Building Relationships Step by Step: One Teacher Leader's Journey

ERIC Educational Resources Information Center

Mangin, Melinda M.

2010-01-01

This case describes how Hannah, a new math specialist, strives to create a positive math culture in her elementary school. Along the way, she works to build relationships with the teachers and the school principal. The accompanying teaching notes facilitate analysis of the case from the perspective of professional relationships in schools.

Cyber Power Potential of the Army’s Reserve Component

DTIC Science & Technology

2017-01-01

and could extend logically to include electric power, water, food, railway, gas pipelines , and so forth. One consideration to note is that in cases...29 CHAPTER FOUR Army Reserve Component Cyber Inventory Analysis .......................... 31...Background and Analytical Framework ........................................................... 31 Army Reserve Component Cyber Inventory Analysis , 2015

Independent component analysis for onset detection in piano trills

NASA Astrophysics Data System (ADS)

Brown, Judith C.; Todd, Jeremy G.; Smaragdis, Paris

2002-05-01

The detection of onsets in piano music is difficult due to the presence of many notes simultaneously and their long decay times from pedaling. This is even more difficult for trills where the rapid note changes make it difficult to observe a decrease in amplitude for individual notes in either the temporal wave form or the time dependent Fourier components. Occasionally one note of the trill has a much lower amplitude than the other making an unambiguous determination of its onset virtually impossible. We have analyzed a number of trills from CD's of performances by Horowitz, Ashkenazy, and Goode, choosing the same trill and different performances where possible. The Fourier transform was calculated as a function of time, and the magnitude coefficients served as input for a calculation using the method of independent component analysis. In most cases this gave a more definitive determination of the onset times, as can be demonstrated graphically. For comparison identical calculations have been carried out on recordings of midi generated performances on a Yamaha Disclavier piano.

Reflection and Double Loop Learning: The Case of HS2

ERIC Educational Resources Information Center

Synnott, Michael

2013-01-01

This paper focuses on the potential role of reflection and double loop learning in policy analysis and shared community learning. The discussion is illustrated by the case of HS2, a proposed high-speed railway project in England. It is noted that the foundation of social learning models is a rejection of traditional reliance on technologies or…

Big Missiles and Big Decks: The Viability of Aircraft Carriers in an A2/AD World

DTIC Science & Technology

2016-06-01

RESEARCH DESIGN This thesis centers on a historical case study of two periods in which the United States and its carrier fleet faced some degree...19 3. Lessons Learned ...........................................................................21 C. APPLICABILITY OF CASE STUDIES ...employed the strategic concepts behind A2/AD since the Persian War of 480 BC. In his analysis of several historic case studies , Tangredi notes that a

A brief history of punctoplasty: the 3-snip revisited.

PubMed

Caesar, R H; McNab, A A

2005-01-01

To determine when and how to perform punctoplasty, review the history, and determine the efficacy of posterior ampullectomy. Retrospective analysis of 53 cases of punctal stenosis, operated by a single surgeon by means of posterior ampullectomy via 3-snips. A review of the history of the procedure from papers found with a Medline search for 1-snip, 2-snip, 3-snip, and punctoplasty. In all, 102 sets of notes were reviewed. The age range was from 9 to 89 years with a mean age of 56 years. A total of 74% of patients were female. We excluded 22 patients who had additional surgery and 16 patients who elected not to have surgery. There was no comment as to success or failure in four sets of notes and seven notes could not be found; these cases were also excluded. Of the remaining 53 patients, success was documented in 49 cases, or 92%. The historical review helps explain the debate about the procedure. The retrospective review confirms that posterior ampullectomy via 3-snips is an effective procedure.

Determining legal responsibility in otolaryngology: a review of 44 trials since 2008.

PubMed

Svider, Peter F; Husain, Qasim; Kovalerchik, Olga; Mauro, Andrew C; Setzen, Michael; Baredes, Soly; Eloy, Jean Anderson

2013-01-01

Medicolegal factors contribute to increasing healthcare costs through the direct costs of malpractice litigation, malpractice insurance premiums, and defensive medicine. Malpractice litigation trends are constantly changing as a result of technological innovations and changes in laws. In this study, we examine the most recent legal decisions related to Otolaryngology and characterize the factors responsible for determining legal responsibility. The Westlaw legal database (Thomson Reuters, New York, NY) was used to search for jury verdicts since 2008 in Otolaryngology malpractice cases. The 44 cases included in this analysis were studied to determine the procedures most commonly litigated and progressing to trial, as well as the year, location, alleged cause of malpractice, specialty of co-defendants, and case outcomes. Out of the 44 cases included in this analysis, physicians were not found liable in 36 (81.8%) cases. Rhinologic procedures comprised 38.6% of cases litigated, and rulings were in physicians' favor in 66.7% of endoscopic sinus surgery (ESS) cases and all non-ESS rhinologic cases. A perceived lack of informed consent was noted in 34.1% of cases. The 8 jury awards averaged $940,000 (range, $148,000-$3,600,000). Otolaryngologists were not found liable in the majority of cases reviewed. Rhinologic surgeries were the most common procedures resulting in litigation. Adenotonsillectomies, thyroidectomies, and airway management are also well-represented. Perceived deficits in informed consent and misdiagnosis were noted in a considerable proportion of otolaryngologic malpractice cases resulting in jury decisions. Copyright © 2013 Elsevier Inc. All rights reserved.

Method overtness, forensic autopsy, and the evidentiary suicide note: A multilevel National Violent Death Reporting System analysis.

PubMed

Rockett, Ian R H; Caine, Eric D; Stack, Steven; Connery, Hilary S; Nolte, Kurt B; Lilly, Christa L; Miller, Ted R; Nelson, Lewis S; Putnam, Sandra L; Nestadt, Paul S; Jia, Haomiao

2018-01-01

Higher prevalence of suicide notes could signify more conservatism in accounting and greater proneness to undercounting of suicide by method. We tested two hypotheses: (1) an evidentiary suicide note is more likely to accompany suicides by drug-intoxication and by other poisoning, as less violent and less forensically overt methods, than suicides by firearm and hanging/suffocation; and (2) performance of a forensic autopsy attenuates any observed association between overtness of method and the reported presence of a note. This multilevel (individual/county), multivariable analysis employed a generalized linear mixed model (GLMM). Representing the 17 states participating in the United States National Violent Death Reporting System throughout 2011-2013, the study population comprised registered suicides, aged 15 years and older. Decedents totaled 32,151. The outcome measure was relative odds of an authenticated suicide note. An authenticated suicide note was documented in 31% of the suicide cases. Inspection of the full multivariable model showed a suicide note was more likely to manifest among drug intoxication (adjusted odds ratio [OR], 1.70; 95% CI, 1.56, 1.85) and other poisoning suicides (OR, 2.12; 1.85, 2.42) than firearm suicides, the referent. Respective excesses were larger when there was no autopsy or autopsy status was unknown (OR, 1.86; 95% CI, 1.61, 2.14) and (OR, 2.25; 95% CI, 1.86, 2.72) relative to the comparisons with a forensic autopsy (OR, 1.62, 95% CI, 1.45, 1.82 and OR, 2.01; 95% CI, 1.66, 2.43). Hanging/suffocation suicides did not differ from the firearm referent given an autopsy. Suicide requires substantial affirmative evidence to establish manner of death, and affirmation of drug intoxication suicides appears to demand an especially high burden of proof. Findings and their implications argue for more stringent investigative standards, better training, and more resources to support comprehensive and accurate case ascertainment, as the foundation for developing evidence-based suicide prevention initiatives.

Four Vantage Points to the Language Performance and Capacity of Human Beings: Response to Saloviita and Sariola.

ERIC Educational Resources Information Center

Niemi, Jussi; Karna-Lin, Eija

2003-01-01

This response to EC 633 617, an analysis of a purported case of facilitated communication, stresses the role of linguistic and grammatical analysis of texts attributed to a Finnish man diagnosed with mental retardation and cerebral palsy. It identifies weaknesses in the analysis, urges use of multi-theoretical approaches, and notes the benefits…

An Analysis of Culturalism in Latino Mental Health: Folk Medicine as a Case in Point.

ERIC Educational Resources Information Center

De La Cancela, Victor; Martinez, Iris Zavala

1983-01-01

Identifies limitations of culturalist perspective often advocated by Latino mental health workers outlines folk healing practices they favor. Notes that culturalist perspective suffers from ahistorical/asocial/static conceptualization, and lacks analysis of class/sex/structural dimensions of so-called cultural expressions. Calls for recognition of…

Notes on Accounting Capstone Course Design: Contemporary Issues versus Case Analysis Enhances Student Interest and Learning

ERIC Educational Resources Information Center

Ehoff, Clemense, Jr.

2010-01-01

This paper presents how the Internet can be used to bring contemporary issues into the accounting capstone course to enhance student interest and learning. While existing cases have been reviewed and structured, they focus on issues that may not be at the forefront of the items currently under examination and/or debate by the accounting…

Ethnic Identity Construction in the Schooling Context: A Case Study of a Tibetan Neidi Boarding School in China

ERIC Educational Resources Information Center

Zhiyong, Zhu

2007-01-01

This article reviews the studies concerning ethnic identity construction in the schooling context. Next, it outlines a conceptual framework about theories of ethnic identity. Finally, it demonstrates a case study of ethnic identity construction of Neidi Tibet School with data collection and analysis. (Contains 1 note, 2 tables, and 2 figures.)

Usage Analysis of a Shared Care Planning System

PubMed Central

Warren, Jim; Gu, Yulong; Humphrey, Gayl

2012-01-01

We examined the content of electronically mediated communications in a trial of shared care planning (SCP) for long-term condition management. Software supports SCP by sharing patient records and care plans among members of the multidisciplinary care team (with patient access). Our analysis focuses on a three-month period with 73 enrolled patients, 149 provider-assigned tasks, 64 clinical notes and 48 care plans with 162 plan elements. Results show that content of notes entries is often related to task assignment and that nurses are the most active users. Directions for refinement of the SCP technology are indicated, including better integration of notes, tasks and care team notifications, as well as the central role of nurses for design use cases. Broader issues are raised about workforce roles and responsibilities for SCP, integrating patient-provider and provider-provider communications, and the centrality of care plans as the key entity in mediation of the care team. PMID:23304370

Dream Work in Grief Therapy

PubMed Central

Noronha, Konrad Joseph

2014-01-01

Working with dreams is useful with grief and loss clients who present with dreams. Adlerian dream analysis is one-way of exploring dreams. It incorporates the life-style of the client. This case report demonstrates how Adlerian dream analysis was used with a client. Progress was noted in improved life-style once the client began to talk about her dream. PMID:25035561

Analysis of Mission Effectiveness: Modern System Architecture Tools for Project Developers

DTIC Science & Technology

2017-12-01

operator input and scripted instructions to describe low-level flow. Note that the case study in Chapter IV describes one pass through evaluation...capability of the sensors. A constraint on the case study is that each sensor type must cover the entire operations area. Cost is a function of 53...completed. 5. Assessment This case study focuses on the first recursive refinement phase completed in a multi-phase effort to demonstrate the effects

Comparison of case note review methods for evaluating quality and safety in health care.

PubMed

Hutchinson, A; Coster, J E; Cooper, K L; McIntosh, A; Walters, S J; Bath, P A; Pearson, M; Young, T A; Rantell, K; Campbell, M J; Ratcliffe, J

2010-02-01

To determine which of two methods of case note review--holistic (implicit) and criterion-based (explicit)--provides the most useful and reliable information for quality and safety of care, and the level of agreement within and between groups of health-care professionals when they use the two methods to review the same record. To explore the process-outcome relationship between holistic and criterion-based quality-of-care measures and hospital-level outcome indicators. Case notes of patients at randomly selected hospitals in England. In the first part of the study, retrospective multiple reviews of 684 case notes were undertaken at nine acute hospitals using both holistic and criterion-based review methods. Quality-of-care measures included evidence-based review criteria and a quality-of-care rating scale. Textual commentary on the quality of care was provided as a component of holistic review. Review teams comprised combinations of: doctors (n = 16), specialist nurses (n = 10) and clinically trained audit staff (n = 3) and non-clinical audit staff (n = 9). In the second part of the study, process (quality and safety) of care data were collected from the case notes of 1565 people with either chronic obstructive pulmonary disease (COPD) or heart failure in 20 hospitals. Doctors collected criterion-based data from case notes and used implicit review methods to derive textual comments on the quality of care provided and score the care overall. Data were analysed for intrarater consistency, inter-rater reliability between pairs of staff using intraclass correlation coefficients (ICCs) and completeness of criterion data capture, and comparisons were made within and between staff groups and between review methods. To explore the process-outcome relationship, a range of publicly available health-care indicator data were used as proxy outcomes in a multilevel analysis. Overall, 1473 holistic and 1389 criterion-based reviews were undertaken in the first part of the study. When same staff-type reviewer pairs/groups reviewed the same record, holistic scale score inter-rater reliability was moderate within each of the three staff groups [intraclass correlation coefficient (ICC) 0.46-0.52], and inter-rater reliability for criterion-based scores was moderate to good (ICC 0.61-0.88). When different staff-type pairs/groups reviewed the same record, agreement between the reviewer pairs/groups was weak to moderate for overall care (ICC 0.24-0.43). Comparison of holistic review score and criterion-based score of case notes reviewed by doctors and by non-clinical audit staff showed a reasonable level of agreement (p-values for difference 0.406 and 0.223, respectively), although results from all three staff types showed no overall level of agreement (p-value for difference 0.057). Detailed qualitative analysis of the textual data indicated that the three staff types tended to provide different forms of commentary on quality of care, although there was some overlap between some groups. In the process-outcome study there generally were high criterion-based scores for all hospitals, whereas there was more interhospital variation between the holistic review overall scale scores. Textual commentary on the quality of care verified the holistic scale scores. Differences among hospitals with regard to the relationship between mortality and quality of care were not statistically significant. Using the holistic approach, the three groups of staff appeared to interpret the recorded care differently when they each reviewed the same record. When the same clinical record was reviewed by doctors and non-clinical audit staff, there was no significant difference between the assessments of quality of care generated by the two groups. All three staff groups performed reasonably well when using criterion-based review, although the quality and type of information provided by doctors was of greater value. Therefore, when measuring quality of care from case notes, consideration needs to be given to the method of review, the type of staff undertaking the review, and the methods of analysis available to the review team. Review can be enhanced using a combination of both criterion-based and structured holistic methods with textual commentary, and variation in quality of care can best be identified from a combination of holistic scale scores and textual data review.

Nutrition Education.

ERIC Educational Resources Information Center

Chauliac, Michel; And Others

1991-01-01

Nutrition education is the theme of this issue of "Children in the Tropics," which emphasizes an analysis of the situation of nutrition education programs, particularly in third world countries. It is noted that in most cases, it is necessary to integrate aspects of nutrition education into broader programs that encompass agricultural…

Hybrid endovascular repair for aortic arch pathology: intermediate outcomes and complications: a retrospective analysis.

PubMed

Kang, Woong Chol; Shin, Eak Kyun; Park, Chul-Hyun; Kang, Jin Mo; Ko, Young-Guk; Choi, Donghoon; Youn, Young Nam; Shim, Won-Heum

2013-08-01

To evaluate the outcomes of hybrid endovascular repair for aortic arch pathology. This study was a retrospective analysis involving patients who underwent hybrid endovascular repair for aortic arch pathologies. Twenty-one patients (16 men; mean age, 64.7 ± 16.2 years) with aortic arch pathologies were treated by hybrid endovascular repair. The indications for treatment included increased aneurysm size in 16 cases (71.4%), rupture or impending aneurysmal rupture in 5 cases (23.8%), and rapid growth of aortic dissection (≥ 10 mm/y) in 1 case (4.8%). Supra-aortic vessel transposition and stent-graft implantation were achieved in all cases. Two types of stent-graft was used, as follows: the Seal thoracic stent-graft in 14 patients (66.7%); and the Valiant stent grafts in 7 patients (33.3%). Perioperative complications affected 5 patients (23.8%), as follows: bleeding (n = 4, 19.0%); stroke (n = 3, 14.3%); renal failure (n = 2, 9.5%); vascular injury (n = 1, 4.8%), and respiratory failure (n = 1, 4.8%). Two patients died within 30 days (9.5%). Technical success was achieved in 15 patients (71.5%). Early endoleaks were noted in 4 patients (19.0%). One patient died during follow-up (mean, 21.3 ± 11.6 months) due to a de novo intramural hematoma. Persistent early endoleaks were noted in 4 patients (19.0%); 2 of the 4 patients were successfully managed with implantation of additional stent-grafts. No late onset endoleaks were noted. The death-free survival and reintervention-free survival rates during follow-up were 85.7% and 90.5%, respectively. Hybrid treatment with supra-aortic vessel transposition and endovascular repair may be an option in frail patients in who open procedures is too risky. © 2013 Wiley Periodicals, Inc.

NLP based congestive heart failure case finding: A prospective analysis on statewide electronic medical records.

PubMed

Wang, Yue; Luo, Jin; Hao, Shiying; Xu, Haihua; Shin, Andrew Young; Jin, Bo; Liu, Rui; Deng, Xiaohong; Wang, Lijuan; Zheng, Le; Zhao, Yifan; Zhu, Chunqing; Hu, Zhongkai; Fu, Changlin; Hao, Yanpeng; Zhao, Yingzhen; Jiang, Yunliang; Dai, Dorothy; Culver, Devore S; Alfreds, Shaun T; Todd, Rogow; Stearns, Frank; Sylvester, Karl G; Widen, Eric; Ling, Xuefeng B

2015-12-01

In order to proactively manage congestive heart failure (CHF) patients, an effective CHF case finding algorithm is required to process both structured and unstructured electronic medical records (EMR) to allow complementary and cost-efficient identification of CHF patients. We set to identify CHF cases from both EMR codified and natural language processing (NLP) found cases. Using narrative clinical notes from all Maine Health Information Exchange (HIE) patients, the NLP case finding algorithm was retrospectively (July 1, 2012-June 30, 2013) developed with a random subset of HIE associated facilities, and blind-tested with the remaining facilities. The NLP based method was integrated into a live HIE population exploration system and validated prospectively (July 1, 2013-June 30, 2014). Total of 18,295 codified CHF patients were included in Maine HIE. Among the 253,803 subjects without CHF codings, our case finding algorithm prospectively identified 2411 uncodified CHF cases. The positive predictive value (PPV) is 0.914, and 70.1% of these 2411 cases were found to be with CHF histories in the clinical notes. A CHF case finding algorithm was developed, tested and prospectively validated. The successful integration of the CHF case findings algorithm into the Maine HIE live system is expected to improve the Maine CHF care. Copyright © 2015. Published by Elsevier Ireland Ltd.

Peter Heller's a Child Analysis with Anna Freud: the significance of the case for the history of child psychoanalysis.

PubMed

Midgley, Nick

2012-02-01

A Child Analysis with Anna Freud, a collection of Anna Freud's detailed case notes of her treatment of the young Peter Heller between 1929 and 1932, was first published in English in 1990. Not only does this work give us direct access to Anna Freud's ways of thinking and working at a crucial period in the early history of child analysis; it is also one of the few records of an adult reflecting in depth on the experience of being in analysis as a child. Yet to date this work has received little attention in the psychoanalytic literature. In an attempt to redress this neglect, the Heller case study is placed in the context of Anna Freud's emerging ideas about child analysis. In particular, its significance in the development of her psychoanalytic thinking is investigated in the light of her 1927 book, The Technique of Child Analysis.

Transdural Indocyanine Green Videography for Superficial Temporal Artery-to-Middle Cerebral Artery Bypass-Technical Note.

PubMed

Yokota, Hiroshi; Yonezawa, Taiji; Yamada, Tomonori; Miyamae, Seisuke; Kim, Taekyun; Takamura, Yoshiaki; Masui, Katsuya; Aketa, Shuta

2017-10-01

Neurosurgical application of indocyanine green (ICG) videography before performing a dural opening, known as transdural ICG videography, has been used during surgery of meningiomas associated with venous sinuses as well as cranial and spinal arteriovenous malformations. However, its use for a superficial temporal artery (STA)-to-middle cerebral artery (MCA) bypass has not been reported. We performed a retrospective analysis of medical records of patients who underwent transdural ICG videography during STA-MCA bypass performed between January 2012 and March 2015. The primary outcome was visualization of recipient cortical arteries; secondary outcomes were surgical modifications and complications as well as any adverse events associated with transdural ICG videography. We analyzed 29 STA-MCA bypass procedures performed in 30 hemispheres with atherosclerotic steno-occlusive disease and found that the proper recipient was identified in 28 hemispheres. Subsequently modified procedures for those were a tailored dural incision and craniotomy correction. No complications associated with ICG administration were encountered; during the postoperative course, transient aphasia was noted in 1 case, chronic subdural hematoma was noted in 1 case, and subdural effusion was noted in 2 cases. Transdural ICG videography for atherosclerotic steno-occlusive disease facilitates modifications during STA-MCA bypass procedures. Recognition of the proper recipient cortical arteries before a dural incision allows the neurosurgeon to perform a tailored dural incision and extension of the bone window, although the contribution to surgical outcome has yet to be determined. Copyright © 2017 Elsevier Inc. All rights reserved.

Australian oral health case notes: assessment of forensic relevance and adherence to recording guidelines.

PubMed

Stow, L; James, H; Richards, L

2016-06-01

Dental case notes record clinical diagnoses and treatments, as well as providing continuity of patient care. They are also used for dento-legal litigation and forensic purposes. Maintaining accurate and comprehensive dental patient records is a dental worker's ethical and legal obligation. Australian registered specialist forensic odontologists were surveyed to determine the relevance of recorded case note items for dental identification. A dental case notes sample was assessed for adherence with odontologist nominated forensic value and compiled professional record keeping guidelines of forensic relevance. Frequency of item recording, confidence interval, examiner agreement and statistical significance were determined. Broad agreement existed between forensic odontologists as to which recorded dental items have most forensic relevance. Inclusion frequency of these items in sampled case notes varied widely (e.g. single area radiographic view present in 75%, CI = 65.65-82.50; completed odontogram in 56%, CI = 46.23-65.33). Recording of information specified by professional record keeping guidelines also varied, although overall inclusion was higher than for forensically desired items (e.g. patient's full name in 99%, CI = 94.01 - >99.99; named treating practitioner in 23%, CI = 15.78-32.31). Many sampled dental case notes lacked details identified as being valuable by forensic specialists and as specified by professional record keeping guidelines. © 2016 Australian Dental Association.

Airpower versus Terrorism: Three Case Studies

DTIC Science & Technology

2007-03-01

not flawless. In poststrike analysis , the assistant secretary of defense for public affairs, Robert B. Sims, admitted that 2 percent of the bombs... analysis centers on the phase of operation employed by the IDF since September 2000 and examines air- power’s role as a significant force multiplier...rent analysis to note that airpower has been a tool normally used in a combined arms approach. As such, the issue of objective attainment will be

An audit of inpatient case records and suggestions for improvements.

PubMed

Arshad, A R; Ganesananthan, S; Ajik, S

2000-09-01

A study was carried out in Kuala Lumpur Hospital to review the adequacy of documentation of bio-data and clinical data including clinical examination, progress review, discharge process and doctor's identification in ten of our clinical departments. Twenty criteria were assessed in a retrospective manner to scrutinize the contents of medical notes and subsequently two prospective evaluations were conducted to see improvement in case notes documentation. Deficiencies were revealed in all the criteria selected. However there was a statistically significant improvement in the eleven clinical data criteria in the subsequent two evaluations. Illegibility of case note entries and an excessive usage of abbreviations were noted during this audit. All clinical departments and hospitals should carry out detailed studies into the contents of their medical notes.

A note on tilted Bianchi type VIh models: the type III bifurcation

NASA Astrophysics Data System (ADS)

Coley, A. A.; Hervik, S.

2008-10-01

In this note we complete the analysis of Hervik, van den Hoogen, Lim and Coley (2007 Class. Quantum Grav. 24 3859) of the late-time behaviour of tilted perfect fluid Bianchi type III models. We consider models with dust, and perfect fluids stiffer than dust, and eludicate the late-time behaviour by studying the centre manifold which dominates the behaviour of the model at late times. In the dust case, this centre manifold is three-dimensional and can be considered a double bifurcation as the two parameters (h and γ) of the type VIh model are varied. We therefore complete the analysis of the late-time behaviour of tilted ever-expanding Bianchi models of types I VIII.

Parallel Curves: Getting There and Getting Back

ERIC Educational Resources Information Center

Agnew, A. F.; Mathews, J. H.

2006-01-01

This note takes up the issue of parallel curves while illustrating the utility of "Mathematica" in computations. This work complements results presented earlier. The presented treatment, considering the more general case of parametric curves, provides an analysis of the appearance of cusp singularities, and emphasizes the utility of symbolic…

Transforming Public Education: Cases in Education Entrepreneurship. Instructor's Guide

ERIC Educational Resources Information Center

Childress, Stacey M., Ed.

2010-01-01

This instructor's guide is intended for use with "Transforming Public Education: Cases in Education Entrepreneurship." This volume includes a teaching note for each case in the student edition; the note provides basic guidance in how to initaite and organize the flow of the case discussion as well as how the case links to others before…

Multivariate optimum interpolation of surface pressure and surface wind over oceans

NASA Technical Reports Server (NTRS)

Bloom, S. C.; Baker, W. E.; Nestler, M. S.

1984-01-01

The present multivariate analysis method for surface pressure and winds incorporates ship wind observations into the analysis of surface pressure. For the specific case of 0000 GMT, on February 3, 1979, the additional data resulted in a global rms difference of 0.6 mb; individual maxima as larse as 5 mb occurred over the North Atlantic and East Pacific Oceans. These differences are noted to be smaller than the analysis increments to the first-guess fields.

Meteoritic Sulfur Isotopic Analysis

NASA Technical Reports Server (NTRS)

Thiemens, Mark H.

1996-01-01

Funds were requested to continue our program in meteoritic sulfur isotopic analysis. We have recently detected a potential nucleosynthetic sulfur isotopic anomaly. We will search for potential carriers. The documentation of bulk systematics and the possible relation to nebular chemistry and oxygen isotopes will be explored. Analytical techniques for delta(sup 33), delta(sup 34)S, delta(sup 36)S isotopic analysis were improved. Analysis of sub milligram samples is now possible. A possible relation between sulfur isotopes and oxygen was detected, with similar group systematics noted, particularly in the case of aubrites, ureilites and entstatite chondrites. A possible nucleosynthetic excess S-33 has been noted in bulk ureilites and an oldhamite separate from Norton County. High energy proton (approximately 1 GeV) bombardments of iron foils were done to experimentally determine S-33, S-36 spallogenic yields for quantitation of isotopic measurements in iron meteorites. Techniques for measurement of mineral separates were perfected and an analysis program initiated. The systematic behavior of bulk sulfur isotopes will continue to be explored.

Do Independent Sector Treatment Centres (ISTC) impact on specialist registrar training in primary hip and knee arthroplasty?

PubMed

Clamp, Jonathan A; Baiju, Dean; Copas, David P; Hutchinson, James W; Rowles, John M

2008-09-01

The introduction of Modernising Medical Careers (MMC) is likely to reduce specialist registrar (SpR) operative experience during higher surgical training (HST). A further negative impact on training by local Independent Sector Treatment Centres (ISTCs) could reduce experience, and thus competence, in primary joint arthroplasty at completion of higher surgical training. Retrospective case note and radiograph analysis of patients receiving primary hip and knee arthroplasty in a teaching hospital, before and after the establishment of a local ISTC. Patients and operative details were recorded from the selected case notes. Corresponding radiographs were assessed and the severity of the disease process assessed. Fewer primary hip and knee replacements were performed by SpRs in the time period after the establishment of an ISTC. ISTCs may adversely affect SpR training in primary joint arthroplasty.

Qualitative analysis of round-table discussions on the business case and procurement challenges for hospital electronic prescribing systems.

PubMed

Cresswell, Kathrin M; Slee, Ann; Coleman, Jamie; Williams, Robin; Bates, David W; Sheikh, Aziz

2013-01-01

There is a pressing need to understand the challenges surrounding procurement of and business case development for hospital electronic prescribing systems, and to identify possible strategies to enhance the efficiency of these processes in order to assist strategic decision making. We organized eight multi-disciplinary round-table discussions in the United Kingdom. Participants included policy makers, representatives from hospitals, system developers, academics, and patients. Each discussion was digitally audio-recorded, transcribed verbatim and, together with accompanying field notes, analyzed thematically with NVivo9. We drew on data from 17 participants (approximately eight per roundtable), six hours of discussion, and 15 pages of field notes. Key challenges included silo planning with systems not being considered as part of an integrated organizational information technology strategy, lack of opportunity for interactions between customers and potential suppliers, lack of support for hospitals in choosing appropriate systems, difficulty of balancing structured planning with flexibility, and the on-going challenge of distinguishing "wants" and aspirations from organizational "needs". Development of business cases for major investments in information technology does not take place in an organizational vacuum. Building on previously identified potentially transferable dimensions to the development and execution of business cases surrounding measurements of costs/benefits and risk management, we have identified additional components relevant to ePrescribing systems. These include: considerations surrounding strategic context, case for change and objectives, future service requirements and options appraisal, capital and revenue implications, timescale and deliverability, and risk analysis and management.

Further results from PIXE analysis of inks in Galileo's notes on motion

NASA Astrophysics Data System (ADS)

Del Carmine, P.; Giuntini, L.; Hooper, W.; Lucarelli, F.; Mandò, P. A.

1996-06-01

We have recently analysed the inks in some of the folios of Vol. 72 of Manoscritti galileiani, kept at the Biblioteca Nazionale Centrale di Firenze, which contains a collection of loose handwritten sheets containing undated notes, data from experiments and propositions on the problems of motion from different periods of Galileo's life. This paper reports specific results obtained from the analysis of some of these propositions, which allowed to make a contribution to their chronological attribution and therefore to the solution of some historical controversies. Even in the case where the "absolute" chronological attributions could not be made on the basis of comparison with dated documents, the PIXE results provided useful information to deny or confirm the hypothesis that different propositions were written in the same or in different periods.

Characteristics and Implications of Diagnostic Justification Scores Based on the New Patient Note Format of the USMLE Step 2 CS Exam.

PubMed

Yudkowsky, Rachel; Park, Yoon Soo; Hyderi, Abbas; Bordage, Georges

2015-11-01

To determine the psychometric characteristics of diagnostic justification scores based on the patient note format of the United States Medical Licensing Examination Step 2 Clinical Skills exam, which requires students to document history and physical findings, differential diagnoses, diagnostic justification, and plan for immediate workup. End-of-third-year medical students at one institution wrote notes for five standardized patient cases in May 2013 (n = 180) and 2014 (n = 177). Each case was scored using a four-point rubric to rate each of the four note components. Descriptive statistics and item analyses were computed and a generalizability study done. Across cases, 10% to 48% provided no diagnostic justification or had several missing or incorrect links between history and physical findings and diagnoses. The average intercase correlation for justification scores ranged from 0.06 to 0.16; internal consistency reliability of justification scores (coefficient alpha across cases) was 0.38. Overall, justification scores had the highest mean item discrimination across cases. The generalizability study showed that person-case interaction (12%) and task-case interaction (13%) had the largest variance components, indicating substantial case specificity. The diagnostic justification task provides unique information about student achievement and curricular gaps. Students struggled to correctly justify their diagnoses; performance was highly case specific. Diagnostic justification was the most discriminating element of the patient note and had the greatest variability in student performance across cases. The curriculum should provide a wide range of clinical cases and emphasize recognition and interpretation of clinically discriminating findings to promote the development of clinical reasoning skills.

Problem Solving Strategies of Selected Pre-Service Secondary School Mathematics Teachers in Malaysia

ERIC Educational Resources Information Center

Yew, Wun Theam; Zamri, Sharifah Norul Akmar Syed

2016-01-01

Problem solving strategies of eight pre-service secondary school mathematics teachers (PSSMTs) were examined in this study. A case study research design was employed and clinical interview technique was used to collect the data. Materials collected for analysis consisted of audiotapes and videotapes of clinical interviews, subjects' notes and…

'Well, I Have to Write That": A Cross-Case Qualitative Analysis of Young Writers' Motivations to Write

ERIC Educational Resources Information Center

Magnifico, Alecia Marie

2013-01-01

Hickey (2003), taking a "stridently sociocultural" position on motivation, notes that conceptualizations of motivation must shift to successfully study "motivation-in-context" (p. 401 ). This study represents an attempt to navigate such a shift. Rather than taking established understandings of achievement goals and motivation…

Spiritual Development in Adolescence: Toward Enriching Theories, Research, and Professional Practice

ERIC Educational Resources Information Center

Petersen, Anne C.

2008-01-01

The author notes that she finds the case for making spiritual development a priority surprisingly compelling--"surprisingly" because although she is an expert on adolescent development, she has not done research or previously written about spiritual development. She suggests that a systems analysis occur first, before engaging frontline youth…

Passive Endwall Treatments for Enhancing Stability

NASA Technical Reports Server (NTRS)

Hathaway, Michael D.

2007-01-01

These lecture notes were presented at the von Karman Institutes lecture series on Advances in Axial Compressor Aerodynamics, May 2006. They provide a fairly extensive overview of what's been learned from numerous investigations of various passive casing endwall technologies that have been proposed for alleviating the stall limiting physics associated with the compressor endwall flow field. The lecture notes are organized to give an appreciation for the inventiveness and understanding of the earliest compressor technologists and to provide a coherent thread of understanding that has arisen out of the early investigations. As such the lecture notes begin with a historical overview of casing treatments from their infancy through the earliest proposed concepts involving blowing, suction and flow recirculation. A summary of lessons learned from these early investigations is provided at the end of this section. The lecture notes then provide a somewhat more in-depth overview of recent advancements in the development of passive casing treatments from the late 1990's through 2006, including advancements in understanding the flow mechanism of circumferential groove casing treatments, and the development of discrete tip injection and self-recirculating casing treatments. At the conclusion of the lecture notes a final summary of lessons learned throughout the history of the development of passive casing treatments is provided. Finally, a list of future needs is given. It is hoped that these lecture notes will be a useful reference for future research endeavors to improve our understanding of the fluid physics of passive casing treatments and how they act to enhance compressor stability, and that they will perhaps provide a springboard for future research activities in this area of interest

Integrating Policies and Systems for Early Childhood Education and Care: The Case of the Republic of Korea. Early Childhood and Family Policy Series.

ERIC Educational Resources Information Center

Na, Jung; Moon, Mugyeong

Noting that young children in the Republic of Korea have received institutional education and care for more than 100 years, this report provides an in-depth analysis of Korea's reform of its early childhood education and care (ECEC) system. The analysis focuses on how ECEC has evolved, the current system, why Korea has attempted to reform the…

Following a natural experiment of guideline adaptation and early implementation: a mixed-methods study of facilitation

PubMed Central

2012-01-01

Background Facilitation is emerging as an important strategy in the uptake of evidence. However, it is not entirely clear from a practical perspective how facilitation occurs to help move research evidence into nursing practice. The Canadian Partnership Against Cancer, also known as the 'Partnership,' is a Pan-Canadian initiative supporting knowledge translation activity for improved care through guideline use. In this case-series study, five self-identified groups volunteered to use a systematic methodology to adapt existing clinical practice guidelines for Canadian use. With 'Partnership' support, local and external facilitators provided assistance for groups to begin the process by adapting the guidelines and planning for implementation. Methods To gain a more comprehensive understanding of the nature of facilitation, we conducted a mixed-methods study. Specifically, we examined the role and skills of individuals actively engaged in facilitation as well as the actual facilitation activities occurring within the 'Partnership.' The study was driven by and builds upon a focused literature review published in 2010 that examined facilitation as a role and process in achieving evidence-based practice in nursing. An audit tool outlining 46 discrete facilitation activities based on results of this review was used to examine the facilitation noted in the documents (emails, meeting minutes, field notes) of three nursing-related cases participating in the 'Partnership' case-series study. To further examine the concept, six facilitators were interviewed about their practical experiences. The case-audit data were analyzed through a simple content analysis and triangulated with participant responses from the focus group interview to understand what occurred as these cases undertook guideline adaptation. Results The analysis of the three cases revealed that almost all of the 46 discrete, practical facilitation activities from the literature were evidenced. Additionally, case documents exposed five other facilitation-related activities, and a combination of external and local facilitation was apparent. Individuals who were involved in the case or group adapting the guideline(s) also performed facilitation activities, both formally and informally, in conjunction with or in addition to appointed external and local facilitators. Conclusions Facilitation of evidence-based practice is a multifaceted process and a team effort. Communication and relationship-building are key components. The practical aspects of facilitation explicated in this study validate what has been previously noted in the literature and expand what is known about facilitation process and activity. PMID:22309743

Data and analysis procedures for improved aerial applications mission performance. [agricultural aircraft wing geometry

NASA Technical Reports Server (NTRS)

Holmes, B. J.; Morris, D. K.; Razak, K.

1979-01-01

An analysis procedure is given and cases analyzed for the effects of wing geometry on lateral transport of a variety of agricultural particles released in the wake of an agricultural airplane. The cases analyzed simulate the release of particles from a fuselage centerline-mounted dry material spreader; however, the procedure applies to particles released anywhere along the wing span. Consideration is given to the effects of taper ratio, aspect ratio, wing loading, and deflected flaps. It is noted that significant lateral transport of large particles can be achieved using high-lift devices positioned to create a strong vortex near the location of particle release.

Do Independent Sector Treatment Centres (ISTC) Impact on Specialist Registrar Training in Primary Hip and Knee Arthroplasty?

PubMed Central

Clamp, Jonathan A; Baiju, Dean SR; Copas, David P; Hutchinson, James W; Rowles, John M

2008-01-01

INTRODUCTION The introduction of Modernising Medical Careers (MMC) is likely to reduce specialist registrar (SpR) operative experience during higher surgical training (HST). A further negative impact on training by local Independent Sector Treatment Centres (ISTCs) could reduce experience, and thus competence, in primary joint arthroplasty at completion of higher surgical training. PATIENTS AND METHODS Retrospective case note and radiograph analysis of patients receiving primary hip and knee arthroplasty in a teaching hospital, before and after the establishment of a local ISTC. Patients and operative details were recorded from the selected case notes. Corresponding radiographs were assessed and the severity of the disease process assessed. RESULTS Fewer primary hip and knee replacements were performed by SpRs in the time period after the establishment of an ISTC. Conclusions ISTCs may adversely affect SpR training in primary joint arthroplasty. PMID:18765029

Case Report: Linezolid Optic Neuropathy and Proposed Evidenced-based Screening Recommendation.

PubMed

Dempsey, Sean P; Sickman, Amy; Slagle, William Scott

2018-05-01

This case illustrates a novel screening protocol for linezolid-induced toxic optic neuropathy. To present a case report and analysis of linezolid-induced optic neuropathies in adult patients to develop screening recommendations. A case report of optic neuropathy from extended use of linezolid illustrates its potential effects on vision. We conduct a retrospective analysis of 39 reported cases to derive a recommended screening protocol for linezolid-induced toxic optic neuropathy in adult patients. Of 39 reported adult cases, 32 presented with optic neuropathy within 90 to 365 days of treatment. Within this subset, the duration of linezolid dosage to first symptoms is 235 ± 71 days. Seven outliers either experienced optic neuropathy within the first 28 days or between 600 and 1125 days. Of the 33 cases that quantified visual recovery, 30 reported final binocular visual acuity equivalent to 20/40 or better when the medication was discontinued from 0 to 268 days after symptom onset. Recovery potential was reported over a period of 2 weeks to approximately 6 months after cessation. To evaluate the effect of cumulative dose, the data were separated into patients taking 600 mg twice daily and those at 600 mg once daily. At the higher dosage, a mean of 180 ± 96 days with a mean cumulative dosage of 216 ± 115 g was noted at first symptom, whereas at lower dosage, a mean of 201 ± 102 days was noted with a mean cumulative dose of 138 ± 69 g. We recommend screening adult patients within 1 month after initiating linezolid, followed by a subsequent evaluation every 30 to 60 days beginning 3 months from initiation. Substantial visual recovery is reported when linezolid is discontinued. Toxicity appears to be correlated to duration of treatment, rather than cumulative dose.

Note Taking on Trial: A Legal Application of Note-Taking Research

ERIC Educational Resources Information Center

Kiewra, Kenneth A.

2016-01-01

This article is about note taking, but it is not an exhaustive review of note-taking literature. Instead, it portrays the application of note-taking research to an unusual and important area of practice--the law. I was hired to serve as an expert witness on note taking in a legal case that hinged, in part, on the completeness and accuracy of…

Is Epenthesis a Means to Optimize Feet? A Reanalysis of the CLPF Database

ERIC Educational Resources Information Center

Taelman, Helena; Gillis, Steven

2008-01-01

Fikkert (1994) analyzed a large corpus of Dutch children's early language production, and found that they often add targetless syllables to their words in order to create bisyllabic feet. In this note we point out a methodological problem with that analysis: in an important number of cases, epenthetic vowels occur at places where grammatical…

Authorship, Gender, and Institutional Affiliation in Library History: The Case of "Libraries & Culture."

ERIC Educational Resources Information Center

Herubel, Jean-Pierre V. M.

1991-01-01

Describes a study that examined two characteristics of authorship--the gender of the authors and their institutional affiliation--to see who is producing published research in the field of library history. The results of an analysis of articles, technical notes, and reviews from 23 years of "Library and Culture" are discussed. (two…

Using the Harp as a Communication Channel with Children with Autism

ERIC Educational Resources Information Center

Kissinger, Lori; Worley, David W.

2008-01-01

This study focused on the feasibility of using the concert harp as a communication channel for children with autism. Two qualitative case studies using constant comparison analysis were conducted over a six-day observation period resulting in field notes both from the primary researcher and the teacher who regularly worked with the two children in…

Student Voice Use and Vocal Health during an All-State Chorus Event

ERIC Educational Resources Information Center

Daugherty, James F.; Manternach, Jeremy N.; Price, Kathy K.

2011-01-01

This field-based case study documented students' (N = 256) voice use and voice health perceptions during a 3-day all-state high school chorus event through daily surveys, phonation duration data, analysis of rehearsal voice use behaviors, and field notes. Among the primary results are the following: (a) First and final day survey comparisons…

Inactivation of Smad4 in gastric carcinomas.

PubMed

Powell, S M; Harper, J C; Hamilton, S R; Robinson, C R; Cummings, O W

1997-10-01

Allelic loss of chromosome 18q has been noted in intestinal type gastric adenocarcinomas. Smad4 is a gene located at 18q that was recently cloned in humans and found to be significantly altered in pancreatic cancers. We sought to determine whether Smad4 genetic alterations played a significant role in gastric tumorigenesis by studying 35 gastric adenocarcinomas of all histopathological types and pathological stages. Microdissected specimens were used for mutational analysis of Smad4 at the nucleotide level, including the entire coding region and intron/exon boundaries. Allelic imbalance was also analyzed at the Smad4 locus using two nearby microsatellite markers. One case of apparent biallelic inactivation of Smad4 was found in our study of 35 gastric carcinomas. A nonsense point mutation at codon 334 was demonstrated, which, similar to other Smad4 mutations, is predicted to truncate the conserved COOH-terminal domain of this protein. This Smad4 C to T transition mutation was proven to be somatically acquired. Allelic loss was also noted on chromosome 18q at a marker near Smad4 in this mutated gastric cancer, apparently producing complete inactivation of Smad4 in this tumor. Significant 18q allelic loss (56% of 34 informative cases) was noted in our gastric carcinomas using microsatellite markers near the Smad4 locus, regardless of histological subtype or pathological stage. Additionally, three cases of microsatellite instability were observed. Thus, Smad4 inactivation was noted in our gastric carcinomas; however, this event was rare. The frequent loss of chromosomal arm 18q observed in gastric cancers suggests the presence of other tumor suppressor genes in this region that are involved in gastric tumorigenesis. Further studies are needed to identify these other targets of inactivation during gastric cancer development.

