Unregulated proliferation of trauma centers undermines cost efficiency of population-based injury control.

PubMed

Tepas, Joseph J; Kerwin, Andrew J; Ra, Jin Hee

2014-03-01

We evaluated the impact on coverage and regional cost of trauma care produced by the activation of a Level II center with no preceding needs analysis in an established trauma region with a Level I center. Patient deidentified trauma registry data for years 2010, 2011, and 2012 were analyzed to assess the effect on trauma service volume during a period at the midpoint of which the Level II center was activated. Trends for each year were evaluated by patient volume, mechanism, resource use as reflected in a transfer to the intensive care unit (ICU) and ICU stay, patient severity as defined by Injury Severity Score (ISS), and patient injury profile determined by mean body region Abbreviated Injury Scale (AIS) score. Between 2010 and 2011, during which the Level II opened, overall volume at the Level I center dropped by 3.7%, and blunt volume remained unchanged. From 2011 to 2012, overall Level I volume dropped by 9.4%, and blunt injury fell by 14%. Proportions requiring immediate operating room or ICU care did not change. ISS distribution at the Level I center across the years was similar. Head, chest, and abdominal injuries, as assessed by AIS body region, increased slightly in severity and decreased in volume by 25%, 17%, and 18%, respectively. For 2012, the new center publically reported treating 1,100 patients, which, in concert with the Level I decrease, translates to increasing regional trauma center access by 25% while increasing expense of necessary core personnel by 217%. Addition of a second trauma center in a stable region, in which injury incidence was actually decreasing, doubled the cost of personnel, one of the most expensive components of the trauma system and decreased the volume of injuries necessary for training and education. Trauma system expansion must be based on needs assessment, which assures system survival and controls societal cost. Economic & value-based evaluation, level III.

The Effect of Trauma Center Designation and Trauma Volume on Outcome in Specific Severe Injuries

PubMed Central

Demetriades, Demetrios; Martin, Mathew; Salim, Ali; Rhee, Peter; Brown, Carlos; Chan, Linda

2005-01-01

Objective: The objective of this study was to investigate the effect of American College of Surgeons (ACS) trauma center designation and trauma volume on outcome in patients with specific severe injuries. Background: Trauma centers are designated by the ACS into different levels on the basis of resources, trauma volume, and educational and research commitment. The criteria for trauma center designation are arbitrary and have never been validated. Methods: The National Trauma Data Bank study, which included patients >14 years of age and had injury severity score (ISS) >15, were alive on admission and had at least one of the following severe injuries: aortic, vena cava, iliac vessels, cardiac, grade IV/V liver injuries, quadriplegia, or complex pelvic fractures. Outcomes (mortality, intensive care unit stay, and severe disability at discharge) were compared among level I and II trauma centers and between centers within the same level designation but different volumes of severe trauma (<240 vs ≥240 trauma admissions with ISS >15 per year). The outcomes were adjusted for age (<65 ≥65), gender, mechanism of injury, hypotension on admission, and ISS (≤25 and >25). Results: A total of 12,254 patients met the inclusion criteria. Overall, level I centers had significantly lower mortality (25.3% vs 29.3%; adjusted odds ratio [OR], 0.81; 95% confidence interval [CI], 0.71–0.94; P = 0.004) and significantly lower severe disability at discharge (20.3% vs 33.8%, adjusted OR, 0.55; 95% CI, 0.44–0.69; P < 0.001) than level II centers. Subgroup analysis showed that cardiovascular injuries (N = 2004) and grades IV–V liver injuries (N = 1415) had a significantly better survival in level I than level II trauma centers (adjusted P = 0.017 and 0.023, respectively). Overall, there was a significantly better functional outcome in level I centers (adjusted P < 0.001). Subgroup analysis showed level I centers had significantly better functional outcomes in complex pelvic fractures (P < 0.001) and a trend toward better outcomes in the rest of the subgroups. The volume of trauma admissions with ISS >15 (<240 vs ≥240 cases per year) had no effect on outcome in either level I or II centers. Conclusions: Level I trauma centers have better outcomes than lower-level centers in patients with specific injuries associated with high mortality and poor functional outcomes. The volume of major trauma admissions does not influence outcome in either level I or II centers. These findings may have significant implications in the planning of trauma systems and the billing of services according to level of accreditation. PMID:16192811

Automotive Manufacturing Assessment System : Volume 4. Engine Manufacturing Analysis.

DOT National Transportation Integrated Search

1979-11-01

Volume IV represents the results of one of four major study areas under the Automotive Manufacturing Assessment System (AMAS) sponsored by the DOT/Transportation Systems Center. AMAS was designed to assist in the evaluation of industry's capability t...

Transplant center volume and outcomes in lung transplantation for cystic fibrosis.

PubMed

Hayes, Don; Sweet, Stuart C; Benden, Christian; Kopp, Benjamin T; Goldfarb, Samuel B; Visner, Gary A; Mallory, George B; Tobias, Joseph D; Tumin, Dmitry

2017-04-01

Transplant volume represents lung transplant (LTx) expertise and predicts outcomes, so we sought to determine outcomes related to center volumes in cystic fibrosis (CF). United Network for Organ Sharing data were queried for patients with CF in the United States (US) receiving bilateral LTx from 2005 to 2015. Multivariable Cox regression was used to model survival to 1 year and long-term (>1 year) survival, conditional on surviving at least 1 year. A total of 2025 patients and 67 centers were included in the analysis. The median annual LTx volumes were three in CF [interquartile range (IQR): 2, 6] and 17 in non-CF (IQR: 8, 33). Multivariable Cox regression in cases with complete data and surviving at least 1 year (n = 1510) demonstrated that greater annual CF LTx volume (HR per 10 LTx = 0.66; 95% CI: 0.49, 0.89; P = 0.006) but not greater non-CF LTx volume (HR = 1.00; 95% CI: 0.96, 1.05; P = 0.844) was associated with improved long-term survival in LTx recipients with CF. A Wald interaction test confirmed that CF LTx volume was more strongly associated with long-term outcomes than non-CF LTx volume (P = 0.012). In a US cohort, center volume was not associated with 1-year survival. CF-specific expertise predicted improved long-term outcomes of LTx for CF, whereas general LTx expertise was unassociated with CF patients' survival. © 2016 Steunstichting ESOT.

Source Hierarchy List. Volume 3. O through Z

DTIC Science & Technology

1994-07-01

NAVAL WEAPONS CENTER CHINA LAKE CA MARINE AVIATION DETACHMENT* 07 NAVAL WEAPONS CENTER CORONA ANNEX CA 08 NAVAL ORDNANCE LAB CORONA CA 08 NAVAL...WEAPONS CENTER CORONA LABS CA 05 NAVAL AIR WEAPONS STATION CHINA LAKE CA 05 PACIFIC MISSILE TEST CENTER POINT MUGU CA 06 AIR DEVELOPMENT SQUADRON FOUR...INDIAN HEAD MD 03 NAVAL ORDNANCE CENTER INDIAN HEAD MO 04 NAVAL WARFARE ASSESSMENT CENTER CORONA CA 05 FLEET ANALYSIS CENTER CORONA CA 03

High Center Volume Does Not Mitigate Risk Associated with Using High Donor Risk Organs in Liver Transplantation.

PubMed

Beal, Eliza W; Black, Sylvester M; Mumtaz, Khalid; Hayes, Don; El-Hinnawi, Ashraf; Washburn, Kenneth; Tumin, Dmitry

2017-09-01

High-risk donor allografts increase access to liver transplant, but potentially reduce patient and graft survival. It is unclear whether the risk associated with using marginal donor livers is mitigated by increasing center experience. The United Network for Organ Sharing registry was queried for adult first-time liver transplant recipients between 2/2002 and 12/2015. High donor risk was defined as donor risk index >1.9, and 1-year patient and graft survival were compared according to donor risk index in small and large centers. Multivariable Cox regression estimated the hazard ratio (HR) associated with using high-risk donor organs, according to a continuous measure of annual center volume. The analysis included 51,770 patients. In 67 small and 67 large centers, high donor risk index predicted increased mortality (p = 0.001). In multivariable analysis, high-donor risk index allografts predicted greater mortality hazard at centers performing 20 liver transplants per year (HR 1.35; 95% CI 1.22, 1.49; p < 0.001) and, similarly, at centers performing 70 per year (HR 1.35; 95% CI 1.26, 1.43; p < 0.001). The interaction between high donor risk index and center volume was not statistically significant (p = 0.747), confirming that the risk associated with using marginal donor livers was comparable between smaller and larger centers. Results were consistent when examining graft loss. At both small and large centers, high-risk donor allografts were associated with reduced patient and graft survival after liver transplant. Specific strategies to mitigate the risk of liver transplant involving high-risk donors are needed, in addition to accumulation of center expertise.

Learning and Teaching Elementary Subjects. Advances in Research on Teaching. Volume 5.

ERIC Educational Resources Information Center

Brophy, Jere, Ed.

This publication is the fifth volume in the "Advanced in Research on Teaching" series, which has been established to provide state-of-the-art conceptualization and analysis of the processes involved in functioning as a classroom teacher. This volume focuses on the work of the Center for the Learning and Teaching of Elementary Subjects in…

Epidemiology and Outcomes After In-Hospital Cardiac Arrest After Pediatric Cardiac Surgery

PubMed Central

Gupta, Punkaj; Jacobs, Jeffrey P.; Pasquali, Sara K.; Hill, Kevin D.; Gaynor, J. William; O’Brien, Sean M.; He, Max; Sheng, Shubin; Schexnayder, Stephen M.; Berg, Robert A.; Nadkarni, Vinay M.; Imamura, Michiaki; Jacobs, Marshall L.

2014-01-01

Background Multicenter data regarding cardiac arrest in children undergoing heart operations are limited. We describe epidemiology and outcomes associated with postoperative cardiac arrest in a large multiinstitutional cohort. Methods Patients younger than 18 years in the Society of Thoracic Surgeons Congenital Heart Surgery Database (2007 through 2012) were included. Patient factors, operative characteristics, and outcomes were described for patients with and without postoperative cardiac arrest. Multivariable models were used to evaluate the association of center volume with cardiac arrest rate and mortality after cardiac arrest, adjusting for patient and procedural factors. Results Of 70,270 patients (97 centers), 1,843 (2.6%) had postoperative cardiac arrest. Younger age, lower weight, and presence of preoperative morbidities (all p < 0.0001) were associated with cardiac arrest. Arrest rate increased with procedural complexity across common benchmark operations, ranging from 0.7% (ventricular septal defect repair) to 12.7% (Norwood operation). Cardiac arrest was associated with significant mortality risk across procedures, ranging from 15.4% to 62.3% (all p < 0.0001). In multivariable analysis, arrest rate was not associated with center volume (odds ratio, 1.06; 95% confidence interval, 0.71 to 1.57 in low- versus high-volume centers). However, mortality after cardiac arrest was higher in low-volume centers (odds ratio, 2.00; 95% confidence interval, 1.52 to 2.63). This association was present for both high- and low-complexity operations. Conclusions Cardiac arrest carries a significant mortality risk across the stratum of procedural complexity. Although arrest rates are not associated with center volume, lower-volume centers have increased mortality after cardiac arrest. Further study of mechanisms to prevent cardiac arrest and to reduce mortality in those with an arrest is warranted. PMID:25443018

Failure of evidence-based cancer care in the United States: the association between rectal cancer treatment, cancer center volume, and geography.

PubMed

Monson, John R T; Probst, Christian P; Wexner, Steven D; Remzi, Feza H; Fleshman, James W; Garcia-Aguilar, Julio; Chang, George J; Dietz, David W

2014-10-01

This study examines recent adherence to recommended neoadjuvant chemoradiotherapy guidelines for patients with rectal cancer across geographic regions and institution volume and assesses trends over time. A recent report by the Institute of Medicine described US cancer care as chaotic. Cited deficiencies included wide variation in adherence to evidence-based guidelines even where clear consensus exists. Patients operated on for clinical stage II and III rectal cancer were selected from the 2006-2011 National Cancer Data Base. Multivariable logistic regressions were used to assess variation in chemotherapy and radiation use by cancer center type, geographical location, and hospital volume. The analysis controlled for patient age at diagnosis, sex, race/ethnicity, primary payer, average household income, average education, urban/rural classification of patient residence, comorbidity, and oncologic stage. There were 30,994 patients who met the inclusion criteria. Use of neoadjuvant radiation therapy and chemotherapy varied significantly by type of cancer center. The highest rates of adherence were observed in high-volume centers compared with low-volume centers (78% vs 69%; adjusted odds ratio = 1.46; P < 0.001). This variation is mirrored by hospital geographic location. Primary payer and year of diagnosis were not predictive of rates of neoadjuvant chemoradiotherapy. Adherence to evidence-based treatment guidelines in rectal cancer is suboptimal in the United States, with significant differences based on hospital volume and geographic regions. Little improvement has occurred in the last 5 years. These results support the implementation of standardized care pathways and a Centers of Excellence program for US patients with rectal cancer.

High Case Volumes and Surgical Fellowships are Associated with Improved Outcomes for Bariatric Surgery Patients: A Justification of Current Credentialing Initiatives for Practice and Training

PubMed Central

Kohn, Geoffrey P; Galanko, Joseph A; Overby, D Wayne; Farrell, Timothy M

2010-01-01

Background Recent years have seen the establishment of bariatric surgery credentialing processes, centers-of-excellence programs and fellowship training positions. The effects of center-of-excellence status and of the presence of training programs have not previously been examined. The objective of this study is to examine the effects of case volume, center-of-excellence status and training programs on early outcomes of bariatric surgery. Study Design Data were obtained from the Nationwide Inpatient Sample from 1998 to 2006. Quantification of patients’ comorbidities was made using the Charlson Index. Using logistic regression modeling, annual case volumes were analyzed for an association with each institution’s center-of-excellence status and training program status. Risk-adjusted outcome measures were calculated for these hospital-level parameters. Results Data from 102,069 bariatric operations were obtained. Adjusting for comorbidities, greater bariatric case volume was associated with improvements in the incidence of total complications (odds ratio [OR] = 0.99937 for each single case increase, p=0.01), in-hospital mortality (OR = 0.99717, p<0.01), and most other complications. Hospitals with a Fellowship Council-affiliated gastrointestinal surgery training program were associated with risk-adjusted improvements in rates of splenectomy (OR = 0.2853, p<0.001) and bacterial pneumonias (OR = 0.65898, p=0.02). Center-of-excellence status, irrespective of the accrediting entity, had minimal independent association with outcome. A surgical residency program had a varying association with outcomes. Conclusions The hypothesized positive volume-outcome relationship of bariatric surgery is shown without arbitrarily categorizing hospitals to case volume groups, by analysis of volume as a continuous variable. Institutions with a dedicated fellowship training program have also been shown, in part, to be associated with improved outcomes. The concept of volume-dependent center-of-excellence programs is supported, though no independent association with the credentialing process is noted. PMID:20510799

Duluth Entertainment Convention Center (DECC) special events traffic flow study : traffic data analysis and signal timing coordination

DOT National Transportation Integrated Search

2003-06-01

Following special events at the Duluth Entertainment Convention Center (DECC) (e.g., conventions, concerts, graduation ceremonies), high volumes of traffic exiting the DECC create substantial congestion at adjacent intersections. The purpose of this ...

Dual-Use Space Technology Transfer Conference and Exhibition. Volume 2

NASA Technical Reports Server (NTRS)

Krishen, Kumar (Compiler)

1994-01-01

This is the second volume of papers presented at the Dual-Use Space Technology Transfer Conference and Exhibition held at the Johnson Space Center February 1-3, 1994. Possible technology transfers covered during the conference were in the areas of information access; innovative microwave and optical applications; materials and structures; marketing and barriers; intelligent systems; human factors and habitation; communications and data systems; business process and technology transfer; software engineering; biotechnology and advanced bioinstrumentation; communications signal processing and analysis; medical care; applications derived from control center data systems; human performance evaluation; technology transfer methods; mathematics, modeling, and simulation; propulsion; software analysis and decision tools; systems/processes in human support technology; networks, control centers, and distributed systems; power; rapid development; perception and vision technologies; integrated vehicle health management; automation technologies; advanced avionics; and robotics technologies.

Summer Research Program - 1997 Summer Faculty Research Program Volume 6 Arnold Engineering Development Center United States Air Force Academy Air Logistics Centers

DTIC Science & Technology

1997-12-01

Fracture Analysis of the F-5, 15%-Spar Bolt DR Devendra Kumar SAALC/LD 6- 16 CUNY-City College, New York, NY A Simple, Multiversion Concurrency Control...Program, University of Dayton, Dayton, OH. [3]AFGROW, Air Force Crack Propagation Analysis Program, Version 3.82 (1997) 15-8 A SIMPLE, MULTIVERSION ...Office of Scientific Research Boiling Air Force Base, DC and San Antonio Air Logistic Center August 1997 16-1 A SIMPLE, MULTIVERSION CONCURRENCY

Electronic Business Transaction Infrastructure Analysis Using Petri Nets and Simulation

ERIC Educational Resources Information Center

Feller, Andrew Lee

2010-01-01

Rapid growth in eBusiness has made industry and commerce increasingly dependent on the hardware and software infrastructure that enables high-volume transaction processing across the Internet. Large transaction volumes at major industrial-firm data centers rely on robust transaction protocols and adequately provisioned hardware capacity to ensure…

Space and Earth Sciences, Computer Systems, and Scientific Data Analysis Support, Volume 1

NASA Technical Reports Server (NTRS)

Estes, Ronald H. (Editor)

1993-01-01

This Final Progress Report covers the specific technical activities of Hughes STX Corporation for the last contract triannual period of 1 June through 30 Sep. 1993, in support of assigned task activities at Goddard Space Flight Center (GSFC). It also provides a brief summary of work throughout the contract period of performance on each active task. Technical activity is presented in Volume 1, while financial and level-of-effort data is presented in Volume 2. Technical support was provided to all Division and Laboratories of Goddard's Space Sciences and Earth Sciences Directorates. Types of support include: scientific programming, systems programming, computer management, mission planning, scientific investigation, data analysis, data processing, data base creation and maintenance, instrumentation development, and management services. Mission and instruments supported include: ROSAT, Astro-D, BBXRT, XTE, AXAF, GRO, COBE, WIND, UIT, SMM, STIS, HEIDI, DE, URAP, CRRES, Voyagers, ISEE, San Marco, LAGEOS, TOPEX/Poseidon, Pioneer-Venus, Galileo, Cassini, Nimbus-7/TOMS, Meteor-3/TOMS, FIFE, BOREAS, TRMM, AVHRR, and Landsat. Accomplishments include: development of computing programs for mission science and data analysis, supercomputer applications support, computer network support, computational upgrades for data archival and analysis centers, end-to-end management for mission data flow, scientific modeling and results in the fields of space and Earth physics, planning and design of GSFC VO DAAC and VO IMS, fabrication, assembly, and testing of mission instrumentation, and design of mission operations center.

The Regionalization of Lumbar Spine Procedures in New York State: A 10-Year Analysis.

PubMed

Jancuska, Jeffrey; Adrados, Murillo; Hutzler, Lorraine; Bosco, Joseph

2016-01-01

A retrospective review of an administrative database. The purpose of this study is to determine the current extent of regionalization by mapping lumbar spine procedures according to hospital and patient zip code, as well as examine the rate of growth of lumbar spine procedures performed at high-, medium-, and low-volume institutions in New York State. The association between hospital and spine surgeon volume and improved patient outcomes is well established. There is no study investigating the actual process of patient migration to high-volume hospitals. New York Statewide Planning and Research Cooperative System (SPARCS) administrative data were used to identify 228,695 lumbar spine surgery patients from 2005 to 2014. The data included the patients' zip code, hospital of operation, and year of discharge. The volume of lumbar spine surgery in New York State was mapped according to patient and hospital 3-digit zip code. New York State hospitals were categorized as low, medium, and high volume and descriptive statistics were used to determine trends in changes in hospital volume. Lumbar spine surgery recipients are widely distributed throughout the state. Procedures are regionalized on a select few metropolitan centers. The total number of procedures grew 2.5% over the entire 10-year-period. High-volume hospital caseload increased 50%, from 7253 procedures in 2005 to 10,915 procedures in 2014. The number of procedures at medium and low-volume hospitals decreased 30% and 13%, respectively. Despite any concerted effort aimed at moving orthopedic patients to high-volume hospitals, migration to high-volume centers occurred. Public interest in quality outcomes and cost, as well as financial incentives among medical centers to increase market share, potentially influence the migration of patients to high-volume centers. Further regionalization has the potential to exacerbate the current level of disparities among patient populations at low and high-volume hospitals. 3.

Analysis of the Effect of Race, Socioeconomic Status, and Center Size on Unrelated National Marrow Donor Program Donor Outcomes: Donor Toxicities Are More Common at Low-Volume Bone Marrow Collection Centers.

PubMed

Shaw, Bronwen E; Logan, Brent R; Kiefer, Deidre M; Chitphakdithai, Pintip; Pedersen, Tanya L; Abdel-Azim, Hisham; Abidi, Muneer H; Akpek, Gorgun; Diaz, Miguel A; Artz, Andrew S; Dandoy, Christopher; Gajewski, James L; Hematti, Peiman; Kamble, Rammurti T; Kasow, Kimberley A; Lazarus, Hillard M; Liesveld, Jane L; Majhail, Navneet S; O'Donnell, Paul V; Olsson, Richard F; Savani, Bipin N; Schears, Raquel M; Stroncek, David F; Switzer, Galen E; Williams, Eric P; Wingard, John R; Wirk, Baldeep M; Confer, Dennis L; Pulsipher, Michael A

2015-10-01

Previous studies have shown that risks of collection-related pain and symptoms are associated with sex, body mass index, and age in unrelated donors undergoing collection at National Marrow Donor Program centers. We hypothesized that other important factors (race, socioeconomic status [SES], and number of procedures at the collection center) might affect symptoms in donors. We assessed outcomes in 2726 bone marrow (BM) and 6768 peripheral blood stem cell (PBSC) donors collected between 2004 and 2009. Pain/symptoms are reported as maximum levels over mobilization and collection (PBSC) or within 2 days of collection (BM) and at 1 week after collection. For PBSC donors, race and center volumes were not associated with differences in pain/symptoms at any time. PBSC donors with high SES levels reported higher maximum symptom levels 1 week after donation (P = .017). For BM donors, black males reported significantly higher levels of pain (OR, 1.90; CI, 1.14 to 3.19; P = .015). No differences were noted by SES group. BM donors from low-volume centers reported more toxicity (OR, 2.09; CI, 1.26 to 3.46; P = .006). In conclusion, race and SES have a minimal effect on donation-associated symptoms. However, donors from centers performing ≤ 1 BM collection every 2 months have more symptoms after BM donation. Approaches should be developed by registries and low-volume centers to address this issue. Copyright © 2015 American Society for Blood and Marrow Transplantation. Published by Elsevier Inc. All rights reserved.

An Analysis of the Effect of Race, Socioeconomic Status and Center Size on Unrelated NMDP Donor Outcomes: Donor Toxicities are More Common at Low Volume Bone Marrow Collection Centers

PubMed Central

Shaw, Bronwen E.; Logan, Brent R.; Kiefer, Deidre M.; Chitphakdithai, Pintip; Pedersen, Tanya L.; Abdel-Azim, Hisham; Abidi, Muneer H.; Akpek, Gorgun; Diaz, Miguel A.; Artz, Andrew S.; Dandoy, Christopher; Gajewski, James L.; Hematti, Peiman; Kamble, Rammurti T.; Kasow, Kimberley A.; Lazarus, Hillard M.; Liesveld, Jane L.; Majhail, Navneet S.; O’Donnell, Paul V.; Olsson, Richard F.; Savani, Bipin N.; Schears, Raquel M.; Stroncek, David F.; Switzer, Galen E.; Williams, Eric P.; Wingard, John R.; Wirk, Baldeep M.; Confer, Dennis L.; Pulsipher, Michael A.

2015-01-01

Previous studies have shown that risks of collection-related pain and symptoms are associated with sex, body mass index (BMI), and age in unrelated donors undergoing collection at National Marrow Donor Program (NMDP) centers. We hypothesized that other important factors (race, socioeconomic status (SES), and number of procedures at the collection center) might affect symptoms in donors. We assessed outcomes in 2,726 bone marrow (BM) and 6,768 peripheral blood stem cell (PBSC) donors collected between 2004 and 2009. Pain/symptoms are reported as maximum levels over mobilization and collection (PBSC) or within 2 days of collection (BM) and at 1 week after collection. For PBSC donors, race and center volumes were not associated with differences in pain/symptoms at any time. PBSC donors with high SES levels reported higher maximum symptom levels 1 week post donation (p=0.017). For BM donors, black males reported significantly higher levels of pain (OR=1.90, CI=1.14-3.19, p=0.015). No differences were noted by SES groups. BM donors from low volume centers reported more toxicity (OR=2.09, CI=1.26-3.46, p=0.006). In conclusion, race and SES have a minimal effect on donation associated symptoms. However, donors from centers performing ≤1 BM collection every 2 months have more symptoms following BM donation. Approaches should be developed by registries and low volume centers to address this issue. PMID:26116089

Interagency registry for mechanically assisted circulatory support report on the total artificial heart.

PubMed

Arabía, Francisco A; Cantor, Ryan S; Koehl, Devin A; Kasirajan, Vigneshwar; Gregoric, Igor; Moriguchi, Jaime D; Esmailian, Fardad; Ramzy, Danny; Chung, Joshua S; Czer, Lawrence S; Kobashigawa, Jon A; Smith, Richard G; Kirklin, James K

2018-04-26

We sought to better understand the patient population who receive a temporary total artificial heart (TAH) as bridge to transplant or as bridge to decision by evaluating data from the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) database. We examined data related to survival, adverse events, and competing outcomes from patients who received TAHs between June 2006 and April 2017 and used hazard function analysis to explore risk factors for mortality. Data from 450 patients (87% men; mean age, 50 years) were available in the INTERMACS database. The 2 most common diagnoses were dilated cardiomyopathy (50%) and ischemic cardiomyopathy (20%). Risk factors for right heart failure were present in 82% of patients. Most patients were INTERMACS Profile 1 (43%) or 2 (37%) at implantation. There were 266 patients who eventually underwent transplantation, and 162 died. Overall 3-, 6-, and 12-month actuarial survival rates were 73%, 62%, and 53%, respectively. Risk factors for death included older age (p = 0.001), need for pre-implantation dialysis (p = 0.006), higher creatinine (p = 0.008) and lower albumin (p < 0.001) levels, and implantation at a low-volume center (≤10 TAHs; p < 0.001). Competing-outcomes analysis showed 71% of patients in high-volume centers were alive on the device or had undergone transplantation at 12 months after TAH implantation vs 57% in low-volume centers (p = 0.003). Patients receiving TAHs have rapidly declining cardiac function and require prompt intervention. Experienced centers have better outcomes, likely related to patient selection, timing of implantation, patient care, and device management. Organized transfer of knowledge to low-volume centers could improve outcomes. Copyright © 2018 International Society for Heart and Lung Transplantation. Published by Elsevier Inc. All rights reserved.

Test Plan Development for Plastic Ammunition Containers. Volume 1

DTIC Science & Technology

1989-03-15

1850 Black Canyon Stage¶I Packaging division (SMCAR-AEP) Picatinny Phoenix, Arizona 85027 Arsenal, New Jersey 07806-5000 86. NAME OF FUNDING...packaging containers. The report is presented in two separate volumes. Volume I contains the Final Technical Report and includes the analysis of... Division of the U.S. Army Armament Research, Development and Engineering Center. Mr. Jasper C. Griggs and Mr. D. E. Jones served as technical consultants

Case mix-adjusted cost of colectomy at low-, middle-, and high-volume academic centers.

PubMed

Chang, Alex L; Kim, Young; Ertel, Audrey E; Hoehn, Richard S; Wima, Koffi; Abbott, Daniel E; Shah, Shimul A

2017-05-01

Efforts to regionalize surgery based on thresholds in procedure volume may have consequences on the cost of health care delivery. This study aims to delineate the relationship between hospital volume, case mix, and variability in the cost of operative intervention using colectomy as the model. All patients undergoing colectomy (n = 90,583) at 183 academic hospitals from 2009-2012 in The University HealthSystems Consortium Database were studied. Patient and procedure details were used to generate a case mix-adjusted predictive model of total direct costs. Observed to expected costs for each center were evaluated between centers based on overall procedure volume. Patient and procedure characteristics were significantly different between volume tertiles. Observed costs at high-volume centers were less than at middle- and low-volume centers. According to our predictive model, high-volume centers cared for a less expensive case mix than middle- and low-volume centers ($12,786 vs $13,236 and $14,497, P < .01). Our predictive model accounted for 44% of the variation in costs. Overall efficiency (standardized observed to expected costs) was greatest at high-volume centers compared to middle- and low-volume tertiles (z score -0.16 vs 0.02 and -0.07, P < .01). Hospital costs and cost efficiency after an elective colectomy varies significantly between centers and may be attributed partially to the patient differences at those centers. These data demonstrate that a significant proportion of the cost variation is due to a distinct case mix at low-volume centers, which may lead to perceived poor performance at these centers. Copyright © 2016 Elsevier Inc. All rights reserved.

Recommendation Analysis for an Ambulatory Surgical Center at Brooke Army Medical Center

DTIC Science & Technology

2005-06-10

impacts BAMC’s ability to maintain or increase the throughput of surgery cases. Anesthesiology and Operative services maintains12 surgical suites, where...established in 1990. This rate is based on a fee schedule that bundles facility services such as nursing, recovery, anesthetics, and supplies. Based...this researcher selected the high volume services (ophthalmology, general surgery , otolaryngology, gynecology, and orthopedics) for this analysis. Hours

Annual health examination program, Ames Research Center

NASA Technical Reports Server (NTRS)

Hughes, L.; Ladou, J.

1975-01-01

A cost analysis of a low-volume multiphasic health testing program is presented. The results indicate that unit costs are similar to those of high-volume automated programs. The comparability in unit cost appears to result from the savings in personnel and space requirements of the smaller program as compared with the larger ones.

Postural Stability and Subsequent Sports Injuries during Indoor Season of Athletes

PubMed Central

Romero-Franco, Natalia; Gallego-Izquierdo, Tomás; Martínez-López, Emilio J; Hita-Contreras, Fidel; Catalina, Osuna-Pérez M; Martínez-Amat, Antonio

2014-01-01

[Purpose] The aim of this study was to analyze stabilometry in athletes during an indoor season in order to determine whether injured athletes show different stabilometric values before injury than non-injured athletes in two different training periods (volume and pre-competition periods). [Subjects] The subjects were 51 athletes from Unicaja athletic club who trained regularly. [Methods] At the end of the preseason and volume periods, athletes were subjected to bipodal and monopodal stabilometry. In addition, all injuries happening in the periods after performing stabilometry (volume and pre-competition periods) were tracked. [Results] Variance analysis of bipodal stabilometric measurements taken at the end of the preseason period showed that athletes with higher values for the center-of-pressure spread variables suffered injuries during the volume period. The right-leg monopodal stabilometric measurements taken at the end of the volume period showed that athletes with higher values in the center-of-pressure position variables suffered injuries during the pre-competition period. [Conclusion] Athletes showing the worst values for center-of-pressure spread variables are more prone to sports injuries in the subsequent training period. In monopodal measurements, athletes with poorer mediolateral stability were more prone to injuries in the subsequent training period. PMID:24926132

The Volume-outcome Relationship in Deceased Donor Kidney Transplantation and Implications for Regionalization.

PubMed

Barbas, Andrew S; Dib, Martin J; Rege, Aparna S; Vikraman, Deepak S; Sudan, Debra L; Knechtle, Stuart J; Scarborough, John E

2018-06-01

The aim of this study was to investigate the volume-outcome relationship in kidney transplantation by examining graft and patient outcomes using standardized risk adjustment (observed-to-expected outcomes). A secondary objective was to examine the geographic proximity of low, medium, and high-volume kidney transplant centers in the United States. The significant survival benefit of kidney transplantation in the context of a severe shortage of donor organs mandates strategies to optimize outcomes. Unlike for other solid organ transplants, the relationship between surgical volume and kidney transplant outcomes has not been clearly established. The Scientific Registry of Transplant Recipients was used to examine national outcomes for adults undergoing deceased donor kidney transplantation from January 1, 1999 to December 31, 2013 (15-year study period). Observed-to-expected rates of graft loss and patient death were compared for low, medium, and high-volume centers. The geographic proximity of low-volume centers to higher volume centers was determined to assess the impact of regionalization on patient travel burden. A total of 206,179 procedures were analyzed. Compared with low-volume centers, high-volume centers had significantly lower observed-to-expected rates of 1-month graft loss (0.93 vs 1.18, P<0.001), 1-year graft loss (0.97 vs 1.12, P<0.001), 1-month patient death (0.90 vs 1.29, P=0.005), and 1-year patient death (0.95 vs 1.15, P=0.001). Low-volume centers were frequently in close proximity to higher volume centers, with a median distance of 7 miles (interquartile range: 2 to 75). A robust volume-outcome relationship was observed for deceased donor kidney transplantation, and low-volume centers are frequently in close proximity to higher volume centers. Increased regionalization could improve outcomes, but should be considered carefully in light of the potential negative impact on transplant volume and access to care.

Space Operations Center system analysis study extension. Volume 2: Programmatics and cost

NASA Technical Reports Server (NTRS)

1982-01-01

A summary of Space Operations Center (SOC) orbital space station costs, program options and program recommendations is presented. Program structure, hardware commonality, schedules and program phasing are considered. Program options are analyzed with respect to mission needs, design and technology options, and anticipated funding constraints. Design and system options are discussed.

Identification of general risk-management countermeasures for unsafe driving actions. Volume 3, A definitional study of speeding, following too closely, and driving left of center

DOT National Transportation Integrated Search

1981-02-01

The report develops a set of operational definitions for three unsafe driving actions (UDAs): speeding, following too closely, and driving left of center. The definitions flow from a methodological development and from an analysis of the literature a...

Space Operations Center system analysis study extension. Volume 4, book 1: SOC system analysis report

NASA Technical Reports Server (NTRS)

1982-01-01

The Space Operations Center (SOC) orbital space station missions are analyzed. Telecommunications missions, space science, Earth sensing, and space testing missions, research and applications missions, defense missions, and satellite servicing missions are modeled and mission needs discussed. The satellite servicing missions are analyzed in detail, including construction and servicing equipment requirements, mission needs and benefits, differential drag characteristics of co-orbiting satellites, and satellite servicing transportation requirements.

Haystack Analysis Center

NASA Technical Reports Server (NTRS)

Niell, Arthur; Cappallo, Roger; Corey, Brian; Titus, Mike

2013-01-01

Analysis activities at Haystack Observatory are directed towards improving the accuracy of geodetic measurements, whether these are from VLBI, GNSS, SLR, or any other technique. Those analysis activities that are related to technology development are reported elsewhere in this volume. In this report, a preliminary analysis of the first geodetic sessions with the new broadband geodetic VLBI system is reported.

Proceedings of the Annual U.S. Army Operations Research Symposium (13th) , AORS XIII, Held at Fort Lee, Virginia on 29 October - 1 November 1974, Co- Hosted by Army Logistics Center, Fort Lee, Virginia and Army Quartermaster Center and Fort Lee, Virginia. Volume 2

DTIC Science & Technology

1974-11-01

Directorate, Rock Island, Illinois. 538 TITLE: Significant Difference Technique AUTHOR: Mr. Robert P. Lewis, Jr. US Army Logistics Management Center...was first used in a Decision Risk Analysis in August, 1971, at the Army Logistics Management Center, by John Cocker- ham and Harold Stafford. There is

Local cost structures and the economics of robot assisted radical prostatectomy.

PubMed

Scales, Charles D; Jones, Peter J; Eisenstein, Eric L; Preminger, Glenn M; Albala, David M

2005-12-01

Robot assisted prostatectomy (RAP) is more costly than traditional radical retropubic prostatectomy (RRP) under the cost structures at certain hospitals. However, this finding may not be the case in all care settings. We investigated the sensitivity of RAP and RRP inpatient costs to variations in length of stay (LOS), local hospitalization costs and robotic case volume in the specialist and generalist settings. We developed a model of RAP vs RRP costs in the specialist and generalist settings using published data on operative time and LOS, and cost data from our academic medical center. All inpatient cost centers were included, namely surgery costs, professional fees, postoperative care, robotic equipment and service. Extensive 1 and 2-way sensitivity analyses were performed. Our base case model demonstrated a cost premium for RAP vs RRP of USD $783 and $195 in the specialist and generalist settings, respectively. Sensitivity analysis of our model assumptions demonstrated that RAP could achieve cost equivalence with RRP at a surgical volume of 10 cases weekly. If case volume increased to 14 cases weekly, RAP would be less expensive than RRP in some practice settings in which RAP LOS was less than 1.5 days. The inpatient costs of robotic assisted prostatectomy are volume dependent and cost equivalence with generalist radical retropubic prostatectomy is possible at higher volume RAP specialty centers. While RAP may be cost competitive with RRP at high cost hospitals or high volume RAP specialist centers, this procedure would exist at a cost premium to RRP in other practice settings.

Baseline Description and Analysis of the Operations Related to Warehouse Controlled Documents at the Navy Publications and Forms Center, Philadelphia, Pennsylvania. Volume I. Phase I.

DTIC Science & Technology

1980-03-06

performing the present NPFC tasks. Potential automation technologies may include order processing mechanization, demand printing from micrographic or...effort and documented in this volume included the following: a. Functional description of the order processing activities as they currently operate. b...covered under each analysis area. i It is obvious from the exhibit that the functional description of order processing operations was to include COG I

Academic Relationships and Teaching Resources. Fogarty International Center Series on the Teaching of Preventive Medicine, Volume 6.

ERIC Educational Resources Information Center

Clark, Duncan W., Ed.

The monograph is one of the Fogarty International Center Series on the Teaching of Preventive Medicine, undertaken to: (1) review and evaluate the state of the art of prevention and control of human diseases; (2) identify deficiences in knowledge requiring further research (including analysis of financial resources, preventive techniques, and…

Evaluation of the Impact, Costs and Benefits of the Albuquerque Model Cities Library Materials and Cultural Centers. Final Report. Volume I and II.

ERIC Educational Resources Information Center

Zink, Lee B.; And Others

The purpose of this study was the examination of the Albuquerque Model Cities Library Materials and Cultural Centers and of their impact upon the community they serve. This was not a traditional cost/benefit study although it contains many of the aspects of such an analysis. The area served by the Centers is an area of relatively poor persons of…

DOE Office of Scientific and Technical Information (OSTI.GOV)

Heath, Jason E.; Bauer, Stephen J.; Broome, Scott Thomas

The Iowa Stored Energy Plant Agency selected a geologic structure at Dallas Center, Iowa, for evaluation of subsurface compressed air energy storage. The site was rejected due to lower-than-expected and heterogeneous permeability of the target reservoir, lower-than-desired porosity, and small reservoir volume. In an initial feasibility study, permeability and porosity distributions of flow units for the nearby Redfield gas storage field were applied as analogue values for numerical modeling of the Dallas Center Structure. These reservoir data, coupled with an optimistic reservoir volume, produced favorable results. However, it was determined that the Dallas Center Structure cannot be simplified to fourmore » zones of high, uniform permeabilities. Updated modeling using field and core data for the site provided unfavorable results for air fill-up. This report presents Sandia National Laboratories petrologic and petrophysical analysis of the Dallas Center Structure that aids in understanding why the site was not suitable for gas storage.« less

Instructional Analysis for Health Occupations.

ERIC Educational Resources Information Center

East Texas State Univ., Commerce. Occupational Curriculum Lab.

This instructional analysis centers on identifying the skills, related knowledge, teacher activities, and student activities that are central to teaching various topics included in the core curriculum for health occupations courses. Addressed in the volume are the following instructional areas: first aid; medical terminology; medical asepsis;…

THE EPIDEMIOLOGY OF EMERGENCY DEPARTMENT THORACOTOMY IN A STATEWIDE TRAUMA SYSTEM: DOES CENTER VOLUME MATTER?

PubMed

Dumas, Ryan P; Seamon, Mark J; Smith, Brian P; Yang, Wei; Cannon, Jeremy W; Schwab, C William; Reilly, Patrick M; Holena, Daniel N

2018-04-17

The relationship between high volume and improved outcomes has been described for a host of elective high-impact, low-frequency procedures, but there are little data to support such a relationship in high-impact low-frequency procedures in trauma. Using emergency department thoracotomy (EDT) as a model, we hypothesized that patients presenting to centers with higher institutional volumes of EDT would have improved survival referent to those presenting to lower volume institutions. We queried the Pennsylvania Trauma Outcomes Study (PTOS) registry from 2007-2015 for all EDTs performed at level I and II centers identified by ICD-9 procedure codes and a location stamp indicating the emergency department. We examined patient-level risk factors for survival in univariate regression and multivariable regression models. Centers were divided into tertiles of mean annual EDT volume and the association between mean annual EDT volume and patient survival was examined using logistic regression after controlling for patient factors. 1,399 emergency department thoracotomies were performed at 28 centers. Overall survival was 6.8%. After controlling for patient age, mechanism of injury, signs of life, and injury severity, patients presenting to centers in the highest tertile of volume had significantly higher odds of survival compared to patients presenting to centers in the lowest tertile of volume (OR 4.56, 95% CI 1.43-14.50). Patients presenting to centers with higher mean annual volume of EDTs have improved survival compared to those presenting to institutions with lower mean annual EDT volume. Efforts to understand the etiology of this finding may lead to interventions to improve outcomes at lower volume centers. Level 3: Retrospective cohort study.

Validity of automated measurement of left ventricular ejection fraction and volume using the Philips EPIQ system.

PubMed

Hovnanians, Ninel; Win, Theresa; Makkiya, Mohammed; Zheng, Qi; Taub, Cynthia

2017-11-01

To assess the efficiency and reproducibility of automated measurements of left ventricular (LV) volumes and LV ejection fraction (LVEF) in comparison to manually traced biplane Simpson's method. This is a single-center prospective study. Apical four- and two-chamber views were acquired in patients in sinus rhythm. Two operators independently measured LV volumes and LVEF using biplane Simpson's method. In addition, the image analysis software a2DQ on the Philips EPIQ system was applied to automatically assess the LV volumes and LVEF. Time spent on each analysis, using both methods, was documented. Concordance of echocardiographic measures was evaluated using intraclass correlation (ICC) and Bland-Altman analysis. Manual tracing and automated measurement of LV volumes and LVEF were performed in 184 patients with a mean age of 67.3 ± 17.3 years and BMI 28.0 ± 6.8 kg/m 2 . ICC and Bland-Altman analysis showed good agreements between manual and automated methods measuring LVEF, end-systolic, and end-diastolic volumes. The average analysis time was significantly less using the automated method than manual tracing (116 vs 217 seconds/patient, P < .0001). Automated measurement using the novel image analysis software a2DQ on the Philips EPIQ system produced accurate, efficient, and reproducible assessment of LV volumes and LVEF compared with manual measurement. © 2017, Wiley Periodicals, Inc.

Space Operations Center system analysis. Volume 3, book 2: SOC system definition report, revision A

NASA Technical Reports Server (NTRS)

1982-01-01

The Space Operations Center (SOC) orbital space station program operations are described. A work breakdown structure for the general purpose support equipment, construction and transportation support, and resupply and logistics support systems is given. The basis for the design of each element is presented, and a mass estimate for each element supplied. The SOC build-up operation, construction, flight support, and satellite servicing operations are described. Detailed programmatics and cost analysis are presented.

Homeland Defense Joint Center for Operational Analysis and Lessons Learned Quarterly Bulletin, Volume 7, Issue 1, December 2004

DTIC Science & Technology

2004-12-01

domestic use of the armed forces. 9Joint Center for Operational Analysis and Lessons Learned (JCOA-LL) Bulletin An almost invisible law In many...enacted a program to increase significantly the role of the armed forces in drug interdiction as part of the Defense Authorization Act for 1989. The...technology, expanded intelligence collection, and the formation of new partnerships are necessary. • Arms control and other multilateral agreements will be

Joint Personnel Recovery Agency Joint Center for Operational Analysis and Lessons Learned Quarterly Bulletin, Volume 7, Issue 2, March 2005

DTIC Science & Technology

2005-03-01

execute these dangerous and uncertain missions. iv In my recent travels in the U.S. Central Command area of operations I had the great fortune of meeting...jfcom.mil 1Joint Center for Operational Analysis and Lessons Learned (JCOA-LL) Bulletin “That others may live…to return with honor” The old Chinese ...information has to travel to meet GCC staff requirements increases the difficulty in handling and maintaining situational awareness on PR events

Space Operations Center system analysis study extension. Volume 4, book 2: SOC system analysis report

NASA Technical Reports Server (NTRS)

1982-01-01

The Space Operations Center (SOC) orbital space station research missions integration, crew requirements, SOC operations, and configurations are analyzed. Potential research and applications missions and their requirements are described. The capabilities of SOC are compared with user requirements. The SOC/space shuttle and shuttle-derived vehicle flight support operations and SOC orbital operations are described. Module configurations and systems options, SOC/external tank configurations, and configurations for geostationary orbits are described. Crew and systems safety configurations are summarized.

Interoperability Outlook in the Big Data Future

NASA Astrophysics Data System (ADS)

Kuo, K. S.; Ramachandran, R.

2015-12-01

The establishment of distributed active archive centers (DAACs) as data warehouses and the standardization of file format by NASA's Earth Observing System Data Information System (EOSDIS) had doubtlessly propelled interoperability of NASA Earth science data to unprecedented heights in the 1990s. However, we obviously still feel wanting two decades later. We believe the inadequate interoperability we experience is a result of the the current practice that data are first packaged into files before distribution and only the metadata of these files are cataloged into databases and become searchable. Data therefore cannot be efficiently filtered. Any extensive study thus requires downloading large volumes of data files to a local system for processing and analysis.The need to download data not only creates duplication and inefficiency but also further impedes interoperability, because the analysis has to be performed locally by individual researchers in individual institutions. Each institution or researcher often has its/his/her own preference in the choice of data management practice as well as programming languages. Analysis results (derived data) so produced are thus subject to the differences of these practices, which later form formidable barriers to interoperability. A number of Big Data technologies are currently being examined and tested to address Big Earth Data issues. These technologies share one common characteristics: exploiting compute and storage affinity to more efficiently analyze large volumes and great varieties of data. Distributed active "archive" centers are likely to evolve into distributed active "analysis" centers, which not only archive data but also provide analysis service right where the data reside. "Analysis" will become the more visible function of these centers. It is thus reasonable to expect interoperability to improve because analysis, in addition to data, becomes more centralized. Within a "distributed active analysis center" interoperability is almost guaranteed because data, analysis, and results all can be readily shared and reused. Effectively, with the establishment of "distributed active analysis centers", interoperation turns from a many-to-many problem into a less complicated few-to-few problem and becomes easier to solve.

The Centralization of Total Joint Arthroplasty in New York State An Analysis of 168,247 Cases.

PubMed

Adrados, Murillo; Theobald, Jason; Hutzler, Lorraine; Bosco, Joseph

2016-11-01

We identified 168,247 total hip and total knee arthroplasties performed in New York State between 2010 and 2012 to examine the evidence for increased geographical and institutional centralization of these procedures. We measured the increased growth of high volume institutions as compared to lower volume hospitals in New York State. We found a high proportion of total arthroplasties already performed in the dozen biggest hospitals in New York back in 2010 and a significant higher growth of these high volume, "centers of excellence," hospitals when compared to low volume hospitals.

Space Operations Center system analysis. Volume 3, book 1: SOC system definition report, revision A

NASA Technical Reports Server (NTRS)

1982-01-01

The Space Operations Center (SOC) orbital space station program and its elements are described. A work breakdown structure is presented and elements for the habitat and service modules, docking tunnel and airlock modules defined. The basis for the element's design is given. Mass estimates for the elements are presented in the work breakdown structure.

A Comparative Analysis of Tri-Service Accreditation Policies and Practices. Volume 1. Of the Accreditation Requirements Study Report

DTIC Science & Technology

1994-02-01

32 A-2 OTHER SURVIAC (Survivability & Vulnerability Information Analysis Center) Kevin Crosthwaite Dennis Detamore 33 J-MASS (Joint Modeling and...Crosthwaite DATE: 27 May 1993 Mr. Dennis Detamore ORGANIZATION: Booz-Allen Hamilton (SURVIAC) ORGANIZATIONAL RESPONSIBILITY: SURVIAC has the

Main Trend Extraction Based on Irregular Sampling Estimation and Its Application in Storage Volume of Internet Data Center

PubMed Central

Dou, Chao

2016-01-01

The storage volume of internet data center is one of the classical time series. It is very valuable to predict the storage volume of a data center for the business value. However, the storage volume series from a data center is always “dirty,” which contains the noise, missing data, and outliers, so it is necessary to extract the main trend of storage volume series for the future prediction processing. In this paper, we propose an irregular sampling estimation method to extract the main trend of the time series, in which the Kalman filter is used to remove the “dirty” data; then the cubic spline interpolation and average method are used to reconstruct the main trend. The developed method is applied in the storage volume series of internet data center. The experiment results show that the developed method can estimate the main trend of storage volume series accurately and make great contribution to predict the future volume value. 
 PMID:28090205

Main Trend Extraction Based on Irregular Sampling Estimation and Its Application in Storage Volume of Internet Data Center.

PubMed

Miao, Beibei; Dou, Chao; Jin, Xuebo

2016-01-01

The storage volume of internet data center is one of the classical time series. It is very valuable to predict the storage volume of a data center for the business value. However, the storage volume series from a data center is always "dirty," which contains the noise, missing data, and outliers, so it is necessary to extract the main trend of storage volume series for the future prediction processing. In this paper, we propose an irregular sampling estimation method to extract the main trend of the time series, in which the Kalman filter is used to remove the "dirty" data; then the cubic spline interpolation and average method are used to reconstruct the main trend. The developed method is applied in the storage volume series of internet data center. The experiment results show that the developed method can estimate the main trend of storage volume series accurately and make great contribution to predict the future volume value. 
 .

The Regionalization of Total Ankle Arthroplasties and Ankle Fusions in New York State: A 10-Year Comparative Analysis.

PubMed

Buza, John A; Liu, James X; Jancuska, Jeffrey; Bosco, Joseph A

2017-06-01

Total ankle arthroplasty (TAA) provides an alternative to ankle fusion (AF). The purpose of this study is to (1) determine the extent of TAA regionalization, as well as examine the growth of TAA performed at high-, medium-, and low-volume New York State institutions and (2) compare this regionalization and growth with AF. The New York Statewide Planning and Research Cooperative System (SPARCS) administrative data were used to identify 737 primary TAA and 7453 AF from 2005 to 2014. The volume of TAA and AF surgery in New York State was mapped according to patient and hospital 3-digit zip code. The number of TAA per year grew 1500% (from 11 to 177) from 2005 to 2014, while there was a 35.6% reduction (from 895 to 576) in yearly AF procedures. TAA recipients were widely distributed throughout the state, while TAA procedures were regionalized to a few select metropolitan centers. AF procedures were performed more uniformly than TAA. The number of TAA has continued to increase at high- (15 to 91) and medium-volume (14 to 67) institutions where it has decreased at low-volume institutions (44 to 19). The increased utilization of TAA is attributed to relatively few high-volume centers located in major metropolitan centers. Level IV: well-designed case-control or cohort studies.

Treatment at high-volume facilities and academic centers is independently associated with improved survival in patients with locally advanced head and neck cancer.

PubMed

David, John M; Ho, Allen S; Luu, Michael; Yoshida, Emi J; Kim, Sungjin; Mita, Alain C; Scher, Kevin S; Shiao, Stephen L; Tighiouart, Mourad; Zumsteg, Zachary S

2017-10-15

The treatment of head and neck cancers is complex and associated with significant morbidity, requiring multidisciplinary care and physician expertise. Thus, facility characteristics, such as clinical volume and academic status, may influence outcomes. The current study included 46,567 patients taken from the National Cancer Data Base who were diagnosed with locally advanced invasive squamous cell carcinomas of the oropharynx, larynx, and hypopharynx and were undergoing definitive radiotherapy. High-volume facilities (HVFs) were defined as the top 1% of centers by the number of patients treated from 2004 through 2012. Multivariable Cox regression and propensity score matching were performed to account for imbalances in covariates. The median follow-up was 55.1 months. Treatment at a HVF (hazard ratio, 0.798; 95% confidence interval, 0.753-0.845 [P<.001]) and treatment at an academic facility (hazard ratio, 0.897; 95% confidence interval, 0.871-0.923 [P<.001]) were found to be independently associated with improved overall survival in multivariable analysis. In propensity score-matched cohorts, the 5-year overall survival rate was 61.6% versus 55.5% for patients treated at an HVF versus lower-volume facilities, respectively (P<.001). Similarly, the 5-year overall survival rate was 52.3% versus 49.7% for patients treated at academic versus nonacademic facilities (P<.001). Analysis of facility volume as a continuous variable demonstrated continual improvement in survival with an increased number of patients treated. The impact of facility volume and academic designation on survival was observed when using a variety of thresholds to define HVF, and across the vast majority of subgroups, including both oropharyngeal and nonoropharyngeal subsites. Patients with locally advanced head and neck squamous cell carcinoma who are undergoing curative radiotherapy at HVFs and academic centers appear to have improved survival. Cancer 2017;123:3933-42. © 2017 American Cancer Society. © 2017 American Cancer Society.

Transcutaneous bowel sonography for inflammatory bowel disease is sensitive and specific when performed in a nonexpert low-volume North American center.

PubMed

Sey, Michael Sai Lai; Gregor, Jamie; Chande, Nilesh; Ponich, Terry; Bhaduri, Mousumi; Lum, Andrea; Zaleski, Witek; Yan, Brian

2013-08-01

Transcutaneous bowel sonography is a nonionizing imaging modality used in inflammatory bowel disease. Although available in Europe, its uptake in North America has been limited. Since the accuracy of bowel sonography is highly operator dependent, low-volume centers in North America may not achieve the same diagnostic accuracy reported in the European literature. Our objective was to determine the diagnostic accuracy of bowel sonography in a nonexpert low-volume center. All cases of bowel sonography at a single tertiary care center during an 18-month period were reviewed. Bowel sonography was compared with reference standards, including small-bowel follow-through, computed tomography, magnetic resonance imaging, colonoscopy, and surgical findings. A total of 103 cases were included for analysis during the study period. The final diagnoses included Crohn disease (72), ulcerative colitis (8), hemolytic uremic syndrome (1), and normal (22). The sensitivity and specificity of bowel sonography for intestinal wall inflammation were 87.8% and 92.6%, respectively. In the subset of patients who had complications of Crohn disease, the sensitivity and specificity were 50% and 100% for fistulas and 14% and 100% for strictures. One patient had an abscess, which was detected by bowel sonography. Abnormal bowel sonographic findings contributed to the escalation of treatment in 55% of cases. Bowel sonography for inflammatory bowel disease can be performed in low-volume centers and provides diagnostic accuracy for luminal disease comparable with published data, although it is less sensitive for complications of Crohn disease.

Specialization and utilization after hepatectomy in academic medical centers.

PubMed

Shaw, Joshua J; Santry, Heena P; Shah, Shimul A

2013-11-01

Specialized procedures such as hepatectomy are performed by a variety of specialties in surgery. We aimed to determine whether variation exists among utilization of resources, cost, and patient outcomes by specialty, surgeon case volume, and center case volume for hepatectomy. We queried centers (n = 50) in the University Health Consortium database from 2007-2010 for patients who underwent elective hepatectomy in which specialty was designated general surgeon (n = 2685; 30%) or specialist surgeon (n = 6277; 70%), surgeon volume was designated high volume (>38 cases annually) and center volume was designated high volume (>100 cases annually). We then stratified our cohort by primary diagnosis, defined as primary tumor (n = 2241; 25%), secondary tumor (n = 5466; 61%), and benign (n = 1255; 14%). Specialist surgeons performed more cases for primary malignancy (primary 26% versus 15%) while general surgeons operated more for secondary malignancies (67% versus 61%) and benign disease (18% versus 13%). Specialists were associated with a shorter total length of stay (LOS) (5 d versus 6 d; P < 0.01) and lower in-hospital morbidity (7% versus 11%; P < 0.01). Patients treated by high volume surgeons or at high volume centers were less likely to die than those treated by low volume surgeons or at low volume centers, (OR 0.55; 95% CI 0.33-0.89) and (OR 0.44; 95% CI 0.13-0.56). Surgical specialization, surgeon volume and center volume may be important metrics for quality and utilization in complex procedures like hepatectomy. Further studies are necessary to link direct factors related to hospital performance in the changing healthcare environment. Copyright © 2013 Elsevier Inc. All rights reserved.

Hospital esophagectomy volume and postoperative length of stay: A systematic review and meta-analysis.

PubMed

Giwa, Femi; Salami, Aitua; Abioye, Ajibola I

2018-01-01

Much attention in the volume-outcomes literature has focused on the empirical impact of surgical caseload on outcomes. However, relevant studies on the association between surgical volume and variables that potentially contribute to healthcare costs are limited. The objective of this study was to systematically elucidate a contemporary analysis of the empirical relationship between hospital esophagectomy volume and postoperative length of stay, a cost-related outcome. OvidSP, PubMed, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), ISI Web of Science and OpenGrey were searched for relevant articles published from 2000 to 2016. High hospital esophagectomy volume was associated with reduced postoperative length of stay (mean: 3 days; 95%CI: 2.8, 3.2) and risk of prolonged length of stay (RR: 0.80, 95%CI: 0.74, 0.87) in a dose-response fashion. Complex surgeries performed at high surgical volume centers may be associated with overall decrease in postoperative length of stay, a cost-related outcome. Copyright © 2017 Elsevier Inc. All rights reserved.

Analysis of Returned Comet Nucleus Samples

NASA Astrophysics Data System (ADS)

Chang, Sherwood

1997-12-01

This volume contains abstracts that have been accepted by the Program Committee for presentation at the Workshop on Analysis of Returned Comet Nucleus Samples, held in Milpitas, California, January 16-18, 1989. Conveners are Sherwood Chang (NASA Ames Research Center) and Larry Nyquist (NASA Johnson Space Center). Program Committee members are Thomas Ahrens (ex-officio; California Institute of Technology), Lou Allamandola (NASA Ames Research Center), David Blake (NASA Ames Research Center), Donald Brownlee (University of Washington, Seattle), Theodore E. Bunch (NASA Ames Research Center), Humberto Campins (Planetary Science Institute), Jeff Cuzzi (NASA Ames Research Center), Eberhard Griin (Max-Plank-Institut fiir Kemphysik), Martha Hanner (Jet Propulsion Laboratory), Alan Harris (Jet Propulsion Laboratory), John Kerrid-e (University of Califomia, Los Angeles), Yves Langevin (University of Paris), Gerhard Schwehm (ESTEC), and Paul Weissman (Jet Propulsion Laboratory). Logistics and administrative support for the workshop were provided by the Lunar and Planetary Institute Projects Office.

Analysis of Returned Comet Nucleus Samples

NASA Technical Reports Server (NTRS)

Chang, Sherwood (Compiler)

1997-01-01

This volume contains abstracts that have been accepted by the Program Committee for presentation at the Workshop on Analysis of Returned Comet Nucleus Samples, held in Milpitas, California, January 16-18, 1989. Conveners are Sherwood Chang (NASA Ames Research Center) and Larry Nyquist (NASA Johnson Space Center). Program Committee members are Thomas Ahrens (ex-officio; California Institute of Technology), Lou Allamandola (NASA Ames Research Center), David Blake (NASA Ames Research Center), Donald Brownlee (University of Washington, Seattle), Theodore E. Bunch (NASA Ames Research Center), Humberto Campins (Planetary Science Institute), Jeff Cuzzi (NASA Ames Research Center), Eberhard Griin (Max-Plank-Institut fiir Kemphysik), Martha Hanner (Jet Propulsion Laboratory), Alan Harris (Jet Propulsion Laboratory), John Kerrid-e (University of Califomia, Los Angeles), Yves Langevin (University of Paris), Gerhard Schwehm (ESTEC), and Paul Weissman (Jet Propulsion Laboratory). Logistics and administrative support for the workshop were provided by the Lunar and Planetary Institute Projects Office.

Single-breath CO2 analysis as a predictor of lung volume in a healthy animal model during controlled ventilation.

PubMed

Stenz, R I; Grenier, B; Thompson, J E; Arnold, J H

1998-08-01

To examine the utility of single-breath CO2 analysis as a measure of lung volume. A prospective, animal cohort study comparing 21 parameters derived from single-breath CO2 analysis with lung volume measurements determined by nitrogen washout in animals during controlled ventilation. An animal laboratory in a university-affiliated medical center. Seven healthy lambs. The single-breath CO2 analysis station consists of a mainstream capnometer, a variable orifice pneumotachometer, a signal processor and computer software with capability for both on- and off-line data analysis. Twenty-one derived components of the CO2 expirogram were evaluated as predictors of lung volume. Lung volume was manipulated by 3 cm H2O incremental increases in positive end-expiratory pressure from 0 to 21 cm H2O, and ranged between 147 and 942 mL. Fifty-five measurements of lung volume were available for comparison with derived variables from the CO2 expirogam. Stepwise linear regression identified four variables that were most predictive of lung volume: a) dynamic lung compliance; b) the slope of phase 3; c) the slope of phase 2 divided by the mixed expired CO2 tension; and d) airway deadspace. The multivariate equation was highly statistically significant and explained 94% of the variance (adjusted r2 =.94, p < .0001). The bias and precision of the calculated lung volume was .00 and 51, respectively. The mean percent difference for the lung volume estimate derived from the single-breath CO2 analysis station was 0.79%. Our data indicate that analysis of the CO2 expirogram can yield accurate information about lung volume. Specifically, four variables derived from a plot of expired CO2 concentration vs. expired volume predict changes in lung volume in healthy lambs with an adjusted coefficient of determination of .94. Prospective application of this technology in the setting of lung injury and rapidly changing physiology is essential in determining the clinical usefulness of the technique.

Liver transplant center performance profiling: 2005-2011 reports of the Scientific Registry for Transplant Recipients.

PubMed

Kettelhut, Valeriya V; Nayar, Preethy

2013-06-01

CONTEXT-Transplant center performance profiling provides important information for various concerned parties. Comparing a transplant center's performance against the performance of the best-in-class centers may help in understanding the performance thresholds for the underperforming centers. OBJECTIVES-(1) To identify and describe "Centers for Medicare and Medicaid Services (CMS)-red-flag" performers and the "best-in-class" performers and (2) to examine the relationships between a center's performance profile and outcomes such as 1-year observed mortality, 1-month observed mortality, 1-year risk-adjusted mortality, and volume. METHODS-The data for analysis was obtained from the published reports on the Scientific Registry for Transplant Recipients (SRTR) website for adult liver transplant programs compiled for the rolling 2 1/2-year cohorts of patients and included 7 cohorts of liver transplant recipients in the study from January through July 1, 2002, through December 31, 2010. We defined 4 performance profiles: CMS-red-flag, lower-than-expected, higher-than-expected, and best-in-class performers. RESULTS-The current SRTR methods classify approximately 7% of the adult liver centers as CMS-red-flag performers and 6% of the centers as best-in-class performers in every reported period. Neither of the low-volume centers (<30 liver transplants per 2 1/2-year cohort) was profiled as CMS-red-flag until the 2010 reporting period. The transplant center's profile was significantly associated with the 1-year and 1-month observed mortality rates in every reported cohort (P< .001). CONCLUSION-The CMS-red-flag profile can be characterized with the following: (1) the highest observed 1-year mortality, (2) the highest observed 1-month mortality, (3) a very large difference between the observed and adjusted mortality rates, and (4) the center volume greater than 30 liver transplants per 2 1/2-year cohort. The SRTR methods are not sensitive for performance profiling in the centers that perform fewer than 30 orthotopic liver transplants per 2 1/2-year cohort.

Attendance and Chronic Absenteeism in Indiana: The Impact on Student Achievement. Education Policy Brief, Volume 10, Number 3, Summer 2012

ERIC Educational Resources Information Center

Spradlin, Terry; Cierniak, Katherine; Shi, Dingjing; Chen, Minge

2012-01-01

This Education Policy Brief summarizes the research and data analysis completed by the Center for Evaluation and Education Policy (CEEP) on Indiana's student attendance and absenteeism data. The study was initiated by The Indiana Partnerships Center and conducted by CEEP with funding from USA Funds and State Farm. Additional partners in the study…

North Carolina DOT traffic separation studies. Volume I, Assessment.

DOT National Transportation Integrated Search

2004-09-01

The Federal Railroad Administration requested the Volpe National Transportation Systems Center to assess ten sites in depth that used the Traffic Separation Study (TSS) process. The assessment involved a quantitative and qualitative analysis of the i...

Space Operations Center system analysis study extension. Volume 1: Executive summary

NASA Technical Reports Server (NTRS)

1982-01-01

The analysis fo Space Operations Center (SOC) systems is summarized. Design considerations, configurations of the manned orbital space station, planned operational and research missions, and subsystem tradeoffs are considered. Integration into the space transportation system is discussed. A modular design concept permitting growth of the SOC as its functions are expanded is described. Additional considerations are special requirements for habitat modules, design modifications needed to operate in geosynchronous orbits, and use of the external tank for cryogenic propellant storage or as a pressurized hangar. A cost summary is presented.

Electrical Systems Analysis at NASA Glenn Research Center: Status and Prospects

NASA Technical Reports Server (NTRS)

Freeh, Joshua E.; Liang, Anita D.; Berton, Jeffrey J.; Wickenheiser, Timothy J.

2003-01-01

An analysis of an electrical power and propulsion system for a 2-place general aviation aircraft is presented to provide a status of such modeling at NASA Glenn Research Center. The thermodynamic/ electrical model and mass prediction tools are described and the resulting system power and mass are shown. Three technology levels are used to predict the effect of advancements in component technology. Methods of fuel storage are compared by mass and volume. Prospects for future model development and validation at NASA as well as possible applications are also summarized.

A Continuation of Base-line Studies for Environmentally Monitoring Space Transportation Systems at John F. Kennedy Space Center. Volume 2; Chemical Studies of Rainfall and Soil Analysis

NASA Technical Reports Server (NTRS)

Madsen, B. C.

1980-01-01

The results of a study which was designed to monitor, characterize, and evaluate the chemical composition of precipitation (rain) which fell at the Kennedy Space Center, Florida (KSC) during the period July 1977 to March 1979 are reported. Results which were obtained from a soil sampling and associated chemical analysis are discussed. The purpose of these studies was to determine the environmental perturbations which might be caused by NASA space activities.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Vlies, C. H. van der, E-mail: c.h.vandervlies@amc.uva.nl; Hoekstra, J.; Ponsen, K. J.

Introduction: Nonoperative management (NOM) has become the treatment of choice for hemodynamically stable patients with blunt splenic injury. Results of outcome after NOM are predominantly based on large-volume studies from level 1 trauma centers in the United States. This study was designed to assess the results of NOM in a relatively low-volume Dutch level 1 trauma center. Methods: An analysis of a prospective trauma registry was performed for a 6-year period before (period 1) and after the introduction and implementation of splenic artery embolization (SAE) (period 2). Primary outcome was the failure rate of initial treatment. Results: A total ofmore » 151 patients were reviewed. An increased use of SAE and a reduction of splenic operations during the second period was observed. Compared with period 1, the failure rate after observation in period 2 decreased from 25% to 10%. The failure rate after SAE in period 2 was 18%. The splenic salvage rate (SSR) after observation increased from 79% in the first period to 100% in the second period. During the second period, all patients with failure after observation were successfully treated with SAE. The SSR after SAE in periods 1 and 2 was respectively 100% and 86%. Conclusions: SAE of patients with blunt splenic injuries is associated with a reduction in splenic operations. The failure and splenic salvage rates in this current study were comparable with the results from large-volume studies of level 1 trauma centers. Nonoperative management also is feasible in a relatively low-volume level 1 trauma center outside the United States.« less

Using telephony data to facilitate discovery of clinical workflows.

