared to nontenure track faculty. Conclusions Based on our experience, we believe it is possible to conduct a rigorous consensus-based evaluation of the quality of clinical cancer research being conducted at an academic medical center. It is reasonable to suggest such evaluations can be used as a management tool and may lead to higher-quality clinical research. PMID:19571599

  18. Nuclear Energy Experiments to the Center for Global Security and Cooperation.

    SciTech Connect

    Osborn, Douglas M.

    2015-06-01

    This is to serve as verification that the Center 6200 experimental pieces supplied to the Technology Training and Demonstration Area within the Center of Global Security and Cooperation are indeed unclassified unlimited released for viewing.

  19. Community Health Center Use After Oregon’s Randomized Medicaid Experiment

    PubMed Central

    DeVoe, Jennifer E.; Marino, Miguel; Gold, Rachel; Hoopes, Megan J.; Cowburn, Stuart; O’Malley, Jean P.; Heintzman, John; Gallia, Charles; McConnell, K. John; Nelson, Christine A.; Huguet, Nathalie; Bailey, Steffani R.

    2015-01-01

    PURPOSE There is debate about whether community health centers (CHCs) will experience increased demand from patients gaining coverage through Affordable Care Act Medicaid expansions. To better understand the effect of new Medicaid coverage on CHC use over time, we studied Oregon’s 2008 randomized Medicaid expansion (the “Oregon Experiment”). METHODS We probabilistically matched demographic data from adults (aged 19–64 years) participating in the Oregon Experiment to electronic health record data from 108 Oregon CHCs within the OCHIN community health information network (originally the Oregon Community Health Information Network) (N = 34,849). We performed intent-to-treat analyses using zero-inflated Poisson regression models to compare 36-month (2008–2011) usage rates among those selected to apply for Medicaid vs not selected, and instrumental variable analyses to estimate the effect of gaining Medicaid coverage on use. Use outcomes included primary care visits, behavioral/mental health visits, laboratory tests, referrals, immunizations, and imaging. RESULTS The intent-to-treat analyses revealed statistically significant differences in rates of behavioral/mental health visits, referrals, and imaging between patients randomly selected to apply for Medicaid vs those not selected. In instrumental variable analyses, gaining Medicaid coverage significantly increased the rate of primary care visits, laboratory tests, referrals, and imaging; rate ratios ranged from 1.27 (95% CI, 1.05–1.55) for laboratory tests to 1.58 (95% CI, 1.10–2.28) for referrals. CONCLUSIONS Our results suggest that use of many different types of CHC services will increase as patients gain Medicaid through Affordable Care Act expansions. To maximize access to critical health services, it will be important to ensure that the health care system can support increasing demands by providing more resources to CHCs and other primary care settings. PMID:26195674

  20. Introducing sexual orientation and gender identity into the electronic health record: one academic health center's experience.

    PubMed

    Callahan, Edward J; Sitkin, Nicole; Ton, Hendry; Eidson-Ton, W Suzanne; Weckstein, Julie; Latimore, Darin

    2015-02-01

    Many U.S. populations experience significant health disparities. Increasing health care providers' awareness of and education about sexual orientation (SO) and gender identity (GI) diversity could help reduce health disparities among lesbian, gay, bisexual, and transgender (LGBT) patients. The authors share the University of California, Davis, Health System's (UCDHS's) experience as it became the first U.S. academic health center to formally introduce patient SO/GI demographic data into its electronic health record (EHR) as a step toward reducing LGBT health disparities. Adding these data to the EHR initially met with resistance. The authors, members of the UCDHS Task Force for Inclusion of SO/GI in the EHR, viewed this resistance as an invitation to educate leaders, providers, and staff about LGBT health disparities and to expose providers to techniques for discussing SO/GI with patients. They describe the strategies they employed to effect institutional culture change, including involvement of senior leadership, key informant interviews, educational outreach via grand rounds and resident workshops, and creation of a patient safety net through inviting providers to self-identify as welcoming LGBT patients. The ongoing cultural change process has inspired spin-off projects contributing to an improved climate for LGBT individuals at UCDHS, including an employee organization supporting SO/GI diversity, support for and among LGBT medical learners through events and listservs, development and implementation of an LGBT health curriculum, and creation of peer navigator programs for LGBT patients with cancer. The authors reflect on lessons learned and on institutional pride in and commitment to providing quality care for LGBT patients. PMID:25162618

  1. An excellent navigation system and experience in craniomaxillofacial navigation surgery: a double-center study

    PubMed Central

    Dai, Jiewen; Wu, Jinyang; Wang, Xudong; Yang, Xudong; Wu, Yunong; Xu, Bing; Shi, Jun; Yu, Hongbo; Cai, Min; Zhang, Wenbin; Zhang, Lei; Sun, Hao; Shen, Guofang; Zhang, Shilei

    2016-01-01

    Numerous problems regarding craniomaxillofacial navigation surgery are not well understood. In this study, we performed a double-center clinical study to quantitatively evaluate the characteristics of our navigation system and experience in craniomaxillofacial navigation surgery. Fifty-six patients with craniomaxillofacial disease were included and randomly divided into experimental (using our AccuNavi-A system) and control (using Strker system) groups to compare the surgical effects. The results revealed that the average pre-operative planning time was 32.32 mins vs 29.74 mins between the experimental and control group, respectively (p > 0.05). The average operative time was 295.61 mins vs 233.56 mins (p > 0.05). The point registration orientation accuracy was 0.83 mm vs 0.92 mm. The maximal average preoperative navigation orientation accuracy was 1.03 mm vs 1.17 mm. The maximal average persistent navigation orientation accuracy was 1.15 mm vs 0.09 mm. The maximal average navigation orientation accuracy after registration recovery was 1.15 mm vs 1.39 mm between the experimental and control group. All patients healed, and their function and profile improved. These findings demonstrate that although surgeons should consider the patients’ time and monetary costs, our qualified navigation surgery system and experience could offer an accurate guide during a variety of craniomaxillofacial surgeries. PMID:27305855

  2. Stent treatment for basilar artery dissection: A single-center experience of 21 patients.

    PubMed

    Li, Li; Li, Tianxiao; Xue, Jiangyu; Wang, Ziliang; Bai, Weixing; Zhu, Liangfu; Feng, Guang; Xu, Gangqin; Yang, Bowen

    2016-06-01

    Basilar artery dissection is a rare disease with high morbidity and mortality. No well-established management strategy exists for this lesion. Endovascular reconstructive therapy using stents (with or without coiling) may be the optimum strategy.We describe our center's experience for this treatment strategy in 21 patients with basilar artery dissection from January 2009 to July 2014 (17 men, four women; age range, 18-70 years; median age, 56 years). We divided patients into two groups: Group 1 patients received stent-assisted coiling treatment, and Group 2 patients received stent-only treatment. Pre-treatment, peri-operation and follow-up evaluation were investigated for complications, clinical outcome and angiographic results. The median follow-up time was 20 months (range, 3-67 months).All patients were treated endovascularly by stent-assisted coiling (14 patients) or stent only (seven patients). Immediate angiography showed: in Group 1, five of 14 lesions were completely occluded, five were partially occluded, four revealed retention of contrast media; in Group 2, all patients (seven of seven) had contrast retention. At the follow-up visit (median seven months, 3-29 months), the aneurysms were angiographically improved in five of 13 patients in Group 1 compared with immediately post-operation, while six of sevenimproved in Group 2. Five patients (all in Group 1) had ischemic or hemorrhage peri-operation complications. Long-term good clinical outcomes (modified Rankin Scale score (mRS) ≤ 2) were achieved in all patients except three death cases (two in Group1, one in Group 2).In our experience, endovascular reconstructive therapy using stents (with or without coiling) for basilar artery dissection is effective and safe. Stent-only treatment seems have a better safety profile during the peri-operation period. PMID:26842610

  3. Presentation and Management of Paroxysmal Nocturnal Hemoglobinuria: A Single-Center Experience

    PubMed Central

    Karakuş, Abdullah; Ekmen, Mehmet Önder; Ayyildiz, Orhan

    2016-01-01

    Paroxysmal nocturnal hemoglobinuria (PNH) is a rare acquired disorder characterized by intravascular hemolysis. Real-world experience of PNH management is largely unreported. A retrospective analysis was undertaken based on medical records from six patients with PNH [two with aplastic anemia (AA)] treated at our center, Dicle University, Turkey. Diagnosis was based on granulocyte PNH clones, ranging from 93% to 66%. All patients had symptoms consistent with PNH. One patient was managed adequately with supportive measures only. Five were treated with the complement inhibitor eculizumab. Follow-up data (<1 year) were available in four cases (the fifth had received only three infusions by final follow-up). Hemoglobin level in these four patients increased from 4.1-7.2 g/dL to 8.3-13.0 g/dL. Lactate dehydrogenase, a marker for hemolysis, decreased profoundly in the two non-AA patients, with more minor improvements in the two AA patients. Weakness and fatigue improved in all eculizumab-treated patients. Four of the five treated patients became transfusion independent, including the patient given only three infusions. In the remaining case, a patient with AA, transfusion requirement decreased, and abdominal pain and dysphagia resolved. No adverse events occurred. PNH can be successfully managed in routine practice. PMID:27103981

  4. Paroxysmal nocturnal hemoglobinuria: a single Spanish center's experience over the last 40 yr.

    PubMed

    Muñoz-Linares, Cristina; Ojeda, Emilio; Forés, Rafael; Pastrana, Miguel; Cabero, Martín; Morillo, Daniel; Bautista, Guiomar; Baños, Isolina; Monteserín, Carmen; Bravo, Pilar; Jaro, Esther; Cedena, Teresa; Steegmann, Juan Luis; Villegas, Ana; Cabrera, José Rafael

    2014-10-01

    Paroxysmal nocturnal hemoglobinuria (PNH) is a rare clonal disease. To date, many reviews and series have been described. We report the experience of our center by presenting a review of 56 PNH patient cases with an average age at diagnosis of 38 yr and follow-ups beginning at approximately 40 yr; the median survival rate was 11 yr. The average clonal size upon diagnosis was 48%, presenting a variable evolution. Thrombotic episodes and cancer were five each, and the main causes of death among our patients were equal at 8.9%. Radiological study by magnetic resonance imaging is presented as a fundamental technique for estimating the deposit of iron levels in the liver and kidney, as well as in some decisive cases at the start of eculizumab therapy. Sixteen patients have been treated with eculizumab so far in our series, and being a safe drug, it provides improvement in the patients' quality of life, and the disappearance of clinical symptoms, and avoids the emergence of new thrombosis. PMID:24758317

  5. Electron cyclotron resonance ion source experience at the Heidelberg Ion Beam Therapy Center.

    PubMed

    Winkelmann, T; Cee, R; Haberer, T; Naas, B; Peters, A; Scheloske, S; Spädtke, P; Tinschert, K

    2008-02-01

    Radiotherapy with heavy ions is an upcoming cancer treatment method with to date unparalleled precision. It associates higher control rates particularly for radiation resistant tumor species with reduced adverse effects compared to conventional photon therapy. The accelerator beam lines and structures of the Heidelberg Ion Beam Therapy Center (HIT) have been designed under the leadership of GSI, Darmstadt with contributions of the IAP Frankfurt. Currently, the accelerator is under commissioning, while the injector linac has been completed. When the patient treatment begins in 2008, HIT will be the first medical heavy ion accelerator in Europe. This presentation will provide an overview about the project, with special attention given to the 14.5 GHz electron cyclotron resonance (ECR) ion sources in operation with carbon, hydrogen, helium, and oxygen, and the experience of one year of continuous operation. It also displays examples for beam emittances, measured in the low energy beam transport. In addition to the outlook of further developments at the ECR ion sources for a continuously stable operation, this paper focuses on some of the technical processings of the past year. PMID:18315121

  6. Post-Transplant Lymphoproliferative Disorder in Kidney Transplant Recipients: A Single-Center Experience in Japan.

    PubMed

    Ishihara, Hiroki; Shimizu, Tomokazu; Unagami, Kohei; Hirai, Toshihito; Toki, Daisuke; Omoto, Kazuya; Okumi, Masayoshi; Imai, Yoichi; Ishida, Hideki; Tanabe, Kazunari

    2016-04-01

    Post-transplant lymphoproliferative disorder is a serious complication of solid organ transplantation; however, few large studies have been performed in Asian institutions. We review our single-center experience with post-transplant lymphoproliferative disorder patients in Japan. We retrospectively evaluated patients with post-transplant lymphoproliferative disorder following kidney transplantation between January 1985 and December 2013. The patients were divided into early-onset post-transplant lymphoproliferative disorder (<1 year) and late-onset post-transplant lymphoproliferative disorder (≥1 year) groups. Thirteen patients had the disorder, an incidence rate of 0.75% (13/1730). Early-onset post-transplant lymphoproliferative disorder (N = 3) had not occurred for the last two decades. In the late-onset group (N = 10), the median time of onset was 108.7 months. The Kaplan-Meier 10-year overall survival rates were 76.9% and 95.4% in patients with and without the disorder, respectively (P = 0.0001). Post-transplant lymphoproliferative disorder significantly affected transplant recipients' mortality. Late-onset occurred even > 10 years after transplantation; therefore, long-term monitoring of patients is needed. PMID:26948427

  7. Partial Cystectomy after Neoadjuvant Chemotherapy: Memorial Sloan Kettering Cancer Center Contemporary Experience

    PubMed Central

    Kopp, Ryan P.; Donahue, Timothy F.; Russo, Paul; Bochner, Bernard H.; Donat, Sherri M.; Dalbagni, Guido; Herr, Harry W.

    2014-01-01

    Objective. To report our contemporary experience with partial cystectomy after neoadjuvant chemotherapy. Patients and Methods. Retrospective review of patients who underwent neoadjuvant chemotherapy and partial cystectomy for urothelial cell carcinoma of the bladder at Memorial Sloan Kettering Cancer Center from 1995 to 2013. Log-rank test and Cox regression models were used to analyze variables possibly associated with recurrence-free, advanced recurrence-free (free from recurrence beyond salvage with intravesical therapy or radical cystectomy), and overall survival. Results. All 36 patients had a solitary tumor <5 cm in size. Twenty-one patients (58%) achieved cT0 following neoadjuvant chemotherapy with 7 (33%) having residual disease at PC. At last follow-up, 19 (53%) patients had recurrence, 15 (42%) had advanced recurrence, 10 (28%) died of disease, and 22 (61%) maintained an intact bladder. Median follow-up of those who were with no evidence of disease was 17 months. On univariable analysis, after neoadjuvant chemotherapy positive nodes on imaging and positive surgical margin at partial cystectomy were both associated with worse recurrence-free, advanced recurrence-free, and overall survival. Five-year recurrence-free, advanced recurrence-free, and overall survival were 28%, 51%, and 63%, respectively. Conclusion. Partial cystectomy following neoadjuvant chemotherapy provides acceptable oncologic outcomes in highly selected patients with muscle-invasive bladder cancer.

  8. Three-Year Experience of an Academic Medical Center Ombuds Office

    PubMed Central

    Layde, Peter M.

    2016-01-01

    An ombuds is an individual who informally helps people or groups (visitors) resolve disputes and/or interpersonal conflicts as an alternative to formal dispute resolution mechanisms within an organization. Ombuds are nearly ubiquitous in many governmental, business, and educational settings but only recently have gained visibility at medical schools. Medical schools in the United States are increasingly establishing ombuds offices as part of comprehensive conflict management systems to address concerns of faculty, staff, students, and others. As of 2015, more than 35 medical schools in the United States have active ombuds Web pages. Despite the growing number of medical schools with ombuds offices, the literature on medical school ombuds offices is scant. In this article, the authors review the first three years of experience of the ombuds office at the Medical College of Wisconsin, a freestanding medical and graduate school with a large physician practice. The article is written from the perspective of the inaugural ombuds and the president who initiated the office. The authors discuss the rationale for, costs of, potential advantages of, and initial reactions of faculty, staff, and administration to having an ombuds office in an academic medical center. Important questions relevant to medical schools that are considering an ombuds office are discussed. The authors conclude that an ombuds office can be a useful complement to traditional approaches for conflict management, regulatory compliance, and identification of systemic issues. PMID:26675192

  9. Reasons, procedures, and outcomes in ventriculoatrial shunts: A single-center experience

    PubMed Central

    Yavuz, Celal; Demırtas, Sinan; Calıskan, Ahmet; Kamasak, Kaan; Karahan, Oguz; Guclu, Orkut; Yazıcı, Suleyman; Mavıtas, Binali

    2013-01-01

    Background: Ventricular shunts are used to drain cerebrospinal fluid into extra-cranial spaces. Ventriculoatrial (VA) shunts are provided to transfer cerebrospinal fluid from the cerebral ventricle into the right atrium of the heart. A single center experience of indications, procedure, and clinical outcomes in VA shunt was presented in current study. Methods: VA shunts were applied in 10 patients who had repeated previous shunt dysfunction or infection. The reasons, clinical findings, replacement methods, and postoperative clinical follow-ups and outcomes were recorded retrospectively. Results: There were seven female (70%) and three (30%) male patients; their ages ranged from 5 to 13 years (mean ± SD; 8.5 ± 2.6 years). Shunt re-placement reasons were as follows: Shunt occlusion in five patients, intraperitoneal infection in four patients and a distal catheter was kinked and knotted in one patient. Postoperative early complications were seen in one patient as early catheter thrombosis and catheter revision were applied. Late complications were seen in two patients as follows: Catheter infection and infective endocarditis occurred in one patient and pulmonary thrombus occurred in one other patient. There was not any catheter-related mortality observed at the one year follow-up period. Conclusion: VA shunts may be an option for cerebrospinal fluid drainage at necessary conditions. However, sterilization and general training on asepsy and antisepsy are the most important determinants affecting the clinical outcome due to the cardio systemic relationship. PMID:23493480

  10. Skin Necrosis and Purpura Fulminans in Children With and Without Thrombophilia--A Tertiary Center's Experience.

    PubMed

    Fruchtman, Yariv; Strauss, Tzipora; Rubinstein, Marina; Ben Harush, Miriam; Revel-Vilk, Shoshana; Kapelushmik, Joseph; Paret, Gideon; Kenet, Gili

    2015-01-01

    Purpura fulminans (PF) is a very rare clinicopathologic skin disorder comprising dermal microvascular thrombosis associated with perivascular hemorrhage of multiple origins. It may occur as the presenting symptom of severe congenital deficiency of protein C (PC) or protein S (PS) during the newborn period, or later in life following oral anticoagulant therapy with vitamin K antagonists, or of sepsis that may be associated with disseminated intravascular coagulation. Treatment consists of anticoagulants and PC concentrates during acute episodes. We report our experience in the diagnosis and management of pediatric PF. The medical records of the 6 children aged 2-16 years (median: 5 years) who presented with PF to our tertiary care center between 1996 and 2013 were studied. The thrombophilia workup revealed either the presence of congenital homozygous PC deficiency, prothrombotic polymorphisms (factor V Leiden and FIIG20210A heterozygosity), acquired PC/PS deficiency, or no discernible thrombophilia. The skin necrosis resolved following conservative fresh-frozen plasma/anticoagulant therapy in 2 cases, whereas 3 children required interventional plastic surgery. The sixth case, a 10-year-old child with severe PC deficiency, heterozygous factor V Leiden, and FIIG20210A, received recombinant activated PC. PF in childhood is rare and has multiple etiologies. Understanding of the variable pathogenesis and risk factors will facilitate diagnosis and appropriate clinical management. PMID:26436558

  11. Three-Year Experience of an Academic Medical Center Ombuds Office.

    PubMed

    Raymond, John R; Layde, Peter M

    2016-03-01

    An ombuds is an individual who informally helps people or groups (visitors) resolve disputes and/or interpersonal conflicts as an alternative to formal dispute resolution mechanisms within an organization. Ombuds are nearly ubiquitous in many governmental, business, and educational settings but only recently have gained visibility at medical schools. Medical schools in the United States are increasingly establishing ombuds offices as part of comprehensive conflict management systems to address concerns of faculty, staff, students, and others. As of 2015, more than 35 medical schools in the United States have active ombuds Web pages. Despite the growing number of medical schools with ombuds offices, the literature on medical school ombuds offices is scant. In this article, the authors review the first three years of experience of the ombuds office at the Medical College of Wisconsin, a freestanding medical and graduate school with a large physician practice. The article is written from the perspective of the inaugural ombuds and the president who initiated the office. The authors discuss the rationale for, costs of, potential advantages of, and initial reactions of faculty, staff, and administration to having an ombuds office in an academic medical center. Important questions relevant to medical schools that are considering an ombuds office are discussed. The authors conclude that an ombuds office can be a useful complement to traditional approaches for conflict management, regulatory compliance, and identification of systemic issues. PMID:26675192

  12. Retroperitoneal Laparoscopic Nephroureterectomy for Tuberculous Nonfunctioning Kidneys: a single-center experience

    PubMed Central

    Tian, Xiquan; Wang, Mingshuai; Niu, Yinong; Zhang, Junhui; Song, Liming; Xing, Nianzeng

    2015-01-01

    Purpose To present our surgical techniques and experiences of retroperitoneal laparoscopic nephroureterectomy for the treatment of tuberculous nonfunctioning kidneys. Materials and Methods From March 2005 to March 2013, a total of 51 patients with tuberculous nonfunctioning kidney underwent retroperitoneal laparoscopic nephroureterectomy at our medical center. The techniques included early control of renal vessels and dissection of the diseased kidney along the underlying layer outside the Gerato’s fascia. The distal ureter was dissected through a Gibson incision and the entire specimen was removed en bloc from the incision. Patient demographics, perioperative characteristics and laboratory parameters as well as postoperative outcome were retrospectively reviewed. Results Retroperitoneal laparoscopic nephroureterectomy was successfully performed in 50 patients, whereas one case required conversion to open surgery due to non-progression of dissection. The mean operating time was 123.0 minutes (107-160 minutes) and the mean estimated blood loss was 134 mL (80-650 mL).The mean postoperative hospital stay was 3.6 days (3-5days) and the mean return to normal activity was 11.6 days (10-14days). Most intra-operative and post-operative complications were minor complications and can be managed conservatively. After 68 months (12-96 months) follow-up, the outcome was satisfactory, and ureteral stump syndrome did not occur. Conclusions Retroperitoneal laparoscopic nephroureterectomy as a minimally invasive treatment option is feasible for treatment of tuberculous nonfunctioning kidneys. PMID:26005971

  13. Routine use of Hemospray for gastrointestinal bleeding: prospective two-center experience in Switzerland.

    PubMed

    Sulz, Michael C; Frei, Remus; Meyenberger, Christa; Bauerfeind, Peter; Semadeni, Gian-Marco; Gubler, Christoph

    2014-07-01

    Hemospray (Cook Medical, Winston-Salem, North Carolina, USA) is a hemostatic agent recently introduced for the management of upper gastrointestinal bleeding (GIB). To date, there is little experience with this fairly new hemostatic tool. The aim of this case series was to reflect the use and effectiveness of Hemospray as a treatment option in GIB in everyday clinical practice at two tertiary referral centers. Consecutive patients (n = 16) with active GIB of various origins were treated with Hemospray. The rate of successful initial hemostasis was 93.75 % (15 /16; salvage therapy 92.85 % [13/14]; monotherapy 100 % [2 /2]). The rebleeding rate within 7 days was 12.5 % (2/16). One patient, in whom interventional radiology also failed, had to undergo surgery as salvage therapy. The effectiveness of Hemospray in the management of GIB in various clinical situations is promising. Future multicenter randomized prospective trials for clearly defined bleeding situations are needed for greater generalizability of case series findings. PMID:24770964

  14. Pharmacomechanical Thrombolysis for the Treatment of Thrombosed Native Arteriovenous Fistula: A Single-Center Experience

    PubMed Central

    Boonsrirat, Ussanee; Hongsakul, Keerati

    2014-01-01

    Summary Background Native arteriovenous fistula is one of the important routes for hemodialysis patients because of increased long-term survival and preservation of quality of life. We reported on a single-center experience with using pharmacomechanical thrombolysis for the treatment of thrombosed native arteriovenous fistula. Material/Methods This was a retrospective study of 12 hemodialysis patients (8 males and 4 females) with 14 thrombosed distal forearm Brescia-Cimino radiocephalic fistulas who were referred for pharmacomechanical thrombolytic treatment in the intervention unit of the Radiology Department, from 1 January 2010 to 30 December 2011. Demographic data, technical success rates, clinical success rates and complications were evaluated. The patency was evaluated by Kaplan-Meier analysis. Results The technical and clinical success was found in 12 thrombosed fistulas. Only 3 procedures had minor complications including small amounts of adjacent soft tissue hematoma. There were no procedure-related major complications. The primary patency rates at 6 and 12 months were 67% and 50%. The secondary patency rates at 6 and 12 months were 75% and 67%. Conclusions Pharmacomechanical thrombolysis is a minimally invasive, effective, durable, and safe procedure for the treatment of thrombosed native arteriovenous fistula. This procedure can be considered as an alternative treatment for thrombosed dialysis fistulas. PMID:25343002

  15. Introducing an enhanced recovery after surgery program in colorectal surgery: A single center experience

    PubMed Central

    Bona, Stefano; Molteni, Mattia; Rosati, Riccardo; Elmore, Ugo; Bagnoli, Pietro; Monzani, Roberta; Caravaca, Monica; Montorsi, Marco

    2014-01-01

    AIM: To study the implementation of an enhanced recovery after surgery (ERAS) program at a large University Hospital from “pilot study” to “standard of care”. METHODS: The study was designed as a prospective single centre cohort study. A prospective evaluation of compliance to a protocol based on full application of all ERAS principles, through the progressive steps of its implementation, was performed. Results achieved in the initial pilot study conducted by a dedicated team (n = 47) were compared to those achieved in the shared protocol phase (n = 143) three years later. Outcomes were length of postoperative hospital stay, readmission rate, compliance to the protocol and morbidity. Primary endpoint was the description of the results and the identification of critical issues of large scale implementation of an ERAS program in colorectal surgery emerged in the experience of a single center. Secondary endpoint was the identification of interventions that have been proven to be effective for facilitating the transition from traditional care pathways to a multimodal management protocol according to ERAS principles in colorectal surgery at a single center. RESULTS: During the initial pilot study (March 2009 to December 2010; 47 patients) conducted by a dedicated multidisciplinary team, compliance to the items of ERAS protocol was 93%, with a median length of hospital stay (LOS) of 3 d. Early anastomotic fistulas were observed in 2 cases (4.2%), which required reoperation (Clavien-Dindo grade IIIb). None of the patients had been discharged before the onset of the complication, which could therefore receive prompt treatment. There were also four (8.5%) minor complications (Clavien-Dindo grade II). Thirty days readmission rate was 4%. Perioperative mortality was nil. After implementation of the protocol throughout the Hospital in unselected patients (May 2012 to December 2012; 147 patients) compliance was 74%, with a median LOS of 6 d. Early anastomotic fistulas

  16. Parent Perspectives on How a Child-Centered Preschool Experience Shapes Children's Navigation of Kindergarten

    ERIC Educational Resources Information Center

    Recchia, Susan; Bentley, Dana Frantz

    2013-01-01

    The authors used qualitative case study methodology to explore parents' perceptions of their children's readiness for kindergarten. The authors interviewed parents, focusing on their children's experiences during their transition from a child-centered, play-based preschool setting guided by an emergent curriculum into a range of…

  17. Laparoscopic splenectomy: a single center experience. Unusual cases and expanded inclusion criteria for laparoscopic approach.

    PubMed

    Marte, Gianpaolo; Scuderi, Vincenzo; Rocca, Aldo; Surfaro, Giuseppe; Migliaccio, Carla; Ceriello, Antonio

    2013-06-01

    Laparoscopic splenectomy (LS) is nowadays considered as the gold standard for most hematological diseases where splenectomy is necessary, but many questions still remain. The aim of this study was to analyze our 5-years experiences consisting of 48 consecutive LS cases in order to assess the optimal approach and the feasibility of the procedure also in malignant diseases and unusual cases such as a primary spleen lymphoma, a big splenic artery aneurism, or a spleen infarct due to a huge pancreatic pseudo-cyst. Forty-eight consecutive patients underwent LS from January 2006 to January 2011 with at least 1-year follow-up. Clinical data and immediate outcome were retrospectively recorded; age, diagnosis, operation time, perioperative transfusion requirement, conversion rate, accessory incision, hospital stay, and complications were analyzed. We had 14 cases of malignant splenic disease, the most frequent malignant diagnosis was non-Hodgkin's lymphoma (12/14, 85.7 %). Splenomegaly (interpole diameter (ID) >20 cm) was observed in 12 cases (25 %) and massive splenomegaly (ID >25 cm) in 3 cases (6.25 %). Conversion to laparotomy occurred in two patients (4.16 %), both associated to uncontrollable bleeding in patients with splenomegaly. Mean operative time was 138 ± 22 min. Mean hospital stay was 4.5 days. Postoperative morbidity rate was 8.8 % for the benign group and 35.7 % in the malignant group. Mortality occurred in 1/48 patients (2.08 %), as a result of overwhelming post-splenectomy infection (OPSI). LS can be performed safely for malignant splenic disease and splenomegaly without any statistically significant increase of morbidity and mortality rate. Conversion rate is increased for massive splenomegaly. LS should be considered as the preferential approach even in patients with malignant disease, splenomegaly, or unusual cases. Massive splenomegaly should be considered as relative contraindication to LS even at experienced centers. PMID:23355349

  18. Radiation-Induced Sarcoma: A 15-Year Experience in a Single Large Tertiary Referral Center

    PubMed Central

    Kim, Kyung Su; Chang, Ji Hyun; Choi, Noorie; Kim, Han-Soo; Han, Ilkyu; Moon, Kyung Chul; Kim, Il Han; Kim, Hak Jae

    2016-01-01

    Purpose The purpose of this study is to report on the incidence and the experience in management of radiation-induced sarcoma (RIS) at a large single center in Korea for 15 years. Materials and Methods We retrospectively reviewed the sarcoma registry of a large institution from January 2000 to April 2014. Results Out of the 3,674 patients listed in the registry, 33 patients (0.9%) diagnosed with RIS were identified. The median latency of RIS was 12.1 years. The number of cases of RIS increased from four cases in the years 2000-2003 to 14 cases in the years 2012-2014. The most common histology was osteosarcoma (36.4%). The median follow-up period was 23.1 months, the median overall survival (OS) of all patients was 2.9 years, and their 5-year survival rate was 44.7%. Univariate and multivariate analyses showed association of the age at diagnosis (p=0.01) and the treatment aim (p=0.001) with the OS. The median OS and the 5-year survival rate of patients treated with curative surgery (n=19) were 9.6 years and 65%, respectively, and of the conservatively treated patients, 0.7 years and 0% (n=14). Re-irradiation was delivered to nine patients, and radiation toxicity was observed in five patients. Conclusion In this study, RIS accounted for 0.9% of the cases of sarcoma, with increasing incidence. Despite the association of curative resection with increased survival, it could be applied to only 58% of the patients. Considering the limited treatment options for RIS, conduct of a genetic study to identify the underlying mechanism of RIS is needed. PMID:27004955

  19. Liver Transplantation for Hepatocellular Carcinoma: A Single Center Resume Overlooking Four Decades of Experience.

    PubMed

    Emmanouilidis, Nikos; Peters, Rickmer; Ringe, Bastian P; Güner, Zeynep; Ramackers, Wolf; Bektas, Hüseyin; Lehner, Frank; Manns, Michael; Klempnauer, Jürgen; Schrem, Harald

    2016-01-01

    Background. This is a single center oncological resume overlooking four decades of experience with liver transplantation (LT) for hepatocellular carcinoma (HCC). Methods. All 319 LT for HCC that were performed between 1975 and 2011 were included. Predictors for HCC recurrence (HCCR) and survival were identified by Cox regression, Kaplan-Meier analysis, Log Rank, and χ (2)-tests where appropriate. Results. HCCR was the single strongest hazard for survival (exp⁡(B) = 10.156). Hazards for HCCR were tumor staging beyond the histologic MILAN (exp⁡(B) = 3.645), bilateral tumor spreading (exp⁡(B) = 14.505), tumor grading beyond G2 (exp⁡(B) = 8.668), and vascular infiltration of small or large vessels (exp⁡(B) = 11.612, exp⁡(B) = 18.324, resp.). Grading beyond G2 (exp⁡(B) = 10.498) as well as small and large vascular infiltrations (exp⁡(B) = 13.337, exp⁡(B) = 16.737, resp.) was associated with higher hazard ratios for long-term survival as compared to liver transplantation beyond histological MILAN (exp⁡(B) = 4.533). Tumor dedifferentiation significantly correlated with vascular infiltration (χ (2) p = 0.006) and intrahepatic tumor spreading (χ (2) p = 0.016). Conclusion. LT enables survival from HCC. HCC dedifferentiation is associated with vascular infiltration and intrahepatic tumor spreading and is a strong hazard for HCCR and survival. Pretransplant tumor staging should include grading by biopsy, because grading is a reliable and easily accessible predictor of HCCR and survival. Detection of dedifferentiation should speed up the allocation process. PMID:27057348

  20. Liver Transplantation for Hepatocellular Carcinoma: A Single Center Resume Overlooking Four Decades of Experience

    PubMed Central

    Emmanouilidis, Nikos; Peters, Rickmer; Ringe, Bastian P.; Güner, Zeynep; Ramackers, Wolf; Bektas, Hüseyin; Lehner, Frank; Manns, Michael; Klempnauer, Jürgen; Schrem, Harald

    2016-01-01

    Background. This is a single center oncological resume overlooking four decades of experience with liver transplantation (LT) for hepatocellular carcinoma (HCC). Methods. All 319 LT for HCC that were performed between 1975 and 2011 were included. Predictors for HCC recurrence (HCCR) and survival were identified by Cox regression, Kaplan-Meier analysis, Log Rank, and χ2-tests where appropriate. Results. HCCR was the single strongest hazard for survival (exp⁡(B) = 10.156). Hazards for HCCR were tumor staging beyond the histologic MILAN (exp⁡(B) = 3.645), bilateral tumor spreading (exp⁡(B) = 14.505), tumor grading beyond G2 (exp⁡(B) = 8.668), and vascular infiltration of small or large vessels (exp⁡(B) = 11.612, exp⁡(B) = 18.324, resp.). Grading beyond G2 (exp⁡(B) = 10.498) as well as small and large vascular infiltrations (exp⁡(B) = 13.337, exp⁡(B) = 16.737, resp.) was associated with higher hazard ratios for long-term survival as compared to liver transplantation beyond histological MILAN (exp⁡(B) = 4.533). Tumor dedifferentiation significantly correlated with vascular infiltration (χ2p = 0.006) and intrahepatic tumor spreading (χ2p = 0.016). Conclusion. LT enables survival from HCC. HCC dedifferentiation is associated with vascular infiltration and intrahepatic tumor spreading and is a strong hazard for HCCR and survival. Pretransplant tumor staging should include grading by biopsy, because grading is a reliable and easily accessible predictor of HCCR and survival. Detection of dedifferentiation should speed up the allocation process. PMID:27057348

  1. Older People’s Experiences of Patient-Centered Treatment for Chronic Pain: A Qualitative Study

    PubMed Central

    Teh, Carrie F.; Karp, Jordan F.; Kleinman, Arthur; Reynolds, Charles F.; Weiner, Debra K.; Cleary, Paul D.

    2010-01-01

    Introduction Older adults with chronic pain who seek treatment often are in a health care environment that emphasizes patient-directed care, a change from the patriarchal model of care to which many older adults are accustomed. Objective To explore the experiences of older adults seeking treatment for chronic pain, with respect to patient-directed care and the patient–provider relationship. Design In-depth interviews with 15 Caucasian older adults with chronic pain who had been evaluated at a university-based pain clinic. All interviews were audiotaped and the transcripts were analyzed using a grounded theory based approach. Results Older adults with chronic pain vary in their willingness to be involved in their treatment decisions. Many frequently participate in decisions about their pain treatment by asking for or refusing specific treatments, demanding quality care, or operating outside of the patient–provider relationship to manage pain on their own. However, others prefer to let their provider make the decisions. In either case, having a mutually respectful patient–provider relationship is important to this population. Specifically, participants described the importance of “being heard” and “being understood” by providers. Conclusions As some providers switch from a patriarchal model of care toward a model of care that emphasizes patient activation and patient-centeredness, the development and cultivation of valued patient–provider relationships may change. While it is important to encourage patient involvement in treatment decisions, high-quality, patient-centered care for older adults with chronic pain should include efforts to strengthen the patient–provider relationship by attending to differences in patients’ willingness to engage in patient-directed care and emphasizing shared decision-making. PMID:19207235

  2. A Single-center Experience in Splenic Diffuse Red Pulp Lymphoma Diagnosis.

    PubMed

    Julhakyan, Hunan L; Al-Radi, L S; Moiseeva, T N; Danishyan, K I; Kovrigina, A M; Glebova, S M; Lugovskaya, S A; Dvirnik, V N; Khvastunova, A N; Yakutik, I A; Savchenko, V G

    2016-08-01

    The World Health Organization 2008 classification highlighted a new nosology-splenic diffuse red pulp lymphoma (SDRPL) with clinical and laboratory features similar to both splenic marginal zone lymphoma and hairy cell leukemia (HCL) and variant form of HCL. Experience of hematologists on the diagnosis and differential diagnosis of SDRPL is extremely limited. The aim of our report was to characterize the clinical and immunomorphologic features of SDRPL on our own observations. During 2013-2014, in National Research Center for Hematology, 87 spleen specimens removed from various B-cell lymphomas were analyzed. In four (4.6%) cases, the diagnosis SDRPL was made based on morphologic, immunohistochemical, immunophenotypic, molecular examination of spleen biopsies, blood and bone marrow samples. In all cases of SDRPL were observed significant splenomegaly, lymphocytosis from 56% to 94% (in two cases with leukocytosis 55.000 and 75.000 109/l). The circulating "villous" lymphocytes phenotype was CD20+ (bright), CD11c+/±, CD103 (weakly)+/±, LAIR-1+, CD25-, CD5-, CD10-, and CD23-. Mutation BRAFV600E was not detected. Bone marrow with minor lymphoid CD20+, CD25-, Annexin1-, Cyclin D1- cell infiltration. The average weight of the spleen was 3900 g (1450-9500 g), and morphologically, there was revealed lymphoid infiltration of red pulp with phenotype CD20+, DBA.44+, CD25-, Annexin1-, Cyclin D1-, CD103-, CD123-, CD27-, focal SD11c± and TRAP±. Now patients are observed in remission: two patients after splenectomy, two after splenectomy and cladribine+rituximab chemotherapy. SRDPL-a rare lymphoma that is suspected in the cases with significant splenomegaly and lymphocytosis with villous lymphocytes forms that have only a part of the classic markers HCL, with minor bone marrow infiltration. The standard diagnosis and treatment is splenectomy. Differential diagnosis of SMZL and HCL has clear criteria, but criteria of differentiation with variant HCL are still unknown. PMID

  3. Radio-chemotherapy in anal cancer: Institutional experience at a large radiation oncology center in Chile

    PubMed Central

    Russo, Moisés; Ovalle, Valentina

    2014-01-01

    Aim In this article the aim is to provide a concise narrative review and inform the institutional experience at a referral center in Chile with the use of radio-chemotherapy in anal cancer. Background Cancer of the anus and anal canal is mainly a loco-regional disease. For years the standard of care has been concomitant radio-chemotherapy, which permits organ preservation and better local control than alternative surgical procedures. Materials and methods A retrospective analysis of 44 patients treated between 2002 and 2010 was performed. Local recurrence, distant recurrence and overall survival were analyzed with the Kaplan–Meier method. Relevant groups where compared with the log-rank test and univariate analysis were done with the Cox proportional hazards model. Results Median follow-up of the cohort was 56 months, with a minimum follow-up of at least 24 months. There was a significant difference between clinical stages in disease free survival (log-rank trend p < 0.001), and a significant difference in overall survival (OS) when comparing clinical stages that were grouped in stage I–IIIa and IIIB (log-rank p = 0.001). On univariate analysis, age older than 60, having received full treatment and dose above 45 Gy were all significantly related to OS (p < 0.05). An overall survival of 45% and disease free survival of 45% at 5 years were found in our series. Conclusions Our findings show that results at the Instituto de Radiomedicina in Chile are comparable to published literature. Dismal results in stage IIIb cases indicate much work remains in therapies to achieve loco-regional control in locally advanced cases. PMID:25061522

  4. Bowel preparation in “real-life” small bowel capsule endoscopy: a two-center experience

    PubMed Central

    Klein, Amir; Dashkovsky, Marianna; Gralnek, Ian; Peled, Ravit; Chowers, Yehuda; Khamaysi, Iyad; Har-Noy, Ofir; Levi, Idan; Nadler, Moshe; Eliakim, Rami; Kopylov, Uri

    2016-01-01

    Background Video capsule endoscopy (VCE) is an established diagnostic tool for the investigation of small bowel (SB) pathology. Bowel preparation prior to VCE may improve visualization, transit time, and diagnostic yield. We aimed to evaluate the “real-life” experience comparing two different preparation protocols in patients undergoing SB VCE. Methods We performed a retrospective analysis of prospectively collected data from SB VCE procedures, performed in two tertiary care medical centers in Israel. VCE procedures performed at “Sheba Medical Center” used a 2-L polyethylene glycol (PEG) bowel preparation (n=360) while VCEs performed at “Rambam Health Care campus” used a clear liquid diet plus 12-h fast protocol (n=500). A dichotomous preparation scale (adequate, inadequate) was used to classify cleansing quality. Data collection included patient and procedural details. The proportion of VCE procedures with adequate bowel preparation and the overall positive SB findings in the two different bowel preparation protocols were evaluated. Results SB completion rates were higher in the PEG protocol (96% vs. 83%, P<0.001) and SB passage time was significantly faster in the PEG protocol (mean 217±73 vs. 238±77 min, P<0.001). Bowel preparation quality was similar between groups (8% vs. 7% inadequate preparation, P=0.591). Overall positive SB findings were similar between the two groups (57% clear liquid fasting only vs. 51% PEG protocol, P=0.119). Conclusion In this large cohort, a 2-L PEG protocol had similar preparation quality and diagnostic yield compared with clear liquid fasting. PMID:27064840

  5. Robotic-assisted partial nephrectomy without using ureteral stent: a single center experience

    PubMed Central

    Özkan, Burak; Coşkuner, Enis Rauf; Yalçın, Veli

    2016-01-01

    Objective To share our results of robotic assisted partial nephrectomy (RAPN) we performed without using ureteral stent in a single center from Turkey. Material and methods Medical records of consecutive 45 patients (34 men and 11 women) who underwent RAPN for kidney lesions between March 2011 and December 2014 were retrieved, and evaluated. All the procedures were performed by a transperitoneal approach without using ureteral stent prior to surgery. Renal artery clamping was used in all cases and intraoperative ultrasonography was used in 2 cases. Results Patients undergoing RAPN had a mean tumor size of 4.42 cm (2–8) and a mean renal nephrometry score of 5.82 (4–11). The mean estimated blood loss was 250 mL (150–450 ml) and the mean operative time was 195 minutes (150–300). There was no statistical difference between the preoperative and postoperative serum creatinine levels at the first follow-up visit (0.9 vs. 0.95, p=0.087). Surgical margin positivity was not detected in any patient, and the mean surgical margin distance was calculated as 0.4 mm (0.2–10). In only 1 patient disease recurrence was detected at the 21st month of the the follow-up period, and no distant metastases was reported in our patients at a mean follow-up of 10 months (3–36 mos). Our complication rate was 11.1% and according to the Clavien system complications were as; grade 2 (3 patients), grade 3a (1 patient) and grade 3b (1 patient). Conclusion With appropriately selected patients and adequate surgical experience, RAPN performed without using ureteral stent is a safe and feasible method for localized renal tumors. PMID:27011873

  6. The Brave New World of GEC Evaluation: The Experience of the Rhode Island Geriatric Education Center

    ERIC Educational Resources Information Center

    Filinson, Rachel; Clark, Phillip G.; Evans, Joann; Padula, Cynthia; Willey, Cynthia

    2012-01-01

    In 2007, the Health Resources Services Administration introduced new mandates that raised the standards on program evaluation for Geriatric Education Centers. Described in this article are the primary and secondary evaluation efforts undertaken for one program within the Rhode Island Geriatric Education Center (RIGEC), the findings from these…

  7. Students Writing Their Own Tests--An Experiment in Student-Centered Assessment in Two Cultures.

    ERIC Educational Resources Information Center

    Kaufman, Lionel M., Jr.

    A study investigated the usefulness of adopting innovative, student-centered instructional techniques in two traditional but very different cultures, Turkey and Puerto Rico. In each country, the study occurred in a program to train teachers of English as a Second Language (ESL). Using a student-centered approach, trainees learned how to prepare…

  8. Patients’ Experiences in Different Models of Community Health Centers in Southern China

    PubMed Central

    Wang, Harry H. X.; Wong, Samuel Y. S.; Wong, Martin C. S.; Wei, Xiao Lin; Wang, Jia Ji; Li, Donald K. T.; Tang, Jin Ling; Gao, Gemma Y.; Griffiths, Sian M.

    2013-01-01

    PURPOSE Current health care reforms in China have an overall goal of strengthening primary care through the establishment and expansion of primary care networks based on community health centers (CHCs). Implementation in urban areas has led to the emergence of different models of ownership and management. The objective of this study was to evaluate the primary care experiences of patients in the Pearl River Delta as measured by the Primary Care Assessment Tool (PCAT) and the relationships with ownership and management in the 3 different models we describe. METHODS This cross-sectional study was conducted on-site at CHCs in 3 cities within the Pearl River Delta, China, using a multistage cluster sampling method. A validated Mandarin Chinese version of the PCAT–Adult Edition (short version) was adopted to collect information from adult patients regarding their experiences with primary care sources. PCAT scores for individual primary care attributes and total primary care assessment scores were assessed with respect to sociodemographic characteristics, health characteristics, and health care service utilization across 3 primary care models. RESULTS One thousand four hundred forty (1,440) primary care patients responded to the survey, for an overall response rate of 86.1%. Respondents gave government-owned and -managed CHCs the highest overall PCAT scores when compared with CHCs either managed by hospitals (95.18 vs 90.81; P = .005) or owned by private and social entities (95.18 vs 90.69; P =.007) as a result of better first-contact care (better first-contact utilization) and coordination of care (better service coordination and information system). Factors that were positively and significantly associated with higher overall assessment scores included the presence of a chronic condition (P <.001), having medical insurance (P = .006), and a self-reported good health status (P <.001). CONCLUSIONS This study suggests that government-owned and -managed CHCs may be able

  9. Review of Restricted Experiment Requests, Division of Select Agents and Toxins, Centers for Disease Control and Prevention, 2006-2013.

    PubMed

    Smith, Jacinta; Gangadharan, Denise; Weyant, Robbin

    2015-01-01

    The Centers for Disease Control and Prevention (CDC) Division of Select Agents and Toxins (DSAT) regulates laboratories that possess, use, or transfer select agents and toxins in the United States. DSAT also mitigates biosafety risks through the review of "restricted experiments," which under the select agent regulations are experiments that pose heightened biosafety risks. From January 2006 through December 2013, DSAT received 618 requests from 109 entities to perform potentially restricted experiments. Of these requests, 85% were determined not to meet the regulatory definition of a restricted experiment, while 15% of the requests met the definition of a restricted experiment. Of the 91 restricted experiments proposed, DSAT approved 31 (34%) requests because the biosafety conditions proposed were commensurate with the experiments' biosafety risk. All 31 approved restricted experiments were for work with select toxins. DSAT did not approve 60 restricted experiment requests due to potentially serious biosafety risks to public health and safety. All 60 denied restricted experiments proposed inserting drug resistance traits into select agents that could compromise the control of disease. The select agents and toxins associated most frequently with requests that met the regulatory definition of a restricted experiment are Shiga toxin (n = 16), Burkholderia mallei (n = 15), Botulinum neurotoxin (n = 14), and Brucella abortus (n = 14). In general, all restricted experiment decisions are determined on a case-by-case basis. This article describes the trends and characteristics of the data associated with restricted experiment requests among select agents that have an impact on public health and safety (HHS only agents) or both public health and safety and animal health or products (overlap agents). The information presented here, coupled with the information published in the restricted experiment guidance document ( www.selectagents.gov ), is intended to promote awareness

  10. Staff's experiences of a person-centered health education group intervention for people with a persistent mental illness.

    PubMed

    Jormfeldt, Henrika; Brunt, David Arthur; Rask, Mikael; Bengtsson, Agneta; Svedberg, Petra

    2013-07-01

    Patient education in mental health care is a conventional intervention to increase patients' knowledge about their illness and treatment. A provider-centered focus in patient education may put patients in a passive role, which can counteract their processes of recovery. There is an increasing emphasis on recovery-oriented practice, an approach that is aligned with the service user perspective, but little is known about health care staff's perspectives on person-centered mental health care. A qualitative approach was used to describe staff's experiences of being group leaders in a person-centered health education intervention in municipal services for persons with a persistent mental illness. The analysis of staff experiences revealed three core categories: (1) implications of the division of responsibility among local authorities, (2) awareness of facilitating factors of growth, and (3) the meaning of dialogue. These formed the theme Preconditions for Person-Centered Care. Further research is required to explore larger economic, political, and social structures as backdrops to person-centered mental health care, from the perspective of service users, families, health professionals, and the community at large. PMID:23875550

  11. Culturally Focused Community-Centered Service Learning: An International Cultural Immersion Experience

    ERIC Educational Resources Information Center

    Tomlinson-Clarke, Saundra M.; Clarke, Darren

    2010-01-01

    An immersion training model is described that incorporates culturally focused community-centered service in South Africa as an experiential learning approach. Recommendations for developing international cultural immersion training with a goal of developing cultural competencies are suggested.

  12. Alternative funding for academic medicine: experience at a Canadian Health Sciences Center.

    PubMed

    Rosenbaum, Paul; Shortt, S E D; Walker, D M C

    2004-03-01

    In 1994 the School of Medicine of Queen's University in Kingston, Ontario, its clinical teachers, and the three principal teaching hospitals initiated a new approach to funding, the Alternative Funding Plan, a pragmatic response to the inability of fee-for-service billing by clinical faculty to subsidize the academic mission of the health sciences center. The center was funded to provide a package of service and academic deliverables (outputs), rather than on the basis of payment for physician clinical activity (inputs). The new plan required a new governance structure representing stakeholders and raised a number of important issues: how to reconcile the preservation of physician professional autonomy with corporate responsibilities; how to gather requisite information so as to equitably allocate resources; and how to report to the Ontario Ministry of Health and Long-term Care in order to demonstrate accountability. In subsequent iterations of the agreement it was necessary to address issues of flexibility resulting from locked-in funding levels and to devise meaningful performance measures for departments and the center as a whole. The authors conclude that the Alternative Funding Plan represents a successful innovation in funding for an academic health sciences center in that it has created financial stability, as well as modest positive effects for education and research. The Ontario government hopes to replicate the model at the province's other four health sciences centers, and it may have applicability in any jurisdiction in which the costs of medical education outstrip the capacity of faculty clinical earnings. PMID:14985191

  13. Measuring User Experience of the Student-Centered e-Learning Environment

    ERIC Educational Resources Information Center

    Santoso, Harry B.; Schrepp, Martin; Isal, R. Yugo Kartono; Utomo, Andika Yudha; Priyogi, Bilih

    2016-01-01

    The aim of the current study is to develop an adapted version of User Experience Questionnaire (UEQ) and evaluate a learning management system. Although there is a growing interest on User Experience, there are still limited resources (i.e. measurement tools or questionnaires) available to measure user experience of any products, especially…

  14. Backward deletion to minimize prediction errors in models from factorial experiments with zero to six center points

    NASA Technical Reports Server (NTRS)

    Holms, A. G.

    1980-01-01

    Population model coefficients were chosen to simulate a saturated 2 to the 4th fixed-effects experiment having an unfavorable distribution of relative values. Using random number studies, deletion strategies were compared that were based on the F-distribution, on an order statistics distribution of Cochran's, and on a combination of the two. The strategies were compared under the criterion of minimizing the maximum prediction error, wherever it occurred, among the two-level factorial points. The strategies were evaluated for each of the conditions of 0, 1, 2, 3, 4, 5, or 6 center points. Three classes of strategies were identified as being appropriate, depending on the extent of the experimenter's prior knowledge. In almost every case the best strategy was found to be unique according to the number of center points. Among the three classes of strategies, a security regret class of strategy was demonstrated as being widely useful in that over a range of coefficients of variation from 4 to 65%, the maximum predictive error was never increased by more than 12% over what it would have been if the best strategy had been used for the particular coefficient of variation. The relative efficiency of the experiment, when using the security regret strategy, was examined as a function of the number of center points, and was found to be best when the design used one center point.

  15. Research Experience for Undergraduates (REU) on River and Coastal Restoration—a Center Approach to Creating a Unique Research Experience for Undergraduates

    NASA Astrophysics Data System (ADS)

    Dalbotten, D. M.; Campbell, K. M.; Hill, K. M.; Podolak, C.; Bevington, A.; Holm, G. O.; Wilcock, P.; Twilley, R.

    2009-12-01

    At the National Center for Earth-surface Dynamics (NCED), the NSF-sponsored REU on River and Coastal Restoration provides students an intensive research experience in a center environment that incorporates many aspects of the typical graduate student experience at an NSF-funded Science and Technology Center. These include a team-oriented approach in which students work closely with one another while completing their individual research projects, team-mentoring that brings together NCED faculty, staff, and graduate students to meet students’ advising needs, and an approach to research that incorporates field research, laboratory experiments, and an introduction to computational and quantitative methodologies. In addition, students' individual research projects constitute a contribution to larger ongoing field campaigns, allowing them, often for the first time, to understand the role of their own research in a larger context. Students join one of two teams: Team Marmot participates in an ongoing campaign to document the geomorphic response of the Sandy River to the 2007 removal of the Marmot Dam; Team Delta participates in research on coastal restoration of the Mississippi River Delta. After an orientation period at our headquarters, the St. Anthony Falls Laboratory in Minnesota, each team spends the majority of their summer in the field. The teams are then reunited for poster sessions at the end of the summer at which they share the outcomes of their research with one another and the larger NCED and University of Minnesota communities.

  16. Single-center experience in pediatric renal transplantation using thymoglobulin induction and steroid minimization.

    PubMed

    Warejko, Jillian K; Hmiel, S Paul

    2014-12-01

    Our center has offered thymoglobulin induction with steroid minimization to our pediatric renal transplant patients for the last 10 yr. Steroid minimization or avoidance has shown favorable results in survival, kidney function, and growth in previous studies of pediatric patients. We report our experience with this protocol over the past 10 yr with respect to patient/graft survival, acute rejection episodes, renal function, linear growth, bone density, cardiovascular risk factors, and opportunistic infections. A retrospective chart review was performed for pediatric renal transplant patients on the steroid-minimized protocol between January 2002 and December 2011 on an intention to treat basis. Patient demographics, height, weight, serum creatinine, iGFR, biopsies, and survival data were collected. Height and weight z-scores were calculated with EpiInfo 7, using the CDC 2000 growth charts. Survival was calculated using Kaplan-Meier analysis. eGFR was calculated using the original and modified Schwartz equations. Forty-four pediatric patients were identified, aged 13 months to 19 yr. Five-yr survival was 95.5% for males and 94.4% for females. Only five patients had biopsy-proven ACR, two of which were at more than 12 months post-transplantation. Height delta z-scores from transplant to one, three, and five yr were 0.34, 0.38, and 0.79, respectively. Weight delta z-scores from transplant to one, three, and five yr were 0.87, 0.79, and 0.84, respectively. Mean original Schwartz eGFR was 84.3 ± 15.8 mL/min/1.73 m(2) , modified Schwartz eGFR was 59.3 ± 11.5 mL/min/1.73 m(2) , and iGFR was 64.2 ± 8.5 mL/min/1.73 m(2) at three yr. Of 18 subjects who had a bone density exam, none had a z-score less than -2 on DEXA exam at one-yr post-transplantation. Fifty-one percent of patients were on antihypertensives at the time of transplant compared with 43% at one-yr post-transplantation. Three yr post-transplantation, the average LDL was <100 mg/dL, and

  17. Understanding and Engagement in Places of Science Experience: Science Museums, Science Centers, Zoos, and Aquariums

    ERIC Educational Resources Information Center

    Schwan, Stephan; Grajal, Alejandro; Lewalter, Doris

    2014-01-01

    Science museums, science centers, zoos, and aquariums (MCZAs) constitute major settings of science learning with unique characteristics of informal science education. Emphasis will be given to the analysis of four specific characteristics of MCZAs that seem relevant for educational research and practice, namely, conditions of mixed motives and…

  18. The Experience of Distance Learning at the Scarman Center: The Realities and the Prospects.

    ERIC Educational Resources Information Center

    Burke, Roger Hopkins; Gill, Martin

    2000-01-01

    Describes the distance learning initiative at the Scarman Center for the Study of Public Order (UK), focusing on two Masters courses. Discusses the course design, course materials, study guides, and complementary reading materials. Describes elements of the student support system: the student handbook, "fax-a-tutor" system, regional seminars, and…

  19. Building a Collaborative Educational Research Center: The Portland Public Schools & Portland State University Experience.

    ERIC Educational Resources Information Center

    Nave, Gary R.

    The Center for Urban Research in Education (CURE), jointly conceived by the Portland (Oregon) Public Schools and Portland State University, was established in 1987 by the Oregon State Legislature to explore solutions to the educational problems of at-risk student populations, especially those in urban settings. This paper shares the results of…

  20. Veterans Affairs and Academic Medical Center Affiliations: The North Texas Experience

    ERIC Educational Resources Information Center

    Mohl, Paul Cecil; Hendrickse, William; Orsak, Catherine; Vermette, Heidi

    2009-01-01

    Objective: The authors review the more than 30-year history of the academic affiliation between the Department of Psychiatry at the University of Texas Southwestern Medical Center in Dallas and the Mental Health Service at the Veterans Affairs North Texas Health Care System. Methods: The authors interviewed individuals involved at various stages…

  1. The Hamovitch Research Center: An Experiment in Collective Responsibility for Advancing Science in the Human Services

    ERIC Educational Resources Information Center

    Flynn, Marilyn; Brekke, John S.; Soydan, Haluk

    2008-01-01

    Research centers in schools of social work are growing in number and scope. In this article the authors argue that this increase is in line with the growing recognition that research and science are critical components of the mission of the social work profession. The authors examine the purposes and various models for establishing research…

  2. The Structure and Functioning of a Low-Budget Center for Applied Linguistics: The Brazilian Experience.

    ERIC Educational Resources Information Center

    Gomes de Matos, Francisco

    1980-01-01

    Describes the structure and functioning of the "Centro de Linguistica Aplicada do Instituto de Idiomas Yazigi" of Sao Paulo and comments on its role in promoting applied linguistics studies in Latin America. Also outlines the Center's historical background and its educational services, particularly those related to the teaching of English. (MES)

  3. The Outsourcing Experience of the Technical Library at NASA Glenn Research Center.

    ERIC Educational Resources Information Center

    Case, Mary S.

    The purpose of this study was to conduct a case study of the NASA (National Aeronautics and Space Administration) Glenn Research Center library to examine strictures related to outsourcing, how they have helped and/or harmed the relationship between the civil servants employed by the library and the contracted employees, and the management of the…

  4. Student-Centered Literacy Instruction: An Examination of an Elementary Teacher's Experience

    ERIC Educational Resources Information Center

    Wiezorek, Carolyn Marie

    2012-01-01

    In this qualitative study, I examined and interpreted the literacy instruction of a fourth grade instructor who identified herself as a student-centered teacher. I sought to understand and interpret the beliefs and attitudes of my participant, Julie. Through seven unstructured interviews and five observations, I collected, and simultaneously…

  5. Family Centered Health Care--A Viable Reality? The Denver Experience.

    ERIC Educational Resources Information Center

    Cowen, David L:; Sbarbaro, John A.

    In early 1966, the Denver Department of Health and Hospitals embarked on a city-wide, decentralized health program in an effort to provide family centered "team" health care to medically indigent patients. The program encompasses 28 different clinics and facilities. Factors hindering or influencing the final pattern of health care delivery…

  6. Intergenerational Learning at a Nature Center: Families Using Prior Experiences and Participation Frameworks to Understand Raptors

    ERIC Educational Resources Information Center

    Zimmerman, Heather Toomey; McClain, Lucy Richardson

    2014-01-01

    Using a sociocultural framework to approach intergenerational learning, this inquiry examines learning processes used by families during visits to one nature center. Data were collected from videotaped observations of families participating in an environmental education program and a follow-up task to draw the habitat of raptors. Based on a…

  7. Use of APTIMA Combo 2: The Experience of a Child Advocacy Center

    ERIC Educational Resources Information Center

    Leder, M. Ranee; Leber, Amy L.; Marcon, Mario J.; Scribano, Philip V.

    2013-01-01

    The Centers for Disease Control and Prevention recommends nucleic acid amplification testing for chlamydia and gonorrhea in sexually abused girls. No studies describe performance of APTIMA Combo 2 Assay with second target confirmation on the same testing platform. This nucleic acid amplification testing is evaluated within a large child advocacy…

  8. Volume of Cataract Surgery and Surgeon Gender: The Florida Ambulatory Surgery Center Experience 2005 Through 2012.

    PubMed

    French, Dustin D; Margo, Curtis E; Campbell, Robert R; Greenberg, Paul B

    2016-01-01

    Cataract is the most common surgically reversible cause of vision loss and the most common major surgical procedure performed in the United States. To understand how gender composition might affect differences in health services, we examined the surgeon gender-specific rates of routine cataract surgery performed in ambulatory surgical centers in Florida. Routine cataract surgeries were identified through the Florida Agency for Health Care Administration (AHCA) ambulatory surgery center dataset. The background of individual surgeons was determined by linking license numbers in the dataset to physician profiles publicly available from AHCA. From 2005 through 2012, women ophthalmologists in Florida performed roughly half the annual rate of cataract surgery as their male counterparts. This difference is not explained by greater time in clinical practice for men. Further investigation into the causes of this gender-volume disparity is warranted to determine what roles choice and barriers may play. PMID:27249881

  9. Bone marrow transplantation in Basel: single center experience from 1973 to 1989.

    PubMed

    Speck, B; Nissen, C; Tichelli, A; Roth, J; Dazzi, H; Stebler, C H; Wernli, M; Signer, E; Gratwohl, A

    1989-01-01

    Bone marrow transplantation with a small to medium-sized single hospital team is feasible. It leads to results similar to those observed at large centers and with the same major risk factors: age, stage of the disease at the time of transplant, degree of histocompatibility, graft-versus-host disease prevention method, and selection. A single small to medium-sized center cannot conduct prospective randomized studies but it can pioneer new concepts. Bone marrow transplantation today offers a good choice for patients suffering from otherwise lethal bone marrow diseases. These include severe aplastic anemia, acute leukemias, chronic myeloid and chronic lymphoid leukemia, myelodysplastic syndrome, and congenital disorders. Changes in outcome are due to innovative steps, such as the introduction of CsA for GvHD prevention. In addition they are certainly influenced by unrecognized changes in the patient selection process. PMID:2487556

  10. My personal experiences at the BEST Medical Center: A day in the clinic-the afternoon.

    PubMed

    Cohen, Philip R; Kurzrock, Razelle

    2016-01-01

    Dr. Ida Lystic is a gastroenterologist who recently began her new faculty position at the BEST (Byron Edwards and Samuel Thompson) Medical Center. After completing her MD degree at the prestigious Harvey Medical School (recently renamed the Harvey Provider School), she did her internal medicine residency and fellowship training at the OTHER (Owen T. Henry and Eugene Rutherford) Medical Center. Her morning in gastroenterology clinic was highlighted by: (1) being reprimanded by the clinic nurse manager for a patient who not only arrived early, before clinic had opened, but also neglected to schedule the anesthesiologist for his colonoscopy; (2) the continued challenges of LEGEND (also known as Lengthy and Excessively Graded Evaluation and Nomenclature for Diagnosis by her colleagues), the new electronic medical record system after the BEST discarded the SIMPLE (Succinct Input Making Patient's Lives Electronic) system; (3) a nurse's interruption of an office visit-once the egg timer on the examination room door ran out-because she had exceeded the allocated time for the appointment; and (4) her chairman's unanticipated arrival in the clinic to visit with the clinic nurse manager. In addition to seeing her patients, Dr. Lystic's afternoon is occupied by attending a LOST (Laboratory OverSight and Testing) Committee meeting and a visit from a wayfinding and signage specialist to depersonalize the doorpost plaques of the examination rooms. Her day ends with a demeaning email from her chairman regarding the poor results of the most recent patient satisfaction survey and being personally held accountable to develop solutions to improve not only her performance but also that of the clinic. Although Dr. Ida Lystic and the gastroenterology clinic at "the BEST Medical Center" are creations of the authors' imagination, the majority of the anecdotes mentioned in this essay are based on individual patients and their physicians, clinics in medical centers and their administration

  11. Resistance calculation of the face-centered cubic lattice: Theory and experiment

    NASA Astrophysics Data System (ADS)

    Owaidat, M. Q.