Suicide notes.

PubMed

O'Donnell, I; Farmer, R; Catalan, J

1993-07-01

Detailed case reports of incidents of suicide and attempted suicide on the London Underground railway system between 1985 and 1989 were examined for the presence of suicide notes. The incidence of note-leaving was 15%. Notes provided little insight into the causes of suicide as subjectively perceived, or strategies for suicide prevention.

Qualitative Analysis of Round-Table Discussions on the Business Case and Procurement Challenges for Hospital Electronic Prescribing Systems

PubMed Central

Cresswell, Kathrin M.; Slee, Ann; Coleman, Jamie; Williams, Robin; Bates, David W.; Sheikh, Aziz

2013-01-01

Objectives There is a pressing need to understand the challenges surrounding procurement of and business case development for hospital electronic prescribing systems, and to identify possible strategies to enhance the efficiency of these processes in order to assist strategic decision making. Materials and Methods We organized eight multi-disciplinary round-table discussions in the United Kingdom. Participants included policy makers, representatives from hospitals, system developers, academics, and patients. Each discussion was digitally audio-recorded, transcribed verbatim and, together with accompanying field notes, analyzed thematically with NVivo9. Results We drew on data from 17 participants (approximately eight per roundtable), six hours of discussion, and 15 pages of field notes. Key challenges included silo planning with systems not being considered as part of an integrated organizational information technology strategy, lack of opportunity for interactions between customers and potential suppliers, lack of support for hospitals in choosing appropriate systems, difficulty of balancing structured planning with flexibility, and the on-going challenge of distinguishing “wants” and aspirations from organizational “needs”. Discussion and conclusions Development of business cases for major investments in information technology does not take place in an organizational vacuum. Building on previously identified potentially transferable dimensions to the development and execution of business cases surrounding measurements of costs/benefits and risk management, we have identified additional components relevant to ePrescribing systems. These include: considerations surrounding strategic context, case for change and objectives, future service requirements and options appraisal, capital and revenue implications, timescale and deliverability, and risk analysis and management. PMID:24260213

Cost-effectiveness analysis: what it really means for transfusion medicine decision making.

PubMed

Custer, Brian; Hoch, Jeffrey S

2009-01-01

Some have suggested that "blood is different," and the role for cost-effectiveness is thus circumscribed. In this article, the authors start by reviewing key concepts in health economics and economic analysis methods. Examples are drawn from published blood safety studies. After explaining the underlying reasoning behind cost-effectiveness analysis, the authors point out how economic thinking is evident in some aspects of transfusion medicine. Some cost-effectiveness study results for blood safety are discussed to provide context, followed by consideration of prominent decisions that have been made in transfusion medicine field. In the last section, the authors conjecture as to why in some cases cost-effectiveness analysis appears to have greater impact than in others, noting the terrible price that is paid in mortality and morbidity when cost-effectiveness analysis is ignored. In this context, the implications of opportunity cost are discussed, and it is noted that opportunity cost should not be viewed as benefits forgone by concentrating on one aspect of blood safety and instead should be viewed as our societal willingness to misallocate resources to achieve less health for the same cost.

Abnormal laughter-like vocalisations replacing speech in primary progressive aphasia

PubMed Central

Rohrer, Jonathan D.; Warren, Jason D.; Rossor, Martin N.

2009-01-01

We describe ten patients with a clinical diagnosis of primary progressive aphasia (PPA) (pathologically confirmed in three cases) who developed abnormal laughter-like vocalisations in the context of progressive speech output impairment leading to mutism. Failure of speech output was accompanied by increasing frequency of the abnormal vocalisations until ultimately they constituted the patient's only extended utterance. The laughter-like vocalisations did not show contextual sensitivity but occurred as an automatic vocal output that replaced speech. Acoustic analysis of the vocalisations in two patients revealed abnormal motor features including variable note duration and inter-note interval, loss of temporal symmetry of laugh notes and loss of the normal decrescendo. Abnormal laughter-like vocalisations may be a hallmark of a subgroup in the PPA spectrum with impaired control and production of nonverbal vocal behaviour due to disruption of fronto-temporal networks mediating vocalisation. PMID:19435636

Abnormal laughter-like vocalisations replacing speech in primary progressive aphasia.

PubMed

Rohrer, Jonathan D; Warren, Jason D; Rossor, Martin N

2009-09-15

We describe ten patients with a clinical diagnosis of primary progressive aphasia (PPA) (pathologically confirmed in three cases) who developed abnormal laughter-like vocalisations in the context of progressive speech output impairment leading to mutism. Failure of speech output was accompanied by increasing frequency of the abnormal vocalisations until ultimately they constituted the patient's only extended utterance. The laughter-like vocalisations did not show contextual sensitivity but occurred as an automatic vocal output that replaced speech. Acoustic analysis of the vocalisations in two patients revealed abnormal motor features including variable note duration and inter-note interval, loss of temporal symmetry of laugh notes and loss of the normal decrescendo. Abnormal laughter-like vocalisations may be a hallmark of a subgroup in the PPA spectrum with impaired control and production of nonverbal vocal behaviour due to disruption of fronto-temporal networks mediating vocalisation.

The ANKLe Score: An Audit of Otolaryngology Emergency Clinic Record Keeping

PubMed Central

Dexter, Sara C; Hayashi, Daichi; Tysome, James R

2008-01-01

INTRODUCTION Accurate and legible medical records are essential to good quality patient care. Guidelines from The Royal College of Surgeons of England (RCSE) state the content required to form a complete medical record, but do not address legibility. An audit of otolaryngology emergency clinic record keeping was performed using a new scoring system. PATIENTS AND METHODS The Adjusted Note Keeping and Legibility (ANKLe) score was developed as an objective and quantitative method to assess both the content and legibility of case notes, incorporating the RCSE guidelines. Twenty consecutive otolaryngology emergency clinic case notes from each of 7 senior house officers were audited against standards for legibility and content using the ANKLe score. A proforma was introduced to improve documentation and handwriting advice was given. A further set of 140 notes (20 notes for each of the 7 doctors) was audited in the same way to provide feedback. RESULTS The introduction of a proforma and advice on handwriting significantly increased the quality of case note entries in terms of content, legibility and overall ANKLe score. CONCLUSIONS Accurate note keeping can be improved by the use of a proforma. The legibility of handwriting can be improved using simple advice. The ANKLe score is an objective assessment tool of the overall quality of medical note documentation which can be adapted for use in other specialties. PMID:18430339

Travel history key to picking up on signs of bubonic plague.

PubMed

2015-11-01

Health officials note an uptick in cases of bubonic plague in the United States this year, with at least 12 reported human cases reported since April 1. The CDC notes that healthcare providers should consider plague in patients who have traveled to plague-endemic areas and exhibit fever, headache, chills, weakness, and one or more swollen or tender and painful lymph nodes, referred to as buboes. Officials note that the disease rarely passes from person to person, but that this is a concern with patients who have developed the pneumonic form of the disease. Health officials note that in recent years there has been an average of seven cases of human plague each year in the United States, and that most of these cases are the bubonic form of the illness. Four patients confirmed to have plague this year have died, including the most recent case, a Utah man in his 70s. Most cases of plague in the United States occur in two regions. The first includes northern New Mexico, northern Arizona, and southern Colorado, and the second includes California, southern Oregon, and far western Nevada. When plague is suspected, treatment with antibiotics should begin immediately.

Impact of a Paper vs Virtual Simulated Patient Case on Student-Perceived Confidence and Engagement

PubMed Central

Gallimore, Casey E.; Pitterle, Michael; Morrill, Josh

2016-01-01

Objective. To evaluate online case simulation vs a paper case on student confidence and engagement. Design. Students enrolled in a pharmacotherapy laboratory course completed a patient case scenario as a component of an osteoarthritis laboratory module. Two laboratory sections used a paper case (n=53); three sections used an online virtual case simulation (n=81). Student module performance was assessed through a submitted subjective objective assessment plan (SOAP) note. Students completed pre/post surveys to measure self-perceived confidence in providing medication management. The simulation group completed postmodule questions related to realism and engagement of the online virtual case simulation. Group assessments were performed using chi-square and Mann Whitney tests. Assessment. A significant increase in all 13 confidence items was seen in both student groups following completion of the laboratory module. The simulation group had an increased change of confidence compared to the paper group in assessing medication efficacy and documenting a thorough assessment. Comparing the online virtual simulation to a paper case, students agreed the learning experience increased interest, enjoyment, relevance, and realism. The simulation group performed better on the subjective SOAP note domain though no differences in total SOAP note scores was found between the two groups. Conclusion. Virtual case simulations result in increased student engagement and may lead to improved documentation performance in the subjective domain of SOAP notes. However, virtual patient cases may offer limited benefit over paper cases in improving overall student self-confidence to provide medication management. PMID:26941442

Impact of a Paper vs Virtual Simulated Patient Case on Student-Perceived Confidence and Engagement.

PubMed

Barnett, Susanne G; Gallimore, Casey E; Pitterle, Michael; Morrill, Josh

2016-02-25

To evaluate online case simulation vs a paper case on student confidence and engagement. Students enrolled in a pharmacotherapy laboratory course completed a patient case scenario as a component of an osteoarthritis laboratory module. Two laboratory sections used a paper case (n=53); three sections used an online virtual case simulation (n=81). Student module performance was assessed through a submitted subjective objective assessment plan (SOAP) note. Students completed pre/post surveys to measure self-perceived confidence in providing medication management. The simulation group completed postmodule questions related to realism and engagement of the online virtual case simulation. Group assessments were performed using chi-square and Mann Whitney tests. A significant increase in all 13 confidence items was seen in both student groups following completion of the laboratory module. The simulation group had an increased change of confidence compared to the paper group in assessing medication efficacy and documenting a thorough assessment. Comparing the online virtual simulation to a paper case, students agreed the learning experience increased interest, enjoyment, relevance, and realism. The simulation group performed better on the subjective SOAP note domain though no differences in total SOAP note scores was found between the two groups. Virtual case simulations result in increased student engagement and may lead to improved documentation performance in the subjective domain of SOAP notes. However, virtual patient cases may offer limited benefit over paper cases in improving overall student self-confidence to provide medication management.

A Quantitative Analysis of Virginia Public School Special Education Due Process Cases and Their Resolutions from 2004-2016

ERIC Educational Resources Information Center

Beaudoin-Saunders, Valerie Ann

2017-01-01

Special education-related lawsuits are a concern to school systems. They are time-consuming, expensive, and contentious. School and parental relationships become strained when litigation is involved. This study analyzed data from the Virginia Department of Education's due process database over a 12-year period of time to note common disabilities…

Long-Term Outcome from a Medium Secure Service for People with Intellectual Disability

ERIC Educational Resources Information Center

Alexander, R. T.; Crouch, K.; Halstead, S.; Piachaud, J.

2006-01-01

Background: The purpose of this paper is to describe long-term outcomes for patients discharged over a 12-year period from a medium secure service for people with intellectual disabilities (ID). Methods: A cohort study using case-notes analysis and a structured interview of current key informants. Results: Eleven per cent of the sample was…

Translating Strategy, Values and Identities in Higher Education: The Case of Multi-Campus Systems

ERIC Educational Resources Information Center

Pinheiro, Rómulo; Charles, David; Jones, Glen

2017-01-01

Multi-campus university systems are not a new phenomenon. In their foundational analysis of multi-campus universities in the United States published in 1971, Lee and Bowen noted that almost 40% of American students were enroled in institutions that were part of multi-campus systems. The role of these complex multi-campus systems has continued to…

76 FR 18145 - Privacy Act of 1974; New System of Records

Federal Register 2010, 2011, 2012, 2013, 2014

2011-04-01

... to include final determinations; billing information to include payment delinquencies; case notes... delinquencies; and case notes. Information collected includes the individual's name, address, telephone number... outside USDA, and so have some impact on privacy of individuals, they are either necessary for carrying...

Notes on Accuracy of Finite-Volume Discretization Schemes on Irregular Grids

NASA Technical Reports Server (NTRS)

Diskin, Boris; Thomas, James L.

2011-01-01

Truncation-error analysis is a reliable tool in predicting convergence rates of discretization errors on regular smooth grids. However, it is often misleading in application to finite-volume discretization schemes on irregular (e.g., unstructured) grids. Convergence of truncation errors severely degrades on general irregular grids; a design-order convergence can be achieved only on grids with a certain degree of geometric regularity. Such degradation of truncation-error convergence does not necessarily imply a lower-order convergence of discretization errors. In these notes, irregular-grid computations demonstrate that the design-order discretization-error convergence can be achieved even when truncation errors exhibit a lower-order convergence or, in some cases, do not converge at all.

Analysis of patient diaries in Danish ICUs: a narrative approach.

PubMed

Egerod, Ingrid; Christensen, Doris

2009-10-01

The objective was to describe the structure and content of patient diaries written for critically ill patients in Danish intensive care units (ICUs). Critical illness is associated with physical and psychological aftermath including cognitive impairment and post-traumatic stress. Patient diaries written in the intensive care unit are used to help ICU-survivors come to terms with their illness. The study had a qualitative, descriptive and explorative design, using a narrative approach of analysis. Data were analysed on several levels: extra-case level, case level, diary-entry level, and sub-entry level. The sample consisted of 25 patient diaries written by critical care nurses in 2007 for patients at a general ICU in Denmark. The base narrative describes three stages: crisis, turning point, and normalisation. Each case includes parallel plots of nurse, patient and family, which converge during normalisation. Each diary is structured by: summary, daily entries and end note. Each diary entry is structured by: greeting, narrator status, patient status, family status/contextual cues and sign-off note. Patient diaries acknowledge the patient experience and provide new insights into nursing performance. This study offers a framework for understanding ICU patient diaries, which may facilitate cross-unit comparisons and support future guideline development. The dual perspectives of patient diaries and the ambiguous ownership of the narratives may pave the way for insights to improve critical care nursing and ICU rehabilitation.

Integrated multidisciplinary analysis of segmented reflector telescopes

NASA Technical Reports Server (NTRS)

Briggs, Hugh C.; Needels, Laura

1992-01-01

The present multidisciplinary telescope-analysis approach, which encompasses thermal, structural, control and optical considerations, is illustrated for the case of an IR telescope in LEO; attention is given to end-to-end evaluations of the effects of mechanical disturbances and thermal gradients in measures of optical performance. Both geometric ray-tracing and surface-to-surface diffraction approximations are used in the telescope's optical model. Also noted is the role played by NASA-JPL's Integrated Modeling of Advanced Optical Systems computation tool, in view of numerical samples.

Analysis of Steady, Two-Dimensional Chemically Reacting Nonequilibrium Flow by an Unsteady, Asymptotically Consistent Technique. Volume I. Theoretical Development.

DTIC Science & Technology

1982-09-01

wall, and exit points are know,, collectively as boundary points. In the following discussion, thi numerical treatment used for each type of mesh point...and fiozen solutions and that it matches the ODK solution 6 [Reference (10)] quite well. Also note that in this case, there is only a small departure...shows the results of the H-F system analysis. The mass-averaged temperature profile falls between the equilibrium and frozen solutions and matches the ODK

The LARSYS educational package: Instructor's notes. [instructional materials for training people to analyze remotely sensed data

NASA Technical Reports Server (NTRS)

Lindenlaub, J. C.; Davis, S. M.

1974-01-01

Materials are presented for assisting instructors in teaching the LARSYS Educational Package, which is a set of instructional materials to train people to analyze remotely sensed multispectral data. The seven units of the package are described. These units are: quantitative remote sensing, overview of the LARSYS software system, the 2780 remote terminal, demonstration of LARSYS on the 2780 remote terminal, exercises, guide to multispectral data analysis, and a case study using LARSYS for analysis of LANDSAT data.

Assessment of Reliable Change Using 95% Credible Intervals for the Differences in Proportions: A Statistical Analysis for Case-Study Methodology.

PubMed

Unicomb, Rachael; Colyvas, Kim; Harrison, Elisabeth; Hewat, Sally

2015-06-01

Case-study methodology studying change is often used in the field of speech-language pathology, but it can be criticized for not being statistically robust. Yet with the heterogeneous nature of many communication disorders, case studies allow clinicians and researchers to closely observe and report on change. Such information is valuable and can further inform large-scale experimental designs. In this research note, a statistical analysis for case-study data is outlined that employs a modification to the Reliable Change Index (Jacobson & Truax, 1991). The relationship between reliable change and clinical significance is discussed. Example data are used to guide the reader through the use and application of this analysis. A method of analysis is detailed that is suitable for assessing change in measures with binary categorical outcomes. The analysis is illustrated using data from one individual, measured before and after treatment for stuttering. The application of this approach to assess change in categorical, binary data has potential application in speech-language pathology. It enables clinicians and researchers to analyze results from case studies for their statistical and clinical significance. This new method addresses a gap in the research design literature, that is, the lack of analysis methods for noncontinuous data (such as counts, rates, proportions of events) that may be used in case-study designs.

Adjunctive antipsychotic in the treatment of body dysmorphic disorder - A retrospective naturalistic case note study.

PubMed

Rashid, Haroon; Khan, Akif A; Fineberg, Naomi A

2015-06-01

A retrospective naturalistic case note study to determine the frequency, co-morbidity and treatment-response of body dysmorphic disorder (BDD). Records from 280 patients attending a highly specialised obsessive-compulsive disorder (OCD)/BDD service were analysed. The clinical outcome was measured either through scoring of the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) for OCD/BDD, or textual analysis of case notes for evidence of symptomatic improvement, treatment tolerability, and premature disengagement. A total of 32 patients (11.43%) were diagnosed with BDD. Of these, 28 (87.5%) had at least one co-morbidity. All patients were offered cognitive behavioural therapy (CBT) and selective serotonin reuptake inhibitor (SSRI). Adjunctive low-dose antipsychotic was prescribed for 21 (66%) patients. Overall, 18/32 (56%) responded, and 7/32 (22%) disengaged prematurely. Patients offered antipsychotic, SSRI and CBT (n = 21) were compared with those offered SSRI and CBT only (n = 11). The treatment was well-tolerated. Whereas there was no significant inter-group difference in the clinical response rate, premature disengagement occurred less frequently in the antipsychotic-treated patients (9.5% versus 45%; Fisher's Exact Test P = 0.0318). BDD frequently presents with co-morbidity, treatment-resistance and premature disengagement. Adjunctive antipsychotic was associated with significantly better treatment adherence, but responder rates did not differ significantly, possibly related to the small sample-size. A well-powered randomised controlled study is warranted, to determine clinical outcomes with adjunctive antipsychotic in BDD.

Systematic review of discharge coding accuracy

PubMed Central

Burns, E.M.; Rigby, E.; Mamidanna, R.; Bottle, A.; Aylin, P.; Ziprin, P.; Faiz, O.D.

2012-01-01

Introduction Routinely collected data sets are increasingly used for research, financial reimbursement and health service planning. High quality data are necessary for reliable analysis. This study aims to assess the published accuracy of routinely collected data sets in Great Britain. Methods Systematic searches of the EMBASE, PUBMED, OVID and Cochrane databases were performed from 1989 to present using defined search terms. Included studies were those that compared routinely collected data sets with case or operative note review and those that compared routinely collected data with clinical registries. Results Thirty-two studies were included. Twenty-five studies compared routinely collected data with case or operation notes. Seven studies compared routinely collected data with clinical registries. The overall median accuracy (routinely collected data sets versus case notes) was 83.2% (IQR: 67.3–92.1%). The median diagnostic accuracy was 80.3% (IQR: 63.3–94.1%) with a median procedure accuracy of 84.2% (IQR: 68.7–88.7%). There was considerable variation in accuracy rates between studies (50.5–97.8%). Since the 2002 introduction of Payment by Results, accuracy has improved in some respects, for example primary diagnoses accuracy has improved from 73.8% (IQR: 59.3–92.1%) to 96.0% (IQR: 89.3–96.3), P= 0.020. Conclusion Accuracy rates are improving. Current levels of reported accuracy suggest that routinely collected data are sufficiently robust to support their use for research and managerial decision-making. PMID:21795302

MANAGEMENT OF ENDOMETRIOSIS IN TWO CAPTIVE MANDRILLS (MANDRILLUS SPHINX).

PubMed

Okeson, Danelle M; Higbie, Christine T; Mylniczenko, Natalie D; Haynes, April; Bennett, Suzanne; Klocke, Emily; Carpenter, James W

2016-06-01

Endometriosis has been reported in humans, great apes, and Old World monkeys. Although cases are noted anecdotally in Mandrillus spp., and a previously reported case was noted on postmortem examination, to the authors' knowledge, no previous reports of case management have been published in the peer-reviewed literature. This paper describes the medical and surgical management of endometriosis in two mandrills (Mandrillus sphinx).

[Tuberculous pneumothorax: Diagnosis and treatment].

PubMed

Ben Saad, S; Melki, B; Douik El Gharbi, L; Soraya, F; Chaouch, N; Aouina, H; Cherif, J; Hamzaoui, A; Merghli, A; Daghfous, H; Tritar, F

2018-04-01

Pneumothorax is a serious complication of cavitary pulmonary tuberculosis. The aim of this study was to describe clinical futures, to highlight challenges of its management. A retrospective multicentric and descriptive study including 65 patients treated for PT (1999-2015) was conducted to figure out clinical futures and its work-up. The mean age was 37.8 years. The sex ratio was 3.6. Smoking history and incarceration were noted respectively in 67.6 and 15.3% of cases. Acute respiratory failure and cachexia were reported in 26.1 and 10.7% of cases. The PT was inaugural in 41.5% of cases. Pyo-pneumothorax was noted in 69.2% of cases. The duration of antituberculous treatment ranged from 6 to 15 months for susceptible TB and was at least 12 months for resistant TB (4 cases). Thoracic drainage was performed in 90.7% patients. Its average length was 47 days. The drain drop was noted in 20% of cases. Bronchopleural fistula was diagnosed in 6 cases and pleural infection in 5 of cases. Surgery treatment was necessary in 6 cases. Mean time to surgery was 171 days. Six patients had pleural decortication associated with pulmonary resection in 4 cases. Persistent chronic PT was noted in 12.6% and chronic respiratory failure in 3% of cases and death in 15.3% of cases. The diagnosis of the PT is often easy. Its treatment encounters multiples difficulties. Duration of thoracic drainage and anti-TB treatment are usually long. Surgery is proposed lately. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

Histological analysis of soft and hard tissues in a periimplantitis lesion: a human case report.

PubMed

Jung, Soong-Ryong; Bashutski, Jill D; Jandali, Rami; Prasad, Hari; Rohrer, Michael; Wang, Hom-Lay

2012-06-01

Little is known regarding the histologic hard and soft tissue changes that occur in chronic periimplantitis situations in humans. It is critical to gain an understanding of all aspects of periimplantitis to develop appropriate therapeutic approaches. An 83-year-old African American man presented with a fractured implant affected by severe, chronic periimplantitis and surrounded by keratinized gingiva. A trephine biopsy of the implant and surrounding tissues was analyzed histologically. Histological analysis of the periimplantitis specimen revealed significant inflammatory infiltrate consisting predominantly of lymphocytes and plasma cells. In addition, epithelial migration and bone loss to the apical vent were noted. This case report documents a single case of periimplantitis that was left untreated for 7 years. The presence of significant keratinized tissue and a smooth surface implant failed to prevent fibrous encapsulation of the implant.

Anthropometric Indices in Children With Refractory Epilepsy.

PubMed

Aminzadeh, Vahid; Dalili, Setila; Ashoorian, Yalda; Kohmanaee, Shahin; Hassanzadeh Rad, Afagh

2016-01-01

We aimed to assess the effect of body mass index (BMI) on reducing the risk of refractory seizure due to lipoid tissue factors. This matched case-control study, consisted of cases (Patients with refractory epilepsy) and controls (Healthy children) referred to 17 Shahrivar Hospital, Guilan University of Medical Sciences, Guilan, Iran during 2013-2014. Data were gathered by a form including demographic characteristics, type of epilepsy, predominant time of epilepsy, therapeutic approach, frequency of epilepsy, time of disease onset and anthropometric indices. We measured anthropometric indices and transformed them into Z-scores. Data were reported by descriptive statistics (mean and standard deviation) and analyzed by Pearson correlation coefficient, paired t test and multinomial regression analysis test using SPSS 19. There was no significant difference between sex groups regarding anthropometric indices. Generalized and focal types of epilepsies were noted on 57.5% and 38.75% of patients, respectively. Daytime epilepsies happened in 46.25% of patients and 33.75% noted no predominant time for epilepsies. Clinicians indicated poly-therapy for the majority of patients (92.5%). The most common onset times for epilepsies were 36-72 months for 32.5% of patients. Lower onset time indicated lower frequency of refractory epilepsies. Although, there was significant difference between Zheight and predominant time of epilepsies but no significant relation was found between types of epilepsies and frequency of epilepsies with anthropometric indices. Using multivariate regression analysis by backward LR, Zweight and birth weight were noted as the predicting factors of refractory epilepsies. This effect may be because of leptin. Therefore, researchers recommend further investigations regarding this issue in children with epilepsy.

A Comparison of Suicide Note Writers with Suicides Who Did Not Leave Notes

ERIC Educational Resources Information Center

Callanan, Valerie J.; Davis, Mark S.

2009-01-01

There is disagreement in the suicide literature on the value of suicide notes as a data source, particularly regarding the extent to which suicide decedents who write notes differ from those who do not. Using 10 years of suicide cases from Summit County, Ohio, these two groups were compared on 40 variables including sociodemographic…

An investigation into the relationship between vigabatrin, movement disorders, and brain magnetic resonance imaging abnormalities in children with infantile spasms.

PubMed

Fong, Choong Yi; Osborne, John P; Edwards, Stuart W; Hemingway, Cheryl; Hancock, Eleanor; Johnson, Anthony L; Kennedy, Colin R; Kneen, Rachel; Likeman, Marcus; Lux, Andrew L; Mordekar, Santosh R; Murugan, Velayutham; Newton, Richard W; Pike, Michael; Quinn, Michael; Spinty, Stefan; Vassallo, Grace; Verity, Christopher M; Whitney, Andrea; O'Callaghan, Finbar J K

2013-09-01

We aimed to investigate the relationship between movement disorders, changes on brain magnetic resonance imaging (MRI), and vigabatrin therapy in children with infantile spasms. Retrospective review and brain MRI analysis of children enrolled in the International Collaborative Infantile Spasms Study (ICISS) who developed a movement disorder on vigabatrin therapy. Comparisons were made with controls within ICISS who had no movement disorder. Ten of 124 infants had a movement disorder and in eight it had developed on vigabatrin therapy. Two had a movement disorder that resolved on dose-reduction of vigabatrin, one had improvement on withdrawing vigabatrin, two had resolution without any dose change, and in three it persisted despite vigabatrin withdrawal. The typical brain MRI changes associated with vigabatrin therapy were noted in two infants. Ten control infants were identified. Typical MRI changes noted with vigabatrin were noted in three controls. It is possible that in two out of eight cases, vigabatrin was associated with the development of a movement disorder. In six out of eight cases a causal relationship was less plausible. The majority of infants treated with vigabatrin did not develop a movement disorder. MRI changes associated with vigabatrin do not appear to be specifically related to the movement disorder. © 2013 Mac Keith Press.

An assessment of scientific and technical aspects of closed investigations of canine forensics DNA – case series from the University of California, Davis, USA

PubMed Central

Scharnhorst, Günther; Kanthaswamy, Sree

2011-01-01

Aim To describe and assess the scientific and technical aspects of animal forensic testing at the University of California, Davis. The findings and recommendations contained in this report are designed to assess the past, evaluate the present, and recommend reforms that will assist the animal forensic science community in providing the best possible services that comply with court standards and bear judicial scrutiny. Methods A batch of 32 closed files of domestic dog DNA cases processed at the University of California, Davis, between August 2003 and July 2005 were reviewed in this study. The case files comprised copies of all original paperwork, copies of the cover letter or final report, laboratory notes, notes on analyses, submission forms, internal chains of custody, printed images and photocopies of evidence, as well as the administrative and technical reviews of those cases. Results While the fundamental aspects of animal DNA testing may be reliable and acceptable, the scientific basis for forensic testing animal DNA needs to be improved substantially. In addition to a lack of standardized and validated genetic testing protocols, improvements are needed in a wide range of topics including quality assurance and quality control measures, sample handling, evidence testing, statistical analysis, and reporting. Conclusion This review implies that although a standardized panel of short tandem repeat and mitochondrial DNA markers and publicly accessible genetic databases for canine forensic DNA analysis are already available, the persistent lack of supporting resources, including standardized quality assurance and quality control programs, still plagues the animal forensic community. This report focuses on closed cases from the period 2003-2005, but extends its scope more widely to include other animal DNA forensic testing services. PMID:21674824

An assessment of scientific and technical aspects of closed investigations of canine forensics DNA--case series from the University of California, Davis, USA.

PubMed

Scharnhorst, Günther; Kanthaswamy, Sree

2011-06-01

To describe and assess the scientific and technical aspects of animal forensic testing at the University of California, Davis. The findings and recommendations contained in this report are designed to assess the past, evaluate the present, and recommend reforms that will assist the animal forensic science community in providing the best possible services that comply with court standards and bear judicial scrutiny. A batch of 32 closed files of domestic dog DNA cases processed at the University of California, Davis, between August 2003 and July 2005 were reviewed in this study. The case files comprised copies of all original paperwork, copies of the cover letter or final report, laboratory notes, notes on analyses, submission forms, internal chains of custody, printed images and photocopies of evidence, as well as the administrative and technical reviews of those cases. While the fundamental aspects of animal DNA testing may be reliable and acceptable, the scientific basis for forensic testing animal DNA needs to be improved substantially. In addition to a lack of standardized and validated genetic testing protocols, improvements are needed in a wide range of topics including quality assurance and quality control measures, sample handling, evidence testing, statistical analysis, and reporting. This review implies that although a standardized panel of short tandem repeat and mitochondrial DNA markers and publicly accessible genetic databases for canine forensic DNA analysis are already available, the persistent lack of supporting resources, including standardized quality assurance and quality control programs, still plagues the animal forensic community. This report focuses on closed cases from the period 2003-2005, but extends its scope more widely to include other animal DNA forensic testing services.

Teaching Notes to Casebook I: Faculty Employment Policies [and] Casebook I: Faculty Employment Policies. Using Cases in Higher Education. The Jossey-Bass Higher and Adult Education Series.

ERIC Educational Resources Information Center

Honan, James P., Ed.; Rule, Cheryl Sternman, Ed.

"Casebook I: Faculty Employment Policies" presents six cases developed by the Project on Faculty Appointments at the Harvard Graduate School of Education. "Teaching Notes to Casebook I" provides detailed suggestions and strategies for leading an effective classroom or workshop discussion about each of the casebook's six case studies, all of which…

I Have Something to Tell You: A Child with a Cochlear Implant's Struggles and Determination to Engage with Peers in an Inclusive Preschool Classroom

ERIC Educational Resources Information Center

Lindeman, Karen Wise

2012-01-01

This study investigated how a child with early cochlear implantation interacted with peers in his inclusive preschool setting. A qualitative case-study framed in a socio-linguistic framework guided the data collection and analysis. Data collection included detailed field notes, classroom free play observations, informal student interviews, teacher…

Requirements Analysis for Effective Management Information Systems Design: A Framework and Case Study.

DTIC Science & Technology

1981-12-01

68 1. Product Policy ---------------------------- 68 2. Price Policy ------------------------------ 69 3. Policy toward Rivals...compete with its rivals; the aim of these policies is to achieve product differentiation; b) Pricing Policies - price structures that are generally...actions which a firm takes to minimize both its actual and potential competition. It should be noted that product and pricing policies are greatly

A Business Case Analysis for the Vulture Program

DTIC Science & Technology

2010-12-01

HARNESSING SOLAR POWER FOR UNMANNED AERIAL VEHICLES Marty Curry noted in a NASA Dryden Fact Sheet, “The first flight of a solar- powered aircraft...wavelength of light absorbed. In order to produce enough power to be 20 Marty Curry , “Solar Power...40 Lim, “Global Observer,” 37. 41 Marty Curry , “Global Hawk – Performance & Specifications,” NASA Dryden Fact Sheet, 7

Gender Ratio in a Clinical Population Sample, Age of Diagnosis and Duration of Assessment in Children and Adults with Autism Spectrum Disorder

ERIC Educational Resources Information Center

Rutherford, Marion; McKenzie, Karen; Johnson, Tess; Catchpole, Ciara; O'Hare, Anne; McClure, Iain; Forsyth, Kirsty; McCartney, Deborah; Murray, Aja

2016-01-01

This article reports on gender ratio, age of diagnosis and the duration of assessment procedures in autism spectrum disorder diagnosis in a national study which included all types of clinical services for children and adults. Findings are reported from a retrospective case note analysis undertaken with a representative sample of 150 Scottish…

A guide to writing case reports for the Journal of Medical Case Reports and BioMed Central Research Notes

PubMed Central

2013-01-01

Case reports are a time-honored, important, integral, and accepted part of the medical literature. Both the Journal of Medical Case Reports and the Case Report section of BioMed Central Research Notes are committed to case report publication, and each have different criteria. Journal of Medical Case Reports was the world’s first international, PubMed-listed medical journal devoted to publishing case reports from all clinical disciplines and was launched in 2007. The Case Report section of BioMed Central Research Notes was created and began publishing case reports in 2012. Between the two of them, thousands of peer-reviewed case reports have now been published with a worldwide audience. Authors now also have Cases Database, a continually updated, freely accessible database of thousands of medical case reports from multiple publishers. This informal editorial outlines the process and mechanics of how and when to write a case report, and provides a brief look into the editorial process behind each of these complementary journals along with the author’s anecdotes in the hope of inspiring all authors (both novice and experienced) to write and continue writing case reports of all specialties. Useful hyperlinks are embedded throughout for easy and quick reference to style guidelines for both journals. PMID:24283456

Histomorphological Spectrum of Duodenal Pathology in Functional Dyspepsia Patients

PubMed Central

Rane, Sharada Raju; Jadhav, Meenal Vitthal

2017-01-01

Introduction Functional Dyspepsia (FD) is one of the most common causes of gastrointestinal symptoms aetiology of which is poorly understood. Aim To study duodenal histomorphological features and their relationship with Helicobacter pylori (H Pylori) infection in patients of FD. Materials and Methods This case control study included 50 cases of FD patients selected according to Rome III criteria and 30 age and sex matched controls. These were subjected to oesophago-gastro-duodenoscopy, rapid urease test for detection of H. pylori on gastric antral biopsy and duodenal biopsy from second part of duodenum for histopathological evaluation by light microscopy. Ten antral urease positive cases of FD with highest Intraepithelial Lymphocyte Count (IEL) were subjected to Immunohistochemistry (IHC). Results Duodenal inflammation was an invariable feature noted in FD. Morphological spectrum consisted of increased IEL in 72%, increased duodenal eosinophils in 92%, presence of focal villous atrophy in 16%, lymphoid aggregates, colonic metaplasia, and duodenal H. pylori infection in 4% each. Gastric H. pylori positivity was noted in 48% cases of FD. Increased duodenal IEL count and duodenal eosinophilia was noted in 75%, 87.5% such cases. Same was noted respectively, with 61.5% and 95.15% cases with gastric H. pylori negativity. In cases of FD, duodenal IEL and eosinophil count in lamina propria showed statistically significant rise when compared with control and had positive correlation with gastric H pylori infection. On IHC, increased expression of CD 8 was noted in duodenal IEL and lymphocytes in lamina propria as compared to CD4. Conclusion Our study provided some insight in pathogenesis of FD and role of H. pylori in its aetiology. PMID:28764169

Pure retroperitoneal natural orifice translumenal endoscopic surgery (NOTES) transvaginal nephrectomy using standard laparoscopic instruments: a safety and feasibility study in a porcine model.

PubMed

Wei, Dechao; Han, Yili; Li, Mingchuan; Wang, Yongxing; Chen, Yatong; Luo, Yong; Jiang, Yongguang

2016-06-11

Among the different organs used for NOTES (natural orifice translumenal endoscopic surgery) technique, the transvaginal approach may be the optimal choice because of a simple and secure closure of colpotomy site. Pure and hybrid NOTES transvaginal operations were routinely performed via transperitoneal access. In this study, we investigate the safety and feasibility of pure retroperitoneal natural orifice translumenal endoscopic surgery (NOTES) transvaginal nephrectomy using conventional laparoscopic techniques in a porcine model. Six female pigs, weighing an average of 30 kg, were used in this study. Under general anesthesia, pure retroperitoneal NOTES transvaginal nephrectomy was conducted using standard laparoscopic instruments. Posterolateral colpotomy was performed, and the incision was enlarged laterally using blunt dissection and pneumatic dilation. A single-port device was inserted to construct the operative channel. The retroperitoneal space was created using sharp and blunt dissection under endoscopic guidance up to the level of the kidney. Dissection and removal of the kidney were performed according to standard surgical procedure, and the colpotomy site was closed using interrupted sutures. The survival and complications were observed 1 week postoperatively. Our results showed that two cases failed because of peritoneal rupture. One case was successful, but required the assistance of an extra 5 mm laparoscopic trocar inserted in the flank. Three cases of pure retroperitoneal NOTES transvaginal nephrectomy were completed, and survived 1 week after the operation. In these three cases, no intra- or postoperative complications were observed. All findings confirmed the safety and feasibility of the retroperitoneal pure retroperitoneal NOTES transvaginal nephrectomy using standard laparoscopic instruments, which suggested the possibility of clinical application in human beings in the future.

The cytologic features of NUT midline carcinoma.

PubMed

Bellizzi, Andrew M; Bruzzi, Cynthia; French, Christopher A; Stelow, Edward B

2009-12-25

Nuclear protein in testis (NUT) midline carcinoma (NMC) represents an aggressive, high-grade carcinoma typically involving the upper aerodigestive tract or mediastinum. Although the tumor was originally noted in young persons, we have subsequently identified 5 adult cases. To our knowledge, the cytology of NMC has not been systematically described. We recently published a series of NMCs identified by fluorescent in situ hybridization for characteristic NUT rearrangement. Three of these patients had undergone fine-needle aspiration. Patient age, sex, primary tumor location, and aspiration site were noted. Cases were assessed for the following: cellularity, architecture, cytoplasm, cell size, nuclear contours, nucleoli, chromatin, anisonucleosis/cytosis, mitotic activity, background, and nuclear crush. The 3 cases occurred in 2 women and 1 man, ages 31-79 years. Primaries involved the sinonasal tract (2) and larynx. Aspirates were of right neck masses (2) and supraclavicular lymph node. Smears were highly cellular and generally noncohesive. Cytoplasm was scant/delicate, although occasional cells with denser cytoplasm were noted in 1 case. Cells were 2-3 times the diameter of a small lymphocyte with irregular nuclear contours, discrete nucleoli, and fine/granular to vesicular chromatin. Anisonucleosis/cytosis was slight to moderate. Mitotic figures were noted in each case. The background contained naked nuclei and karyorrhectic debris; nuclear crush was noted. NMCs exhibit cytologic features of a poorly differentiated or undifferentiated carcinoma. Although reports mention squamous differentiation as a histologic feature, it is typically focal, and overt squamous differentiation was not identified in our cases. Given morphologic overlap with other high-grade carcinomas, diagnosis requires a high index of suspicion. (c) 2009 American Cancer Society.

Giving women their own case notes to carry during pregnancy.

PubMed

Brown, Heather C; Smith, Helen J; Mori, Rintaro; Noma, Hisashi

2015-10-14

In many countries women are given their own case notes to carry during pregnancy to increase their sense of control over, and satisfaction with, their care. To evaluate the effects of giving women their own case notes to carry during pregnancy. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 August 2015) and reference lists of retrieved studies. Randomised controlled trials of women given their own case notes to carry during pregnancy. Two review authors independently applied the inclusion criteria and assessed study quality. One review author extracted data from the included studies using a standard form (checked by second review author). We assessed estimates of effect using risk ratio (RR) with 95% confidence intervals (CI). The quality of the evidence was assessed using the GRADE approach. Four trials were included (n = 1176 women). Overall, the quality of the evidence was graded as low to moderate mainly due to the nature of the intervention not allowing blinding. The updated search identified one cluster-randomised trial, which was included.Women carrying their own notes were more likely to feel in control (two trials, RR 1.56, 95% CI 1.18 to 2.06; 450 women; moderate quality evidence), although there is no evidence of difference in women's satisfaction (two trials, average RR 1.09, 95% CI 0.92 to 1.29); 698 women; low quality evidence). More women in the case notes group wanted to carry their own notes in a subsequent pregnancy (three trials, RR 1.79, 95% CI 1.57 to 2.03; 552 women; low quality evidence). Overall, the pooled estimate of the two trials (n = 347) that reported on the risk of notes lost or left at home was not significant (average RR 0.38, 95% CI 0.04 to 3.84). There was no evidence of difference for health-related behaviours (cigarette smoking and breastfeeding (moderate quality evidence)), analgesia needs during labour (low quality evidence), maternal depression, miscarriage, stillbirth and neonatal deaths (moderate quality evidence). More women in the case notes group had operative deliveries (one trial, RR 1.83, 95% CI 1.08 to 3.12; 212 women), and caesarean sections (one trial, average RR 1.51, 95% CI 1.10 to 2.08; 501 women; moderate quality evidence). The four trials are small, and not all of them reported on all outcomes. The results suggest that there are both potential benefits (increased maternal control and increased availability of antenatal records during hospital attendance) and harms (more operative deliveries). Importantly, all of the trials report that more women in the case notes group would prefer to carry their antenatal records in another pregnancy. There is insufficient evidence on health-related behaviours (smoking and breastfeeding), women's satisfaction, and clinical outcomes. It is important to emphasise that this review shows a lack of evidence of benefit rather than evidence of no benefit.

Prenatal irradiation, possible etiological factor in epilepsy (in French)

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

Geets, W.

1972-01-01

Twenty four cases of epilepsy in a group of 28 children aged 1 month to 16 yrs, in whom antecedents were negative except that - the mother had undergone an abdominal radiography during pregnancy were observed. In seven cases a mild mental retardation was noted. Generalized seizures were first observed between the age of 1 month and 4.5 yrs, focal attacks between the age of 7 and 12.5 yrs. EEG recordings at rest show discharges of generalized or focal slow waves in eight cases and a reduced acceleration of the cerebral rhythm between 3 and 7 yrs, in seven cases.more » These clinical observations confirm some experimental data but a statistical analysis on a larger scale is necessary. (auth)« less

Polynomial elimination theory and non-linear stability analysis for the Euler equations

NASA Technical Reports Server (NTRS)

Kennon, S. R.; Dulikravich, G. S.; Jespersen, D. C.

1986-01-01

Numerical methods are presented that exploit the polynomial properties of discretizations of the Euler equations. It is noted that most finite difference or finite volume discretizations of the steady-state Euler equations produce a polynomial system of equations to be solved. These equations are solved using classical polynomial elimination theory, with some innovative modifications. This paper also presents some preliminary results of a new non-linear stability analysis technique. This technique is applicable to determining the stability of polynomial iterative schemes. Results are presented for applying the elimination technique to a one-dimensional test case. For this test case, the exact solution is computed in three iterations. The non-linear stability analysis is applied to determine the optimal time step for solving Burgers' equation using the MacCormack scheme. The estimated optimal time step is very close to the time step that arises from a linear stability analysis.