PubMed

Rucker, Donald W

2017-04-19

Discovery of clinical workflows to target for redesign using methods such as Lean and Six Sigma is difficult. VoIP telephone call pattern analysis may complement direct observation and EMR-based tools in understanding clinical workflows at the enterprise level by allowing visualization of institutional telecommunications activity. To build an analytic framework mapping repetitive and high-volume telephone call patterns in a large medical center to their associated clinical units using an enterprise unified communications server log file and to support visualization of specific call patterns using graphical networks. Consecutive call detail records from the medical center's unified communications server were parsed to cross-correlate telephone call patterns and map associated phone numbers to a cost center dictionary. Hashed data structures were built to allow construction of edge and node files representing high volume call patterns for display with an open source graph network tool. Summary statistics for an analysis of exactly one week's call detail records at a large academic medical center showed that 912,386 calls were placed with a total duration of 23,186 hours. Approximately half of all calling called number pairs had an average call duration under 60 seconds and of these the average call duration was 27 seconds. Cross-correlation of phone calls identified by clinical cost center can be used to generate graphical displays of clinical enterprise communications. Many calls are short. The compact data transfers within short calls may serve as automation or re-design targets. The large absolute amount of time medical center employees were engaged in VoIP telecommunications suggests that analysis of telephone call patterns may offer additional insights into core clinical workflows.

Radio advertising increases hospital call center volume by 48%.

PubMed

2006-01-01

Since the fall of 2005, call volume at University of Southern California University Hospital of Los Angeles' call center has increased by nearly 50%. How? The hospital embarked on a long-term radio campaign to promote its presence as a premier academic medical center and to increase patient volume.

Accuracy Analysis for Finite-Volume Discretization Schemes on Irregular Grids

NASA Technical Reports Server (NTRS)

Diskin, Boris; Thomas, James L.

2010-01-01

A new computational analysis tool, downscaling test, is introduced and applied for studying the convergence rates of truncation and discretization errors of nite-volume discretization schemes on general irregular (e.g., unstructured) grids. The study shows that the design-order convergence of discretization errors can be achieved even when truncation errors exhibit a lower-order convergence or, in some cases, do not converge at all. The downscaling test is a general, efficient, accurate, and practical tool, enabling straightforward extension of verification and validation to general unstructured grid formulations. It also allows separate analysis of the interior, boundaries, and singularities that could be useful even in structured-grid settings. There are several new findings arising from the use of the downscaling test analysis. It is shown that the discretization accuracy of a common node-centered nite-volume scheme, known to be second-order accurate for inviscid equations on triangular grids, degenerates to first order for mixed grids. Alternative node-centered schemes are presented and demonstrated to provide second and third order accuracies on general mixed grids. The local accuracy deterioration at intersections of tangency and in flow/outflow boundaries is demonstrated using the DS tests tailored to examining the local behavior of the boundary conditions. The discretization-error order reduction within inviscid stagnation regions is demonstrated. The accuracy deterioration is local, affecting mainly the velocity components, but applies to any order scheme.

Facility Volume and Survival in Nasopharyngeal Carcinoma.

PubMed

Yoshida, Emi J; Luu, Michael; David, John M; Kim, Sungjin; Mita, Alain; Scher, Kevin; Shiao, Stephen L; Tighiouart, Mourad; Lee, Nancy Y; Ho, Allen S; Zumsteg, Zachary S

2018-02-01

Definitive treatment of nasopharyngeal carcinoma (NPC) is challenging owing to its rarity, complicated regional anatomy, and the intensity of therapy. In contrast to other head and neck cancers, the effect of facility volume has not been well described for NPC. The National Cancer Database was queried for patients with stage II-IVB NPC diagnosed from 2004 to 2014 and treated with definitive radiation. Patients with incomplete staging, unknown receipt or timing of treatment, unknown follow-up duration, incomplete socioeconomic information, or treatment outside the reporting facility were excluded. High-volume facilities (HVFs) were defined as the top 5% of facilities according to the annual facility volume. The present analysis included 3941 NPC patients treated at 804 facilities with a median follow-up duration of 59.4 months, including 1025 patients (26.0%) treated at HVFs. Treatment at HVFs was associated with significantly improved overall survival (OS) on multivariable analysis (hazard ratio 0.79, 95% confidence interval 0.69-0.90; P=.001). In propensity score-matched cohorts, 5-year OS was 69.1% versus 63.3% at HVFs versus lower volume facilities (LVFs), respectively (P=.003). Similar results were seen when facility volume was analyzed as a continuous variable. The effect of facility volume on survival varied by academic status (P=.002 for interaction). At academic centers, the propensity score-matched cohorts had 5-year OS of 71.4% compared with 62.4% (P<.001) at HVFs and LVFs, respectively. In contrast, the 5-year OS was 63.5% versus 67.9% (P=.68) in propensity score-matched patients at nonacademic HVFs and LVFs. Treatment at HVFs was associated with improved OS for patients with NPC, with the effect exclusively seen at academic centers. Copyright © 2017 Elsevier Inc. All rights reserved.

Solar power satellite system definition study, volume 5. Phase 2: Final briefing

NASA Technical Reports Server (NTRS)

1979-01-01

A briefing outline of the definition study is presented. Topics discussed include: Solar Power Satellite (SPS) research and development, definition study, operations control, transportation, solid state SPS, pilot link analysis, and offshore space center.

Joint Center for Operational Analysis Journal. Volume 12, Issue 3, Winter 2010-2011

DTIC Science & Technology

2011-01-01

building . One technique that worked well involved demonstra- tion projects such as green houses, center-pivot and drip irrigation, and grain silos...or other professional objectives such that failure is not really verifiable. A common example from foreign assistance project objectives is... professionals . Indeed, there is a long litany of far more egregious and damaging projects wholly planned and executed by development professionals

A 20-year period of orthotopic liver transplantation activity in a single center: a time series analysis performed using the R Statistical Software.

PubMed

Santori, G; Andorno, E; Morelli, N; Casaccia, M; Bottino, G; Di Domenico, S; Valente, U

2009-05-01

In many Western countries a "minimum volume rule" policy has been adopted as a quality measure for complex surgical procedures. In Italy, the National Transplant Centre set the minimum number of orthotopic liver transplantation (OLT) procedures/y at 25/center. OLT procedures performed in a single center for a reasonably large period may be treated as a time series to evaluate trend, seasonal cycles, and nonsystematic fluctuations. Between January 1, 1987 and December 31, 2006, we performed 563 cadaveric donor OLTs to adult recipients. During 2007, there were another 28 procedures. The greatest numbers of OLTs/y were performed in 2001 (n = 51), 2005 (n = 50), and 2004 (n = 49). A time series analysis performed using R Statistical Software (Foundation for Statistical Computing, Vienna, Austria), a free software environment for statistical computing and graphics, showed an incremental trend after exponential smoothing as well as after seasonal decomposition. The predicted OLT/mo for 2007 calculated with the Holt-Winters exponential smoothing applied to the previous period 1987-2006 helped to identify the months where there was a major difference between predicted and performed procedures. The time series approach may be helpful to establish a minimum volume/y at a single-center level.

IMP: Interactive mass properties program. Volume 1: Program description

NASA Technical Reports Server (NTRS)

Stewart, W. A.

1976-01-01

A method of computing a weights and center of gravity analysis of a flight vehicle using interactive graphical capabilities of the Adage 340 computer is described. The equations used to calculate area, volume, and mass properties are based on elemental surface characteristics. The input/output methods employ the graphic support of the Adage computer. Several interactive program options are available for analyzing the mass properties of a vehicle. These options are explained.

Impact of hospital and surgeon case volume on morbidity in colorectal endometriosis management: a plea to define criteria for expert centers.

PubMed

Bendifallah, Sofiane; Roman, Horace; Rubod, Chrystel; Leguevaque, Pierre; Watrelot, Antoine; Bourdel, Nicolas; Ballester, Marcos; Darai, Emile

2018-04-01

National and international guidelines recommend referring patients with severe forms of endometriosis to expert centers. However, there is a lack of clear criteria to define an expert center. We examined the roles of surgeon and hospital procedure volumes as determinants of morbidity in deep infiltrating endometriosis of the rectum and sigmoid colon (DIERS). We conducted a French retrospective multicenter study of hospital facilities performing colorectal surgery for DIERS in 2015. The primary end point was to analyze the relation between case volume and the incidence of complications. We estimated the optimal cut-off (OCO) determined by a minimal p-value approach. The study included 56 hospital facilities and collected data of 1135 cases of surgical management of colorectal endometriosis. The mean and median number of procedures per year and per surgeon were 9.17 and 5.58, respectively. The overall rate of grade III-V complication was 7.6% (82/1135). One grade V complication occurred. The rates of rectovaginal fistula, anastomotic leakage, pelvic abscess, and ureteral fistula were: 2.7% (31/1135), 0.79% (9/1135), 3.4% (39/1135), and 0.70% (8/1135), respectively. An OCO of 20 procedures per center and per year (p < 0.001) was defined. The OCO per surgeon and per year varied between seven (p = 0.007) and 13 procedures (p = 0.03). In a multivariate analysis, we found that only the volume of activity was independently correlated to complication outcomes (p = 0.0013). Our results contribute to providing objective morbidity data to determine criteria for defining expert centers for colorectal surgery for endometriosis.

Going the Extra Mile: Improved Survival for Pancreatic Cancer Patients Traveling to High-volume Centers.

PubMed

Lidsky, Michael E; Sun, Zhifei; Nussbaum, Daniel P; Adam, Mohamed A; Speicher, Paul J; Blazer, Dan G

2017-08-01

This study compares outcomes following pancreaticoduodenectomy (PD) for patients treated at local, low-volume centers and those traveling to high-volume centers. Although outcomes for PD are superior at high-volume institutions, not all patients live in proximity to major medical centers. Theoretical advantages for undergoing surgery locally exist. The 1998 to 2012 National Cancer Data Base was queried for T1-3N0-1M0 pancreatic adenocarcinoma patients who underwent PD. Travel distances to treatment centers were calculated. Overlaying the upper and lower quartiles of travel distance with institutional volume established short travel/low-volume (ST/LV) and long travel/high-volume (LT/HV) cohorts. Overall survival was evaluated. Of 7086 patients, 773 ST/LV patients traveled ≤6.3 (median 3.2) miles to centers performing ≤3.3 PDs yearly, and 758 LT/HV patients traveled ≥45 (median 97.3) miles to centers performing ≥16 PDs yearly. LT/HV patients had higher stage disease (P < 0.001), but lower margin positivity (20.5% vs 25.9%, P = 0.01) and improved lymphadenectomy (16 vs 11 nodes, P < 0.01). Moreover, LT/HV patients had shorter hospitalizations (9 vs 12 days, P < 0.01) and lower 30-day mortality (2.0% vs 6.3%, P < 0.01) with similar 30-day readmission rates (10.1% vs 9.8%, P = 0.83). Despite more advanced disease, LT/HV patients had superior unadjusted survival (20.3 vs 15.7 months). After adjustment, travel to a high-volume center remained associated with reduced long-term mortality (hazard ratio 0.75, P < 0.01). Despite an increased travel burden, patients treated at high-volume centers had improved perioperative outcomes, short-term mortality, and overall survival. These data support ongoing efforts to centralize care for patients undergoing PD.

Rail Safety/Equipment Crashworthiness : Volume 1. A Systems Analysis of Injury Minimization in Rail Systems

DOT National Transportation Integrated Search

1978-07-01

The Department of Transportation, Transportation Systems Center (TSC), is providing technical assistance to the Federal Railroad Administration (FRA) in a program to improve railroad safety and efficiency by providing a technological basis for improv...

Achieving Good Perioperative Outcomes After Pancreaticoduodenectomy in a Low-Volume Setting: A 25-Year Experience

PubMed Central

Chedid, Aljamir D.; Chedid, Marcio F.; Winkelmann, Leonardo V.; Filho, Tomaz J. M. Grezzana; Kruel, Cleber D. P.

2015-01-01

Perioperative mortality following pancreaticoduodenectomy has improved over time and is lower than 5% in selected high-volume centers. Based on several large literature series on pancreaticoduodenectomy from high-volume centers, some defend that high annual volumes are necessary for good outcomes after pancreaticoduodenectomy. We report here the outcomes of a low annual volume pancreaticoduodenectomy series after incorporating technical expertise from a high-volume center. We included all patients who underwent pancreaticoduodenectomy performed by a single surgeon (ADC.) as treatment for periampullary malignancies from 1981 to 2005. Outcomes of this series were compared to those of 3 high-volume literature series. Additionally, outcomes for first 10 cases in the present series were compared to those of all 37 remaining cases in this series. A total of 47 pancreaticoduodenectomies were performed over a 25-year period. Overall in-hospital mortality was 2 cases (4.3%), and morbidity occurred in 23 patients (48.9%). Both mortality and morbidity were similar to those of each of the three high-volume center comparison series. Comparison of the outcomes for the first 10 to the remaining 37 cases in this series revealed that the latter 37 cases had inferior mortality (20% versus 0%; P = 0.042), less tumor-positive margins (50 versus 13.5%; P = 0.024), less use of intraoperative blood transfusions (90% versus 32.4%; P = 0.003), and tendency to a shorter length of in-hospital stay (20 versus 15.8 days; P = 0.053). Accumulation of surgical experience and incorporation of expertise from high-volume centers may enable achieving satisfactory outcomes after pancreaticoduodenectomy in low-volume settings whenever referral to a high-volume center is limited. PMID:25875555

Analysis of the access patterns at GSFC distributed active archive center

NASA Technical Reports Server (NTRS)

Johnson, Theodore; Bedet, Jean-Jacques

1996-01-01

The Goddard Space Flight Center (GSFC) Distributed Active Archive Center (DAAC) has been operational for more than two years. Its mission is to support existing and pre Earth Observing System (EOS) Earth science datasets, facilitate the scientific research, and test Earth Observing System Data and Information System (EOSDIS) concepts. Over 550,000 files and documents have been archived, and more than six Terabytes have been distributed to the scientific community. Information about user request and file access patterns, and their impact on system loading, is needed to optimize current operations and to plan for future archives. To facilitate the management of daily activities, the GSFC DAAC has developed a data base system to track correspondence, requests, ingestion and distribution. In addition, several log files which record transactions on Unitree are maintained and periodically examined. This study identifies some of the users' requests and file access patterns at the GSFC DAAC during 1995. The analysis is limited to the subset of orders for which the data files are under the control of the Hierarchical Storage Management (HSM) Unitree. The results show that most of the data volume ordered was for two data products. The volume was also mostly made up of level 3 and 4 data and most of the volume was distributed on 8 mm and 4 mm tapes. In addition, most of the volume ordered was for deliveries in North America although there was a significant world-wide use. There was a wide range of request sizes in terms of volume and number of files ordered. On an average 78.6 files were ordered per request. Using the data managed by Unitree, several caching algorithms have been evaluated for both hit rate and the overhead ('cost') associated with the movement of data from near-line devices to disks. The algorithm called LRU/2 bin was found to be the best for this workload, but the STbin algorithm also worked well.

Redesigning a joint replacement program using Lean Six Sigma in a Veterans Affairs hospital.

PubMed

Gayed, Benjamin; Black, Stephen; Daggy, Joanne; Munshi, Imtiaz A

2013-11-01

In April 2009, an analysis of joint replacement surgical procedures at the Richard L. Roudebush Veterans Affairs Medical Center, Indianapolis, Indiana, revealed that total hip and knee replacements incurred $1.4 million in non-Veterans Affairs (VA) care costs with an average length of stay of 6.1 days during fiscal year 2008. The Joint Replacement Program system redesign project was initiated following the Vision-Analysis-Team-Aim-Map-Measure-Change-Sustain (VA-TAMMCS) model to increase efficiency, decrease length of stay, and reduce non-VA care costs. To determine the effectiveness of Lean Six Sigma process improvement methods applied in a VA hospital. Perioperative processes for patients undergoing total joint replacement were redesigned following the VA-TAMMCS model--the VA's official, branded method of Lean Six Sigma process improvement. A multidisciplinary team including the orthopedic surgeons, frontline staff, and executive management identified waste in the current processes and initiated changes to reduce waste and increase efficiency. Data collection included a 1-year baseline period and a 20-month sustainment period. The primary endpoint was length of stay; a secondary analysis considered non-VA care cost reductions. Length of stay decreased 36% overall, decreasing from 5.3 days during the preproject period to 3.4 days during the 20-month sustainment period (P < .001). Non-VA care was completely eliminated for patients undergoing total hip and knee replacement at the Richard L. Roudebush Veterans Affairs Medical Center, producing an estimated return on investment of $1 million annually when compared with baseline cost and volumes. In addition, the volume of total joint replacements at this center increased during the data collection period. The success of the Joint Replacement Program demonstrates that VA-TAMMCS is an effective tool for Lean and Six Sigma process improvement initiatives in a surgical practice, producing a 36% sustained reduction in length of stay and completely eliminating non-VA care for total hip and knee replacements while increasing total joint replacement volume at this medical center.

Is the Distance Worth It? Patients With Rectal Cancer Traveling to High-Volume Centers Experience Improved Outcomes.

PubMed

Xu, Zhaomin; Becerra, Adan Z; Justiniano, Carla F; Boodry, Courtney I; Aquina, Christopher T; Swanger, Alex A; Temple, Larissa K; Fleming, Fergal J

2017-12-01

It is unclear whether traveling long distances to high-volume centers would compensate for travel burden among patients undergoing rectal cancer resection. The purpose of this study was to determine whether operative volume outweighs the advantages of being treated locally by comparing the outcomes of patients with rectal cancer treated at local, low-volume centers versus far, high-volume centers. This was a population-based study. The National Cancer Database was queried for patients with rectal cancer. Patients with stage II or III rectal cancer who underwent surgical resection between 2006 and 2012 were included. The outcomes of interest were margins, lymph node yield, receipt of neoadjuvant chemoradiation, adjuvant chemotherapy, readmission within 30 days, 30-day and 90-day mortality, and 5-year overall survival. A total of 18,605 patients met inclusion criteria; 2067 patients were in the long-distance/high-volume group and 1362 in the short-distance/low-volume group. The median travel distance was 62.6 miles for the long-distance/high-volume group and 2.3 miles for the short-distance/low-volume group. Patients who were younger, white, privately insured, and stage III were more likely to have traveled to a high-volume center. When controlled for patient factors, stage, and hospital factors, patients in the short-distance/low-volume group had lower odds of a lymph node yield ≥12 (OR = 0.51) and neoadjuvant chemoradiation (OR = 0.67) and higher 30-day (OR = 3.38) and 90-day mortality (OR = 2.07) compared with those in the long-distance/high-volume group. The short-distance/low-volume group had a 34% high risk of overall mortality at 5 years compared with the long-distance/high-volume group. We lacked data regarding patient and physician decision making and surgeon-specific factors. Our results indicate that when controlled for patient, tumor, and hospital factors, patients who traveled a long distance to a high-volume center had improved lymph node yield, neoadjuvant chemoradiation receipt, and 30- and 90-day mortality compared with those who traveled a short distance to a low-volume center. They also had improved 5-year survival. See Video Abstract at http://links.lww.com/DCR/A446.

A comparison of center-based vs. home-based daily hemodialysis for patients with end-stage renal disease.

PubMed

Kraus, Michael; Burkart, John; Hegeman, Rebecca; Solomon, Richard; Coplon, Norman; Moran, John

2007-10-01

Home hemodialysis has been a therapeutic option for almost 4 decades. The complexity of dialysis equipment has been a factor-limiting adoption of this modality. We performed a feasibility study to demonstrate the safety of center-based vs. home-based daily hemodialysis with the NxStage System One portable hemodialysis device. We also performed a retrospective analysis to determine if clinical effects previously associated with short-daily dialysis were also seen using this novel device. We conducted a prospective, 2-treatment, 2-period, open-label, crossover study of in-center hemodialysis vs. home hemodialysis in 32 patients treated at 6 U.S. centers. The 8-week In-Center Phase (6 days/week) was followed by a 2-week transition period and then followed by the 8-week Home Phase (6 days/week). We retrospectively collected data on hemodialysis treatment parameters immediately preceding the study in a subset of patients. Twenty-six out of 32 patients (81%) successfully completed the study. Successful delivery of at least 90% of prescribed fluid volume (primary endpoint) was achieved in 98.5% of treatments in-center and 97.3% at home. Total effluent volume as a percentage of prescribed volume was between 94% and 100% for all study weeks. The composite rate of intradialytic and interdialytic adverse events per 100 treatments was significantly higher for the In-Center Phase (5.30) compared with the Home Phase (2.10; p=0.007). Compared with the period immediately preceding the study, there were reductions in blood pressure, antihypertensive medications, and interdialytic weight gain. Daily home hemodialysis with a small, easy-to-use hemodialysis device is a viable dialysis option for end-stage renal disease patients capable of self/partner-administered dialysis.

Quantitative analysis of treatment process time and throughput capacity for spot scanning proton therapy.

PubMed

Suzuki, Kazumichi; Palmer, Matthew B; Sahoo, Narayan; Zhang, Xiaodong; Poenisch, Falk; Mackin, Dennis S; Liu, Amy Y; Wu, Richard; Zhu, X Ronald; Frank, Steven J; Gillin, Michael T; Lee, Andrew K

2016-07-01

To determine the patient throughput and the overall efficiency of the spot scanning system by analyzing treatment time, equipment availability, and maximum daily capacity for the current spot scanning port at Proton Therapy Center Houston and to assess the daily throughput capacity for a hypothetical spot scanning proton therapy center. At their proton therapy center, the authors have been recording in an electronic medical record system all treatment data, including disease site, number of fields, number of fractions, delivered dose, energy, range, number of spots, and number of layers for every treatment field. The authors analyzed delivery system downtimes that had been recorded for every equipment failure and associated incidents. These data were used to evaluate the patient census, patient distribution as a function of the number of fields and total target volume, and equipment clinical availability. The duration of each treatment session from patient walk-in to patient walk-out of the spot scanning treatment room was measured for 64 patients with head and neck, central nervous system, thoracic, and genitourinary cancers. The authors retrieved data for total target volume and the numbers of layers and spots for all fields from treatment plans for a total of 271 patients (including the above 64 patients). A sensitivity analysis of daily throughput capacity was performed by varying seven parameters in a throughput capacity model. The mean monthly equipment clinical availability for the spot scanning port in April 2012-March 2015 was 98.5%. Approximately 1500 patients had received spot scanning proton therapy as of March 2015. The major disease sites treated in September 2012-August 2014 were the genitourinary system (34%), head and neck (30%), central nervous system (21%), and thorax (14%), with other sites accounting for the remaining 1%. Spot scanning beam delivery time increased with total target volume and accounted for approximately 30%-40% of total treatment time for the total target volumes exceeding 200 cm(3), which was the case for more than 80% of the patients in this study. When total treatment time was modeled as a function of the number of fields and total target volume, the model overestimated total treatment time by 12% on average, with a standard deviation of 32%. A sensitivity analysis of throughput capacity for a hypothetical four-room spot scanning proton therapy center identified several priority items for improvements in throughput capacity, including operation time, beam delivery time, and patient immobilization and setup time. The spot scanning port at our proton therapy center has operated at a high performance level and has been used to treat a large number of complex cases. Further improvements in efficiency may be feasible in the areas of facility operation, beam delivery, patient immobilization and setup, and optimization of treatment scheduling.

Learning To Bridge the Digital Divide: Schooling for Tomorrow. Education and Skills. [National Center on Adult Literacy (NCAL)/Organization for Economic Cooperation and Development (OECD) Roundtable (5th, Philadelphia, Pennsylvania, December 8-10, 1999)].

ERIC Educational Resources Information Center

Jame, Edwyn; Istance, David

This publication builds on the papers and discussions of the Fifth National Center on Adult Literacy (NCAL)/Organization for Economic Cooperation and Development (OECD) Roundtable. The volume presents an analysis of the "learning digital divide" in different countries--developed and developing--and the policies and innovations designed…

Wheel/Rail Force Measurement at the Washington Metropolitan Area Transit Authority - Phase II. Volume I. Analysis Report.

DOT National Transportation Integrated Search

1983-06-01

In support of the Office of Rail and Construction Technology of the Urban Mass Transportation Administration, the Transportation Systems Center (TSC) is conducting analytical and experimental studies to relate transit truck design characteristics, wh...

Influence of Transplant Center Procedural Volume on Survival Outcomes of Heart Transplantation for Children Bridged with Mechanical Circulatory Support.

PubMed

Hsieh, Alex; Tumin, Dmitry; McConnell, Patrick I; Galantowicz, Mark; Tobias, Joseph D; Hayes, Don

2017-02-01

Transplant center expertise improves survival after heart transplant (HTx) but it is unknown whether center expertise ameliorates risk associated with mechanical circulatory support (MCS) bridge to transplantation. This study investigated whether center HTx volume reduced survival disparities among pediatric HTx patients bridged with extracorporeal membrane oxygenation (ECMO), left ventricular assist device (LVAD), or no MCS. Patients ≤18 years of age receiving first-time HTx between 2005 and 2015 were identified in the United Network of Organ Sharing registry. Center volume was the total number of HTx during the study period, classified into tertiles. The primary outcome was 1 year post-transplant survival, and MCS type was interacted with center volume in Cox proportional hazards regression. The study cohort included 4131 patients, of whom 719 were supported with LVAD and 230 with ECMO. In small centers (≤133 HTx over study period), patients bridged with ECMO had increased post-transplant mortality hazard compared to patients bridged with LVAD (HR 0.29, 95% CI 0.12, 0.71; p = 0.006) and patients with no MCS (HR 0.33, 95% CI 0.19, 0.57; p < 0.001). Interactions of MCS type with medium or large center volume were not statistically significant, and the same differences in survival by MCS type were observed in medium- or large-volume centers (136-208 or ≥214 HTx over the study period). Post-HTx survival disadvantage of pediatric patients bridged with ECMO persisted regardless of transplant program volume. The role of institutional ECMO expertise outside the transplant setting for improving outcomes of ECMO bridge to HTx should be explored.

Air Force Global Weather Central System Architecture Study. Final System/Subsystem Summary Report. Volume 2. Requirements Compilation and Analysis. Part 3. Characteristics Summaries and Network Analysis

DTIC Science & Technology

1976-03-01

DB DC DCT DDB DET DF DFS DML DMS DMSP DOD DS DSARC DT EDB EDS EG ESSA ETAC EWO Control and Reporting Post Cathode Ray Tube...National and Aviation Meteorological Facsimile Network NC - Network Control NCA - National Command Authority NCAR - National Center for Atmospheric

Pros and cons of practice-owned and office-based ambulatory surgery centers.

PubMed

Bert, J M

2000-01-01

A detailed feasibility analysis is imperative to ensure the success of a practice-owned ASC. Analysis of the payer mix and the market relating to surgical volume that can be performed at the ASC is imperative. If overbuilding, overequipping, and overstaffing are avoided and the group has adequate volume that can be managed at the ASC, the facility should be a success. Building a practice-owned ASC without an accurate and detailed financial feasibility and payer study can place the endeavor at risk. A well-planned, economically constructed and properly managed ASC will result in an efficient and successful ancillary service for the orthopedic group practice.

User's operating procedures. Volume 2: Scout project financial analysis program

NASA Technical Reports Server (NTRS)

Harris, C. G.; Haris, D. K.

1985-01-01

A review is presented of the user's operating procedures for the Scout Project Automatic Data system, called SPADS. SPADS is the result of the past seven years of software development on a Prime mini-computer located at the Scout Project Office, NASA Langley Research Center, Hampton, Virginia. SPADS was developed as a single entry, multiple cross-reference data management and information retrieval system for the automation of Project office tasks, including engineering, financial, managerial, and clerical support. This volume, two (2) of three (3), provides the instructions to operate the Scout Project Financial Analysis program in data retrieval and file maintenance via the user friendly menu drivers.

Measurement of Wheel/Rail Forces at the Washington Metropolitan Area Transit Authority. Volume I. Analysis Report.

DOT National Transportation Integrated Search

1980-07-01

Under the direction of the Urban Mass Transportation Administration (UMTA), measurements of wheel/rail forces were made in August 1979 by the Transportation Systems Center (TSC) with the assistance of Battelle Columbus Laboratories to determine the c...

The Impact of Hospital Closures and Hospital and Population Characteristics on Increasing Emergency Department Volume: A Geographic Analysis.

PubMed

Lee, David C; Carr, Brendan G; Smith, Tony E; Tran, Van C; Polsky, Daniel; Branas, Charles C

2015-12-01

Emergency visits are rising nationally, whereas the number of emergency departments is shrinking. However, volume has not increased uniformly at all emergency departments. It is unclear what factors account for this variability in emergency volume growth rates. The objective of this study was to test the association of hospital and population characteristics and the effect of hospital closures with increases in emergency department volume. The study team analyzed emergency department volume at New York State hospitals from 2004 to 2010 using data from cost reports and administrative databases. Multivariate regression was used to evaluate characteristics associated with emergency volume growth. Spatial analytics and distances between hospitals were used in calculating the predicted impact of hospital closures on emergency department use. Among the 192 New York hospitals open from 2004 to 2010, the mean annual increase in emergency department visits was 2.7%, but the range was wide (-5.5% to 11.3%). Emergency volume increased nearly twice as fast at tertiary referral centers (4.8%) and nonurban hospitals (3.7% versus urban at 2.1%) after adjusting for other characteristics. The effect of hospital closures also strongly predicted variation in growth. Emergency volume is increasing faster at specific hospitals: tertiary referral centers, nonurban hospitals, and those near hospital closures. This study provides an understanding of how emergency volume varies among hospitals and predicts the effect of hospital closures in a statewide region. Understanding the impact of these factors on emergency department use is essential to ensure that these populations have access to critical emergency services.

Systems Design and Pilot Operation of a Regional Center for Technical Processing for the Libraries of the New England State Universities. NELINET, New England Library Information Network. Progress Report, July 1, 1967 - March 30, 1968, Volume II, Appendices.

ERIC Educational Resources Information Center

Agenbroad, James E.; And Others

Included in this volume of appendices to LI 000 979 are acquisitions flow charts; a current operations questionnaire; an algorithm for splitting the Library of Congress call number; analysis of the Machine-Readable Cataloging (MARC II) format; production problems and decisions; operating procedures for information transmittal in the New England…

A time series analysis performed on a 25-year period of kidney transplantation activity in a single center.

PubMed

Santori, G; Fontana, I; Bertocchi, M; Gasloli, G; Valente, U

2010-05-01

Following the example of many Western countries, where a "minimum volume rule" policy has been adopted as a quality parameter for complex surgical procedures, the Italian National Transplant Centre set the minimum number of kidney transplantation procedures/y at 30/center. The number of procedures performed in a single center over a large period may be treated as a time series to evaluate trends, seasonal cycles, and nonsystematic fluctuations. Between January 1, 1983, and December 31, 2007, we performed 1376 procedures in adult or pediatric recipients from living or cadaveric donors. The greatest numbers of cases/y were performed in 1998 (n = 86) followed by 2004 (n = 82), 1996 (n = 75), and 2003 (n = 73). A time series analysis performed using R Statistical Software (Foundation for Statistical Computing, Vienna, Austria), a free software environment for statistical computing and graphics, showed a whole incremental trend after exponential smoothing as well as after seasonal decomposition. However, starting from 2005, we observed a decreased trend in the series. The number of kidney transplants expected to be performed for 2008 by using the Holt-Winters exponential smoothing applied to the period 1983 to 2007 suggested 58 procedures, while in that year there were 52. The time series approach may be helpful to establish a minimum volume/y at a single-center level. Copyright (c) 2010 Elsevier Inc. All rights reserved.

Winged cargo return vehicle. Volume 1: Conceptual design

NASA Technical Reports Server (NTRS)

1990-01-01

The Advanced Design Project (ADP) allows an opportunity for students to work in conjunction with NASA and other aerospace companies on NASA Advanced Design Projects. The following volumes represent the design report: Volume 1 Conceptual Design; Volume 2 Wind Tunnel Tests; Volume 3 Structural Analysis; and Volume 4 Water Tunnel Tests. The project chosen by the University of Minnesota in conjunction with NASA Marshall Space Flight Center for this year is a Cargo Return Vehicle (CRV) to support the Space Station Freedom. The vehicle is the third generation of vehicles to be built by NASA, the first two being the Apollo program, and the Space Shuttle program. The CRV is to work in conjunction with a personnel launch system (PLS) to further subdivide and specialize the vehicles that NASA will operate in the year 2000. The cargo return vehicle will carry payload to and from the Space Station Freedom (SSF).

STARS Conceptual Framework for Reuse Processes (CFRP). Volume 2: application Version 1.0

DTIC Science & Technology

1993-09-30

Analysis and Design DISA/CIM process x OProcess [DIS93] Feature-Oriented Domain SEI process x Analysis ( FODA ) [KCH+90] JIAWG Object-Oriented Domain JIAWG...Domain Analysis ( FODA ) Feasibility Study. Technical Report CMU/S[1 ,N. I R 21. Soft- ware Engineering Institute, Carnegie Mellon University, Pittsburgh...Electronic Systems Center Air Force Materiel Command, USAF Hanscom AFB, MA 01731-5000 Prepared by: The Boeing Company , IBM, Unisys Corporation, Defense

Volume changes and electrostriction in the primary photoreactions of various photosynthetic systems: estimation of dielectric coefficient in bacterial reaction centers and of the observed volume changes with the Drude-Nernst equation.

PubMed

Mauzerall, David; Hou, Jian-Min; Boichenko, Vladimir A

2002-01-01

Photoacoustics (PA) allows the determination of enthalpy and volume changes of photoreactions in photosynthetic reaction centers on the 0.1-10 mus time scale. These include the bacterial centers from Rb. sphaeroides, PS I and PS II centers from Synechocystis and in whole cells. In vitro and in vivo PA data on PS I and PS II revealed that both the volume change (-26 A(3)) and reaction enthalpy (-0.4 eV) in PS I are the same as those in the bacterial centers. However the volume change in PS II is small and the enthalpy far larger, -1 eV. Assigning the volume changes to electrostriction allows a coherent explanation of these observations. One can explain the large volume decrease in the bacterial centers with an effective dielectric coefficient of approximately 4. This is a unique approach to this parameter so important in estimation of protein energetics. The value of the volume contraction for PS I can only be explained if the acceptor is the super- cluster (Fe(4)S(4))(Cys(4)) with charge change from -1 to -2. The small volume change in PS II is explained by sub-mus electron transfer from Y(Z) anion to P(680) cation, in which charge is only moved from the Y(Z) anion to the Q(A) with no charge separation or with rapid proton transfer from oxidized Y(Z) to a polar region and thus very little change in electrostriction. At more acid pH equally rapid proton transfer from a neighboring histidine to a polar region may be caused by the electric field of the P(680) cation.

Deployed Analyst History Report, Volume 2. Analytic Support to Combat Operations in the Philippines (2011-2014)

DTIC Science & Technology

2015-12-01

Army Training and Doctrine Command (TRADOC) Analysis Center (TRAC) to the Philippines for Operation ENDURING FREEDOM – Philippines (OEF-P). PROJECT...management, doctrine and force development, training management, system testing, system acquisition, decision analysis, and resource management, as...influenced procurement decisions and reshaped Army doctrine . Additionally, CAA itself has benefited in numerous ways. Combat experience provides analysts

Risk factors for hospital morbidity and mortality after the Norwood procedure: A report from the Pediatric Heart Network Single Ventricle Reconstruction trial.

PubMed

Tabbutt, Sarah; Ghanayem, Nancy; Ravishankar, Chitra; Sleeper, Lynn A; Cooper, David S; Frank, Deborah U; Lu, Minmin; Pizarro, Christian; Frommelt, Peter; Goldberg, Caren S; Graham, Eric M; Krawczeski, Catherine Dent; Lai, Wyman W; Lewis, Alan; Kirsh, Joel A; Mahony, Lynn; Ohye, Richard G; Simsic, Janet; Lodge, Andrew J; Spurrier, Ellen; Stylianou, Mario; Laussen, Peter

2012-10-01

We sought to identify risk factors for mortality and morbidity during the Norwood hospitalization in newborn infants with hypoplastic left heart syndrome and other single right ventricle anomalies enrolled in the Single Ventricle Reconstruction trial. Potential predictors for outcome included patient- and procedure-related variables and center volume and surgeon volume. Outcome variables occurring during the Norwood procedure and before hospital discharge or stage II procedure included mortality, end-organ complications, length of ventilation, and hospital length of stay. Univariate and multivariable Cox regression analyses were performed with bootstrapping to estimate reliability for mortality. Analysis included 549 subjects prospectively enrolled from 15 centers; 30-day and hospital mortality were 11.5% (63/549) and 16.0% (88/549), respectively. Independent risk factors for both 30-day and hospital mortality included lower birth weight, genetic abnormality, extracorporeal membrane oxygenation (ECMO) and open sternum on the day of the Norwood procedure. In addition, longer duration of deep hypothermic circulatory arrest was a risk factor for 30-day mortality. Shunt type at the end of the Norwood procedure was not a significant risk factor for 30-day or hospital mortality. Independent risk factors for postoperative renal failure (n = 46), sepsis (n = 93), increased length of ventilation, and hospital length of stay among survivors included genetic abnormality, lower center/surgeon volume, open sternum, and post-Norwood operations. Innate patient factors, ECMO, open sternum, and lower center/surgeon volume are important risk factors for postoperative mortality and/or morbidity during the Norwood hospitalization. Copyright © 2012 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.

A satellite-based analysis of the Val d'Agri Oil Center (southern Italy) gas flaring emissions

NASA Astrophysics Data System (ADS)

Faruolo, M.; Coviello, I.; Filizzola, C.; Lacava, T.; Pergola, N.; Tramutoli, V.

2014-10-01

In this paper, the robust satellite techniques (RST), a multi-temporal scheme of satellite data analysis, was implemented to analyze the flaring activity of the Val d'Agri Oil Center (COVA), the largest Italian gas and oil pre-treatment plant, owned by Ente Nazionale Idrocarburi (ENI). For this site, located in an anthropized area characterized by a large environmental complexity, flaring emissions are mainly related to emergency conditions (i.e., waste flaring), as industrial processes are regulated by strict regional laws. While regarding the peculiar characteristics of COVA flaring, the main aim of this work was to assess the performances of RST in terms of sensitivity and reliability in providing independent estimations of gas flaring volumes in such conditions. In detail, RST was implemented for 13 years of Moderate Resolution Imaging Spectroradiometer (MODIS) medium and thermal infrared data in order to identify the highly radiant records associated with the COVA flare emergency discharges. Then, using data provided by ENI about gas flaring volumes in the period 2003-2009, a MODIS-based regression model was developed and tested. The results achieved indicate that the such a model is able to estimate, with a good level of accuracy (R2 of 0.83), emitted gas flaring volumes at COVA.

A satellite-based analysis of the Val d'Agri (South of Italy) Oil Center gas flaring emissions

NASA Astrophysics Data System (ADS)

Faruolo, M.; Coviello, I.; Filizzola, C.; Lacava, T.; Pergola, N.; Tramutoli, V.

2014-06-01

In this paper the Robust Satellite Techniques (RST), a multi-temporal scheme of satellite data analysis, was implemented to analyze the flaring activity of the largest Italian gas and oil pre-treatment plant (i.e. the Ente Nazionale Idrocarburi - ENI - Val d'Agri Oil Center - COVA). For this site, located in an anthropized area characterized by a~large environmental complexity, flaring emissions are mainly related to emergency conditions (i.e. waste flaring), being the industrial process regulated by strict regional laws. With reference to the peculiar characteristics of COVA flaring, the main aim of this work was to assess the performances of RST in terms of sensitivity and reliability in providing independent estimations of gas flaring volumes in such conditions. In detail, RST was implemented on thirteen years of Moderate Resolution Imaging Spectroradiometer (MODIS) medium and thermal infrared data in order to identify the highly radiant records associated to the COVA flare emergency discharges. Then, exploiting data provided by ENI about gas flaring volumes in the period 2003-2009, a MODIS-based regression model was developed and tested. Achieved results indicate that such a model is able to estimate, with a good level of accuracy (R2 of 0.83), emitted gas flaring volumes at COVA.

Solution of the Average-Passage Equations for the Incompressible Flow through Multiple-Blade-Row Turbomachinery

DTIC Science & Technology

1994-02-01

numerical treatment. An explicit numerical procedure based on Runqe-Kutta time stepping for cell-centered, hexahedral finite volumes is...An explicit numerical procedure based on Runge-Kutta time stepping for cell-centered, hexahedral finite volumes is outlined for the approximate...Discretization 16 3.1 Cell-Centered Finite -Volume Discretization in Space 16 3.2 Artificial Dissipation 17 3.3 Time Integration 21 3.4 Convergence

Operation Enduring Freedom. Joint Center for Operational Analysis Journal, Volume 11, Issue 3, Fall 2009

DTIC Science & Technology

2009-01-01

began a period known as the Great Game , which was a century and a half long competition for Afghanistan by Britain and Russia. Each of the countries...It is yet to be determined whether or not the United States is capable of sustaining initial success, or if the Great Game will continue...showed Malik Noorafzal video footage of the World Trade Center towers collapsing. He had never seen this and it made a deep impression. He had heard

Systematic donor selection review process improves cardiac transplant volumes and outcomes.

PubMed

Smith, Jason W; O'Brien, Kevin D; Dardas, Todd; Pal, Jay D; Fishbein, Daniel P; Levy, Wayne C; Mahr, Claudius; Masri, Sofia C; Cheng, Richard K; Stempien-Otero, April; Mokadam, Nahush A

2016-01-01

Heart transplant remains the definitive therapy for advanced heart failure patients but is limited by organ availability. We identified a large number of donor hearts from our organ procurement organization (OPO) being exported to other regions. We engaged a multidisciplinary team including transplant surgeons, cardiologists, and our OPO colleagues to identify opportunities to improve our center-specific organ utilization rate. We performed a retrospective analysis of donor offers before and after institution of a novel review process. Each donor offer made to our program was reviewed on a monthly basis from July 2013 to June 2014 and compared with the previous year. This review process resulted in a transplant utilization rate of 28% for period 1 versus 49% for period 2 (P = .007). Limiting the analysis to offers from our local OPO changed our utilization rate from 46% to 75% (P = .02). Transplant volume increased from 22 to 35 between the 2 study periods. Thirty-day and 1-year mortality were unchanged over the 2 periods. A total of 58 hearts were refused by our center and transplanted at other centers. During period 1, the 30-day and 1-year survival rates for recipients of those organs were 98% and 90%, respectively, comparable with our historical survival data. The simple process of systematically reviewing donor turndown events as a group tended to reduce variability, increase confidence in expanded criteria for donors, and resulted in improved donor organ utilization and transplant volumes. Copyright © 2016 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

Enhancing Aircraft Survivability - A Vulnerability Perspective. Volume I

DTIC Science & Technology

1997-10-21

37 Mr. Kevin R. Crosthwaite Director, Survivability/Vulnerability Information Analysis Center (SURVIAC) Wright-Patterson AFB...340 W"E "W*TE "-y N... T SUE,--* WAER FIGURE 4. WIDE CABIN BODY RESULTS/SAVE SYSTEM/MODERATE WIND 302 12-9 210 .............. tos -to. " 0 3253 GPM -00

Quantitative analysis of treatment process time and throughput capacity for spot scanning proton therapy

DOE Office of Scientific and Technical Information (OSTI.GOV)

Suzuki, Kazumichi, E-mail: kazumichisuzuki@gmail.c

Purpose: To determine the patient throughput and the overall efficiency of the spot scanning system by analyzing treatment time, equipment availability, and maximum daily capacity for the current spot scanning port at Proton Therapy Center Houston and to assess the daily throughput capacity for a hypothetical spot scanning proton therapy center. Methods: At their proton therapy center, the authors have been recording in an electronic medical record system all treatment data, including disease site, number of fields, number of fractions, delivered dose, energy, range, number of spots, and number of layers for every treatment field. The authors analyzed delivery systemmore » downtimes that had been recorded for every equipment failure and associated incidents. These data were used to evaluate the patient census, patient distribution as a function of the number of fields and total target volume, and equipment clinical availability. The duration of each treatment session from patient walk-in to patient walk-out of the spot scanning treatment room was measured for 64 patients with head and neck, central nervous system, thoracic, and genitourinary cancers. The authors retrieved data for total target volume and the numbers of layers and spots for all fields from treatment plans for a total of 271 patients (including the above 64 patients). A sensitivity analysis of daily throughput capacity was performed by varying seven parameters in a throughput capacity model. Results: The mean monthly equipment clinical availability for the spot scanning port in April 2012–March 2015 was 98.5%. Approximately 1500 patients had received spot scanning proton therapy as of March 2015. The major disease sites treated in September 2012–August 2014 were the genitourinary system (34%), head and neck (30%), central nervous system (21%), and thorax (14%), with other sites accounting for the remaining 1%. Spot scanning beam delivery time increased with total target volume and accounted for approximately 30%–40% of total treatment time for the total target volumes exceeding 200 cm{sup 3}, which was the case for more than 80% of the patients in this study. When total treatment time was modeled as a function of the number of fields and total target volume, the model overestimated total treatment time by 12% on average, with a standard deviation of 32%. A sensitivity analysis of throughput capacity for a hypothetical four-room spot scanning proton therapy center identified several priority items for improvements in throughput capacity, including operation time, beam delivery time, and patient immobilization and setup time. Conclusions: The spot scanning port at our proton therapy center has operated at a high performance level and has been used to treat a large number of complex cases. Further improvements in efficiency may be feasible in the areas of facility operation, beam delivery, patient immobilization and setup, and optimization of treatment scheduling.« less

Which Kind of Provider’s Operation Volumes Matters? Associations between CABG Surgical Site Infection Risk and Hospital and Surgeon Operation Volumes among Medical Centers in Taiwan

PubMed Central

Yu, Tsung-Hsien; Tung, Yu-Chi; Chung, Kuo-Piao

2015-01-01

Background Volume-infection relationships have been examined for high-risk surgical procedures, but the conclusions remain controversial. The inconsistency might be due to inaccurate identification of cases of infection and different methods of categorizing service volumes. This study takes coronary artery bypass graft (CABG) surgical site infections (SSIs) as an example to examine whether a relationship exists between operation volumes and SSIs, when different SSIs case identification, definitions and categorization methods of operation volumes were implemented. Methods A population-based cross-sectional multilevel study was conducted. A total of 7,007 patients who received CABG surgery between 2006 and 2008 from19 medical centers in Taiwan were recruited. SSIs associated with CABG surgery were identified using International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9 CM) codes and a Classification and Regression Trees (CART) model. Two definitions of surgeon and hospital operation volumes were used: (1) the cumulative CABG operation volumes within the study period; and (2) the cumulative CABG operation volumes in the previous one year before each CABG surgery. Operation volumes were further treated in three different ways: (1) a continuous variable; (2) a categorical variable based on the quartile; and (3) a data-driven categorical variable based on k-means clustering algorithm. Furthermore, subgroup analysis for comorbidities was also conducted. Results This study showed that hospital volumes were not significantly associated with SSIs, no matter which definitions or categorization methods of operation volume, or SSIs case identification approaches were used. On the contrary, the relationships between surgeon’s volumes varied. Most of the models demonstrated that the low-volume surgeons had higher risk than high-volume surgeons. Conclusion Surgeon volumes were more important than hospital volumes in exploring the relationship between CABG operation volumes and SSIs in Taiwan. However, the relationships were not robust. Definitions and categorization methods of operation volume and correct identification of SSIs are important issues for future research. PMID:26053035

A Multi-Level Geographical Study of Italian Political Elections from Twitter Data

PubMed Central

Caldarelli, Guido; Chessa, Alessandro; Pammolli, Fabio; Pompa, Gabriele; Puliga, Michelangelo; Riccaboni, Massimo; Riotta, Gianni

2014-01-01

In this paper we present an analysis of the behavior of Italian Twitter users during national political elections. We monitor the volumes of the tweets related to the leaders of the various political parties and we compare them to the elections results. Furthermore, we study the topics that are associated with the co-occurrence of two politicians in the same tweet. We cannot conclude, from a simple statistical analysis of tweet volume and their time evolution, that it is possible to precisely predict the election outcome (or at least not in our case of study that was characterized by a “too-close-to-call” scenario). On the other hand, we found that the volume of tweets and their change in time provide a very good proxy of the final results. We present this analysis both at a national level and at smaller levels, ranging from the regions composing the country to macro-areas (North, Center, South). PMID:24802857

AOIPS 3 User's guide. Volume 1: Overview and software utilization

NASA Technical Reports Server (NTRS)

Schotz, S. S.; Negri, A. J.; Robinson, W.

1989-01-01

This is Volume I of the Atmospheric and Oceanographic Information Processing System (AOIPS) User's Guide. AOIPS 3 is the version of the AOIPS software as of April 1989. The AOIPS software was developed jointly by the Goddard Space Flight Center and General Sciences Corporation. Volume 1 is intended to provide the user with an overall guide to the AOIPS system. It introduces the user to AOIPS system concepts, explains how programs are related and the necessary order of program execution, and provides brief descriptions derived from on-line help for every AOIPS program. It is intended to serve as a reference for information such as: program function, inmput/output variable descriptions, program limitations, etc. AOIPS is an interactive meteorological processing system with capabilities to ingest and analyze the many types of meteorological data. AOIPS includes several applications in areas of relevance to meteorological research. AOIPS is partitioned into four applications components: satellite data analysis, radar data analysis, aircraft data analysis, and utilities.

The Collins Center Update. Volume 10, Issue 1, October-December 2007

DTIC Science & Technology

2007-12-01

developmental focus area topics are Strategic Leadership , Management of Change, and Strategic Communications. (b) The Expeditionary Thinking...Volume 10, Issue 1 October - December 2007 THE COLLINS CENTER UPDATE THE CENTER FOR STRATEGIC LEADERSHIP U.S. ARMY WAR COLLEGE CARLISLE...PENNSYLVANIA INSIDE THIS ISSUE The Center for strategic • Leadership : An Overview of Recent and Future Activities Strategic Negotiation

Final Report of the AMC Committee-Armament. Armament Development Center Concept Plan. Volume 2

DTIC Science & Technology

1974-12-01

Considerations 111-22 Section C Operational Considerations 111-26 Section D Community Economic Impact 111-35 Statements Section E Delphi Benefit Analysis 111-37...Cost Analysis 111-3 B Personnel Considerations III-22 C Operational Considerations 111-26 D Community Economic Impact Statements 111-35 E Delphi ...sidered to be minimal. 111-36 S SECTION E. Delphi Benefit Analysis 1. Introduction. The assessment and comparison of the relative benefits of the various

Reduction of variance in spectral estimates for correction of ultrasonic aberration.

PubMed

Astheimer, Jeffrey P; Pilkington, Wayne C; Waag, Robert C

2006-01-01

A variance reduction factor is defined to describe the rate of convergence and accuracy of spectra estimated from overlapping ultrasonic scattering volumes when the scattering is from a spatially uncorrelated medium. Assuming that the individual volumes are localized by a spherically symmetric Gaussian window and that centers of the volumes are located on orbits of an icosahedral rotation group, the factor is minimized by adjusting the weight and radius of each orbit. Conditions necessary for the application of the variance reduction method, particularly for statistical estimation of aberration, are examined. The smallest possible value of the factor is found by allowing an unlimited number of centers constrained only to be within a ball rather than on icosahedral orbits. Computations using orbits formed by icosahedral vertices, face centers, and edge midpoints with a constraint radius limited to a small multiple of the Gaussian width show that a significant reduction of variance can be achieved from a small number of centers in the confined volume and that this reduction is nearly the maximum obtainable from an unlimited number of centers in the same volume.

Impact of academic facility type and volume on post-surgical outcomes following diagnosis of glioblastoma.

PubMed

Hauser, Alan; Dutta, Sunil W; Showalter, Timothy N; Sheehan, Jason P; Grover, Surbhi; Trifiletti, Daniel M

2018-01-01

To identify if facility type and/or facility volume impact overall survival (OS) following diagnosis of glioblastoma (GBM). We also sought to compare early post-surgical outcomes based on these factors. The National Cancer Database was queried for patients with GBM diagnosed from 2004 to 2013 with known survival. Patients were grouped based on facility type and facility volume. Multivariable analyses were performed to investigate factors associated OS following diagnosis and Chi-square tests were used to compare early post-surgical outcomes. 89,839 patients met inclusion criteria. Factors associated with improved OS on multivariable analysis included younger patient age, female gender, race, lower comorbidity score, higher performance score, smaller tumor size, unifocal tumors, MGMT hypermethylation, fully resected tumors, radiotherapy, and chemotherapy (each p < .001). Also, OS was improved among patients treated at centers averaging at least 30.2 cases per year (HR 0.948, compared to <7.4 cases/year, p < .001), and patients treated at Academic/Research programs had improved survival compared to those treated at Comprehensive Community Cancer programs (HR 1.069, p < .001) and Integrated Network Cancer programs (HR 1.126, p < .001). Similarly, Academic/Research programs and high volume centers demonstrated improved 30- and 90-day morality as well as 30-day readmission rates (p < .001). This study suggests that patients treated in Academic/Research programs and high patient-volume centers have increased survival and more favorable early-postsurgical outcomes. The extent to which differences in patient populations, socioeconomic factors, and/or provider expertise play into this cause will be areas of future research. Copyright © 2017 Elsevier Ltd. All rights reserved.

Evaluation of Agency Non-Code Layered Pressure Vessels (LPVs) . Volume 2; Appendices

NASA Technical Reports Server (NTRS)

Prosser, William H.

2014-01-01

In coordination with the Office of Safety and Mission Assurance and the respective Center Pressure System Managers (PSMs), the NASA Engineering and Safety Center (NESC) was requested to formulate a consensus draft proposal for the development of additional testing and analysis methods to establish the technical validity, and any limitation thereof, for the continued safe operation of facility non-code layered pressure vessels. The PSMs from each NASA Center were asked to participate as part of the assessment team by providing, collecting, and reviewing data regarding current operations of these vessels. This document contains the appendices to the main report.

Strategic Planning: An Integrated Academic Information Management System (IAIMS) at Georgetown University Medical Center. Volume 1, Implementation Plan. Volume 2, Planning Accomplishments. Volume 3, Environmental Forecast. Volume 4, Institutional Self Study.

ERIC Educational Resources Information Center

Broering, Naomi C.; And Others

Strategic planning for an Integrated Academic Information Management System (IAIMS) for Georgetown University Medical Center is considered. The goal is to organize and transmit accessible and timely biomedical information where it is needed. Activities are proposed for education, research, patient care, management, sharing information on…

Geographic access to high capability severe acute respiratory failure centers in the United States.

PubMed

Wallace, David J; Angus, Derek C; Seymour, Christopher W; Yealy, Donald M; Carr, Brendan G; Kurland, Kristen; Boujoukos, Arthur; Kahn, Jeremy M

2014-01-01

Optimal care of adults with severe acute respiratory failure requires specific resources and expertise. We sought to measure geographic access to these centers in the United States. Cross-sectional analysis of geographic access to high capability severe acute respiratory failure centers in the United States. We defined high capability centers using two criteria: (1) provision of adult extracorporeal membrane oxygenation (ECMO), based on either 2008-2013 Extracorporeal Life Support Organization reporting or provision of ECMO to 2010 Medicare beneficiaries; or (2) high annual hospital mechanical ventilation volume, based 2010 Medicare claims. Nonfederal acute care hospitals in the United States. We defined geographic access as the percentage of the state, region and national population with either direct or hospital-transferred access within one or two hours by air or ground transport. Of 4,822 acute care hospitals, 148 hospitals met our ECMO criteria and 447 hospitals met our mechanical ventilation criteria. Geographic access varied substantially across states and regions in the United States, depending on center criteria. Without interhospital transfer, an estimated 58.5% of the national adult population had geographic access to hospitals performing ECMO and 79.0% had geographic access to hospitals performing a high annual volume of mechanical ventilation. With interhospital transfer and under ideal circumstances, an estimated 96.4% of the national adult population had geographic access to hospitals performing ECMO and 98.6% had geographic access to hospitals performing a high annual volume of mechanical ventilation. However, this degree of geographic access required substantial interhospital transfer of patients, including up to two hours by air. Geographic access to high capability severe acute respiratory failure centers varies widely across states and regions in the United States. Adequate referral center access in the case of disasters and pandemics will depend highly on local and regional care coordination across political boundaries.

The effects of contrast media volume on acute kidney injury after transcatheter aortic valve replacement: a systematic review and meta-analysis.

PubMed

Thongprayoon, Charat; Cheungpasitporn, Wisit; Podboy, Alexander J; Gillaspie, Erin A; Greason, Kevin L; Kashani, Kianoush B

2016-11-01

The goal of this systematic review was to assess the effects of contrast media volume on transcatheter aortic valve replacement-related acute kidney injury. A literature search was performed using Medline, EMbase, the Cochrane Database of Systematic Reviews, and clinicaltrials.gov from the inception of these databases through December 2015. Studies that reported relative risk, odds ratio, or hazard ratio comparing the risks of acute kidney injury following transcatheter aortic valve replacement in patients who received high contrast media volume were included. Pooled risk ratio (RR) and 95% confidence intervals (95% CI) were calculated using a random-effect, generic inverse variance method. Four cohort studies composed of 891 patients were included in the analyses to assess the risk of acute kidney injury after transcatheter aortic valve replacement in patients who received high contrast media volume. The pooled RR of acute kidney injury after transcatheter aortic valve replacement in patients who received a large volume of contrast media was 1.41 (95% CI, 0.87 to 2.28) compared with low contrast media volume. The meta-analysis was limited to studies using standard acute kidney injury definitions, and the pooled RR of acute kidney injury in patients who received high contrast media volume is 1.12 (95% CI, 0.78 to 1.62). Our meta-analysis shows no significant association between contrast media volume and risk of acute kidney injury after transcatheter aortic valve replacement. © 2016 Chinese Cochrane Center, West China Hospital of Sichuan University and John Wiley & Sons Australia, Ltd.

Navigation Performance of Global Navigation Satellite Systems in the Space Service Volume

NASA Technical Reports Server (NTRS)

Force, Dale A.

2013-01-01

GPS has been used for spacecraft navigation for many years center dot In support of this, the US has committed that future GPS satellites will continue to provide signals in the Space Service Volume center dot NASA is working with international agencies to obtain similar commitments from other providers center dot In support of this effort, I simulated multi-constellation navigation in the Space Service Volume In this presentation, I extend the work to examine the navigational benefits and drawbacks of the new constellations center dot A major benefit is the reduced geometric dilution of precision (GDOP). I show that there is a substantial reduction in GDOP by using all of the GNSS constellations center dot The increased number of GNSS satellites broadcasting does produce mutual interference, raising the noise floor. A near/far signal problem can also occur where a nearby satellite drowns out satellites that are far away. - In these simulations, no major effect was observed Typically, the use of multi-constellation GNSS navigation improves GDOP by a factor of two or more over GPS alone center dot In addition, at the higher altitudes, four satellite solutions can be obtained much more often center dot This show the value of having commitments to provide signals in the Space Service Volume Besides a commitment to provide a minimum signal in the Space Service Volume, detailed signal gain information is useful for mission planning center dot Knowledge of group and phase delay over the pattern would also reduce the navigational uncertainty

Cardiologist service volume, percutaneous coronary intervention and hospital level in relation to medical costs and mortality in patients with acute myocardial infarction: a nationwide study.

PubMed

Liu, C-Y; Lin, Y-N; Lin, C-L; Chang, Y-J; Hsu, Y-H; Tsai, W-C; Kao, C-H

2014-07-01

We explore whether cardiologist service volume, hospital level and percutaneous coronary intervention (PCI) are associated with medical costs and acute myocardial infarction (AMI) mortality. From the 1997-2010 Taiwan National Health Insurance Research Database of the National Health Research Institute, we identified AMI patients and performed multiple regression analyses to explore the relationships among the different hospital levels and treatment factors. We identified 2942 patients with AMI in medical centers and 4325 patients with AMI in regional hospitals. Cardiologist service volume, performing PCI and medical costs per patient were higher in medical centers than in regional hospitals (P < 0.0001). However, the two hospital levels did not differ significantly in in-hospital mortality (P = 0.1557). Post hoc analysis showed significant differences in in-hospital mortality rate and in medical costs among the eight groups subdivided on the basis of hospital level, cardiologist service volume, and whether PCI was performed (P < 0.001 and P = 0.001, respectively). These results highlight the importance of encouraging hospitals to develop PCI capability and increase their cardiologist service volume after taking medical costs into account. Transferring AMI patients to hospitals with higher cardiologist service volume and PCI performed can also be very important. © The Author 2014. Published by Oxford University Press on behalf of the Association of Physicians. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Safety and efficacy of bariatric surgery in Mexico: A detailed analysis of 500 surgeries performed at a high-volume center.

PubMed

Guilbert, L; Joo, P; Ortiz, C; Sepúlveda, E; Alabi, F; León, A; Piña, T; Zerrweck, C

2018-06-19

Bariatric surgery is the best method for treating obesity and its comorbidities. Our aim was to provide a detailed analysis of the perioperative outcomes in Mexican patients that underwent surgery at a high-volume hospital center. A retrospective study was conducted on all the patients that underwent bariatric surgery at a single hospital center within a time frame of 4 and one-half years. Demographics, the perioperative variables, complications (early and late), weight loss, failure, and type 2 diabetes mellitus remission were all analyzed. Five hundred patients were included in the study, 83.2% of whom were women. Mean patient age was 38.8 years and BMI was 44.1kg/m 2 . The most common comorbidities were high blood pressure, dyslipidemia, and diabetes. Laparoscopic gastric bypass surgery was performed in 85.8% of the patients, sleeve gastrectomy in 13%, and revision surgeries in 1%. There were 9.8% early complications and 12.2% late ones, with no deaths. Overall weight loss as the excess weight loss percentage at 12 and 24 months was 76.9 and 77.6%. The greatest weight loss at 12 months was seen in the patients that underwent laparoscopic gastric bypass. A total of 11.4% of the patients had treatment failure. In the patients with type 2 diabetes mellitus, 68.7% presented with complete disease remission and 9.3% with partial remission. There was improvement in 21.8% of the cases. In our experience at a high-volume hospital center, bariatric surgery is safe and effective, based on the low number of adverse effects and consequent weight loss and type 2 diabetes mellitus control. Long-term studies with a larger number of patients are needed to determine the final impact of those procedures. Copyright © 2018 Asociación Mexicana de Gastroenterología. Publicado por Masson Doyma México S.A. All rights reserved.

Iberian Spanish Function Catalog. Method for Determining Language Objectives and Criteria, Volume VI.

ERIC Educational Resources Information Center

Setzler, Hubert H., Jr.; And Others

This Iberian Spanish Function Catalog presents sentences, phrases, and patterns organized by language functions and functional categories. This catalog is part of the communication/language objectives-based system (C/LOBS), which supports the front-end analysis efforts of the Defense Language Institute Foreign Language Center. The C/LOBS project,…

Space shuttle navigation analysis. Volume 1: GPS aided navigation

NASA Technical Reports Server (NTRS)

Matchett, G. A.; Vogel, M. A.; Macdonald, T. J.

1980-01-01

Analytical studies related to space shuttle navigation are presented. Studies related to the addition of NAVSTAR Global Positioning System user equipment to the shuttle avionics suite are presented. The GPS studies center about navigation accuracy covariance analyses for both developmental and operational phases of GPS, as well as for various orbiter mission phases.

The Relationship Between Hospital Volume and Outcome in Bariatric Surgery at Academic Medical Centers

PubMed Central

Nguyen, Ninh T.; Paya, Mahbod; Stevens, C Melinda; Mavandadi, Shahrzad; Zainabadi, Kambiz; Wilson, Samuel E.

2004-01-01

Objective: To examine the effect of hospital volume of bariatric surgery on morbidity, mortality, and costs at academic centers. Summary Background Data: The American Society for Bariatric Surgery recently proposed categorization of certain bariatric surgery centers as “Centers of Excellence.” Some of the proposed inclusion criteria were hospital volume and operative outcomes. The volume–outcome relationship has been well established in several complex abdominal operations; however, few studies have examined this relationship in patients undergoing bariatric surgery. Methods: Using the International Classification of Diseases, 9th edition, diagnosis and procedure codes, we obtained data from the University HealthSystem Consortium Clinical Data Base for all patients who underwent Roux-en-Y gastric bypass for the treatment of morbid obesity between 1999 and 2002 (n = 24,166). Outcomes of bariatric surgery, including length of hospital stay, 30-day readmission, morbidity, observed and expected (risk-adjusted) mortality, and costs were compared between high-volume (>100 cases/year), medium-volume (50–100 cases/year), and low-volume hospitals (<50 cases/year). Results: There were 22 high-volume (n = 13,810), 27 medium-volume (n = 7634), and 44 low-volume (n = 2722) hospitals included in our study. Compared with low-volume hospitals, patients who underwent gastric bypass at high-volume hospitals had a shorter length of hospital stay (3.8 versus 5.1 days, P < 0.01), lower overall complications (10.2% versus 14.5%, P < 0.01), lower complications of medical care (7.8% versus 10.8%, P < 0.01), and lower costs ($10,292 versus $13,908, P < 0.01). The expected mortality rate was similar between high- and low-volume hospitals (0.6% versus 0.6%), demonstrating similarities in characteristics and severity of illness between groups. The observed mortality, however, was significantly lower at high-volume hospitals (0.3% versus 1.2%, P < 0.01). In a subset of patients older than 55 years, the observed mortality was 0.9% at high-volume centers compared with 3.1% at low-volume centers (P < 0.01). Conclusions: Bariatric surgery performed at hospitals with more than 100 cases annually is associated with a shorter length of stay, lower morbidity and mortality, and decreased costs. This volume–outcome relationship is even more pronounced for a subset of patients older than 55 years, for whom in-hospital mortality was 3-fold higher at low-volume compared with high-volume hospitals. High-volume hospitals also have a lower rate of overall postoperative and medical care complications, which may be related in part to formalization of the structures and processes of care. PMID:15383786

Tracking and data relay satellite system configuration and tradeoff study. Volume 4: TDRS system operation and control and telecommunications service system, part 1

NASA Technical Reports Server (NTRS)

1972-01-01

Major study areas treated in this volume are: 1) operations and control and 2) the telecommunication service system. The TDRS orbit selection, orbital deployment, ground station visibility, sequence of events from launch to final orbit position, and TDRS control center functions required for stationkeeping, repositioning, attitude control, and antenna pointing are briefly treated as part of the operations and control section. The last topic of this section concerns the operations required for efficiently providing the TDRSS user telecommunication services. The discussion treats functions of the GSFC control and data processing facility, ground station, and TDRS control center. The second major portion of this volume deals with the Telecommunication Service System (TSS) which consists of the ground station, TDRS communication equipment and the user transceiver. A summary of the requirements and objectives for the telecommunication services and a brief summary of the TSS capabilities is followed by communication system analysis, signal design, and equipment design. Finally, descriptions of the three TSS elements are presented.

Native Aging Visions: A Resource for Native Elders. Volume 1, 1994-97.