    2013-12-01

    The effective resistance between two arbitrary lattice points in an infinite, face-centered cubic lattice network of identical resistors is calculated using the lattice Green's function method. Theoretical results have been verified experimentally by constructing actual finite networks of resistors. This problem could be useful in undergraduate courses (e.g., advanced mathematical methods course) and would provide a good example for introducing the concept of Green's function.

  12. Creating an academy of clinical excellence at Johns Hopkins Bayview Medical Center: a 3-year experience.

    PubMed

    Wright, Scott M; Kravet, Steven; Christmas, Colleen; Burkhart, Kathleen; Durso, Samuel C

    2010-12-01

    Academic health centers (AHCs) are committed to the tripartite missions of research, education, and patient care. Promotion decisions at many AHCs focus predominantly on research accomplishments, and some members of the community remain concerned about how to reward clinicians who excel in, and spend a majority of their time, caring for patients. Many clinically excellent physicians contribute substantively to all aspects of the mission by collaborating with researchers (either through intellectual discourse or enrolling participants in trials), by serving as role models for trainees with respect to ideal caring and practice, and by attracting patients to the institution. Not giving fair and appreciative recognition to these clinically excellent faculty places AHCs at risk of losing them. The Center for Innovative Medicine at Johns Hopkins set out to address this concern by defining, measuring, and rewarding clinical excellence. Prior to this initiative, little attention was directed toward the "bright spots" of excellence in patient care at Johns Hopkins Bayview. Using a scholarly approach, the authors launched a new academy; this manuscript describes the history, creation, and ongoing activities of the Miller-Coulson Academy of Clinical Excellence at Johns Hopkins University Bayview Medical Center. While membership in the academy is honorific, the members of this working academy are committed to influencing institutional culture as they collaborate on advocacy, scholarship, and educational initiatives. PMID:20978424

  13. Cost analysis of awake versus asleep deep brain stimulation: a single academic health center experience.

    PubMed

    Jacob, R Lorie; Geddes, Jonah; McCartney, Shirley; Burchiel, Kim J

    2016-05-01

    OBJECT The objective of this study was to compare the cost of deep brain stimulation (DBS) performed awake versus asleep at a single US academic health center and to compare costs across the University HealthSystem Consortium (UHC) Clinical Database. METHODS Inpatient and outpatient demographic and hospital financial data for patients receiving a neurostimulator lead implant (from the first quarter of 2009 to the second quarter of 2014) were collected and analyzed. Inpatient charges included those associated with International Classification of Diseases, Ninth Revision (ICD-9) procedure code 0293 (implantation or replacement of intracranial neurostimulator lead). Outpatient charges included all preoperative charges ≤ 30 days prior to implant and all postoperative charges ≤ 30 days after implant. The cost of care based on reported charges and a cost-to-charge ratio was estimated. The UHC database was queried (January 2011 to March 2014) with the same ICD-9 code. Procedure cost data across like hospitals (27 UHC hospitals) conducting similar DBS procedures were compared. RESULTS Two hundred eleven DBS procedures (53 awake and 158 asleep) were performed at a single US academic health center during the study period. The average patient age ( ± SD) was 65 ± 9 years old and 39% of patients were female. The most common primary diagnosis was Parkinson's disease (61.1%) followed by essential and other forms of tremor (36%). Overall average DBS procedure cost was $39,152 ± $5340. Asleep DBS cost $38,850 ± $4830, which was not significantly different than the awake DBS cost of $40,052 ± $6604. The standard deviation for asleep DBS was significantly lower (p ≤ 0.05). In 2013, the median cost for a neurostimulator implant lead was $34,052 at UHC-affiliated hospitals that performed at least 5 procedures a year. At Oregon Health & Science University, the median cost was $17,150 and the observed single academic health center cost for a neurostimulator lead implant was

  14. Outcome of patients with glioblastoma in Saudi Arabia: Single center experience

    PubMed Central

    ALTWAIRGI, ABDULLAH K.; ALGAREEB, WALEED; YAHYA, GAAEM; MAKLAD, AHMED M.; ALY, MOAMEN MOM; AL SHAKWEER, WAFA; BALBAID, ALI; ALSAEED, EYAD; ALHUSSAIN, HUSSAIN; ORZ, YASSIR; LARY, AHMED; ELYAMANY, ASHRAF

    2016-01-01

    Glioblastoma multiforme (GBM), the most common primary brain tumor in adults, is associated with one of the worst 5 year survival rates among all human cancer types. To date, no published data are available for the outcome of this disease in Saudi Arabia. The present study performed a single-center, retrospective cohort study to evaluate the outcome of patients with GBM in Saudi Arabia. The Comprehensive Cancer Center at King Fahad Medical city (Riyadh, Saudi Arabia) was used in the present study. All adult patients (≥18 years) diagnosed with histologically proven GBM between January 2008 and December 2013 were included in the present study. A total of 90 patients were treated during the specified period. Of this, 73 (81%) patients underwent resection and 17 (19%) had biopsy only. The majority of patients (n=88; 98%) received radiotherapy (XRT): 67 (76%) with standard and 21 (24%) with hypo-fractionated dosage. Of the total patients, 65 (72%) received combined modality therapy [standard XRT concurrently with Temozolmide (TMZ)]. The 6 month progression-free survival rate was 43% for all patients and 55% for the combined modality subgroup. The median overall survival (OS) for all patients was 13.7 months. However, the median OS for patients treated with combined modality was 19.7 months. In this single-center retrospective study, the outcomes of patients with GBM were similar to those in previously reported studies. An improved outcome was associated with an improved performance status, absence of residual disease and use of adjuvant TMZ. PMID:27123275

  15. [Mycobacterial species repartition: experience of the Antituberculosis Center in Pointe Noire (Republic of Congo)].

    PubMed

    Ontsira Ngoyi, E N; Obengui; Taty Taty, R; Koumba, E L; Ngala, P; Ossibi Ibara, R B

    2014-12-01

    The aim of the present work was to describe mycobacteria species isolated in the antituberculosis center of Pointe-Noire city in Congo Brazzaville. It was a descriptive transversal study, conducted between September 2008 and April 2009 (7 months). A simple random sample was established from patients who came to the antituberculosis center of Pointe-Noire City (reference center on diagnosis and treatment of tuberculosis). To those patients consulting with symptoms leading to suspect pulmonary tuberculosis, a sputum sampling in three sessions was conducted. Staining techniques to Ziehl-Neelsen and auramine were performed in Pointe-Noire. Culture, molecular hybridization and antibiotic susceptibility testing to first-line antituberculosis drugs (isoniazid, rifampicin, ethambutol, pyrazinamide or streptomycine) using diffusion method on agar were performed in Cerba Pasteur laboratory in France. In 77 patients, 24 sputum (31.20%) were positive to the microscopic examination and 45 (58.44%) to the culture and identification by molecular hybridization. Mycobacteria species complex isolated were M. tuberculosis with 31 cases (68.9%) and M. africanum with 3 cases (6.67%). Non-tuberculous mycobacteria (NMT) were isolated in association or not with M. tuberculosis in 9 cases (20%) and the most common species were M. intracellulare. In M. tuberculosis species, 7 strains (41.20%) were tested sensitive to the first-line antituberculosis drugs, 8 cases (47%) monoresistance and 2 cases multidrug resistance at both isoniazide and rifampicine (12%) (MDR). This study showed the importance of Mycobacteria species complex and non-mycobacteria species in pulmonary tuberculosis. The data on resistance can help medical physicians in the treatment of pulmonary tuberculosis. Another study with a large population is required to confirm these data. PMID:25260392

  16. "Bath salts" and "plant food" products: the experience of one regional US poison center.

    PubMed

    Murphy, Christine M; Dulaney, Anna R; Beuhler, Michael C; Kacinko, Sherri

    2013-03-01

    Abuse of psychogenic substances sold as "bath salts" and "plant food" has escalated in recent years in the United States (USA). Previous reports suggest regional differences in the primary active β-keto phenylalkylamines found in these products and the corresponding signs and symptoms reported after exposure. Currently, there are only limited studies describing the clinical effects associated with reported "bath salts" exposure in the USA. This study describes the clinical effects associated with "bath salt" and "plant food" exposures as reported to the poison center serving the state of North Carolina (Carolinas Poison Center). We performed a retrospective review of the Carolinas Poison Center database for all cases of reported human exposure to "bath salt" and "plant food" products from 2010 to 2011 with specific attention to clinical effects and routes of exposure. Additionally, we reviewed therapies used, trended the volume of exposure cases reported over the study period, and evaluated the distribution of calls within state counties using descriptive statistics. Carolinas Poison Center received 485 total calls and 409 reported exposure calls regarding "bath salt" or "plant food" products between January of 2010 and December of 2011. The peak of reported exposures occurred in May of 2011. Clinical effects commonly reported in the exposure cases generated from these calls included tachycardia (53.3 %, n = 218), agitated/irritable (50.4 %, n = 206), hallucination/delusions (26.7 %, n = 109), and hypertension (25.2 %, n = 103). In addition to intravenous fluids, common therapies included benzodiazepines (46.0 %, n = 188), sedation (13.4 %, n = 55), alkalinization (3.90 %, n = 16), antihistamine (4.16 %, n = 17), and intubation (3.67 %, n = 15). Haloperidol was the antipsychotic agent used most often to treat agitation (n = 40). Serious complications associated with reported exposure to "bath salt" and "plant food" products

  17. Inventory management for cardiac catheterization labs: the Princeton-Baptist Medical Center experience.

    PubMed

    Long, T A

    1993-08-01

    Several issues must be considered for implementation in order to decrease inventories and make them more manageable. Physician consensus on products, strict vendor control by the department manager, setting and maintaining low par levels, inventorying stock daily, negotiating just-in-time deliveries, conservation-minded staff, and working in concert with central supply and materiel management personnel are steps that when employed correctly can lead to more manageable inventories in cardiac catheterization departments. If these steps are implemented, they will enhance the liquidity of the department and ultimately that of the medical center. PMID:10127553

  18. Holmium:YAG laser coronary angioplasty: quantitative angiography and clinical results in a large experience of a single medical center

    NASA Astrophysics Data System (ADS)

    Topaz, On; Luxenberg, Michael; Schumacher, Audrey

    1994-07-01

    Clinical experience with the mid IR holmium:YAG laser in a single medical center (St. Paul Ramsey Medical Center, University of Minnesota Medical School, St. Paul, MN) includes 112 patients who underwent holmium laser coronary angioplasty. Utilizing a unique lasing technique; `pulse and retreat,' we applied this laser to thrombotic and nonthrombotic lesions in patients presenting with unstable angina, stable angina, and acute myocardial infarction. A very high clinical success and very low complication rates were achieved. Holmium:YAG laser is effective and safe therapy for patients with symptomatic coronary artery disease. Unlike excimer lasers, the clinical success, efficacy and safety of holmium laser angioplasty is not compromised when thrombus is present.

  19. COOP 3D ARPA Experiment 109 National Center for Atmospheric Research

    NASA Technical Reports Server (NTRS)

    1998-01-01

    Coupled atmospheric and hydrodynamic forecast models were executed on the supercomputing resources of the National Center for Atmospheric Research (NCAR) in Boulder, Colorado and the Ohio Supercomputing Center (OSC)in Columbus, Ohio. respectively. The interoperation of the forecast models on these geographically diverse, high performance Cray platforms required the transfer of large three dimensional data sets at very high information rates. High capacity, terrestrial fiber optic transmission system technologies were integrated with those of an experimental high speed communications satellite in Geosynchronous Earth Orbit (GEO) to test the integration of the two systems. Operation over a spacecraft in GEO orbit required modification of the standard configuration of legacy data communications protocols to facilitate their ability to perform efficiently in the changing environment characteristic of a hybrid network. The success of this performance tuning enabled the use of such an architecture to facilitate high data rate, fiber optic quality data communications between high performance systems not accessible to standard terrestrial fiber transmission systems. Thus obviating the performance degradation often found in contemporary earth/satellite hybrids.

  20. Urinary tract infections following renal transplantation: a single-center experience.

    PubMed

    Barbouch, Samia; Cherif, Mejda; Ounissi, Mondher; Karoui, Cyrine; Mzoughi, Sonia; Hamida, Fethi Ben; Abderrahim, Ezeddine; Bozouita, Abdellatif; Abdalla, Taiebben; Kheder, Adel

    2012-11-01

    Urinary tract infection (UTI) is the most frequent infectious complication among renal transplant recipients and a frequent cause of bacteremia, sepsis and acute graft failure. To evaluate the incidence, risk factors, type of pathogens and long-term effect of UTIs on graft and patient survivals in our center, we performed a retrospective cohort study reviewing the medical records of patients who received a renal transplant at our center from June 1986 to December 2009, excluding patients who lost their grafts in the first month due to arterial or veins thrombosis and acute antibody-mediated rejection. We studied 393 kidney-transplanted recipients; at least one UTI occurred in 221 (53.69%) patients during the follow-up period. The most frequent pathogens isolated in urine culture were Escherichia coli (n = 39, 18.4%) and Klebsiella pneumonia (n = 31, 14.6%). When patients with UTIs were compared with those without UTIs, female gender and use of mycophenolate mofetil or azathioprine seemed to be risk factors for UTIs on univariate analysis. However, female gender was the only independent risk factor on multivariate analysis RR = 1.964 (1.202-3.207), P = 0.007. This study confirmed that UTIs remain a major problem in renal transplant recipients, and female gender was the only independent risk factor. PMID:23168875

  1. Liver Transplantation for Metabolic Liver Disease: Experience at a Living Donor Dominant Liver Transplantation Center

    PubMed Central

    Kim, Jun Suk; Oh, Seak Hee; Kim, Hyun Jin; Cho, Jin Min; Yoo, Han-Wook; Namgoong, Jung-Man; Kim, Dae Yeon; Kim, Ki-Hun; Hwang, Shin; Lee, Sung-Gyu

    2015-01-01

    Purpose Metabolic liver disease (MLD) often progresses to life-threatening conditions. This study intends to describe the outcomes of liver transplantation (LTx) for MLD at a living donor-dominant transplantation center where potentially heterozygous carrier grafts are employed. Methods We retrospectively evaluated the medical records of 54 patients with MLD who underwent LTx between November 1995 and February 2012 at Asan Medical Center in Seoul, Korea. The cumulative graft and patient survival rates were analyzed according to patient age, and living or deceased donor LTx. Recurrence of the original disease was also investigated. Results The post-transplant cumulative patient survival rates at one, five, and 10 years were 90.7%, 87.5% and 87.5%, and the graft survival rates were 88.8%, 85.5%, and 85.5%, respectively. There were no differences in the patient survival rates according to the recipient age, human leukocyte antigen matching, and living or deceased donor LTx. There were also no differences in the patient survival rates between the MLD and the non-MLD groups for children. Recurrence of the original metabolic disease was not observed in any patient during the follow-up period. Conclusion Our results suggest that the living donor-dominant transplantation program is well-tolerated in MLD without recurrence of the original MLD using all types of transplantation. PMID:25866733

  2. Lionfish string experiences of an inland poison center: a retrospective study of 23 cases.

    PubMed

    Trestrail, J H; al-Mahasneh, Q M

    1989-04-01

    From January 1979 through March 1988, our regional poison center, located many hundreds of miles from the nearest coastal salt water, documented 23 cases of envenomation by "Lionfish" (members of genus Pterois). All cases involved specimens which were maintained in the homes of amateur aquarists. A study of patient epidemiology showed the following: patient's sex 91.3% male, 8.7% female; patients ages ranged from 17 to 50 years with an average age for males of 29.8 years and 35 years for females; the site of the envenomation accident was always in the home; the only part of the body envenomated was the hand or finger; and all of the patients were symptomatic. Symptoms noted included sharp pain, swelling, redness, bleeding, nausea, numbness, joint pain, anxiety, headache, disorientation, and dizziness. One patient had a complication of cellulitis. Treatment provided included immersion of the effected area in hot water at 40 C for 60 to 90 min, analgesics, tetanus toxoid, and antibiotics. There were no deaths noted and treatment proved effective in all cases. This paper also discusses the natural history, clinical effects, and current treatment for envenomations from these beautiful but dangerous venomous fish, which can cause poisoning exposures that are likely to be encountered by poison centers anywhere in the world. PMID:2929130

  3. Subcutaneous Trastuzumab for HER2-positive Breast Cancer – Evidence and Practical Experience in 7 German Centers

    PubMed Central

    Jackisch, C.; Müller, V.; Dall, P.; Neumeister, R.; Park-Simon, T.-W.; Ruf-Dördelmann, A.; Seiler, S.; Tesch, H.; Ataseven, B.

    2015-01-01

    A subcutaneous formulation of trastuzumab to treat patients with HER2-positive breast cancer is available since August 2013. The subcutaneous formulation is administered as a fixed dose of 600 mg over a period of up to 5 minutes. The HannaH trial compared subcutaneous with intravenous administration and found comparable pharmacokinetics, efficacy and tolerability for both administration forms of trastuzumab in the neoadjuvant setting. The randomized crossover study PrefHer reported a clear preference from the patientʼs point of view for subcutaneous over intravenous administration of trastuzumab. The accompanying time-and-motion study reported a reduction concerning the total time spent for the institution as well as for the patient receiving trastuzumab s. c.. The experience of 7 German centers largely corresponded with the results of these studies. Patients expressed a clear preference for subcutaneous trastuzumab administration, with the time saved by the subcutaneous administration route cited as the greatest benefit. Although the existing reimbursement terms mean that centers will receive a lower remuneration, the centersʼ overall evaluation of the subcutaneous administration route for trastuzumab was overwhelmingly positive. The greatest benefit cited by the centers was the flexibility in scheduling patient appointments. This increased flexibility improved conditions in some centers which were experiencing pressures due to a shortage of staff, particularly at peak times. The general consensus, however, was that the remuneration systems for oncological treatments urgently need to be amended to ensure that the real costs of treatment are covered, even if the administration route has changed. PMID:26166837

  4. Hemoptysis workup before embolization: single-center experience with a 15-year period follow-up.

    PubMed

    de Gregorio, Miguel A; Medrano, Joaquin; Laborda, Alicia; Higuera, Teresa

    2007-12-01

    The objective of this work was to present our experience in arterial embolization in the endovascular treatment of massive hemoptysis and remark on the importance of the workup before embolization. We present some clinical aspects to keep in mind before carrying out a bronchial embolization in a patient with severe hemoptysis. The main causes of hemoptysis are presented, as well as diagnosis means and the most important therapeutic procedures aimed to stabilize the patient who will undergo a bronchial arterial embolization. Likewise, we present our own experience with 401 patients with over a 15-year period of follow-up. PMID:18572140

  5. Compulsory drug detention center experiences among a community-based sample of injection drug users in Bangkok, Thailand

    PubMed Central

    2011-01-01

    Background Despite Thailand's official reclassification of drug users as "patients" deserving care and not "criminals," the Thai government has continued to rely heavily on punitive responses to drug use such as "boot camp"-style compulsory "treatment" centers. There is very little research on experiences with compulsory treatment centers among people who use drugs. The work reported here is a first step toward filling that gap. Methods We examined experiences of compulsory drug treatment among 252 Thai people who inject drugs (IDU) participating in the Mitsampan Community Research Project in Bangkok. Multivariate logistic regression was used to identify factors independently associated with a history of compulsory treatment experience. Results In total, 80 (31.7%) participants reported a history of compulsory treatment. In multivariate analyses, compulsory drug detention experience was positively associated with current spending on drugs per day (adjusted odds ratio [AOR] = 1.86; 95%CI: 1.07 - 3.22) and reporting drug planting by police (AOR = 1.81; 95%CI: 1.04 - 3.15). Among those with compulsory treatment experience, 77 (96.3%) reported injecting in the past week, and no difference in intensity of drug use was observed between those with and without a history of compulsory detention. Conclusion These findings raise concerns about the current approach to compulsory drug detention in Thailand. Exposure to compulsory drug detention was associated with police abuse and high rates of relapse into drug use, although additional research is needed to determine the precise impact of exposure to this form of detention on future drug use. More broadly, compulsory "treatment" based on a penal approach is not consistent with scientific evidence on addressing drug addiction and should be phased out in favor of evidence-based interventions. PMID:22014093

  6. Outcome science in practice: an overview and initial experience at the Vanderbilt Spine Center.

    PubMed

    McGirt, Matthew J; Speroff, Theodore; Godil, Saniya Siraj; Cheng, Joseph S; Selden, Nathan R; Asher, Anthony L

    2013-01-01

    In terms of policy, research, quality improvement, and practice-based learning, there are essential principles--namely, quality, effectiveness, and value of care--needed to navigate changes in the current and future US health care environment. Patient-centered outcome measurement lies at the core of all 3 principles. Multiple measures of disease-specific disability, generic health-related quality of life, and preference-based health state have been introduced to quantify disease impact and define effectiveness of care. This paper reviews the basic principles of patient outcome measurement and commonly used outcome instruments. The authors provide examples of how utilization of outcome measurement tools in everyday neurosurgical practice can facilitate practice-based learning, quality improvement, and real-world comparative effectiveness research, as well as promote the value of neurosurgical care. PMID:23278268

  7. Acute Ataxia in Childhood: 11-Year Experience at a Major Pediatric Neurology Referral Center.

    PubMed

    Thakkar, Kavita; Maricich, Stephen M; Alper, Gulay

    2016-08-01

    We categorized the causes of acute ataxia in the pediatric population-referred to the Division of Neurology-at a large, urban pediatric medical center. Of the 120 cases identified over the past 11 years, post-infectious cerebellar ataxia was the most commonly diagnosed (59%), followed by drug intoxication, opsoclonus-myoclonus ataxia syndrome, episodic ataxia, acute cerebellitis, cerebellar stroke, ADEM, meningitis, cerebral vein thrombosis, Leigh's disease, Miller-Fisher syndrome, and concussion. Among the patients with post-infectious cerebellar ataxia, 85% were 1-6 years old and all had a history of antecedent viral illness. CSF pleocytosis was present in 40% of patients; all had normal brain MRIs. The majority (91%) recovered within 30 days. We conclude that post-infectious cerebellar ataxia remains the most common cause of acute ataxia in childhood and that it carries a good prognosis. We also differentiate acute post-infectious cerebellar ataxia from other causes with similar presentations. PMID:27071467

  8. NASA Glenn Research Center Experience Using DOE Midwest Region Super ESPC

    NASA Technical Reports Server (NTRS)

    Zala, Laszlo F.

    2000-01-01

    The energy crisis of 1973 prompted the Federal Government and private industry to look into alternative methods to save energy. At the same time the constant reduction of operations and maintenance funds during the last 5 years forced Glenn Research Center (GRC) to look for alternative funding sources to meet the mandate to reduce energy consumption. The Super Energy Savings Performance Contract (ESPC) was chosen as a viable source of facility improvement funding that can create larger project scope and help replace aging, inefficient equipment. This paper describes Glenn's participation in the Department of Energy (DOE) Super ESPC program. This program provided Glenn cost savings in the performance of energy audits, preparation of documents, evaluation of proposals, and selection of energy service company (ESCO).

  9. Household bleaches based on sodium hypochlorite: review of acute toxicology and poison control center experience.

    PubMed

    Racioppi, F; Daskaleros, P A; Besbelli, N; Borges, A; Deraemaeker, C; Magalini, S I; Martinez Arrieta, R; Pulce, C; Ruggerone, M L; Vlachos, P

    1994-09-01

    Bleaches based on solutions of sodium hypochlorite (NaOCl) are widely used in the household to disinfect and clean hard surfaces and to bleach the laundry. A review of both published and unpublished toxicological data is presented. In addition, the results of a survey of human accidents with hypochlorite bleaches by the Poison Control Centers of France, Italy, Belgium, Greece, Turkey, Spain and Portugal for the period 1989-1992 are presented. The data show that acute accidental exposure to household bleach in use or in foreseeable misuse situations results, in the great majority of the cases, in minor, transient adverse effects on health, with no permanent sequelae. Ingestion is the most frequent route of exposure, followed by inhalation of gases evolved by mixing sodium hypochlorite bleach with acid or alkaline products. All evidence presented confirms the normal safety profile of hypochlorite-based bleaches to be similar to that of other 'generally recognized as safe' household products. PMID:7927083

  10. Experience Transitioning Models and Data at the NOAA Space Weather Prediction Center

    NASA Astrophysics Data System (ADS)

    Berger, Thomas

    2016-07-01

    The NOAA Space Weather Prediction Center has a long history of transitioning research data and models into operations and with the validation activities required. The first stage in this process involves demonstrating that the capability has sufficient value to customers to justify the cost needed to transition it and to run it continuously and reliably in operations. Once the overall value is demonstrated, a substantial effort is then required to develop the operational software from the research codes. The next stage is to implement and test the software and product generation on the operational computers. Finally, effort must be devoted to establishing long-term measures of performance, maintaining the software, and working with forecasters, customers, and researchers to improve over time the operational capabilities. This multi-stage process of identifying, transitioning, and improving operational space weather capabilities will be discussed using recent examples. Plans for future activities will also be described.

  11. Establishing effective working relations with a potential user community - NASA Lewis Research Center experience

    NASA Technical Reports Server (NTRS)

    Foster, P.

    1977-01-01

    The NASA Lewis Research Center has held a series of six major and unique technology utilization conferences which were major milestones in planned structured efforts to establish effective working relationships with specific technology user communities. These efforts were unique in that the activities undertaken prior to the conference were extensive, and effectively laid the groundwork for productive technology transfer following, and as a direct result of, the conferences. The effort leading to the conference was in each case tailored to the characteristics of the potential user community, however, the common factors comprise a basic framework applicable to similar endeavors. The process is essentially a planned sequence of steps that constitute a technical market survey and a marketing program for the development of beneficial applications of aerospace technology beyond the aerospace field.

  12. Delayed-Interval Delivery in Dichorionic Twin Pregnancies: A Single-Center Experience

    PubMed Central

    Cozzolino, Mauro; Seravalli, Viola; Masini, Giulia; Pasquini, Lucia; Di Tommaso, Mariarosaria

    2015-01-01

    Background Preterm delivery is the most common complication of multiple gestations and is associated with high perinatal mortality. When preterm labor occurs, delivery of the first fetus is inevitable. However, successfully delaying the delivery of the second fetus can be lifesaving. Case Report We report 2 cases of delayed-interval delivery of dichorionic diamniotic twin pregnancies admitted to our emergency department at 17+5 and 22+1 weeks of gestation. After abortion of the first fetus, the second twin was left in utero, and uterine contractions ceased. The patients received antibiotics, and tocolytic therapy was administered when needed after 24 weeks. This management prolonged pregnancy for 64 and 16 days, respectively. Conclusion Although no accepted protocol for the treatment of this condition currently exists, an excellent outcome for the second fetus is possible if these pregnancies are managed in a tertiary perinatal center. PMID:26412996

  13. The Schema.org Datasets Schema: Experiences at the National Snow and Ice Data Center

    NASA Astrophysics Data System (ADS)

    Duerr, R.; Billingsley, B. W.; Harper, D.; Kovarik, J.

    2014-12-01

    Data discovery, is still a major challenge for many users. Relevant data may be located anywhere. There are currently no existing universal data registries. Often users start with a simple query through their web browser. But how do you get your data to actually show up near the top of the results? One relatively new way to accomplish this is to use schema.org dataset markup in your data pages. Theoretically this provides web crawlers the additional information needed so that a query for data will preferentially return those pages that were marked up accordingly. The National Snow and Ice Data Center recently implemented an initial set of markup in the data set pages returned by its catalog. The Datasets data model, our process, challenges encountered and results will be described.

  14. An Academic Medical Center's Experience with Mandatory Managed Care for Medicaid Recipients.

    ERIC Educational Resources Information Center

    Hillman, Alan L.; And Others

    1991-01-01

    This paper reports on experiences and concerns of the Hospital of the University of Pennsylvania as a participating primary care site in a Medicaid managed care program (HealthPASS). Discussed are the modification of existing activities to meet increased care demands and administrative demands, and characteristics of HealthPASS that have impeded…

  15. Managing Disaster Recovery Centers on Campus: The Experience of Southeastern Louisiana University

    ERIC Educational Resources Information Center

    Lawrence, Heather; Shafer, Duane

    2007-01-01

    When Hurricane Katrina hit the Gulf Coast in August 2005, Southeastern Louisiana University was spared the brunt of the storm and was fortunate that most structures on campus remained intact. However, the storm still affected the campus for weeks. This article reflects on the experiences of university leaders and facility managers as they provided…

  16. Hitting the TARGET? A Case Study of the Experiences of Teachers in Steel Mill Learning Centers.

    ERIC Educational Resources Information Center

    Rose, Amy D.; Jeris, Laurel; Smith, Robert

    Part of a larger study on the experience of teaching in the steel mill learning environment was an inquiry focused on professional development. Teachers and coordinators were all members of the Teachers Action Research Group for Educational Technology (TARGET), a group of adult educators interested in improving learning and teaching in career…

  17. Group Project Work and Student-centered Active Learning: Two Different Experiences.

    ERIC Educational Resources Information Center

    Livingstone, David; Lynch, Kenneth

    2000-01-01

    Compared experiences with group-based student projects in a Geographical Information Systems degree taught by one faculty member and in geography degree modules taught by another. Concludes that care must be taken in the design and execution of these projects to avoid problems that might reinforce myths about negative effects of team-based…

  18. The Manuel Lujan, Jr. Neutron Scattering Center LANSCE experiment reports 1989 run cycle

    SciTech Connect

    Hyer, D.K.; DiStravolo, M.A.

    1990-10-01

    This report contains a listing and description of experiments carried on at the LANSCE neutron scattering facility in the following areas: High Density Powder Diffraction; Neutron Powder Diffractometer, (NPD); Single Crystal Diffractometer, (SCD); Low-Q Diffractometer, (LQD); Surface Profile Analysis Reflectometer, (SPEAR); Filter Difference Spectrometer, (FDS); and Constant-Q Spectrometer.

  19. Online Digital Archives Technology That Supports Rich, Student-Centered Learning Experiences

    ERIC Educational Resources Information Center

    Hofer, Mark

    2004-01-01

    Today's students watch the newest movie trailers on the Web, share music files, play video games with other players over the Internet, and swap digital pictures of the latest teen idols. Donald Tapscott points out in his book Growing Up Digital that as this rich multimedia experience becomes more a part of students' lives outside of school, they…

  20. The Pawnee Experience: From Center Village to Oklahoma (Junior High Unit).

    ERIC Educational Resources Information Center

    Solberg, Chris; Goldenstein, Erwin, Ed.

    A sample packet on the Pawnee experience, developed for use by junior high teachers, includes a reading list and materials for teachers and students. Sections on Pawnee origins, history, religion and world view, tribal structure and kinship, and economic system before and after relocation from Nebraska to Oklahoma include objectives, lists of…

  1. Authorship in a Multi-Center Clinical Trial: the HF-ACTION Experience

    PubMed Central

    Whellan, DJ; Kraus, WE; Kitzman, DW; Rooney, B; Keteyian, SJ; Piña, IL; Ellis, SJ; Ghali, JK; Lee, K; Cooper, L; O'Connor, CM

    2015-01-01

    Background Few guidelines exist regarding authorship on manuscripts resulting from large multicenter trials. The HF-ACTION investigators devised a system to address assignment of authorship on trial publications and tested the outcomes in the course of conducting the large, multi-center, NHLBI-funded trial (n=2,331; 82 clinical sites; 3 countries). The HF-ACTION Authorship and Publication (HAP) Scoring System was designed to enhance rate of dissemination, recognize investigator contributions to the successful conduct of the trial, and harness individual expertise in manuscript generation. Methods The HAP score was generated by assigning points based on investigators’ participation in trial enrollment, follow-up, and adherence, as well as participation in committees and other trial activity. Overall publication rates, publication rates by author, publication rates by site, and correlation between site publication and HAP score using a Poisson regression model were examined. Results Fifty peer-reviewed, original manuscripts were published within 6.5 years following conclusion of study enrollment. In total, 137 different authors were named in at least 1 publication. Forty-five of the 82 sites (55%) had an author named to at least one manuscript. A Poisson regression model examining incident rate ratios revealed that a higher HAP score resulted in a higher incidence of a manuscript, with a 100-point increase in site score corresponding to an approximately 32% increase in the incidence of a published manuscript. Conclusions Given the success in publishing a large number of papers and widely distributing authorship, regular use of a transparent, objective authorship assignment system for publishing results from multi-center trials may be recommended to optimize fairness and dissemination of trial results. PMID:25819851

  2. Incidence of Atypical Femur Fractures in Cancer Patients: The MD Anderson Cancer Center Experience.

    PubMed

    Edwards, Beatrice J; Sun, Ming; West, Dennis P; Guindani, Michele; Lin, Yan Heather; Lu, Huifang; Hu, Mimi; Barcenas, Carlos; Bird, Justin; Feng, Chun; Saraykar, Smita; Tripathy, Debasish; Hortobagyi, Gabriel N; Gagel, Robert; Murphy, William A

    2016-08-01

    Atypical femoral fractures (AFFs) are rare adverse events attributed to bisphosphonate (BP) use. Few cases of AFF in cancer have been described; the aim of this study is to identify the incidence and risk factors for AFF in a large cancer center. This retrospective study was conducted at the MD Anderson Cancer Center. The incidence rate of AFF among BP users was calculated from January 1, 2004 through December 31, 2013. The control group (n = 51) included 2 or 3 patients on BPs matched for age (≤1 year) and gender. Logistic regression analysis was used to assess the relationship between clinical characteristics and AFF. Twenty-three AFF cases were identified radiographically among 10,587 BP users, the total BP exposure was 53,789 months (4482 years), and the incidence of AFF in BP users was 0.05 cases per 100,000 person-years. Meanwhile, among 300,553 patients who did not receive BPs there were 2 cases of AFF as compared with the 23 cases noted above. The odds ratio (OR) of having AFF in BP users was 355.58 times higher (95% CI, 84.1 to 1501.4, p < 0.0001) than the risk in non-BP users. The OR of having AFF in alendronate users was 5.54 times greater (OR 5.54 [95% CI, 1.60 to 19.112, p = 0.007]) than the odds of having AFF among other BP users. Patients who were on zoledronic acid (ZOL) had smaller odds of developing AFF compared with other BP users in this matched case control sample. AFFs are rare, serious adverse events that occur in patients with cancer who receive BP therapy. Patients with cancer who receive BPs for prior osteoporosis therapy or for metastatic cancer are at higher risk of AFF. © 2016 American Society for Bone and Mineral Research. PMID:26896384

  3. Diversity of Disorders Causing Neonatal Cholestasis – The Experience of a Tertiary Pediatric Center in Germany

    PubMed Central

    Hoerning, André; Raub, Simon; Dechêne, Alexander; Brosch, Michelle N.; Kathemann, Simone; Hoyer, Peter F.; Gerner, Patrick

    2014-01-01

    Background and Objective: Rapidly establishing the cause of neonatal cholestasis is an urgent matter. The aim of this study was to report on the prevalence and mortality of the diverse disorders causing neonatal cholestasis in an academic center in Germany. Methods: Clinical chemistry and cause of disease were retrospectively analyzed in 82 infants (male n = 42, 51%) that had presented with neonatal cholestasis to a tertiary medical center from January 2009 to April 2013. Results: Altogether, 19 disorders causing neonatal cholestasis were identified. Biliary atresia was the most common diagnosis (41%), followed by idiopathic cases (13%), progressive familial intrahepatic cholestasis (PFIC, 10%), cholestasis in preterm infants (10%), α1AT deficiency, Alagille syndrome, portocaval shunts, mitochondriopathy, biliary sludge (all 2%), and others. Infants with biliary atresia were diagnosed with a mean age of 62 days, they underwent Kasai portoenterostomy ~66 days after birth. The majority of these children (~70%) received surgery within 10 weeks of age and 27% before 60 days. The 2-year survival with their native liver after Kasai procedure was 12%. The time span between Kasai surgery and liver transplantation was 176 ± 73 days. Six children (7%), of whom three patients had a syndromic and one a non-syndromic biliary atresia, died prior to liver transplantation. The pre- and post-transplant mortality rate for children with biliary atresia was ~12 and ~17%, respectively. Conclusion: Neonatal cholestasis is a severe threat associated with a high risk of complications in infancy and it therefore requires urgent investigation in order to initiate life saving therapy. Although in the last 20 years new causes such as the PFICs have been identified and newer diagnostic tools have been introduced into the clinical routine biliary atresia still represents the major cause. PMID:25003101

  4. The 10-year Trend of Periprocedural Complication Following Carotid Artery Stenting; Single Center Experience

    SciTech Connect

    Hong, Jeong-Ho; Kang, Jihoon; Yeo, Min-Ju; Kim, Beom Joon; Jang, Min Uk; Bae, Hee-Joon; Kwon, O-Ki; Hwang, Gyo Jun; Oh, Chang Wan; Jung, Cheolkyu; Lee, Ji Sung; Han, Moon-Ku

    2015-04-15

    PurposeCarotid endarterectomy and stenting are used to treat carotid stenosis, with the volume of carotid artery procedures increasing over the past decade. We investigated the 10-year trend of periprocedural complications with an increasing procedure volume of carotid stenting at a single tertiary hospital.MethodsWe collected 416 consecutive cases (384 patients) of carotid artery stenting performed for either symptomatic (231 cases, 55.5 %) or asymptomatic (185 cases, 44.5 %) internal carotid artery stenosis at a single center. Periprocedural complication was defined as any stroke, myocardial infarction, or death. Procedure-related outcome included any dissection, hemodynamic event, or periprocedural complication.ResultsThe mean age was 68.8 years (82.8 % males; range of 20–89 years); 23.9 % were older than 75 years. Before the procedure, 99.3 and 56.0 % of patients received antiplatelet and lipid-lowering medication, respectively. The overall periprocedural complication rate was 3.6 % (1.6 and 5.2 % in the asymptomatic and symptomatic group, respectively). The composite outcome of any stroke or death was 3.4 %. Periprocedural complication and procedure-related outcome showed a decremental trend with increasing procedure volume, and this trend remained after adjusting for confounders.ConclusionsOur study suggests that carotid stenting at an experienced center might reduce the periprocedural complications. Our periprocedural complication rate of carotid artery stenting may be comparable to, or somewhat lower than, that reported in other clinical trials.

  5. Single center TAVR experience with a focus on the prevention and management of catastrophic complications

    PubMed Central

    Kapadia, Samir R; Svensson, Lars G; Roselli, Eric; Schoenhagen, Paul; Popovic, Zoran; Alfirevic, Andrej; Barzilai, Benico; Krishnaswamy, Amar; Stewart, William; Mehta, Anand; lal Poddar, Kanhaiya; Parashar, Akhil; Modi, Dhruv; Ozkan, Alper; Khot, Umesh; Lytle, Bruce W; Murat Tuzcu, E

    2014-01-01

    Background Transcatheter aortic valve replacement (TAVR) is an important treatment option for patients with severe symptomatic aortic stenosis (AS) who are inoperable or at high risk for complications with surgical aortic valve replacement. We report here our single-center data on consecutive patients undergoing transfemoral (TF) TAVR since the inception of our program, with a special focus on minimizing and managing complications. Methods The patient population consists of all consecutive patients who underwent an attempted TF-TAVR at our institution, beginning with the first proctored case in May 2006, through December 2012. Clinical, procedural, and echocardiographic data were collected by chart review and echo database query. All events are reported according to Valve Academic Research Consortium-2. Results During the study period, 255 patients with AS had attempted TF-TAVR. The procedure was successful in 244 (95.7%) patients. Serious complications including aortic annular rupture (n = 2), coronary occlusion (n = 2), iliac artery rupture (n = 1), and ventricular embolization (n = 1) were successfully managed. Death and stroke rate at 30 days was 0.4% and 1.6%, respectively. One-year follow-up was complete in 171 (76%) patients. One-year mortality was 17.5% with a 3.5% stroke rate. Descending aortic rupture, while advancing the valve, was the only fatal procedural event. There were 24.4% patients with ≥2+ aortic regurgitation. Conclusions TAVR can be accomplished with excellent safety in a tertiary center with a well-developed infrastructure for the management of serious complications. The data presented here provide support for TAVR as an important treatment option, and results from randomized trials of patients with lower surgical risk are eagerly awaited. PMID:24407775

  6. Blood blister-like aneurysms: single center experience and systematic literature review.

    PubMed

    Gonzalez, Ana Marcos; Narata, Ana Paula; Yilmaz, Hasan; Bijlenga, Philippe; Radovanovic, Ivan; Schaller, Karl; Lovblad, Karl-Olof; Pereira, Vitor Mendes

    2014-01-01

    Blood blister-like aneurysms (BBAs) are a controversial entity. They arise from non-branching sites on the supraclinoid internal carotid artery (ICA) and are suspected to originate from a dissection. Our aim is to describe the BBA cases seen in our center and to present a systematic review of the literature on BBAs. We analyzed the eleven cases of BBA admitted to our center from 2003 to 2012. We assessed the medical history, treatment modality (endovascular and/or surgery), complications and clinical outcome. The cohort included 8 women and 4 men with a mean age of 53.16 years. Treatment of the BBA consisted of stenting and coiling in 5 patients, stenting only in 4 patients, coiling and clipping in 1 patient, clipping only in 1 patient, and conservative treatment in 1 patient. A good outcome was found in 10 patients, as defined by a modified Rankin Scale (mRS) less than or equal to two at three months. A systematic review of the literature was performed, and 314 reported patients were found: 221 patients were treated with a primarily surgical approach, and 87 patients were treated with a primarily endovascular approach. A rescue or second treatment was required in 46 patients (21%). The overall estimated treatment morbidity rate was 17%, and the mortality rate was 15%. BBAs exhibit more aggressive behavior compared to saccular aneurysms, and more intra-operative complications occur with BBAs, independent of the treatment type offered. They are also significantly more likely to relapse and rebleed after treatment. Endovascular treatment offers a lower morbidity-mortality compared with surgical approaches. Multilayer flow-diverting stents appear to be a promising strategy. PMID:24231267

  7. Male victims of sexual assault; 10 years' experience from a Danish Assault Center.

    PubMed

    Larsen, Mie-Louise; Hilden, Malene

    2016-10-01

    This study aims to provide descriptive data regarding male victims of sexual assault seen at the Centre for Victims of Sexual Assault in Copenhagen, Denmark. All 55 male victims attending the center in the time period of March 2001 until December 2010 underwent a standardized data collection. Data included information on the victim and the sexual assault. Male victims accounted for less than 2% of the total number of visits to the center in this time period. Fifty three percent were between 15 and 24 years. In all cases the perpetrator was male, and 25% were assaulted by more than one perpetrator. Of the 62% of male victims who gave information on sexual orientation, 36% reported themselves as heterosexuals. A total of 45.5% had an alcohol intake of more than 5 units in the hours before the assault. Forty two percent reported the assault to the police. The male victims differed from female victims in several ways; they were more often assaulted by a stranger; more likely to be assaulted by more than one perpetrator; more likely being victim of drug rape; less likely to have experienced previous sexual abuse and less willing to report their assault to the police. Being victim of a sexual assault by another man is considered a taboo subject and it is likely that the dark figure of men exposed to sexual assault is much higher than it is for women. Strengthening our knowledge regarding male victims of sexual assault is necessary to improve both primary and secondary preventive measures in order to make male victims feel safe in coming forward. Male victims should have equal access to both medical and psychological help as female victims. PMID:27391940

  8. Cardiovascular Impact of Eating Disorders in Adults: A Single Center Experience and Literature Review

    PubMed Central

    Sardar, Muhammad Rizwan; Greway, Andrea; DeAngelis, Michael; Tysko, Erin O'Malley; Lehmann, Shawn; Wohlstetter, Melinda; Patel, Riti

    2015-01-01

    Eating disorders have multiple medical sequelae, including potentially life-threatening cardiovascular complications. This article describes our cardiology practice experience of treating adults with eating disorders in the outpatient setting and documents baseline cardiac findings in this complex patient population. We describe our findings in patients across the spectrum of eating disorders; past studies have generally focused on anorexia only. This article also includes a review of the current literature on cardiovascular complications associated with disordered eating. PMID:27326349

  9. Mass storage system experiences and future needs at the National Center for Atmospheric Research

    NASA Technical Reports Server (NTRS)

    Olear, Bernard T.

    1992-01-01

    This presentation is designed to relate some of the experiences of the Scientific Computing Division at NCAR dealing with the 'data problem'. A brief history and a development of some basic Mass Storage System (MSS) principles are given. An attempt is made to show how these principles apply to the integration of various components into NCAR's MSS. There is discussion of future MSS needs for future computing environments.

  10. The Manuel Lujan, Jr. Neutron Scattering Center, LANSCE experiment reports: 1990 Run Cycle

    SciTech Connect

    DiStravolo, M.A.

    1991-10-01

    This year was the third in which LANSCE ran a formal user program. A call for proposals was issued before the scheduled run cycles, and experiment proposals were submitted by scientists from universities, industry, and other research facilities around the world. An external program advisory committee, which LANSCE shares with the Intense Pulsed Neutron Source (IPNS), Argonne National Laboratory examined the proposals and made recommendations. At LANSCE, neutrons are produced by spallation when a pulsed, 800-MeV proton beam impinges on a tungsten target. The proton pulses are provided by the Clinton P. Anderson Meson Physics Facility (LAMPF) accelerator and an associated Proton Storage Ring (PSR), which can alter the intensity, time structure, and repetition rate of the pulses. The LAMPF protons of Line D are shared between the LANSCE target and the Weapons Neutron Research facility, which results in LANSCE spectrometers being available to external users for unclassified research about 80% of each six-month LAMPF run cycle. Measurements of interest to the Los Alamos National Laboratory may also be performed and may occupy up to an additional 20% of the available beam time. These experiments are reviewed by an internal program advisory committee. One hundred thirty-four proposals were submitted for unclassified research and twelve proposals for research of a programmatic nature to the Laboratory. Our definition of beam availability is when the proton current from the PSR exceeds 50% of the planned value. The PSR ran at 65{mu}A current (average) at 20 Hz for most of 1990. All of the scheduled experiments were performed and experiments in support of the LANSCE research program were accomplished during the discretionary periods.

  11. Major Complications of Pneumatic Dilation and Heller Myotomy for Achalasia: Single Center Experience and Systematic Review of the Literature

    PubMed Central

    Lynch, Kristle L; Pandolfino, John E; Howden, Colin W; Kahrilas, Peter J

    2013-01-01

    Background & Aims Pneumatic dilation (PD) and laparoscopic Heller myotomy (LHM) can be definitive therapies for achalasia; recent data suggest comparable efficacy. However, risk must also be considered. We reviewed the major complication rate of PD and LHM in a high volume center and reviewed the corresponding literature. Methods We reviewed 12 years of our institution’s achalasia treatment experience. During this interval a consistent technique of PD was used utilizing Rigiflex dilators. Medical records were reviewed for post-procedure complications. We administered a telephone survey and examined medical records to assess efficacy of treatment. We also performed a systematic review of the literature for comparable clinical data and examined 80 reports encompassing 12,494 LHM and PD procedures. Results At our center, 463 achalasia patients underwent 567 PD or LHM procedures. 78% of the PDs used a 30 mm Rigiflex dilator. 157/184 (85%) patients underwent 1 or 2 PD without any subsequent treatment. There were seven clinically significant perforations; one from PD and 6 from LHM. There were no resultant deaths from these perforations; two deaths occurred within 30 days of LHM from unrelated causes. Complications and deaths post-PD were significantly fewer than those post-LHM (p=.02). Conclusions Esophageal perforation from PD at our high-volume center was less common than often reported and lower than that associated with LHM. We conclude that, in the hands of experienced operators using conservative technique, PD has fewer major complications and deaths than LHM. PMID:23032978

  12. The end-of-life experiences of 9/11 civilians: death and dying in the World Trade Center.

    PubMed

    Rosenthal, M Sara

    2013-01-01

    This bioethics analysis of trapped civilians in the World Trade Center (WTC) on September 11, 2001, is based on a review of materials in the public domain. Death and dying experiences are divided into three major groups: sudden death, of which there was virtually no suffering or foreknowledge; deaths in which there was a maximum of 102 minutes of suffering; and death by falling or jumping, in which an autonomous decision may have been exercised as a palliative approach. A content analysis of publicly available records of this event reveals many types of end-of-life decisions were being made within the 102-minute time frame from aircraft impact to collapse. Many WTC occupants experienced intensified suffering directly consequent to unprepared emergency dispatchers and inaccurate instructions. Truthtelling and appropriate end-of-life dialogues could have reduced loss of life, suffering, and led to qualitatively improved dying experiences. PMID:24416875

  13. Evolution in the diagnosis and treatment of autoimmune pancreatitis: experience from a single tertiary care center

    PubMed Central

    Yurci, Alper; Stevens, Tyler; Shah, Shetal N; Law, Ryan E; Walsh, Matthew R; Yerian, Lisa; Liu, Xiuli

    2013-01-01

    Background: Autoimmune pancreatitis (AIP) is a recently characterized disease with specific clinical, radiographic, and histological features. These diagnostic features have been codified in the recently revised HISORt criteria. The aim of this study was to determine how the recognition and management of AIP has evolved at our center since the publication of the HISORt criteria in 2006. Methods: We conducted a historical cohort study consisting of patients with AIP based on the revised HISORt criteria seen at our tertiary care center since 1990. Cases were identified from pathology, laboratory, and pancreas clinic databases. The medical records were reviewed to ascertain demographic and clinical characteristics, radiologic and laboratory results, and patient outcomes. When available, prior images and pathology slides were retrospectively reviewed. The clinical outcomes of the patients were assessed following surgical or medical treatment, and compared based on the calendar year of presentation (before or after 2006). Results: Forty-seven cases were identified based on the revised HISORt criteria. Of these, 22 were evaluated before and 25 after January 1, 2006. In the early cohort, the diagnosis was frequently missed, including 15 patients that underwent surgical resections. None from the early cohort had a serum IgG4 drawn or mention of possible AIP in the imaging reports. When histology was obtained, the surgical pathologist did not perform IgG4 or Movat stain to allow a histological diagnosis of AIP. Several patients developed diabetes (n=3), calcific pancreatitis with exocrine insufficiency (n=3), proximal biliary strictures (n=7), and pancreatic cancer (n=1) during follow-up. In contrast, patients in the late cohort were less likely to undergo a surgical resection that the early cohort (36% vs. 68%, p=0.042). They were more likely to have a serum IgG4 drawn (80% vs. 0%) and to undergo a corticosteroid trial (44% vs. 0%, p=0.0003). 10/11 patients (92%) who

  14. Circumcision with Glubran® 2 in children: experience of Italian Center

    PubMed Central

    Cerchia, Elisa; Molinaro, Francesco; Bulotta, Anna Lavinia; Ferrara, Francesco; Bindi, Edoardo; Messina, Mario

    2016-01-01

    Background Circumcision is one of the most common surgical procedures in the world. Despite it is known its wide prevalence for religious and medical reasons in children, it remains a controversial practice in paediatric age. To date, there is no described the gold standard technique to circumcise paediatric patients. We started to use glue for circumcision about 2 years ago. We designed this prospective study with the aim to compare two surgical techniques, which were used in our hospital to perform circumcision in children. The implication for practice was the understanding if there were differences between these approaches related to patient’s and parents benefits to manage this condition and benefits for surgeon and hospital in term of saving money and time. Methods This is a randomized, single-blind one-center study. It was conducted at the Department of Paediatric Surgery of Siena. Data were collected between March 2011 and December 2012. Study’s population involved all patients who required circumcision. Two randomizes groups: group one which involved patients who underwent circumcision using sutures and group two, which involved patients who underwent circumcision using surgical glue (Glubran® 2). Two exclusion criteria were used: the redo-circumcision and the allergy or hyper-sensibility to cyanoacrylate (main component of glue). Results We report 99 patients who underwent circumcision with Glubran® 2 in comparison with a group of children circumcised with sutures (vycril rapide). We measured three outcomes (operating time, postoperative pain and assessment of cosmetic), which, even if not all statistically significant, allowed us to draw any conclusions about the use of glue in circumcision. Conclusions Traditional circumcision is performed using a standard sleeve technique with sutures for the approximation of the skin edges. However, since some years a tissue adhesive as N-butyl-2-cyanoacrylate (NBCA) (Glubran® 2) is used in many centers to

  15. Wide-Angle Refraction Tomographic Inversion of Mid Cayman Spreading Center and its Oceanic Core Complex, CaySEIS Experiment

    NASA Astrophysics Data System (ADS)

    Harding, J.; Van Avendonk, H. J.; Hayman, N. W.; Grevemeyer, I.; Peirce, C.; Dannowski, A.; Papenberg, C. A.

    2015-12-01

    The CaySEIS experiment, conducted in April 2015, is a multi-national collaborative seismic study of the Mid Cayman Spreading Center (MCSC), an ultra-slow spreading center [15 mm/yr fr] in the Caribbean Sea. Ultra-slow spreading centers are thought to have very thin crust and a paucity of magmatism due to cooler mantle conditions. However, the suggestion that gabbro-cored oceanic core complexes (OCCs), volcanic deposits, and multiple layers of hydrothermal vents are widespread in the MCSC and other ultra-slow spreading centers has led to questions about the relationship between seafloor spreading rates and magmatism. To investigate this further, we conducted the CaySEIS experiment, with five wide-angle seismic refraction lines parallel and perpendicular to the neovolcanic zone. This analysis is based on two east-west oriented 100-km-long seismic refraction lines, which were each occupied by 18 ocean bottom seismometers. Line 2 lies across the central MCSC and an OCC called Mt. Dent. Line 3 crosses the northern end of the MCSC near the Oriente Transform Zone. With the wide-angle OBS data we can image the seismic velocity structure of Mt. Dent and distinguish between two models of OCCs - either Mt. Dent is composed of mostly gabbro with peridotite lenses identified by a low velocity gradient, or it is composed of mostly peridotite with gabbroic bodies identified by a constant velocity gradient. The crustal structure of both lines gives more insight into the asymmetry of the MCSC and the style of seafloor spreading to the east vs. the west. The 2-D velocity models reveal Mt. Dent has thick crust of 8 km with a low velocity gradient, supporting the magmatic gabbroic origin of OCCs. The surrounding crust to the west of the MCSC is highly variable, with areas of very thin crust. The crust to the east of the MCSC has an approximately constant thickness of 4 km. The development of OCCs may contribute to the crustal heterogeneity of ultra-slow spreading centers.

  16. Frequency of kidney diseases and clinical indications of pediatric renal biopsy: A single center experience

    PubMed Central

    Imtiaz, S.; Nasir, K.; Drohlia, M. F.; Salman, B.; Ahmad, A.

    2016-01-01

    Kidney biopsy occupies a fundamental position in the management of kidney diseases. There are very few renal pathology studies available in the literature from developing world. This study scrutinized the frequency and clinicopathological relationship of kidney biopsies done at the kidney center from 1997 to 2013 amongst pediatric patients. Kidney allograft biopsy were excluded. The specimen was examined under light microscopy and immunofluorescence while electron microscopy was not done. The study includes 423 patients, mean age was 10.48 ± 4.58 years, males 245 (57.9%) were more than females 178 (42.1%). Nephrotic syndrome 314 (74.2%) was the most common clinical presentation followed by acute nephritic syndrome 35 (8.3%) and acute renal failure 24 (5.7%). Primary glomerulonephritis (PGN) was the most common group of diseases, seen in 360 (85.1%) followed by secondary glomerulonephritis (SGN) in 27 (6.4%) and tubulointerstitial nephritis in 21 (5.0%). Among PGN, minimal change disease (MCD) was the most dominant disease, with 128 (30.3%) cases followed by focal segmental glomerulosclerosis FSGS in 109 (25.8%) and membranous glomerulonephropathy in 27 (6.4%). Lupus nephritis (LN) was the leading cause of glomerular disease in SGN followed by hemolytic uremic syndrome. In conclusion, MCD is the most common histological finding, especially in younger children and FSGS is second to it. SGN is rare, and the most common disease in this category is LN while tubulointerstitial and vascular diseases are infrequent. PMID:27194835

  17. Insulin degludec and insulin degludec/insulin aspart in Ramadan: A single center experience

    PubMed Central

    Kalra, Sanjay

    2016-01-01

    This study aimed to document the utility and safety of insulin degludec (IDeg) and insulin degludec aspart (IDegAsp) in persons with type 2 diabetes, observing the Ramadan fast. An observational study was conducted at a single center, in the real world setting, on six persons who either switched to IDeg or IDegAsp a month before Ramadan or changed time of administration of IDegAsp at the onset of Ramadan, to keep the fast in a safe manner. Subjects were kept under regular monitoring and surveillance before, during, and after Ramadan, and counseled in an opposite manner. Four persons, who shifted from premixed insulin to IDegAsp, experienced a 12–18% dose reduction after 14 days. At the onset of Ramadan, the Suhur dose was reduced by 30%, and this remained unchanged during the fasting month. The Iftar dose had to be increased by 4 units. One person who shifted from neutral protamine hagedorn to IDeg demonstrated a 25% dose reduction at 20 days, without any further change in insulin requirement during Ramadan. One person who changed time of injection of IDegAsp from morning to night reported no change in dosage. No episode of major hypoglycemia was reported. IDeg and IDegAsp are effective, safe, and well-tolerated means of achieving glycemic control in persons with type 2 diabetes who wish to fast. PMID:27366727

  18. Comparison of Capsule Endoscopy Findings to Subsequent Double Balloon Enteroscopy: A Dual Center Experience.

    PubMed

    Kalra, Amandeep S; Walker, Andrew J; Benson, Mark E; Soni, Anurag; Guda, Nalini M; Misha, Mehak; Gopal, Deepak V

    2015-01-01

    Background. There has been a growing use of both capsule endoscopy (CE) and double balloon enteroscopy (DBE) to diagnose and treat patients with obscure gastrointestinal blood loss and suspected small bowel pathology. Aim. To compare and correlate sequential CE and DBE findings in a large series of patients at two tertiary level hospitals in Wisconsin. Methods. An IRB approved retrospective study of patients who underwent sequential CE and DBE, at two separate tertiary care academic centers from May 2007 to December 2011, was performed. Results. 116 patients were included in the study. The mean age ± SD was 66.6 ± 13.2 years. There were 56% males and 43.9% females. Measure of agreement between prior capsule and DBE findings was performed using kappa statistics, which gave kappa value of 0.396 with P < 0.001. Also contingency coefficient was calculated and was found to be 0.732 (P < 0.001). Conclusions. Our study showed good overall agreement between DBE and CE. Findings of angioectasia had maximum agreement of 69%. PMID:26420979

  19. Is one head and neck immobilization system as good as another? One center's experience

    SciTech Connect

    Lord, Leah Bapp; May, Sharon; Bailey, Michael; Smith, Leigh

    2003-03-31

    The William Buckland Radiotherapy Center has used 2 different immobilization systems for patients requiring radiotherapy to the head-and-neck region. A polycarbonate mask was manufactured for radical treatments and a thermoplastic mask for palliative treatments. This study evaluated field placement accuracy, staff opinion, and production costs of both systems. The manual matching program of Varian PortalVision Electronic Portal Imaging (EPI) System was used to assess field placement accuracy on a daily basis. Radiation therapists (RTs) were surveyed before and after the study to determine their opinions of each system. Production time and required materials were recorded to assess cost. Nineteen patients from each system had daily EPI results compiled with no statistically significant difference observed in field placement accuracy. The thermoplastic system was found to be more cost efficient due to a combination of the reduced production time and reuseability of the masks. User acceptability of the thermoplastic system has increased so that it is now the preferred system. In conclusion, the thermoplastic system is a viable alternative to the polycarbonate system in terms of treatment accuracy and cost. It is recommended that the thermoplastic system be used for all radical and palliative treatments. In addition, RTs prefer the thermoplastic system.

  20. Frequency of kidney diseases and clinical indications of pediatric renal biopsy: A single center experience.

    PubMed

    Imtiaz, S; Nasir, K; Drohlia, M F; Salman, B; Ahmad, A

    2016-01-01

    Kidney biopsy occupies a fundamental position in the management of kidney diseases. There are very few renal pathology studies available in the literature from developing world. This study scrutinized the frequency and clinicopathological relationship of kidney biopsies done at the kidney center from 1997 to 2013 amongst pediatric patients. Kidney allograft biopsy were excluded. The specimen was examined under light microscopy and immunofluorescence while electron microscopy was not done. The study includes 423 patients, mean age was 10.48 ± 4.58 years, males 245 (57.9%) were more than females 178 (42.1%). Nephrotic syndrome 314 (74.2%) was the most common clinical presentation followed by acute nephritic syndrome 35 (8.3%) and acute renal failure 24 (5.7%). Primary glomerulonephritis (PGN) was the most common group of diseases, seen in 360 (85.1%) followed by secondary glomerulonephritis (SGN) in 27 (6.4%) and tubulointerstitial nephritis in 21 (5.0%). Among PGN, minimal change disease (MCD) was the most dominant disease, with 128 (30.3%) cases followed by focal segmental glomerulosclerosis FSGS in 109 (25.8%) and membranous glomerulonephropathy in 27 (6.4%). Lupus nephritis (LN) was the leading cause of glomerular disease in SGN followed by hemolytic uremic syndrome. In conclusion, MCD is the most common histological finding, especially in younger children and FSGS is second to it. SGN is rare, and the most common disease in this category is LN while tubulointerstitial and vascular diseases are infrequent. PMID:27194835

  1. Evaluation of cardiac masses by CMR-strengths and pitfalls: a tertiary center experience.

    PubMed

    Tumma, Roja; Dong, Wei; Wang, Jing; Litt, Harold; Han, Yuchi

    2016-06-01

    Cardiovascular magnetic resonance (CMR) imaging is often considered the reference method to assess cardiac tumors. However, little data exists concerning the effectiveness of CMR for the accurate diagnosis of cardiac masses. We sought to understand the diagnostic value of CMR for evaluation of suspected cardiac mass. A total of 249 consecutive CMR cases performed at a single center from January 2005 to June 2013 for evaluation of masses found on echocardiography or computed tomography (CT) were included. All the clinical data and imaging features of these patients were retrospectively reviewed and medical records were verified for follow up care. More than half of the patients referred for evaluation of masses found at echocardiography or CT were found to have no evidence of mass by CMR. CMR correctly differentiated between thrombus and myxoma in 88.4 % cases. Malignant masses were accurately diagnosed on CMR. However, CMR missed or misdiagnosed a few cases of benign masses. Diagnosing cardiac masses remains an important use for imaging, despite technical difficulties with current imaging modalities. CMR can play a key role in confirming presence or absence of a mass. Additionally, in the presence of a mass, CMR can provide accurate differentiation of pseudomasses, benign and malignant masses. However, the limitations of CMR must be recognized. PMID:26838354

  2. Outcome of rhegmatogenous retinal detachment repair: Experience of a tertiary center in Oman

    PubMed Central

    Al-Hinai, Ahmed S.; Al-Abri, Mohamed S.