A case study of the sensitivity of forecast skill to data and data analysis techniques

NASA Technical Reports Server (NTRS)

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

1983-01-01

A series of experiments have been conducted to examine the sensitivity of forecast skill to various data and data analysis techniques for the 0000 GMT case of January 21, 1979. These include the individual components of the FGGE observing system, the temperatures obtained with different satellite retrieval methods, and the method of vertical interpolation between the mandatory pressure analysis levels and the model sigma levels. It is found that NESS TIROS-N infrared retrievals seriously degrade a rawinsonde-only analysis over land, resulting in a poorer forecast over North America. Less degradation in the 72-hr forecast skill at sea level and some improvement at 500 mb is noted, relative to the control with TIROS-N retrievals produced with a physical inversion method which utilizes a 6-hr forecast first guess. NESS VTPR oceanic retrievals lead to an improved forecast over North America when added to the control.

Composition dependent effects in gas chromatography. [used in chemical analysis system onboard unmanned roving vehicle on Mars

NASA Technical Reports Server (NTRS)

Lavoie, R. C.

1974-01-01

Fundamantal concepts are developed which are required to optimize a gas chromatograph-mass spectrometer chemical analysis system suitable for use on an unmanned roving vehicle for Mars exploration. Prior efforts have developed simulation models for the chromatograph which were compared with data obtained from a test facility. Representation of binary systems by superposition was shown to be a first-order approximation and in certain cases large discrepencies were noted. This subtask has as its objective generation of additional binary data and analysis of the observed nonlinear effects.

Four cases of vertebrobasilar insufficiency.

PubMed

Inui, H; Yoneyama, K; Kitaoku, Y; Nakane, M; Ohue, S; Yamanaka, T; Ueda, T; Fujita, N; Miyahara, H; Matsunaga, T

1998-01-01

Four cases of vertebrobasilar insufficiency are reported. Case 1 was a 38-year-old man who felt a sudden onset of dizziness when he turned his head to the back. An abnormal positional nystagmus was observed when he rotated his head to the left. A magnetic resonance angiogram (MRA) demonstrated total occlusion of the left vertebral artery (VA). Case 2 was a 31-year-old woman who had a total occlusion of her left VA as observed in the MRA. Case 3 was a 68-year-old man who noted dizziness. The systolic blood pressure change on his Schellong test was 28 mmHg. On his MRA, severe displacement of the basilar and the vertebral arteries was visible. Case 4 was a 76-year-old woman who noted a blackout-like sensation. Optokinetic nystagmus was noted with a hyponystagmus pattern, and an eye tracking test showed a saccadic pattern. On her MRA, the vertebrobasilar system was narrowed. The arterial architecture and any stenosis of the blood vessels could be detected non-invasively by MRA.

Gender trends in authorship in oral and maxillofacial surgery literature: A 30-year analysis.

PubMed

Nkenke, Emeka; Seemann, Rudolf; Vairaktaris, Elefterios; Schaller, Hans-Günter; Rohde, Maximilian; Stelzle, Florian; Knipfer, Christian

2015-07-01

The aim of the present study was to perform a bibliometric analysis of the gender distribution of first and senior authorships in important oral and maxillofacial journals over the 30-year period from 1980 to 2010. Articles published in three representative oral and maxillofacial surgery journals were selected. The years 1980, 1990, 2000, and 2010 were chosen as representative points in time for article selection. Original research, case reports, technical notes, and reviews were included in the analysis. Case reports and technical notes were pooled in one group. For each article, the gender of the first author as well as that of the senior author was determined, based on the inspection of their first name. The type of article was determined and the country of origin of the article was documented. A total 1412 articles were subjected to the data analysis. A significant increase in female authorship in oral and maxillofacial surgery could be identified over the chosen 30-year period. However, the number of publications by male authors was still significantly higher at all points of time, exceeding those of female authors by at least 3.8 fold in 2010. As there is a trend towards feminization of medicine and dentistry, the results of the present study may serve as the basis for further analysis of the current situation, and the identification of necessary actions to accelerate the closure of the gender gap in publishing in oral and maxillofacial surgery. Copyright © 2015 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

Approaches to ascertaining comorbidity information: validation of routine hospital episode data with clinician-based case note review.

PubMed

Soo, Martin; Robertson, Lynn M; Ali, Tariq; Clark, Laura E; Fluck, Nicholas; Johnston, Marjorie; Marks, Angharad; Prescott, Gordon J; Smith, William Cairns S; Black, Corri

2014-04-21

In clinical practice, research, and increasingly health surveillance, planning and costing, there is a need for high quality information to determine comorbidity information about patients. Electronic, routinely collected healthcare data is capturing increasing amounts of clinical information as part of routine care. The aim of this study was to assess the validity of routine hospital administrative data to determine comorbidity, as compared with clinician-based case note review, in a large cohort of patients with chronic kidney disease. A validation study using record linkage. Routine hospital administrative data were compared with clinician-based case note review comorbidity data in a cohort of 3219 patients with chronic kidney disease. To assess agreement, we calculated prevalence, kappa statistic, sensitivity, specificity, positive predictive value and negative predictive value. Subgroup analyses were also performed. Median age at index date was 76.3 years, 44% were male, 67% had stage 3 chronic kidney disease and 31% had at least three comorbidities. For most comorbidities, we found a higher prevalence recorded from case notes compared with administrative data. The best agreement was found for cerebrovascular disease (κ = 0.80) ischaemic heart disease (κ = 0.63) and diabetes (κ = 0.65). Hypertension, peripheral vascular disease and dementia showed only fair agreement (κ = 0.28, 0.39, 0.38 respectively) and smoking status was found to be poorly recorded in administrative data. The patterns of prevalence across subgroups were as expected and for most comorbidities, agreement between case note and administrative data was similar. Agreement was less, however, in older ages and for those with three or more comorbidities for some conditions. This study demonstrates that hospital administrative comorbidity data compared moderately well with case note review data for cerebrovascular disease, ischaemic heart disease and diabetes, however there was significant under-recording of some other comorbid conditions, and particularly common risk factors.

Analysis of 43 cases of Langerhans cell histiocytosis (LCH)-induced central diabetes insipidus registered in the JLSG-96 and JLSG-02 studies in Japan.

PubMed

Shioda, Yoko; Adachi, Souichi; Imashuku, Shinsaku; Kudo, Kazuko; Imamura, Toshihiko; Morimoto, Akira

2011-12-01

To determine the ability of recent systemic chemotherapy protocols to reduce the incidence of central diabetes insipidus (CDI) in Langerhans cell histiocytosis (LCH), 43 CDI cases that belonged to a cohort of 348 pediatric patients with multi-focal LCH who were treated with the JLSG-96/-02 protocols were analyzed. The overall incidence of CDI was 12.4%, but in 24 cases CDI was already present at the time LCH was diagnosed. Thus, CDI developed during or after systemic chemotherapy over a follow-up period of 5.0 (0.2-14.7) years in only 19 patients (5.9%), with 7.4% at 5-year cumulative risk by Kaplan-Meier analysis. In two cases, complete resolution of CDI was noted. Anterior pituitary hormone deficiency was detected in 13 cases, while CDI-associated neurodegenerative disease was observed in six cases. The JLSG-96/-02 protocol appears to effectively reduce the occurrence of CDI. However, novel therapeutic measures are required to reverse pre-existing CDI and to prevent CDI-associated neurological complications.

Necrotic and inflammatory changes in metal-on-metal resurfacing hip arthroplasties

PubMed Central

2009-01-01

Background Necrosis and inflammation in peri-implant soft tissues have been described in failed second-generation metal-on-metal (MoM) resurfacing hip arthroplasties and in the pseudotumors associated with these implants. The precise frequency and significance of these tissue changes is unknown. Method We analyzed morphological and immunophenotypic changes in the periprosthetic soft tissues and femoral heads of 52 revised MoM arthroplasties (fracture in 21, pseudotumor in 13, component loosening in 9, and other causes in 9 cases). Results Substantial necrosis was observed in the periprosthetic connective tissue in 28 of the cases, including all pseudotumors, and 5 cases of component loosening. A heavy, diffuse inflammatory cell infiltrate composed mainly of HLA-DR+/CD14+/CD68+ macrophages and CD3+ T cells was seen in 45 of the cases. Perivascular lymphoid aggregates composed of CD3+ cells and CD20+ B cells were noted in 27 of the cases, but they were not seen in all cases of component loosening or pseudotumors. Plasma cells were noted in 30 cases. Macrophage granulomas were noted in 6 cases of component loosening. In the bone marrow of the femoral head, a macrophage and T cell response was seen in 31 of the cases; lymphoid aggregates were noted in 19 of the cases and discrete granulomas in 1 case. Interpretation Our findings indicate that there is a spectrum of necrotic and inflammatory changes in response to the deposition of cobalt-chrome (Co-Cr) wear particles in periprosthetic tissues. Areas of extensive coagulative necrosis and a macrophage and T lymphocyte response occur in implant failure and pseudotumors, in which there is also granuloma formation. The pathogenesis of these changes is uncertain but it may involve both a cytotoxic response and a delayed hypersensitivity (type IV) response to Co-Cr particles. PMID:19995315

[Histopathological analysis of organs submitted by legal medicine experts in Baojii City: 358 forensic identification cases].

PubMed

Dong, Du-xuan; Shi, Ping-xia; Li, Yun-li; Tian, San-hu; Yang, Jia; Gao, Gang; Zheng, Yun; Jia, Le; Ju, Hong-ya; Sun, Lu-ying; Chen, Ni; Wang, Xiao-bao

2014-08-01

To analyze pathological characteristics of organs recovered during forensic autopsy submitted by legal medicine experts. From Baoji city, 358 cases of forensic autopsy specimens from a series of routine exams were collected. And histopathological diagnoses were reviewed. Majority of the 358 cases were young men. The major causes of death were trauma, sudden death and poisoning. The cause of death was determined with histology in 250 cases. No typical histological changes were noted in 101 cases. The tissue autolysis and decomposition were present in 7 cases. The major pathological diagnosis was cardiovascular disease, followed by diseases in respiratory, nervous, and digestive systems. Forensic autopsy with its professional characteristics, is different from regular autopsy. When diagnosing cause of death by histopathological examination, pathologists should collaborate with legal medicine experts to know the details of the cases, circumstances surrounding the death, and specific forensic pathological characteristics.

Analysis of Synthetic Aperture Radar data acquired over a variety of land cover

NASA Technical Reports Server (NTRS)

Wu, S. T.

1983-01-01

An analysis has been conducted of two-look-angle, multipolarization X-band SAR results. On the basis of the variety of land covers studied, the vertical-vertical polarization (VV) data is judged to contain the highest degree of contrast, while the horizontal-vertical (HV) polarization contained the least. VV polarization data is accordingly recommended for forest vegetation classification in those cases where only one data channel is available. The inclusion of horizontal-horizontal polarization data, however, is noted to be capable of delineating special surface features.

Model-free methods to study membrane environmental probes: a comparison of the spectral phasor and generalized polarization approaches

PubMed Central

Malacrida, Leonel; Gratton, Enrico; Jameson, David M

2016-01-01

In this note, we present a discussion of the advantages and scope of model-free analysis methods applied to the popular solvatochromic probe LAURDAN, which is widely used as an environmental probe to study dynamics and structure in membranes. In particular, we compare and contrast the generalized polarization approach with the spectral phasor approach. To illustrate our points we utilize several model membrane systems containing pure lipid phases and, in some cases, cholesterol or surfactants. We demonstrate that the spectral phasor method offers definitive advantages in the case of complex systems. PMID:27182438

Postmortem analysis of encapsulation around long-term ventricular endocardial pacing leads.

PubMed

Candinas, R; Duru, F; Schneider, J; Lüscher, T F; Stokes, K

1999-02-01

To analyze the site and thickness of encapsulation around ventricular endocardial pacing leads and the extent of tricuspid valve adhesion, from today's perspective, with implications for lead removal and sensor location. Gross cardiac postmortem analysis was performed in 11 cases (8 female and 3 male patients; mean age, 78+/-7 years). None of the patients had died because of pacemaker malfunction. The mean implant time was 61+/-60 months (range, 4 to 184). The observations ranged from encapsulation only at the tip of the pacing lead to complete encapsulation along the entire length of the pacing lead within the right ventricle. Substantial areas of adhesion at the tricuspid valve apparatus were noted in 7 of the 11 cases (64%). The firmly attached leads could be removed only by dissection, and in some cases, removal was possible only by damaging the associated structures. No specific optimal site for sensor placement could be identified along the ventricular portion of the pacing leads; however, the fibrotic response was relatively less prominent in the atrial chamber. Extensive encapsulation is present in most long-term pacemaker leads, which may complicate lead removal. The site and thickness of encapsulation seem to be highly variable. Tricuspid valve adhesion, which is usually underestimated, may be severe. In contrast to earlier reports, our study demonstrates that the extent of fibrotic encapsulation may not be related to the duration since lead implantation. Moreover, we noted no ideal encapsulation-free site for sensors on the ventricular portion of long-term pacing leads.

[Evaluation of nutritional Status in lung cancer using bio electrical impedance analysis and mini nutritional assessment].

PubMed

Daghfous, Hafaoua; El Ayeb, Wejdène; Alouane, Leila; Tritar, Fatma

2014-12-01

Malnutrition and cachexia were a frequent problem in lung cancer and increases the risks of morbidity and mortality in these patients. Bioelectrical impedance analysis (BIA) is easy, non-invasive and reproducible method that can be performed. Evaluate nutritional status in patients with primary lung cancer by Mini Nutritional Assessment (MNA), BIA and anthropometric values (weight, arm and calf circumferences) and correlate the nutritional parameters to severity of cancer and histopathology. The nutritional status of 73 cases of primary lung cancer was evaluated by anthropometric parameters, MNA test and impedencemetrie Results: According to body mass index (BMI), malnutrition, overweight and obesity were noted in 34,2%, 13,7% and 5,5%. According to BMI, free-fat mass index (FFMI) and fat mass index (FMI), the investigations occurred malnutrition and depletion of muscle in respectively 19,2% and 23,3% of cases. Fat depletion was noted in 21,9%. Overweight and obesity were detected in 6,8% and 5,5% of cases. Assessment by MNA, revealed that 28,7% of patients were already malnourished and 49,3% of patients were at risk of malnutrition. A significant correlation existed between the score of MNA and arm and calf circumferences, FFMI and FMI. FMI was significantly lower in group of patients with small lung carcinoma. Only FFMI allows early detection of malnutrition in cancer patients overestimated by measuring BMI and arm circumference was the better indicator of depletion of muscle.

Analysis of human papilloma virus in oral squamous cell carcinoma using p16: An immunohistochemical study

PubMed Central

Patil, S.; Rao, R. S.; Amrutha, N.; Sanketh, D. S.

2014-01-01

Aims: The aim of this study is to evaluate the expression of human papilloma virus (HPV) in oral squamous cell carcinoma (OSCC) and to correlate the association of HPV in histological grades of OSCC using p16 (p16INK4a) immunohistochemistry (IHC). Subjects and Methods: This study consists of 30 histological diagnosed cases of OSCC (10-well-differentiated oral squamous cell carcinoma [WDOSCC], 10-moderately differentiated oral squamous cell carcinoma [MDOSCC] and 10-poorly differentiated oral squamous cell carcinoma [PDOSCC]). The sections were subjected to IHC procedure using p16. Two parameters in immunohistochemical p16 expression were evaluated by 3 observers based on the criteria by Galgano M. Tetal (2010) (a) percentage of p16 positive cases (b) pattern of p16 staining in various grades of OSCC. Statistical Analysis Used: Kappa test. Results: Totally, 30 samples of 0SCC, p16 positivity was noted in 26/30 (86.66%). Of 26 positive cases, p16 staining was positive in 7/10 (70%) of WDOSCC, 9/10 (90%) in MDOSCC and, 10/10 (100%) PDOSCC. Incidentally, we also found single dispersed cell staining in WDOSCC, patchy staining in MDOSCC and more diffuse staining pattern predominant in PDOSCC. Conclusions: Our study revealed an association between HPV and OSCC. Diffuse staining pattern was noted in PDOSCC, which in turn depicts the increase viral overload, which might have an influence on its aggressive behavior. PMID:24818098

United Nations Operations: Who Should be in Charge?

DTIC Science & Technology

1994-04-01

interpretation would also appear to resolve Kelsen’s dilemma (see KELSEN , supra note 35, at 935) with respect to the Korean conflict. Kelsen argues the Security...and Scheffer, supra note 35, at 131. 45. See D. J. HARRIS, CASES AND MATERIAL ON INTERNATIONAL LAW 681 (4th ed. 1991); KELSEN , supra note 35, at 756...167 (July 20). 58. KELSEN , supra note 35, at 768. 59. SEYERSTED, supra note 46, at 156. 60. In opening the Security Council session of 31 December 1992

About the cumulants of periodic signals

NASA Astrophysics Data System (ADS)

Barrau, Axel; El Badaoui, Mohammed

2018-01-01

This note studies cumulants of time series. These functions originating from the probability theory being commonly used as features of deterministic signals, their classical properties are examined in this modified framework. We show additivity of cumulants, ensured in the case of independent random variables, requires here a different hypothesis. Practical applications are proposed, in particular an analysis of the failure of the JADE algorithm to separate some specific periodic signals.

From source material to news story in New Zealand print media: a prospective study of the stigmatizing processes in depicting mental illness.

PubMed

Nairn, R; Coverdale, J; Claasen, D

2001-10-01

The aim of this study was to analyse how newspaper articles that depict mental illnesses are generated from source materials. From a prospectively collected national sample of print materials involving mental illness, 50 published items that related to the Privacy Commissioner's opinion about disclosure of a psychiatric patient's health information were identified. A copy of the Privacy Commissioner's original Case Note and three news stories about the Case Note distributed by the New Zealand Press Association constituted the database. These materials were subjected to discourse analysis. We identified themes and their transformation from the Case Note through the news stories and examined the impact of these transformations on the stigmatization of mental illness. Four themes were identified: human rights, vulnerability, risk of dangerousness and threat, and mental illness/psychiatric patient. The only potentially positive theme, human rights, was limited both by being fragmented in the source material, and by being utilized, in the published news stories to undermine the legitimacy of the patient's right to privacy. Use of the other themes was consistent with stereotypes about mental illness. Although there were no inaccuracies in the content of the news stories they were substantially more negative than the source material in their depiction of the identified patient. A potentially positive discourse (human rights) was not by itself sufficient to ensure a positive portrayal of mental illness. An understanding of the transformations is important for efforts to effectively combat the stigmatization of those with mental illness.

Endovascular Treatment of Cerebral Aneurysms in Relation to Their Parent Artery Wall: A Single Center Study

PubMed Central

Mitsos, A.P.; Giannakopoulou, M.D.; Kaklamanos, I.G.; Kapritsou, M.; Konstantinou, M.I.; Fotis, T.; Mamoura, K.V.; Mariolis-Sapsakos, T.; Ntountas, I.T.; Konstantinou, E.A.

2013-01-01

We report our two-year experience in the endovascular treatment of brain aneurysms in relation to their parent artery wall. We prospectively recorded patients with intracranial aneurysms (107 ruptured - 38 unruptured) treated with coiling during a two-year period: 145 patients, 94 females and 51 males - mean age 56 years. The aneurysms were divided into side-wall (A) and bifurcation (B) groups. A total occlusion rate was noted in post-embolization angiograms in 101 aneurysms (70%) with a morbidity of 4%. No angiographic recurrence arose in the six-month follow-up. The two groups had a similar total occlusion rate (68.31% and 71.8% respectively), while the complication rate was 3% in group A and 4.7% in group B. Significant differences between the two groups were noted in the number of assisted coiling cases: 28 out of 60 cases (46.7%) in group A - 14 out of 85 cases (16.5%) in group B. Further statistical analysis showed strong dependencies for the type of endovascular procedure between the ruptured and unruptured aneurysms in both groups (p 0.000<0.05), but no dependencies between the aneurysm occlusion rate and the ruptured or non-ruptured aneurysms, or between the occlusion rate and the type of endovascular procedure (p 0.552 >0.05 and 0.071 >0.05 respectively). In conclusion, the anatomic relation of the aneurysm sac with the wall of the parent artery is important, as significant differences in endovascular practice, devices and techniques were noted between side-wall and bifurcation aneurysms. PMID:23859171

7 CFR 1786.205 - Application procedure.

Code of Federal Regulations, 2010 CFR

2010-01-01

... subpart should apply by letter to the appropriate RUS Regional Director or, in the case of power supply borrowers, to the Director of the Power Supply Division. The borrower will be required to submit... amount, outstanding balance, and date(s) of any substitute FFB note(s) amending the original FFB Note; (4...

A collective case study of nursing students with learning disabilities.

PubMed

Kolanko, Kathrine M

2003-01-01

This collective case study described the meaning of being a nursing student with a learning disability and examined how baccalaureate nursing students with learning disabilities experienced various aspects of the nursing program. It also examined how their disabilities and previous educational and personal experiences influenced the meaning that they gave to their educational experiences. Seven nursing students were interviewed, completed a demographic data form, and submitted various artifacts (test scores, evaluation reports, and curriculum-based material) for document analysis. The researcher used Stake's model for collective case study research and analysis (1). Data analysis revealed five themes: 1) struggle, 2) learning how to learn with LD, 3) issues concerning time, 4) social support, and 5) personal stories. Theme clusters and individual variations were identified for each theme. Document analysis revealed that participants had average to above average intellectual functioning with an ability-achievement discrepancy among standardized test scores. Participants noted that direct instruction, structure, consistency, clear directions, organization, and a positive instructor attitude assisted learning. Anxiety, social isolation from peers, and limited time to process and complete work were problems faced by the participants.

A Content Analysis of Online Suicide Notes: Attempted Suicide Versus Attempt Resulting in Suicide.

PubMed

Synnott, John; Ioannou, Maria; Coyne, Angela; Hemingway, Siobhan

2017-09-28

Fifty suicide notes of those who died by suicide and 50 suicide notes of those who survived their suicide attempt were analyzed using Smallest Space Analysis. The core of all suicide notes was discovered to be constructed with the use of four variables: saying goodbye to their audience, feelings of loneliness, method used to attempt suicide, and negative self-image. Furthermore, three different suicide note themes of those who died and three suicide note themes from those who survived were also identified. The analysis revealed that suicide note writers who died by their attempt were more likely to combine a dislike of themselves and a concern for loved ones. The implications of the work in terms of suicide prevention are discussed. © 2017 The American Association of Suicidology.

Computer templates in chronic disease management: ethnographic case study in general practice.

PubMed

Swinglehurst, Deborah; Greenhalgh, Trisha; Roberts, Celia

2012-01-01

To investigate how electronic templates shape, enable and constrain consultations about chronic diseases. Ethnographic case study, combining field notes, video-recording, screen capture with a microanalysis of talk, body language and data entry-an approach called linguistic ethnography. Two general practices in England. Ethnographic observation of administrative areas and 36 nurse-led consultations was done. Twenty-four consultations were directly observed and 12 consultations were video-recorded alongside computer screen capture. Consultations were transcribed using conversation analysis conventions, with notes on body language and the electronic record. The analysis involved repeated rounds of viewing video, annotating field notes, transcription and microanalysis to identify themes. The data was interpreted using discourse analysis, with attention to the sociotechnical theory. Consultations centred explicitly or implicitly on evidence-based protocols inscribed in templates. Templates did not simply identify tasks for completion, but contributed to defining what chronic diseases were, how care was being delivered and what it meant to be a patient or professional in this context. Patients' stories morphed into data bytes; the particular became generalised; the complex was made discrete, simple and manageable; and uncertainty became categorised and contained. Many consultations resembled bureaucratic encounters, primarily oriented to completing data fields. We identified a tension, sharpened by the template, between different framings of the patient-as 'individual' or as 'one of a population'. Some clinicians overcame this tension, responding creatively to prompts within a dialogue constructed around the patient's narrative. Despite their widespread implementation, little previous research has examined how templates are actually used in practice. Templates do not simply document the tasks of chronic disease management but profoundly change the nature of this work. Designed to assure standards of 'quality' care they contribute to bureaucratisation of care and may marginalise aspects of quality care which lie beyond their focus. Creative work is required to avoid privileging 'institution-centred' care over patient-centred care.

Computer templates in chronic disease management: ethnographic case study in general practice

PubMed Central

Swinglehurst, Deborah; Greenhalgh, Trisha; Roberts, Celia

2012-01-01

Objective To investigate how electronic templates shape, enable and constrain consultations about chronic diseases. Design Ethnographic case study, combining field notes, video-recording, screen capture with a microanalysis of talk, body language and data entry—an approach called linguistic ethnography. Setting Two general practices in England. Participants and methods Ethnographic observation of administrative areas and 36 nurse-led consultations was done. Twenty-four consultations were directly observed and 12 consultations were video-recorded alongside computer screen capture. Consultations were transcribed using conversation analysis conventions, with notes on body language and the electronic record. The analysis involved repeated rounds of viewing video, annotating field notes, transcription and microanalysis to identify themes. The data was interpreted using discourse analysis, with attention to the sociotechnical theory. Results Consultations centred explicitly or implicitly on evidence-based protocols inscribed in templates. Templates did not simply identify tasks for completion, but contributed to defining what chronic diseases were, how care was being delivered and what it meant to be a patient or professional in this context. Patients’ stories morphed into data bytes; the particular became generalised; the complex was made discrete, simple and manageable; and uncertainty became categorised and contained. Many consultations resembled bureaucratic encounters, primarily oriented to completing data fields. We identified a tension, sharpened by the template, between different framings of the patient—as ‘individual’ or as ‘one of a population’. Some clinicians overcame this tension, responding creatively to prompts within a dialogue constructed around the patient's narrative. Conclusions Despite their widespread implementation, little previous research has examined how templates are actually used in practice. Templates do not simply document the tasks of chronic disease management but profoundly change the nature of this work. Designed to assure standards of ‘quality’ care they contribute to bureaucratisation of care and may marginalise aspects of quality care which lie beyond their focus. Creative work is required to avoid privileging ‘institution-centred’ care over patient-centred care. PMID:23192245

Endobronchial Ultrasound-guided Transbronchial Needle Aspiration With a 19-G Needle Device.

PubMed

Tremblay, Alain; McFadden, Seamus; Bonifazi, Martina; Luzzi, Valentina; Kemp, Samuel V; Gasparini, Stefano; Chee, Alex; MacEachern, Paul; Dumoulin, Elaine; A Hergott, Christopher; Shah, Pallav L

2018-05-16

Endobronchial ultrasound (EBUS)-guided transbronchial needle aspiration is a well-established first-line minimally invasive modality for mediastinal lymph node sampling. Although results are excellent overall, the technique underperforms in certain situations. We aimed to describe our results using a new 19-G EBUS-guided transbronchial needle aspiration device to determine safety and feasibility of this approach. We completed a retrospective chart review of all cases performed to the time of data analysis at each of 3 study sites. A total of 165 procedures were performed with a total of 297 individual lymph nodes or lesions sampled with the 19-G device by 10 bronchoscopists. Relatively large targets were selected for sampling with the device (mean lymph node size: 20.4 mm; lung lesions: 33.5 mm). A specific diagnosis was obtained in 77.3% of cases with an additional 13.6% of cases with benign lymphocytes, for a procedural adequacy rate of 90.9%. Procedure sample adequacy was 88.6% in suspected malignant cases, 91.0% in suspected sarcoidosis/lymphadenopathy cases, and 85.7% of cases with suspected lymphoma. On a per-node basis, a specific diagnosis was noted in 191/280 (68.2%) of samples, with an additional 61 showing benign lymphocytes for a per-node sample adequacy rate of 90%. One case (0.6%) of intraprocedure bleeding was noted. A new flexible 19-G EBUS needle was successfully and safely applied in a large patient cohort for sampling of lung and enlarged mediastinal lesions with high diagnostic rates across clinical indications.

Towards scar-free surgery: An analysis of the increasing complexity from laparoscopic surgery to NOTES

PubMed Central

Chellali, Amine; Schwaitzberg, Steven D.; Jones, Daniel B.; Romanelli, John; Miller, Amie; Rattner, David; Roberts, Kurt E.; Cao, Caroline G.L.

2014-01-01

Background NOTES is an emerging technique for performing surgical procedures, such as cholecystectomy. Debate about its real benefit over the traditional laparoscopic technique is on-going. There have been several clinical studies comparing NOTES to conventional laparoscopic surgery. However, no work has been done to compare these techniques from a Human Factors perspective. This study presents a systematic analysis describing and comparing different existing NOTES methods to laparoscopic cholecystectomy. Methods Videos of endoscopic/laparoscopic views from fifteen live cholecystectomies were analyzed to conduct a detailed task analysis of the NOTES technique. A hierarchical task analysis of laparoscopic cholecystectomy and several hybrid transvaginal NOTES cholecystectomies was performed and validated by expert surgeons. To identify similarities and differences between these techniques, their hierarchical decomposition trees were compared. Finally, a timeline analysis was conducted to compare the steps and substeps. Results At least three variations of the NOTES technique were used for cholecystectomy. Differences between the observed techniques at the substep level of hierarchy and on the instruments being used were found. The timeline analysis showed an increase in time to perform some surgical steps and substeps in NOTES compared to laparoscopic cholecystectomy. Conclusion As pure NOTES is extremely difficult given the current state of development in instrumentation design, most surgeons utilize different hybrid methods – combination of endoscopic and laparoscopic instruments/optics. Results of our hierarchical task analysis yielded an identification of three different hybrid methods to perform cholecystectomy with significant variability amongst them. The varying degrees to which laparoscopic instruments are utilized to assist in NOTES methods appear to introduce different technical issues and additional tasks leading to an increase in the surgical time. The NOTES continuum of invasiveness is proposed here as a classification scheme for these methods, which was used to construct a clear roadmap for training and technology development. PMID:24902811

Perforated peptic ulcer in Tikur Anbessa Hospital: a review of 74 cases.

PubMed

Ersumo, Tessema; W/Meskel, Yidnekachew; Kotisso, Berhanu

2005-01-01

Little is known on the pattern of perforated peptic ulcer in Ethiopia. To evaluate the early, outcome of management, a five-year retrospective analysis of 74 operated cases of perforated peptic ulcer was undertaken. Perforated peptic ulcer accounted for 3.4% of the adult emergency surgical procedures. The mean age was 32.6 years, with a male to female ratio of 7.2 to 1.0. Fifty-six percent of the cases were unmarried. In nearly 22.0% of the patients, no previous history of peptic ulcer disease was documented. Delay in diagnosis was noted in 95% of the cases. Most patients had duodenal ulcer perforation, and about 78% had purulent peritonitis at laparotomy. Fourteen died in hospital. Early presentation of patients to surgical care facilities may reduce morbidity and mortality in cases of peptic ulcer perforation.

Evaluation of usefulness of fine-needle aspiration cytology in the diagnosis of tumours of the accessory parotid gland: a preliminary analysis of a case series in Japan.

PubMed

Iguchi, Hiroyoshi; Wada, Tadashi; Matsushita, Naoki; Oishi, Masahiro; Teranishi, Yuichi; Yamane, Hideo

2014-07-01

The accuracy and sensitivity of fine-needle aspiration cytology (FNAC) in this analysis were not satisfactory, and the false-negative rate seemed to be higher than for parotid tumours. The possibility of low-grade malignancy should be considered in the surgical treatment of accessory parotid gland (APG) tumours, even if the preoperative results of FNAC suggest that the tumour is benign. Little is known about the usefulness of FNAC in the preoperative evaluation of APG tumours, probably due to the paucity of APG tumour cases. We examined the usefulness of FNAC in the detection of malignant APG tumours. We conducted a retrospective analysis of 3 cases from our hospital, along with 18 previously reported Japanese cases. We compared the preoperative FNAC results with postoperative histopathological diagnoses of APG tumours and evaluated the accuracy, sensitivity, specificity and false-negative rates of FNAC in detecting malignant APG tumours. There were four false-negative cases (19.0%), three of mucoepidermoid carcinomas and one of malignant lymphoma. One false-positive result was noted in the case of a myoepithelioma, which was cytologically diagnosed as suspected adenoid cystic carcinoma. The accuracy, sensitivity and specificity of FNAC in detecting malignant tumours were 76.2%, 60.0% and 90.9%, respectively.

A Comparison of Vertical and Transverse Sections in the Histological Diagnosis of Alopecia Areata Scalp Biopsy Specimens

PubMed Central

Singh, Kanika; Sharma, Sonal; Singh, Usha Rani; Bhattacharya, Sambit Nath

2016-01-01

Context: Both vertical and transverse sections are used for the diagnosis of alopecia areata. However when a single biopsy is submitted the pathologist has to decide which type is better. Aims: To compare the diagnostic histological features in vertical and transverse sections in alopecia areata scalp biopsy specimens. Settings and Design: Tertiary Care Hospital. Comparative Study. Materials and Methods: A total of 30 patients were enrolled in the study. Two four mm punch biopsy were taken. One was used to take vertical sections and the other for transverse section and histological features of alopecia areata noted in both. Statistical Analysis Used: Chi-square test, percentage. Results: Diagnosis of alopecia areata could be made in 30 (100%) cases in transverse sections and 28 cases (93.3%) in vertical sections. The number of hair follicles available for evaluation was more in the transverse section. Nanogen follicles and miniaturization of follicles were better visualized in the transverse sections. However the catagen and telogen follicles were noted in both vertical and transverse sections but the number and the ratio of anagen and telogen hair follicles could be better assessed in the transverse sections. Presence of peribulbar lymphocytic infiltrate, eosinophils and pigment casts were noted in both transverse and vertical sections. Conclusions: Transverse sections provide a better assessment of the histological features of alopecia areata than vertical sections and thus should be preferred. PMID:27625562

31 CFR 203.20 - Investment account requirements.

Code of Federal Regulations, 2014 CFR

2014-07-01

... obligations will be in the form of open-ended interest-bearing notes, or in the case of term investments, interest-bearing notes maintained for a predetermined period of time, and additions and reductions will be... in the form of interest-bearing notes payable upon a predetermined period of time not to exceed 90...

31 CFR 203.20 - Investment account requirements.

Code of Federal Regulations, 2013 CFR

2013-07-01

... obligations will be in the form of open-ended interest-bearing notes, or in the case of term investments, interest-bearing notes maintained for a predetermined period of time, and additions and reductions will be... in the form of interest-bearing notes payable upon a predetermined period of time not to exceed 90...

7 CFR 1463.105 - Base quota levels for eligible quota holders.

Code of Federal Regulations, 2013 CFR

2013-01-01

... the BQL adjustment factor 1.071295. (Note: The factor adjusts the 2004 basic quota to the 2002 basic... farm. (Note: In the case of undivided tract ownership, BQL must be distributed among the tract quota... basic quota, multiplied by the BQL adjustment factor 1.23457. (Note: The factor adjusts the 2004 basic...

7 CFR 1463.105 - Base quota levels for eligible quota holders.

Code of Federal Regulations, 2014 CFR

2014-01-01

... the BQL adjustment factor 1.071295. (Note: The factor adjusts the 2004 basic quota to the 2002 basic... farm. (Note: In the case of undivided tract ownership, BQL must be distributed among the tract quota... basic quota, multiplied by the BQL adjustment factor 1.23457. (Note: The factor adjusts the 2004 basic...

Versatile utilization of real-time intraoperative contrast-enhanced ultrasound in cranial neurosurgery: technical note and retrospective case series.

PubMed

Lekht, Ilya; Brauner, Noah; Bakhsheshian, Joshua; Chang, Ki-Eun; Gulati, Mittul; Shiroishi, Mark S; Grant, Edward G; Christian, Eisha; Zada, Gabriel

2016-03-01

Intraoperative contrast-enhanced ultrasound (iCEUS) offers dynamic imaging and provides functional data in real time. However, no standardized protocols or validated quantitative data exist to guide its routine use in neurosurgery. The authors aimed to provide further clinical data on the versatile application of iCEUS through a technical note and illustrative case series. Five patients undergoing craniotomies for suspected tumors were included. iCEUS was performed using a contrast agent composed of lipid shell microspheres enclosing perflutren (octafluoropropane) gas. Perfusion data were acquired through a time-intensity curve analysis protocol obtained using iCEUS prior to biopsy and/or resection of all lesions. Three primary tumors (gemistocytic astrocytoma, glioblastoma multiforme, and meningioma), 1 metastatic lesion (melanoma), and 1 tumefactive demyelinating lesion (multiple sclerosis) were assessed using real-time iCEUS. No intraoperative complications occurred following multiple administrations of contrast agent in all cases. In all neoplastic cases, iCEUS replicated enhancement patterns observed on preoperative Gd-enhanced MRI, facilitated safe tumor debulking by differentiating neoplastic tissue from normal brain parenchyma, and helped identify arterial feeders and draining veins in and around the surgical cavity. Intraoperative CEUS was also useful in guiding a successful intraoperative needle biopsy of a cerebellar tumefactive demyelinating lesion obtained during real-time perfusion analysis. Intraoperative CEUS has potential for safe, real-time, dynamic contrast-based imaging for routine use in neurooncological surgery and image-guided biopsy. Intraoperative CEUS eliminates the effect of anatomical distortions associated with standard neuronavigation and provides quantitative perfusion data in real time, which may hold major implications for intraoperative diagnosis, tissue differentiation, and quantification of extent of resection. Further prospective studies will help standardize the role of iCEUS in neurosurgery.

Ophthalmic Evaluation in Beta-Thalassemia.

PubMed

Merchant, Rashid H; Punde, Hrishikesh; Thacker, Neepa; Bhatt, Deepak

2017-07-01

To determine the association of ocular manifestations in beta-thalassemia with the patient's age, blood transfusion requirements, average serum ferritin and dose and duration of iron chelation therapy. Sixty multi-transfused beta thalassemia patients of 12 to 18 y of age on chelation therapy were included in this cross-sectional analysis. Structural and functional evaluation of the retina was done using Optical coherence tomography (OCT) and Electroretinography (ERG), including flash ERG and Pattern ERG (PERG). Routine ophthalmic examination and B scan of the eye was also done. Flash ERG a-waves and b-waves were recorded, however only a-wave amplitude was evaluated. Pattern ERG n35, n95 and p50 waves were recorded and p50 wave amplitude was evaluated. The a-wave on flash and p50 on pattern waves represent retinal photoreceptor epithelium (RPE) photoreceptor response, which is mainly affected in beta-thalassemia. Ocular changes were detected in 38.3% and a significant correlation was noted with increase in age (p = 0.045) but not with serum ferritin, transfusion requirements or chelation therapy. Refractive errors were found in 14 cases (23%), such as myopia with astigmatism in 13 (21.7%) and only myopia in 6 subjects (10%). OCT abnormality was noted in 1 patient (1.7%) who had thinning of central retina; right eye 132 μm and left eye 146 μm (n > 200 μm). Abnormalities were noted in a-wave amplitude on flash ERG in 20% of cases, while reduced p50 amplitude on PERG was noted in 15%. A significant correlation was noted between ocular findings and increase in age, but not with serum ferritin, transfusion requirements or chelation therapy. ERG appears to be a promising tool for screening patients with beta-thalassemia and can serve as a follow-up test for evaluating retinal function.

Do Concomitant Cranium and Axis Injuries Predict Worse Outcome? A Trauma Database Quantitative Analysis

PubMed Central

Chittiboina, Prashant; Banerjee, Anirban Deep; Nanda, Anil

2011-01-01

We performed a trauma database analysis to identify the effect of concomitant cranial injuries on outcome in patients with fractures of the axis. We identified patients with axis fractures over a 14-year period. A binary outcome measure was used. Univariate and multiple logistic regression analysis were performed. There were 259 cases with axis fractures. Closed head injury was noted in 57% and skull base trauma in 14%. Death occurred in 17 cases (6%). Seventy-two percent had good outcome. Presence of abnormal computed tomography head findings, skull base fractures, and visceral injury was significantly associated with poor outcome. Skull base injury in association with fractures of the axis is a significant independent predictor of worse outcomes, irrespective of the severity of the head injury. We propose that presence of concomitant cranial and upper vertebral injuries require careful evaluation in view of the associated poor prognosis. PMID:22470268

Natural orifice translumenal endoscopic surgery (NOTES): emerging trends and specifications for a virtual simulator.

PubMed

Schwaitzberg, Steven D; Dorozhkin, Denis; Sankaranarayanan, Ganesh; Matthes, Kai; Jones, Daniel B; De, Suvranu

2016-01-01

A virtual translumenal endoscopic surgical trainer (VTEST) is being developed to accelerate the development of natural orifice translumenal endoscopic surgery (NOTES) procedures and devices in a safe and risk-free environment. For a rapidly developing field such as NOTES, a needs analysis must be conducted regularly to discover emerging research trends and areas of potential high impact for a virtual simulator. This paper presents a survey-based study which follows a similar study conducted by this group in 2011 (Sankaranarayanan et al. in Surg Endosc 27:1607-1616, 2013). A 32-point questionnaire was distributed at the 2012 Natural Orifice Surgery Consortium for Assessment and Research annual meeting. These data were subsequently augmented by an identical online survey, targeted at the members of the American Society for Gastrointestinal Endoscopy and the Society of American Gastrointestinal and Endoscopic Surgeons, and analyzed. Twenty-eight NOTES experts participated in the 2012 study. Cholecystectomy (CE) procedure remained the most commonly performed NOTES technique, with 18 positive responses (64%). In contrast to 2011, the popularity of the NOTES appendectomy (AE) was significantly lower, with only 2 (7%) instances (CE vs. AE, p < 0.001), while the number of peroral endoscopic myotomy (POEM, PE) cases had increased significantly, with 11 (39%) positive responses, respectively (PE vs. AE, p = 0.013). Strong preference toward hybrid rather than pure NOTES techniques (82 vs. 11%, p < 0.001) was also expressed. Other responses were similar to those in the 2011 study, with the VTEST™ utility in developing and testing new techniques and instruments ranked particularly high. Based on the results of this study, a decision was made to focus exclusively on the transvaginal hybrid NOTES cholecystectomy procedure, including both rigid and flexible scope techniques. The importance of developing a virtual NOTES simulator was reaffirmed, with POEM identified as a promising candidate for future simulator development.

Providers' Perspectives on Case Management of a Healthy Start Program: A Qualitative Study

PubMed Central

Moise, Imelda K.; Mulhall, Peter F.