ERIC Educational Resources Information Center

Native Aging Visions, 1997

1997-01-01

This volume of newsletters reports on the activities and research projects of the National Resource Center on Native American Aging located at the University of North Dakota, Grand Forks. The Center studies health issues and access problems facing American Indian, Alaska Native, and Native Hawaiian elders. Specifically, the resource center was…

Cone Beam CT Imaging Analysis of Interfractional Variations in Bladder Volume and Position During Radiotherapy for Bladder Cancer

DOE Office of Scientific and Technical Information (OSTI.GOV)

Yee, Don, E-mail: dony@ualberta.c; Parliament, Matthew; Rathee, Satyapal

2010-03-15

Purpose: To quantify daily bladder size and position variations during bladder cancer radiotherapy. Methods and Materials: Ten bladder cancer patients underwent daily cone beam CT (CBCT) imaging of the bladder during radiotherapy. Bladder and planning target volumes (bladder/PTV) from CBCT and planning CT scans were compared with respect to bladder center-of-mass shifts in the x (lateral), y (anterior-posterior), and z (superior-inferior) coordinates, bladder/PTV size, bladder/PTV margin positions, overlapping areas, and mutually exclusive regions. Results: A total of 262 CBCT images were obtained from 10 bladder cancer patients. Bladder center of mass shifted most in the y coordinate (mean, -0.32 cm).more » The anterior bladder wall shifted the most (mean, -0.58 cm). Mean ratios of CBCT-derived bladder and PTV volumes to planning CT-derived counterparts were 0.83 and 0.88. The mean CBCT-derived bladder volume (+- standard deviation [SD]) outside the planning CT counterpart was 29.24 cm{sup 3} (SD, 29.71 cm{sup 3}). The mean planning CT-derived bladder volume outside the CBCT counterpart was 47.74 cm{sup 3} (SD, 21.64 cm{sup 3}). The mean CBCT PTV outside the planning CT-derived PTV was 47.35 cm{sup 3} (SD, 36.51 cm{sup 3}). The mean planning CT-derived PTV outside the CBCT-derived PTV was 93.16 cm{sup 3} (SD, 50.21). The mean CBCT-derived bladder volume outside the planning PTV was 2.41 cm{sup 3} (SD, 3.97 cm{sup 3}). CBCT bladder/ PTV volumes significantly differed from planning CT counterparts (p = 0.047). Conclusions: Significant variations in bladder and PTV volume and position occurred in patients in this trial.« less

Summer research program (1992). Summer faculty research program (SFRP) reports. Volume 6. Arnold Engineering Development Center, Civil Engineering Laboratory, Frank J. Seiler research laboratory, Wilford Hall Medical Center. Annual report, 1 September 1991-31 August 1992

DOE Office of Scientific and Technical Information (OSTI.GOV)

Moore, G.

1992-12-28

The following Topics were among those completed at the Air Force Faculty Research Summer Program: Experiences using Model-Based Techniques for the Development of a Large Parallel Instrumentation System; Data Reduction of Laser Induced Fluorescence in Rocket Motor Exhausts; Feasibility of Wavelet Analysis for Plume Data Study; Characterization of Seagrass Meadows in St. Andrew (Crooked Island) Sound, Northern Gulf of Mexico; A Preliminary Study of the Weathering of Jet Fuels in Soil Monitored by SFE with GC Analysis; Preliminary Numerical model of Groundwater Flow at the MADE2 Site.

Cost drivers and resource allocation in military health care systems.

PubMed

Fulton, Larry; Lasdon, Leon S; McDaniel, Reuben R

2007-03-01

This study illustrates the feasibility of incorporating technical efficiency considerations in the funding of military hospitals and identifies the primary drivers for hospital costs. Secondary data collected for 24 U.S.-based Army hospitals and medical centers for the years 2001 to 2003 are the basis for this analysis. Technical efficiency was measured by using data envelopment analysis; subsequently, efficiency estimates were included in logarithmic-linear cost models that specified cost as a function of volume, complexity, efficiency, time, and facility type. These logarithmic-linear models were compared against stochastic frontier analysis models. A parsimonious, three-variable, logarithmic-linear model composed of volume, complexity, and efficiency variables exhibited a strong linear relationship with observed costs (R(2) = 0.98). This model also proved reliable in forecasting (R(2) = 0.96). Based on our analysis, as much as $120 million might be reallocated to improve the United States-based Army hospital performance evaluated in this study.

Automotive manufacturing assessment system. Volume IV: engine manufacturing analysis. Final report Jun 77-Aug 78

DOE Office of Scientific and Technical Information (OSTI.GOV)

Taylor, T. Jr

Volume IV represents the results of one of four major study areas under the Automotive Manufacturing Assessment System (AMAS) sponsored by the DOT/Transportation Systems Center. AMAS was designed to assist in the evaluation of industry's capability to produce fuel efficient vehicles. An analysis of automotive engine manufacturing was conducted in order to determine the impact of regulatory changes on tooling costs and the production process. The 351W CID V-8 engine at Ford's Windsor No. 1 Plant was the subject of the analysis. A review of plant history and its product is presented along with an analysis of manufacturing operations, includingmore » material and production flow, plant layout, machining and assembly processes, tooling, supporting facilities, inspection, service and repair. Four levels of product change intensity showing the impact on manufacturing methods and cost is also presented.« less

MAC/GMC 4.0 User's Manual: Keywords Manual. Volume 2

NASA Technical Reports Server (NTRS)

Bednarcyk, Brett A.; Arnold, Steven M.

2002-01-01

This document is the second volume in the three volume set of User's Manuals for the Micromechanics Analysis Code with Generalized Method of Cells Version 4.0 (MAC/GMC 4.0). Volume 1 is the Theory Manual, this document is the Keywords Manual, and Volume 3 is the Example Problem Manual. MAC/GMC 4.0 is a composite material and laminate analysis software program developed at the NASA Glenn Research Center. It is based on the generalized method of cells (GMC) micromechanics theory, which provides access to the local stress and strain fields in the composite material. This access grants GMC the ability to accommodate arbitrary local models for inelastic material behavior and various types of damage and failure analysis. MAC/GMC 4.0 has been built around GMC to provide the theory with a user-friendly framework, along with a library of local inelastic, damage, and failure models. Further, applications of simulated thermo-mechanical loading, generation of output results, and selection of architectures to represent the composite material have been automated in MAC/GMC 4.0. Finally, classical lamination theory has been implemented within MAC/GMC 4.0 wherein GMC is used to model the composite material response of each ply. Consequently, the full range of GMC composite material capabilities is available for analysis of arbitrary laminate configurations as well. This volume describes the basic information required to use the MAC/GMC 4.0 software, including a 'Getting Started' section, and an in-depth description of each of the 22 keywords used in the input file to control the execution of the code.

Serial 3-dimensional computed tomography and a novel method of volumetric analysis for the evaluation of the osteo-odonto-keratoprosthesis.

PubMed

Sipkova, Zuzana; Lam, Fook Chang; Francis, Ian; Herold, Jim; Liu, Christopher

2013-04-01

To assess the use of serial computed tomography (CT) in the detection of osteo-odonto-lamina resorption in osteo-odonto-keratoprosthesis (OOKP) and to investigate the use of new volumetric software, Advanced Lung Analysis software (3D-ALA; GE Healthcare), for detecting changes in OOKP laminar volume. A retrospective assessment of the radiological databases and hospital records was performed for 22 OOKP patients treated at the National OOKP referral center in Brighton, United Kingdom. Three-dimensional surface reconstructions of the OOKP laminae were performed using stored CT data. For the 2-dimensional linear analysis, the linear dimensions of the reconstructed laminae were measured, compared with original measurements taken at the time of surgery, and then assigned a CT grade based on a predetermined resorption grading scale. The volumetric analysis involved calculating the laminar volumes using 3D-ALA. The effectiveness of 2-dimensional linear analysis, volumetric analysis, and clinical examination in detecting laminar resorption was compared. The mean change in laminar volume between the first and second scans was -6.67% (range, +10.13% to -24.86%). CT grades assigned to patients based on laminar dimension measurements remained the same, despite significant changes in laminar volumes. Clinical examination failed to identify 60% of patients who were found to have resorption on volumetric analysis. Currently, the detection of laminar resorption relies on clinical examination and the measurement of laminar dimensions on the 2- and 3-dimensional radiological images. Laminar volume measurement is a useful new addition to the armamentarium. It provides an objective tool that allows for a precise and reproducible assessment of laminar resorption.

Automotive Gas Turbine Power System-Performance Analysis Code

NASA Technical Reports Server (NTRS)

Juhasz, Albert J.

1997-01-01

An open cycle gas turbine numerical modelling code suitable for thermodynamic performance analysis (i.e. thermal efficiency, specific fuel consumption, cycle state points, working fluid flowrates etc.) of automotive and aircraft powerplant applications has been generated at the NASA Lewis Research Center's Power Technology Division. The use this code can be made available to automotive gas turbine preliminary design efforts, either in its present version, or, assuming that resources can be obtained to incorporate empirical models for component weight and packaging volume, in later version that includes the weight-volume estimator feature. The paper contains a brief discussion of the capabilities of the presently operational version of the code, including a listing of input and output parameters and actual sample output listings.

Pancreatic mucinous cystic neoplasm size using CT volumetry, spherical and ellipsoid formulas: validation study.

PubMed

Chalian, Hamid; Seyal, Adeel Rahim; Rezai, Pedram; Töre, Hüseyin Gürkan; Miller, Frank H; Bentrem, David J; Yaghmai, Vahid

2014-01-10

The accuracy for determining pancreatic cyst volume with commonly used spherical and ellipsoid methods is unknown. The role of CT volumetry in volumetric assessment of pancreatic cysts needs to be explored. To compare volumes of the pancreatic cysts by CT volumetry, spherical and ellipsoid methods and determine their accuracy by correlating with actual volume as determined by EUS-guided aspiration. Setting This is a retrospective analysis performed at a tertiary care center. Patients Seventy-eight pathologically proven pancreatic cysts evaluated with CT and endoscopic ultrasound (EUS) were included. Design The volume of fourteen cysts that had been fully aspirated by EUS was compared to CT volumetry and the routinely used methods (ellipsoid and spherical volume). Two independent observers measured all cysts using commercially available software to evaluate inter-observer reproducibility for CT volumetry. The volume of pancreatic cysts as determined by various methods was compared using repeated measures analysis of variance. Bland-Altman plot and intraclass correlation coefficient were used to determine mean difference and correlation between observers and methods. The error was calculated as the percentage of the difference between the CT estimated volumes and the aspirated volume divided by the aspirated one. CT volumetry was comparable to aspirated volume (P=0.396) with very high intraclass correlation (r=0.891, P<0.001) and small mean difference (0.22 mL) and error (8.1%). Mean difference with aspirated volume and error were larger for ellipsoid (0.89 mL, 30.4%; P=0.024) and spherical (1.73 mL, 55.5%; P=0.004) volumes than CT volumetry. There was excellent inter-observer correlation in volumetry of the entire cohort (r=0.997, P<0.001). CT volumetry is accurate and reproducible. Ellipsoid and spherical volume overestimate the true volume of pancreatic cysts.

Predictors of lung transplant survival in eurotransplant.

PubMed

Smits, J M A; Mertens, B J A; Van Houwelingen, H C; Haverich, A; Persijn, G G; Laufer, G

2003-11-01

This study was undertaken to assess the influence of patient/donor and center factors on lung transplantation outcome. Outcomes of all consecutive first cadaveric lung transplants performed at 21 Eurotransplant centers in 1997-99 were analyzed. The risk-adjusted center effect on mortality was estimated. A Cox model was built including donor and recipient age and gender, primary disease, HLA mismatches, patient's residence, cold ischemic time, donor's cause of death, serum creatinine, type of lung transplant, respiratory support status, clinical condition and percentage predicted FEV1. The center effect was calculated (expressed as the standardized difference between the observed and expected survival rates), and empirical and full Bayes methods were applied to evaluate between-center differences. A total of 590 adults underwent lung transplantation. The primary disease (p=0.01), HLA-mismatches (p = 0.02), clinical condition(p < 0.0001) and the patient's respiratory support status (p = 0.05) were significantly associated with survival. After adjusting for case-mix, no between-center differences could be found. An in-depth empirical Bayes analysis showed the between-center variation to be zero. Similar results were obtained from the full Bayes analysis. Based on these data, there is no scientific basis to support a hypothesis of possible association between center volume and lung survival rates.

Association between liver transplant center performance evaluations and transplant volume.

PubMed

Buccini, L D; Segev, D L; Fung, J; Miller, C; Kelly, D; Quintini, C; Schold, J D

2014-09-01

There has been increased oversight of transplant centers and stagnation in liver transplantation nationally in recent years. We hypothesized that centers that received low performance (LP) evaluations were more likely to alter protocols, resulting in reduced rates of transplants and patients placed on the waiting list. We evaluated the association of LP evaluations and transplant activity among liver transplant centers in the United States using national Scientific Registry of Transplant Recipients data (January 2007 to July 2012). We compared the average change in recipient and candidate volume and donor and patient characteristics based on whether the centers received LP evaluations. Of 92 eligible centers, 27 (29%) received at least one LP evaluation. Centers without an LP evaluation (n = 65) had an average increase of 9.3 transplants and 14.9 candidates while LP centers had an average decrease of 39.9 transplants (p < 0.01) and 67.3 candidates (p < 0.01). LP centers reduced the use of older donors, donations with longer cold ischemia, and donations after cardiac death (p-values < 0.01). There was no association between the change in transplant volume and measured performance (R(2)  = 0.002, p = 0.91). Findings indicate a strong association between performance evaluations and changes in candidate listings and transplants among liver transplant centers, with no measurable improvement in outcomes associated with reduction in transplant volume. © Copyright 2014 The American Society of Transplantation and the American Society of Transplant Surgeons.

Regional gray matter atrophy in relapsing remitting multiple sclerosis: baseline analysis of multi-center data.

PubMed

Datta, Sushmita; Staewen, Terrell D; Cofield, Stacy S; Cutter, Gary R; Lublin, Fred D; Wolinsky, Jerry S; Narayana, Ponnada A

2015-03-01

Regional gray matter (GM) atrophy in multiple sclerosis (MS) at disease onset and its temporal variation can provide objective information regarding disease evolution. An automated pipeline for estimating atrophy of various GM structures was developed using tensor based morphometry (TBM) and implemented on a multi-center sub-cohort of 1008 relapsing remitting MS (RRMS) patients enrolled in a Phase 3 clinical trial. Four hundred age and gender matched healthy controls were used for comparison. Using the analysis of covariance, atrophy differences between MS patients and healthy controls were assessed on a voxel-by-voxel analysis. Regional GM atrophy was observed in a number of deep GM structures that included thalamus, caudate nucleus, putamen, and cortical GM regions. General linear regression analysis was performed to analyze the effects of age, gender, and scanner field strength, and imaging sequence on the regional atrophy. Correlations between regional GM volumes and expanded disability status scale (EDSS) scores, disease duration (DD), T2 lesion load (T2 LL), T1 lesion load (T1 LL), and normalized cerebrospinal fluid (nCSF) were analyzed using Pearson׳s correlation coefficient. Thalamic atrophy observed in MS patients compared to healthy controls remained consistent within subgroups based on gender and scanner field strength. Weak correlations between thalamic volume and EDSS (r=-0.133; p<0.001) and DD (r=-0.098; p=0.003) were observed. Of all the structures, thalamic volume moderately correlated with T2 LL (r=-0.492; P-value<0.001), T1 LL (r=-0.473; P-value<0.001) and nCSF (r=-0.367; P-value<0.001). Copyright © 2015 Elsevier B.V. All rights reserved.

High call volume at poison control centers: identification and implications for communication

PubMed Central

CARAVATI, E. M.; LATIMER, S.; REBLIN, M.; BENNETT, H. K. W.; CUMMINS, M. R.; CROUCH, B. I.; ELLINGTON, L.

2016-01-01

Context High volume surges in health care are uncommon and unpredictable events. Their impact on health system performance and capacity is difficult to study. Objectives To identify time periods that exhibited very busy conditions at a poison control center and to determine whether cases and communication during high volume call periods are different from cases during low volume periods. Methods Call data from a US poison control center over twelve consecutive months was collected via a call logger and an electronic case database (Toxicall®). Variables evaluated for high call volume conditions were: (1) call duration; (2) number of cases; and (3) number of calls per staff member per 30 minute period. Statistical analyses identified peak periods as busier than 99% of all other 30 minute time periods and low volume periods as slower than 70% of all other 30 minute periods. Case and communication characteristics of high volume and low volume calls were compared using logistic regression. Results A total of 65,364 incoming calls occurred over 12 months. One hundred high call volume and 4885 low call volume 30 minute periods were identified. High volume periods were more common between 1500 and 2300 hours and during the winter months. Coded verbal communication data were evaluated for 42 high volume and 296 low volume calls. The mean (standard deviation) call length of these calls during high volume and low volume periods was 3 minutes 27 seconds (1 minute 46 seconds) and 3 minutes 57 seconds (2 minutes 11 seconds), respectively. Regression analyses revealed a trend for fewer overall verbal statements and fewer staff questions during peak periods, but no other significant differences for staff-caller communication behaviors were found. Conclusion Peak activity for poison center call volume can be identified by statistical modeling. Calls during high volume periods were similar to low volume calls. Communication was more concise yet staff was able to maintain a good rapport with callers during busy call periods. This approach allows evaluation of poison exposure call characteristics and communication during high volume periods. PMID:22889059

High call volume at poison control centers: identification and implications for communication.

PubMed

Caravati, E M; Latimer, S; Reblin, M; Bennett, H K W; Cummins, M R; Crouch, B I; Ellington, L

2012-09-01

High volume surges in health care are uncommon and unpredictable events. Their impact on health system performance and capacity is difficult to study. To identify time periods that exhibited very busy conditions at a poison control center and to determine whether cases and communication during high volume call periods are different from cases during low volume periods. Call data from a US poison control center over twelve consecutive months was collected via a call logger and an electronic case database (Toxicall®).Variables evaluated for high call volume conditions were: (1) call duration; (2) number of cases; and (3) number of calls per staff member per 30 minute period. Statistical analyses identified peak periods as busier than 99% of all other 30 minute time periods and low volume periods as slower than 70% of all other 30 minute periods. Case and communication characteristics of high volume and low volume calls were compared using logistic regression. A total of 65,364 incoming calls occurred over 12 months. One hundred high call volume and 4885 low call volume 30 minute periods were identified. High volume periods were more common between 1500 and 2300 hours and during the winter months. Coded verbal communication data were evaluated for 42 high volume and 296 low volume calls. The mean (standard deviation) call length of these calls during high volume and low volume periods was 3 minutes 27 seconds (1 minute 46 seconds) and 3 minutes 57 seconds (2 minutes 11 seconds), respectively. Regression analyses revealed a trend for fewer overall verbal statements and fewer staff questions during peak periods, but no other significant differences for staff-caller communication behaviors were found. Peak activity for poison center call volume can be identified by statistical modeling. Calls during high volume periods were similar to low volume calls. Communication was more concise yet staff was able to maintain a good rapport with callers during busy call periods. This approach allows evaluation of poison exposure call characteristics and communication during high volume periods.

Federal Logistics Information System (FLIS) Procedures Manual. Volume 5: Data Bank Interrogations/Search.

DTIC Science & Technology

1995-04-01

NO. 5 DoD 4100.39-M D oD 4100.39-MN Volume 5 DLSC- VPH 1 January 1997 "N FEDERAL LOGISTICS INFORMATION SYSTEM (FLIS) PROCEDURES MANUAL I. Volume 5. DoD...LOGISTICS SERVICES CENTER 74 WASHINGTON AVE N BATTLE CREEK MI 49017-3084 CH 4 CHANGE NO. 4 DoD 4100.39-M DoD 4100.39-M Volume 5 DLSC- VPH 1 July 1996 "FEDERAL...CENTER Volume 5 74 WASHINGTON AVE N BATTLE CREEK, MI 49017-3084 DLSC- VPH 1 April 1995 FOREWORD This is one of the volumes (see backside of cover for

Dual-Use Space Technology Transfer Conference and Exhibition. Volume 1

NASA Technical Reports Server (NTRS)

Krishen, Kumar (Compiler)

1994-01-01

This document contains papers presented at the Dual-Use Space Technology Transfer Conference and Exhibition held at the Johnson Space Center February 1-3, 1994. Possible technology transfers covered during the conference were in the areas of information access; innovative microwave and optical applications; materials and structures; marketing and barriers; intelligent systems; human factors and habitation; communications and data systems; business process and technology transfer; software engineering; biotechnology and advanced bioinstrumentation; communications signal processing and analysis; new ways of doing business; medical care; applications derived from control center data systems; human performance evaluation; technology transfer methods; mathematics, modeling, and simulation; propulsion; software analysis and decision tools systems/processes in human support technology; networks, control centers, and distributed systems; power; rapid development perception and vision technologies; integrated vehicle health management; automation technologies; advanced avionics; ans robotics technologies. More than 77 papers, 20 presentations, and 20 exhibits covering various disciplines were presented b experts from NASA, universities, and industry.

Relation of perioperative deaths to hospital volume among patients undergoing pancreatic resection for malignancy.

PubMed Central

Lieberman, M D; Kilburn, H; Lindsey, M; Brennan, M F

1995-01-01

OBJECTIVE: The authors examined the effect of hospital and surgeon volume on perioperative mortality rates after pancreatic resection for the treatment of pancreatic cancer. METHODS: Discharge abstracts from 1972 patients who had undergone pancreaticoduodenectomy or total pancreatectomy for malignancy in New York State between 1984 and 1991 were obtained from the Statewide Planning and Research Cooperative System. Logistic regression analysis was used to determine the relationship between hospital and surgeon experience to perioperative outcome. RESULTS: More than 75% of patients underwent resection at minimal-volume (fewer than 10 cases) or low-volume (10-50 cases) centers (defined as hospitals in which a minimal number of resections were performed in a given year), and these hospitals represented 98% of the institutions treating peripancreatic cancer. The two high-volume hospitals (more than 81 cases) demonstrated a significantly lower perioperative mortality rate (4.0%) compared with the minimal- (21.8%) and low-volume (12.3%) hospitals (p < 0.001). The perioperative mortality rate was 15.5% for low-volume (fewer than 9 cases) surgeons (defined as surgeons who had performed a minimal number of resections in any hospital in a given year) (n = 687) compared with 4.7% for high-volume (more than 41 cases) pancreatic surgeons (n = 4) (p < 0.001). Logistic regression analysis demonstrated that perioperative death is significantly (p < 0.05) related to hospital volume, but the surgeon's experience is not significantly related to perioperative deaths when hospital volume is controlled. CONCLUSIONS: These data support a defined minimum hospital experience for elective pancreatectomy for malignancy to minimize perioperative deaths. PMID:7487211

Basewide energy systems plan for army material and mechanic research center; Volume 1 - executive summary. Final report

DOE Office of Scientific and Technical Information (OSTI.GOV)

NONE

1983-08-01

The report includes the analysis of the energy use patterns at the base and the identification and evaluation of energy conservation opportunities. The obtained results indicate that AMMRC energy use can potentially be reduced 42 percent by FY 1985, compared to the FY 1975 energy use baseline.

Russian Function Catalog and Rolebooks. Methods for Determining Language Objectives and Criteria, Volume XIII.

ERIC Educational Resources Information Center

Setzler, Hubert H., Jr.; And Others

A Russian Function Catalog and Instructor and Advisor Rolebooks for Russian are presented. The catalog and rolebooks are part of the communication/language objectives-based system (C/LOBS), which supports the front-end analysis efforts of the Defense Language Institute Foreign Language Center. The C/LOBS projects, which is described in 13 volumes…

Science Cadre Training in Russia and Abroad (A Comparative Analysis)

ERIC Educational Resources Information Center

Ismailov, E. E.

2010-01-01

Today the scientific potential of any country, its science cadres, the volume and scale of the research being conducted, the number of science centers, the quality and subject matter of the research, the level of the material and technical equipment of its research laboratories, and other aspects constitute a most important factor in ensuring…

1968-1973: A Trend Analysis. Student Development Report, Volume 11, No. 5, 1973-74.

ERIC Educational Resources Information Center

Bryer, James

Colorado State University Counseling Center (UCC) direct service activities over the last five years were reviewed. The variables examined were: number of clients seen, client load by quarter, number of interviews per client, clients' type of problem, sex, class, college and marital status. Results indicated that UCC doubled its client load during…

High-Speed Research: Sonic Boom, volume 2

NASA Technical Reports Server (NTRS)

Darden, Christine M. (Compiler)

1992-01-01

A High-Speed Sonic Boom Workshop was held at NASA Langley Research Center on February 25-27, 1992. The purpose of the workshop was to make presentations on current research activities and accomplishments and to assess progress in the area of sonic boom since the program was initiated in FY-90. Twenty-nine papers were presented during the 2-1/2 day workshop. Attendees included representatives from academia, industry, and government who are actively involved in sonic-boom research. Volume 2 contains papers related to low sonic-boom design and analysis using both linear theory and higher order computational fluid dynamics (CFD) methods.

National Crime Information Center Mandatory Minimum Standards Curriculum for Full Access Terminal Operators. Volume Two--NCIC "Hot" Files.

ERIC Educational Resources Information Center

Federal Bureau of Investigation, Washington, DC. National Crime Information Center.

This document is the second volume of a two-volume set of lesson plans that together make up a complete training package for full-service terminal operators. The lesson plans are designed to ensure that a state's National Crime Information Center (NCIC) training program meets Advisory Policy Board standards. (NCIC is a nationwide computerized…

A Competency Based, Field Centered, Systems Approach to Elementary Teacher Education. Volume I: Overview and Specifications. Final Report.

ERIC Educational Resources Information Center

Schalock, H. Del, Ed.; Hale, James R., Ed.

This main volume (SP 002 155-SP 002 180 comprise the appendixes to this volume) explains the ComField (competency based, field centered) Model--a systems approach to the education of elementary school teachers which entails specifications (1) for instruction and (2) for management of the instructional program. In an overview, the ComField Model is…

Laser Doppler, velocimeter system for turbine stator cascade studies and analysis of statistical biasing errors

NASA Technical Reports Server (NTRS)

Seasholtz, R. G.

1977-01-01

A laser Doppler velocimeter (LDV) built for use in the Lewis Research Center's turbine stator cascade facilities is described. The signal processing and self contained data processing are based on a computing counter. A procedure is given for mode matching the laser to the probe volume. An analysis is presented of biasing errors that were observed in turbulent flow when the mean flow was not normal to the fringes.

M1A2 Adjunct Analysis (POSNOV Volume)

DTIC Science & Technology

1989-12-01

MD 20814-2797 Director 2 U.S. Army Materiel Systems Analysis Activity ATTN: AMXSY-CS, AMXSY-GA Aberden Proving Grounds , MD 21005-5071 U.S. Army...Leonard Wood, MO Commander U.S. Army Ordnance Center & School ATTN: ATSL-CD-CS Aberdeen Proving Ground , MD 21005 Commander 2 U.S. Army Soldier Support...NJ Commander U.S. Army Test and Evaluation Command ATrN: AMSTE-CM-R Aberdeen Proving Ground , MD 21005 Commander U.S. Army Tank Automotive Command

Long-term results from the Contura multilumen balloon breast brachytherapy catheter phase 4 registry trial.

PubMed

Cuttino, Laurie W; Arthur, Douglas W; Vicini, Frank; Todor, Dorin; Julian, Thomas; Mukhopadhyay, Nitai

2014-12-01

To describe the long-term outcomes from a completed, multi-institutional phase 4 registry trial using the Contura multilumen balloon (CMLB) breast brachytherapy catheter to deliver accelerated partial breast irradiation (APBI) in patients with early-stage breast cancer. Three hundred forty-two evaluable patients were enrolled by 23 institutions between January 2008 and February 2011. All patients received 34 Gy in 10 fractions, delivered twice daily. Rigorous target coverage and normal tissue dose constraints were observed. The median follow-up time was 36 months (range, 1-54 months). For the entire patient cohort of 342 patients, 10 patients experienced an ipsilateral breast tumor recurrence (IBTR). Eight of these IBTR were classified as true recurrences/marginal miss (TRMM), and 2 were elsewhere failures (EF). Local recurrence-free survival was 97.8% at 3 years. For the entire cohort, 88% of patients had good to excellent overall cosmesis. The overall incidence of infection was 8.5%. Symptomatic seroma was reported in only 4.4% of patients. A separate analysis was performed to determine whether improved outcomes would be observed for patients treated at high-volume centers with extensive brachytherapy experience. Three IBTR were observed in this cohort, only 1 of which was classified as a TRMM. Local recurrence-free survival at high-volume centers was 98.1% at 3 years. Overall cosmetic outcome and toxicity were superior in patients treated at high-volume centers. In these patients, 95% had good to excellent overall cosmesis. Infection was observed in only 2.9% of patients, and symptomatic seroma was reported in only 1.9%. Use of the CMLB for APBI delivery is associated with acceptable long-term local control and toxicity. Local recurrence-free survival was 97.8% at 3 years. Significant (grade 3) toxicity was uncommon, and no grade 4 toxicity was observed. Treatment at high-volume centers was associated with decreased late toxicity. Copyright © 2014 Elsevier Inc. All rights reserved.

Long-Term Results From the Contura Multilumen Balloon Breast Brachytherapy Catheter Phase 4 Registry Trial

DOE Office of Scientific and Technical Information (OSTI.GOV)

Cuttino, Laurie W., E-mail: lcuttino@mcvh-vcu.edu; Arthur, Douglas W.; Vicini, Frank

2014-12-01

Purpose: To describe the long-term outcomes from a completed, multi-institutional phase 4 registry trial using the Contura multilumen balloon (CMLB) breast brachytherapy catheter to deliver accelerated partial breast irradiation (APBI) in patients with early-stage breast cancer. Methods and Materials: Three hundred forty-two evaluable patients were enrolled by 23 institutions between January 2008 and February 2011. All patients received 34 Gy in 10 fractions, delivered twice daily. Rigorous target coverage and normal tissue dose constraints were observed. Results: The median follow-up time was 36 months (range, 1-54 months). For the entire patient cohort of 342 patients, 10 patients experienced an ipsilateral breast tumor recurrencemore » (IBTR). Eight of these IBTR were classified as true recurrences/marginal miss (TRMM), and 2 were elsewhere failures (EF). Local recurrence-free survival was 97.8% at 3 years. For the entire cohort, 88% of patients had good to excellent overall cosmesis. The overall incidence of infection was 8.5%. Symptomatic seroma was reported in only 4.4% of patients. A separate analysis was performed to determine whether improved outcomes would be observed for patients treated at high-volume centers with extensive brachytherapy experience. Three IBTR were observed in this cohort, only 1 of which was classified as a TRMM. Local recurrence-free survival at high-volume centers was 98.1% at 3 years. Overall cosmetic outcome and toxicity were superior in patients treated at high-volume centers. In these patients, 95% had good to excellent overall cosmesis. Infection was observed in only 2.9% of patients, and symptomatic seroma was reported in only 1.9%. Conclusion: Use of the CMLB for APBI delivery is associated with acceptable long-term local control and toxicity. Local recurrence-free survival was 97.8% at 3 years. Significant (grade 3) toxicity was uncommon, and no grade 4 toxicity was observed. Treatment at high-volume centers was associated with decreased late toxicity.« less

Robot-assisted versus open radical prostatectomy: the differential effect of regionalization, procedure volume and operative approach.

PubMed

Sammon, Jesse D; Karakiewicz, Pierre I; Sun, Maxine; Sukumar, Shyam; Ravi, Praful; Ghani, Khurshid R; Bianchi, Marco; Peabody, James O; Shariat, Shahrokh F; Perrotte, Paul; Hu, Jim C; Menon, Mani; Trinh, Quoc-Dien

2013-04-01

The use of robot-assisted radical prostatectomy has increased rapidly despite the absence of randomized, controlled trials showing the superiority of this approach. While recent studies suggest an advantage for perioperative complication rates, they fail to account for the volume-outcome relationship. We compared perioperative outcomes after robot-assisted and open radical prostatectomy, while considering the impact of this established relationship. Using the NIS (Nationwide Inpatient Sample), we abstracted data on patients treated with radical prostatectomy in 2009. Univariable and multivariable logistic regression analyses were done to compare the rates of blood transfusion, intraoperative and postoperative complications, prolonged length of stay, increased hospital charges and mortality between robot-assisted and open radical prostatectomy overall and across volume quartiles. An estimated 77,616 men underwent radical prostatectomy, including a robot-assisted and an open procedure in 63.9% and 36.1%, respectively. Low volume centers averaged 26.2 robot-assisted and 5.2 open cases, while very high volume centers averaged 578.8 robot-assisted and 150.2 open cases. Overall, patients treated with the robot-assisted procedure experienced a lower rate of adverse outcomes than those treated with the open procedure for all measured categories. Across equivalent volume quartiles robot-assisted radical prostatectomy outcomes were generally favorable. However, the open procedure at high volume centers resulted in a lower postoperative complication rate (OR 0.59, 95% CI 0.46-0.75), elevated hospital charges (OR 0.75, 95% CI 0.64-0.87) and a comparable blood transfusion rate (OR 1.38, 95% CI 0.93-2.02) relative to the robot-assisted procedure at low volume centers. Regionalization has occurred to a greater extent for robot-assisted than for open radical prostatectomy with an associated benefit in overall outcomes. Nonetheless, low volume institutions experienced inferior outcomes relative to the highest volume centers irrespective of approach. These findings demonstrate the importance of accounting for hospital volume when examining the benefit of a surgical technique. Copyright © 2013 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

The Volume-Outcome Relationship in Critical Care

PubMed Central

Wallace, David J.; Yordanov, Youri; Trinquart, Ludovic; Blomkvist, Josefin; Angus, Derek C.; Kahn, Jeremy M.; Ravaud, Philippe; Guidet, Bertrand

2015-01-01

OBJECTIVE: The purpose of this study was to systematically review the research on volume and outcome relationships in critical care. METHODS: From January 1, 2001, to April 30, 2014, MEDLINE and EMBASE were searched for studies assessing the relationship between admission volume and clinical outcomes in critical illness. Bibliographies were reviewed to identify other articles of interest, and experts were contacted about missing or unpublished studies. Of 127 studies reviewed, 46 met inclusion criteria, covering seven clinical conditions. Two investigators independently reviewed each article using a standardized form to abstract information on key study characteristics and results. RESULTS: Overall, 29 of the studies (63%) reported a statistically significant association between higher admission volume and improved outcomes. The magnitude of the association (mortality OR between the lowest vs highest stratum of volume centers), as well as the thresholds used to characterize high volume, varied across clinical conditions. Critically ill patients with cardiovascular (n = 7, OR = 1.49 [1.11-2.00]), respiratory (n = 12, OR = 1.20 [1.04-1.38]), severe sepsis (n = 4, OR = 1.17 [1.03-1.33]), hepato-GI (n = 3, OR = 1.30 [1.08-1.78]), neurologic (n = 3, OR = 1.38 [1.22-1.57]), and postoperative admission diagnoses (n = 3, OR = 2.95 [1.05-8.30]) were more likely to benefit from admission to higher-volume centers compared with lower-volume centers. Studies that controlled for ICU or hospital organizational factors were less likely to find a significant volume-outcome relationship than studies that did not control for these factors. CONCLUSIONS: Critically ill patients generally benefit from care in high-volume centers, with more substantial benefits in selected high-risk conditions. This relationship may in part be mediated by specific ICU and hospital organizational factors. PMID:25927593

MAC/GMC 4.0 User's Manual: Example Problem Manual. Volume 3

NASA Technical Reports Server (NTRS)

Bednarcyk, Brett A.; Arnold, Steven M.

2002-01-01

This document is the third volume in the three volume set of User's Manuals for the Micromechanics Analysis Code with Generalized Method of Cells Version 4.0 (MAC/GMC 4.0). Volume 1 is the Theory Manual, Volume 2 is the Keywords Manual, and this document is the Example Problems Manual. MAC/GMC 4.0 is a composite material and laminate analysis software program developed at the NASA Glenn Research Center. It is based on the generalized method of cells (GMC) micromechanics theory, which provides access to the local stress and strain fields in the composite material. This access grants GMC the ability to accommodate arbitrary local models for inelastic material behavior and various types of damage and failure analysis. MAC/GMC 4.0 has been built around GMC to provide the theory with a user-friendly framework, along with a library of local inelastic, damage, and failure models. Further, application of simulated thermo-mechanical loading, generation of output results, and selection of architectures to represent the composite material, have been automated in MAC/GMC 4.0. Finally, classical lamination theory has been implemented within MAC/GMC 4.0 wherein GMC is used to model the composite material response of each ply. Consequently, the full range of GMC composite material capabilities is available for analysis of arbitrary laminate configurations as well. This volume provides in-depth descriptions of 43 example problems, which were specially designed to highlight many of the most important capabilities of the code. The actual input files associated with each example problem are distributed with the MAC/GMC 4.0 software; thus providing the user with a convenient starting point for their own specialized problems of interest.

Evaluation of Street Projects for the Spanish Speaking. Findings, Conclusions, Recommendations. Volume II of a Two-Volume Report.

ERIC Educational Resources Information Center

Vasquez Associates Ltd., Milwaukee, WI.

Nine Street Projects designed for the Spanish speaking and funded by Region V of the Department of Health, Education and Welfare (HEW) are examined here. They were: the El Hogar del Nino Day Care Center, Spanish-American Day Care Center, United Migrant Opportunity Services' Bilingual/Bicultural Early Childhood Center, Youth Services at El Centro…

A randomized controlled pilot trial of modified whole blood versus component therapy in severely injured patients requiring large volume transfusions.

PubMed

Cotton, Bryan A; Podbielski, Jeanette; Camp, Elizabeth; Welch, Timothy; del Junco, Deborah; Bai, Yu; Hobbs, Rhonda; Scroggins, Jamie; Hartwell, Beth; Kozar, Rosemary A; Wade, Charles E; Holcomb, John B

2013-10-01

To determine whether resuscitation of severely injured patients with modified whole blood (mWB) resulted in fewer overall transfusions compared with component (COMP) therapy. For decades, whole blood (WB) was the primary product for resuscitating patients in hemorrhagic shock. After dramatic advances in blood banking in the 1970s, blood donor centers began supplying hospitals with individual components [red blood cell (RBC), plasma, platelets] and removed WB as an available product. However, no studies of efficacy or hemostatic potential in trauma patients were performed before doing so. Single-center, randomized trial of severely injured patients predicted to large transfusion volume. Pregnant patients, prisoners, those younger than 18 years or with more than 20% total body surface area burns (TBSA) burns were excluded. Patients were randomized to mWB (1 U mWB) or COMP therapy (1 U RBC+ 1 U plasma) immediately on arrival. Each group also received 1 U platelets (apheresis or prepooled random donor) for every 6 U of mWB or 6 U of RBC + 6 U plasma. The study was performed under the Exception From Informed Consent (Food and Drug Administration 21 code of federal regulations [CFR] 50.24). Primary outcome was 24-hour transfusion volumes. A total of 107 patients were randomized (55 mWB, 52 COMP therapy) over 14 months. There were no differences in demographics, arrival vitals or laboratory values, injury severity, or mechanism. Transfusions were similar between groups (intent-to-treat analysis). However, when excluding patients with severe brain injury (sensitivity analysis), WB group received less 24-hour RBC (median 3 vs 6, P = 0.02), plasma (4 vs 6, P = 0.02), platelets (0 vs 3, P = 0.09), and total products (11 vs 16, P = 0.02). Compared with COMP therapy, WB did not reduce transfusion volumes in severely injured patients predicted to receive massive transfusion. However, in the sensitivity analysis (patients without severe brain injuries), use of mWB significantly reduced transfusion volumes, achieving the prespecified endpoint of this initial pilot study.

Proving and Improving. Volume ll: Tools and Techniques for Assessing the First College Year. The First-Year Experience Monograph Series No. 37

ERIC Educational Resources Information Center

Swing, Randy L., Ed.

2004-01-01

This second volume of "Proving and Improving" collects essays from the First-Year Assessment Listserv, which is hosted by the Policy Center on the First Year of College and the National Resource Center. Like the first volume, this one brings together the nation's leading experts and practitioners of assessment in the first college year. They offer…

Proceedings of the Annual Meeting of the International Group for the Psychology of Mathematics Education (PME) (28th, Bergen, Norway, July 14-18, 2004). Volume 1

ERIC Educational Resources Information Center

Hoines, Marit Johnsen, Ed.; ; Fuglestad, Anne Berit, Ed.

2004-01-01

This document contains the first volume of the proceedings of the 28th Annual Conference of the International Group for the Psychology of Mathematics Education. Conference presentations are centered around the theme "Inclusion and Diversity". In total, 147 presentations centered around the vision of mathematics for all. This volume features eight…

Poster - Thur Eve - 54: A software solution for ongoing DVH quality assurance in radiation therapy.

PubMed

Annis, S-L; Zeng, G; Wu, X; Macpherson, M

2012-07-01

A program has been developed in MATLAB for use in quality assurance of treatment planning of radiation therapy. It analyzes patient DVH files and compiles dose volume data for review, trending, comparison and analysis. Patient DVH files are exported from the Eclipse treatment planning system and saved according to treatment sites and date. Currently analysis is available for 4 treatment sites; Prostate, Prostate Bed, Lung, and Upper GI, with two functions for data report and analysis: patient-specific and organ-specific. The patient-specific function loads one patient DVH file and reports the user-specified dose volume data of organs and targets. These data can be compiled to an external file for a third party analysis. The organ-specific function extracts a requested dose volume of an organ from the DVH files of a patient group and reports the statistics over this population. A graphical user interface is utilized to select clinical sites, function and structures, and input user's requests. We have implemented this program in planning quality assurance at our center. The program has tracked the dosimetric improvement in GU sites after VMAT was implemented clinically. It has generated dose volume statistics for different groups of patients associated with technique or time range. This program allows reporting and statistical analysis of DVH files. It is an efficient tool for the planning quality control in radiation therapy. © 2012 American Association of Physicists in Medicine.

Impact of introduction of endoscopic ultrasound on volume, success, and complexity of endoscopic retrograde cholangiopancreatography in a tertiary referral center.

PubMed

Yandrapu, Harathi; Elhanafi, Sherif; Chowdhury, Farhanaz; Liu, Jiayang; Onate, Eduardo J; Dwivedi, Alok; Othman, Mohamed O

2017-01-01

Endoscopic ultrasound (EUS) is commonly used to examine pancreaticobiliary disorders. We hypothesize that the introduction of EUS service may change the pattern and the complexity of endoscopic retrograde cholangiopancreatographies (ERCPs) performed. The aim of this study is to assess the impact of introducing EUS on the volume, success, and complexity of ERCP. This is a single-center retrospective data review of ERCP procedures done "before" and "after" the introduction of EUS (before EUS and after EUS). Patients' demographics, ERCP indications, types of sedation, therapeutic interventions, outcomes, complications, and complexity of ERCP were collected. The categorical and continuous variables were compared using Fisher's exact test and the unpaired t-test, respectively. Multivariable logistic regression analysis was used to compare ERCP outcomes. A total of 945 ERCPs performed over a 3-year period between January 2010 and January 2013 (411 and 534 in the "before EUS" and "after EUS" time periods, respectively) were included in this study. There was a 30% relative increase in the volume of ERCPs after the introduction of EUS. ERCP success rate was higher after the introduction of EUS, even after adjusting the complexity grade [odds ratio (OR) = 4.54, P = 0.001]. Significant increase in the complexity of ERCP was observed after the introduction of EUS service. The OR of performing grade 4 ERCP was 4.44 (P = 0.0005) after the introduction of EUS. The introduction of a new EUS service in our tertiary referral university medical center is associated with an increase in the volume, success, and complexity of ERCP procedures. EUS expertise may be valuable for better ERCP outcomes.

Robotic Assisted Simple Prostatectomy versus Holmium Laser Enucleation of the Prostate for Lower Urinary Tract Symptoms in Patients with Large Volume Prostate: A Comparative Analysis from a High Volume Center.

PubMed

Umari, Paolo; Fossati, Nicola; Gandaglia, Giorgio; Pokorny, Morgan; De Groote, Ruben; Geurts, Nicolas; Goossens, Marijn; Schatterman, Peter; De Naeyer, Geert; Mottrie, Alexandre

2017-04-01

We report a comparative analysis of robotic assisted simple prostatectomy vs holmium laser enucleation of the prostate in patients who had benign prostatic hyperplasia with a large volume prostate (greater than 100 ml). A total of 81 patients underwent robotic assisted simple prostatectomy and 45 underwent holmium laser enucleation of the prostate in a 7-year period. Patients were preoperatively assessed with transrectal ultrasound and uroflowmetry. Functional parameters were assessed postoperatively during followup. Perioperative outcomes included operative time, postoperative hemoglobin, catheterization time and hospitalization. Complications were reported according to the Clavien-Dindo classification. Compared to the holmium laser enucleation group, patients treated with prostatectomy were significantly younger (median age 69 vs 74 years, p = 0.032) and less healthy (Charlson comorbidity index 2 or greater in 62% vs 29%, p = 0.0003), and had a lower rate of suprapubic catheterization (23% vs 42%, p = 0.028) and a higher preoperative I-PSS (International Prostate Symptom Score) (25 vs 21, p = 0.049). Both groups showed an improvement in the maximum flow rate (15 vs 11 ml per second, p = 0.7), and a significant reduction in post-void residual urine (-73 vs -100 ml, p = 0.4) and I-PSS (-20 vs -18, p = 0.8). Median operative time (105 vs 105 minutes, p = 0.9) and postoperative hemoglobin (13.2 vs 13.8 gm/dl, p = 0.08) were similar for robotic assisted prostatectomy and holmium laser enucleation, respectively. Median catheterization time (3 vs 2 days, p = 0.005) and median hospitalization (4 vs 2 days, p = 0.0001) were slightly shorter in the holmium laser group. Complication rates were similar with no Clavien grade greater than 3 in either group. Our results from a single center suggest comparable outcomes for robotic assisted simple prostatectomy and holmium laser enucleation of the prostate in patients with a large volume prostate. These findings require external validation at other high volume centers. Copyright © 2017 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

Mandarin Chinese Function Catalog and Rolebook. Method for Determining Language Objectives and Criteria, Volume IX.

ERIC Educational Resources Information Center

Setzler, Hubert H., Jr.; And Others

A Mandarin Chinese Function Catalog and Instructor Rolebook for Mandarin Chinese are presented. The catalog and rolebook are part of the communication/language objectives-based system (C/LOBS), which supports the front-end analysis efforts of the Defense Language Institute Foreign Language Center. The C/LOBS project, which is described in 13…

The DTIC Review: Volume 2, Number 4, Surviving Chemical and Biological Warfare

DTIC Science & Technology

1996-12-01

CHROMATOGRAPHIC ANALYSIS, NUCLEAR MAGNETIC RESONANCE, INFRARED SPECTROSCOPY , ARMY RESEARCH, DEGRADATION, VERIFICATION, MASS SPECTROSCOPY , LIQUID... mycotoxins . Such materials are not attractive as weapons of mass destruction however, as large amounts are required to produce lethal effects. In...VERIFICATION, ATOMIC ABSORPTION SPECTROSCOPY , ATOMIC ABSORPTION. AL The DTIC Review Defense Technical Information Center AD-A285 242 AD-A283 754 EDGEWOOO

Metric Selection for Ecosystem Restoration

DTIC Science & Technology

2013-06-01

focus on wetlands, submerged aquatic vegetation, oyster reefs, riparian forest, and wet prairie (Miner 2005). The objective of these Corps...of coastal habitats, Volume Two: Tools for monitoring coastal habitats. NOAA Coastal Ocean Program Decision Analysis Series No. 23. Silver Spring, MD...NOAA National Centers for Coastal Ocean Science. Thom, R. M., and K. F. Wellman. 1996. Planning aquatic ecosystem restoration monitoring programs

Spacelab Level 4 Programmatic Implementation Assessment Study. Volume 4: Executive summary

NASA Technical Reports Server (NTRS)

1978-01-01

The study objectives of the Spacelab level 4 analysis were defined, along with the most significant results. The approach used in the synthesis and selection of alternate level 4 integration is described; the options included distributed site, lead center, and launch site. Principal characteristics, as well as the functional flow diagrams for each option, are presented and explained.

Laser-Induced Incandescence Measurements in Low Gravity

NASA Technical Reports Server (NTRS)

VanderWal, R. L.

1997-01-01

A low-gravity environment offers advantages to investigations concerned with soot growth or flame radiation by eliminating of buoyancy-induced convection. Basic to each type of study is knowledge of spatially resolved soot volume fraction, (f(sub v). Laser-induced incandescence (LII) has emerged as a diagnostic for soot volume fraction determination because it possesses high temporal and spatial resolution, geometric versatility and high sensitivity. Implementation and system characterization of LII in a drop tower that provides 2.2 sec of low-gravity (micro)g) at the NASA Lewis Research Center are described here. Validation of LII for soot volume fraction determination in (micro)g is performed by comparison between soot volume fraction measurements obtained by light extinction [20] and LII in low-gravity for a 50/50 mixture (by volume) of 0 acetylene/nitrogen issuing into quiescent air. Quantitative soot volume fraction measurements within other laminar flames of ethane and propane and a turbulent diffusion flame in (micro)g via LII are also demonstrated. An analysis of LII images of a turbulent acetylene diffusion flame in 1-g and (micro)g is presented.

AGARD Flight Test Techniques Series. Volume 14. Introduction to Flight Test Engineering (Introduction a la Technique d’essais en vol)

DTIC Science & Technology

1995-09-01

path and aircraft attitude and other flight or aircraft parameters • Calculations in the frequency domain ( Fast Fourier Transform) • Data analysis...Signal filtering Image processing of video and radar data Parameter identification Statistical analysis Power spectral density Fast Fourier Transform...airspeeds both fast and slow, altitude, load factor both above and below 1g, centers of gravity (fore and aft), and with system/subsystem failures. Whether

Are characteristics of hospitals associated with outcome after cardiac arrest? Insights from the Great Paris registry.

PubMed

Chocron, Richard; Bougouin, Wulfran; Beganton, Frankie; Juvin, Philippe; Loeb, Thomas; Adnet, Frédéric; Lecarpentier, Eric; Lamhaut, Lionel; Jost, Daniel; Marijon, Eloi; Cariou, Alain; Jouven, Xavier; Dumas, Florence

2017-09-01

As post-cardiac arrest care may influence patients' outcome, characteristics of receiving hospitals should be integrated in the evaluation of survival. We aimed at assessing the influence of care level center on patients' survival at hospital discharge using a regional registry of out-of-hospital cardiac arrest patients (OHCA). We retrospectively analysed a Utstein and in-hospital data prospectively collected for all non-traumatic OHCA patients, in whom a successful return of spontaneous circulation (ROSC) had been obtained, from a large metropolitan area (Great Paris). Receiving hospitals were categorized in 3 groups as follows: A centers (High-case volume with cath-lab 24/7), B centers (Intermediate-case volume with cath-lab partly available) and C centers (Low-case volume and no cath-lab) We compared patients' characteristics and outcome in the 3 groups and performed a multivariate logistic regression using survival to discharge as primary endpoint. Between May 2011 and December 2013, 1476 patients were admitted in 48 hospitals (group A: n=917; group B: n=428; group C: n=91). Overall survival rate at discharge was 433/1436 (30%). Patients' baseline characteristics significantly differed, as hospitals from group A received younger patients with a higher rate of shockable cardiac rhythms (p<0.001). Unadjusted survival rate differed significantly among the 3 groups of hospitals (respectively 34%, 25% and 15.4% for A-C, p<0.01). In multivariate analysis, the category of receiving hospital was no longer associated with survival, even in the subgroup of witnessed arrest and shockable patients. In this population-based study, characteristics of receiving hospitals are not associated with survival rate at discharge. This might be partially explained by the prehospital triage organization used in France. Copyright © 2017. Published by Elsevier B.V.

Review of Adult Learning and Literacy, Volume 5. Connecting Research, Policy, and Practice: A Project of the National Center for the Study of Adult Learning and Literacy

ERIC Educational Resources Information Center

Comings, John, Ed.; Garner, Barbara, Ed.; Smith, Cristine, Ed.

2005-01-01

"The Review of Adult Learning and Literacy: Connecting Research, Policy, and Practice, Volume 5" is a volume in a series of annual publications of the National Center for the Study of Adult Learning and Literacy (NCSALL) that address major issues, the latest research, and the best practices in the field of adult literacy and learning.…

The Impact of Price Transparency for Surgical Services.

PubMed

Mehta, Ambar; Xu, Tim; Bai, Ge; Hawley, Kristy L; Makary, Martin A

2018-04-01

Increasing insurance deductibles have prompted some medical centers to initiate transparent pricing. However, the impact of price transparency (PT) on surgical volume, revenue, and patient satisfaction is unknown, along with the barriers to achieving PT. We identified ambulatory surgical centers in the Free Market Medical Association database that publicly list prices for surgical services online. Six of eight centers (75%) responded to our data collection inquiry. Among five centers that reported their patient volume and revenue after adopting PT, patient volume increased by a median of 50 per cent (range 10-200%) at one year. Four centers (80%) reported an increase in revenue by a median of 30 per cent (range 4-75%), whereas three centers (60%) experienced an increase in third-party administrator contracts with the average increase being seven new third-party administrator contracts (range = 2-12 contracts). Three centers (50%) reported a reduction in their administrative burden and five centers (83%) reported an increase in patient satisfaction and patient engagement after PT. The leading barrier reported to making prices transparent was discouragement from another practice, hospital, or insurance company. The findings of this preliminary study may help guide medical practices in designing and implementing PT strategies.

Red Blood Cell Transfusion Need for Elective Primary Posterior Lumbar Fusion in A High-Volume Center for Spine Surgery

PubMed Central

Ristagno, Giuseppe; Beluffi, Simonetta; Tanzi, Dario; Belloli, Federica; Carmagnini, Paola; Croci, Massimo; D’Aviri, Giuseppe; Menasce, Guido; Pastore, Juan C.; Pellanda, Armando; Pollini, Alberto; Savoia, Giorgio

2018-01-01

(1) Background: This study evaluated the perioperative red blood cell (RBC) transfusion need and determined predictors for transfusion in patients undergoing elective primary lumbar posterior spine fusion in a high-volume center for spine surgery. (2) Methods: Data from all patients undergoing spine surgery between 1 January 2014 and 31 December 2016 were reviewed. Patients’ demographics and comorbidities, perioperative laboratory results, and operative time were analyzed in relation to RBC transfusion. Multivariate logistic regression analysis was performed to identify the predictors of transfusion. (3) Results: A total of 874 elective surgeries for primary spine fusion were performed over the three years. Only 54 cases (6%) required RBC transfusion. Compared to the non-transfused patients, transfused patients were mainly female (p = 0.0008), significantly older, with a higher ASA grade (p = 0.0002), and with lower pre-surgery hemoglobin (HB) level and hematocrit (p < 0.0001). In the multivariate logistic regression, a lower pre-surgery HB (OR (95% CI) 2.84 (2.11–3.82)), a higher ASA class (1.77 (1.03–3.05)) and a longer operative time (1.02 (1.01–1.02)) were independently associated with RBC transfusion. (4) Conclusions: In the instance of elective surgery for primary posterior lumbar fusion in a high-volume center for spine surgery, the need for RBC transfusion is low. Factors anticipating transfusion should be taken into consideration in the patient’s pre-surgery preparation. PMID:29385760

Center for Space Power, Texas A and M University

NASA Astrophysics Data System (ADS)

Jones, Ken

Johnson Controls is a 106 year old company employing 42,000 people worldwide with $4.7 billion annual sales. Though we are new to the aerospace industry we are a world leader in automobile battery manufacturing, automotive seating, plastic bottling, and facilities environment controls. The battery division produces over 24,000,000 batteries annually under private label for the new car manufacturers and the replacement market. We are entering the aerospace market with the nickel hydrogen battery with the help of NASA's Center for Space Power at Texas A&M. Unlike traditional nickel hydrogen battery manufacturers, we are reaching beyond the space applications to the higher volume markets of aircraft starting and utility load leveling. Though space applications alone will not provide sufficient volume to support the economies of scale and opportunities for statistical process control, these additional terrestrial applications will. For example, nickel hydrogen batteries do not have the environmental problems of nickel cadmium or lead acid and may someday start your car or power your electric vehicle. However you envision the future, keep in mind that no manufacturer moves into a large volume market without fine tuning their process. The Center for Space Power at Texas A&M is providing indepth technical analysis of all of the materials and fabricated parts of our battery as well as thermal and mechanical design computer modeling. Several examples of what we are doing with nickel hydrogen chemistry to lead to these production efficiencies are presented.

Center for Space Power, Texas A and M University

NASA Technical Reports Server (NTRS)

Jones, Ken

1991-01-01

Johnson Controls is a 106 year old company employing 42,000 people worldwide with $4.7 billion annual sales. Though we are new to the aerospace industry we are a world leader in automobile battery manufacturing, automotive seating, plastic bottling, and facilities environment controls. The battery division produces over 24,000,000 batteries annually under private label for the new car manufacturers and the replacement market. We are entering the aerospace market with the nickel hydrogen battery with the help of NASA's Center for Space Power at Texas A&M. Unlike traditional nickel hydrogen battery manufacturers, we are reaching beyond the space applications to the higher volume markets of aircraft starting and utility load leveling. Though space applications alone will not provide sufficient volume to support the economies of scale and opportunities for statistical process control, these additional terrestrial applications will. For example, nickel hydrogen batteries do not have the environmental problems of nickel cadmium or lead acid and may someday start your car or power your electric vehicle. However you envision the future, keep in mind that no manufacturer moves into a large volume market without fine tuning their process. The Center for Space Power at Texas A&M is providing indepth technical analysis of all of the materials and fabricated parts of our battery as well as thermal and mechanical design computer modeling. Several examples of what we are doing with nickel hydrogen chemistry to lead to these production efficiencies are presented.

Identification of risk factors for post-endoscopic retrograde cholangiopancreatography pancreatitis in a high volume center.

PubMed

Phillip, Veit; Schwab, Miriam; Haf, David; Algül, Hana

2017-01-01

Pancreatitis is the most common complication of endoscopic retrograde cholangiopancreatography (ERCP). Several patients´ or procedure related risk factors for post-ERCP pancreatitis (PEP) have been suggested. The aim of this study was to validate the risk factors for PEP in a high-volume center. All patients undergoing first time ERCP at a tertiary referral center between December 2010 and October 2013 were retrospectively included. PEP was defined according to the Atlanta Classification. 344 patients were included in the final analysis. The risk to develop PEP was increased in patients with chronic pancreatitis (odds ratio 3.7) and after inadvertent cannulation of the pancreatic duct (odds ratio 2.2), which occurred in 26.5% of the patients. Inadvertent cannulation occurred significantly more frequently in patients with difficult cannulation of the papilla duodeni major (odds ratio 12.7; p<0.001). ERCP on call was associated with an increased risk for difficult cannulation (odds ratio 3.0). Inadvertent cannulation of the pancreatic duct is a procedure related risk factor for PEP. Measurements on preventing inadvertent cannulation of the pancreatic duct should be established and studies on prophylactic measurements should focus particularly on patients with inadvertent cannulation of the pancreatic duct.

Comparison of the outcomes for laparoscopic gastrectomy performed by the same surgeon between a low-volume hospital and a high-volume center.

PubMed

Kim, Min Gyu; Kwon, Sung Joon

2014-05-01

The volume-outcome relationship in laparoscopic surgery is controversial. This study was designed to identify differences in laparoscopic gastrectomy outcomes between a low-volume hospital and a high-volume center and to provide guidelines for overcoming the problems associated with a low-volume hospital. From April 2009 to November 2012, one surgeon performed 134 totally laparoscopic distal gastrectomies (TLDGs) at a high-volume center (HVC; ASAN Medical Center) and at a low-volume hospital (LVH; Hanyang University Guri Hospital). All laparoscopically assisted gastrectomies were excluded from this study. During the early period of laparoscopic gastrectomy at the low-volume hospital, TLDG with Roux-en-Y gastrojejunostomy (RYGJ) was performed according to the surgeon's choice. The reconstruction method was classified as gastroduodenostomy (GD) or RYGJ. Early surgical outcomes achieved at the LVH were investigated and compared with those obtained at the HVC. The early surgical outcomes differed significantly between the two hospitals. In particular, the postoperative complication rate for the patients who underwent TLDG RYGJ at the LVH was higher than at the HVC (LVH 15.4 % vs. HVC 0 %; p = 0.037). Furthermore, significant differences were observed in the mean operation time (TLDG GD: LVH 141.0 min vs. HVC 117.4 min, p = 0.001; TLDG RYGJ: LVH 186.3 min vs. HVC 134.6 min, p = 0.009) and length of hospital stay (TLDG GD: LVH 8.1 days vs. HVC 7.2 days, p = 0.044; TLDG RYGJ: LVH 11.5 day vs. HVC 6.8 day, p = 0.009). Although all the operations were performed by one experienced surgeon, the early surgical outcomes differed significantly between the low- and high-volume hospitals. Low-volume hospitals often lack well-trained surgical professionals such as first assistants and scrub nurses. Therefore, the authors recommend that a surgeon who works at an LVH should assess potential personnel shortages and find a solution before operating.

United States Air Force Summer Research Program -- 1993. Volume 16. Arnold Engineering Development Center. Frank J. Seiler Research Laboratory. Wilford Hall Medical Center

DTIC Science & Technology

1993-12-01

A I 7f t UNITED STATE AIR FORCE SUMMER RESEARCH PROGRAM -- 1993 SUMMER RESEARCH PROGRAM FINAL REPORTS VOLUME 16 ARNOLD ENGINEERING DEVELOPMENT CENTER...FRANK J. SELLER RESEARCH LABORATORY WILFORD HALL MEDICAL CENTER RESEARCH & DEVELOPMENT LABORATORIES 5800 Uplander Way Culver City, CA 90230-6608...National Rd. Vol-Page No: 15-44 Dist Tecumseh High School 8.4 New Carlisle, OH 45344-0000 Barber, Jason Laboratory: AL/CF 1000 10th St. Vol-Page No

Water balance monitoring for two bioretention gardens in Omaha, Nebraska, 2011–14

USGS Publications Warehouse

Strauch, Kellan R.; Rus, David L.; Holm, Kent E.

2016-01-29

Bioretention gardens are used to help mitigate stormwater runoff in urban settings in an attempt to restore the hydrologic response of the developed land to a natural predevelopment response in which more water is infiltrated rather than routed directly to urban drainage networks. To better understand the performance of bioretention gardens in facilitating infiltration of stormwater in eastern Nebraska, the U.S. Geological Survey, in cooperation with the Douglas County Environmental Services and the Nebraska Environmental Trust, assessed the water balance of two bioretention gardens located in Omaha, Nebraska by monitoring the amount of stormwater entering and leaving the gardens. One garden is on the Douglas County Health Center campus, and the other garden is on the property of the Eastern Nebraska Office on Aging.For the Douglas County Health Center, bioretention garden performance was evaluated on the basis of volume reduction by comparing total inflow volume to total outflow volume. The bioretention garden reduced inflow volumes from a minimum of 33 percent to 100 percent (a complete reduction in inflow volume) depending on the size of the event. Although variable, the percent reduction of the inflow volume tended to decrease with increasing total event rainfall. To assess how well the garden reduces stormwater peak inflow rates, peak inflows were plotted against peak outflows measured at the bioretention garden. Only 39 of the 255 events had any overflow, indicating 100 percent peak reduction in the other events. Of those 39 events having overflow, the mean peak reduction was 63 percent.No overflow events were recorded at the bioretention garden at the Eastern Nebraska Office on Aging; therefore, data were not available for an event-based overflow analysis.Monitoring period summary of the water balance at both bio-retention gardens indicates that most of the stormwater in the bioretention gardens is stored in the subsurface.Evapotranspiration was attributed to a small percentage of the outputs on an annual basis (3 percent at Douglas County Health Center site and 5 percent at Eastern Nebraska Office onAging site), which indicates that vegetative water uptake is not a primary factor in the water budget.

Empirical Model Development for Predicting Shock Response on Composite Materials Subjected to Pyroshock Loading. Volume 2, Part 1; Appendices

NASA Technical Reports Server (NTRS)

Gentz, Steven J.; Ordway, David O.; Parsons, David S.; Garrison, Craig M.; Rodgers, C. Steven; Collins, Brian W.

2015-01-01

The NASA Engineering and Safety Center (NESC) received a request to develop an analysis model based on both frequency response and wave propagation analyses for predicting shock response spectrum (SRS) on composite materials subjected to pyroshock loading. The model would account for near-field environment (approximately 9 inches from the source) dominated by direct wave propagation, mid-field environment (approximately 2 feet from the source) characterized by wave propagation and structural resonances, and far-field environment dominated by lower frequency bending waves in the structure. This document contains appendices to the Volume I report.

Digital image analysis of ossification centers in the axial dens and body in the human fetus.

PubMed

Baumgart, Mariusz; Wiśniewski, Marcin; Grzonkowska, Magdalena; Małkowski, Bogdan; Badura, Mateusz; Dąbrowska, Maria; Szpinda, Michał

2016-12-01

The detailed understanding of the anatomy and timing of ossification centers is indispensable in both determining the fetal stage and maturity and for detecting congenital disorders. This study was performed to quantitatively examine the odontoid and body ossification centers in the axis with respect to their linear, planar and volumetric parameters. Using the methods of CT, digital image analysis and statistics, the size of the odontoid and body ossification centers in the axis in 55 spontaneously aborted human fetuses aged 17-30 weeks was studied. With no sex difference, the best fit growth dynamics for odontoid and body ossification centers of the axis were, respectively, as follows: for transverse diameter y = -10.752 + 4.276 × ln(age) ± 0.335 and y = -10.578 + 4.265 × ln(age) ± 0.338, for sagittal diameter y = -4.329 + 2.010 × ln(age) ± 0.182 and y = -3.934 + 1.930 × ln(age) ± 0.182, for cross-sectional area y = -7.102 + 0.520 × age ± 0.724 and y = -7.002 + 0.521 × age ± 0.726, and for volume y = -37.021 + 14.014 × ln(age) ± 1.091 and y = -37.425 + 14.197 × ln(age) ± 1.109. With no sex differences, the odontoid and body ossification centers of the axis grow logarithmically in transverse and sagittal diameters, and in volume, while proportionately in cross-sectional area. Our specific-age reference data for the odontoid and body ossification centers of the axis may be relevant for determining the fetal stage and maturity and for in utero three-dimensional sonographic detecting segmentation anomalies of the axis.

Enabling High-performance Interactive Geoscience Data Analysis Through Data Placement and Movement Optimization

NASA Astrophysics Data System (ADS)

Zhu, F.; Yu, H.; Rilee, M. L.; Kuo, K. S.; Yu, L.; Pan, Y.; Jiang, H.

2017-12-01

Since the establishment of data archive centers and the standardization of file formats, scientists are required to search metadata catalogs for data needed and download the data files to their local machines to carry out data analysis. This approach has facilitated data discovery and access for decades, but it inevitably leads to data transfer from data archive centers to scientists' computers through low-bandwidth Internet connections. Data transfer becomes a major performance bottleneck in such an approach. Combined with generally constrained local compute/storage resources, they limit the extent of scientists' studies and deprive them of timely outcomes. Thus, this conventional approach is not scalable with respect to both the volume and variety of geoscience data. A much more viable solution is to couple analysis and storage systems to minimize data transfer. In our study, we compare loosely coupled approaches (exemplified by Spark and Hadoop) and tightly coupled approaches (exemplified by parallel distributed database management systems, e.g., SciDB). In particular, we investigate the optimization of data placement and movement to effectively tackle the variety challenge, and boost the popularization of parallelization to address the volume challenge. Our goal is to enable high-performance interactive analysis for a good portion of geoscience data analysis exercise. We show that tightly coupled approaches can concentrate data traffic between local storage systems and compute units, and thereby optimizing bandwidth utilization to achieve a better throughput. Based on our observations, we develop a geoscience data analysis system that tightly couples analysis engines with storages, which has direct access to the detailed map of data partition locations. Through an innovation data partitioning and distribution scheme, our system has demonstrated scalable and interactive performance in real-world geoscience data analysis applications.

Shop for quality or volume? Volume, quality, and outcomes of coronary artery bypass surgery.

PubMed

Auerbach, Andrew D; Hilton, Joan F; Maselli, Judith; Pekow, Penelope S; Rothberg, Michael B; Lindenauer, Peter K

2009-05-19

Care from high-volume centers or surgeons has been associated with lower mortality rates in coronary artery bypass surgery, but how volume and quality of care relate to each other is not well understood. To determine how volume and differences in quality of care influence outcomes after coronary artery bypass surgery. Observational cohort. 164 hospitals in the United States. 81,289 patients 18 years or older who had coronary artery bypass grafting from 1 October 2003 to 1 September 2005. Hospital and surgeon case volumes were estimated by using a data set. Quality measures were defined by whether patients received specific medications and by counting the number of measures missed. Hierarchical models were used to estimate effects of volume and quality on death and readmission up to 30 days. After adjustment for clinical factors, lowest surgeon volume and highest hospital volume were associated with higher mortality rates and lower readmission risk, respectively. Patients who did not receive aspirin (odds ratio, 1.89 [95% CI, 1.65 to 2.16) or beta-blockers (odds ratio, 1.29 [CI, 1.12 to 1.49]) had higher odds for death, after adjustment for clinical risk factors and case volume. Adjustment for individual quality measures did not alter associations between volume and readmission or death. However, if no quality measures were missed, mortality rates at the lowest-volume centers (adjusted mortality rate, 1.05% [CI, 0.81% to 1.29%]) and highest-volume centers (adjusted mortality rate, 0.98% [CI, 0.72% to 1.25%]) were similar. Because administrative data were used, the quality measures may not replicate measures collected through chart abstraction. Maximizing adherence to quality measures is associated with improved mortality rates, independent of hospital or surgeon volume. California HealthCare Foundation.