    2013-01-01

    Aim: To study the outcome of repair of rhegmatogenous retinal detachment (RRD) in a tertiary center. Materials and Methods: Review of electronic medical records within a period of 29 months of consecutive patients who underwent surgical repair for RRD in Sultan Qaboos University Hospital (SQUH). Results: We included 33 consecutive patients (36 eyes). Males constituted 70% of them. The average age was 47 years. Seven eyes out of the 36 had macula-on RRD at presentation. The primary success rate with a single procedure was 86%. However, redetachment occurred in five eyes (14%). Visual acuity was either same as preoperative or better in 81% of the eyes. Giant retinal tear was found in three eyes (8%). The average follow-up period for all patients was 10.25 months (range: 3-25 months). Conclusion: Rhegmatogenous RD is not uncommon disorder. It occurs more frequently in males. However, it has a good prognosis if an intervention was performed in early stages. PMID:24379553

  3. Prognostic factors and treatment results of pediatric Hodgkin's lymphoma: A single center experience.

    PubMed

    Büyükkapu-Bay, Sema; Çorapçıoğlu, Funda; Aksu, Görkem; Anık, Yonca; Demir, Hakan; Erçin, Cengiz

    2015-01-01

    The aim of this study was to assess the demographic, clinic data, prognostic factors and treatment/follow-up results of children who were diagnosed with Hodgkin lymphoma and followed in our center of Pediatric Oncology, Kocaeli University Medical Faculty, Kocaeli, Turkey, for 10 years. This retrospective study evaluated 41 patients with Hodgkin lymphoma who were younger than 18 years-old. All patients were treated with risked adapted ABVD (Adriamycin, Bleomycin, Vincristine, Dacarbazine) chemotherapy and also received involved field radiotherapy. Thirty-two patients (78%) were males and 9 (22%) were females, with a mean age of 10.7±4.0 years. The histopathological diagnosis was mixed cellular type in 51.2% of the patients. B symptoms (unexplained fever, unexplained weight loss, drenching night sweats) were present in 53.7% of the patients and 36.6% of the patients were at advanced stage at the time of the diagnosis. The 3-year overall and event-free survival rates were 88% and 5-year overall and event-free survival rates were 88%, 78%. Age, stage, treatment risk groups, presence of B symptoms and hematological parameters had no significant effect on overall and event-free survival in univariate analysis while bulky disease was the only significant factor on overall survival. Our treatment policy was succesful regarding the similar survival rates in the treatment risk groups, however novel treatment strategies adopting the early response with the reduction of adverse effects are planned in the near future. PMID:27186698

  4. Thoracic outlet syndrome: a 50-year experience at Baylor University Medical Center

    PubMed Central

    Kourlis, Harry

    2007-01-01

    During the past 5 decades, the recognition and management of thoracic outlet syndrome (TOS) have evolved. This article elucidates these changes and improvements in the diagnosis and management of TOS at Baylor University Medical Center. The most remarkable change over the past 50 years is the use of nerve conduction velocity to diagnose and monitor patients with nerve compression. Recognition that procedures such as breast implantation and median sternotomy may produce TOS has been revealing. Prompt thrombolysis followed by surgical venous decompression for Paget-Schroetter syndrome has markedly improved results compared with the conservative anticoagulation approach; thrombolysis and prompt first rib resection is the optimal treatment for most patients with Paget-Schroetter syndrome. Complete first rib extirpation at the initial procedure markedly reduces the incidence of recurrent neurologic symptoms or the need for a second procedure. Chest pain or pseudoangina can be caused by TOS. Dorsal sympathectomy is helpful for patients with sympathetic maintained pain syndrome or causalgia and patients with recurrent TOS symptoms who need a second procedure. PMID:17431445

  5. Insulin degludec and insulin degludec/insulin aspart in Ramadan: A single center experience.

    PubMed

    Kalra, Sanjay

    2016-01-01

    This study aimed to document the utility and safety of insulin degludec (IDeg) and insulin degludec aspart (IDegAsp) in persons with type 2 diabetes, observing the Ramadan fast. An observational study was conducted at a single center, in the real world setting, on six persons who either switched to IDeg or IDegAsp a month before Ramadan or changed time of administration of IDegAsp at the onset of Ramadan, to keep the fast in a safe manner. Subjects were kept under regular monitoring and surveillance before, during, and after Ramadan, and counseled in an opposite manner. Four persons, who shifted from premixed insulin to IDegAsp, experienced a 12-18% dose reduction after 14 days. At the onset of Ramadan, the Suhur dose was reduced by 30%, and this remained unchanged during the fasting month. The Iftar dose had to be increased by 4 units. One person who shifted from neutral protamine hagedorn to IDeg demonstrated a 25% dose reduction at 20 days, without any further change in insulin requirement during Ramadan. One person who changed time of injection of IDegAsp from morning to night reported no change in dosage. No episode of major hypoglycemia was reported. IDeg and IDegAsp are effective, safe, and well-tolerated means of achieving glycemic control in persons with type 2 diabetes who wish to fast. PMID:27366727

  6. Outcome analysis of management of liver trauma: A 10-year experience at a trauma center

    PubMed Central

    She, Wong Hoi; Cheung, Tan To; Dai, Wing Chiu; Tsang, Simon H Y; Chan, Albert C Y; Tong, Daniel K H; Leung, Gilberto K K; Lo, Chung Mau

    2016-01-01

    AIM: To review the outcomes of liver trauma in patients with hepatic injuries only and in patients with associated injuries outside the liver. METHODS: Data of liver trauma patients presented to our center from January 2003 to October 2013 were reviewed. The patients were divided into two groups. Group 1 consisted of patients who had hepatic injuries only. Group 2 consisted of patients who also had associated injuries outside the liver. RESULTS: Seven (30.4%) patients in group 1 and 10 (28.6%) patients in group 2 received non-operative management; the rest underwent operation. Blunt trauma occurred in 82.8% (48/58) of the patients and penetrative trauma in 17.2% (10/58). A higher injury severity score (ISS) was observed in group 2 (median 45 vs 25, P < 0.0001). More patients in group 1 were hemodynamically stable (65.2% vs 37.1%, P = 0.036). Other parameters were comparable between groups. Group 1 had better 30-d survival (91.3% vs 71.4%, P = 0.045). On multivariate analysis using the logistic regression model, ISS was found to be associated with mortality (P = 0.004, hazard ratio = 1.035, 95%CI: 1.011-1.060). CONCLUSION: Liver trauma patients with multiple injuries are relatively unstable on presentation. Despite a higher ISS in group 2, non-operative management was possible for selected patients. Associated injuries outside the liver usually account for morbidity and mortality. PMID:27239257

  7. Genotypic and phenotypic features of citrin deficiency: five-year experience in a Chinese pediatric center.

    PubMed

    Song, Yuan-Zong; Deng, Mei; Chen, Feng-Ping; Wen, Fang; Guo, Li; Cao, Shui-Liang; Gong, Jian; Xu, Hao; Jiang, Guang-Yu; Zhong, Le; Kobayashi, Keiko; Saheki, Takeyori; Wang, Zi-Neng

    2011-07-01

    Citrin is a liver-type aspartate/glutamate carrier (AGC) encoded by the gene SLC25A13. Two phenotypes for human citrin deficiency have been described, namely the adult-onset citrullinemia type II (CTLN2) and the neonatal intrahepatic cholestasis caused by citrin deficiency (NICCD). However, citrin deficiency currently remains a perplexing and poorly recognized disorder. In particular, description of post-NICCD clinical presentations before CTLN2 onset is rather limited. Analysis of SLC25A13 mutations, identification of dysmorphic erythrocytes, hepatobiliary scintigraphic imaging and investigation of post-NICCD clinical presentations were performed in a citrin-deficient cohort comprised of 51 cases of children diagnosed with citrin deficiency in a Chinese pediatric center. Twelve SLC25A13 mutations were detected in this cohort, including the novel V411M and G283X mutations. Among the 51 citrin-deficient subjects, 7 cases had echinocytosis, which was associated with more severe biochemical abnormalities. Delayed hepatic discharge and bile duct/bowel visualization were common scintigraphic findings. Moreover, 9 of the 34 post-NICCD cases demonstrated concurrent failure to thrive and dyslipidemia, constituting a clinical phenotype different from NICCD and CTLN2. The novel mutations, echinocytosis, hepatobiliary scintigraphic features and the novel clinical phenotype in this study expanded the genotypic and phenotypic spectrum of citrin deficiency, and challenge the traditionally-assumed 'apparently healthy' period after the NICCD state for this disease entity. PMID:21424115

  8. Sports hernia: the experience of Baylor University Medical Center at Dallas.

    PubMed

    Preskitt, John T

    2011-04-01

    Groin injuries in high-performance athletes are common, occurring in 5% to 28% of athletes. Athletic pubalgia syndrome, or so-called sports hernia, is one such injury that can be debilitating and sport ending in some athletes. It is a clinical diagnosis of chronic, painful musculotendinous injury to the medial inguinal floor occurring with athletic activity. Over the past 12 years, we have operated on >100 patients with this injury at Baylor University Medical Center at Dallas. These patients have included professional athletes, collegiate athletes, competitive recreational athletes, and the occasional "weekend warrior." The repair used is an open technique using a lightweight polypropylene mesh. Patient selection is important, as is collaboration with other experienced and engaged sports health care professionals, including team trainers, physical therapists, team physicians, and sports medicine and orthopedic surgeons. Of the athletes who underwent surgery, 98% have returned to competition. After a minimum of 6 weeks for recovery and rehabilitation, they have usually returned to competition within 3 months. PMID:21566750

  9. Sports hernia: the experience of Baylor University Medical Center at Dallas

    PubMed Central

    2011-01-01

    Groin injuries in high-performance athletes are common, occurring in 5% to 28% of athletes. Athletic pubalgia syndrome, or so-called sports hernia, is one such injury that can be debilitating and sport ending in some athletes. It is a clinical diagnosis of chronic, painful musculotendinous injury to the medial inguinal floor occurring with athletic activity. Over the past 12 years, we have operated on >100 patients with this injury at Baylor University Medical Center at Dallas. These patients have included professional athletes, collegiate athletes, competitive recreational athletes, and the occasional “weekend warrior.” The repair used is an open technique using a lightweight polypropylene mesh. Patient selection is important, as is collaboration with other experienced and engaged sports health care professionals, including team trainers, physical therapists, team physicians, and sports medicine and orthopedic surgeons. Of the athletes who underwent surgery, 98% have returned to competition. After a minimum of 6 weeks for recovery and rehabilitation, they have usually returned to competition within 3 months. PMID:21566750

  10. Kratom abuse in Ramathibodi Poison Center, Thailand: a five-year experience.

    PubMed

    Trakulsrichai, Satariya; Tongpo, Achara; Sriapha, Charuwan; Wongvisawakorn, Sunun; Rittilert, Panee; Kaojarern, Sming; Wananukul, Winai

    2013-01-01

    Kratom (Mitragyna speciosa Korth), a native tree in Southeast Asia, is misused as an abuse drug and becomes legally widespread to several countries. Currently, it is available through the online market or by some shops. The clinical manifestations of Kratom's effects are not well-defined and the clinical studies are limited. This study was designed to identify the characteristics of Kratom poisoning and withdrawal cases from Kratom exposure cases in Ramathibodi Poison Center (RPC), Thailand, during a five-year period. We used a retrospective review of Kratom exposure cases from the RPC toxic surveillance system. A total of 52 Kratom exposure cases were identified. The trend of case consultations has been increasing. There were Kratom poisoning cases (76.9%) and withdrawal cases (23.1%). Common presenting symptoms in the poisoning group were palpitation (22.5%), followed by seizure (17.5%). For the withdrawal group, the common presenting symptoms were myalgia (33.3%), insomnia (16.67%), fatigue (16.67%), and chest discomfort (16.67%). There was a baby with withdrawal symptoms who was delivered from a chronic Kratom-abusing mother, suggesting possible exposure via the transplacental route. There were no deaths in either group. Kratom abuse can cause either poisoning or withdrawal. Most cases in both groups had good prognostic outcome. PMID:24592666

  11. Upper Limb Ischemia: Clinical Experiences of Acute and Chronic Upper Limb Ischemia in a Single Center

    PubMed Central

    Bae, Miju; Chung, Sung Woon; Lee, Chung Won; Choi, Jinseok; Song, Seunghwan; Kim, Sang-pil

    2015-01-01

    Background Upper limb ischemia is less common than lower limb ischemia, and relatively few cases have been reported. This paper reviews the epidemiology, etiology, and clinical characteristics of upper limb ischemia and analyzes the factors affecting functional sequelae after treatment. Methods The records of 35 patients with acute and chronic upper limb ischemia who underwent treatment from January 2007 to December 2012 were retrospectively reviewed. Results The median age was 55.03 years, and the number of male patients was 24 (68.6%). The most common etiology was embolism of cardiac origin, followed by thrombosis with secondary trauma, and the brachial artery was the most common location for a lesion causing obstruction. Computed tomography angiography was the first-line diagnostic tool in our center. Twenty-eight operations were performed, and conservative therapy was implemented in seven cases. Five deaths (14.3%) occurred during follow-up. Twenty patients (57.1%) complained of functional sequelae after treatment. Functional sequelae were found to be more likely in patients with a longer duration of symptoms (odds ratio, 1.251; p=0.046) and higher lactate dehydrogenase (LDH) levels (odds ratio, 1.001; p=0.031). Conclusion An increased duration of symptoms and higher initial serum LDH levels were associated with the more frequent occurrence of functional sequelae. The prognosis of upper limb ischemia is associated with prompt and proper treatment and can also be predicted by initial serum LDH levels. PMID:26290835

  12. Various anatomic locations of surgically proven endometriosis: A single-center experience

    PubMed Central

    Lee, Hyun Ju; Park, Ye Mi; Kim, Yong Beom; Suh, Chang Suk

    2015-01-01

    Objective To report the various anatomic locations of surgically and pathologically proven endometriosis. Methods Pathologic reports (n=1,376) of women who underwent surgeries at a single center between April 2005 and March 2013 were retrieved from the electronic medical record system of the hospital. Pathologic reports were included after performing a search by using the key-words "endometrial cyst," "endometriotic cyst," "endometriosis," or "endometrioma." Only reports dealing with female patients were selected, and the pathologic reports of 1,350 women (1,374 surgery cases) were included in the analysis. Results The predominant location of endometriosis was the ovaries (96.4%), followed by the soft tissue (2.8%), gastrointestinal tract (0.3%) and urinary tract (0.2%). Laparoscopic surgery was the major surgical technique used for the pelvic endometriosis (89.2%). Adrenal gland endometriosis was found in a 55-year-old woman. Conclusion We established the various anatomic locations of surgically and pathologically proven endometriosis in Korean women. PMID:25629019

  13. Family Centered Approach in Primary Health Care: Experience from an Urban Area of Mangalore, India

    PubMed Central

    Majra, J. P.; Akshaya, K. M.; Qadiri, Ghulam Jeelani

    2015-01-01

    Introduction. “Health for All” still eludes public health experts despite many approaches to prevent disease and promote health among urban poor. Several key illness factors lie beyond the conventional healthcare boundaries. Objective. To examine the effectiveness of family centered approach (FCA) in addressing health and related issues in an urban area of Mangalore, India. Method. A longitudinal study was conducted in Bengre, an outreach centre of Mangalore from June 2011 to November 2013. Family folders were created with pertinent details. Demand generation and health education activities were conducted through two female community health link workers. An FCA package was implemented by medical and nursing interns, under supervision, to address the priority issues. Effect was assessed by comparing their practices and service utilization before and after the study. Results. About 809 families participated in this study. Social, cultural, and religious factors were responsible for viciousness of malaria and maternal and child health issues. FCA improved their perceptions and practices towards health and related issues. Significant (P < 0.05) and sustained hike in service utilization was evident. Conclusion. FCA exposes key illness factors beyond the conventional care, eases need based healthcare implementation, and provides feasible and enduring solutions. Community involvement makes it more practicable. PMID:25695098

  14. Factitious Disorder-Experience at a Neuropsychiatric Center in Southern India

    PubMed Central

    Dahale, Ajit Bhalchandra; Hatti, Shivananda; Thippeswamy, Harish; Chaturvedi, Santosh Kumar

    2014-01-01

    Objective: Factitious disorder is amongst the more intriguing but less-studied psychological disorders. Studies from different parts of the world have reported of varying prevalence rates. Here, we try to study the prevalence of factitious disorder in a specific sample of patients attending a neuropsychiatric center in India. Materials and Methods: We did a retrospective review of our institute's database for cases with a diagnosis of factitious disorder in the 10-year duration from 2001 to 2010. We reviewed the available clinical and socio-demographic data. Results: Of the 81,176 patients seen in the 10-year duration, only 8 patients had been assigned the diagnosis of factitious disorder, leading to a prevalence rate of 0.985 per 10,000 patients in this sample. Most of the patients were lost to follow-up; hence. Conclusion: Factitious disorder remains highly underdiagnosed in developing countries like India. Mental health professionals need to be more aware and inquisitive about this particular disorder, so that they do not miss the diagnosis. PMID:24701013

  15. [An original experience through the creation of a new functional rehabilitation center for Vietnamese lepers].

    PubMed

    Vu, D L; Chabaud, B; Nguyen, K K; Nguyen, V T; Hoang, T Q

    1994-01-01

    Since 1990, the creation of a Rehabilitation Center for Vietnamese leprosy patients under the aegis of "Oeuvres Hospitalières Françaises de l'Ordre de Malte" is the result of emphasized collaboration between governmental and non-governmental organizations, and between medical and paramedical specialists. This humanitarian action is not "a present home delivery". The end of this action is to set progressively a realist enterprise that depends on preliminary epidemiologic investigations on the spot to analyse means and necessities. Frequency of disabilities (49.6%) and predominance of grades 1 and 2 (83.5%) require aids. The realisation of technology transfer at all medical care levels is necessary. But at the same time, it is essential to build surroundings adapted infrastructure, to equip with effective material giving comfort and security for patients, and even to supply with pharmaceutic drugs in order to continue rehabilitation's activities. In short range, patient's selection and regular control give first objective results. PMID:8209627

  16. [De novo malignant tumors following liver transplantation. A single-center experience in Argentina].

    PubMed

    Antinucci, Florencia; Anders, Margarita; Orozco, Federico; Mella, José; Cobos, Manuel; McCormack, Lucas; Mastai, Ricardo

    2015-01-01

    The aim of the present study was to evaluate the incidence and clinical features of de novo tumors in patients undergoing liver transplantation in our center as well as to assess survival. We retrospectively analyzed 168 liver transplantations (159 patients) performed from May 2006 to May 2014. The incidence of de novo tumors was 7.5% (n = 12). The mean age at diagnosis was 63 ± 7 years. The most frequent neoplasms were non melanoma skin tumors and adenocarcinomas. Fifty percent of the tumors developed in the second and third year after transplantation. Type of immunosuppression did not influence tumoral type, although most patients receive tacrolimus in combination with mycofenolate and/or corticoids. The mean duration of follow-up after diagnosis of the tumor was 25 ± 29 months (range 0-76) and the mortality was 41%. The actuarial probability of survival at 1 and 5 years was 83 and 55%, respectively. De novo tumors are frequent after liver transplantation and their clinical course differs from that in the general population. Because their clinical course is more aggressive, regular follow up of these patients is essential for early diagnosis. PMID:25637895

  17. Driving under the influence--a level-I trauma center's experience.

    PubMed

    Fantus, R J; Zautcke, J L; Hickey, P A; Fantus, P P; Nagorka, F W

    1991-11-01

    Alcohol-impaired driving is a major issue confronting today's society. New legislation is emerging to help curtail this ongoing problem. To evaluate the legislative effects in terms of outcome pertaining to injured drivers, we analyzed the records of 116 consecutive motor vehicle drivers who were admitted to our trauma center over a 16-month period. Medical reports, police reports, and drivers' abstracts were reviewed. Of the 116 drives, 61 (53%) had blood alcohol concentrations that exceeded the legal limit (blood alcohol level greater than or equal to 100 mg/dL) on arrival at the emergency department. Only four of these patients were ticketed for driving under the influence and received the mandatory suspension of their driver's license. None was convicted of this offense, which carries criminal charges and a revocation of the driver's license. Mechanisms for efficient collection of blood specimens and mandatory occurrence reporting are two recommendations that merit investigation to obviate further escape of injured, intoxicated drivers from the legal net. In addition, alcohol rehabilitation and education cannot be overlooked and should warrant strong societal support. PMID:1942173

  18. Controversies Surrounding Renal Denervation: Lessons Learned From Real-World Experience in Two United Kingdom Centers.

    PubMed

    Burchell, Amy E; Chan, Kenneth; Ratcliffe, Laura E K; Hart, Emma C; Saxena, Manish; Collier, David J; Jain, Ajay K; Mathur, Anthony; Knight, Charles J; Caulfield, Mark J; Paton, Julian F R; Nightingale, Angus K; Lobo, Melvin D; Baumbach, Andreas

    2016-06-01

    Renal denervation (RDN) is a therapy that targets treatment-resistant hypertension (TRH). The Renal Denervation in Patients With Uncontrolled Hypertension (Symplicity) HTN-1 and Symplicity HTN-2 trials reported response rates of >80%; however, sham-controlled Symplicity HTN-3 failed to reach its primary blood pressure (BP) outcome. The authors address the current controversies surrounding RDN, illustrated with real-world data from two centers in the United Kingdom. In this cohort, 52% of patients responded to RDN, with a 13±32 mm Hg reduction in office systolic BP (SBP) at 6 months (n=29, P=.03). Baseline office SBP and number of ablations correlated with office SBP reduction (R=-0.47, P=.01; R=-0.56, P=.002). RDN appears to be an effective treatment for some patients with TRH; however, individual responses are highly variable. Selecting patients for RDN is challenging, with only 10% (33 of 321) of the screened patients eligible for the study. Medication alterations and nonadherence confound outcomes. Adequate ablation is critical and should impact future catheter design/training. Markers of procedural success and improved patient selection parameters remain key research aims. PMID:26857092

  19. Comparison of Capsule Endoscopy Findings to Subsequent Double Balloon Enteroscopy: A Dual Center Experience

    PubMed Central

    Kalra, Amandeep S.; Walker, Andrew J.; Benson, Mark E.; Soni, Anurag; Guda, Nalini M.; Misha, Mehak; Gopal, Deepak V.

    2015-01-01

    Background. There has been a growing use of both capsule endoscopy (CE) and double balloon enteroscopy (DBE) to diagnose and treat patients with obscure gastrointestinal blood loss and suspected small bowel pathology. Aim. To compare and correlate sequential CE and DBE findings in a large series of patients at two tertiary level hospitals in Wisconsin. Methods. An IRB approved retrospective study of patients who underwent sequential CE and DBE, at two separate tertiary care academic centers from May 2007 to December 2011, was performed. Results. 116 patients were included in the study. The mean age ± SD was 66.6 ± 13.2 years. There were 56% males and 43.9% females. Measure of agreement between prior capsule and DBE findings was performed using kappa statistics, which gave kappa value of 0.396 with P < 0.001. Also contingency coefficient was calculated and was found to be 0.732 (P < 0.001). Conclusions. Our study showed good overall agreement between DBE and CE. Findings of angioectasia had maximum agreement of 69%. PMID:26420979

  20. Perinatal Diagnostic Approach to Fetal Skeletal Dysplasias: Six Years Experience of a Tertiary Center.

    PubMed

    Toru, Havva Serap; Nur, Banu Guzel; Sanhal, Cem Yasar; Mihci, Ercan; Mendilcioğlu, İnanç; Yilmaz, Elanur; Yilmaz, Gulden Tasova; Ozbudak, Irem Hicran; Karaali, Kamil; Alper, Ozgul M; Karaveli, Fatma Şeyda

    2015-01-01

    Skeletal dysplasias (SDs) constitute a group of heterogeneous disorders affecting growth morphology of the chondro-osseous tissues. Prenatal diagnosis of SD is a considerable clinical challenge due to phenotypic variability. We performed a retrospective analysis of the fetal autopsies series conducted between January 2006 and December 2012 at our center. SD was detected in 54 (10%) out of 542 fetal autopsy cases which included; 11.1% thanatophoric dysplasia (n = 6), 7.4% achondroplasia (n = 4), 3.7% osteogenesis imperfect (n = 2), 1.9% Jarcho-Levin Syndrome (n = 1), 1.9% arthrogryposis (n = 1), 1.9% Dyggve-Melchior-Clausen syndrome (n = 1), 72.1% of dysostosis cases (n = 39). All SD cases were diagnosed by ultrasonography. In 20 of the cases, amniocentesis was performed, 4 cases underwent molecular genetic analyses. Antenatal identification of dysplasia is important in the management of pregnancy and in genetic counseling. Our data analysis showed that SD is usually detected clinically after the 20th gestational week. Genetic analyses for SD may provide early diagnosis and management. PMID:26376227

  1. Sociodemographic Parameters of Esophageal Cancer in Northwest India: A Regional Cancer Center Experience of 10 Years

    PubMed Central

    Kapoor, Akhil; Kumar, Vanita; Singhal, Mukesh Kumar; Nirban, Raj Kumar; Beniwal, Surender Kumar; Kumar, Harvindra Singh

    2015-01-01

    Background: Despite various advances in the treatment of Esophageal Cancer (EC), being one of the least responsive tumors to cancer therapy, the overall prognosis remains poor. Therefore, it is significant to understand various sociodemographic factors associated with EC to find out various schemes for primary prevention of the disease. Materials and Methods: This is a retrospective analysis of medical records of the EC patients registered in the regional cancer center of northwest India from January 2003 to December 2012. The site of the disease and the histology were also recorded in addition to the various sociodemographic parameters. Results: Out of 55,742 patients registered in our hospital; 3,667 were diagnosed to have EC. Male:female ratio was 1.15:1. The mean age was 54.6 ± 11.74 years; 66.15% of the patients were illiterate and 48.6% belonged to the low socioeconomic status. Smoking and alcohol consumption were identified as risk factors in 48 and 25.6% of the patients, respectively. Conclusions: The etiology in majority of the patients is linked to tobacco and alcohol, thus, modification of life style with limiting the use of addictions may be an effective strategy in the prevention of this dreaded and mostly incurable disease. PMID:26435600

  2. Extended interval dosing of natalizumab: a two-center, 7-year experience

    PubMed Central

    Pawate, Siddharama

    2014-01-01

    Background: The enthusiasm for natalizumab, a highly efficacious agent in the treatment of multiple sclerosis (MS), has been tempered by the risks of progressive multifocal leukoencephalopathy associated with its use, and strategies to minimize those risks are of great interest. Extended interval dosing (EID) has been proposed as a way to maintain the efficacy of natalizumab while reducing exposure to it. We reviewed a cohort of patients who received natalizumab at 6–8-week intervals instead of the typical infusions every 4 weeks with the goal to assess if patients on EID had an increase in clinical relapses. Methods: This is a retrospective review of all patients with MS treated with natalizumab at two MS centers where patients were offered the opportunity to switch to an EID every 6 or 8 weeks. Results: A total of 361 patients received natalizumab for 22 ± 13 months (minimum duration 6 months). Of these, 96 patients received EID natalizumab at some point for 20 ± 11 months (minimum duration 6 months). Over the study period, there was no significant difference between the relapse rate in the monthly dosing (13%) and the EID (13%) groups of patients. Conclusion: Natalizumab is effective in controlling MS as very few clinical relapses were observed in our dataset. We found that EID did not compromise the treatment effect as measured by relapse rate and no significant breakthrough disease activity was observed. EID is an optional regimen for maintenance natalizumab therapy, but prospective studies are warranted to determine its efficacy. PMID:25342976

  3. Importance and feasibility of creating hypertrophic cardiomyopathy centers in developing countries: the experience in India.

    PubMed

    Maron, Barry J

    2015-07-15

    Hypertrophic cardiomyopathy (HC) is a relatively common genetic heart disease responsible for mortality and morbidity at all ages. Using contemporary treatment advances, such as implantable defibrillators, surgical myectomy, heart transplant, and modern defibrillation for out-of-hospital cardiac arrest, it is now possible to reduce HC-related mortality considerably to 0.5% per year, less than expected in the general US adult population. However, in much of the developing world, HC has not yet become a priority given the many other cardiac conditions, such as coronary artery disease and systemic hypertension, so prevalent in the most populous countries such as China and India. Management of HC is best achieved in dedicated centers within institutions, such as previously demonstrated in the United States, Canada, some European countries, and Australia. This model has recently been introduced for the first time in India at the Amrita Institute of Medical Sciences and Research in Kochi, Kerala, in which a robust program focused on HC has emerged. This novel initiative, created despite the many obstacles in the Indian health care system, is an important step forward and is reported here detail. PMID:25983127

  4. Acute lymphoblastic leukemia: A single center experience with Berlin, Frankfurt, and Munster-95 protocol

    PubMed Central

    Radhakrishnan, Venkatraman; Gupta, Sumant; Ganesan, Prasanth; Rajendranath, Rejiv; Ganesan, Trivadi S.; Rajalekshmy, Kamalalayan Raghavan; Sagar, Tenali Gnana

    2015-01-01

    Background: There is a paucity of data on the outcome following the treatment for acute lymphoblastic leukemia (ALL) from developing countries. Materials and Methods: Two hundred and thirty-eight consecutive patients with ALL <30 years of age diagnosed between January 2005 and December 2011 were analyzed retrospectively. Patients were treated modified Berlin, Frankfurt, and Munster 95 protocol. Event-free survival (EFS) was calculated using Kaplan–Meier survival analysis and variables were compared using log-rank test. Results: The EFS was 63.4% at a median follow-up was 32.7 months. On univariate analysis National Cancer Institute (NCI) risk stratification, sex, white blood cell count, day 8 blast clearance, and income were significantly associated with EFS. However, on multivariate analysis only female sex (P = 0.01) and day 8 blast clearance (P = 0.006) were significantly associated with EFS. Seventy-four of 238 (31%) patients had recurrent leukemia. The common sites of relapse were bone marrow in 55/74 (75%) patients and central nervous system in 11/74 (20%) patients. Conclusion: Compared to western data, there was an increased proportion of NCI high-risk patients and T-cell immunophenotype in our study. There has been an improvement in outcome of patients with ALL at our center over the last 2 decades. Female sex and clearance of blast in peripheral blood by day 8 of induction was associated with better EFS. PMID:26811597

  5. Early enteral nutrition vs parenteral nutrition following pancreaticoduodenectomy: Experience from a single center

    PubMed Central

    Lu, Jian-Wen; Liu, Chang; Du, Zhao-Qing; Liu, Xue-Min; Lv, Yi; Zhang, Xu-Feng

    2016-01-01

    AIM: To analyze and compare postoperative morbidity between patients receiving total parenteral nutrition (TPN) and early enteral nutrition supplemented with parenteral nutrition (EEN + PN). METHODS: Three hundred and forty patients receiving pancreaticoduodenectomy (PD) from 2009 to 2013 at our center were enrolled retrospectively. Patients were divided into two groups depending on postoperative nutrition support scheme: an EEN + PN group (n = 87) and a TPN group (n = 253). Demographic characteristics, comorbidities, preoperative biochemical parameters, pathological diagnosis, intraoperative information, and postoperative complications of the two groups were analyzed. RESULTS: The two groups did not differ in demographic characteristics, preoperative comorbidities, preoperative biochemical parameters or pathological findings (P > 0.05 for all). However, patients with EEN + PN following PD had a higher incidence of delayed gastric emptying (16.1% vs 6.7%, P = 0.016), pulmonary infection (10.3% vs 3.6%, P = 0.024), and probably intraperitoneal infection (18.4% vs 10.3%, P = 0.059), which might account for their longer nasogastric tube retention time (9 d vs 5 d, P = 0.006), postoperative hospital stay (25 d vs 20 d, P = 0.055) and higher hospitalization expenses (USD10397 vs USD8663.9, P = 0.008), compared to those with TPN. CONCLUSION: Our study suggests that TPN might be safe and sufficient for patient recovery after PD. Postoperative EEN should only be performed scrupulously and selectively. PMID:27076767

  6. Attending an activity center: positive experiences of a group of home-dwelling persons with early-stage dementia

    PubMed Central

    Söderhamn, Ulrika; Aasgaard, Live; Landmark, Bjørg

    2014-01-01

    Background In Norway, there is a focus on home-dwelling people with dementia receiving the opportunity to participate in organized meaningful activities. The aim of this study was to elucidate the experiences of home-dwelling persons with early-stage dementia who attend an activity center and participate in adapted physical and social activities delivered by nurses and volunteers. Methods The study adopted a qualitative approach, with individual interviews conducted among eight people diagnosed with early-stage dementia. The interview texts were analyzed using manifest and latent content analysis. Results Four categories, ie, “appreciated activities”, “praised nurses and volunteers”, “being more active”, and “being included in a fellowship”, as well as the overall theme “participation in appreciated activities and a sense of feeling included in a fellowship may have a positive influence on health and well-being” emerged in the analysis. The informants appreciated the adapted physical and social activities and expressed their enjoyment and gratitude. They found the physical activities useful, and they felt themselves to be included in a fellowship through cheerful nurses and volunteers. The nurses were able to create a good atmosphere and spread joy in the center together with the volunteers. The informants felt themselves valued as the persons they were. These findings indicated that such activities may have had a positive influence on the informants’ health and well-being. Conclusion In order to succeed with this kind of activity center, it is decisive that the nurses are able to tailor meaningful activities and create an environment where the persons with dementia can feel that they are respected and valued. The municipality health care service should implement such activity centers with specialist nurses in dementia care together with volunteers. PMID:25419121

  7. The Manuel Lujan, Jr. Neutron Scattering Center (LANSCE) experiment reports 1992 run cycle. Progress report

    SciTech Connect

    DiStravolo, M.A.

    1993-09-01

    This year was the fifth in which LANSCE ran a formal user program. A call for proposals was issued before the scheduled run cycles, and experiment proposals were submitted by scientists from universities, industry, and other research facilities around the world. An external program advisory committee, which LANSCE shares with the Intense Pulsed Neutron Source (IPNS), Argonne National Laboratory, examined the proposals and made recommendations. At LANSCE, neutrons are produced by spallation when a pulsed, 800-MeV proton beam impinges on a tungsten target. The proton pulses are provided by the Clinton P. Anderson Meson Physics Facility (LAMPF) accelerator and an associated Proton Storage Ring (PSR), which can alter the intensity, time structure, and repetition rate of the pulses. The LAMPF protons of Line D are shared between the LANSCE target and the Weapons Neutron Research (WNR) facility, which results in LANSCE spectrometers being available to external users for unclassified research about 80% of each annual LAMPF run cycle. Measurements of interest to the Los Alamos National Laboratory may also be performed and may occupy up to an additional 20% of the available beam time. These experiments are reviewed by an internal program advisory committee. One hundred sixty-seven proposals were submitted for unclassified research and twelve proposals for research of a programmatic interest to the Laboratory; six experiments in support of the LANSCE research program were accomplished during the discretionary periods. Oversubscription for instrument beam time by a factor of three was evident with 839 total days requested and only 371 available for allocation.

  8. The Versatility of Autologous Fat Transplantation in Correction of Facial Deformities: A Single-Center Experience

    PubMed Central

    Hammer-Hansen, Niels; Akram, Javed; Damsgaard, Tine Engberg

    2015-01-01

    Deformities in the craniofacial region are of great social and functional importance. Several surgical techniques have been used to treat such pathologies often with high morbidity and lacking the ability to address smaller contour defects. The minimally invasive technique of fat transplantation has evolved rapidly within the last few decades. The objective of this paper is to present the versatility and applicability of fat transplantation in a wide range of contour deformities in the craniofacial region. We share our experiences in treating 13 patients with autoimmune disorders, congenital malformations, and acquired defects. Future perspectives of fat transplantation in the field of craniofacial reconstruction are discussed. PMID:25821598

  9. Escalating therapy of cutaneous side effects of EGFR inhibitors: experience of German reference centers.

    PubMed

    Homey, Bernhard; Gerber, Peter Arne; Wollenberg, Andreas; Dirschka, Thomas; Hassel, Jessica C; Bölke, Edwin; Hauschild, Axel; Gutzmer, Ralf

    2012-08-01

    Recommendations for the management of cutaneous adverse effects of inhibitors of the epidermal growth factor receptor (EGFR) are urgently needed. In this context an expert panel of German dermatologists recently proposed a 3-step management concept based on personal experience and a current literature consensus. While steps 1 and 2 addressed general and preventive measures, as well as the therapy that can be performed by the primary treating physician, here we address the management of challenging cases (step 3) that do not respond well to basic measures and should be referred to an experienced dermatologist. PMID:22672156

  10. Contrast ultrasound in hepatocellular carcinoma at a tertiary liver center: First Indian experience

    PubMed Central

    Laroia, Shalini Thapar; Bawa, Simranjeet Singh; Jain, Deepak; Mukund, Amar; Sarin, Shiv

    2013-01-01

    AIM: To assess the role of contrast enhanced ultrasonography in evaluation of hepatocellular carcinoma (HCC) at the first Indian tertiary liver center. METHODS: Retrospective analysis of contrast enhanced ultrasound (CEUS) examinations over 24 mo for diagnosis, surveillance, characterization and follow up of 50 patients in the context of HCC was performed. The source and indication of referrals, change in referral rate, accuracy and usefulness of CEUS in a tertiary liver center equipped with a 64 slice dual energy computer tomography (CT) and 3 tesla magnetic resonance imaging (MRI) were studied. Sonovue (BR1, Bracco, Italy, a second generation contrast agent) was used for contrast US studies. Contrast enhanced CT/MRI or both were performed in all patients. The findings were taken as a baseline reference and correlation was done with respect to contrast US. Contrast enhanced MRI was performed using hepatocyte specific gadobenate dimeglumine (Gd-BOPTA). Iomeron (400 mg; w/v) was used for dynamic CT examinations. RESULTS: About 20 (40%) of the examinations were referred from clinicians for characterization of a mass from previous imaging. About 15 (30%) were performed for surveillance in chronic liver disease; 5 (10%) examinations were performed for monitoring lesions after radiofrequency ablation (RFA); 3 (6%) were post trans-arterial chemo-embolization (TACE) assessments and 3 (6%) were patients with h/o iodinated contrast allergy. About 2 (4%) were performed on hemodynamically unstable patients in the intensive care with raised alpha fetoprotein and 2 (4%) patients were claustrophobic. The number of patients referred from clinicians steadily increased from 12 in the first 12 mo of the study to 38 in the last 12 mo. CEUS was able to diagnose 88% of positive cases of HCC as per reference standards. In the surveillance group, specificity was 53.3% vs 100% by CT/MRI. Post RFA and TACE specificity of lesion characterization by CEUS was 100% in single/large mass

  11. Robot-Assisted Cardiac Surgery Using the Da Vinci Surgical System: A Single Center Experience

    PubMed Central

    Kim, Eung Re; Lim, Cheong; Kim, Dong Jin; Kim, Jun Sung; Park, Kay Hyun

    2015-01-01

    Background We report our initial experiences of robot-assisted cardiac surgery using the da Vinci Surgical System. Methods Between February 2010 and March 2014, 50 consecutive patients underwent minimally invasive robot-assisted cardiac surgery. Results Robot-assisted cardiac surgery was employed in two cases of minimally invasive direct coronary artery bypass, 17 cases of mitral valve repair, 10 cases of cardiac myxoma removal, 20 cases of atrial septal defect repair, and one isolated CryoMaze procedure. Average cardiopulmonary bypass time and average aorta cross-clamping time were 194.8±48.6 minutes and 126.1±22.6 minutes in mitral valve repair operations and 132.0±32.0 minutes and 76.1±23.1 minutes in myxoma removal operations, respectively. During atrial septal defect closure operations, the average cardiopulmonary bypass time was 128.3±43.1 minutes. The median length of stay was between five and seven days. The only complication was that one patient needed reoperation to address bleeding. There were no hospital mortalities. Conclusion Robot-assisted cardiac surgery is safe and effective for mitral valve repair, atrial septal defect closure, and cardiac myxoma removal surgery. Reducing operative time depends heavily on the experience of the entire robotic surgical team. PMID:25883892

  12. Intraoperative Boost Radiotherapy during Targeted Oncoplastic Breast Surgery: Overview and Single Center Experiences

    PubMed Central

    Richters, Lisa; Fridrich, Claudius; Markiefka, Birgid; Bongartz, Rudolf; Semrau, Robert; Mallmann, Peter; Kraemer, Stefan

    2014-01-01

    Breast-conserving surgery followed by whole-breast irradiation is the standard local therapy for early breast cancer. The international discussion of reduced importance of wider tumor-free resection margins than “tumor not touching ink” leads to the development of five principles in targeted oncoplastic breast surgery. IORT improves local recurrence risk and diminishes toxicity since there is less irradiation of healthy tissue. Intraoperative radiotherapy (IORT) can be delivered in two settings: an IORT boost followed by a conventional regimen of external beam radiotherapy or a single IORT dose. The data from TARGIT-A and ELIOT reinforce the conviction that intraoperative radiotherapy during breast-conserving surgery is a reliable alternative to conventional postoperative fractionated irradiation, but only in a carefully selected population at low risk of local recurrence. We describe our experiences with IORT boost (50 kV energy X-rays; 20 Gy) in combination with targeted oncoplastic breast surgery in a routine clinical setting. Our experiences demonstrate the applicability and reliability of combining IORT boost with targeted oncoplastic breast surgery in breast-conserving therapy of early breast cancer. PMID:25587453

  13. Effectiveness and properties of the biological prosthesis Permacol™ in pediatric surgery: A large single center experience

    PubMed Central

    Filisetti, Claudia; Costanzo, Sara; Marinoni, Federica; Vella, Claudio; Klersy, Catherine; Riccipetitoni, Giovanna

    2016-01-01

    Introduction The use of prosthetic patches of non-absorbable materials represents a valid tool in the treatment of abdominal wall and diaphragmatic defects in pediatric age. In recent years research has developed biological dermal scaffolds made from a sheet of acellular matrix that can provide the desired support and reduce the occurrence of complications from non-absorbable implant. We present our experience and a systematic review to evaluate the use of biologic prosthesis for abdominal wall closure in pediatric patients. Methods The study from January 2009 to January 2015 involved 20 patients treated with Permacol™ implant. We observed postoperative complications only in patients treated for abdominal wall closure, which is the major indication for the use of Permacol™. We conducted a systematic review and meta-analysis (according to PRISMA) on PubMed/Medline, Scopus and EMBASE regarding the use of biological prosthesis in pediatric population considering the incidence of complications as the primary outcome. Results 3/20 patients experienced complications: 2 patients with skin necrosis healed conservatively and 1 of them developed laparocele. Thus only 1 patient with incisional hernia had significant surgery complication. In patients who were permanently implanted with Permacol™ it has not determined adverse reactions with optimal functional outcome. Conclusions In accordance with the few data (case reports and case series) reported in literature about pediatric patients, our experience in different pathologies and applications has shown the effectiveness of Permacol™, in particular for the non-occurrence of infections, that often affect the use of prosthesis. PMID:27054034

  14. Clinical profile and outcome of renal tubular disorders in children: A single center experience

    PubMed Central

    Kiran, B. Vijay; Barman, H.; Iyengar, A

    2014-01-01

    Tubular disorders form a significant proportion of pediatric kidney diseases and are an important differential diagnosis of failure to thrive (FTT) in children. Data regarding their outcome is scarce from India. We evaluated the clinical profile of these children and studied the outcome in terms of their growth and renal failure. This is a retrospective longitudinal study of all children with renal tubular disorders attending a tertiary care pediatric nephrology center from 2005 to 2010. Growth and renal outcomes were assessed by Z scores and estimated glomerular filtration rate at diagnosis and. The common disorders encountered were distal renal tubular acidosis (d-RTA) (44%), Bartter-like (Bartter's and Gitelman) syndromes (22%) followed by hereditary Fanconi syndrome (cystinosis and idiopathic Fanconi syndrome) (13%) and few cases of nephrogenic diabetes insipidus, hypophosphatemic rickets and idiopathic hypercalciuria. Male: female ratio was 1.22. The median age at diagnosis was 1.5 (range 0.13-11) years. Growth failure was the presenting feature in 86% of children followed by polyuria (60%) and bone deformities (47%). In 60% of children with hereditary Fanconi syndrome, nephropathic cystinosis was diagnosed, all of whom progressed to stage III chronic kidney disease (CKD) within 3.41 ± 1.42 years. With appropriate therapy, catch-up growth was noted in d-RTA and Bartter syndrome. Renal tubular disorders usually present with FTT. d-RTA is the most common etiology followed by Bartter-like syndrome. Renal function is preserved in all these disorders except for nephropathic cystinosis, who ultimately progressed to CKD. With appropriate and inexpensive therapy, these children do grow well. PMID:25484529

  15. Neonates born to mothers with immune thrombocytopenic purpura: a single-center experience of 20 years.

    PubMed

    Bayhan, Turan; Tavil, Betül; Korkmaz, Ayşe; Ünal, Şule; Hanalioğlu, Damla; Yiğit, Şule; Gümrük, Fatma; Çetin, Mualla; Yurdakök, Murat

    2016-01-01

    Neonates born to mothers with immune thrombocytopenic purpura (ITP) have an increased risk of having thrombocytopenia and bleeding. The aim of our study was to determine maternal and fetal factors that can predict bleeding risk in neonates born to mothers with ITP, and effective treatment strategies by retrospective analysis of our single-center data. We performed a retrospective data review of neonates that were recorded as 'neonates born to mothers with ITP' in the Neonatal ICU of Hacettepe University, Ihsan Dogramacı Children's Hospital, Ankara, Turkey. Medical records of 36 neonates born from 35 mothers were analyzed. Among the 36 neonates born to mothers with ITP, thrombocytopenia (platelet count of less than 150 × 10/l) was detected in 20 (56.0%) neonates on the first day of life. Twelve of the 20 neonates with thrombocytopenia (60.0%) required treatment to increase the platelet counts. Clinical findings related to thrombocytopenia occurred in three (15.0%) neonates, but none of them presented with severe bleeding. There was no statistically significant association between neonatal lowest platelet count and maternal lowest platelet count, maternal platelet count at the time of delivery, and duration of thrombocytopenia, respectively. Neonates born to mothers with ITP have an increased tendency to develop thrombocytopenia, but severe bleeding is very rare in these neonates. Clinicians should pay special attention to follow these neonates. According to our results, both intravenous immunoglobulin and methyl prednisolone were found to be in equivalent efficacy for the treatment of neonatal thrombocytopenia due to maternal ITP. PMID:26258676

  16. Evaluation of Sensorimotor Nerve Damage in Patients with Maxillofacial Trauma; a Single Center Experience

    PubMed Central

    Poorian, Behnaz; Bemanali, Mehdi; Chavoshinejad, Mohammad

    2016-01-01

    Objective: To evaluate sensorimotor nerve damage in patients with maxillofacial trauma referring to Taleghani hospital, Tehran, Iran Methods: This cross-sectional study was conducted during a 2-year period from 2014 to 2012 in Taleghani hospital of Tehran. We included a total number of 495 patients with maxillofacial trauma referring to our center during the study period. The demographic information, type of fracture, location of fracture and nerve injuries were assessed and recorded in each patients. The frequency of sensorimotor injuries in these patients was recorded. Data are presented as frequencies and proportions as appropriate. Results: Overall we included 495 patients with maxillofacial trauma with mean age of 31.5±13.8 years. There were 430 (86.9% men and in 65 (13.1%) women among the patients. The frequency of nerve injuries was 67.7% (336 patients). The mean age of the patients with nerve injuries was 33.4 ± 3.7 years. Marginal mandibular branch of facial nerve was the most common involved nerve being involved in 5 patients (1%). Regarding trigeminal nerve, the inferior alveolar branch (194 patients 39.1%) was the most common involved branch followed by infraorbital branch (135 patients 27.2%). Mandibular fracture was the most common injured bone being reported in 376 patient (75.9%) patients followed by zygomatic bone in 100 patient (20%). Conclusion: The most frequent fracture occurred in mandible followed by zygoma and the most injured nerve was inferior alveolar nerve followed by infraorbital branch of trigeminal nerve. In facial nerve the marginal branch was the most involved nerve. The frequency of nerve injury and the male to female ratio was higher in the current study compared to the literature. PMID:27331065

  17. Mesenchymal stem cell therapy in patients with small bowel transplantation: Single center experience

    PubMed Central

    Doğan, Sait Murat; Kılınç, Selçuk; Kebapçı, Eyüp; Tuğmen, Cem; Gürkan, Alp; Baran, Maşallah; Kurtulmuş, Yusuf; Ölmez, Mustafa; Karaca, Cezmi

    2014-01-01

    AIM: To study the effects of mesenchymal stem cell (MSC) therapy on the prevention of acute rejection and graft vs host disease following small bowel transplantation. METHODS: In our transplantation center, 6 isolated intestinal transplants have been performed with MSC therapy since 2009. The primary reasons for transplants were short gut syndrome caused by surgical intestine resection for superior mesenteric artery thrombosis (n = 4), Crohn’s disease (n = 1) and intestinal aganglionosis (n = 1). Two of the patients were children. At the time of reperfusion, the first dose of MSCs cultured from the patient’s bone marrow was passed into the transplanted intestinal artery at a dose of 1000000 cells/kg. The second and third doses of MSCs were given directly into the mesenteric artery through the arterial anastomosis using an angiography catheter on day 15 and 30 post-transplant. RESULTS: The median follow-up for these patients was 10.6 mo (min: 2 mo-max: 30 mo). Three of the patients developed severe acute rejection. One of these patients did not respond to bolus steroid therapy. Although the other two patients did respond to anti-rejection treatment, they developed severe fungal and bacterial infections. All of these patients died in the 2nd and 3rd months post-transplant due to sepsis. The remaining patients who did not have acute rejection had good quality of life with no complications observed during the follow-up period. In addition, their intestinal grafts were functioning properly in the 13th, 25th and 30th month post-transplant. The patients who survived did not encounter any problems related to MSC transplantation. CONCLUSION: Although this is a small case series and not a randomized study, it is our opinion that small bowel transplantation is an effective treatment for intestinal failure, and MSC therapy may help to prevent acute rejection and graft vs host disease following intestinal transplantation. PMID:25009395

  18. The Cost of Sustaining a Patient-Centered Medical Home: Experience From 2 States

    PubMed Central

    Magill, Michael K.; Ehrenberger, David; Scammon, Debra L.; Day, Julie; Allen, Tatiana; Reall, Andreu J.; Sides, Rhonda W.; Kim, Jaewhan

    2015-01-01

    PURPOSE As medical practices transform to patient-centered medical homes (PCMHs), it is important to identify the ongoing costs of maintaining these “advanced primary care” functions. A key required input is personnel effort. This study’s objective was to assess direct personnel costs to practices associated with the staffing necessary to deliver PCMH functions as outlined in the National Committee for Quality Assurance Standards. METHODS We developed a PCMH cost dimensions tool to assess costs associated with activities uniquely required to maintain PCMH functions. We interviewed practice managers, nurse supervisors, and medical directors in 20 varied primary care practices in 2 states, guided by the tool. Outcome measures included categories of staff used to perform various PCMH functions, time and personnel costs, and whether practices were delivering PCMH functions. RESULTS Costs per full-time equivalent primary care clinician associated with PCMH functions varied across practices with an average of $7,691 per month in Utah practices and $9,658 in Colorado practices. PCMH incremental costs per encounter were $32.71 in Utah and $36.68 in Colorado. The average estimated cost per member per month for an assumed panel of 2,000 patients was $3.85 in Utah and $4.83 in Colorado. CONCLUSIONS Identifying costs of maintaining PCMH functions will contribute to effective payment reform and to sustainability of transformation. Maintenance and ongoing support of PCMH functions require additional time and new skills, which may be provided by existing staff, additional staff, or both. Adequate compensation for ongoing and substantial incremental costs is critical for practices to sustain PCMH functions. PMID:26371263

  19. Early Air Force Flight Test Center (AFFTC) experience with Peripheral Vision Horizon Displays (PVHD)

    NASA Technical Reports Server (NTRS)

    Schofield, B. L.

    1984-01-01

    Three separate Air Force Flight Test Center (AFFTC) tests were conducted in 1980 and 1981 on two models of the peripheral vision horizon displays (PVHD) (Malcolm Horizon). A fixed base simulator test was conducted with twenty test pilot subjects using the Flight Simulator Demonstration Model which incorporated a Helium Neon laser as the light bar medium. Two separate flight tests were conducted by the Test Pilot School classes 80A and 80B in a Twin Otter commuter aircraft using the Stage A Model PVHD. The Xenon lighted A Model was tested in its original configuration by class 80A. Class 80B used a modified configuration which incorporated an AFFTC designed and manufactured hood. With the hood, the PVHD projected a thinner, distinct light bar. Only a few general remarks concerning the tests and unrestricted, overall conclusions reached by the author are presented. The conclusions of all three AFFTC evaluations of the PVHD concept were that it has not yet been adequately evaluated. There seems to be a significant learning curve associated with the PVHD and the project pilots for Test Pilot School Class 80B only got a good start on the learning curve. A lengthy learning curve for the PVHD should be anticipated in view of the training period required for the attitude display indicator (ADI). This does seem to point out that the PVHD, in its present form, is simply not as compelling as the natural horizon. It can also be concluded that any attempt at a valid evaluation of the PVHD concept can be done only under instrument meteorological conditions (IMC) or validly simulated IMC conditions. The knee in the learning curve, however, may be reached without full IMC, although it may take much longer to reach.

  20. Relationship between renal function and extracorporeal membrane oxygenation use: a single-center experience.

    PubMed

    Gupta, Punkaj; Carlson, Jacob; Wells, Dennis; Selakovich, Patrick; Robertson, Michael J; Gossett, Jeffrey M; Fontenot, Eudice E; Steiner, Matthew B

    2015-04-01

    The effects of extracorporeal membrane oxygenation (ECMO) support on renal function in children with critical illness are unknown. The objective of this study was to investigate the impact of ECMO on renal function among children in different age groups. We performed a single-center retrospective observational study in critically ill children ≤ 18 years supported on ECMO for refractory cardiac or pulmonary failure (2006-2012). The patient population was divided into four age groups for the purpose of comparisons. The Acute Kidney Injury Network's (AKIN's) validated, three-tiered staging system for acute kidney injury was used to categorize the degree of worsening renal function. Data on patient demographics, baseline characteristics, renal function parameters, dialysis, ultrafiltration, duration of mechanical cardiac support, and mortality were collected. Comparisons of baseline characteristics, duration of mechanical cardiac support, and renal function were made between the four age groups. During the study period, 311 patients qualified for inclusion, of whom 289 patients (94%) received venoarterial (VA) ECMO, 12 (4%) received venovenous (VV) ECMO, and 8 (3%) received both VV and VA ECMO. A total of 109 patients (36%) received ultrafiltration on ECMO, 58 (19%) received hemodialysis, and 51 (16%) received peritoneal dialysis. There was a steady and sustained improvement in renal function in all age groups during the ECMO run, with the maximum and longest-sustained improvement occurring in the oldest age group. Proportions of patients in different AKIN stages remained similar in the first 7 days after ECMO initiation. We demonstrate that renal dysfunction improves early after ECMO support. Irrespective of the underlying disease process or patient age, renal function improves in children with pulmonary or cardiac failure who are placed on ECMO. PMID:25296564

  1. Endometriosis of Extra-Abdominal Soft Tissues: A Tertiary Center Experience.

    PubMed

    Wang, Jayson; Strauss, Dirk C; Messiou, Christina; Thway, Khin

    2016-09-01

    While endometriosis, defined as the presence of endometrial tissue in extrauterine sites, is most frequently encountered within the peritoneal cavity, a small but significant proportion of cases occur at extra-abdominal soft tissue sites, particularly in relation to previous abdominal surgery. We reviewed the cases of endometriosis of soft tissue sites seen at a tertiary soft tissue center. All cases of extra-abdominal soft tissue endometriosis diagnosed at this institution over a 13-year period were reviewed, and clinical and pathologic findings were recorded. Forty-five patients had diagnoses of soft tissue endometriosis and there were 34 diagnostic biopsies and 26 surgical excision specimens. All but 1 case were abdominal wall lesions, with 1 located in the upper arm. A total of 33 patients presented with lesions in scars of previous operations (31 in Pfannenstiel incisions for Caesarean sections, presenting with a median interval of 6 years (range 1-16 years) following surgery). The lesions ranged in size from 1 to 8 cm (median 3.5 cm). One case showed decidualized stroma with trophoblast cells, while 2 had secondary adenocarcinoma arising from endometriosis. Eighteen cases were tested for β-catenin expression immunohistochemically, of which 5 showed at least focal nuclear positivity in the surrounding fibrous tissue (although not within glands or stroma). Soft tissue endometriosis is seen most commonly in surgical scars, particularly following Caesarean sections. Spontaneous endometriosis also most commonly occurs in the abdominal wall, although can occur exceptionally at unusual sites, such as extremities. Secondary changes, including carcinomas, can arise from endometriosis. The differential diagnosis of these lesions includes fibromatosis, which may be erroneously diagnosed on small, nonrepresentative core biopsy specimens. PMID:27098587

  2. Febrile neutropenia in children with acute lymphoblastic leukemia: single center experience

    PubMed Central

    Özdemir, Nihal; Tüysüz, Gülen; Çelik, Nigar; Yantri, Leman; Erginöz, Ethem; Apak, Hilmi; Özkan, Alp; Yıldız, İnci; Celkan, Tiraje

    2016-01-01

    Aim: An important life-threatening complication of intensive chemotherapy administered in children with leukemia is febrile neutropenia. The objective of this study was to evaluate the clinical features and consequences of febrile neutropenia attacks in children who were treated for acute lymphoblastic leukemia. Material and Methods: Nighty-six children who received chemotherapy for acute lymphoblastic leukemia in our center between January 1995 and December 2010 were included in the study. The data related to demographic characteristics, treatment features, relapse and febrile neutropenia incidences, risk factors, culture results and prognosis were retrospectively evaluated from the patients’ files. Results: A total of two hundred-ninety nine febrile neutropenia attacks observed in the patients during initial treatment and relapse treatment were evaluated. When the incidence of febrile neutropenia was evaluated by years, it was observed that the patients treated after year 2000 had statistically significantly more febrile neutopenia attacks compared to the patients treated before year 2000. When the incidences of febrile neutropenia during initial treatment and during relapse treatment were compared, it was observed that more febrile neutropenia attacks occured during relapse treatment. Fifty-nine percent of all febrile neutropenia attacks were fever of unknown origin. Eighty microorganisms grew in cultures during febrile neutropenia throughout treatment in 75 patients; 86% were bacterial infections (50% gram positive and 50% gram negative), 8% were viral infections and 6% were fungal infections. Coagulase negative staphylococcus (n=17) was the most frequent gram positive pathogen; E. Coli (n=17) was the most commonly grown gram negative pathogen. Conclusions: In this study, it was found that an increase in the incidence of febrile neutropenia occured in years. Increments in treatment intensities increase the incidence of febrile neutropenia while improving

  3. Selective extra levator versus conventional abdomino perineal resection: experience from a tertiary-care center

    PubMed Central

    Pai, Vishwas D.; Engineer, Reena; Patil, Prachi S.; Arya, Supreeta; Desouza, Ashwin L.

    2016-01-01

    Background To compare extra levator abdomino perineal resection (ELAPER) with conventional abdominoperineal resection (APER) in terms of short-term oncological and clinical outcomes. Methods This is a retrospective review of a prospectively maintained database including all the patients of rectal cancer who underwent APER at Tata Memorial Center between July 1, 2013, and January 31, 2015. Short-term oncological parameters evaluated included circumferential resection margin involvement (CRM), tumor site perforation, and number of nodes harvested. Peri operative outcomes included blood loss, length of hospital stay, postoperative perineal wound complications, and 30-day mortality. The χ2-test was used to compare the results between the two groups. Results Forty-two cases of ELAPER and 78 cases of conventional APER were included in the study. Levator involvement was significantly higher in the ELAPER compared with the conventional group; otherwise, the two groups were comparable in all the aspects. CRM involvement was seen in seven patients (8.9%) in the conventional group compared with three patients (7.14%) in the ELAPER group. Median hospital stay was significantly longer with ELAPER. The univariate analysis of the factors influencing CRM positivity did not show any significance. Conclusions ELAPER should be the preferred approach for low rectal tumors with involvement of levators. For those cases in which levators are not involved, as shown in preoperative magnetic resonance imaging (MRI), the current evidence is insufficient to recommend ELAPER over conventional APER. This stresses the importance of preoperative MRI in determining the best approach for an individual patient. PMID:27284466

  4. Liver transplantation in the MELD era: a single-center experience.

    PubMed

    Sachdev, Mankanwal; Hernandez, Jose L; Sharma, Pratima; Douglas, David D; Byrne, Thomas; Harrison, M Edwyn; Mulligan, David; Moss, Adyr; Reddy, Kunam; Vargas, Hugo E; Rakela, Jorge; Balan, Vijayan

    2006-06-01

    Model for Endstage Liver Disease (MELD) score has been used to allocate organs since February 2002. This policy allocates organs to candidates with regard to severity of their underlying liver disease except in the case of hepatocellular carcinoma (HCC) patients. The purpose of this study was to determine the impact of MELD on waiting times, dropout rates, and transplantation rates in all patients awaiting liver transplantation at our center. The records of all patients listed for liver transplantation between May 28, 1999, and February 27, 2004, at the Mayo Clinic, Scottsdale, Arizona, were reviewed. Candidates were grouped by two time periods as pre-MELD or post-MELD based on date of MELD implementation (February 27, 2002). The incidence of deceased donor liver transplantation (DDLT), waiting time to DDLT, dropout rate from the waiting list because of clinical deterioration or death, and survival while waiting for or after DDLT were determined for each group. Three hundred fifty-one patients were listed for liver transplantation (195 pre-MELD, 156 post-MELD) during the study period. HCC patients had an improved rate of transplantation after MELD (pre-MELD, 1.39 persons per year; post-MELD, 3.48 persons per year). In all groups, with the exception of hepatitis C virus, the transplantation rates were the same for both categories. The hepatitis C virus group also had improved transplantation rates in the post-MELD period. HCC candidates under the new allocation policy have an increased incidence of DDLT in our institution. However, this has not disadvantaged patients with non-HCC diagnoses. Thus, the new MELD-based allocation policy has benefited all candidates by allowing more timely transplants. PMID:16865573

  5. Chromogranin A as Serum Marker for Gastroenteropancreatic Neuroendocrine Tumors: A Single Center Experience and Literature Review

    PubMed Central

    Nölting, Svenja; Kuttner, Axel; Lauseker, Michael; Vogeser, Michael; Haug, Alexander; Herrmann, Karin A.; Hoffmann, Johannes N.; Spitzweg, Christine; Göke, Burkhard; Auernhammer, Christoph J.