2016-01-01

Although Healthy Start case managers recognized the benefits of case management for facilitating optimal service delivery to women and their families, structural factors impact effective implementation. This study investigated case managers' views of 1) the structural challenges faced in implementing case management for program participants, and 2) possible strategies to enhance case management in medical home settings. Two focus groups were conducted separately with case managers from the four program service sites to gain insight into these issues noted above. Each group was co-facilitated by two evaluators using a previously developed semi-structured interview guide. The group discussions were audio recorded and the case managers' comments were transcribed verbatim. Transcripts were analyzed using thematic analysis, a deductive approach. Data were collected in 2013 and analyzed in 2015. Case managers are challenged by externalities (demographic shifts in target populations, poverty); contractual requirements (predefined catchment neighborhoods, caseload); limited support (client incentives, tailored training, and a high staff turnover rate); and logistic difficulties (organizational issues). Their approach to case management tends to be focused on linking Although Healthy Start case managers recognized the benefits of case management for facilitating optimal service delivery to women and their families, structural factors impact effective implementation. This study investigated case managers' views of 1) the structural challenges faced in implementing case management for program participants, and 2) possible strategies to enhance case management in medical home settings. Two focus groups were conducted separately with case managers from the four program service sites to gain insight into these issues noted above. Each group was co-facilitated by two evaluators using a previously developed semi-structured interview guide. The group discussions were audio recorded and the case managers' comments were transcribed verbatim. Transcripts were analyzed using thematic analysis, a deductive approach. Data were collected in 2013 and analyzed in 2015. Case managers are challenged by externalities (demographic shifts in target populations, poverty); contractual requirements (predefined catchment neighborhoods, caseload); limited support (client incentives, tailored training, and a high staff turnover rate); and logistic difficulties (organizational issues). Their approach to case management tends to be focused on linking clients to adequate services rather than reporting performance. Case managers favored measurable deliverables rather than operational work products. A proposed solution to current challenges emphasizes and encourages the iterative learning process and shared decision making between program targets, funders and providers. Case managers are aware of the challenging environment in which they operate for their clients and for themselves. However, future interventions will require clearly identified performance measures and increased systems support. PMID:27149061

The relationship between waiting times and 'adherence' to the Scottish Intercollegiate Guidelines Network 98 guideline in autism spectrum disorder diagnostic services in Scotland.

PubMed

McKenzie, Karen; Forsyth, Kirsty; O'Hare, Anne; McClure, Iain; Rutherford, Marion; Murray, Aja; Irvine, Linda

2016-05-01

The aim of this study was to explore the extent to which the Scottish Intercollegiate Guidelines Network 98 guidelines on the assessment and diagnosis of autism spectrum disorder were adhered to in child autism spectrum disorder diagnostic services in Scotland and whether there was a significant relationship between routine practice which more closely reflected these recommendations (increased adherence) and increased waiting times. Retrospective, cross-sectional case note analysis was applied to data from 80 case notes. Adherence ranged from a possible 0 (no adherence) to 19 (full adherence). Overall, 17/22 of the recommendations were adhered to in over 50 of the 80 cases and in 70 or more cases for 11/22 of the recommendations, with a mean adherence score of 16 (standard deviation = 1.9). No significant correlation was found between adherence and total wait time for untransformed (r = 0.15, p = 0.32) or transformed data (r = 0.12, p = 0.20). The results indicated that the assessment and diagnostic practices were consistent with the relevant Scottish Intercollegiate Guidelines Network 98 guideline recommendations. Increased adherence to the 19 included recommendations was not significantly related to increased total waiting times, indicating that the Scottish Intercollegiate Guidelines Network 98 recommendations have generally been integrated into practice, without a resultant increase in patient waits. © The Author(s) 2015.

Harsh humour: a therapeutic discourse.

PubMed

McCreaddie, May

2010-11-01

Humour research in healthcare has tended to focus on rehearsed as opposed to spontaneous humour. This paper reports an empirical example of spontaneous humour in healthcare interactions: a negative case analysis from a constructivist grounded theory study. Twenty Clinical Nurse Specialist (CNS)-patient interactions and CNS pre- and postinteraction audio diaries provided the baseline data corpus. Follow-up interviews, field notes, focus groups and observations serviced theory generation with a constant comparison approach to data collection and analyses. Interpretative and illustrative frameworks incorporating humour theories, non-laughter humour support, discursive features and prosodical features of speech were applied to all data. This paper is based upon the negative case comprising a 90-minute follow-up interview and 10 hours of field note observations. The negative case - a CNS working with female drug users' sexual and reproductive health needs - contradicted emerging findings from the baseline data corpus. First, the negative case had greater awareness of humour, deliberately initiated humour and recognised parameters and exclusion zones. Second, a good patient personal was evident in the baseline data corpus but the negative case worked with 'bad' patients. Accordingly, a specific type of humour - harsh humour - was evident in the negative case. Harsh humour used areas of potential discord (e.g. drug use) as a focus of humour creation and maintenance. The deliberate initiation of harsh humour enabled the negative case and her colleagues to achieve their aims by engaging effectively with unpredictable, reluctant and recalcitrant patients. The negative case demonstrates how humour can be used to therapeutically enhance healthcare interactions with disenfranchised individuals. Humour is not superficial but integral to the accomplishment of key aspects of interactions. Health and social care workers should consider the potential for therapeutic humour to engage and maintain all patients - disenfranchised or otherwise - in healthcare interactions. © 2010 Blackwell Publishing Ltd.

Skills Development Using Role-Play in a First-Year Pharmacy Practice Course

PubMed Central

2011-01-01

Objectives. To evaluate the usefulness of a role-play model in developing students’ patient-care skills in a first-year undergraduate pharmacy practice course. Design. A role-play model was developed and implemented in workshops across 2 semesters of a year-long course. Students performed different roles, including that of a pharmacist and a patient, and documented case notes in a single interaction. Assessment. Student perceptions of the usefulness of the approach in acquiring skills were measured by surveying students during both semesters. All student assessments (N=130 in semester1; N=129 in semester 2) also were analyzed for skills in verbal communication, information gathering, counselling and making recommendations, and accurately documenting information. A majority of students found the approach useful in developing skills. An analysis of student assessments revealed that role-playing was not as effective in building skills related to accurate documentation as it was in other areas of patient care. Conclusions. Role play is useful for developing patient-care skills in communication and information gathering but not for documentation of case notes. PMID:21829258

Encounters with Wisdom: A Case Study of Community Worker Reflection Circles in San Antonio, TX

ERIC Educational Resources Information Center

Arispe, Don D.

2013-01-01

This case study focuses upon the transformational experiences of 28 social service and pastoral workers engaged in a Reflection Circle Process (RCP) in San Antonio, TX. The RCP involves the writing of a holistic journal entry, known as a process note, coupled with an in-depth exploration of the note with the help of a group of trusted peers, known…

26 CFR 1.453-9 - Gain or loss on disposition of installment obligations.

Code of Federal Regulations, 2013 CFR

2013-04-01

...) the amount realized, in the case of satisfaction at other than face value or in the case of a sale or... the face value of the obligation over an amount equal to the income which would be returnable were the.... Face value of notes 15,000 Amount of income returnable were the notes satisfied in full, 50 percent of...

26 CFR 1.453-9 - Gain or loss on disposition of installment obligations.

Code of Federal Regulations, 2011 CFR

2011-04-01

...) the amount realized, in the case of satisfaction at other than face value or in the case of a sale or... the face value of the obligation over an amount equal to the income which would be returnable were the.... Face value of notes 15,000 Amount of income returnable were the notes satisfied in full, 50 percent of...

26 CFR 1.453-9 - Gain or loss on disposition of installment obligations.

Code of Federal Regulations, 2012 CFR

2012-04-01

...) the amount realized, in the case of satisfaction at other than face value or in the case of a sale or... the face value of the obligation over an amount equal to the income which would be returnable were the.... Face value of notes 15,000 Amount of income returnable were the notes satisfied in full, 50 percent of...

26 CFR 1.453-9 - Gain or loss on disposition of installment obligations.

Code of Federal Regulations, 2014 CFR

2014-04-01

...) the amount realized, in the case of satisfaction at other than face value or in the case of a sale or... the face value of the obligation over an amount equal to the income which would be returnable were the.... Face value of notes 15,000 Amount of income returnable were the notes satisfied in full, 50 percent of...

26 CFR 1.453-9 - Gain or loss on disposition of installment obligations.

Code of Federal Regulations, 2010 CFR

2010-04-01

...) the amount realized, in the case of satisfaction at other than face value or in the case of a sale or... the face value of the obligation over an amount equal to the income which would be returnable were the.... Face value of notes 15,000 Amount of income returnable were the notes satisfied in full, 50 percent of...

Civilian blast-related burn injuries

PubMed Central

Patel, J.N.; Tan, A.; Dziewulski, P.

2016-01-01

Summary There is limited English literature describing the experience of a civilian hospital managing blast-related burn injuries. As the largest regional burn unit, we reviewed our cases with the aim of identifying means to improve current management. A 6-year retrospective analysis of all patients coded as sustaining blast-related burns was conducted through the unit’s burns database. Medical case notes were reviewed for information on burn demographics, management and outcomes. 42 patients were identified. Male to female ratio was 37:5. Age range was 12-84 years, (mean=33 years). Total body surface area (%TBSA) burn ranged from 0.25% to 60%, (median=1%). The most common burn injury was flame (31/42, 73.8%). Gas explosions were the most common mechanism of injury (19 cases; 45.2%). 7/42 cases (16.7%) had full ATLS management pre-transfer to the burns unit. The Injury Severity Score (ISS) ranged from 0-43 (median=2). 17/42 (40.4%) patients required admission. 37/36 (88.1%) patients were managed conservatively of which 1 patient later required surgery due to deeper burns. 5/42 (11.9%) patients required surgical management at presentation and these were noted to be burns with >15% TBSA requiring resuscitation. One case required emergency escharotomies and finger amputations. All patients survived their burn injuries. Blast-related burn injuries are generally uncommon in the civilian setting. Following proper assessment, most of these cases can be deemed as minor injuries and managed conservatively. Improvement in burns management education and training at local emergency departments would provide efficient patient care and avoid unnecessary referrals to a burns unit. PMID:27857651

Prospective randomized clinical trial comparing laparoscopic cholecystectomy and hybrid natural orifice transluminal endoscopic surgery (NOTES) (NCT00835250).

PubMed

Noguera, José F; Cuadrado, Angel; Dolz, Carlos; Olea, José M; García, Juan C

2012-12-01

Natural orifice transluminal endoscopic surgery (NOTES) is a technique still in experimental development whose safety and effectiveness call for assessment through clinical trials. In this paper we present a three-arm, noninferiority, prospective randomized clinical trial of 1 year duration comparing the vaginal and transumbilical approaches for transluminal endoscopic surgery with the conventional laparoscopic approach for elective cholecystectomy. Sixty female patients between the ages of 18 and 65 years who were eligible for elective cholecystectomy were randomized in a ratio of 1:1:1 to receive hybrid transvaginal NOTES (TV group), hybrid transumbilical NOTES (TU group) or conventional laparoscopy (CL group). The main study variable was parietal complications (wound infection, bleeding, and eventration). The analysis was by intention to treat, and losses were not replaced. Cholecystectomy was successfully performed on 94% of the patients. One patient in the TU group was reconverted to CL owing to difficulty in maneuvering the endoscope. After a minimum follow-up period of 1 year, no differences were noted in the rate of parietal complications. Postoperative pain, length of hospital stay, and time off from work were similar in the three groups. No patient developed dyspareunia. Surgical time was longer among cases in which a flexible endoscope was used (CL, 47.04 min; TV, 64.85 min; TU, 59.80 min). NOTES approaches using the flexible endoscope are not inferior in safety or effectiveness to conventional laparoscopy. The transumbilical approach with flexible endoscope is as effective and safe as the transvaginal approach and is a promising, single-incision approach.

Case Study: Testing with Case Studies

ERIC Educational Resources Information Center

Herreid, Clyde Freeman

2015-01-01

This column provides original articles on innovations in case study teaching, assessment of the method, as well as case studies with teaching notes. This month's issue discusses using case studies to test for knowledge or lessons learned.

Commercial speech in crisis: Crisis Pregnancy Center regulations and definitions of commercial speech.

PubMed

Gilbert, Kathryn E

2013-02-01

Recent attempts to regulate Crisis Pregnancy Centers, pseudoclinics that surreptitiously aim to dissuade pregnant women from choosing abortion, have confronted the thorny problem of how to define commercial speech. The Supreme Court has offered three potential answers to this definitional quandary. This Note uses the Crisis Pregnancy Center cases to demonstrate that courts should use one of these solutions, the factor-based approach of Bolger v. Youngs Drugs Products Corp., to define commercial speech in the Crisis Pregnancy Center cases and elsewhere. In principle and in application, the Bolger factor-based approach succeeds in structuring commercial speech analysis at the margins of the doctrine.

Transesophageal NOTES--a critical analysis of relevant problems.

PubMed

Grund, Karl E; Lehmann, Thorsten G

2010-10-01

The transesophageal access route has not become a principal topic in the discussion about NOTES up to now. Analyzing the problems in this new field of surgery, however, the transesophageal route shows high relevance. Here, all possibilities, limitations, and problems of NOTES become obvious. This paper contains a critical analysis of the literature published to date (nine full papers, five abstracts). Nearly all publications represent experimental studies in living pigs. In most cases a submucosal tunnel technique is performed as access route to mediastinum, pleural cavity, and heart. Interventions and operations include simple mediastinoscopies as well as epicardial operations after exposition of the heart. For access and manipulation, conventional flexible endoscopes and instruments are used. Clips, T-bars, or a combination of both achieve the closure. Some studies rely on spontaneous closure of the incision without any suturing or approximation. In such experimental settings, the following results are presented: Access is achieved in 90% of cases, the aim of the operation is met in 92%, technical success in closure is achieved in 90%, healing of incision assessed as good in two of five studies, satisfactory in three of five studies. Mortality, ranging from 6 to 25%, and complication rates were (surprisingly) high. It has to be stressed that analyzing these papers published to date, no adequate attention is paid to basic facts and problems of general and thoracic surgery (e.g. different forms, prevention, diagnosis and therapy of pneumothorax or differentiated forms of ventilation). Relevant differences in the anatomy and physiology of the esophagus and mediastinum between humans and pigs should additionally be taken into account to choose optimal experimental parameters when transferring results to human settings. Moreover, requirements regarding sterility and hygiene in a structure like the mediastinum, which is at high risk from the point of view of infection biology, have not yet been respected. These factors should be taken into account in further studies--as well as clinically relevant disease patterns in humans--to be able to realize possible advantages of this NOTES access in a clinical setting.

'Shell shock' revisited: an examination of the case records of the National Hospital in London.

PubMed

Linden, Stefanie Caroline; Jones, Edgar

2014-10-01

During the First World War the National Hospital for the Paralysed and Epileptic, in Queen Square, London, then Britain's leading centre for neurology, took a key role in the treatment and understanding of shell shock. This paper explores the case notes of all 462 servicemen who were admitted with functional neurological disorders between 1914 and 1919. Many of these were severe or chronic cases referred to the National Hospital because of its acknowledged expertise and the resources it could call upon. Biographical data was collected together with accounts of the patient's military experience, his symptoms, diagnostic interpretations and treatment outcomes. Analysis of the notes showed that motor syndromes (loss of function or hyperkinesias), often combined with somato-sensory loss, were common presentations. Anxiety and depression as well as vegetative symptoms such as sweating, dizziness and palpitations were also prevalent among this patient population. Conversely, psychogenic seizures were reported much less frequently than in comparable accounts from German tertiary referral centres. As the war unfolded the number of physicians who believed that shell shock was primarily an organic disorder fell as research failed to find a pathological basis for its symptoms. However, little agreement existed among the Queen Square doctors about the fundamental nature of the disorder and it was increasingly categorised as functional disorder or hysteria.

Retrospective Analysis of Nonepileptic Patients With Isolated Epileptiform Discharges Treated With Anticonvulsants.

PubMed

Swatzyna, Ronald J; Tarnow, Jay D; Proler, Meyer L; Roark, Alexandra J; MacInerney, Erin K; Kozlowski, Gerald P

2017-09-01

Many antiepileptic drugs (AEDs) have been tested on nonepileptic patients with a variety of diagnoses. The Food and Drug Administration has only approved certain AEDs for a small number of psychiatric conditions. There are few studies of nonepileptic patients that recommend an empirical trial of AEDs when isolated epileptiform discharges (IEDs) are identified in the electroencephalogram (EEG). However, no trials have been published. The purpose of this study is to evaluate the outcome of treating nonepileptic patients with AEDs when IEDs are present. Refractory cases were reviewed from a multidisciplinary practice whose EEG readings contained IEDs and were subsequently medicated with anticonvulsants by the clinic's psychiatrist. The psychiatrist's progress notes were assessed to determine the impact of adding anticonvulsants based on parent reports, teacher reports, and clinical observation. The final sample was composed of 76 refractory cases. Of the 76 patients treated with anticonvulsants, the majority were found to be improved in follow-up progress notes: 65 improved (85.53%), 6 unchanged (7.89%), and 5 more severe (6.58%). These observational findings suggest that further studies will be needed to show that IEDs may predict positive treatment outcome to anticonvulsant medication and act as a step toward an evidence-based treatment. Also, EEG screening may prove to be useful for refractory cases regardless of age, gender, or diagnosis.

Computer-assisted spinal osteotomy: a technical note and report of four cases.

PubMed

Fujibayashi, Shunsuke; Neo, Masashi; Takemoto, Mitsuru; Ota, Masato; Nakayama, Tomitaka; Toguchida, Junya; Nakamura, Takashi

2010-08-15

A report of 4 cases of spinal osteotomy performed under the guidance of a computer-assisted navigation system and a technical note about the use of the navigation system for spinal osteotomy. To document the surgical technique and usefulness of computer-assisted surgery for spinal osteotomy. A computer-assisted navigation system provides accurate 3-dimensional (3D) real-time surgical information during the operation. Although there are many reports on the accuracy and usefulness of a navigation system for pedicle screw placement, there are few reports on the application for spinal osteotomy. We report on 4 complex cases including 3 solitary malignant spinal tumors and 1 spinal kyphotic deformity of ankylosing spondylitis, which were treated surgically using a computer-assisted spinal osteotomy. The surgical technique and postoperative clinical and radiologic results are presented. 3D spinal osteotomy under the guidance of a computer-assisted navigation system was performed successfully in 4 patients. All malignant tumors were resected en bloc, and the spinal deformity was corrected precisely according to the preoperative plan. Pathologic analysis confirmed the en bloc resection without tumor exposure in the 3 patients with a spinal tumor. The use of a computer-assisted navigation system will help ensure the safety and efficacy of a complex 3D spinal osteotomy.

The relationship between childhood trauma and adult psychosis in a UK Early Intervention Service: results of a retrospective case note study.

PubMed

Reeder, Francesca D; Husain, Nusrat; Rhouma, Abdul; Haddad, Peter M; Munshi, Tariq; Naeem, Farooq; Khachatryan, Davit; Chaudhry, Imran B

2017-01-01

There is evidence that childhood trauma is a risk factor for the development of psychosis and it is recommended that childhood trauma is inquired about in all patients presenting with psychosis. This study aimed to determine the prevalence of childhood trauma in patients in the UK Early Intervention Service based on a case note review. This is a retrospective case note study of 296 patients in an UK Early Intervention Service. Trauma history obtained on service entry was reviewed and trauma experienced categorized. Results were analyzed using crosstab and frequency analysis. The mean age of the sample was 24 years, 70% were male, 66% were White, and 23% Asian (ethnicity not documented in 11% of the sample). Approximately 60% of patients reported childhood trauma, 21% reported no childhood trauma, and data were not recorded for the remaining 19%. Among those reporting trauma, the prevalence of most frequently reported traumas were: severe or repeated disruption (21%), parental mental illness (19%), bullying (18%), absence of a parent (13%), and 'other' trauma (24%) - the majority of which were victimization events. Sixty-six percent of those reporting trauma had experienced multiple forms of trauma. A high prevalence of childhood trauma (particularly trauma related to the home environment or family unit) was reported. This is consistent with other studies reporting on trauma and psychosis. The main weakness of the study is a lack of a control group reporting experience of childhood trauma in those without psychosis. Guidelines recommend that all patients with psychosis are asked about childhood trauma; but in 19% of our sample there was no documentation that this had been done indicating the need for improvement in assessment.

Downscattering due to Wind Outflows in Compact X-ray Sources: Theory and Interpretation

NASA Technical Reports Server (NTRS)

Titarchuk, Lev; Shrader, Chris

2004-01-01

A number of recent lines of evidence point towards the presence of hot, outflowing plasma from the central regions of compact Galactic and extragalactic X-ray sources. Additionally, it has long been noted that many of these sources exhibit an "excess" continuum component, above approx. 10 keV, usually attributed to Compton Reflection from a static medium. Motivated by these facts, as well as by recent observational constraints on the Compton reflection models - specifically apparently discrepant variability timescales for line and continuum components in some cases - we consider possible of effects of out-flowing plasma on the high-energy continuum spectra of accretion powered compact objects. We present a general formulation for photon downscattering diffusion which includes recoil and Comptonization effects due to divergence of the flow. We then develop an analytical theory for the spectral formation in such systems that allows us to derive formulae for the emergent spectrum. Finally we perform the analytical model fitting on several Galactic X-ray binaries. Objects which have been modeled with high-covering-fraction Compton reflectors, such as GS1353-64 are included in our analysis. In addition, Cyg X-3, is which is widely believed to be characterized by dense circumstellar winds with temperature of order 10(exp 6) K, provides an interesting test case. Data from INTEGRAL and RXTE covering the approx. 3 - 300 keV range are used in our analysis. We further consider the possibility that the widely noted distortion of the power-law continuum above 10 keV may in some cases be explained by these spectral softening effects.

Caring and its role in effective life science teaching: A case study

NASA Astrophysics Data System (ADS)

Seals, Mark A.

The focus of this inquiry was to explore, analyze, and describe the reciprocity of caring as it is embedded in and shapes the culture of the high school life science classroom. The data collection and analysis was guided by the theoretical underpinnings of phenomenology and heuristics, while following a multiple case study design. The case study involved two life science teachers, one male (Mr. Gene Fischer) and one female (Mrs. Carrie Sanders), who are perceived to be effective and caring educators. They were selected purposely, along with two of their classes (an upper level genetic/molecular biology class and a lower level freshman biology course), which included 82 students. Data were collected in the form of field notes, videotapes and documents at each site. Grounded theory generated from the study was analyzed by following a case analysis (Merriam, 1988), and cross-case analysis (Merriam, 1988) approach, while also using the tenets of the constant comparative method by Glaser and Strauss (1967). By studying experienced, effective and caring teachers (and their students) over time, it was hoped to expand the extant theory about the ethic of care to better understanding the impact caring has in a variety of teaching and learning situations within the life science classroom.

Effect of digital problem-based learning cases on student learning outcomes in ophthalmology courses.

PubMed

Kong, Jun; Li, Xiaoyan; Wang, Youdong; Sun, Wei; Zhang, Jinsong

2009-09-01

To assess the impact of digital problem-based learning (PBL) cases on student learning in ophthalmology courses. Ninety students were randomly divided into 3 classes (30 students per class). The first class studied under a didactic model. The other 2 classes were divided into 6 groups (10 students per group) and received PBL teaching; 3 groups studied via cases presented in digital form and the others studied via paper-form cases. The results of theoretical and case analysis examinations were analyzed using the chi(2) test. Student performance on the interval practice was analyzed using the Kruskal-Wallis test. Questionnaires were used to evaluate student and facilitator perceptions. Students in the digital groups exhibited better performance in the practice procedures according to tutorial evaluations compared with the other groups (P < .05). The 2 PBL classes had significantly higher mean results of theoretical and case analysis examinations (P < .001), but there was no significant difference between the 2 PBL classes. Ninety-three percent of students in the digital groups (vs 73% in the paper groups) noted that the cases greatly stimulated their interest. Introducing PBL into ophthalmology could improve educational quality and effectiveness. Digital PBL cases stimulate interest and motivate students to further improve diagnosis and problem-handling skills.

50. THIRD FLOOR, HALL, LOOKING SOUTH. Note ceiling extends down ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

50. THIRD FLOOR, HALL, LOOKING SOUTH. Note ceiling extends down over window case and exterior frieze extends halfway down top light of sash - Robinson-Aiken House, 48 Elizabeth Street, Charleston, Charleston County, SC

Stage Presentation, Care Patterns, and Treatment Outcomes for Squamous Cell Carcinoma of the Penis

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

Burt, Lindsay M.; Shrieve, Dennis C.; Tward, Jonathan D., E-mail: Jonathan.Tward@hci.utah.edu

Purpose: Penile squamous cell carcinoma (SCC) is a rare entity, with few published series on outcomes. We evaluated the stage distributions and outcomes for surgery and radiation therapy in a U.S. population database. Methods and Materials: Subjects with SCC of the penis were identified using the National Cancer Institute Surveillance, Epidemiology and End Results (SEER) Program database between 1988 and 2006. Descriptive statistics were performed, and cause-specific survival (CSS) was estimated using Kaplan-Meier analysis. Comparisons of treatment modalities were analyzed using multivariate Cox regression. Subjects were staged using American Joint Committee on Cancer, sixth edition, criteria. Results: There were 2458more » subjects identified. The median age was 66.8 years (range, 17-102 years). Grade 2 disease was present in 94.5% of cases. T1, T2, T3, T4, and Tx disease was present in 64.8%, 17.1%, 9.5%, 2.1%, and 6.5% of cases, respectively. N0, N1, N2, N3, and Nx disease was noted in 61.6%, 6.9%, 4.0%, 3.7%, and 23.8% of cases, respectively. M1 disease was noted in 2.5% of subjects. Individuals of white ethnicity accounted for 85.1% of cases. Lymphadenectomy was performed in 16.7% of cases. The CSS for all patients at 5 and 10 years was 80.8% and 78.6%. By multivariable analysis grades 2 and 3 disease, T3 stage, and positive lymph nodes were adverse prognostic factors for CSS. Conclusion: SCC of the penis often presents as early-stage T1, N0, M0, grade 1, or grade 2 disease. The majority of patients identified were treated with surgery, and only a small fraction of patients received radiation therapy alone or as adjuvant therapy.« less

Large space antennas: A systems analysis case history

NASA Technical Reports Server (NTRS)

Keafer, Lloyd S. (Compiler); Lovelace, U. M. (Compiler)

1987-01-01

The value of systems analysis and engineering is aptly demonstrated by the work on Large Space Antennas (LSA) by the NASA Langley Spacecraft Analysis Branch. This work was accomplished over the last half-decade by augmenting traditional system engineering, analysis, and design techniques with computer-aided engineering (CAE) techniques using the Langley-developed Interactive Design and Evaluation of Advanced Spacecraft (IDEAS) system. This report chronicles the research highlights and special systems analyses that focused the LSA work on deployable truss antennas. It notes developmental trends toward greater use of CAE techniques in their design and analysis. A look to the future envisions the application of improved systems analysis capabilities to advanced space systems such as an advanced space station or to lunar and Martian missions and human habitats.

Improved patient notes from medical students during web-based teaching using faculty-calibrated peer review and self-assessment.

PubMed

McCarty, Teresita; Parkes, Marie V; Anderson, Teresa T; Mines, Jan; Skipper, Betty J; Grebosky, James

2005-10-01

This study examines the effectiveness of Calibrated Peer Review (CPR), a Web-based writing development program, to teach and assess medical students' patient note-writing skills in a standardized fashion. At the end of the clerkship year, 67 medical students were divided into three groups, introduced to CPR, and instructed in patient note-writing. Students then wrote notes for three clinical cases, presented in different order to each group. After training on faculty-calibrated standards, students evaluated their peers' notes and their own notes. Trained faculty, blinded to author, order, and group, also graded student notes. Faculty gave lower scores than students, but both groups found students' scores improved significantly from the first to the third note written. Student-written patient notes improved in quality while using CPR. The program uses approaches valued in medicine (accurate peer review and self-reflection) to enhance performance.

CRREL (Cold Regions Research and Engineering Laboratory) Technical Publications. Supplement, October 1986-September 1988

DTIC Science & Technology

1988-09-01

1000. Extensive post -test optical analysis allowed Antenna polarization and height, and sigaal stacking estimation of the size distribution and number of...to 10 C higher under natural activated sludge. A design example is presented for conditions than in the wind tunnel studies. Results each case. All...typically limitations of the methcd are presented, examples are columnar type crystal structure. The remaining 2i% shown, and notes on user instructions are

Simple interventions can greatly improve clinical documentation: a quality improvement project of record keeping on the surgical wards at a district general hospital.

PubMed

Glen, Peter; Earl, Naomi; Gooding, Felix; Lucas, Emily; Sangha, Nicole; Ramcharitar, Steve

2015-01-01

Clinical documentation is an integral part of the healthcare professional's job. Good record keeping is essential for patient care, accurate recording of consultations and for effective communication within the multidisciplinary team. Within the surgical department at the Great Western Hospital, Swindon, the case notes were deemed to be bulky and cumbersome, inhibiting effective record keeping, potentially putting patients' at risk. The aim of this quality improvement project was therefore to improve the standard of documentation, the labelling of notes and the overall filing. A baseline audit was firstly undertaken assessing the notes within the busiest surgical ward. A number of variables were assessed, but notably, only 12% (4/33) of the case notes were found to be without loose pages. Furthermore, less than half of the pages with entries written within the last 72 hours contained adequate patient identifiers on them. When assessing these entries further, the designation of the writer was only recorded in one third (11/33) of the cases, whilst the printed name of the writer was only recorded in 65% (21/33) of the entries. This project ran over a 10 month period, using a plan, do study, act methodology. Initial focus was on simple education. Afterwards, single admission folders were introduced, to contain only information required for that admission, in an attempt to streamline the notes and ease the filing. This saw a global improvement across all data subsets, with a sustained improvement of over 80% compliance seen. An educational poster was also created and displayed in clinical areas, to remind users to label their notes with patient identifying stickers. This saw a 4-fold increase (16%-68%) in the labelling of notes. In conclusion, simple, cost effective measures in streamlining medical notes, improves the quality of documentation, facilitates the filing and ultimately improves patient care.

Mining Peripheral Arterial Disease Cases from Narrative Clinical Notes Using Natural Language Processing

PubMed Central

Afzal, Naveed; Sohn, Sunghwan; Abram, Sara; Scott, Christopher G.; Chaudhry, Rajeev; Liu, Hongfang; Kullo, Iftikhar J.; Arruda-Olson, Adelaide M.

2016-01-01

Objective Lower extremity peripheral arterial disease (PAD) is highly prevalent and affects millions of individuals worldwide. We developed a natural language processing (NLP) system for automated ascertainment of PAD cases from clinical narrative notes and compared the performance of the NLP algorithm to billing code algorithms, using ankle-brachial index (ABI) test results as the gold standard. Methods We compared the performance of the NLP algorithm to 1) results of gold standard ABI; 2) previously validated algorithms based on relevant ICD-9 diagnostic codes (simple model) and 3) a combination of ICD-9 codes with procedural codes (full model). A dataset of 1,569 PAD patients and controls was randomly divided into training (n= 935) and testing (n= 634) subsets. Results We iteratively refined the NLP algorithm in the training set including narrative note sections, note types and service types, to maximize its accuracy. In the testing dataset, when compared with both simple and full models, the NLP algorithm had better accuracy (NLP: 91.8%, full model: 81.8%, simple model: 83%, P<.001), PPV (NLP: 92.9%, full model: 74.3%, simple model: 79.9%, P<.001), and specificity (NLP: 92.5%, full model: 64.2%, simple model: 75.9%, P<.001). Conclusions A knowledge-driven NLP algorithm for automatic ascertainment of PAD cases from clinical notes had greater accuracy than billing code algorithms. Our findings highlight the potential of NLP tools for rapid and efficient ascertainment of PAD cases from electronic health records to facilitate clinical investigation and eventually improve care by clinical decision support. PMID:28189359

Inter-rater reliability and generalizability of patient note scores using a scoring rubric based on the USMLE Step-2 CS format.

PubMed

Park, Yoon Soo; Hyderi, Abbas; Bordage, Georges; Xing, Kuan; Yudkowsky, Rachel

2016-10-01

Recent changes to the patient note (PN) format of the United States Medical Licensing Examination have challenged medical schools to improve the instruction and assessment of students taking the Step-2 clinical skills examination. The purpose of this study was to gather validity evidence regarding response process and internal structure, focusing on inter-rater reliability and generalizability, to determine whether a locally-developed PN scoring rubric and scoring guidelines could yield reproducible PN scores. A randomly selected subsample of historical data (post-encounter PN from 55 of 177 medical students) was rescored by six trained faculty raters in November-December 2014. Inter-rater reliability (% exact agreement and kappa) was calculated for five standardized patient cases administered in a local graduation competency examination. Generalizability studies were conducted to examine the overall reliability. Qualitative data were collected through surveys and a rater-debriefing meeting. The overall inter-rater reliability (weighted kappa) was .79 (Documentation = .63, Differential Diagnosis = .90, Justification = .48, and Workup = .54). The majority of score variance was due to case specificity (13 %) and case-task specificity (31 %), indicating differences in student performance by case and by case-task interactions. Variance associated with raters and its interactions were modest (<5 %). Raters felt that justification was the most difficult task to score and that having case and level-specific scoring guidelines during training was most helpful for calibration. The overall inter-rater reliability indicates high level of confidence in the consistency of note scores. Designs for scoring notes may optimize reliability by balancing the number of raters and cases.

Caudal dysplasia sequence with penile enlargement: case report and a potential pathogenic hypothesis.

PubMed

Makhoul, I R; Aviram-Goldring, A; Paperna, T; Sujov, P; Rienstein, S; Smolkin, T; Epelman, M; Gershoni-Baruch, R

2001-02-15

The clinical spectrum of caudal dysplasia sequence (CDS) is noted for its diversity. The origin of CDS remains unknown, though poorly controlled gestational diabetes has been implicated in some cases. Here we describe the case of a newborn with CDS associated with penile enlargement (PE). The main anomalies included anal atresia, agenesis of the kidneys and of the sacrococcygeal vertebrae, dysgenesis of lumbar vertebrae, and bilateral cryptorchidism. Penile enlargement (7 cm), a rather unusual finding, has so far not been reported in association with CDS. Chromosomal analysis failed, and the neonate died 30 min after birth. Comparative genomic hybridization analysis using stored DNA showed a balanced normal male DNA content, which negates chromosomal losses or gains as a cause of CDS and/or PE. PE due to virilizing-type adrenal hyperplasia, caused by common mutations in the genes encoding for the adrenal enzymes 21-hydroxylase and 11-hydroxylase, was ruled out. We report on a previously unpublished case of the coexistence of PE and severe CDS and propose a possible pathogenetic hypothesis of this association. Copyright Wiley-Liss. Inc.

Mesothelioma in the Quebec chrysotile mining region

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

Case, B.W.; Armstrong, B.; McDonald, J.C.

Previous studies of incidence of mesothelioma and lung tissue burden in workers and nonworkers in the Quebec chrysotile mining region showed that mesothelioma incidence is very slightly increased in the mining area, and that tremolite, or even commercial amphiboles, are responsible (and chrysotile is not). Recently, one of us (BC) noted an increase in the numbers of cases of mesothelioma coming to autopsy in the mining region. There were 19 cases, all confirmed histologically, since 1982, vs. 6 that we know of in the previous 10 y. Eighteen were occupationally exposed; one was the wife of chrysotile miner/miller. We examinedmore » lung tissue from 9 cases matched to controls of the same sex and age, dying in the same years in the same hospitals, without evidence of malignant disease. We found an excess in cases of typical asbestos bodies; tremolite fibers; and total amphiboles. In univariate linear relative risk analysis, both longer (>8 {mu}m) and shorter fibers are significant. Multivariate analysis indicates that while adjustment of chrysotile lung content for tremolite content eliminates any statistical effect of chrysotile, the reverse comparison retains significance.« less

Consistent t(1;10) with Rearrangements of TGFBR3 and MGEA5 in both Myxoinflammatory Fibroblastic Sarcoma and Hemosiderotic Fibrolipomatous Tumor

PubMed Central

Antonescu, Cristina R; Zhang, Lei; Nielsen, G Petur; Rosenberg, Andrew E; Cin, Paola Dal; Fletcher, Christopher DM

2012-01-01

Despite their shared predilection for superficial soft tissue of distal extremities and frequent local recurrences, myxoinflammatory fibroblastic sarcoma (MIFS) and hemosiderotic fibrolipomatous tumor (HFLT) have distinct morphologic appearances. Recent studies have identified an identical t(1;10)(p22;q24) in 5 cases of MIFS and 2 of HFLT, as well as common amplifications on 3p11-12. In order to investigate further their potential relationship and to determine the incidence of t(1;10) in a larger cohort, we subjected 7 MIFS, 14 HFLT, and 3 cases with mixed morphology, to molecular and cytogenetic analysis. FISH analysis for rearrangements of TGFBR3 on 1p22 and of MGEA5 on 10q24 was performed in all cases, while the status of VGLL3 gene amplification on 3p12.1 was investigated in 12 cases. Conventional karyotyping was performed in one HFLT and two cases with mixed MIFS/HFLT histology. Overall 83% of cases showed rearrangements in both TGFBR3 and MGEA5. All three cases with mixed features of MIFS and HFLT were positive. Cytogenetic analysis performed in three cases confirmed an unbalanced der(10)t(1;10)(p22;q24). VGLL3 gene amplification was noted in 10/12 cases of both histologies. The high incidence of t(1;10) in MIFS and HFLT reinforces a shared pathogenetic relationship. Furthermore, the co-existence of both components either synchronously or metachronously in a primary or subsequent recurrence, suggest either different morphologic variants or different levels of tumor progression of a single biologic entity. FISH analysis for TGFBR3 and MGEA5 rearrangements can be applied as a reliable diagnostic molecular test when confronted with limited material or a challenging diagnosis. PMID:21717526

Case Study: Writing a Journal Case Study

ERIC Educational Resources Information Center

Prud'homme-Genereux, Annie

2016-01-01

This column provides original articles on innovations in case study teaching, assessment of the method, as well as case studies with teaching notes. This month's issue describes incorporating a journal article into the classroom by first converting it into a case study.

The ventrolateral medulla and medullary raphe in sudden unexpected death in epilepsy.

PubMed

Patodia, Smriti; Somani, Alyma; O'Hare, Megan; Venkateswaran, Ranjana; Liu, Joan; Michalak, Zuzanna; Ellis, Matthew; Scheffer, Ingrid E; Diehl, Beate; Sisodiya, Sanjay M; Thom, Maria

2018-06-01

Sudden unexpected death in epilepsy (SUDEP) is a leading cause of premature death in patients with epilepsy. One hypothesis proposes that sudden death is mediated by post-ictal central respiratory depression, which could relate to underlying pathology in key respiratory nuclei and/or their neuromodulators. Our aim was to investigate neuronal populations in the ventrolateral medulla (which includes the putative human pre-Bötzinger complex) and the medullary raphe. Forty brainstems were studied comprising four groups: 14 SUDEP, six epilepsy controls, seven Dravet syndrome cases and 13 non-epilepsy controls. Serial sections through the medulla (from obex 1 to 10 mm) were stained for Nissl, somatostatin, neurokinin 1 receptor (for pre-Bötzinger complex neurons) and galanin, tryptophan hydroxylase and serotonin transporter (neuromodulatory systems). Using stereology total neuronal number and densities, with respect to obex level, were measured. Whole slide scanning image analysis was used to quantify immunolabelling indices as well as co-localization between markers. Significant findings included reduction in somatostatin neurons and neurokinin 1 receptor labelling in the ventrolateral medulla in sudden death in epilepsy compared to controls (P < 0.05). Galanin and tryptophan hydroxylase labelling was also reduced in sudden death cases and more significantly in the ventrolateral medulla region than the raphe (P < 0.005 and P < 0.05). With serotonin transporter, reduction in labelling in cases of sudden death in epilepsy was noted only in the raphe (P ≤ 0.01); however, co-localization with tryptophan hydroxylase was significantly reduced in the ventrolateral medulla. Epilepsy controls and cases with Dravet syndrome showed less significant alterations with differences from non-epilepsy controls noted only for somatostatin in the ventrolateral medulla (P < 0.05). Variations in labelling with respect to obex level were noted of potential relevance to the rostro-caudal organization of respiratory nuclear groups, including tryptophan hydroxylase, where the greatest statistical difference noted between all epilepsy cases and controls was at obex 9-10 mm (P = 0.034), the putative level of the pre-Bötzinger complex. Furthermore, there was evidence for variation with duration of epilepsy for somatostatin and neurokinin 1 receptor. Our findings suggest alteration to neuronal populations in the medulla in SUDEP with evidence for greater reduction in neuromodulatory neuropeptidergic and mono-aminergic systems, including for galanin, and serotonin. Other nuclei need to be investigated to evaluate if this is part of more widespread brainstem pathology. Our findings could be a result of previous seizures and may represent a pathological risk factor for SUDEP through impaired respiratory homeostasis during a seizure.

Assessor Decision Making While Marking a Note-Taking Listening Test: The Case of the OET

ERIC Educational Resources Information Center

Harding, Luke; Pill, John; Ryan, Kerry

2011-01-01

This article investigates assessor decision making when using and applying a marking guide for a note-taking task in a specific purpose English language listening test. In contexts where note-taking items are used, a marking guide is intended to stipulate what kind of response should be accepted as evidence of the ability under test. However,…

Retrospective evaluation of prehospital triage, presentation, interventions and outcome in paediatric drowning managed by a physician staffed helicopter emergency medical service.

PubMed

Garner, Alan A; Barker, Claire L; Weatherall, Andrew D

2015-11-06

Drowning patients may benefit from the advanced airway management capabilities that can be provided by physician staffed helicopter emergency medical services. The aim of this study is to describe paediatric drowning patients treated by such a service examining tasking systems, initial physiology at the incident scene, survival and neurological outcome. Retrospective analysis of paediatric drowning victims over a 5- year period. Case identification system, patient age, site of drowning, presence or absence of cardiac output, first Glasgow Coma Scale (GCS) score and interventions were collected from prehospital notes, and survival and neurological outcomes from hospital and rehabilitation notes. The P-HEMS direct case identification system operating in parallel with a central control system identified all severe drowning cases but 3 of 7 cases (43%) were missed when the central control system operated in isolation. All severe drowning cases (22) identified for P-HEMS response were intubated and transported directly to a paediatric specialist centre. Intubation required adjuvant anaesthesia in 10 (45%) cases. All children with GCS greater than eight on arrival of the P-HEMS survived neurologically intact. Seven of eight children with a GCS between four and seven survived without neurological impairment and all children with a GCS greater than three survived. Four of twelve asystolic children survived including one child who at 18 months post drowning is neurologically normal. All children who survived had return of spontaneous circulation prior to arrival in the emergency department. P-HEMS played a significant role in the management of severe paediatric drowning in this case series. Requirement for P-HEMS only interventions were high and all identified cases were transferred directly to a paediatric specialist centre. Discontinuation of the P-HEMS direct case identication system that operated during the majority of the study period resulted in deterioration in system performance with some paediatric drowning cases subsequently not identified for P-HEMS response being transported to adult hospitals.

Transitioning from child and adolescent mental health services with attention-deficit hyperactivity disorder in Ireland: Case note review.

PubMed

Tatlow-Golden, Mimi; Gavin, Blanaid; McNamara, Niamh; Singh, Swaran; Ford, Tamsin; Paul, Moli; Cullen, Walter; McNicholas, Fiona

2018-06-01

In a context of international concern about early adult mental health service provision, this study identifies characteristics and service outcomes of young people with attention-deficit hyperactivity disorder (ADHD) reaching the child and adolescent mental health service (CAMHS) transition boundary (TB) in Ireland. The iTRACK study invited all 60 CAMHS teams in Ireland to participate; 8 teams retrospectively identified clinical case files for 62 eligible young people reaching the CAMHS TB in all 4 Health Service Executive Regions. A secondary case note analysis identified characteristics, co-morbidities, referral and service outcomes for iTRACK cases with ADHD (n = 20). Two-thirds of young people with ADHD were on psychotropic medication and half had mental health co-morbidities, yet none was directly transferred to public adult mental health services (AMHS) at the TB. Nearly half were retained in CAMHS, for an average of over a year; most either disengaged from services (40%) and/or actively refused transfer to AMHS (35%) at or after the TB. There was a perception by CAMHS clinicians that adult services did not accept ADHD cases or lacked relevant service/expertise. Despite high rates of medication use and co-morbid mental health difficulties, there appears to be a complete absence of referral to publicly available AMHS for ADHD youth transitioning from CAMHS in Ireland. More understanding of obstacles and optimum service configuration is essential to ensure that care is both available and accessible to young people with ADHD. © 2017 John Wiley & Sons Australia, Ltd.