Dedicated Perioperative Hip Fracture Comanagement Programs are Cost-effective in High-volume Centers: An Economic Analysis.

PubMed

Swart, Eric; Vasudeva, Eshan; Makhni, Eric C; Macaulay, William; Bozic, Kevin J

2016-01-01

Osteoporotic hip fractures are common injuries typically occurring in patients who are older and medically frail. Studies have suggested that creation of a multidisciplinary team including orthopaedic surgeons, internal medicine physicians, social workers, and specialized physical therapists, to comanage these patients can decrease complication rates, improve time to surgery, and reduce hospital length of stay; however, they have yet to achieve widespread implementation, partly owing to concerns regarding resource requirements necessary for a comanagement program. We performed an economic analysis to determine whether implementation of a comanagement model of care for geriatric patients with osteoporotic hip fractures would be a cost-effective intervention at hospitals with moderate volume. We also calculated what annual volume of cases would be needed for a comanagement program to "break even", and finally we evaluated whether universal or risk-stratified comanagement was more cost effective. Decision analysis techniques were used to model the effect of implementing a systems-based strategy to improve inpatient perioperative care. Costs were obtained from best-available literature and included salary to support personnel and resources to expedite time to the operating room. The major economic benefit was decreased initial hospital length of stay, which was determined via literature review and meta-analysis, and a health benefit was improvement in perioperative mortality owing to expedited preoperative evaluation based on previously conducted meta-analyses. A break-even analysis was conducted to determine the annual case volume necessary for comanagement to be either (1) cost effective (improve health-related quality of life enough to be worth additional expenses) or (2) result in cost savings (actually result in decreased total expenses). This calculation assumed the scenario in which a hospital could hire only one hospitalist (and therapist and social worker) on a full-time basis. Additionally, we evaluated the scenario where the necessary staff was already employed at the hospital and could be dedicated to a comanagement service on a part-time basis, and explored the effect of triaging only patients considered high risk to a comanagement service versus comanaging all geriatric patients. Finally, probabilistic sensitivity analysis was conducted on all critical variables, with broad ranges used for values around which there was higher uncertainty. For the base case, universal comanagement was more cost effective than traditional care and risk-stratified comanagement (incremental cost effectiveness ratios of USD 41,100 per quality-adjusted life-year and USD 81,900 per quality-adjusted life-year, respectively). Comanagement was more cost effective than traditional management as long as the case volume was more than 54 patients annually (range, 41-68 patients based on sensitivity analysis) and resulted in cost savings when there were more than 318 patients annually (range, 238-397 patients). In a scenario where staff could be partially dedicated to a comanagement service, universal comanagement was more cost effective than risk-stratified comanagement (incremental cost effectiveness of USD 2300 per quality-adjusted life-year), and both comanagement programs had lower costs and better outcomes compared with traditional management. Sensitivity analysis was conducted and showed that the level of uncertainty in key variables was not high enough to change the core conclusions of the model. Implementation of a systems-based comanagement strategy using a dedicated team to improve perioperative medical care and expedite preoperative evaluation is cost effective in hospitals with moderate volume and can result in cost savings at higher-volume centers. The optimum patient population for a comanagement strategy is still being defined. Level 1, Economic and Decision Analysis.

Thermophysical and Electronic Properties Information Analysis Center (TEPIAC): A Continuing Systematic Program on Data Tables of Thermophysical and Electronic Properties of Materials.

DTIC Science & Technology

1980-03-01

laboratories and agencies, defense contractors and other industrial organizations, and academic institutions. Furthermore, under multiple sponsorship...agencies, defense contractors and other industrial organizations, and academic institutions. Furthermore, under multiple sponsorship four volumes of...1,091 Inquiries from defense contractors and other industrial organizations ... ........... 357 4,007 Inquiries from academic institutions

Seismology of the Oso-Steelhead landslide

NASA Astrophysics Data System (ADS)

Hibert, C.; Stark, C. P.; Ekström, G.

2014-12-01

We carry out a combined analysis of the short- and long-period seismic signals generated by the devastating Oso-Steelhead landslide that occurred on 22 March 2014. The seismic records show that the Oso-Steelhead landslide was not a single slope failure, but a succession of multiple failures distinguished by two major collapses that occurred approximately three minutes apart. The first generated long-period surface waves that were recorded at several proximal stations. We invert these long-period signals for the forces acting at the source, and obtain estimates of the first failure runout and kinematics, as well as its mass after calibration against the mass-center displacement estimated from remote-sensing imagery. Short-period analysis of both events suggests that the source dynamics of the second are more complex than the first. No distinct long-period surface waves were recorded for the second failure, which prevents inversion for its source parameters. However, by comparing the seismic energy of the short-period waves generated by both events we are able to estimate the volume of the second. Our analysis suggests that the volume of the second failure is about 15-30% of the total landslide volume, which is in agreement with ground observations.

The Collins Center Update. Volume 13, Issue 1, October-December 2010

DTIC Science & Technology

2010-10-01

Volume 13, Issue 1 October-December 2010 THE COLLINS CENTER UPDATE THE CENTER FOR STRATEGIC LEADERSHIP U.S. ARMY WAR COLLEGE CARLISLE...development.” Ambassador Cavanaugh noted the Army War College and the Patterson School both trace their origins to the 1898 Spanish- American War ...Japan in response to a territorial dispute, and reduced export quotas for rare earth’s by 35% for the first half of 2011. During the Cold War , American

[The meningococcal infection on Navy: modern clinical-and-epidemiological aspects].

PubMed

Makhnev, M V; Makhneva, I Iu

2004-10-01

The article presents the own data about modern clinical-and-epidemiological peculiarities of a meningococcal infection on Navy for 20 consecutive years (1982-2002) based on the analysis of the annual reports of fleet medical services and the inspection of 275 centers of a meningococcal infection in military troops. The centers with the single generalized form of a meningococcal infection prevailed. The centers with the number of people from 10 to 40 men amounted to 82%. The frequency of the meningococcal defeat of the people in the centers varied from 25% to 37% with the main role of meningococcae A. In the structure of a meningococcal infection the generalized forms amounted to 16%, located forms--25%, carriers--59%. In all regions the major form of the display of epidemic process in military collectives was seasonal sick rate. The article proved the electoral approach to the character and volume of curative-and-preventive measures.

The Volume and Mix of Inpatient Services Provided by Academic Medical Centers.

ERIC Educational Resources Information Center

Moy, Ernest; And Others

1996-01-01

A study examined trends in the volume and type of inpatient clinical diagnoses, common medical services, and specialized services in academic medical centers (AMCs)--integrated and independent, other teaching hospitals, and nonteaching hospitals. Results indicate that despite rapid change in the health care environment, little change has occurred…

Earth Observations Division version of the Laboratory for Applications of Remote Sensing System (EOD-LARSYS) user guide for the IBM 370/148. Volume 2: User reference manual

NASA Technical Reports Server (NTRS)

Aucoin, P. J.; Stewart, J.; Mckay, M. F. (Principal Investigator)

1980-01-01

This document presents instructions for analysts who use the EOD-LARSYS as programmed on the Purdue University IBM 370/148 (recently replaced by the IBM 3031) computer. It presents sample applications, control cards, and error messages for all processors in the system and gives detailed descriptions of the mathematical procedures and information needed to execute the system and obtain the desired output. EOD-LARSYS is the JSC version of an integrated batch system for analysis of multispectral scanner imagery data. The data included is designed for use with the as built documentation (volume 3) and the program listings (volume 4). The system is operational from remote terminals at Johnson Space Center under the virtual machine/conversational monitor system environment.

Single-dose volume regulation algorithm for a gas-compensated intrathecal infusion pump.

PubMed

Nam, Kyoung Won; Kim, Kwang Gi; Sung, Mun Hyun; Choi, Seong Wook; Kim, Dae Hyun; Jo, Yung Ho

2011-01-01

The internal pressures of medication reservoirs of gas-compensated intrathecal medication infusion pumps decrease when medication is discharged, and these discharge-induced pressure drops can decrease the volume of medication discharged. To prevent these reductions, the volumes discharged must be adjusted to maintain the required dosage levels. In this study, the authors developed an automatic control algorithm for an intrathecal infusion pump developed by the Korean National Cancer Center that regulates single-dose volumes. The proposed algorithm estimates the amount of medication remaining and adjusts control parameters automatically to maintain single-dose volumes at predetermined levels. Experimental results demonstrated that the proposed algorithm can regulate mean single-dose volumes with a variation of <3% and estimate the remaining medication volume with an accuracy of >98%. © 2010, Copyright the Authors. Artificial Organs © 2010, International Center for Artificial Organs and Transplantation and Wiley Periodicals, Inc.

An Analysis of Information Technology Adoption by IRBs of Large Academic Medical Centers in the United States.

PubMed

He, Shan; Botkin, Jeffrey R; Hurdle, John F

2015-02-01

The clinical research landscape has changed dramatically in recent years in terms of both volume and complexity. This poses new challenges for Institutional Review Boards' (IRBs) review efficiency and quality, especially at large academic medical centers. This article discusses the technical facets of IRB modernization. We analyzed the information technology used by IRBs in large academic institutions across the United States. We found that large academic medical centers have a high electronic IRB adoption rate; however, the capabilities of electronic IRB systems vary greatly. We discuss potential use-cases of a fully exploited electronic IRB system that promise to streamline the clinical research work flow. The key to that approach utilizes a structured and standardized information model for the IRB application. © The Author(s) 2014.

Communications among data and science centers

NASA Technical Reports Server (NTRS)

Green, James L.

1990-01-01

The ability to electronically access and query the contents of remote computer archives is of singular importance in space and earth sciences; the present evaluation of such on-line information networks' development status foresees swift expansion of their data capabilities and complexity, in view of the volumes of data that will continue to be generated by NASA missions. The U.S.'s National Space Science Data Center (NSSDC) manages NASA's largest science computer network, the Space Physics Analysis Network; a comprehensive account is given of the structure of NSSDC international access through BITNET, and of connections to the NSSDC available in the Americas via the International X.25 network.

NASA/ASEE Summer Faculty Fellowship Program, 1990, volume 2

NASA Technical Reports Server (NTRS)

Bannerot, Richard B. (Editor); Goldstein, Stanley H. (Editor)

1990-01-01

The 1990 Johnson Space Center (JSC) National Aeronautics and Space Administration (NASA)/American Society for Engineering Education (ASEE) Summer Faculty Fellowship Program was conducted by the University of Houston-University Park and Johnson Space Centers (JSC). A compilation of the final reports on the research projects is presented. The following topics are covered: the Space Shuttle; the Space Station; lunar exploration; mars exploration; spacecraft power supplies; mars rover vehicle; mission planning for the Space Exploration Initiative; instrument calibration standards; a lunar oxygen production plant; optical filters for a hybrid vision system; dynamic structural analysis; lunar bases; pharmacodynamics of scopolamine; planetary spacecraft cost modeling; and others.

Proceedings of the Annual U.S. Army Operations Research Symposium (13th) , AORS XIII, Held at Fort Lee, Virginia on 29 October - 1 November 1974, Co- Hosted by Army Logistics Center, Fort Lee, Virginia and Army Quartermaster Center and Fort Lee, Virginia. Volume 1

DTIC Science & Technology

1974-11-01

Challenge to Operations Research" 263 Mr. R. H. Adams Mr..F. P. Paca Mr. A. T. Sylvester "A Combat Rates Logistics Analysis...Staff; if we average a tour of duty in the Pentagon as three years, the Army has had eight successive generations of planners and operators in the...doctrine, originally enunciated for Greece and Turkey, brought the Army full tilt into the Military Assistance Program ( MAP ) as this contributed to

Accessibility and Analysis to NASA's New Large Volume Missions

NASA Astrophysics Data System (ADS)

Hausman, J.; Gangl, M.; McAuley, J.; Toaz, R., Jr.

2016-12-01

Each new satellite mission continues to measure larger volumes of data than the last. This is especially true with the new NASA satellite missions NISAR and SWOT, launching in 2020 and 2021, which will produce petabytes of data a year. A major concern is how will users be able to analyze such volumes? This presentation will show how cloud storage and analysis can help overcome and accommodate multiple users' needs. While users may only need gigabytes of data for their research, the data center will need to leverage the processing power of the cloud to perform search and subsetting capabilities over the large volume of data. There is also a vast array of user types that require different tools and services to access and analyze the data. Some users need global data to run climate models, while others require small, dynamic regions with lots of analysis and transformations. There will also be a need to generate data that have different inputs or correction algorithms that the project may not be able to provide as those will be very specialized for specific regions or evolve quicker than what the project can reprocess. By having the data and tools side by side, users will be able to access the data they require and analyze it all in one place. By placing data in the cloud, users can analyze the data there, shifting the current "download and analyze" paradigm to "log-in and analyze". The cloud will provide adequate processing power needed to analyze large volumes of data, subset small regions over large volumes of data, and regenerate/reformat data to the specificity each user requires.

An Approach to Data Center-Based KDD of Remote Sensing Datasets

NASA Technical Reports Server (NTRS)

Lynnes, Christopher; Mack, Robert; Wharton, Stephen W. (Technical Monitor)

2001-01-01

The data explosion in remote sensing is straining the ability of data centers to deliver the data to the user community, yet many large-volume users actually seek a relatively small information component within the data, which they extract at their sites using Knowledge Discovery in Databases (KDD) techniques. To improve the efficiency of this process, the Goddard Earth Sciences Distributed Active Archive Center (GES DAAC) has implemented a KDD subsystem that supports execution of the user's KDD algorithm at the data center, dramatically reducing the volume that is sent to the user. The data are extracted from the archive in a planned, organized "campaign"; the algorithms are executed, and the output products sent to the users over the network. The first campaign, now complete, has resulted in overall reductions in shipped volume from 3.3 TB to 0.4 TB.

High air volume to low liquid volume aerosol collector

DOEpatents

Masquelier, Donald A.; Milanovich, Fred P.; Willeke, Klaus

2003-01-01

A high air volume to low liquid volume aerosol collector. A high volume flow of aerosol particles is drawn into an annular, centripetal slot in a collector which directs the aerosol flow into a small volume of liquid pool contained is a lower center section of the collector. The annular jet of air impinges into the liquid, imbedding initially airborne particles in the liquid. The liquid in the pool continuously circulates in the lower section of the collector by moving to the center line, then upwardly, and through assistance by a rotating deflector plate passes back into the liquid at the outer area adjacent the impinging air jet which passes upwardly through the liquid pool and through a hollow center of the collector, and is discharged via a side outlet opening. Any liquid droplets escaping with the effluent air are captured by a rotating mist eliminator and moved back toward the liquid pool. The collector includes a sensor assembly for determining, controlling, and maintaining the level of the liquid pool, and includes a lower centrally located valve assembly connected to a liquid reservoir and to an analyzer for analyzing the particles which are impinged into the liquid pool.

Aperture size, materiality of the secondary room, and listener location: Impact on the simulated impulse response of a coupled-volume concert hall

NASA Astrophysics Data System (ADS)

Ermann, Michael; Johnson, Marty E.; Harrison, Byron W.

2002-11-01

By adding a second room to a concert hall, and designing doors to control the sonic transparency between the two rooms, designers can create a new, coupled acoustic. Concert halls use coupling to achieve a variable, longer, and distinct reverberant quality for their musicians and listeners. For this study, a coupled-volume concert hall based on an existing performing arts center is conceived and computer modeled. It has a fixed geometric volume, form, and primary-room sound absorption. Ray-tracing software simulates impulse responses, varying both aperture size and secondary-room sound-absorption level, across a grid of receiver (listener) locations. The results are compared with statistical analysis that suggests a highly sensitive relationship between the double-sloped condition and the architecture of the space. This line of study aims to quantitatively and spatially correlate the double-sloped condition with (1) aperture size exposing the chamber, (2) sound absorptance in the coupled volume, and (3) listener location.

Aperture size, materiality of the secondary room and listener location: Impact on the simulated impulse response of a coupled-volume concert hall

NASA Astrophysics Data System (ADS)

Ermann, Michael; Johnson, Marty E.; Harrison, Byron W.

2003-04-01

By adding a second room to a concert hall, and designing doors to control the sonic transparency between the two rooms, designers can create a new, coupled acoustic. Concert halls use coupling to achieve a variable, longer and distinct reverberant quality for their musicians and listeners. For this study, a coupled-volume concert hall based on an existing performing arts center is conceived and computer-modeled. It has a fixed geometric volume, form and primary-room sound absorption. Ray-tracing software simulates impulse responses, varying both aperture size and secondary-room sound absorption level, across a grid of receiver (listener) locations. The results are compared with statistical analysis that suggests a highly sensitive relationship between the double-sloped condition and the architecture of the space. This line of study aims to quantitatively and spatially correlate the double-sloped condition with (1) aperture size exposing the chamber, (2) sound absorptance in the coupled volume, and (3) listener location.

Space Mechanisms Lessons Learned Study. Volume 2: Literature Review

NASA Technical Reports Server (NTRS)

Shapiro, Wilbur; Murray, Frank; Howarth, Roy; Fusaro, Robert

1995-01-01

Hundreds of satellites have been launched to date. Some have operated extremely well and others have not. In order to learn from past operating experiences, a study was conducted to determine the conditions under which space mechanisms (mechanically moving components) have previously worked or failed. The study consisted of an extensive literature review that included both government contractor reports and technical journals, communication and visits (when necessary) to the various NASA and DOD centers and their designated contractors (this included contact with project managers of current and prior NASA satellite programs as well as their industry counterparts), requests for unpublished information to NASA and industry, and a mail survey designed to acquire specific mechanism experience. The information obtained has been organized into two volumes. Volume 1 provides a summary of the lesson learned, the results of a needs analysis, responses to the mail survey, a listing of experts, a description of some available facilities, and a compilation of references. Volume 2 contains a compilation of the literature review synopsis.

Space Mechanisms Lessons Learned Study. Volume 1: Summary

NASA Technical Reports Server (NTRS)

Shapiro, Wilbur; Murray, Frank; Howarth, Roy; Fusaro, Robert

1995-01-01

Hundreds of satellites have been launched to date. Some have operated extremely well and others have not. In order to learn from past operating experiences, a study was conducted to determine the conditions under which space mechanisms (mechanically moving components) have previously worked or failed. The study consisted of: (1) an extensive literature review that included both government contractor reports and technical journals; (2) communication and visits (when necessary) to the various NASA and DOD centers and their designated contractors (this included contact with project managers of current and prior NASA satellite programs as well as their industry counterparts); (3) requests for unpublished information to NASA and industry; and (4) a mail survey designed to acquire specific mechanism experience. The information obtained has been organized into two volumes. Volume 1 provides a summary of the lessons learned, the results of a needs analysis, responses to the mail survey, a listing of experts, a description of some available facilities and a compilation of references. Volume 2 contains a compilation of the literature review synopsis.

SU-G-JeP4-05: Effects of Irregular Respiratory Motion On the Positioning Accuracy of Moving Target with Free Breathing Cone-Beam Computerized Tomography

DOE Office of Scientific and Technical Information (OSTI.GOV)

Li, X; Xiong, W; Gewanter, R

Purpose: Average or maximum intensity projection (AIP or MIP) images derived from 4DCT images are often used as a reference image for target alignment when free breathing Cone-beam CT (FBCBCT) is used for positioning a moving target at treatment. This method can be highly accurate if the patient has stable respiratory motion. However, a patient’s breathing pattern often varies irregularly. The purpose of this study is to investigate the effect of irregular respiration on the positioning accuracy of a moving target with FBCBCT. Methods: Eight patients’ respiratory motion curves were selected to drive a Quasar phantom with embedded cubic andmore » spherical targets. A 4DCT of the moving phantom was acquired on a CT scanner (Philips Brilliance 16) equipped with a Varian RPM system. The phase binned 4DCT images and the corresponding MIP and AIP images were transferred into Eclipse for analysis. CBCTs of the phantom driven by the same breathing curves were acquired on a Varian TrueBeam and fused such that the zero positions of moving targets are the same on both CBCT and AIP images. The sphere and cube volumes and centrioid differences (alignment error) determined by MIP, AIP and FBCBCT images were compared. Results: Compared to the volume determined by FBCBCT, the volumes of cube and sphere in MIP images were 22.4%±8.8% and 34.2%±6.2% larger while the volumes in AIP images were 7.1%±6.2% and 2.7%±15.3% larger, respectively. The alignment errors for the cube and sphere with center-center matches between MIP and FBCBCT were 3.5±3.1mm and 3.2±2.3mm, and the alignment errors between AIP and FBCBCT were 2.1±2.6mm and 2.1±1.7mm, respectively. Conclusion: AIP images appear to be superior reference images than MIP images. However, irregular respiratory motions could compromise the positioning accuracy of a moving target if the target center-center match is used to align FBCBCT and AIP images.« less

Development of a Flexible Framework of Common Hypersonic Navier-Strokes Meshes for the Space Shuttle Orbiter

NASA Technical Reports Server (NTRS)

Alter, Stephen J.; Reuthler, James J.; McDaniel, Ryan D.

2003-01-01

A flexible framework for the development of block structured volume grids for hypersonic Navier-Stokes flow simulations was developed for analysis of the Shuttle Orbiter Columbia. The development of the flexible framework, resulted in an ability to quickly generate meshes to directly correlate solutions contributed by participating groups on a common surface mesh, providing confidence for the extension of the envelope of solutions and damage scenarios. The framework draws on the experience of NASA Langely and NASA Ames Research Centers in structured grid generation, and consists of a grid generation process that is implemented through a division of responsibilities. The nominal division of labor consisted of NASA Johnson Space Center coordinating the damage scenarios to be analyzed by the Aerothermodynamics Columbia Accident Investigation (CAI) team, Ames developing the surface grids that described the computational volume about the orbiter, and Langely improving grid quality of Ames generated data and constructing the final volume grids. Distributing the work among the participants in the Aerothermodynamic CIA team resulted in significantly less time required to construct complete meshes than possible by any individual participant. The approach demonstrated that the One-NASA grid generation team could sustain the demand for new meshes to explore new damage scenarios within a aggressive timeline.

Cranial Tumor Surgical Outcomes at a High-Volume Academic Referral Center.

PubMed

Brown, Desmond A; Himes, Benjamin T; Major, Brittny T; Mundell, Benjamin F; Kumar, Ravi; Kall, Bruce; Meyer, Fredric B; Link, Michael J; Pollock, Bruce E; Atkinson, John D; Van Gompel, Jamie J; Marsh, W Richard; Lanzino, Giuseppe; Bydon, Mohamad; Parney, Ian F

2018-01-01

To determine adverse event rates for adult cranial neuro-oncologic surgeries performed at a high-volume quaternary academic center and assess the impact of resident participation on perioperative complication rates. All adult patients undergoing neurosurgical intervention for an intracranial neoplastic lesion between January 1, 2009, and December 31, 2013, were included. Cases were categorized as biopsy, extra-axial/skull base, intra-axial, or transsphenoidal. Complications were categorized as neurologic, medical, wound, mortality, or none and compared for patients managed by a chief resident vs a consultant neurosurgeon. A total of 6277 neurosurgical procedures for intracranial neoplasms were performed. After excluding radiosurgical procedures and pediatric patients, 4151 adult patients who underwent 4423 procedures were available for analysis. Complications were infrequent, with overall rates of 9.8% (435 of 4423 procedures), 1.7% (73 of 4423), and 1.4% (63 of 4423) for neurologic, medical, and wound complications, respectively. The rate of perioperative mortality was 0.3% (14 of 4423 procedures). Case performance and management by a chief resident did not negatively impact outcome. In our large-volume brain tumor practice, rates of complications were low, and management of cases by chief residents in a semiautonomous manner did not negatively impact surgical outcomes. Copyright © 2017 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.

Finding the Center of Volume of the Forearm

NASA Astrophysics Data System (ADS)

Klein, Stacy S.; Roselli, Robert J.

2008-04-01

A typical first-year physics course teaches students about the center of mass using both regular and irregularly shaped objects. Students often suspend an object in each of two dimensions from a string with the intersection determining the center of mass of the object. While these methods can be effective, they are not particularly exciting or motivating. Wouldn't it be more interesting to find the center of mass of a body part, such as the forearm? Through a series of simple measurements and assumptions, students can generate a first-order approximation of the center of volume and center of mass of their forearm. Comparisons can be made between the muscular forearm of the football player in the class with the scrawniest arm in the room, creating a deeper understanding of center of mass and how it relates to the human body.

NASA/ASEE Summer Faculty Fellowship Program, 1990, Volume 1

NASA Technical Reports Server (NTRS)

Bannerot, Richard B. (Editor); Goldstein, Stanley H. (Editor)

1990-01-01

The 1990 Johnson Space Center (JSC) NASA/American Society for Engineering Education (ASEE) Summer Faculty Fellowship Program was conducted by the University of Houston-University Park and JSC. A compilation of the final reports on the research projects are presented. The topics covered include: the Space Station; the Space Shuttle; exobiology; cell biology; culture techniques; control systems design; laser induced fluorescence; spacecraft reliability analysis; reduced gravity; biotechnology; microgravity applications; regenerative life support systems; imaging techniques; cardiovascular system; physiological effects; extravehicular mobility units; mathematical models; bioreactors; computerized simulation; microgravity simulation; and dynamic structural analysis.

The ERTS-1 investigation (ER-600). Volume 3: ERTS-1 forest analysis

NASA Technical Reports Server (NTRS)

Erb, R. B.

1974-01-01

The Forest Analysis Team of the Lyndon B. Johnson Space Center Earth Observations Division conducted a year's investigation of LANDSAT 1 multispectral data to determine the size of forest features that could be detected and to determine the suitability for making forest classification maps. The Sam Houston National Forest of Texas was used as the test site. Using conventional interpretation and computer aided techniques, the team was able to differentiate up to 14 classes of forest features to an accuracy ranging between 55 and 84 percent.

Earth observing system. Output data products and input requirements, version 2.0. Volume 1: Instrument data product characteristics

NASA Technical Reports Server (NTRS)

Lu, Yun-Chi; Chang, Hyo Duck; Krupp, Brian; Kumar, Ravindra; Swaroop, Anand

1992-01-01

Information on Earth Observing System (EOS) output data products and input data requirements that has been compiled by the Science Processing Support Office (SPSO) at GSFC is presented. Since Version 1.0 of the SPSO Report was released in August 1991, there have been significant changes in the EOS program. In anticipation of a likely budget cut for the EOS Project, NASA HQ restructured the EOS program. An initial program consisting of two large platforms was replaced by plans for multiple, smaller platforms, and some EOS instruments were either deselected or descoped. Updated payload information reflecting the restructured EOS program superseding the August 1991 version of the SPSO report is included. This report has been expanded to cover information on non-EOS data products, and consists of three volumes (Volumes 1, 2, and 3). Volume 1 provides information on instrument outputs and input requirements. Volume 2 is devoted to Interdisciplinary Science (IDS) outputs and input requirements, including the 'best' and 'alternative' match analysis. Volume 3 provides information about retrieval algorithms, non-EOS input requirements of instrument teams and IDS investigators, and availability of non-EOS data products at seven primary Distributed Active Archive Centers (DAAC's).

SU-E-J-79: Evaluation of Prostate Volume Changes During Radiotherapy Using Implanted Markers and On-Board Imaging

DOE Office of Scientific and Technical Information (OSTI.GOV)

Ispir, B; Akdeniz, Y; Ugurluer, G

2015-06-15

Purpose: To evaluate prostate volume changes during radiation therapy using implanted gold markers and on-board imaging. Methods: Twenty-five patients were included who underwent an implantation of three gold markers. Cartesian coordinates of markers were assessed in kV-images. The coordinates of centers of two markers were measured on kV-images from the center of the marker at the apex which was reference. The distances between the markers were extrapolated from the coordinates using the Euclid formula. The radius of the sphere through markers was calculated using sinus theorem. The prostate volume for the first and last fraction was substituted with a spheremore » model and was calculated for each patient. The t-test was used for analysis. Results: The mean prostate volume for first and last fraction was 24.65 and 20.87 cc, respectively (p≤0.05). The prostate volume was smaller for 23 patients, whereas there was an expansion for 2 patients. Fifteen patients had androgen deprivation during radiotherapy (H group) and ten did not (NH group). The mean prostate volume for the first and last fraction for the NH group was 30.73 cc and 24.89 cc and for the H group 20.84 cc and 18.19 cc, respectively. There was a 15.8% volume change during treatment for the NH group and 12.2% for the H group, but the difference was not statistically significant. The radius difference of the theoretical sphere for the first and last fraction was 0.98 mm (range, 0.09–2.95 mm) and remained below 2 mm in 88% of measurements. Conclusion: There was a significant volume change during prostate radiotherapy. The difference between H group and NH group was not significant. The radius changes did not exceed 3 mm and it was below adaptive treatment requirements. Our results indicate that prostate volume changes during treatment should be taken into account during contouring and treatment planning.« less

Report of the Presidential Commission on the Space Shuttle Challenger Accident, Volume 5

NASA Technical Reports Server (NTRS)

1986-01-01

This volume contains all the hearings of the Presidential Commission on the Space Shuttle Challenger accident from 26 February to 2 May 1986. Among others is the testimony of L. Mulloy, Manager, Space Shuttle Solid Rocket Booster Program, Marshall Space Flight Center and G. Hardy, Deputy Director, Science and Engineering, Marshall Space Flight Center.

SOAC - State-of-the-Art Car Engineering Tests at Department of Transportation High Speed Ground Test Center : Volume 4. Noise Tests.

DOT National Transportation Integrated Search

1975-01-01

The six-volume report presents the technical methodology, data samples, and results of tests conducted on the SOAC on the Rail Transit Test Track at the High Speed Ground Test Center in Pueblo, Colorado during the period April to July 1973. The Test ...

SOAC - State-of-the-Art Car Engineering Tests at Department of Transportation High Speed Ground Test Center : Volume 3. Ride Quality Tests.

DOT National Transportation Integrated Search

1975-01-01

The six-volume report presents the technical methodology, data samples, and results of tests conducted on the SOAC on the Rail Transit Test Track at the High Speed Ground Test Center in Pueblo, Colorado during the period April to July 1973. The Test ...

Miami-Dade Community College 1984 Institutional Self-Study. Volume VIII: Medical Center Campus Studies.

ERIC Educational Resources Information Center

Miami-Dade Community Coll., FL.

Part of a systematic, in-depth assessment of Miami-Dade Community College's (MDCC's) educational programs, student support systems, and selected campus-level activities, this volume of the college's institutional self-study report examines the impact and effectiveness of the Medical Center Campus. The report contains the results of a campus study…

SOAC - State-of-the-Art Car Engineering Tests at Department of Transportation High Speed Ground Test Center : Volume 6. SOAC Instrumentation System.

DOT National Transportation Integrated Search

1975-01-01

The six-volume report presents the technical methodology, data samples, and results of tests conducted on the SOAC on the Rail Transit Test Track at the High Speed Ground Test Center in Pueblo, Colorado during the period April to July 1973. The Test ...

SOAC - State-of-the-Art Car Engineering Tests at Department of Transportation High Speed Ground Test Center : Volume 2. Performance Tests.

DOT National Transportation Integrated Search

1975-01-01

The six-volume report presents the technical methodology, data samples, and results of tests conducted on the SOAC on the Rail Transit Test Track at the High Speed Ground Test Center in Pueblo, Colorado during the period April to July 1973. The Test ...

SOAC - State-of-the-Art Car Engineering Tests at Department of Transportation High Speed Ground Test Center : Volume 1. Program Description and Test Summary

DOT National Transportation Integrated Search

1975-01-01

The six-volume report presents the technical methodology, data samples, and results of tests conducted on the SOAC on the Rail Transit Test Track at the High Speed Ground Test Center in Pueblo, Colorado during the period April to July 1973. The Test ...

NASA Propulsion Engineering Research Center, Volume 2

NASA Technical Reports Server (NTRS)

1994-01-01

This is the second volume in the 1994 annual report for the NASA Propulsion Engineering Research Center's Sixth Annual Symposium. This conference covered: (1) Combustors and Nozzles; (2) Turbomachinery Aero- and Hydro-dynamics; (3) On-board Propulsion systems; (4) Advanced Propulsion Applications; (5) Vaporization and Combustion; (6) Heat Transfer and Fluid Mechanics; and (7) Atomization and Sprays.

Joint Center for Operational Analysis Journal. Volume 12, Issue 1, Spring 2010

DTIC Science & Technology

2010-01-01

enable research into captured records with “complete openness and rigid adherence to acadamic freedom and integrity.” The CRRC will thereby...various levels of effort in the former area, the latter provides a common ground and opportunities for developing close collaborations. This allows...consequence management (CM) capability, specifi cally the use of the CM Decision Support Tool (DST) developed by the DTRA. Ms. Jessica Iannotti

Consequence Management Joint Center for Operational Analysis Journal, Volume 11, Issue 1, Winter 2008-2009

DTIC Science & Technology

2009-01-01

not only fuel speculation and rumors , but also undermine all future communications between responders and the public. The media has the ability...cell phones, generate fragmented snapshots of an event. Communication professionals must remain proactive, counter false perceptions, and provide...Approximately 24 hours after it was determined that radioactive material had been released into the environment, rumors spread in the local area

Model Uncertainty and Test of a Segmented Mirror Telescope

DTIC Science & Technology

2014-03-01

Optical Telescope project EOM: equation of motion FCA: fine control actuator FCD: Face-Centered Cubic Design FEA: finite element analysis FEM: finite...housed in a dark tent to isolate the telescope from stray light, air currents, or dust and other debris. However, the closed volume is prone to...is composed of six hexagonal segments that each have six coarse control actuators (CCA) for segment phasing control, three fine control actuators

Joint Center for Operational Analysis Quarterly Bulletin. Volume 8, Issue 3, September 2006

DTIC Science & Technology

2006-09-01

Kuwait drove planning for Operation Desert Storm. The Dayton Peace Accord included an agreement by warring factions not to attack coalition forces as they...informants.29 Pinpointing the insurgent strongholds substantially helps the military shape its plan of attack. The government prepares the political...campaign plan . The use of informants, sting operations, and undercover internal affairs officers to name the most salient means, is effective in

Officer Career Development: An Overview of Analytic Concerns

DTIC Science & Technology

1989-07-01

some form of quasi-experimental analysis with nonequivalent control groups may be implemented. We shall not attempt to explic te all the variables...Development Center. 5. University of San Diego (1984, October 23-25). Pro z.ings: Volume I. Group reports. Tri-service career research workshop. San Die... design rather than a repeated measures design , where differences among diverse groups of different individuals (at different career stages) are used to

CACDA JIFFY III War Game. Volume II. Methodology

DTIC Science & Technology

1980-09-01

Devens , MA 01433 Commandant USA Air ,Defense School ATTN:’ ATSA-CD-SC-S Fort Bliss, TX 79916 Commandant USA Intelligence Center and School Fort Huachuca...RELEASE: DISTRIBUTION UNLIMITED 0 801030o 033 1 Technical Report TR 6-80, Septenber 1980 US Army Combined Arms Studies and Analysis Activity Fort ...manual war game developed and operated at the USATRADOC Combined Arms Combat Developments Activity (CACDA),, Fort Leavenworth, Kansas, for scenzrio

46th Annual Gun and Missile Systems Conference and Exhibition. Volume 2. Wednesday

DTIC Science & Technology

2011-09-01

military/systems/munitions/images/ Page 7 Designing for Operational Challenges  Gun hardening – Multiple charges • Angular acceleration variation ...The industrial base overestimated readiness at SDD start – Analysis/models were naive • Impulsive loads — pressure variation — SOM under impulse...Manufacture and Producibility Branch, US Army Armament Research, Development and Engineering Center • Alan Sweet and William Goldberg , Packaging Division

Office for Analysis and Evaluation of Operational Data 1994-FY 95 annual report. Volume 9, Number 2

DOE Office of Scientific and Technical Information (OSTI.GOV)

NONE

This annual report of the US Nuclear Regulatory Commission`s Office for Analysis and Evaluation of Operational Data (AEOD) describes activities conducted during CY 1994 and FY 1995. The report is published in three parts. NUREG-1272, Vol. 9, No. 1, covers power reactors and presents an overview of the operating experience of the nuclear power industry from the NRC perspective, including comments about the trends of some key performance measures. The report also includes the principal findings and issues identified in AEOD studies over the past year and summarizes information from such sources as licensee event reports, diagnostic evaluations, and reportsmore » to the NRC`s Operations Center. NUREG-1272, Vol. 9, No. 2, covers nuclear materials and presents a review of the events and concerns associated with the use of licensed material in nonreactor applications, such as personnel overexposures and medical misadministrations. Both reports also contain a discussion of the Incident Investigation Team program and summarize both the Incident Investigation Team and Augmented Inspection Team reports. Each volume contains a list of the AEOD reports issued from 1980 through FY 1995. NUREG-1272, Vol. 9, No. 3, covers technical training and presents the activities of the Technical Training Center in support of the NRC`s mission.« less

Office for Analysis and Evaluation of Operational Data 1996 annual report. Volume 10, Number 1: Reactors

DOE Office of Scientific and Technical Information (OSTI.GOV)

NONE

1997-12-01

This annual report of the US Nuclear Regulatory Commission`s Office for Analysis and Evaluation of Operational Data (AEOD) describes activities conducted during 1996. The report is published in three parts. NUREG-1272, Vol. 10, No. 1, covers power reactors and presents an overview of the operating experience of the nuclear power industry from the NRC perspective, including comments about trends of some key performance measures. The report also includes the principal findings and issues identified in AEOD studies over the past year and summarizes information from such sources as licensee event reports and reports to the NRC`s Operations Center. NUREG-1272, Vol.more » 10, No. 2, covers nuclear materials and presents a review of the events and concerns during 1996 associated with the use of licensed material in nonreactor applications, such as personnel overexposures and medical misadministrations. Both reports also contain a discussion of the Incident Investigation Team program and summarize both the Incident Investigation Team and Augmented Inspection Team reports. Each volume contains a list of the AEOD reports issued from CY 1980 through 1996. NUREG-1272, Vol. 10, No. 3, covers technical training and presents the activities of the Technical Training Center in support of the NRC`s mission in 1996.« less

Predictors of malignancy in intraductal papillary mucinous neoplasm of the pancreas: analysis of 310 pancreatic resection patients at multiple high-volume centers.

PubMed

Shimizu, Yasuhiro; Yamaue, Hiroki; Maguchi, Hiroyuki; Yamao, Kenji; Hirono, Seiko; Osanai, Manabu; Hijioka, Susumu; Hosoda, Waki; Nakamura, Yasushi; Shinohara, Toshiya; Yanagisawa, Akio

2013-07-01

The present study was a retrospective investigation of predictors of malignancy in intraductal papillary mucinous neoplasm (IPMN) of the pancreas. The subjects were 310 patients who underwent pancreatic resection at 3 high-volume centers. Preoperative laboratory and imaging findings were analyzed in logistic regression analyses. Endoscopic ultrasonography measurements were essential for the size of mural nodules, and a central review was conducted for pathological diagnosis. Pathological diagnosis was benign IPMN in 150 cases and malignant in 160 (noninvasive carcinoma, n = 100; invasive, n = 60). In multivariate analysis, size of mural nodules, diameter of main pancreatic duct, and cyst size of branch pancreatic duct were independent predictors of malignancy, and areas under the receiver operating characteristic curve for these 3 factors were 0.798, 0.643, and 0.601, respectively. With 7 mm taken as the cutoff value for the size of mural nodules, the diagnosis of malignant IPMN had sensitivity of 74.3% and specificity of 72.7%. Carcinoma without nodules was present in 15 patients (15/160 [9.4%]). The size of mural nodules measured with endoscopic ultrasonography showed high predictive ability. However, about 10% of carcinoma patients did not have nodules, and the handling of the diagnosis in such cases is a problem for the future.

Regional trends and the impact of various patient and hospital factors on outcomes and costs of hospitalization between academic and nonacademic centers after deep brain stimulation surgery for Parkinson's disease: a United States Nationwide Inpatient Sample analysis from 2006 to 2010.

PubMed

Sharma, Mayur; Ambekar, Sudheer; Guthikonda, Bharat; Wilden, Jessica; Nanda, Anil

2013-11-01

The aim of this study was to analyze the incidence of adverse outcomes, complications, inpatient mortality, length of hospital stay, and the factors affecting them between academic and nonacademic centers after deep brain stimulation (DBS) surgery for Parkinson's disease (PD). The authors also analyzed the impact of various factors on the total hospitalization charges after this procedure. This is a retrospective cohort study using the Nationwide Inpatient Sample (NIS) from 2006 to 2010. Various patient and hospital variables were analyzed from the database. The adverse discharge disposition and the higher cost of hospitalization were taken as the dependent variables. A total of 2244 patients who underwent surgical treatment for PD were identified from the database. The mean age was 64.22 ± 9.8 years and 68.7% (n = 1523) of the patients were male. The majority of the patients was discharged to home or self-care (87.9%, n = 1972). The majority of the procedures was performed at high-volume centers (64.8%, n = 1453), at academic institutions (85.33%, n = 1915), in urban areas (n = 2158, 96.16%), and at hospitals with a large bedsize (86.6%, n = 1907) in the West or South. Adverse discharge disposition was more likely in elderly patients (OR > 1, p = 0.011) with high comorbidity index (OR 1.508 [95% CI 1.148-1.98], p = 0.004) and those with complications (OR 3.155 [95% CI 1.202-8.279], p = 0.033). A hospital with a larger annual caseload was an independent predictor of adverse discharge disposition (OR 3.543 [95% CI 1.781-7.048], p < 0.001), whereas patients treated by physicians with high case volumes had significantly better outcomes (p = 0.006). The median total cost of hospitalization had increased by 6% from 2006 through 2010. Hospitals with a smaller case volume (OR 0.093, p < 0.001), private hospitals (OR 11.027, p < 0.001), nonteaching hospitals (OR 3.139, p = 0.003), and hospitals in the West compared with hospitals in Northeast and the Midwest (OR 1.885 [p = 0.033] and OR 2.897 [p = 0.031], respectively) were independent predictors of higher hospital cost. The mean length of hospital stay decreased from 2.03 days in 2006 to 1.55 days in 2010. There was no difference in the discharge disposition among academic versus nonacademic centers and rural versus urban hospitals (p > 0.05). Elderly female patients with nonprivate insurance and high comorbidity index who underwent surgery at low-volume centers performed by a surgeon with a low annual case volume and the occurrence of postoperative complications were correlated with an adverse discharge disposition. High-volume, government-owned academic centers in the Northeast were associated with a lower cost incurred to the hospitals. It can be recommended that the widespread availability of this procedure across small, academic centers in rural areas may not only provide easier access to the patients but also reduces the total cost of hospitalization.

Pioneering quality assessment in European cancer centers: a data analysis of the organization for European cancer institutes accreditation and designation program.

PubMed

Saghatchian, Mahasti; Thonon, Frédérique; Boomsma, Femke; Hummel, Henk; Koot, Bert; Harrison, Chris; Rajan, Abinaya; de Valeriola, Dominique; Otter, Renée; Laranja Pontes, José; Lombardo, Claudio; McGrath, Eoin; Ringborg, Ulrik; Tursz, Thomas; van Harten, Wim

2014-09-01

In order to improve the quality of care in Cancer Centers (CC) and designate Comprehensive Cancer Centers (CCCs), the Organization for European Cancer Institutes (OECI) launched an Accreditation and Designation (A&D) program. The program facilitates the collection of defined data and the assessment of cancer center quality. This study analyzes the results of the first 10 European centers that entered the program. The assessment included 927 items divided across qualitative and quantitative questionnaires. Data collected during self-assessment and peer-review from the 10 first participating centers were combined in a database for comparative analysis using simple statistics. Quantitative and qualitative results were validated by auditors during the peer review visits. Volumes of various functions and activities dedicated to care, research, and education varied widely among centers. There were no significant differences in resources for radiology, radiotherapy, pathologic diagnostic, and surgery. Differences were observed in the use of clinical pathways but not for the practices of holding multidisciplinary team meetings and conforming to guidelines. Regarding human resources, main differences were in the composition and number of supportive care and research staff. All 10 centers applied as CCCs; five obtained the label, and five were designated as CCs. The OECI A&D program allows comparisons between centers with regard to management, research, care, education, and designation as CCs or CCCs. Through the peer review system, recommendations for improvements are given. Assessing the added value of the program, as well as research and patient treatment outcomes, is the next step. Copyright © 2014 by American Society of Clinical Oncology.

Space station data system analysis/architecture study. Task 3: Trade studies, DR-5, volume 2

NASA Technical Reports Server (NTRS)

1985-01-01

Results of a Space Station Data System Analysis/Architecture Study for the Goddard Space Flight Center are presented. This study, which emphasized a system engineering design for a complete, end-to-end data system, was divided into six tasks: (1); Functional requirements definition; (2) Options development; (3) Trade studies; (4) System definitions; (5) Program plan; and (6) Study maintenance. The Task inter-relationship and documentation flow are described. Information in volume 2 is devoted to Task 3: trade Studies. Trade Studies have been carried out in the following areas: (1) software development test and integration capability; (2) fault tolerant computing; (3) space qualified computers; (4) distributed data base management system; (5) system integration test and verification; (6) crew workstations; (7) mass storage; (8) command and resource management; and (9) space communications. Results are presented for each task.

Environmental exposure effects on composite materials for commercial aircraft

NASA Technical Reports Server (NTRS)

Hoffman, D. J.

1978-01-01

Activities reported include completion of the program design tasks, resolution of a high fiber volume problem and resumption of specimen fabrication, fixture fabrication, and progress on the analysis methodology and definition of the typical aircraft environment. Program design activities including test specimens, specimen holding fixtures, flap-track fairing tailcones, and ground exposure racks were completed. The problem experienced in obtaining acceptable fiber volume fraction results on two of the selected graphite epoxy material systems was resolved with an alteration to the bagging procedure called out in BAC 5562. The revised bagging procedure, involving lower numbers of bleeder plies, produces acceptable results. All required laminates for the contract have now been laid up and cured. Progress in the area of analysis methodology has been centered about definition of the environment that a commercial transport aircraft undergoes. The selected methodology is analagous to fatigue life assessment.

Advanced Techniques in Pulmonary Function Test Analysis Interpretation and Diagnosis

PubMed Central

Gildea, T.J.; Bell, C. William

1980-01-01

The Pulmonary Functions Analysis and Diagnostic System is an advanced clinical processing system developed for use at the Pulmonary Division, Department of Medicine at the University of Nebraska Medical Center. The system generates comparative results and diagnostic impressions for a variety of routine and specialized pulmonary functions test data. Routine evaluation deals with static lung volumes, breathing mechanics, diffusing capacity, and blood gases while specialized tests include lung compliance studies, small airways dysfunction studies and dead space to tidal volume ratios. Output includes tabular results of normal vs. observed values, clinical impressions and commentary and, where indicated, a diagnostic impression. A number of pulmonary physiological and state variables are entered or sampled (A to D) with periodic status reports generated for the test supervisor. Among the various physiological variables sampled are respiratory frequency, minute ventilation, oxygen consumption, carbon dioxide production, and arterial oxygen saturation.

The Condition of Education, 1990. Volume 2: Postsecondary Education.

ERIC Educational Resources Information Center

Alsalam, Nabeel, Ed.; Rogers, Gayle Thompson, Ed.

The National Center for Education Statistics' annual statistical report on the condition of education in the United States is presented in two volumes for 1990. This volume covers postsecondary education, while the first volume addresses elementary and secondary education. Condition of education indicators (CEIs)--key data that measure the health…

Stereotactic body radiation therapy for early-stage primary lung cancer, is an active breath coordinator necessary? An audit from a tertiary cancer care center.

PubMed

Madhavan, R; Renilmon, P S; Nair, H M; Lal, A; Nair, S S; Unnikrishnan, U G; Makuny, D

2017-01-01

The hypofractionated stereotactic body radiation therapy (SBRT) has emerged as a safe and effective treatment modality for early-stage nonsmall cell lung carcinoma. An audit SBRT in primary lung cancer treated in our center with and without an active breath coordinator (ABC) was undertaken to evaluate its impact on target volumes and clinical outcomes. This was an observational study. Nine patients with lung carcinoma were treated from January 2014 to August 2016. Five patients were simulated using ABC and four patients with free breathing. Volumetric modulated arc therapy plans were generated using Monaco treatment planning software. Three patients were treated with a dose of 54 Gy in three fractions and six patients with a dose of 48 Gy in four fractions. The statistical analysis was performed using Kaplan-Meier survival. The mean planning target volumes (PTV) in ABC and free breathing groups were 42.19cc and 60.17cc, respectively. The mean volume of lung receiving 20, 10, and 5 Gy (V20, V10and V5) in ABC group were 5.37cc, 10.49cc, and 18.45cc whereas in free breathing 6.63cc, 12.74cc, and 20.64cc, respectively. At a median follow-up of 18 months, there were three local recurrences. No significant toxicity occurred in our series. Our initial results show that SBRT is well tolerated with good local control. Although the PTV volume and irradiated normal lung volume was higher in this group compared to ABC group, this did not translate to any added clinical toxicity.

Atmospheric Boundary Layer Wind Data During the Period January 1, 1998 Through January 21, 1999 at the Dallas-Fort Worth Airport. Volume 2; Data and Processing

NASA Technical Reports Server (NTRS)

Zak, J. Allen; Rodgers, William G., Jr.

2000-01-01

The NASA Langley Research Center's Aircraft Vortex Spacing System (AVOSS) requires accurate winds and turbulence to determine aircraft wake vortex behavior near the ground. Volume 1 described the wind input and quality analysis process. This volume documents the data available during the period January 1998 through January 1999 and the partitioning and concatenation of files for time of day, turbulence, non duplication, cross wind profile quality and ceiling and visibility. It provides the resultant filtered files for the first three partitions as well as identification of ceiling/visibility conditions when they were below 5000 feet and 5 miles respectively. It also includes the wind profile quality flags to permit automatic selection of files for AVOSS application using selected ceiling/visibility and wind profile quality values and flags (or no flags).

SOAC - State-of-the-Art Car Engineering Tests at Department of Transportation High Speed Ground Test Center : Volume 5. Structural, Voltage, and Radio Frequency Interference Tests

DOT National Transportation Integrated Search

1975-01-01

The six-volume report presents the technical methodology, data samples, and results of tests conducted on the SOAC on the Rail Transit Test Track at the High Speed Ground Test Center in Pueblo, Colorado during the period April to July 1973. The Test ...

California State Library: Processing Center Design and Specifications. Volume III, Coding Manual.

ERIC Educational Resources Information Center

Sherman, Don; Shoffner, Ralph M.

As part of the report on the California State Library Processing Center design and specifications, this volume is a coding manual for the conversion of catalog card data to a machine-readable form. The form is compatible with the national MARC system, while at the same time it contains provisions for problems peculiar to the local situation. This…

Technical Report Series on Global Modeling and Data Assimilation. Volume 13; Interannual Variability and Potential Predictability in Reanalysis Products

NASA Technical Reports Server (NTRS)

Min, Wei; Schubert, Siegfried D.; Suarez, Max J. (Editor)

1997-01-01

The Data Assimilation Office (DAO) at Goddard Space Flight Center and the National Center for Environmental Prediction and National Center for Atmospheric Research (NCEP/NCAR) have produced multi-year global assimilations of historical data employing fixed analysis systems. These "reanalysis" products are ideally suited for studying short-term climatic variations. The availability of multiple reanalysis products also provides the opportunity to examine the uncertainty in the reanalysis data. The purpose of this document is to provide an updated estimate of seasonal and interannual variability based on the DAO and NCEP/NCAR reanalyses for the 15-year period 1980-1995. Intercomparisons of the seasonal means and their interannual variations are presented for a variety of prognostic and diagnostic fields. In addition, atmospheric potential predictability is re-examined employing selected DAO reanalysis variables.

Automated linking of suspicious findings between automated 3D breast ultrasound volumes

NASA Astrophysics Data System (ADS)

Gubern-Mérida, Albert; Tan, Tao; van Zelst, Jan; Mann, Ritse M.; Karssemeijer, Nico

2016-03-01

Automated breast ultrasound (ABUS) is a 3D imaging technique which is rapidly emerging as a safe and relatively inexpensive modality for screening of women with dense breasts. However, reading ABUS examinations is very time consuming task since radiologists need to manually identify suspicious findings in all the different ABUS volumes available for each patient. Image analysis techniques to automatically link findings across volumes are required to speed up clinical workflow and make ABUS screening more efficient. In this study, we propose an automated system to, given the location in the ABUS volume being inspected (source), find the corresponding location in a target volume. The target volume can be a different view of the same study or the same view from a prior examination. The algorithm was evaluated using 118 linkages between suspicious abnormalities annotated in a dataset of ABUS images of 27 patients participating in a high risk screening program. The distance between the predicted location and the center of the annotated lesion in the target volume was computed for evaluation. The mean ± stdev and median distance error achieved by the presented algorithm for linkages between volumes of the same study was 7.75±6.71 mm and 5.16 mm, respectively. The performance was 9.54±7.87 and 8.00 mm (mean ± stdev and median) for linkages between volumes from current and prior examinations. The proposed approach has the potential to minimize user interaction for finding correspondences among ABUS volumes.

Outcomes analysis of radioactive iodine and total thyroidectomy for pediatric Graves' disease.

PubMed

Cohen, Reuven Zev; Felner, Eric I; Heiss, Kurt F; Wyly, J Bradley; Muir, Andrew B

2016-03-01

The majority of pediatric patients with Graves' disease will ultimately require definitive therapy in the form of radioactive iodine (RAI) ablation or thyroidectomy. There are few studies that directly compare the efficacy and complication rates between RAI and thyroidectomy. We compared the relapse rate as well as the acute and long-term complications of RAI and total thyroidectomy among children and adolescents with Graves' disease treated at our center. Medical records from 81 children and adolescents with a diagnosis of Graves' disease who received definitive therapy over a 12-year period were reviewed. Fifty one patients received RAI and 30 patients underwent thyroidectomy. The relapse rate was not significantly different between RAI and thyroidectomy (12.1% vs. 0.0%, p=0.28). There were no acute or long-term complications in the RAI group, but there were eight cases of hypoparathyroidism (two transient and six permanent) in the thyroidectomy group. None of the patients developed a recurrent laryngeal nerve injury. RAI is a safe and effective option for treatment of children and adolescents with Graves' disease. In light of the rate of permanent hypoparathyroidism seen at our center with thyroidectomy and previously published long-term safety of RAI, we recommend RAI as the first line treatment for children and adolescents with Graves' disease. For those centers performing thyroidectomies, we recommend that each center select 1-2 high-volume pediatric surgeons to perform all thyroid procedures, allowing individuals to increases case volume and potentially decrease long-term complications of thyroidectomy.

Cell-centered high-order hyperbolic finite volume method for diffusion equation on unstructured grids

NASA Astrophysics Data System (ADS)

Lee, Euntaek; Ahn, Hyung Taek; Luo, Hong

2018-02-01

We apply a hyperbolic cell-centered finite volume method to solve a steady diffusion equation on unstructured meshes. This method, originally proposed by Nishikawa using a node-centered finite volume method, reformulates the elliptic nature of viscous fluxes into a set of augmented equations that makes the entire system hyperbolic. We introduce an efficient and accurate solution strategy for the cell-centered finite volume method. To obtain high-order accuracy for both solution and gradient variables, we use a successive order solution reconstruction: constant, linear, and quadratic (k-exact) reconstruction with an efficient reconstruction stencil, a so-called wrapping stencil. By the virtue of the cell-centered scheme, the source term evaluation was greatly simplified regardless of the solution order. For uniform schemes, we obtain the same order of accuracy, i.e., first, second, and third orders, for both the solution and its gradient variables. For hybrid schemes, recycling the gradient variable information for solution variable reconstruction makes one order of additional accuracy, i.e., second, third, and fourth orders, possible for the solution variable with less computational work than needed for uniform schemes. In general, the hyperbolic method can be an effective solution technique for diffusion problems, but instability is also observed for the discontinuous diffusion coefficient cases, which brings necessity for further investigation about the monotonicity preserving hyperbolic diffusion method.

Longitudinal Study of Gray Matter Changes in Parkinson Disease.

PubMed

Jia, X; Liang, P; Li, Y; Shi, L; Wang, D; Li, K

2015-12-01

The pathology of Parkinson disease leads to morphological brain volume changes. So far, the progressive gray matter volume change across time specific to patients with Parkinson disease compared controls remains unclear. Our aim was to investigate the pattern of gray matter changes in patients with Parkinson disease and to explore the progressive gray matter volume change specific to patients with Parkinson disease with disease progression by using voxel-based morphometry analysis. Longitudinal cognitive assessment and structural MR imaging of 89 patients with Parkinson disease (62 men) and 55 healthy controls (33 men) were from the Parkinson's Progression Markers Initiative data base, including the initial baseline and 12-month follow-up data. Two-way analysis of covariance was performed with covariates of age, sex, years of education, imaging data from multiple centers, and total intracranial volume by using Diffeomorphic Anatomical Registration Through Exponentiated Lie Algebra tool from SPM8 software. Gray matter volume changes for patients with Parkinson disease were detected with decreased gray matter volume in the frontotemporoparietal areas and the bilateral caudate, with increased gray matter volume in the bilateral limbic/paralimbic areas, medial globus pallidus/putamen, and the right occipital cortex compared with healthy controls. Progressive gray matter volume decrease in the bilateral caudate was found for both patients with Parkinson disease and healthy controls, and this caudate volume was positively associated with cognitive ability for both groups. The progressive gray matter volume increase specific to the patients with Parkinson disease was identified close to the left ventral lateral nucleus of thalamus, and a positive relationship was found between the thalamic volume and the tremor scores in a subgroup with tremor-dominant patients with Parkinson disease. The observed progressive changes in gray matter volume in Parkinson disease may provide new insights into the neurodegenerative process. The current findings suggest that the caudate volume loss may contribute to cognitive decline in patients with Parkinson disease and the progressive thalamus enlargement may have relevance to tremor severity in Parkinson disease. © 2015 by American Journal of Neuroradiology.

Cross-sectional study of variables associated with length of stay and ICU need in open Roux-En-Y gastric bypass surgery for morbid obese patients: an exploratory analysis based on the Public Health System administrative database (Datasus) in Brazil.

PubMed

Asano, Elio Fernando; Rasera, Irineu; Shiraga, Elisabete Cristina

2012-12-01

This is an exploratory analysis of potential variables associated with open Roux-en-Y gastric bypass (RYGB) surgery hospitalization resource use pattern. Cross-sectional study based on an administrative database (DATASUS) records. Inclusion criteria were adult patients undergoing RYGB between Jan/2008 and Jun/2011. Dependent variables were length of stay (LoS) and ICU need. Independent variables were: gender, age, region, hospital volume, surgery at certified center of excellence (CoE) by the Surgical Review Corporation (SRC), teaching hospital, and year of hospitalization. Univariate and multivariate analysis (logistic regression for ICU need and linear regression for length of stay) were performed. Data from 13,069 surgeries were analyzed. In crude analysis, hospital volume was the most impactful variable associated with log-transformed LoS (1.312 ± 0.302 high volume vs. 1.670 ± 0.581 low volume, p < 0.001), whereas for ICU need it was certified CoE (odds ratio (OR), 0.016; 95% confidence interval (CI), 0.010-0.026). After adjustment by logistic regression, certified CoE remained as the strongest predictor of ICU need (OR, 0.011; 95% CI, 0.007-0.018), followed by hospital volume (OR, 3.096; 95% CI, 2.861-3.350). Age group, male gender, and teaching hospital were also significantly associated (p < 0.001). For log-transformed LoS, final model includes hospital volume (coefficient, -0.223; 95% CI, -0.250 to -0.196) and teaching hospital (coefficient, 0.375; 95% CI, 0.351-0.398). Region of Brazil was not associated with any of the outcomes. High-volume hospital was the strongest predictor for shorter LoS, whereas SRC certification was the strongest predictor of lower ICU need. Public health policies targeting an increase of efficiency and patient access to the procedure should take into account these results.

Results of a pressure loads investigation on a 0.030-scale model (47-OTS) of the integrated space shuttle vehicle configuration 5 in the NASA Ames Research Center 9 by 7 foot leg of the unitary plan wind tunnel (IA81B), volume 1

NASA Technical Reports Server (NTRS)

Chee, E.

1975-01-01

The investigations of pressure distributions are presented for aeroloads analysis at Mach numbers from 1.55 through 2.5. Angles of attack and sideslip varied from -6 to +6 degrees. Photographs of wind tunnel models are shown.

Review of Exploration Systems Development (ESD) Integrated Hazard Development Process. Volume 1; Appendices

NASA Technical Reports Server (NTRS)

Smiles, Michael D.; Blythe, Michael P.; Bejmuk, Bohdan; Currie, Nancy J.; Doremus, Robert C.; Franzo, Jennifer C.; Gordon, Mark W.; Johnson, Tracy D.; Kowaleski, Mark M.; Laube, Jeffrey R.

2015-01-01

The Chief Engineer of the Exploration Systems Development (ESD) Office requested that the NASA Engineering and Safety Center (NESC) perform an independent assessment of the ESD's integrated hazard development process. The focus of the assessment was to review the integrated hazard analysis (IHA) process and identify any gaps/improvements in the process (e.g., missed causes, cause tree completeness, missed hazards). This document contains the outcome of the NESC assessment.

Joint Center for Operational Analysis Quarterly Bulletin. Volume 9, Issue 1, December 2006

DTIC Science & Technology

2006-12-01

hospitalizations and 6 deaths. Since then, other outbreaks of avian viruses (such as H9N2 in 1999, H7N2 in 2002, H7N7 in 2003, and H5N1 again in 2004) have...in recent years. In 1999, H9N2 infections were identified Nations With Confirmed Cases H5N1 Avian Influenza (July 7, 2006) Total number of cases

Review of Exploration Systems Development (ESD) Integrated Hazard Development Process. Appendices; Volume 2

NASA Technical Reports Server (NTRS)

Smiles, Michael D.; Blythe, Michael P.; Bejmuk, Bohdan; Currie, Nancy J.; Doremus, Robert C.; Franzo, Jennifer C.; Gordon, Mark W.; Johnson, Tracy D.; Kowaleski, Mark M.; Laube, Jeffrey R.

2015-01-01

The Chief Engineer of the Exploration Systems Development (ESD) Office requested that the NASA Engineering and Safety Center (NESC) perform an independent assessment of the ESD's integrated hazard development process. The focus of the assessment was to review the integrated hazard analysis (IHA) process and identify any gaps/improvements in the process (e.g. missed causes, cause tree completeness, missed hazards). This document contains the outcome of the NESC assessment.

Joint Center for Operational Analysis Journal. Volume 12, Issue 2, Summer 2010

DTIC Science & Technology

2010-01-01

Peixoto. In 19X7. then-Major Keen attended Bra- zil’s Command and General Staff Course in Rio de Janeiro . Bra- zil. In 1988, then Captain Floriano...controlling DoD office). • DISTRIBUTION STATEMENT E . Distribution authorized to DoD Components only (fill in reason) (date of determination). Other... basic joint functions that integrate, synchronize, and direct joint operations, which arc: command and control, intelligence, fires, movement and

Joint Center for Operational Analysis Journal. Volume 9, Issue 3, September 2007

DTIC Science & Technology

2007-09-01

to be capable of guarding the states “against those violent and oppressive fac- tions which embitter the blessings of liberty.”21 The Constitution...disaster response. Whether it was a good or bad precedent depends on which level of government you are viewing it from. Initially, guardsmen were...likely be stressed to reimburse the federal government. Relationship to EMAC Generally, when states require assistance beyond their resources, they

Association of umbilical hernia with volume of ascites in liver cirrhosis: a retrospective observational study.

PubMed

Wang, Ran; Qi, Xingshun; Peng, Ying; Deng, Han; Li, Jing; Ning, Zheng; Dai, Junna; Hou, Feifei; Zhao, Jiancheng; Guo, Xiaozhong

2016-11-01

Umbilical hernia is a common abdominal complication in cirrhotic patients with ascites. Our study aimed to evaluate the correlation of umbilical hernia with the volume of ascites. Cirrhotic patients that underwent axial abdominopelvic computed tomography (CT) scans at our hospital between June 2012 and June 2014 were eligible. All CT images were reviewed to confirm the presence of umbilical hernia. The volume of ascites was estimated by five-point method. One hundred and fifty-seven patients were enrolled into this study. Among them, 101 patients had ascites and 6 patients had umbilical hernia. Alkaline phosphatase (AKP) and serum sodium were significantly lower in patients with umbilical hernia (P = 0.008, P = 0.011, respectively). Child-Pugh scores and the volume of ascites were significantly higher in patients with umbilical hernia (P = 0.03, P < 0.0001, respectively). Correlation analysis demonstrated that the volume of ascites, Child-Pugh scores, and blood ammonia had positive correlations with umbilical hernia (r = 0.4579, P < 0.0001; r = 0.175, P = 0.03; r = 0.342, P = 0.001, respectively) and that serum sodium had a negative correlation with umbilical hernia (r = -0.203, P = 0.011). In patients with ascites ≥2000 mL, only AKP was significantly associated with umbilical hernia (P = 0.0497). No variables were significantly associated with umbilical hernia in a subgroup analysis of patients matched according to the volume of ascites. The volume of ascites has a positive correlation with umbilical hernia. However, the factors associated with umbilical hernia in patients with severe ascites remain unclear. © 2016 Chinese Cochrane Center, West China Hospital of Sichuan University and John Wiley & Sons Australia, Ltd.

Morphometric study of the neural ossification centers of the atlas and axis in the human fetus.

PubMed

Baumgart, Mariusz; Wiśniewski, Marcin; Grzonkowska, Magdalena; Małkowski, Bogdan; Badura, Mateusz; Szpinda, Michał

2016-12-01

The knowledge of the developing cervical spine and its individual vertebrae, including their neural processes may be useful in the diagnostics of congenital vertebral malformations. This study was performed to quantitatively examine the neural ossification centers of the atlas and axis with respect to their linear, planar and volumetric parameters. Using the methods of CT, digital-image analysis and statistics, the size of neural ossification centers in the atlas and axis in 55 spontaneously aborted human fetuses aged 17-30 weeks was studied. Without any male-female and right-left significant differences, the best fit growth dynamics for the neural ossification centers of the atlas and axis were, respectively, modelled by the following functions: for length: y = -13.461 + 6.140 × ln(age) ± 0.570 and y = -15.683 + 6.882 × ln(age) ± 0.503, for width: y = -4.006 + 1.930 × ln(age) ± 0.178 and y = -3.054 + 1.648 × ln(age) ± 0.178, for cross-sectional area: y = -7.362 + 0.780 × age ± 1.700 and y = -9.930 + 0.869 × age ± 1.911, and for volume: y = -6.417 + 0.836 × age ± 1.924 and y = -11.592 + 1.087 × age ± 2.509. The size of neural ossification centers of the atlas and axis shows neither sexual nor bilateral differences. The neural ossification centers of the atlas and axis grow logarithmically in both length and width and linearly in both cross-sectional area and volume. The numerical data relating to the size of neural ossification centers of the atlas and axis derived from the CT and digital-image analysis are considered specific-age reference values of potential relevance in both the ultrasound monitoring and the early detection of spinal abnormalities relating to the neural processes of the first two cervical vertebrae in the fetus.

Temporal Analysis of Market Competition and Density in Renal Transplantation Volume and Outcome.