    2012-01-01

    The aim of this study was to assess the clinical sensitivities of the tumor markers chromogranin A (CgA), urinary 5-hydroxyindoleacetic acid (5-HIAA) and alkaline phosphatase (AP) in neuroendocrine tumors (NETs) of the GastroEnteroPancreatic-(GEP-) system depending on tumor primary location and metastatic spread. In a retrospective single-center series, sensitivities were evaluated in serum samples from 110 patients with midgut (n = 62) and pancreatic (n = 48) NETs. CgA levels were analyzed by a commercially-available immunoradiometric assay (CIS-bio) during routine follow-up in the years 2000–2009. CgA showed a higher sensitivity for midgut (68%) than pancreatic (54%) NETs. A higher CgA sensitivity and significantly higher median CgA values were found in patients with liver metastases than in those without, and in patients with hepatic and additionally extra-hepatic metastases than in those with hepatic and nodal metastases alone, respectively. We found an overall sensitivity for elevated 5HIAA excretion of 69% for midgut NETs and a significant correlation between median CgA and 5-HIAA values. The sensitivity of AP and the correlations of AP/CgA-data-pairs were low in both midgut and pancreatic NETs, although highest for metastatic pancreatic NETs. The sensitivity of CgA measurement depends on the NET primary location and spread of disease. 5-HIAA and CgA showed comparable sensitivity in midgut NETs, while AP does not seem to be useful as a tumor marker in GEP-NETs. PMID:24213232

  6. Cytomegalovirus Reactivation in Adult Recipients of Autologous Stem Cell Transplantation: a Single Center Experience

    PubMed Central

    Al-Rawi, Omar; Abdel-Rahman, Fawzi; Al-Najjar, Rula; Abu-Jazar, Husam; Salam, Mourad; Saad, Mustafa

    2015-01-01

    Introduction Cytomegalovirus (CMV) reactivation and infection are well-recognized complications after allogeneic stem cell transplantation (SCT). Only a few studies have addressed CMV reactivation after autologous SCT (ASCT). Methods We retrospectively reviewed medical records of 210 adult patients who underwent ASCT for lymphoma or multiple myeloma (MM) at a single center from January 1st, 2007 until December 31st, 2012. All patients were monitored weekly with CMV antigenemia test till day 42 after transplantation, and for 2 months after last positive test in those who had any positive CMV antigenemia test before day 42. Results Thirty-seven (17.6%) patients had CMV reactivation; 23 patients had lymphoma while 14 had MM as the underlying disease. There was no difference in the rate of CMV reactivation between lymphoma and MM patients (20% versus 14.7%, P = 0.32). The majority of the patients were treated with ganciclovir/valganciclovir, all patients had their reactivation resolved with therapy, and none developed symptomatic CMV infection. None of the patients who died within 100 days of transplantation had CMV reactivation. Log-rank test showed that CMV reactivation had no effect on the overall survival of patients (P values, 0.29). Conclusion In our cohort, CMV reactivation rate after ASCT was 17.6%. There was no difference in reactivation rates between lymphoma and MM patients. With the use of preemptive therapy, symptomatic CMV infection was not documented in any patient in our cohort. CMV reactivation had no impact on patients’ survival post ASCT. PMID:26401238

  7. Sudden Unexplained Cardiac Arrest in Apparently Healthy Children: A Single Center Experience

    PubMed Central

    Alapati, Srilatha; Strobel, Nathaniel; Hashmi, Sharukh; Bricker, John T.; Gupta-Malhotra, Monesha

    2012-01-01

    Objective To determine the causes of sudden cardiac arrest (SCA) in apparently healthy children in a single center in the era of primary prevention (screening questionnaire, SQ) and secondary prevention (automated external defibrillator, AED and automated implantable cardioverter defibrillator, AICD). Study Design Any child (0–18 year’s age) without prior known disease except for attention deficit disorder who underwent out-of-the hospital cardiopulmonary resuscitation was included in the study as SCA. Using retrospective chart review we evaluated the efficacy of the SQ, electrocardiogram (EKG), chest roentgenogram (CXR) and an echocardiogram. Results We found 44 out of 6,656 children admitted to intensive care with SCA; an AED was used in 39%, AICD placed in 18% and survival to hospital discharge was 50%. The etiology for SCA was identified in 57% of the cases, mostly in those above one year of age and among these the majority of had a cardiac etiology (50%) while 7% had rupture of an arteriovenous malformation. Stimulant medication use was seen in 11% of the SCA. In the best case scenario of hypothesized primary prevention, a prior SQ, CXR, EKG and echocardiogram may have detected 18%, 9%, 23% and 16% of at-risk cases respectively and 32% may have been detected with EKG and SQ together. Based on a historical control cohort, a positive EKG was significantly higher in children with SCA (p = 0.014). Conclusion An EKG along with a screening SQ may be more effective in identifying children who are potentially at-risk for SCA than a SQ alone. PMID:23052663

  8. Invasive Fusariosis in the Voriconazole Era: Single-Center 13-Year Experience.

    PubMed

    Stempel, Jessica M; Hammond, Sarah P; Sutton, Deanna A; Weiser, Linda M; Marty, Francisco M

    2015-09-01

    Background.  Invasive fusariosis remains an aggressive, albeit infrequent infection in immunocompromised patients. Methods.  We identified all cases of invasive fusariosis between January 2002 and December 2014. We recorded patient characteristics including clinical presentation, treatment, and outcomes at 6 and 12 weeks after diagnosis, as well as species identification and antifungal drug susceptibilities. Results.  Fifteen patients were diagnosed with proven (12, 80%) or probable (3, 20%) fusariosis. Median age was 60 years (range, 26-78), and 10 patients were male. Underlying conditions included hematological malignancies (13, 87%), juvenile idiopathic arthritis (1, 7%), and third-degree burns (1, 7%). Five patients underwent hematopoietic stem-cell transplantation before diagnosis. Six patients (40%) received systemic glucocorticoids, and 11 patients (73%) had prolonged neutropenia at the time of diagnosis. Clinical presentations included the following: skin/soft tissue infection (8, 53%), febrile neutropenia (4, 27%), respiratory tract infection (2, 13%), and septic arthritis (1, 7%). Twelve patients were treated with voriconazole: 6 (40%) with voriconazole alone, 4 (27%) with voriconazole and terbinafine, and 2 (13%) with voriconazole, terbinafine, and amphotericin. One patient (7%) was treated with terbinafine alone, and another with micafungin alone. Four patients underwent surgical debridement (4, 27%). Susceptibility testing was performed on 9 isolates; 8 demonstrated voriconazole minimum inhibitory concentrations ≥4 µg/mL. The cumulative probability of survival was 66.7% and 53.3% at 6 and 12 weeks after diagnosis. Conclusions.  Mortality associated with invasive fusariosis remains high. Cumulative mortality at our center was lower than previous reports despite elevated voriconazole minimum inhibitory concentrations. Combination therapy should be studied systematically for fusariosis. PMID:26258156

  9. Invasive Fusariosis in the Voriconazole Era: Single-Center 13-Year Experience

    PubMed Central

    Stempel, Jessica M.; Hammond, Sarah P.; Sutton, Deanna A.; Weiser, Linda M.; Marty, Francisco M.

    2015-01-01

    Background. Invasive fusariosis remains an aggressive, albeit infrequent infection in immunocompromised patients. Methods. We identified all cases of invasive fusariosis between January 2002 and December 2014. We recorded patient characteristics including clinical presentation, treatment, and outcomes at 6 and 12 weeks after diagnosis, as well as species identification and antifungal drug susceptibilities. Results. Fifteen patients were diagnosed with proven (12, 80%) or probable (3, 20%) fusariosis. Median age was 60 years (range, 26–78), and 10 patients were male. Underlying conditions included hematological malignancies (13, 87%), juvenile idiopathic arthritis (1, 7%), and third-degree burns (1, 7%). Five patients underwent hematopoietic stem-cell transplantation before diagnosis. Six patients (40%) received systemic glucocorticoids, and 11 patients (73%) had prolonged neutropenia at the time of diagnosis. Clinical presentations included the following: skin/soft tissue infection (8, 53%), febrile neutropenia (4, 27%), respiratory tract infection (2, 13%), and septic arthritis (1, 7%). Twelve patients were treated with voriconazole: 6 (40%) with voriconazole alone, 4 (27%) with voriconazole and terbinafine, and 2 (13%) with voriconazole, terbinafine, and amphotericin. One patient (7%) was treated with terbinafine alone, and another with micafungin alone. Four patients underwent surgical debridement (4, 27%). Susceptibility testing was performed on 9 isolates; 8 demonstrated voriconazole minimum inhibitory concentrations ≥4 µg/mL. The cumulative probability of survival was 66.7% and 53.3% at 6 and 12 weeks after diagnosis. Conclusions. Mortality associated with invasive fusariosis remains high. Cumulative mortality at our center was lower than previous reports despite elevated voriconazole minimum inhibitory concentrations. Combination therapy should be studied systematically for fusariosis. PMID:26258156

  10. Clinical course and prognostic factors of childhood immune thrombocytopenia: single center experience of 10 years

    PubMed Central

    Jung, Jae Yeob; O, A Rum; Kim, Je Keong

    2016-01-01

    Purpose This study aimed to evaluate the clinical course of childhood immune thrombocytopenia (ITP) and to assess the risk factors for developing chronic ITP. Methods The records of 64 children diagnosed with ITP from November 2005 and December 2014 at single center were retrospectively analyzed. Results The median age at diagnosis and the median platelet count were 1 year (range, 1 month to 15 years) and 9×109/L (range, 0–84×109/L), respectively. No patient experienced severe bleeding. Nineteen children (29.7%) spontaneously recovered their platelet count to ≥100×109/L at a median of 10 days. In total 45 patients (70.3%) received intravenous immunoglobulin (IVIG) as first-line therapy, and showed platelet recovery at 1 week. The final diagnosis of 55 (85.9%) and 9 patients (14.1%) was acute and chronic ITP, respectively. Older age, absence of prior infection and insidious onset of symptoms were significantly associated with the development of chronic ITP. Among the patients who received IVIG, those with platelet count <45×109/L at 1 month after IVIG showed a significantly higher incidence of chronic ITP compared to those with platelet count ≥45×109/L (88.8% vs. 44.4%, P<0.01). Conclusion In most patients, ITP runs a benign course and approximately 86% of them recover within 1 year of their initial diagnosis. The potential impact of the risk factors of chronic ITP on clinical practice needs to be explored and further studies are warranted to determine whether IVIG influences the course of ITP. PMID:27610182

  11. Predictors of pathologic complete response after preoperative concurrent chemoradiotherapy of rectal cancer: a single center experience

    PubMed Central

    Choi, Euncheol; Kim, Jin Hee; Kim, Ok Bae; Kim, Mi Young; Oh, Young Ki; Baek, Sung Gyu

    2016-01-01

    Purpose: To identify possible predictors of pathologic complete response (pCR) of rectal cancer after preoperative concurrent chemoradiotherapy (CCRT). Materials and Methods: We conducted a retrospective review of 53 patients with rectal cancer who underwent preoperative CCRT followed by radical surgery at a single center between January 2007 and December 2012. The median radiotherapy dose to the pelvis was 54.0 Gy (range, 45.0 to 63.0 Gy). Five-fluorouracil-based chemotherapy was administered via continuous infusion with leucovorin. Results: The pCR rate was 20.8%. The downstaging rate was 66%. In univariate analyses, poor and undifferentiated tumors (p = 0.020) and an interval of ≥7 weeks from finishing CCRT to surgery (p = 0.040) were significantly associated with pCR, while female gender (p = 0.070), initial carcinoembryonic antigen concentration of <5.0 ng/dL (p = 0.100), and clinical stage T2 (p = 0.100) were marginally significant factors. In multivariate analysis, an interval of ≥7 weeks from finishing CCRT to surgery (odds ratio, 0.139; 95% confidence interval, 0.022 to 0.877; p = 0.036) was significantly associated with pCR, while stage T2 (odds ratio, 5.363; 95% confidence interval, 0.963 to 29.877; p = 0.055) was a marginally significant risk factor. Conclusion: We suggest that the interval from finishing CCRT to surgery is a predictor of pCR after preoperative CCRT in patients with rectal cancer. Stage T2 cancer may also be an important predictive factor. We hope to perform a robust study by collecting data during treatment to obtain more advanced results. PMID:27306776

  12. Clinical outcomes of liver transplantation for polycystic liver disease: a single center experience.

    PubMed

    Chandok, Natasha; Uhanova, Julia; Marotta, Paul

    2010-01-01

    Polycystic liver disease (PLD) is a celiopathy characterized by progressive growth of multiple hepatic cysts. In a minority of patients, severe symptomatic hepatomegaly necessitates liver transplantation (LT). The purpose of this study is to describe the postoperative and long-term outcomes of all patients transplanted for PLD at our center. All patients who underwent LT for PLD were identified through our database. Using patient charts, data were extracted on patient demographics and medical history, postoperative surgical and medical complications, length of hospitalization, prevalence of chronic kidney failure, and patient and graft survival. Subjects were contacted in April 2010 to verify their survival and confirm their need, if any, for hemodialysis and/or kidney transplantation. Descriptive statistics for patient and graft survival were performed. From 1993 to 2010, 14 subjects underwent LT and 1 subject underwent combined kidney and LT; all subjects were female and the mean age was 49.0 years. 10 (66.7%) subjects had polycystic kidney disease. Patients experienced a high rate of vascular complications, including hepatic artery thrombosis (HAT) or stenosis in 3 (20%) and 2 (13.3%) subjects, respectively. One subject had early graft loss due to HAT and underwent re-transplantation. The mean length of hospitalization was 18.8 days. After a mean of 66.8 months of follow-up (3-200), 13 (86.7%) subjects are alive with satisfactory graft function, and no patients had renal failure. In conclusion, patients who underwent LT for PLD had a high rate of postoperative vascular complications. However, long-term patient and graft survival, and kidney function, is excellent. PMID:20720268

  13. Central nervous system involvement in T-cell lymphoma: A single center experience.

    PubMed

    Gurion, Ronit; Mehta, Neha; Migliacci, Jocelyn C; Zelenetz, Andrew; Moskowitz, Alison; Lunning, Matthew; Moskowitz, Craig; Hamlin, Paul; Horwitz, Steven

    2016-05-01

    Background We characterized the incidence of central nervous system (CNS) involvement, risk factors and outcome in a large single institution dataset of peripheral T-cell lymphoma (PTCL). Methods Retrospective review of the PTCL database at Memorial Sloan Kettering Cancer Center. We identified 231 patients with any subtype of PTCL between 1994-2011 with a minimum six months of follow-up or an event defined as relapse or death. Results Histologies included peripheral T-cell lymphoma-not otherwise specified (PTCL-NOS) (31.6%), angioimmunoblastic (16.9%), anaplastic large cell lymphoma (ALCL), ALK- (12.1%), ALCL, ALK + (6.1%), extranodal NK/T-cell lymphoma (7.4%), adult T-cell leukemia/lymphoma (ATLL) (7.4%), and transformed mycosis fungoides (8.7%). Seventeen patients had CNS disease (7%). Fifteen had CNS involvement with PTCL and two had diffuse large B-cell lymphoma and glioblastoma. Median time to CNS involvement was 3.44 months (0.16-103.1). CNS prophylaxis was given to 24 patients (primarily intrathecal methotrexate). Rates of CNS involvement were not different in patients who received prophylaxis. Univariate analysis identified stage III-IV, bone marrow involvement, >1 extranodal site and ATLL as risk factors for CNS disease. On multivariate analysis, >1 extranodal site and international prognostic index (IPI) ≥ 3 were predictive for CNS involvement. The median survival of patients with CNS involvement was 2.63 months (0.10-75). Conclusions Despite high relapse rates, PTCL, except ATLL, carries a low risk of CNS involvement. Prognosis with CNS involvement is poor and risk factors include: >1 extra nodal site and IPI ≥3. PMID:27046135

  14. Mycetoma: experience of 482 cases in a single center in Mexico.

    PubMed

    Bonifaz, Alexandro; Tirado-Sánchez, Andrés; Calderón, Luz; Saúl, Amado; Araiza, Javier; Hernández, Marco; González, Gloria M; Ponce, Rosa María

    2014-08-01

    Mycetoma is a chronic granulomatous disease. It is classified into eumycetoma caused by fungi and actinomycetoma due to filamentous actinomycetes. Mycetoma can be found in geographic areas in close proximity to the Tropic of Cancer. Mexico is one of the countries in which this disease is highly endemic. In this retrospective study we report epidemiologic, clinical and microbiologic data of mycetoma observed in the General Hospital of Mexico in a 33 year-period (1980 to 2013). A total of 482 cases were included which were clinical and microbiology confirmed. Four hundred and forty four cases (92.11%) were actinomycetomas and 38 cases (7.88%) were eumycetomas. Most patients were agricultural workers; there was a male predominance with a sex ratio of 3:1. The mean age was 34.5 years old (most ranged from 21 to 40 years). The main affected localization was lower and upper limbs (70.74% and 14.52% respectively). Most of the patients came from humid tropical areas (Morelos, Guerrero and Hidalgo were the regions commonly reported). The main clinical presentation was as tumor-like soft tissue swelling with draining sinuses (97.1%). Grains were observed in all the cases. The principal causative agents for actinomycetoma were: Nocardia brasiliensis (78.21%) and Actinomadura madurae (8.7%); meanwhile, for eumycetomas: Madurella mycetomatis and Scedosporium boydii (synonym: Pseudallescheria boydii) were identified. This is a single-center, with long-follow up, cross-sectional study that allows determining the prevalence and characteristics of mycetoma in different regions of Mexico. PMID:25144462

  15. Conversion from temporary to tunneled catheters by nephrologists: report of a single-center experience

    PubMed Central

    Silva, Bruno C; Rodrigues, Camila E; Abdulkader, Regina CRM; Elias, Rosilene M

    2016-01-01

    Background Nephrologists have increasingly participated in the conversion from temporary catheters (TC) to tunneled-cuffed catheters (TCCs) for hemodialysis. Objective To prospectively analyze the outcomes associated with TCC placement by nephrologists with expertise in such procedure, in different time periods at the same center. The impact of vancomycin or cefazolin as prophylactic antibiotics on the infection outcomes was also tested. Patients and methods Hemodialysis patients who presented to such procedure were divided into two cohorts: A (from 2004 to 2008) and B (from 2013 to 2015). Time from TC to TCC conversion, prophylactic antibiotics, and reasons for TCC removal were evaluated. Results One hundred and thirty patients were included in cohort A and 228 in cohort B. Sex, age, and follow-up time were similar between cohorts. Median time from TC to TCC conversion was longer in cohort A than in cohort B (14 [3; 30] vs 4 [1; 8] days, respectively; P⩽0.0001). Infection leading to catheter removal occurred in 26.4% vs 18.9% of procedures in cohorts A and B, respectively, and infection rate was 0.93 vs 0.73 infections per 1,000 catheter-days, respectively (P=0.092). Infection within 30 days from the procedure occurred in 1.4% of overall cohort. No differences were observed when comparing vancomycin and cefazolin as prophylactic antibiotics on 90-day infection-free TCC survival in a Kaplan–Meier model (log-rank = 0.188). TCC removal for low blood flow occurred in 8.9% of procedures. Conclusion Conversion of TC to TCC by nephrologists had overall infection, catheter patency, and complications similar to data reported in the literature. Vancomycin was not superior to cefazolin as a prophylactic antibiotic. PMID:27114715

  16. Mycetoma: Experience of 482 Cases in a Single Center in Mexico

    PubMed Central

    Bonifaz, Alexandro; Tirado-Sánchez, Andrés; Calderón, Luz; Saúl, Amado; Araiza, Javier; Hernández, Marco; González, Gloria M.; Ponce, Rosa María

    2014-01-01

    Mycetoma is a chronic granulomatous disease. It is classified into eumycetoma caused by fungi and actinomycetoma due to filamentous actinomycetes. Mycetoma can be found in geographic areas in close proximity to the Tropic of Cancer. Mexico is one of the countries in which this disease is highly endemic. In this retrospective study we report epidemiologic, clinical and microbiologic data of mycetoma observed in the General Hospital of Mexico in a 33 year-period (1980 to 2013). A total of 482 cases were included which were clinical and microbiology confirmed. Four hundred and forty four cases (92.11%) were actinomycetomas and 38 cases (7.88%) were eumycetomas. Most patients were agricultural workers; there was a male predominance with a sex ratio of 3∶1. The mean age was 34.5 years old (most ranged from 21 to 40 years). The main affected localization was lower and upper limbs (70.74% and 14.52% respectively). Most of the patients came from humid tropical areas (Morelos, Guerrero and Hidalgo were the regions commonly reported). The main clinical presentation was as tumor-like soft tissue swelling with draining sinuses (97.1%). Grains were observed in all the cases. The principal causative agents for actinomycetoma were: Nocardia brasiliensis (78.21%) and Actinomadura madurae (8.7%); meanwhile, for eumycetomas: Madurella mycetomatis and Scedosporium boydii (synonym: Pseudallescheria boydii) were identified. This is a single-center, with long-follow up, cross-sectional study that allows determining the prevalence and characteristics of mycetoma in different regions of Mexico. PMID:25144462

  17. Helical Tomotherapy in Head and Neck Cancer: A European Single-Center Experience

    PubMed Central

    Van den Weyngaert, Danielle; De Kerf, Geert; De Ost, Bie; Vanderveken, Olivier; Van Laer, Carl; Specenier, Pol; Geussens, Yasmyne; Wouters, Kristien; Meulemans, Els; Cheung, Kin Jip; Grégoire, Vincent; Vermorken, Jan B.

    2015-01-01

    Background. We report on a retrospective analysis of 147 patients with early and locoregionally advanced squamous cell head and neck cancer (SCCHN) treated with helical tomotherapy (HT). Patients and Methods. Included were patients with SCCHN of the oral cavity (OC), oropharynx (OP), hypopharynx (HP), or larynx (L) consecutively treated in one radiotherapy center in 2008 and 2009. The prescribed HT dose was 60–66 Gy in the postoperative setting (group A) and 66–70 Gy when given as primary treatment (group B). HT was given alone, concurrent with systemic therapy (ST), that is, chemotherapy, biotherapy, or both, and with or without induction therapy (IT). Acute and late toxicities are reported using standard criteria; locoregional failure/progression (LRF), distant metastases (DM), and second primary tumors (SPT) were documented, and event-free survival (EFS) and overall survival (OS) were calculated from the start of HT. Results. Group A patients received HT alone in 22 cases and HT + ST in 20 cases; group B patients received HT alone in 17 cases and HT + ST in 88 cases. Severe (grade ≥ 3) acute mucosal toxicity and swallowing problems increased with more additional ST. After a median follow-up of 44 months, grade ≥2 late toxicity after HT + ST was approximately twice that of HT alone for skin, subcutis, pharynx, and larynx. Forty percent had grade ≥2 late xerostomia, and 29% had mucosal toxicity. At 3 years, LRF/DM/SPT occurred in 7%/7%/17% and 25%/13%/5% in groups A and B, respectively, leading to a 3-year EFS/OS of 64%/74% and 56%/63% in groups A and B, respectively. Conclusion. The use of HT alone or in combination with ST is feasible and promising and has a low late fatality rate. However, late toxicity is nearly twice as high when ST is added to HT. PMID:25673104

  18. Trastuzumab Administration in Patients with Metastatic Breast Cancer – Experience of a Large University Breast Center

    PubMed Central

    Hartkopf, A. D.; Brendel, M. H.; Wallwiener, M.; Taran, F.-A.; Brucker, S.; Grischke, E.-M.

    2014-01-01

    Background: Administered either alone or in combination with various cytostatic, endocrine or targeted therapies, trastuzumab significantly improves the prognosis of patients with HER2-positive breast cancer. As trastuzumab is effective across multiple lines of therapy in the metastatic setting (treatment beyond progression: TBP), it is often administered over a long period of time. The aim of this study was to evaluate the tolerability and clinical practice of long-term trastuzumab administration (> 1 year) in metastatic breast cancer patients treated in a large university breast center. Methods: Metastatic breast cancer patients who received at least 18 cycles of trastuzumab administered every three weeks at the University Gynecological Hospital of Tuebingen between 1999 and 2012 were included in this retrospective study. Typical combination drugs, side effects, and the impact of administration on left ventricular ejection fraction (LVEF) were investigated. Results: 72 patients were eligible for inclusion in the study. The mean number of administrations was 50.14 (SD: 27.51). In 53 patients the principle of TBP was followed across an average of 2.4 therapy lines. Classic cardiac risk factors were present at the beginning of trastuzumab treatment in 34 patients (47 %). Seven patients (10 %) experienced a decrease in LVEF during treatment, 9 patients (13 %) had hypersensitivity reactions. Treatment was discontinued in two patients due to side effects (1 × progressive LVEF decrease, 1 × intolerance). Summary: The administration of trastuzumab across multiple lines of therapy was generally tolerated well. Cardiac risk factors were not a limiting factor. If regular cardiac monitoring is done, trastuzumab appears not only to improve survival but also helps preserve the quality of life of patients with HER2-positive metastatic breast cancer. PMID:24976638

  19. Initial clinical experience with scanned proton beams at the Italian National Center for Hadrontherapy (CNAO)

    PubMed Central

    Tuan, J.; Vischioni, B.; Fossati, P.; Srivastava, A.; Vitolo, V.; Iannalfi, A.; Fiore, M.R.; Krengli, M.; Mizoe, J.E.; Orecchia, R.

    2013-01-01

    We report the initial toxicity data with scanned proton beams at the Italian National Center for Hadrontherapy (CNAO). In September 2011, CNAO commenced patient treatment with scanned proton beams within two prospective Phase II protocols approved by the Italian Health Ministry. Patients with chondrosarcoma or chordoma of the skull base or spine were eligible. By October 2012, 21 patients had completed treatment. Immobilization was performed using rigid non-perforated thermoplastic-masks and customized headrests or body-pillows as indicated. Non-contrast CT scans with immobilization devices in place and MRI scans in supine position were performed for treatment-planning. For chordoma, the prescribed doses were 74 cobalt grey equivalent (CGE) and 54 CGE to planning target volume 1 (PTV1) and PTV2, respectively. For chondrosarcoma, the prescribed doses were 70 CGE and 54 CGE to PTV1 and PTV2, respectively. Treatment was delivered five days a week in 35–37 fractions. Prior to treatment, the patients' positions were verified using an optical tracking system and orthogonal X-ray images. Proton beams were delivered using fixed-horizontal portals on a robotic couch. Weekly MRI incorporating diffusion-weighted-imaging was performed during the course of proton therapy. Patients were reviewed once weekly and acute toxicities were graded with the Common Terminology Criteria for Adverse Events (CTCAE). Median age of patients = 50 years (range, 21–74). All 21 patients completed the proton therapy without major toxicities and without treatment interruption. Median dose delivered was 74 CGE (range, 70–74). The maximum toxicity recorded was CTCAE Grade 2 in four patients. Our preliminary data demonstrates the clinical feasibility of scanned proton beams in Italy. PMID:23824124

  20. Pancreas Transplantation From Living Donors: A Single Center Experience of 20 Cases.

    PubMed

    Choi, J Y; Jung, J H; Kwon, H; Shin, S; Kim, Y H; Han, D J

    2016-08-01

    Living donor pancreas transplantation (LDPT) has several advantages over deceased donor pancreas transplantation (DDPT), including better HLA matching, shorter ischemic time, and shorter waiting time. It remains an attractive option for diabetes mellitus (DM) patients with end stage renal disease. We reviewed 20 cases of LDPT performed in Asan Medical Center between October 1992 and March 2015. Six cases (30%) were pancreas transplantation alone (PTA), and the rest (70%) were simultaneous pancreas and kidney transplantation (SPK). Relations of donor and recipient were parents in 7 (35%), siblings in 6 (30%), spouse in 6 (30%), and cousin in 1 (5%). Graft survival in SPK at 1, 3, 5, and 10 years was 91.7%, 83.3%, 83.3%, and 83.3%, respectively, and that in PTA recipients was 50%, 33.3%, 16.7%, and 16.7%, respectively (p = 0.005). Causes of graft failure in SPK were thrombosis (one case), and rejection (one case), whereas those in PTA were noncompliance (two cases), thrombosis (one case), reflux pancreatitis (one case), and chronic rejection (one case). In terms of pancreas exocrine drainage, two grafts (25%) maintained their function in bladder drainage, while all grafts maintained in enteric drainage p < 0.05). Seven (35%) donors experienced minor pancreatic juice leakage and one underwent reoperation due to postoperative hematoma. Most donors maintained normoglycemia and normal renal function. However, two donors developed DM (at 1 and 90 months postdonation), and were treated with oral hypoglycemic agents. Graft survival in PTA recipients was poorer than in SPK due to poor compliance and bladder drainage-related problems. The surgical and metabolic complication rates of donors can be minimized by applying strict donor criteria. Therefore, LDPT with enteric drainage is an acceptable treatment for SPK. PMID:26833623

  1. Real-time three-dimensional intracardiac echocardiography: an early single-center experience.

    PubMed

    Maini, Brijeshwar

    2015-01-01

    As interventional procedures in structural heart diseases are coming of age, there is a significant lag in the periinterventional imaging development for these procedures to become safe, expedient, accurate, and well tolerated by this patient population. Currently, transesophageal echocardiography (TEE), including real-time three-dimensional (RT-3D), has been used for monitoring and guidance for these procedures. Accurate identification of the pathology, its anatomy, and its relationship with the adjoining structures along with spatial resolution is of paramount importance for wire and catheter placement, device deployment, evaluation of the results, and any potential complications. Two-dimensional intracardiac echocardiography (ICE) has been used extensively for a variety of interventional procedures that undergo conscious sedation of monitored anesthesia. RT-3D ICE has recently become available; we describe our initial experience with this new imaging technology. PMID:25589706

  2. Interactive data analysis for astronomy Shuttle experiments at Goddard Space Flight Center

    NASA Technical Reports Server (NTRS)

    Klinglesmith, D. A., III

    1981-01-01

    The eye as an efficient selection device for determining what is important in astronomical imagery can be greatly aided by the computer. A suitable facility, called the Interactive Astronomical Data Analysis Facility (IADAF), has been developed for the display and analysis of astronomical imagery by the Laboratory for Astronomy and Solar Physics. The Laboratory for Astronomy and Solar Physics currently has approval to fly two experiments on Spacelab. The Solar Extreme Ultraviolet Telescope (SEUTS) is to be used for the study of several fundamental problems of solar physics. The Ultraviolet Image Telescope for Astronomical Investigations (UIT) is to provide direct imagery of selected fields of view throughout the sky. A description is given of IADAF, taking into account its 16-bit computer and the COMTAL image processing display system. The use of IADAF by SEUTS and UIT is discussed.

  3. Renal Medullary Carcinoma Response to Chemotherapy: a Referral Center Experience in Brazil

    PubMed Central

    Maroja Silvino, Marina Cavalcanti; Venchiarutti Moniz, Camila Motta; Munhoz Piotto, Gustavo Henrique; Siqueira, Sheila; Galapo Kann, Ariel; Dzik, Carlos

    2013-01-01

    Renal medullary carcinoma (RMC) is rare, accounting for less than 1% of all renal neoplasms. Case reports suggest RMC is highly aggressive, poorly responsive to chemotherapy, often metastatic at diagnosis, affects young men with sickle cell trait, and median overall survival (mOS) is less than 12 months. We report the epidemiological characteristics, treatments performed, response rate to each treatment and mOS of five patients with RMC. All patients had sickle cell trait, four were male, three had metastatic disease at diagnosis and mean age at diagnosis was 25 years. Non-metastatic patients were submitted to nephrectomy. Two patients had partial response to first line chemotherapy including cisplatin and gemcitabine. There was no response to sunitinib or second line chemo - therapy; mOS was 6 months. Due to its rarity, case series are the only evidence available to discuss the treatment for RMC. In our experience, only cisplatin and gemcitabine based regimen offered response. PMID:24179656

  4. Combined radiological-endoscopic management of difficult bile duct stones: 18-year single center experience

    PubMed Central

    Cannavale, Alessandro; Bezzi, Mario; Cereatti, Fabrizio; Lucatelli, Pierleone; Fanello, Gianfranco; Salvatori, Filippo Maria; Fanelli, Fabrizio; Fiocca, Fausto; Donatelli, Gianfranco

    2015-01-01

    Objectives: Clinical evidence regarding radiological–endoscopic management of intrahepatic bile duct stones is currently lacking. Our aim is to report our 18-year experience in combined radiological–endoscopic management of intrahepatic difficult bile duct stones. Methods: From June 1994 to June 2012, 299 symptomatic patients with difficult bile duct stones were admitted to our institution. Percutaneous transhepatic cholangiography (PTC)/biliary drainage/s was performed, dilating the PTC track to 10 or 16 French within 3–7 days. Afterward we carried out percutaneous transhepatic cholangioscopy (PTCS) with electrohydraulic lithotripsy (EHL) and/or interventional radiology techniques. Follow up was made with clinical/laboratory tests and ultrasound (US). We retrospectively analyzed our radiological–endoscopic approach and reported our technical and clinical outcomes. Results: Complete stone clearance was achieved in 298 patients after a maximum of 4 consecutive sessions. Most patients (64.6%) were treated with PTCS/EHL alone, while the remaining with radiological techniques alone (26%) or a combination of both techniques (13.3%). Recurrence of stones occurred in 45 cases (15%, Tsunoda class III and class IV) within 2 years and were successfully retreated. Major adverse events were: 5 (1.6%) cases of massive bleeding that required embolisation, 2 (0.66%) perforations of the common bile duct and 31 cases (10.3%) of acute cholangitis managed with medical therapy or intervention. Conclusion: After 18 years of experience we demonstrated that our combined radiological–endoscopic approach to ‘difficult bile duct stones‘ may result in both immediate and long-term clearance of stones with a low rate of adverse events. PMID:26557890

  5. A Large Single-Center Experience of Open Lateral Abdominal Wall Hernia Repairs.

    PubMed

    Patel, Puraj P; Warren, Jeremy A; Mansour, Roozbeh; Cobb, William S; Carbonell, Alfredo M

    2016-07-01

    Lateral abdominal wall hernias may occur after a variety of procedures, including anterior spine exposure, urologic procedures, ostomy closures, or after trauma. Anatomically, these hernias are challenging and require a complete understanding of abdominal wall, interparietal and retroperitoneal, anatomy for successful repair. Mesh placement requires extensive dissection of often unfamiliar planes, and its fixation is difficult. We report our experience with open mesh repair of lateral abdominal wall hernias. A retrospective review of a prospectively maintained database was performed to identify patients with a classification of lateral abdominal wall hernia who underwent an open repair. A total of 61 patients underwent open lateral hernia repairs. Mean patient age was 58 years (range 25-78), with a mean body mass index of 32 kg/m(2) (range 19.0-59.1). According to the European Hernia Society classification, defects were located subcostal (L1, 14 patients), flank (L2, 33 patients), iliac (L3, 11 patients), and lumber (L4, 3 patients). Mean defect size was 78.6 cm(2), with a mean greatest single dimension of 9.2 cm (range 2-25 cm). Retromuscular or interparietal repair was performed in 50.8 per cent, preperitoneal in 41.0 per cent, intraperitoneal in 6.6 per cent, and onlay in 1.6 per cent. The rate of surgical site occurrence was 49.2 per cent, primarily seroma and surgical site infection rate was 13.1 per cent. With a mean follow-up of 15.4 months, seven patients (11.5%) have documented recurrence. Synthetic mesh reconstruction of lateral wall hernias is challenging. Our experience demonstrates the safety and success of repair using synthetic mesh primarily in the retromuscular, interparietal, or preperitoneal planes. PMID:27457859

  6. Laparoendoscopic Single-Site Surgeries: A Single-Center Experience of 171 Consecutive Cases

    PubMed Central

    Choi, Kyung Hwa; Ham, Won Sik; Rha, Koon Ho; Lee, Jae Won; Jeon, Hwang Gyun; Arkoncel, Francis Raymond P.; Yang, Seung Choul

    2011-01-01

    Purpose We report our experience to date with 171 patients who underwent laparoendoscopic single-site surgery for diverse urologic diseases in a single institution. Materials and Methods Between December 2008 and August 2010, we performed 171 consecutive laparoendoscopic single-site surgeries. These included simple nephrectomy (n=18; robotic surgeries, n=1), radical nephrectomy (n=26; robotic surgeries, n=2), partial nephrectomy (n=59; robotic surgeries, n=56), nephroureterectomy (n=20; robotic surgeries, n=12), pyeloplasty (n=4), renal cyst decortications (n=22), adrenalectomy (n=4; robotic surgeries, n=2), ureterolithotomy (n=10), partial cystectomy (n=3), ureterectomy (n=1), urachal mass excision (n=1), orchiectomy (n=1), seminal vesiculectomy (n=1), and retroperitoneal mass excision (n=1). All procedures were performed by use of a homemade single-port device with a wound retractor and surgical gloves. A prospective study was performed to evaluate outcomes in 171 cases. Results Of the 171 patients, 98 underwent conventional laparoendoscopic single-site surgery and 73 underwent robotic laparoendoscopic single-site surgery. Mean patient age was 53 years, mean operative time was 190.8 minutes, and mean estimated blood loss was 204 ml. Intraoperative complications occurred in seven cases (4.1%), and postoperative complications in nine cases (5.3%). There were no complications classified as Grade IIIb or higher (Clavien-Dindo classification for surgical complications). Conversion to mini-incision open surgery occurred in seven (4.1%) cases. Regarding oncologic outcomes, no cancer-related events occurred during follow-up other than one aggressive progression of Ewing sarcoma. Conclusions Laparoendoscopic single-site surgery is technically feasible and safe for various urologic diseases; however, surgical experience and long-term follow-up are needed to test the superiority of laparoendoscopic single-site surgery. PMID:21344028

  7. Donor race does not affect cadaver kidney transplant survival--a single center experience.

    PubMed

    Tesi, R J; DeboisBlanc, M; Saul, C; O'Donovan, R; Etheredge, E

    1995-12-27

    Black kidney transplant recipients have worse graft survival than white recipients. Speculation regarding etiology has focused on differences in human lymphocyte antigens (HLA). Some suggest that improvements in graft survival would be obtained if donor and recipient race were matched. We reviewed 236 cadaver transplants performed over 9 years at a single center using an HLA-match-driven allocation system and a uniform immunosuppressive protocol to determine the impact of donor race on graft survival. A multivariate analysis of graft survival using patient race, sex, age, transplant number, current and maximum plasma renin activity, donor race, cold ischemia time and HLA mismatch, the need for dialysis, and the presence of rejection as independent variables. Sixty percent of recipients were black, and 82% were primary transplants; 28 kidneys (12%) were from black donors. The 112 patients with the same race donor had identical 5-year graft survival as the 124 who had a different race donor (40%; P = 0.1726). The 5-year survival of the 88 white recipients of white donor organs was better than that of the 120 black recipients of white donor organs (54% vs. 42%, respectively; P = 0.0398). Black recipients (t1/2 = 37 months) did worse than white recipients (t1/2 = 60 months) regardless of organ source (P = 0.023). In the multivariate analysis, neither donor nor recipient race were an independent variable in predicting graft survival. Rejection (RR = 2.9) and the need for dialysis on the transplant admission (RR = 4.1) were the only factors that predicted poor survival. Black recipients had more rejection (P = 0.04) but not more need for dialysis posttransplant regardless of donor race. Donor race did not affect graft survival in this series. The effect of recipient race on graft survival was due to an increased incidence of rejection episodes in black recipients, which was independent of HLA mismatch. These data suggest that improvements in immunosuppression, not

  8. Impact of hepatitis C infection on renal transplant patients: a single-center experience in Libya.

    PubMed

    Elzouki, Abdel-Naser Y; Gargoum, Huda M; Habas, Elmukhtar M; Rayani, Amnna A; Othman, Muftah

    2014-11-01

    The objective of this study was to assess the effect of hepatitis C virus (HCV) infection on graft and patient survival in a cohort of Libyan renal transplant recipients. Medical records of 241 renal transplant (RT) patients who have been followed-up at the Benghazi Nephrology Center up to February 2010 were reviewed. Based on the presence or absence of anti-HCV antibodies and HCV-RNA in the serum, patients were divided into two groups: HCV-positives and HCV-negatives. Anti-HCV antibodies were detected by the enzyme-linked immunosorbent assay technique and HCV-RNA by the polymerase chain reaction. Of the 241 RT patients, 162 were male and 79 were female. One hundred and ten patients (45.6%) were HCV-positives and 131 (54.4%) were HCV-negatives. Acute graft rejection was significantly higher among HCV-negative than HCV-positive patients (42 patients versus 28 patients, respectively; P<0.001). Conversely, chronic graft rejection was higher among HCV-positives than that among HCV-negative patients (35 patients versus 24 patients, respectively; P<0.05), and this difference became more significant after a 12-month period of transplantation (P<0.01). Seventeen patients died during the follow-up: Seven HCV-positives (6.3%) and 10 HCV-negatives (7.6%), and there was no significant difference in the death rate following RT between the two groups (P=0.08). Among the seven deaths of HCV-positives, liver disease-related complications were the main cause of death in three (42.8%) HCV-positive patients compared with none in the HCV-negative patients. The presence of HCV infection influenced chronic graft survival in RT patients and a higher proportion of HCV-infected patients had hepatic dysfunctions after RT. An increase in fatal liver complications was noted in HCV-positive patients with RT. In addition to pre-RT-specific therapy of HCV infection, all measures should be taken to prevent HCV infection pre- and post-RT. HCV-infected RT recipients need close monitoring for graft

  9. Performance characteristics of retrograde single-balloon endoscopy: A single center experience

    PubMed Central

    Christian, Kaci E; Kapoor, Karan; Goldberg, Eric M

    2016-01-01

    AIM To evaluate the technical success, diagnostic yield (DY) and therapeutic potential of retrograde single balloon enteroscopy (rSBE). METHODS A retrospective review of 136 rSBE procedures performed at a tertiary academic referral center from January 2006 and September 2013 was completed. Patient characteristics including age, gender and inpatient status were collected. The indication for the procedure was categorized into one of three groups: Obscure gastrointestinal bleeding (GIB), evaluation for Crohn’s disease and abnormal imaging. Procedural characteristics including insertion depth (ID), procedure time, concordance with pre-procedural imaging and complications were also recorded. Lastly, DY, defined as the percentage of cases producing either a definitive diagnosis or findings that could explain clinical symptoms and therapeutic yield (TY), defined as the percentage of cases in which a definitive intervention was performed, were determined. Mucosal tattooing and biopsy alone were not included in the TY. RESULTS A total of 136 rSBE procedures were identified. Mean patient age was 57.5 (± 16.2) years, 67 (49.2%) were male, and 110 (80.9%) procedures were performed on an outpatient basis. Indications for rSBE included GIB in 55 (40.4%), evaluation of inflammatory bowel disease (IBD) in 29 (21.3%), and imaging suggestive of pathology other than GIB or IBD in 43 (31.6%). Nine (6.6%) rSBEs were performed for other indications. Mean ID was 68.3 (± 39.3) cm proximal to the ileocecal valve and mean time to completion was 41.7 (± 15.5) min. Overall, 73 (53.7%) cases were diagnostic and 25 (18.4%) cases were therapeutic in which interventions (argon plasma coagulation, stricture dilatation, polypectomy, etc.) were performed. Pre-procedural imaging was performed in 88 (64.7%) patients. Endoscopic concordance of positive imaging findings was seen in 31 (35.2%) cases. Follow up data was available in 93 (68.4%) patients; 2 (2.2%) reported post-procedural abdominal

  10. Patient Radiation Dose in Diagnostic and Interventional Procedures for Intracranial Aneurysms: Experience at a Single Center

    PubMed Central

    Chun, Chang Woo; Lee, Cheol Hyoun; Ihn, Yon Kwon; Shin, Yong-Sam

    2014-01-01

    Objective To assess patient radiation doses during cerebral angiography and embolization of intracranial aneurysms in a large sample size from a single center. Materials and Methods We studied a sample of 439 diagnostic and 149 therapeutic procedures for intracranial aneurysms in 480 patients (331 females, 149 males; median age, 57 years; range, 21-88 years), which were performed in 2012 with a biplane unit. Parameters including fluoroscopic time, dose-area product (DAP), and total angiographic image frames were obtained and analyzed. Results Mean fluoroscopic time, total mean DAP, and total image frames were 12.6 minutes, 136.6 ± 44.8 Gy-cm2, and 251 ± 49 frames for diagnostic procedures, 52.9 minutes, 226.0 ± 129.2 Gy-cm2, and 241 frames for therapeutic procedures, and 52.2 minutes, 334.5 ± 184.6 Gy-cm2, and 408 frames for when both procedures were performed during the same session. The third quartiles for diagnostic reference levels (DRLs) were 14.0, 61.1, and 66.1 minutes for fluoroscopy time, 154.2, 272.8, and 393.8 Gy-cm2 for DAP, and 272, 276, and 535 for numbers of image frames in diagnostic, therapeutic, and both procedures in the same session, respectively. The proportions of fluoroscopy in DAP for the procedures were 11.4%, 50.5%, and 36.1%, respectively, for the three groups. The mean DAP for each 3-dimensional rotational angiographic acquisition was 19.2 ± 3.2 Gy-cm2. On average, rotational angiography was used 1.4 ± 0.6 times/session (range, 1-4; n = 580). Conclusion Radiation dose in our study as measured by DAP, fluoroscopy time and image frames did not differ significantly from other reported DRL studies for cerebral angiography, and DAP was lower with fewer angiographic image frames for embolization. A national registry of radiation-dose data is a necessary next step to refine the dose reference level. PMID:25469098

  11. Spectrum of intradialytic complications during hemodialysis and its management: a single-center experience.

    PubMed

    Singh, Rana Gopal; Singh, Shivendra; Rathore, Surendra Singh; Choudhary, Tauhidul Alam

    2015-01-01

    Hemodialysis (HD) is one of the important modalities of renal replacement therapy in acute renal failure (ARF) as well as chronic renal failure (CRF). This study was performed to evaluate the various intradialytic complications that occur during HD and their management. This is a retrospective study performed in patients who underwent conventional HD during the period of 1 January 2000 to 31 December 2011 at our center. Clinical details, various complications faced and their management were retrieved from dialysis case sheets. A total of 2325 patients of renal failure (790 ARF and 1535 CRF patients) were assessed for the intradialytic complications of HD. During the study period, there were 12,785 bicarbonate dialyses performed on these patients. In the ARF patients, the common intradialytic complications were: Hypotension, seen in 1296 sessions (30.4%), nausea and vomiting seen in 1125 sessions (26.4%), fever and chills seen in 818 sessions (19.2%), headache seen in 665 sessions (15.6%), cramps seen in 85 sessions (2.0%), chest pain and back pain seen in 82 sessions (1.92%), hypoglycemia seen in 77 sessions (1.8%), first-use syndrome seen in 72 sessions (1.7%) and femoral hematoma seen in 31 sessions (0.73%). In the CRF group, common complications were hypotension in 2230 sessions (26.1%), nausea and vomiting in 1211 sessions (14.2%), fever and chills in 1228 sessions (14.4%), chest pain and back pain in 1108 cases (13.0%), hypertension in 886 sessions (10.4%), headache in 886 sessions (10.4%), cramps in 256 sessions (3.0%), hematoma in 55 sessions (0.64%), intracerebral hemorrhage in three sessions (0.03%) and catheter tip migration in three sessions (0.03%). There is a need for special attention for the diagnosis and management of intradialytic complications of HD because such complications could be managed successfully without the need for termination of the dialysis procedure. PMID:25579743

  12. Surgical treatment of cardiac tumors: a 5-year experience from a single cardiac center

    PubMed Central

    Yin, Liang; He, Dengke; Shen, Hua; Ling, Xinyu; Li, Wei; Xue, Qian

    2016-01-01

    Background Cardiac tumors are rare but manifested with various clinical presentations and often cause unexpected symptoms or sudden death. The objective is to review the clinical presentation, histopathological spectrum, mortality and follow-up data of patients with cardiac tumors following surgery treatment over a period of 5 years. Methods We retrospectively collected the medical records of all patients diagnosed of cardiac tumors in the period between January 2008 and December 2013 at the cardiac center of our university. Clinical histories, perioperative data, surgical findings, efficacy and follow-up data were reviewed in our study. Patients were divided into two groups according to site distribution of the tumors in the heart. Results A total of 131 patients underwent surgical treatment of cardiac tumors were enrolled in this study, with a mean age of 51.39±16.37. The result of analysis showed that 79.47% (n=104) of the primary intracardiac tumors were benign, while primary malignant neoplasms accounted for 16.03% (n=21) of all patients, with the remainder (n=6, 4.6%) metastatic tumors transferred from other organs. Among all patients there were 2 in-hospital deaths and the survival rate in all patients at 1-year, 3-year and 5-year follow up was 83.20%, 78.62% and 66.41% respectively. Both patients with tumors in the left and right heart had similar basic characteristics except sex gender (P=0.002), BSA (P=0.045) and weight (P=0.033). Compared with patients with tumors in the right heart, patients with tumors in the left heart had significant higher CPB time (P<0.001), cross clamp time (P<0.001) and time of mechanical ventilation (P<0.001), and they also had longer ICU stay (P<0.001) but not total hospital stay (P=0.434). Conclusions Surgical resection represents an effective protocol in treating cardiac tumors. Data in our study of cardiac tumors on frequency and allocation were consistent with previous reports which may provide useful clinical evidence on

  13. Estimation of thyroglobulin in lymph node aspirates: Pilot experience from a tertiary referral cancer center

    PubMed Central

    Kannan, Subramanian; Chauhan, Subhra; Naveen; Latha, B. S.; Raju, Nalini; Chandrasekhar, Naveen Hedne; Kekatpure, Vikram; Kuriakose, Moni Abraham; Manjunath, P.

    2016-01-01

    Background: Assessment of cervical lymph node involvement in patients with thyroid cancer either during preoperative surgical mapping or detection of recurrences during follow-up is a crucial step in the management of differentiated thyroid cancers (DTCs). In most patients, fine needle aspiration cytology (FNAC) confirms the presence of metastasis in lymph node. However, in cases of paucicellular lymph node aspirate or discordant sonogram and cytology results, thyroglobulin (Tg) measurement in the lymph node aspirate (FNA-Tg) is useful and a value >1 ng/ml is considered consistent with metastatic disease. Context: The addition of FNAC to the US improves the specificity, but 5–10% are nondiagnostic and 6–8% rate of false-negative results. Several studies have reported that the detection of Tg in FNA-needle washes improves the evaluation of suspicious lymph nodes in patients with DTC.Data from Indian centers on FNA-Tg are limited. Aims: We piloted the utility of FNA-Tg in patients with sonographically suspicious cervical lymph node enlargement in the setting of suspicious thyroid nodule or in the follow-up of thyroid cancer. Settings and Design: Prospective data collection. Results: We measured Tg in 13 lymph node aspirates (12 patients, 10 females) among whom 4 patients had a total thyroidectomy and 1 had a hemithyroidectomy. Eight of the 13 lymph node aspirates had FNA-Tg values >150 ng/ml, all of them had unequivocal malignant cytology and four among them had proven metastatic DTC on surgical pathology. The median FNA-Tg of the patients with malignant cytology was 7550 ng/ml with a range of 162–30,000 ng/ml. Among the remaining 5 lymph node aspirate, 2 lymph nodes showed cytological features suggestive of reactive lymphadenitis (FNA-Tg <0.2 ng/ml) and were not operated, 1 had a high-grade malignancy consistent with anaplastic thyroid cancer (FNA-Tg <0.2 ng/ml), and 2 had nondiagnostic cytology (one had non-caseating granuloma on surgical pathology [FNA-Tg 1

  14. Epilepsia Partialis Continua over last 14 years: experience from a tertiary care center from south India.

    PubMed

    Sinha, S; Satishchandra, P

    2007-04-01

    Epilepsia Partialis Continua (EPC), a subtype of status epilepticus has varied etiology and the outcome depends on the cause. The aim of this study was to analyze the demographic, semiology, etiology, radiological findings, therapeutic response and outcome of EPC. This is a retrospective analysis of 76 patients (M:F: 46:30; mean age: 30.2+/-23.4 years; median age: 26 years) evaluated at our center over last 14 years. Twenty-three subjects (30.3%) had epilepsy for a mean of 25.8+/-52.3 months (range: 1-81 years; median: 14) before developing EPC and in half of them, seizures were controlled with anti-epileptic drugs (AEDs). Rest 53 (69.3%) manifested as de novo. The mean duration of EPC was 47.02+/-188.2 days (range: 1h to 48 months; median: 3 days). One patient of generalized convulsive SE (GCSE) evolved into EPC while five patients of EPC evolved into GCSE. CT scan of brain (n-76) was abnormal in 53 (69.7%) while all the 11 MRI scans which were available were abnormal. EEG (n-21) was abnormal in all but one, however it was non-specific in 7. The diagnoses were-idiopathic: 17, ischemic stroke: 15, meningo-encephalitis: 8, Rasmussen's encephalitis (RE): 7, granuloma: 6, diabetic-non-ketotic-hyperosmolar-coma (DNKHC): 6, CNS malignancies (primary/secondary): 4, birth injury: 4, cerebral venous thrombosis: 3, CNS tuberculosis: 2, and cerebritis, HIV-related, toxemia of pregnancy, and MERRF one each. Patients of >40 years (n=21) had stroke (10), idiopathic (6), DNKHC (4) and metastasis (1) as common causes. Only 12 of them received single AED, while others required 2 or more AEDs to control the seizures. The outcome (n=72) was-controlled: 43 (59.7%); uncontrolled: 26 (36.1%) (RE: 7, idiopathic: 5, birth injury: 4, encephalitis: 3, malignancy: 2, granuloma and MERRF: 1 each) and three patients succumbed (encephalitis: 2, idiopathic: 1). Causes of EPC are varied and it depends on age. Underlying cause determined the outcome and could be refractory in RE, idiopathic, and

  15. Thirty-Day Outcome Following Carotid Artery Stenting: A 10-Year Experience from a Single Center

    SciTech Connect

    Karkos, Christos D. Karamanos, Dimitrios G.; Papazoglou, Konstantinos O.; Demiropoulos, Filippos P.; Papadimitriou, Dimitrios N.; Gerassimidis, Thomas S.

    2010-02-15

    We aimed to present our experience with carotid angioplasty and stenting (CAS) and to document how the technique evolved over the last decade (1997-2007). A retrospective study of 333 patients (259 men; median age, 69 years) who underwent 336 CAS procedures. Of these, 118 (35%) patients were symptomatic and 164 (49%) lesions involved the left carotid bifurcation. The first 163 patients received a balloon-expandable stent, whereas the remaining 173 received a self-expandable one. Cerebral protection devices were used in the last 84 (25%) procedures. Access was via the femoral artery in all but six cases, in which direct puncture of the common carotid was necessary. The left common carotid originated from the innominate artery in 18 cases (5%). Conversion to open endarterectomy was necessary in two patients due to inability to remove the filter. Perioperative neurological events included stroke in 6 patients (1.8%), transient ischemic attack in 15 (4.5%), and hyperperfusion syndrome in 10 (3.0%). Three patients died during the first 30 days. As a result, the mortality and the combined stroke/death rate were 0.9 and 2.4%, respectively, with no differences between symptomatic and asymptomatic patients. Bradycardia was noted in 48 patients (14%), and hypotension in 45 (13%). Univariate analysis identified hypertension (P = 0.03), hyperlipidemia (P = 0.02), and current or ex-smoking (P = 0.02) as significant risk factors for death/stroke. On multivariate analysis using logistic regression, only hyperlipidemia [odds ratio (OR), 53.90; 95% confidence interval (CI), 4.19-693.47; P = 0.002] and current or ex-smoking (OR, 63.84; 95% CI,: 4.80-848.68; P = 0.001) remained statistically significant. In conclusion, CAS can be performed safely and effectively, with acceptable mortality, stroke/death, and cardiovascular complication rates. Although technological advances (stent design, cerebral protection devices), perioperative pharmacological management, and increasing experience

  16. Robotic versus conventional laparoscopic colorectal operations: a-single center experience

    PubMed Central

    Bozkurt, Mehmet Abdussamet; Kocataş, Ali; Gemici, Eyüp; Kalaycı, Mustafa Uygar; Alış, Halil

    2016-01-01

    Objective: Robotic surgery was first introduced in 2000 especially to overcome the limitations of low rectum cancer surgery. There is still no consensus regarding the standard method for colorectal surgery. The aim of this study was to compare robotic surgery with laparoscopic colorectal surgery. Material and Methods: This is a retrospective study. Data of patients with a diagnosis of colon or rectal cancer were analyzed for robotic colorectal surgery and laparoscopic colorectal surgery. Results: The cost of robotic surgery group was statistically higher than the laparoscopic surgery group (p=0.032). The average operation duration was 178 minutes in the laparoscopic surgery group and 228 minutes in the robotic surgery group, and this difference was statistically significant (p=0.044). There was no statistically significant difference between the groups regarding other parameters. Discussion: Disadvantages of robotic surgery seem to be its higher cost and longer operation duration as compared to laparoscopic surgery. We claim that an increase in the number of cases and experience may shorten the operation time while the increase in commercial interest may decrease the cost disadvantage of robotic surgery. PMID:27436931

  17. Hematopoietic stem-cell transplantation in the developing world: experience from a center in Western India.

    PubMed

    Shah, Chirag A; Karanwal, Arun; Desai, Maharshi; Pandya, Munjal; Shah, Ravish; Shah, Rutvij

    2015-01-01

    We describe our experience of first 50 consecutive hematopoietic stem-cell transplants (HSCT) done between 2007 and 2012 at the Apollo Hospital, Gandhinagar, 35 autologous HSCT and 15 allogeneic HSCT. Indications for autologous transplant were multiple myeloma, non-Hodgkin lymphoma, Hodgkin lymphoma, and acute myeloid leukemia, and indications for allogeneic transplants were thalassemia major, aplastic anaemia, chronic myeloid leukemia, and acute lymphoblastic and myeloid leukaemia. The median age of autologous and allogeneic patient's cohort was 50 years and 21 years, respectively. Median follow-up period for all patients was 39 months. Major early complications were infections, mucositis, acute graft versus host disease, and venoocclusive disease. All of our allogeneic and autologous transplant patients survived during the first month of transplant. Transplant related mortality (TRM) was 20% (N = 3) in our allogeneic and 3% (N = 1) in autologous patients. Causes of these deaths were disease relapse, sepsis, hemorrhagic complications, and GVHD. 46% of our autologous and 47% of our allogeneic patients are in complete remission phase after a median follow-up of 39 months. 34% of our autologous patients and 13% of our allogeneic patients had disease relapse. Overall survival rate in our autologous and allogeneic patients is 65.7% and 57.1%, respectively. Our results are comparable to many national and international published reports. PMID:25722722

  18. COMBREX-DB: an experiment centered database of protein function: knowledge, predictions and knowledge gaps.

    PubMed

    Chang, Yi-Chien; Hu, Zhenjun; Rachlin, John; Anton, Brian P; Kasif, Simon; Roberts, Richard J; Steffen, Martin

    2016-01-01

    The COMBREX database (COMBREX-DB; combrex.bu.edu) is an online repository of information related to (i) experimentally determined protein function, (ii) predicted protein function, (iii) relationships among proteins of unknown function and various types of experimental data, including molecular function, protein structure, and associated phenotypes. The database was created as part of the novel COMBREX (COMputational BRidges to EXperiments) effort aimed at accelerating the rate of gene function validation. It currently holds information on ∼ 3.3 million known and predicted proteins from over 1000 completely sequenced bacterial and archaeal genomes. The database also contains a prototype recommendation system for helping users identify those proteins whose experimental determination of function would be most informative for predicting function for other proteins within protein families. The emphasis on documenting experimental evidence for function predictions, and the prioritization of uncharacterized proteins for experimental testing distinguish COMBREX from other publicly available microbial genomics resources. This article describes updates to COMBREX-DB since an initial description in the 2011 NAR Database Issue. PMID:26635392

  19. Cardiac side effects of trastuzumab in breast cancer patients – single centere experiences

    PubMed Central

    Leś, Dominika; Sarzyczny-Słota, Danuta; Nowara, Elżbieta

    2013-01-01

    Aim of the study The aim of this study was to present our own experiences concerning risk factors for cardiac side effects in the study group. Material and methods The study was performed in 120 patients with HER2-overexpressing breast cancer who received immunotherapy in the Clinical and Experimental Oncology Department, between 2006 and 2011. Results LVEF reduction > 10% of the baseline fraction was observed in 10 (8%) patients. Symptomatic heart failure occurred in two individuals. Due to persistent cardiotoxicity five patients (4%) had to discontinue therapy prematurely. Risk factors for cardiac toxicity in the analyzed group included: previous radiotherapy to the left side of the chest (p = 0.05), higher BMI (p = 0.05), negative steroid receptor status (p = 0.045) and low baseline LVEF (p < 0.001). Patients receiving radiotherapy were more likely to develop cardiotoxicity if presenting older age (p = 0.0003). Conclusions Previous radiotherapy to the left side of the chest, negative steroid receptor status, high BMI and low baseline LVEF were associated with increased risk of cardiac dysfunction. There was no difference between patients receiving adjuvant therapy and those treated due to metastatic disease. PMID:23788989

  20. Hematopoietic Stem-Cell Transplantation in the Developing World: Experience from a Center in Western India

    PubMed Central

    Shah, Chirag A.; Karanwal, Arun; Desai, Maharshi; Pandya, Munjal; Shah, Ravish; Shah, Rutvij

    2015-01-01

    We describe our experience of first 50 consecutive hematopoietic stem-cell transplants (HSCT) done between 2007 and 2012 at the Apollo Hospital, Gandhinagar, 35 autologous HSCT and 15 allogeneic HSCT. Indications for autologous transplant were multiple myeloma, non-Hodgkin lymphoma, Hodgkin lymphoma, and acute myeloid leukemia, and indications for allogeneic transplants were thalassemia major, aplastic anaemia, chronic myeloid leukemia, and acute lymphoblastic and myeloid leukaemia. The median age of autologous and allogeneic patient's cohort was 50 years and 21 years, respectively. Median follow-up period for all patients was 39 months. Major early complications were infections, mucositis, acute graft versus host disease, and venoocclusive disease. All of our allogeneic and autologous transplant patients survived during the first month of transplant. Transplant related mortality (TRM) was 20% (N = 3) in our allogeneic and 3% (N = 1) in autologous patients. Causes of these deaths were disease relapse, sepsis, hemorrhagic complications, and GVHD. 46% of our autologous and 47% of our allogeneic patients are in complete remission phase after a median follow-up of 39 months. 34% of our autologous patients and 13% of our allogeneic patients had disease relapse. Overall survival rate in our autologous and allogeneic patients is 65.7% and 57.1%, respectively. Our results are comparable to many national and international published reports. PMID:25722722

  1. Spectrum of retroperitoneal and genitourinary paraganglioma: Experience at a North Indian tertiary care center

    PubMed Central

    Choudhary, Gautam Ram; Singh, Shivanshu; Prasad, Seema; Singh, Shrawan Kumar; Bhansali, Anil; Bhadada, Sanjay; Dutta, Pinaki

    2015-01-01

    Introduction Genitourinary and retroperitoneal paragangliomas are infrequent tumors with bizarre presentation. A high index of suspicion is required to make a diagnosis in young hypertensive individuals. Our aim is to study the varied clinical presentations and management of these paragangliomas. Herein, we share our experience of clinical presentation, diagnosis, and management of these paragangliomas. Material and methods Seventeen consecutive patients who underwent surgery for paraganglioma at our institute from August 2009 to July 2014 were included. Demographic, peri-operative, surgical, and follow up data were collected and analyzed. Results Mean age of presentation was 34.8 years with female predominance. The majority of the tumors were located in the retroperitoneum and urinary bladder. Most of them presented with classical symptoms of catecholamine excess and hypertension. Complete surgical resection could be performed in 13 cases. At a median follow up of two years, cases with R0 resection (no microscopic malignant cells) did not show recurrence. Among patients on chemotherapy, one died, another had partial response, and yet another had progressive disease. Conclusions Genitourinary and retroperitoneal paragangliomas are a disease of a young age group with variable clinical features at presentation. Appropriate pre-operative optimization and complete surgical resection provide the best chance of cure. PMID:26855794

  2. Experience with voice recognition in surgical pathology at a large academic multi-institutional center.

    PubMed

    Kang, Hyunseok Peter; Sirintrapun, S Joseph; Nestler, Rick J; Parwani, Anil V

    2010-01-01

    There are few reports of institutional use of voice recognition technology in clinical practice. We describe our experience with voice recognition-integrated synoptic-like dictation, associating templates with key spoken phrases, that we have used in gross examination of common specimens and as a major component of our workflow since 2001. The primary application is VoiceOver Enterprise (Voicebrook, Lake Success, NY), which uses Dragon NaturallySpeaking Medical Edition (Nuance Communications, Burlington, MA) as its speech engine. This integrates with the anatomic pathology laboratory information system (APLIS) and other applications, such as Microsoft Office (Microsoft, Redmond, WA). The largest user group, pathology assistants, mainly dictates biopsy reports, numbering approximately 210,000 specimens since 2001. The technology has been useful in our anatomic pathology workflow and provided a good return on investment, including marked improvements in turnaround time, results standardization, error reduction, and cost savings. The most helpful features of the software are templating, the seamless integration with APLIS, and the voice command creation tools. PMID:20023272

  3. Incidence and outcome of transplant renal artery stenosis: single center experience.

    PubMed

    Polak, W G; Jezior, D; Garcarek, J; Chudoba, P; Patrzałek, D; Boratyńska, M; Szyber, P; Klinger, M

    2006-01-01

    Since the incidence of transplant renal artery stenosis (TRAS) in renal allografts varies from 1% to 23%, we sought to examine its incidence, to analyze treatment options, and to ascertain its outcomes. Retrospective analysis of 793 kidney allograft recipients transplanted between 1996 and 2004 revealed an incidence of 0.9% (n = 7). Time from kidney transplantation to the first symptoms varied from 1 week to 3 years (median, 4 months). Three patients experiences refractory hypertension and six patients developed allograft dysfunction. Screening color Doppler ultrasonography showed hemodynamic changes in six patients with the definitive diagnosis confirmed by angiography in all patients. One patient with an anastomotic stenosis was treated with a surgical operation and six patients, percutaneous transluminal angioplasty (PTA), with stenting in three cases. Both surgical as well as PTA treatment were successful in all but one patient, who underwent PTA alone, developed chronic renal insufficiency necessitating hemodialysis and finally lost his allograft. In the other patients all symptoms resolved after treatment and the patients are doing well with functioning allografts. Although TRAS was an uncommon complication, if recognized promptly it could be treated by surgery or PTA with a high success rate. PMID:16504683

  4. An obstruction not to forget: Pseudo-obstruction (Ogilvie syndrome): Single center experience

    PubMed Central

    Yazar, Fatih Mehmet; Kanat, Burhan Hakan; Emir, Seyfi; Bozan, Mehmet Buğra; Bilgiç, Yılmaz; Şahin, Abdurrahman; Erol, Fatih; Özkan, Zeynep; Gül, Evrim; Urfalioğlu, Aykut

    2016-01-01

    Purpose: Colonic pseudo obstruction disease commonly seen in the elderly, immobile patient group can cause serious mortality and morbidity. Our objective in this retrospective study is to share our clinical experience by evaluating patients with Ogilvie syndrome who were followed and treated in our clinic. Methods: Eleven cases with the diagnosis of Ogilvie syndrome followed up and treated between September 2010 and April 2013 were evaluated retrospectively. All the patients that had no symptoms of acute abdominal pain were initiated conservative treatment. Colonoscopic decompression was attempted for patients whose clinical pictures were not recovered. Patients underwent operation if they developed peritoneal irritation symptoms during these procedures and of their number of white blood cells seriously increased during the follow-up period. Results: A total of 11 patients were treated for Ogilvie syndrome. 6 of the patients underwent surgical treatment, and 5 were treated medically. Mortality developed in two patients. The main cause of mortality was a delay in diagnosis and additional severe underlying diseases. Seven patients were given Neostigmine. Of these, 2 patients required surgery and 3 patients responded to Neostigmine. Conclusion: Ogilvie syndrome is a rare cause of ileus of the colon. It is more common particularly in old patients with additional problems. If the disease is suspected and diagnosed early, unnecessary surgical interventions can be prevented with medical treatment choices. PMID:27076728

  5. Determination of Significant Composite Processing Factors by Designed Experiment (MSFC Center Director's Discretionary Fund)

    NASA Technical Reports Server (NTRS)

    Finckenor, J. L.