Retrospective analysis of nonendodontic periapical lesions misdiagnosed as endodontic apical periodontitis lesions in a population of Taiwanese patients.

PubMed

Huang, Hsun-Yu; Chen, Yuk-Kwan; Ko, Edward Cheng-Chuan; Chuang, Fu-Hsiung; Chen, Ping-Ho; Chen, Ching-Yi; Wang, Wen-Chen

2017-07-01

We aimed to evaluate nonendodontic periapical lesions clinically misdiagnosed as endodontic periapical pathoses in a population of Taiwanese patients. Cases (2000-2014) of histopathological diagnoses of nonendodontic periapical lesions were retrieved from all cases with a clinical diagnosis of radicular cyst, apical granuloma, or apical periodontitis in the institution. These cases were regarded as misdiagnosed nonendodontic periapical lesions, of which the types and frequencies, in addition to the demographic data, were determined. Four thousand and four specimens were clinically diagnosed as endodontically associated pathoses, of which 118 cases (2.95%) received a histopathological diagnosis of a nonendodontic pathologic entity, the most frequent lesion being keratocystic odontogenic tumor (KCOT, n = 38, 32.20%), followed by fibro-osseous lesion (n = 18, 15.25%), and dentigerous cyst (n = 13, 11.02%). Nine malignant lesions in the periapical area [squamous cell carcinoma (n = 7, 5.93%), adenoid cystic carcinoma (n = 1, 0.85%), and Langerhans cell histiocytosis (n = 1, 0.85%)] were also noted. A wide variety of histopathological diagnoses, including benign odontogenic and non-odontogenic cystic and tumorous lesions and infectious diseases, as well as malignant lesions, was noted in these 118 cases of nonendodontic periapical lesions. Squamous cell carcinoma was the most predominant malignancy of nonendodontic periapical lesions misdiagnosed as apical periodontitis lesions from imaging examination overlooking the clinical findings. The current data form a useful basis for clinicopathological investigation and educational teaching regarding nonendodontic periapical lesions misdiagnosed as endodontic apical periodontitis lesions.

Putting Words in Their Mouth: Writing Dialogue for Case Studies

ERIC Educational Resources Information Center

Herreid, Clyde Freeman

2018-01-01

This column provides original articles on innovations in case study teaching, assessment of the method, as well as case studies with teaching notes. This issue discusses dialogue writing guidelines most relevant to case writing.

An audit of the quality of operation notes in an otolaryngology unit.

PubMed

Bateman, N D; Carney, A S; Gibbin, K P

1999-04-01

Hand-written operation notes are often produced as evidence in medico-legal cases. Incomplete and illegible notes, along with the use of confusing abbreviations, are a common source of weakness in a surgeon's defence. An audit of 100 sets of operation notes was carried out in a single otolaryngology department. Notes were scrutinised for the accuracy of data, ward, department and name of surgeon, as well as for the inclusion of unacceptable abbreviations. Using an aide-memoire attached to the front of the operation sheet, the audit was repeated with identical criteria. The aide-memoire improved the standard of operation note with respect to all measured criteria. Clear identification of operating surgeon improved from 74% to 93%, and the avoidance of unacceptable abbreviations rose from 53% to 84%. We conclude that a simple aide-memoire attached to operation note sheets can significantly improve the quality of note-keeping and potentially avoid medico-legal problems.

Establishing Cost-Effective Allocation of Proton Therapy for Breast Irradiation

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

Mailhot Vega, Raymond B.; Ishaq, Omar; Raldow, Ann

Purpose: Cardiac toxicity due to conventional breast radiation therapy (RT) has been extensively reported, and it affects both the life expectancy and quality of life of affected women. Given the favorable oncologic outcomes in most women irradiated for breast cancer, it is increasingly paramount to minimize treatment side effects and improve survivorship for these patients. Proton RT offers promise in limiting heart dose, but the modality is costly and access is limited. Using cost-effectiveness analysis, we provide a decision-making tool to help determine which breast cancer patients may benefit from proton RT referral. Methods and Materials: A Markov cohort model wasmore » constructed to compare the cost-effectiveness of proton versus photon RT for breast cancer management. The model was analyzed for different strata of women based on age (40 years, 50 years, and 60 years) and the presence or lack of cardiac risk factors (CRFs). Model entrants could have 1 of 3 health states: healthy, alive with coronary heart disease (CHD), or dead. Base-case analysis assumed CHD was managed medically. No difference in tumor control was assumed between arms. Probabilistic sensitivity analysis was performed to test model robustness and the influence of including catheterization as a downstream possibility within the health state of CHD. Results: Proton RT was not cost-effective in women without CRFs or a mean heart dose (MHD) <5 Gy. Base-case analysis noted cost-effectiveness for proton RT in women with ≥1 CRF at an approximate minimum MHD of 6 Gy with a willingness-to-pay threshold of $100,000/quality-adjusted life-year. For women with ≥1 CRF, probabilistic sensitivity analysis noted the preference of proton RT for an MHD ≥5 Gy with a similar willingness-to-pay threshold. Conclusions: Despite the cost of treatment, scenarios do exist whereby proton therapy is cost-effective. Referral for proton therapy may be cost-effective for patients with ≥1 CRF in cases for which photon plans are unable to achieve an MHD <5 Gy.« less

Utility of CT in the diagnosis and management of small-bowel obstruction in children.

PubMed

Wang, Qiuyan; Chavhan, Govind B; Babyn, Paul S; Tomlinson, George; Langer, Jacob C

2012-12-01

CT is often used in the diagnosis and management of small-bowel obstruction in children. To determine sensitivity of CT in delineating presence, site and cause of small-bowel obstruction in children. We retrospectively reviewed the CT scans of 47 children with surgically proven small-bowel obstruction. We noted any findings of obstruction and the site and cause of obstruction. Presence, absence or equivocal findings of bowel obstruction on abdominal radiographs performed prior to CT were also noted. We reviewed patient charts for clinical details and surgical findings, including bowel resection. Statistical analysis was performed using Fisher exact test to determine which CT findings might predict bowel resection. CT correctly diagnosed small-bowel obstruction in 43/47 (91.5%) cases. CT correctly indicated site of obstruction in 37/47 (78.7%) cases and cause of obstruction in 32/47 (68.1%) cases. Small-bowel feces sign was significantly associated with bowel resection at surgery (P = 0.0091). No other CT finding was predictive of bowel resection. Out of 41 children who had abdominal radiographs before CT, 29 (70.7%) showed unequivocal obstruction, six (14.6%) showed equivocal findings and six (14.6%) were unremarkable. CT is highly sensitive in diagnosing small-bowel obstruction in children and is helpful in determining the presence of small-bowel obstruction in many clinically suspected cases with equivocal or normal plain radiographs. CT also helps to determine the site and cause of the obstruction with good sensitivity.

Building America Case Study: Cold Climate Foundation Wall Hygrothermal Research Facility, Cloquet, Minnesota (Fact Sheet)

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

NorthernSTAR

2014-09-01

This report focuses on the progress made to date and the technical details of the experiment. An overview of the experimental data being collected with some interesting highlights noted thus far is also provided. A full analysis of the experimental data and the drawing of conclusions with regard to the thermal and hygrothermal performance of the retrofit foundation insulation systems tested will only be possible after a full year of data has been collected in 2014.

Report on the Feasibility of Three Data Bases as Sources for the Ambulatory Resource Analysis Project,

DTIC Science & Technology

1991-01-08

type (250.00) * Otitis media , unspecified (382.9) This latter diagnosis was confined largely to children. It should be noted that one of the top ten... Otitis media , unspecified (382.9) * Routine infant or child care (V20.2) Essential hypertension was either the first or second most common diagnosis in...401) * Suppurative and unspecified otitis media (382.0) * Sprains and strains, ankle (845.0) * Acute nasopharyngitis (460) As was the case for the

Evolving S Boxes with Reduced Differential Power Analysis Susceptibiltiy

DTIC Science & Technology

2016-12-02

coefficient [PEB+14,PPE+14]. Note that in the 4-bit case they could simultaneously maximize both cryptanalytic and side channel prop- erties [ PEP +14]. When its... PEP +14, PMMB15]; which makes sense for criteria of similar types, or when carefully weighting an understood trade-off. Work that combined...cryptanalytic and side channel properties failed to explore the trade- off [PEB+14,PPE+14, PEP +14,PMMB15], other than to provide loose bounds [MMS13]. Instead, it

European Scientific Notes. Volume 35, Number 4,

DTIC Science & Technology

1981-04-30

Physics in 1.915. Sir Lawrence used have utilized a laser excitation source X-ray analysis to obtain the first struc- consisting of a CW rhodamine 6G dye...imported. In case of a war or 44% of the samples that were tested in other crisis, it is entirely possilble summer positively determined the pros- that...that sibility that it would be the innocent this is due to the fact that there is victim of a war in lhich it was neutral, more sunshine in summer than

Metal matrix composite fabrication processes for high performance aerospace structures

NASA Astrophysics Data System (ADS)

Ponzi, C.

A survey is conducted of extant methods of metal matrix composite (MMC) production in order to serve as a basis for prospective MMC users' selection of a matrix/reinforcement combination, cost-effective primary fabrication methods, and secondary fabrication techniques for the achievement of desired performance levels. Attention is given to the illustrative cases of structural fittings, control-surface connecting rods, hypersonic aircraft air inlet ramps, helicopter swash plates, and turbine rotor disks. Methods for technical and cost analysis modeling useful in process optimization are noted.

Proceedings of the 1982 Army Numerical Analysis and Computers Conference.

DTIC Science & Technology

1982-08-01

field array WACC (l,J). Configuration types. The cartesian coordinates of the points on the entire boundary of the physical region, i.e., the closed outer...the field array WACC . This calculation is discussed in Ref.[8],where it is noted that the values obtained are not truly optimum in all cases...placed in the field 60 4g array WACC . The addition to the control functions from attraction to specified lines and/or points in the physical region is

Robotic-assisted laparoendoscopic single-site surgery (R-LESS) in urology: an evidence-based analysis.

PubMed

Barret, E; Sanchez-Salas, R; Ercolani, M; Forgues, A; Rozet, F; Galiano, M; Cathelineau, X

2011-06-01

The objective of this manuscript is to provide an evidence-based analysis of the current status and future perspectives of robotic laparoendoscopic single-site surgery (R-LESS). A PubMed search has been performed for all relevant urological literature regarding natural orifice transluminal endoscopic surgery (NOTES) and laparoendoscopic single-site surgery (LESS). All clinical and investigative reports for robotic LESS and NOTES procedures in the urological literature have been considered. A significant number of clinical urological procedures have been successfully completed utilizing R-LESS procedures. The available experience is limited to referral centers, where the case volume is sufficient to help overcome the challenges and learning curve of LESS surgery. The robotic interface remains the best fit for LESS procedures but its mode of use continues to evolve in attempts to improve surgical technique. We stand today at the dawn of R-LESS surgery, but this approach may well become the standard of care in the near future. Further technological development is needed to allow widespread adoption of the technique.

A note on local BRST cohomology of Yang-Mills type theories with free Abelian factors

NASA Astrophysics Data System (ADS)

Barnich, Glenn; Boulanger, Nicolas

2018-05-01

We extend previous work on antifield dependent local Becchi-Rouet-Stora-Tyutin (BRST) cohomology for matter coupled gauge theories of Yang-Mills type to the case of gauge groups that involve free Abelian factors. More precisely, we first investigate in a model independent way how the dynamics enters the computation of the cohomology for a general class of Lagrangians in general spacetime dimensions. We then discuss explicit solutions in the case of specific models. Our analysis has implications for the structure of characteristic cohomology and for consistent deformations of the classical models, as well as for divergences/counterterms and for gauge anomalies that may appear during perturbative quantization.

Characteristics of Abductive Inquiry in Earth and Space Science: An Undergraduate Teacher Prospective Case Study

NASA Astrophysics Data System (ADS)

Ramalis, T. R.; Liliasari; Herdiwidjaya, D.

2016-08-01

The purpose this case study was to describe characteristic features learning activities in the domain of earth and space science. Context of this study is earth and space learning activities on three groups of student teachers prospective, respectively on the subject of the shape and size of Earth, land and sea breeze, and moon's orbit. The analysis is conducted qualitatively from activity data and analyze students doing project work, student worksheets, group project report documents, note and audio recordings of discussion. Research findings identified the type of abduction: theoretical models abduction, factual abduction, and law abduction during the learning process. Implications for science inquiry learning as well as relevant research were suggested.

Progressive supranuclear palsy: neuropathologically based diagnostic clinical criteria.

PubMed Central

Collins, S J; Ahlskog, J E; Parisi, J E; Maraganore, D M

1995-01-01

All cases examined postmortem at the Mayo Clinic that met the classic neuropathological criteria for progressive supranuclear palsy (PSP) were identified for retrospective clinical analyses. The necropsy material was re-examined by a second neuropathologist to confirm the pathological diagnosis of PSP, yielding 12 cases. A range of clinical signs were documented in these patients, with numerous findings beyond those noted in the original descriptions of this disorder. Atypical clinical findings included absence of supranuclear gaze palsy (two cases), prominent asymmetry (two), arm dystonia (two), upper limb apraxia (two), myoclonus (two), chorea (one), eyelid opening apraxia (one), and respiratory disturbance (one). A definite clinical diagnosis of PSP had been made during life in only eight of the 12 patients. From the retrospective analysis of these 12 cases, a set of clinical criteria were developed for the premortem diagnosis of PSP emphasising differences from other akinetic-rigid disorders. PMID:7876846

Improved external valvuloplasty, intravenous laser photocoagulation and local sclerotheraphy treatment of primary deep venous valvular insufficiency: long term result

NASA Astrophysics Data System (ADS)

Wang, Chun-xi; Han, Li-na; Gu, Ying; Liang, Fa-qi; Zhang, Li; Liu, Hong-yi; Zhao, Wen-guang; Wang, Qi; Wang, Xiao-ling

2007-11-01

The purpose of this article is to report long-term follow-up of improved external vulvuloplasty, intravenous laser photocoagulation and local sclerotherapy treatment of primary deep venous valvular insufficiency in eight hundred and seventy-two patients from Nov. 2000 to May 2006. Patients were evaluated clinically and with duplex ultrasound at 1, 3, and 12 months, and yearly thereafter until the fifth year to assess treatment efficacy and adverse reactions. Successful occlusion of the great saphenous vein and absence of deep vein reflux on color Doppler imaging, were noted in 956 limbs of 852 cases( 1 month follow-up), 946 limbs of 842 cases (6 month to 1 year follow-up), 717 of 626 (1~2 year follow-up), 501 of 417 (2~3 year follow-up), 352 of 296 (3~5year follow-up), 142 of 106 (5 year follow-up) after initial treatment. The cumulative total number of recurrence of reflux was fifteen cases. The respective competence rate was 95.18%, 96.23%, 94.23%, 95.25%, 94.23% and 94.12%. Of note, all recurrence occurred before 9 months, with the majority noted before 3 months. Bruising was noted in 0.7% of patients, tightness along the course of treated vein in 1.0% of limbs. There have been no paresthesia of cases, skin burns and deep vein thrombosis.

Micronodular thymic neoplasms: case series and literature review with emphasis on the spectrum of differentiation.

PubMed

Mneimneh, Wadad S; Gökmen-Polar, Yesim; Kesler, Kenneth A; Loehrer, Patrick J; Badve, Sunil

2015-11-01

We report nine cases of micronodular thymoma with lymphoid B-cell hyperplasia and one case of micronodular thymic carcinoma with lymphoid hyperplasia from our institution. For a better understanding of these rare tumors, clinical records, and histological features of these cases were reviewed, with detailed review of additional 64 literature cases of micronodular thymic neoplasms. The joint analysis identified 64 cases of micronodular thymoma with lymphoid B-cell hyperplasia and 9 cases of micronodular thymic carcinoma with lymphoid hyperplasia. Both groups revealed slight male predilection, with male:female ratio of 1.3:1 and 5:4, and occurred at >40 years of age, with a mean of 64 (41-83) and 62 (42-78) years, respectively. Myasthenia gravis was noted in 3/64 (5%) and 1/9 (11%) patients, respectively. Other systemic, disimmune, or hematologic disorders were noted in 6/64 (9%) and 1/9 (11%) patients, respectively. Components of conventional thymoma were reported in 11/64 (17%) micronodular thymomas with lymphoid B-cell hyperplasia, with transitional morphology between the two components in most of them. Cellular morphology was predominantly spindle in micronodular thymoma with lymphoid B-cell hyperplasia when specified (30/43), and epithelioid in micronodular thymic carcinoma with lymphoid hyperplasia (6/9), and cytological atypia was more encountered in the latter. Dedifferentiation/transformation from micronodular thymoma with lymphoid B-cell hyperplasia to micronodular thymic carcinoma with lymphoid hyperplasia seems to occur in a small subset of cases. Three cases of micronodular thymomas with lymphoid B-cell hyperplasia were described with co-existent low-grade B-cell lymphomas. Follow-up data were available for 30 micronodular thymomas with lymphoid B-cell hyperplasia and 6 micronodular thymic carcinomas with lymphoid hyperplasia, with a mean of 47 (0.2-180) months and 23 (3-39) months, respectively. Patients were alive without disease, except for five micronodular thymoma with lymphoid B-cell hyperplasia patients (dead from unrelated causes), and one micronodular thymic carcinoma with lymphoid hyperplasia patient (dead of disease).

Comparative analysis of non-destructive methods to control fissile materials in large-size containers

NASA Astrophysics Data System (ADS)

Batyaev, V. F.; Sklyarov, S. V.

2017-09-01

The analysis of various non-destructive methods to control fissile materials (FM) in large-size containers filled with radioactive waste (RAW) has been carried out. The difficulty of applying passive gamma-neutron monitoring FM in large containers filled with concreted RAW is shown. Selection of an active non-destructive assay technique depends on the container contents; and in case of a concrete or iron matrix with very low activity and low activity RAW the neutron radiation method appears to be more preferable as compared with the photonuclear one. Note to the reader: the pdf file has been changed on September 22, 2017.

Issues relating to long-term follow-up in hip arthroplasty surgery: a review of 598 cases at 7 years comparing 2 prostheses using revision rates, survival analysis, and patient-based measures.

PubMed

Dawson, J; Jameson-Shortall, E; Emerton, M; Flynn, J; Smith, P; Gundle, R; Murray, D

2000-09-01

We reviewed 598 cemented Charnley and Hi-nek total hip arthroplasties at 7 years. Data were obtained from general practitioners, hospital medical notes, microfilm, and patient questionnaires. Outcome measures were revision rates, survival analysis, 12-item Oxford Hip Score, and satisfaction ratings. There were 471 Charnley (79%) and 127 Hi-nek (21%) total hip arthroplasties; 139 deaths (23%) occurred, and 5 (<1%) were lost to follow-up. Characteristics of the Charnley and Hi-nek patient groups were similar, with more information missing for Charnley cases. Revision rates were Charnley, 37 (8%), and Hi-nek, 6 (5%) (not significant). Survival analysis revealed no difference between the 2 groups (P = .23). The patients' median Oxford Hip Score was low/good (19), slightly worse for the Hi-nek group (not significant). Taking all evidence together, neither implant was outperforming the other at 7 years.

Assembling a Case Study Tool Kit: 10 Tools for Teaching with Cases

ERIC Educational Resources Information Center

Prud'homme-Généreux, Annie

2017-01-01

This column provides original articles on innovations in case study teaching, assessment of the method, as well as case studies with teaching notes. The author shares the strategies and tools that teachers can use to manage a case study classroom effectively.

When to suspect tinea; a histopathologic study of 103 cases of PAS-positive tinea.

PubMed

Elbendary, Amira; Valdebran, Manuel; Gad, AbdAllah; Elston, Dirk M

2016-10-01

The histopathologic features of tinea vary widely and its diagnosis could be easily missed if the index of suspicion is not high. We aimed in this study to detect histopathologic features that could be a clue for diagnosis We retrospectively reviewed 103 cases of tinea, confirmed by Periodic acid-Schiff (PAS) staining. For each case, gender, biopsy site, and pre-biopsy suspicion were recorded. The presence or absence of 17 microscopic features was noted. Concordance between pre-biopsy and histopathologic diagnosis was noted in 57.28% of cases, suggesting that the diagnosis is often not suspected clinically. Among the histopathologic features studied, a compact stratum corneum (either uniform or forming a layer beneath a basket weave stratum corneum), parakeratosis, mild spongiosis and neutrophils in the stratum corneum and within the blood vessels were the most frequent features noted. This study suggests histopathologic clues that should prompt the pathologist to order a PAS stain, especially when diagnosis is not suspected clinically. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Mining peripheral arterial disease cases from narrative clinical notes using natural language processing.

PubMed

Afzal, Naveed; Sohn, Sunghwan; Abram, Sara; Scott, Christopher G; Chaudhry, Rajeev; Liu, Hongfang; Kullo, Iftikhar J; Arruda-Olson, Adelaide M

2017-06-01

Lower extremity peripheral arterial disease (PAD) is highly prevalent and affects millions of individuals worldwide. We developed a natural language processing (NLP) system for automated ascertainment of PAD cases from clinical narrative notes and compared the performance of the NLP algorithm with billing code algorithms, using ankle-brachial index test results as the gold standard. We compared the performance of the NLP algorithm to (1) results of gold standard ankle-brachial index; (2) previously validated algorithms based on relevant International Classification of Diseases, Ninth Revision diagnostic codes (simple model); and (3) a combination of International Classification of Diseases, Ninth Revision codes with procedural codes (full model). A dataset of 1569 patients with PAD and controls was randomly divided into training (n = 935) and testing (n = 634) subsets. We iteratively refined the NLP algorithm in the training set including narrative note sections, note types, and service types, to maximize its accuracy. In the testing dataset, when compared with both simple and full models, the NLP algorithm had better accuracy (NLP, 91.8%; full model, 81.8%; simple model, 83%; P < .001), positive predictive value (NLP, 92.9%; full model, 74.3%; simple model, 79.9%; P < .001), and specificity (NLP, 92.5%; full model, 64.2%; simple model, 75.9%; P < .001). A knowledge-driven NLP algorithm for automatic ascertainment of PAD cases from clinical notes had greater accuracy than billing code algorithms. Our findings highlight the potential of NLP tools for rapid and efficient ascertainment of PAD cases from electronic health records to facilitate clinical investigation and eventually improve care by clinical decision support. Copyright © 2016 The Authors. Published by Elsevier Inc. All rights reserved.

Case Study: Puttin' on the Ritz: How to Put Science into Cases

ERIC Educational Resources Information Center

Herreid, Clyde Freeman

2017-01-01

There are multiple ways to put science into a case. This column provides original articles on innovations in case study teaching, assessment of the method, as well as case studies with teaching notes. This month's issue discusses different ways of presenting science in case studies.

Fetal protection and potential liability: judicial application of the Pregnancy Discrimination Act and the disparate impact theory.

PubMed

Moelis, L S

1985-01-01

"Fetal vulnerability programs," which are employer attempts to protect employees' unborn fetuses from harm caused by the mothers' exposure to hazardous material in the workplace, have been challenged as a form of employment discrimination. This Note analyzes the recent judicial application of the Pregnancy Discrimination Act (PDA) and the disparate impact theory to fetal vulnerability cases. The Note also examines the business necessity defense's accommodation of legitimate employer interests. The Note concludes that a more potent business necessity defense, a stricter standard for evaluating alternative protective measures, and a judicial interpretation of the PDA which is more consistent with congressional intent are necessary for fair and reasonable resolution of these cases.

The Composer's Program Note for Newly Written Classical Music: Content and Intentions.

PubMed

Blom, Diana M; Bennett, Dawn; Stevenson, Ian

2016-01-01

In concerts of western classical music the provision of a program note is a widespread practice dating back to the 18th century and still commonly in use. Program notes tend to inform listeners and performers about historical context, composer biographical details, and compositional thinking. However, the scant program note research conducted to date reveals that program notes may not foster understanding or enhance listener enjoyment as previously assumed. In the case of canonic works, performers and listeners may already be familiar with much of the program note information. This is not so in the case of newly composed works, which formed the basis of the exploratory study reported here. This article reports the views of 17 living contemporary composers on their writing of program notes for their own works. In particular, the study sought to understand the intended recipient, role and the content of composer-written program notes. Participating composers identified three main roles for their program notes: to shape a performer's interpretation of the work; to guide, engage or direct the listener and/or performer; and as collaborative mode of communication between the composer, performer, and listener. For some composers, this collaboration was intended to result in "performative listening" in which listeners were actively engaged in bringing each composition to life. This was also described as a form of empathy that results in the co-construction of the musical experience. Overall, composers avoided giving too much personal information and they provided performers with more structural information. However, composers did not agree on whether the same information should be provided to both performers and listeners. Composers' responses problematize the view of a program note as a simple statement from writer to recipient, indicating instead a more complex set of relations at play between composer, performer, listener, and the work itself. These relations are illustrated in a model. There are implications for program note writers and readers, and for educators. Future research might seek to enhance understanding of program notes, including whether the written program note is the most effective format for communications about music.

The Composer’s Program Note for Newly Written Classical Music: Content and Intentions

PubMed Central

Blom, Diana M.; Bennett, Dawn; Stevenson, Ian

2016-01-01

In concerts of western classical music the provision of a program note is a widespread practice dating back to the 18th century and still commonly in use. Program notes tend to inform listeners and performers about historical context, composer biographical details, and compositional thinking. However, the scant program note research conducted to date reveals that program notes may not foster understanding or enhance listener enjoyment as previously assumed. In the case of canonic works, performers and listeners may already be familiar with much of the program note information. This is not so in the case of newly composed works, which formed the basis of the exploratory study reported here. This article reports the views of 17 living contemporary composers on their writing of program notes for their own works. In particular, the study sought to understand the intended recipient, role and the content of composer-written program notes. Participating composers identified three main roles for their program notes: to shape a performer’s interpretation of the work; to guide, engage or direct the listener and/or performer; and as collaborative mode of communication between the composer, performer, and listener. For some composers, this collaboration was intended to result in “performative listening” in which listeners were actively engaged in bringing each composition to life. This was also described as a form of empathy that results in the co-construction of the musical experience. Overall, composers avoided giving too much personal information and they provided performers with more structural information. However, composers did not agree on whether the same information should be provided to both performers and listeners. Composers’ responses problematize the view of a program note as a simple statement from writer to recipient, indicating instead a more complex set of relations at play between composer, performer, listener, and the work itself. These relations are illustrated in a model. There are implications for program note writers and readers, and for educators. Future research might seek to enhance understanding of program notes, including whether the written program note is the most effective format for communications about music. PMID:27881967

Extreme precipitation in the Polish Carpathians in the 20th century in the context of last 500 years

NASA Astrophysics Data System (ADS)

Limanowka, Danuta; Cebulak, Elzbieta; Pyrc, Robert

2010-05-01

Extreme weather phenomena together with their exceptional course and intensity have always been dangerous for people. In the historical documents such phenomena were marked as basic disasters. First notes about weather phenomena were made in Polish lands in the 10th century. Most information concerns floods caused by intensive rains. Using the data base created within the Millennium project, extreme precipitation cases exceeding 100 mm were analysed. In each case, the intensive precipitation was followed by a summer flood in the Polish Carpathians in the Upper Vistula River basin. Data from the period of instrumental measurements in the 20th century were studied in detail by the analysis of the frequency of occurrence and the spatial and temporal distribution. The results were referred to last 500 years. The information obtained gives approximate image of extreme precipitation in the historical times in Polish lands. All available multi-proxy data were used. Newspapers' notes concerning described phenomena from 1848-1850 published in Kraków were used to complete and verify the quality of data from the early instrumental period and also to complete the data from the period of the Second World War.

Trochanteric bursitis: the last great misnomer.

PubMed

Board, Tim N; Hughes, Simon J; Freemont, Anthony J

2014-12-05

Trochanteric bursitis has been used as a general term to describe pain around the greater trochanteric region of the hip. We hypothesised that trochanteric bursitis may not however have an inflammatory component and that accordingly, bursal inflammation has no role in lateral hip pain. This study was designed to test this hypothesis. Patients undergoing primary total hip replacement were enrolled in this prospective, case-controlled, blinded study. Twenty-five patients who met the criteria for diagnosis of trochanteric bursitis (group A) were matched with a control group of 25 patients (group B). Trochanteric bursal samples were harvested from all patients intraoperatively and sent for histological analysis for the presence of inflammation. The intraoperative appearance of the abductor tendon insertion was also noted. None of the samples showed any evidence of acute or chronic inflammatory changes. Intraoperatively, five patients (20%) in group A were noted to have thinning of the gluteus medius tendon but no macroscopic tendon tears were detected in any bursal samples. This study suggests that there is no inflammatory component to so-called trochanteric bursitis, which accordingly casts doubt on both the terminology and the existence of this condition as a separate clinical entity. Clinicians should search for an alternative cause of symptoms in such cases.

The Impact of Guided Notes on Post-Secondary Student Achievement: A Meta-Analysis

ERIC Educational Resources Information Center

Larwin, Karen H.; Larwin, David A.

2013-01-01

The common practice of using of guided notes in the post-secondary classroom is not fully appreciated or understood. In an effort to add to the existing research about this phenomenon, the current investigation expands on previously published research and one previously published meta-analysis that examined the impact of guided notes on…

Young Adult and Usual Adult Body Mass Index and Multiple Myeloma Risk: A Pooled Analysis in the International Multiple Myeloma Consortium (IMMC).

PubMed

Birmann, Brenda M; Andreotti, Gabriella; De Roos, Anneclaire J; Camp, Nicola J; Chiu, Brian C H; Spinelli, John J; Becker, Nikolaus; Benhaim-Luzon, Véronique; Bhatti, Parveen; Boffetta, Paolo; Brennan, Paul; Brown, Elizabeth E; Cocco, Pierluigi; Costas, Laura; Cozen, Wendy; de Sanjosé, Silvia; Foretová, Lenka; Giles, Graham G; Maynadié, Marc; Moysich, Kirsten; Nieters, Alexandra; Staines, Anthony; Tricot, Guido; Weisenburger, Dennis; Zhang, Yawei; Baris, Dalsu; Purdue, Mark P

2017-06-01

Background: Multiple myeloma risk increases with higher adult body mass index (BMI). Emerging evidence also supports an association of young adult BMI with multiple myeloma. We undertook a pooled analysis of eight case-control studies to further evaluate anthropometric multiple myeloma risk factors, including young adult BMI. Methods: We conducted multivariable logistic regression analysis of usual adult anthropometric measures of 2,318 multiple myeloma cases and 9,609 controls, and of young adult BMI (age 25 or 30 years) for 1,164 cases and 3,629 controls. Results: In the pooled sample, multiple myeloma risk was positively associated with usual adult BMI; risk increased 9% per 5-kg/m 2 increase in BMI [OR, 1.09; 95% confidence interval (CI), 1.04-1.14; P = 0.007]. We observed significant heterogeneity by study design ( P = 0.04), noting the BMI-multiple myeloma association only for population-based studies ( P trend = 0.0003). Young adult BMI was also positively associated with multiple myeloma (per 5-kg/m 2 ; OR, 1.2; 95% CI, 1.1-1.3; P = 0.0002). Furthermore, we observed strong evidence of interaction between younger and usual adult BMI ( P interaction <0.0001); we noted statistically significant associations with multiple myeloma for persons overweight (25-<30 kg/m 2 ) or obese (30+ kg/m 2 ) in both younger and usual adulthood (vs. individuals consistently <25 kg/m 2 ), but not for those overweight or obese at only one time period. Conclusions: BMI-associated increases in multiple myeloma risk were highest for individuals who were overweight or obese throughout adulthood. Impact: These findings provide the strongest evidence to date that earlier and later adult BMI may increase multiple myeloma risk and suggest that healthy BMI maintenance throughout life may confer an added benefit of multiple myeloma prevention. Cancer Epidemiol Biomarkers Prev; 26(6); 876-85. ©2017 AACR . ©2017 American Association for Cancer Research.

High times, low sats: diffuse pulmonary infiltrates associated with chronic synthetic cannabinoid use.

PubMed

Alhadi, Sameir; Tiwari, Anupama; Vohra, Rais; Gerona, Roy; Acharya, Janak; Bilello, Kathryn

2013-06-01

In recent years, cases of severe adverse effects from recreational use of synthetic cannabinoids (SC) have established that these agents represent a novel toxicologic hazard. A 21-year-old male presenting as a vehicular trauma victim was noted with diffuse pulmonary infiltrates related to chronic inhalation of multiple synthetic cannabinoid-containing products. Chest imaging revealed bilateral, subacute lung infiltrates; histopathological analysis of bronchial and alveolar tissues revealed an inflammatory process. An extensive workup failed to identify infectious, malignant, autoimmune, or hematologic causes of the syndrome, and toxicological analysis of the blood and body fluids confirmed the presence of multiple synthetic cannabinoids and metabolites. The patient recovered after an 8-day ICU course, wherein he received antibiotics, steroids, and mechanical ventilation. This case contributes to the currently evolving knowledge about SC agents, adding a rarely described pulmonary complication to the growing list of adverse effects associated with these products.

‘Shell shock’ Revisited: An Examination of the Case Records of the National Hospital in London

PubMed Central

Linden, Stefanie Caroline; Jones, Edgar

2014-01-01

During the First World War the National Hospital for the Paralysed and Epileptic, in Queen Square, London, then Britain’s leading centre for neurology, took a key role in the treatment and understanding of shell shock. This paper explores the case notes of all 462 servicemen who were admitted with functional neurological disorders between 1914 and 1919. Many of these were severe or chronic cases referred to the National Hospital because of its acknowledged expertise and the resources it could call upon. Biographical data was collected together with accounts of the patient’s military experience, his symptoms, diagnostic interpretations and treatment outcomes. Analysis of the notes showed that motor syndromes (loss of function or hyperkinesias), often combined with somato-sensory loss, were common presentations. Anxiety and depression as well as vegetative symptoms such as sweating, dizziness and palpitations were also prevalent among this patient population. Conversely, psychogenic seizures were reported much less frequently than in comparable accounts from German tertiary referral centres. As the war unfolded the number of physicians who believed that shell shock was primarily an organic disorder fell as research failed to find a pathological basis for its symptoms. However, little agreement existed among the Queen Square doctors about the fundamental nature of the disorder and it was increasingly categorised as functional disorder or hysteria. PMID:25284893

The conversion to electronic hospital notes at Mayo Clinic. Overcoming barriers and challenges.

PubMed

Andreen, Debra L; Dobie, Linda J; Jasperson, Jan C; Lucas, Thomas A; Wubbenhorst, Cathryn L

2010-01-01

This article describes the conversion to electronic hospital notes at a large, multi-specialty group practice: Mayo Clinic in Rochester, Minnesota. Because of the size of the institution and the barriers to the adoption of electronic notes, the process was a gradual one that took several years. Making a convincing case for change to institutional leaders and maintaining their support was crucial to success. Equally vital was the careful investigation of user requirements and the development of software features that allowed providers to complete their notes quickly in the fast-paced hospital environment. Care providers discovered the value of having immediate access to legible hospital notes throughout the campus and from remote locations.

A polyphonic acoustic vortex and its complementary chords

NASA Astrophysics Data System (ADS)

Wilson, C.; Padgett, M. J.

2010-02-01

Using an annular phased array of eight loudspeakers, we generate sound beams that simultaneously contain phase singularities at a number of different frequencies. These frequencies correspond to different musical notes and the singularities can be set to overlap along the beam axis, creating a polyphonic acoustic vortex. Perturbing the drive amplitudes of the speakers means that the singularities no longer overlap, each note being nulled at a slightly different lateral position, where the volume of the other notes is now nonzero. The remaining notes form a tri-note chord. We contrast this acoustic phenomenon to the optical case where the perturbation of a white light vortex leads to a spectral spatial distribution.

Development and evaluation of 'briefing notes' as a novel knowledge translation tool to aid the implementation of sex/gender analysis in systematic reviews: a pilot study.

PubMed

Doull, Marion; Welch, Vivian; Puil, Lorri; Runnels, Vivien; Coen, Stephanie E; Shea, Beverley; O'Neill, Jennifer; Borkhoff, Cornelia; Tudiver, Sari; Boscoe, Madeline

2014-01-01

There is increasing recognition of sex/gender differences in health and the importance of identifying differential effects of interventions for men and women. Yet, to whom the research evidence does or does not apply, with regard to sex/gender, is often insufficiently answered. This is also true for systematic reviews which synthesize results of primary studies. A lack of analysis and reporting of evidence on sex/gender raises concerns about the applicability of systematic reviews. To bridge this gap, this pilot study aimed to translate knowledge about sex/gender analysis (SGA) into a user-friendly 'briefing note' format and evaluate its potential in aiding the implementation of SGA in systematic reviews. Our Sex/Gender Methods Group used an interactive process to translate knowledge about sex/gender into briefing notes, a concise communication tool used by policy and decision makers. The briefing notes were developed in collaboration with three Cochrane Collaboration review groups (HIV/AIDS, Hypertension, and Musculoskeletal) who were also the target knowledge users of the briefing notes. Briefing note development was informed by existing systematic review checklists, literature on sex/gender, in-person and virtual meetings, and consultation with topic experts. Finally, we held a workshop for potential users to evaluate the notes. Each briefing note provides tailored guidance on considering sex/gender to reviewers who are planning or conducting systematic reviews and includes the rationale for considering sex/gender, with examples specific to each review group's focus. Review authors found that the briefing notes provided welcome guidance on implementing SGA that was clear and concise, but also identified conceptual and implementation challenges. Sex/gender briefing notes are a promising knowledge translation tool. By encouraging sex/gender analysis and equity considerations in systematic reviews, the briefing notes can assist systematic reviewers in ensuring the applicability of research evidence, with the goal of improved health outcomes for diverse populations.

Remarks about the prognosis in case of antenatal diagnosis of gastroschisis.

PubMed

Poulain, P; Milon, J; Frémont, B; Proudhon, J F; Odent, S; Babut, J M; Le Marec, B; Grall, J Y; Giraud, J R

1994-05-18

We report our experience of 15 cases of gastroschisis which occurred between 1981 and 1993. All but one were diagnosed antenatally by ultrasound between 16 and 32 weeks of pregnancy. We made a termination of the pregnancy in 3 cases, for multiple malformations in 2 cases and one case of very early premature rupture of the membranes (PROM). When checked (11 cases), the karyotype was normal. We made a cesarean section in 11 cases: the indication was a complication for 6 (fetal distress, PROM, polyhydramnios, large dilatation of the gut). We noted growth retardation in 7 newborns and prematurity in 5/12 (mean gestational age of 36.8 weeks). The preoperative study of the gut noted 5 cases with intestinal damage and one case of complete necrosis of the gut. The global prognosis is not as good as usual, with a perinatal mortality of 41.6% (5/12). We discuss this latter point and examine the literature.

OpenNotes in oncology: oncologists' perceptions and a baseline of the content and style of their clinician notes.

PubMed

Alpert, Jordan M; Morris, Bonny B; Thomson, Maria D; Matin, Khalid; Geyer, Charles E; Brown, Richard F

2018-03-27

Patients' ability to access their provider's clinical notes (OpenNotes) has been well received and has led to greater transparency in health systems. However, the majority of this research has occurred in primary care, and little is known about how patients' access to notes is used in oncology. This study aims to understand oncologists' perceptions of OpenNotes, while also establishing a baseline of the linguistic characteristics and patterns used in notes.Data from 13 in-depth, semistructured interviews with oncologists were thematically analyzed. In addition, the Linguistic Inquiry and Word Count (LIWC) program evaluated over 200 clinician notes, measuring variables encompassing emotions, thinking styles, social concerns, and parts of speech. Analysis from LIWC revealed that notes contained negative emotional tone, low authenticity, high clout, and high analytical writing. Oncologists' use of stigmatized and sensitive words, such as "obese" and "distress," was mainly absent. Themes from interviews revealed that oncologists were uncertain about patients' access to their notes and may edit their notes to avoid problematic terminology. Despite their reluctance to embrace OpenNotes, they envisioned opportunities for an improved patient-provider relationship due to patients initiating interactions from viewing notes.Oncologists believe notes are not intended for patients and altering their content may compromise the integrity of the note. This study established a baseline for further study to compare notes pre-implementation to post-implementation. Further analysis will clarify whether oncologists are altering the style and content of their notes and determine the presence of patient-centered language.

Mobile phone use and risk for intracranial tumors and salivary gland tumors - A meta-analysis.

PubMed

Bortkiewicz, Alicja; Gadzicka, Elżbieta; Szymczak, Wiesław

2017-02-21

Results of epidemiological studies on the association between use of mobile phone and brain cancer are ambiguous, as well as the results of 5 meta-analysis studies published to date. Since the last meta-analysis (2009), new case-control studies have been published, which theoretically could affect the conclusions on this relationship. Therefore, we decided to perform a new meta-analysis. We conducted a systematic review of multiple electronic data bases for relevant publications. The inclusion criteria were: original papers, case-control studies, published till the end of March 2014, measures of association (point estimates as odds ratio and confidence interval of the effect measured), data on individual exposure. Twenty four studies (26 846 cases, 50 013 controls) were included into the meta-analysis. A significantly higher risk of an intracranial tumor (all types) was noted for the period of mobile phone use over 10 years (odds ratio (OR) = 1.324, 95% confidence interval (CI): 1.028-1.704), and for the ipsilateral location (OR = 1.249, 95% CI: 1.022-1.526). The results support the hypothesis that long-term use of mobile phone increases risk of intracranial tumors, especially in the case of ipsilateral exposure. Further studies are needed to confirm this relationship. Int J Occup Med Environ Health 2017;30(1)27-43. This work is available in Open Access model and licensed under a CC BY-NC 3.0 PL license.

Surgical implications and variability in the use of the flat epithelial atypia diagnosis on breast biopsy specimens.

PubMed

Samples, Laura S; Rendi, Mara H; Frederick, Paul D; Allison, Kimberly H; Nelson, Heidi D; Morgan, Thomas R; Weaver, Donald L; Elmore, Joann G

2017-08-01

Flat epithelial atypia (FEA) is a relatively new diagnostic term with uncertain clinical significance for surgical management. Any implied risk of invasive breast cancer associated with FEA is contingent upon diagnostic reproducibility, yet little is known regarding its use. Pathologists in the Breast Pathology Study interpreted one of four 60-case test sets, one slide per case, constructed from 240 breast biopsy specimens. An electronic data form with standardized diagnostic categories was used; participants were instructed to indicate all diagnoses present. We assessed participants' use of FEA as a diagnostic term within: 1) each test set; 2) 72 cases classified by reference as benign without FEA; and 3) six cases classified by reference as FEA. 115 pathologists participated, providing 6900 total independent assessments. Notation of FEA ranged from 0% to 35% of the cases interpreted, with most pathologists noting FEA on 4 or more test cases. At least one participant noted FEA in 34 of the 72 benign non-FEA cases. For the 6 reference FEA cases, participant agreement with the case reference FEA diagnosis ranged from 17% to 52%; diagnoses noted by participating pathologists for these FEA cases included columnar cell hyperplasia, usual ductal hyperplasia, atypical lobular hyperplasia, and atypical ductal hyperplasia. We observed wide variation in the diagnosis of FEA among U.S. pathologists. This suggests that perceptions of diagnostic criteria and any implied risk associated with FEA may also vary. Surgical excision following a core biopsy diagnosis of FEA should be reconsidered and studied further. Copyright © 2017 Elsevier Ltd. All rights reserved.