PubMed

Adler, Joel T; Yeh, Heidi; Markmann, James F; Nguyen, Louis L

2016-03-01

Kidney transplant centers are distributed unevenly throughout 58 donor service areas (DSAs) in the United States. Market competition and transplant center density may affect transplantation access and outcomes. We evaluated the role of spatial organization of transplant centers in conjunction with market competition in the conduct of kidney transplantation. The Scientific Registry of Transplant Recipients was queried for market characteristics associated with kidney transplantation between 2003 and 2012. Market competition was calculated using the Herfindahl Hirschman Index. Kidney transplant centers were geocoded to measure spatial organization by the average nearest neighbor (ANN) method. Kidney quality was assessed by kidney donor risk index. A hierarchical negative binomial mixed effects model tested the relationship between market characteristics and annual kidney transplants by DSA. About 152,071 kidney transplants were performed at 229 adult kidney transplant centers in 58 DSAs. Greater market competition was associated with kidney transplant center spatial clustering (P < 0.001). In multivariable analysis, more kidney transplant centers (incidence rate ratio [IRR], 1.04; P = 0.005), 100 more new listings (IRR, 1.02; P = 0.003), 100 more deceased donors (IRR, 1.23; P < 0.001), 100 more new dialysis registrants (IRR, 1.01; P < 0.001), and higher kidney donor risk index (IRR, 1.98; P < 0.001) were associated with increased kidney transplants. After controlling for market characteristics, larger numbers of kidney transplant centers were associated with more kidney transplants and increased utilization of deceased donor kidneys. This underlines the importance of understanding geography as well as competition in improving access to kidney transplantation.

Today's Delinquent. Volumes 1 and 2.

ERIC Educational Resources Information Center

Hurst, Hunter, Ed.; And Others

1983-01-01

This document contains the first two volumes of "Today's Delinquent," an annual publication of the National Center for Juvenile Justice. The primary focus of both volumes is serious crime by juveniles. Articles in volume one include: (1) "Violent Juvenile Crime: The Problem in Perspective" (Howard N. Snyder); (2) "Canon to the Left, Canon to the…

The Condition of Education, 1990. Volume 1: Elementary and Secondary Education.

ERIC Educational Resources Information Center

Ogle, Laurence T., Ed.; Alsalam, Nabeel, Ed.

This is the first of two volumes of the National Center for Education Statistics' annual statistical report on the condition of education in the United States for 1990. This volume addresses elementary and secondary education, while the second volume covers postsecondary education (PE). Condition of education indicators (CEIs)--key data that…

Automotive Manufacturing Assessment System : Volume 1. Master Product Schedules.

DOT National Transportation Integrated Search

1999-11-01

Volume I is part of a four volume set documenting areas of research resulting from the development of the Automotive Manufacturing Assessment System (AMAS) for the DOT/Transportation Systems Center. AMAS was designed to assist in the evaluation of in...

An evaluation of the effects of eyeball structure on ocular pulse amplitude in healthy subjects.

PubMed

Ishii, Kotaro; Mori, Mikiro; Oshika, Tetsuro

2012-12-01

To evaluate the effects of eyeball structure on ocular pulse amplitude (OPA) measured using dynamic contour tonometer (DCT). In 86 eyes of 43 healthy subjects, we measured OPA and intraocular pressure (IOP) with DCT (DCT-IOP), IOP with Goldmann applanation tonometry (GAT-IOP), central corneal thickness (CCT), corneal thickness 2 mm (2 mmCT) and 4 mm (4 mmCT) apart from the center, corneal volume within a 3.5-mm radius from the corneal center, corneal curvature, anterior chamber depth, anterior chamber volume, and axial length (AL). OPA had a significant positive correlation with GAT-IOP (Pearson's r = 0.412, p < 0.001), DCT-IOP (r = 0.350, p < 0.001), and 4 mmCT (r = 0.244, p = 0.0231), and had a significant negative correlation with AL (r = -0.268, p = 0.0122). In a multiple linear regression analysis, AL and GAT-IOP were significantly associated with OPA. OPA measured with DCT is significantly influenced by several factors, such as IOP, peripheral corneal thickness (4 mmCT), and AL.

Engineer Modeling Study. Volume II. Users Manual.

DTIC Science & Technology

1982-09-01

Distribution Center, Digital Equip- ment Corporation, 1980). The following paragraphs briefly describe each of the major input sections...abbreviation 3. A sequence number for post-processing 4. Clock time 5. Order number pointer (six digits ) 6. Job number pointer (six digits ) 7. Unit number...KIT) Users Manual (Boeing Computer % Services, Inc., 1977). S VAX/VMS Users Manual. Volume 3A (Software Distribution Center, Digital Equipment

Morphometric study of the two fused primary ossification centers of the clavicle in the human fetus.

PubMed

Baumgart, Mariusz; Wiśniewski, Marcin; Grzonkowska, Magdalena; Badura, Mateusz; Dombek, Małgorzata; Małkowski, Bogdan; Szpinda, Michał

2016-10-01

A satisfactory understanding of the clavicle development may be contributing to both the diagnosis of its congenital defects and prevention of perinatal damage to the shoulder girdle. This study was carried out to examine the transverse and sagittal diameters, cross-sectional area and volume of the two fused primary ossification centers of the clavicle. Using the methods of CT, digital-image analysis and statistics, the size for two fused primary ossification centers of the clavicle in 42 spontaneously aborted human fetuses at ages of 18-30 weeks was studied. Without any male-female and right-left significant differences, the best fit growth models for two fused primary ossification centers of the clavicle were as follows: y = -31.373 + 15.243 × ln(age) ± 1.424 (R (2) = 0.74) for transverse diameter, y = -7.945 + 3.225 × ln(age) ± 0.262 (R (2) = 0.78), y = -4.503 + 2.007 × ln(age) ± 0.218 (R (2) = 0.68), and y = -4.860 + 2.117 × ln(age) ± 0.200 (R (2) = 0.73) for sagittal diameters of the lateral, middle and medial ends respectively, y = -31.390 + 2.432 × age ± 4.599 (R (2) = 0.78) for cross-sectional area, and y = 28.161 + 0.00017 × (age)(4) ± 15.357 (R (2) = 0.83) for volume. With no sex and laterality differences, the fused primary ossification centers of the clavicle grow logarithmically in both transverse and sagittal diameters, linearly in cross-sectional area, and fourth-degree polynomially in volume. Our normative quantitative findings may be conducive in monitoring normal fetal growth and screening for inherited faults and anomalies of the clavicle in European human fetuses.

MIPS: a database for protein sequences and complete genomes.

PubMed Central

Mewes, H W; Hani, J; Pfeiffer, F; Frishman, D

1998-01-01

The MIPS group [Munich Information Center for Protein Sequences of the German National Center for Environment and Health (GSF)] at the Max-Planck-Institute for Biochemistry, Martinsried near Munich, Germany, is involved in a number of data collection activities, including a comprehensive database of the yeast genome, a database reflecting the progress in sequencing the Arabidopsis thaliana genome, the systematic analysis of other small genomes and the collection of protein sequence data within the framework of the PIR-International Protein Sequence Database (described elsewhere in this volume). Through its WWW server (http://www.mips.biochem.mpg.de ) MIPS provides access to a variety of generic databases, including a database of protein families as well as automatically generated data by the systematic application of sequence analysis algorithms. The yeast genome sequence and its related information was also compiled on CD-ROM to provide dynamic interactive access to the 16 chromosomes of the first eukaryotic genome unraveled. PMID:9399795

High volume improves outcomes: The argument for centralization of rectal cancer surgery.

PubMed

Aquina, Christopher T; Probst, Christian P; Becerra, Adan Z; Iannuzzi, James C; Kelly, Kristin N; Hensley, Bradley J; Rickles, Aaron S; Noyes, Katia; Fleming, Fergal J; Monson, John R T

2016-03-01

Centralization of care to "centers of excellence" in Europe has led to improved oncologic outcomes; however, little is known regarding the impact of nonmandated regionalization of rectal cancer care in the United States. The Statewide Planning and Research Cooperative System (SPARCS) was queried for elective abdominoperineal and low anterior resections for rectal cancer from 2000 to 2011 in New York with the use of International Classification of Diseases, Ninth Revision codes. Surgeon volume and hospital volume were grouped into quartiles, and high-volume surgeons (≥ 10 resections/year) and hospitals (≥ 25 resections/year) were defined as the top quartile of annual caseload of rectal cancer resection and compared with the bottom 3 quartiles during analyses. Bivariate and multilevel regression analyses were performed to assess factors associated with restorative procedures, 30-day mortality, and temporal trends in these endpoints. Among 7,798 rectal cancer resections, the overall rate of no-restorative proctectomy and 30-day mortality decreased by 7.7% and 1.2%, respectively, from 2000 to 2011. In addition, there was a linear increase in the proportion of cases performed by both high-volume surgeons and high-volume hospitals and a decrease in the number of surgeons and hospitals performing rectal cancer surgery. High-volume surgeons at high-volume hospitals were associated independently with both less nonrestorative proctectomies (odds ratio 0.65, 95% confidence interval 0.48-0.89) and mortality (odds ratio 0.43, 95% confidence interval 0.21-0.87) rates. No patterns of significant improvement within the volume strata of the surgeon and hospitals were observed over time. This study suggests that the current trend toward regionalization of rectal cancer care to high-volume surgeons and high-volume centers has led to improved outcomes. These findings have implications regarding the policy of health care delivery in the United States, supporting referral to high-volume centers of excellence. Copyright © 2016 Elsevier Inc. All rights reserved.

Changes in the timing of high river flows in New England over the 20th Century

USGS Publications Warehouse

Hodgkins, G.A.; Dudley, R.W.; Huntington, T.G.

2003-01-01

The annual timing of river flows is a good indicator of climate-related changes, or lack of changes, for rivers with long-term data that drain unregulated basins with stable land use. Changes in the timing of annual winter/spring (January 1 to May 31) and fall (October 1 to December 31) center of volume dates were analyzed for 27 rural, unregulated river gaging stations in New England, USA with an average of 68 years of record. The center of volume date is the date by which half of the total volume of water for a given period of time flows past a river gaging station, and is a measure of the timing of the bulk of flow within the time period. Winter/spring center of volume (WSCV) dates have become significantly earlier (p < 0.1) at all 11 river gaging stations in areas of New England where snowmelt runoff has the most effect on spring river flows. Most of this change has occurred in the last 30 years with dates advancing by 1-2 weeks. WSCV dates were correlated with March through April air temperatures (r = -0.72) and with January precipitation (r = -0.37). Three of 16 river gaging stations in the remainder of New England had significantly earlier WSCV dates. Four out of 27 river gaging stations had significantly earlier fall center of volume dates in New England. Changes in the timing of winter/spring and fall peak flow dates were consistent with the changes in the respective center of volume dates, given the greater variability in the peak flow dates. Changes in the WSCV dates over the last 30 years are consistent with previous studies of New England last-frost dates, lilac bloom dates, lake ice-out dates, and spring air temperatures. This suggests that these New England spring geophysical and biological changes all were caused by a common mechanism, temperature increases.

Properties of II-VI Semiconductors: Bulk Crystals, Epitaxial Films, Quantum Well Structures, and Dilute Magnetic Systems. Materials Research Society Symposium Proceedings. Volume 161

DTIC Science & Technology

1990-11-21

1989, ISBN 1-55899-063-1 Volume 176-Scientific Basis for Nuclear Waste Management XIII, V.M. Oversby, P.W. Brown, 1989, ISBN 1-55899-064-X Volume 177...J.M. PePUYDT, H. CHENG, M.A. HAASE AND J.E. POTTS 3M Company, 201-1N-35 / 3M Center, St. Paul , MN 55144. Recently, with the advent of thermal...their small business innovative research program. The authors wish to thank Larry Knight, director of the Center for X-ray Imaging at Brigham Young

Empirical analysis of domestic medical travel for elective cardiovascular procedures.

PubMed

Langley, Jacob D; Johnson, Tricia J; Hohmann, Samuel F; Meurer, Steve J; Garman, Andy N

2013-10-01

To investigate whether domestic medical travel (DMT; traveling outside of one's home region but within the United States for medical care) and surgeon volume affect clinical outcomes and costs for patients undergoing elective cardiovascular procedures. Retrospective, cross-sectional analysis of patient discharge data from US academic medical centers. Patients were classified as medical travelers if they received elective, nonemergent care more than 250 miles from home. High-volume surgeons (HVSs) were those above the 75th percentile compared with other study surgeons in the annual number of cardiovascular surgeries performed. Multivariable regression models were fit to test the relationships among complications, mortality, length of stay (LOS), cost, DMT status, and surgeon volume, controlling for sociodemographic and clinical factors. Patients who traveled to HVSs were more likely to be male, white, have lower severity of illness, and have health insurance through an indemnity plan or preferred provider organization with coverage outside of the patient's home region. Patients who traveled to HVSs had shorter LOS and fewer complications than those who received care from local, low-volume surgeons. There was no significant difference in mortality between travelers and nontravelers. Patients who travelled to HVSs for elective cardiovascular procedures had outcomes similar to or better than those of patients who received care locally from low-volume surgeons. We found no increase in complications or LOS, despite potentially complex logistical arrangements required by travelers. More work is needed to evaluate the potential of DMT to improve the value of care provided for selected procedures.

Multivariate analysis of factors predicting prostate dose in intensity-modulated radiotherapy

DOE Office of Scientific and Technical Information (OSTI.GOV)

Tomita, Tsuneyuki; Nakamura, Mitsuhiro, E-mail: m_nkmr@kuhp.kyoto-u.ac.jp; Hirose, Yoshinori

We conducted a multivariate analysis to determine relationships between prostate radiation dose and the state of surrounding organs, including organ volumes and the internal angle of the levator ani muscle (LAM), based on cone-beam computed tomography (CBCT) images after bone matching. We analyzed 270 CBCT data sets from 30 consecutive patients receiving intensity-modulated radiation therapy for prostate cancer. With patients in the supine position on a couch with the HipFix system, data for center of mass (COM) displacement of the prostate and the state of individual organs were acquired and compared between planning CT and CBCT scans. Dose distributions weremore » then recalculated based on CBCT images. The relative effects of factors on the variance in COM, dose covering 95% of the prostate volume (D{sub 95%}), and percentage of prostate volume covered by the 100% isodose line (V{sub 100%}) were evaluated by a backward stepwise multiple regression analysis. COM displacement in the anterior-posterior direction (COM{sub AP}) correlated significantly with the rectum volume (δVr) and the internal LAM angle (δθ; R = 0.63). Weak correlations were seen for COM in the left-right (R = 0.18) and superior-inferior directions (R = 0.31). Strong correlations between COM{sub AP} and prostate D{sub 95%} and V{sub 100%} were observed (R ≥ 0.69). Additionally, the change ratios in δVr and δθ remained as predictors of prostate D{sub 95%} and V{sub 100%}. This study shows statistically that maintaining the same rectum volume and LAM state for both the planning CT simulation and treatment is important to ensure the correct prostate dose in the supine position with bone matching.« less

A MODIS-based analysis of the Val d'Agri Oil Center (South of Italy) thermal emission: an independent gas flaring estimation strategy

NASA Astrophysics Data System (ADS)

Pergola, Nicola; Faruolo, Mariapia; Irina, Coviello; Carolina, Filizzola; Teodosio, Lacava; Valerio, Tramutoli

2014-05-01

Different kinds of atmospheric pollution affect human health and the environment at local and global scale. The petroleum industry represents one of the most important environmental pollution sources, accounting for about 18% of well-to-wheels greenhouse gas (GHG) emissions. The main pollution source is represented by the flaring of gas, one of the most challenging energy and environmental problems facing the world today. The World Bank has estimated that 150 billion cubic meters of natural gas are being flared annually, that is equivalent to 30% of the European Union's gas consumption. Since 2002, satellite-based methodologies have shown their capability in providing independent and reliable estimation of gas flaring emissions, at both national and global scale. In this paper, for the first time, the potential of satellite data in estimating gas flaring volumes emitted from a single on-shore crude oil pre-treatment plant, i.e. the Ente Nazionale Idrocarburi (ENI) Val d'Agri Oil Center (COVA), located in the Basilicata Region (South of Italy), was assessed. Specifically, thirteen years of night-time Moderate Resolution Imaging Spectroradiometer (MODIS) data acquired in the medium and thermal infrared (MIR and TIR, respectively) bands were processed. The Robust Satellite Techniques (RST) approach was implemented for identifying anomalous values of the signals under investigation (i.e. the MIR-TIR difference one), associated to the COVA flares emergency discharges. Then, the Fire Radiative Power (FRP), computed for the thermal anomalies previously identified, was correlated to the emitted gas flaring volumes, available for the COVA in the period 2003 - 2009, defining a satellite based regression model for estimating COVA gas flaring emitted volumes. The used strategy and the preliminary results of this analysis will be described in detail in this work.

Effect of transplant center volume on post-transplant survival in patients listed for simultaneous liver and kidney transplantation

PubMed Central

Modi, Rohan M; Tumin, Dmitry; Kruger, Andrew J; Beal, Eliza W; Hayes, Don; Hanje, James; Michaels, Anthony J; Washburn, Kenneth; Conteh, Lanla F; Black, Sylvester M; Mumtaz, Khalid

2018-01-01

AIM To examine the effect of center size on survival differences between simultaneous liver kidney transplantation (SLKT) and liver transplantation alone (LTA) in SLKT-listed patients. METHODS The United Network of Organ Sharing database was queried for patients ≥ 18 years of age listed for SLKT between February 2002 and December 2015. Post-transplant survival was evaluated using stratified Cox regression with interaction between transplant type (LTA vs SLKT) and center volume. RESULTS During the study period, 393 of 4580 patients (9%) listed for SLKT underwent a LTA. Overall mortality was higher among LTA recipients (180/393, 46%) than SLKT recipients (1107/4187, 26%). The Cox model predicted a significant survival disadvantage for patients receiving LTA vs SLKT [hazard ratio, hazard ratio (HR) = 2.85; 95%CI: 2.21, 3.66; P < 0.001] in centers performing 30 SLKT over the study period. This disadvantage was modestly attenuated as center SLKT volume increased, with a 3% reduction (HR = 0.97; 95%CI: 0.95, 0.99; P = 0.010) for every 10 SLKs performed. CONCLUSION In conclusion, LTA is associated with increased mortality among patients listed for SLKT. This difference is modestly attenuated at more experienced centers and may explain inconsistencies between smaller-center and larger registry-wide studies comparing SLKT and LTA outcomes. PMID:29399287

Retrospective Analysis Comparing Hollow Fiber and Silicone Membrane Oxygenators for Neonates on ECMO

PubMed Central

Mejak, Brian; Giacomuzzi, Carmen; Heller, Eileen; You, Xiaomang; Ungerleider, Ross; Shen, Irving

2007-01-01

Abstract: There is little information showing the use of microporous polypropylene hollow fiber oxygenators during extracorporeal life support (ECLS). Recent surveys have shown increasing use of these hollow fibers amongst ECLS centers in the United States. We performed a retrospective analysis comparing the Terumo BabyRx hollow fiber oxygenator to the Medtronic 800 silicone membrane oxygenator on 14 neonatal patients on extracorporeal membrane oxygenation (ECMO). The aim of this study was to investigate the similarities and differences when comparing pressure drops, prime volumes, oxygenator endurance, and gas transfer capabilities between the two groups. PMID:17672186

Brain Gliomas: Multicenter Standardized Assessment of Dynamic Contrast-enhanced and Dynamic Susceptibility Contrast MR Images.

PubMed

Anzalone, Nicoletta; Castellano, Antonella; Cadioli, Marcello; Conte, Gian Marco; Cuccarini, Valeria; Bizzi, Alberto; Grimaldi, Marco; Costa, Antonella; Grillea, Giovanni; Vitali, Paolo; Aquino, Domenico; Terreni, Maria Rosa; Torri, Valter; Erickson, Bradley J; Caulo, Massimo

2018-06-01

Purpose To evaluate the feasibility of a standardized protocol for acquisition and analysis of dynamic contrast material-enhanced (DCE) and dynamic susceptibility contrast (DSC) magnetic resonance (MR) imaging in a multicenter clinical setting and to verify its accuracy in predicting glioma grade according to the new World Health Organization 2016 classification. Materials and Methods The local research ethics committees of all centers approved the study, and informed consent was obtained from patients. One hundred patients with glioma were prospectively examined at 3.0 T in seven centers that performed the same preoperative MR imaging protocol, including DCE and DSC sequences. Two independent readers identified the perfusion hotspots on maps of volume transfer constant (K trans ), plasma (v p ) and extravascular-extracellular space (v e ) volumes, initial area under the concentration curve, and relative cerebral blood volume (rCBV). Differences in parameters between grades and molecular subtypes were assessed by using Kruskal-Wallis and Mann-Whitney U tests. Diagnostic accuracy was evaluated by using receiver operating characteristic curve analysis. Results The whole protocol was tolerated in all patients. Perfusion maps were successfully obtained in 94 patients. An excellent interreader reproducibility of DSC- and DCE-derived measures was found. Among DCE-derived parameters, v p and v e had the highest accuracy (are under the receiver operating characteristic curve [A z ] = 0.847 and 0.853) for glioma grading. DSC-derived rCBV had the highest accuracy (A z = 0.894), but the difference was not statistically significant (P > .05). Among lower-grade gliomas, a moderate increase in both v p and rCBV was evident in isocitrate dehydrogenase wild-type tumors, although this was not significant (P > .05). Conclusion A standardized multicenter acquisition and analysis protocol of DCE and DSC MR imaging is feasible and highly reproducible. Both techniques showed a comparable, high diagnostic accuracy for grading gliomas. © RSNA, 2018 Online supplemental material is available for this article.

Pattern of care and effectiveness of treatment for glioblastoma patients in the real world: Results from a prospective population-based registry. Could survival differ in a high-volume center?

PubMed Central

Brandes, Alba A.; Franceschi, Enrico; Ermani, Mario; Tosoni, Alicia; Albani, Fiorenzo; Depenni, Roberta; Faedi, Marina; Pisanello, Anna; Crisi, Girolamo; Urbini, Benedetta; Dazzi, Claudio; Cavanna, Luigi; Mucciarini, Claudia; Pasini, Giuseppe; Bartolini, Stefania; Marucci, Gianluca; Morandi, Luca; Zunarelli, Elena; Cerasoli, Serenella; Gardini, Giorgio; Lanza, Giovanni; Silini, Enrico Maria; Cavuto, Silvio; Baruzzi, Agostino

2014-01-01

Background As yet, no population-based prospective studies have been conducted to investigate the incidence and clinical outcome of glioblastoma (GBM) or the diffusion and impact of the current standard therapeutic approach in newly diagnosed patients younger than aged 70 years. Methods Data on all new cases of primary brain tumors observed from January 1, 2009, to December 31, 2010, in adults residing within the Emilia-Romagna region were recorded in a prospective registry in the Project of Emilia Romagna on Neuro-Oncology (PERNO). Based on the data from this registry, a prospective evaluation was made of the treatment efficacy and outcome in GBM patients. Results Two hundred sixty-seven GBM patients (median age, 64 y; range, 29–84 y) were enrolled. The median overall survival (OS) was 10.7 months (95% CI, 9.2–12.4). The 139 patients ≤aged 70 years who were given standard temozolomide treatment concomitant with and adjuvant to radiotherapy had a median OS of 16.4 months (95% CI, 14.0–18.5). With multivariate analysis, OS correlated significantly with KPS (HR = 0.458; 95% CI, 0.248–0.847; P = .0127), MGMT methylation status (HR = 0.612; 95% CI, 0.388–0.966; P = .0350), and treatment received in a high versus low-volume center (HR = 0.56; 95% CI, 0.328–0.986; P = .0446). Conclusions The median OS following standard temozolomide treatment concurrent with and adjuvant to radiotherapy given to (72.8% of) patients aged ≤70 years is consistent with findings reported from randomized phase III trials. The volume and expertise of the treatment center should be further investigated as a prognostic factor. PMID:26034628

Variation in ventilation time after coronary artery bypass grafting: an analysis from the society of thoracic surgeons adult cardiac surgery database.

PubMed

Jacobs, Jeffrey P; He, Xia; O'Brien, Sean M; Welke, Karl F; Filardo, Giovanni; Han, Jane M; Ferraris, Victor A; Prager, Richard L; Shahian, David M

2013-09-01

Short postoperative ventilation times are accepted as a marker of quality. This analysis assesses center level variation in postoperative ventilation time in a subset of patients undergoing isolated coronary artery bypass grafting (CABG). In 2009 and 2010, 325,129 patients in the STS Adult Cardiac Surgery Database underwent isolated CABG. Patients were excluded if they were intubated before entering the operating room, required ventilation for greater than 24 hours, or had missing data on key covariates. The final study cohort was 274,231 isolated CABG patients from 1,008 centers. Bayesian hierarchical models were used to assess between-center variation in ventilation time and to explore the effect of center-level covariates. Analyses were performed with and without adjusting for case mix. After adjusting for case mix, the ratio of median ventilator time at the 90th percentile of the center-level distribution compared with the tenth percentile was 9.0:5.0=1.8 (95% credible interval: 1.79 to 1.85). This ratio illustrates the scale of between-center differences: centers above the 90th percentile have a ventilation time of at least 1.8 times that of centers below the tenth percentile. Smaller hospital volume, presence of a residency program, and some census regions were associated with longer ventilation times. After adjustment for severity of illness, substantial inter-center variation exists in postoperative ventilation time in this subset of patients undergoing isolated CABG. This finding represents an opportunity for multi-institutional quality improvement initiatives designed to limit variations in ventilator management and achieve the shortest possible ventilation times for all patients, thus benefiting both clinical outcomes and resource utilization. Copyright © 2013 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

10 Years Later: Lessons Learned from an Academic Multidisciplinary Cosmetic Center

PubMed Central

Chen, Jenny T.; Nayar, Harry S.

2017-01-01

Background: In 2006, a Centers for Medicare and Medicaid Services-accredited multidisciplinary academic ambulatory surgery center was established with the goal of delivering high-quality, efficient reconstructive, and cosmetic services in an academic setting. We review our decade-long experience since its establishment. Methods: Clinical and financial data from 2006 to 2016 are reviewed. All cosmetic procedures, including both minimally invasive and operative cases, are included. Data are compared to nationally published reports. Results: Nearly 3,500 cosmetic surgeries and 10,000 minimally invasive procedures were performed. Compared with national averages, surgical volume in abdominoplasty is high, whereas rhinoplasty and breast augmentation is low. Regarding trend data, breast augmentation volume has decreased by 25%, whereas minimally invasive procedural volume continues to grow and is comparable with national reports. Similarly, where surgical revenue remains steady, minimally invasive revenue has increased significantly. The majority of surgical cases (70%) are reconstructive in nature and insurance-based. Payer mix is 71% private insurance, 18% Medicare and Medicaid, and 11% self-pay. Despite year-over-year revenue increases, net profit in 2015 was $6,120. Rent and anesthesia costs exceed national averages, and employee salary and wages are the highest expenditure. Conclusion: Although the creation of our academic cosmetic ambulatory surgery center has greatly increased the overall volume of cosmetic surgery performed at the University of Wisconsin, the majority of surgical volume and revenue is reconstructive. As is seen nationwide, minimally invasive cosmetic procedures represent our most rapidly expanding revenue stream. PMID:29062640

Development of a Flexible Framework for Hypersonic Navier-Stoke Space Shuttle Orbiter Meshes

NASA Technical Reports Server (NTRS)

Alter, Stephen J.; Reuthler, James J.; McDaniel, Ryan D.

2004-01-01

A flexible framework constructing block structured volume grids for hypersonic Navier-Strokes flow simulations was developed for the analysis of the Shuttle Orbiter Columbia. The development of the framework, which was partially basedon the requirements of the primary flow solvers used resulted in an ability to directly correlate solutions contributed by participating groups on a common surface mesh. A foundation was built through the assessment of differences between differnt solvers, which provided confidence for independent assessment of other damage scenarios by team members. The framework draws on the experience of NASA Langley and NASA Ames Research Centers in structured grid generation, and consists of a grid generation, and consist of a grid generation process implemented through a division of responsibilities. The nominal division of labor consisted of NASA Johnson Space Center coordinating the damage scenarios to be analyzed by the Aerothermodynamics Columbia Accident Investigation (ACAI) team, Ames developing the surface grids that described the computational volume about the Orbiter, and Langley improving grid quality of Ames generated data and constructing the final computational volume grids. Distributing the work among the participant in th ACAI team resulted in significantl less time required to construct complete meshes than possible by any individual participant. The approach demonstrated that the One-NASA grid generation team could sustain the demand of for five new meshes to explore new damage scenarios within an aggressive time-line.

The Journal of the Society for Accelerative Learning and Teaching. (Volume 5, Numbers 3 through Volume 6, Number 4).

ERIC Educational Resources Information Center

Journal of the Society for Accelerative Learning and Teaching, 1981

1981-01-01

Numbers 3 and 4 of volume 5 and numbers 1 through 4 of volume 6 of the journal, spanning fall 1980 through winter 1981, include articles concerning the individualized study center; consciousness, psychology, and education; suggestive-accelerative learning and suggestopedia; creativity; brain lateralization; the Lozanov method; biofeedback and…

The effect of surgeon and hospital volume on shoulder arthroplasty perioperative quality metrics.

PubMed

Singh, Anshu; Yian, Edward H; Dillon, Mark T; Takayanagi, Miwa; Burke, Mary F; Navarro, Ronald A

2014-08-01

There has been a significant increase in both the incidence of shoulder arthroplasty and the number of surgeons performing these procedures. Literature regarding the relationship between surgeon or hospital volume and the performance of modern shoulder arthroplasty is limited. This study examines the effect of surgeon or hospital shoulder arthroplasty volume on perioperative metrics related to shoulder hemiarthroplasty, total shoulder arthroplasty, and reverse shoulder arthroplasty. Blood loss, length of stay, and operative time were the main endpoints analyzed. Prospective data were analyzed from a multicenter shoulder arthroplasty registry; 1176 primary shoulder arthroplasty cases were analyzed. Correlation and analysis of covariance were used to examine the association between surgeon and hospital volume and perioperative metrics adjusting for age, sex, and body mass index. Surgeon volume is inversely correlated with length of stay for hemiarthroplasty and total shoulder arthroplasty and with blood loss and operative time for all 3 procedures. Hospital volume is inversely correlated with length of stay for hemiarthroplasty, with blood loss for total and reverse shoulder arthroplasty, and with operative time for all 3 procedures. High-volume surgeons performed shoulder arthroplasty 30 to 50 minutes faster than low-volume surgeons did. Higher surgeon and hospital case volumes led to improved perioperative metrics with all shoulder arthroplasty procedures, including reverse total shoulder arthroplasty, which has not been previously described in the literature. Surgeon volume had a larger effect on metrics than hospital volume did. This study supports the concept that complex shoulder procedures are, on average, performed more efficiently by higher volume surgeons in higher volume centers. Copyright © 2014 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Mosby, Inc. All rights reserved.

Dielectric resonator antenna for coupling to NV centers in diamond

NASA Astrophysics Data System (ADS)

Kapitanova, Polina; Soshenko, Vladimir; Vorobyov, Vadim; Dobrykh, Dmitry; Bolshedvorskiih, Stepan; Sorokin, Vadim; Akimov, Alexey

2017-09-01

Here we present the design of a dielectric resonator antenna for spin manipulation of large volume ensemble of nitrogen-vacancy centers in a bulk diamond. The proposed antenna design is based on a high permittivity hollow dielectric resonator excited by a symmetric microstrip loop. We present the result of numerical simulation of the magnetic field excited at the TE01δ mode of the dielectric resonator. We analyze the uniformity of the magnetic field in volume and discuss the possibility to use the antenna for efficient excitation of nitrogen-vacancy centers in whole commercially available sample.

The current status of emergency operations at a high-volume cancer center.

PubMed

Komori, Koji; Kimura, Kenya; Kinoshita, Takashi; Ito, Seiji; Abe, Tetsuya; Senda, Yoshiki; Misawa, Kazunari; Ito, Yuichi; Uemura, Norihisa; Natsume, Seiji; Kawai, Ryosuke; Kawakami, Jiro; Asano, Tomonari; Iwata, Yoshinori; Kurahashi, Shintaro; Tsutsuyama, Masayuki; Shigeyoshi, Itaru; Shimizu, Yasuhiro

2014-01-01

This study aimed to assess the pathogenic causes, clinical conditions, surgical procedures, in-hospital mortality, and operative death associated with emergency operations at a high-volume cancer center. Although many reports have described the contents, operative procedures, and prognosis of elective surgeries in high-volume cancer centers, emergency operations have not been studied in sufficient detail. We retrospectively enrolled 28 consecutive patients who underwent emergency surgery. Cases involving operative complications were excluded. The following surgical procedures were performed during emergency operations: closure in 3 cases (10.7%), diversion in 22 cases (78.6%), ileus treatment in 2 cases (7.1%), and hemostasis in 1 case (3.6%). Closure alone was performed only once for peritonitis. Diversion was performed in 17 cases (77.3%) of peritonitis, 4 cases (18.2%) of stenosis of the gastrointestinal tract, and 1 case (4.5%) of bleeding. There was a significant overall difference (P = 0.001). The frequency of emergency operations was very low at a high-volume cancer center. However, the recent shift in treatment approaches toward nonoperative techniques may enhance the status of emergency surgical procedures. The results presented in this study will help prepare for emergency situations and resolve them as quickly and efficiently as possible.

Performance evaluation of extension education centers in universities based on the balanced scorecard.

PubMed

Wu, Hung-Yi; Lin, Yi-Kuei; Chang, Chi-Hsiang

2011-02-01

This study aims at developing a set of appropriate performance evaluation indices mainly based on balanced scorecard (BSC) for extension education centers in universities by utilizing multiple criteria decision making (MCDM). Through literature reviews and experts who have real practical experiences in extension education, adequate performance evaluation indices have been selected and then utilizing the decision making trial and evaluation laboratory (DEMATEL) and analytic network process (ANP), respectively, further establishes the causality between the four BSC perspectives as well as the relative weights between evaluation indices. According to this previous result, an empirical analysis of the performance evaluation of extension education centers of three universities at Taoyuan County in Taiwan is illustrated by applying VlseKriterijumska Optimizacija I Kompromisno Resenje (VIKOR). From the analysis results, it indicates that "Learning and growth" is the significant influential factor and it would affect the other three perspectives. In addition, it is discovered that "Internal process" perspective as well as "Financial" perspective play important roles in the performance evaluation of extension education centers. The top three key performance indices are "After-sales service", "Turnover volume", and "Net income". The proposed evaluation model could be considered as a reference for extension education centers in universities to prioritize their improvements on the key performance indices after performing VIKOR analyses. 2010 Elsevier Ltd. All rights reserved.

Functional Requirements for Onboard Management of Space Shuttle Consumables. Volume 2

NASA Technical Reports Server (NTRS)

Graf, P. J.; Herwig, H. A.; Neel, L. W.

1973-01-01

This report documents the results of the study "Functional Requirements for Onboard Management of Space Shuttle Consumables." The study was conducted for the Mission Planning and Analysis Division of the NASA Lyndon B. Johnson Space Center, Houston, Texas, between 3 July 1972 and 16 November 1973. The overall study program objective was two-fold. The first objective was to define a generalized consumable management concept which is applicable to advanced spacecraft. The second objective was to develop a specific consumables management concept for the Space Shuttle vehicle and to generate the functional requirements for the onboard portion of that concept. Consumables management is the process of controlling or influencing the usage of expendable materials involved in vehicle subsystem operation. The report consists of two volumes. Volume I presents a description of the study activities related to general approaches for developing consumable management, concepts for advanced spacecraft applications, and functional requirements for a Shuttle consumables management concept. Volume II presents a detailed description of the onboard consumables management concept proposed for use on the Space Shuttle.

Multiparametric MRI characterization and prediction in autism spectrum disorder using graph theory and machine learning.

PubMed

Zhou, Yongxia; Yu, Fang; Duong, Timothy

2014-01-01

This study employed graph theory and machine learning analysis of multiparametric MRI data to improve characterization and prediction in autism spectrum disorders (ASD). Data from 127 children with ASD (13.5±6.0 years) and 153 age- and gender-matched typically developing children (14.5±5.7 years) were selected from the multi-center Functional Connectome Project. Regional gray matter volume and cortical thickness increased, whereas white matter volume decreased in ASD compared to controls. Small-world network analysis of quantitative MRI data demonstrated decreased global efficiency based on gray matter cortical thickness but not with functional connectivity MRI (fcMRI) or volumetry. An integrative model of 22 quantitative imaging features was used for classification and prediction of phenotypic features that included the autism diagnostic observation schedule, the revised autism diagnostic interview, and intelligence quotient scores. Among the 22 imaging features, four (caudate volume, caudate-cortical functional connectivity and inferior frontal gyrus functional connectivity) were found to be highly informative, markedly improving classification and prediction accuracy when compared with the single imaging features. This approach could potentially serve as a biomarker in prognosis, diagnosis, and monitoring disease progression.

Influence of hospital type on survival in stage IV colorectal cancer.

PubMed

Hoshino, Nobuaki; Hasegawa, Suguru; Hida, Koya; Kawada, Kenji; Okamura, Ryosuke; Hamada, Madoka; Munemoto, Yoshinori; Sakai, Yoshiharu; Watanabe, Masahiko

2016-08-01

Hospital factors along with various patient and surgeon factors are considered to affect the prognosis of colorectal cancer. Hospital volume is well known, but little is known regarding other hospital factors. We reviewed data on 853 patients with stage IV colorectal cancer who underwent elective palliative primary tumor resection between January 2006 and December 2007. To detect the hospital factors that could influence the prognosis of incurable colorectal cancer, the relationships between patient/hospital factors and overall survival were analyzed. Among hospital factors, hospital type (Group A: university hospital or cancer center; Group B: community hospital), hospital volume, and number of colorectal surgeons were examined. In univariate analysis, Group A hospitals showed significantly better prognosis than Group B hospitals (p = 0.034), while hospital volume and number of colorectal surgeons were not associated with overall survival. After adjustment for patient factors in multivariate analysis, hospital type was significantly associated with overall survival (hazard ratio: 1.31; 95 % confidence interval: 1.05-1.63; p = 0.016). However, there was no significant difference in short-term outcomes between hospital types. Hospital type was identified as a hospital factor that possibly affects the prognosis of stage IV colorectal cancer patients.

Automotive Manufacturing Assessment System : Volume 2. Product Schedules of Engine/Drivetrain Combinations.

DOT National Transportation Integrated Search

1979-11-01

Volume II is part of a four volume set documenting areas of research resulting from the development of the Automotive Manufacturing Assessment System (AMAS) for the DOT/Transportation Systems Center. AMAS was designed to assist in the evaluation of i...

Survey Plan For Characterization of the Subsurface Underlying the National Aeronautics and Space Administration's Marshall Space Flight Center in Huntsville, Alabama. Volume 1 and 2

NASA Technical Reports Server (NTRS)

1996-01-01

Topic considered include: survey objectives; technologies for non-Invasive imaging of subsurface; cost; data requirements and sources; climatic condition; hydrology and geology; chemicals; magnetometry; electrical(resistivity, potential); optical-style imaging; reflection/refraction seismics; gravitometry; photo-acoustic activation;well drilling and borehole analysis; comparative assessment matrix; ground sensors; choice of the neutron sources; logistic of operations; system requirements; health and safety plans.

Joint Center for Operational Analysis Quarterly Bulletin. Volume 7, Issue 3, June 2005

DTIC Science & Technology

2005-06-01

sharp salute. Then, between us, coffins draped in the Romanian colors and holding the remains of Romanian soldiers killed in action slowly passed by... Armoured Division integrated with the US 1st Marine Expeditionary Force was helped by similar doctrine, and the Royal Air Force’s (RAF) ability to...various situations. While research continues in this focus area across the coalition, there are some findings to convey. 3.3.1 Armour in the Urban

Joint Center for Operational Analysis Quarterly Bulletin. Volume 8, Issue 2, June 2006

DTIC Science & Technology

2006-06-01

aware that notwithstanding any other provision of law, no person shall be subject to a penalty for failing to comply with a collection of information if...OF PAGES 72 19a. NAME OF RESPONSIBLE PERSON a. REPORT unclassified b. ABSTRACT unclassified c. THIS PAGE unclassified Standard Form 298 (Rev...reaches out across the Department of Defense to handle all IED related inquires. As the capability continues to mature and improve, the long term

Joint Center for Operational Analysis Journal. Volume 10, Issue 1, December 2007

DTIC Science & Technology

2007-12-01

data needed , and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this...political bosses) of a handful of powerful families. As a result, Shia youth often emigrated to Africa, South America , or other Arab countries, and then...religion designed for a society that can revolt and build a state.” Hassan Nasrallah In 1991, recognizing the need to legitimize their power base

Joint Center for Operational Analysis Journal. Volume 9, Issue 2, June 2007

DTIC Science & Technology

2007-06-01

black market . • Pakistan Institute of Medical Sciences (PIMS) complained that we did more harm than good by evacuating patients to their hospitals...pharmacies and created a pharmaceutical black market in the local towns. • Local Pakistan physicians lost patients. • Local Pakistan physicians and...geology.com/news/2005/09/ atlantic-ocean-tsunami-threat.html Auf Der Heide, E. (2002). “ Principles of hospital disaster planning;” in Hogan D.E. and

Target Signature Analysis Center: Data Compilation. Eleventh Supplement. Volume 1. Bidirectional Reflectance: Definition, Discussion, and Utilization

DTIC Science & Technology

1972-10-01

description of the important experi- mental conditions. iii CONTENTS 1. Introduction .... .. ... .. ... ... ..... ... .. ... ... I 2. Bidirectional Reflectance...contribute to received power. Case III : Laser Source Not Arranged Coaxially with a Receiver If the terms used to develop Eq. (171 are rewritten with...Lr(ur, r)1 , Involves a 4-by -4,16-elerment Mueller natr Lx (Ref. 9). That Is, a coiplete bpvc - ificatLion of the polarization characteristics of

The Spectrum of Warfare Challenge. Joint Center for Operational Analysis Journal, Volume 11, Issue 2, Spring 2009

DTIC Science & Technology

2009-01-01

all missing. The opinion at the time was that these problems—coupled with many other issues— signifi cantly undermined the overall effectiveness of...and provide clarify- ing information. The second method involved using timely and effective press releases from MNF-I. These press releases...by Lyman Cutlar several times before to stay off his property and quit eating his potatoes . Cutlar, a Kentuckian, was an American miner who had

Spatially resolved texture and microstructure evolution of additively manufactured and gas gun deformed 304L stainless steel investigated by neutron diffraction and electron backscatter diffraction

DOE PAGES

Takajo, Shigehiro; Brown, Donald William; Clausen, Bjorn; ...

2018-04-30

In this study, we report the characterization of a 304L stainless steel cylindrical projectile produced by additive manufacturing. The projectile was compressively deformed using a Taylor Anvil Gas Gun, leading to a huge strain gradient along the axis of the deformed cylinder. Spatially resolved neutron diffraction measurements on the HIgh Pressure Preferred Orientation time-of-flight diffractometer (HIPPO) and Spectrometer for Materials Research at Temperature and Stress diffractometer (SMARTS) beamlines at the Los Alamos Neutron Science CEnter (LANSCE) with Rietveld and single-peak analysis were used to quantitatively evaluate the volume fractions of the α, γ, and ε phases as well as residualmore » strain and texture. The texture of the γ phase is consistent with uniaxial compression, while the α texture can be explained by the Kurdjumov–Sachs relationship from the γ texture after deformation. This indicates that the material first deformed in the γ phase and subsequently transformed at larger strains. The ε phase was only found in volumes close to the undeformed material with a texture connected to the γ texture by the Shoji–Nishiyama orientation relationship. This allows us to conclude that the ε phase occurs as an intermediate phase at lower strain, and is superseded by the α phase when strain increases further. We found a proportionality between the root-mean-squared microstrain of the γ phase, dominated by the dislocation density, with the α volume fraction, consistent with strain-induced martensite α formation. In conclusion, knowledge of the sample volume with the ε phase from the neutron diffraction analysis allowed us to identify the ε phase by electron back scatter diffraction analysis, complementing the neutron diffraction analysis with characterization on the grain level.« less

Spatially resolved texture and microstructure evolution of additively manufactured and gas gun deformed 304L stainless steel investigated by neutron diffraction and electron backscatter diffraction

DOE Office of Scientific and Technical Information (OSTI.GOV)

Takajo, Shigehiro; Brown, Donald William; Clausen, Bjorn

In this study, we report the characterization of a 304L stainless steel cylindrical projectile produced by additive manufacturing. The projectile was compressively deformed using a Taylor Anvil Gas Gun, leading to a huge strain gradient along the axis of the deformed cylinder. Spatially resolved neutron diffraction measurements on the HIgh Pressure Preferred Orientation time-of-flight diffractometer (HIPPO) and Spectrometer for Materials Research at Temperature and Stress diffractometer (SMARTS) beamlines at the Los Alamos Neutron Science CEnter (LANSCE) with Rietveld and single-peak analysis were used to quantitatively evaluate the volume fractions of the α, γ, and ε phases as well as residualmore » strain and texture. The texture of the γ phase is consistent with uniaxial compression, while the α texture can be explained by the Kurdjumov–Sachs relationship from the γ texture after deformation. This indicates that the material first deformed in the γ phase and subsequently transformed at larger strains. The ε phase was only found in volumes close to the undeformed material with a texture connected to the γ texture by the Shoji–Nishiyama orientation relationship. This allows us to conclude that the ε phase occurs as an intermediate phase at lower strain, and is superseded by the α phase when strain increases further. We found a proportionality between the root-mean-squared microstrain of the γ phase, dominated by the dislocation density, with the α volume fraction, consistent with strain-induced martensite α formation. In conclusion, knowledge of the sample volume with the ε phase from the neutron diffraction analysis allowed us to identify the ε phase by electron back scatter diffraction analysis, complementing the neutron diffraction analysis with characterization on the grain level.« less

Analysis of Convective Weather Impact on Pre-Departure Routing of Flights from Fort Worth Center to New York Center

NASA Technical Reports Server (NTRS)

Arneson, Heather; Bombelli, Alessandro; Segarra-Torne, Adria; Tse, Elmer

2017-01-01

In response to severe weather conditions, Traffic Managers specify flow constraints and reroutes to route air traffic around affected regions of airspace. Providing analysis and recommendations of available reroute options and associated airspace capacities would assist Traffic Managers in making more efficient decisions in response to convective weather. These recommendations can be developed by examining historical data to determine which previous reroute options were used in similar weather and traffic conditions. This paper describes the initial steps and methodology used towards this goal. The focus of this work is flights departing from Fort Worth Center destined for New York Center. Dominant routing structures used in the absence of convective weather are identified. A method to extract relevant features from the large volume of weather data available to quantify the impact of convective weather on this routing structure over a given time range is presented. Finally, a method of estimating flow rate capacity along commonly used routes during convective weather events is described. Results show that the flow rates drop exponentially as a function of the values of the proposed feature and that convective weather on the final third of the route was found to have a greater impact on the flow rate restriction than other portions of the route.

Current principles and practice in autologous intraportal islet transplantation: a meta-analysis of the technical considerations.

PubMed

Kumar, Rohan; Chung, Wen Yuan; Dennison, Ashley Robert; Garcea, Giuseppe

2016-04-01

Autologous islet transplantation (IAT) following pancreatectomy is now a recognized, albeit highly specialized procedure carried out in a small number of centers worldwide. Current clinical principles and best practice with emphasis on examining the technical aspects of surgery in centers with significant IAT experience are reviewed. Literature search for studies discussing any technical aspect of pancreatectomy with intraportal IAT was included. Thirty-five papers were included; all were single-center case series. The indications, surgical approach to pancreatectomy with IAT, islet yield, static pancreas preservation prior to islet digestion, portal vein access, absolute islet infusion volumes, and portal venous pressure changes during transfusion evaluated. IAT is considered a "last resort" when alternative approaches have been exhausted. Pre-morbid histology and prior surgical drainage adversely influence islet yields and may influence the clinical decision to perform pancreatectomy and IAT. Following pancreas digestion, absolute numbers of islets recovered and smaller islet size predict rates of insulin independence following IAT. Islet volumes and portal venous pressure changes are important factors for the development of complications. Surgical access for IAT includes intra-operative, immediate or delayed infusion via an "exteriorized" vein, and radiological percutaneous approaches. Delayed infusion can be combined with pancreas preservation techniques prior to islet isolation. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Capacitance probe for fluid flow and volume measurements

NASA Technical Reports Server (NTRS)

Arndt, G. Dickey (Inventor); Nguyen, Thanh X. (Inventor); Carl, James R. (Inventor)

1995-01-01

Method and apparatus for making measurements on fluids are disclosed, including the use of a capacitive probe for measuring the flow volume of a material within a flow stream. The capacitance probe has at least two elongate electrodes and, in a specific embodiment of the invention, has three parallel elongate electrodes with the center electrode being an extension of the center conductor of a co-axial cable. A conductance probe is also provided to provide more accurate flow volume data in response to conductivity of the material within the flow stream. A preferred embodiment of the present invention provides for a gas flow stream through a microgravity environment that allows for monitoring a flow volume of a fluid sample, such as a urine sample, that is entrained within the gas flow stream.

Capacitance Probe for Fluid Flow and Volume Measurements

NASA Technical Reports Server (NTRS)

Arndt, G. Dickey (Inventor); Nguyen, Thanh X. (Inventor); Carl, James R. (Inventor)

1997-01-01

Method and apparatus for making measurements on fluids are disclosed, including the use of a capacitive probe for measuring the flow volume of a material within a flow stream. The capacitance probe has at least two elongate electrodes and, in a specific embodiment of the invention, has three parallel elongate electrodes with the center electrode being an extension of the center conductor of a co-axial cable. A conductance probe is also provided to provide more accurate flow volume data in response to conductivity of the material within the flow stream. A preferred embodiment of the present invention provides for a gas flow stream through a micro-gravity environment that allows for monitoring a flow volume of a fluid sample, such as a urine sample, that is entrained within the gas flow stream.

Mechanical ventilation management during extracorporeal membrane oxygenation for acute respiratory distress syndrome: a retrospective international multicenter study.

PubMed

Schmidt, Matthieu; Stewart, Claire; Bailey, Michael; Nieszkowska, Ania; Kelly, Joshua; Murphy, Lorna; Pilcher, David; Cooper, D James; Scheinkestel, Carlos; Pellegrino, Vincent; Forrest, Paul; Combes, Alain; Hodgson, Carol

2015-03-01

To describe mechanical ventilation settings in adult patients treated for an acute respiratory distress syndrome with extracorporeal membrane oxygenation and assess the potential impact of mechanical ventilation settings on ICU mortality. Retrospective observational study. Three international high-volume extracorporeal membrane oxygenation centers. A total of 168 patients treated with extracorporeal membrane oxygenation for severe acute respiratory distress syndrome from January 2007 to January 2013. We analyzed the association between mechanical ventilation settings (i.e. plateau pressure, tidal volume, and positive end-expiratory pressure) on ICU mortality using multivariable logistic regression model and Cox-proportional hazards model. We obtained detailed demographic, clinical, daily mechanical ventilation settings and ICU outcome data. One hundred sixty-eight patients (41 ± 14 years old; PaO2/FIO2 67 ± 19 mm Hg) fulfilled our inclusion criteria. Median duration of extracorporeal membrane oxygenation and ICU stay were 10 days (6-18 d) and 28 days (16-42 d), respectively. Lower positive end-expiratory pressure levels and significantly lower plateau pressures during extracorporeal membrane oxygenation were used in the French center than in both Australian centers (23.9 ± 1.4 vs 27.6 ± 3.7 and 27.8 ± 3.6; p < 0.0001). Overall ICU mortality was 29%. Lower positive end-expiratory pressure levels (until day 7) and lower delivered tidal volume after 3 days on extracorporeal membrane oxygenation were associated with significantly higher mortality (p < 0.05). In multivariate analysis, higher positive end-expiratory pressure levels during the first 3 days of extracorporeal membrane oxygenation support were associated with lower mortality (odds ratio, 0.75; 95% CI, 0.64-0.88; p = 0.0006). Other independent predictors of ICU mortality included time between ICU admission and extracorporeal membrane oxygenation initiation, plateau pressure greater than 30 cm H2O before extracorporeal membrane oxygenation initiation, and lactate level on day 3 of extracorporeal membrane oxygenation support. Protective mechanical ventilation strategies were routinely used in high-volume extracorporeal membrane oxygenation centers. However, higher positive end-expiratory pressure levels during the first 3 days on extracorporeal membrane oxygenation support were independently associated with improved survival. Further prospective trials on the optimal mechanical ventilation strategy during extracorporeal membrane oxygenation support are warranted.

Sensitivity of Spaceborne and Ground Radar Comparison Results to Data Analysis Methods and Constraints

NASA Technical Reports Server (NTRS)

Morris, Kenneth R.; Schwaller, Mathew

2011-01-01

With the availability of active weather radar observations from space from the Precipitation Radar (PR) on board the Tropical Rainfall Measuring Mission (TR.MM) satellite, numerous studies have been performed comparing PR reflectivity and derived rain rates to similar observations from ground-based weather radars (GR). These studies have used a variety of algorithms to compute matching PR and GR volumes for comparison. Most studies have used a fixed 3-dimensional Cartesian grid centered on the ground radar, onto which the PR and GR data are interpolated using a proprietary approach and/or commonly available GR analysis software (e.g., SPRINT, REORDER). Other studies have focused on the intersection of the PR and GR viewing geometries either explicitly or using a hybrid of the fixed grid and PR/GR common fields of view. For the Dual-Frequency Precipitation Radar (DPR) of the upcoming Global Precipitation Measurement (GPM) mission, a prototype DPR/GR comparison algorithm based on similar TRMM PR data has been developed that defines the common volumes in terms of the geometric intersection of PR and GR rays, where smoothing of the PR and GR data are minimized and no interpolation is performed. The PR and GR volume-averaged reflectivity values of each sample volume are accompanied by descriptive metadata, for attributes including the variability and maximum of the reflectivity within the sample volume, and the fraction of range gates in the sample average having reflectivity values above an adjustable detection threshold (typically taken to be 18 dBZ for the PR). Sample volumes are further characterized by rain type (Stratiform or Convective), proximity to the melting layer, underlying surface (land/water/mixed), and the time difference between the PR and GR observations. The mean reflectivity differences between the PR and GR can differ between data sets produced by the different analysis methods; and for the GPM prototype, by the type of constraints and categorization applied to the data. In this paper, we will show results comparing the 3-D gridded analysis "black box" approach to the GPM prototype volume-matching approach, using matching TRMM PR and WSR-88D ground radar data. The affects of applying data constraints and data categorizations on the volume-matched data to the results will be shown, and explanations of the differences in terms of data and analysis algorithm characteristics will be presented. Implications of the differences to the determination of PR/DPR calibration differences and use of ground radar data to evaluate the PR and DPR attenuation correction algorithms will be discussed.

Accurate Analysis of the Change in Volume, Location, and Shape of Metastatic Cervical Lymph Nodes During Radiotherapy

DOE Office of Scientific and Technical Information (OSTI.GOV)

Takao, Seishin, E-mail: takao@mech-me.eng.hokudai.ac.jp; Tadano, Shigeru; Taguchi, Hiroshi

2011-11-01

Purpose: To establish a method for the accurate acquisition and analysis of the variations in tumor volume, location, and three-dimensional (3D) shape of tumors during radiotherapy in the era of image-guided radiotherapy. Methods and Materials: Finite element models of lymph nodes were developed based on computed tomography (CT) images taken before the start of treatment and every week during the treatment period. A surface geometry map with a volumetric scale was adopted and used for the analysis. Six metastatic cervical lymph nodes, 3.5 to 55.1 cm{sup 3} before treatment, in 6 patients with head and neck carcinomas were analyzed inmore » this study. Three fiducial markers implanted in mouthpieces were used for the fusion of CT images. Changes in the location of the lymph nodes were measured on the basis of these fiducial markers. Results: The surface geometry maps showed convex regions in red and concave regions in blue to ensure that the characteristics of the 3D tumor geometries are simply understood visually. After the irradiation of 66 to 70 Gy in 2 Gy daily doses, the patterns of the colors had not changed significantly, and the maps before and during treatment were strongly correlated (average correlation coefficient was 0.808), suggesting that the tumors shrank uniformly, maintaining the original characteristics of the shapes in all 6 patients. The movement of the gravitational center of the lymph nodes during the treatment period was everywhere less than {+-}5 mm except in 1 patient, in whom the change reached nearly 10 mm. Conclusions: The surface geometry map was useful for an accurate evaluation of the changes in volume and 3D shapes of metastatic lymph nodes. The fusion of the initial and follow-up CT images based on fiducial markers enabled an analysis of changes in the location of the targets. Metastatic cervical lymph nodes in patients were suggested to decrease in size without significant changes in the 3D shape during radiotherapy. The movements of the gravitational center of the lymph nodes were almost all less than {+-}5 mm.« less

Review of Adult Learning and Literacy, Volume 4. Connecting Research, Policy, and Practice: A Project of the National Center for the Study of Adult Learning and Literacy

ERIC Educational Resources Information Center

Comings, John, Ed.; Garner, Barbara, Ed.; Smith, Cristine, Ed.

2004-01-01

"The Review of Adult Learning and Literacy: Connecting Research Policy, and Practice, Volume 4" is an addition to a series of annual publications of the National Center for the Study of Adult Learning and Literacy (NCSALL) that address major issues, the latest research, and the best practices in the field of adult literacy and learning.…

A continuation of base-line studies for environmentally monitoring Space Transportation Systems (STS) at John F. Kennedy Space Center. Volume 4: Threatened and endangered species of the Kennedy Space Center. Part 2: Threatened and endangered birds and other threatened and endangered forms

NASA Technical Reports Server (NTRS)

Ehrhart, L. M.

1980-01-01

Data are presented which were collected by ground and aerial surveillance of 37 species of birds observed within the environs of KSC which are on lists of rare and endangered biota in Florida. Additional information was obtained on other threatened species such as the West Indian manatee, the salt marsh snake, the Indigo snake, the Gopher tortoise, the American alligator, and the Florida mouse. Results of the literature search were used to obtain a historical perspective and aid in the analysis of the field data collected.

Evaluating Transient Global and Regional Model Simulations: Bridging the Model/Observations Information Gap

NASA Astrophysics Data System (ADS)

Rutledge, G. K.; Karl, T. R.; Easterling, D. R.; Buja, L.; Stouffer, R.; Alpert, J.

2001-05-01

A major transition in our ability to evaluate transient Global Climate Model (GCM) simulations is occurring. Real-time and retrospective numerical weather prediction analysis, model runs, climate simulations and assessments are proliferating from a handful of national centers to dozens of groups across the world. It is clear that it is no longer sufficient for any one national center to develop its data services alone. The comparison of transient GCM results with the observational climate record is difficult for several reasons. One limitation is that the global distributions of a number of basic climate quantities, such as precipitation, are not well known. Similarly, observational limitations exist with model re-analysis data. Both the NCEP/NCAR, and the ECMWF, re-analysis eliminate the problems of changing analysis systems but observational data also contain time-dependant biases. These changes in input data are blended with the natural variability making estimates of true variability uncertain. The need for data homogeneity is critical to study questions related to the ability to evaluate simulation of past climate. One approach to correct for time-dependant biases and data sparse regions is the development and use of high quality 'reference' data sets. The primary U.S. National responsibility for the archive and service of weather and climate data rests with the National Climatic Data Center (NCDC). However, as supercomputers increase the temporal and spatial resolution of both Numerical Weather Prediction (NWP) and GCM models, the volume and varied formats of data presented for archive at NCDC, using current communications technologies and data management techniques is limiting the scientific access of these data. To address this ever expanding need for climate and NWP information, NCDC along with the National Center's for Environmental Prediction (NCEP) have initiated the NOAA Operational Model Archive and Distribution System (NOMADS). NOMADS is a collaboration between the Center for Ocean-Land-Atmosphere studies (COLA); the Geophysical Fluid Dynamics Laboratory (GFDL); the George Mason University (GMU); the National Center for Atmospheric Research (NCAR); the NCDC; NCEP; the Pacific Marine Environmental Laboratory (PMEL); and the University of Washington. The objective of the NOMADS is to preserve and provide retrospective access to GCM's and reference quality long-term observational and high volume three dimensional data as well as NCEP NWP models and re-start and re-analysis information. The creation of the NOMADS features a data distribution, format independent, methodology enabling scientific collaboration between researchers. The NOMADS configuration will allow a researcher to transparently browse, extract and intercompare retrospective observational and model data products from any of the participating centers. NOMADS will provide the ability to easily initialize and compare the results of ongoing climate model assessments and NWP output. Beyond the ingest and access capability soon to be implemented with NOMADS is the challenge of algorithm development for the inter-comparison of large-array data (e.g., satellite and radar) with surface, upper-air, and sub-surface ocean observational data. The implementation of NOMADS should foster the development of new quality control processes by taking advantage of distributed data access.

Bragg superlattice for obtaining individual photoluminescence of diamond color centers in dense 3D ensembles

NASA Astrophysics Data System (ADS)

Kukushkin, V. A.

2017-10-01

A way to significantly increase the spatial resolution of the color center photoluminescence collection in chemically vapor-deposited (CVD) diamond at a fixed exciting beam focal volume is suggested. It is based on the creation of a narrow waveguide for the color center photoluminescence with a small number of allowed vertical indices of guided modes. The waveguide is formed between the top surface of a CVD diamond film and an underlaid mirror—a Bragg superlattice made of interchanging high- and low boron-doped layers of CVD diamond. The guided color center photoluminescence is extracted through the top surface of a CVD diamond film with the frustrated total internal reflection method. According to the results of simulation made for a case when color centers are nitrogen-vacancy (NV) centers, the suggested way allows to increase the maximal value of the NV center concentration still compatible with selective collection of their photoluminescence by several times at a fixed exciting beam focal volume. This increase is provided without the deterioration of the NV center photoluminescence collection efficiency.

Planning for the Rheumatologist Workforce: Factors Associated With Work Hours and Volumes.

PubMed

Barber, Claire E H; Nasr, Mina; Barnabe, Cheryl; Badley, Elizabeth M; Lacaille, Diane; Pope, Janet; Cividino, Alfred; Yacyshyn, Elaine; Baillie, Cory; Mosher, Dianne; Thomson, John G; Charnock, Christine; Thorne, J Carter; Zummer, Michel; Brophy, Julie; Ruban, Thanu Nadarajah; Ahluwalia, Vandana; McDougall, Robert; Marshall, Deborah A

2018-05-25

The aim of this study was to evaluate factors associated with rheumatologists' clinical work hours and patient volumes based on a national workforce survey in rheumatology. Adult rheumatologists who participated in a 2015 workforce survey were included (n = 255). Univariate analysis evaluated the relationship between demographics (sex, age, academic vs. community practice, billing fee for service vs. other plan, years in practice, retirement plans) and workload (total hours and number of ½-day clinics per week) or patient volumes (number of new and follow-up consults per week). Multiple linear regression models were used to evaluate the relationship between practice type, sex, age, and working hours or clinical volumes. Male rheumatologists had more ½-day clinics (P = 0.05) and saw more new patients per week (P = 0.001) compared with females. Community rheumatologists had more ½-day clinics and new and follow-up visits per week (all P < 0.01). Fee-for-service rheumatologists reported more ½-day clinics per week (P < 0.001) and follow-ups (P = 0.04). Workload did not vary by age, years in practice, or retirement plans. In multivariate analysis, community practice remained independently associated with higher patient volumes and more clinics per week. Female rheumatologists reported fewer clinics and fewer follow-up patients per week than males, but this did not affect the duration of working hours or new consultations. Age was not associated with work volumes or hours. Practice type and rheumatologist sex should be considered when evaluating rheumatologist workforce needs, as the proportion of female rheumatologists has increased over time and alternative billing practices have been introduced in many centers.

The contribution of multidimensional spatial analysis to a waste management policy: implementation of the ELECTRE method for characterizing transfer centers in the region of Oran

NASA Astrophysics Data System (ADS)

Saidi, A.; Trache, M. A.; Khelfi, M. F.

2016-08-01

The social and economic activity steadily growing in our cities creates a significant waste production in constantly evolving. The management of this waste is problematic because it is the center of many issues and interests. Indeed, any action or decision to the collection, transportation, treatment and disposal of waste should be considered in the economic, social, political and especially environmental aspect. A global Geomatic solution requires implementing a GIS with powerful multidimensional spatial analysis tools that support really waste management problem. Algeria has adopted a solution of waste landfill for all urban cities. In the Oran region, it exists three Centers Controlled landfill (CET) which the most important is that of Hassi-Bounif. This center currently meeting the needs of the region is unsustainable solution at the long-term because of its rapid saturation and its geographic location, which is still far from city centers (20-30 km) implying a negative impact on the vehicle park collecting such frequent breakdowns, the rapid degradation, slow delivery time and especially the high cost of the maintenance operation. This phenomenon is aggravated by the absence of real and actual initiatives targeting the recycling and recovery of waste, which makes the CET an endpoint for all types of waste. We present in this study, the use of the ELECTRE method (Multicriteria Analysis) integrated into a GIS to characterize the impact of the implementation of transfers centers at Oran region. The results of this study will accentuate the advantages of the activation of waste warehouse closer to the city, and relieving considerably the volume of transfer towards CET. The objective of our presentation is to show the leading role of the new Geomatics tools and the multidimensional spatial analysis in the apprehension of an environmental problem such the waste management and more generally in the urban management.

Comparative analysis of operational forecasts versus actual weather conditions in airline flight planning, volume 4

NASA Technical Reports Server (NTRS)

Keitz, J. F.

1982-01-01

The impact of more timely and accurate weather data on airline flight planning with the emphasis on fuel savings is studied. This volume of the report discusses the results of Task 4 of the four major tasks included in the study. Task 4 uses flight plan segment wind and temperature differences as indicators of dates and geographic areas for which significant forecast errors may have occurred. An in-depth analysis is then conducted for the days identified. The analysis show that significant errors occur in the operational forecast on 15 of the 33 arbitrarily selected days included in the study. Wind speeds in an area of maximum winds are underestimated by at least 20 to 25 kts. on 14 of these days. The analysis also show that there is a tendency to repeat the same forecast errors from prog to prog. Also, some perceived forecast errors from the flight plan comparisons could not be verified by visual inspection of the corresponding National Meteorological Center forecast and analyses charts, and it is likely that they are the result of weather data interpolation techniques or some other data processing procedure in the airlines' flight planning systems.

NASA University Research Centers Technical Advances in Aeronautics, Space Sciences and Technology, Earth Systems Sciences, Global Hydrology, and Education. Volumes 2 and 3

NASA Technical Reports Server (NTRS)

Coleman, Tommy L. (Editor); White, Bettie (Editor); Goodman, Steven (Editor); Sakimoto, P. (Editor); Randolph, Lynwood (Editor); Rickman, Doug (Editor)

1998-01-01

This volume chronicles the proceedings of the 1998 NASA University Research Centers Technical Conference (URC-TC '98), held on February 22-25, 1998, in Huntsville, Alabama. The University Research Centers (URCS) are multidisciplinary research units established by NASA at 11 Historically Black Colleges or Universities (HBCU's) and 3 Other Minority Universities (OMU's) to conduct research work in areas of interest to NASA. The URC Technical Conferences bring together the faculty members and students from the URC's with representatives from other universities, NASA, and the aerospace industry to discuss recent advances in their fields.

Aggressive Surgical Management of Congenital Diaphragmatic Hernia: Worth the Effort?: A Multicenter, Prospective, Cohort Study.