    2003-01-01

    To determie composite material properties' effects from porcessing variables, a 3 factorial designed experiment with two replicates was conducted. The factors were cure method (oven versus autoclave), layup (hand versus tape-laying machine), and thickness (8 versus 52 ply). Four material systems were tested: AS4/3501-6, IM7/8551-7, IM7/F655 bismaleimide (BMI), and shear tests on IM7/F584. Material properties were G(sub 12), v(sub 12), E(sub 1c) and E(sub 2c). Since the samples were necessarily nonstandard, strengths, though recorded, cannot be considered valid. Void content was also compared. Autoclave curing helped material properties for the low modulus fiber material but showed little benefit for higher stiffness fibers. The number of plies was very important for epoxy composites but not for the BMI. E(sub 1) was generally unaffected by any factor. Particularly high void content did correlate to reduced properties. Autoclave curing reduced void content over oven curiing but a moderate amount of voids, less than 1 percent void content, didnot correlate with material properties. Oven cures and hand layups can produce high-quality parts. Part thickness of epoxy composites is important, though cure optimization may improve performance. Significant variations can be caused by processing and it is important that test coupons always reflect the layup and processes of the final part.

  6. Tolerability of sirolimus: a decade of experience at a single cardiac transplant center.

    PubMed

    Thibodeau, Jennifer T; Mishkin, Joseph D; Patel, Parag C; Kaiser, Patricia A; Ayers, Colby R; Mammen, Pradeep P A; Markham, David W; Ring, William Steves; Peltz, Matthias; Drazner, Mark H

    2013-01-01

    Sirolimus is used in cardiac transplant recipients to prevent rejection, progression of cardiac allograft vasculopathy, and renal dysfunction. However, sirolimus has many potential side effects and its tolerability when used outside of clinical trials is not well established. We describe a decade of experience with sirolimus in cardiac transplant recipients at our institution. We retrospectively reviewed records of all adult cardiac transplant recipients living between September 1999 and February 2010 (n = 329) and identified 67 patients (20%) who received sirolimus. The indications for sirolimus were cardiac allograft vasculopathy (67%), renal dysfunction (25%), rejection (4%), and intolerability of tacrolimus (3%). One-third of patients discontinued sirolimus at a median (25th, 75th percentiles) of 0.9 (0.2, 1.6) yr of duration. Over 70% of subjects experienced an adverse event attributed to sirolimus. Adverse events were associated with higher average sirolimus levels (9.1 ng/mL vs. 7.1 ng/mL, p = 0.004). We conclude that sirolimus is frequently used in cardiac transplant recipients (20%) and commonly causes side effects, often necessitating discontinuation. Higher average sirolimus levels were associated with adverse events, suggesting that tolerability may improve if levels are maintained within the lower end of the current therapeutic range; however, the improvement in tolerability would need to be balanced with the potential for decreased efficacy. PMID:24304376

  7. Management of traumatic carotid artery dissection: initial experience of a single center.

    PubMed

    Zhengxing, Xie; Zhenwen, Cui; Yuhao, Sun; Zhihong, Zhong; Liuguan, Bian; Qingfang, Sun

    2016-07-01

    Traumatic carotid artery dissection (tCAD) bears the risk of hypoperfusion inducing delayed cerebral ischemia. The lack of consensus on standard treatment of tCAD remains a great challenge. Here, we present our successes on a series of patients with delayed tCAD diagnosis and treatment using multimodality treatment strategies. We retrospectively reviewed 21 patients with tCAD treated with carotid artery stent placement or anticoagulation therapy. There were 14 dissection locations (66.67 %) which involved extracranial internal carotid artery (ICA) and seven locations (33.33 %) which involved both extracranial and intracranial ICA. Stenosis severity was 70-99 % in 16 cases (76.19 %) and <70 % in 5 cases (23.81 %). Endovascular stents were administrated to 17 patients with hypoperfusion as evaluated by radiological methods, while anticoagulation therapy was administrated to the other four patients. Carotid revascularization was performed with one (9/17 patients) or multiple (8/17 patients) stents. None of the patients experienced a procedure-related complication. At discharge, the mean modified Rankin Scale (mRS) score of patients was 1.08 ± 0.76. Neither additional neurological deficient nor restenosis happened during the follow-up period. More vigilance is required to assure timely diagnosis of patients with delayed tCAD. Assessment of cerebral perfusion is an effective approach in tCAD treatment in our experience. PMID:26924802

  8. Phenylketonuria—Experience at One Center in the First Year of Screening in California

    PubMed Central

    Peterson, Raymond M.; Koch, Richard; Schaeffler, Graciela E.; Wohlers, Audrey; Acosta, Phyllis B.; Boyle, David

    1968-01-01

    One year's experience with phenylketonuria during the calendar year 1966, the first year for compulsory newborn screening in California, was reviewed. The over-all prevalence rate from reported cases in California during this period was one case per 19,500 persons tested. Fifty-seven persons suspected of having pku were evaluated, and 25 of them were determined to be phenylketonuric. Eleven of the 25 were infants in whom the abnormality was detected through the newborn screening program or because it was detected in a sibling through a screening program. All the newborn phenylketonuric patients were developing normally at the time of last report (although the follow-up periods were short). In nine of the other children, pku was detected because they were retarded. Five retarded children who were diagnosed as phenylketonuric at another clinic were given dietary assistance. Five additional infants had elevated serum phenylalanines but did not have the classic biochemical findings of pku and are being evaluated further. Nine infants with positive screening tests exhibited biochemical and clinical findings consistent with transient tyrosinemia. Eighteen other children were evaluated and found to have no metabolic abnormality. The newborn screening program for pku is of decided benefit in early identification of a group of infants who have a high rate of potentially serious metabolic disease. Early identification permits treatment soon enough to prevent mental retardation. Newly identified patients should be evaluated in a medical setting capable of careful pediatric, biochemical and nutritional surveillance. PMID:5652755

  9. Phenylketonuria. Experience at one center in the first year of screening in California.

    PubMed

    Peterson, R M; Koch, R; Schaeffler, G E; Wohlers, A; Acosta, P B; Boyle, D

    1968-05-01

    One year's experience with phenylketonuria during the calendar year 1966, the first year for compulsory newborn screening in California, was reviewed. The over-all prevalence rate from reported cases in California during this period was one case per 19,500 persons tested. Fifty-seven persons suspected of having pku were evaluated, and 25 of them were determined to be phenylketonuric. Eleven of the 25 were infants in whom the abnormality was detected through the newborn screening program or because it was detected in a sibling through a screening program. All the newborn phenylketonuric patients were developing normally at the time of last report (although the follow-up periods were short). In nine of the other children, pku was detected because they were retarded. Five retarded children who were diagnosed as phenylketonuric at another clinic were given dietary assistance. Five additional infants had elevated serum phenylalanines but did not have the classic biochemical findings of pku and are being evaluated further. Nine infants with positive screening tests exhibited biochemical and clinical findings consistent with transient tyrosinemia. Eighteen other children were evaluated and found to have no metabolic abnormality. The newborn screening program for pku is of decided benefit in early identification of a group of infants who have a high rate of potentially serious metabolic disease. Early identification permits treatment soon enough to prevent mental retardation. Newly identified patients should be evaluated in a medical setting capable of careful pediatric, biochemical and nutritional surveillance. PMID:5652755

  10. The Impact of Labour Epidural Analgesia on the Childbirth Expectation and Experience at a Tertiary Care Center in Southern India.

    PubMed Central

    Bhatt, Hitanshu; Pandya, Sunil; Kolar, Geeta; Nirmalan, Praveen Kumar

    2014-01-01

    Background: Labour epidural analgesia is increasingly used as a means of pain relief for women during labour and delivery. The significant pain during labour and delivery can be terrifying for mothers-to-be and the prospect of relief from pain can help reduce fear of childbirth to an extent. However, it is not necessary that reduced fear of childbirth may lead to an increased satisfaction with the childbirth experience. Aim: To determine the influence of labour epidural analgesia (LEA) on the experience of childbirth in pregnant women at a tertiary care center in southern India Materials and Methods: A pre-post interventional non-randomized study design at a tertiary care perinatal institute that used the Wijma Delivery Expectation and Experience questionnaires to determine baseline expectations of labour and childbirth and the actual experience in pregnant women. Labour analgesia was provided on maternal request or demand. Total and domain scores were compared between the two groups using non-parametric tests and a generalized linear repeated measures model after adjusting for factors that were found significant in the bivariate model. Results: The study included 235 pregnant women who opted for LEA and 219 pregnant women who opted against LEA. Overall, 37 (15.74%) of woman with LEA and 30 (13.70%) of women without LEA had a worse than expected experience of childbirth. Significant pain relief (p<0.001) was provided with LEA, however, the post-delivery scores did not differ significantly between the two groups (F=0.90, p=0.34) in a generalized linear repeated measures model. Conclusion: Maternal satisfaction with the process of childbirth is a complex dynamic that is not limited to the significant relief from pain provided by LEA. PMID:24783086

  11. Transcatheter arterial embolization for traumatic mesenteric bleeding: a 15-year, single-center experience

    PubMed Central

    Shin, Jong Soo; Shin, Ji Hoon; Ko, Heung-Kyu; Kim, Jong Woo; Yoon, Hyun-Ki

    2016-01-01

    PURPOSE We aimed to assess the safety and effectiveness of transcatheter arterial embolization (TAE) for mesenteric bleeding following trauma. METHODS From 2001 to 2015, 12 patients were referred to our interventional unit for mesenteric bleeding following trauma, based on clinical decisions and computed tomography (CT) images. After excluding one patient with no bleeding focus and one patient who underwent emergency surgery, a total of 10 patients (male:female ratio, 9:1; mean age, 52.1 years) who underwent super selective TAE of visceral arteries were included in this study. Technical and clinical success, complications, and 30-day mortality rate were analyzed. RESULTS In 10 patients who underwent TAE, the types of trauma were motor vehicle collision (n=6), fall (n=2), assault (n=1), and penetrating injury (n=1), and the bleeding arteries were in the pancreaticoduodenal arterial arcade (n=4), jejunal artery (n=3), colic artery (n=2), and sigmoid artery (n=1). N-butyl-2-cyanoacrylate (NBCA) (n=2), microcoils (n=2), and combinations of NBCA, microcoils, or gelatin sponge particles (n=6) were used as embolic agents. Technical success was achieved in all 10 patients, with immediate cessation of bleeding. Clinical success rate was 90% (9/10), and all patients were discharged with no further treatment required for mesenteric bleeding. However, one patient showed rebleeding 10 days later and underwent repeated TAE with successful result. There were no TAE-related ischemic complications such as bowel infarction. The 30-day mortality rate was 0%. CONCLUSION Our clinical experience suggests that TAE used to control mesenteric bleeding following trauma is safe and effective as a minimally invasive alternative to surgery. PMID:27306658

  12. Extraperitoneal versus transperitoneal laparoscopic radical cystectomy for selected elderly bladder cancer patients: a single center experience

    PubMed Central

    Feng, Lang; Song, Jian; Wu, Menghua; Tian, Ye; Zhang, Daoxin

    2016-01-01

    ABSTRACT Objective: This study reports the initial experience of extraperitoneal laparoscopic radical cystectomy (ELRC) and compared with transperitoneal laparoscopic radical cystectomy (TLRC) in the treatment of selected elderly bladder cancer patients. Patients and Methods: A total of forty male bladder cancer patients who underwent ELRC (n=19) or TLRC (n=21) with ureterocutaneostomy were investigated. Demographic parameters, perioperative variables, oncological outcomes and follow-up data were retrospectively analyzed. Results: A significantly shorter time to exsufflation (1.5±0.7 vs 2.1±1.1 d; p=0.026) and liquid intake (1.8±0.9 vs 2.8±1.9 d; p=0.035) were observed in the ELRC group compared with the TLRC group. The incidence of postoperative ileus in the ELRC group was lower than the TLRC group (0 vs 9.5%). However, the difference had no statistical significance (p>0.05). The removed lymph node number in the ELRC group was significantly lower than the TLRC group (p<0.001). No significant differences were observed between the two groups in the overall and cancer-free survival rates (p>0.05). Conclusions: ELRC seems to be a safe and feasible surgical strategy for the selected elderly bladder cancer patients with ≤ T2 disease. The surgical and oncological efficacy of the ELRC is similar to that of the TLRC, but with faster intestinal function recovery. Further studies with a large series including different urinary diversions are needed to confirm our results and to better evaluate the benefit of ELRC in bladder cancer patients. PMID:27564274

  13. Totally robotic vs 3D laparoscopic colectomy: A single centers preliminary experience

    PubMed Central

    Guerrieri, Mario; Campagnacci, Roberto; Sperti, Pierluigi; Belfiori, Giulio; Gesuita, Rosaria; Ghiselli, Roberto

    2015-01-01

    AIM: To compare robotic and three-dimensional (3D) laparoscopic colectomy based on the literature and our preliminary experience. METHODS: This retrospective observational study compared operative measures and postoperative outcomes between laparoscopic 3D and robotic colectomy for cancer. From September 2013 to September 2014, 24 robotic colectomies and 23 3D laparoscopic colectomy were performed at our Department. Data were analyzed and reported both by approach and by colectomy side. Robotic left colectomy (RL) vs laparoscopic 3D left colectomy (LL 3D) and Robotic right colectomy (RR) vs laparoscopic 3D (LR 3D). Rectal cancer procedures were not included. RESULTS: There were 18 RR and 11 LR 3D, 6 RL and 12 LL 3D. As regards LR 3D, extracorporeal anastomosis (EA) was performed in 7 patients and intracorporeal anastomosis (IA) in 4; the RR group included 14 IA and 4 EA. There was no mortality. Median operative time was higher for the robotic group while conversion rate (12.5% vs 13%) and lymph nodes removed (14 vs 13) were similar for both. First flatus time was 1 d for RR and 2 d the other patient groups. Oral intake was resumed in 1 d by LR and in 2 d by the other patients (P = 0.012). Overall cost was €4950 and €1950 for RL and LL 3D, and €4450 and €1450 for RR and LR 3D, respectively. CONCLUSION: There were no differences between RR and LR 3D, except that IA was easier with RR, and probably contributed with the learning curve to the longer operative time recorded. Both techniques offer similar advantages for the patient with significantly different costs. In left colectomies robotic colectomy provided better outcomes, especially in resections approaching the rectum. PMID:26674518

  14. Surgical Management of Benign Biliary Stricture in Chronic Pancreatitis: A Single-Center Experience.

    PubMed

    Ray, Sukanta; Ghatak, Supriyo; Das, Khaunish; Dasgupta, Jayanta; Ray, Sujay; Khamrui, Sujan; Sonar, Pankaj Kumar; Das, Somak

    2015-12-01

    Biliary stricture in chronic pancreatitis (CP) is not uncommon. Previously, all cases were managed by surgery. Nowadays, three important modes of treatment in these patients are observation, endoscopic therapy, and surgery. In the modern era, surgery is recommended only in a subset of patients who develop biliary symptoms or those who have asymptomatic biliary stricture and require surgery for intractable abdominal pain. We want to report on our experience regarding surgical management of CP-induced benign biliary stricture. Over a period of 5 years, we have managed 340 cases of CP at our institution. Bile duct stricture was found in 62 patients. But, surgical intervention was required in 44 patients, and the remaining 18 patients were managed conservatively. Demographic data, operative procedures, postoperative complications, and follow-up parameters of these patients were collected from our prospective database. A total 44 patients were operated for biliary obstruction in the background of CP. Three patients were excluded, so the final analysis was based on 41 patients. The indication for surgery was symptomatic biliary stricture in 27 patients and asymptomatic biliary stricture with intractable abdominal pain in 14 patients. The most commonly performed operation was Frey's procedure. There was no inhospital mortality. Thirty-five patients were well at a mean follow-up of 24.4 months (range 3 to 54 months). Surgery is still the best option for CP-induced benign biliary stricture, and Frey's procedure is a versatile operation unless you suspect malignancy as the cause of biliary obstruction. PMID:26730073

  15. Thromboprophylaxis and Outcomes for Total Joint Arthroplasty in Congenital Bleeding Disorders: A Single-Center Experience.

    PubMed

    Holderness, Britt M; Goto, Yuika; McKernan, Laurel; Bernini, Philip; Ornstein, Deborah L

    2016-09-01

    Total joint arthroplasty (TJA) improves the quality of life for patients with end-stage osteoarthritis but is associated with an increased risk of venous thromboembolism (VTE), thus pharmacologic thromboprophylaxis is recommended for most patients. Patients with congenital bleeding disorders may develop severe arthropathies due to repeated hemarthroses and derive similar benefit from TJA as the general population. No guidelines for pharmacologic thromboprophylaxis in this population exist, however, as the risks and benefits are not well defined. We undertook the current study to assess the safety and efficacy of pharmacologic VTE prophylaxis in patients with congenital bleeding disorders undergoing TJA. We retrospectively reviewed the medical records of patients with bleeding disorders who underwent TJA at our academic institution between 1987 and 2012. We identified 28 patients who underwent 38 TJA procedures. Low-molecular-weight heparin (LMWH) was administered in 29 procedures (76%) and was discontinued early in 3 procedures (2 patients) due to nonjoint bleeding. No symptomatic VTE was identified, and no joint or deep wound infections were seen. Twenty-two patients accounting for 31 procedures were contacted to discuss their experience with TJA. All reported decreased pain, and 97% reported improved function after the surgery. Impressively, 97% stated that they would choose to have the surgery again. These results confirm the benefit of TJA in patients with congenital bleeding disorders and end-stage arthropathies and suggest that LMWH thromboprophylaxis is safe. No patient in our cohort developed symptomatic VTE, whether or not thromboprophylaxis was administered, thus necessity of thromboprophylaxis remains an unanswered question. PMID:27099385

  16. Ammonia Level and Mortality in Acute Liver Failure: A Single-Center Experience.

    PubMed

    Niranjan-Azadi, Ashwini M; Araz, Filiz; Patel, Yuval A; Alachkar, Nada; Alqahtani, Saleh; Cameron, Andrew M; Stevens, Robert D; Gurakar, Ahmet

    2016-01-01

    BACKGROUND Acute liver failure (ALF) is an emergent condition that requires intensive care and manifests in particular by significant elevation in serum ammonia level. Patients with ALF with concomitant renal failure experience a further rise in ammonia levels due to decreased kidney excretion. The aim of this study was to evaluate the relationship between elevated ammonia levels and mortality and to characterize the subgroup of ALF patients who develop acute kidney injury (AKI) and require renal replacement therapy. MATERIAL AND METHODS This was a retrospective study of 36 consecutive patients admitted to Johns Hopkins Hospital's intensive care units from December 2008 to May 2013 who presented with grade III and IV hepatic encephalopathy (HE). Patients who developed AKI and required hemodialysis (HD) were compared to those without AKI. Patients with chronic kidney disease were excluded. RESULTS Sixteen patients developed AKI and underwent HD (HD group). Median ammonia levels in the HD and non-HD groups were not significantly different (p=0.95). In the HD group, 4 patients underwent liver transplantation (LT) and 3 of them survived the hospitalization. Among the 12 HD patients who did not receive LT, 6 (50%) survived. Out of 20 non-HD patients, 3 were transplanted, all of whom survived the hospitalization. Among the 17 non-HD patients who did not receive LT, 14 (82%) survived. Admission ammonia level (>120 µmol/L) was associated with higher mortality rate (OR=7.188 [95% CI 1.3326-38.952], p=0.026) in all patients. CONCLUSIONS Admission ammonia level is predictive of mortality in ALF patients with grade 3-4 HE. PMID:27480786

  17. Initial Management of Childhood Acute Immune Thrombocytopenia: Single-Center Experience of 32 Years.

    PubMed

    Yildiz, Inci; Ozdemir, Nihal; Celkan, Tiraje; Soylu, Selen; Karaman, Serap; Canbolat, Aylin; Dogru, Omer; Erginoz, Ethem; Apak, Hilmi

    2015-01-01

    Immune thrombocytopenia (ITP) is an acute self-limited disease of childhood, mostly resolving within 6 months irrespective of whether therapy is given or not. Treatment options when indicated include corticosteroids, intravenous immune globulin (IVIG), and anti-RhD immunoglobulin. We reviewed our 32 years' experience for first-line therapy of acute ITP. Five hundred forty-one children (mean age: 5.3 years) diagnosed and treated for ITP were evaluated retrospectively. Among 491 acute ITP patients, IVIG was used in 27%, high-dose steroids in 27%, low-dose steroids in 20%, anti-D immunoglobulin G (IgG) in 2%, and no therapy in 22%. When the initial response (platelets >50 × 10(9)/L) to first-line treatment modalities were compared, 89%, 84%, and 78% patients treated by low-dose steroids, high-dose steroids, and IVIG responded to treatment, respectively (P > .05). Mean time to recovery of platelets was 16.8, 3.8, and 3.0 days in patients treated with low-dose steroids, high-dose steroids, and IVIG, respectively (P < .0001). Thrombocytopenia recurred in 23% of low-dose steroid, 39% of high-dose steroid, and in 36% of IVIG (P < .0001) treatment groups. Of 108 patients who were observed alone, 4 (3%) had a recurrence on follow-up and only 2 of these required treatment subsequently. Recurrence was significantly less in no therapy group compared with children treated with 1 of the 3 options of pharmacotherapy (P < .0001). Response rates were similar between patients treated by IVIG and low- and high-dose steroids; however, time to response was slower in patients treated with low-dose steroids compared with IVIG and high-dose steroids. PMID:26154620

  18. Laparoscopic trans-mesocolic pyeloplasty in children: initial experience from a center in India.

    PubMed

    Khan, Muneer; Ahangar, Shahnawaz; Nazir, Syed Sajjad; Qadri, Syed Javid Farooq; Salroo, Nazir Ahmad

    2011-07-01

    The aim of the present study is to report our experience with laparoscopic pyeloplasty via trans-mesocolic approach in children with left pelvi-ureteric junction (PUJ) obstruction. Between May 2007 and May 2008, 12 children aged between five and 16 years, with documented PUJ obstruction on the left side, underwent laparoscopic pyeloplasty via trans-mesocolic approach. The outcome was assessed by post-operative isotope renal scan. The mean age of the study patients was eight years, ranging between five and 16 years. There were five males and seven females in the study. All children underwent Anderson Hynes Pyeloplasty by a single surgeon. All cases were stented with a JJ stent for a period of six weeks post-operatively. The procedures were completed successfully in all patients without need for conversion to open pyeloplasty in any patient. The mean operative time was 95 min, with a range of 80-140 min. The average blood loss was 57 mL. The mean hospital stay was 3.5 days with a range of 2.5 to six days. All children returned back to school within nine days following surgery. The mean follow-up period was 12 months (range, nine to 14 months). Eleven of the patients were completely asymptomatic, while one reported mild flank pain. All children underwent renal scans and renal ultrasound three months after stent removal. Ten had improved function on the scan while in one patient, the function remained the same and, in another, it showed obstructed response to diuretic, although the symptoms had improved. In all the cases, renal ultrasound showed a decrease in the severity of hydronephrosis by at least one degree. These results confirm that laparoscopic pyeloplasty by trans-mesocolic approach in children for left-sided PUJ obstruction is safe and feasible. PMID:21743246

  19. Minimally invasive video-assisted thyroidectomy: experience of 200 cases in a single center

    PubMed Central

    Jie, Xu; Lixin, Jiang

    2014-01-01

    Introduction Minimally invasive techniques in thyroid surgery including video-assisted technique originally described by Miccoli have been accepted in several continents for more than 10 years. Aim To analyze our preliminary results from minimally invasive video-assisted thyroidectomy (MIVAT) and to evaluate the feasibility and effects of this method in a general department over a 4-year period. Material and methods Initial experience was presented based on a series of 200 patients selected for MIVAT at the General Surgery Department of Yantai Yuhuangding Hospital affiliated with Qingdao University during the period from May 2008 to June 2012. The enrolling criteria were rigorously observed. An above sternal incision with average length of 2.5 cm (1.5–3.0 cm) was made. Clinicopathologic characteristics, postoperative pain, length of hospital stay, cosmetic results and complications were retrospectively analyzed. Results All patients received general anesthesia. Thyroid unilateral lobectomy was successfully accomplished in 108 cases, total thyroidectomy in 84, and partial lobectomy in 8. Conversion to standard conventional thyroidectomy was required in 6 patients (3%) because of thyroiditis and bleeding. The mean lymph node yield of the cancer specimens was 3.6 per patient. Permanent unilateral recurrent laryngeal nerve (RLN) palsy occurred in 1 case (0.5%), transient unilateral RLN palsy in 6 patients (3.0%, complete recovery after 1–6 months), and transient hypocalcemia in 7 patients (3.5%). No definitive hypocalcemia was observed. No postoperative hematomas occurred. Postoperative pain was endurable. The cosmetic result was excellent in most cases. Conclusions The MIVAT is feasible and safe in selected patients, with better results comparable to conventional thyroidectomy. The MIVAT can also be performed in a general surgery department. PMID:25337155

  20. Liver transplantation in children with hyper-reduced grafts - a single-center experience.

    PubMed

    Thomas, Naveen; Thomas, Gordon; Verran, Deborah; Stormon, Michael; O'Loughlin, Edward; Shun, Albert

    2010-05-01

    In small infants and babies who receive split or living-related adult left lateral segmental liver grafts, further reduction (hyper-reduction) of the graft may be necessary to optimize the size of the graft for the child. We report our experience with hyper-reduction of adult left lateral segment grafts in nine children. A retrospective review of the medical records of children who received hyper-reduced grafts at the Children's Hospital at Westmead, Australia was performed. Of 215 liver transplants performed on 186 children between 1986 and May 2009, 147 were reduced grafts. Nine grafts were further reduced (hyper-reduced) after an on-table assessment of graft size relative to the available abdominal space was made. Mean graft size reduction was by 30%. The pledgetted technique of resection was used in four patients. All required delayed closure of the abdomen, and in three patients, fascial closure was not possible and a Surgisis patch (Cook Surgical International, West Lafayette, IN, USA) was placed to augment the abdominal capacity. Two children had hepatic artery thrombosis. One was successfully thrombectomized. In the other, technical problems with the donor liver contributed to death 10 days post-transplant. Two bile leaks, one from the cut surface and the other at the anastomotic site, were oversewn at the time of abdominal closure. On follow-up (median 33 months), two developed biliary strictures requiring dilatation. Hyper-reduction of segmental grafts can be safely performed when needed. In view of its versatility, it may be preferable to hyper-reduce a graft rather than use a monosegment graft. Comparable long-term results are possible. The pledgetted technique of resection is easy, quick, and safe. The fact that it can be performed after revascularization with minimal blood loss adds great flexibility to this technically challenging procedure. PMID:20214746

  1. Conjoined twins – twenty years' experience at a reference center in Brazil

    PubMed Central

    Tannuri, Ana Cristina Aoun; Batatinha, Julio Americo Pereira; Velhote, Manoel Carlos Prieto; Tannuri, Uenis

    2013-01-01

    OBJECTIVE: This study reports on the experience of one hospital regarding the surgical aspects, anatomic investigation and outcomes of the management of 21 conjoined twin pairs over the past 20 years. METHODS: All cases of conjoined twins who were treated during this period were reviewed. A careful imaging evaluation was performed to detail the abdominal anatomy (particularly the liver), inferior vena cava, spleen and pancreas, either to identify the number of organs or to evaluate the degree of organ sharing. RESULTS: There were eight sets of ischiopagus twins, seven sets of thoracopagus twins, three sets of omphalopagus twins, two sets of thoraco-omphalo-ischiopagus twins and one set of craniopagus twins. Nine pairs of conjoined twins could not be separated due to the complexity of the organs (mainly the liver and heart) that were shared by both twins; these pairs included one set of ischiopagus twins, six sets of thoracopagus twins and one set of thoraco-omphalo-ischiopagus twins. Twelve sets were separated, including seven sets of ischiopagus twins, three sets of omphalopagus twins, one set of thoracopagus twins and one set of craniopagus conjoined twins. The abdominal wall was closed in the majority of patients with the use of mesh instead of the earlier method of using tissue expanders. The surgical survival rate was 66.7%, and one pair of twins who did not undergo separation is currently alive. CONCLUSION: A detailed anatomic study of the twins and surgical planning must precede separation. A well-prepared pediatric surgery team is sufficient to surgically manage conjoined twins. PMID:23644858

  2. Outcomes of Surgical Repair for Persistent Truncus Arteriosus from Neonates to Adults: A Single Center's Experience

    PubMed Central

    Chen, Qiuming; Gao, Huawei; Hua, Zhongdong; Yang, Keming; Yan, Jun; Zhang, Hao; Ma, Kai; Zhang, Sen; Qi, Lei; Li, Shoujun

    2016-01-01

    Objective This study aimed to report our experiences with surgical repair in patients of all ages with persistent truncus arteriosus. Methods From July 2004 to July 2014, 50 consecutive patients with persistent truncus arteriosus who underwent anatomical repair were included in the retrospective review. Median follow-up time was 3.4 years (range, 3 months to 10 years). Results Fifty patients underwent anatomical repair at a median age of 19.6 months (range, 20 days to 19.1 years). Thirty patients (60%) were older than one year. The preoperative pulmonary vascular resistance and mean pulmonary artery pressure were 4.1±2.1 (range, 0.1 to 8.9) units.m2 and 64.3±17.9 (range, 38 to 101) mmHg, respectively. Significant truncal valve regurgitation was presented in 14 (28%) patients. Hospital death occurred in 3 patients, two due to pulmonary hypertensive crisis and the other due to pneumonia. Three late deaths occurred at 3, 4 and 11 months after surgery. The actuarial survival rates were 87.7% and 87.7% at 1 year and 5 years, respectively. Multivariate analysis identified significant preoperative truncal valve regurgitation was a risk factor for overall mortality (odds ratio, 7.584; 95%CI: 1.335–43.092; p = 0.022). Two patients required reoperation of truncal valve replacement. One patient underwent reintervention for conduit replacement. Freedom from reoperation at 5 years was 92.9%. At latest examination, there was one patient with moderate-to-severe truncal valve regurgitation and four with moderate. Three patients had residual pulmonary artery hypertension. All survivors were in New York Heart Association class I-II. Conclusions Complete repair of persistent truncus arteriosus can be achieved with a relatively low mortality and acceptable early- and mid-term results, even in cases with late presentation. Significant preoperative truncal valve regurgitation remains a risk factor for overall mortality. The long-term outcomes warrant further follow-up. PMID:26752522

  3. Single center experience in selecting the laparoscopic Frey procedure for chronic pancreatitis

    PubMed Central

    Tan, Chun-Lu; Zhang, Hao; Li, Ke-Zhou

    2015-01-01

    AIM: To share our experience regarding the laparoscopic Frey procedure for chronic pancreatitis (CP) and patient selection. METHODS: All consecutive patients undergoing duodenum-preserving pancreatic head resection from July 2013 to July 2014 were reviewed and those undergoing the Frey procedure for CP were included in this study. Data on age, gender, body mass index (BMI), American Society of Anesthesiologists score, imaging findings, inflammatory index (white blood cells, interleukin (IL)-6, and C-reaction protein), visual analogue score score during hospitalization and outpatient visit, history of CP, operative time, estimated blood loss, and postoperative data (postoperative mortality and morbidity, postoperative length of hospital stay) were obtained for patients undergoing laparoscopic surgery. The open surgery cases in this study were analyzed for risk factors related to extensive bleeding, which was the major reason for conversion during the laparoscopic procedure. Age, gender, etiology, imaging findings, amylase level, complications due to pancreatitis, functional insufficiency, and history of CP were assessed in these patients. RESULTS: Nine laparoscopic and 37 open Frey procedures were analyzed. Of the 46 patients, 39 were male (85%) and seven were female (16%). The etiology of CP was alcohol in 32 patients (70%) and idiopathic in 14 patients (30%). Stones were found in 38 patients (83%). An inflammatory mass was found in five patients (11%). The time from diagnosis of CP to the Frey procedure was 39 ± 19 (9-85) mo. The BMI of patients in the laparoscopic group was 20.4 ± 1.7 (17.8-22.4) kg/m2 and was 20.6 ± 2.9 (15.4-27.7) kg/m2 in the open group. All patients required analgesic medication for abdominal pain. Frequent acute pancreatitis or severe abdominal pain due to acute exacerbation occurred in 20 patients (43%). Pre-operative complications due to pancreatitis were observed in 18 patients (39%). Pancreatic functional insufficiency was observed in

  4. [Post-transplant lymphoproliferative disease in liver transplant recipients--Merkur University Hospital single center experience].

    PubMed

    Filipec-Kanizaj, Tajana; Budimir, Jelena; Colić-Cvrlje, Vesna; Kardum-Skelin, Ika; Sustercić, Dunja; Naumovski-Mihalić, Slavica; Mrzljak, Anna; Kolonić, Slobodanka Ostojić; Sobocan, Nikola; Bradić, Tihomir; Dolić, Zrinka Misetić; Kocman, Branislav; Katicić, Miroslava; Zidovec-Lepej, Snjezana; Vince, Adriana

    2011-09-01

    favoring the diagnosis. The management of PTLD poses a major therapeutic challenge and although there is reasonable agreement about the overall principles of treatment, there is still considerable controversy about the optimal treatment of individual patients. EBV-related PTLDs are a significant cause of mortality in patients undergoing orthotopic liver transplantation with the observed mortality rate of up to 50%. This paper presents the experience acquired at Merkur University Hospital in the diagnosis and treatment of patients with liver transplantation and PTLD. PMID:23126028

  5. Biodegradable esophageal stents in benign and malignant strictures – a single center experience

    PubMed Central

    Sigounas, Dimitrios E.; Siddhi, Sandeep; Plevris, John N.

    2016-01-01

    Background and study aims: Biodegradable (BD) esophageal stents were recently developed mainly for refractory benign strictures, but experience and available literature are limited. Patients and methods: This was a retrospective observational study. All patients who had BD stents inserted due to refractory benign esophageal strictures or malignant strictures, or were awaiting radical radiotherapy/chemotherapy or neo-adjuvant therapy and esophagectomy between March 2011 and July 2015 were included. Results: Stent placement was successful in all patients. Ten patients with benign strictures (3 male, median age 80.5 years, IQR: 68.75 – 89.5) were followed-up for a median of 171.5 weeks (IQR: 24 – 177.25). The interval between dilatations prior to the first BD stent placement (median: 34.25 days, IQR: 23.06 – 48.29) was significantly shorter than the interval between the first BD stent placement and the first intervention required (median: 149.5 days, IQR: 94.25 – 209.5) and this difference was statistically significant (P = 0.012). Ten patients with esophageal cancer (8 male, median age: 69 years, IQR: 59.25 – 80.75) were included and they were followed up for a median of 36 weeks (IQR: 26 – 58). Only 1 completed radical radiotherapy successfully, but developed refractory post-radiotherapy stricture. No one proceeded to esophagectomy and 50 % required a self-expanding metal stent (SEMS) at a median of 134 days (IQR: 100 – 263) following stent placement. Conclusions: BD stents were successfully deployed in both benign and malignant strictures. They offered a prolonged dilatation-free interval in benign strictures, yet in the majority of patients, strictures recurred. In malignant strictures, stent patency was similar to that of benign strictures, which suggests a potential value in ensuring adequate oral intake during oncologic therapy. In our cohort, however, use of stents did not contribute to improved outcome. PMID

  6. Transrectal ultrasound-guided aspiration in the management of prostatic abscess: A single-center experience

    PubMed Central

    Vyas, Jigish B; Ganpule, Sanika A; Ganpule, Arvind P; Sabnis, Ravindra B; Desai, Mahesh R

    2013-01-01

    Objectives: The safety and efficacy of transrectal ultrasound (TRUS) guided aspiration of prostatic abscess (PA) is known. The objective of this study is to describe a treatment algorithm for management of PA with TRUS-guided aspiration, emphasizing on indications and factors predicting the treatment outcome. Materials and Methods: After the institutional review board approval was obtained, a retrospective study was done of all patients suspected with PA on digital rectal examination (DRE) and confirmed on TRUS. An 18-gauge two-part needle was used for aspiration. The real-time TRUS-guided aspiration of PA was done in the longitudinal axis. The aspiration of pus and the sequential collapse of cavity was seen “real time.” A suprapubic catheter was placed, if the patient had urinary retention, persistent dysuria, and/or severe lower urinary tract symptoms (LUTS). Success was defined as complete resolution of the abscess and/or symptoms. Results: Forty-eight patients were studied with PA, with a mean age of 54.6 ± 14.6 (range 26-79) years. The DRE diagnosed PA in 22 (45.83%) patients, while abdominal sonography diagnosed PA in 13 (27.08%) patients. TRUS revealed a hypoechoic area with internal echoes in all 48 (100%) patients. The diagnosis was confirmed in all 48 cases with aspiration. The mean size of the lesion was 3.2 ± 1.2 (range 1.5-8) cm. Mean volume aspirated was 10.2 ml (range 2.5-30 ml). Complete resolution after first aspiration was observed in 20 (41.66%) patients. An average of 4.1 (range 1-7) aspirations was required for complete resolution which was seen in 41 patients (85.42%). Seven (14.58%) patients required transurethral resection (deroofing) of the abscess cavity. We formulated a treatment algorithm based on the above findings. Conclusion: The proposed algorithm based on our experience suggests that patients with PA larger than 2 cm with severe LUTS and/or leukocytosis benefit from TRUS-guided aspiration. In addition, these patients are

  7. The future of health care delivery and the experience of a tertiary care center in Saudi Arabia.

    PubMed

    Alsanea, Nasser

    2012-01-01

    Five major technological changes will herald a new era in health care delivery around the World: digitalization of the personal health record, sharing of health care digital data across different platforms, applications and institutions, delivery of patient services via the internet, use of the digital media and social networking as a medium for education and preventive medicine and introduction of smart applications as counselors to prevent medical errors. The implications of such changes are huge. Saudi Arabia is not isolated from such important developments. This article explores the future of health care delivery with a special focus on the experience of a tertiary care center in Saudi Arabia that has led the wave in such changes regionally. PMID:22366822

  8. Extracranial to intracranial by-pass anastomosis: Review of our preliminary experience from a low volume center in Egypt

    PubMed Central

    Biswas, Arundhati; Samadoni, A. EL; Elbassiouny, Ahmed; Sobh, Khaled; Hegazy, Ahmed

    2015-01-01

    Background: Cerebral revascularization is a useful microsurgical technique for the treatment of steno-occlusive intracranial ischemic disease, complex intracranial aneurysms that require deliberate occlusion of a parent artery and invasive skull base tumors. We describe our preliminary experience with extracranial-to-intracranial by-passes at a low volume center; and discuss clinical indications and microsurgical techniques, challenges in comparison to large advanced referral centers. Materials and Methods: Twenty-seven patients with hemodynamic ischemia or complex aneurysms or skull base tumors were operated at Cairo University Hospitals in the period between May 2009 and June 2014. All patients operated by a low flow by-pass were operated through a superficial temporal artery to middle cerebral artery (MCA) anastomosis. All patients chosen for a high flow by-pass were operated using a radial artery graft interposed between the MCAs distally and the common or the external carotid artery proximally. Patency was confirmed at the end of surgery using appearance on the table and confirmed after surgery by transcranial color-coded duplex or computed tomography angiography. All patient data were prospectively collected and retrospectively analyzed at the end of surgery. Results: Nineteen patients (70.4%) were operated upon for flow augmentation and eight patients (29.6%) were operated upon for flow replacement. A total of 30 anastomoses were performed. All except one were patent which gives a patency rate of 96.3%. There was one death in the present series resulting from a hyperperfusion syndrome. 89.5% of patients with hemodynamic ischemia stopped having symptoms after surgery. All but one patient operated for hemodynamic ischemia showed a considerable cognitive improvement after surgery. None of the patients operated upon for flow replacement showed improvement of oculomotor nerve function in spite of adequate intraoperative decompression. All patients treated for

  9. The National Criticality Experiments Research Center at the Device Assembly Facility, Nevada National Security Site: Status and Capabilities, Summary Report

    SciTech Connect

    S. Bragg-Sitton; J. Bess; J. Werner

    2011-09-01

    The National Criticality Experiments Research Center (NCERC) was officially opened on August 29, 2011. Located within the Device Assembly Facility (DAF) at the Nevada National Security Site (NNSS), the NCERC has become a consolidation facility within the United States for critical configuration testing, particularly those involving highly enriched uranium (HEU). The DAF is a Department of Energy (DOE) owned facility that is operated by the National Nuclear Security Agency/Nevada Site Office (NNSA/NSO). User laboratories include the Lawrence Livermore National Laboratory (LLNL) and Los Alamos National Laboratory (LANL). Personnel bring their home lab qualifications and procedures with them to the DAF, such that non-site specific training need not be repeated to conduct work at DAF. The NNSS Management and Operating contractor is National Security Technologies, LLC (NSTec) and the NNSS Safeguards and Security contractor is Wackenhut Services. The complete report provides an overview and status of the available laboratories and test bays at NCERC, available test materials and test support configurations, and test requirements and limitations for performing sub-critical and critical tests. The current summary provides a brief summary of the facility status and the method by which experiments may be introduced to NCERC.

  10. Perceived Impacts of a Public Health Training Center Field Placement Program among Trainees: Findings from a Small Group Externship Experience.

    PubMed

    Johansson, Patrik; Grimm, Brandon; Abdel-Monem, Tarik; Hoffman, Stacey J; DeKraai, Mark; McMillan, Analisa

    2014-01-01

    There is heightened interest in identifying the impact of the federally funded Public Health Training Center (PHTC) program. Although evaluation studies have been conducted of public health training in general, evaluations of PHTC programs are rare. Field placement components are congressionally mandated requirements of PHTCs. Field placements are typically intensive, supervised externships for students to gain public health experience with local health departments or non-profit organizations. We have found no published evaluations of PHTC field placement components. This may be because of their small size and unique nature. We designed and evaluated a 200-h field placement program at an established PHTC. The evaluation included pre/post surveys measuring public health core competencies, and post-experience interviews. We found significant increases in three competency domains among trainees: policy development and program planning, communication skills, and community dimensions of practice. These outcomes contribute to evidence based on the efficacy of PHTC field placement programs, and underscore their role in public health training. PMID:25072041

  11. Perceived Impacts of a Public Health Training Center Field Placement Program among Trainees: Findings from a Small Group Externship Experience

    PubMed Central

    Johansson, Patrik; Grimm, Brandon; Abdel-Monem, Tarik; Hoffman, Stacey J.; DeKraai, Mark; McMillan, Analisa

    2014-01-01

    There is heightened interest in identifying the impact of the federally funded Public Health Training Center (PHTC) program. Although evaluation studies have been conducted of public health training in general, evaluations of PHTC programs are rare. Field placement components are congressionally mandated requirements of PHTCs. Field placements are typically intensive, supervised externships for students to gain public health experience with local health departments or non-profit organizations. We have found no published evaluations of PHTC field placement components. This may be because of their small size and unique nature. We designed and evaluated a 200-h field placement program at an established PHTC. The evaluation included pre/post surveys measuring public health core competencies, and post-experience interviews. We found significant increases in three competency domains among trainees: policy development and program planning, communication skills, and community dimensions of practice. These outcomes contribute to evidence based on the efficacy of PHTC field placement programs, and underscore their role in public health training. PMID:25072041

  12. The response of academic medical centers to the 2010 Haiti earthquake: the Mount Sinai School of Medicine experience.

    PubMed

    Ripp, Jonathan A; Bork, Jacqueline; Koncicki, Holly; Asgary, Ramin

    2012-01-01

    On January 12, 2010, Haiti was struck by a 7.0 earthquake which left the country in a state of devastation. In the aftermath, there was an enormous relief effort in which academic medical centers (AMC) played an important role. We offer a retrospective on the AMC response through the Mount Sinai School of Medicine (MSSM) experience. Over the course of the year that followed the Earthquake, MSSM conducted five service trips in conjunction with two well-established groups which have provided service to the Haitian people for over 15 years. MSSM volunteer personnel included nurses, resident and attending physicians, and specialty fellows who provided expertise in critical care, emergency medicine, wound care, infectious diseases and chronic disease management of adults and children. Challenges faced included stressful and potentially hazardous working conditions, provision of care with limited resources and cultural and language barriers. The success of the MSSM response was due largely to the strength of its human resources and the relationship forged with effective relief organizations. These service missions fulfilled the institution's commitment to social responsibility and provided a valuable training opportunity in advocacy. For other AMCs seeking to respond in future emergencies, we suggest early identification of a partner with field experience, recruitment of administrative and faculty support across the institution, significant pre-departure orientation and utilization of volunteers to fundraise and advocate. Through this process, AMCs can play an important role in disaster response. PMID:22232447

  13. Screening for Hepatitis B Virus and Hepatitis C Virus at a Community Fair: A Single-Center Experience

    PubMed Central

    Woo, Garmen A.; Hill, Mary A.; de Medina, Maria D.

    2013-01-01

    Despite recommendations for screening for hepatitis B virus (HBV) and hepatitis C virus (HCV), most individuals are still unaware of their infection status. The disparities in screening for HBV and HCV can be attributed to lack of awareness, language barriers, and difficulty in accessing healthcare. To address these issues, an exhibit booth was set up at an annual cultural festival to promote awareness about HBV and HCV and also provide free screening for a local Floridian community. Recruitment was conducted in various languages by physicians and nurses who specialize in hepatology. All materials associated with the screening process were sponsored by the Schiff Center for Liver Diseases, which is located at the University of Miami Miller School of Medicine in Florida. In the first year of the screening initiative, 173 of 11,000 fair attendees were screened for HBV. Twenty-nine (17%) of those screened tested positive for antibodies to hepatitis B core antigen (anti-HBc), and only 1 individual tested positive for chronic HBV, with positive hepatitis B surface antigen (HBsAg). Screening for HCV and an extended patient questionnaire were added to the screening program in the second year of the initiative. A total 231 of 9,000 fair attendees volunteered to be screened for both HBV and HCV. Twenty-nine (13%) of these people tested positive for anti-HBc, and 3 tested positive for HBsAg. Only 1 person tested positive for anti-HCV, but this individual had undetectable HCV RNA levels. Our single-center experience illustrates that, despite efforts to improve access to screening, only 2-3% of attendees at a cultural fair embraced the screening efforts. Other strategies will be required to enhance participation in screening programs for viral hepatitis. PMID:23943664

  14. Distance to the Center of the Milky Way Galaxy: An Experiment for Intermediate-Level Students Using Research Data and Professional Analysis Tools

    ERIC Educational Resources Information Center

    Fitzgerald, M. T.; Feteris, S. M.; Gillessen, S.; Eisenhauer, F.

    2008-01-01

    The most recent data on stars orbiting Sagittarius A*, the black hole at the center of the Milky Way galaxy, have been used in an experiment undertaken by second-year university students to determine the distance R[theta] to the center of the galaxy. Students applied each of Kepler's 17th-century laws, in turn, to 21st-century data. The…

  15. The KLH Experience: An Evaluative Report of Day Care in Action at the KLH Child Development Center Cambridge, Massachusetts.

    ERIC Educational Resources Information Center

    Curran, Joseph R.; Jordan, John W.

    This report concludes a two part study of the KLH Child Development Center covering July 1969-June 1970. The history and background of this industry-based, experimental day care center are presented along with the nature and reasons for its change from an industry-related center identified with one work community to a private community center…

  16. Telework Centers. An Evaluation of the North American and Japanese Experience. Workscape 21: The Ecology of New Ways of Working.

    ERIC Educational Resources Information Center

    Becker, Franklin; Rappaport, Andrew J.; Quinn, Kristen L.; Sims, William R.

    Telework Centers are work locations used by firms to acommodate staff who live near the telework center location. A study examined the impact of using telework centers on communication, work groups/departments, performance, supervision, travel/environment, and type of work done in various locations. A case study approach was used to investigate 10…

  17. Review of the High Performance Antiproton Trap (HiPAT) Experiment at the Marshall Space Flight Center

    NASA Technical Reports Server (NTRS)

    Pearson, J. B.; Sims, Herb; Martin, James; Chakrabarti, Suman; Lewis, Raymond; Fant, Wallace

    2003-01-01

    The significant energy density of matter-antimatter annihilation is attractive to the designers of future space propulsion systems, with the potential to offer a highly compact source of power. Many propulsion concepts exist that could take advantage of matter-antimatter reactions, and current antiproton production rates are sufficient to support basic proof-of-principle evaluation of technology associated with antimatter- derived propulsion. One enabling technology for such experiments is portable storage of low energy antiprotons, allowing antiprotons to be trapped, stored, and transported for use at an experimental facility. To address this need, the Marshall Space Flight Center's Propulsion Research Center is developing a storage system referred to as the High Performance Antiproton Trap (HiPAT) with a design goal of containing 10(exp 12) particles for up to 18 days. The HiPAT makes use of an electromagnetic system (Penning- Malmberg design) consisting of a 4 Telsa superconductor, high voltage electrode structure, radio frequency (RF) network, and ultra high vacuum system. To evaluate the system normal matter sources (both electron guns and ion sources) are used to generate charged particles. The electron beams ionize gas within the trapping region producing ions in situ, whereas the ion sources produce the particles external to the trapping region and required dynamic capture. A wide range of experiments has been performed examining factors such as ion storage lifetimes, effect of RF energy on storage lifetime, and ability to routinely perform dynamic ion capture. Current efforts have been focused on improving the FW rotating wall system to permit longer storage times and non-destructive diagnostics of stored ions. Typical particle detection is performed by extracting trapped ions from HiPAT and destructively colliding them with a micro-channel plate detector (providing number and energy information). This improved RF system has been used to detect various

  18. TIPS for refractory ascites: a 6-year single-center experience with expanded polytetrafluoroethylene-covered stent-grafts.

    PubMed

    Bercu, Zachary L; Fischman, Aaron M; Kim, Edward; Nowakowski, F Scott; Patel, Rahul S; Schiano, Thomas D; Chang, Charissa Y; Lookstein, Robert A

    2015-03-01

    OBJECTIVE. This single-center study evaluated the use of expanded polytetrafluoroethylene (ePTFE)-covered stent-grafts for transjugular intrahepatic portosystemic shunt (TIPS) placement to manage portal hypertension-related refractory ascites. MATERIALS AND METHODS. One hundred patients at a single tertiary care center in a major metropolitan hospital underwent TIPS placement with an ePTFE-covered stent-graft (Viatorr TIPS Endoprosthesis). Patients with portal hypertension-related ascites and preexisting hepatocellular carcinoma or liver transplant were excluded from the analysis. Records were reviewed for demographic characteristics, technical success of the TIPS procedures, and stent follow-up findings. Clinical results were assessed at 90- and 180-day intervals. RESULTS. Immediate technical success of the TIPS procedure was 100%. Of the 61 patients with documented follow-up, 55 (90.2%) had a partial or complete ascites response to TIPS creation. Of these 55 patients, nine experienced severe encephalopathy. Six of 61 patients (9.8%) did not experience a significant ascites response. Overall survival was 78.7% at 365-day follow-up. The 365-day survival was 84.2% for patients with a model for end-stage liver disease (MELD) score of less than 15, 67.0% for those with a score of 15-18, and 53.8% for those with a score of greater than 18 (p = 0.01). For patients with a MELD score of less than 18, the 365-day survival was 88.0% for those with an albumin value of 3 mg/dL or greater and 72.8% for those with an albumin value of less than 3 mg/dL (p = 0.04). CONCLUSION. TIPS placement using an ePTFE-covered stent-graft is an efficacious therapy for refractory ascites. Patients with preserved liver function-characterized by a MELD score of less than 15 or a MELD score of less than 18 and an albumin value of 3 mg/dL or greater-experience the greatest survival benefit. PMID:25714299

  19. Nurturing 21st century physician knowledge, skills and attitudes with medical home innovations: the Wright Center for Graduate Medical Education teaching health center curriculum experience

    PubMed Central

    Palamaner Subash Shantha, Ghanshyam; Gollamudi, Lakshmi Rani; Sheth, Jignesh; Ebersole, Brian; Gardner, Katlyn J.; Nardella, Julie; Ruddy, Meaghan P.; Meade, Lauren

    2015-01-01

    Purpose. The effect of patient centered medical home (PCMH) curriculum interventions on residents’ self-reported and demonstrated knowledge, skills and attitudes in PCMH competency arenas (KSA) is lacking in the literature. This study aimed to assess the impact of PCMH curricular innovations on the KSA of Internal Medicine residents. Methods. Twenty four (24) Internal Medicine residents—12 Traditional (TR) track residents and 12 Teaching Health Center (THC) track residents—began training in Academic Year (AY) 2011 at the Wright Center for Graduate Medical Education (WCGME). They were followed through AY2013, covering three years of training. PCMH curricular innovations were focally applied July 2011 until May 2012 to THC residents. These curricular innovations were spread program-wide in May 2012. Semi-annual, validated PCMH Clinician Assessments assessing KSA were started in AY2011 and were completed by all residents. Results. Mean KSA scores of TR residents were similar to those of THC residents at baseline for all PCMH competencies. In May 2012, mean scores of THC residents were significantly higher than TR residents for most KSA. After program-wide implementation of PCMH innovations, mean scores of TR residents for all KSA improved and most became equalized to those of THC residents. Globally improved KSA scores of THC and TR residents were maintained through May 2014, with the majority of improvements above baseline and reaching statistical significance. Conclusions. PCMH curricular innovations inspired by Health Resources and Services Administration (HRSA’s) Teaching Health Center funded residency program expansion quickly and consistently improved the KSA of Internal Medicine residents. PMID:25699213

  20. Nurturing 21st century physician knowledge, skills and attitudes with medical home innovations: the Wright Center for Graduate Medical Education teaching health center curriculum experience.

    PubMed

    Thomas-Hemak, Linda; Palamaner Subash Shantha, Ghanshyam; Gollamudi, Lakshmi Rani; Sheth, Jignesh; Ebersole, Brian; Gardner, Katlyn J; Nardella, Julie; Ruddy, Meaghan P; Meade, Lauren

    2015-01-01

    Purpose. The effect of patient centered medical home (PCMH) curriculum interventions on residents' self-reported and demonstrated knowledge, skills and attitudes in PCMH competency arenas (KSA) is lacking in the literature. This study aimed to assess the impact of PCMH curricular innovations on the KSA of Internal Medicine residents. Methods. Twenty four (24) Internal Medicine residents-12 Traditional (TR) track residents and 12 Teaching Health Center (THC) track residents-began training in Academic Year (AY) 2011 at the Wright Center for Graduate Medical Education (WCGME). They were followed through AY2013, covering three years of training. PCMH curricular innovations were focally applied July 2011 until May 2012 to THC residents. These curricular innovations were spread program-wide in May 2012. Semi-annual, validated PCMH Clinician Assessments assessing KSA were started in AY2011 and were completed by all residents. Results. Mean KSA scores of TR residents were similar to those of THC residents at baseline for all PCMH competencies. In May 2012, mean scores of THC residents were significantly higher than TR residents for most KSA. After program-wide implementation of PCMH innovations, mean scores of TR residents for all KSA improved and most became equalized to those of THC residents. Globally improved KSA scores of THC and TR residents were maintained through May 2014, with the majority of improvements above baseline and reaching statistical significance. Conclusions. PCMH curricular innovations inspired by Health Resources and Services Administration (HRSA's) Teaching Health Center funded residency program expansion quickly and consistently improved the KSA of Internal Medicine residents. PMID:25699213

  1. Endovascular treatment of central venous obstruction as a complication of prolonged hemodialysis – Preliminary experience in a tertiary care center

    PubMed Central

    Yadav, Mukesh K; Sharma, Madhurima; Lal, Anupam; Gupta, Vivek; Sharma, Ashish; Khandelwal, Niranjan

    2015-01-01

    Background: Central venous disease is a serious complication in patients undergoing hemodialysis, often presenting with symptoms of venous hypertension. Treatment is aimed to provide symptomatic relief and to maintain hemodialysis access site patency. Aim: To describe our initial experience in the endovascular treatment of central venous stenosis or obstruction in patients undergoing hemodialysis. Settings and Design: This was a retrospective study carried out in a tertiary care center. Study duration was 24 months. Follow-up was variable. Materials and Methods: Eleven patients of chronic renal failure undergoing hemodialysis presented with central vein stenosis or obstruction having ipsilateral vascular access, between July 2012 and July 2014. All the patients underwent endovascular treatment and were analyzed retrospectively. Results and Conclusion: A total of 11 patients (4 male and 7 female) underwent 18 interventions for 13 stenotic segments during a time period of 2 years. Eight stenotic segments were in brachiocephalic vein, three in subclavian vein, and two in axillary veins. The technical success rate for endovascular treatment was 81.8%. Two patients underwent percutaneous transluminal angioplasty (PTA) alone and presented with restenosis later. Balloon angioplasty followed by stenting was done in seven patients, two of which required reintervention during follow-up. We found endovascular treatment safe and effective in treating central venous disease. PMID:26752817

  2. Haploidentical hematopoietic stem cell transplantation without total body irradiation for pediatric acute leukemia: a single-center experience

    PubMed Central

    Mu, Yanshun; Qin, Maoquan; Wang, Bin; Li, Sidan; Zhu, Guanghua; Zhou, Xuan; Yang, Jun; Wang, Kai; Lin, Wei; Zheng, Huyong

    2016-01-01

    Hematopoietic stem cell transplantation (HSCT) is a promising method for therapy of pediatric patients with acute leukemia. However, less availability of matched donors limited its wide application. Recently, haploidentical HSCT has become a great resource. Here, we have retrospectively reported our experience of 20 pediatric patients with acute leukemia who underwent haploidentical HSCT without total body irradiation (TBI) myeloablative regimen in our center from November 2007 to June 2014. All the patients attained successful HSCT engraftment in terms of myeloid and platelet recovery. Thirteen patients developed grade I–IV acute graft-versus-host disease (a-GVHD). The incidence of grade I–II a-GVHD, grade III–IV a-GVHD, and chronic GVHD (c-GVHD) was 45%, 20%, and 25%, respectively. The mean myeloid and platelet recovery time was 13.20±2.41 and 19.10±8.37 days. The median follow-up time was 43.95±29.26 months. During the follow-up, three patients died. The overall survival (OS) rate was 85%. The present study indicated that haploidentical HSCT without TBI myeloablative regimen significantly improved the OS rate of pediatric patients with acute leukemia. PMID:27217774

  3. Cytoreductive Surgery plus Hyperthermic Intraperitoneal Chemotherapy for Management of Peritoneal Sarcomatosis: A Preliminary Single-Center Experience from Saudi Arabia

    PubMed Central

    Abu-Zaid, Ahmed; Azzam, Ayman; Abuzaid, Mohammed; Elhassan, Tusneem; Albadawi, Naryman; Alkhatib, Lynn; AlOmar, Osama; Alsuhaibani, Abdullah; Amin, Tarek; Al-Badawi, Ismail A.

    2016-01-01

    Aim. To report our preliminary single-center experience with cytoreductive surgery (CRS) plus hyperthermic intraperitoneal chemotherapy (HIPEC) for management of peritoneal sarcomatosis (PS). Methods. Eleven patients were retrospectively analyzed for perioperative details. Results. Cytoreduction completeness (CC-0/1) was achieved in all patients with median peritoneal cancer index (PCI) of 14 ± 8.9 (range: 3–29). Combination cisplatin + doxorubicin HIPEC chemotherapy was used in 6 patients. Five patients received intraoperative radiation therapy (IORT). The median operative time, estimated blood loss, and hospital stay were 8 ± 1.4 hours (range: 6–10), 1000 ± 250 mL (range: 700–3850), and 11 ± 2.4 days (range: 7–15), respectively. Major postoperative Clavien-Dindo grade III/IV complications occurred in 1 patient and none developed HIPEC chemotherapy-related toxicities. The median overall survival (OS) and disease-free survival (DFS) after CRS + HIPEC were 28.3 ± 3.2 and 18.0 ± 4.0 months, respectively. The median follow-up time was 12 months (range: 6–33). Univariate analysis of several prognostic factors (age, gender, PS presentation/pathology, CC, PCI, HIPEC chemotherapy, and IORT) did not demonstrate statistically significant differences of OS and DFS. Conclusion. CRS + HIPEC appear to be feasible, safe, and offer survival oncological benefits. However, definitive conclusions cannot be deduced. PMID:27212941

  4. Treatment of the iatrogenic lesion of the biliary tree secondary to laparoscopic cholecystectomy: a single center experience.

    PubMed

    Tropea, Alessandro; Pagano, Duilio; Biondi, Antonio; Spada, Marco; Gruttadauria, Salvatore

    2016-06-01

    Surgical bile duct injury (SBDI), during laparoscopic cholecystectomy, is a worldwide ongoing problem. The purpose of this study is to analyze a single center retrospective experience with this topic. From 1999 to 2012, 30 patients with diagnosis of SBDI after laparoscopic cholecystectomy performed in other institute for gallbladder lithiasis and then transferred to our facility were enrolled in this analysis. We considered in the study the following parameters: classification and site of the bile duct injury, infective complications and therapeutic management according to early or late referral. Twenty four patients (80 %) had a SBDI type E1; a concomitant vascular injury was described in 3/30 (10 %) in right hepatic artery. 11 patients had HJJ as primary surgical treatment in our hospital. Surgical site infection was documented in 9/30 (30 %). The most common micro-organisms documented in SSI were E. coli with an incidence of 55.5 % of SSI. Worse infective complications were detected in the late referral group. Complex SBDI occurred during laparoscopic cholecystectomy should be early referred to advanced hepatobiliary program, for appropriate multidisciplinary management. PMID:26961379

  5. MSSM A-funnel and the galactic center excess: prospects for the LHC and direct detection experiments

    NASA Astrophysics Data System (ADS)

    Freese, Katherine; López, Alejandro; Shah, Nausheen R.; Shakya, Bibhushan

    2016-04-01

    The pseudoscalar resonance or " A-funnel" in the Minimal Supersymmetric Standard Model (MSSM) is a widely studied framework for explaining dark matter that can yield interesting indirect detection and collider signals. The well-known Galactic Center excess (GCE) at GeV energies in the gamma ray spectrum, consistent with annihilation of a ≲ 40 GeV dark matter particle, has more recently been shown to be compatible with significantly heavier masses following reanalysis of the background. In this paper, we explore the LHC and direct detection implications of interpreting the GCE in this extended mass window within the MSSM A-funnel framework. We find that compatibility with relic density, signal strength, collider constraints, and Higgs data can be simultaneously achieved with appropriate parameter choices. The compatible regions give very sharp predictions of 200-600 GeV CP-odd/even Higgs bosons at low tan β at the LHC and spin-independent cross sections ≈ 10-11 pb at direct detection experiments. Regardless of consistency with the GCE, this study serves as a useful template of the strong correlations between indirect, direct, and LHC signatures of the MSSM A-funnel region.

  6. Recent Experiences of the NASA Engineering and Safety Center (NESC) GN and C Technical Discipline Team (TDT)

    NASA Technical Reports Server (NTRS)

    Dennehy, Cornelius J.

    2010-01-01

    The NASA Engineering and Safety Center (NESC), initially formed in 2003, is an independently funded NASA Program whose dedicated team of technical experts provides objective engineering and safety assessments of critical, high risk projects. The GN&C Technical Discipline Team (TDT) is one of fifteen such discipline-focused teams within the NESC organization. The TDT membership is composed of GN&C specialists from across NASA and its partner organizations in other government agencies, industry, national laboratories, and universities. This paper will briefly define the vision, mission, and purpose of the NESC organization. The role of the GN&C TDT will then be described in detail along with an overview of how this team operates and engages in its objective engineering and safety assessments of critical NASA projects. This paper will then describe selected recent experiences, over the period 2007 to present, of the GN&C TDT in which they directly performed or supported a wide variety of NESC assessments and consultations.