In Search of Social Translucence: An Audit Log Analysis of Handoff Documentation Views and Updates.

PubMed

Jiang, Silis Y; Hum, R Stanley; Vawdrey, David; Mamykina, Lena

2015-01-01

Communication and information sharing are critical parts of teamwork in the hospital; however, achieving open and fluid communication can be challenging. Finding specific patient information within documentation can be difficult. Recent studies on handoff documentation tools show that resident handoff notes are increasingly used as an alternative information source by non-physician clinicians. Previous findings also show that residents have become aware of this unintended use. This study investigated the alignment of resident note updating patterns and team note viewing patterns based on usage log data of handoff notes. Qualitative interviews with clinicians were used to triangulate findings based on the log analysis. The study found that notes that were frequently updated were viewed significantly more frequently than notes updated less often (p < 2.2 × 10(-16)). Almost 44% of all notes had aligned frequency of views and updates. The considerable percentage (56%) of mismatched note utilization suggests an opportunity for improvement.

Information theory analysis of patterns of modulation in the advertisement call of the male bullfrog, Rana catesbeianaa)

PubMed Central

Suggs, Dianne N.; Simmons, Andrea Megela

2005-01-01

Male bullfrogs often amplitude modulate the envelopes of the individual notes (croaks) in their multinote advertisement calls. These amplitude modulations change the envelope of the note from smooth and unmodulated to one with varying numbers of modulations. A Markov analysis shows the pattern of change in the envelope to be highly ordered, but not completely so (semi-Markovian). Three simple rules govern the presence or absence of modulations in individual notes. These rules are (1) all calls begin with an unmodulated note; (2) the first note to be modulated will contain only one modulation; and (3) when a change in modulation occurs from one note to the next, it does so with an increase or a decrease of one modulation only. The addition of modulations is correlated with an increase in note duration. Physiologically, the presence of modulations might increase the precision of temporal coding of note periodicities in the central auditory system. PMID:15898673

Discerning suicide in drug intoxication deaths: Paucity and primacy of suicide notes and psychiatric history.

PubMed

Rockett, Ian R H; Caine, Eric D; Connery, Hilary S; D'Onofrio, Gail; Gunnell, David J; Miller, Ted R; Nolte, Kurt B; Kaplan, Mark S; Kapusta, Nestor D; Lilly, Christa L; Nelson, Lewis S; Putnam, Sandra L; Stack, Steven; Värnik, Peeter; Webster, Lynn R; Jia, Haomiao

2018-01-01

A paucity of corroborative psychological and psychiatric evidence may be inhibiting detection of drug intoxication suicides in the United States. We evaluated the relative importance of suicide notes and psychiatric history in the classification of suicide by drug intoxication versus firearm (gunshot wound) plus hanging/suffocation-the other two major, but overtly violent methods. This observational multilevel (individual/county), multivariable study employed a generalized linear mixed model (GLMM) to analyze pooled suicides and undetermined intent deaths, as possible suicides, among the population aged 15 years and older in the 17 states participating in the National Violent Death Reporting System throughout 2011-2013. The outcome measure was relative odds of suicide versus undetermined classification, adjusted for demographics, precipitating circumstances, and investigation characteristics. A suicide note, prior suicide attempt, or affective disorder was documented in less than one-third of suicides and one-quarter of undetermined deaths. The prevalence gaps were larger among drug intoxication cases than gunshot/hanging cases. The latter were more likely than intoxication cases to be classified as suicide versus undetermined manner of death (adjusted odds ratio [OR], 41.14; 95% CI, 34.43-49.15), as were cases documenting a suicide note (OR, 33.90; 95% CI, 26.11-44.05), prior suicide attempt (OR, 2.42; 95% CI, 2.11-2.77), or depression (OR, 1.61; 95% CI, 1.38 to 1.88), or bipolar disorder (OR, 1.41; 95% CI, 1.10-1.81). Stratification by mechanism/cause intensified the association between a note and suicide classification for intoxication cases (OR, 45.43; 95% CI, 31.06-66.58). Prior suicide attempt (OR, 2.64; 95% CI, 2.19-3.18) and depression (OR, 1.48; 95% CI, 1.17-1.87) were associated with suicide classification in intoxication but not gunshot/hanging cases. Without psychological/psychiatric evidence contributing to manner of death classification, suicide by drug intoxication in the US is likely profoundly under-reported. Findings harbor adverse implications for surveillance, etiologic understanding, and prevention of suicides and drug deaths.

Discerning suicide in drug intoxication deaths: Paucity and primacy of suicide notes and psychiatric history

PubMed Central

Caine, Eric D.; Connery, Hilary S.; D’Onofrio, Gail; Gunnell, David J.; Miller, Ted R.; Nolte, Kurt B.; Kaplan, Mark S.; Kapusta, Nestor D.; Lilly, Christa L.; Nelson, Lewis S.; Putnam, Sandra L.; Stack, Steven; Värnik, Peeter; Webster, Lynn R.; Jia, Haomiao

2018-01-01

Objective A paucity of corroborative psychological and psychiatric evidence may be inhibiting detection of drug intoxication suicides in the United States. We evaluated the relative importance of suicide notes and psychiatric history in the classification of suicide by drug intoxication versus firearm (gunshot wound) plus hanging/suffocation—the other two major, but overtly violent methods. Methods This observational multilevel (individual/county), multivariable study employed a generalized linear mixed model (GLMM) to analyze pooled suicides and undetermined intent deaths, as possible suicides, among the population aged 15 years and older in the 17 states participating in the National Violent Death Reporting System throughout 2011–2013. The outcome measure was relative odds of suicide versus undetermined classification, adjusted for demographics, precipitating circumstances, and investigation characteristics. Results A suicide note, prior suicide attempt, or affective disorder was documented in less than one-third of suicides and one-quarter of undetermined deaths. The prevalence gaps were larger among drug intoxication cases than gunshot/hanging cases. The latter were more likely than intoxication cases to be classified as suicide versus undetermined manner of death (adjusted odds ratio [OR], 41.14; 95% CI, 34.43–49.15), as were cases documenting a suicide note (OR, 33.90; 95% CI, 26.11–44.05), prior suicide attempt (OR, 2.42; 95% CI, 2.11–2.77), or depression (OR, 1.61; 95% CI, 1.38 to 1.88), or bipolar disorder (OR, 1.41; 95% CI, 1.10–1.81). Stratification by mechanism/cause intensified the association between a note and suicide classification for intoxication cases (OR, 45.43; 95% CI, 31.06–66.58). Prior suicide attempt (OR, 2.64; 95% CI, 2.19–3.18) and depression (OR, 1.48; 95% CI, 1.17–1.87) were associated with suicide classification in intoxication but not gunshot/hanging cases. Conclusions Without psychological/psychiatric evidence contributing to manner of death classification, suicide by drug intoxication in the US is likely profoundly under-reported. Findings harbor adverse implications for surveillance, etiologic understanding, and prevention of suicides and drug deaths. PMID:29320540

Notes on Linguistics, 1990.

ERIC Educational Resources Information Center

Notes on Linguistics, 1990

1990-01-01

This document consists of the four issues of "Notes on Linguistics" published during 1990. Articles in the four issues include: "The Indians Do Say Ugh-Ugh" (Howard W. Law); "Constraints of Relevance, A Key to Particle Typology" (Regina Blass); "Whatever Happened to Me? (An Objective Case Study)" (Aretta…

Preinjury and postinjury running analysis along with measurements of strength and tendon length in a patient with a surgically repaired Achilles tendon rupture.

PubMed

Silbernagel, Karin Grävare; Willy, Richard; Davis, Irene

2012-06-01

Case report. The Achilles tendon is the most frequently ruptured tendon, and the incidence of Achilles tendon rupture has increased in the last decade. The rupture generally occurs without any preceding warning signs, and therefore preinjury data are seldom available. This case represents a unique opportunity to compare preinjury running mechanics with postinjury evaluation in a patient with an Achilles tendon rupture. A 23-year-old female sustained a right complete Achilles tendon rupture while playing soccer. Running mechanics data were collected preinjury, as she was a healthy participant in a study on running analysis. In addition, patient-reported symptoms, physical activity level, strength, ankle range of motion, heel-rise ability, Achilles tendon length, and running kinetics were evaluated 1 year after surgical repair. During running, greater ankle dorsiflexion and eversion and rearfoot abduction were noted on the involved side postinjury when compared to preinjury data. In addition, postinjury, the magnitude of all kinetics data was lower on the involved limb when compared to the uninvolved limb. The involved side displayed differences in strength, ankle range of motion, heel rise, and tendon length when compared to the uninvolved side 1 year after injury. Despite a return to normal running routine and reports of only minor limitations with running, considerable changes were noted in running biomechanics 1 year after injury. Calf muscle weakness and Achilles tendon elongation were also found when comparing the involved and uninvolved sides.

Discovering Peripheral Arterial Disease Cases from Radiology Notes Using Natural Language Processing

PubMed Central

Savova, Guergana K.; Fan, Jin; Ye, Zi; Murphy, Sean P.; Zheng, Jiaping; Chute, Christopher G.; Kullo, Iftikhar J.

2010-01-01

As part of the Electronic Medical Records and Genomics Network, we applied, extended and evaluated an open source clinical Natural Language Processing system, Mayo’s Clinical Text Analysis and Knowledge Extraction System, for the discovery of peripheral arterial disease cases from radiology reports. The manually created gold standard consisted of 223 positive, 19 negative, 63 probable and 150 unknown cases. Overall accuracy agreement between the system and the gold standard was 0.93 as compared to a named entity recognition baseline of 0.46. Sensitivity for the positive, probable and unknown cases was 0.93–0.96, and for the negative cases was 0.72. Specificity and negative predictive value for all categories were in the 90’s. The positive predictive value for the positive and unknown categories was in the high 90’s, for the negative category was 0.84, and for the probable category was 0.63. We outline the main sources of errors and suggest improvements. PMID:21347073

Analysis of Tonguing and Blowing Actions During Clarinet Performance.

PubMed

Pàmies-Vilà, Montserrat; Hofmann, Alex; Chatziioannou, Vasileios

2018-01-01

Articulation on the clarinet is achieved by a combination of precise actions taking place inside the player's mouth. With the aim to analyse the effects of tonguing and blowing actions during playing, several physical variables are measured and parameters related to articulation are studied. Mouth pressure, mouthpiece pressure and reed displacement are recorded in an experiment with clarinet players to evaluate the influence of the player's actions on the selected parameters and on the sound. The results show that different combinations of tongue and blowing actions are used during performance. Portato and legato playing show constant blowing throughout the musical phrase, which varies according to the dynamic level. In portato, short tongue-reed interaction is used homogeneously among players and playing conditions. In staccato playing, where the tongue-reed contact is longer, the mouth pressure is reduced significantly between notes. Such a mouth-pressure decrease might be used to stop the note in slow staccato playing. It is hereby shown that when the note is stopped by the action of the tongue both the attack and release transients are shorter compared to the case where the vibration of the reed is stopped by a decrease of mouth pressure.

Notes on Piezoelectricity

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

Redondo, Antonio

These notes provide a pedagogical discussion of the physics of piezoelectricity. The exposition starts with a brief analysis of the classical (continuum) theory of piezoelectric phenomena in solids. The main subject of the notes is, however, a quantum mechanical analysis. We first derive the Frohlich Hamiltonian as part of the description of the electron-phonon interaction. The results of this analysis are then employed to derive the equations of piezoelectricity. A couple of examples with the zinc blende and and wurtzite structures are presented at the end

A retrospective study of 100 cases of feline distal aortic thromboembolism: 1977-1993.

PubMed

Laste, N J; Harpster, N K

1995-01-01

The medical records of 100 cats with distal aortic thromboembolism were reviewed. The average age was 7.7 years, with the neutered male being the most common signalment (63%). Evidence of preexisting cardiac disease was noted in 11% of the cases. A murmur or arrhythmia was noted in 57% of the cases on presentation. Frequent laboratory abnormalities included elevations in blood glucose, alanine aminotransferase, aspartate aminotransferase, blood urea nitrogen, and creatinine. Radiographic and electrocardiographic abnormalities were common (89% and 85%, respectively). The most frequent, underlying disease was hypertrophic feline cardiomyopathy (58%), with the left atrial size (as measured by M-mode) significantly increased in the majority of cases (mean left atrial-to-aortic ratio, 2.08). The average, long-term survival in the 37% of cases which survived the initial thromboembolic episode was 11.5 months. The remaining cases either died (28%) or were euthanized (35%).

Sanctions for Reporters Who Refuse to Disclose Sources in Libel Cases.

ERIC Educational Resources Information Center

Mehra, Achal

1983-01-01

Notes that the courts have specific sanctions under the "Federal Rules of Civil Procedure" to ensure discovery in libel and invasion of privacy cases. Examines media-related cases in which courts have used these sanctions and relates them to nonmedia cases. (FL)

Is daily shaving of axillary and pubic hair a feature of suicide in the Muslim community?

PubMed

Demirci, Serafettin; Dogan, Kamil Hakan; Erkol, Zerrin; Deniz, Idris

2008-12-01

In the Islamic context, "fitrah" refers to humanity's innate disposition toward virtue and the ability to differentiate between right and wrong. A common quote regarding fitrah, from the Prophet is "The fitrah consists of 5 things: circumcision, trimming the moustache, cutting the nails, plucking the armpit hairs, and shaving the pubic hairs."In this study, our aim was to determine the status of axillary and pubic shaving in medicolegal death cases that took place in the Konya Province of Turkey and to evaluate the relationship with the origin of suicide. Of 2850 medicolegal death cases, 206 (7.2%) were of suicidal origin. It was observed that the average age in the cases of suicidal origin was 36.76 +/- 17.72 years, and 146 of 206 cases (70.9%) were men. As a method of suicide, hanging was the chosen method in 100 cases (48.5%), whereas firearm injuries occurred in 54 cases (26.2%), and intoxication was involved in 37 cases (18.0%). Daily axillary and pubic shaving was observed in 26 of 2644 (1.0%) death cases that occurred with nonsuicidal reasons, but in 65 of 206 were (31.6%) suicidal cases. Because suicidal notes were present in 25 (12.1%) of all of the suicidal cases, the ratio of daily axillary and pubic shaving was significantly higher than that of the suicidal notes.In investigating the cases of suicidal origin for medicolegal purposes, evidence showing that this action was committed by the victim, the presence of a suicide note at the death scene and, a history of a previous suicidal attempt, it was thought that the presence of daily axillary and pubic shaving on external examination of the victim's body, when of Muslim faith, could also be considered a feature of suicide.

Meta-analysis: Does garlic intake reduce risk of gastric cancer?

PubMed

Kodali, R T; Eslick, Guy D

2015-01-01

In the past 2 decades, various epidemiological studies investigated whether garlic can positively modify the risk of gastric cancer. Garlic contains numerous sulfide compounds, including diallyl trisulfide, which have anticarcinogenic properties. We conducted a meta-analysis to determine if garlic intake reduces the risk of gastric cancer. An electronic search of MEDLINE, PubMed, and EMBASE to June 2014 was completed. There were 14 case control studies, 2 randomized controlled studies, and 1 cohort study that fulfilled our inclusion criteria. We used a random effects model to calculate pooled odds ratios (OR) and 95% confidence intervals (CIs) for risk of gastric cancer with garlic consumption. Meta-analysis of a total of 8,621 cases and 14,889 controls was conducted. Significant variability in duration of garlic intake and reference categories for amount of intake was noted. High, low, and any garlic intake were all associated with reduced risk of gastric cancer. High intake had the most significant risk reduction, OR = 0.49 (95% CI: 0.38-0.62). Heterogeneity was low (I² = 30.85, P = 0.17). A more modest risk reduction was associated with low intake, OR = 0.75 (95% CI: 0.58-0.97). Half of the studies did not separate garlic intake into high or low amounts, intake was only noted as consumption vs. non-consumption. Any amount of consumption still showed a risk reduction similar to low intake, OR = 0.77 (95% CI: 0.60-1.00). Low and any amount of consumption showed moderate heterogeneity (58% and 45%, respectively). Garlic intake appears to be associated with reduced risk of gastric cancer. Further high quality studies are required to confirm this finding and to assess the amount of garlic that needs to be consumed for protective effect.

The "Hefferline Notes": B. F. Skinner's First Public Exposition of His Analysis of Verbal Behavior

ERIC Educational Resources Information Center

Knapp, Terry J.

2009-01-01

B. F. Skinner's first public exposition of his analysis of verbal behavior was the "Hefferline Notes" (1947a), a written summary of a course Skinner taught at Columbia University during the summer of 1947 just prior to his presentation of the William James Lectures at Harvard University in the fall. The Notes are significant because they display…

Extensor Pollicis Longus Injury in Addition to De Quervain’s with Text Messaging on Mobile Phones

PubMed Central

Kumar, Bhaskaranand; Bhat, Anil K; Venugopal, Anand

2014-01-01

Objective: To do a clinical and ultrasonic evaluation of subjects with thumb pain with text messaging. Background: Thumbs are commonly used for text messaging, which are not as well designed for fine manipulative or dexterous work. Repetitive use as in text messaging can lead to the injury to the tendons of the thumb. Materials and Methods: Ninety eight students with symptoms of Repetitive Strain Type of injuries of the thumb were selected from a survey and evaluated both clinically and by ultrasound analysis of the musculotendinous unit of the thumb to note changes due to excessive use of the mobile phone. Age and sex matched controls were also subjected to ultrasound evaluation. Results: Clinical examination showed positive Finkelstein test in 40% of the cases, significant reduction in the lateral and tip pinch strengths in the cases. Ultrasound detected changes in the first and the third compartments in 19% of the cases. Conclusion: Isolated cases of pain in the thumb have been reported but this study noted changes both clinically and by ultrasound in the tendons of the thumb. These changes should be taken as warning signs of possible subclinical changes taking place in the soft tissues of the thumb in these subjects due to repetitive use of mobile phones and thus, making them prone for developing painful Musculoskeletal Disorders. Application: Repetitive use of mobile phones for text messaging can lead to the damage of Extensor pollicis longus of the thumb in addition to the tendons of the first compartment of the wrist. PMID:25584249

Using natural language processing for identification of herpes zoster ophthalmicus cases to support population-based study.

PubMed

Zheng, Chengyi; Luo, Yi; Mercado, Cheryl; Sy, Lina; Jacobsen, Steven J; Ackerson, Brad; Lewin, Bruno; Tseng, Hung Fu

2018-06-19

Diagnosis codes are inadequate for accurately identifying herpes zoster ophthalmicus (HZO). There is significant lack of population-based studies on HZO due to the high expense of manual review of medical records. To assess whether HZO can be identified from the clinical notes using natural language processing (NLP). To investigate the epidemiology of HZO among HZ population based on the developed approach. A retrospective cohort analysis. A total of 49,914 southern California residents aged over 18 years, who had a new diagnosis of HZ. An NLP-based algorithm was developed and validated with the manually curated validation dataset (n=461). The algorithm was applied on over 1 million clinical notes associated with the study population. HZO versus non-HZO cases were compared by age, sex, race, and comorbidities. We measured the accuracy of NLP algorithm. NLP algorithm achieved 95.6% sensitivity and 99.3% specificity. Compared to the diagnosis codes, NLP identified significant more HZO cases among HZ population (13.9% versus 1.7%). Compared to the non-HZO group, the HZO group was older, had more males, had more Whites, and had more outpatient visits. We developed and validated an automatic method to identify HZO cases with high accuracy. As one of the largest studies on HZO, our finding emphasizes the importance of preventing HZ in the elderly population. This method can be a valuable tool to support population-based studies and clinical care of HZO in the era of big data. This article is protected by copyright. All rights reserved.

The Epidemiological and Molecular Aspects of Influenza H5N1 Viruses at the Human-Animal Interface in Egypt

PubMed Central

Kayali, Ghazi; Webby, Richard J.; Ducatez, Mariette F.; El Shesheny, Rabeh A.; Kandeil, Ahmed M.; Govorkova, Elena A.; Mostafa, Ahmed; Ali, Mohamed A.

2011-01-01

With 119 confirmed cases between March 2006 and December 2010, Egypt ranks second among countries reporting human H5N1 influenza virus infections. In 2009–2010, Egypt reported 68 new human cases and became the new epicenter for H5N1 infections. We conducted an epidemiological and molecular analysis in order to better understand the situation in Egypt. The onset of new cases peaked annually during the winter and spring months, with majority of cases reported in the Nile Delta region. Most cases were less than 18 years old (62%) and females (60%). The overall case-fatality rate was 34% and significantly increased by age. There was a significant difference between the case-fatality rates among females and males. We observed a significant drop (p = 0.004) in case fatality rate in 2009 (10%) as compared to higher rates (36%–56%) in other years. Hospitalization within 2 or 3 days after onset of symptoms significantly decreased mortality. Molecular analysis showed that variations do occur among viruses isolated from birds as well as from humans in Egypt, and these mutations were especially noted in 2009 viruses. As the epidemiological profile of Egyptian cases differs from other countries, there is an urgent need to conduct prospective studies to enhance our understanding of incidence, prevalence, and determinants of virulence of human infections with avian H5N1 influenza viruses. PMID:21445292

Cluster analysis of Scedosporium boydii infections in a single hospital.

PubMed

Bernhardt, Anne; Seibold, Michael; Rickerts, Volker; Tintelnot, Kathrin

2015-10-01

Scedosporiosis is a rare, but often fatal mycotic infection occurring in immunosuppressed as well as in immunocompetent patients. Over a period of 14 months, Scedosporium boydii isolates were sent to our reference laboratory from six immunocompetent patients treated at a single hospital in Germany. In analogy to the EORTC/MSG criteria, four patients were classified as proven invasive scedosporiosis cases, and two patients as probable or possible cases. Of note, in five patients scedosporiosis was diagnosed between 1 and 14 months (median 5.0 months) after cardiac surgery. Despite antimycotic treatment two patients died, and three were lost for long-term follow-up. All clinical S. boydii isolates were characterized by molecular analysis using multilocus sequence typing (MLST). An identical MLST type was found in five patients who had been treated in the surgery unit, suggesting a link between these infections. The source of S. boydii has not been identified. Within an observation period of 2 years before and after this cluster of infections no further cases of scedosporiosis were reported from this hospital. Copyright © 2015 Elsevier GmbH. All rights reserved.

Prediction of Welded Joint Strength in Plasma Arc Welding: A Comparative Study Using Back-Propagation and Radial Basis Neural Networks

NASA Astrophysics Data System (ADS)

Srinivas, Kadivendi; Vundavilli, Pandu R.; Manzoor Hussain, M.; Saiteja, M.

2016-09-01

Welding input parameters such as current, gas flow rate and torch angle play a significant role in determination of qualitative mechanical properties of weld joint. Traditionally, it is necessary to determine the weld input parameters for every new welded product to obtain a quality weld joint which is time consuming. In the present work, the effect of plasma arc welding parameters on mild steel was studied using a neural network approach. To obtain a response equation that governs the input-output relationships, conventional regression analysis was also performed. The experimental data was constructed based on Taguchi design and the training data required for neural networks were randomly generated, by varying the input variables within their respective ranges. The responses were calculated for each combination of input variables by using the response equations obtained through the conventional regression analysis. The performances in Levenberg-Marquardt back propagation neural network and radial basis neural network (RBNN) were compared on various randomly generated test cases, which are different from the training cases. From the results, it is interesting to note that for the above said test cases RBNN analysis gave improved training results compared to that of feed forward back propagation neural network analysis. Also, RBNN analysis proved a pattern of increasing performance as the data points moved away from the initial input values.

A Note on the Heterogeneous Choice Model

ERIC Educational Resources Information Center

Rohwer, Goetz

2015-01-01

The heterogeneous choice model (HCM) has been proposed as an extension of the standard logit and probit models, which allows taking into account different error variances of explanatory variables. In this note, I show that in an important special case, this model is just another way to specify an interaction effect.

Electronic Nursing Notes: A Case Study on Interdisciplinary Collaboration

ERIC Educational Resources Information Center

Howard, Elizabeth V.; Teets, Janet

2006-01-01

In an interdisciplinary collaboration between the Computer & Information Technology (CIT) and Nursing (NSG) Departments at the Middletown and Hamilton regional campuses of Miami University (of Ohio), student team members created a Web-based application to create Electronic Nursing Notes. Students from the two departments worked together to…

[Surgical treatment of gynecomastia].

PubMed

Târcoveanu, E; Lupaşcu, C; Vasilescu, A; Moldovanu, R; Ichim, Mihaela; Georgescu, St; Niculescu, D; Dănilă, N; Dimofte, G; Anton, Raluca; Crumpei, Felicia; Florea, Niculina; Ungureanu, Cristina

2008-01-01

Gynecomastia describes a benign increase of the mammary gland in men. When medical treatment fails, the surgical procedure is the treatment of choice. There are two main surgical procedures: subdermal mastectomy and liposuction. To evaluate the results after surgical treatment (mastectomy) performed in a general surgery unit. We performed a retrospective study; all the patients operated for gynecomastia were reviewed. The clinical, imaging, biological, intraoperative and histological data were included into a MS Access database and statistical analyzed. From 1990-2007, 114 patients were admitted in the First Surgical Clinic Iaşi for gynecomastia. Only 12.6% from the patients were with bilateral gynecomastia. The mean age was 40.54 +/- 1.83 years old (range 12-84). Mean body mass was 26.72 +/- 0.46 kg/m2 (range 18.5-41), and about 20% from the patients had a BMI of over 30 kg/m2. We also noted that 46.5% were smokers. Simon classification was used for preoperative staging: 2.6% from the cases (N = 3) were included in stage I, 16.7% (N = 19) in stage IIa, 50% (N = 57) in stage IIb and 30.7% in stage III. The patients included in stages IIa and I are younger then the patients included in stage III (p = 0.024). Mastodynia was noted in 46 cases (40.4%). Ultrasound exam was performed in all the cases, and the larger diameter of the nodule measured was 3.75 +/- 0.18 cm (range 0.5-9.7). Only three cases were preoperatively treated with tamoxifen. Most of the cases were operated using general anesthesia (53.5%). Mastectomy was performed by peri-areolar (70.2%), elliptical (28.9%) or radial (0.9%) incisions. The subdermal mastectomy using peri-areolar approach was performed especially for the cases included in stages I, IIa and IIb--p < 10(-3). The epi-pectoral vacuum drainage has been used in 79.8%. The postoperative morbidity rate was 15.8%--4 cases of hematoma, 13 cases of seroma and 1 case complicated with skin necrosis. No specific risk factors for postoperative complications were found by univariate and multivariate statistical analysis. The pathological exam revealed pseudo-gynecomastia in 6 cases; the other cases presented dilated ducts. We also noted intraductal papillary hyperplasia in 87 cases and chronic inflammation in 35 cases. The histological exam also revealed intraductal papilloma--9 cases, fibro-adenoma--1 case, papillary ductal carcinoma--1 case and mucinous carcinoma--1 case. From all these data, the etiological diagnosis in presented series was: pseudo-gynecomastia--5.3% (N = 6), idiopathic--64.9% (N = 73), endocrine--7.9% (N = 9), drug induce--5.3% (N = 6), metabolic--7.9% (N = 9), tumoral--8.8% (N = 10). The postoperative hospital stay was 4.04 +/- 0.26 days (range 1-12). A literature review has also been performed. The management of gynecomastia has to be performed by a multidisciplinary team. Gynecomastia it is possible to be associated with a breast cancer, even in younger people. The surgical treatment, especially the type of incision, will be chosen from point of view of Simon stages. Liposuction can be associated in selected cases.

A Case Study in the Misrepresentation of Applied Behavior Analysis in Autism: The Gernsbacher Lectures

PubMed Central

Morris, Edward K

2009-01-01

I know that most men, including those at ease with problems of the greatest complexity, can seldom accept the simplest and most obvious truth if it be such as would oblige them to admit the falsity of conclusions which they have proudly taught to others, and which they have woven, thread by thread, into the fabrics of their life. (Tolstoy, 1894) This article presents a case study in the misrepresentation of applied behavior analysis for autism based on Morton Ann Gernsbacher's presentation of a lecture titled “The Science of Autism: Beyond the Myths and Misconceptions.” Her misrepresentations involve the characterization of applied behavior analysis, descriptions of practice guidelines, reviews of the treatment literature, presentations of the clinical trials research, and conclusions about those trials (e.g., children's improvements are due to development, not applied behavior analysis). The article also reviews applied behavior analysis' professional endorsements and research support, and addresses issues in professional conduct. It ends by noting the deleterious effects that misrepresenting any research on autism (e.g., biological, developmental, behavioral) have on our understanding and treating it in a transdisciplinary context. PMID:22478522

The Benign Hamburger.

ERIC Educational Resources Information Center

Peaslee, Graham; Lantz, Juliette M.; Walczak, Mary M.

1998-01-01

Uses a case study of food poisoning from hamburgers at the fictitious Jill-at-the-Grill to teach the nuclear science behind food irradiation. Includes case teaching notes on the benign hamburger. (ASK)

Fluorescence of fungi in superficial and deep fungal infections

PubMed Central

Elston, Dirk M

2001-01-01

Background Fluorescence of many fungi is noted when H&E stained sections are examined under a fluorescent microscope. In theory, this phenomenon could aid in the diagnosis of cutaneous and disseminated fungal infections without the delay associated with special stains. Seventy-six cases of superficial and deep fungal infections and 3 cases of protothecosis were studied to determine the clinical usefulness of this technique. Results In most cases, fluorescence was noted, but was not intense. Fluorescence of fungi did not correlate with the age of the specimen. In most cases, organisms in H&E stained sections were more easily identified with routine light microscopy than with fluorescent microscopy. Conclusion This report suggests that in H&E stained skin specimens, fluorescent microscopy is of little benefit in the identification of fungal organisms. PMID:11602016

Radiation Boundary Conditions for Maxwell’s Equations: A Review of Accurate Time-Domain Formulations

DTIC Science & Technology

2007-01-01

conditions have only been constructed for the case ne = 0. Lastly we note that exact reflection formulas have recently been derived by Diaz and Joly [20, 21...SIAM J. Numer. Anal. 41 (2003), 287–305. 6. E. Bécache and P. Joly , On the analysis of Bérenger’s perfectly matched layers for Maxwell’s equations...Computational Wave Propagation (M. Ainsworth, P. Davies, D. Duncan, P. Martin , and B. Rynne, eds.), Springer-Verlag, 2003, pp. 43–82. 13. O. Bruno and D. Hoch

Pulmonary Vasculitis and a Horseshoe Kidney in Noonan Syndrome.

PubMed

Puvabanditsin, Surasak; Abellar, Rosanna; Madubuko, Adaora; Mehta, Rajeev; Walzer, Lauren

2018-01-01

We report a term male neonate with congenital myeloproliferative disorder, thrombocytopenia, a horseshoe kidney, feeding difficulty secondary to dysphagia/foregut dysmotility, and respiratory failure. Prenatal molecular genetic analysis revealed a fetus carrying c.184T>G (p.Tyr62Asp) pathogenic variant in PTPN11 . The infant eventually succumbed to respiratory failure. Bacterial and viral cultures/studies were all no growth/negative. Pulmonary capillaritis and vasculitis were noted at autopsy. This report presents a new case of Noonan syndrome with unusual associated disorders and a review of the literature.

Pulmonary Vasculitis and a Horseshoe Kidney in Noonan Syndrome

PubMed Central

Abellar, Rosanna; Madubuko, Adaora; Mehta, Rajeev

2018-01-01

We report a term male neonate with congenital myeloproliferative disorder, thrombocytopenia, a horseshoe kidney, feeding difficulty secondary to dysphagia/foregut dysmotility, and respiratory failure. Prenatal molecular genetic analysis revealed a fetus carrying c.184T>G (p.Tyr62Asp) pathogenic variant in PTPN11. The infant eventually succumbed to respiratory failure. Bacterial and viral cultures/studies were all no growth/negative. Pulmonary capillaritis and vasculitis were noted at autopsy. This report presents a new case of Noonan syndrome with unusual associated disorders and a review of the literature. PMID:29670795

Ultrathin metallized PBI paper

NASA Technical Reports Server (NTRS)

Chenevey, E. C.

1978-01-01

A study to determine the feasibility of preparing ultrathin papers with a target weight of 3.5 g/m squared from polybenzimidazole (PBI) fibrids was undertaken. Small hand sheets of target weight were fabricated. They were light brown, low density materials with sufficient strength to be readily handleable. Characterization of these sheets included strength, fold endurance, thermal gravimetric analysis in air and nitrogen and photomicrographs. Two different batches of PBI fibrids were studied and differences in fabrication performance were noted. In neither case could target weight papers be prepared using conventional paper making techniques.

What Limits the Encoding Effect of Note-Taking? A Meta-Analytic Examination

ERIC Educational Resources Information Center

Kobayashi, K.

2005-01-01

Previous meta-analyses indicate that the overall encoding effect of note-taking is positive but modest. This meta-analysis of 57 note-taking versus no note-taking comparison studies explored what limits the encoding effect by examining the moderating influence of seven variables: intervention, schooling level, presentation mode and length, test…

A case of reccuring giant condyloma of vulva in infant without sexual abuse successfully treated with electrocoagulation in Benin

PubMed Central

Akpadjan, Fabrice; Adégbidi, Hugues; Attinsounon, Cossi Angelo; Koudoukpo, Christiane; Dégboé, Bérénice; Agbessi, Nadège; Atadokpèdé, Félix

2017-01-01

We report here a case of giant vulval condyloma in a two-year-old infant infected by her “baby sitter” without sexual abuse. Treated by surgical excision coupled with electrocoagulation, it was noted a rapid recurrence two weeks after treatment requiring a second electrocoagulation session. More than a year later, no lesion was noted, thus demonstrating therapeutic success. The unavailability of imiquimod in our context requires a systematic use of invasive treatment regardless of the age of the patient. PMID:28904687

A case of reccuring giant condyloma of vulva in infant without sexual abuse successfully treated with electrocoagulation in Benin.

PubMed

Akpadjan, Fabrice; Adégbidi, Hugues; Attinsounon, Cossi Angelo; Koudoukpo, Christiane; Dégboé, Bérénice; Agbessi, Nadège; Atadokpèdé, Félix

2017-01-01

We report here a case of giant vulval condyloma in a two-year-old infant infected by her "baby sitter" without sexual abuse. Treated by surgical excision coupled with electrocoagulation, it was noted a rapid recurrence two weeks after treatment requiring a second electrocoagulation session. More than a year later, no lesion was noted, thus demonstrating therapeutic success. The unavailability of imiquimod in our context requires a systematic use of invasive treatment regardless of the age of the patient.

Teaching Business Demography Using Case Studies.

PubMed

Swanson, David A; Morrison, Peter A

2010-02-01

Many faculty members consider using case studies but not all end up using them. We provide a brief review of what cases are intended to do and identify three ways in which they can be used. We then use an example to illustrate how we have used the case study method in teaching business demography. Among other benefits, we note that the case studies method not only encourages the acquisition of skills by students, but can be used to promote "deep structure learning," an approach naturally accommodates other features associated with the case studies method-the development of critical thinking skills, the use of real world problems, the emphasis of concepts over mechanics, writing and presentation skills, active cooperative learning and the "worthwhileness" of a course. As noted by others, we understand the limitations of the case study method. However, given its strengths, we believe it has a place in the instructional toolbox for courses in business demography. The fact that courses we teach is a testament to our perceived efficacy of this tool.

Long-term study of patients with congenital pit of the optic nerve and persistent macular detachment.

PubMed

Theodossiadis, G P; Panopoulos, M; Kollia, A K; Georgopoulos, G

1992-08-01

During the period 1970-87 we evaluated the changes of the optic disc, peripapillary area, detached macula and visual acuity in 16 cases with congenital pit of the optic nerve and macular detachment. The study revealed in 9 of the 16 cases (56%) an increase of the dimension of the pit or changes in its color, findings which were directly related to the duration of the macular detachment. Chorioretinal scarring, pigment migration, or both, were also noted mainly at the temporal margin of optic disc. In 5/16 cases we found during the follow-up an extension of macular elevation. In altogether 10 out of 16 cases the retinal elevation covered the larger portion of the mid-periphery temporally. In 7/16 cases the final visual acuity remained unchanged, in 9/16 cases deteriorated. The difference, however, in the latter 9 cases between initial and final visual acuity was negligible. During the follow-up period deterioration of the visual fields was also noted.

Genital streptococcal infection in non-pregnant women: a case-note review.

PubMed

Sonnex, C

2013-06-01

The purpose of this case-note review was to examine the clinical features and management of women with either vulval or vaginal swabs culturing positive for streptococci. Group B haemolytic streptococcus was isolated in all cases. The majority of women with vulval streptococci presented with irritation or soreness. Candidal infection was found in 43% and a dermatosis in 27%. All women with positive vaginal culture had vaginal soreness and/or discharge. Candida was isolated in 27% and there were features of desquamative vaginitis in 20%. Women treated with erythromycin failed to improve symptomatically. The findings of this study suggest that streptococci mostly play a secondary role and colonize an already damaged genital epithelium.

Case Study: A Peek behind the Curtain of Tenure and Promotion

ERIC Educational Resources Information Center

Herreid, Clyde Freeman; Prud'homme-Genereux, Annie; Schiller, Nancy A.; Herreid, Ky F.; Wright, Carolyn

2015-01-01

This column provides original articles on innovations in case study teaching, assessment of the method, as well as case studies with teaching notes. This month's issue describes a survey that looks at the system for tenure and promotion.

The Hefferline Notes: B. F. Skinner's First Public Exposition of His Analysis of Verbal Behavior.

PubMed

Knapp, Terry J

2009-01-01

B. F. Skinner's first public exposition of his analysis of verbal behavior was the Hefferline Notes (1947a), a written summary of a course Skinner taught at Columbia University during the summer of 1947 just prior to his presentation of the William James Lectures at Harvard University in the fall. The Notes are significant because they display Skinner's analysis as it made the transition from spoken to written form; moreover, they are an effective supplemental source of examples and early approximations for comprehending Skinner's functional verbal operants.

Comparative analysis of public opinion research in the U.S. and Canada

NASA Astrophysics Data System (ADS)

Setlakwe, Linda; DiNunzio, Lisa A.

2004-06-01

Bank note producers are working to thwart the threat of counterfeit notes created using high resolution, digital image processing software and color output devices such as inkjet printers, color copiers, and scanners. Genuine notes must incorporate better overt and machine-readable security features that will reduce the chance of counterfeit notes being passed. Recently, Canada and the United States introduced newly designed bank notes that are intended to enable the general public to more easily distinguish genuine notes from counterfeits. The Bank of Canada (BoC) and the U.S. Department of Treasury"s Bureau of Engraving and Printing (BEP) have conducted similar market research projects to explore target audiences' perceptions and attitudes towards currency design and security features. This paper will present a comparative analysis of the two research projects, both of which were conducted using similar methodology. The results of these research studies assist in the selection of security features for future generations of bank notes.

Weighing of risk factors for penetrating keratoplasty graft failure: application of Risk Score System.

PubMed

Tourkmani, Abdo Karim; Sánchez-Huerta, Valeria; De Wit, Guillermo; Martínez, Jaime D; Mingo, David; Mahillo-Fernández, Ignacio; Jiménez-Alfaro, Ignacio

2017-01-01

To analyze the relationship between the score obtained in the Risk Score System (RSS) proposed by Hicks et al with penetrating keratoplasty (PKP) graft failure at 1y postoperatively and among each factor in the RSS with the risk of PKP graft failure using univariate and multivariate analysis. The retrospective cohort study had 152 PKPs from 152 patients. Eighteen cases were excluded from our study due to primary failure (10 cases), incomplete medical notes (5 cases) and follow-up less than 1y (3 cases). We included 134 PKPs from 134 patients stratified by preoperative risk score. Spearman coefficient was calculated for the relationship between the score obtained and risk of failure at 1y. Univariate and multivariate analysis were calculated for the impact of every single risk factor included in the RSS over graft failure at 1y. Spearman coefficient showed statistically significant correlation between the score in the RSS and graft failure ( P <0.05). Multivariate logistic regression analysis showed no statistically significant relationship ( P >0.05) between diagnosis and lens status with graft failure. The relationship between the other risk factors studied and graft failure was significant ( P <0.05), although the results for previous grafts and graft failure was unreliable. None of our patients had previous blood transfusion, thus, it had no impact. After the application of multivariate analysis techniques, some risk factors do not show the expected impact over graft failure at 1y.

Weighing of risk factors for penetrating keratoplasty graft failure: application of Risk Score System

PubMed Central

Tourkmani, Abdo Karim; Sánchez-Huerta, Valeria; De Wit, Guillermo; Martínez, Jaime D.; Mingo, David; Mahillo-Fernández, Ignacio; Jiménez-Alfaro, Ignacio

2017-01-01

AIM To analyze the relationship between the score obtained in the Risk Score System (RSS) proposed by Hicks et al with penetrating keratoplasty (PKP) graft failure at 1y postoperatively and among each factor in the RSS with the risk of PKP graft failure using univariate and multivariate analysis. METHODS The retrospective cohort study had 152 PKPs from 152 patients. Eighteen cases were excluded from our study due to primary failure (10 cases), incomplete medical notes (5 cases) and follow-up less than 1y (3 cases). We included 134 PKPs from 134 patients stratified by preoperative risk score. Spearman coefficient was calculated for the relationship between the score obtained and risk of failure at 1y. Univariate and multivariate analysis were calculated for the impact of every single risk factor included in the RSS over graft failure at 1y. RESULTS Spearman coefficient showed statistically significant correlation between the score in the RSS and graft failure (P<0.05). Multivariate logistic regression analysis showed no statistically significant relationship (P>0.05) between diagnosis and lens status with graft failure. The relationship between the other risk factors studied and graft failure was significant (P<0.05), although the results for previous grafts and graft failure was unreliable. None of our patients had previous blood transfusion, thus, it had no impact. CONCLUSION After the application of multivariate analysis techniques, some risk factors do not show the expected impact over graft failure at 1y. PMID:28393027

How clarinettists articulate: The effect of blowing pressure and tonguing on initial and final transients.

PubMed

Li, Weicong; Almeida, André; Smith, John; Wolfe, Joe

2016-02-01

Articulation, including initial and final note transients, is important to tasteful music performance. Clarinettists' tongue-reed contact, the time variation of the blowing pressure P¯mouth, the mouthpiece pressure, the pressure in the instrument bore, and the radiated sound were measured for normal articulation, accents, sforzando, staccato, and for minimal attack, i.e., notes started very softly. All attacks include a phase when the amplitude of the fundamental increases exponentially, with rates r ∼1000 dB s(-1) controlled by varying both the rate of increase in P¯mouth and the timing of tongue release during this increase. Accented and sforzando notes have shorter attacks (r∼1300 dB s(-1)) than normal notes. P¯mouth reaches a higher peak value for accented and sforzando notes, followed by a steady decrease for accented notes or a rapid fall to a lower, nearly steady value for sforzando notes. Staccato notes are usually terminated by tongue contact, producing an exponential decrease in sound pressure with rates similar to those calculated from the bandwidths of the bore resonances: ∼400 dB s(-1). In all other cases, notes are stopped by decreasing P¯mouth. Notes played with different dynamics are qualitatively similar, but louder notes have larger P¯mouth and larger r.