PubMed

Harting, Matthew T; Hollinger, Laura; Tsao, Kuojen; Putnam, Luke R; Wilson, Jay M; Hirschl, Ronald B; Skarsgard, Erik D; Tibboel, Dick; Brindle, Mary E; Lally, Pamela A; Miller, Charles C; Lally, Kevin P

2018-05-01

The objectives of this study were (i) to evaluate infants with congenital diaphragmatic hernia (CDH) that do not undergo repair, (ii) to identify nonrepair rate by institution, and (iii) to compare institutional outcomes based on nonrepair rate. Approximately 20% of infants with CDH go unrepaired and the threshold to offer surgical repair is variable. Data were abstracted from a multicenter, prospectively collected database. Standard clinical variables, including repair (or nonrepair), and outcome were analyzed. Institutions were grouped based on volume and rate of nonrepair. Preoperative mortality predictors were identified using logistic regression, expected mortality for each center was calculated, and observed /expected (O/E) ratios were computed for center groups and compared by Kruskal-Wallis ANOVA. A total of 3965 infants with CDH were identified and 691 infants (17.5%) were not repaired. Nonrepaired patients had lower Apgar scores (P < 0.05) and increased incidence of anomalies (P < 0.0001). Low-volume centers ("Lo", n=44 total, < 10 CDH pts/yr) and high-volume centers ("Hi", n = 21) had median nonrepair rates of 19.8% (range 0%-66.7%) and 16.7% (5.1%-38.5%), respectively. High-volume centers were further dichotomized by rate of nonrepair (HiLo = 5.1-16.7% and HiHi = 17.6-38.5%), leaving 3 groups: HiLo, HiHi, and Lo. Predictors of mortality were lower birth weight, lower Apgar scores, prenatal diagnosis, and presence of congenital anomalies. O/E ratios for mortality in the HiLo, HiHi, and Lo groups were 0.81, 0.94, and 1.21, respectively (P < 0.0001). For every 100 CDH patients, HiLo centers have 2.73 (2.4-3.1, 95% confidence interval) survivors beyond expectation. There are significant differences between repaired and nonrepaired CDH infants and significant center variation in rate of nonrepair exists. Aggressive surgical management, leading to a low rate of nonrepair, is associated with improved risk-adjusted mortality.

Integrated payload and mission planning, phase 3. Volume 2: Logic/Methodology for preliminary grouping of spacelab and mixed cargo payloads

NASA Technical Reports Server (NTRS)

Rodgers, T. E.; Johnson, J. F.

1977-01-01

The logic and methodology for a preliminary grouping of Spacelab and mixed-cargo payloads is proposed in a form that can be readily coded into a computer program by NASA. The logic developed for this preliminary cargo grouping analysis is summarized. Principal input data include the NASA Payload Model, payload descriptive data, Orbiter and Spacelab capabilities, and NASA guidelines and constraints. The first step in the process is a launch interval selection in which the time interval for payload grouping is identified. Logic flow steps are then taken to group payloads and define flight configurations based on criteria that includes dedication, volume, area, orbital parameters, pointing, g-level, mass, center of gravity, energy, power, and crew time.

Heat Melt Compaction as an Effective Treatment for Eliminating Microorganisms from Solid Waste

NASA Technical Reports Server (NTRS)

Hummerick, Mary P.; Strayer, Richard F.; McCoy, Lashelle E.; Richards, Jeffrey T.; Ruby, Anna Maria; Wheeler, Ray; Fisher, John

2013-01-01

One of the technologies being tested at NASA Ames Research Center (ARC) for the Advance Exploration Systems program and as part of the logistics and repurposing project is heat melt compaction (HMC) of solid waste. Reduces volume, removes water and renders a biologically stable and safe product. The HMC compacts and reduces the trash volume as much as 90o/o greater than the current manual compaction used by the crew.The project has three primary goals or tasks. 1. Microbiological analysis of HMC hardware surfaces before and after operation. 2. Microbiological and physical characterizations of heat melt tiles made from trash at different processing times and temperatures. 3. Long term storage and stability of HMC trash tiles or "Do the bugs grow back?"

Military Occupational Speciality Training Cost Handbook (MOSB)

DTIC Science & Technology

1983-10-01

FINANCE & ACCOUNTING CENTER "JUN 1 i 184’, l APPROVED:_ . A " W. M. ALLENi T - DIRECTOR OF COST ANALYSIS _ "OFFICE OF THE COMPTROLLER OF THE ARMYj 84 04 16 ...COVERED j14. DATE OF REPORT (Yr.. Alo.. Day) 15 AE COUNT 16 . SUPPLEMENTARY NOTAOMION IFROM TO 83/10 43o Supersedes Volumes I and II, MOSB, dated 81... depreciation of equipment, minimum consumption of utilities, pay of minimum grounds staff, etc. Of course, per capita fixed cost will rise with a decreasing

Cannon Reservoir Human Ecology Project. Volume 2. An Analysis of Historical Ceramics from the Central Salt River Valley of Northeast Missouri.

DTIC Science & Technology

1984-01-01

common with how ceramic items wcre centered on sites in the eastern United States, almost to cataloged and marketed . To understand something about...that functioned relative to Sto Prese for eteaiatio n of alI d current modes of production. As markets were estab- Seven of the 34 sites were...historical-period contexts potters viewed the ceramic pieces they manufactured tend to emphasize one or more of the following objectives: and marketed

Medical Research: A Bibliography of Walter Reed Army Medical Center Staff Publications, 1986-1989. Volume 1

DTIC Science & Technology

1990-01-01

Wilson PD Jr: Fracture of the femoral component. Analysis of failure and long-term follow-up of rev-ision. Orthop Chin North Am 1988 Jul;19(3):637-47...DMED,DCI 88224857 Dysart SH, Savory CG, Callaghan JJ: Nonoperative treatment of a postoperative fracture around an uncemented porous-coated femoral...trochanter fractures of the hip without intertrochanteric extension: a case report. Milit Med 1988 Aug;153(8):421-3. DSURG 89015096 Lucente FE, Patow

Legal Aspects: Civilians/Contractors in the War Zone And Disaster Relief Support Joint Center for Operational Analysis Journal, Volume 10, Issue 2, June 2008

DTIC Science & Technology

2008-06-01

operations . The JSC, however, has analyzed the new legislation and their JCOA Journal, June 2008 13 recommendations for managing how these cases are...CBRNE) consequence management operations . 4 While the Department of Homeland Security’s (DHS) Federal Emergency Management Agency (FEMA) 5 is...affect the Department of Defense’s consequence management operations in support of a primary federal agency. Although the U.S. Constitution’s Supremacy

Low Angle-of-Attack Longitudinal Aerodynamic Parameters of Navy T-2 Trainer Aircraft Extracted from Flight Data: A Comparison of Identification Techniques. Volume I. Data Acquisition and Modified Newton-Raphson Analysis

DTIC Science & Technology

1975-06-23

SYSTEM • The numbunng o» tec^nic«! pioject (ep<.iii muert My the N<»v-«l AN Development Center is ariaogert (or specific identitf.ition onrposti E«i.h...chord (W.P. + 73,92) Av Sweepback (257. chord) Airfoil Section lv Tall length (.25 cw to .25 cv) VERTICAL FIN Sf Area (including 2.14 ft 2

Solid Modeling Aerospace Research Tool (SMART) user's guide, version 2.0

NASA Technical Reports Server (NTRS)

Mcmillin, Mark L.; Spangler, Jan L.; Dahmen, Stephen M.; Rehder, John J.

1993-01-01

The Solid Modeling Aerospace Research Tool (SMART) software package is used in the conceptual design of aerospace vehicles. It provides a highly interactive and dynamic capability for generating geometries with Bezier cubic patches. Features include automatic generation of commonly used aerospace constructs (e.g., wings and multilobed tanks); cross-section skinning; wireframe and shaded presentation; area, volume, inertia, and center-of-gravity calculations; and interfaces to various aerodynamic and structural analysis programs. A comprehensive description of SMART and how to use it is provided.

An Analysis of Image Segmentation Time in Beam’s-Eye-View Treatment Planning

DOE Office of Scientific and Technical Information (OSTI.GOV)

Li, Chun; Spelbring, D.R.; Chen, George T.Y.

In this work we tabulate and histogram the image segmentation time for beam’s eye view (BEV) treatment planning in our center. The average time needed to generate contours on CT images delineating normal structures and treatment target volumes is calculated using a data base containing over 500 patients’ BEV plans. The average number of contours and total image segmentation time needed for BEV plans in three common treatment sites, namely, head/neck, lung/chest, and prostate, were estimated.

WSTIAC: Weapon Systems Technology Information Analysis Center. Volume 6, Number 1

DTIC Science & Technology

2005-01-01

official documentation. 2 WS"IAE Newslelter Winter 2005 Lobster Robo [s (Continued from page 1) When compared to terrestrial arthropods, underwater...were partially offset by a net during the S&T phase, could help ease the transition to the decrease of planned quantities to be purchased (-$24.4...environment to archive the ly always involves the use of a Test and Evaluation Master development of an entire system, on paper qnd/or elec- Plan (TEMP). Test

Risk adjustment for case mix and the effect of surgeon volume on morbidity.

PubMed

Maas, Matthew B; Jaff, Michael R; Rordorf, Guy A

2013-06-01

Retrospective studies of large administrative databases have shown higher mortality for procedures performed by low-volume surgeons, but the adequacy of risk adjustment in those studies is in doubt. To determine whether the relationship between surgeon volume and outcomes is an artifact of case mix using a prospective sample of carotid endarterectomy cases. Observational cohort study from January 1, 2008, through December 31, 2010, with preoperative, immediate postoperative, and 30-day postoperative assessments acquired by independent monitors. Urban, tertiary academic medical center. All 841 patients who underwent carotid endarterectomy performed by a vascular surgeon or cerebrovascular neurosurgeon at the institution. Carotid endarterectomy without another concurrent surgery. Stroke, death, and other surgical complications occurring within 30 days of surgery along with other case data. A low-volume surgeon performed 40 or fewer cases per year. Variables used in a comparison administrative database study, as well as variables identified by our univariate analysis, were used for adjusted analyses to assess for an association between low-volume surgeons and the rate of stroke and death as well as other complications. RESULTS The rate of stroke and death was 6.9% for low-volume surgeons and 2.0% for high-volume surgeons (P = .001). Complications were similarly higher (13.4% vs 7.2%, P = .008). Low-volume surgeons performed more nonelective cases. Low-volume surgeons were significantly associated with stroke and death in the unadjusted analysis as well as after adjustment with variables used in the administrative database study (odds ratio, 3.61; 95% CI, 1.70-7.67, and odds ratio, 3.68; 95% CI, 1.72-7.89, respectively). However, adjusting for the significant disparity of American Society of Anesthesiologists Physical Status classification in case mix eliminated the effect of surgeon volume on the rate of stroke and death (odds ratio, 1.65; 95% CI, 0.59-4.64) and other complications. Variables selected for risk adjustment in studies using administrative databases appear to be inadequate to control for case mix bias between low-volume and high-volume surgeons. Risk adjustment should empirically analyze for case mix imbalances between surgeons to identify meaningful risk modifiers in clinical practice such as the American Society of Anesthesiologists Physical Status classification. A true relationship between surgeon volume and outcomes remains uncertain, and caution is advised in developing policies based on these findings.

Impact of the establishment of a specialty hernia referral center.

PubMed

Williams, Kristopher B; Belyansky, Igor; Dacey, Kristian T; Yurko, Yuliya; Augenstein, Vedra A; Lincourt, Amy E; Horton, James; Kercher, Kent W; Heniford, B Todd

2014-12-01

Creating a surgical specialty referral center requires a strong interest, expertise, and a market demand in that particular field, as well as some form of promotion. In 2004, we established a tertiary hernia referral center. Our goal in this study was to examine its impact on institutional volume and economics. The database of all hernia repairs (2004-2011) was reviewed comparing hernia repair type and volume and center financial performance. The ventral hernia repair (VHR) patient subset was further analyzed with particular attention paid to previous repairs, comorbidities, referral patterns, and the concomitant involvement of plastic surgery. From 2004 to 2011, 4927 hernia repairs were performed: 39.3% inguinal, 35.5% ventral or incisional, 16.2% umbilical, 5.8% diaphragmatic, 1.6% femoral, and 1.5% other. Annual billing increased yearly from 7% to 85% and averaged 37% per year. Comparing 2004 with 2011, procedural volume increased 234%, and billing increased 713%. During that period, there was a 2.5-fold increase in open VHRs, and plastic surgeon involvement increased almost 8-fold, (P = .004). In 2005, 51 VHR patients had a previous repair, 27.0% with mesh, versus 114 previous VHR in 2011, 58.3% with mesh (P < .0001). For VHR, in-state referrals from 2004 to 2011 increased 340% while out-of-state referrals jumped 580%. In 2011, 21% of all patients had more than 4 comorbidities, significantly increased from 2004 (P = .02). The establishment of a tertiary, regional referral center for hernia repair has led to a substantial increase in surgical volume, complexity, referral geography, and financial benefit to the institution. © The Author(s) 2014.

Issues in the Development of Long Term Care Gerontology Centers: The Centers Concept. Selected Topics in Long Term Care. Volume 6.

ERIC Educational Resources Information Center

Mortenson, Lee E.; Berdes, Celia M.

This document, one in a series developed to provide technical assistance to 22 Long-Term Care Gerontology Centers, describes the current administrative and structural phenomenon of these centers. Precedents useful in assessing both the current climate and actual prospects for development of long term care centers are cited. The first section…

Center Stage: A Platform for the Discussion of Teaching/Learning Ideas. 1991-1992.

ERIC Educational Resources Information Center

O'Heron, Paul, Ed.

1992-01-01

"Center Stage" is a monthly publication of Broome Community College (Binghamton, New York), sponsored by the Teaching Resources Center as a platform for the discussion of ideas about teaching and learning by Broome College faculty. The second volume (nine issues) of "Center Stage" includes the following articles: "Towards a Learning Community:…

Optimizing efficiency and operations at a California safety-net endoscopy center: a modeling and simulation approach.

PubMed

Day, Lukejohn W; Belson, David; Dessouky, Maged; Hawkins, Caitlin; Hogan, Michael

2014-11-01

Improvements in endoscopy center efficiency are needed, but scant data are available. To identify opportunities to improve patient throughput while balancing resource use and patient wait times in a safety-net endoscopy center. Safety-net endoscopy center. Outpatients undergoing endoscopy. A time and motion study was performed and a discrete event simulation model constructed to evaluate multiple scenarios aimed at improving endoscopy center efficiency. Procedure volume and patient wait time. Data were collected on 278 patients. Time and motion study revealed that 53.8 procedures were performed per week, with patients spending 2.3 hours at the endoscopy center. By using discrete event simulation modeling, a number of proposed changes to the endoscopy center were assessed. Decreasing scheduled endoscopy appointment times from 60 to 45 minutes led to a 26.4% increase in the number of procedures performed per week, but also increased patient wait time. Increasing the number of endoscopists by 1 each half day resulted in increased procedure volume, but there was a concomitant increase in patient wait time and nurse utilization exceeding capacity. By combining several proposed scenarios together in the simulation model, the greatest improvement in performance metrics was created by moving patient endoscopy appointments from the afternoon to the morning. In this simulation at 45- and 40-minute appointment times, procedure volume increased by 30.5% and 52.0% and patient time spent in the endoscopy center decreased by 17.4% and 13.0%, respectively. The predictions of the simulation model were found to be accurate when compared with actual changes implemented in the endoscopy center. Findings may not be generalizable to non-safety-net endoscopy centers. The combination of minor, cost-effective changes such as reducing appointment times, minimizing and standardizing recovery time, and making small increases in preprocedure ancillary staff maximized endoscopy center efficiency across a number of performance metrics. Copyright © 2014 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.

Use of EORTC target definition guidelines for dose-intensified salvage radiation therapy for recurrent prostate cancer: results of the quality assurance program of the randomized trial SAKK 09/10.

PubMed

Sassowsky, Manfred; Gut, Philipp; Hölscher, Tobias; Hildebrandt, Guido; Müller, Arndt-Christian; Najafi, Yousef; Kohler, Götz; Kranzbühler, Helmut; Guckenberger, Matthias; Zwahlen, Daniel R; Azinwi, Ngwa C; Plasswilm, Ludwig; Takacs, Istvan; Reuter, Christiane; Sumila, Marcin; Manser, Peter; Ost, Piet; Böhmer, Dirk; Pilop, Christiane; Aebersold, Daniel M; Ghadjar, Pirus

2013-11-01

Different international target volume delineation guidelines exist and different treatment techniques are available for salvage radiation therapy (RT) for recurrent prostate cancer, but less is known regarding their respective applicability in clinical practice. A randomized phase III trial testing 64 Gy vs 70 Gy salvage RT was accompanied by an intense quality assurance program including a site-specific and study-specific questionnaire and a dummy run (DR). Target volume delineation was performed according to the European Organisation for the Research and Treatment of Cancer guidelines, and a DR-based treatment plan was established for 70 Gy. Major and minor protocol deviations were noted, interobserver agreement of delineated target contours was assessed, and dose-volume histogram (DVH) parameters of different treatment techniques were compared. Thirty European centers participated, 43% of which were using 3-dimensional conformal RT (3D-CRT), with the remaining centers using intensity modulated RT (IMRT) or volumetric modulated arc technique (VMAT). The first submitted version of the DR contained major deviations in 21 of 30 (70%) centers, mostly caused by inappropriately defined or lack of prostate bed (PB). All but 5 centers completed the DR successfully with their second submitted version. The interobserver agreement of the PB was moderate and was improved by the DR review, as indicated by an increased κ value (0.59 vs 0.55), mean sensitivity (0.64 vs 0.58), volume of total agreement (3.9 vs 3.3 cm(3)), and decrease in the union volume (79.3 vs 84.2 cm(3)). Rectal and bladder wall DVH parameters of IMRT and VMAT vs 3D-CRT plans were not significantly different. The interobserver agreement of PB delineation was moderate but was improved by the DR. Major deviations could be identified for the majority of centers. The DR has improved the acquaintance of the participating centers with the trial protocol. Copyright © 2013 Elsevier Inc. All rights reserved.

Provider cost analysis supports results-based contracting out of maternal and newborn health services: an evidence-based policy perspective.

PubMed

Hatcher, Peter; Shaikh, Shiraz; Fazli, Hassan; Zaidi, Shehla; Riaz, Atif

2014-11-13

There is dearth of evidence on provider cost of contracted out services particularly for Maternal and Newborn Health (MNH). The evidence base is weak for policy makers to estimate resources required for scaling up contracting. This paper ascertains provider unit costs and expenditure distribution at contracted out government primary health centers to inform the development of optimal resource envelopes for contracting out MNH services. This is a case study of provider costs of MNH services at two government Rural Health Centers (RHCs) contracted out to a non-governmental organization in Pakistan. It reports on four selected Basic Emergency Obstetrical and Newborn Care (BEmONC) services provided in one RHC and six Comprehensive Emergency Obstetrical and Newborn Care (CEmONC) services in the other. Data were collected using staff interviews and record review to compile resource inputs and service volumes, and analyzed using the CORE Plus tool. Unit costs are based on actual costs of MNH services and are calculated for actual volumes in 2011 and for volumes projected to meet need with optimal resource inputs. The unit costs per service for actual 2011 volumes at the BEmONC RHC were antenatal care (ANC) visit USD$ 18.78, normal delivery US$ 84.61, newborn care US$ 16.86 and a postnatal care (PNC) visit US$ 13.86; and at the CEmONC RHC were ANC visit US$ 45.50, Normal Delivery US$ 148.43, assisted delivery US$ 167.43, C-section US$ 183.34, Newborn Care US$ 41.07, and PNC visit US$ 27.34. The unit costs for the projected volumes needed were lower due to optimal utilization of resources. The percentage distribution of expenditures at both RHCs was largest for salaries of technical staff, followed by salaries of administrative staff, and then operating costs, medicines, medical and diagnostic supplies. The unit costs of MNH services at the two contracted out government rural facilities remain higher than is optimal, primarily due to underutilization. Provider cost analysis using standard treatment guideline (STG) based service costing frameworks should be applied across a number of health facilities to calculate the cost of services and guide development of evidence based resource envelopes and performance based contracting.

Magnetic resonance imaging volume of the angular gyri predicts financial skill deficits in people with amnestic mild cognitive impairment.

PubMed

Griffith, H Randall; Stewart, Christopher C; Stoeckel, Luke E; Okonkwo, Ozioma C; den Hollander, Jan A; Martin, Roy C; Belue, Katherine; Copeland, Jacquelynn N; Harrell, Lindy E; Brockington, John C; Clark, David G; Marson, Daniel C

2010-02-01

To better understand how brain atrophy in amnestic mild cognitive impairment (MCI) as measured using magnetic resonance imaging (MRI) volumetrics could affect instrumental activities of daily living (IADLs) such as financial abilities. Controlled, matched-sample, cross-sectional analysis regressing MRI volumetrics with financial performance measures. University medical and research center. Thirty-eight people with MCI and 28 older adult controls. MRI volumetric measurement of the hippocampi, angular gyri, precunei, and medial frontal lobes. Participants also completed neuropsychological tests and the Financial Capacity Instrument (FCI). Correlations were performed between FCI scores and MRI volumes in the group with MCI. People with MCI performed significantly below controls on the FCI and had significantly smaller hippocampi. Among people with MCI, performance on the FCI was moderately correlated with angular gyri and precunei volumes. Regression models demonstrated that angular gyrus volumes were predictive of FCI scores. Tests of mediation showed that measures of arithmetic and possibly attention partially mediated the relationship between angular gyrus volume and FCI score. Impaired financial abilities in amnestic MCI correspond with volume of the angular gyri as mediated by arithmetic knowledge. The findings suggest that early neuropathology within the lateral parietal region in MCI leads to a breakdown of cognitive abilities that affect everyday financial skills. The findings have implications for diagnosis and clinical care of people with MCI and AD.

Patient selection and volume in the era surrounding implementation of Medicare conditions of participation for transplant programs.

PubMed

White, Sarah L; Zinsser, Dawn M; Paul, Matthew; Levine, Gregory N; Shearon, Tempie; Ashby, Valarie B; Magee, John C; Li, Yi; Leichtman, Alan B

2015-04-01

To evaluate evidence of practice changes affecting kidney transplant program volumes, and donor, recipient and candidate selection in the era surrounding the introduction of Centers for Medicare and Medicaid Services (CMS) conditions of participation (CoPs) for organ transplant programs. Scientific Registry of Transplant Recipients; CMS ESRD and Medicare claims databases. Retrospective analysis of national registry data. A Cox proportional hazards model of 1-year graft survival was used to derive risks associated with deceased-donor kidney transplants performed from 2001 to 2010. Among programs with ongoing noncompliance with the CoPs, kidney transplant volumes declined by 38 percent (n = 766) from 2006 to 2011, including a 55 percent drop in expanded criteria donor transplants. Volume increased by 6 percent (n = 638) among programs remaining in compliance. Aggregate risk of 1-year graft failure increased over time due to increasing recipient age and obesity, and longer ESRD duration. Although trends in aggregate risk of 1-year kidney graft loss do not indicate that the introduction of the CoPs has systematically reduced opportunities for marginal candidates or that there has been a systematic shift away from utilization of higher risk deceased donor kidneys, total volume and expanded criteria donor utilization decreased overall among programs with ongoing noncompliance. © Health Research and Educational Trust.

Changes in the planning target volume and liver volume dose based on the selected respiratory phase in respiratory-gated radiation therapy for a hepatocellular carcinoma

NASA Astrophysics Data System (ADS)

Lee, Jae-Seung; Im, In-Chul; Kang, Su-Man; Goo, Eun-Hoe; Baek, Seong-Min

2013-11-01

The aim of this study was to quantitatively analyze the changes in the planning target volume (PTV) and liver volume dose based on the respiratory phase to identify the optimal respiratory phase for respiratory-gated radiation therapy for a hepatocellular carcinoma (HCC). Based on the standardized procedure for respiratory-gated radiation therapy, we performed a 4-dimensional computed tomography simulation for 0 ˜ 90%, 30 ˜ 70%, and 40 ˜ 60% respiratory phases to assess the respiratory stability (S R ) and the defined PTV i for each respiratory phase i. A treatment plan was established, and the changes in the PTV i and dose volume of the liver were quantitatively analyzed. Most patients (91.5%) passed the respiratory stability test (S R = 0.111 ± 0.015). With standardized respiration training exercises, we were able to minimize the overall systematic error caused by irregular respiration. Furthermore, a quantitative analysis to identify the optimal respiratory phase revealed that when a short respiratory phase (40 ˜ 60%) was used, the changes in the PTV were concentrated inside the center line; thus, we were able to obtain both a PTV margin accounting for respiration and a uniform radiation dose within the PTV.

ERCMExpress. Volume 1, Issue 1

ERIC Educational Resources Information Center

US Department of Education, 2005

2005-01-01

This is the inaugural issue of the Emergency Response and Crisis Management (ERCM) Technical Assistance Center's "ERCMExpress," and it focuses on the new technical assistance center. The center will support 243 grantees funded under the Emergency Response and Crisis Management program in managing and implementing their projects, and in sustaining…

Prospective study of cost of care at multidisciplinary ALS centers adhering to American Academy of Neurology (AAN) ALS practice parameters.

PubMed

Boylan, Kevin; Levine, Todd; Lomen-Hoerth, Catherine; Lyon, Mary; Maginnis, Kimberly; Callas, Peter; Gaspari, Celeste; Tandan, Rup

2015-01-01

Multidisciplinary care in ALS is associated with longer survival, improved quality of life, and reduced hospital admissions, but there are no published data on institutional costs associated with multidisciplinary ALS care at U.S. centers. We prospectively examined institutional costs, adherence to AAN Practice Parameters and patient satisfaction in multidisciplinary ALS clinics at 18 U.S. ALS centers. Centers reported patient volumes; direct costs for staff salary/benefits, supplies and equipment; and institutional non-salary and overhead costs over a three-month period. In 1117 patients seen during this period, mean age was 61.5 years (range 25-91 years), 56% were male, and mean ALSFRS-R score was 29. Mean total salary/benefit cost per clinic day for all providers was $2964 (range $1692-$5236 across centers). Mean salary/benefit cost per patient per clinic was $507 (range $258-$806 across centers). Differences among centers in reporting non-salary costs prevented meaningful analysis. Practice parameter adherence and patient satisfaction were high. This prospective collaborative study demonstrates the direct financial burden of evidence-based multidisciplinary ALS care in the U.S.; more refined non-salary and overhead cost data are needed to evaluate the full cost impact of care. These data may be useful in supporting evidence-based models of patient centered care for ALS.

Mechanical ventilation during extracorporeal membrane oxygenation. An international survey.

PubMed

Marhong, Jonathan D; Telesnicki, Teagan; Munshi, Laveena; Del Sorbo, Lorenzo; Detsky, Michael; Fan, Eddy

2014-07-01

In patients with severe, acute respiratory failure undergoing venovenous extracorporeal membrane oxygenation (VV-ECMO), the optimal strategy for mechanical ventilation is unclear. Our objective was to describe ventilation practices used in centers registered with the Extracorporeal Life Support Organization (ELSO). We conducted an international cross-sectional survey of medical directors and ECMO program coordinators from all ELSO-registered centers. The survey was distributed using a commercial website that collected information on center characteristics, the presence of a mechanical ventilator protocol, ventilator settings, and weaning practices. E-mails were sent out to medical directors or coordinators at each ELSO center and their responses were pooled for analysis. We analyzed 141 (50%) individual responses from the 283 centers contacted across 28 countries. Only 27% of centers reported having an explicit mechanical ventilation protocol for ECMO patients. The majority of these centers (77%) reported "lung rest" to be the primary goal of mechanical ventilation, whereas 9% reported "lung recruitment" to be their ventilation strategy. A tidal volume of 6 ml/kg or less was targeted by 76% of respondents, and 58% targeted a positive end-expiratory pressure of 6-10 cm H2O while ventilating patients on VV-ECMO. Centers prioritized weaning VV-ECMO before mechanical ventilation. Although ventilation practices in patients supported by VV-ECMO vary across ELSO centers internationally, the majority of centers used a strategy that targeted lung-protective thresholds and prioritized weaning VV-ECMO over mechanical ventilation.

The Impact of Hospital Size on CMS Hospital Profiling.

PubMed

Sosunov, Eugene A; Egorova, Natalia N; Lin, Hung-Mo; McCardle, Ken; Sharma, Vansh; Gelijns, Annetine C; Moskowitz, Alan J

2016-04-01

The Centers for Medicare & Medicaid Services (CMS) profile hospitals using a set of 30-day risk-standardized mortality and readmission rates as a basis for public reporting. These measures are affected by hospital patient volume, raising concerns about uniformity of standards applied to providers with different volumes. To quantitatively determine whether CMS uniformly profile hospitals that have equal performance levels but different volumes. Retrospective analysis of patient-level and hospital-level data using hierarchical logistic regression models with hospital random effects. Simulation of samples including a subset of hospitals with different volumes but equal poor performance (hospital effects=+3 SD in random-effect logistic model). A total of 1,085,568 Medicare fee-for-service patients undergoing 1,494,993 heart failure admissions in 4930 hospitals between July 1, 2005 and June 30, 2008. CMS methodology was used to determine the rank and proportion (by volume) of hospitals reported to perform "Worse than US National Rate." Percent of hospitals performing "Worse than US National Rate" was ∼40 times higher in the largest (fifth quintile by volume) compared with the smallest hospitals (first quintile). A similar gradient was seen in a cohort of 100 hospitals with simulated equal poor performance (0%, 0%, 5%, 20%, and 85% in quintiles 1 to 5) effectively leaving 78% of poor performers undetected. Our results illustrate the disparity of impact that the current CMS method of hospital profiling has on hospitals with higher volumes, translating into lower thresholds for detection and reporting of poor performance.

Summer Research Program (1992). Summer Faculty Research Program (SFRP) Reports. Volume 6. Arnold Engineering Development Center, Civil Engineering Laboratory, Frank J. Seiler Research Laboratory, Wilford Hall Medical Center

DTIC Science & Technology

1992-12-01

concentrations of DNT, its degradation intermediate 4-methyl 5- nitrocatechol, and TNT were determined by high pressure liquid chromatography (HPLC...to more cost-effective site characterization and cleanup. Many such studies have been performed using chromatography and/or liquid scintillation...volume set that summarizes the research accomplishments of faculty, graduate student, and high school participants in the 1992 AFOSR Summer Research

Hurricane Forecasting with the High-resolution NASA Finite-volume General Circulation Model

NASA Technical Reports Server (NTRS)

Atlas, R.; Reale, O.; Shen, B.-W.; Lin, S.-J.; Chern, J.-D.; Putman, W.; Lee, T.; Yeh, K.-S.; Bosilovich, M.; Radakovich, J.

2004-01-01

A high-resolution finite-volume General Circulation Model (fvGCM), resulting from a development effort of more than ten years, is now being run operationally at the NASA Goddard Space Flight Center and Ames Research Center. The model is based on a finite-volume dynamical core with terrain-following Lagrangian control-volume discretization and performs efficiently on massive parallel architectures. The computational efficiency allows simulations at a resolution of a quarter of a degree, which is double the resolution currently adopted by most global models in operational weather centers. Such fine global resolution brings us closer to overcoming a fundamental barrier in global atmospheric modeling for both weather and climate, because tropical cyclones and even tropical convective clusters can be more realistically represented. In this work, preliminary results of the fvGCM are shown. Fifteen simulations of four Atlantic tropical cyclones in 2002 and 2004 are chosen because of strong and varied difficulties presented to numerical weather forecasting. It is shown that the fvGCM, run at the resolution of a quarter of a degree, can produce very good forecasts of these tropical systems, adequately resolving problems like erratic track, abrupt recurvature, intense extratropical transition, multiple landfall and reintensification, and interaction among vortices.

Treatment of Pancreatic and Periampullary Cancers at a Community Hospital: Successful Application of Tertiary Care Treatment Standards

PubMed Central

Moesinger, Robert C.; Davis, Jan W.; Hill, Britani; Johnston, W. Cory; Gray, Carl; Johnson, Harold; Ingersoll, Leslye; Whipple, Gary; Reilly, Mark; Harris, Robert; Hansen, Vincent

2011-01-01

Background. The treatment of pancreatic cancer and other periampullary neoplasms is complex and challenging. Major high-volume cancer centers can provide excellent multidisciplinary care of these patients but almost two-thirds of pancreatic cancer patients are treated at low volume centers. There is very little published data from low volume community cancer programs in regards to the treatment of periampullary cancer. In this study, a review of comprehensive periampullary cancer care at two low volume hospitals with comparison to national standards is presented. Methods. This is a retrospective review of 70 consecutive patients with periampullary neoplasms who underwent surgery over a 5-year period (2006–2010) at two community hospitals. Results. There were 51 successful resections of 70 explorations (73%) including 34 Whipple procedures. Mortality rate was 2.9%. Comparison of these patients to national standards was made in terms of operative mortality, resectability rate, administration of adjuvant therapy, clinical trial participation and overall survival. The results in these patients were comparable to national standards. Conclusions. With adequate commitment of resources and experienced surgical and oncologic practitioners, community cancer centers can meet national tertiary care standards in terms of pancreatic and periampullary cancer care. PMID:22312532

Simulation Framework for Rapid Entry, Descent, and Landing (EDL) Analysis. Volume 2; Appendices

NASA Technical Reports Server (NTRS)

Murri, Daniel G.

2010-01-01

The NASA Engineering and Safety Center (NESC) was requested to establish the Simulation Framework for Rapid Entry, Descent, and Landing (EDL) Analysis assessment, which involved development of an enhanced simulation architecture using the Program to Optimize Simulated Trajectories II (POST2) simulation tool. The assessment was requested to enhance the capability of the Agency to provide rapid evaluation of EDL characteristics in systems analysis studies, preliminary design, mission development and execution, and time-critical assessments. Many of the new simulation framework capabilities were developed to support the Agency EDL Systems Analysis (EDL-SA) team, that is conducting studies of the technologies and architectures that are required to enable higher mass robotic and human mission to Mars. The appendices to the original report are contained in this document.

Simulation Framework for Rapid Entry, Descent, and Landing (EDL) Analysis. Volume 1

NASA Technical Reports Server (NTRS)

Murri, Daniel G.

2010-01-01

The NASA Engineering and Safety Center (NESC) was requested to establish the Simulation Framework for Rapid Entry, Descent, and Landing (EDL) Analysis assessment, which involved development of an enhanced simulation architecture using the Program to Optimize Simulated Trajectories II (POST2) simulation tool. The assessment was requested to enhance the capability of the Agency to provide rapid evaluation of EDL characteristics in systems analysis studies, preliminary design, mission development and execution, and time-critical assessments. Many of the new simulation framework capabilities were developed to support the Agency EDL Systems Analysis (EDL-SA) team, that is conducting studies of the technologies and architectures that are required to enable higher mass robotic and human mission to Mars. The findings of the assessment are contained in this report.

Choice and competition between adult congenital heart disease centers: evidence of considerable geographical disparities and association with clinical or academic results.

PubMed

Diller, Gerhard-Paul; Kempny, Aleksander; Piorkowski, Adam; Grübler, Martin; Swan, Lorna; Baumgartner, Helmut; Dimopoulos, Konstantinos; Gatzoulis, Michael A

2014-03-01

Although concentrating adult congenital heart disease services at high-volume centers has been widely advocated, the potential beneficial effects of competition and patient choice have received relatively little attention. We aimed to assess the degree of patient choice and competition between adult congenital heart disease units and to investigate whether competition indices correlate with clinical quality or research output. Competition between the 10 major adult congenital heart disease units in England was evaluated based on the Herfindahl-Hirschman Index, representing the sum of squared market shares of individual units. In addition, to account for geography and feasible access, we calculated spatial indices of competition based on travel time by road. These indices were correlated with 30-day mortality postpulmonary valve replacement in adult patients (as obtained from the National Central Cardiac Audit Database) and the aggregate research impact factors of individual centers. On a national level, a high level of competition without obvious dominant players was found (Herfindahl-Hirschman Index between 0.107 and 0.013). When accounting for geography, however, important disparities in patient choice and competition faced by individual centers emerged. The degree of local competition was correlated significantly with clinical outcomes and research output. In contrast, no association between center volume and outcome could be established. Beyond the usual focus on concentrating services at high-volume centers, the potentially beneficial effects of competition should not be ignored. Therefore, policymakers should consider fostering a competitive environment for adult congenital heart disease centers or at least avoiding creating government-granted monopolies in the field.

New Directions in Library and Information Science Education. Final Report. Volume 2.7: Information Center/Clearinghouse Professional Competencies.

ERIC Educational Resources Information Center

Griffiths, Jose-Marie; And Others

This document contains validated activities and competencies needed by information professionals working in an information center/clearinghouse. The activities and competencies are organized according to the functions which information center professionals perform: acquisitions; thesaurus development and control; indexing/abstracting;…

Preoperative Magnetic Resonance Volumetry in Predicting Myometrial Invasion, Lymphovascular Space Invasion, and Tumor Grade: Is It Valuable in International Federation of Gynecology and Obstetrics Stage I Endometrial Cancer?

PubMed

Sahin, Hilal; Sarioglu, Fatma Ceren; Bagci, Mustafa; Karadeniz, Tugba; Uluer, Hatice; Sanci, Muzaffer

2018-05-01

The aim of this retrospective single-center study was to evaluate the relationship between maximum tumor size, tumor volume, tumor volume ratio (TVR) based on preoperative magnetic resonance (MR) volumetry, and negative histological prognostic parameters (deep myometrial invasion [MI], lymphovascular space invasion, tumor histological grade, and subtype) in International Federation of Gynecology and Obstetrics stage I endometrial cancer. Preoperative pelvic MR imaging studies of 68 women with surgical-pathologic diagnosis of International Federation of Gynecology and Obstetrics stage I endometrial cancer were reviewed for assessment of MR volumetry and qualitative assessment of MI. Volume of the tumor and uterus was measured with manual tracing of each section on sagittal T2-weighted images. Tumor volume ratio was calculated according to the following formula: TVR = (total tumor volume/total uterine volume) × 100. Receiver operating characteristics curve was performed to investigate a threshold for TVR associated with MI. The Mann-Whitney U test, Kruskal-Wallis test, and linear regression analysis were applied to evaluate possible differences between tumor size, tumor volume, TVR, and negative prognostic parameters. Receiver operating characteristics curve analysis of TVR for prediction of deep MI was statistically significant (P = 0.013). An optimal TVR threshold of 7.3% predicted deep myometrial invasion with 85.7% sensitivity, 46.8% specificity, 41.9% positive predictive value, and 88.0% negative predictive value. Receiver operating characteristics curve analyses of TVR, tumor size, and tumor volume for prediction of tumor histological grade or lymphovascular space invasion were not significant. The concordance between radiologic and pathologic assessment for MI was almost excellent (κ value, 0.799; P < 0.001). Addition of TVR to standard radiologic assessment of deep MI increased the sensitivity from 90.5% to 95.2%. Tumor volume ratio, based on preoperative MR volumetry, seems to predict deep MI independently in stage I endometrial cancer with insufficient sensitivity and specificity. Its value in clinical practice for risk stratification models in endometrial cancer has to be studied in larger cohort of patients.

Increasing volume and complexity of pediatric epilepsy surgery with stable seizure outcome between 2008 and 2014: A nationwide multicenter study.

PubMed

Barba, Carmen; Specchio, Nicola; Guerrini, Renzo; Tassi, Laura; De Masi, Salvatore; Cardinale, Francesco; Pellacani, Simona; De Palma, Luca; Battaglia, Domenica; Tamburrini, Gianpiero; Didato, Giuseppe; Freri, Elena; Consales, Alessandro; Nozza, Paolo; Zamponi, Nelia; Cesaroni, Elisabetta; Di Gennaro, Giancarlo; Esposito, Vincenzo; Giulioni, Marco; Tinuper, Paolo; Colicchio, Gabriella; Rocchi, Raffaele; Rubboli, Guido; Giordano, Flavio; Lo Russo, Giorgio; Marras, Carlo Efisio; Cossu, Massimo

2017-10-01

The objective of the study was to assess common practice in pediatric epilepsy surgery in Italy between 2008 and 2014. A survey was conducted among nine Italian epilepsy surgery centers to collect information on presurgical and postsurgical evaluation protocols, volumes and types of surgical interventions, and etiologies and seizure outcomes in pediatric epilepsy surgery between 2008 and 2014. Retrospective data on 527 surgical procedures were collected. The most frequent surgical approaches were temporal lobe resections and disconnections (133, 25.2%) and extratemporal lesionectomies (128, 24.3%); the most frequent etiologies were FCD II (107, 20.3%) and glioneuronal tumors (105, 19.9%). Volumes of surgeries increased over time independently from the age at surgery and the epilepsy surgery center. Engel class I was achieved in 73.6% of patients (range: 54.8 to 91.7%), with no significant changes between 2008 and 2014. Univariate analyses showed a decrease in the proportion of temporal resections and tumors and an increase in the proportion of FCDII, while multivariate analyses revealed an increase in the proportion of extratemporal surgeries over time. A higher proportion of temporal surgeries and tumors and a lower proportion of extratemporal and multilobar surgeries and of FCD were observed in low (<50surgeries/year) versus high-volume centers. There was a high variability across centers concerning pre- and postsurgical evaluation protocols, depending on local expertise and facilities. This survey reveals an increase in volume and complexity of pediatric epilepsy surgery in Italy between 2008 and 2014, associated with a stable seizure outcome. Copyright © 2017 Elsevier Inc. All rights reserved.

A Big Data Task Force Review of Advances in Data Access and Discovery Within the Science Disciplines of the NASA Science Mission Directorate (SMD)

NASA Astrophysics Data System (ADS)

Walker, R. J.; Beebe, R. F.

2017-12-01

One of the basic problems the NASA Science Mission Directorate (SMD) faces when dealing with preservation of scientific data is the variety of the data. This stems from the fact that NASA's involvement in the sciences spans a broad range of disciplines across the Science Mission Directorate: Astrophysics, Earth Sciences, Heliophysics and Planetary Science. As the ability of some missions to produce large data volumes has accelerated, the range of problems associated with providing adequate access to the data has demanded diverse approaches for data access. Although mission types, complexity and duration vary across the disciplines, the data can be characterized by four characteristics: velocity, veracity, volume, and variety. The rate of arrival of the data (velocity) must be addressed at the individual mission level, validation and documentation of the data (veracity), data volume and the wide variety of data products present huge challenges as the science disciplines strive to provide transparent access to their available data. Astrophysics, supports an integrated system of data archives based on frequencies covered (UV, visible, IR, etc.) or subject areas (extrasolar planets, extra galactic, etc.) and is accessed through the Astrophysics Data Center (https://science.nasa.gov/astrophysics/astrophysics-data-centers/). Earth Science supports the Earth Observing System (https://earthdata.nasa.gov/) that manages the earth science satellite data. The discipline supports 12 Distributed Active Archive Centers. Heliophysics provides the Space Physics Data Facility (https://spdf.gsfc.nasa.gov/) that supports the heliophysics community and Solar Data Analysis Center (https://umbra.nascom.nasa.gov/index.html) that allows access to the solar data. The Planetary Data System (https://pds.nasa.gov) is the main archive for planetary science data. It consists of science discipline nodes (Atmospheres, Geosciences, Cartography and Imaging Sciences, Planetary Plasma Interactions, Ring-Moon Systems, and Small Bodies) and supporting nodes (Engineering and the Navigation and Ancillary Information Facility). This presentation will address current efforts by the disciplines to face the demands of providing user access in the era of Big Data.

Path analysis of phenotypic traits in young cacao plants under drought conditions.

PubMed

Santos, Emerson Alves Dos; Almeida, Alex-Alan Furtado de; Branco, Marcia Christina da Silva; Santos, Ivanildes Conceição Dos; Ahnert, Dario; Baligar, Virupax C; Valle, Raúl René

2018-01-01

Drought is worldwide considered one of the most limiting factors of Theobroma cacao production, which can be intensified by global climate changes. In this study, we aimed to investigate the phenotypic correlation among morphological characteristics of cacao progenies submitted to irrigation and drought conditions and their partitions into direct and indirect effects. Path analysis with phenotypic plasticity index was used as criteria for estimation of basic and explanatory variables. The experiment was conducted in a greenhouse at the Cacao Research Center (CEPEC), Ilhéus, Bahia, Brazil, in a randomized block 21 x 2 factorial arrangement [21 cacao progenies obtained from complete diallel crosses and two water regimes (control and drought)] and six replications. In general, drought conditions influenced biomass production in most progenies, causing significant reductions in total leaf area, leaf number, leaf biomass, fine-roots length (diameter <1 mm), root volume and root area for considered drought intolerant. All progenies showed alterations in growth due to drought. Phenotypic plasticity was most strongly pronounced in root volume. Stem and root diameters, as well as stem dry biomass were the growth variables with the greatest direct effects on root volume under drought conditions, these characters being indicated in screening of cacao progenies drought tolerant.

Path analysis of phenotypic traits in young cacao plants under drought conditions

PubMed Central

dos Santos, Emerson Alves; de Almeida, Alex-Alan Furtado; Branco, Marcia Christina da Silva; dos Santos, Ivanildes Conceição; Ahnert, Dario; Baligar, Virupax C.; Valle, Raúl René

2018-01-01

Drought is worldwide considered one of the most limiting factors of Theobroma cacao production, which can be intensified by global climate changes. In this study, we aimed to investigate the phenotypic correlation among morphological characteristics of cacao progenies submitted to irrigation and drought conditions and their partitions into direct and indirect effects. Path analysis with phenotypic plasticity index was used as criteria for estimation of basic and explanatory variables. The experiment was conducted in a greenhouse at the Cacao Research Center (CEPEC), Ilhéus, Bahia, Brazil, in a randomized block 21 x 2 factorial arrangement [21 cacao progenies obtained from complete diallel crosses and two water regimes (control and drought)] and six replications. In general, drought conditions influenced biomass production in most progenies, causing significant reductions in total leaf area, leaf number, leaf biomass, fine-roots length (diameter <1 mm), root volume and root area for considered drought intolerant. All progenies showed alterations in growth due to drought. Phenotypic plasticity was most strongly pronounced in root volume. Stem and root diameters, as well as stem dry biomass were the growth variables with the greatest direct effects on root volume under drought conditions, these characters being indicated in screening of cacao progenies drought tolerant. PMID:29408854

Impact of acute care surgery to departmental productivity.

PubMed

Barnes, Stephen L; Cooper, Christopher J; Coughenour, Jeffrey P; MacIntyre, Allan D; Kessel, James W

2011-10-01

The face of trauma surgery is rapidly evolving with a paradigm shift toward acute care surgery (ACS). The formal development of ACS has been viewed by some general surgeons as a threat to their practice. We sought to evaluate the impact of a new division of ACS to both departmental productivity and provider satisfaction at a University Level I Trauma Center. Two-year retrospective analysis of annual work relative value unit (wRVU) productivity, operative volume, and FTEs before and after establishment of an ACS division at a University Level I trauma center. Provider satisfaction was measured using a 10-point scale. Analysis completed using Microsoft Excel with a p value less than 0.05 significant. The change to an ACS model resulted in a 94% increase in total wRVU production (78% evaluation and management, 122% operative; p<0.05) for ACS, whereas general surgery wRVU production increased 8% (-15% evaluation and management, 14% operative; p<0.05). Operative productivity was substantial after transition to ACS, with 129% and 44% increases (p<0.05) in operative and elective case load, respectively. Decline in overall general surgery operative volume was attributed to reduction in emergent cases. Establishment of the ACS model necessitated one additional FTE. Job satisfaction substantially improved with the ACS model while allowing general surgery a more focused practice. The ACS practice model significantly enhances provider productivity and job satisfaction when compared with trauma alone. Fears of a productivity impact to the nontrauma general surgeon were not realized.

Connecting Research, Policy, and Practice. Review of Adult Learning and Literacy, Volume 7

ERIC Educational Resources Information Center

Comings, John, Ed.; Garner, Barbara, Ed.; Smith, Christine, Ed.

2007-01-01

"Review of Adult Learning and Literacy: Connecting Research, Policy, and Practice, Volume 7" is the newest volume in a series of annual publications of the National Center for the Study of Adult Learning and Literacy (NCSALL) that address major issues, the latest research, and the best practices in the field of adult literacy and…

Alternative occupied volume integrity (OVI) tests and analyses.

DOT National Transportation Integrated Search

2013-10-01

FRA, supported by the Volpe Center, conducted research on alternative methods of evaluating occupied volume integrity (OVI) in passenger railcars. Guided by this research, an alternative methodology for evaluating OVI that ensures an equivalent or gr...

Current use of imaging and electromagnetic source localization procedures in epilepsy surgery centers across Europe.

PubMed

Mouthaan, Brian E; Rados, Matea; Barsi, Péter; Boon, Paul; Carmichael, David W; Carrette, Evelien; Craiu, Dana; Cross, J Helen; Diehl, Beate; Dimova, Petia; Fabo, Daniel; Francione, Stefano; Gaskin, Vladislav; Gil-Nagel, Antonio; Grigoreva, Elena; Guekht, Alla; Hirsch, Edouard; Hecimovic, Hrvoje; Helmstaedter, Christoph; Jung, Julien; Kalviainen, Reetta; Kelemen, Anna; Kimiskidis, Vasilios; Kobulashvili, Teia; Krsek, Pavel; Kuchukhidze, Giorgi; Larsson, Pål G; Leitinger, Markus; Lossius, Morten I; Luzin, Roman; Malmgren, Kristina; Mameniskiene, Ruta; Marusic, Petr; Metin, Baris; Özkara, Cigdem; Pecina, Hrvoje; Quesada, Carlos M; Rugg-Gunn, Fergus; Rydenhag, Bertil; Ryvlin, Philippe; Scholly, Julia; Seeck, Margitta; Staack, Anke M; Steinhoff, Bernhard J; Stepanov, Valentin; Tarta-Arsene, Oana; Trinka, Eugen; Uzan, Mustafa; Vogt, Viola L; Vos, Sjoerd B; Vulliémoz, Serge; Huiskamp, Geertjan; Leijten, Frans S S; Van Eijsden, Pieter; Braun, Kees P J

2016-05-01

In 2014 the European Union-funded E-PILEPSY project was launched to improve awareness of, and accessibility to, epilepsy surgery across Europe. We aimed to investigate the current use of neuroimaging, electromagnetic source localization, and imaging postprocessing procedures in participating centers. A survey on the clinical use of imaging, electromagnetic source localization, and postprocessing methods in epilepsy surgery candidates was distributed among the 25 centers of the consortium. A descriptive analysis was performed, and results were compared to existing guidelines and recommendations. Response rate was 96%. Standard epilepsy magnetic resonance imaging (MRI) protocols are acquired at 3 Tesla by 15 centers and at 1.5 Tesla by 9 centers. Three centers perform 3T MRI only if indicated. Twenty-six different MRI sequences were reported. Six centers follow all guideline-recommended MRI sequences with the proposed slice orientation and slice thickness or voxel size. Additional sequences are used by 22 centers. MRI postprocessing methods are used in 16 centers. Interictal positron emission tomography (PET) is available in 22 centers; all using 18F-fluorodeoxyglucose (FDG). Seventeen centers perform PET postprocessing. Single-photon emission computed tomography (SPECT) is used by 19 centers, of which 15 perform postprocessing. Four centers perform neither PET nor SPECT in children. Seven centers apply magnetoencephalography (MEG) source localization, and nine apply electroencephalography (EEG) source localization. Fourteen combinations of inverse methods and volume conduction models are used. We report a large variation in the presurgical diagnostic workup among epilepsy surgery centers across Europe. This diversity underscores the need for high-quality systematic reviews, evidence-based recommendations, and harmonization of available diagnostic presurgical methods. Wiley Periodicals, Inc. © 2016 International League Against Epilepsy.

"Center punch" and "whole spot" bioanalysis of apixaban in human dried blood spot samples by UHPLC-MS/MS.

PubMed

Zheng, Naiyu; Yuan, Long; Ji, Qin C; Mangus, Heidi; Song, Yan; Frost, Charles; Zeng, Jianing; Aubry, Anne-Françoise; Arnold, Mark E

2015-04-15

Apixaban (Eliquis™) was developed by Bristol-Myers Squibb (BMS) and Pfizer to use as an antithrombotic/anticoagulant agent and has been recently approved for the prevention of stroke and systemic embolism in patients with nonvalvular atrial fibrillation. A clinical study of apixaban, sponsored by BMS and Pfizer, included a pilot exploratory portion to evaluate the potential for future drug concentration monitoring using dried blood spot (DBS) sample collection. For DBS sample collection, a fixed blood volume was dispensed onto a DBS card by either regular volumetric pipette (venous blood collection) or capillary dispenser (finger prick blood collection). A 96-well semi-automated liquid-liquid extraction sample preparation procedure was developed to provide clean extracts for UHPLC-MS/MS quantitation. Assays using both partial-spot center punch and whole spot punch were developed and validated. The linear dynamic ranges for all the analyses were from 0.5 to 500 ng/mL. The coefficient of determination (r(2)) values was >0.9944 for all the validation runs. For the center punch approach, the intra-assay precision (%CV) was within 4.4% and inter-assay precision was within 2.6%. The assay accuracy, expressed as %Dev., was within ± 5.4% of the nominal concentrations. One accuracy and precision run was performed using the whole spot approach, the intra-assay precision (%CV) was within 7.1% and the accuracy was within ± 8.0% of the nominal concentrations. In contrast to the center punch approach, the whole spot approach eliminated the effect of hematocrit and high lipids on the analysis of apixaban in human DBS when an accurate sample blood volume was collected on DBS cards. Copyright © 2015 Elsevier B.V. All rights reserved.

BSM Delta Qualification 2, volume 3, book 2

NASA Technical Reports Server (NTRS)

1994-01-01

This report, presented in three volumes, provides the results of a two-motor Delta Qualification 2 program conducted in 1993 to certify the following enhancements for incorporation into booster separation motor (BSM0 flight hardware: vulcanized-in-place nozzle aft closure insulation; new iso-static ATJ bulk graphite throat insert material, adhesive EA9394 for bonding the nozzle throat, igniter grain rod/centering insert/igniter case; deletion of the igniter adapter insulator ring; deletion of the igniter adapter/igniter case interface RTV; and deletion of loctite from igniter retainer plate threads. The enhancements above directly resulted from (1) the BSM total quality management (TQM) team initiatives to enhance the BSM producibility, and (2) the necessity to qualify new throat insert and adhesive systems to replace existing materials that will not be available. Testing was completed at both the component and motor levels. Component testing was accomplished to screen candidate materials (e.g., throat materials, adhesive systems) and to optimize processes (e.g., aft closure insulator vulcanization approach) prior to their incorporation into the test motors. Motor testing--consisting of two motors, randomly selected by USBI's on-site quality personnel from production lot AAY, which were modified to accept the enhancements -- was completed to provide the final qualification of the enhancements for incorporation into flight hardware. Volume 3, Book 2 provides various supporting documentation to the previous volumes with regards to the testing of the two Delta qualification units: data acceptance records, thermal conditioning analysis, igniter adapter thermal flake analysis, laboratory adhesive (EA-9394) qualification report, throat insert thermal/structural analysis, Delta Qualification Nonconformance Reports (NCR's), O-ring seating tests, and interim test report for vulcanization process qualification.

Cone Beam Computed Tomography Analysis of Oropharyngeal Airway in Preadolescent Nonsyndromic Bilateral and Unilateral Cleft Lip and Palate Patients.

PubMed

Al-Fahdawi, Mahmood Abd; El-Kassaby, Marwa Abdelwahab; Farid, Mary Medhat; El-Fotouh, Mona Abou

2018-01-01

Objective The objective of this study was to assess the volume, area, and dimensions of the oropharyngeal airway (OPA) in a previously repaired nonsyndromic unilateral cleft lip and palate (UCLP) versus bilateral cleft lip and palate (BCLP) patients when compared with noncleft controls using cone beam computed tomography (CBCT). Design This was a retrospective case-control study. Setting The Cleft Care Center and outpatient clinic that are affiliated to our faculty were the settings for the study. Participants A total of 58 CBCT scans were selected of preadolescent individuals: 14 BCLP, 20 UCLP, and 24 age- and gender-matched noncleft controls. Variables Variables were volume, cross-sectional area (CSA), midsagittal area (MSA), and dimensions of OPA. Statistical analysis One-way analysis of variance and post hoc tests were used to compare variables. Statistical significance was set at P ≤ .05. Results UCLP showed significantly smaller superior oropharyngeal airway volume than both controls and BCLP ( P ≤ .05). BCLP showed significantly larger CSA at soft palate plane and significantly larger MSA than both UCLP and controls ( P < .05). Conclusions UCLP patients at the studied age and stage of previously repaired clefts have significantly less superior oropharyngeal airway volume than both controls and BCLP patients. This confirms that preadolescents with UCLP are at greater risk for superior oropharyngeal airway obstruction when compared with those BCLP and controls. Furthermore, BCLP patients showed significantly larger CSA at soft palate plane and MSA than both controls and UCLP patients. These variations in OPA characteristics of cleft patients can influence function in terms of respiration and vocalization.

Longitudinal predictors of aerobic performance in adolescent soccer players.

PubMed

Valente-dos-Santos, João; Coelho-e-Silva, Manuel J; Duarte, João; Figueiredo, António J; Liparotti, João R; Sherar, Lauren B; Elferink-Gemser, Marije T; Malina, Robert M

2012-01-01

The importance of aerobic performance in youth soccer is well established. The aim of the present study was to evaluate the contributions of chronological age (CA), skeletal age (SA), body size, and training to the longitudinal development of aerobic performance in youth male soccer players aged 10 to 18 years. Players (n=83) were annually followed up during 5 years, resulting in an average of 4.4 observations per player. Decimal CA was calculated, and SA, stature, body weight, and aerobic performance were measured once per year. Fat-free mass (FFM) was estimated from age- and gender-specific anthropometric formulas, and annual volume training was recorded. After testing for multicollinearity, multilevel regression modeling was used to analyze the longitudinal data aligned by CA and SA (Model 1 and 2, respectively) and to develop aerobic performance scores. The following equations provide estimations of the aerobic performance for young soccer players: ŷ(Model 1 [deviance from the null model =388.50; P<0.01]) =57.75+9.06×centered CA-0.57×centered CA(2)+0.03×annual volume training and ŷ(Model 2 [deviance from the null model=327.98; P<0.01])=13.03+4.04×centered SA-0.12×centered SA(2)+0.99×FFM+0.03×annual volume training. The development of aerobic performance in young soccer players was found to be significantly related to CA, biological development, and volume of training.

Outcome differences in adolescent blunt severe polytrauma patients managed at pediatric versus adult trauma centers.

PubMed

Rogers, Amelia T; Gross, Brian W; Cook, Alan D; Rinehart, Cole D; Lynch, Caitlin A; Bradburn, Eric H; Heinle, Colin C; Jammula, Shreya; Rogers, Frederick B

2017-12-01

Previous research suggests adolescent trauma patients can be managed equally effectively at pediatric and adult trauma centers. We sought to determine whether this association would be upheld for adolescent severe polytrauma patients. We hypothesized that no difference in adjusted outcomes would be observed between pediatric trauma centers (PTCs) and adult trauma centers (ATCs) for this population. All severely injured adolescent (aged 12-17 years) polytrauma patients were extracted from the Pennsylvania Trauma Outcomes Study database from 2003 to 2015. Polytrauma was defined as an Abbreviated Injury Scale (AIS) score ≥3 for two or more AIS-defined body regions. Dead on arrival, transfer, and penetrating trauma patients were excluded from analysis. ATC were defined as adult-only centers, whereas standalone pediatric hospitals and adult centers with pediatric affiliation were considered PTC. Multilevel mixed-effects logistic regression models assessed the adjusted impact of center type on mortality and total complications while controlling for age, shock index, Injury Severity Score, Glasgow Coma Scale motor score, trauma center level, case volume, and injury year. A generalized linear mixed model characterized functional status at discharge (FSD) while controlling for the same variables. A total of 1,606 patients met inclusion criteria (PTC: 868 [54.1%]; ATC: 738 [45.9%]), 139 (8.66%) of which died in-hospital. No significant difference in mortality (adjusted odds ratio [AOR]: 1.10, 95% CI 0.54-2.24; p = 0.794; area under the receiver operating characteristic: 0.89) was observed between designations in adjusted analysis; however, FSD (AOR: 0.38, 95% CI 0.15-0.97; p = 0.043) was found to be lower and total complication trends higher (AOR: 1.78, 95% CI 0.98-3.32; p = 0.058) at PTC for adolescent polytrauma patients. Contrary to existing literature on adolescent trauma patients, our results suggest patients aged 12-17 presenting with polytrauma may experience improved overall outcomes when managed at adult compared to pediatric trauma centers. Epidemiologic study, level III.

Satisfactory rate of postprocessing visualization of standard fetal cardiac views from 4-dimensional cardiac volumes acquired during routine ultrasound practice by experienced sonographers in peripheral centers.

PubMed

Rizzo, Giuseppe; Capponi, Alessandra; Pietrolucci, Maria Elena; Capece, Giuseppe; Cimmino, Ernesto; Colosi, Enrico; Ferrentino, Salvatore; Sica, Carmine; Di Meglio, Aniello; Arduini, Domenico

2011-01-01

The aim of this study was to evaluate the feasibility of visualizing standard cardiac views from 4-dimensional (4D) cardiac volumes obtained at ultrasound facilities with no specific experience in fetal echocardiography. Five sonographers prospectively recorded 4D cardiac volumes starting from the 4-chamber view on 500 consecutive pregnancies at 19 to 24 weeks' gestation undergoing routine ultrasound examinations (100 pregnancies for each sonographer). Volumes were sent to the referral center, and 2 independent reviewers with experience in 4D fetal echocardiography assessed their quality in the display of the abdominal view, 4-chamber view, left and right ventricular outflow tracts, and 3-vessel and trachea view. Cardiac volumes were acquired in 474 of 500 pregnancies (94.8%). The 2 reviewers respectively acknowledged the presence of satisfactory images in 92.4% and 93.6% of abdominal views, 91.5% and 93.0% of 4-chamber views, in 85.0% and 86.2% of left ventricular outflow tracts, 83.9% and 84.5% of right ventricular outflow tracts, and 85.2% and 84.5% of 3-vessel and trachea views. The presence of a maternal body mass index of greater than 30 altered the probability of achieving satisfactory cardiac views, whereas previous maternal lower abdominal surgery did not affect the quality of reconstructed cardiac views. In conclusion, cardiac volumes acquired by 4D sonography in peripheral centers showed high enough quality to allow satisfactory diagnostic cardiac views.

Satisfactory rate of post-processing visualization of fetal cerebral axial, sagittal, and coronal planes from three-dimensional volumes acquired in routine second trimester ultrasound practice by sonographers of peripheral centers.

PubMed

Rizzo, Giuseppe; Pietrolucci, Maria Elena; Capece, Giuseppe; Cimmino, Ernesto; Colosi, Enrico; Ferrentino, Salvatore; Sica, Carmine; Di Meglio, Aniello; Arduini, Domenico

2011-08-01

The aim of this study was to evaluate the feasibility to visualize central nervous system (CNS) diagnostic planes from three-dimensional (3D) brain volumes obtained in ultrasound facilities with no specific experience in fetal neurosonography. Five sonographers prospectively recorded transabdominal 3D CNS volumes starting from an axial approach on 500 consecutive pregnancies at 19-24 weeks of gestation undergoing routine ultrasound examination. Volumes were sent to the referral center (Department of Obstetrics and Gynecology, Università Roma Tor Vergata, Italy) and two independent reviewers with experience in 3D ultrasound assessed their quality in the display of axial, coronal, and sagittal planes. CNS volumes were acquired in 491/500 pregnancies (98.2%). The two reviewers acknowledged the presence of satisfactory images with a visualization rate ranging respectively between 95.1% and 97.14% for axial planes, 73.72% and 87.16% for coronal planes, and 78.41% and 94.29% for sagittal planes. The agreement rate between the two reviewers as expressed by Cohen's kappa coefficient was >0.87 for axial planes, >0.89 for coronal planes, and >0.94 for sagittal planes. The presence of a maternal body mass index >30 alters the probability of achieving satisfactory CNS views, while existence of previous maternal lower abdomen surgery does not affect the quality of the reconstructed planes. CNS volumes acquired by 3D ultrasonography in peripheral centers showed a quality high enough to allow a detailed fetal neurosonogram.

Quantifying the impact of immediate reconstruction in postmastectomy radiation: a large, dose-volume histogram-based analysis.

PubMed

Ohri, Nisha; Cordeiro, Peter G; Keam, Jennifer; Ballangrud, Ase; Shi, Weiji; Zhang, Zhigang; Nerbun, Claire T; Woch, Katherine M; Stein, Nicholas F; Zhou, Ying; McCormick, Beryl; Powell, Simon N; Ho, Alice Y

2012-10-01

To assess the impact of immediate breast reconstruction on postmastectomy radiation (PMRT) using dose-volume histogram (DVH) data. Two hundred forty-seven women underwent PMRT at our center, 196 with implant reconstruction and 51 without reconstruction. Patients with reconstruction were treated with tangential photons, and patients without reconstruction were treated with en-face electron fields and customized bolus. Twenty percent of patients received internal mammary node (IMN) treatment. The DVH data were compared between groups. Ipsilateral lung parameters included V20 (% volume receiving 20 Gy), V40 (% volume receiving 40 Gy), mean dose, and maximum dose. Heart parameters included V25 (% volume receiving 25 Gy), mean dose, and maximum dose. IMN coverage was assessed when applicable. Chest wall coverage was assessed in patients with reconstruction. Propensity-matched analysis adjusted for potential confounders of laterality and IMN treatment. Reconstruction was associated with lower lung V20, mean dose, and maximum dose compared with no reconstruction (all P<.0001). These associations persisted on propensity-matched analysis (all P<.0001). Heart doses were similar between groups (P=NS). Ninety percent of patients with reconstruction had excellent chest wall coverage (D95 >98%). IMN coverage was superior in patients with reconstruction (D95 >92.0 vs 75.7%, P<.001). IMN treatment significantly increased lung and heart parameters in patients with reconstruction (all P<.05) but minimally affected those without reconstruction (all P>.05). Among IMN-treated patients, only lower lung V20 in those without reconstruction persisted (P=.022), and mean and maximum heart doses were higher than in patients without reconstruction (P=.006, P=.015, respectively). Implant reconstruction does not compromise the technical quality of PMRT when the IMNs are untreated. Treatment technique, not reconstruction, is the primary determinant of target coverage and normal tissue doses. Published by Elsevier Inc.

Postmenopausal hormone therapy and subclinical cerebrovascular disease

PubMed Central

Coker, L H.; Hogan, P E.; Bryan, N R.; Kuller, L H.; Margolis, K L.; Bettermann, K; Wallace, R B.; Lao, Z; Freeman, R; Stefanick, M L.; Shumaker, S A.