  7. Experiences at Langley Research Center in the application of optimization techniques to helicopter airframes for vibration reduction

    NASA Technical Reports Server (NTRS)

    Sreekanta Murthy, T.; Kvaternik, Raymond G.

    1991-01-01

    A NASA/industry rotorcraft structural dynamics program known as Design Analysis Methods for VIBrationS (DAMVIBS) was initiated at Langley Research Center in 1984 with the objective of establishing the technology base needed by the industry for developing an advanced finite-element-based vibrations design analysis capability for airframe structures. As a part of the in-house activities contributing to that program, a study was undertaken to investigate the use of formal, nonlinear programming-based, numerical optimization techniques for airframe vibrations design work. Considerable progress has been made in connection with that study since its inception in 1985. This paper presents a unified summary of the experiences and results of that study. The formulation and solution of airframe optimization problems are discussed. Particular attention is given to describing the implementation of a new computational procedure based on MSC/NASTRAN and CONstrained function MINimization (CONMIN) in a computer program system called DYNOPT for the optimization of airframes subject to strength, frequency, dynamic response, and fatigue constraints. The results from the application of the DYNOPT program to the Bell AH-1G helicopter are presented and discussed.

  8. Undifferentiated Embryonal Sarcoma of the Liver (UESL): A Single-Center Experience and Review of the Literature.

    PubMed

    Techavichit, Piti; Masand, Prakash M; Himes, Ryan W; Abbas, Rana; Goss, John A; Vasudevan, Sanjeev A; Finegold, Milton J; Heczey, Andras

    2016-05-01

    Undifferentiated embryonal sarcoma of the liver (UESL) is a rare and aggressive pediatric malignancy. The purpose of this study was to review the clinical, radiologic, and pathologic features and outcome of children with UESL at our institution, in the United Network of Organ Sharing database and to review the existing literature to define the state of the art for children with UESL. Six children were diagnosed with UESL at the Texas Children's Cancer Center between 1993 and 2014, 12 children underwent liver transplantation registered in the United Network of Organ Sharing database, and 198 children with UESL were described in 23 case series during 1978 to 2014. Patients were treated with multimodal treatment approaches including primary surgical resection, neoadjuvant and/or adjuvant chemotherapy, and liver transplantation resulting in overall survival reported between 20% and 100% with significant improvement over the recent years. We show that complete tumor removal remains the key element of treatment and our single-institutional experience and data in the published literature suggest that combination chemotherapy with ifosfamide and doxorubicin to facilitate complete surgical resection is an effective approach to cure children with UESL. PMID:26925712

  9. OOD/OOP experience in the Science Operations Center part of the ground system for X ray Timing Explorer mission

    NASA Technical Reports Server (NTRS)

    Choudhary, Abdur Rahim

    1994-01-01

    The Science Operations Center (SOC) for the X-ray Timing Explorer (XTE) mission is an important component of the XTE ground system. Its mandate includes: (1) command and telemetry for the three XTE instruments, using CCSDS standards; (2) monitoring of the real-time science operations, reconfiguration of the experiment and the instruments, and real-time commanding to address the targets of opportunity (TOO) and alternate observations; and (3) analysis, processing, and archival of the XTE telemetry, and the timely delivery of the data products to the principal investigator (PI) teams and the guest observers (GO). The SOC has two major components: the science operations facility (SOF) that addresses the first two objectives stated above and the guest observer facility (GOF) that addresses the third. The SOF has subscribed to the object oriented design and implementation; while the GOF uses the traditional approach in order to take advantage of the existing software developed in support of previous missions. This paper details the SOF development using the object oriented design (OOD), and its implementation using the object oriented programming (OOP) in C++ under Unix environment on client-server architecture using Sun workstations. It also illustrates how the object oriented (OO) and the traditional approaches coexist in SOF and GOF, the lessons learned, and how the OOD facilitated the distributed software development collaboratively by four different teams. Details are presented for the SOF system, its major subsystems, its interfaces with the rest of the XTE ground data system, and its design and implementation approaches.

  10. Radiation therapy in the treatment of meningioma: the Joint Center for Radiation Therapy experience 1970 to 1982

    SciTech Connect

    Forbes, A.R.; Goldberg, I.D.

    1984-10-01

    The standard treatment for meningioma is complete resection. However, complete resection is often not possible because of tumor location and extent. To evaluate the usefulness of radiation therapy in patients with unresected or residual tumor, the Joint Center for Radiation Therapy experience from 1970 to 1982 (n . 31) was reviewed. Histologic diagnosis was available in 27 patients. The patients were treated with megavoltage radiation to a mean dose of 5,280 rad (3,780 to 6,050 rad) in 180- to 200-rad daily fractions using multiple static or rotational fields. The median follow-up period was 45 months, with a range of four to 156 months. The overall four-year relapse-free survival (RFS) rate was 72%. All relapses occurred within the first 37 months; the mean time to relapse was 31 months. The four-year RFS was the same whether patients were treated at initial presentation or after recurrence (74% v 67%, respectively). There was no difference in RFS for patients treated after partial resection or those patients with no resection (76% v 64%). No patients with malignant meningioma were relapse free three years after radiation therapy. Complications included decreased auditory acuity in three patients and retinopathy in one patient. These data suggest that moderate dose radiation therapy can offer long-term symptom-free survival with few complications in patients having unresected or partially resected benign meningioma.

  11. Impact of age on the prognosis after liver transplantation for patients with hepatocellular carcinoma: a single-center experience

    PubMed Central

    Wang, Pusen; Wang, Chunguang; Li, Hao; Shi, Baojie; Wang, Jianning; Zhong, Lin

    2015-01-01

    Background Liver transplantation (LT) offers the most effective treatment for hepatocellular carcinoma patients. Various preoperative variables are correlated with survival after LT, but the prognostic role of aging on LT remains controversial. Methods Between January 2001 and December 2011, 290 consecutive transplants for patients with hepatocellular carcinoma performed in Shanghai First People’s Hospital (People’s Republic of China) were analyzed retrospectively. We compared patient characteristics and survival curves between a younger group (less than 49 years, n=135) and an aged group (50 years or older, n=155). We then performed Cox multivariate regression analysis of the risk factors for survival in aged and younger patients. Results Younger age was associated with higher alpha-fetoprotein (P=0.014), larger tumor size (P=0.038), poorer differentiation (P=0.025), portal lymph node metastasis (P=0.001), and higher recurrence rate (P=0.038). Aged patients had significantly longer recurrence-free survival and overall survival (P=0.020 and P=0.014, respectively); however, there were no significant differences between the younger and aged patients who met the Milan criteria (P>0.05). The 1-, 3-, and 5-year recurrence-free survival rates were 59.7%, 44.5%, and 37.3%, respectively, in the younger group, and 67.9%, 55.3%, and 53.8%, respectively, in the aged group. The 1-, 3-, and 5-year overall survival rates were 68.4%, 45.5%, and 38.9%, respectively, in the younger group, and 76.1%, 59.7%, and 53.9%, respectively, in the aged group. Alpha-fetoprotein ≥400 ng/mL, microvascular invasion, and tumor size >5 cm were independent risk factors for prognosis in both groups. Conclusion Younger patients in our center tended to present with more aggressive tumors and have a higher risk of recurrence. Our single-center experience suggests that younger patients should be assessed more rigorously before LT, while aged patients should be actively considered for LT after

  12. Experiences of Multidisciplinary Development Team Members During User-Centered Design of Telecare Products and Services: A Qualitative Study

    PubMed Central

    2014-01-01

    Background User-centered design (UCD) methodologies can help take the needs and requirements of potential end-users into account during the development of innovative telecare products and services. Understanding how members of multidisciplinary development teams experience the UCD process might help to gain insight into factors that members with different backgrounds consider critical during the development of telecare products and services. Objective The primary objective of this study was to explore how members of multidisciplinary development teams experienced the UCD process of telecare products and services. The secondary objective was to identify differences and similarities in the barriers and facilitators they experienced. Methods Twenty-five members of multidisciplinary development teams of four Research and Development (R&D) projects participated in this study. The R&D projects aimed to develop telecare products and services that can support self-management in elderly people or patients with chronic conditions. Seven participants were representatives of end-users (elderly persons or patients with chronic conditions), three were professional end-users (geriatrician and nurses), five were engineers, four were managers (of R&D companies or engineering teams), and six were researchers. All participants were interviewed by a researcher who was not part of their own development team. The following topics were discussed during the interviews: (1) aim of the project, (2) role of the participant, (3) experiences during the development process, (4) points of improvement, and (5) what the project meant to the participant. Results Experiences of participants related to the following themes: (1) creating a development team, (2) expectations regarding responsibilities and roles, (3) translating user requirements into technical requirements, (4) technical challenges, (5) evaluation of developed products and services, and (6) valorization. Multidisciplinary team members

  13. Demystifying the Chemistry Literature: Building Information Literacy in First-Year Chemistry Students through Student-Centered Learning and Experiment Design

    ERIC Educational Resources Information Center

    Bruehl, Margaret; Pan, Denise; Ferrer-Vinent, Ignacio J.

    2015-01-01

    This paper describes curriculum modules developed for first-year general chemistry laboratory courses that use scientific literature and creative experiment design to build information literacy in a student-centered learning environment. Two curriculum units are discussed: Exploring Scientific Literature and Design Your Own General Chemistry…

  14. Pedagogies, Perspectives, and Practices: Mobile Learning through the Experiences of Faculty Developers and Instructional Designers in Centers for Teaching and Learning

    ERIC Educational Resources Information Center

    Hosler, Kim A.

    2013-01-01

    The purpose of this qualitative case study was to explore the experiences, perceptions, and pedagogy of nine self-identified faculty developers and instructional designers who work in centers for teaching and learning supporting faculty members requesting assistance with mobile learning. With the ever-increasing use of mobile devices across…

  15. Asian-American Students' Severity of Problems and Willingness To Seek Help from University Counseling Centers: Role of Previous Counseling Experience, Gender, and Ethnicity.

    ERIC Educational Resources Information Center

    Solberg, V. Scott; And Others

    1994-01-01

    Examined concerns and help-seeking likelihood of Asian American college students (n=596). Results indicated that previous counseling experience was related to higher ratings for substance abuse concerns and willingness to seek help from university counseling center to address academic, interpersonal, and substance abuse concerns. Asian American…

  16. Impact of changing trends in technique and learning curve on outcome of hypospadias repair: An experience from tertiary care center

    PubMed Central

    Ansari, M. S.; Agarwal, Shikhar; Sureka, Sanjoy Kumar; Mandhani, Anil; Kapoor, Rakesh; Srivastava, Aneesh

    2016-01-01

    Introduction: Apart from numerous clinical factors, surgical experience and technique are important determinants of hypospadias repair outcome. This study was aimed to evaluate the learning curve of hypospadias repair and the impact of changing trends in surgical techniques on the success of primary hypospadias repair. Materials and Methods: We retrospectively analyzed of data of 324 patients who underwent primary repair of hypospadias between January 1997 and December 2013 at our center. During the initial 8 years, repairs were performed by multiple 5 different urologists. From 2005 onwards, all procedures were performed by a single urologist. The study cohorts was categorized into three groups; Group I, surgeries performed between 1997–2004 by multiple surgeons, Group II, between 2005–2006 during the initial learning curve of a single surgeon, and Group III, from 2007 onwards after completion of the learning curve of the single surgeon. The groups were compared in respect to surgical techniques, overall success and complications. Results: Overall 296 patients fulfilled the inclusion criterion, 93 (31.4%), 50 (16.9%), and 153 (51.7%) in Group I, II, and III, respectively. Overall success was achieved in 60 (64.5%), 32 (64%), and 128 (83.7%) patients among the three groups respectively (P < 0.01). Nineteen (20.4%), 20 (40%), and 96 (62.7%) patients underwent tubularized incised plate repair in Group I, II, and III, with successful outcome in 12 (63.2%), 15 (75%), and 91 (94.8%) patients, respectively (P < 0.01). The most common complication among all groups was urethrocutaneous fistula, 20 (21.5%) in Group I, 11 (22%) in Group II, and 17 (11.1%) in Group III. Conclusion: There is a learning curve for attaining surgical skills in hypospadias surgery. Surgeons dedicated for this surgery provide better results. Tubularized incised plate urethroplasty appear promising in both distal and proximal type hypospadias. PMID:27555680

  17. Multibeam inverse intensity-modulated radiotherapy (IMRT) for whole breast irradiation: a single center experience in China

    PubMed Central

    Ma, Jinli; Mei, Xin; Chen, Jiayi; Yu, Xiaoli; Guo, Xiaomao

    2015-01-01

    Purpose To present the clinical experience in our cancer center with multibeam inverse intensity-modulated radiotherapy (IMRT) for early stage breast cancer (BC) patients with whole breast irradiation (WBI). Methods We retrospectively analyzed 622 patients with Stage 0 to III BC treated from 2008 to 2011 with wide local excision and WBI, using an inverse IMRT technique. All of the patients were prescribed a total dose of 50 Gy to the whole breast in 2-Gy fractions, followed by a tumor bed boost of 10 Gy in 5 fractions using an electron beam. Results Of all of the patients, 132 (21.2%) received whole breast plus regional lymph node (RLN) irradiation. 438 of 622 patients had records of acute skin toxicity based on common terminology criteria (CTC) for adverse events. Two hundred eighty (64%) patients had Grade 0/1 toxicity, 153 (35%) had Grade 2 and only 4 patients experienced grade 3 toxicity. Seventy patients (16%) had moist desquamation. Univariate analysis revealed that breast planning target volume was the only predictive factor for Grade ≥2 acute dermatitis (P = 0.002). After 4 years, 170 patients reported cosmetic results by self-assessment, of whom 151 (89%) patients reported good/excellent cosmetic results, and 17 (11%) patients reported fair assessments. For invasive cancer, the four-year rate of freedom from locoregional recurrence survival was 98.3%. Regarding carcinoma in situ, no patients experienced recurrence. Conclusion BC patients who underwent conservative surgery followed by inverse IMRT plan exhibited acceptable acute toxicities and clinical outcomes. Longer follow-up is needed. PMID:26393681

  18. OUTBACK catheter for treatment of superficial femoral and iliac artery chronic total occlusion: Experience from two centers

    PubMed Central

    Husainy, Mohammad Ali; Suresh, Balla; Fang, Cheng; Ammar, Thoraya; Botchu, Rajesh; Thava, V

    2016-01-01

    Purpose: The OUTBACK® catheter is a reentry device that enables reentry into a vessel lumen from the subintimal space during subintimal angioplasty. It is reserved for cases where reentry has not been possible using conventional wire and catheter techniques. We report a two-center experience in recanalization of the chronic total occlusions of the common iliac (CIA) and the superficial femoral artery (SFA) using the OUTBACK® catheter in cases where other techniques were unsuccessful. Material and Methods: All cases where recanalization was performed using the OUTBACK® reentry catheter between January 2010 to January 2015 were retrospectively identified and included in this study. 21 patients were identified. The indication for intervention in these cases included claudication and critical leg ischemia. In all cases, conventional recanalization could not be successfully achieved. Results: The OUTBACK® catheter was used to recanalize 10 SFA occlusion and 9 CIA occlusions. In 19 patients (90%), reentry into true arterial lumen was successfully achieved. 17 patients had their recanalization through the transfemoral approach whereas 2 patients had a transpopliteal artery approach. In 2 patients, reentry into the true lumen could not be achieved using the OUTBACK® catheter due to patient's intolerability for the procedure and severe atherosclerotic calcified plaques. There was 100% patency of the vessel intervened on Duplex ultrasound at 24 months of follow up. 16 patients (84%) remained asymptomatic and 2 patients (10.5%) reported worsening of their symptoms due to the development of new lesions within the arterial system. Conclusion: The OUTBACK® catheter is an effective and safe technique for reentry into the vessel lumen when conventional techniques fail. PMID:27413275

  19. The impact of interventional nephrologists on the growth of a peritoneal dialysis program: Long-term, single-center experience.

    PubMed

    Ros-Ruiz, Silvia; Alonso-Esteve, Ángela; Gutiérrez-Vílchez, Elena; Rudas-Bermúdez, Edisson; Hernández, Domingo

    2016-01-01

    Peritoneal dialysis (PD) is an underutilized form of renal replacement therapy. Although a variety of factors have been deemed responsible, timely insertion of a PD catheter may also be a contributory factor. Furthermore, a good catheter implantation technique is important to allow for effective peritoneal access function and long-term technique survival. Studies regarding results obtained by nephrologists in comparison with surgeons have been limited to small single-center experiences. Thus, the objective of this study was to explore the impact of the peritoneal dialysis (PD) catheter insertion by nephrologists compared to surgeons on early catheter complications and on technique survival. We also examine whether PD catheter insertion by nephrologists has a positive impact on the growth in the number of patients using PD. We performed 313 consecutive procedures: 192 catheter insertions and 121 catheter removal from January 1, 2006 to December 31, 2013. The main reasons for catheter removal were: renal transplantation, 52 (43%) follow of transfer to HD, 48 (40%) and catheter malfunction, 16 (13%). The patients were mostly male (63.4%) with the mean age of 50.8±15.1 years and 23.8 were diabetics. We only observed seven (2.5%) early complications (<4 weeks) associated to peritoneal catheter surgery (3 peritonitis episodes, 2 hemoperitoneum episodes, one complicated hernia and one omental entrapment). There were not significant differences in surgery-related complications in both periods. The penetration ratio of PD after 2006 was 117% higher compared with procedures performing before this date. In conclusions, we have demonstrated a positive impact on the growth of the PD population when catheter insertion is performed by nephrologists with a minimal incidence of complications associated. PMID:26520209

  20. Problem vs. Subject: Pupils Learn More in Problem-Centered Units, According to 16-Unit, 1,415-Pupil Experiment.

    ERIC Educational Resources Information Center

    Kight, Stanford S.; Mickelson, John M.

    1995-01-01

    Reprints an article originally published in 1949. Determines the relative effects on learning of problem-centered and subject-centered units of instruction. Finds that pupils learned significantly more factual information and made more connections of specific rules of action with their corresponding facts with the problem type. Suggests that…

  1. [Improving the ambulatory surgical services on the basis of the work experience of the Center of Ambulatory Surgery].

    PubMed

    Polozhentsev, S D; Malkin, D M; Marushkin, A V; Lisitsyn, A S; Vinnik, L F; Goncharov, V P; Shanin, S S

    1990-06-01

    Centers of ambulatory surgery made on the basis of large city polyclinics and regional medical formations are considered to be a perspective and economically effective form of perestroika of the ambulatory surgical aid to people. Specificity of the operative procedures performed at the Center and specific features of postoperative management of the patients should be taken into consideration, and the staff of such units must consist of highly trained surgeons of wide type. The ambulatory surgery Center must occupy its place in the system of dispensary examinations of the population. PMID:2175517

  2. 9/11-Related Experiences and Tasks of Landfill and Barge Workers: Qualitative Analysis from the World Trade Center Health Registry

    PubMed Central

    2011-01-01

    Background Few studies have documented the experiences of individuals who participated in the recovery and cleanup efforts at the World Trade Center Recovery Operation at Fresh Kills Landfill, on debris loading piers, and on transport barges after the September 11, 2001 terrorist attack. Methods Semi-structured telephone interviews were conducted with a purposive sample of workers and volunteers from the World Trade Center Health Registry. Qualitative methods were used to analyze the narratives. Results Twenty workers and volunteers were interviewed. They described the transport of debris to the Landfill via barges, the tasks and responsibilities associated with their post-9/11 work at the Landfill, and their reflections on their post-9/11 experiences. Tasks included sorting through debris, recovering human remains, searching for evidence from the terrorist attacks, and providing food and counseling services. Exposures mentioned included dust, fumes, and odors. Eight years after the World Trade Center disaster, workers expressed frustration about poor risk communication during recovery and cleanup work. Though proud of their contributions in the months after 9/11, some participants were concerned about long-term health outcomes. Conclusions This qualitative study provided unique insight into the experiences, exposures, and concerns of understudied groups of 9/11 recovery and cleanup workers. The findings are being used to inform the development of subsequent World Trade Center Health Registry exposure and health assessments. PMID:21575237

  3. Acquired immunodeficiency syndrome among patients attending hemophilia treatment centers and mortality experience of hemophiliacs in the United States.

    PubMed

    Johnson, R E; Lawrence, D N; Evatt, B L; Bregman, D J; Zyla, L D; Curran, J W; Aledort, L M; Eyster, M E; Brownstein, A P; Carman, C J

    1985-06-01

    The acquired immunodeficiency syndrome (AIDS) was first recognized among hemophiliacs in 1982. The authors have conducted investigations to determine the onset and incidence of AIDS among hemophiliacs and to determine trends in hemophilia mortality since the introduction of clotting-factor concentrates in the late 1960s. A survey of United States hemophilia treatment centers, supported by the Centers for Disease Control and the National Hemophilia Foundation, defined a population of hemophiliacs which was monitored for AIDS cases through June 1984. Death reports from the United States Vital Statistics System and from the hemophilia treatment center survey provided mortality trends for 1968-1979 and for 1978-1982, respectively. The results of these investigations demonstrate the following points. 1) The AIDS epidemic is a new and important cause of illness and mortality among hemophiliacs, although a very low incidence of AIDS among hemophiliacs prior to 1982 cannot be ruled out. 2) The AIDS cases who attended the surveyed hemophilia treatment centers were distributed throughout the United States and were older than hemophilia treatment center patients without AIDS. AIDS cases also used more lyophilized clotting-factor concentrate, but only a small number of cases were reported with this information. 3) Improved care for hemophilia, including the use of clotting-factor concentrates, dramatically reduced hemophilia mortality rates during the 1970s. 4) In 1982, hemorrhage was the major cause of death among hemophiliacs. Deaths from non-alcoholic liver disease were also increased. AIDS incidence among hemophilia treatment center attendees was stable at 0.6 cases per 1,000 hemophilia treatment center attendees per year during 1982 and 1983 but increased sharply to 5.4 cases per 1,000 during the first quarter of 1984. PMID:4014173

  4. Experiences of Power and Violence in Mexican Men Attending Mutual-Aid Residential Centers for Addiction Treatment.

    PubMed

    Lozano-Verduzco, Ignacio; Marín-Navarrete, Rodrigo; Romero-Mendoza, Martha; Tena-Suck, Antonio

    2016-05-01

    Fundamental elements of hegemonic masculinity such as power and violence are analyzed through characteristics of 12-step programs and philosophy immersed in Mutual-Aid Residential Centers for Addiction Treatment (CRAMAAs). CRAMAAs are a culturally specific form of substance abuse treatment in Mexico that are characterized by control and violence. Fifteen interviews were carried out with men of varied sociodemographic characteristics, and who resided in at least two of these centers. Results identify that power is expressed through drug abuse and leads them to subsequent biopsychosocial degradation. Residency in CRAMAAs is motivated by women, but men do not seek the residency and are usually admitted unwillingly. Power through violence is carried out inside CRAMAAs where men are victims of abuse. From a 12-step philosophy, this violence is believed to lead them to a path of recovery but instead produces feelings of anger and frustration. The implications of these centers on Mexican public health are discussed. PMID:25585860

  5. Intensity-modulated radiation therapy for the treatment of oropharyngeal carcinoma: The Memorial Sloan-Kettering Cancer Center experience

    SciTech Connect

    Arruda, Fernando F. de; Puri, Dev R.; Zhung, Joanne; Narayana, Ashwatha; Wolden, Suzanne; Hunt, Margie; Stambuk, Hilda; Pfister, David; Kraus, Dennis; Shaha, Ashok; Shah, Jatin; Lee, Nancy Y. . E-mail: leen2@mskcc.org

    2006-02-01

    Purpose: To review the Memorial Sloan-Kettering Cancer Center's experience in using intensity-modulated radiation therapy (IMRT) for the treatment of oropharyngeal cancer. Methods and Materials: Between September 1998 and June 2004, 50 patients with histologically confirmed cancer of the oropharynx underwent IMRT at our institution. There were 40 men and 10 women with a median age of 56 years (range, 28-78 years). The disease was Stage I in 1 patient (2%), Stage II in 3 patients (6%), Stage III in 7 (14%), and Stage IV in 39 (78%). Forty-eight patients (96%) received definitive treatment, and 2 (4%) were treated in the postoperative adjuvant setting. Concurrent chemotherapy was used in 43 patients (86%). Patients were treated using three different IMRT approaches: 76% dose painting, 18% concomitant boost with IMRT in both am and pm deliveries, and 6% concomitant boost with IMRT only in pm delivery. Regardless of the approach, the average prescription dose to the gross tumor planning target volume was 70 Gy, while the average dose delivered to the subclinical volume was 59.4 Gy in the dose painting group and 54 Gy in the concomitant boost group. Percutaneous endoscopic gastrostomy feeding tubes (PEGs) were placed before the beginning of treatment in 84% of the patients. Acute and late toxicity were graded according to the Radiation Therapy Oncology Group (RTOG) radiation morbidity scoring criteria. Toxicity was also evaluated using subjective criteria such as the presence of esophageal stricture, and the need for PEG usage. The local progression-free, regional progression-free, and distant metastases-free rates, and overall survival were calculated using the Kaplan-Meier method. Results: Three patients had persistent locoregional disease after treatment. The 2-year estimates of local progression-free, regional progression-free, distant metastases-free, and overall survival were 98%, 88%, 84%, and 98%, respectively. The worst acute mucositis experienced was Grade 1

  6. The identification, characterization and optimization of small molecule probes of cysteine proteases: experiences of the Penn Center for Molecular Discovery with cathepsin B and cathepsin L.

    PubMed

    Huryn, Donna M; Smith, Amos B

    2009-01-01

    During the pilot phase of the NIH Molecular Library Screening Network, the Penn Center for Molecular Discovery focused on a series of projects aimed at high throughput screening and the development of probes of a variety of protease targets. This review provides our medicinal chemistry experience with two such targets--cathepsin B and cathepsin L. We describe our approach for hit validation, characterization and triage that led to a critical understanding of the nature of hits from the cathepsin B project. In addition, we detail our experience at hit identification and optimization that led to the development of a novel thiocarbazate probe of cathepsin L. PMID:19807666

  7. Creating Student-Centered Learning Experience through the Assistance of High-End Technology in Physical Education: A Case Study

    ERIC Educational Resources Information Center

    Wang, Lin; Myers, Deborah L.; Yanes, Martha J.

    2010-01-01

    Student-centered learning is an approach in education focusing on the needs of the students, rather than those of others involved in the educational process, such as teachers and administrators (Blumberg, 2009). This approach has many implications for the design of curriculum, course content, and interactivity of courses (O'Neil & McMahon, 2005).…

  8. Technology Transfer: Learning from Lost Opportunities and Sharing Best Practices--Experiences at Cedars-Sinai Medical Center, USA

    ERIC Educational Resources Information Center

    Vari, Sandor G.; Laur, James D.

    2006-01-01

    One significant aspect of Cedars-Sinai Medical Center's charitable mission is to ensure that its research results benefit society at large. This is accomplished through researcher education, securing appropriate intellectual property protection and licensing so that inventions are developed into useful products. The Swan-Ganz and Barath balloon…

  9. Higher Rates of Retinopathy of Prematurity after Increasing Oxygen Saturation Targets for Very Preterm Infants: Experience in a Single Center.

    PubMed

    Manley, Brett J; Kuschel, Carl A; Elder, James E; Doyle, Lex W; Davis, Peter G

    2016-01-01

    Randomized trials of oxygen saturation target ranges for extremely preterm infants showed increased survival but increased retinopathy of prematurity with higher compared with lower target ranges. In our center, changing from a target range of 88%-92% to 91%-95% has been associated with increased rates and severity of retinopathy of prematurity. PMID:26548746

  10. Routine Use of Continuous, Hyperfractionated, Accelerated Radiotherapy for Non-Small-Cell Lung Cancer: A Five-Center Experience

    SciTech Connect

    Din, Omar S. Lester, Jason; Cameron, Alison; Ironside, Janet; Gee, Amanda; Falk, Stephen; Morgan, Sally A.; Worvill, Jackie; Hatton, Matthew Q.F.

    2008-11-01

    Purpose: To report the results from continuous, hyperfractionated, accelerated radiotherapy (CHART) used as the standard fractionation for radical RT in the management of non-small cell lung cancer (NSCLC) in five United Kingdom centers. Methods and Materials: In 2005, the CHART consortium identified six U.K. centers that had continued to use CHART after the publication of the CHART study in 1997. All centers had been using CHART for >5 years and agreed to use a common database to audit their results. Patients treated with CHART between 1998 and December 2003 were identified to allow a minimum of 2 years of follow-up. Patient demographics, tumor characteristics, treatment details, and survival were recorded retrospectively. Five centers completed the data collection. Results: A total of 583 patients who had received CHART were identified. Of these patients, 69% were male, with a median age of 68 years (range, 31-89); 83% had performance status 0 or 1; and 43% had Stage I or II disease. Of the 583 patients, 99% received the prescribed dose. In only 4 patients was any Grade 4-5 toxicity documented. The median survival from the start of RT was 16.2 months, and the 2-year survival rate of 34% was comparable to that reported in the original study. Conclusion: The results of this unselected series have confirmed that CHART is deliverable in routine clinical practice, with low levels of toxicity. Importantly, this series has demonstrated that the results of CHART reported from the randomized trial can be reproduced in routine clinical practice.

  11. The grand experiment, a historical account of a museum/school partnership: The Alexander Science Center School of Los Angeles

    NASA Astrophysics Data System (ADS)

    Heughins, Andrew R.

    This study tells the history of The Alexander Science Center School, a museum/school partnership between the Los Angeles Unified School District and the California Science Center created with the goal of becoming a national model in elementary science education. To provide a background to the development of the school, this study explores the definition of what constitutes a museum school, including the existence of a formal partnership between a school district and a museum and systemic change in the partner institutions leading to a marriage of formal and informal learning styles. In addition, the literature review explores the unique models of museum/school partnerships developed in the United States. The history of the Alexander Science Center School is told in a narrative style using documentation from the schools development and through interviews with individuals who played key roles, from the schools inception through its opening. The study covers the initiation of concept, architectural design, formation of the partnership, and development of the curriculum. The study also identifies the roadblocks encountered in the schools development and makes recommendations for school districts and institutions seeking to create future museum school projects. In addition, a comparison is made other recently studied museum schools to provide a context for the school's historical and programmatic development.

  12. Patient Experience Assessment is a Requisite for Quality Evaluation: A Discussion of the In-Center Hemodialysis Consumer Assessment of Health Care Providers and Systems (ICH CAHPS) Survey.

    PubMed

    Cavanaugh, Kerri L

    2016-01-01

    Patient experience surveys provide a critical and unique perspective on the quality of patient-centered healthcare delivery. These surveys provide a mechanism to systematically express patients' voice on topics valued by patients to make decisions about choices in care. They also provide an assessment to healthcare organizations about their service that cannot be obtained from any other source. Regulatory agencies have mandated the assessment of patients' experience as part of healthcare value based purchasing programs and weighted the results to account for up to 30% of the total scoring. This is a testimony to the accepted importance of this metric as a fundamental assessment of quality. After more than a decade of rigorous research, there is a significant body of growing evidence supporting specifically the validity and use of the Consumer Assessment of Healthcare Providers and Systems (CAHPS) surveys, including a version specific to in-center hemodialysis (ICH CAHPS). This review will focus on the ICH CAHPS survey including a review of its development, content, administration, and also a discussion of common criticisms. Although it is suggested that the survey assesses activities and experiences that are not modifiable by the healthcare organization (or the dialysis facility in our case) emerging evidence suggests otherwise. Dialysis providers have an exclusive opportunity to lead the advancement of understanding the implications and serviceability of the evaluation of the patient experience in health care. PMID:26858008

  13. Nutmeg poisonings: a retrospective review of 10 years experience from the Illinois Poison Center, 2001-2011.

    PubMed

    Ehrenpreis, Jamie E; DesLauriers, Carol; Lank, Patrick; Armstrong, P Keelan; Leikin, Jerrold B

    2014-06-01

    Nutmeg is a commonly consumed spice. The toxic effects of nutmeg have been purported to be due mainly to myristicin oil. Prior poison center series of nutmeg exposures show very few unintentional exposures of nutmeg to children younger than 13. Case series from these centers did not record drug exposures combined with nutmeg. This study is a review of Illinois Poison Center (IPC) data regarding nutmeg exposures from January of 2001 to December 2011. The goal of this study was to compare the Illinois data to the literature as well as look for current trends in nutmeg poisonings. The data were extracted using the code for hallucinogenic plants in the IPC database, and poisonings unrelated to nutmeg exposure were eliminated. Medical outcomes were noted as recorded. Thirty-two cases of nutmeg ingestion were reported. Of the 17 (53.1 %) unintentional exposures, 10 subjects (58.8 %) were under the age of 13. Four of the exposures in children under the age of 13 were ocular exposures. Fifteen exposures (46.9 %) were intentional exposures. Of these intentional exposures, five (33.3 %) were recorded to have combined drug intoxication. All of these were between the ages of 15 and 20. One patient with polypharmaceutical exposure required ventilatory support in the hospital. Our study shows an unexpected percentage of unintentional exposures in juveniles under the age of 13, out of the total exposures to nutmeg. Mixing of nutmeg with other drugs was seen and required more intervention in adolescents. More education about these two factors, i.e., nutmeg exposures as intentional polypharmacy in adolescents and unintentional exposures in young children, is advised. PMID:24452991

  14. [Experiment studies of electron-positron interactions at the Stanford Linear Accelerator Center]. Progress report, calendar year 1993

    SciTech Connect

    Hertzbach, S.S.; Kofler, R.R.

    1993-12-31

    The High Energy Physics group at the University of Massachusetts has continued its` program of experimental studies of electron-positron interactions at the Stanford Linear Accelerator Center (SLAC). The group activities have included: analysis of data taken between 1982 and 1990 with the TPC detector at the PEP facility, continuing data collection and data analysis using the SLC/SLD facility, planning for the newly approved B-factory at SLAC, and participation in design studies for future high energy linear colliders. This report will briefly summarize these activities.

  15. Farm machinery injuries: the 15-year experience at an urban joint trauma center system in a rural state.

    PubMed

    Jawa, Randeep S; Young, David H; Stothert, Joseph C; Yetter, Diane; Dumond, Robbie; Shostrom, Valerie K; Cemaj, Samuel; Rautiainen, Risto H; Mercer, David W

    2013-01-01

    Farm machinery is a major source of injury. The objective of this study is to characterize the incidence, injury characteristics, and outcomes of patients admitted with farm machinery injuries (FMIs) to an urban joint trauma system in a rural state. A retrospective 15-year review of the trauma registries of the two trauma centers that function as a single state-designated Level I joint trauma center system was conducted. There were 65 admissions for FMIs at hospital A and 41 at hospital B; this represents under 0.4% of total trauma admissions. The patients ranged in age from 2 to 87 years. At hospital A, 89% of admitted patients sustained extremity injuries, 16% sustained torso trauma, 92% required surgical intervention, and the mortality rate was 0%. At hospital B, 60% of admitted patients sustained extremity injuries, 36.6% of patients sustained torso trauma, 63% required surgical intervention, and the mortality rate was 14.6%. Tractor-related injuries were responsible for 17% of admissions at hospital A and 69% at hospital B. Of the six fatalities, five were tractor related. The data demonstrate that FMIs affect people in nearly all decades of life. FMIs at the two hospitals had differing injury characteristics and outcomes, in large part secondary to the differing frequency of tractor-related injuries. FMIs frequently required surgical intervention. PMID:23540300

  16. Implementing health information technology in a patient-centered manner: patient experiences with an online evidence-based lifestyle intervention.

    PubMed

    Lyden, Jennifer R; Zickmund, Susan L; Bhargava, Tina D; Bryce, Cindy L; Conroy, Molly B; Fischer, Gary S; Hess, Rachel; Simkin-Silverman, Laurey R; McTigue, Kathleen M

    2013-01-01

    The patient-centered care (PCC) model and the use of health information technology (HIT) are major initiatives for improving U.S. healthcare quality and delivery. A lack of published data on patient perceptions of Internet-based care makes patient-centered implementation of HIT challenging. To help ascertain patients' perceptions of an online intervention, patients completing a 1-year web-based lifestyle intervention were asked to complete a semistructured interview. We used qualitative methodology to determine frequency and types of interview responses. Overall satisfaction with program features was coded on a Likert-type scale. High levels of satisfaction were seen with the online lifestyle coaching (80%), self-monitoring tools (57%), and structured lesson features (54%). Moderated chat sessions and online resources were rarely used. Frequently identified helpful aspects were those that allowed for customized care and shared decision-making consistent with the tenets of PCC. Unhelpful program aspects were reported less often. Findings suggest that despite challenges for communicating effectively in an online forum, the personalized support, high-tech data management capabilities, and easily followed evidence-based curricula afforded by HIT may be a means of providing PCC and improving healthcare delivery and quality. PMID:24004039

  17. Early Liver Transplantation for Severe Alcoholic Hepatitis in the United States-A Single-Center Experience.

    PubMed

    Im, G Y; Kim-Schluger, L; Shenoy, A; Schubert, E; Goel, A; Friedman, S L; Florman, S; Schiano, T D

    2016-03-01

    Early liver transplantation (LT) in European centers reportedly improved survival in patients with severe alcoholic hepatitis (AH) not responding to medical therapy. Our aim was to determine if a strategy of early LT for severe AH could be applied successfully in the United States. We reviewed 111 patients with severe AH at our center from January 2012 to January 2015. The primary end point was mortality at 6 months or early LT, with a secondary end point of alcohol relapse after LT. Survival was compared between those receiving early LT and matched patients who did not. Using a process similar to the European trial, 94 patients with severe AH not responding to medical therapy were evaluated for early LT. Overall, 9 (9.6%) candidates with favorable psychosocial profiles underwent early LT, comprising 3% of all adult LT during the study period. The 6-month survival rate was higher among those receiving early LT compared with matched controls (89% vs 11%, p<0.001). Eight recipients are alive at a median of 735 days with 1 alcohol relapse. Early LT for severe AH can achieve excellent clinical outcomes with low impact on the donor pool and low rates of alcohol relapse in highly selected patients in the United States. PMID:26710309

  18. Ethics in psychosocial and biomedical research - A training experience at the Interdisciplinary Center for Bioethics (CIEB) of the University of Chile().

    PubMed

    Lolas, Fernando; Rodriguez, Eduardo

    2012-01-01

    This paper reviews the experience in training Latin American professionals and scientists in the ethics of biomedical and psychosocial research at the Interdisciplinary Center for Studies in Bioethics (CIEB) of the University of Chile, aided by a grant from Fogarty International Center (FIC) - National Institutes of Health from 2002 to 2011. In these 10 years of experience, 50 trainees have completed a 12-month training combining on-line and in-person teaching and learning activities, with further support for maintaining contact via webmail and personal meetings. The network formed by faculty and former trainees has published extensively on issues relevant in the continent and has been instrumental in promoting new master level courses at different universities, drafting regulations and norms, and promoting the use of bioethical discourse in health care and research. Evaluation meetings have shown that while most trainees did benefit from the experience and contributed highly to developments at their home institutions and countries, some degree of structuring of demand for qualified personnel is needed in order to better utilize the human resources created by the program. Publications and other deliverables of trainees and faculty are presented. PMID:22754084

  19. Ethics in psychosocial and biomedical research – A training experience at the Interdisciplinary Center for Bioethics (CIEB) of the University of Chile1

    PubMed Central

    Lolas, Fernando; Rodriguez, Eduardo

    2012-01-01

    This paper reviews the experience in training Latin American professionals and scientists in the ethics of biomedical and psychosocial research at the Interdisciplinary Center for Studies in Bioethics (CIEB) of the University of Chile, aided by a grant from Fogarty International Center (FIC) – National Institutes of Health from 2002 to 2011. In these 10 years of experience, 50 trainees have completed a 12-month training combining on-line and in-person teaching and learning activities, with further support for maintaining contact via webmail and personal meetings. The network formed by faculty and former trainees has published extensively on issues relevant in the continent and has been instrumental in promoting new master level courses at different universities, drafting regulations and norms, and promoting the use of bioethical discourse in health care and research. Evaluation meetings have shown that while most trainees did benefit from the experience and contributed highly to developments at their home institutions and countries, some degree of structuring of demand for qualified personnel is needed in order to better utilize the human resources created by the program. Publications and other deliverables of trainees and faculty are presented. PMID:22754084

  20. Moving Toward Patient-Centered Care in Africa: A Discrete Choice Experiment of Preferences for Delivery Care among 3,003 Tanzanian Women

    PubMed Central

    Larson, Elysia; Vail, Daniel; Mbaruku, Godfrey M.; Kimweri, Angela; Freedman, Lynn P.; Kruk, Margaret E.

    2015-01-01

    Objective In order to develop patient-centered care we need to know what patients want and how changing socio-demographic factors shape their preferences. Methods We fielded a structured questionnaire that included a discrete choice experiment to investigate women’s preferences for place of delivery care in four rural districts of Pwani Region, Tanzania. The discrete choice experiment consisted of six attributes: kind treatment by the health worker, health worker medical knowledge, modern equipment and medicines, facility privacy, facility cleanliness, and cost of visit. Each woman received eight choice questions. The influence of potential supply- and demand- side factors on patient preferences was evaluated using mixed logit models. Results 3,003 women participated in the discrete choice experiment (93% response rate) completing 23,947 choice tasks. The greatest predictor of health facility preference was kind treatment by doctor (β = 1.13, p<0.001), followed by having a doctor with excellent medical knowledge (β = 0.89 p<0.001) and modern medical equipment and drugs (β = 0.66 p<0.001). Preferences for all attributes except kindness and cost were changed with changes to education, primiparity, media exposure and distance to nearest hospital. Conclusions Care quality, both technical and interpersonal, was more important than clinic inputs such as equipment and cleanliness. These results suggest that while basic clinic infrastructure is necessary, it is not sufficient for provision of high quality, patient-centered care. There is an urgent need to build an adequate, competent, and kind health workforce to raise facility delivery and promote patient-centered care. PMID:26262840

  1. Filovirus Research in Gabon and Equatorial Africa: The Experience of a Research Center in the Heart of Africa

    PubMed Central

    Leroy, Eric; Gonzalez, Jean Paul

    2012-01-01

    Health research programs targeting the population of Gabon and Equatorial Africa at the International Center for Medical Research in Franceville (CIRMF), Gabon, have evolved during the years since its inception in 1979 in accordance with emerging diseases. Since the reemergence of Ebola virus in Central Africa, the CIRMF “Emerging Viral Disease Unit” developed diagnostic tools and epidemiologic strategies and transfers of such technology to support the response of the National Public Health System and the World Health Organization to epidemics of Ebola virus disease. The Unit carries out a unique investigation program on the natural history of the filoviruses, emergence of epidemics, and Ebola virus pathogenesis. In addition, academic training is provided at all levels to regional and international students covering emerging conditions (host factors, molecular biology, genetics) that favor the spread of viral diseases. PMID:23170174

  2. The War on Poverty’s Experiment in Public Medicine: Community Health Centers and the Mortality of Older Americans†

    PubMed Central

    Bailey, Martha J.; Goodman-Bacon, Andrew

    2015-01-01

    This paper uses the rollout of the first Community Health Centers (CHCs) to study the longer-term health effects of increasing access to primary care. Within ten years, CHCs are associated with a reduction in age-adjusted mortality rates of 2 percent among those 50 and older. The implied 7 to 13 percent decrease in one-year mortality risk among beneficiaries amounts to 20 to 40 percent of the 1966 poor/non-poor mortality gap for this age group. Large effects for those 65 and older suggest that increased access to primary care has longer-term benefits, even for populations with near universal health insurance. (JEL H75, I12, I13, I18, I32, I38, J14) PMID:25999599

  3. Total-skin electron irradiation for cutaneous T-cell lymphoma: the Northern Israel Oncology Center experience.

    PubMed

    Kuten, A; Stein, M; Mandelzweig, Y; Tatcher, M; Yaacov, G; Epelbaum, R; Rosenblatt, E

    1991-07-01

    Total-skin electron irradiation (TSEI) is effective and frequently used in the treatment of cutaneous T-cell lymphoma. A treatment technique has been developed at our center, using the Philips SL 75/10 linear accelerator. In our method, the patient is irradiated in a recumbent position by five pairs of uncollimated electron beams at a source to skin distance of 150 cm. This method provides a practical solution to clinical requirements with respect to uniformity of electron dose and low X-ray contamination. Its implementation does not require special equipment or modification of the linear accelerator, 19 of 23 patients (83%) with mycosis fungoides, treated by this method, achieved complete regression of their cutaneous lesions. PMID:1858014

  4. Protecting worker and public health during responses to catastrophic disasters-learning from the World Trade Center experience.

    PubMed

    Newman, David M

    2014-11-01

    Despite incremental lessons learned since 9/11, responder and community health remain at unnecessary risk during responses to catastrophic disasters, as evidenced during the BP Deepwater Horizon spill and Hurricanes Katrina, Rita, and Sandy. Much of the health harm that occurs during disaster response, as distinct from during the disaster event itself, is avoidable. Protection of public health should be an integral component of disaster response, which should "do no additional harm." This commentary examines how challenges and gaps the World Trade Center response resulted in preventable occupational and environmental health harm. It proposes changes in disaster response policies to better protect the health of rescue and recovery workers, volunteers, and impacted worker and residential communities. PMID:25255981

  5. Recent Lightning Experiments at the International Center for Lightning Research and Testing: From Ball Lightning to Gamma Rays

    NASA Astrophysics Data System (ADS)

    Uman, M. A.

    2008-12-01

    Recent lightning data and the instrumentation used to acquire it at the UF-FIT International Center for Lightning Research and Testing, located on about 1 square kilometer of flat ground at the Camp Blanding Army National Guard Base in north-central Florida, are discussed. The progress of several on-going studies is reviewed: (1) understanding the physics of the "classical" rocket-and-wire triggering of lightning from natural overhead thunderclouds, (2) attempting to generate ball lightning by allowing triggered-lightning to strike various materials and objects (e.g., tree-trunk sections, pools of salt water, silicon powder), (3) measuring the very close (100 m to 1 km) electric and magnetic fields of natural cloud-to-ground lightning, and (4) probing the relationship between lightning processes and the x-rays and gamma-rays associated with them.

  6. Transdisciplinary Cardiovascular and Cancer Health Disparities Training: Experiences of the Centers for Population Health and Health Disparities

    PubMed Central

    Ferketich, Amy; Boyington, Josephine; Dugan, Sheila; Garroutte, Eva; Kaufmann, Peter G.; Krok, Jessica; Kuo, Alice; Ortega, Alexander N.; Purnell, Tanjala; Srinivasan, Shobha

    2015-01-01

    The Centers for Population Health and Health Disparities program promotes multilevel and multifactorial health equity research and the building of research teams that are transdisciplinary. We summarized 5 areas of scientific training for empowering the next generation of health disparities investigators with research methods and skills that are needed to solve disparities and inequalities in cancer and cardiovascular disease. These areas include social epidemiology, multilevel modeling, health care systems or health care delivery, community-based participatory research, and implementation science. We reviewed the acquisition of the skill sets described in the training components; these skill sets will position trainees to become leaders capable of effecting significant change because they provide tools that can be used to address the complexities of issues that promote health disparities. PMID:25905828

  7. Autonomy, Choice, Patient-Centered Care, and Hip Protectors: The Experience of Residents and Staff in Long-Term Care

    PubMed Central

    Sims-Gould, Joanie; McKay, Heather A.; Feldman, Fabio; Scott, Victoria; Robinovitch, Stephen N.

    2013-01-01

    The purpose of this study was to examine long-term care (LTC) resident and staff perceptions on the decision to use hip protectors and identify the factors that influence attitudes toward hip protector use. Staff (N = 39) and residents (N = 27) at two residential care facilities in British Columbia, Canada were invited to participate in focus groups on fall prevention and hip protector use. A total of 11 focus groups were conducted. Using framework analysis results show that residents and staff shared concerns on aesthetic and comfort issues with hip protectors. Residents also generally felt they did not need, or want to use, hip protectors. However, they also had desire to be cooperative within the LTC environment. Staff underscored their role in advocating for hip protector use and their desire to protect residents from harm. Practice considerations for facilities wishing to promote hip protectors within a patient centered framework are highlighted. PMID:24652886

  8. Improving Quality of Life and Career Attitudes of Youth with Disabilities: Experiences from the Adolescent Employment Readiness Center

    ERIC Educational Resources Information Center

    Wolf-Branigin, Michael; Schuyler, Vincent; White, Patience

    2007-01-01

    Improving quality of life is the primary focus as adolescents with disabilities enter adulthood. They increasingly, however, encounter difficulties transitioning into domains such as employment as these services occur near the end of their high school experience. Using an ecosystems model within a developmental approach, the program sought to…

  9. Training Consumer Educators: A Curriculum and Program Handbook. A Report on the Experience of the Consumer Law Training Center.

    ERIC Educational Resources Information Center

    New York Law School, NY. Consumer Law Training Center.

    Information is presented on the administration of consumer education programs to train teachers and community group leaders who will be teaching consumer education in their own communities. Suggestions and examples are based on experience in creating and teaching such a program in consumer law in New York City. The first three chapters give…

  10. Backward deletion to minimize prediction errors in models from factorial experiments with zero to six center points

    NASA Technical Reports Server (NTRS)

    Holms, A. G.

    1980-01-01

    Population model coefficients were chosen to simulate a saturated 2 to the fourth power fixed effects experiment having an unfavorable distribution of relative values. Using random number studies, deletion strategies were compared that were based on the F distribution, on an order statistics distribution of Cochran's, and on a combination of the two. Results of the comparisons and a recommended strategy are given.

  11. LabView Based Nuclear Physics Laboratory experiments as a remote teaching and training tool for Latin American Educational Centers

    SciTech Connect

    Sajo-Bohus, L.; Greaves, E. D.; Barros, H.; Gonzalez, W.; Rangel, A.

    2007-10-26

    A virtual laboratory via internet to provide a highly iterative and powerful teaching tool for scientific and technical discipline is given. The experimenter takes advantage of a virtual laboratory and he can execute nuclear experiment at introductory level e.g. Gamma ray detection with Geiger-Mueller Counter at remote location using internet communication technology.

  12. Numerical simulation of natural convection in a spherical container due to cooling at the center (idealization of the Lal/Kroes experiment)

    NASA Technical Reports Server (NTRS)

    Robertson, S. J.

    1981-01-01

    Natural convection in a spherical container with cooling at the center was numerically simulated using a numerical fluid dynamics computer program. The numerical analysis was simplified by assuming axisymmetric flow in the spherical container, with the symmetry axis being a sphere diagonal parallel to the gravity vector. This axisymmetric spherical geometry was intended as an idealization of the proposed Lal/Kroes crystal growing experiment to be performed on Spacelab. Results were obtained for a range of Rayleigh numbers from 25 to 10,000. The computed velocities were found to be approximately proportional to the Rayleigh number over the range of Rayleigh numbers investigated.

  13. Lessons Learned from Delayed Versus Immediate Microsurgical Reconstruction of Complex Maxillectomy and Midfacial Defects: Experience in a Tertiary Center in Mexico.

    PubMed

    Santamaria, Eric; de la Concha, Erika

    2016-10-01

    Microsurgical reconstruction of complex midfacial and maxillectomy defects is among the most challenging procedures in plastic surgery, and it often requires composite flaps to improve functional and aesthetic results. Various factors have been identified as having influence in the outcome of microsurgical reconstruction. In this article, the authors present their experience with immediate and delayed reconstruction of complex maxillectomy defects in a tertiary center in Mexico. The authors present a total of 37 patients with microsurgical reconstruction of a complex maxillectomy defect; 13 patients had immediate and 24 had delayed reconstructions. The authors recommend doing immediate reconstruction when feasible. PMID:27601395

  14. Review of Experience of a Statewide Poison Control Center With Pediatric Exposures to Oral Antineoplastic Drugs in the Nonmedical Setting.

    PubMed

    Thornton, Stephen L; Liu, Jehnan; Soleymani, Kamyar; Romasco, Rebecca L; Farid, Hanieh; Clark, Richard F; Cantrell, F Lee

    2016-01-01

    The use of oral antineoplastic agents in nonmedical settings continues to increase. There are limited data available on pediatric exposures to these agents. We sought to identify characteristics of such exposures. We performed a retrospective review of database of a statewide poison system from 2000 to 2009 for all cases of pediatric exposures to oral antineoplastic agents, which took place in a nonmedical setting. Data collected include gender, age, agent of exposure, dose, drug concentration, reason for exposure, symptoms, outcomes, interventions, and length of hospital stay. There were a total of 328 patients. The mean average age was 4.1 years. Eighty-nine percentage (n = 293) was unintentional. Exposures to 21 different antineoplastic agents were identified. Methotrexate (n = 91) and 6-mercaptopurine (n = 47) were the most common agents encountered. Two hundred ninety-nine (91%) cases had no symptoms reported. When reported, gastrointestinal symptoms (n = 17) and central nervous system sedation (n = 6) were most common. One case of pancytopenia was reported. No deaths were reported in this series. Sixty-seven percent (n = 220) were managed at home, whereas 19 (6%) were admitted to a health care facility. Cases were followed by the poison control center for 0.34 days (SD = 1.40). In this study, exposures to oral antineoplastics were primarily unintentional, asymptomatic, and managed at home. Study limitations include possible reporting bias, inability to objectively confirm exposures, and limited duration of monitoring by the poison control center. In this retrospective review, no significant morbidity or mortality was reported from pediatric exposures to oral antineoplastic drugs in the nonmedical setting. PMID:23884076

  15. Donor Safety in Adult-Adult Living Donor Liver Transplantation: A Single-Center Experience of 356 Cases

    PubMed Central

    Meng, Haipeng; Yang, Jiayin; Yan, Lunan

    2016-01-01

    Background As an important means to tackle the worldwide shortage of liver grafts, adult-adult living donor liver transplantation (A-ALDLT) is the most massive operation a healthy person could undergo, so donor safety is of prime importance. However, most previous research focused on recipients, while complications in donors have not been fully described or investigated. Material/Methods To investigate donor safety in terms of postoperative complications, the clinical data of 356 A-ALDLT donors in our center from January 2002 to September 2015 were retrospectively analyzed. These patients were divided into a pre-2008 group (before January 2008) and a post-2008 group (after January 2008). Donor safety was evaluated with regard to the type, frequency, and severity of postoperative complications. Results There were no donor deaths in our center during this period. The overall complication rate was 23.0% (82/356). The proportion of Clavien I, II, III, and IV complications was 51.2% (42/82), 25.6% (21/82), 22.0% (18/82), and 1.2% (1/82), respectively. In all the donors, the incidence of Clavien I, II, III, and IV complications was 11.8% (42/356), 5.9% (21/356), 5.1% (18/356), and 0.3% (1/356), respectively. The overall complication rate in the post-2008 group was significantly lower than that in the pre-2008 group (18.1% (41/227) vs. 32.6% (42/129), P<0.01). Biliary complications were the most common, with an incidence of 8.4% (30/356). Conclusions The risk to A-ALDLT donors is controllable and acceptable with improvement in preoperative assessment and liver surgery. PMID:27178367

  16. Gastrointestinal Fistulas in Acute Pancreatitis With Infected Pancreatic or Peripancreatic Necrosis: A 4-Year Single-Center Experience.

    PubMed

    Jiang, Wei; Tong, Zhihui; Yang, Dongliang; Ke, Lu; Shen, Xiao; Zhou, Jing; Li, Gang; Li, Weiqin; Li, Jieshou

    2016-04-01

    Gastrointestinal (GI) fistula is a well-recognized complication of acute pancreatitis (AP). However, it has been reported in limited literature. This study aimed to evaluate the incidence and outcome of GI fistulas in AP patients complicated with infected pancreatic or peripancreatic necrosis (IPN).Between 2010 and 2013 AP patients with IPN who diagnosed with GI fistula in our center were analyzed in this retrospective study. And we also conducted a comparison between patients with and without GI fistula regarding the baseline characteristics and outcomes.Over 4 years, a total of 928 AP patients were admitted into our center, of whom 119 patients with IPN were diagnosed with GI fistula and they developed 160 GI fistulas in total. Colonic fistula found in 72 patients was the most common form of GI fistula followed with duodenal fistula. All duodenal fistulas were managed by nonsurgical management. Ileostomy or colostomy was performed for 44 (61.1%) of 72 colonic fistulas. Twenty-one (29.2%) colonic fistulas were successfully treated by percutaneous drainage or continuous negative pressure irrigation. Mortality of patients with GI fistula did not differ significantly from those without GI fistula (28.6% vs 21.9%, P = 0.22). However, a significantly higher mortality (34.7%) was observed in those with colonic fistula.GI fistula is a common finding in patients of AP with IPN. Most of these fistulas can be successfully managed with different procedures depending on their sites of origin. Colonic fistula is related with higher mortality than those without GI fistula. PMID:27057908

  17. Donor Safety in Adult-Adult Living Donor Liver Transplantation: A Single-Center Experience of 356 Cases.

    PubMed

    Meng, Haipeng; Yang, Jiayin; Yan, Lunan

    2016-01-01

    BACKGROUND As an important means to tackle the worldwide shortage of liver grafts, adult-adult living donor liver transplantation (A-ALDLT) is the most massive operation a healthy person could undergo, so donor safety is of prime importance. However, most previous research focused on recipients, while complications in donors have not been fully described or investigated. MATERIAL AND METHODS To investigate donor safety in terms of postoperative complications, the clinical data of 356 A-ALDLT donors in our center from January 2002 to September 2015 were retrospectively analyzed. These patients were divided into a pre-2008 group (before January 2008) and a post-2008 group (after January 2008). Donor safety was evaluated with regard to the type, frequency, and severity of postoperative complications. RESULTS There were no donor deaths in our center during this period. The overall complication rate was 23.0% (82/356). The proportion of Clavien I, II, III, and IV complications was 51.2% (42/82), 25.6% (21/82), 22.0% (18/82), and 1.2% (1/82), respectively. In all the donors, the incidence of Clavien I, II, III, and IV complications was 11.8% (42/356), 5.9% (21/356), 5.1% (18/356), and 0.3% (1/356), respectively. The overall complication rate in the post-2008 group was significantly lower than that in the pre-2008 group (18.1% (41/227) vs. 32.6% (42/129), P<0.01). Biliary complications were the most common, with an incidence of 8.4% (30/356). CONCLUSIONS The risk to A-ALDLT donors is controllable and acceptable with improvement in preoperative assessment and liver surgery. PMID:27178367

  18. Experiences in Bridging the Gap Between Science and Decision Making at NASAs GSFC Earth Sciences Data and Information Services Center (GES DISC)

    NASA Astrophysics Data System (ADS)

    Kempler, S.; Teng, W.; Friedl, L.; Lynnes, C.

    2008-12-01

    In recognizing the significance of NASA remote sensing Earth science data in monitoring and better understanding our planet's natural environment, NASA has implemented the 'Decision Support Through Earth Science Research Results' program to solicit "proposals that develop and demonstrate innovative and practicable applications of NASA Earth science observations and research"that focus on improving decision making activities", as stated in the NASA ROSES-2008, A.18 solicitation. This very successful program has yielded several monitoring, surveillance, and decision support systems through collaborations with benefiting organizations in the areas of agriculture, air quality, disaster management, ecosystems, public health, water resources, and aviation weather. The Goddard Space Flight Center (GSFC) Earth Sciences Data and Information Services Center (GES DISC) has participated in this program on two projects (one complete, one ongoing), and has had opportune ad hoc collaborations gaining much experience in the formulation, management, development, and implementation of decision support systems utilizing NASA Earth science data. Coupling this experience with the GES DISC's total understanding and vast experience regarding Earth science missions and resulting data and information, including data structures, data usability and interpretation, data interoperability, and information management systems, the GES DISC is in the unique position to more readily identify challenges that come with bringing science data to decision makers. These challenges consist of those that can be met within typical science data usage frameworks, as well as those challenges that arise when utilizing science data for previously unplanned applications, such as decision support systems. The purpose of this presentation is to share GES DISC decision support system project experiences in regards to system sustainability, required data quality (versus timeliness), data provider understanding how

  19. Outcomes of acute upper gastrointestinal bleeding in relation to timing of endoscopy and the experience of endoscopist: a tertiary center experience

    PubMed Central

    Mohammed, Noor; Rehman, Amer; Swinscoe, Mark Thomas; Mundre, Pradeep; Rembacken, Bjorn

    2016-01-01

    Introduction: Patients with gastrointestinal bleeding admitted out of hours or at the weekends may have an excess mortality rate. The literature reports around this are conflicting. Aims and methods: We aimed to analyze the outcomes of emergency endoscopies performed out of hours and over the weekends in our center. We retrospectively analyzed data from April 2008 to June 2012. Results: A total of 507 ‘high risk’ emergency gastroscopies were carried out over the study period for various indications. Patients who died within 30 days of the index procedure [22 % (114 /510)] had a significantly higher Rockall score (7.6 vs. 6.0, P < 0.0001), a higher American Society of Anesthesiologists (ASA) status (3.5 vs. 2.7, P < 0.001), and a lower systolic blood pressure (BP) at the time of the examination (94.8 vs 103, P = 0.025). These patients were significantly older (77.7 vs. 67.5 years, P = 0.006), and required more blood transfusion (5.9 versus 3.8 units). Emergency out-of-hours endoscopy was not associated with an increased risk of death [relative risk (RR) 1.09, 95 % confidence interval (CI) 1.12 – 1.95]. Whether the examination was carried out by a senior specialist registrar (senior trainee) or a consultant made no difference to the survival of the patient (RR 0.98, CI 0.77 – 1.32). Conclusion: Higher pre-endoscopy Rockall score and ASA status contributed significantly to the 30-day mortality following upper gastrointestinal bleeding, whereas lower BP tended towards significance. Outcomes did not vary with the time of the endoscopy nor was there any difference between a consultant and a senior specialist registrar led service. PMID:27004244

  20. Costs Associated with Surgically Treated Cases of Abdominal Cystic Echinococcosis: A Single Center's Experience from 2008 to 2014, Pavia, Italy.

    PubMed

    Narra, Roberta; Maestri, Marcello; Budke, Christine M; Tamarozzi, Francesca; Mariconti, Mara; Nicoletti, Giovanni J; Rinaldi, Francesca; Brunetti, Enrico

    2016-08-01

    Cystic echinococcosis (CE) is a globally distributed zoonosis caused by the Echinococcus granulosus sensu lato species complex. Four approaches are available for treatment of abdominal CE: surgery, percutaneous aspiration, chemotherapy with albendazole, and watch-and-wait. Allocation of patients to these different treatment options mainly depends on the stage of the cystic lesion. However, as available guidelines are not widely followed, surgery is often applied even without the correct indication outside referral centers. This is not only a disadvantage for the patient, but also a waste of money. In this study, we evaluated the cost of the surgical approach for abdominal CE by analyzing hospitalization costs for 14 patients admitted to the General Surgery Ward at the "San Matteo" Hospital Foundation in Pavia, Italy, from 2008 through 2014. We found that the total cost of a single hospitalization, including hospital stay, surgical intervention, personnel, drugs, and administrative costs ranged from €5,874 to 23,077 (median €11,033) per patient. Our findings confirm that surgery can be an expensive option. Therefore, surgical intervention should be limited to cyst types that do not benefit from nonsurgical therapies and appropriate case management can best be accomplished by using a cyst stage-specific approach. PMID:27273641

  1. How does epidemiological and clinicopathological features affect survival after gastrectomy for gastric cancer patients-single Egyptian center experience

    PubMed Central

    El Hanafy, Ehab; El Nakeeb, Ayman; Ezzat, Helmy; Hamdy, Emad; Atif, Ehab; Kandil, Tharwat; Fouad, Amgad; Wahab, Mohamed Abdel; Monier, Ahmed

    2016-01-01

    AIM: To investigate the clinicopathological features and the significance of different prognostic factors which predict surgical overall survival in patients with gastric carcinoma. METHODS: This retrospective study includes 80 patients diagnosed and treated at gastroenterology surgical center, Mansoura University, Egypt between February 2009 to February 2013. Prognostic factors were assessed by cox proportional hazard model. RESULTS: There were 57 male and 23 female. The median age was 57 years (24-83). One, 3 and 5 years survival rates were 71%, 69% and 46% respectively. The median survival was 69.96 mo. During the follow-up period, 13 patients died (16%). Hospital morbidity was reported in 10 patients (12.5%). The median number of lymph nodes removed was 22 (4-41). Lymph node (LN) involvement was found in 91% of cases. After R0 resection, depth of wall invasion, LN involvement and the number (> 15) of retrieved LN, LN ratio and tumor differentiation predict survival. In multivariable analysis, tumor differentiation, curability of resection and a number of resected LN superior to 15 were found to be independent prognostic factors. CONCLUSION: Surgery remains the cornerstone of treatment. Tumor differentiation, curability of resection and a number of resected LN superior to 15 were found to be independent prognostic factors. Extended LN dissection does not increase the morbidity or mortality rate but markedly improves long term survival. PMID:27358677

  2. Integration of an academic medical center and a community hospital: the Brigham and Women's/Faulkner hospital experience.