Consistent t(1;10) with rearrangements of TGFBR3 and MGEA5 in both myxoinflammatory fibroblastic sarcoma and hemosiderotic fibrolipomatous tumor.

PubMed

Antonescu, Cristina R; Zhang, Lei; Nielsen, G Petur; Rosenberg, Andrew E; Dal Cin, Paola; Fletcher, Christopher D M

2011-10-01

Despite their shared predilection for superficial soft tissue of distal extremities and frequent local recurrences, myxoinflammatory fibroblastic sarcoma (MIFS) and hemosiderotic fibrolipomatous tumor (HFLT) have distinct morphologic appearances. Recent studies have identified an identical t(1;10)(p22;q24) in five cases of MIFS and two of HFLT, as well as common amplifications on 3p11-12. To investigate further their potential relationship and to determine the incidence of t(1;10) in a larger cohort, we subjected seven MIFS, 14 HFLT, and three cases with mixed morphology, to molecular and cytogenetic analysis. Fluorescence in situ hybridization (FISH) analysis for rearrangements of TGFBR3 on 1p22 and of MGEA5 on 10q24 was performed in all cases, whereas the status of VGLL3 gene amplification on 3p12.1 was investigated in 12 cases. Conventional karyotyping was performed in one HFLT and two cases with mixed MIFS/HFLT histology. Overall 83% of cases showed rearrangements in both TGFBR3 and MGEA5. All three cases with mixed features of MIFS and HFLT were positive. Cytogenetic analysis performed in three cases confirmed an unbalanced der(10)t(1;10)(p22;q24). VGLL3 gene amplification was noted in 10/12 cases of both histologies. The high incidence of t(1;10) in MIFS and HFLT reinforces a shared pathogenetic relationship. Furthermore, the co-existence of both components either synchronously or metachronously in a primary or subsequent recurrence, suggest either different morphologic variants or different levels of tumor progression of a single biologic entity. FISH analysis for TGFBR3 and MGEA5 rearrangements can be applied as a reliable diagnostic molecular test when confronted with limited material or a challenging diagnosis. Copyright © 2011 Wiley-Liss, Inc.

Peptide Receptor Radionuclide Therapy with 177Lu-DOTATATE for Metastatic Neuroendocrine Tumor Occurring in Association with Multiple Endocrine Neoplasia Type 1 and Cushing's Syndrome.

PubMed

Naik, Chinna; Basu, Sandip

2017-01-01

Neuroendocrine tumor (NET) occurring in association with other endocrine syndromes forms a distinct entity. The aim was to assess the therapy response profile of the routine peptide receptor radionuclide therapy (PRRT) in this relatively uncommon but clinically challenging subgroup of patients. A retrospective analysis was undertaken from the case records from those who were treated with 177 Lu-DOTATATE for metastatic NET. In addition to assessing the therapeutic efficacy, emphasis was also given to study lesional sites and scan pattern. A total of 5 cases were found: In this series of five cases, four belonged to multiple endocrine neoplasia type 1 (MEN1) syndrome; in these four MEN1 syndrome patients, the primary site of NET was thymic region ( n = 1), duodenum ( n = 1), and pancreas ( n = 2). The fifth case was of Cushing's syndrome with the primary site of NET in the thymus. A good symptomatic response was observed in all MEN1 syndrome cases (100%) and progression of symptoms in the patient with Cushing's syndrome. The biochemical response (assessed by measurement of tumor marker serum chromogranin A) demonstrated very good partial response (defined by more than 75% reduction of tumor marker) in 2 MEN1 cases and Cushing's syndrome, good partial response (25-75% reduction of tumor marker) in the remaining 2 MEN1 cases. Scan wise (assessed by technetium [ 99m Tc]-hydrazinonicotinamide [HYNIC]-tektrotyd [TOC]/ 68 Ga-DOTA-NOC/TATE positron emission tomography-computed tomography [PET-CT] and fluorodeoxyglucose [FDG] PET-CT) partial response was observed in 3 MEN1 cases, stable disease was noted in one MEN1 case and disease progression was noted in the patient with Cushing's syndrome. The change in FDG uptake was found to be an important sensitive scan parameter in the treatment evaluation of NETs compared to somatostatin receptor-based imaging in the cases with low MiB1 index. In our series, good palliative response to 177 Lu-DOTA-octreotate (DOTATATE) PRRT was observed in most NET patients associated with MEN1 syndrome without any major hematological or renal toxicity.

The Novaya Zemlya Bora: Analysis and Numerical Modeling

NASA Astrophysics Data System (ADS)

Efimov, V. V.; Komarovskaya, O. I.

2018-01-01

We consider the data of an ASRI reanalysis to distinguish the properties of velocity and temperature fields in the region of Novaya Zemlya (NZ). A numerical simulation of the bora development is performed using the WRF-ARW regional model of atmospheric circulation for two cases with different directions of the wind. In the case of southeastern winds, the wind speed and temperature fields are reproduced and the characteristics of the bora are defined: temperature and wind speed increase over the lee slope of mountains and coastal western area of the Barents Sea. In the case of a western wind, the bora does not appear. The estimates of temperature contrasts in the flow of the air stream over the NZ mountains found in the processing of the ASRI data are reported. The region of high velocities and fluxes of sensible and latent heat indicating the climatic role of the NZ archipelago noted earlier in [12] is determined.

Sonographic findings in a case of tetrasomy 9p associated with increased nuchal translucency and Dandy-Walker malformation.

PubMed

Nakamura-Pereira, Marcos; Cima, Luciana Carneiro do; Llerena, Juan Clinton; Guerra, Fernando Antonio Ramos; Peixoto-Filho, Fernando Maia

2009-10-01

We report a case of a 23-year-old pregnant woman, who underwent amniocentesis after ultrasound (US) examination in the first trimester which revealed a nuchal translucency thickness of 2.9 mm. Cytogenetic analysis revealed complete tetrasomy of the short arm of chromosome 9. Further US evaluation in the second trimester revealed Dandy-Walker malformation, ventriculomegaly, bilateral clubfoot, lip and palate clefts, arthrogryposis and hyperechoic kidneys with bilateral pelvic dilatation. At 30 weeks of gestation, a placental abruption was noted and a Cesarean section was performed. The infant died shortly after birth. A review of previous cases of tetrasomy 9p shows that the remarkable sonographic findings are ventriculomegaly, intrauterine growth restriction, genitourinary anomaly, Dandy-Walker malformation, cleft lip/palate and limb malformation, but the association of tetrasomy 9p and increased nuchal translucency had not been reported.

STS-114: Engine Cut-Off Sensors Are a No-Go: Teaching Notes for NASA Case Study

NASA Technical Reports Server (NTRS)

Ransom, Khadijah S.; Johnson, Grace K.

2013-01-01

This case study format is intended to simulate the experience of facing the same difficult challenges and making the same critical decisions as managers, engineers, and scientists in the Space Shuttle Program. It has been designed for use in the classroom setting to help students develop skills related to decision-making. Students will read about the engine cut-off sensor anomaly which created challenges during the STS-114 mission and have the opportunity to make decisions as lead NASA engineers and Mission Management Team members. Included within this document are three case study presentation options - class discussion, group activity, and open-ended research. Please read the full case prior to in-class presentation to allow ample time for students' analysis and reflection, as well as to prepare additional questions. activities or exercises, material selection, etc. Depending upon the setting of your presentation and the number of participants, please choose at least one presentation format beforehand and plan accordingly. You may expect the following learning objectives by using the proposed formats. Learning Objectives: To enable students to experience the responsibilities of NASA management, engineers, and analysis; to discover possible procedures for investigating system anomalies; to become familiar with the liquid hydrogen low level engine cut-off sensor, including its function, connecting components, and location within the Space Shuttle; and to encourage critical analysis and stimulating discussion of Space Shuttle mission challenges.

'He left me a message on Facebook': comparing the risk profiles of self-harming patients who leave paper suicide notes with those who leave messages on new media.

PubMed

Barrett, Jessica R; Shetty, Hitesh; Broadbent, Matthew; Cross, Sean; Hotopf, Matthew; Stewart, Robert; Lee, William

2016-05-01

In cases of non-fatal self-harm, suicide notes are a major risk factor for repeated self-harm and suicide. Suicide notes can now be left on new media services, emails or text messages, as well as on paper. In a group of people who had harmed themselves, we aimed to compare new media note-leavers with paper note-leavers and characterise these groups demographically and by risk factors. Clinical notes of patients who presented with non-fatal self-harm to two London emergency departments were anonymously searched for mentions of new media use. These were categorised and risk factors were compared for those who had left a new media note, a paper note, or no note to establish differences in risk of note-leaving. New media note-leaving was associated with younger age and substance use; both risk factors for repeated self-harm. However, suicidal intent remained highest in paper note-leavers. Paper note-leavers remain at greatest risk, however new media note leaving is still correlated with risk factors related to repeated self-harm and suicide. Clinicians should enquire about new media use during emergency department assessments of self-harm. None. © The Royal College of Psychiatrists 2016. This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) licence.

Farewell to the World: Suicide Notes from Turkey

ERIC Educational Resources Information Center

Demirel, Birol; Akar, Taner; Sayin, Aslihan; Candansayar, Selcuk; Leenaars, Antoon A.

2008-01-01

There has been limited study of suicide in Islamic countries. This paper marks the first study of suicide notes in Turkey, an Islamic country. Using a classification scheme, 49 suicide notes (a rate of 34.5%) were studied. The results show that note writers do not differ greatly from other suicides. Further analysis of younger (less than 40) and…

A Bayesian approach to reliability and confidence

NASA Technical Reports Server (NTRS)

Barnes, Ron

1989-01-01

The historical evolution of NASA's interest in quantitative measures of reliability assessment is outlined. The introduction of some quantitative methodologies into the Vehicle Reliability Branch of the Safety, Reliability and Quality Assurance (SR and QA) Division at Johnson Space Center (JSC) was noted along with the development of the Extended Orbiter Duration--Weakest Link study which will utilize quantitative tools for a Bayesian statistical analysis. Extending the earlier work of NASA sponsor, Richard Heydorn, researchers were able to produce a consistent Bayesian estimate for the reliability of a component and hence by a simple extension for a system of components in some cases where the rate of failure is not constant but varies over time. Mechanical systems in general have this property since the reliability usually decreases markedly as the parts degrade over time. While they have been able to reduce the Bayesian estimator to a simple closed form for a large class of such systems, the form for the most general case needs to be attacked by the computer. Once a table is generated for this form, researchers will have a numerical form for the general solution. With this, the corresponding probability statements about the reliability of a system can be made in the most general setting. Note that the utilization of uniform Bayesian priors represents a worst case scenario in the sense that as researchers incorporate more expert opinion into the model, they will be able to improve the strength of the probability calculations.

Selection and ranking of patient video cases in paediatric neurology in relation to learner levels.

PubMed

Balslev, Thomas; Muijtjens, Arno M M; Maarbjerg, Sabine Frølich; de Grave, Willem

2018-05-01

Teaching and learning with patient video cases may add authenticity, enhance diagnostic accuracy and improve chances of early diagnosis. The aim of this study is firstly to identify selection criteria for key Patient video cases (PVCs), secondly to identify trends in relevance of PVCs for learner levels and thirdly, to rank PVCs for learner levels. Based on a literature review, we identified criteria for key PVCs for use in paediatric neurology. We then performed a multi-round Delphi analysis to obtain agreement between 28 expert clinician teachers concerning key PVCs for four learner levels. We identified two major criteria: key PVCs should demonstrate key movements, and these movements should be subtle and/or difficult to note. The expert clinician teachers subsequently assessed a list of 14 topics for key PVCs. We found a clear, increasing trend in relevance scores, from medical students to young residents to experienced residents and specialists. For medical students and residents, epileptic spasms, Down syndrome, developmental delay, cerebral palsy and absence epilepsy were highly ranked. For specialists, conditions like chorea, focal seizures or eye movement disorders topped the ranking list, although ranking was less clear for this group of advanced learners. Key PVCs should demonstrate movements that are difficult to note for learners. Ranked lists of key PVCs for teaching and learning at different learner levels are now available and may help institutions build validated local libraries of PVCs. Copyright © 2017 European Paediatric Neurology Society. Published by Elsevier Ltd. All rights reserved.

Retrospective Analysis of the Accuracy of Ultrasound-Guided Magnetic Resonance Arthrogram Injections of the Hip in the Office Setting.

PubMed

Jernick, Michael; Walker Gallego, Edward; Nuzzo, Michael

2017-12-01

Ultrasound (US)-guided intra-articular hip injections have been proposed in the literature to be accurate, reliable, and safe alternatives to fluoroscopy-guided injections. To evaluate the accuracy of US-guided magnetic resonance (MR) arthrogram injections of the hip performed in the office setting by a single orthopaedic surgeon and elucidate the potential effects that patient age, sex, and body mass index (BMI) have on contrast placement. Case series; Level of evidence, 4. From a review of the senior author's office database, 89 patients (101 hips) who had US-guided MR arthrogram injections performed between December 2014 and June 2016 were identified. Official radiology reports were evaluated to determine whether extra-articular contrast was noted. Patient variables, including BMI, age, and sex, were evaluated between patients who had inappropriately placed contrast and those who did not. Of the 101 hip injections, there were 6 cases that demonstrated inadequate contrast placement within the joint, likely secondary to extravasation or incorrect placement; however, an MR arthrogram was adequately interpreted in all cases. There were no significant differences noted between those with appropriate versus inappropriate contrast placement when evaluating BMI ( P = .57), age ( P = .33), or sex ( P = .67), and neither group had an adverse event. US-guided injections are safe and accurate alternatives to fluoroscopy-guided injections in the office setting, with 94% accuracy. Furthermore, BMI, age, and sex did not play a statistically significant role among patients with inappropriately placed contrast.

Organizational Factors that Influence E-Learning Development and Implementation in the Corporate Context

ERIC Educational Resources Information Center

Wang, Feng-Kwei; Schwen, Thomas

2003-01-01

In the context of Autoparts, a multinational manufacturer for automotive electronics, Lotus Notes was employed to create an e-learning system. This system was titled "Using Notes for Case-based Learning Environments" (UNCLE). The UNCLE project attempted to encapsulate knowledge and understanding of those organizational factors that might influence…

Broadcast Condom Advertising: A Case Study.

ERIC Educational Resources Information Center

Kaplan, Herb; Houlberg, Rick

1990-01-01

Examines a San Francisco television station's decision to accept paid condom advertising. Notes that station leaders debated questions of public interest and public tastes in a city hard hit by AIDS. Finds that the station devised careful guidelines and began broadcasting the commercials on a trial basis. Notes that nearly all public and media…

Note Passing and Gendered Discipline in Vietnamese Schools

ERIC Educational Resources Information Center

Horton, Paul

2015-01-01

While researchers agree that note passing is predominantly an activity engaged in by girls, there has been relatively little consideration of why this is the case. In this article, I argue that gendered expectations about the appropriate characters of boys and girls in Vietnam are incorporated into the disciplinary framework of schools, and that…

Case Study: What Makes a Good Case, Revisited: The Survey Monkey Tells All

ERIC Educational Resources Information Center

Herried, Clyde Freeman; Prud'homme-Genereux, Annie; Schiller, Nancy A.; Herreid, Ky F.; Wright, Carolyn

2016-01-01

This column provides original articles on innovations in case study teaching, assessment of the method, as well as case studies with teaching notes. In this month's issue the authors provide a more definitive answer to the "What Makes a Good Case?" question based on a just-completed Survey Monkey survey given to NCCSTS teachers.

Early Complications and Outcomes in Combat Injury Related Invasive Fungal Wound Infections: A Case-Control Analysis

PubMed Central

Lewandowski, Louis R.; Weintrob, Amy C.; Tribble, David R.; Rodriguez, Carlos J.; Petfield, Joseph; Lloyd, Bradley A.; Murray, Clinton K.; Stinner, Daniel; Aggarwal, Deepak; Shaikh, Faraz; Potter, Benjamin K.

2015-01-01

Objective Clinicians have anecdotally noted that combat-related invasive fungal wound infections (IFIs) lead to residual limb shortening, additional days and operative procedures prior to initial wound closure, and high early complication rates. We evaluated the validity of these observations and identified risk factors that may impact time to initial wound closure. Design Retrospective review and case-control analysis. Setting Military hospitals. Patients/Participants United States military personnel injured during combat operations (2009–2011). The IFI cases were identified based upon the presence of recurrent, necrotic extremity wounds with mold growth in culture and/or histopathologic fungal evidence. Non-IFI controls were matched on injury pattern and severity. In a supplemental matching analysis, non-IFI controls were also matched by blood volume transfused within 24 hours of injury. Intervention None. Main Outcome Measurements Amputation revision rate and loss of functional levels. Results Seventy-one IFI cases (112 fungal-infected extremity wounds) were identified and matched to 160 control patients (315 non-IFI extremity wounds). The IFI wounds resulted in significantly more changes in amputation level (p<0.001). Additionally, significantly (p<0.001) higher number of operative procedures and longer duration to initial wound closure was associated with IFI. A shorter duration to initial wound closure was significantly associated with wounds lacking IFIs (Hazard ratio: 1.53; 95% CI: 1.17, 2.01). The supplemental matching analysis found similar results. Conclusions Our analysis indicates that IFIs adversely impact wound healing and patient recovery, requiring more frequent proximal amputation revisions and leading to higher early complication rates. PMID:26360542

Spatial Case Information Management System (SCIMS)

Science.gov Websites

SCIMS facilitates the update of the Land Administration System (LAS) Case File location. Please select Cleanup Notes Utilities LAS Request Import Utility Privacy Copyright System Status Support User Guide

Factors associated with prevalence and types of 'may be fit' advice on fit notes: a cross-sectional primary care analysis.

PubMed

Shiels, Chris; Gabbay, Mark; Hillage, Jim

2014-03-01

The 'fit note', with the opportunity for the GP to advise that a patient 'may be fit' to do some work, was introduced in April 2010. To estimate numbers of fit notes with 'may be fit' advice, the types of advice, and factors associated with any inclusion of such advice in the fit note. Cross-sectional analysis of fit note data from 68 general practices in eight regions of England, Wales and Scotland. Collection of practice fit note data via GP use of carbonised pads of fit notes for a period of 12 months. The 'may be fit' box was ticked on 5080 fit notes (6.4% of all fit notes in study). But there was a wide variation in completion rates across the 68 practices (from 1% to 15%). The most prevalent individual item of advice was to 'amend duties' of patient as a prerequisite for return to work (included in 42% of all notes containing any 'may be fit' advice). Advice was often incomplete or irrelevant, with some GPs failing to comply with official guidance. Inclusion of any 'may be fit' advice was independently associated with the patient being female, less socially deprived and having a physical health reason for receiving a fit note. Unlike other studies that have relied upon eliciting opinion, this study investigates how the fit note is being used in practice. Findings provide some evidence that the fit note is not yet being used to the optimum benefit of patients (and their employers).

Developing a risk stratification tool for audit of outcome after surgery for head and neck squamous cell carcinoma.

PubMed

Tighe, David F; Thomas, Alan J; Sassoon, Isabel; Kinsman, Robin; McGurk, Mark

2017-07-01

Patients treated surgically for head and neck squamous cell carcinoma (HNSCC) represent a heterogeneous group. Adjusting for patient case mix and complexity of surgery is essential if reporting outcomes represent surgical performance and quality of care. A case note audit totaling 1075 patients receiving 1218 operations done for HNSCC in 4 cancer networks was completed. Logistic regression, decision tree analysis, an artificial neural network, and Naïve Bayes Classifier were used to adjust for patient case-mix using pertinent preoperative variables. Thirty-day complication rates varied widely (34%-51%; P < .015) between units. The predictive models allowed risk stratification. The artificial neural network demonstrated the best predictive performance (area under the curve [AUC] 0.85). Early postoperative complications are a measurable outcome that can be used to benchmark surgical performance and quality of care. Surgical outcome reporting in national clinical audits should be taking account of the patient case mix. © 2017 Wiley Periodicals, Inc.

Outbreak of hepatitis A in two federal states of Germany: bakery products as vehicle of infection.

PubMed

Schenkel, K; Bremer, V; Grabe, C; Van Treeck, U; Schreier, E; Höhne, M; Ammon, A; Alpers, K

2006-12-01

In April 2004, increased numbers of hepatitis A were noted in six neighbouring districts in Germany. Exploratory interviews showed that patients had consumed bakery products from company X where two employees had been diagnosed with hepatitis A in February. A case-control study of consumption of products of company X was carried out through telephone interviews. Altogether, 64 cases were identified. Fifty-two cases and 112 controls aged >or=16 years were included in the case-control study. In total, 46/52 cases and 37/112 controls had consumed company X products [odds ratio (OR) 15.5, 95% confidence interval (CI) 6.1-39.7]. Of these, 36/46 cases and 16/37 controls had consumed pastries (OR 4.7, 95% CI 1.8-12.3), 25/46 cases and 12/37 controls had consumed filled doughnuts (OR 2.5, 95% CI 1.0-6.1). Sequence analysis of the VP1-2A junction region indicated 100% strain homology between cases and an infected employee of company X. We recommended reinforcement of hygiene precautions, and consideration of a prolongation of compulsory work absence after post-exposure vaccination.

Preparing for fieldwork: Students' perceptions of their readiness to provide evidence-based practice.

PubMed

Evenson, Mary E

2013-01-01

The purpose of this study was to explore students' perceptions of their confidence to use research evidence to complete a client case analysis assignment in preparation for participation in fieldwork and future practice. A convenience sample of 42 entry-level occupational therapy Masters students, included 41 females and one male, ages 24 to 35. A quasi-experimental pretest-posttest design was used. Students participated in a problem-based learning approach supported by educational technology. Measures included a pre- and post-semester confidence survey, a post-semester satisfaction survey, and an assignment rubric. Based on paired t-tests and Wilcoxin Signed Ranks Tests, statistically significant differences in pre- and post-test scores were noted for all 18 items on the confidence survey (p< 0.001). Significant increases in students' confidence were noted for verbal and written communication of descriptive, assessment, and intervention evidence, along with increased confidence to effectively use assessment evidence. Results suggest that problem-based learning methods were significantly associated with students' perceptions of their confidence to use research evidence to analyze a client case. These results cannot necessarily be generalized due to the limitations of using non-standardized measures with a convenience sample, without a control group, within the context of a single course as part of one academic program curriculum.

Clinical and electrodiagnostic characteristics of nitrous oxide-induced neuropathy in Taiwan.

PubMed

Li, Han-Tao; Chu, Chun-Che; Chang, Kuo-Hsuan; Liao, Ming-Feng; Chang, Hong-Shiu; Kuo, Hung-Chou; Lyu, Rong-Kuo

2016-10-01

Nitrous oxide-induced neuropathy is toxic neuropathy occasionally encountered in Taiwanese neurological clinics. Only several case reports described their electrodiagnostic features. We used a case-control design to investigate the detailed electrodiagnostic characteristics and possible factors relating to severe nerve injury. We retrospectively reviewed 33 patients with nitrous oxide-induced neuropathy over a 10-year period and reported their demographic data, spinal cord MRI, laboratory examinations and nerve conduction studies. 56 healthy controls' nerve conduction studies were collected for comparison analysis. We noted significant motor and sensory amplitudes reduction, conduction velocities slowing, and latencies prolongation in most tested nerves compared to the controls. Similar nerve conduction study characteristics with prominent lower limbs' motor and sensory amplitudes reduction was observed in patient groups with or without abnormal vitamin B12 and/or homocysteine levels. Among those with lower limbs' motor or sensory amplitudes reduction <20% of the lower limit of normal, higher homocysteine levels were detected. Severe impairments of the lower limbs' sensory and motor amplitudes were frequently noted in patients with nitrous oxide exposure. Nitrous oxide exposure itself is an important factor for the development of neuropathy. Our study contributes to the understanding of electrodiagnostic features underlying the nitrous oxide-induced neuropathy. Copyright © 2016 International Federation of Clinical Neurophysiology. Published by Elsevier Ireland Ltd. All rights reserved.

Long-term results and prognostic factors of fractionated strontium-90 eye applicator for pterygium.

PubMed

Viani, Gustavo Arruda; Stefano, Eduardo Jose; De Fendi, Ligia Issa; Fonseca, Ellen Carrara

2008-11-15

To evaluate the long-term safety, effectiveness, and prognostic factors of fractionated postoperative beta-irradiation. Between 1993 and 2005, 623 patients with 737 pterygium lesions were treated with a strontium-90 eye applicator after surgical excision. The median follow-up period was 60 months (range, 6.7-139.5). Of the 737 lesions, 644 were primary and 93 were recurrences after surgical removal alone. Fractionated radiotherapy (RT) to a total dose of 35 Gy in five to seven fractions was used. A total of 73 local pterygium recurrences (9.9%) were noted. Of the recurrent cases, 80% were noted within 3 years after treatment. The 5- and 10-year probability of local control was 90% and 88%, respectively. The multivariate analysis for all cases demonstrated that gender, age, total radiation dose, recurrent pterygia, and interval between surgery and RT affected the overall local control rate. Late toxicities that might have been associated with strontium-90 RT included scleromalacia (scleral thinning) in nine eyes, adhesion of the eyelids in eight, cataracts in six, and scleral ulcer in five eyes. Fractionated strontium-90 RT to a total dose of approximately 35 Gy in five to seven fractions results in a similar local control rate as higher doses in other series, with an acceptable complication rate.

[Diversity and frequency of scientific research design and statistical methods in the "Arquivos Brasileiros de Oftalmologia": a systematic review of the "Arquivos Brasileiros de Oftalmologia"--1993-2002].

PubMed

Crosta, Fernando; Nishiwaki-Dantas, Maria Cristina; Silvino, Wilmar; Dantas, Paulo Elias Correa

2005-01-01

To verify the frequency of study design, applied statistical analysis and approval by institutional review offices (Ethics Committee) of articles published in the "Arquivos Brasileiros de Oftalmologia" during a 10-year interval, with later comparative and critical analysis by some of the main international journals in the field of Ophthalmology. Systematic review without metanalysis was performed. Scientific papers published in the "Arquivos Brasileiros de Oftalmologia" between January 1993 and December 2002 were reviewed by two independent reviewers and classified according to the applied study design, statistical analysis and approval by the institutional review offices. To categorize those variables, a descriptive statistical analysis was used. After applying inclusion and exclusion criteria, 584 articles for evaluation of statistical analysis and, 725 articles for evaluation of study design were reviewed. Contingency table (23.10%) was the most frequently applied statistical method, followed by non-parametric tests (18.19%), Student's t test (12.65%), central tendency measures (10.60%) and analysis of variance (9.81%). Of 584 reviewed articles, 291 (49.82%) presented no statistical analysis. Observational case series (26.48%) was the most frequently used type of study design, followed by interventional case series (18.48%), observational case description (13.37%), non-random clinical study (8.96%) and experimental study (8.55%). We found a higher frequency of observational clinical studies, lack of statistical analysis in almost half of the published papers. Increase in studies with approval by institutional review Ethics Committee was noted since it became mandatory in 1996.

Air Quality Dispersion Modeling - Alternative Models

EPA Pesticide Factsheets

Models, not listed in Appendix W, that can be used in regulatory applications with case-by-case justification to the Reviewing Authority as noted in Section 3.2, Use of Alternative Models, in Appendix W.

Case Study: Student-Produced Videos for the Flipped Classroom

ERIC Educational Resources Information Center

Prud'homme-Genereux, Annie

2016-01-01

This column provides original articles on innovations in case study teaching, assessment of the method, as well as case studies with teaching notes. This month's issue describes a way of building a library of student-produced videos to use in the flipped classroom.

Case Study: The Chemistry of Cocaine

ERIC Educational Resources Information Center

Dewprashad, Brahmadeo

2011-01-01

This column provides original articles on innovations in case study teaching, assessment of the method, as well as case studies with teaching notes. This month's case study focuses on the chemistry of cocaine to teach a number of core concepts in organic chemistry. It also requires that students read and analyze an original research paper on…

Case Management and the Integration of Services: How Service Delivery Systems Shape Case Management.

ERIC Educational Resources Information Center

Moore, Stephen

1992-01-01

Notes that primary role that case management plays in coordination of services is determined by level of service integration and by level of resources in service delivery system. Describes conditions under which case management serves as mechanism for rationing services, marketing function, brokering function, or development role. Discusses…

Absent end diastolic flow of umbilical artery Doppler: pregnancy outcome in 62 cases.

PubMed

Poulain, P; Palaric, J C; Milon, J; Betremieux, P; Proudhon, J F; Signorelli, D; Grall, J Y; Giraud, J R

1994-02-01

We retrospectively studied the outcome of pregnancy in 62 cases of absent end diastolic flow (AEDF) of umbilical artery Doppler flow velocity waveform. The history of pregnancies revealed that nearly all were of high risk. Many cases presented cerebral (65%) or uterine (55.5%) Doppler flow abnormalities, or both (38%). We noted 10 fetal deaths and decided 7 pregnancy terminations. Malformation and chromosomal defect rate was 16%. We noted 44 (71%) live-births, a very high rate of cesarean section (86%), prematurity (75%), small for gestational age (39%). Forty-five percent of the neonates had a 1-min Apgar score under 7, which dropped to 27% at 5 min. Neonate mortality rate was 6.9% and the total mortality rate was 34% (21/62). Morbidity was significant (7 cases with severe morbidity, 2 cases with chromosomal abnormality of poor prognosis). We compared different sub-groups with a view to looking for some prenatal factors which predict poor neonatal outcome in case of AEDF.

Unexpected deaths in cardiology outpatients - what can we learn from case review?

PubMed

Kitz, Thomas Michael; Burnand, Nikki; Ortner, Astrid; Rudd, Ian G; Sampson, Rod; Rushworth, Gordon F; Leslie, Stephen James

2016-12-01

A proportion of cardiac patients managed at a cardiology outpatient clinic will die between clinic visits. This study aimed to identify the cause of death, to determine if case review occurred and if a formal review of such cases might be useful. Single-centre retrospective cohort study. A remote regional centre in the North of Scotland. All patients who had been removed from the cardiology outpatient clinic due to death in the community. Cause of death, comorbidities and treatments were collected from hospital records and the national register of deaths. Chi-squared test and Student's t -test were used with significance taken at the 5% level. Of 10,606 patients who attended the cardiology outpatient clinic, 75 (0.7%) patients died in the community. The majority (57.0%) died from a non-cardiac cause. Eleven patients (14.9%) died due to an unexpected cardiac death. A detailed case note review was undertaken. In only two (18.2%) cases was any note made as to the cause of death in the hospital records and in only one was there details of post mortem discussion between primary and secondary care. A small proportion of patients attending a cardiology outpatient clinic died in the community. Documentation of the death in the hospital notes was very poor and evidence of post mortem communication between primary and secondary care was absent in all but one case. Better documentation and communication between primary and secondary care would seem desirable.

Programmable Logic Application Notes

NASA Technical Reports Server (NTRS)

Katz, Richard

2000-01-01

This column will be provided each quarter as a source for reliability, radiation results, NASA capabilities, and other information on programmable logic devices and related applications. This quarter will continue a series of notes concentrating on analysis techniques with this issue's section discussing: Digital Timing Analysis Tools and Techniques. Articles in this issue include: SX and SX-A Series Devices Power Sequencing; JTAG and SXISX-AISX-S Series Devices; Analysis Techniques (i.e., notes on digital timing analysis tools and techniques); Status of the Radiation Hard reconfigurable Field Programmable Gate Array Program, Input Transition Times; Apollo Guidance Computer Logic Study; RT54SX32S Prototype Data Sets; A54SX32A - 0.22 micron/UMC Test Results; Ramtron FM1608 FRAM; and Analysis of VHDL Code and Synthesizer Output.

Meeting the Challenge of Practice Quality Improvement: A Study of Seven Family Medicine Residency Training Practices

PubMed Central

Chase, Sabrina M.; Miller, William L.; Shaw, Eric; Looney, Anna; Crabtree, Benjamin F.

2011-01-01

Purpose Incorporating quality improvement (QI) into resident education and clinical care is challenging. This report explores key characteristics shaping the relative success or failure of QI efforts in seven primary care practices serving as family medicine residency training sites. Method The authors used data from the 2002–2008 Using Learning Teams for Reflective Adaptation (ULTRA) study to conduct a comparative case analysis. This secondary data analysis focused on seven residency training practices' experiences with RAP (reflective adaptive process), a 12-week intensive QI process. Field notes, meeting notes, and audiotapes of RAP meetings were used to construct case summaries. A matrix comparing key themes across practices was used to rate practices' QI progress during RAP on a scale of 0 to 3. Results Three practices emerged as unsuccessful (scores of 0–1) and four as successful (scores of 2–3). Larger practices with previous QI experience, faculty with extensive exposure to QI literature, and an office manager, residency director, or medical director who advocated for the process made substantial progress during RAP, succeeding at QI. Smaller practices without these characteristics were unable to do so. Successful practices also engaged residents in the QI process and identified serious problems as potential crises; unsuccessful practices did not. Conclusions Larger residency training practices are more likely to have the resources and characteristics that permit them to create a QI-supportive culture leading to QI success. The authors suggest, however, that smaller practices may increase their chances of success by adopting a developmental approach to QI. PMID:22030767

Multimodal MSI in Conjunction with Broad Coverage Spatially Resolved MS 2 Increases Confidence in Both Molecular Identification and Localization

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

Veličković, Dušan; Chu, Rosalie K.; Carrell, Alyssa A.

One critical aspect of mass spectrometry imaging (MSI) is the need to confidently identify detected analytes. While orthogonal tandem MS (e.g., LC-MS 2) experiments from sample extracts can assist in annotating ions, the spatial information about these molecules is lost. Accordingly, this could cause mislead conclusions, especially in cases where isobaric species exhibit different distributions within a sample. In this Technical Note, we employed a multimodal imaging approach, using matrix assisted laser desorption/ionization (MALDI)-MSI and liquid extraction surface analysis (LESA)-MS 2I, to confidently annotate and One critical aspect of mass spectrometry imaging (MSI) is the need to confidently identify detectedmore » analytes. While orthogonal tandem MS (e.g., LC-MS2) experiments from sample extracts can assist in annotating ions, the spatial information about these molecules is lost. Accordingly, this could cause mislead conclusions, especially in cases where isobaric species exhibit different distributions within a sample. In this Technical Note, we employed a multimodal imaging approach, using matrix assisted laser desorption/ionization (MALDI)-MSI and liquid extraction surface analysis (LESA)-MS 2I, to confidently annotate and localize a broad range of metabolites involved in a tripartite symbiosis system of moss, cyanobacteria, and fungus. We found that the combination of these two imaging modalities generated very congruent ion images, providing the link between highly accurate structural information onfered by LESA and high spatial resolution attainable by MALDI. These results demonstrate how this combined methodology could be very useful in differentiating metabolite routes in complex systems.« less

A Focus Group Exploration of Automated Case-Finders to Identify High-Risk Heart Failure Patients Within an Urban Safety Net Hospital.

PubMed

Patterson, Mark E; Miranda, Derick; Schuman, Greg; Eaton, Christopher; Smith, Andrew; Silver, Brad

2016-01-01

Leveraging "big data" as a means of informing cost-effective care holds potential in triaging high-risk heart failure (HF) patients for interventions within hospitals seeking to reduce 30-day readmissions. Explore provider's beliefs and perceptions about using an electronic health record (EHR)-based tool that uses unstructured clinical notes to risk-stratify high-risk heart failure patients. Six providers from an inpatient HF clinic within an urban safety net hospital were recruited to participate in a semistructured focus group. A facilitator led a discussion on the feasibility and value of using an EHR tool driven by unstructured clinical notes to help identify high-risk patients. Data collected from transcripts were analyzed using a thematic analysis that facilitated drawing conclusions clustered around categories and themes. From six categories emerged two themes: (1) challenges of finding valid and accurate results, and (2) strategies used to overcome these challenges. Although employing a tool that uses electronic medical record (EMR) unstructured text as the benchmark by which to identify high-risk patients is efficient, choosing appropriate benchmark groups could be challenging given the multiple causes of readmission. Strategies to mitigate these challenges include establishing clear selection criteria to guide benchmark group composition, and quality outcome goals for the hospital. Prior to implementing into practice an innovative EMR-based case-finder driven by unstructured clinical notes, providers are advised to do the following: (1) define patient quality outcome goals, (2) establish criteria by which to guide benchmark selection, and (3) verify the tool's validity and reliability. Achieving consensus on these issues would be necessary for this innovative EHR-based tool to effectively improve clinical decision-making and in turn, decrease readmissions for high-risk patients.

Briefing and debriefing in the cardiac operating room. Analysis of impact on theatre team attitude and patient safety.

PubMed

Papaspyros, Sotiris C; Javangula, Kalyana C; Adluri, Rajeshwara Krishna Prasad; O'Regan, David J

2010-01-01

Error in health services delivery has long been recognised as a significant cause of inpatient morbidity and mortality. Root-cause analyses have cited communication failure as one of the contributing factors in adverse events. The formalised fighter pilot mission brief and debrief formed the basis of the National Aeronautics and Space Administration (NASA) crew resource management (CRM) concept produced in 1979. This is a qualitative analysis of our experience with the briefing-debriefing process applied to cardiac theatres. We instituted a policy of formal operating room (OR) briefing and debriefing in all cardiac theatre sessions. The first 118 cases were reviewed. A trouble-free operation was noted in only 28 (23.7%) cases. We experienced multiple problems in 38 (32.2%) cases. A gap was identified in the second order problem solving in relation to instrument repair and maintenance. Theatre team members were interviewed and their comments were subjected to qualitative analysis. The collaborative feeling is that communication has improved. The health industry may benefit from embracing the briefing-debriefing technique as an adjunct to continuous improvement through reflective learning, deliberate practice and immediate feedback. This may be the initial step toward a substantive and sustainable organizational transformation.

Is there still an unknown Freud? A note on the publications of Freud's texts and on unpublished documents.

PubMed

Falzeder, Ernst

2007-01-01

This article presents an overview of the existing editions of what Freud wrote (works, letters, manuscripts and drafts, diaries and calendar notes, dedications and margin notes in books, case notes, and patient calendars) and what he is recorded as having said (minutes of meetings, interviews, memoirs of and interviews with patients, family members, and followers, and other quotes). There follows a short overview of biographies of Freud and other documentation on his life. It is concluded that a wealth of material is now available to Freud scholars, although more often than not this information is used in a biased and partisan way.

Impact of payment system change from per-case to per-diem on high severity patient's length of stay.

PubMed

Jang, Sung-In; Nam, Chung Mo; Lee, Sang Gyu; Kim, Tae Hyun; Park, Sohee; Park, Eun-Cheol

2016-09-01

A new payment system, the diagnosis-related group (DRG) system, and Korean diagnosis procedure combination (KDPC, per-diem) payment system were officially introduced in 2002 and in 2012, respectively. We evaluated the impact of payment system change from per-case to per-diem on high severity patient's length of stay (LOS).Claim data was used. A total of 36,240 case admissions and 72,480 control admissions were included in the analysis. Segmented regression analysis of interrupted time series between cases and controls was conducted. Hospitals that consistently participated in the DRG payment system and changed to the KDPC payment system were defined as case hospitals. Hospitals that consistently participated in the DRG payment system were defined as control hospitals.LOS increased by 0.025 days per month (P = 0.0055) for 3 surgical diagnosis-related admissions due to the bundled payment system change. LOS among emergency admissions also increased and showed an increasing tendency under the KDPC. The LOS increase was observed specifically for complex procedure admissions and high severity cases (CCI 0, 1: 0.022, P = 0.0142; CCI 2, 3: 0.026, P = 0.0288; CCI ≥ 4: 0.055, P = 0.0003).Although both payment systems are optimized to decrease LOS, incentives to reduce LOS are stronger under the DRG system than under the KDPC system. It is worth noting that too strong incentive for reducing LOS is suitable to high severity cases.

De novo reciprocal translocation t(5;11)(q22;p15) associated with hydrops fetalis (reciprocal translocation and hydrops fetalis).

PubMed

Pala, Halil Gursoy; Artunc-Ulkumen, Burcu; Uyar, Yildiz; Bal, Filiz; Baytur, Yesim Bulbul; Koyuncu, Faik Mumtaz

2015-02-01

This is a case of a prenatally diagnosed non-immune hydrops fetalis (NIHF) associated with translocation t(5;11)(q22;p15). An association between NIHF and this translocation has not been reported previously. The patient was referred to the perinatology clinic with hydrops fetalis diagnosis at 23 weeks' gestation. We noted that the fetus had bilateral pleural effusion, ascites, widespread subcutaneous edema, membranous ventricular septal defect, hypoplastic fifth finger middle phalanx, clinodactyly, single umbilical artery. We performed cordocentesis. Chromosomal analysis on blood showed a balanced translocation between the long arm of chromosome 5 and the short arm of chromosome 11 with karyotype of 46,XX,t(5;11)(q22;p15). We present prenatal diagnosis of a de novo translocation (5;11) in a hydropic fetus with ultrason abnormalities. In our case, karyotype analysis of the fetus, mother and father provided evidence of a de novo translocation, that might explain the NIHF.

Laminar resorption in modified osteo-odonto-keratoprosthesis procedure: a cause for concern.

PubMed

Iyer, Geetha; Srinivasan, Bhaskar; Agarwal, Shweta; Rachapalle, Sudhir Reddi

2014-08-01

To analyze the cases of lamina resorption following the modified osteo-odonto-keratoprosthesis (MOOKP) procedure. Retrospective case series. Case records of 18 eyes (20 laminae) of 17 patients who showed evidence of lamina resorption out of the 85 eyes (87 laminae) of 82 patients that underwent MOOKP procedure between March 2003 and March 2013 were analyzed. Of the 17 patients (20 laminae), 1 underwent MOOKP procedure following multiple graft failures, 6 (7 laminae) belonged to the chemical injury group, and 10 (12 laminae) to the Stevens-Johnson syndrome (SJS) group. Resorption was noted in 20 out of 87 laminae (22.98%). The need for removal of lamina/extrusion was noted in 3 out of the 7 laminae in the chemical injury group and 8 out of the 12 laminae in the SJS group. The mean duration to the first sign suggestive of resorption among patients of SJS was 36.7 months and among patients of chemical injury was 43 months. Vitritis was the presenting feature (7 of 20 laminae, 35%) indicative of early resorption, and the occurrence of the same in eyes with lamina resorption was noted to be statistically significant in comparison to controls (P<.001). Sixteen out of 20 laminae showed evidence of resorption superiorly. Vitritis was the most common presenting feature of lamina resorption and could be an indicator of lamina resorption. Resorption of the laminae was noted to occur along the aspect with thinner bone support in all eyes. Incidence of severe resorption with extrusion of cylinder/requiring lamina removal was noted to be higher among patients with SJS. Copyright © 2014 Elsevier Inc. All rights reserved.

The problem with rescue medicine.

PubMed

Jecker, Nancy S

2013-02-01

Is there a rational and ethical basis for efforts to rescue individuals in dire straits? When does rescue have ethical support, and when does it reflect an irrational impulse? This paper defines a Rule of Rescue and shows its intuitive appeal. It then proceeds to argue that this rule lacks support from standard principles of justice and from ethical principles more broadly, and should be rejected in many situations. I distinguish between agent-relative and agent-neutral reasons, and argue that the Rule of Rescue qualifies only in a narrow range of cases where agent-relative considerations apply. I conclude that it would be wise to set aside the Rule of Rescue in many cases, especially those involving public policies, where it has only weak normative justification. The broader implications of this analysis are noted.