2009-01-01

Objective: The Women's Health Initiative Memory Study (WHIMS) hormone therapy (HT) trials reported that conjugated equine estrogen (CEE) with or without medroxyprogesterone acetate (MPA) increases risk for all-cause dementia and global cognitive decline. WHIMS MRI measured subclinical cerebrovascular disease as a possible mechanism to explain cognitive decline reported in WHIMS. Methods: We contacted 2,345 women at 14 WHIMS sites; scans were completed on 1,424 (61%) and 1,403 were accepted for analysis. The primary outcome measure was total ischemic lesion volume on brain MRI. Mean duration of on-trial HT or placebo was 4 (CEE+MPA) or 5.6 years (CEE-Alone) and scans were conducted an average of 3 (CEE+MPA) or 1.4 years (CEE-Alone) post-trial termination. Cross-sectional analysis of MRI lesions was conducted; general linear models were fitted to assess treatment group differences using analysis of covariance. A (two-tailed) critical value of α = 0.05 was used. Results: In women evenly matched within trials at baseline, increased lesion volumes were significantly related to age, smoking, history of cardiovascular disease, hypertension, lower post-trial global cognition scores, and increased incident cases of on- or post-trial mild cognitive impairment or probable dementia. Mean ischemic lesion volumes were slightly larger for the CEE+MPA group vs placebo, except for the basal ganglia, but the differences were not significant. Women assigned to CEE-Alone had similar mean ischemic lesion volumes compared to placebo. Conclusions: Conjugated equine estrogen–based hormone therapy was not associated with a significant increase in ischemic brain lesion volume relative to placebo. This finding was consistent within each trial and in pooled analyses across trials. GLOSSARY 3MSE = modified Mini-Mental State Examination; BMI = body mass index; CEE = conjugated equine estrogen; CVD = cerebrovascular disease; HT = hormone therapy; MCI = mild cognitive impairment; MPA = medroxyprogesterone acetate; MRIQCC = MRI Quality Control Center; ROI = region of interest; WHIMS = Women's Health Initiative Memory Study. PMID:19139363

Intensity-Modulated Radiation Therapy in Oropharyngeal Carcinoma: Effect of Tumor Volume on Clinical Outcomes

DOE Office of Scientific and Technical Information (OSTI.GOV)

Lok, Benjamin H.; New York University School of Medicine, New York, NY; Setton, Jeremy

2012-04-01

Purpose: To analyze the effect of primary gross tumor volume (pGTV) and nodal gross tumor volume (nGTV) on treatment outcomes in patients treated with definitive intensity-modulated radiation therapy (IMRT) for oropharyngeal cancer (OPC). Methods and Materials: Between September 1998 and April 2009, a total of 442 patients with squamous cell carcinoma of the oropharynx were treated with IMRT with curative intent at our center. Thirty patients treated postoperatively and 2 additional patients who started treatment more than 6 months after diagnosis were excluded. A total of 340 patients with restorable treatment plans were included in this present study. The majoritymore » of the patients underwent concurrent platinum-based chemotherapy. The pGTV and nGTV were calculated using the original clinical treatment plans. Cox proportional hazards models and log-rank tests were used to evaluate the correlation between tumor volumes and overall survival (OS), and competing risks analysis tools were used to evaluate the correlation between local failure (LF), regional failure (RF), distant metastatic failure (DMF) vs. tumor volumes with death as a competing risk. Results: Median follow-up among surviving patients was 34 months (range, 5-67). The 2-year cumulative incidence of LF, RF and DF in this cohort of patients was 6.1%, 5.2%, and 12.2%, respectively. The 2-year OS rate was 88.6%. Univariate analysis determined pGTV and T-stage correlated with LF (p < 0.0001 and p = 0.004, respectively), whereas nGTV was not associated with RF. On multivariate analysis, pGTV and N-stage were independent risk factors for overall survival (p = 0.0003 and p = 0.0073, respectively) and distant control (p = 0.0008 and p = 0.002, respectively). Conclusions: In this cohort of patients with OPC treated with IMRT, pGTV was found to be associated with overall survival, local failure, and distant metastatic failure.« less

Oceanic Area System Improvement Study (OASIS). Volume II. North Atlantic Region Air Traffic Services System Description.

DTIC Science & Technology

1981-09-01

centers (OACCs), while units serving oceanic and domestic CTAs are area control centers ( ACCa ). Flight information centers (FICs) provide the non-ATC...Shanwick OACC, and also might be applied by the Santa Maria and Reykjavik ACCa . An alternative procedure permits the inclusion of altitude or time...OACCs), while units serving oceanic and domestic CTAs are area control centers ( ACCa ). Although control centers generally have responsibility for total

Intraoperative Red Blood Cell Transfusion in Infant Heart Transplant Patients Is Not Associated with Worsened Outcomes.

PubMed

Carter, Harmony F; Lau, Carol; Juma, David; Wells, Briana; Applegate, Richard L

2016-05-01

Red blood cell (RBC) transfusion is common during infant cardiac surgery. A previous report of pediatric heart transplant recipients showed that increased RBC transfusion volume was independently associated with increased length of intensive care unit stay. It is unclear whether transfusion to infants as a subgroup carries similar risks. This study investigated relationships between intraoperative RBC transfusion during heart transplantation and postoperative length of stay (LOS), morbidity, and mortality in infants. Retrospective analysis of medical records from infants <1 year old undergoing primary heart transplantation at Loma Linda University Medical Center from 1985 to 2012 was conducted. Exclusion criteria included preoperative exchange transfusion or extracorporeal membrane oxygenation. Data sought included patient characteristics; intraoperative RBC transfusion volume and cardiopulmonary bypass details; and postoperative vasoactive support, ventilator support, morbidity, LOS, and 30-day mortality. The relationship of RBC transfusion volume (mL/kg) to these postoperative variables was assessed by univariate analysis. Multiple regression analysis of postoperative LOS included variables that were independent predictors of LOS or associated with ≥10% change in the β-estimate for RBC effect. Data from 307 infants showed that most (66.8%) had single-ventricle physiology. Median age at transplant was 50 days, weight 3.95 kg, and intraoperative transfusion volume 109 mL/kg. Transfusion volume was inversely related to age and weight. Median postoperative LOS was 18.2 days. Univariate linear regression analysis of transfused volume showed no relationship to log-transformed postoperative LOS (F(1,305) = 0.00; P = 0.960; R = 0.000; β-coefficient = 0.004; 95% confidence interval = -0.1542 to 0.1623). Transfused volume was not related to 30-day mortality (difference -0.162; -0.048 to 0.371 mL/kg; P = 0.112) or to postoperative ventilator support (R = 0.047), but was greater in patients who required reoperation (difference -0.246; -0.494 to -0.025; P = 0.004). Multiple regression analysis for all patients revealed age, preoperative ventilator support, prolonged postoperative ventilatory or vasoactive support, transplant year, and 30-day mortality, but not major adverse events, to be significant confounding variables. Adjusting for these variables, transfused volume was not associated with prolonged postoperative LOS. In contrast to a prior report, we found no correlation between intraoperative RBC transfusion and postoperative LOS when studying only infants. Infants have maturing organ systems, less physiologic reserve, and increased surgical blood loss (evaluated as mL/kg) during cardiac surgery than their larger, older counterparts, distinguishing them from the general pediatric population. These differences require additional studies to determine the outcome impact of transfusion strategies in the infant subgroup.

Reduced Cortical Gray Matter Volume In Male Adolescents With Substance And Conduct Problems

PubMed Central

Dalwani, Manish; Sakai, Joseph T.; Mikulich-Gilbertson, Susan K.; Tanabe, Jody; Raymond, Kristen; McWilliams, Shannon K.; Thompson, Laetitia L.; Banich, Marie T.; Crowley, Thomas J.

2011-01-01

Boys with serious conduct and substance problems (“Antisocial Substance Dependence” (ASD)) repeatedly make impulsive and risky decisions in spite of possible negative consequences. Because prefrontal cortex (PFC) is involved in planning behavior in accord with prior rewards and punishments, structural abnormalities in PFC could contribute to a person's propensity to make risky decisions. Methods We acquired high-resolution structural images of 25 male ASD patients (ages 14–18 years) and 19 controls of similar ages using a 3T MR system. We conducted whole-brain voxel-based morphometric analysis (p<0.05, corrected for multiple comparisons at whole-brain cluster-level) using Statistical Parametric Mapping version-5 and tested group differences in regional gray matter (GM) volume with analyses of covariance, adjusting for total GM volume, age, and IQ; we further adjusted between-group analyses for ADHD and depression. As secondary analyses, we tested for negative associations between GM volume and impulsivity within groups and separately, GM volume and symptom severity within patients using whole-brain regression analyses. Results ASD boys had significantly lower GM volume than controls in left dorsolateral PFC (DLPFC), right lingual gyrus and bilateral cerebellum, and significantly higher GM volume in right precuneus. Left DLPFC GM volume showed negative association with impulsivity within controls and negative association with substance dependence severity within patients. Conclusions ASD boys show reduced GM volumes in several regions including DLPFC, a region highly relevant to impulsivity, disinhibition, and decision-making, and cerebellum, a region important for behavioral regulation, while they showed increased GM in precuneus, a region associated with self-referential and self-centered thinking. PMID:21592680

Calcine Waste Storage at the Idaho Nuclear Technology and Engineering Center

DOE Office of Scientific and Technical Information (OSTI.GOV)

Staiger, Merle Daniel; M. C. Swenson

2005-01-01

This report documents an inventory of calcined waste produced at the Idaho Nuclear Technology and Engineering Center during the period from December 1963 to May 2000. The report was prepared based on calciner runs, operation of the calcined solids storage facilities, and miscellaneous operational information that establishes the range of chemical compositions of calcined waste stored at Idaho Nuclear Technology and Engineering Center. The report will be used to support obtaining permits for the calcined solids storage facilities, possible treatment of the calcined waste at the Idaho National Engineering and Environmental Laboratory, and to ship the waste to an off-sitemore » facility including a geologic repository. The information in this report was compiled from calciner operating data, waste solution analyses and volumes calcined, calciner operating schedules, calcine temperature monitoring records, and facility design of the calcined solids storage facilities. A compact disk copy of this report is provided to facilitate future data manipulations and analysis.« less

Experiments with Analytic Centers: A confluence of data, tools and help in using them.

NASA Astrophysics Data System (ADS)

Little, M. M.; Crichton, D. J.; Hines, K.; Cole, M.; Quam, B. M.

2017-12-01

Traditional repositories have been primarily focused on data stewardship. Over the past two decades, data scientists have attempted to overlay a superstructure to make these repositories more amenable to analysis tasks, with limited success. This poster will summarize lessons learned and some realizations regarding what it takes to create an analytic center. As the volume of Earth Science data grows and the sophistication of analytic tools improves, a pattern has emerged that indicates different science communities uniquely apply a selection of tools to the data to produce scientific results. Infrequently do the experiences of one group help steer other groups. How can the information technology community seed these domains with tools that conform to the thought processes and experiences of that particular science group? What types of succcessful technology infusions have occured and how does technology get adopted. AIST has been experimenting with the management of this analytic center process; this paper will summarize the results and indicate a direction for future infusion attempts.

Daycare and Preschool Handbook for Churches.

ERIC Educational Resources Information Center

McMurphy, John R.

Designed to guide church groups interested in opening and operating day care and preschool centers, this book offers a view of such centers as extensions of the church. Contents of the volume are divided into four parts devoted to (1) getting a church early childhood education program started, (2) administering the center, (3) operating the new…

76 FR 57744 - Advisory Committee to the Director (ACD), Centers for Disease Control and Prevention (CDC)-Ethics...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-09-16

... DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Disease Control and Prevention Advisory Committee to the Director (ACD), Centers for Disease Control and Prevention (CDC)--Ethics Subcommittee (ES) Correction: This notice was published in the Federal Register on September 8, 2011, Volume 76, Number 174...

Assessment of lung function in a large cohort of patients with acromegaly.

PubMed

Störmann, Sylvère; Gutt, Bodo; Roemmler-Zehrer, Josefine; Bidlingmaier, Martin; Huber, Rudolf M; Schopohl, Jochen; Angstwurm, Matthias W

2017-07-01

Acromegaly is associated with increased mortality due to respiratory disease. To date, lung function in patients with acromegaly has only been assessed in small studies, with contradicting results. We assessed lung function parameters in a large cohort of patients with acromegaly. Lung function of acromegaly patients was prospectively assessed using spirometry, blood gas analysis and body plethysmography. Biochemical indicators of acromegaly were assessed through measurement of growth hormone and IGF-I levels. This study was performed at the endocrinology outpatient clinic of a tertiary referral center in Germany. We prospectively tested lung function of 109 acromegaly patients (53 male, 56 female; aged 24-82 years; 80 with active acromegaly) without severe acute or chronic pulmonary disease. We compared lung volume, air flow, airway resistance and blood gases to normative data. Acromegaly patients had greater lung volumes (maximal vital capacity, intra-thoracic gas volume and residual volume: P  < 0.001, total lung capacity: P  = 0.006) and showed signs of small airway obstruction (reduced maximum expiratory flow when 75% of the forced vital capacity (FVC) has been exhaled: P  < 0.001, lesser peak expiratory flow: P  = 0.01). There was no significant difference between active and inactive acromegaly. Female patients had significantly altered lung function in terms of subclinical airway obstruction. In our cross-sectional analysis of lung function in 109 patients with acromegaly, lung volumes were increased compared to healthy controls. Additionally, female patients showed signs of subclinical airway obstruction. There was no difference between patients with active acromegaly compared with patients biochemically in remission. © 2017 European Society of Endocrinology.

Association of Attorney Advertising and FDA Action with Prescription Claims: A Time Series Segmented Regression Analysis.

PubMed

Tippett, Elizabeth C; Chen, Brian K

2015-12-01

Attorneys sponsor television advertisements that include repeated warnings about adverse drug events to solicit consumers for lawsuits against drug manufacturers. The relationship between such advertising, safety actions by the US Food and Drug Administration (FDA), and healthcare use is unknown. To investigate the relationship between attorney advertising, FDA actions, and prescription drug claims. The study examined total users per month and prescription rates for seven drugs with substantial attorney advertising volume and FDA or other safety interventions during 2009. Segmented regression analysis was used to detect pre-intervention trends, post-intervention level changes, and changes in post-intervention trends relative to the pre-intervention trends in the use of these seven drugs, using advertising volume, media hits, and the number of Medicare enrollees as covariates. Data for these variables were obtained from the Center for Medicare and Medicaid Services, Kantar Media, and LexisNexis. Several types of safety actions were associated with reductions in drug users and/or prescription rates, particularly for fentanyl, varenicline, and paroxetine. In most cases, attorney advertising volume rose in conjunction with major safety actions. Attorney advertising volume was positively correlated with prescription rates in five of seven drugs, likely because advertising volume began rising before safety actions, when prescription rates were still increasing. On the other hand, attorney advertising had mixed associations with the number of users per month. Regulatory and safety actions likely reduced the number of users and/or prescription rates for some drugs. Attorneys may have strategically chosen to begin advertising adverse drug events prior to major safety actions, but we found little evidence that attorney advertising reduced drug use. Further research is needed to better understand how consumers and physicians respond to attorney advertising.

Cost effectiveness of lung-volume-reduction surgery for patients with severe emphysema.

PubMed

Ramsey, Scott D; Berry, Kristin; Etzioni, Ruth; Kaplan, Robert M; Sullivan, Sean D; Wood, Douglas E

2003-05-22

The National Emphysema Treatment Trial, a randomized clinical trial comparing lung-volume-reduction surgery with medical therapy for severe emphysema, included a prospective economic analysis. After pulmonary rehabilitation, 1218 patients at 17 medical centers were randomly assigned to lung-volume-reduction surgery or continued medical treatment. Costs for the use of medical care, medications, transportation, and time spent receiving treatment were derived from Medicare claims and data from the trial. Cost effectiveness was calculated over the duration of the trial and was estimated for 10 years of follow-up with the use of modeling based on observed trends in survival, cost, and quality of life. Interim analyses identified a group of patients with excess mortality and little chance of improved functional status after surgery. When these patients were excluded, the cost-effectiveness ratio for lung-volume-reduction surgery as compared with medical therapy was 190,000 dollars per quality-adjusted life-year gained at 3 years and 53,000 dollars per quality-adjusted life-year gained at 10 years. Subgroup analyses identified patients with predominantly upper-lobe emphysema and low exercise capacity after pulmonary rehabilitation who had lower mortality and better functional status than patients who received medical therapy. The cost-effectiveness ratio in this subgroup was 98,000 dollars per quality-adjusted life-year gained at 3 years and 21,000 dollars at 10 years. Bootstrap analysis revealed substantial uncertainty for the subgroup and 10-year estimates. Given its cost and benefits over three years of follow-up, lung-volume-reduction surgery is costly relative to medical therapy. Although the predictions are subject to substantial uncertainty, the procedure may be cost effective if benefits can be maintained over time. Copyright 2003 Massachusetts Medical Society

DOE Office of Scientific and Technical Information (OSTI.GOV)

Meintz, A.; Markel, T.; Burton, E.

Analysis has been performed on the Transportation Secure Data Center (TSDC) warehouse of collected GPS second-by-second driving profile data of vehicles in the Atlanta, Chicago, Fresno, Kansas City, Los Angeles, Sacramento, and San Francisco Consolidated Statistical Areas (CSAs) to understand in-motion wireless power transfer introduction scenarios. In this work it has been shown that electrification of 1% of road miles could reduce fuel use by 25% for Hybrid Electric Vehicles (HEVs) in these CSAs. This analysis of strategically located infrastructure offers a promising approach to reduced fuel consumption; however, even the most promising 1% of road miles determined by thesemore » seven analysis scenarios still represent an impressive 2,700 miles of roadway to electrify. Therefore to mitigate the infrastructure capital costs, integration of the grid-tied power electronics in the Wireless Power Transfer (WPT) system at the DC-link to photovoltaic and/or battery storage is suggested. The integration of these resources would allow for the hardware to provide additional revenue through grid services at times of low traffic volumes and conversely at time of high traffic volumes these resources could reduce the peak demand that the WPT system would otherwise add to the grid.« less

Operative Mortality After Arthroplasty for Femoral Neck Fracture and Hospital Volume.

PubMed

Maceroli, Michael A; Nikkel, Lucas E; Mahmood, Bilal; Elfar, John C

2015-12-01

The purpose of the present study is to use a statewide, population-based data set to identify mortality rates at 30-day and 1-year postoperatively following total hip arthroplasty (THA) and hemiarthroplasty (HA) for displaced femoral neck fractures. The secondary aim of the study is to determine whether arthroplasty volume confers a protective effect on the mortality rate following femoral neck fracture treatment. New York's Statewide Planning and Research Cooperative System was used to identify 45 749 patients older than 60 years of age with a discharge diagnosis of femoral neck fracture undergoing THA or HA from 2000 through 2010. Comorbidities were identified using the Charlson comorbidity index. Mortality risk was modeled using Cox proportional hazards models while controlling for demographic and comorbid characteristics. High-volume THA centers were defined as those in the top quartile of arthroplasty volume, while low-volume centers were defined as the bottom quartile. Patients undergoing THA for femoral neck fracture rather than HA were younger (79 vs 83 years, P < .001), more likely to have rheumatoid disease, and less likely to have heart disease, dementia, cancer, or diabetes (all P < .05). Thirty-day mortality after HA was higher (8.4% vs 5.7%; P < .001) as was 1-year mortality (25.9% vs 17.8%; P < .001). After controlling for age, gender, ethnicity, and comorbidities, risk of mortality following THA was 21% lower (hazard ratio [HR] 0.79; P = .003) at 30 days and 22% lower (HR 0.78; P < .001) at 1 year than HA. Patients undergoing THA at high-volume arthroplasty centers had improved 1-year mortality when compared to those undergoing THA at low-volume hospitals (HR 0.55; P = .008). Based on this large, population-based study, there is no basis to assume THA carries a greater mortality risk after hip fracture than does standard HA, even when accounting for institutional volume of hip arthroplasty.

Reproducibility of lung tumor position and reduction of lung mass within the planning target volume using active breathing control (ABC).

PubMed

Cheung, Patrick C F; Sixel, Katharina E; Tirona, Romeo; Ung, Yee C

2003-12-01

The active breathing control (ABC) device allows for temporary immobilization of respiratory motion by implementing a breath hold at a predefined relative lung volume and air flow direction. The purpose of this study was to quantitatively evaluate the ability of the ABC device to immobilize peripheral lung tumors at a reproducible position, increase total lung volume, and thereby reduce lung mass within the planning target volume (PTV). Ten patients with peripheral non-small-cell lung cancer tumors undergoing radiotherapy had CT scans of their thorax with and without ABC inspiration breath hold during the first 5 days of treatment. Total lung volumes were determined from the CT data sets. Each peripheral lung tumor was contoured by one physician on all CT scans to generate gross tumor volumes (GTVs). The lung density and mass contained within a 1.5-cm PTV margin around each peripheral tumor was calculated using CT numbers. Using the center of the GTV from the Day 1 ABC scan as the reference, the displacement of subsequent GTV centers on Days 2 to 5 for each patient with ABC applied was calculated in three dimensions. With the use of ABC inspiration breath hold, total lung volumes increased by an average of 42%. This resulted in an average decrease in lung mass of 18% within a standard 1.5-cm PTV margin around the GTV. The average (+/- standard deviation) displacement of GTV centers with ABC breath hold applied was 0.3 mm (+/- 1.8 mm), 1.2 mm (+/- 2.3 mm), and 1.1 mm (+/- 3.5 mm) in the lateral direction, anterior-posterior direction, and superior-inferior direction, respectively. Results from this study indicate that there remains some inter-breath hold variability in peripheral lung tumor position with the use of ABC inspiration breath hold, which prevents significant PTV margin reduction. However, lung volumes can significantly increase, thereby decreasing the mass of lung within a standard PTV.

Building Petascale Cyberinfrastructure and Science Support for Solar Physics: Approach of the DKIST Data Center

NASA Astrophysics Data System (ADS)

Berukoff, Steven; Reardon, Kevin; Hays, Tony; Spiess, DJ; Watson, Fraser

2015-08-01

When construction is complete in 2019, the Daniel K. Inouye Solar Telescope will be the most-capable large aperture, high-resolution, multi-instrument solar physics facility in the world. The telescope is designed as a four-meter off-axis Gregorian, with a rotating Coude laboratory designed to simultaneously house and support five first-light imaging and spectropolarimetric instruments. At current design, the facility and its instruments will generate data volumes of 5 PB, produce 108 images, and 107-109 metadata elements annually. This data will not only forge new understanding of solar phenomena at high resolution, but enhance participation in solar physics and further grow a small but vibrant international community.The DKIST Data Center is being designed to store, curate, and process this flood of information, while augmenting its value by providing association of science data and metadata to its acquisition and processing provenance. In early Operations, the Data Center will produce, by autonomous, semi-automatic, and manual means, quality-controlled and -assured calibrated data sets, closely linked to facility and instrument performance during the Operations lifecycle. These data sets will be made available to the community openly and freely, and software and algorithms made available through community repositories like Github for further collaboration and improvement.We discuss the current design and approach of the DKIST Data Center, describing the development cycle, early technology analysis and prototyping, and the roadmap ahead. In this budget-conscious era, a key design criterion is elasticity, the ability of the built system to adapt to changing work volumes, types, and the shifting scientific landscape, without undue cost or operational impact. We discuss our deep iterative development approach, the underappreciated challenges of calibrating ground-based solar data, the crucial integration of the Data Center within the larger Operations lifecycle, and how software and hardware support, intelligently deployed, will enable high-caliber solar physics research and community growth for the DKIST's 40-year lifespan.

Research Results of the National Day Care Study. Final Report of the National Day Care Study. Volume II.

ERIC Educational Resources Information Center

Travers, Jeffrey; And Others

This final report of the National Day Care Study (NDCS), Volume II, provides researchers, social scientists and lay readers with information for judging the soundness of the evidence underlying NDCS conclusions about relationships between regulatable center characteristics and the outcome of care for the child. Thus, Volume II makes free use of…

Disparities in Adherence to National Comprehensive Cancer Network Treatment Guidelines and Survival for Stage IB-IIA Cervical Cancer in California.

PubMed

Pfaendler, Krista S; Chang, Jenny; Ziogas, Argyrios; Bristow, Robert E; Penner, Kristine R

2018-05-01

To evaluate the association of sociodemographic and hospital characteristics with adherence to National Comprehensive Cancer Network treatment guidelines for stage IB-IIA cervical cancer and to analyze the relationship between adherent care and survival. This is a retrospective population-based cohort study of patients with stage IB-IIA invasive cervical cancer reported to the California Cancer Registry from January 1, 1995, through December 31, 2009. Adherence to National Comprehensive Cancer Network guideline care was defined by year- and stage-appropriate surgical procedures, radiation, and chemotherapy. Multivariate logistic regression, Kaplan-Meier estimate, and Cox proportional hazard models were used to examine associations between patient, tumor, and treatment characteristics and National Comprehensive Cancer Network guideline adherence and cervical cancer-specific 5-year survival. A total of 6,063 patients were identified. Forty-seven percent received National Comprehensive Cancer Network guideline-adherent care, and 18.8% were treated in high-volume centers (20 or more patients/year). On multivariate analysis, lowest socioeconomic status (adjusted odds ratio [OR] 0.69, 95% CI 0.57-0.84), low-middle socioeconomic status (adjusted OR 0.76, 95% CI 0.64-0.92), and Charlson-Deyo comorbidity score 1 or higher (adjusted OR 0.78, 95% CI 0.69-0.89) were patient characteristics associated with receipt of nonguideline care. Receiving adherent care was less common in low-volume centers (45.9%) than in high-volume centers (50.9%) (effect size 0.90, 95% CI 0.84-0.96). Death from cervical cancer was more common in the nonadherent group (13.3%) than in the adherent group (8.6%) (effect size 1.55, 95% CI 1.34-1.80). Black race (adjusted hazard ratio 1.56, 95% CI 1.08-2.27), Medicaid payer status (adjusted hazard ratio 1.47, 95% CI 1.15-1.87), and Charlson-Deyo comorbidity score 1 or higher (adjusted hazard ratio 2.07, 95% CI 1.68-2.56) were all associated with increased risk of dying from cervical cancer. Among patients with early-stage cervical cancer, National Comprehensive Cancer Network guideline-nonadherent care was independently associated with increased cervical cancer-specific mortality along with black race and Medicaid payer status. Nonadherence was more prevalent in patients with older age, lower socioeconomic status, and receipt of care in low-volume centers. Attention should be paid to increase guideline adherence.

Robots drive the German radical prostatectomy market: a total population analysis from 2006 to 2013.

PubMed

Groeben, C; Koch, R; Baunacke, M; Wirth, M P; Huber, J

2016-12-01

To assess trends in the distribution of patients for radical prostatectomy in Germany from 2006 to 2013 and the impact of robotic surgery on annual caseloads. We hypothesized that the advent of robotics and the establishment of certified prostate cancer centers caused centralization in the German radical prostatectomy market. Using remote data processing we analyzed the nationwide German billing data from 2006 to 2013. We supplemented this database with additional hospital characteristics like the prostate cancer center certification status. Inclusion criteria were a prostate cancer diagnosis combined with radical prostatectomy. Hospitals with certification or a surgical robot in 2009 were defined as 'early' group. Linear covariant-analytic models were applied to describe trends over time. Annual radical prostatectomy numbers declined from 28 374 (2006) to 21 850 (2013). High-volume hospitals (⩾100 cases) decreased from 87 (22.0%) in 2006 to 43 (10.4%) in 2013. Low-volume hospitals (<50 cases) increased from 193 (48.7%) to 280 (67.4%). Mean radical prostatectomy caseloads of hospitals with early vs without certification declined from 155 to 130 vs 77 to 39 (P=0.021 for trend comparison). Early robotic hospitals maintained their volume >200 cases per year contrary to the overall trend (P<0.001 for trend comparison). A multivariate model for caseload numbers of 2013 indicated a robotic system to be the most important factor for higher caseloads (multiplication factor 7.3; 95% confidence interval: 6.6-8.0). A prostate cancer center certification (multiplication factor 1.6; 95% confidence interval: 1.50-1.59) had a much smaller impact. We found decentralization of radical prostatectomy in Germany. The driving force for this development might consist in the overall decline of radical prostatectomy numbers. The most important factor for achieving higher caseloads was the presence of a robotic system. In order to optimize outcomes of radical prostatectomy additional health policy measures might be necessary.

Association of Key Magnetic Resonance Imaging Markers of Cerebral Small Vessel Disease With Hematoma Volume and Expansion in Patients With Lobar and Deep Intracerebral Hemorrhage

PubMed Central

Boulouis, Gregoire; van Etten, Ellis S.; Charidimou, Andreas; Auriel, Eitan; Morotti, Andrea; Pasi, Marco; Haley, Kellen E.; Brouwers, H. Bart; Ayres, Alison M.; Vashkevich, Anastasia; Jessel, Michael J.; Schwab, Kristin M.; Viswanathan, Anand; Greenberg, Steven M.; Rosand, Jonathan; Goldstein, Joshua N.; Gurol, M. Edip

2017-01-01

IMPORTANCE Hematoma expansion is an important determinant of outcome in spontaneous intracerebral hemorrhage (ICH) due to small vessel disease (SVD), but the association between the severity of the underlying SVD and the extent of bleeding at the acute phase is unknown to date. OBJECTIVE To investigate the association between key magnetic resonance imaging (MRI) markers of SVD (as per the Standards for Reporting Vascular Changes on Neuroimaging [STRIVE] guidelines) and hematoma volume and expansion in patients with lobar or deep ICH. DESIGN, SETTING, AND PARTICIPANTS Analysis of data collected from 418 consecutive patients admitted with primary lobar or deep ICH to a single tertiary care medical center between January 1, 2000, and October 1, 2012. Data were analyzed on March 4, 2016. Participants were consecutive patients with computed tomographic images allowing ICH volume calculation and MRI allowing imaging markers of SVD assessment. MAIN OUTCOMES AND MEASURES The ICH volumes at baseline and within 48 hours after symptom onset were measured in 418 patients with spontaneous ICH without anticoagulant therapy, and hematoma expansion was calculated. Cerebral microbleeds, cortical superficial siderosis, and white matter hyperintensity volume were assessed on MRI. The associations between these SVD markers and ICH volume, as well as hematoma expansion, were investigated using multivariable models. RESULTS This study analyzed 254 patients with lobar ICH (mean [SD] age, 75 [11] years and 140 [55.1%] female) and 164 patients with deep ICH (mean [SD] age 67 [14] years and 71 [43.3%] female). The presence of cortical superficial siderosis was an independent variable associated with larger ICH volume in the lobar ICH group (odds ratio per quintile increase in final ICH volume, 1.49; 95% CI, 1.14–1.94; P = .004). In multivariable models, the absence of cerebral microbleeds was associated with larger ICH volume for both the lobar and deep ICH groups (odds ratios per quintile increase in final ICH volume, 1.41; 95% CI, 1.11–1.81; P = .006 and 1.43; 95% CI, 1.04–1.99; P = .03; respectively) and with hematoma expansion in the lobar ICH group (odds ratio, 1.70; 95% CI, 1.07–2.92; P = .04). The white matter hyperintensity volumes were not associated with either hematoma volume or expansion. CONCLUSIONS AND RELEVANCE In patients admitted with primary lobar or deep ICH to a single tertiary care medical center, the presence of cortical superficial siderosis was an independent variable associated with larger lobar ICH volume, and the absence of cerebral microbleeds was associated with larger lobar and deep ICHs. The absence of cerebral microbleeds was independently associated with more frequent hematoma expansion in patients with lobar ICH. We provide an analytical framework for future studies aimed at limiting hematoma expansion. PMID:27723863

Mars power system concept definition study. Volume 2: Appendices

NASA Technical Reports Server (NTRS)

Littman, Franklin D.

1994-01-01

This report documents the work performed by Rockwell International's Rocketdyne Division on NASA Contract No. NAS3-25808 (Task Order No. 16) entitled 'Mars Power System Definition Study'. This work was performed for NASA's Lewis Research Center (LeRC). The report is divided into two volumes as follows: Volume 1 - Study Results; and Volume 2 - Appendices. The results of the power system characterization studies, operations studies, and technology evaluations are summarized in Volume 1. The appendices include complete, standalone technology development plans for each candidate power system that was investigated.

Association Between Serum Calcium Level and Extent of Bleeding in Patients With Intracerebral Hemorrhage.

PubMed

Morotti, Andrea; Charidimou, Andreas; Phuah, Chia-Ling; Jessel, Michael J; Schwab, Kristin; Ayres, Alison M; Romero, Javier M; Viswanathan, Anand; Gurol, M Edip; Greenberg, Steven M; Anderson, Christopher D; Rosand, Jonathan; Goldstein, Joshua N

2016-11-01

Calcium is a key cofactor of the coagulation cascade and may play a role in the pathophysiology of intracerebral hemorrhage (ICH). To investigate whether a low serum calcium level is associated with an increase in the extent of bleeding in patients with ICH as measured by baseline hematoma volume and risk of hematoma expansion. Prospective cohort study of 2103 consecutive patients with primary ICH ascertained during the period between 1994 and 2015 at an academic medical center. The statistical analysis was performed in January 2016. Total calcium level was measured on admission, and hypocalcemia was defined as a serum calcium level of less than 8.4 mg/dL. Baseline and follow-up hematoma volumes, detected by noncontrast computed tomography, were measured using a computer-assisted semiautomatic analysis. Hematoma expansion was defined as an increase of more than 30% or 6 mL from baseline ICH volume. Associations between serum calcium level and baseline hematoma volume and between serum calcium level and ICH expansion were investigated in multivariable linear and logistic regression models, respectively. A total of 2123 patients with primary ICH were screened, and 2103 patients met the inclusion criteria (mean [SD] age, 72.7 [12.5] years; 54.3% male patients), of whom 229 (10.9%) had hypocalcemia on admission. Hypocalcemic patients had a higher median baseline hematoma volume than did normocalcemic patients (37 mL [IQR, 15-72 mL] vs 16 mL [IQR, 6-44 mL]; P < .001). Low calcium levels were independently associated with higher baseline ICH volume (β = -0.13, SE = .03, P < .001). A total of 1393 patients underwent follow-up noncontrast computed tomography and were included in the ICH expansion analysis. In this subgroup, a higher serum calcium level was associated with reduced risk of ICH expansion (odds ratio, 0.55 [95% CI, 0.35-0.86]; P = .01), after adjusting for other confounders. Hypocalcemia correlates with the extent of bleeding in patients with ICH. A low calcium level may be associated with a subtle coagulopathy predisposing to increased bleeding and might therefore be a promising therapeutic target for acute ICH treatment trials.

17.9.3 Radical cations of diazo compounds

NASA Astrophysics Data System (ADS)

Davies, A. G.

This document is part of Subvolume E2 `Phosphorus-Centered Radicals, Radicals Centered on Other Heteroatoms, Organic Radical Ions' of Volume 26 `Magnetic Properties of Free Radicals' of Landolt-Börnstein Group II `Molecules and Radicals'.

North Carolina DOT traffic separation studies. Volume II, Findings by community.

DOT National Transportation Integrated Search

2004-09-01

The Federal Railroad Administration requested the U.S. Department of Transportation's (DOT's) Volpe National Transportation Systems Center (Volpe Center) to assess the Traffic Separation Study (TSS) process developed by the North Carolina Department ...

Visualizing the Big (and Large) Data from an HPC Resource

NASA Astrophysics Data System (ADS)

Sisneros, R.

2015-10-01

Supercomputers are built to endure painfully large simulations and contend with resulting outputs. These are characteristics that scientists are all too willing to test the limits of in their quest for science at scale. The data generated during a scientist's workflow through an HPC center (large data) is the primary target for analysis and visualization. However, the hardware itself is also capable of generating volumes of diagnostic data (big data); this presents compelling opportunities to deploy analogous analytic techniques. In this paper we will provide a survey of some of the many ways in which visualization and analysis may be crammed into the scientific workflow as well as utilized on machine-specific data.

Year-Round Daylight Saving Time Study : Volume 2. Supporting Studies

DOT National Transportation Integrated Search

1975-06-01

This volume contains detailed background material in support of findings of the Interim Report. It includes the findings of a survey of attifudes towards daylight saving conducted by the National Opinion Research Center; description of sunrise and su...

Market Competition and Density in Liver Transplantation: Relationship to Volume and Outcomes.

PubMed

Adler, Joel T; Yeh, Heidi; Markmann, James F; Nguyen, Louis L

2015-08-01

Liver transplantation centers are unevenly distributed within the Donor Service Areas (DSAs) of the United States. This study assessed how market competition and liver transplantation center density are associated with liver transplantation volume within individual DSAs. We conducted a retrospective cohort study of 53,156 adult liver transplants in 45 DSAs with 110 transplantation centers identified from the Scientific Registry of Transplant Recipients between 2003 and 2012. The following measures were derived annually for each DSA: market competition using the Herfindahl Hirschman Index, transplantation center density by the Average Nearest Neighbor method, liver quality by the Liver Donor Risk Index, and patient risk by the Model for End-Stage Liver Disease. A hierarchical mixed effects negative binomial regression model of the relationship between liver transplants and market factors was created annually. Patient and graft survival were investigated with a Cox proportional hazards model. Transplantation center density was associated with market competition (p < 0.0001), listings for organ transplantation (p < 0.0001), and Model for End-Stage Liver Disease at transplantation (p = 0.0005). More liver transplantation centers (incidence rate ratio [IRR] = 1.03; p = 0.04), greater market competition (IRR = 1.36; p = 0.02), increased listings (IRR = 1.14; p < 0.0001), more donors (IRR = 1.24; p < 0.0001), and higher Liver Donor Risk Index (IRR = 3.35; p < 0.0001) were associated with more transplants. No market variables were associated with increased mortality after transplantation. After controlling for demographic and market factors, a greater concentration of centers was associated with more liver transplants without impacting overall survival. These results warrant additional investigation into the relationship between geospatial factors and liver transplantation volume with consideration for the optimization of scarce resources. Copyright © 2015 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

File Specification for GEOS-5 FP-IT (Forward Processing for Instrument Teams)

NASA Technical Reports Server (NTRS)

Lucchesi, R.

2013-01-01

The GEOS-5 FP-IT Atmospheric Data Assimilation System (GEOS-5 ADAS) uses an analysis developed jointly with NOAA's National Centers for Environmental Prediction (NCEP), which allows the Global Modeling and Assimilation Office (GMAO) to take advantage of the developments at NCEP and the Joint Center for Satellite Data Assimilation (JCSDA). The GEOS-5 AGCM uses the finite-volume dynamics (Lin, 2004) integrated with various physics packages (e.g, Bacmeister et al., 2006), under the Earth System Modeling Framework (ESMF) including the Catchment Land Surface Model (CLSM) (e.g., Koster et al., 2000). The GSI analysis is a three-dimensional variational (3DVar) analysis applied in grid-point space to facilitate the implementation of anisotropic, inhomogeneous covariances (e.g., Wu et al., 2002; Derber et al., 2003). The GSI implementation for GEOS-5 FP-IT incorporates a set of recursive filters that produce approximately Gaussian smoothing kernels and isotropic correlation functions. The GEOS-5 ADAS is documented in Rienecker et al. (2008). More recent updates to the model are presented in Molod et al. (2011). The GEOS-5 system actively assimilates roughly 2 × 10(exp 6) observations for each analysis, including about 7.5 × 10(exp 5) AIRS radiance data. The input stream is roughly twice this volume, but because of the large volume, the data are thinned commensurate with the analysis grid to reduce the computational burden. Data are also rejected from the analysis through quality control procedures designed to detect, for example, the presence of cloud. To minimize the spurious periodic perturbations of the analysis, GEOS-5 FP-IT uses the Incremental Analysis Update (IAU) technique developed by Bloom et al. (1996). More details of this procedure are given in Appendix A. The analysis is performed at a horizontal resolution of 0.625-degree longitude by 0.5-degree latitude and at 72 levels, extending to 0.01 hPa. All products are generated at the native resolution of the horizontal grid. The majority of data products are time-averaged, but four instantaneous products are also available. Hourly data intervals are used for two-dimensional products, while 3-hourly intervals are used for three-dimensional products. These may be on the model's native 72-layer vertical grid or at 42 pressure surfaces extending to 0.1 hPa. This document describes the gridded output files produced by the GMAO near real-time operational GEOS-5 FP-IT processing in support of the EOS instrument teams. Additional details about variables listed in this file specification can be found in a separate document, the GEOS-5 File Specification Variable Definition Glossary.

The 2012 Brown Center Report on American Education: How Well Are American Students Learning? With Sections on Predicting the Effect of the Common Core State Standards, Achievement Gaps on the Two NAEP Tests, and Misinterpreting International Test Scores. Volume III, Number 1

ERIC Educational Resources Information Center

Loveless, Tom

2012-01-01

This edition of the Brown Center Report on American Education marks the first issue of volume three--and eleventh issue over all. The first installment was published in 2000, just as the Presidential campaigns of George W. Bush and Al Gore were winding down. Education was an important issue in that campaign. It has not been thus far in the current…

How Well Are American Students Learning? With Sections on Reading and Math in the Common Core Era, Tracking and Advanced Placement (AP), and Principals as Instructional Leaders. The 2016 Brown Center Report on American Education. Volume 3, Number 5

ERIC Educational Resources Information Center

Loveless, Tom

2016-01-01

The 2016 edition of the Brown Center Report (BCR) is number five in the third volume and the 15th issue overall. As is customary, this year's BCR contains three studies. Part one is on the Common Core State Standards (CCSS) and instruction in math and reading. National Assessment of Educational Progress (NAEP) data indicate that nonfiction is…

United States Air Force Summer Research Program -- 1993 Summer Research Program Final Reports. Volume 11. Arnold Engineering Development Center, Frank J. Seiler Research Laboratory, Wilford Hall Medical Center

DTIC Science & Technology

1993-01-01

external parameters such as airflow, temperature, pressure, etc, are measured. Turbine Engine testing generates massive volumes of data at very high...a form that describes the signal flow graph topology as well as specific parameters of the processing blocks in the diagram. On multiprocessor...provides an interface to the symbolic builder and control functions such that parameters may be set during the build operation that will affect the

Tri-FAST Hardware-in-the-Loop Simulation. Volume I. Tri-FAST Hardware-in-the-Loop Simulation at the Advanced Simulation Center

DTIC Science & Technology

1979-03-28

TECHNICAL REPORT T-79-43 TRI- FAST HARDWARE-IN-THE-LOOP SIMULATION Volume 1: Trn FAST Hardware-In-the. Loop Simulation at the Advanced Simulation...Identify by block number) Tri- FAST Hardware-in-the-Loop ACSL Advanced Simulation Center Simulation RF Target Models I a. AfIACT ( sin -oveme skit N nem...e n tdositr by block number) The purpose of this report is to document the Tri- FAST missile simulation development and the seeker hardware-in-the

The U.S. Coast Guard and Joint Operations. Joint Center for Operational Analysis and Lessons Learned: Volume VI, Issue 4, September 2004

DTIC Science & Technology

2004-09-01

contributions during combat operations in Iraq. Vice Admiral Timothy J. Keating , U.S. Navy, then commander of the U.S. Fifth Fleet and Naval Forces...Admiral Keating described the boat crews as having been the “first line of defense” for coalition naval forces during the amphibious assault of Iraq’s Al...illegally. This law- enforcement presence to preserve maritime security in the 3.4-million-square-mile American exclusive economic zone also led to the

The Evolving Nature of Warfare. Joint Center for Operational Analysis. Quarterly Bulletin, Volume 10, Issue 3, Fall 2008

DTIC Science & Technology

2008-01-01

to arm Marines with knowl- edge of where the Bible and the Koran are similar or the same, and where they diverge. The Marine still has to make a...ment, and an organization. Lubavitch means the “city of brotherly love.” The word “Chabad” is a Hebrew acronym for the three intellectual faculties...were competent in conversational English and their prayer books were in Hebrew , with French and Arabic translation. 3 According to the dictates of

500 Contractors Receiving the Largest Dollar Volume of Prime Contract Awards for RDT&E, Fiscal Year 1992

DTIC Science & Technology

1992-01-01

201 F CANADIAN COMMERCIAL CORPORATI 268 B AMTEC CORPORATION 67 N CARNEGIE MELLON UNIVERSITY 118 B ANALYSIS & TECHNOLOGY INC 192 B CAS INC 86 N...LAB INC 342 F GENERAL ELECTRIC CO PLC THE 356 B DU PONT E I DE NEMOURS & CO 3 B GENERAL ELECTRIC COMPANY 325 N DUKE UNIVERSITY 295 N GENERAL HOSPITAL...F SOREQ NUCLEAR RESEARCH CENTER 260 F PORTON INTERNATIONAL INC 55 N SOUTH CAROLINA RESCH AUTHORITY 82 B PRC INC 206 N SOUrTHEASTN CTR ELECTR ENG ED

Advanced technology airfoil research, volume 1, part 2

NASA Technical Reports Server (NTRS)

1978-01-01

This compilation contains papers presented at the NASA Conference on Advanced Technology Airfoil Research held at Langley Research Center on March 7-9, 1978, which have unlimited distribution. This conference provided a comprehensive review of all NASA airfoil research, conducted in-house and under grant and contract. A broad spectrum of airfoil research outside of NASA was also reviewed. The major thrust of the technical sessions were in three areas: development of computational aerodynamic codes for airfoil analysis and design, development of experimental facilities and test techniques, and all types of airfoil applications.

Analysis and Evaluation of German Attainments and Research in the Liquid Rocket Engine Field. Volume 4. Propellant Injectors

DTIC Science & Technology

1951-02-01

they were ob- served at a given pressure drop in "cold" testing with water or unreacted propellants. heat-transfer considerations and the location of... water as a coolant in the main chamber. The Winkler injector was used.on a test unit developing a thrust of 220 lb and an exhaust ve- locity of 6370 ft... water . Provision was made for an igniter in the center of the injector. The relatively high performance reported for this unit does not seem to be

Strategy Planning Visualization Tool (SPVT) for the Air Operations Center (AOC) Volume I: SPVT Summary and COA Sketch

DTIC Science & Technology

2009-12-01

Limitations of Real Time Battle Damage Assessment. [Thesis.] Maxwell AFB, AL: Air University. Shadbolt, N., Hall, W., Berners - Lee , T. (2006, May-June... Tim ) COA Development Use Case 3.7: User creates a new Course of Action (COA) User Story / Context of Use:  The JFACC may issue clear and...default, the timing of a Mission Analysis object will be r elative to the Operation’s Default tim ing (D-Day). If Use Case 3.24 is implem ented, then

Repeatability of quantitative 18F-FLT uptake measurements in solid tumors: an individual patient data multi-center meta-analysis.

PubMed

Kramer, G M; Liu, Y; de Langen, A J; Jansma, E P; Trigonis, I; Asselin, M-C; Jackson, A; Kenny, L; Aboagye, E O; Hoekstra, O S; Boellaard, R

2018-06-01

3'-deoxy-3'-[ 18 F]fluorothymidine ( 18 F-FLT) positron emission tomography (PET) provides a non-invasive method to assess cellular proliferation and response to antitumor therapy. Quantitative 18 F-FLT uptake metrics are being used for evaluation of proliferative response in investigational setting, however multi-center repeatability needs to be established. The aim of this study was to determine the repeatability of 18 F-FLT tumor uptake metrics by re-analyzing individual patient data from previously published reports using the same tumor segmentation method and repeatability metrics across cohorts. A systematic search in PubMed, EMBASE.com and the Cochrane Library from inception-October 2016 yielded five 18 F-FLT repeatability cohorts in solid tumors. 18 F-FLT avid lesions were delineated using a 50% isocontour adapted for local background on test and retest scans. SUV max , SUV mean , SUV peak , proliferative volume and total lesion uptake (TLU) were calculated. Repeatability was assessed using the repeatability coefficient (RC = 1.96 × SD of test-retest differences), linear regression analysis, and the intra-class correlation coefficient (ICC). The impact of different lesion selection criteria was also evaluated. Images from four cohorts containing 30 patients with 52 lesions were obtained and analyzed (ten in breast cancer, nine in head and neck squamous cell carcinoma, and 33 in non-small cell lung cancer patients). A good correlation was found between test-retest data for all 18 F-FLT uptake metrics (R 2  ≥ 0.93; ICC ≥ 0.96). Best repeatability was found for SUV peak (RC: 23.1%), without significant differences in RC between different SUV metrics. Repeatability of proliferative volume (RC: 36.0%) and TLU (RC: 36.4%) was worse than SUV. Lesion selection methods based on SUV max  ≥ 4.0 improved the repeatability of volumetric metrics (RC: 26-28%), but did not affect the repeatability of SUV metrics. In multi-center studies, differences ≥ 25% in 18 F-FLT SUV metrics likely represent a true change in tumor uptake. Larger differences are required for FLT metrics comprising volume estimates when no lesion selection criteria are applied.

Design and Application of the Exploration Maintainability Analysis Tool

NASA Technical Reports Server (NTRS)

Stromgren, Chel; Terry, Michelle; Crillo, William; Goodliff, Kandyce; Maxwell, Andrew

2012-01-01

Conducting human exploration missions beyond Low Earth Orbit (LEO) will present unique challenges in the areas of supportability and maintainability. The durations of proposed missions can be relatively long and re-supply of logistics, including maintenance and repair items, will be limited or non-existent. In addition, mass and volume constraints in the transportation system will limit the total amount of logistics that can be flown along with the crew. These constraints will require that new strategies be developed with regards to how spacecraft systems are designed and maintained. NASA is currently developing Design Reference Missions (DRMs) as an initial step in defining future human missions. These DRMs establish destinations and concepts of operation for future missions, and begin to define technology and capability requirements. Because of the unique supportability challenges, historical supportability data and models are not directly applicable for establishing requirements for beyond LEO missions. However, supportability requirements could have a major impact on the development of the DRMs. The mass, volume, and crew resources required to support the mission could all be first order drivers in the design of missions, elements, and operations. Therefore, there is a need for enhanced analysis capabilities to more accurately establish mass, volume, and time requirements for supporting beyond LEO missions. Additionally, as new technologies and operations are proposed to reduce these requirements, it is necessary to have accurate tools to evaluate the efficacy of those approaches. In order to improve the analysis of supportability requirements for beyond LEO missions, the Space Missions Analysis Branch at the NASA Langley Research Center is developing the Exploration Maintainability Analysis Tool (EMAT). This tool is a probabilistic simulator that evaluates the need for repair and maintenance activities during space missions and the logistics and crew requirements to support those activities. Using a Monte Carlo approach, the tool simulates potential failures in defined systems, based on established component reliabilities, and then evaluates the capability of the crew to repair those failures given a defined store of spares and maintenance items. Statistical analysis of Monte Carlo runs provides probabilistic estimates of overall mission safety and reliability. This paper will describe the operation of the EMAT, including historical data sources used to populate the model, simulation processes, and outputs. Analysis results are provided for a candidate exploration system, including baseline estimates of required sparing mass and volume. Sensitivity analysis regarding the effectiveness of proposed strategies to reduce mass and volume requirements and improve mission reliability is included in these results.

Resource Utilization in Pediatric Patients Supported With Ventricular Assist Devices in the United States: A Multicenter Study From the Pediatric Interagency Registry for Mechanically Assisted Circulatory Support and the Pediatric Health Information System.

PubMed

Rossano, Joseph W; Cantor, Ryan S; Dai, Dingwei; Shamszad, Pirouz; Huang, Yuan-Shung; Hall, Matthew; Lin, Kimberly Y; Edens, R Erik; Parrino, P Eugene; Kirklin, James K

2018-06-01

Few data exist on resource utilization with pediatric ventricular assist devices (VADs). We tested the hypothesis that device type and adverse events are associated with increased resource utilization in pediatric patients supported with VADs. The Pediatric Interagency Registry for Mechanically Assisted Circulatory Support, a national registry of VADs in patients <19 years old, and the Pediatric Health Information System, an administrative database, were merged. Univariate analysis was performed assessing the association of all factors with the total cost and length of stay first. Significant variables ( P <0.05) were subjected to multivariable analysis. The study included 142 patients from 19 centers with VAD implants from October 2012 to June 2016. The median age was 9 years (interquartile range [IQR] 2-15), 84 (59%) supported with a continuous-flow VAD. Overall median hospital costs were $750 000 (IQR $539 000 to $1 100 000) with a median hospital length of stay of 81 days (IQR 54-128). On multivariable analysis, device type and postoperative complications were not associated with resource utilization. Factors associated with increased costs included patient age, lower-volume VAD center, being intubated, being on extracorporeal membrane oxygenation, number of complex chronic medical conditions, and length of stay. Among continuous-flow VAD patients, discharge to home before transplant versus remaining hospitalized was associated with lower hospital costs (median $600 000 [IQR $400 000 to $820 000] versus median $680 000 [IQR $500 000 to $970 000], P =0.03). VADs in pediatric patients are associated with high resource utilization. Increased resource utilization was associated with lower-volume VAD centers, disease severity at VAD implantation, and the presence of complex chronic medical conditions. Further study is needed to develop cost-effective strategies in this complex population. © 2018 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.

A microfabricated bio-sensor for erythrocytes deformability and volume distributions analysis

NASA Astrophysics Data System (ADS)

Bransky, Avishay; Korin, Natanel; Nemirovski, Yael; Dinnar, Uri

2007-12-01

The deformability of erythrocytes is of great importance for oxygen delivery in the microcirculation. Reduced RBC deformability is associated with several types of hemolytic anaemias, malaria, sepsis and diabetes. Aging of erythrocytes is also associated with loss of deformability as well as reduction in cell volume. An automated rheoscope has been developed, utilizing a microfabricated glass flow cell, high speed camera and advanced image-processing software. RBCs suspended in a high viscosity medium were filmed flowing through a microchannel. The system produces valuable data such as velocity profiles of RBCs, spatial distribution within the microchannel, cell volume and deformation index (DI) curves. The variation of DI across the channel height, due to change in shear stress, was measured for the first time. Such DI curves were obtained for normal and Thalassemia RBCs and their diagnostic potential was demonstrated. The spatial distribution and velocity of RBCs and rigid microspheres were measured. Both RBC and rigid spheres showed enhanced inward lateral migration, however the RBCs form a depletion region at the center of flow. The volume and surface area of the flowing cells have been estimated based on a fluid mechanics model and experimental results and fell within the normal range. Hence, the system developed, provides means for examining the behavior of individual RBCs in microchannels, and may serve as a microfabricated diagnostic device for deformability and volume measurements.

Single passenger rail car impact test. Volume III, Test procedures, instrumentation and data.

DOT National Transportation Integrated Search

2000-01-12

A full-scale impact test was performed November 16, 1999, at the Federal Railroad Administrations Transportation : Technology Center, Pueblo, Colorado, by Transportation Technology Center, Inc., a subsidiary of the Association of : American Railro...

Next generation traffic management centers.

DOT National Transportation Integrated Search

2013-05-01

Traffic management centers (TMCs) are critical to providing mobility to millions of people travelling on high-volume roadways. In Virginia, as with most regions of the United States, TMCs were aggressively deployed in the late 1990s and early 2000s. ...

Transportation management center data capture for performance and mobility measures guidebook.

DOT National Transportation Integrated Search

2013-03-01

The Guide to Transportation Management Center (TMC) Data Capture for Performance and Mobility Measures is a two-volume document consisting of this summary Guidebook and a Reference Manual. These documents provide technical guidance and recommended pr...

ITS enhanced bus rapid transit. Research and deployment program. [Draft for comment

DOT National Transportation Integrated Search

2000-02-01

The purpose of this guide is to provide a resource on worldwide transportation libraries and information centers for domestic and international professionals in the highway transportation field. This guide, Volume 1, is part of a multi-volume set of ...

Finding the Center of Volume of the Forearm

ERIC Educational Resources Information Center

Klein, Stacy S.; Roselli, Robert J.

2008-01-01

A typical first-year physics course teaches students about the center of mass using both regular and irregularly shaped objects. Students often suspend an object in each of two dimensions from a string with the intersection determining the center of mass of the object. While these methods can be effective, they are not particularly exciting or…

Army Communicator. Volume 30, Number 3, Summer 2005

DTIC Science & Technology

2005-01-01

radio is an IP phone. coffee runner for the brigade signal officer and need to understand the Signal commander’s role in the big picture. We as...111th (center front), LTC Kite , 54th BN CDR (center back), PV2 Harrington, Guidon Bearer A/280th (center front), 1SG Fields, A/280th (right back

77 FR 8877 - World Trade Center Health Program Scientific/Technical Advisory Committee (WTCHP STAC or Advisory...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-02-15

... DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Disease Control and Prevention World Trade Center Health Program Scientific/Technical Advisory Committee (WTCHP STAC or Advisory Committee), National Institute for Occupational Safety and Health (NIOSH) Correction This notice was published in the Federal Register on January 31, 2012, Volume 77,...

A Guide to the Management of Curriculum Materials Centers for the 21st Century: The Promise and the Challenge.

ERIC Educational Resources Information Center

Carr, Jo Ann, Ed.

Curriculum Materials Centers (CMCs), resource centers that support teacher education programs, are facing many challenges, including maintaining funding, meeting increased expectations, and coping with changes in technology. This volume covers a wide range of management issues from the perspective of 18 librarians, including practical advice on…

California State Library: Processing Center Design and Specifications. Volume I, System Description and Input Processing.

ERIC Educational Resources Information Center

Sherman, Don; Shoffner, Ralph M.

The scope of the California State Library-Processing Center (CSL-PC) project is to develop the design and specifications for a computerized technical processing center to provide services to a network of participating California libraries. Immediate objectives are: (1) retrospective conversion of card catalogs to a machine-form data base,…

YF-12 Experiments Symposium, Volume 1

NASA Technical Reports Server (NTRS)

1978-01-01

Papers presented by personnel from the Dryden Flight Research Center, the Lewis Research Center, and the Ames Research Center are presented. Topics cover propulsion system performance, inlet time varying distortion, structures, aircraft controls, propulsion controls, and aerodynamics. The reports were based on analytical studies, laboratory experiments, wind tunnel tests, and extensive flight research with two YF-12 airplanes.

Empirical Inquiry Into Teacher Centers. Teacher Education Forum; Volume 3, Number 13.

ERIC Educational Resources Information Center

Ruchkin, Judith P.

This report represents a summary of a larger, on-going investigation in teacher education committed to providing a detailed description of the differences found in teacher center and noncenter programs. Part one describes the design, and then summarizes the findings, of the initial phase of the center study by providing the answers to the six…

IUS/TUG orbital operations and mission support study. Volume 2: Interim upper stage operations

NASA Technical Reports Server (NTRS)

1975-01-01

Background data and study results are presented for the interim upper stage (IUS) operations phase of the IUS/tug orbital operations study. The study was conducted to develop IUS operational concepts and an IUS baseline operations plan, and to provide cost estimates for IUS operations. The approach used was to compile and evaluate baseline concepts, definitions, and system, and to use that data as a basis for the IUS operations phase definition, analysis, and costing analysis. Both expendable and reusable IUS configurations were analyzed and two autonomy levels were specified for each configuration. Topics discussed include on-orbit operations and interfaces with the orbiter, the tracking and data relay satellites and ground station support capability analysis, and flight control center sizing to support the IUS operations.

National Aeronautics and Space Administration (NASA)/American Society for Engineering Education (ASEE) Summer Faculty Fellowship Program, 1987, volume 1

NASA Technical Reports Server (NTRS)

Jones, William B. (Editor); Goldstein, Stanley H. (Editor)

1987-01-01

The objective of the NASA/ASEE program were: (1) to further the professional knowledge of qualified engineering and science faculty members; (2) to stimulate an exchange of ideas between participants and NASA; (3) to enrich and refresh the research and teaching activities of participants' institutions; and (4) to contribute to the research objectives of the NASA centers. Each faculty fellow spent 10 weeks at Johnson Space Center engaged in a research project commensurate with his/her interests and background and worked in collaboration with a NASA/JSC colleague. A compilation is presented of the final reports on the research projects done by the fellows during the summer of 1987. This is volume 1 of a 2 volume report.

Cardiovascular simulator improvement: pressure versus volume loop assessment.

PubMed

Fonseca, Jeison; Andrade, Aron; Nicolosi, Denys E C; Biscegli, José F; Leme, Juliana; Legendre, Daniel; Bock, Eduardo; Lucchi, Julio Cesar

2011-05-01

This article presents improvement on a physical cardiovascular simulator (PCS) system. Intraventricular pressure versus intraventricular volume (PxV) loop was obtained to evaluate performance of a pulsatile chamber mimicking the human left ventricle. PxV loop shows heart contractility and is normally used to evaluate heart performance. In many heart diseases, the stroke volume decreases because of low heart contractility. This pathological situation must be simulated by the PCS in order to evaluate the assistance provided by a ventricular assist device (VAD). The PCS system is automatically controlled by a computer and is an auxiliary tool for VAD control strategies development. This PCS system is according to a Windkessel model where lumped parameters are used for cardiovascular system analysis. Peripheral resistance, arteries compliance, and fluid inertance are simulated. The simulator has an actuator with a roller screw and brushless direct current motor, and the stroke volume is regulated by the actuator displacement. Internal pressure and volume measurements are monitored to obtain the PxV loop. Left chamber internal pressure is directly obtained by pressure transducer; however, internal volume has been obtained indirectly by using a linear variable differential transformer, which senses the diaphragm displacement. Correlations between the internal volume and diaphragm position are made. LabVIEW integrates these signals and shows the pressure versus internal volume loop. The results that have been obtained from the PCS system show PxV loops at different ventricle elastances, making possible the simulation of pathological situations. A preliminary test with a pulsatile VAD attached to PCS system was made. © 2011, Copyright the Authors. Artificial Organs © 2011, International Center for Artificial Organs and Transplantation and Wiley Periodicals, Inc.

Heritability of changes in brain volume over time in twin pairs discordant for schizophrenia.

PubMed

Brans, Rachel G H; van Haren, Neeltje E M; van Baal, G Caroline M; Schnack, Hugo G; Kahn, René S; Hulshoff Pol, Hilleke E

2008-11-01

Structural brain abnormalities have consistently been found in schizophrenia, with increased familial risk for the disease associated with these abnormalities. Some brain volume changes are progressive over the course of the illness. Whether these progressive brain volume changes are mediated by genetic or disease-related factors is unknown. To investigate whether genetic and/or environmental factors are associated with progressive brain volume changes in schizophrenia. Longitudinal 5-year follow-up in monozygotic (MZ) and dizygotic (DZ) twin pairs discordant for schizophrenia and healthy comparison twin pairs using brain magnetic resonance imaging. Participants were recruited from the twin pair cohort at the University Medical Center Utrecht. A total of 92 participants completed the study: 9 MZ and 10 DZ twin pairs discordant for schizophrenia and 14 MZ and 13 DZ healthy twin pairs. Percentage volume changes of the whole brain; cerebral gray and white matter of the frontal, temporal, parietal, and occipital lobes; cerebellum; and lateral and third ventricles over time between and within twin pairs were compared using repeated measures analysis of covariance. Structural equation modeling was applied to estimate contributions of additive genetic and common and unique environmental factors. Significant decreases over time in whole brain and frontal and temporal lobe volumes were found in patients with schizophrenia and their unaffected co-twins compared with control twins. Bivariate structural equation modeling using cross-trait/cross-twin correlations revealed significant additive genetic influences on the correlations between schizophrenia liability and progressive whole brain (66%; 95% confidence interval [CI], 51%-100%), frontal lobe (76%; 95% CI, 54%-100%), and temporal lobe (79%; CI, 56%-100%) volume change. The progressive brain volume loss found in patients with schizophrenia and their unaffected co-twins is at least partly attributable to genetic factors related to the illness.

Relationship between volume and survival in closed intensive care units is weak and apparent only in mechanically ventilated patients.

PubMed

Fernández, Rafael; Altaba, Susana; Cabre, Lluis; Lacueva, Victoria; Santos, Antonio; Solsona, Jose-Felipe; Añon, Jose-Manuel; Catalan, Rosa-Maria; Gutierrez, Maria-Jose; Fernandez-Cid, Ramon; Gomez-Tello, Vicente; Curiel, Emilio; Fernandez-Mondejar, Enrique; Oliva, Joan-Carles; Tizon, Ana Isabel; Gonzalez, Javier; Monedero, Pablo; Sanchez, Manuela Garcia; de la Torre, M Victoria; Ibañez, Pedro; Frutos, Fernando; Del Nogal, Frutos; Gomez, M Jesus; Marcos, Alfredo; Vera, Paula; Serrano, Jose Manuel; Umaran, Isabel; Carrillo, Andres; Lopez-Pueyo, M-Jose; Rascado, Pedro; Balerdi, Begoña; Suberviola, Borja; Hernandez, Gonzalo

2013-10-01

Recent studies have found an association between increased volume and increased intensive care unit (ICU) survival; however, this association might not hold true in ICUs with permanent intensivist coverage. Our objective was to determine whether ICU volume correlates with survival in the Spanish healthcare system. Post hoc analysis of a prospective study of all patients admitted to 29 ICUs during 3 months. At ICU discharge, the authors recorded demographic variables, severity score, and specific ICU treatments. Follow-up variables included ICU readmission and hospital mortality. Statistics include logistic multivariate analyses for hospital mortality according to quartiles of volume of patients. The authors studied 4,001 patients with a mean predicted risk of death of 23% (range at hospital level: 14-46%). Observed hospital mortality was 19% (range at hospital level: 11-35%), resulting in a standardized mortality ratio of 0.81 (range: 0.5-1.3). Among the 1,923 patients needing mechanical ventilation, the predicted risk of death was 32% (14-60%) and observed hospital mortality was 30% (12-61%), resulting in a standardized mortality ratio of 0.96 (0.5-1.7). The authors found no correlation between standardized mortality ratio and ICU volume in the entire population or in mechanically ventilated patients. Only mechanically ventilated patients in very low-volume ICUs had slightly worse outcome. In the currently studied healthcare system characterized by 24/7 intensivist coverage, the authors found wide variability in outcome among ICUs even after adjusting for severity of illness but no relationship between ICU volume and outcome. Only mechanically ventilated patients in very low-volume centers had slightly worse outcomes.

Posterior cingulate glucose metabolism, hippocampal glucose metabolism, and hippocampal volume in cognitively normal, late-middle-aged persons at 3 levels of genetic risk for Alzheimer disease.

PubMed

Protas, Hillary D; Chen, Kewei; Langbaum, Jessica B S; Fleisher, Adam S; Alexander, Gene E; Lee, Wendy; Bandy, Daniel; de Leon, Mony J; Mosconi, Lisa; Buckley, Shannon; Truran-Sacrey, Diana; Schuff, Norbert; Weiner, Michael W; Caselli, Richard J; Reiman, Eric M

2013-03-01

To characterize and compare measurements of the posterior cingulate glucose metabolism, the hippocampal glucose metabolism, and hippocampal volume so as to distinguish cognitively normal, late-middle-aged persons with 2, 1, or 0 copies of the apolipoprotein E (APOE) ε4 allele, reflecting 3 levels of risk for late-onset Alzheimer disease. Cross-sectional comparison of measurements of cerebral glucose metabolism using 18F-fluorodeoxyglucose positron emission tomography and measurements of brain volume using magnetic resonance imaging in cognitively normal ε4 homozygotes, ε4 heterozygotes, and noncarriers. Academic medical center. A total of 31 ε4 homozygotes, 42 ε4 heterozygotes, and 76 noncarriers, 49 to 67 years old, matched for sex, age, and educational level. The measurements of posterior cingulate and hippocampal glucose metabolism were characterized using automated region-of-interest algorithms and normalized for whole-brain measurements. The hippocampal volume measurements were characterized using a semiautomated algorithm and normalized for total intracranial volume. Although there were no significant differences among the 3 groups of participants in their clinical ratings, neuropsychological test scores, hippocampal volumes (P = .60), or hippocampal glucose metabolism measurements (P = .12), there were significant group differences in their posterior cingulate glucose metabolism measurements (P = .001). The APOE ε4 gene dose was significantly associated with posterior cingulate glucose metabolism (r = 0.29, P = .0003), and this association was significantly greater than those with hippocampal volume or hippocampal glucose metabolism (P < .05, determined by use of pairwise Fisher z tests). Although our findings may depend in part on the analysis algorithms used, they suggest that a reduction in posterior cingulate glucose metabolism precedes a reduction in hippocampal volume or metabolism in cognitively normal persons at increased genetic risk for Alzheimer disease.

Magnetic resonance imaging-guided focused ultrasound treatment of symptomatic uterine fibroids: impact of technology advancement on ablation volumes in 115 patients.

PubMed

Trumm, Christoph G; Stahl, Robert; Clevert, Dirk-André; Herzog, Peter; Mindjuk, Irene; Kornprobst, Sabine; Schwarz, Christina; Hoffmann, Ralf-Thorsten; Reiser, Maximilian F; Matzko, Matthias

2013-06-01

The aim of this study was to assess the impact of the advanced technology of the new ExAblate 2100 system (Insightec Ltd, Haifa, Israel) for magnetic resonance imaging (MRI)-guided focused ultrasound surgery on treatment outcomes in patients with symptomatic uterine fibroids, as measured by the nonperfused volume ratio. This is a retrospective analysis of 115 women (mean age, 42 years; range, 27-54 years) with symptomatic fibroids who consecutively underwent MRI-guided focused ultrasound treatment in a single center with the new generation ExAblate 2100 system from November 2010 to June 2011. Mean ± SD total volume and number of treated fibroids (per patient) were 89 ± 94 cm and 2.2 ± 1.7, respectively. Patient baseline characteristics were analyzed regarding their impact on the resulting nonperfused volume ratio. Magnetic resonance imaging-guided focused ultrasound treatment was technically successful in 115 of 123 patients (93.5%). In 8 patients, treatment was not possible because of bowel loops in the beam pathway that could not be mitigated (n = 6), patient movement (n = 1), and system malfunction (n = 1). Mean nonperfused volume ratio was 88% ± 15% (range, 38%-100%). Mean applied energy level was 5400 ± 1200 J, and mean number of sonications was 74 ± 27. No major complications occurred. Two cases of first-degree skin burn resolved within 1 week after the intervention. Of the baseline characteristics analyzed, only the planned treatment volume had a statistically significant impact on nonperfused volume ratio. With technological advancement, the outcome of MRI-guided focused ultrasound treatment in terms of the nonperfused volume ratio can be enhanced with a high safety profile, markedly exceeding results reported in previous clinical trials.