    PubMed

    Sussman, Andrew J; Otten, Jeffrey R; Goldszer, Robert C; Hanson, Margaret; Trull, David J; Paulus, Kenneth; Brown, Monte; Dzau, Victor; Brennan, Troyen A

    2005-03-01

    Brigham and Women's Hospital (BWH), a major academic tertiary medical center, and Faulkner Hospital (Faulkner), a nearby community teaching hospital, both in the Boston, Massachusetts area, have established a close affiliation relationship under a common corporate parent that achieves a variety of synergistic benefits. Formed under the pressures of limited capacity at BWH and excess capacity at Faulkner, and the need for lower-cost clinical space in an era of provider risk-sharing, BWH and Faulkner entered into a comprehensive affiliation agreement. Over the past seven years, the relationship has enhanced overall volume, broadened training programs, lowered the cost of resources for secondary care, and improved financial performance for both institutions. The lessons of this relationship, both in terms of success factors and ongoing challenges for the hospitals, medical staffs, and a large multispecialty referring physician group, are reviewed. The key factors for success of the relationship have been integration of training programs and some clinical services, provision of complementary clinical capabilities, geographic proximity, clear role definition of each institution, commitment and flexibility of leadership and medical staff, active and responsive communication, and the support of a large referring physician group that embraced the affiliation concept. Principal challenges have been maintaining the community hospital's cost structure, addressing cultural differences, avoiding competition among professional staff, anticipating the pace of patient migration, choosing a name for the new affiliation, and adapting to a changing payer environment. PMID:15734807

  3. Clostridium Difficile Infection in Hospitalized Patients at University Clinical Center Tuzla, Bosnia and Herzegovina: a 4 Year Experience

    PubMed Central

    Ahmetagic, Sead; Salkic, Nermin; Ahmetagic, Aldina; Custovic, Amer; Tihic, Nijaz; Smajlovic, Jasmina; Porobic-Jahic, Humera

    2013-01-01

    Introduction: Clostridium difficile (C. difficile) is currently the leading cause of healthcare-associated diarrhea, but almost nothing is known about the extent of C. difficile infection (CDI) in Bosnia and Herzegovina. Goal: We aimed to retrospectively analyze CDI in hospitalized patients at University Clinical Center (UCC) Tuzla, Bosnia and Herzegovina from January 2009 through June 2012. Methods: We analyzed all patients (except children ages 0-2), diagnosed with CDI based on anamnestic and epidemiological, clinical picture and microbiological tests (proof of toxins in the stool by enzyme-linked immunosorbent assay). Results: From a total of 989 patients tested for C. difficile toxin (60.2 per 10,000 inpatient days) 347 (35.08%) were positives. The mean incidence rate of CDI was 2.23 per 10,000 inpatient days (range 1.32-2.87). Annual rates of hospitalization were 15.68 per 10,000 admissions (range 8.99-20.35). Most patients had a previously identified risk profile of old age, comorbidity and recent use of antibiotics. 41/276 (14.86%) patients had died, and 11/41 (26.82%) were CDI-associated deaths. Complicated CDI were registered in 53/276 (19.21%) patients, and recurrent infections in 65/276 (23.55%). Conclusion: Our data suggest that CDI is largely present in our setting which represents a serious problem and points to the importance of international surveillance, detection and control of CDI. PMID:24167425

  4. Prediction of delayed graft function by means of a novel web-based calculator: a single-center experience.

    PubMed

    Rodrigo, E; Miñambres, E; Ruiz, J C; Ballesteros, A; Piñera, C; Quintanar, J; Fernández-Fresnedo, G; Palomar, R; Gómez-Alamillo, C; Arias, M

    2012-01-01

    Renal failure persisting after renal transplant is known as delayed graft function (DGF). DGF predisposes the graft to acute rejection and increases the risk of graft loss. In 2010, Irish et al. developed a new model designed to predict DGF risk. This model was used to program a web-based DGF risk calculator, which can be accessed via http://www.transplantcalculator.com . The predictive performance of this score has not been tested in a different population. We analyzed 342 deceased-donor adult renal transplants performed in our hospital. Individual and population DGF risk was assessed using the web-based calculator. The area under the ROC curve to predict DGF was 0.710 (95% CI 0.653-0.767, p < 0.001). The "goodness-of-fit" test demonstrates that the DGF risk was well calibrated (p = 0.309). Graft survival was significantly better for patients with a lower DGF risk (5-year survival 71.1% vs. 60.1%, log rank p = 0.036). The model performed well with good discrimination ability and good calibration to predict DGF in a single transplant center. Using the web-based DGF calculator, we can predict the risk of developing DGF with a moderate to high degree of certainty only by using information available at the time of transplantation. PMID:22026730

  5. Preparation of cell blocks for lung cancer diagnosis and prediction: protocol and experience of a high-volume center.

    PubMed

    Kossakowski, Claudia A; Morresi-Hauf, Alicia; Schnabel, Philipp A; Eberhardt, Ralf; Herth, Felix J F; Warth, Arne

    2014-01-01

    Minimally invasive diagnostic techniques are increasingly being used to obtain specimens for pathological diagnosis and prediction. Referring to lung cancer, both endobronchial and endoesophageal ultrasound are used worldwide as diagnostic routine methods. Consequently, an increasing number of pathological samples are cytological and fewer are histological. On the other hand, the requirements for specific and sensitive tumor subtyping complemented by predictive analyses are steadily increasing and are an essential basis for evidence-based treatment decisions. In this article we focus on the cell block method as a helpful tool for diagnostic and predictive analyses in lung cancer and point out its advantages and disadvantages in comparison to conventional cytological and biopsy specimens. Furthermore, we retrospectively analyze the diagnostic results of the cell block method in a high-volume center over 5 years. The main advantages of cell blocks are the availability of established and validated protocols, archiving and the opportunity to have serial sections from the same specimens to provide or repeat molecular analyses. Actually, in case of tumor progression, even additional biomarkers can be tested using the original cell block when re-biopsies are not feasible. The cell block method should be considered as a reliable, complimentary approach to conventional cytological or biopsy procedures, which is helpful to fulfill the increasing requirements of high-quality diagnostics and prediction. PMID:24457174

  6. Matrix support strategies: the experience of two Family Health Support Centers (NASFs) in São Paulo, Brazil.

    PubMed

    Barros, Juliana de Oliveira; Gonçalves, Rita Maria de Abreu; Kaltner, Ronaldo Pires; Lancman, Selma

    2015-09-01

    The aim of Family Health Support Centers (NASFs) is to expand and qualify primary health care initiatives. Working together with Family Health Teams (EqSFs) they use matrix support strategies. This paper discusses how NASF professionals develop their work, emphasizing how matrix support approaches are appropriated and incorporated into daily working practices. The results that are presented are based on a case study of the work process of NASFs in a region of the city of São Paulo, Brazil. In order to investigate this issue, specific questions were introduced at different stages of the ergonomic work analysis. The implementation of the NASF, without a review of the guidance documents provided by the EqSF, created the following paradoxes: the different requirements of productivity and the working strategies between the NASF and the EqSF; the different demands of care for the population and different priorities for action, which were reflected in the division of tasks and the time allocated to each of them, etc. The practices that have been accumulated since the creation of the NASF suggests a review of these documents in order to transform the organization of planned work of these organizations in order to create better conditions for shared working practices. PMID:26331516

  7. Strategies for Conducting Adolescent Health Research in the Clinical Setting: The Mount Sinai Adolescent Health Center HPV Experience

    PubMed Central

    Braun-Courville, Debra K.; Schlecht, Nicolas F.; Burk, Robert D.; Strickler, Howard D.; Rojas, Mary; Lorde-Rollins, Elizabeth; Nucci-Sack, Anne; Hollman, Dominic; Linares, L. Oriana; Diaz, Angela

    2013-01-01

    Background Clinical research with adolescents can be challenging due to issues of informed consent, parental involvement, institutional review board requirements, and adolescent psychosocial development. This presents a dilemma, particularly in the area of sexual health research, as adolescents are disproportionately affected by sexually transmitted infections such as human papillomavirus (HPV). To successfully conduct adolescent research in the clinical setting, one requires an awareness of state statutes regarding adolescent confidentiality and consent for medical care, and a close partnership with the IRB. Case Study In 2007, the Mount Sinai Adolescent Health Center (MSAHC) in collaboration with the Albert Einstein College of Medicine developed a longitudinal research study to examine the natural history of oral, cervical, and anal HPV in an adolescent female population engaged in high-risk sexual behaviors. We use this research project as a case study to explore the ethical, methodological, and clinical issues related to conducting adolescent health research. Summary and Conclusions Several strategies were identified to promote adolescent study participation, including: (1) building a research team that is motivated to work with adolescents; (2) combining research and patient care visits to avoid duplication of services; and (3) establishing a personalized communication network with participants. Using these methods, adolescent sexual health research can successfully be integrated into the clinical setting. While retaining a prospective cohort of adolescents has its challenges, a persistent and multi-disciplinary approach can help improve recruitment, sustain participation, and acquire critical data that will lead to improved healthcare knowledge applicable to understudied populations of adolescents. PMID:24332677

  8. Liquid Metal Processing and Casting Experiences at the U.S. Department of Energy's Albany Research Center

    SciTech Connect

    Jablonski, Paul D.; Turner, Paul C.

    2005-09-01

    In this paper we will discuss some of the early pioneering work as well as some of our more recent research. The Albany Research Center (ARC) has been involved with the melting and processing of metals since it was established in 1942. In the early days, hardly anything was known about melting refractory or reactive metals and as such, virtually everything had to be developed in-house. Besides the more common induction heated air-melt furnaces, ARC has built and/or utilized a wide variety of furnaces including vacuum arc remelt ingot and casting furnaces, cold wall induction furnaces, electric arc furnaces, cupola furnaces and reverberatory furnaces. The melt size of these furnaces range from several grams to a ton or more. We have used these furnaces to formulate custom alloys for wrought applications as well as for such casting techniques as spin casting, investment casting and lost foam casting among many. Two early spin-off industrializations were Wah Chang (wrought zirconium alloys for military and commercial nuclear applications) and Oremet (both wrought and cast Ti). Both of these companies are now part of the ATI Allegheny Ludlum Corporation.

  9. Insulation Failure of the Linox Defibrillator Lead: A Case Report and Retrospective Review of a Single Center Experience.

    PubMed

    Howe, Andrew J; McKeag, Nicholas A; Wilson, Carol M; Ashfield, Kyle P; Roberts, Michael J

    2015-06-01

    Implantable cardioverter defibrillator (ICD) lead insulation failure and conductor externalization have been increasingly reported. The 7.8F silicon-insulated Linox SD and Linox S ICD leads (Biotronik, Berlin, Germany) were released in 2006 and 2007, respectively, with an estimated 85,000 implantations worldwide. A 39-year-old female suffered an out-of-hospital ventricular fibrillation (VF) arrest with successful resuscitation. An ICD was implanted utilizing a single coil active fixation Linox(Smart) S lead (Biotronik, Berlin, Germany). A device-triggered alert approximately 3 years after implantation confirmed nonphysiological high rate sensing leading to VF detection. A chest X-ray showed an abnormality of the ICD lead and fluoroscopic screening confirmed conductor externalization proximal to the defibrillator coil. In view of the combined electrical and fluoroscopic abnormalities, urgent lead extraction and replacement were performed. A review of Linox (Biotronik) and Vigila (Sorin Group, Milan, Italy) lead implantations within our center (n = 98) identified 3 additional patients presenting with premature lead failure, 2 associated with nonphysiological sensed events and one associated with a significant decrease in lead impedance. All leads were subsequently removed and replaced. This case provides a striking example of insulation failure affecting the Linox ICD lead and, we believe, is the first to demonstrate conductor externalization manifesting both electrical and fluoroscopic abnormalities. PMID:25711237

  10. Determinants of graft survival in pediatric and adolescent live donor kidney transplant recipients: a single center experience.

    PubMed

    El-Husseini, Amr A; Foda, Mohamed A; Shokeir, Ahmed A; Shehab El-Din, Ahmed B; Sobh, Mohamed A; Ghoneim, Mohamed A

    2005-12-01

    To study the independent determinants of graft survival among pediatric and adolescent live donor kidney transplant recipients. Between March 1976 and March 2004, 1600 live donor kidney transplants were carried out in our center. Of them 284 were 20 yr old or younger (mean age 13.1 yr, ranging from 5 to 20 yr). Evaluation of the possible variables that may affect graft survival were carried out using univariate and multivariate analyses. Studied factors included age, gender, relation between donor and recipient, original kidney disease, ABO blood group, pretransplant blood transfusion, human leukocyte antigen (HLA) matching, pretransplant dialysis, height standard deviation score (SDS), pretransplant hypertension, cold ischemia time, number of renal arteries, ureteral anastomosis, time to diuresis, time of transplantation, occurrence of acute tubular necrosis (ATN), primary and secondary immunosuppression, total dose of steroids in the first 3 months, development of acute rejection and post-transplant hypertension. Using univariate analysis, the significant predictors for graft survival were HLA matching, type of primary urinary recontinuity, time to diuresis, ATN, acute rejection and post-transplant hypertension. The multivariate analysis restricted the significance to acute rejection and post-transplant hypertension. The independent determinants of graft survival in live-donor pediatric and adolescent renal transplant recipients are acute rejection and post-transplant hypertension. PMID:16269048

  11. Three Experiments Examining the Use of Electroencephalogram,Event-Related Potentials, and Heart-Rate Variability for Real-Time Human-Centered Adaptive Automation Design

    NASA Technical Reports Server (NTRS)

    Prinzel, Lawrence J., III; Parasuraman, Raja; Freeman, Frederick G.; Scerbo, Mark W.; Mikulka, Peter J.; Pope, Alan T.

    2003-01-01

    Adaptive automation represents an advanced form of human-centered automation design. The approach to automation provides for real-time and model-based assessments of human-automation interaction, determines whether the human has entered into a hazardous state of awareness and then modulates the task environment to keep the operator in-the-loop , while maintaining an optimal state of task engagement and mental alertness. Because adaptive automation has not matured, numerous challenges remain, including what the criteria are, for determining when adaptive aiding and adaptive function allocation should take place. Human factors experts in the area have suggested a number of measures including the use of psychophysiology. This NASA Technical Paper reports on three experiments that examined the psychophysiological measures of event-related potentials, electroencephalogram, and heart-rate variability for real-time adaptive automation. The results of the experiments confirm the efficacy of these measures for use in both a developmental and operational role for adaptive automation design. The implications of these results and future directions for psychophysiology and human-centered automation design are discussed.

  12. Experiences in Bridging the Gap between Science and Decision Making at NASA's GSFC Earth Science Data and Information Services Center (GES DISC)

    NASA Technical Reports Server (NTRS)

    Kempler, Steven; Teng, Bill; Friedl, Lawrence; Lynnes, Chris; Leptoukh, Gregory

    2008-01-01

    Recognizing the significance of NASA remote sensing Earth science data in monitoring and better understanding our planet s natural environment, NASA has implemented the Decision Support Through Earth Science Research Results program (NASA ROSES solicitations). a) This successful program has yielded several monitoring, surveillance, and decision support systems through collaborations with benefiting organizations. b) The Goddard Space Flight Center (GSFC) Earth Sciences Data and Information Services Center (GES DISC) has participated in this program on two projects (one complete, one ongoing), and has had opportune ad hoc collaborations gaining much experience in the formulation, management, development, and implementation of decision support systems utilizing NASA Earth science data. c) In addition, GES DISC s understanding of Earth science missions and resulting data and information, including data structures, data usability and interpretation, data interoperability, and information management systems, enables the GES DISC to identify challenges that come with bringing science data to decision makers. d) The purpose of this presentation is to share GES DISC decision support system project experiences in regards to system sustainability, required data quality (versus timeliness), data provider understanding of how decisions are made, and the data receivers willingness to use new types of information to make decisions, as well as other topics. In addition, defining metrics that really evaluate success will be exemplified.

  13. Information Technology in Science (ITS) Center for Teaching and Learning Environment Design Experiment Study for the Development of New Generation Leaders in Science Education

    NASA Astrophysics Data System (ADS)

    Herbert, B. E.; Schroeder, C.; Brody, S.; Cahill, T.; Kenimer, A.; Loving, C.; Schielack, J.

    2003-12-01

    The ITS Center for Teaching and Learning is a five-year NSF-funded collaborative effort to engage scientists and university and school or district-based science educators in the use of information technology to improve science teaching and learning at all levels. One assumption is that science and mathematics teaching and learning will be improved when they become more connected to the authentic science research done in field settings or laboratories. The effective use of information technology in science classrooms has been shown to help achieve this objective. As a design study that is -working toward a greater understanding of a -learning ecology", the research related to the creation and refinement of the ITS Centeres collaborative environment for professional development is contributing information about an important setting not often included in the descriptions of professional development, a setting that incorporates distributed expertise and resulting distributed growth in the various categories of participants: scientists, science graduate students, education researchers, education graduate students, and master teachers. Design-based research is an emerging paradigm for the study of learning in context through the systematic design and study of instructional strategies and tools. This presentation will discuss the results of the formative evaluation process that has moved the ITS Centeres collaborative environment for professional development through the iterative process from Phase I (the planned program designed in-house) to Phase II (the experimental program being tested in-house). In particular, we will focus on the development of the ITS Centeres Project Teams, which create learning experiences over two summers focused on the exploration of science, technology, engineering or mathematics (STEM) topics through the use of modeling, visualization and complex data sets to explore authentic scientific questions that can be integrated within the K-16

  14. Successful establishment of patient-derived tumor xenografts from gastrointestinal stromal tumor-a single center experience

    PubMed Central

    Jiang, Quan; Tong, Han-Xing; Zhang, Yong; Hou, Ying-Yong; Li, Jing-Lei; Wang, Jiong-Yuan; Zhou, Yu-Hong; Lu, Wei-Qi

    2016-01-01

    Patient-derived tumor xenografts (PDTX) generally represent a kind of more reliable model of human disease, by which a potential drugs’ preclinical efficacy could be evaluated. To date, no stable gastrointestinal stromal tumor (GIST) PDTX models have been reported. In this study, we aimed to establish stable GIST PDTX models and to evaluate whether these models accurately reflected the histological feature of the corresponding patient tumors and create a reliable GIST PDTX models for our future experiment. By engrafting fresh patient GIST tissues into immune-compromised mice (BALB/c athymic mice), 4 PDTX models were established. Histological features were assessed by a qualified pathologist based on H&E staining, CD117 and DOG-1. We also conduct whole exome sequencing(WES) for the 4 established GIST PDTX models to test if the model still harbored the same mutation detected in corresponding patient tumors and get a more intensive vision for the genetic profile of the models we have established, which will help a lot for our future experiment. To explore the tumorigenesis mechanism for GIST, we also have a statistical analysis for the genes detected as nonsynchronous-mutated simultaneously in 4 samples. All 4 GIST PDTX models retained the histological features of the corresponding human tumors, with original morphology type and positive stains for CD117 and DOG-1. Between the GIST PDTX models and their parental tumors, a same mutation site was detected, which confirmed the genetic consistency. The stability of molecular profiles observed within the GIST PDTX models provides confidence in the utility and translational significance of these models for in vivo testing of personalized therapies. To date, we conducted the first study to successfully establish a GIST PDTX model whose genetic profiles were revealed by whole exome sequencing. Our experience could be of great use. PMID:27186422

  15. Allogeneic hematopoietic SCT performed in non-HEPA filter rooms: initial experience from a single center in India.

    PubMed

    Kumar, R; Naithani, R; Mishra, P; Mahapatra, M; Seth, T; Dolai, T K; Bhargava, R; Saxena, R

    2009-01-01

    In developing countries, it is important to ascertain the safety of performing allogeneic hematopoietic SCT (HSCT) in single rooms without high-efficiency particulate air (HEPA) filters. We present our experience of performing 40 such transplants from July 2004 to November 2007. Source of stem cells was peripheral blood in 33, bone marrow in six and combined in one. G-CSF started from day +1. The indications were SAA-18, CML-7, AML-7, ALL-2, myelodysplastic syndrome-2 and thalassemia major-4. The median age was 19 years (range 2.2-46) with 29 male and 11 female participants. Antibacterial and antifungal prophylaxis was administered along with conditioning, and at the onset of fever, systemic antibiotics were started. Antifungal agents were added if fever persisted for 3 days. Median time for neutrophil engraftment was 10 days (range 8-17). Fever occurred in 38 (95%) for a median of 5 days (range 1-38), and blood cultures were positive in seven (17.5%). Systemic antibiotics were used in 95% and antifungals in 57.5% cases. The 30-day mortality was nil, and 100-day mortality was 1 (2.5%). After day 100, there were eight fatalities (20%) due to chronic GVHD-3, relapse-2, graft rejection-2, disseminated tuberculosis and aspergillosis-1. Our experience suggests that allogeneic HSCT can be safely performed in non-HEPA filter rooms in India. PMID:18794872

  16. Caudal Neuromodulation with the Transforaminal Sacral Electrode (InterStim®): Experience in a Pain Center Regarding 12 Implants

    PubMed Central

    Cano Gala, Carlos; Sánchez Poveda, David; Rueda Juan, Pablo; Sánchez Montero, Francisco José; Garzón Sánchez, José Carlos; Santos Lamas, Juan Ignacio; Sánchez Hernández, Miguel Vicente

    2016-01-01

    Background Sacral nerve stimulation is a therapeutic option with demonstrated efficacy for conditions presenting with perineal pain caused by different etiologies. We aimed to assess whether a sacral electrode (InterStim®, Medtronic, Minneapolis, MN, USA) inserted through the caudal pathway is able to offer an acceptable level of sacral stimulation and rate of catheter migration. Methods We present 12 patients with pelvic pain who received sacral neuromodulation via the sacral hiatus with the InterStim electrode. We evaluated patient satisfaction as well as migration and removal of the electrode, if necessary. Results Our experience included 12 patients, 10 women and two men, with a mean age of 60 years. In eight of the 12 patients, the initial therapy was effective, and the final system implantation was performed. During subsequent follow-up, patient satisfaction was good. To date, there have been no cases of electrode displacement or migration. Conclusions The caudal insertion of the InterStim electrode, with its own fixation system, and initially designed for transsacral insertion, appears in our experience to be a satisfactory option which can minimize electrode displacements, achieving similar results in therapeutic efficacy and causing no difficulties in removal. PMID:26839667

  17. Outcomes of Patients After Arterial Switch Operation: 18 Years of Experience in a Single Medium-Volume Center.

    PubMed

    Manso, Paulo H; Amaral, Fernando T V; Júnior, Tarcísio J S; Jurca, Mauro C; Haddad, Jorge; Vicente, Walter V A; Sgarbieri, Ricardo N; Carmona, Fabio

    2015-12-01

    The objective of this paper was to describe the outcomes in patients submitted to arterial switch operation and to analyze the predictors of in-hospital mortality and further need of re-operation at a single-center institution. Between September 1995 and January 2014, 128 consecutive arterial switch operations were performed. Surgical mortality during this period was analyzed retrospectively, and a follow-up analysis of the survivors was conducted. Surgical era, cardiopulmonary bypass time (p = 0.001), and diagnosis category (p = 0.025) influenced in-hospital mortality. The estimated overall survival for the 91 hospital survivors was 96.8, 96.4, and 96.2 % at 5, 10, and 15 years, respectively. The median follow-up time was 67 months (range 0.71-222 months). Three patients (5 %) presented severe aortic regurgitation. Right ventricle outflow tract systolic gradient by echocardiography was above 60 mmHg in 2 %. Late re-interventions occurred in 12 (13 %) patients with mean time of 64 ± 34 months after the initial procedure. Actuarial freedom from re-interventions at 5, 10, and 15 years was 96.4, 69.7, and 61.9 %, respectively. Arterial switch operation remains the procedure of choice in patients with transposition of great arteries. It can be performed even in middle-volume institutions, leading to the same middle- and long-term outcomes of high-volume institutions. Early high mortality rate may occur due not only to learning curve, but also to cardiopulmonary bypass time and ventricular septal defect closure. PMID:26036352

  18. An analysis of clinical process measures for acute healthcare delivery in Appalachia: The Roane Medical Center experience

    PubMed Central

    Pope, Karla Rae; Hancock, John S; Sills, Eric Scott

    2006-01-01

    Objective To survey management of selected emergency healthcare needs in a Tennessee community hospital. Materials and methods In this descriptive report, discharges and associated standard process measures were retrospectively studied for Roane Medical Center (RMC) in Harriman, Tennessee (pop. 6,757). Hospital data were extracted from a nationwide database of short-term acute care hospitals to measure 16 quality performance measures in myocardial infarction (MI), heart failure, and pneumonia during the 14 month interval ending March 2005. The data also permitted comparisons with state and national reference groups. Results Of RMC patients with myocardial infarction (MI), 94% received aspirin on arrival, a figure higher than both state (85%) and national (91%) averages. Assessment of left ventricular dysfunction among heart failure patients was also higher at RMC (98%) than the state (74%) or national (79%) average. For RMC pneumonia patients, 79% received antibiotics within 4 h of admission, which compared favorably with State (76%) and national (75%) average. RMC scored higher on 13 of 16 clinical process measures (p<0.01, sign test analysis, >95% CI) compared to state and national averages. Discussion Although acute health care needs are often met with limited resources in medically underserved regions, RMC performed above state and national average for most process measures assessed in this review. Our data were derived from one facility and the associated findings may not be applicable in other healthcare settings. Further studies are planned to track other parameters and specific clinical outcomes at RMC, as well as to identify specific institutional policies that facilitate attainment of target quality measures. PMID:16571127

  19. Transcatheter Arterial Chemoembolization with Epirubicin-Loaded Superabsorbent Polymer Microspheres for 135 Hepatocellular Carcinoma Patients: Single-Center Experience

    SciTech Connect

    Seki, Akihiko Hori, Shinich; Kobayashi, Kazuya; Narumiya, Seizi

    2011-06-15

    Purpose: To evaluate the safety, clinical outcomes, and hepatic artery damage after transcatheter arterial chemoembolization (TACE) with epirubicin-loaded superabsorbent polymer microspheres (ELM-TACE) in patients with hepatocellular carcinoma (HCC) in a single center in Japan. Materials and Methods: This embolic agent is the original form of microspheres, which has the same composition and nature as HepaSpheres. Between May 2007 and June 2009, 135 patients with unresectable HCC who underwent ELM-TACE were enrolled. Embolization through extrahepatic collaterals was performed in 27 (20.0%) patients. Tumor response was evaluated using European Association for the Study of the Liver criteria at 1 and 6 months after initial ELM-TACE. Results: All procedures were successfully performed. The median number of TACE per patient was 1.7 sessions (range 1-5), and the mean epirubicin dose per session was 19.7 mg (range 2.0-60.0). Local pooling within target tumors was observed during TACE in 34 (25.2%) patients, and in 14 (10.4%) of the patients, gelatin sponge particles were added after the microspheres until each pooling disappeared. No serious adverse events associated with TACE occurred, and the incidence of postembolization syndrome was {<=}17.8%. The 1- and 6-month tumor response rates were 56.3 and 52.6%, respectively. The overall 1- and 2-year survival rates were 73.7 and 59.0%, respectively. Among 99 evaluated patients, 90 (90.9%) were found to have no hepatic artery damage after initial ELM-TACE. Conclusion: ELM-TACE is safe and effective treatment for unresectable HCC and is associated with low frequency of postembolization syndrome and minimal damage to the hepatic artery.

  20. Incidence and root causes of cancellations for elective orthopaedic procedures: a single center experience of 17,625 consecutive cases

    PubMed Central

    2014-01-01

    Background The purpose of the Swedish public health-care system is to provide care on equal terms for all citizens. In this, as in most other systems where taxes and/or insurances pay for most of the care, normal market forces are set aside at least in part. At times, this has, for example, resulted in long waiting lists, particularly in terms of elective orthopaedic surgery, with several negative consequences, such as cancellations of planned surgery. Methods The main purpose of this retrospective observational single center study was to evaluate and describe the number and reasons for cancellations in elective orthopaedic surgery. Studied were all the elective patients scheduled for joint replacement, arthroscopy and foot & ankle surgery, January 1, 2007 to December 31, 2011, whose procedure was cancelled at least once. Results Of all 17,625 patients scheduled for elective surgery 6,911 (39%) received at least one, some several cancellations. The most common reason for cancelling a planned surgery was different patient-related factors 3,293 (33%). Cancellations due to treatment guarantee legislation reached 2,885 (29%) and 1,181 (12%) of the cancellations were related to incomplete pre-operative preparation of the patients. Organisational reasons were the cause of approximately 869 (9%) of the cancellations. Conclusions In this study of patients waiting for elective orthopaedic surgery 6,911(39%) had their surgical procedure cancelled at least once, some several times. It appears that it should be possible to eliminate many of these cancellations, while others are unavoidable or caused by factors outside the responsibility of the individual clinic or even hospital. One possible way of influencing the high rate of cancellations might be to change the view of the patients and involve them in the overall planning of the care process. PMID:24955115

  1. Association of interatrial septal abnormalities with cardiac impulse conduction disorders in adult patients: experience from a tertiary center in Kosovo

    PubMed Central

    Bakalli, Aurora; Pllana, Ejup; Koçinaj, Dardan; Bekteshi, Tefik; Dragusha, Gani; Gashi, Masar; Musliu, Nebih; Gashi, Zaim

    2011-01-01

    Interatrial septal disorders, which include: atrial septal defect, patent foramen ovale and atrial septal aneurysm, are frequent congenital anomalies found in adult patients. Early detection of these anomalies is important to prevent their hemodynamic and/or thromboembolic consequences. The aims of this study were: to assess the association between impulse conduction disorders and anomalies of interatrial septum; to determine the prevalence of different types of interatrial septum abnormalities; to assess anatomic, hemodynamic, and clinical consequences of interatrial septal pathologies. Fifty-three adult patients with impulse conduction disorders and patients without ECG changes but with signs of interatrial septal abnormalities, who were referred to our center for echocardiography, were included in a prospective transesophageal echocardiography study. Interatrial septal anomalies were detected in around 85% of the examined patients. Patent foramen ovale was encountered in 32% of the patients, and in combination with atrial septal aneurysm in an additional 11.3% of cases. Atrial septal aneurysm and atrial septal defect were diagnosed with equal frequency in 20.7% of our study population. Impulse conduction disorders were significantly more suggestive of interatrial septal anomalies than clinical signs and symptoms observed in our patients (84.91% vs 30.19%, P=0.002). Right bundle branch block was the most frequent impulse conduction disorder, found in 41 (77.36%) cases. We conclude that interatrial septal anomalies are highly associated with impulse conduction disorders, particularly with right bundle branch block. Impulse conduction disorders are more indicative of interatrial septal abnormalities in earlier stages than can be understood from the patient’s clinical condition. PMID:21977304

  2. Association of interatrial septal abnormalities with cardiac impulse conduction disorders in adult patients: experience from a tertiary center in Kosovo.

    PubMed

    Bakalli, Aurora; Pllana, Ejup; Koçinaj, Dardan; Bekteshi, Tefik; Dragusha, Gani; Gashi, Masar; Musliu, Nebih; Gashi, Zaim

    2011-01-01

    INTERATRIAL SEPTAL DISORDERS, WHICH INCLUDE: atrial septal defect, patent foramen ovale and atrial septal aneurysm, are frequent congenital anomalies found in adult patients. Early detection of these anomalies is important to prevent their hemodynamic and/or thromboembolic consequences. The aims of this study were: to assess the association between impulse conduction disorders and anomalies of interatrial septum; to determine the prevalence of different types of interatrial septum abnormalities; to assess anatomic, hemodynamic, and clinical consequences of interatrial septal pathologies. Fifty-three adult patients with impulse conduction disorders and patients without ECG changes but with signs of interatrial septal abnormalities, who were referred to our center for echocardiography, were included in a prospective transesophageal echocardiography study. Interatrial septal anomalies were detected in around 85% of the examined patients. Patent foramen ovale was encountered in 32% of the patients, and in combination with atrial septal aneurysm in an additional 11.3% of cases. Atrial septal aneurysm and atrial septal defect were diagnosed with equal frequency in 20.7% of our study population. Impulse conduction disorders were significantly more suggestive of interatrial septal anomalies than clinical signs and symptoms observed in our patients (84.91% vs 30.19%, P=0.002). Right bundle branch block was the most frequent impulse conduction disorder, found in 41 (77.36%) cases. We conclude that interatrial septal anomalies are highly associated with impulse conduction disorders, particularly with right bundle branch block. Impulse conduction disorders are more indicative of interatrial septal abnormalities in earlier stages than can be understood from the patient's clinical condition. PMID:21977304

  3. Incidence, etiology, and outcome of primary graft dysfunction in adult heart transplant recipients: a single-center experience in Japan.

    PubMed

    Seguchi, Osamu; Fujita, Tomoyuki; Murata, Yoshihiro; Sunami, Haruki; Sato, Takuma; Watanabe, Takuya; Nakajima, Seiko; Kuroda, Kensuke; Hisamatsu, Eriko; Sato, Takamasa; Yanase, Masanobu; Hata, Hiroki; Wada, Kyoichi; Ishibashi-Ueda, Hatsue; Kobayashi, Junjiro; Nakatani, Takeshi

    2016-04-01

    Donor and recipient characteristics, as well as donor-recipient matching, affect clinical outcomes after heart transplantation (HTx). This study aimed to clarify how donor and recipient characteristics affect the clinical course after HTx. The medical records of all the patients who underwent HTx at the National Cerebral and Cardiovascular Center from 1999 to 2014 were retrospectively reviewed. Sixty-one patients (48 males) underwent HTx. Six recipients (9.8 %) developed primary graft dysfunction (PGD) determined by criteria recently established at a consensus conference. Development of PGD was associated with high-dose inotropic support for the donor heart and a history of stroke in the recipient (p = 0.04 and p = 0.002, respectively). Recipients with PGD had higher right atrial pressure (RAP) and lower cardiac output (CO) compared with those without PGD at 6 months after HTx (RAP, 6.8 ± 3.6 vs. 2.8 ± 2.2 mmHg, p < 0.001; CO, 4.6 ± 0.8 l vs. 5.8 ± 1.2 l/min, p = 0.02). With respect to survival, patients with PGD had a 5-year survival rate equivalent to those without PGD (83.3 vs. 93.3 %, p = 0.23). High-dose inotropic support for the donor heart and a history of stroke in the recipient are significant predictive factors for the development of PGD. However, recipients with PGD demonstrate mid-term survival comparable to those without PGD. PMID:25682298

  4. Clinical utility of panfungal polymerase chain reaction for the diagnosis of invasive fungal disease: a single center experience.

    PubMed

    Trubiano, J A; Dennison, A M; Morrissey, C O; Chua, K Y; Halliday, C L; Chen, S C-A; Spelman, D

    2016-02-01

    The role of panfungal polymerase chain reaction (PCR) assays for diagnosis of invasive fungal disease (IFD) is inadequately defined. We describe the use of an internal transcribed spacer 1 (ITS-1) region-directed panfungal PCR in this context at a tertiary referral transplant center. A retrospective review of patients at Alfred Health, Melbourne, Australia (2009-2014) who had clinical samples referred for panfungal PCR testing was conducted. Baseline patient characteristics, antifungal drug history, fungal culture/histopathology, and radiology results were recorded. For bronchoalveolar lavage (BAL) fluid samples, identification of a fungus other than a Candida spp. was defined as a potential pathogen.Of 138 panfungal PCR tests (108 patients), 41 (30%) were positive for a fungal product. Ninety-seven percent (134/138) of specimens were from immunocompromised hosts. Thirteen percent (19/138) of panfungal PCR positive results were for potential pathogens and potential pathogens were detected more frequently in tissue as compared with BAL (12/13 vs. 6/26; P = .0001). No positive panfungal PCR results were obtained from CSF specimens. If histopathology examination was negative, panfungal PCR identified a potential pathogen in only 12% (11/94) of specimens. For the 20 culture negative/histopathology positive specimens, diagnosis of IFD to causative species level by panfungal PCR occurred in 35% (6/20).Sterile site specimens, in particular tissue, were more frequently panfungal PCR positive for potential pathogens than BAL. The utility of panfungal PCR appears greatest in tissue specimens, as an adjunct to histopathology to improve diagnostic sensitivity and specificity. Based on the results of this study we are now only testing tissue specimens by panfungal PCR. PMID:26527638

  5. An Overview of 9/11 Experiences and Respiratory and Mental Health Conditions among World Trade Center Health Registry Enrollees

    PubMed Central

    DiGrande, Laura; Brackbill, Robert; Prann, Angela; Cone, James; Friedman, Stephen; Walker, Deborah J.; Pezeshki, Grant; Thomas, Pauline; Galea, Sandro; Williamson, David; Frieden, Thomas R.; Thorpe, Lorna

    2008-01-01

    To date, health effects of exposure to the September 11, 2001 disaster in New York City have been studied in specific groups, but no studies have estimated its impact across the different exposed populations. This report provides an overview of the World Trade Center Health Registry (WTCHR) enrollees, their exposures, and their respiratory and mental health outcomes 2–3 years post-9/11. Results are extrapolated to the estimated universe of people eligible to enroll in the WTCHR to determine magnitude of impact. Building occupants, persons on the street or in transit in lower Manhattan on 9/11, local residents, rescue and recovery workers/volunteers, and area school children and staff were interviewed and enrolled in the WTCHR between September 2003 and November 2004. A total of 71,437 people enrolled in the WTCHR, for 17.4% coverage of the estimated eligible exposed population (nearly 410,000); 30% were recruited from lists, and 70% were self-identified. Many reported being in the dust cloud from the collapsing WTC Towers (51%), witnessing traumatic events (70%), or sustaining an injury (13%). After 9/11, 67% of adult enrollees reported new or worsening respiratory symptoms, 3% reported newly diagnosed asthma, 16% screened positive for probable posttraumatic stress disorder (PTSD), and 8% for serious psychological distress (SPD). Newly diagnosed asthma was most common among rescue and recovery workers who worked on the debris pile (4.1%). PTSD was higher among those who reported Hispanic ethnicity (30%), household income <$25,000 (31%), or being injured (35%). Using previously published estimates of the total number of exposed people per WTCHR eligibility criteria, we estimate between 3,800 and 12,600 adults experienced newly diagnosed asthma and 34,600–70,200 adults experienced PTSD following the attacks, suggesting extensive adverse health impacts beyond the immediate deaths and injuries from the acute event. PMID:18785012

  6. Clinical Outcomes of Myasthenia Gravis with Thymoma and Thymic Hyperplasia Undergoing Extended Transsternal Thymectomy: A Single-Center Experience

    PubMed Central

    Nazarbaghi, Surena; Amiri-Nikpour, Mohammad Reza; Mahmodlou, Rahim; Arjmand, Nasim; Rezaei, Yousef

    2015-01-01

    Background: Despite the widespread use of thymectomy in myasthenia gravis (MG) patients, it has remained controversial as to whether this procedure is of a similar efficacy and clinical outcome among MG patients with thymoma and thymic hyperplasia. Aim: We sought to determine the long-term clinical outcomes of MG patients who received extended transsternal thymectomy associated with pyridostigmine and prednisolone postoperatively. Materials and Methods: In a retrospective study from January 1999 to December 2013, MG patients who underwent thymectomy were followed up. Out of 41 MG patients admitted in our center, 25 patients had undergone thymectomy adjunctive to pyridostigmine and prednisolone therapy postoperatively. The primary endpoints included improvement in individual diplopia, ptosis, dysphagia, dysarthria, dyspnea, and limb weakness. In addition, according to the MG Foundation of America (MGFA) criteria, response to therapy was defined as complete stable remission (CSR), pharmacologic remission (PR), and minimal manifestation (MM) as secondary endpoints. Results: Majority of the patients were male (60%) and the mean age of the patients was 32.2 ± 13.9 years. Fifteen (60%) and 10 patients (40%) had thymoma and thymic hyperplasia, respectively. All the patients were followed up during a mean period of of 86.9 ± 50.3 months (minimum 10 months and maximum 168 months). The rates of CSR, PR, and MM were comparable between the thymoma and thymic hyperplasia groups (P = 0.584). Based on the Kaplan Meier analysis, the probabilities of CSR, PR, and MM were not significantly different between patients with thymoma and thymic hyperplasia. Conclusion: The extended transsternal thymectomy, along with the postoperative regimen of pyridostigmine and prednisolone was associated with a high rate of clinical improvement among MG patients with thymoma or thymic hyperplasia. PMID:26713298

  7. A Colorectal “Care Bundle” to Reduce Surgical Site Infections in Colorectal Surgeries: A Single-Center Experience

    PubMed Central

    Lutfiyya, Waleed; Parsons, David; Breen, Juliann

    2012-01-01

    Background: Kaiser Sunnyside Medical Center has participated in the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) since January 2006. Data on general and colorectal surgical site infections (SSIs) demonstrated a need for improvement in SSI rates. Objective: To evaluate application of a “care bundle” for patients undergoing colorectal operations, with the goal of reducing overall SSI rates. Methods: We prospectively implemented multiple interventions, with retrospective analysis of data using the NSQIP database. The overall, superficial, deep, and organ/space SSI rates were compared before and after implementation of this colorectal care bundle. Results: Between January 2006 and December 2009, there were 430 colorectal cases in our NSQIP report with 91 infections, an overall rate of 21.16%. Between January 2010, when the colorectal care bundle was implemented, and June 2011, there were 195 cases and 13 infections, a 6.67% overall rate. The absolute decrease of 14.49% is significant (p < 0.0001). The rate of superficial SSI decreased from 15.12% to 3.59% (p < 0.0001). The rates for deep and organ/space SSI also showed a decrease; however, this was not statistically significant. The NSQIP observed-to-expected ratio for colorectal SSI decreased from a range of 1.27 to 1.83 before implementation to 0.54 after implementation (fiscal year 2010). Conclusions: Our institution was a NSQIP high outlier in general surgery SSIs and had a high proportion of these cases represented in colorectal cases. By instituting a care bundle composed of core and adjunct strategies, we significantly decreased our rate of colorectal SSIs. PMID:23012593

  8. An overview of 9/11 experiences and respiratory and mental health conditions among World Trade Center Health Registry enrollees.

    PubMed

    Farfel, Mark; DiGrande, Laura; Brackbill, Robert; Prann, Angela; Cone, James; Friedman, Stephen; Walker, Deborah J; Pezeshki, Grant; Thomas, Pauline; Galea, Sandro; Williamson, David; Frieden, Thomas R; Thorpe, Lorna

    2008-11-01

    To date, health effects of exposure to the September 11, 2001 disaster in New York City have been studied in specific groups, but no studies have estimated its impact across the different exposed populations. This report provides an overview of the World Trade Center Health Registry (WTCHR) enrollees, their exposures, and their respiratory and mental health outcomes 2-3 years post-9/11. Results are extrapolated to the estimated universe of people eligible to enroll in the WTCHR to determine magnitude of impact. Building occupants, persons on the street or in transit in lower Manhattan on 9/11, local residents, rescue and recovery workers/volunteers, and area school children and staff were interviewed and enrolled in the WTCHR between September 2003 and November 2004. A total of 71,437 people enrolled in the WTCHR, for 17.4% coverage of the estimated eligible exposed population (nearly 410,000); 30% were recruited from lists, and 70% were self-identified. Many reported being in the dust cloud from the collapsing WTC Towers (51%), witnessing traumatic events (70%), or sustaining an injury (13%). After 9/11, 67% of adult enrollees reported new or worsening respiratory symptoms, 3% reported newly diagnosed asthma, 16% screened positive for probable posttraumatic stress disorder (PTSD), and 8% for serious psychological distress (SPD). Newly diagnosed asthma was most common among rescue and recovery workers who worked on the debris pile (4.1%). PTSD was higher among those who reported Hispanic ethnicity (30%), household income < $25,000 (31%), or being injured (35%). Using previously published estimates of the total number of exposed people per WTCHR eligibility criteria, we estimate between 3,800 and 12,600 adults experienced newly diagnosed asthma and 34,600-70,200 adults experienced PTSD following the attacks, suggesting extensive adverse health impacts beyond the immediate deaths and injuries from the acute event. PMID:18785012

  9. Radiotherapy and Sorafenib in the Management of Patients with Hepatocellular Carcinoma Have Led to Improved Survival: A Single Center Experience

    PubMed Central

    Moore, Assaf; Cohen-Naftaly, Michal; Benjaminov, Ofer; Braun, Marius; Issachar, Assaf; Mor, Eitan; Tovar, Anna; Sarfaty, Michal; Gordon, Noa; Stemmer, Salomon M.

    2016-01-01

    Background & Aims: Hepatocellular Carcinoma (HCC) is the sixth most common malignancy and the third most common cause of cancer mortality worldwide. We aimed to assess the effect of novel treatment options on the survival of HCC patients. Methods: This retrospective study included all HCC patients diagnosed between 2000 and 2013 referred to the Davidoff center and treated by a multidisciplinary team. Results: The analysis included 321 patients (median age, 64 years; 74.8% males; 74.1% viral carriers; 76.0% cirrhosis; 56.7% diagnosis at an early stage). The estimated hazard ratio by multivariate analysis for the effect of the period of diagnosis (2007-2013 vs. 2000-2006) on survival was 0.72 (95% CI: 0.54-0.96; p=0.027). There was no difference in the distribution by CP score, by BCLC stage at diagnosis or in the proportion of patients undergoing surgical procedures (liver transplantation or resection). In the later time frame, there was a significant decrease in the proportion of patients undergoing percutaneous treatments (14.6% vs.4.2%, p=0.004) and embolization (46.9% vs.24.6%, p=0.001), and a significant increase in radiotherapy (1.5% vs. 8.4%, p=0.009) and treatment with sorafenib (6% vs. 18.3%, p=0.002). Conclusion: Technological/pharmaceutical innovations have led to advancement in HCC treatment. Since there was no significant difference in the proportion of patients undergoing surgical procedures during the evaluated timeframe, the improved survival may stem from better management of advanced stage patients by a multidisciplinary team. PMID:27313777

  10. Clinicopathological profile of orbital exenteration: 14 years of experience from a tertiary eye care center in South India.

    PubMed

    Ali, Mohammad Javed; Pujari, Aditi; Dave, Tarjani Vivek; Kaliki, Swathi; Naik, Milind N

    2016-04-01

    This study aims to describe the clinicopathological features and outcomes of patients who underwent orbital exenteration at a tertiary eye care center in south India. Retrospective chart reviews were performed on all patients undergoing orbital exenteration from January 1999 to December 2012. Parameters recorded include demographic data, clinical presentations, past medical or surgical interventions, exenteration notes, histopathological diagnosis, adjunctive treatment, follow-up examination findings, recurrences, complications, and their management. Orbital exenteration was performed on 119 orbits of 119 patients over a 14-year period. The mean age was 48.9 years (range 1-82 years). The indications were malignancies in 90.7 % (108/119), while 9.3 % (11/119) of cases were exenterated for non-malignant indications. Among the malignancies, the commonest tissue of origin was conjunctiva, noted in 45.4 % (49/108), followed by eyelids (25.9 %, 28/108), orbit (19.4 %, 21/108), and intraocular tissues (9.3 %, 10/108). The commonest malignancies noted in this series were an extensive ocular surface squamous neoplasia (OSSN) (44.4 %, 48/108) and sebaceous gland carcinoma of eyelids with an orbital involvement (18.5 %, 20/108). Extensive fungal granuloma (mucormycosis-4, aspergillosis-4) was the commonest (81.8 %, 9/11) indication among the non-malignant group. All complications were wound related, and none had a recurrence at a mean follow-up of 12.8 months. Extensive orbital involvement with OSSN and SGC were the commonest indications for exenteration. There is a need of creating awareness among general ophthalmologists in specific geographical regions regarding early diagnosis, standardized protocols of management, and appropriate referral. PMID:26249131

  11. Presentation, Management, and Outcome of Thyroglossal Duct Cysts in Adult and Pediatric Populations: A 14-Year Single Center Experience

    PubMed Central

    Al-Thani, Hassan; El-Menyar, Ayman; Sulaiti, Maryam Al; El-Mabrok, Jamela; Hajaji, Khairi; Elgohary, Hesham; Asim, Mohammad; Taha, Ibrahim; Tabeb, Abdelhakem

    2016-01-01

    Objectives A thyroglossal duct cyst (TDC) is a frequent congenital midline anomaly of the neck that usually manifests during the first decade of life. We aimed to describe the presentation, management, and outcome of TDC in pediatric and adult cases. Methods A retrospective observational analysis was conducted for all patients diagnosed and treated for TDC between 2000 and 2014 in a single center in Qatar. Data included patients’ demographics, presentations, preoperative investigations, anesthesia type, histopathological findings, surgical management, recurrences, and complications. Results We identified 102 patients, of which 57% were males. The mean age of patients was 20.2±15.6 years. A bimodal distribution of TDC has been observed, which peaked between the ages of 6–13 years and at ≥19 years. The preoperative evaluation mainly includes ultrasonography (66%), thyroid function test (44%), and fine-needle aspiration cytology (10%). The median size of the cyst was 25 (2–60) mm. Patients mainly presented with an asymptomatic midline neck mass at or below the hyoid bone (82%), followed by fistula (9%), infection (2%), and dysphagia (2%). Eighty-nine cases were identified preoperatively as TDC. The histopathological findings confirmed TDC with hyoid bone in 61 cases, and TDC alone in 38 cases. Eighty patients underwent the Sistrunk procedure while excision of TDC alone was observed in 18 cases. Five cases of recurrent disease were also treated. Adults had a greater median cyst size (30 (9–60) vs. 22 (2–55) mm; p = 0.005) and required prolonged operation time (69 (1–169) vs. 32.5 (1–140) mins; 
p = 0.004) compared to the pediatric group. Conclusion The occurrence of TDC shows a bimodal age distribution. Preoperative evaluation and time for surgery vary whereas clinical presentations, surgical management, and postoperative outcomes are comparable among adult and pediatric groups. Ultrasonography is the preferred diagnostic modality, and the Sistrunk

  12. Outcome and Safety of Anterograde and Retrograde Single-Balloon Enteroscopy: Clinical Experience at a Tertiary Medical Center in Taiwan

    PubMed Central

    Lin, Meng-Chiung; Chen, Peng-Jen; Shih, Yu-Lueng; Huang, Hsin-Hung; Chang, Wei-Kuo; Hsieh, Tsai-Yuan; Huang, Tien-Yu

    2016-01-01

    Single-balloon enteroscopy (SBE) is designed for identifying possible small bowel lesions with balloon-assisted enteroscopy that allows deep intubation of the intestine. However, data regarding the outcome and safety of SBE remain limited. We conducted this study to evaluate the outcome and safety of anterograde and retrograde SBE approaches. This retrospective review from a tertiary medical center in Taiwan included endoscopic reports and chart data from 128 patients with 200 anterograde and retrograde procedures from September 2009 to November 2014. In this study, the most common indication for both anterograde and retrograde SBE was obscure gastrointestinal bleeding (64.4% vs. 60.6%). There were no significant differences between anterograde and retrograde approaches in terms of the diagnostic yield (69.3% vs. 52.5%) and intervention rate (23.8% vs. 17.2%). The procedure time was shorter for anterograde SBE than for retrograde SBE (68.1 ± 23.9 vs. 76.8 ± 27.7 min, P = 0.018). In addition, among the subgroup of patients with obscure gastrointestinal bleeding, the most common etiologies for those in different age-groups were angiodysplasia (≥ 65 years), non-specific ulcers (30–64 years), and Meckel’s diverticulum (< 30 years). The major complication rate during the study was 1.5%; the rate of asymptomatic hyperamylasemia was higher for patients who underwent anterograde SBE than for those who underwent retrograde SBE (13.9% vs. 2%, P = 0.005). The outcome and safety of anterograde and retrograde SBE are similar. However, anterograde SBE has a shorter procedural time and a higher rate of asymptomatic hyperamylasemia. PMID:27548619

  13. Quality Improvement in the National Cancer Institute Community Cancer Centers Program: The Quality Oncology Practice Initiative Experience

    PubMed Central

    Siegel, Robert D.; Castro, Kathleen M.; Eisenstein, Jana; Stallings, Holley; Hegedus, Patricia D.; Bryant, Donna M.; Kadlubek, Pam J.; Clauser, Steven B.

    2015-01-01

    Purpose: The National Cancer Institute (NCI) Community Cancer Centers Program (NCCCP) began in 2007; it is a network of community-based hospitals funded by the NCI. Quality of care is an NCCCP priority, with participation in the American Society of Clinical Oncology Quality Oncology Practice Initiative (QOPI) playing a fundamental role in quality assessment and quality improvement (QI) projects. Using QOPI methodology, performance on quality measures was analyzed two times per year over a 3-year period to enhance our implementation of quality standards at NCCCP hospitals. Methods: A data-sharing agreement allowed individual-practice QOPI data to be electronically sent to the NCI. Aggregated data with the other NCCCP QOPI participants were presented to the network via Webinars. The NCCCP Quality of Care Subcommittee selected areas in which to focus subsequent QI efforts, and high-performing practices shared voluntarily their QI best practices with the network. Results: QOPI results were compiled semiannually between fall 2010 and fall 2013. The network concentrated on measures with a quality score of ≤ 0.75 and planned voluntary group-wide QI interventions. We identified 13 measures in which the NCCCP fell at or below the designated quality score in fall 2010. After implementing a variety of QI initiatives, the network registered improvements in all parameters except one (use of treatment summaries). Conclusion: Using the NCCCP as a paradigm, QOPI metrics provide a useful platform for group-wide measurement of quality performance. In addition, these measurements can be used to assess the effectiveness of QI initiatives. PMID:25538082

  14. Illness representations and cultural practices play a role in patient-centered care in childhood asthma: experiences of Mexican mothers

    PubMed Central

    Arcoleo, Kimberly; Zayas, Luis E.; Hawthorne, April; Begay, Rachelle

    2016-01-01

    Objective Patients’ cultural health beliefs and behaviors may conflict with biomedical healthcare values and practices potentially leading to non-adherence with asthma treatment regimens. To optimize shared decision-making, healthcare providers should understand and be sensitive to these cultural beliefs and behaviors and negotiate an asthma management plan acceptable to parents. The purpose of this study was to obtain the perspective of Mexican mothers regarding (1) their experiences of living with a child with asthma, (2) their understanding of the nature of asthma, and (3) how their cultural beliefs influence asthma management. Methods A qualitative, phenomenological study design was employed to assess mothers’ lived experiences with and perceptions of their child’s asthma. Individual in-depth interviews were conducted with a purposeful sample of 20 Mexican mothers of children ages 5-17 years with asthma. An inductive, theory-driven, phenomenological analysis approach was used to elicit thematic findings. Results Mothers expressed a symptomatic perception of asthma and limited understanding of the disease. Most believe the disease is present only when their child is symptomatic. Many are surprised and puzzled by the unpredictability of their child’s asthma attacks, which they report as sometimes “silent”. The inconsistency of triggers also leads to frustration and worry, which may reflect their concerns around daily controller medication use and preference for alternative illness management strategies. Conclusions Our clinical encounters should be refocused to better understand the context of these families’ lives and the cultural lens through which they view their child’s asthma. PMID:25539396

  15. Cytomegalovirus infection: its incidence and management in cytomegalovirus-seropositive living related liver transplant recipients: a single-center experience.

    PubMed

    Wadhawan, Manav; Gupta, Subash; Goyal, Neerav; Vasudevan, Karisangal R; Makki, Kausar; Dawar, Reetika; Sardana, Raman; Lal, Nand; Kumar, Ajay

    2012-12-01

    It is believed that antiviral prophylaxis decreases the incidence of cytomegalovirus (CMV) reactivation and disease. There are few data regarding weekly assays for CMV DNA after transplantation and the subsequent management of CMV. Here we report a cohort of living related liver transplantation (LRLT) patients who were treated for invasive CMV disease or for CMV infections if they were receiving steroids for rejection. Patients who underwent liver transplantation at our center between September 2006 and August 2010 and were recipient-positive/donor-positive (R(+) /D(+) ) were prospectively included. Patients were tested for CMV DNA 3 weeks after transplantation. CMV DNA-positive patients underwent weekly DNA monitoring until there were 2 consecutive negative reports. Those who developed CMV disease or had rising DNA titers while they were on treatment for rejection were treated. A Cox regression analysis was performed for factors predicting survival. Two hundred sixty-six of the 306 R(+) /D(+) patients were CMV DNA-negative 3 weeks after transplantation, and 40 had detectable DNA. One of the DNA-negative patients developed CMV disease after treatment for rejection with methylprednisolone. Thirty patients had <500 copies/mL, and 10 had ≥500 copies/mL. Two of the 30 patients with DNA levels < 500 copies/mL developed CMV disease. Six of the 10 patients with DNA levels ≥500 copies/mL developed disease. CMV disease occurred in 9 of the 306 patients (2.9%). One patient received treatment for a rise in DNA titers while he was receiving steroids. There was a significant correlation between steroid administration for acute cellular rejection (ACR) and CMV reactivation (P = 0.003) and disease (P = 0.002). A multivariate analysis showed that CMV reactivation/disease did not predict survival. There was no difference in survival between CMV DNA-positive patients and CMV DNA-negative patients (P = 0.68). In conclusion, CMV reactivation is common after LRLT (13%), but the

  16. Allogeneic Stem Cell Transplantation in Congenital Hemoglobinopathies Using a Tailored Busulfan-Based Conditioning Regimen: Single-Center Experience.

    PubMed

    Zaidman, Irina; Rowe, Jacob M; Khalil, Abdalla; Ben-Arush, Myriam; Elhasid, Ronit

    2016-06-01

    Hematopoietic stem cell transplantation (HSCT) is the only proven curative option for patients with hemoglobinopathies, both thalassemia and sickle cell anemia (SCA). A busulfan-based myeloablative conditioning regimen is the standard of care for HSCT in these patients, although increased treatment-related morbidity, including veno-occlusive disease (VOD), has been demonstrated. Thirty-eight pediatric patients, median age 8 years (range, 6 months to 22 years), suffering from hemoglobinopathy were treated at Rambam Medical Center in Haifa, Israel, between 1998 and 2011. Thirty-four patients had thalassemia major and 4 had SCA. The 38 patients underwent 40 HSCTs, 34 of which were first transplants and 6 second transplants. Most transplants (32/40) were from matched sibling donors. Sources of stem cells were peripheral blood in 30 transplants, bone marrow in 7 transplants, and cord blood in 3 transplants. All received different customized busulfan-based conditioning regimens tailored by pharmacokinetic analysis of busulfan levels. Primary engraftment occurred in 37 of 40 transplants. Neutrophil engraftment (>.5 × 10(9)/L) occurred at a median of 15.3 days post-transplantation (range, 10 to 45). Platelet transfusion independence (>20 × 10(9)/L) occurred at a median of 22.3 days (range, 11 to 60). The rate of 5-year overall survival for thalassemia patients after first transplantation was 90.5% ± 5.3%. The rate of 5-year thalassemia-free survival was 81.7% ± 6.8%. Cumulative incidence of acute graft-versus-host disease (GVHD) was 17.6%. Rate of grades III to IV GVHD was 8.8%. Cumulative incidence of chronic GVHD was 23.5%, with 11.8% incidence of extensive chronic GVHD. One patient developed VOD. Full donor chimerism occurred in 36.4% of patients with class 1 + 2 thalassemia, compared with 78.6% in class 3 thalassemia (P = .049). Overall survival above 90% in patients undergoing their first transplant was demonstrated using busulfan

  17. Excellent long term patient and renal allograft survival after ABO-incompatible kidney transplantation: Experience of one center

    PubMed Central

    Melexopoulou, Christina; Marinaki, Smaragdi; Liapis, George; Skalioti, Chrysanthi; Gavalaki, Maria; Zavos, George; Boletis, John N

    2015-01-01

    AIM: To investigate the long-term results of ABO-incompatible (ABOi) kidney transplantation in a single center in Greece. METHODS: Thirty consecutive ABOi kidney transplantations were performed from June 2005 to December 2013. All patients received rituximab one month prior to transplantation. Immunoadsorption therapy was performed for the removal of anti-A/B IgG antibodies until the titer was ≤ 1:16. Additional apheresis sessions were performed post-operatively. Intravenous immunoglobulin and oral immunosuppression consisting of tacrolimus (TAC) in combination with either everolimus or mycophenolate acid was administered. We compared the long term results of our ABOi group to those of a matched group of 30 ABO compatible (ABOc) living kidney recipients with similar baseline characteristics. The ABOc recipients received an immunosuppressive regimen consisting of TAC and mycophenolate acid. All patients in both groups received induction therapy with Basiliximab or Daclizumab, whereas corticosteroids were instituted on the day of surgery. During the follow-up period, indication biopsies were performed and interpreted by an experienced nephropathologist. The parameters we analyzed included the following: Donor/recipient age, gender, blood type, human leukocyte antigen mismatches, panel reactive antibodies, primary cause of renal failure, mean time on dialysis, immunosuppressive regimen, patient survival, graft outcome, incidence of rejections, surgical and infectious complications. RESULTS: The mean follow-up period was 6 years (range 1 to 9 years). A mean of 5.0 ± 3.0 (range 0-14) pre-transplant immunoadsorptions were required in order to reach the target titer. Patient survival in ABOi group in comparison to ABOc group at 1, 3, 5 and 8 years did not differ significantly (100% vs 100%, 96% vs 100%, 92% vs 100% and 92% vs 100%, P = ns). Additionally, graft survival was similar in the two groups at the same time points (100% vs 100%, 96% vs 96%, 92% vs 96% and 81

  18. Doubled CO2 experiments with the Global Change Research Center two-dimensional statistical dynamical climate model

    NASA Astrophysics Data System (ADS)

    Mackay, R. M.; Khalil, M. A. K.

    1995-10-01

    The zonally averaged response of the Global Change Research Center two-dimensional (2-D) statistical dynamical climate model (GCRC 2-D SDCM) to a doubling of atmospheric carbon dioxide (350 parts per million by volume (ppmv) to 700 ppmv) is reported. The model solves the two-dimensional primitive equations in finite difference form (mass continuity, Newton's second law, and the first law of thermodynamics) for the prognostic variables: zonal mean density, zonal mean zonal velocity, zonal mean meridional velocity, and zonal mean temperature on a grid that has 18 nodes in latitude and 9 vertical nodes (plus the surface). The equation of state, p=ρRT, and an assumed hydrostatic atmosphere, Delta;p=-ρgΔz, are used to diagnostically calculate the zonal mean pressure and vertical velocity for each grid node, and the moisture balance equation is used to estimate the precipitation rate. The model includes seasonal variations in solar intensity, including the effects of eccentricity, and has observed land and ocean fractions set for each zone. Seasonally varying values of cloud amounts, relative humidity profiles, ozone, and sea ice are all prescribed in the model. Equator to pole ocean heat transport is simulated in the model by turbulent diffusion. The change in global mean annual surface air temperature due to a doubling of atmospheric CO2 in the 2-D model is 1.61 K, which is close to that simulated by the one-dimensional (1-D) radiative convective model (RCM) which is at the heart of the 2-D model radiation code (1.67 K for the moist adiabatic lapse rate assumption in 1-D RCM). We find that the change in temperature structure of the model atmosphere has many of the characteristics common to General Circulation Models, including amplified warming at the poles and the upper tropical troposphere, and stratospheric cooling. Because of the potential importance of atmospheric circulation feedbacks on climate change, we have also investigated the response of the zonal wind

  19. Real-Time Data Management, IP Telemetry, Data Integration, and Data Center Operations for the Source Physics Experiment (SPE), Nevada National Security Site

    NASA Astrophysics Data System (ADS)

    Plank, G.; Slater, D.; Torrisi, J.; Presser, R.; Williams, M.; Smith, K. D.