Forecasting the Future Food Service World of Work. Final Report. Volume II. Centralized Food Service Systems. Service Management Reports.

ERIC Educational Resources Information Center

Powers, Thomas F., Ed.; Swinton, John R., Ed.

Volume II of a three-volume study on the future of the food service industry considers the effects that centralized food production will have on the future of food production systems. Based on information from the Fair Acres Project and the Michigan State University Vegetable Processing Center, the authors describe the operations of a centralized…

Keeping the Edge. Air Force Materiel Command Cold War Context (1945-1991). Volume 3: Index

DTIC Science & Technology

2003-08-01

485 The Architects Collaborative (Harvard University) see Gropius , Walter , under Architects and Engineers, across the Department of Defense The...Sons (Newark, New Jersey) Volume II: 250 Graham, Anderson, Probst & White (Chicago) Volume II: 392, 455, 460, 461,475 Gropius , Walter ...models for Air Force research and development centers Gropius , Walter (The Architects Collaborative) see Architects and Engineers, across the

Proceedings of the Conference of the International Group for the Psychology of Mathematics Education (30th, Prague, Czech Republic, July 16-21, 2006). Volume 4

ERIC Educational Resources Information Center

Novotna, Jarmila, Ed.; Moraova, Hana, Ed.; Kratka, Magdalena, Ed.; Stehlikova, Nad'a, Ed.

2006-01-01

This document contains the fourth volume of the proceedings of the 30th Conference of the International Group for the Psychology of Mathematics Education. Conference presentations are centered around the theme "Mathematics at the Centre." This volume features 59 research reports by presenters with last names beginning between Kun and…

Proceedings of the Conference of the International Group for the Psychology of Mathematics Education (30th, Prague, Czech Republic, July 16-21, 2006). Volume 2

ERIC Educational Resources Information Center

Novotna, Jarmila, Ed.; Moraova, Hana, Ed.; Kratka, Magdalena, Ed.; Stehlikova, Nad'a, Ed.

2006-01-01

This document contains the second volume of the proceedings of the 30th Annual Conference of the International Group for the Psychology of Mathematics Education. Conference presentations are centered around the theme "Mathematics at the Centre." This volume features 60 research reports by presenters with last names beginning between Abr…

Proceedings of the Annual Meeting of the International Group for the Psychology of Mathematics Education (PME) (28th, Bergen, Norway, July 14-18, 2004). Volume 2

ERIC Educational Resources Information Center

Hoines, Marit Johnsen, Ed.; ; Fuglestad, Anne Berit, Ed.

2004-01-01

This document contains the second volume of the proceedings of the 28th annual conference of the International Group for the Psychology of Mathematics Education. Conference presentations are centered around the theme "Inclusion and Diversity". This volume features 65 research report papers: (1) Constructing Meanings and Utilities within Algebraic…

Proceedings of the Conference of the International Group for the Psychology of Mathematics Education (29th, Melbourne, Australia, July 10-15, 2005). Volume 2

ERIC Educational Resources Information Center

Chick, Helen L., Ed.; Vincent, Jill L., Ed.

2005-01-01

This document contains the second volume of the proceedings of the 29th Conference of the International Group for the Psychology of Mathematics Education. Conference papers are centered around the theme of "Learners and Learning Environments." This volume features 43 research reports by presenters with last names beginning between Adl…

The Effects of Travel Burden on Outcomes After Resection of Extrahepatic Biliary Malignancies: Results from the US Extrahepatic Biliary Consortium.

PubMed

O'Connor, Sean C; Mogal, Harveshp; Russell, Gregory; Ethun, Cecilia; Fields, Ryan C; Jin, Linda; Hatzaras, Ioannis; Vitiello, Gerardo; Idrees, Kamran; Isom, Chelsea A; Martin, Robert; Scoggins, Charles; Pawlik, Timothy M; Schmidt, Carl; Poultsides, George; Tran, Thuy B; Weber, Sharon; Salem, Ahmed; Maithel, Shishir; Shen, Perry

2017-12-01

Surgical resection of extrahepatic biliary malignancies has been increasingly centralized at high-volume tertiary care centers. While this has improved outcomes overall, increased travel burden has been associated with worse survival for many other malignancies. We hypothesized that longer travel distances are associated with worse outcomes for these patients as well. Data was analyzed from the US Extrahepatic Biliary Consortium database, which retrospectively reviewed patients who received resection of extrahepatic biliary malignancies at 10 high-volume centers. Driving distance to the patient's treatment center was measured for 1025 patients. These were divided into four quartiles for analysis: < 24.5, 24.5-57.2, 57.2-117, and < 117 mi. Cox proportional hazard models were then used to measure differences in overall survival. No difference was found between the groups in severity of disease or post-operative complications. The median overall survival in each quartile was as follows: 1st = 1.91, 2nd = 1.60, 3rd = 1.30, and 4th = 1.39 years. Patients in the 3rd and 4th quartile had a significantly lower median household income (p = 0.0001) and a greater proportion Caucasian race (p = 0.0001). However, neither of these was independently associated with overall survival. The two furthest quartiles were found to have decreased overall survival (HR = 1.39, CI = 1.12-1.73 and HR = 1.3, CI = 1.04-1.62), with quartile 3 remaining significant after multivariate analysis (HR = 1.45, CI = 1.04-2.0, p = 0.028). Longer travel distances were associated with decreased overall survival, especially in the 3rd quartile of our study. Patients traveling longer distances also had a lower household income, suggesting that these patients have significant barriers to care.

Anesthesia and Databases: Pediatric Cardiac Disease as a Role Model.

PubMed

Vener, David F; Pasquali, Sara K; Mossad, Emad B

2017-02-01

Large data sets have now become ubiquitous in clinical medicine; they are particularly useful in high-acuity, low-volume conditions such as congenital heart disease where data must be collected from many centers. These data fall into 2 categories: administrative data arising from hospital admissions and charges and clinical data relating to specific diseases or procedures. In congenital cardiac diseases, there are now over a dozen of these data sets or registries focusing on various elements of patient care. Using probabilistic statistic matching, it is possible to marry administrative and clinical data post hoc using common elements to determine valuable information about care patterns, outcomes, and costs. These data sets can also be used in a collaborative fashion between institutions to drive quality improvement (QI). Because these data may include protected health information (PHI), care must be taken to adhere to federal guidelines on their use. A fundamental principle of large data management is the use of a common language and definition (nomenclature) to be effective. In addition, research derived from these information sources must be appropriately balanced to ensure that risk adjustments for preoperative and surgical factors are taken into consideration during the analysis. Care of patients with cardiac disease both in the United States and abroad consistently shows wide variability in mortality, morbidity, and costs, and there has been a tremendous amount of discussion about the benefits of regionalization of care based on center volume and outcome measurements. In the absence of regionalization, collaborative learning techniques have consistently been shown to minimize this variability and improve care at all centers, but before changes can be made it is necessary to accurately measure accurately current patient outcomes. Outcomes measurement generally falls under hospital-based QI initiatives, but more detailed analysis and research require Institutional Review Board and administrative oversight. Cardiac anesthesia providers for these patients have partnered with the Society of Thoracic Surgeons Congenital Heart surgeons to include anesthesia elements to help in this process.

Successful introduction of Model for End-stage Liver Disease scoring in deceased donor liver transplantation in Korea: analysis of first 1 year experience at a high-volume transplantation center.

PubMed

Ha, Soo-Min; Hwang, Shin; Song, Gi-Won; Ahn, Chul-Soo; Moon, Deok-Bog; Ha, Tae-Yong; Jung, Dong-Hwan; Park, Gil-Chun; Kim, Ki-Hun; Kim, Dae-Yeon; Namgung, Jungman; Kang, Woo-Hyoung; Kim, Seok-Hwan; Jwa, Eunkyoung; Kwon, Jae-Hyeon; Cho, Hui-Dong; Jung, Yong-Kyu; Kang, Sang-Hyeon; Lee, Sung-Gyu

2017-11-01

Model for End-stage Liver Disease (MELD) score was adopted in June 2016 in Korea. We analyzed changes in volumes and outcomes of deceased donor liver transplantation (DDLT) for 1 year before and after introduction of MELD scoring at Asan Medical Center. There were 64 cases of DDLT in 1 year before MELD introduction and 106 in 1 year after MELD introduction, an increase of 65%. The volume of DDLTs abruptly increased during first 3 months, but then returned to its usual level before MELD introduction, which indicated 3-month depletion of accumulated recipient pool with high MELD scores. The number of pediatric DDLT cases increased from 3 before MELD introduction to 11 after it, making up 21.4% and 47.8% of all cases of pediatric liver transplantation, respectively. The number of cases of retransplanted DDLTs increased from 4 to 27, representing 6.3% and 25.5% of all DDLT cases, respectively. The number of status 1 DDLT cases increased from 5 to 12, being 7.8% and 11.3% of all cases. Patient survival outcomes were similar before and after MELD introduction. The number of DDLTs temporarily increased after adoption of MELD scoring due to accumulated recipient pool with high MELD scores. The numbers of retransplanted and pediatric DDLT cases significantly increased. Patient survival in adult and pediatric DDLT was comparable before and after adoption of MELD scoring. These results imply that Korean MELD score-based allocation system was successfully established within its first year.

Case volumes of intra-arterial and intravenous treatment of ischemic stroke in the USA.

PubMed

Hirsch, J A; Yoo, A J; Nogueira, R G; Verduzco, L A; Schwamm, L H; Pryor, J C; Rabinov, J D; González, R G

2009-07-01

Ischemic stroke is a major cause of disability and death in the USA. Intravenous tissue plasminogen activator (t-PA) remains underutilized. With the development of newer intra-arterial reperfusion therapies, there is increased opportunity to address the more devastating large-vessel occlusions. We seek to identify the numbers of patients with stroke treated with intravenous and intra-arterial therapies, as well as to estimate the potential number of intra-arterial cases in the foreseeable future. We performed a literature search to determine case volumes of intravenous t-PA use. We extrapolated the current case volume of intra-arterial stroke therapies from the numbers of cases in which the Merci retrieval device was used. In order to estimate the potential numbers of intra-arterial stroke cases, we characterized the percentage of patients with stroke who received intra-arterial therapy at two leading stroke centers. We applied these percentages to the numbers of patients with stroke seen at the top 100, 200 and 500 stroke centers by volume. The rate of intravenous t-PA use is 2.4-3.6%, resulting in 15 000-22 000 cases/year in the USA. The estimated case volume of intra-arterial therapies is 3500-7200 in 2006. Based on data from St. Luke's Brain and Stroke Institute and Massachusetts General Hospital, approximately 5-20% of patients with ischemic stroke can be treated with intra-arterial therapies. Extrapolating this to the top 500 stroke centers by volume, the potential number of intra-arterial cases in the USA is 10 400-41 500/year. Based on the current numbers of intra-arterial cases, our theoretical model identifies a potential for significant growth of this stroke therapy.

File Specification for GEOS-5 FP (Forward Processing)

NASA Technical Reports Server (NTRS)

Lucchesi, R.

2013-01-01

The GEOS-5 FP Atmospheric Data Assimilation System (GEOS-5 ADAS) uses an analysis developed jointly with NOAA's National Centers for Environmental Prediction (NCEP), which allows the Global Modeling and Assimilation Office (GMAO) to take advantage of the developments at NCEP and the Joint Center for Satellite Data Assimilation (JCSDA). The GEOS-5 AGCM uses the finite-volume dynamics (Lin, 2004) integrated with various physics packages (e.g, Bacmeister et al., 2006), under the Earth System Modeling Framework (ESMF) including the Catchment Land Surface Model (CLSM) (e.g., Koster et al., 2000). The GSI analysis is a three-dimensional variational (3DVar) analysis applied in grid-point space to facilitate the implementation of anisotropic, inhomogeneous covariances (e.g., Wu et al., 2002; Derber et al., 2003). The GSI implementation for GEOS-5 FP incorporates a set of recursive filters that produce approximately Gaussian smoothing kernels and isotropic correlation functions. The GEOS-5 ADAS is documented in Rienecker et al. (2008). More recent updates to the model are presented in Molod et al. (2011). The GEOS-5 system actively assimilates roughly 2 × 10(exp 6) observations for each analysis, including about 7.5 × 10(exp 5) AIRS radiance data. The input stream is roughly twice this volume, but because of the large volume, the data are thinned commensurate with the analysis grid to reduce the computational burden. Data are also rejected from the analysis through quality control procedures designed to detect, for example, the presence of cloud. To minimize the spurious periodic perturbations of the analysis, GEOS-5 FP uses the Incremental Analysis Update (IAU) technique developed by Bloom et al. (1996). More details of this procedure are given in Appendix A. The assimilation is performed at a horizontal resolution of 0.3125-degree longitude by 0.25- degree latitude and at 72 levels, extending to 0.01 hPa. All products are generated at the native resolution of the horizontal grid. The majority of data products are time-averaged, but four instantaneous products are also available. Hourly data intervals are used for two-dimensional products, while 3-hourly intervals are used for three-dimensional products. These may be on the model's native 72-layer vertical grid or at 42 pressure surfaces extending to 0.1 hPa. This document describes the gridded output files produced by the GMAO near real-time operational FP, using the most recent version of the GEOS-5 assimilation system. Additional details about variables listed in this file specification can be found in a separate document, the GEOS-5 File Specification Variable Definition Glossary. Documentation about the current access methods for products described in this document can be found on the GMAO products page: http://gmao.gsfc.nasa.gov/products/.

Infrared astronomical satellite (IRAS) catalogs and atlases. Volume 7: The small scale structure catalog

NASA Technical Reports Server (NTRS)

Helou, George (Editor); Walker, D. W. (Editor)

1988-01-01

The Infrared Astronomical Satellite (IRAS) was launched January 26, 1983. During its 300-day mission, it surveyed over 96 pct of the celestial sphere at four infrared wavelengths, centered approximately at 12, 25, 60, and 100 microns. Volume 1 describes the instrument, the mission, and the data reduction process. Volumes 2 through 6 present the observations of the approximately 245,000 individual point sources detected by IRAS; each volume gives sources within a specified range of declination. Volume 7 gives the observations of the approximately 16,000 sources spatially resolved by IRAS and smaller than 8'. This is Volume 7, The Small Scale Structure Catalog.

Broadband spatial optical filtering with a volume Bragg grating and a blazed grating pair

NASA Astrophysics Data System (ADS)

Chen, Guanjin; Sun, Xiaojie; Yuan, Xiao; Zhang, Guiju

2017-10-01

A broadband spatial optical filtering system is presented in this paper, which is composed of a Volume Bragg Grating (VBG) and a blazed grating pair. The diffraction efficiency and filtering properties are calculated and simulated by using Fourier diffraction analysis and Coupled Wave Theory. A blazed grating pair and VBG structures are designed and optimized in our simulation. The diffraction efficiency of filtering system shows more than 77.2% during the wavelength period from 953nm to 1153nm, especially 84.1% at the center wavelength. The beam quality is described with near-field modulation (M) and contrast ratio (C). The M of filtering beam are 1.44, 1.49 and 1.55, respectively and the C of filtering beam are 10.1%, 10.2% and 10.5% , respectively and the beam intensity distribution is great improved. The cut-off frequencies of three filtering systems are 1.57mm-1 , 2.06 mm-1 and 2.38 mm-1 , respectively from power spectral density (PSD) curve. It's clear that the cut-off frequency of filtering system is closely related to the angular selectivity of VBG, and the value of cut-off frequency is decided by VBG's Half Width at First Zero (HWFZ) and center wavelength.

Failed biliary cannulation: Clinical and technical outcomes after tertiary referral endoscopic retrograde cholangiopancreatography

PubMed Central

Swan, Michael P; Bourke, Michael J; Williams, Stephen J; Alexander, Sina; Moss, Alan; Hope, Rick; Ruppin, David

2011-01-01

AIM: Prospective evaluation of repeat endoscopic retrograde cholangiopancreatography (ERCP) for failed Schutz grade 1 biliary cannulation in a high-volume center. METHODS: Prospective intention-to-treat analysis of patients referred for biliary cannulation following recent unsuccessful ERCP. RESULTS: Fifty-one patients (35 female; mean age: 62.5 years; age range: 40-87 years) with previous failed biliary cannulation were referred for repeat ERCP. The indication for ERCP was primarily choledocholithiasis (45%) or pancreatic malignancy (18%). Successful biliary cannulation was 100%. The precut needle knife sphincterotomy (NKS) rate was 27.4%. Complications occurred in 3.9% (post-ERCP pancreatitis). An identifiable reason for initial unsuccessful biliary cannulation was present in 55% of cases. Compared to a cohort of 940 naïve papilla patients (female 61%; mean age: 59.9 years; age range: 18-94 years) who required sphincterotomy over the same time period, there was no statistical difference in the cannulation success rate (100% vs 98%) or post-ERCP pancreatitis (3.1% vs 3.9%). Precut NKS use was more frequent (27.4% vs 12.7%) (P = 0.017). CONCLUSION: Referral to a high-volume center following unsuccessful ERCP is associated with high technical success, with a favorable complication rate, compared to routine ERCP procedures. PMID:22174549

Skin and Soft Tissue Surgery in the Office Versus Operating Room Setting: An Analysis Based on Individual-Level Medicare Data.

PubMed

Kantor, Jonathan

2018-03-23

The relative volume of skin and soft tissue excision and reconstructive procedures performed in the outpatient office versus facility (ambulatory surgical center or hospital) differs by specialty, and has major implications for quality of care, outcomes, development of guidelines, resident education, health care economics, and patient perception. To assess the relative volume of surgical procedures performed in each setting (office vs ambulatory surgery center [ASC]/hospital) by dermatologists and nondermatologists. A cross-sectional analytical study was performed using the Medicare public use file (PUF) for 2014, which includes every patient seen in an office, ASC, or hospital in the United States billed to Medicare part B. Data were divided by physician specialty and setting. A total of 9,316,307 individual encounters were included in the Medicare PUF. Dermatologists account for 195,001 (2.1%) of the total. Dermatologists were more likely to perform surgical procedures in an office setting only (odds ratio 5.48 [95% confidence interval 5.05-5.95], p < .0001) than other specialists in aggregate. More than 90% of surgical procedures are performed in an office setting, and dermatologists are more than 5 times as likely as other specialists to operate in an office setting.

Liquid-core photonic crystal fiber platform for raman scattering measurements of microliter analyte solutions

NASA Astrophysics Data System (ADS)

Han, Yun; Oo, Maung Khaing; Zhu, Yinian; Sukhishvili, Svetlana; Xiao, Limin; Demokan, M. Süleyman; Jin, Wei; Du, Henry

2007-09-01

We have explored the use of index-guiding liquid-core photonic crystal fiber (LC-PCF) as a platform for sensing and measurements of analyte solutions of minute volume by normal and surface-enhanced Raman scattering (SERS). The index-guiding LC-PCF was fabricated by selectively sealing via fusion splicing the cladding air channels of a hollow-core PCF (HC-PCF) while leaving the center core open at both ends of the fiber. The center core of the resultant fiber was subsequently filled with water-ethanol solution mixtures at various ethanol concentrations for normal Raman scattering measurements and with water-thiocynate solutions containing Ag nanoparticle aggregates for SERS detection of thiocynate at trace concentrations. The light-guiding nature in the solution phase inside the LC-PCF allows direct and strong light-field overlap with the solution phase over the entire length of the PCF (~30 cm). This detection scheme also dramatically reduces the contribution of silica to Raman spectral background, compared with the solid-core counterpart, thus its potential interference in spectral analysis. These features attribute to ready normal Raman measurements of water, ethanol, and water (99 vol.%)-ethanol (1 vol.%) solutions as well as sensitive and reproducible SERS detection of ~10 ppb thiocynate in water, all at a volume of ~0.1 μL.

Deceased Organ Donor Management: Does Hospital Volume Matter?

PubMed

Patel, Madhukar S; Mohebali, Jahan; Sally, Mitchell; Groat, Tahnee; Vagefi, Parsia A; Chang, David C; Malinoski, Darren J

2017-03-01

Identification of strategies to improve organ donor use remains imperative. Despite the association between hospital volume and outcomes for many common disease processes, there have been no studies that assess the impact of organ donor hospital volume on organ yield. A prospective observational study of all deceased organ donors managed by 10 organ procurement organizations across United Network for Organ Sharing regions 4, 5, and 6 was conducted from February 2012 to June 2015. To study the impact of hospital volume on organ yield, each donor was placed into a hospital-volume quartile based on the number of donors managed by their hospital. Stepwise logistic regression was used to identify the independent effect of hospital volume on the primary outcomes measure of having ≥4 organs transplanted per donor. Data from 4,427 donors across 384 hospitals were collected and hospitals were assigned quartiles based on their volume of deceased donors. Hospitals managed a mean ± SD of 3.3 ± 5.2 donors per hospital per year. After adjusting for age, ethnicity, donor type, blood type, BMI, creatinine, and organ procurement organization/donor service area, being managed in hospitals within the highest volume quartile remained a positive independent predictor of ≥4 organs transplanted per donor (odds ratio = 1.52; 95% CI 1.29 to 1.79; p < 0.001). Deceased organ donor hospital volume impacts organ yield, with the highest-volume centers being 52% more likely to achieve ≥4 organs transplanted per donor. Efforts should be made to share practices from these higher-volume centers and consideration should be given to centralization of donor care. Published by Elsevier Inc.

Globally distributed software defined storage (proposal)

NASA Astrophysics Data System (ADS)

Shevel, A.; Khoruzhnikov, S.; Grudinin, V.; Sadov, O.; Kairkanov, A.

2017-10-01

The volume of the coming data in HEP is growing. The volume of the data to be held for a long time is growing as well. Large volume of data - big data - is distributed around the planet. The methods, approaches how to organize and manage the globally distributed data storage are required. The distributed storage has several examples for personal needs like own-cloud.org, pydio.com, seafile.com, sparkleshare.org. For enterprise-level there is a number of systems: SWIFT - distributed storage systems (part of Openstack), CEPH and the like which are mostly object storage. When several data center’s resources are integrated, the organization of data links becomes very important issue especially if several parallel data links between data centers are used. The situation in data centers and in data links may vary each hour. All that means each part of distributed data storage has to be able to rearrange usage of data links and storage servers in each data center. In addition, for each customer of distributed storage different requirements could appear. The above topics are planned to be discussed in data storage proposal.

Improved Low Temperature Performance of Supercapacitors

NASA Technical Reports Server (NTRS)

Brandon, Erik J.; West, William C.; Smart, Marshall C.; Gnanaraj, Joe

2013-01-01

Low temperature double-layer capacitor operation enabled by: - Base acetonitrile / TEATFB salt formulation - Addition of low melting point formates, esters and cyclic ethers center dot Key electrolyte design factors: - Volume of co-solvent - Concentration of salt center dot Capacity increased through higher capacity electrodes: - Zeolite templated carbons - Asymmetric cell designs center dot Continuing efforts - Improve asymmetric cell performance at low temperature - Cycle life testing Motivation center dot Benchmark performance of commercial cells center dot Approaches for designing low temperature systems - Symmetric cells (activated carbon electrodes) - Symmetric cells (zeolite templated carbon electrodes) - Asymmetric cells (lithium titanate/activated carbon electrodes) center dot Experimental results center dot Summary

Family.

ERIC Educational Resources Information Center

Hurst, Hunter, Ed.; And Others

1985-01-01

This document contains the fourth volume of "Today's Delinquent," an annual publication of the National Center for Juvenile Justice. This volume deals with the issue of the family and delinquency. "The Family and Delinquency" (LaMar T. Empey) systematically reviews and weighs the evidence to support prominent theories on the origins of…

Passenger flows in underground railway stations and platforms.

DOT National Transportation Integrated Search

2015-05-01

Urban rail systems are designed to carry large volumes of people into and out of major activity centers. As a result, the stations : at these major activity centers are often crowded with boarding and alighting passengers, resulting in passenger inco...

Introduction: Photons and ground-based

NASA Astrophysics Data System (ADS)

Spann, James; Moore, Thomas

2017-02-01

A Conference on Measurement Techniques for Solar and Space Physics was held on 20-24 April 2015 in Boulder, Colorado, at the National Center for Atmospheric Research Center Green Campus. The present volume collects together the conference papers for photons and ground-based categories.

Transportation management center data capture for performance and mobility measures reference manual.

DOT National Transportation Integrated Search

2013-03-01

The Guide to Transportation Management Center (TMC) Data Capture for Performance and Mobility Measures is a two-volume document consisting of a summary Guidebook and this Reference Manual. These documents provide technical guidance and recommended pr...

New Analysis of Solute Drag in AA5754 by Precise Determination of Point Defect Generation and the Orowan Relation

NASA Astrophysics Data System (ADS)

Diak, Brad J.; Penlington, Alex; Saimoto, Shig

Serrated deformation in Al-Mg alloys creates problems that affect consumer product acceptability. This effect is usually attributed to the Portevin-LeChâtelier effect. In this study the inverse PLC effect due to solute drag on moving dislocations is examined in AA5754. The drag mechanism is dependent on the diffusivity of the solute which is in-turn dependent on the point defect evolution during deformation. Experimental determination of the parabolic James-Barnett drag profile by strain rate change experiments indicates the peak stress is centered at 1.5×10-9m/s, which requires a mechanical formation energy for vacancies of 0.4eV/at. A new slip-based constitutive relation was used to determine the evolution of vacancy volume fraction with deformation with strain, which is greater than the volume fraction of vacancies predicted by the solute drag profile.

A Guide to the Data Resources of the Henry A. Murray Research Center of Radcliffe College: A Center for the Study of Lives [and] Index to [the] Guide.

ERIC Educational Resources Information Center

Radcliffe Coll., Cambridge, MA. Henry A. Murray Research Center.

The first of two volumes provides information about data resources available at the Henry A. Murray Research Center of Radcliffe College, a multidisciplinary research center that is a national repository for social and behavioral science data on human development and social change; topics of special concern to women are collection priorities. The…

Symposium on Naval Hydrodynamics (9th). Volume 1. Unconventional Ships; Ocean Engineering. Held at Paris (France) on August 20-25, 1972

DTIC Science & Technology

1972-01-01

DESIGN OF AN S3 SEMI-SUBMERGED SHIP 549 Thomas G. Lang, PhD, Naval Undersea Research and Development Center, San Diego, California... Undersea Research and Development Center, San Diego, California DISCUSSION 574 Nils Salvesen, Naval Ship Research and De- velopment Center...Bethesda, Maryland REPLY TO DISCUSSION 576 Thomas G. Lang, Naval Undersea Research and Development Center, San Diego, California

Reversing the established order: Should adrenal venous sampling precede cross-sectional imaging in the evaluation of primary aldosteronism?

PubMed

Asmar, Melissa; Wachtel, Heather; Yan, Yan; Fraker, Douglas L; Cohen, Debbie; Trerotola, Scott O

2015-08-01

Adrenal venous sampling (AVS) is the definitive evaluation for primary aldosteronism (PA). Pre-AVS cross-sectional imaging does not reduce the need for AVS. The goal of this study was to examine whether performing AVS prior to imaging could decrease the use of imaging in the evaluation of PA at a high volume, experienced center. We performed a retrospective analysis of all AVS procedures (n = 337) done for PA from 2001-2013. Patients whose cross-sectional imaging reports were unavailable (n = 90) or AVS was non-diagnostic (n = 12) were excluded. AVS was performed using modified Mayo technique. Univariate analysis utilized the χ² test and fisher's exact test. Of the 235 patients analyzed, 63% (n = 148) were male. The mean age was 55 ± 11 years. AVS was non-lateralizing in 43% (n = 101); these patients might have avoided imaging with an AVS-first approach. Imaging and AVS were concordant in 52% (n = 123). In patients ≤40yo (n = 23), 35% (n = 8) had no lateralization on AVS, and might have avoided imaging in an AVS-first approach. Imaging and AVS were concordant in 52% (n = 12) of patients ≤ 40yo, versus 52% (n = 111) of patients > 40 yo (P = 0.987). An AVS-first, imaging-second approach could have avoided CT/MRI in 43% of patients. At a high volume, experienced center, performing AVS first on patients with PA may reduce unnecessary cross-sectional imaging studies. © 2015 Wiley Periodicals, Inc.

Use of a Volume Navigation Technique for Combining Real-Time Ultrasound and Contrast-Enhanced MRI: Accuracy and Feasibility of a Novel Technique for Locating Breast Lesions.

PubMed

Kucukkaya, Fikret; Aribal, Erkin; Tureli, Derya; Altas, Hilal; Kaya, Handan

2016-01-01

The objective of this study was to evaluate the accuracy of the volume navigation technique for combining real-time ultrasound and contrast-enhanced MRI (CE-MRI) of breast lesions. Thirty-eight women with single breast lesions underwent 3-T MRI. A 3.5-minute CE-MRI sequence was used, as was a flexible body coil. Patients underwent imaging in the supine position, with three markers placed on their breasts. Real-time sonographic images were coregistered to the preloaded breast CE-MRI volume by coupling skin markers, with the use of an electromagnetic transmitter positioned next to the subjects. The transmitter detected the spatial positions of the two electromagnetic sensors mounted on the transducer bracket. After this fusion process in 3D space was completed, divergences in the location of the center of each lesion on CE-MRI and ultrasound images were analyzed. The mean lesion size was 17.4 mm on ultrasound and 17.9 mm on MRI, whereas the mean (± SD) misalignment of the lesion centers on CE-MRI and ultrasound was 3.9 ± 2.5 mm on the x-axis (mediolateral view), 3.6 ± 2.7 mm on the y-axis (anteroposterior view), and 4.3 ± 2.6 mm on the z-axis (craniocaudal view). No lesion had a misalignment greater than 10 mm on any of three axes. The accuracy of volume navigation was independent of patient age and the lesion size, location, and histopathologic findings (p > 0.05). Intermediate lesions, which had a depth of center of 11-20 mm on ultrasound had a mean misalignment of 2.6 ± 1.9 mm, compared with 5.5 ± 2.2 mm for deep lesions, which had a depth of center greater than 20 mm (p = 0.049). The volume navigation technique is an accurate method for coregistration of CE-MRI and sonographic images, enabling lesion localization within a limited volume.

Naval Medical R and D News. March 2017, Volume 9, Issue 3

DTIC Science & Technology

2017-03-01

Medical Research Center (Feature) Military Medicine Provides World-Class Solutions for Combat Casualties From Naval Medical Research Center Public... Researchers from the Naval Surface Warfare Center Panama City Division and the Naval Postgraduate School spent the voyage conducting experiments to...interruptions, motion sickness incidence, and Sopite syndrome on surgical procedures while in a shipboard environment.... From Naval Medical Research

Systems Newsletter. Volume 18, Number 1, Summer 2009

ERIC Educational Resources Information Center

Benson, Dawn, Ed.

2009-01-01

This issue of the Center's "Systems Newsletter" will be the last one published under the aegis of Dr. JoyceVanTassel-Baska, the Center's founder and current Executive Director. As of this August Dr. VanTassel-Baska will officially retire from the College of William and Mary and the Center. She will still be an integral part of the Center…

Bird Vision System

NASA Technical Reports Server (NTRS)

2008-01-01

The Bird Vision system is a multicamera photogrammerty software application that runs on a Microsoft Windows XP platform and was developed at Kennedy Space Center by ASRC Aerospace. This software system collects data about the locations of birds within a volume centered on the Space Shuttle and transmits it in real time to the laptop computer of a test director in the Launch Control Center (LCC) Firing Room.

Photocopy of drawing. LAUNCH COMPLEX 39. NASA, John F. Kennedy ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

Photocopy of drawing. LAUNCH COMPLEX 39. NASA, John F. Kennedy Space Center, Florida. File Number 203-100, Urbahn-Roberts-Seelye-Moran, October, 1963. VOLUME 29, LAUNCH CONTROL CENTER (LCC) TITLE AND LOCATION SHEET. Sheet 29-01 - Cape Canaveral Air Force Station, Launch Complex 39, Launch Control Center, LCC Road, East of Kennedy Parkway North, Cape Canaveral, Brevard County, FL

Proceedings of the Annual Meeting of the International Group for the Psychology of Mathematics Education (PME) (28th, Bergen, Norway, July 14-18, 2004). Volume 4

ERIC Educational Resources Information Center

Hoines, Marit Johnsen, Ed.; ; Fuglestad, Anne Berit, Ed.

2004-01-01

This document contains the fourth volume of the proceedings of the 28th annual conference of the International Group for the Psychology of Mathematics Education. Conference presentations are centered around the theme "Inclusion and Diversity". This volume features 64 research report papers: (1) Situated or Abstract: The Effect of Combining Context…

Proceedings of the Conference of the International Group for the Psychology of Mathematics Education (30th, Prague, Czech Republic, July 16-21, 2006). Volume 3

ERIC Educational Resources Information Center

Novotna, Jarmila, Ed.; Moraova, Hana, Ed.; Kratka, Magdalena, Ed.; Stehlikova, Nad'a, Ed.

2006-01-01

This document contains the third volume of the proceedings of the 30th Conference of the International Group for the Psychology of Mathematics Education. Conference presentations are centered around the theme "Mathematics at the Centre." This volume features 60 research reports by presenters with last names beginning between Ead and Kou:…

Proceedings of the Conference of the International Group for the Psychology of Mathematics Education (30th, Prague, Czech Republic, July 16-21, 2006). Volume 5

ERIC Educational Resources Information Center

Novotna, Jarmila, Ed.; Moraova, Hana, Ed.; Kratka, Magdalena, Ed.; Stehlikova, Nad'a, Ed.

2006-01-01

This document contains the fifth volume of the proceedings of the 30th Conference of the International Group for the Psychology of Mathematics Education. Conference presentations are centered around the theme "Mathematics at the Centre." This volume features 59 research reports by presenters with last names beginning between Sac and Zaz:…

Proceedings of the Conference of the International Group for the Psychology of Mathematics Education (29th, Melbourne, Australia, July 10-15, 2005). Volume 4

ERIC Educational Resources Information Center

Chick, Helen L., Ed.; Vincent, Jill L., Ed.

2005-01-01

This document is the fourth volume of the proceedings of the 29th Conference of the International Group for the Psychology of Mathematics Education. Conference papers are centered around the theme of "Learners and Learning Environments." This volume features 42 research reports by presenters with last names beginning between Mul and Wu:…

Modern Chemical Technology, Volume 2.

ERIC Educational Resources Information Center

Pecsok, Robert L.; Chapman, Kenneth

This volume contains chapters 8 to 13 of the ACS "Modern Chemical Technology" (ChemTeC) curriculum material which is intended to prepare chemical technologists. The content is centered around the background needed to understand the structure of the atom, covalence, electrovalence, elements and compounds, liquids and solutions, and chemical…

Cross-sectional changes in lung volume measured by electrical impedance tomography are representative for the whole lung in ventilated preterm infants.

PubMed

van der Burg, Pauline S; Miedema, Martijn; de Jongh, Frans H; Frerichs, Inez; van Kaam, Anton H

2014-06-01

Electrical impedance tomography measures lung volume in a cross-sectional slice of the lung. Whether these cross-sectional volume changes are representative of the whole lung has only been investigated in adults, showing conflicting results. This study aimed to compare cross-sectional and whole lung volume changes using electrical impedance tomography and respiratory inductive plethysmography. A prospective, single-center, observational, nonrandomized study. The study was conducted in a neonatal ICU in the Netherlands. High-frequency ventilated preterm infants with respiratory distress syndrome. Cross-sectional and whole lung volume changes were continuously and simultaneously measured by, respectively, electrical impedance tomography and respiratory inductive plethysmography during a stepwise recruitment procedure. End-expiratory lung volume changes were assessed by mapping the inflation and deflation limbs using both the pressure/impedance and pressure/inductance pairs and characterized by calculating the inflection points. In addition, oscillatory tidal volume changes were assessed at each pressure step. Twenty-three infants were included in the study. Of these, eight infants had to be excluded because the quality of the registration was insufficient for analysis (two electrical impedance tomography and six respiratory inductive plethysmography). In the remaining 15 infants (gestational age 28.0 ± 2.6 wk; birth weight 1,027 ± 514 g), end-expiratory lung volume changes measured by electrical impedance tomography were significantly correlated to respiratory inductive plethysmography measurements in 12 patients (mean r = 0.93 ± 0.05). This was also true for the upper inflection point on the inflation (r = 0.91, p < 0.01) and deflation limb (r = 0.83, p < 0.01). In 13 patients, impedance and inductance data also correlated significantly on oscillatory tidal volume/pressure relationships (mean r = 0.81 ± 0.18). This study shows that cross-sectional lung volume changes measured by electrical impedance tomography are representative for the whole lung and that this concept also applies to newborn infants.

48 CFR 5452.249 - Allocation.

Code of Federal Regulations, 2010 CFR

2010-10-01

... Section 5452.249 Federal Acquisition Regulations System DEFENSE LOGISTICS AGENCY, DEPARTMENT OF DEFENSE... Fuel Supply Center is authorized to use the following clause in domestic and overseas petroleum... Defense that the Defense Fuel Supply Center be provided contract volumes exceeding the pro rata amount of...

48 CFR 5452.249 - Allocation.

Code of Federal Regulations, 2014 CFR

2014-10-01

... Section 5452.249 Federal Acquisition Regulations System DEFENSE LOGISTICS AGENCY, DEPARTMENT OF DEFENSE... Fuel Supply Center is authorized to use the following clause in domestic and overseas petroleum... Defense that the Defense Fuel Supply Center be provided contract volumes exceeding the pro rata amount of...

48 CFR 5452.249 - Allocation.

Code of Federal Regulations, 2013 CFR

2013-10-01

... Section 5452.249 Federal Acquisition Regulations System DEFENSE LOGISTICS AGENCY, DEPARTMENT OF DEFENSE... Fuel Supply Center is authorized to use the following clause in domestic and overseas petroleum... Defense that the Defense Fuel Supply Center be provided contract volumes exceeding the pro rata amount of...

48 CFR 5452.249 - Allocation.

Code of Federal Regulations, 2011 CFR

2011-10-01

... Section 5452.249 Federal Acquisition Regulations System DEFENSE LOGISTICS AGENCY, DEPARTMENT OF DEFENSE... Fuel Supply Center is authorized to use the following clause in domestic and overseas petroleum... Defense that the Defense Fuel Supply Center be provided contract volumes exceeding the pro rata amount of...

48 CFR 5452.249 - Allocation.

Code of Federal Regulations, 2012 CFR

2012-10-01

... Section 5452.249 Federal Acquisition Regulations System DEFENSE LOGISTICS AGENCY, DEPARTMENT OF DEFENSE... Fuel Supply Center is authorized to use the following clause in domestic and overseas petroleum... Defense that the Defense Fuel Supply Center be provided contract volumes exceeding the pro rata amount of...

International Guide to Highway Transportation Information: Volume 1 - Highway Transportation Libraries and Information Centers

DOT National Transportation Integrated Search

2013-01-01

The FHWA Road Weather Management Program partnered with Utah DOT to develop and implement advanced traveler information strategies during weather events. UDOT already has one of the most sophisticated Traffic Operations Centers (TOCs) in the country ...

EPA’s permeable pavement research and the Edison Environmental Center

EPA Science Inventory

A deteriorated parking area on EPA’s Edison Environmental Center needed replacement. The replacement offered an opportunity for the facility managers to reduce the impervious footprint and the reduce stormwater runoff volume. This also provided researchers from the National Risk ...

Astronomical Data Center Bulletin, volume 1, no. 1

NASA Technical Reports Server (NTRS)

Warren, W. H., Jr. (Editor); Nagy, T. A. (Editor); Mead, J. M. (Editor)

1980-01-01

Information about work in progress on astronomical catalogs is presented. In addition to progress reports, an upadated status list for astronomical catalogs available at the Astronomical Data Center is included. Papers from observatories and individuals involved with astronomical data are also presented.

Positive and negative volume-outcome relationships in the geriatric trauma population.

PubMed

Matsushima, Kazuhide; Schaefer, Eric W; Won, Eugene J; Armen, Scott B; Indeck, Matthew C; Soybel, David I

2014-04-01

In trauma populations, improvements in outcome are documented in institutions with higher case volumes. However, it is not known whether improved outcomes are attributable to the case volume within specific higher-risk groups, such as the elderly, or to the case volume among all trauma patients treated by an institution. To test the hypothesis that outcomes of trauma care for geriatric patients are affected differently by the volume of geriatric cases and nongeriatric cases of an institution. This retrospective cohort study using a statewide trauma registry was set in state-designated levels 1 and 2 trauma centers in Pennsylvania. It included 39 431 eligible geriatric trauma patients (aged >65 years) in the Pennsylvania Trauma Outcomes Study. In-hospital mortality, major complications, and mortality after major complications (failure to rescue). Between 2001 and 2010, 39 431 geriatric trauma patients and 105 046 nongeriatric patients were captured in a review of outcomes in 20 state-designated levels 1 and 2 trauma centers. Larger volumes of geriatric trauma patients were significantly associated with lower odds of in-hospital mortality, major complications, and failure to rescue. In contrast, larger nongeriatric trauma volumes were significantly associated with higher odds of major complications in geriatric patients. Higher rates of in-hospital mortality, major complications, and failure to rescue were associated with lower volumes of geriatric trauma care and paradoxically with higher volumes of trauma care for younger patients. These findings offer the possibility that outcomes might be improved with differentiated pathways of care for geriatric trauma patients.

Value-added Data Services at the Goddard Earth Sciences Data and Information Services Center

NASA Technical Reports Server (NTRS)

Leptoukh, Gregory G.; Alcott, Gary T.; Kempler, Steven J.; Lynnes, Christopher S.; Vollmer, Bruce E.

2004-01-01

The NASA Goddard Earth Sciences Data and Information Services Center (GES DISC), in addition to serving the Earth Science community as one of the major Distributed Active Archives Centers (DAACs), provides much more than just data. Among the value-added services available to general users are subsetting data spatially and/or by parameter, online analysis (to avoid downloading unnecessarily all the data), and assistance in obtaining data from other centers. Services available to data producers and high-volume users include consulting on building new products with standard formats and metadata and construction of data management systems. A particularly useful service is data processing at the DISC (i.e., close to the input data) with the users algorithm. This can take a number of different forms: as a configuration-managed algorithm within the main processing stream; as a stand-alone program next to the on-line data storage; as build-it-yourself code within the Near-Archive Data Mining (NADM) system; or as an on-the-fly analysis with simple algorithms embedded into the web-based tools. Partnerships between the GES DISC and scientists, both producers and users, allow the scientists to concentrate on science, while the GES DISC handles the data management, e.g., formats, integration, and data processing. The existing data management infrastructure at the GES DISC supports a wide spectrum of options: from simple data support to sophisticated on-line analysis tools, producing economies of scale and rapid time-to-deploy. At the same time, such partnerships allow the GES DISC to serve the user community more efficiently and to better prioritize on-line holdings. Several examples of successful partnerships are described in the presentation.

ICU Telemedicine Program Financial Outcomes.

PubMed

Lilly, Craig M; Motzkus, Christine; Rincon, Teresa; Cody, Shawn E; Landry, Karen; Irwin, Richard S

2017-02-01

ICU telemedicine improves access to high-quality critical care, has substantial costs, and can change financial outcomes. Detailed information about financial outcomes and their trends over time following ICU telemedicine implementation and after the addition of logistic center function has not been published to our knowledge. Primary data were collected for consecutive adult patients of a single academic medical center. We compared clinical and financial outcomes across three groups that differed regarding telemedicine support: a group without ICU telemedicine support (pre-ICU intervention group), a group with ICU telemedicine support (ICU telemedicine group), and an ICU telemedicine group with added logistic center functions and support for quality-care standardization (logistic center group). The primary outcome was annual direct contribution margin defined as aggregated annual case revenue minus annual case direct costs (including operating costs of ICU telemedicine and its related programs). All monetary values were adjusted to 2015 US dollars using Producer Price Index for Health-Care Facilities. Annual case volume increased from 4,752 (pre-ICU telemedicine) to 5,735 (ICU telemedicine) and 6,581 (logistic center). The annual direct contribution margin improved from $7,921,584 (pre-ICU telemedicine) to $37,668,512 (ICU telemedicine) to $60,586,397 (logistic center) due to increased case volume, higher case revenue relative to direct costs, and shorter length of stay. The ability of properly modified ICU telemedicine programs to increase case volume and access to high-quality critical care with improved annual direct contribution margins suggests that there is a financial argument to encourage the wider adoption of ICU telemedicine. Copyright © 2016 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

Characteristics and performance of a micro-MOSFET: an "imageable" dosimeter for image-guided radiotherapy.

PubMed

Rowbottoma, Carl G; Jaffray, David A

2004-03-01

The performance and characteristics of a miniature metal oxide semiconductor field effect transistor (micro-MOSFET) detector was investigated for its potential application to integral system tests for image-guided radiotherapy. In particular, the position of peak response to a slit of radiation was determined for the three principal axes to define the co-ordinates for the center of the active volume of the detector. This was compared to the radiographically determined center of the micro-MOSFET visible using cone-beam CT. Additionally, the angular sensitivity of the micro-MOSFET was measured. The micro-MOSFETs are clearly visible on the cone-beam CT images, and produce no artifacts. The center of the active volume of the micro-MOSFET aligned with the center of the visible micro-MOSFET on the cone-beam CT images for the x and y axes to within 0.20 mm and 0.15 mm, respectively. In z, the long axis of the detector, the peak response was found to be 0.79 mm from the tip of the visible micro-MOSFET. Repeat experiments verified that the position of the peak response of the micro-MOSFET was reproducible. The micro-MOSFET response for 360 degrees of rotation in the axial plane to the micro-MOSFET was +/-2%, consistent with values quoted by the manufacturer. The location of the active volume of the micro-MOSFETs under investigation can be determined from the centroid of the visible micro-MOSFET on cone-beam CT images. The CT centroid position corresponds closely to the center of the detector response to radiation. The ability to use the cone-beam CT to locate the active volume to within 0.20 mm allows their use in an integral system test for the imaging of and dose delivery to a phantom containing an array of micro-MOSFETs. The small angular sensitivity allows the investigation of noncoplanar beams.

Procedural volume, cost, and reimbursement of outpatient incisional hernia repair: implications for payers and providers.

PubMed

Song, Chao; Liu, Emelline; Tackett, Scott; Shi, Lizheng; Marcus, Daniel

2017-06-01

This analysis aimed to evaluate trends in volumes and costs of primary elective incisional ventral hernia repairs (IVHRs) and investigated potential cost implications of moving procedures from inpatient to outpatient settings. A time series study was conducted using the Premier Hospital Perspective ® Database (Premier database) for elective IVHR identified by International Classification of Diseases, Ninth revision, Clinical Modification codes. IVHR procedure volumes and costs were determined for inpatient, outpatient, minimally invasive surgery (MIS), and open procedures from January 2008-June 2015. Initial visit costs were inflation-adjusted to 2015 US dollars. Median costs were used to analyze variation by site of care and payer. Quantile regression on median costs was conducted in covariate-adjusted models. Cost impact of potential outpatient migration was estimated from a Medicare perspective. During the study period, the trend for outpatient procedures in obese and non-obese populations increased. Inpatient and outpatient MIS procedures experienced a steady growth in adoption over their open counterparts. Overall median costs increased over time, and inpatient costs were often double outpatient costs. An economic model demonstrated that a 5% shift of inpatient procedures to outpatient MIS procedures can have a cost surplus of ∼ US $1.8 million for provider or a cost-saving impact of US $1.7 million from the Centers for Medicare & Medicaid Services perspective. The study was limited by information in the Premier database. No data were available for IVHR cases performed in free-standing ambulatory surgery centers or federal healthcare facilities. Volumes and costs of outpatient IVHRs and MIS procedures increased from January 2008-June 2015. Median costs were significantly higher for inpatients than outpatients, and the difference was particularly evident for obese patients. A substantial cost difference between inpatient and outpatient MIS cases indicated a financial benefit for shifting from inpatient to outpatient MIS.

Association of emergency department and hospital characteristics with elopements and length of stay.

PubMed

Handel, Daniel A; Fu, Rongwei; Vu, Eugene; Augustine, James J; Hsia, Renee Y; Shufflebarger, Charles M; Sun, Benjamin

2014-06-01

As the Centers for Medicare & Medicaid Services (CMS) core measures in 2013 compare Emergency Department (ED) treatment time intervals, it is important to identify ED and hospital characteristics associated with these metrics to facilitate accurate comparisons. The objective of this study is to assess differences in operational metrics by ED and hospital characteristics. ED-level characteristics included annual ED volume, percentage of patients admitted, percentage of patients presenting by ambulance, and percentage of pediatric patients. Hospital-level characteristics included teaching hospital status, trauma center status, hospital ownership (nonprofit or for-profit), inpatient bed capacity, critical access status, inpatient bed occupancy, and rural vs. urban location area. Data from the ED Benchmarking Alliance from 2004 to 2009 were merged with the American Hospital Association's Annual Survey Database to include hospital characteristics that may impact ED throughput. Overall median length of stay (LOS) and left before treatment is complete (LBTC) were the primary outcome variables, and a linear mixed model was used to assess the association between outcome variables and ED and hospital characteristics, while accounting for correlations among multiple observations within each hospital. All data were at the hospital level on a yearly basis. There were 445 EDs included in the analysis, from 2004 to 2009, with 850 observations over 6 years. Higher-volume EDs were associated with higher rates of LBTC and LOS. For-profit hospitals had lower LBTC and LOS. Higher inpatient bed occupancies were associated with a higher LOS. Increasing admission percentages were positively associated with overall LOS for EDs, but not with rates of LBTC. Higher-volume EDs are associated with higher LBTC and LOS, and for-profit hospitals appear more favorably in these metrics compared with their nonprofit counterparts. It is important to appreciate that hospitals have different baselines for performance that may be more tied to volume and capacity, and less to quality of care. Copyright © 2014 Elsevier Inc. All rights reserved.

Network-based approaches to climate knowledge discovery

NASA Astrophysics Data System (ADS)

Budich, Reinhard; Nyberg, Per; Weigel, Tobias

2011-11-01

Climate Knowledge Discovery Workshop; Hamburg, Germany, 30 March to 1 April 2011 Do complex networks combined with semantic Web technologies offer the next generation of solutions in climate science? To address this question, a first Climate Knowledge Discovery (CKD) Workshop, hosted by the German Climate Computing Center (Deutsches Klimarechenzentrum (DKRZ)), brought together climate and computer scientists from major American and European laboratories, data centers, and universities, as well as representatives from industry, the broader academic community, and the semantic Web communities. The participants, representing six countries, were concerned with large-scale Earth system modeling and computational data analysis. The motivation for the meeting was the growing problem that climate scientists generate data faster than it can be interpreted and the need to prepare for further exponential data increases. Current analysis approaches are focused primarily on traditional methods, which are best suited for large-scale phenomena and coarse-resolution data sets. The workshop focused on the open discussion of ideas and technologies to provide the next generation of solutions to cope with the increasing data volumes in climate science.

A bronchoscopic navigation system using bronchoscope center calibration for accurate registration of electromagnetic tracker and CT volume without markers.

PubMed

Luo, Xiongbiao

2014-06-01

Various bronchoscopic navigation systems are developed for diagnosis, staging, and treatment of lung and bronchus cancers. To construct electromagnetically navigated bronchoscopy systems, registration of preoperative images and an electromagnetic tracker must be performed. This paper proposes a new marker-free registration method, which uses the centerlines of the bronchial tree and the center of a bronchoscope tip where an electromagnetic sensor is attached, to align preoperative images and electromagnetic tracker systems. The chest computed tomography (CT) volume (preoperative images) was segmented to extract the bronchial centerlines. An electromagnetic sensor was fixed at the bronchoscope tip surface. A model was designed and printed using a 3D printer to calibrate the relationship between the fixed sensor and the bronchoscope tip center. For each sensor measurement that includes sensor position and orientation information, its corresponding bronchoscope tip center position was calculated. By minimizing the distance between each bronchoscope tip center position and the bronchial centerlines, the spatial alignment of the electromagnetic tracker system and the CT volume was determined. After obtaining the spatial alignment, an electromagnetic navigation bronchoscopy system was established to real-timely track or locate a bronchoscope inside the bronchial tree during bronchoscopic examinations. The electromagnetic navigation bronchoscopy system was validated on a dynamic bronchial phantom that can simulate respiratory motion with a breath rate range of 0-10 min(-1). The fiducial and target registration errors of this navigation system were evaluated. The average fiducial registration error was reduced from 8.7 to 6.6 mm. The average target registration error, which indicates all tracked or navigated bronchoscope position accuracy, was much reduced from 6.8 to 4.5 mm compared to previous registration methods. An electromagnetically navigated bronchoscopy system was constructed with accurate registration of an electromagnetic tracker and the CT volume on the basis of an improved marker-free registration approach that uses the bronchial centerlines and bronchoscope tip center information. The fiducial and target registration errors of our electromagnetic navigation system were about 6.6 and 4.5 mm in dynamic bronchial phantom validation.

A bronchoscopic navigation system using bronchoscope center calibration for accurate registration of electromagnetic tracker and CT volume without markers

DOE Office of Scientific and Technical Information (OSTI.GOV)

Luo, Xiongbiao, E-mail: xiongbiao.luo@gmail.com

2014-06-15

Purpose: Various bronchoscopic navigation systems are developed for diagnosis, staging, and treatment of lung and bronchus cancers. To construct electromagnetically navigated bronchoscopy systems, registration of preoperative images and an electromagnetic tracker must be performed. This paper proposes a new marker-free registration method, which uses the centerlines of the bronchial tree and the center of a bronchoscope tip where an electromagnetic sensor is attached, to align preoperative images and electromagnetic tracker systems. Methods: The chest computed tomography (CT) volume (preoperative images) was segmented to extract the bronchial centerlines. An electromagnetic sensor was fixed at the bronchoscope tip surface. A model wasmore » designed and printed using a 3D printer to calibrate the relationship between the fixed sensor and the bronchoscope tip center. For each sensor measurement that includes sensor position and orientation information, its corresponding bronchoscope tip center position was calculated. By minimizing the distance between each bronchoscope tip center position and the bronchial centerlines, the spatial alignment of the electromagnetic tracker system and the CT volume was determined. After obtaining the spatial alignment, an electromagnetic navigation bronchoscopy system was established to real-timely track or locate a bronchoscope inside the bronchial tree during bronchoscopic examinations. Results: The electromagnetic navigation bronchoscopy system was validated on a dynamic bronchial phantom that can simulate respiratory motion with a breath rate range of 0–10 min{sup −1}. The fiducial and target registration errors of this navigation system were evaluated. The average fiducial registration error was reduced from 8.7 to 6.6 mm. The average target registration error, which indicates all tracked or navigated bronchoscope position accuracy, was much reduced from 6.8 to 4.5 mm compared to previous registration methods. Conclusions: An electromagnetically navigated bronchoscopy system was constructed with accurate registration of an electromagnetic tracker and the CT volume on the basis of an improved marker-free registration approach that uses the bronchial centerlines and bronchoscope tip center information. The fiducial and target registration errors of our electromagnetic navigation system were about 6.6 and 4.5 mm in dynamic bronchial phantom validation.« less

Origin of Tumor Recurrence After Intensity Modulated Radiation Therapy for Oropharyngeal Squamous Cell Carcinoma

DOE Office of Scientific and Technical Information (OSTI.GOV)

Raktoe, Sawan A.S.; Dehnad, Homan, E-mail: h.dehnad@umcutrecht.nl; Raaijmakers, Cornelis P.J.

Purpose: To model locoregional recurrences of oropharyngeal squamous cell carcinomas (OSCC) treated with primary intensity modulated radiation therapy (IMRT) in order to find the origins from which recurrences grow and relate their location to original target volume borders. Methods and Materials: This was a retrospective analysis of OSCC treated with primary IMRT between January 2002 and December 2009. Locoregional recurrence volumes were delineated on diagnostic scans and coregistered rigidly with treatment planning computed tomography scans. Each recurrence was analyzed with two methods. First, overlapping volumes of a recurrence and original target were measured ('volumetric approach') and assessed as 'in-field', 'marginal',more » or 'out-field'. Then, the center of mass (COM) of a recurrence volume was assumed as the origin from where a recurrence expanded, the COM location was compared with original target volume borders and assessed as 'in-field', 'marginal', or 'out-field'. Results: One hundred thirty-one OSCC were assessed. For all patients alive at the end of follow-up, the mean follow-up time was 40 months (range, 12-83 months); 2 patients were lost to follow-up. The locoregional recurrence rate was 27%. Of all recurrences, 51% were local, 23% were regional, and 26% had both local and regional recurrences. Of all recurrences, 74% had imaging available for assessment. Regarding volumetric analysis of local recurrences, 15% were in-field gross tumor volume (GTV), and 65% were in-field clinical tumor volume (CTV). Using the COM approach, we found that 70% of local recurrences were in-field GTV and 90% were in-field CTV. Of the regional recurrences, 25% were volumetrically in-field GTV, and using the COM approach, we found 54% were in-field GTV. The COM of local out-field CTV recurrences were maximally 16 mm outside CTV borders, whereas for regional recurrences, this was 17 mm. Conclusions: The COM model is practical and specific for recurrence assessment. Most recurrences originated in the GTV. This suggests radioresistance in certain tumor parts.« less

Analysis of severe storm data

NASA Technical Reports Server (NTRS)

Hickey, J. S.

1983-01-01

The Mesoscale Analysis and Space Sensor (MASS) Data Management and Analysis System developed by Atsuko Computing International (ACI) on the MASS HP-1000 Computer System within the Systems Dynamics Laboratory of the Marshall Space Flight Center is described. The MASS Data Management and Analysis System was successfully implemented and utilized daily by atmospheric scientists to graphically display and analyze large volumes of conventional and satellite derived meteorological data. The scientists can process interactively various atmospheric data (Sounding, Single Level, Gird, and Image) by utilizing the MASS (AVE80) share common data and user inputs, thereby reducing overhead, optimizing execution time, and thus enhancing user flexibility, useability, and understandability of the total system/software capabilities. In addition ACI installed eight APPLE III graphics/imaging computer terminals in individual scientist offices and integrated them into the MASS HP-1000 Computer System thus providing significant enhancement to the overall research environment.

Visual interface for space and terrestrial analysis

NASA Technical Reports Server (NTRS)

Dombrowski, Edmund G.; Williams, Jason R.; George, Arthur A.; Heckathorn, Harry M.; Snyder, William A.

1995-01-01

The management of large geophysical and celestial data bases is now, more than ever, the most critical path to timely data analysis. With today's large volume data sets from multiple satellite missions, analysts face the task of defining useful data bases from which data and metadata (information about data) can be extracted readily in a meaningful way. Visualization, following an object-oriented design, is a fundamental method of organizing and handling data. Humans, by nature, easily accept pictorial representations of data. Therefore graphically oriented user interfaces are appealing, as long as they remain simple to produce and use. The Visual Interface for Space and Terrestrial Analysis (VISTA) system, currently under development at the Naval Research Laboratory's Backgrounds Data Center (BDC), has been designed with these goals in mind. Its graphical user interface (GUI) allows the user to perform queries, visualization, and analysis of atmospheric and celestial backgrounds data.

Three-Dimensional Analysis of Nuclear Size, Shape and Displacement in Clover Root Cap Statocytes from Space and a Clinostat

NASA Technical Reports Server (NTRS)

Smith, J.D.; Todd, P. W.; Staehelin, L. A.; Holton, Emily (Technical Monitor)

1997-01-01

Under normal (l-g) conditions the statocytes of root caps have a characteristic polarity with the nucleus in tight association with the proximal cell wall; but, in altered gravity environments including microgravity (mu-g) and the clinostat (c-g) movement of the nucleus away from the proximal cell wall is not uncommon. To further understand the cause of gravity-dependent nuclear displacement in statocytes, three-dimensional cell reconstruction techniques were used to precisely measure the volumes, shapes, and positions of nuclei in white clover (Trifolium repens) flown in space and rotated on a clinostat. Seeds were germinated and grown for 72 hours aboard the Space Shuttle (STS-63) in the Fluid Processing Apparatus (BioServe Space Technologies, Univ. of Colorado, Boulder). Clinorotation experiments were performed on a two-axis clinostat (BioServe). Computer reconstruction of selected groups of statocytes were made from serial sections (0.5 microns thick) using the ROSS (Reconstruction Of Serial Sections) software package (Biocomputation Center, NASA Ames Research Center). Nuclei were significantly displaced from the tops of cells in mu-g (4.2 +/- 1.0 microns) and c-g (4.9 +/- 1.4 microns) when compared to l-g controls (3.4 +/- 0.8 gm); but, nuclear volume (113 +/- 36 cu microns, 127 +/- 32 cu microns and 125 +/- 28 cu microns for l-g, mu-g and c-g respectively) and the ratio of nuclear volume to cell volume (4.310.7%, 4.211.0% and 4.911.4% respectively) were not significantly dependent on gravity treatment (ANOVA; alpha = 0.05). Three-dimensional analysis of nuclear shape and proximity to the cell wall, however, showed that nuclei from l-g controls appeared ellipsoidal while those from space and the clinostat were more spherically shaped. This change in nuclear shape may be responsible for its displacement under altered gravity conditions. Since the cytoskeleton is known to affect nuclear polarity in root cap statocytes, those same cytoskeletal elements could also control nuclear shape. This alteration in nuclear shape and position in mu-g and c-g when compared to l-g may lead to functional differences in the gravity signaling systems of plants subjected to altered gravity environments.

Kitchen Physics: Lessons in Fluid Pressure and Error Analysis

NASA Astrophysics Data System (ADS)

Vieyra, Rebecca Elizabeth; Vieyra, Chrystian; Macchia, Stefano

2017-02-01

Although the advent and popularization of the "flipped classroom" tends to center around at-home video lectures, teachers are increasingly turning to at-home labs for enhanced student engagement. This paper describes two simple at-home experiments that can be accomplished in the kitchen. The first experiment analyzes the density of four liquids using a waterproof case and a smartphone barometer in a container, sink, or tub. The second experiment determines the relationship between pressure and temperature of an ideal gas in a constant volume container placed momentarily in a refrigerator freezer. These experiences provide a ripe opportunity both for learning fundamental physics concepts as well as to investigate a variety of error analysis techniques that are frequently overlooked in introductory physics courses.

Life Science Research Facility materials management requirements and concepts

NASA Technical Reports Server (NTRS)

Johnson, Catherine C.

1986-01-01

The Advanced Programs Office at NASA Ames Research Center has defined hypothetical experiments for a 90-day mission on Space Station to allow analysis of the materials necessary to conduct the experiments and to assess the impact on waste processing of recyclable materials and storage requirements of samples to be returned to earth for analysis as well as of nonrecyclable materials. The materials include the specimens themselves, the food, water, and gases necessary to maintain them, the expendables necessary to conduct the experiments, and the metabolic products of the specimens. This study defines the volumes, flow rates, and states of these materials. Process concepts for materials handling will include a cage cleaner, trash compactor, biological stabilizer, and various recycling devices.

The ERTS-1 investigation (ER-600). Volume 2: ERTS-1 coastal/estuarine analysis. [Galveston Bay, Texas

NASA Technical Reports Server (NTRS)

Erb, R. B.

1974-01-01

The Coastal Analysis Team of the Johnson Space Center conducted a 1-year investigation of ERTS-1 MSS data to determine its usefulness in coastal zone management. Galveston Bay, Texas, was the study area for evaluating both conventional image interpretation and computer-aided techniques. There was limited success in detecting, identifying and measuring areal extent of water bodies, turbidity zones, phytoplankton blooms, salt marshes, grasslands, swamps, and low wetlands using image interpretation techniques. Computer-aided techniques were generally successful in identifying these features. Aerial measurement of salt marshes accuracies ranged from 89 to 99 percent. Overall classification accuracy of all study sites was 89 percent for Level 1 and 75 percent for Level 2.

Multiphasic Health Testing in the Clinic Setting

PubMed Central

LaDou, Joseph

1971-01-01

The economy of automated multiphasic health testing (amht) activities patterned after the high-volume Kaiser program can be realized in low-volume settings. amht units have been operated at daily volumes of 20 patients in three separate clinical environments. These programs have displayed economics entirely compatible with cost figures published by the established high-volume centers. This experience, plus the expanding capability of small, general purpose, digital computers (minicomputers) indicates that a group of six or more physicians generating 20 laboratory appraisals per day can economically justify a completely automated multiphasic health testing facility. This system would reside in the clinic or hospital where it is used and can be configured to do analyses such as electrocardiography and generate laboratory reports, and communicate with large computer systems in university medical centers. Experience indicates that the most effective means of implementing these benefits of automation is to make them directly available to the medical community with the physician playing the central role. Economic justification of a dedicated computer through low-volume health testing then allows, as a side benefit, automation of administrative as well as other diagnostic activities—for example, patient billing, computer-aided diagnosis, and computer-aided therapeutics. PMID:4935771

Modeling emissions and environmental impacts of transportation activities associated with high volume horizontal hydraulic fracturing operations in the Marcellus Shale Formation : final report.

DOT National Transportation Integrated Search

2015-09-18

The researchers' initial University Transportation Research Center (UTRC) research project identified routes and road segments with predicted high volumes of truck traffic related to natural gas extraction in the Marcellus Shale region. Results also ...

Quality of Life. Volume II: Application to Persons with Disabilities.

ERIC Educational Resources Information Center

Schalock, Robert L., Ed.; Siperstein, Gary N., Ed.

This volume summarizes current policies and programmatic practices that are influencing the quality of life of persons with mental retardation and developmental disabilities. Part 1, "Service Delivery Application," contains: "Using Person-Centered Planning To Address Personal Quality of Life" (John Butterworth and others); "The Aftermath of…

Infrared astronomical satellite (IRAS) catalogs and atlases. Volume 1: Explanatory supplement

NASA Technical Reports Server (NTRS)

Beichman, C. A. (Editor); Neugebauer, G. (Editor); Habing, H. J. (Editor); Clegg, P. E. (Editor); Chester, Thomas J. (Editor)

1988-01-01

The Infrared Astronomical Satellite (IRAS) was launched on January 26, 1983. During its 300-day mission, IRAS surveyed over 96 pct of the celestial sphere at four infrared wavelengths, centered approximately at 12, 25, 60, and 100 microns. Volume 1 describes the instrument, the mission, and data reduction.

The Condition of Education 1991. Volume 2: Postsecondary Education.

ERIC Educational Resources Information Center

Alsalam, Nabeel; Rogers, Gayle Thompson

This volume contains 30 indicators that collectively describe the condition of postsecondary education from a variety of perspectives. The indicators have been derived from studies conducted by the Center for Education Statistics and from other surveys conducted both within and outside the Federal Government. Indicators have been grouped under the…

DEMONSTRATION BULLETIN: PO*WW*ER™ WASTEWATER TREATMENT SYSTEMS - LAKES CHARLES TREATMENT CENTER - CHEMICAL WASTE MANAGEMENT, INC.

EPA Science Inventory

The PO*WW*ER™ system developed by Chemical Waste Management, Inc. (CWM), reduces the volume of aqueous waste and catalytically oxidizes volatile contaminants. The PO*WW*ER™ system consists primarily of (1) an evaporator that reduces influent wastewater volume, (2) a catalytic o...

Footing the bill: patient portals, part I.

PubMed

Lawrence, Daphne

2009-05-01

Tie financial portal strategy into overall portal strategy. Savings from patient portals for finance come in the areas of call center volumes, bill pay, scheduling, and increased volume. Financial functions on the patient portal should be balanced with clinical functions. Improve the revenue cycle process before going to a portal.

Tech Transfer News. Volume 9, No. 1

NASA Technical Reports Server (NTRS)

Victor, Megan E. (Compiler)

2017-01-01

Kennedy Tech Transfer News is the magazine of the Technology Transfer Office at NASA's Kennedy Space Center, Florida. This magazine seeks to inform and educate civil servant and contractor personnel at Kennedy Space Center about actively participating in achieving NASA's technology transfer and partnership goals.