    2012-12-01

    The Nevada Seismological Laboratory (NSL) manages time-series data and high-throughput IP telemetry for the National Center for Nuclear Security (NCNS) Source Physics Experiment (SPE), underway on the Nevada National Security Site (NNSS). During active-source experiments, SPE's heterogeneous systems record over 350 channels of a variety of data types including seismic, infrasound, acoustic, and electro-magnetic. During the interim periods, broadband and short period instruments record approximately 200 channels of continuous, high-sample-rate seismic data. Frequent changes in sensor and station configurations create a challenging meta-data environment. Meta-data account for complete operational histories, including sensor types, serial numbers, gains, sample rates, orientations, instrument responses, data-logger types etc. To date, these catalogue 217 stations, over 40 different sensor types, and over 1000 unique recording configurations (epochs). Facilities for processing, backup, and distribution of time-series data currently span four Linux servers, 60Tb of disk capacity, and two data centers. Bandwidth, physical security, and redundant power and cooling systems for acquisition, processing, and backup servers are provided by NSL's Reno data center. The Nevada System of Higher Education (NSHE) System Computer Services (SCS) in Las Vegas provides similar facilities for the distribution server. NSL staff handle setup, maintenance, and security of all data management systems. SPE PIs have remote access to meta-data, raw data, and CSS3.0 compilations, via SSL-based transfers such as rsync or secure-copy, as well as shell access for data browsing and limited processing. Meta-data are continuously updated and posted on the Las Vegas distribution server as station histories are better understood and errors are corrected. Raw time series and refined CSS3.0 data compilations with standardized formats are transferred to the Las Vegas data server as available. For better

  20. The use of failure mode and effect analysis in a radiation oncology setting: the Cancer Treatment Centers of America experience.

    PubMed

    Denny, Diane S; Allen, Debra K; Worthington, Nicole; Gupta, Digant

    2014-01-01

    Delivering radiation therapy in an oncology setting is a high-risk process where system failures are more likely to occur because of increasing utilization, complexity, and sophistication of the equipment and related processes. Healthcare failure mode and effect analysis (FMEA) is a method used to proactively detect risks to the patient in a particular healthcare process and correct potential errors before adverse events occur. FMEA is a systematic, multidisciplinary team-based approach to error prevention and enhancing patient safety. We describe our experience of using FMEA as a prospective risk-management technique in radiation oncology at a national network of oncology hospitals in the United States, capitalizing not only on the use of a team-based tool but also creating momentum across a network of collaborative facilities seeking to learn from and share best practices with each other. The major steps of our analysis across 4 sites and collectively were: choosing the process and subprocesses to be studied, assembling a multidisciplinary team at each site responsible for conducting the hazard analysis, and developing and implementing actions related to our findings. We identified 5 areas of performance improvement for which risk-reducing actions were successfully implemented across our enterprise. PMID:22364244

  1. Surgical management of intradural spinal cord tumors in children and young adults: A single-center experience with 50 patients

    PubMed Central

    Özkan, Neriman; Jabbarli, Ramazan; Wrede, Karsten Henning; Sariaslan, Zeynep; Stein, Klaus Peter; Dammann, Philipp; Ringelstein, Adrian; Sure, Ulrich; Sandalcioglu, Erol Ibrahim

    2015-01-01

    Background: Intradural spinal cord tumors (IDSCTs) in children and young adults are rare diseases. This present study is aimed to demonstrate our experience with a large series of children and young adults with IDSCT. Methods: A total of 50 patients aged <20 years with IDSCT treated in our department between 1990 and 2010 were included in the study. Clinical, histological, and radiological findings, treatment strategies, and clinical outcome were retrospectively assessed. Depending on the relation to the spinal cord, IDSCT were dichotomized into intramedullary SCT (IMSCT) and extramedullary SCT (EMSCT). The functional outcome was evaluated with the Frankel score assessing the longest available follow-up period. Results: Mean age was 10.3 years (range 6 months–19 years). IDSCT surgery was performed in 44 patients (88%). A common first symptom in patients with EMSCT was neck and back pain (41%), whereas monoparesis of arms (43%) were often seen in patients with IMSCT. The main duration of the symptoms was longer in patients with IMSCT. The postoperative functional outcome was generally comparable to the preoperative functional condition, while better for EMSCT (P < 0.01). The functional outcome at last follow-up correlated significantly with the preoperative Frankel score (P < 0.002). Conclusion: Due to the mostly mild impact of the surgery on the functional outcome, the surgical treatment of IDSCT in children and young patients can be uniquely advocated. PMID:26713174

  2. Pre- and Postnatal Transplantation of Fetal Mesenchymal Stem Cells in Osteogenesis Imperfecta: A Two-Center Experience

    PubMed Central

    Westgren, Magnus; Shaw, S.W. Steven; Åström, Eva; Biswas, Arijit; Byers, Peter H.; Mattar, Citra N.Z.; Graham, Gail E.; Taslimi, Jahan; Ewald, Uwe; Fisk, Nicholas M.; Yeoh, Allen E.J.; Lin, Ju-Li; Cheng, Po-Jen; Choolani, Mahesh; Le Blanc, Katarina; Chan, Jerry K.Y.

    2014-01-01

    Osteogenesis imperfecta (OI) can be recognized prenatally with ultrasound. Transplantation of mesenchymal stem cells (MSCs) has the potential to ameliorate skeletal damage. We report the clinical course of two patients with OI who received prenatal human fetal MSC (hfMSC) transplantation and postnatal boosting with same-donor MSCs. We have previously reported on prenatal transplantation for OI type III. This patient was retransplanted with 2.8 × 106 same-donor MSCs per kilogram at 8 years of age, resulting in low-level engraftment in bone and improved linear growth, mobility, and fracture incidence. An infant with an identical mutation who did not receive MSC therapy succumbed at 5 months despite postnatal bisphosphonate therapy. A second fetus with OI type IV was also transplanted with 30 × 106 hfMSCs per kilogram at 31 weeks of gestation and did not suffer any new fractures for the remainder of the pregnancy or during infancy. The patient followed her normal growth velocity until 13 months of age, at which time longitudinal length plateaued. A postnatal infusion of 10 × 106 MSCs per kilogram from the same donor was performed at 19 months of age, resulting in resumption of her growth trajectory. Neither patient demonstrated alloreactivity toward the donor hfMSCs or manifested any evidence of toxicities after transplantation. Our findings suggest that prenatal transplantation of allogeneic hfMSCs in OI appears safe and is of likely clinical benefit and that retransplantation with same-donor cells is feasible. However, the limited experience to date means that it is not possible to be conclusive and that further studies are required. PMID:24342908

  3. Discontinuation of Anticoagulant or Antiplatelet Therapy for Transrectal Ultrasound-Guided Prostate Biopsies: A Single-Center Experience

    PubMed Central

    Casey, Rowan G; Galvin, David J; Manecksha, Rustom P; Varadaraj, Haradikar; McDermott, TED; Grainger, Ronald; Lynch, Thomas H

    2012-01-01

    Purpose Historically, it was thought that hemorrhagic complications were increased with transrectal ultrasound-guided prostate biopsies (TRUS biopsy) of patients receiving anticoagulation/antiplatelet therapy. However, the current literature supports the continuation of anticoagulation/antiplatelet therapy without additional morbidity. We assessed our experience regarding the continuation of anticoagulation/antiplatelet therapy during TRUS biopsy. Materials and Methods A total of 91 and 98 patients were included in the anticoagulation/antiplatelet (group I) and control (group II) groups, respectively. Group I subgroups consisted of patients on monotherapy or dual therapy of aspirin, warfarin, clopidogrel, or low molecular weight heparin. The TRUS biopsy technique was standardized to 12 cores from the peripheral zones. Patients completed a questionnaire over the 7 days following TRUS biopsy. The questionnaire was designed to assess the presence of hematuria, rectal bleeding, and hematospermia. Development of rectal pain, fever, and emergency hospital admissions following TRUS biopsy were also recorded. Results The patients' mean age was 65 years (range, 52 to 74 years) and 63.5 years (range, 54 to 74 years) in groups I and II, respectively. The overall incidence of hematuria was 46% in group I compared with 63% in group II (p=0.018). The incidence of hematospermia was 6% and 10% in groups I and II, respectively. The incidence of rectal bleeding was similar in group I (40%) and group II (39%). Statistical analysis was conducted by using Fisher exact test. Conclusions There were fewer hematuria episodes in anticoagulation/antiplatelet patients. This study suggests that it is not necessary to discontinue anticoagulation/antiplatelet treatment before TRUS biopsy. PMID:22536465

  4. Use of small bowel capsule endoscopy in patients with chronic kidney disease: experience from a University Referral Center

    PubMed Central

    Docherty, Emily; Koulaouzidis, Anastasios; Douglas, Sarah; Plevris, John N.

    2015-01-01

    Background There are only few reports on the diagnostic yield (DY) of small bowel capsule endoscopy (SBCE) in patients with chronic kidney disease (CKD). We aim to report our SBCE experience in patients with CKD. Methods Retrospective study; case notes of patients with low estimated glomerular filtration rate (eGFR) who underwent SBCE (March 2005-August 2012) for anemia and/or obscure gastrointestinal bleeding (OGIB) were retrieved and abstracted. Severity of CKD was defined according to Renal Association recommendations as: stage 3 (eGFR: 30-59); stage 4 (eGFR: 15-29); and stage 5 (eGFR <15 or on dialysis). Results In the aforementioned period, 69 patients with CKD [stage 3: 65/69 (92.8%), stage 4 or 5:4/69 (7.2%)] had SBCE. 51/65 (78.5%) patients with stage 3 CKD had SBCE due to unexplained anemia and/or OGIB [43 (66.1%) and 8 (12.3%), respectively]. In 25/51 (49%), the SBCE was normal and in 17/51 (33.3%) showed small-bowel angiectasias. Other findings were active bleeding (n=2), fold edema (n=2), ileal erosions (n=1), adenocarcinoma (n=1), and inconclusive/videos not available (n=3). All patients (n=4) with CKD grade 4 or 5 were referred due to unexplained anemia; 3/4 (75%) had angiectasias and 1 normal SBCE. Fecal calprotectin (FC) was measured in 12 patients with CKD stage 3 and unexplained anemia prior to their SBCE; no significant small-bowel inflammation was found in this subgroup. Conclusion SBCE has limited DY in CKD patients referred for unexplained anemia. Sinister SB pathology is rare, while the most common finding is angiectasias. Furthermore, FC measurement prior to SBCE -in this cohort of patients- is not associated with increased DY. PMID:25608445

  5. Home Mechanical Ventilation in Childhood-Onset Hereditary Neuromuscular Diseases: 13 Years’ Experience at a Single Center in Korea

    PubMed Central

    Han, Young Joo; Park, June Dong; Lee, Bongjin; Choi, Yu Hyeon; Suh, Dong In; Lim, Byung Chan; Chae, Jong-Hee

    2015-01-01

    Introduction Children with hereditary neuromuscular diseases (NMDs) are at a high risk of morbidity and mortality related to respiratory failure. The use of home mechanical ventilation (HMV) has saved the lives of many children with NMD but, due to a lack of studies, dependable guidelines are not available. We drew upon our experience to compare the various underlying NMDs and to evaluate HMV with regard to respiratory morbidity, the proper indications and timing for its use, and to develop a policy to improve the quality of home noninvasive ventilation (NIV). Methods We retrospectively analyzed the medical records of 57 children with childhood-onset hereditary NMDs in whom HMV was initiated between January 2000 and May 2013 at Seoul National University Children's Hospital. The degree of respiratory morbidity was estimated by the frequency and duration of hospitalizations caused by respiratory distress. Results The most common NMD was spinal muscular atrophy (SMA, n = 33). Emergent mechanical ventilation was initiated in 44% of the patients before the confirmed diagnosis, and the indicators of pre-HMV respiratory morbidity (e.g., extubation trials, hypoxia, hospitalizations, and intensive care unit stay) were greater in these patients than in others. The proportion of post-HMV hospitalizations (range, 0.00−0.52; median, 0.01) was lower than that of pre-HMV hospitalizations (0.02−1.00; 0.99) (P < 0.001). Eight patients were able to maintain home NIV. The main causes of NIV failure were air leakage and a large amount of airway secretions. Conclusions The application of HMV helped reduce respiratory morbidity in children with childhood-onset hereditary NMD. Patients with SMA type I can benefit from an early diagnosis and the timely application of HMV. The choice between invasive and noninvasive HMV should be based on the patient’s age and NIV trial tolerance. Systematic follow-up guidelines provided by a multidisciplinary team are needed. PMID:25822836

  6. Learning to “Swim” with the Experts: Experiences of Two Patient Co-Investigators for a Project Funded by the Patient-Centered Outcomes Research Institute

    PubMed Central

    Robbins, Michele; Tufte, Janice; Hsu, Clarissa

    2016-01-01

    The Patient-Centered Outcomes Research Institute (PCORI), established in 2010, launched a new model of incorporating stakeholder perspectives into health care research. To ensure that PCORI-funded studies address issues important to health care consumers, all projects must fully involve patients and other stakeholders in every step of the research process: from planning and design to implementation and dissemination of results. As members of the first cohort of PCORI-funded researchers, our team was on the forefront of developing new approaches to engaging patients in research. One innovation we pioneered was the creation of a “patient co-investigator” role for two nonscientists who were recruited to be active members of the research team throughout the project. This commentary, based on our experiences, aims to help other research teams to 1) understand how to effectively collaborate with stakeholder team members such as patients; 2) anticipate possible challenges; and 3) offer tools for the orientation, training, and integration of patients into a scientific team. Written from the perspective of two PCORI patient co-investigators, our commentary provides lessons learned and recommendations about incorporating nonscientists into research teams. Specifically, we suggest recruiting people with a record of relevant volunteer experience and commitment; establishing a formal application process that provides candidates with details about expectations and responsibilities; and providing comprehensive orientation with ongoing training, encouragement, and support. We hope the points in this commentary help research teams that are incorporating patient co-investigators move toward a positive and productive experience. PMID:27083011

  7. From Margins to Center: An Oral History of the Wartime Experience of Iranian Nurses in Iran-Iraq War, 1980-1988.

    PubMed

    Peyrovi, Hamid; Parsa-Yekta, Zohreh; Vosoughi, Mohammad Bagher; Fathiyan, Nasrollah; Ghadirian, Fataneh

    2014-11-10

    Abstract Background: The extensive nature of the Iraq-Iran war converted to a human tragedy with large casualties; it has affected nursing discipline dramatically. Aim: To analyze the history of the wartime experience of Iranian nurses in Iran-Iraq war. Method: The current study was conducted with oral history. The study sample consisted of 13 Iranian nurses who served in the war zones during the wartime. Purposive and snowball sampling were used to recruit the participants. During the face-to-face interviews, participants were asked to describe their experience in the war zones at the war years. Data collection and analysis took place from April to August 2013, when saturation was reached. All interviews were tape recorded and transcribed and then analyzed with thematic content analysis. Results: Finally, 5 themes and 18 subthemes emerged from data analysis of significant statements from 17 interviews. The five emerged themes included (1) "From margin to center," (2) "Development of referral care," (3) "Personal and professional growth and development," (4) "The emerging pillar of culture in war nursing," and (5) "Threats to nursing at the war". Conclusion and relevance to clinical practice: Nursing in Iran at wartime has a difficult path to development. There are powerful implications for clinical practice. It is recommended to continue collection, archiving, and analyzing the wartime experiences of Iranian nurses. PMID:25381871

  8. Patient experiences with self-monitoring renal function after renal transplantation: results from a single-center prospective pilot study

    PubMed Central

    van Lint, Céline L; van der Boog, Paul JM; Wang, Wenxin; Brinkman, Willem-Paul; Rövekamp, Ton JM; Neerincx, Mark A; Rabelink, Ton J; van Dijk, Sandra

    2015-01-01

    Background After a kidney transplantation, patients have to visit the hospital often to monitor for early signs of graft rejection. Self-monitoring of creatinine in addition to blood pressure at home could alleviate the burden of frequent outpatient visits, but only if patients are willing to self-monitor and if they adhere to the self-monitoring measurement regimen. A prospective pilot study was conducted to assess patients’ experiences and satisfaction. Materials and methods For 3 months after transplantation, 30 patients registered self-measured creatinine and blood pressure values in an online record to which their physician had access to. Patients completed a questionnaire at baseline and follow-up to assess satisfaction, attitude, self-efficacy regarding self-monitoring, worries, and physician support. Adherence was studied by comparing the number of registered with the number of requested measurements. Results Patients were highly motivated to self-monitor kidney function, and reported high levels of general satisfaction. Level of satisfaction was positively related to perceived support from physicians (P<0.01), level of self-efficacy (P<0.01), and amount of trust in the accuracy of the creatinine meter (P<0.01). The use of both the creatinine and blood pressure meter was considered pleasant and useful, despite the level of trust in the accuracy of the creatinine device being relatively low. Trust in the accuracy of the creatinine device appeared to be related to level of variation in subsequent measurement results, with more variation being related to lower levels of trust. Protocol adherence was generally very high, although the range of adherence levels was large and increased over time. Conclusion Patients’ high levels of satisfaction suggest that at-home monitoring of creatinine and blood pressure after transplantation offers a promising strategy. Important prerequisites for safe implementation in transplant care seem to be support from physicians

  9. Percutaneous peripheral rotational ablation using the Rotablator: immediate and mid term results. Single center experience concerning 146 lesions treated.

    PubMed

    Henry, M; Amor, M; Ethevenot, G; Henry, I

    1993-09-01

    In order to assess the role of percutaneous peripheral rotational ablation using Rotablator (PPRA), 95 symptomatic patients (58 M, 37 F, m. age: 77 +/- 1 y) (r: 50-90 y) having 146 peripheral vascular lesions (PVL) were treated by PPRA. 59% were below the knee and 41% above. The runoff status (n of distal leg art. involved) was as follows: 3:52 pts, 2:23 pts, 1:14 pts, 0:6 pts. The femoral lesions were significantly longer than those at other sites (5.27 +/- 0.43 vs 2.97 +/- 0.3 cm) (p < 0.001). The mean length was 3.73 +/- 0.26 cm (r: 1-20 cm). Complementary PTA was significantly (p < 0.001) more frequent in femoro-popliteal (32 PTA/48 Fem, 5 PTA/12 Pop) than in distal leg lesions (10/86.). RESULTS. After PPRA alone (99 PVL) the stenosis % decreased from 81 +/- 0.75 to 18 +/- 1.1. The residual stenosis was greater at femoral (26 +/- 2.3%) than at distal leg level (16 +/- 1.2%) (p < 0.01). Complementary PTA (47 PVL) lowered residual stenosis from 44% to 13%. 52 complications (spasm, perforation, dissection, distal emboli, no reflow, others) were cured in 47 PVL. Thus our primary technical success per PVL was 97% and per pt 95%. The mean follow-up period was 11 +/- 1 mths (r: 1-37 m). Among 78 pts having a follow-up period > or = 4 mths, 74 pts representing 115 treated PVL underwent an angiography control (2 deaths, 2 lost for follow-up). 87 lesions (76%) showed no restenosis and 28 lesions (34%) showed restenosis of 83 +/- 2.4% (r: 50-100%). The restenosis rate was higher in femoral (12/21: 36%) than in distal (15/58: 21%) or popliteal arteries (1/8: 12%). Restenosis was more frequent for PVL > or = 7 cm (67% vs 16%) (p < 0.001) at all sites. This result together with the complication rate would seem to indicate that lesions > or = 6.7 cm would be a limitation for PPRA. CONCLUSIONS. In our experience Percutaneous Peripheral Rotational Ablation has taken a pre-eminent position in the treatment of distal leg arteries. Our results lead us to broaden its indications to

  10. Continuous Flow Device Support in Children Using the HeartWare HVAD: 1,000 Days of Lessons Learned From a Single Center Experience.

    PubMed

    Sparks, Joshua; Epstein, Deirdre; Baltagi, Sirine; Mehegan, Mary E; Simpson, Kathleen E; Canter, Charles E; Silvestry, Scott; Eghtesady, Pirooz; Boston, Umar S

    2015-01-01

    The purpose of this study is to provide a single center experience with a continuous flow device in adolescents with end-stage heart failure. A retrospective single center analysis of patients aged 18 years or younger implanted with HVAD (HeartWare Inc, Framingham, MA) between October 2012 and March 2014 was performed. Demographics, preimplant and postimplant clinical data, survival, and adverse events (AEs) were recorded. A matched group of adults based on diagnosis, body surface area (BSA), and time period were used for outcome comparisons. Six adolescents with dilated cardiomyopathy were implanted with the HVAD. Median age and BSA were 13.4 years and 1.45 m2, respectively. All were Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) profile-1 or profile-2. Median days on device were 108 with total patient-days on device of 1,017. Four adolescents were discharged home on device all in New York Heart Association 1. Five underwent transplantation with 100% survival. There were 18 AEs with one AE per 170 days on device. Compared with the adult cohort (n = 5), there was no difference in 1 year survival (p = 0.32). HVAD support in adolescents is highly successful as a bridge to transplantation. It provides early rehabilitation and improvement in quality of life. Morbidity is not negligible but appears comparable with that seen in adults. PMID:25967955

  11. Feasibility of Telerehabilitation Implementation as a Novel Experience in Rehabilitation Academic Centers and Affiliated Clinics in Tehran: Assessment of Rehabilitation Professionals' Attitudes

    PubMed Central

    Movahedazarhouligh, Sara; Vameghi, Roshanak; Hatamizadeh, Nikta; Bakhshi, Enayatollah; Moosavy Khatat, Seyed Muhammad

    2015-01-01

    Introduction. This study aimed to assess rehabilitation professionals' attitude toward implementation and application of telerehabilitation technology as a novel study in rehabilitation academic centers and affiliated clinics in Tehran. Methods. It was a descriptive cross-sectional study. To collect data, a researcher-designed questionnaire was developed. 141 rehabilitation experts participated in the study. Results. A majority of faculty members (78%) and clinicians (89.7%) either were in “definite agreement” or “somewhat agreed” with implementation and application of this technology, which demonstrates an overall positive attitude. Discussion. Based on the positive attitudes of the majority of participants toward implementation and application of this technology and their preferences in offering different telerehabilitation services, it seems that there is an appropriate and desirable acceptance and administrative culture to implement this technology among rehabilitation experts in Tehran. It is thus expected that implementation and application of this technology will be a promising experience in rehabilitation academic centers and affiliate clinics in Tehran. PMID:26640483

  12. Breast Imaging Utilizing Dedicated Gamma Camera and (99m)Tc-MIBI: Experience at the Tel Aviv Medical Center and Review of the Literature Breast Imaging.

    PubMed

    Even-Sapir, Einat; Golan, Orit; Menes, Tehillah; Weinstein, Yuliana; Lerman, Hedva

    2016-07-01

    The scope of the current article is the clinical role of gamma cameras dedicated for breast imaging and (99m)Tc-MIBI tumor-seeking tracer, as both a screening modality among a healthy population and as a diagnostic modality in patients with breast cancer. Such cameras are now commercially available. The technology utilizing a camera composed of a NaI (Tl) detector is termed breast-specific gamma imaging. The technology of dual-headed camera composed of semiconductor cadmium zinc telluride detectors that directly converts gamma-ray energy into electronic signals is termed molecular breast imaging. Molecular breast imaging system has been installed at the Department of Nuclear medicine at the Tel Aviv Sourasky Medical Center, Tel Aviv in 2009. The article reviews the literature well as our own experience. PMID:27237439

  13. Acute and late obstruction of a modified Blalock-Taussig shunt: a two-center experience in different catheter-based methods of treatment.

    PubMed

    Moszura, Tomasz; Zubrzycka, Maria; Michalak, Krzysztof W; Rewers, Bozena; Dryzek, Pawel; Moll, Jacek J; Sysa, Andrzej; Burczynski, Piotr

    2010-05-01

    Modified Blalock-Taussig (B-T) shunt occlusion results in a sudden reduction of pulmonary vascular perfusion, causing dramatic saturation drop and cyanosis which pose a direct hazard to a child's life. The results of percutaneous local r-tpa infusion, balloon angioplasty and additionally stent implantation in obstructed modified B-T shunts were studied to assess their role as an alternative to a re-do surgery. We outline two pediatric centers' experience (period 2004-2008) regarding the effectiveness of various emergency treatment methods for occlusion or critical stenosis of systemic-to-pulmonary arterial shunts in 23 children. Local r-tpa infusion via catheter was performed in 12/23 patients, balloon angioplasty in 22/23 and additionally stent implantation in 3/23 children. Procedures were successful in 22/23 patients (96%), with an increase in arterial saturation [average: 30%; standard deviation (S.D.) 15%; Shapiro-Wilk test; dependent t-test-P<0.01]. Unrestricted contrast flow was achieved in 18 patients, reduced central flow in three and minimal flow in one child. Neither local nor systemic complications occurred. Our experience demonstrates the possibility of successful early shunt recanalization with the use of local thrombolytic therapy combined with the balloon angioplasty. The presence of old fixed thrombus with neointimal hypertrophy in the shunt constitutes an indication for endovascular stent implantation. PMID:20139195

  14. The National Environmental Respiratory Center (NERC) experiment in multi-pollutant air quality health research: I. Background, experimental strategy and critique.

    PubMed

    Mauderly, Joe L

    2014-09-01

    The National Environmental Respiratory Center Program was initiated as an experiment to explore strategies for identifying the components of complex air pollution mixtures that cause health effects associated statistically with air pollution. A strategy involving multivariate analysis of a composition-concentration-response database was adopted. A novel database was created by exposing rodents daily for up to six months to one of four combustion-related mixtures and measuring respiratory, cardiovascular and general toxicological responses after one week or six months of exposure. The mixtures included multiple concentrations of diesel and gasoline engine exhaust, hardwood smoke and simulated downwind coal combustion emissions. After reporting the biological effects of each mixture and comparing effects among them, 47 significant effects were selected for multiple additive regression tree analysis to identify putative causal components. Although the four mixtures provided a database marginally sufficient for the analysis, the results suggested the putative causes of 19 significant effects with acceptable confidence. This article describes and critiques the Program and its strategy. The integrated results are presented in two accompanying papers, and mixture-specific results were presented in preceding papers, which are cited. The experiment demonstrated the potential utility of the general approach and identified certain cause-effect relationships for confirmatory studies. A follow-up study provided support for causation by the components implicated for one of those relationships. The advantages and disadvantages of the Program's management and funding strategies are discussed. PMID:25162718

  15. Research ethics review practices: experiences of the Armauer Hansen Research Institute/All Africa Leprosy and Tuberculosis Rehabilitation and Training Center Ethics Review Committee, Ethiopia.

    PubMed

    Wassie, Liya; Woldeamanuel, Yimtubezinash; Gebre-Mariam, Senkenesh; Feleke, Yeweyenhareg; Temam, Fuad; Hailu, Abebe; Abay, Hiwot; Zerihun, Zeyin; Bussa, Solomon; Aberra, Lensa; Tarekegne, Geremew; Gebre-Yohannes, Asfawessen; Aseffa, Abraham

    2015-01-01

    The need for ethics review committees (ERCs) is imperative in the conduct of research to ensure the protection of the rights, safety and well-being of research participants. However, the capacities of most ERCs in Africa are limited in terms of trained experts, competence, resources as well as standard operating procedures. The aim of this report is to share experiences of one of the local institutional ERCs, the Armauer Hansen Research Institute (AHRI)/All Africa Leprosy and Tuberculosis Rehabilitation and Training Center (ALERT) Ethics Review Committee (AAERC), to other ERCs found in academic and research institutions in the Country. In this report, we used an empirical approach to review archived documents of the AAERC Secretariat to assess the Committee's strengths and weaknesses. The experiences of the AAERC in terms of its composition, routine work activities, learning practices and pitfalls that require general attention are summarized. In spite of this summary, the Committee strongly acknowledges the functions and roles of other ERCs in the Country. In addition, an independent assessment of the Committee's activity in general is warranted to evaluate its performance and further assess the level of awareness or oversights among researchers about the roles of ERCs. PMID:25816497

  16. Health Services OutPatient Experience questionnaire: factorial validity and reliability of a patient-centered outcome measure for outpatient settings in Italy

    PubMed Central

    Coluccia, Anna; Ferretti, Fabio; Pozza, Andrea

    2014-01-01

    Purpose The patient-centered approach to health care does not seem to be sufficiently developed in the Italian context, and is still characterized by the biomedical model. In addition, there is a lack of validated outcome measures to assess outpatient experience as an aspect common to a variety of settings. The current study aimed to evaluate the factorial validity, reliability, and invariance across sex of the Health Services OutPatient Experience (HSOPE) questionnaire, a short ten-item measure of patient-centeredness for Italian adult outpatients. The rationale for unidimensionality of the measure was that it could cover global patient experience as a process common to patients with a variety of diseases and irrespective of the phase of treatment course. Patients and methods The HSOPE was compiled by 1,532 adult outpatients (51% females, mean age 59.22 years, standard deviation 16.26) receiving care in ten facilities at the Santa Maria alle Scotte University Hospital of Siena, Italy. The sample represented all the age cohorts. Twelve percent were young adults, 57% were adults, and 32% were older adults. Exploratory and confirmatory factor analyses were conducted to evaluate factor structure. Reliability was evaluated as internal consistency using Cronbach’s α. Factor invariance was assessed through multigroup analyses. Results Both exploratory and confirmatory analyses suggested a clearly defined unidimensional structure of the measure, with all the ten items having salient loadings on a single factor. Internal consistency was excellent (α=0.95). Indices of model fit supported a single-factor structure for both male and female outpatient groups. Young adult outpatients had significantly lower scores on perceived patient-centeredness relative to older adults. No significant difference emerged on patient-centeredness between male and female outpatients. Conclusion The HSOPE questionnaire seemed to be a tool with high acceptability and excellent psychometric

  17. WE-G-BRE-07: Proton Therapy Enhanced by Tumor-Targeting Gold Nanoparticles: A Pilot in Vivo Experiment at The Proton Therapy Center at MD Anderson Cancer Center

    SciTech Connect

    Wolfe, T; Grant, J; Wolfe, A; Gillin, M; Krishnan, S

    2014-06-15

    Purpose: Assess tumor-growth delay and survival in a mouse model of prostate cancer treated with tumor-targeting gold nanoparticles (AuNPs) and proton therapy. Methods: We first examined the accumulation of targeting nanoparticles within prostate tumors by imaging AuNPs with ultrasound-guided photoacoustics at 24h after the intravenous administration of goserelin-conjugated AuNPs (gAuNP) in three mice. Nanoparticles were also imaged at the cellular level with TEM in PC3 cells incubated with gAuNP for 24h. Pegylated AuNPs (pAuNP) were also imaged in vivo and in vitro for comparison. PC3 cells were then implanted subcutaneously in nude mice; 51mice with 8–10mm tumors were included. AuNPs were injected intravenously at 0.2%w/w final gold concentration 24h before irradiation. A special jig was designed to facilitate tumor irradiation perpendicular to the proton beam. Proton energy was set to 180MeV, the radiation field was 18×18cm{sup 2}, and 9cm or 13.5cm thick solid-water compensators were used to position the tumors at either the beam entrance (BE) or the SOBP. Physical doses of 5Gy were delivered to all tumors on a patient beam line at MD Anderson's Proton Therapy Center. Results: The photoacoustic experiment reveled that our nanoparticles leak from the tumor-feeding vasculature and accumulate within the tumor volume over time. Additionally, TEM images showed gAuNP are internalized in cancer cells, accumulating within the cytoplasm, whereas pAuNP are not. Tumor-growth was delayed by 11 or 32days in mice receiving gAuNP irradiated at the BE or the SOBP, relative to proton radiation alone. Survival curves (ongoing experiment) reveal that gAuNPs improved survival by 36% or 74% for tumors irradiated at the BE or SOBP. Conclusion: These important, albeit preliminary, in vivo findings reveal nanoparticles to be potent sensitizers to proton therapy. Further, conjugation of AuNPs to tumor-specific antigens that promote enhanced cellular internalization improved both

  18. Intensity-Modulated Radiotherapy in the Treatment of Oropharyngeal Cancer: An Update of the Memorial Sloan-Kettering Cancer Center Experience

    SciTech Connect

    Setton, Jeremy; Caria, Nicola; Romanyshyn, Jonathan; Koutcher, Lawrence; Wolden, Suzanne L.; Zelefsky, Michael J.; Rowan, Nicholas; Sherman, Eric J.; Fury, Matthew G.; Pfister, David G.; Wong, Richard J.; Shah, Jatin P.; Kraus, Dennis H.; Shi Weiji; Zhang Zhigang; Schupak, Karen D.; Gelblum, Daphna Y.; Rao, Shyam D.; Lee, Nancy Y.

    2012-01-01

    Purpose: To update the Memorial Sloan-Kettering Cancer Center's experience with intensity-modulated radiotherapy (IMRT) in the treatment of oropharyngeal cancer (OPC). Methods and Materials: Between September 1998 and April 2009, 442 patients with histologically confirmed OPC underwent IMRT at our center. There were 379 men and 63 women with a median age of 57 years (range, 27-91). The disease was Stage I in 2%, Stage II in 4%, Stage III in 21%, and Stage IV in 73% of patients. The primary tumor subsite was tonsil in 50%, base of tongue in 46%, pharyngeal wall in 3%, and soft palate in 2%. The median prescription dose to the planning target volume of the gross tumor was 70 Gy for definitive (n = 412) cases and 66 Gy for postoperative cases (n = 30). A total 404 patients (91%) received chemotherapy, including 389 (88%) who received concurrent chemotherapy, the majority of which was platinum-based. Results: Median follow-up among surviving patients was 36.8 months (range, 3-135). The 3-year cumulative incidence of local failure, regional failure, and distant metastasis was 5.4%, 5.6%, and 12.5%, respectively. The 3-year OS rate was 84.9%. The incidence of late dysphagia and late xerostomia {>=}Grade 2 was 11% and 29%, respectively. Conclusions: Our results confirm the feasibility of IMRT in achieving excellent locoregional control and low rates of xerostomia. According to our knowledge, this study is the largest report of patients treated with IMRT for OPC.

  19. The Magnetospheric Multiscale (MMS) Mission Science Data Center: Technologies, Methods, and Experiences in Making Available Large Volumes of In-Situ Particle and Field Data

    NASA Astrophysics Data System (ADS)

    Pankratz, Christopher; Kokkonen, Kim; Larsen, Kristopher; Panneton, Russell; Putnam, Brian; Schafer, Corey; Baker, Daniel; Burch, James

    2016-04-01

    On September 1, 2015 the Magnetospheric MultiScale (MMS) constellation of four satellites completed their six-month commissioning period and began routine science data collection. Science operations for the mission is conducted at the Science Operations Center (SOC) at the Laboratory for Atmospheric and Space Physics, University of Colorado in Boulder, Colorado, USA. The MMS Science Data Center (SDC) is a component of the SOC responsible for the data production, management, dissemination, archiving, and visualization of the data from the extensive suite of 100 instruments onboard the four spacecraft. As of March 2016, MMS science data are openly available to the entire science community via the SDC. This includes hundreds of science parameters, and 50 gigabytes of data per day distributed across thousands of data files. Products are produced using integrated software systems developed and maintained by teams at other institutions using their own institutional software management procedures and made available via a centralized public web site and web services. To accomplish the data management, data processing, and system integration challenges present on this space mission, the MMS SDC incorporates a number of evolutionary techniques and technologies. This presentation will provide an informatics-oriented view of the MMS SDC, summarizing its technical aspects, novel technologies and data management practices that are employed, experiences with its design and development, and lessons learned. Also presented is the MMS "Scientist-in-the-Loop" (SITL) system, which is used to leverage human insight and expertise to optimize the data selected for transmission to the ground. This smoothly operating system entails the seamless interoperability of multiple mission facilities and data systems that ultimately translate scientist insight into uplink commands that triggers optimal data downlink to the ground.

  20. Comment on Cross, Fine, Jones, and Walsh (2012): Do Mental Health Professionals Who Serve on/with Child Advocacy Centers Experience Role Conflict?

    ERIC Educational Resources Information Center

    Friend, Colleen

    2012-01-01

    Cross, Fine, Jones, and Walsh's (2012) article "Mental Health Professionals in Children's Advocacy Centers: Is There Role Conflict?" challenges two recent publications' criticisms that child advocacy centers create role conflict for mental health professionals and explains how child advocacy centers actually work, describing the different roles…

  1. A Review of Experience: Establishing, Operating, Evaluating a Demonstration Nursery Center for the Daytime Care of Infants and Toddlers, 1967-1970. Final Report.

    ERIC Educational Resources Information Center

    Keister, Mary Elizabeth

    This document is the final report of Phase One (1967-1970) of the Group Care of Infants Demonstration (Center) Project. This report devotes major attention to the problems of establishing, operating, and evaluating a group day care center for infant and toddler care. The Center project describes what is required to provide housing, equipment,…

  2. Tsukuba VLBI Analysis Center

    NASA Technical Reports Server (NTRS)

    Kurihara, Shinobu; Nozawa, Kentaro

    2013-01-01

    The Tsukuba Analysis Center is funded by the Geospatial Information Authority of Japan (GSI). The c5++ analysis software is regularly used for the IVS-INT2 analysis and the ultra-rapid EOP experiments.

  3. Journey to the Patient-Centered Medical Home: A Qualitative Analysis of the Experiences of Practices in the National Demonstration Project

    PubMed Central

    Nutting, Paul A.; Crabtree, Benjamin F.; Miller, William L.; Stewart, Elizabeth E.; Stange, Kurt C.; Jaén, Carlos Roberto

    2010-01-01

    PURPOSE We describe the experience of practices in transitioning toward patient-centered medical homes (PCMHs) in the National Demonstration Project (NDP). METHODS The NDP was launched in June 2006 as the first national test of a model of the PCMH in a diverse sample of 36 family practices, randomized to facilitated and self-directed intervention groups. An independent evaluation team used a multimethod evaluation strategy, analyzing data from direct observation, depth interviews, e-mail streams, medical records, and patient and practice surveys. The evaluation team reviewed data from all practices as they became available and produced interim summaries. Four 2- to 3-day evaluation team retreats were held during which case summaries of all practices were discussed and patterns were described. RESULTS The 6 themes that emerged from the data reflect major shifts in individual and practice roles and identities, as well as changes in practices’ management strategies. The themes are (1) practice adaptive reserve is critical to managing change, (2) developmental pathways to success vary considerably by practice, (3) motivation of key practice members is critical, (4) the larger system can help or hinder, (5) practice transformation is more than a series of changes and requires shifts in roles and mental models, and (6) practice change is enabled by the multiple roles that facilitators play. CONCLUSIONS Transformation to a PCMH requires more than a sequence of discrete changes. The practice transformation process may be fostered by promoting adaptive reserve and local control of the developmental pathway. PMID:20530394

  4. Improving chronic illness care for veterans within the framework of the Patient-Centered Medical Home: experiences from the Ann Arbor Patient-Aligned Care Team Laboratory.

    PubMed

    Piette, John D; Holtz, Bree; Beard, Ashley J; Blaum, Caroline; Greenstone, C Leo; Krein, Sarah L; Tremblay, Adam; Forman, Jane; Kerr, Eve A

    2011-12-01

    While key components of the Patient-Centered Medical Home (PCMH) have been described, improved patient outcomes and efficiencies have yet to be conclusively demonstrated. We describe the rationale, conceptual framework, and progress to date as part of the VA Ann Arbor Patient-Aligned Care Team (PACT) Demonstration Laboratory, a clinical care-research partnership designed to implement and evaluate PCMH programs. Evidence and experience underlying this initiative is presented. Key components of this innovation are: (a) a population-based registry; (b) a navigator system that matches veterans to programs; and (c) a menu of self-management support programs designed to improve between-visit support and leverage the assistance of patient-peers and informal caregivers. This approach integrates PCMH principles with novel implementation tools allowing patients, caregivers, and clinicians to improve disease management and self-care. Making changes within a complex organization and integrating programmatic and research goals represent unique opportunities and challenges for evidence-based healthcare improvements in the VA. PMID:24073085

  5. A global health elective for US medical students: the 35 year experience of the State University of New York, Downstate Medical Center, School of Public Health.

    PubMed

    Bruno, Denise Marie; Imperato, Pascal James

    2015-04-01

    The School of Public Health at the State University of New York, Downstate Medical Center has sponsored a 6-8 week global health elective for fourth year medical students since 1980. The purpose of this elective is to provide students with an opportunity to observe the health care and public health delivery systems in low-income countries, provide medical service and have a cross-cultural experience. Over the course of the past 35 years, 388 students have participated in this global health elective in more than 41 low-income countries. The most popular sites include the Dominican Republic, Guatemala, India, Kenya and Thailand. Overall, interest in this elective has persisted throughout the course of time, sometimes temporarily increasing or decreasing with outside factors, such as the events of 11 September 2001 and the outbreak of Severe Acute Respiratory Syndrome in Asia. Recent annual applications for this elective have been as high as 44 out of a class of 200 students. Over the past 10 years, annual acceptance rates have varied, ranging from a low of 32 % in 2007-2008 to a high of 74 % in 2010-2011 and 2013-2014. Careful screening, including a written application, review of academic records and personal interviews has resulted in the selection of highly mature, adaptable and dedicated students who have performed well at overseas sites. Student rated satisfaction levels with this elective are almost universally high, with most rating it the best experience of their medical school years. Students undergo extensive preparation prior to their travel overseas, including a review of individual health and safety issues, travel and lodging, and the nature of the host country culture, health care system and assignment site. Downstate medical students are especially experienced in cross-cultural understanding because of the unusual diversity of the patient population in Brooklyn, and the diversity of local hospital staff and the medical school class. The Alumni Fund of

  6. International telepathology consultation: Three years of experience between the University of Pittsburgh Medical Center and KingMed Diagnostics in China

    PubMed Central

    Zhao, Chengquan; Wu, Tao; Ding, Xiangdong; Parwani, Anil V.; Chen, Hualin; McHugh, Jeffrey; Piccoli, Anthony; Xie, Qinling; Lauro, Gonzalo Romero; Feng, Xiaodong; Hartman, Douglas J.; Seethala, Raja R.; Wu, Shangwei; Yousem, Samuel; Liang, Yaoming; Pantanowitz, Liron

    2015-01-01

    Background: Telepathology is increasingly being employed to support diagnostic consultation services. Prior publications have addressed technology aspects for telepathology, whereas this paper will address the clinical telepathology experience of KingMed Diagnostics, the largest independent pathology medical laboratory in China. Beginning in 2012 the University of Pittsburgh Medical Center (UPMC) and KingMed Diagnostics partnered to establish an international telepathology consultation service. Materials and Methods: This is a retrospective study that summarizes the telepathology experience and diagnostic consultation results between UPMC and KingMed over a period of 3 years from January 2012 to December 2014. Results: A total of 1561 cases were submitted for telepathology consultation including 144 cases in 2012, 614 cases in 2013, and 803 in 2014. Most of the cases (61.4%) submitted were referred by pathologists, 36.9% by clinicians, and 1.7% by patients in China. Hematopathology received the most cases (23.7%), followed by bone/soft tissue (21.0%) and gynecologic/breast (20.2%) subspecialties. Average turnaround time (TAT) per case was 5.4 days, which decreased from 6.8 days in 2012 to 5.0 days in 2014. Immunostains were required for most of the cases. For some difficult cases, more than one round of immunostains was needed, which extended the TAT. Among 855 cases (54.7%) where a primary diagnosis or impression was provided by the referring local hospitals in China, the final diagnoses rendered by UPMC pathologists were identical in 25.6% of cases and significantly modified (treatment plan altered) in 50.8% of cases. Conclusion: These results indicate that international telepathology consultation can significantly improve patient care by facilitating access to pathology expertise. The success of this international digital consultation service was dependent on strong commitment and support from leadership, information technology expertise, and dedicated

  7. Hastings Center

    MedlinePlus

    ... Events October 19, Hastings Center Seminar, Garrison : Human Genetic Engineering: Wh at Can We Do? What Should We ... Events October 19, Hastings Center Seminar, Garrison : Human Genetic Engineering: Wh at Can We Do? What Should We ...

  8. Minimally invasive percutaneous nephrolithotomy: an effective treatment for kidney stones in infants under 1 year of age. A single-center experience.

    PubMed

    Dağgülli, Mansur; Sancaktutar, Ahmet Ali; Dede, Onur; Utanğaç, Mehmet Mazhar; Bodakçi, Mehmet Nuri; Penbegül, Necmettin; Hatipoğlu, Namık Kemal; Çakmakçı, Süleyman

    2015-11-01

    We aimed to present the outcomes of PNL surgery performed in infantile patients with small renal stones who were younger than 1 year of age. A single-center prospective trial was initiated and during the period between Jan 2013 and Jan 2015, PNL was applied to 20 renal units of 16 infants (6 girls and 10 boys), including 4 patients with bilateral kidney stones. PNL was performed in patients with renal stones larger than 2 cm, as well as stones resistant to SWL or renal stones that were undetectable during SWL. The mean age of the patients was 9.55 (5-12) months. Of the 20 renal units, 1 had complete staghorn stones, 3 had partial staghorn stones, 13 had renal pelvic stones, and 3 had lower pole stones. The mean stone size was 18.5 mm (range 12-36 mm). Mean operative time for PNL was 88 (25-135 min). Mean fluoroscopy time was estimated as 3.4 min. Mean hemoglobin loss was 0.72 g/L (0.2-3). The mean hospital stay was 4.1 days (2-8 days). On postoperative day 1, a complete stone-free state was achieved in 70% of renal units (14 of 20). At the end of the first postoperative week, the remaining two patients had insignificant residual fragments of 3 mm and were followed conservatively without any specific intervention. Thus, the total SFR was 80% (16 of 20) at discharge. In infants aged less than 1 year, minimal access tract dilation during PNL, the use of smaller caliber pediatric instruments, and the realization of this procedure by surgeons with adequate experience in adults carry utmost importance. In addition, special care should be taken to avoid hypothermia and radiation exposure during PNL. PMID:26002160

  9. Role of basiliximab in the prevention of acute cellular rejection in adult to adult living-related liver transplantation: a single center experience

    PubMed Central

    Gruttadauria, S; Mandalà, L; Biondo, D; Spampinato, M; Lamonaca, V; Volpes, R; Vizzini, G; Marsh, JW; Marcos, A; Gridelli, B

    2007-01-01

    We report our single center experience with the use of basiliximab, a chimeric monoclonal antibody directed against the alpha chain of the interleukin-2 (IL-2) receptor (CD25), in combination with a steroid- and tacrolimus-based regimen in adult to adult living-related liver transplantation (ALRLT). Sixty consecutive ALRLTs were analyzed. All patients received two 20-mg doses of basiliximab (days 0 and 4 after transplantation) followed by tacrolimus (0.15 mg/kg/day; 10–15 ng/mL target trough levels) and a dose regimen of steroids (starting with 20 mg iv, switched to po as soon as the patient was able to eat, and weaned off within 1–2 months). Follow-up ranged from 6 to 1699.4 days after transplantation (mean 517.5 days, SD ± 413.4; median 424 days). Of the recipients, 95% remained rejection-free during follow-up, with an actuarial rejection-free probability of 96.61% within 3 months. Three patients had episodes of biopsy-proven acute cellular rejection (ACR). Actuarial patient and graft survival rates at 3 years were 82.09% and 75.61%. Six patients (10%) experienced sepsis. There was no evidence of cytomegalovirus infections or side-effects related to the basiliximab. We found zero de novo malignancy, although we observed 5 patients with metastatic spread of their primary malignancy during the follow-up. Basiliximab in association with tacrolimus and steroids is effective in reducing episodes of ACR and increasing ACR-free survival after ALRLT. PMID:19707350

  10. Single-Center Experience and 1-Year Follow-up Results of 'Sandwich Technique' in the Management of Common Iliac Artery Aneurysms During EVAR

    SciTech Connect

    Ricci, Carmelo; Ceccherini, Claudio Cini, Marco; Vigni, Francesco; Leonini, Sara; Tommasino, Giulio; Muzzi, Luigi; Tucci, Enrico; Benvenuti, Antonio; Neri, Eugenio

    2012-10-15

    Purpose: Abdominal aortic aneurysm (AAA) accompanied by common iliac artery (CIA) aneurysms requires a more demanding procedure owing to the difficulties in obtaining an adequate distal landing zone for the stent-graft limb(s), a potential site of endoleak. The 'sandwich technique' is a procedure to increase EVAR feasibility in the setting of adverse or challenging CIA anatomy. Its main advantages include no restrictions in terms of CIA diameter or length or internal iliac artery (IIA) diameter, no need to wait for a specific stent-graft. Our purpose is to describe our single-center experience and one year follow-up results of this new procedure. Materials and Methods: From April 2009 to June 2010, the sandwich technique was performed in our institution in 7 patients treated for AAA and unilateral CIA aneurysms (n. 5) or bilateral CIA aneurysms (n. 2). Inclusion criteria were the presence of unilateral or bilateral CIA aneurysm (independently from its diameter), IIA artery measuring up to 9 mm in its maximum diameter, not dilatation of IIA and EIA. Results: The mean follow-up length was 15 months (range: 14-20 months). All stent-implanted iliac branches remained patent on 1 year follow-up and IIA flow was preserved. None of the patients had symptoms of pelvic ischemia. CT scan follow-up showed aneurysm shrinkage in five patients, without any sign of endoleaks in all cases. Conclusions: In selected cases, the 'sandwich technique' showed good outcomes confirming to be a safe and easy to perform way to overcome anatomical constraints and expanding the limits of EVAR.

  11. The 5-Year EFS of Multisystem LCH With Risk-Organ Involvement Is Suboptimal: A Single-center Experience From India.

    PubMed

    Totadri, Sidharth; Bansal, Deepak; Trehan, Amita; Srinivasan, Radhika; Varma, Neelam; Kakkar, Nandita; Saxena, Akshay K; Bhatia, Prateek

    2016-01-01

    The study describes an 8-year experience of a single center in managing patients with langerhans cell histiocytosis on the basis of the langerhans cell histiocytosis-III platform. A retrospective case-file review of children diagnosed during 2006 to 2013 was performed. Group 1 (multisystem with risk-organ involvement) patients received an initial treatment of 6 to 12 weeks, followed by continuation treatment to complete 12 months. Drugs included vinblastine, prednisolone, and 6-mercaptopurine. Group 2 (multisystem without risk-organ involvement) patients received a similar treatment, except for 6-mercaptopurine. Group 3 (single-system/multifocal bone disease) patients were treated for a duration of 6 months. Forty-nine patients were treated: 24 (49%), 14 (28.6%), and 11 (22.4%) in groups 1, 2, and 3, respectively. The mean age at diagnosis was 31.6 ± 28.4 months (range, 4 to 120 mo). Five patients abandoned treatment. There were 7 deaths, all in group 1. All patients who died had either a partial response or progressive disease after induction (P=0.000). Among patients with liver involvement, those with sclerosing cholangitis had a greater mortality (P=0.007). A relapse was observed in 12 (24.5%) patients. The frequency of relapse was not different in the 3 groups (P=0.833). The 5-year event-free survival in groups 1, 2, and 3 was 29.3 ± 10%, 58.9 ± 14.6%, and 69.3 ± 15%, respectively (P=0.019). The 5-year overall survival was 100% in groups 2/3 and 68.9 ± 9.8% in group 1 (P=0.011). PMID:26274033

  12. Use of Learner-Centered Principles Test Battery in Pre-Service Educational Programs and in the School Setting: Implications for Teacher Roles and Professional Development Experiences.

    ERIC Educational Resources Information Center

    Fasko, Daniel, Jr.; Grubb, Deborah J.

    The Learner-Centered Psychological Principles (LCP) were developed through the efforts of an American Psychological Association task force as part of an effort to add to educational reform literature regarding the learner and the learner process. The Learner-Centered Battery (LCB) was administered to 38 teachers and 656 students in grades 6…

  13. Job center

    NASA Astrophysics Data System (ADS)

    To better meet the needs of AGU members, a program has been started to increase the effectiveness of the Job Center activity at the Spring and Fall Meetings. As a result, participation in the Job Center at the 1988 AGU Spring Meeting in Baltimore increased substantially compared to previous Spring Meetings. The number of employers, applicants, and interviews scheduled more than doubled compared to the 1987 Spring Job Center.In order to make the meeting Job Centers even better, a survey is being conducted of employers and applicants who participated in the 1988 Spring Job Center. Evaluation of this survey will be useful in continuing increased participation in and the effectiveness of the Job Center at the 1988 Fall Meeting. Past participants and those interested in the future of the Job Center are encouraged to forward comments and suggestions to AGU, Member Programs Division, 2000 Florida Ave., N.W., Washington, DC 20009.

  14. Study of various clinical and laboratory parameters among 178 patients affected by hooch tragedy in Ahmedabad, Gujarat (India): A single center experience

    PubMed Central

    Jarwani, Bhavesh S; Motiani, Puja D; Sachdev, Sachin

    2013-01-01

    Introduction/Purpose: The outbreak of methanol poisoning described in this paper occurred in Ahmedabad, Gujarat, India in July 2009. Our intention is to share the experience of clinical features, laboratory investigations and their relation during this tragedy. Materials and Methods: Single center, retrospective study of clinical features and laboratory parameters of 178 cases of methanol toxicity treated at tertiary care hospital in Ahmedabad, Gujarat. Results: Maximum patients (39.8%, n = 45) were received in 48 h; Mean age of presentation was 41.9 ± 10.2 years. Most of them were men (175 out of 178). On presentation, 83% patients had gastro-intestinal symptoms, 46% had neurological symptoms, 73% had visual symptoms and 32% had dyspnoea. 62% had blurred vision, 10.5% had blindness. Patients with visual symptoms had high mean level of methanol (120.12 ± 23.12 vs. 55.43 ± 29.24, P = 0.014). On fundus examination 52.8% (n = 62) had bilateral hyperaemia of discs, 8.4% (n = 12) had bilateral disc pallor and 4.5% had papilledema (n = 5). Patients with hyperaemia of discs, discs pallor or papilledema, had higher mean methanol level (121.1 ± 32.2 mg% v/s 70.1 ± 23.2 mg%, P = 0.032). Mean of pH values was 7.17 ± 0.22 and bicarbonate was 12.3 ± 7.3 mmol/L. Both pH and bicarbonate levels correlated well with mortality and serum methanol level. Mean serum methanol level was 87.1 mg/dL, and correlated significantly with the mortality (53.1 ± 41 mg/dL v/s 121 ± 92 mg/dL, P value < 0.05). Conclusion: GI symptoms, neurological symptoms and breathlessness are important clue to ED physician for diagnose methanol poisoning. Visual symptoms and fundus findings correlate well with the methanol level. Arterial Blood Gas derived pH and bicarbonate levels correlate significantly with the methanol level and mortality. PMID:23723613

  15. Finding Center: How Learning Centers Evolved in a Secondary Student-Centered Classroom

    ERIC Educational Resources Information Center

    Movitz, Allison P.; Holmes, Kerry P.

    2007-01-01

    The authors elaborate on the experience of creating for high school students effective multisensory, hands-on learning centers that address a full range of elements from the English language arts curriculum. Allison P. Movitz and Kerry P. Holmes detail the centers Movitz designed for a Mostly Medieval unit to show how learning centers can help…

  16. Skills Center.

    ERIC Educational Resources Information Center

    Canter, Patricia; And Others

    The services of the Living Skills Center for the Visually Handicapped, a habilitative service for blind young adults, are described. It is explained that the Center houses its participants in their own apartments in a large complex and has served over 70 young people in 4 years. The evaluation section describes such assessment instruments as an…

  17. [Scientific and methodologic basis of a program for occupational control of ambient air quality within a totally sanitary protective zone at an industrial center borderline (Permsky area experience)].

    PubMed

    Maĭ, I V; Balashov, S Iu

    2013-01-01

    The authors suggested and tested an algorithm to select optimal placement of stationary and mobile points for controlling ambient air quality on borderline of united sanitary protective zone of industrial center. The method involves claster analysis to outline sites even in levels and lists of parameters, on borderline of united sanitary protective zone of industrial center. Informative value of the occupational control parameters is evaluated through conjugated analysis of general level of surface concentration of admixtures and enterprise's contribution into pollution. For each enterprise, separate control program is provided. Tests of the method demonstrated that it is effective and conclusive in formation of minimally sufficient programs for occupational control in complicated conditions of industrial centers with single-field enterprises, when industrial releases are close in composition and in created pollution level. PMID:24640091

  18. ACTS propagation experiment discussion: Ka-band propagation measurements using the ACTS propagation terminal and the CSU-CHILL and Space Communications Technology Center Florida propagation program

    NASA Technical Reports Server (NTRS)

    Bringi, V. N.; Chandrasekar, V.; Mueller, Eugene A.; Turk, Joseph; Beaver, John; Helmken, Henry F.; Henning, Rudy

    1993-01-01

    Papers on Ka-band propagation measurements using the ACTS propagation terminal and the Colorado State University CHILL multiparameter radar and on Space Communications Technology Center Florida Propagation Program are discussed. Topics covered include: microwave radiative transfer and propagation models; NASA propagation terminal status; ACTS channel characteristics; FAU receive only terminal; FAU terminal status; and propagation testbed.

  19. Emergency Contraceptive Pill (ECP) Use and Experiences at College Health Centers in the Mid-Atlantic United States: Changes since ECP Went Over-the-Counter

    ERIC Educational Resources Information Center

    Miller, Laura M.

    2011-01-01

    Objective: To investigate the availability of emergency contraceptive pills (ECPs) at college health centers since ECP went over-the-counter (OTC) in 2006. Related issues, such as distribution procedure, existence of a written protocol, personnel involved, contraindications, follow-up procedures, methods of advertising, and staff attitudes, were…

  20. Making the Shift: A Phenomenological Study of Teachers' Experiences in a Student-Centered, 21st Century Laptop Program

    ERIC Educational Resources Information Center

    Rizzo, Susan Kay

    2013-01-01

    As one-to-one laptop environments are becoming more commonplace in the educational system, teachers are often expected to provide a student-centered environment that incorporates 21st century skills in effort to better prepare students for the future. Teaching in this type of environment is a difficult pedagogical shift for classroom educators.…

  1. Emergency Contraceptive Pills: A 10-Year Follow-up Survey of Use and Experiences at College Health Centers in the Mid-Atlantic United States

    ERIC Educational Resources Information Center

    Miller, Laura McKeller; Sawyer, Robin G.

    2006-01-01

    The authors conducted a 10-year follow-up study using a telephone survey to investigate the availability of emergency contraceptive pills (ECPs) at college health centers in the mid-Atlantic region of the United States. They also examined related issues, such as distribution procedure, existence of a written protocol, personnel involved,…

  2. Senior Centers

    MedlinePlus Videos and Cool Tools

    ... something many older adults would like to do as long as they can. Senior centers, adult day care, transportation, ... adults who live independently can go to find a variety of social and recreational activities. [Karen Albers] ...

  3. Literature or Experience?

    ERIC Educational Resources Information Center

    Robinson, Dennis

    1978-01-01

    Shows that the need to choose between literature-centered or experience-centered English instruction is a delusion, because instruction in literature also adds to the child's experience of language. (RL)

  4. Providing operational guidance for the development of sea breeze thunderstorms at the Kennedy Space Center - An experiment using a mesoscale numerical model

    NASA Technical Reports Server (NTRS)

    Lyons, Walter A.; Moon, Dennis A.; Keen, Cecil S.; Schuh, Jerome A.; Pielke, Roger A.

    1988-01-01

    The effectiveness of a mesoscale numerical model to provide improved local forecast guidance is evaluated with respect to sea breeze convection storms at the Kennedy Space Center. The model and operational forecast guidance production are described. A case study is presented for sea breeze convection storms and lightning events on July 1, 1986. It is found that the mesoscale numerical model outperforms purely subjective predictions of sea breeze convection. The range of applications for the model are considered.

  5. Reliability Centered Maintenance - Methodologies

    NASA Technical Reports Server (NTRS)

    Kammerer, Catherine C.

    2009-01-01

    Journal article about Reliability Centered Maintenance (RCM) methodologies used by United Space Alliance, LLC (USA) in support of the Space Shuttle Program at Kennedy Space Center. The USA Reliability Centered Maintenance program differs from traditional RCM programs because various methodologies are utilized to take advantage of their respective strengths for each application. Based on operational experience, USA has customized the traditional RCM methodology into a streamlined lean logic path and has implemented the use of statistical tools to drive the process. USA RCM has integrated many of the L6S tools into both RCM methodologies. The tools utilized in the Measure, Analyze, and Improve phases of a Lean Six Sigma project lend themselves to application in the RCM process. All USA RCM methodologies meet the requirements defined in SAE JA 1011, Evaluation Criteria for Reliability-Centered Maintenance (RCM) Processes. The proposed article explores these methodologies.

  6. [Epidemiological, clinical, cytologic and immunophenotypic aspects of acute leukemia in children: the experience at the hematology laboratory of IBN SINA University Hospital Center].

    PubMed

    Doumbia, Mariam; Uwingabiye, Jean; Bissan, Aboubacar; Rachid, Razine; Benkirane, Souad; Masrar, Azlarab

    2016-01-01

    The aim of this study was to describe epidemiological, cytologic and immunophenotypic aspects of acute leukemias (AL) in children diagnosed at IBN SINA University Hospital Center and to determine the concordance between cytology and immunophenotyping results. This is a cross-sectional study conducted in the hematology laboratory of IBN SINA University Hospital Center between June 2012 and May 2014. Among the 104 cases with diagnosed AL, 52% were boys with a sex-ratio H/F= 1.32, the average age was 5.7 years. The distribution of different types of AL was: lymphoid AL (LAL) (74%), myeloid (AML) (20.2%), biphenotypic AL (BAL) (65.8%). Among the LALs, 78% were classified as B LAL and 22% as T LAL. Clinical signs were mainly presented with tumor syndrome (73.1%), fever (61%) and hemorrhagic syndrome (50%). The most common blood count abnormalities were: thrombopenia (89.4%), anemia (86.5%), hyperleukocytosis (79.8%). The rate of peripheral and bone marrow blasts was statistically higher for LAL than for AML and BAL (p <0.001). The rate of relapse and mortality was 21.2% and 16. 3% respectively. Concordance rate between the results of cytology and of immunophenotyping was 92.7% for LAL and 82.6% for AML. Diagnosis of AL is always based primarily on cytology. Immunophenotyping allowed us to make a better distinction between acute leukemias. The management of paediatric AL is a major health problem which requires specialized care centers. PMID:27516823

  7. Short-term and medium-term outcomes of transapical aortic valve implantation as a single-strategy approach: one center's experience

    PubMed Central

    Mokráček, Aleš; Pešl, Ladislav; Kurfirst, Vojtěch; Šulda, Mirek

    2015-01-01

    Introduction Transcatheter aortic valve replacement has been developed as an alternative option for surgical high-risk or inoperable patients with severe symptomatic aortic stenosis. Aim of the study Aim of the study was to evaluate the outcomes of patients undergoing transapical aortic valve replacement as a single-strategy option by a single-center multidisciplinary heart team. Material and methods Between June 2009 and December 2014, 41 patients underwent transapical transcatheter aortic valve implantation (TA-TAVI) at our institution. All patients received Edwards SAPIEN balloon expandable pericardial valves (Edwards Lifesciences, Irvine, CA, USA). Our center followed a “clear transapical strategy” for all patients. Results The mean age of the patients was 79.6 years, and the mean logistic EuroSCORE was 21.06 ± 12.82%. Fifteen patients (36.6%) underwent redo operations. Complications included stroke (n = 1), re-exploration for bleeding or cardiac tamponade (n = 4), renal failure requiring temporary hemodialysis (n = 4) and permanent pacemaker implantation (n = 3). There were no myocardial infarctions or coronary obstruction. The total 30-day mortality rate was 17.1% (7 patients). Postoperative intensive care unit stay was 4.6 ± 5.7 days, and mean hospitalization was 11.6 ± 7.2 days. Conclusions The TA-TAVI approach provides good results in terms of early and midterm outcomes. This approach is feasible and safe for patients who have high surgical risk. PMID:26336490

  8. Person--job match among frontline staff working in residential treatment centers: the impact of personality and child psychopathology on burnout experiences.

    PubMed

    Leon, Scott C; Visscher, Linn; Sugimura, Niwako; Lakin, Brittany L

    2008-04-01

    Prior research has shown that the personality variables extraversion and neuroticism predict burnout among frontline staff working in residential treatment centers. This study tested the hypothesis that the effect of personality on burnout would be moderated by the psychiatric characteristics of the youth served on the milieu. Two hundred and three frontline staff working in 21 residential treatment centers in Illinois serving troubled youth completed surveys regarding opinions about their jobs, the Big Five Inventory (BFI), a youth presenting problems scale for the entire milieu, and the Maslach Burnout Inventory (MBI). Results indicated that the effect of neuroticism on burnout is moderated by psychosis and posttraumatic stress disorder (PTSD); high and moderate milieu ratings of psychosis and PTSD showed a positive relationship between neurosis and burnout, while low ratings of these conditions showed no relationship. These findings suggest that the optimal work setting is a function of the interaction between specific personality characteristics and specific work environments, with implications for personnel selection and future research on person-environment fit. PMID:18954187