Case Study: Mini-Case Studies: Small Infusions of Active Learning for Large-Lecture Courses

ERIC Educational Resources Information Center

Carloye, Lisa

2017-01-01

In this article, the author introduces the usage of case studies to be an excellent method for engaging students through stories. The author notes she developed a series of mini-case studies that can be implemented, with a little advance preparation, within a 10- to 15-minute window during lecture. What makes them "mini" case studies?…

Teaching Business French through Case Studies: Presentation of a Marketing Case.

ERIC Educational Resources Information Center

Federico, Salvatore; Moore, Catherine

The use of case studies as a means for teaching business French is discussed. The approach is advocated because of the realism of case studies, which are based on actual occurrences. Characteristics of a good case are noted: it tells a story, focuses on interest-arousing issues, is set in the past 10 years, permits empathy with the main…

Integration of Peer Philosophy into a Standardized Self-Management Mobile Health Intervention.

PubMed

Fortuna, Karen L; Storm, Marianne; Aschbrenner, Kelly A; Bartels, Stephen J

2018-04-19

Description of certified peer specialists integration of peer philosophy into the delivery of a self-management intervention enhanced with mobile health. Qualitative examination of peer case notes that were routinely entered on a peer care management electronic dashboard. This study included consumers with serious mental illness (N = 8) with a mean age of 68.8 years (SD = 4.9). Certified peer specialists (N = 3) were all female and aged 55 years or older. Peers entered 146 case notes on the peer care management notes dashboard. Five themes emerged including encouragement of self-determination, bio-psychosocial-spiritual framework guides practice, sharing lived experience to teach self-management skills, personalized text messages to reinforce self-management skill development, and identifying unmet needs and advocating for human rights. Peers unique perspectives and expertise was complemented with the standardized delivery of evidence-based intervention enhanced with mobile health.

Laboratory model for the study and treatment of traumatic tattoos with the Q-switched ruby laser

NASA Astrophysics Data System (ADS)

Silverman, Richard T.; Lach, Elliot

1994-09-01

The outcome of laser tattoo removal is dependent on the type of laser and characteristics of the tattoo. A rabbit model was developed to study the Q-switched ruby laser in the treatment of traumatic tattooing. On the backs of white New Zealand rabbits, three 3 cm patches were dermabraded and dressed with carbon black and antibiotic ointment. After a healing period of eight weeks, pre-treatment biopsies were obtained, and the rabbits were treated with the Q- switched ruby laser at various fluence settings with a pulse width of 34 nsec. At set intervals, further biopsies were obtained and studied with light and electron microscopic analysis, and photodocumentation was performed. Grossly, clearance of the tattooed areas was noted in the laser treated specimens. More effective clearance was observed with higher fluence treatment. No infections occurred, and hair regrowth was noted in all cases, though the rate seemed to be altered by laser treatment.

North-East monsoon rainfall extremes over the southern peninsular India and their association with El Niño

NASA Astrophysics Data System (ADS)

Singh, Prem; Gnanaseelan, C.; Chowdary, J. S.

2017-12-01

The present study investigates the relationship between extreme north-east (NE) monsoon rainfall (NEMR) over the Indian peninsula region and El Niño forcing. This turns out to be a critical science issue especially after the 2015 Chennai flood. The puzzle being while most El Niños favour good NE monsoon, some don't. In fact some El Niño years witnessed deficit NE monsoon. Therefore two different cases (or classes) of El Niños are considered for analysis based on standardized NEMR index and Niño 3.4 index with case-1 being both Niño-3.4 and NEMR indices greater than +1 and case-2 being Niño-3.4 index greater than +1 and NEMR index less than -1. Composite analysis suggests that SST anomalies in the central and eastern Pacific are strong in both cases but large differences are noted in the spatial distribution of SST over the Indo-western Pacific region. This questions our understanding of NEMR as mirror image of El Niño conditions in the Pacific. It is noted that the favourable excess NEMR in case-1 is due to anomalous moisture transport from Bay of Bengal and equatorial Indian Ocean to southern peninsular India. Strong SST gradient between warm western Indian Ocean (and Bay of Bengal) and cool western Pacific induced strong easterly wind anomalies during NE monsoon season favour moisture transport towards the core NE monsoon region. Further anomalous moisture convergence and convection over the core NE monsoon region supported positive rainfall anomalies in case-1. While in case-2, weak SST gradients over the Indo-western Pacific and absence of local low level convergence over NE monsoon region are mainly responsible for deficit rainfall. The ocean dynamics in the Indian Ocean displayed large differences during case-1 and case-2, suggesting the key role of Rossby wave dynamics in the Indian Ocean on NE monsoon extremes. Apart from the large scale circulation differences the number of cyclonic systems land fall for case-1 and case-2 have also contributed for variations in NE monsoon rainfall extremes during El Niño years. This study indicates that despite having strong warming in the central and eastern Pacific, NE monsoon rainfall variations over the southern peninsular India is mostly determined by SST gradient over the Indo-western Pacific region and number of systems formation in the Bay of Bengal and their land fall. The paper concludes that though the favourable large scale circulation induced by Pacific is important in modulating the NE monsoon rainfall the local air sea interaction plays a key role in modulating or driving rainfall extremes associated with El Niño.

Diagnostics of and Specific Hyposensitization to Pollen Rhinopathy (Hay Fever),

DTIC Science & Technology

Patients (120 in all) were studied for precise diagnosis of pollen rhinopathy. Among them aggravated allergic heredity was revealed in 63% of cases; a positive allergological anamnesis was noted in 55% of cases.

Teaming and Teaching in ECE: Neoliberal Reforms, Teacher Metaphors, and Identity in Head Start

ERIC Educational Resources Information Center

Bullough, Robert V., Jr.

2015-01-01

Noting that surprisingly little researcher attention has been directed toward teaming in early childhood education (ECE), the author conducted parallel case studies of two Head Start teacher teams in a single center. Drawing on interviews, extensive observational notes taken over the course of a school year, and teacher-generated metaphors, the…

7 CFR 1962.49 - Civil and criminal cases.

Code of Federal Regulations, 2010 CFR

2010-01-01

... sources, has agreed in the note or other instrument to do so, but refuses to comply with that agreement... office). Ordinarily, it will not be necessary to inform the third-party purchaser of OGC's decision when... now be sent to the borrower and any other obligor(s) on the note. Any appeal must be concluded before...

Compartment A126 port side. Note ash hoist for boiler room ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

Compartment A-126 port side. Note ash hoist for boiler room compartment B-1 and compartment B-2. Scuttlebutt (drinking water fountain) is at right center of photograph. Manikin wearing WWII wave uniform is in display case at left center. (045) - USS Olympia, Penn's Landing, 211 South Columbus Boulevard, Philadelphia, Philadelphia County, PA

Sherlock Holmes and the Strange Case of the Missing Attribution: A Historical Note on "The Grandfather Passage"

ERIC Educational Resources Information Center

Reilly, Jamie; Fisher, Jamie L.

2012-01-01

Purpose: In 1963, Charles Van Riper published "My Grandfather," a short reading passage that has evolved into a ubiquitous metric of reading ability and speech intelligibility. In this historical note, we describe several heretofore unacknowledged similarities between "The Grandfather Passage" (Darley, Aronson, & Brown, 1975) and a portion of "The…

Historical note: Drumine--a new Australian local anaesthetic.

PubMed

Bailey, R J

1977-02-01

An article in the Australiasian Medical Gazette of October, 1886 indicates the method of extraction, experimentation and therapeutic application of an active principle, prepared from Euphorbia Drummondii. Further correspondence is noted, refining the method of extraction, reporting cases, answering criticisms, and announcing eventually, drumine's commercial preparation. Despite enthusiastic support, the drug soon disappears from the therapeutic scene.

Electrical injuries due to railway high tension cables.

PubMed

Reichl, M; Kay, S

1985-08-01

We have noted a large number of young boys being admitted to our Unit with burns due to railway high tension cables. On review of these cases we have noted: most of the burns were due to arcing, there is a high level of ignorance among the population at risk. We propose some ways of preventing these injuries.

Facilitating Collaboration in Lecture-Based Learning through Shared Notes Using Wireless Technologies

ERIC Educational Resources Information Center

Valtonen, T.; Havu-Nuutinen, S.; Dillon, P.; Vesisenaho, M.

2011-01-01

This paper reports a case study for developing lecture teaching in higher education by connecting simultaneously the benefits of face-to-face teaching and social software for capturing and sharing students' lecture notes. The study was conducted with 12 university students taking a degree course on pre-primary education. Data were collected on (1)…

7 CFR 1738.30 - Rural broadband access loans and loan guarantees.

Code of Federal Regulations, 2010 CFR

2010-01-01

... interest at a rate set by the lender consistent with the current applicable market rate for a loan of... Derivative or any Guaranteed-Amount Debt Derivative; or (B) Any holder of the Guaranteed Loan Note or any Guaranteed Loan Portion Note or any Derivative, as the case may be, having a claim to payments on the...

Application Note: Power Grid Modeling With Xyce.

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

Sholander, Peter E.

This application note describes how to model steady-state power flows and transient events in electric power grids with the SPICE-compatible Xyce TM Parallel Electronic Simulator developed at Sandia National Labs. This application notes provides a brief tutorial on the basic devices (branches, bus shunts, transformers and generators) found in power grids. The focus is on the features supported and assumptions made by the Xyce models for power grid elements. It then provides a detailed explanation, including working Xyce netlists, for simulating some simple power grid examples such as the IEEE 14-bus test case.

Expression of CDX-2 and Ki-67 in different grades of colorectal adenocarcinomas.

PubMed

Sen, Anway; Mitra, Sumit; Das, Ram Narayan; Dasgupta, Shatavisha; Saha, Koushik; Chatterjee, Uttara; Mukherjee, Krishnendu; Datta, Chhanda; Chattopadhyay, Bitan K

2015-01-01

CDX2 is a caudal homeobox gene essential for intestinal differentiation and is specifically expressed in colorectal adenocarcinomas. Its role in colorectal carcinogenesis is not fully elucidated. To study the expression pattern of CDX2 and Ki-67 in different grades of colorectal adenocarcinomas and to observe the relationship of their staining patterns in various tumor stages and to look for correlation if any, between Ki-67 labeling index (Ki-67 LI) and CDX2 expression. A total of 74 cases were enrolled. Detailed clinical profile, peroperative findings, histological grading and staging were noted. Immunohistochemistry for CDX2 and Ki-67 was done, and Ki-67 LI was calculated. CDX2 staining was graded semi-quantitatively, and statistical analysis was done. Age of presentation ranged from 20 to 75 years, and the male:female ratio was 1.83:1. There were 8, 47 and 13 cases of well, moderate and poorly differentiated adenocarcinomas, respectively. The mean Ki-67 LI of well, moderate and poorly differentiated adenocarcinomas were 14.25, 31.34 and 43.08 respectively, and their difference was statistically significant, correlation was also noted with stage. CDX2 expression appeared to be stronger in poorly differentiated cases, but there was no significant difference in its expression in the different grades and stages. There was no correlation between Ki-67 LI and CDX2 immunostaining pattern. The lymph node metastasis showed CDX2 positivity in all the cases. Expression of CDX2 does not significantly change with the grade of colorectal adenocarcinomas. However, it is an important diagnostic marker in metastatic colonic lesions. The Ki-67 LI, on the other hand, showed a strong correlation with histopathological grades.

East London Experience with Enteric Fever 2007-2012

PubMed Central

Dave, Jayshree; Millar, Michael; Maxeiner, Horst; Freedman, Joanne; Meade, Rachel; Rosmarin, Caryn; Jordan, Matthew; Andrews, Nick; Holliman, Richard; Sefton, Armine

2015-01-01

Purpose The clinical presentation and epidemiology for patients with enteric fever at two hospitals in East London during 2007–2012 is described with the aim to identify preventive opportunities and to reduce the cost of treatment. Methods A retrospective analysis of case notes from patients admitted with enteric fever during 2007 to 2012 with a microbiologically confirmed diagnosis was undertaken. Details on clinical presentation, travel history, demographic data, laboratory parameters, treatment, patient outcome and vaccination status were collected. Results Clinical case notes were available for 98/129 (76%) patients including 69 Salmonella enterica serovar Typhi (S. Typhi) and 29 Salmonella enterica serovar Paratyphi (S. Paratyphi). Thirty-four patients (35%) were discharged from emergency medicine without a diagnosis of enteric fever and then readmitted after positive blood cultures. Seventy-one of the 98 patients (72%) were UK residents who had travelled abroad, 23 (23%) were foreign visitors/new entrants to the UK and four (4%) had not travelled abroad. Enteric fever was not considered in the initial differential diagnosis for 48/98 (49%) cases. The median length of hospital stay was 7 days (range 0–57 days). The total cost of bed days for managing enteric fever was £454,000 in the two hospitals (mean £75,666/year). Median time to clinical resolution was five days (range 1–20). Seven of 98 (7%) patients were readmitted with relapsed or continued infection. Six of the 71 (8%) patients had received typhoid vaccination, 34 (48%) patients had not received vaccination, and for 31 cases (44%) vaccination status was unknown. Conclusions Further interventions regarding education and vaccination of travellers and recognition of the condition by emergency medicine clinicians in travellers to South Asia is required. PMID:25790017

Use of Simvastatin and Risk of Acute Pancreatitis: A Nationwide Case-Control Study in Taiwan.

PubMed

Lin, Chih-Ming; Liao, Kuan-Fu; Lin, Cheng-Li; Lai, Shih-Wei

2017-07-01

The correlation between simvastatin use and acute pancreatitis is explored. A case-control study was conducted to analyze claim data from the Taiwan National Health Insurance Program. The case group comprising a total of 3882 subjects aged 20 to 84 years with their first acute pancreatitis episode occurring between 1998 and 2011 formed the case group, against 3790 randomly selected controls matched for sex, age, comorbidities, and index year of acute pancreatitis diagnosis. Recent use of simvastatin was defined as subjects whose last remaining simvastatin tablet was noted ≤7 days before the date of acute pancreatitis diagnosis. Remote use of simvastatin was defined as subjects whose last remaining 1 tablet for simvastatin was noted >7 days before the date of acute pancreatitis diagnosis. Never use of simvastatin was defined as subjects who had never been prescribed simvastatin. A multivariable unconditional logistic regression model was used to estimate the odds ratio and 95%CI to explore the correlation between simvastatin use and acute pancreatitis. After adjustment for confounders, multivariable logistic regression analysis revealed that the adjusted odds ratio of acute pancreatitis was 1.3 for subjects with recent use of simvastatin (95%CI 1.02, 1.73), when compared with those with never use of simvastatin. The crude odds ratio decreased to 1.1 for those with remote use of simvastatin (95%CI 0.93, 1.34) but without statistical significance. Recent use of simvastatin is associated with acute pancreatitis. Clinicians should consider the possibility of simvastatin-associated acute pancreatitis for patients presenting for acute pancreatitis without known cause. © 2017, The American College of Clinical Pharmacology.

The role of copy and paste function in orthopedic trauma progress notes.

PubMed

Winn, Wesley; Shakir, Irshad A; Israel, Heidi; Cannada, Lisa K

2017-01-01

The electronic medical record (EMR) is standard in institutions. While there is not concern for legibility of notes and access to charts, there is an ease of copy and paste for daily notes. This may not lead to accurate portrayal of patient's status. Our purpose was to evaluate the use of copy and paste functions in daily notes of patients with injuries at high risk for complications. IRB approval was obtained for a retrospective review. Inclusion criteria included patients aged 18 and older treated at our Level 1 Trauma Center after implementation of Epic Systems Corporation, Verona, WI, USA. Those who were surgically treated for bicondylar tibial plateau fracture, or open tibial shaft fracture type I or II were included. Manual comparison of daily progress to the previous day's note was carried out. Comparisons were made by evaluating the subjective, objective, and plan portions of the notes, coded nominally using 1 for a change 0 for remaining the same. 38 patients' charts were reviewed during a 10-month (July 2012-April 2013) period, and the average length of stay was 12 days (range: 2-35). A total of 418 notes were compared. The overall average of copied data was 85% daily. In the subjective portion, 85-97% of the data was copied on a daily basis and 71-92% of the data was copied within the objective portion of the notes. There were 15 medical complications necessitating intervention. Of these medical complications, the note the day after the complication reflected the event in 10 out of 15, or 70%, of the complications. Thus 5, or 30%, of the patients did not have notes reflecting the complication ( p  < 0.05). There were 7 complications related to the injuries: 4 cases of compartment syndrome, 1 case of foot drop, representing a change in neurologic status, an amputation, and a wound infection treated with antibiotics. Four of the 7 complications (57%) were not reflected in the notes the following day after the complication ( p  < 0.05). There were 54 planned returns to the operating room for procedures, yet 30 of the 54 (56%) notes regarding planned surgical procedures notes did not accurately report the plan for surgery ( p  < 0.05). There were 4 patients with unplanned trips to the operating room and 3 of the notes (75%) did not reflect this ( p  < 0.05). Twelve patients (32%) did not have notes accurately reflecting discharge plans and/or destination ( p  < 0.05). Our results demonstrated widespread use of copy and paste function. We encourage evaluation of the charts by comparing notes to check and a plan to minimize this practice. There needs to be consistent note writing guidelines and appropriate templates used. This will decrease the inaccuracies in the chart and provide a clear picture of the patient, their injuries, and current status.

Climate drivers on malaria transmission in Arunachal Pradesh, India.

PubMed

Upadhyayula, Suryanaryana Murty; Mutheneni, Srinivasa Rao; Chenna, Sumana; Parasaram, Vaideesh; Kadiri, Madhusudhan Rao

2015-01-01

The present study was conducted during the years 2006 to 2012 and provides information on prevalence of malaria and its regulation with effect to various climatic factors in East Siang district of Arunachal Pradesh, India. Correlation analysis, Principal Component Analysis and Hotelling's T² statistics models are adopted to understand the effect of weather variables on malaria transmission. The epidemiological study shows that the prevalence of malaria is mostly caused by the parasite Plasmodium vivax followed by Plasmodium falciparum. It is noted that, the intensity of malaria cases declined gradually from the year 2006 to 2012. The transmission of malaria observed was more during the rainy season, as compared to summer and winter seasons. Further, the data analysis study with Principal Component Analysis and Hotelling's T² statistic has revealed that the climatic variables such as temperature and rainfall are the most influencing factors for the high rate of malaria transmission in East Siang district of Arunachal Pradesh.

Using known map category marginal frequencies to improve estimates of thematic map accuracy

NASA Technical Reports Server (NTRS)

Card, D. H.

1982-01-01

By means of two simple sampling plans suggested in the accuracy-assessment literature, it is shown how one can use knowledge of map-category relative sizes to improve estimates of various probabilities. The fact that maximum likelihood estimates of cell probabilities for the simple random sampling and map category-stratified sampling were identical has permitted a unified treatment of the contingency-table analysis. A rigorous analysis of the effect of sampling independently within map categories is made possible by results for the stratified case. It is noted that such matters as optimal sample size selection for the achievement of a desired level of precision in various estimators are irrelevant, since the estimators derived are valid irrespective of how sample sizes are chosen.

Case Study: Let's Get Personal--Putting Personality into Your Cases

ERIC Educational Resources Information Center

Herreid, Clyde Freeman

2017-01-01

In this case study, the subject for discussion is the need to use teaching notes in order to add personality to case studies. Personality, it is said, is more important than policy, than demographics, than finances, or amorous peccadillos. Personality is essential. It is the interaction of people that capture our interest, yet, the question is…

Bewitching Ideas Influence Learning: An Evaluation of an Interdisciplinary Teaching Experience

ERIC Educational Resources Information Center

Nava-Whitehead, Susan M.; Augusto, Kerri W.; Gow, Joan-Beth

2011-01-01

This column provides original articles on innovations in case study teaching, assessment of the method, as well as case studies with teaching notes. In this month's issue the authors describe an interdisciplinary approach to case study teaching that addresses the demand to balance the goals of process and content. The case study, Salem's Secrets…

Automated identification of wound information in clinical notes of patients with heart diseases: Developing and validating a natural language processing application.

PubMed

Topaz, Maxim; Lai, Kenneth; Dowding, Dawn; Lei, Victor J; Zisberg, Anna; Bowles, Kathryn H; Zhou, Li

2016-12-01

Electronic health records are being increasingly used by nurses with up to 80% of the health data recorded as free text. However, only a few studies have developed nursing-relevant tools that help busy clinicians to identify information they need at the point of care. This study developed and validated one of the first automated natural language processing applications to extract wound information (wound type, pressure ulcer stage, wound size, anatomic location, and wound treatment) from free text clinical notes. First, two human annotators manually reviewed a purposeful training sample (n=360) and random test sample (n=1100) of clinical notes (including 50% discharge summaries and 50% outpatient notes), identified wound cases, and created a gold standard dataset. We then trained and tested our natural language processing system (known as MTERMS) to process the wound information. Finally, we assessed our automated approach by comparing system-generated findings against the gold standard. We also compared the prevalence of wound cases identified from free-text data with coded diagnoses in the structured data. The testing dataset included 101 notes (9.2%) with wound information. The overall system performance was good (F-measure is a compiled measure of system's accuracy=92.7%), with best results for wound treatment (F-measure=95.7%) and poorest results for wound size (F-measure=81.9%). Only 46.5% of wound notes had a structured code for a wound diagnosis. The natural language processing system achieved good performance on a subset of randomly selected discharge summaries and outpatient notes. In more than half of the wound notes, there were no coded wound diagnoses, which highlight the significance of using natural language processing to enrich clinical decision making. Our future steps will include expansion of the application's information coverage to other relevant wound factors and validation of the model with external data. Copyright © 2016 Elsevier Ltd. All rights reserved.

Association between rs3087243 and rs231775 polymorphism within the cytotoxic T-lymphocyte antigen 4 gene and Graves' disease: a case/control study combined with meta-analyses

PubMed Central

Dai, Yu; Zeng, Tianshu; Xiao, Fei; Chen, Lulu; Kong, Wen

2017-01-01

We conducted a case/control study to assess the impact of SNP rs3087243 and rs231775 within the CTLA4 gene, on the susceptibility to Graves' disease (GD) in a Chinese Han dataset (271 cases and 298 controls). The frequency of G allele for rs3087243 and rs231775 was observed to be significantly higher in subjects with GD than in control subjects (p = 0.005 and p = 0.000, respectively). After logistic regression analysis, a significant association was detected between SNP rs3087243 and GD in the additive and recessive models. Similarly, association for the SNP rs231775 could also be detected in the additive model, dominant model and recessive model. A meta-analysis, including 27 published datasets along with the current dataset, was performed to further confirm the association. Consistent with our case/control results, rs3087243 and rs231775 showed a significant association with GD in all genetic models. Of note, ethnic stratification revealed that these two SNPs were associated with susceptibility to GD in populations of both Asian and European descent. In conclusion, our data support that the rs3087243 and rs231775 polymorphisms within the CTLA4 gene confer genetic susceptibility to GD. PMID:29299173

Lung function in type 2 diabetes: the Normative Aging Study.

PubMed

Litonjua, Augusto A; Lazarus, Ross; Sparrow, David; Demolles, Debbie; Weiss, Scott T

2005-12-01

Cross-sectional studies have noted that subjects with diabetes have lower lung function than non-diabetic subjects. We conducted this analysis to determine whether diabetic subjects have different rates of lung function change compared with non-diabetic subjects. We conducted a nested case-control analysis in 352 men who developed diabetes and 352 non-diabetic subjects in a longitudinal observational study of aging in men. We assessed lung function among cases and controls at three time points: Time0, prior to meeting the definition of diabetes; Time1, the point when the definition of diabetes was met; and Time2, the most recent follow-up exam. Cases had lower forced expiratory volume in 1s (FEV1) and forced vital capacity (FVC) at all time points, even with adjustment for age, height, weight, and smoking. In multiple linear regression models adjusting for relevant covariates, there were no differences in rates of FEV1 or FVC change over time between cases and controls. Men who are predisposed to develop diabetes have decreased lung function many years prior to the diagnosis, compared with men who do not develop diabetes. This decrement in lung function remains after the development of diabetes. We postulate that mechanisms involved in the insulin resistant state contribute to the diminished lung function observed in our subjects.

Autistic Disorder in Nineteenth-Century London. Three Case Reports

ERIC Educational Resources Information Center

Waltz, Mitzi; Shattock, Paul

2004-01-01

This article examines the existence, description, perception, treatment, and outcome of symptoms consistent with autistic disorder in nineteenth-century London, England, based on case histories from the notes of Dr William Howship Dickinson at Great Ormond Street Hospital for Children. Three cases meeting the DSM-IV criteria for autistic disorder…

Educator Sexual Abuse: Two Case Reports

ERIC Educational Resources Information Center

Burgess, Ann Wolbert; Welner, Michael; Willis, Danny G.

2010-01-01

Sexual abuse by educators has become an increasingly noted type of sexual abuse, especially among adolescents, for two reasons. First, there is a potential for these cases to be silent and prolonged and second, when disclosed, the forensic implications usually include both criminal and/or civil sanctions. For forensic case evaluations,…

Software quality assurance | News

Science.gov Websites

Measure was removed: "Sufficient level of detail in the requirements to develop test cases." ; This control measure was removed since the sufficient level of detail needed to develop test cases is recorded for all test cases. (Note: This is mandatory for applications graded with a High Quality Assurance

Neither Saints nor Sinners: Initial Reporting of the "Progressive" Case.

ERIC Educational Resources Information Center

Swain, Bruce M.

1980-01-01

Examines the circumstances of the 1979 "Progressive" case, in which the federal government quashed an article about hydrogen bomb production. Notes reportorial lapses that prevented a full and balanced account of the situation. (RL)

Socio-technical issues and challenges in implementing safe patient handovers: insights from ethnographic case studies.

PubMed

Balka, Ellen; Tolar, Marianne; Coates, Shannon; Whitehouse, Sandra

2013-12-01

Ineffective handovers in patient care, including those where information loss occurs between care providers, have been identified as a risk to patient safety. Computerization of health information is often offered as a solution to improve the quality of care handovers and decrease adverse events related to patient safety. The purpose of this paper is to broaden our understanding of clinical handover as a patient safety issue, and to identify socio-technical issues which may come to bear on the success of computer based handover tools. Three in depth ethnographic case studies were undertaken. Field notes were transcribed and analyzed with the aid of qualitative data analysis software. Within case analysis was performed on each case, and subsequently, cross case analyses were performed. We identified five types of socio-technical issues which must be addressed if electronic handover tools are to succeed. The inter-dependencies of these issues are addressed in relation to arenas in which health care work takes place. We suggest that the contextual nature of information, ethical and medico-legal issues arising in relation to information handover, and issues related to data standards and system interoperability must be addressed if computerized health information systems are to achieve improvements in patient safety related to handovers in care. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

Calcium Tartrate Tetrahydrate, Case Report of a Novel Human Kidney Stone.

PubMed

Kleinguetl, Colin; Williams, James C; Ibrahim, Samar A; Daudon, Michel; Bird, Erin T; El Tayeb, Marawan M

2017-01-01

Background: Calcium tartrate tetrahydrate has been reported as the main mineral in urinary stones in rats that have significant tartrate in their diet, but in humans, there has been only one mention of calcium tartrate stones in the form of bladder stone, and that case was in Africa. Case Presentation: Patient is a 34-year-old Caucasian male who presented with typical symptoms of nephrolithiasis. CT abd/pelvis (renal stone protocol) revealed a 2 cm nonobstructing stone of the right renal pelvis. Patient underwent an uncomplicated right percutaneous nephrolithotomy and was noted to be stone free after surgery. Stone analysis was difficult with regard to determining composition, but was finally identified as calcium tartrate tetrahydrate. Conclusion: This was an unusual case, as this is the first recorded case of a calcium tartrate tetrahydrate outside of Africa. This type of stone had only been mainly described in rat models with dl- bitartrate in their diet. Our patient was an otherwise healthy, relatively muscular individual with no obvious source for this stone other than a vitamin and amino acid supplement that he takes regularly that contains l-carnitine (as tartrate) and choline (as bitartrate and citrate). The prevalence of this stone type is presently unknown, as stone analysis laboratories have not had the ability to recognize it. Although a connection between the supplement and stone formation is conjecture at this time, we believe this necessitates further investigation.

Beyond the specific child. What is 'a child's case' in general practice?

PubMed

Hølge-Hazelton, Bibi; Tulinius, Charlotte

2010-01-01

Too many abused and neglected children are being overlooked by GPs and other professionals who are in contact with the families. Some suggestions for a definition of 'a child in need' have been given, but the functionality of these definitions has not been tested in general practice. To describe the problems presented by GPs as cases with children in need during supervision, and from here to suggest an empirically-based definition of a child in need in general practice. A mixed-method evaluation design was used. Twenty-one GPs, in Denmark, participated in supervision groups concerning cases with children in need in general practice. The data were analysed via field notes and video recordings; case categorisation into sex, ethnicity, and developmental stages; thematically using the GPs' own descriptions; and a theoretically supported style. Analysis of the data led to the suggested definition of a case concerning 'a child in need' in general practice as one that directly or indirectly involves problems with a specific child, an as-yet unborn child, or one or both parents of a family currently or potentially threatening the wellbeing of the family or the child. Based on this analysis, one suggestion as to why some abused and neglected children are overlooked in general practice is that GPs often have to navigate in difficult indirect consultations, where there is a high risk of losing the overview.

The impact of three discharge coding methods on the accuracy of diagnostic coding and hospital reimbursement for inpatient medical care.

PubMed

Tsopra, Rosy; Peckham, Daniel; Beirne, Paul; Rodger, Kirsty; Callister, Matthew; White, Helen; Jais, Jean-Philippe; Ghosh, Dipansu; Whitaker, Paul; Clifton, Ian J; Wyatt, Jeremy C

2018-07-01

Coding of diagnoses is important for patient care, hospital management and research. However coding accuracy is often poor and may reflect methods of coding. This study investigates the impact of three alternative coding methods on the inaccuracy of diagnosis codes and hospital reimbursement. Comparisons of coding inaccuracy were made between a list of coded diagnoses obtained by a coder using (i)the discharge summary alone, (ii)case notes and discharge summary, and (iii)discharge summary with the addition of medical input. For each method, inaccuracy was determined for the primary, secondary diagnoses, Healthcare Resource Group (HRG) and estimated hospital reimbursement. These data were then compared with a gold standard derived by a consultant and coder. 107 consecutive patient discharges were analysed. Inaccuracy of diagnosis codes was highest when a coder used the discharge summary alone, and decreased significantly when the coder used the case notes (70% vs 58% respectively, p < 0.0001) or coded from the discharge summary with medical support (70% vs 60% respectively, p < 0.0001). When compared with the gold standard, the percentage of incorrect HRGs was 42% for discharge summary alone, 31% for coding with case notes, and 35% for coding with medical support. The three coding methods resulted in an annual estimated loss of hospital remuneration of between £1.8 M and £16.5 M. The accuracy of diagnosis codes and percentage of correct HRGs improved when coders used either case notes or medical support in addition to the discharge summary. Further emphasis needs to be placed on improving the standard of information recorded in discharge summaries. Copyright © 2018 Elsevier B.V. All rights reserved.

Towards automatic music transcription: note extraction based on independent subspace analysis

NASA Astrophysics Data System (ADS)

Wellhausen, Jens; Hoynck, Michael

2005-01-01

Due to the increasing amount of music available electronically the need of automatic search, retrieval and classification systems for music becomes more and more important. In this paper an algorithm for automatic transcription of polyphonic piano music into MIDI data is presented, which is a very interesting basis for database applications, music analysis and music classification. The first part of the algorithm performs a note accurate temporal audio segmentation. In the second part, the resulting segments are examined using Independent Subspace Analysis to extract sounding notes. Finally, the results are used to build a MIDI file as a new representation of the piece of music which is examined.

Towards automatic music transcription: note extraction based on independent subspace analysis

NASA Astrophysics Data System (ADS)

Wellhausen, Jens; Höynck, Michael

2004-12-01

Due to the increasing amount of music available electronically the need of automatic search, retrieval and classification systems for music becomes more and more important. In this paper an algorithm for automatic transcription of polyphonic piano music into MIDI data is presented, which is a very interesting basis for database applications, music analysis and music classification. The first part of the algorithm performs a note accurate temporal audio segmentation. In the second part, the resulting segments are examined using Independent Subspace Analysis to extract sounding notes. Finally, the results are used to build a MIDI file as a new representation of the piece of music which is examined.

On the hierarchy of partially invariant submodels of differential equations

NASA Astrophysics Data System (ADS)

Golovin, Sergey V.

2008-07-01

It is noted that the partially invariant solution (PIS) of differential equations in many cases can be represented as an invariant reduction of some PISs of the higher rank. This introduces a hierarchic structure in the set of all PISs of a given system of differential equations. An equivalence of the two-step and the direct ways of construction of PISs is proved. The hierarchy simplifies the process of enumeration and analysis of partially invariant submodels to the given system of differential equations. In this framework, the complete classification of regular partially invariant solutions of ideal MHD equations is given.

ADA Title I allegations and the Mining, Quarrying, and Oil/Gas Extraction industry.

PubMed

Van Wieren, Todd A; Rhoades, Laura; McMahon, Brian T

2017-01-01

The majority of research about employment discrimination in the U.S. Mining, Quarrying, and Oil/Gas (MQOGE) industries has concentrated on gender and race, while little attention has focused on disability. To explore allegations of Americans with Disabilities Act (ADA) Title I discrimination made to the Equal Employment Opportunity Commission (EEOC) by individuals with disabilities against MQOGE employers. Key data available to this study included demographic characteristics of charging parties, size of employers, types of allegations, and case outcomes. Using descriptive analysis, allegation profiles were developed for MQOGE's three main sectors (i.e., Oil/Gas Extraction, Mining except Oil/Gas, and Support Activities). These three profiles where then comparatively analyzed. Lastly, regression analysis explored whether some of the available data could partially predict MQOGE case outcomes. The predominant characteristics of MQOGE allegations were found to be quite similar to the allegation profile of U.S. private-sector industry as a whole, and fairly representative of MQOGE's workforce demographics. Significant differences between MQOGE's three main sector profiles were noted on some important characteristics. Lastly, it was found that MQOGE case outcomes could be partially predicted via some of the available variables. The study's limitations were presented and recommendations were offered for further research.

Use of Modified SOAP Notes and Peer-Led Small-Group Discussion in a Medical Physiology Course: Addressing the Hidden Curriculum

ERIC Educational Resources Information Center

Kibble, Jonathan; Hansen, Penelope A.; Nelson, Loren

2006-01-01

Peer leading of small-group discussion of cases; use of modified subjective, objective, assessment of physiology (SOAP) notes; and opportunities for self-assessment were introduced into a Medical Physiology course to increase students' awareness and practice of professional behaviors. These changes arose from faculty members' understanding of the…

31 CFR 315.35 - Payment (redemption).

Code of Federal Regulations, 2014 CFR

2014-07-01

... and Savings Notes. A Series E bond will be paid at any time after two months from issue date at the... time after six (6) months from issue date. In any case where Series H bonds are surrendered to a..., SERIES A, B, C, D, E, F, G, H, J, AND K, AND U.S. SAVINGS NOTES General Provisions for Payment § 315.35...

Granulomatous lobular mastitis: report of a case with previously undescribed histopathological abnormalities.

PubMed

Axelsen, R A; Reasbeck, P

1988-10-01

A 41-yr-old multiparous woman presented with a discrete breast lump which proved histologically to be an example of granulomatous lobular mastitis. The clinical and histological features were similar to those noted in previous reports. Additional histological features in the present case were an intense mononuclear cell infiltration of lobular and ductal epithelium, associated with nuclear fragments morphologically suggestive of apoptosis. These appearances, which have not previously been described, are illustrated, together with the more classical features of the condition well demonstrated by the present case. The novel histological features noted here suggest that the development of granulomatous lobular mastitis may be at least in part immunologically mediated, and that the cellular infiltrates seen may be a manifestation of cell-mediated destruction of mammary epithelium.

Natural language processing of clinical notes for identification of critical limb ischemia.

PubMed

Afzal, Naveed; Mallipeddi, Vishnu Priya; Sohn, Sunghwan; Liu, Hongfang; Chaudhry, Rajeev; Scott, Christopher G; Kullo, Iftikhar J; Arruda-Olson, Adelaide M

2018-03-01

Critical limb ischemia (CLI) is a complication of advanced peripheral artery disease (PAD) with diagnosis based on the presence of clinical signs and symptoms. However, automated identification of cases from electronic health records (EHRs) is challenging due to absence of a single definitive International Classification of Diseases (ICD-9 or ICD-10) code for CLI. In this study, we extend a previously validated natural language processing (NLP) algorithm for PAD identification to develop and validate a subphenotyping NLP algorithm (CLI-NLP) for identification of CLI cases from clinical notes. We compared performance of the CLI-NLP algorithm with CLI-related ICD-9 billing codes. The gold standard for validation was human abstraction of clinical notes from EHRs. Compared to billing codes the CLI-NLP algorithm had higher positive predictive value (PPV) (CLI-NLP 96%, billing codes 67%, p < 0.001), specificity (CLI-NLP 98%, billing codes 74%, p < 0.001) and F1-score (CLI-NLP 90%, billing codes 76%, p < 0.001). The sensitivity of these two methods was similar (CLI-NLP 84%; billing codes 88%; p < 0.12). The CLI-NLP algorithm for identification of CLI from narrative clinical notes in an EHR had excellent PPV and has potential for translation to patient care as it will enable automated identification of CLI cases for quality projects, clinical decision support tools and support a learning healthcare system. Copyright © 2017 The Authors. Published by Elsevier B.V. All rights reserved.

PubMed

Ridha, Fatnassi; Houssem, Ragmoun; Latifa, Marzougui; Ines, Mkhinini; Sabra, Hammami

2017-01-01

The delivery of a macrosomic infant is a relatively common situation. It can put mother and fetus at high risk. The main maternal complications are the increase in cesarean rates, postpartum hemorrhage and cervicovaginal traumatic lacerations. The main fetal complication is shoulder dystocia increasing the risk of brachial plexus. The objective was to identify risk factors and maternal-fetal complications associated with fetal macrosomia. Comparative retrospective study conducted at Kairouan University Hospital maternity unit in 2010. We compared a group of 820 cases of macrosomic infants to a control group of 800 cases of infants born in the same period of time. During the study period we collected clinical data of 820 macrosomic cases on a total of 7.495 deliveries, corresponding to a total incidence of 10.94%. Several factors predisposing to fetal macrosomia were highlighted: Maternal age> 35 years was present in 28.5% of cases; Maternal obesity was found in 45% of cases; A personal history of macrosomia was noted in 28,8% of cases; Prolonged pregnancies > 41 weeks of amenorrhoea was noted in 35.6% of cases; Multiparity was found in 47% of cases. Maternal complications were essentially postpartum hemorrhage: 71 cases and genital traumas: 24 cases. Perinatal complications were dominated by shoulder dystocia: 27 cases (3.3%). Traumatic postpartum complications were found in 11.6%.

Creating Your Own Case Studies: A Guide for Early Field Experience.

ERIC Educational Resources Information Center

Florio-Ruane, Susan

1990-01-01

A guide for creating case studies is provided for teacher educators to share with students. Suggestions are offered for becoming a participant observer in a classroom. The appendix contains sample appropriate and inappropriate field notes. (SM)

[Shoulder dystocia: Quality of retranscription in medical files].

PubMed

Martin, E; Bouet, P-E; Sentilhes, L; Legendre, G

2016-03-01

Shoulder dystocia is a rare obstetrical event and potentially serious. Apart from possible psychological implications, it may be responsible for maternal (haemorrhage and perineal tear) and neonatal complications (brachial plexus) leading to complaints and even lawsuits. The transcription of this event in medical files is essential as it is a reflection of the work in an emergency. It allows the obstetrician to defend him in case of trial. Our objective was to assess the quality of the transcription of shoulder dystocia situations in medical files. Retrospective chart study conducted in a university hospital with maternity type III. The primary objective was the rate of comprehensive records (name maneuvers and order of maneuvers of the anterior shoulder hand, time between the expulsion of the head and body, Apgar score). Between 2007 and 2015, 54 cases of shoulder dystocia requiring a second line maneuver after vaginal delivery (Wood and/or Jacquemier) were included. In all, 98.2% of the files were incomplete. The maneuvers and their order were noted in 100% of cases. However, the operation was not correctly described in 16.7% of cases. The anterior shoulder was noted in 16.7% of cases. The time between the expulsion of the head and the body was noted in one single files. Neither broken collarbone nor brachial plexus were observed. To improve the management of dystocia shoulder and transcription of data in files, simulation sessions and the creation of a standardized form would be needed. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

Features of surface phase formation during case-hardening of iron- and titanium-based alloys

NASA Astrophysics Data System (ADS)

Vintaikin, B. E.; Kamynin, A. V.; Kraposhin, V. S.; Smirnov, A. E.; Terezanova, K. V.; Cherenkova, S. A.; Sheykina, V. I.

2017-11-01

The article provides a detailed analysis of formation features for surface phases in technical iron and Cr20-Ni80 alloy samples that undergo case-hardening at a temperature of 850°C for 2, 4 and 6 hours of saturation in two different environments: acetylene, and molten salt consisting of sodium tetraborate and amorphous boron. We carried out an X-ray phase analysis to determine the phase structure of surface material layers that formed as a result of the case-hardening process. We discovered that after carburising it was possible to detect Fe3C and Fe-α phases on the surface of technical iron samples, and after boriding we found FeB, Fe2B and Fe3B phases; we noted a lack of characteristic Fe-α and Fe-γ peaks on the X-ray diffraction pattern. We detected many different phases in the Cr20-Ni80 alloy after the same type of case-hardening. Titanium oxides appeared after case-hardening of titanium in air at 800°C. We provide data on surface structure of samples subjected to vacuum carburising: over a 2 to 6 hour interval, the layer thickness is a parabolic function of time. When carrying out electrolysis-free liquid boriding, increasing exposure time from 2 to 6 hours alters the thickness of the strengthened layer only slightly, so, when carrying out case-hardening, it is less efficient to increase saturation time in molten salt containing sodium tetraborate and amorphous boron.

Analysis of discrepancies observed between digital and analog images during a clinical trial of IRIS

NASA Astrophysics Data System (ADS)

Goldberg, Morris; Coristine, Marjorie; Currie, Shawn; Belanger, Garry; Ahuja, J.; Dillon, Richard F.; Robertson, John G.

1990-08-01

A clinical trial of an Integrated Radiological Information System (IRIS) was conducted at the Ottawa Civic Hospital with the Department of Emergency Medicine and the Department of Radiological Sciences between April 4, and May 12, 1989. During the trial, 319 active Emergency Department cases (905 films) were processed using IRIS. Radiologists examined the digital images on the image screen to formulate a diagnosis, then before dictating a report, they examined the analog films. In 30 cases there was a discrepancy between the information obtained while viewing the digital images on IRIS and the information obtained from the analog films. These anomalous cases were used in an independent study of the discrepancies. In the study, each case was reviewed in both digital and analog form by three physicians who provided a comparative rating of diagnostic quality. Any perceived differences between the digital and analog media were noted. Particular attention was paid to rating the relevance of the IRIS enhancement capabilities. Although ratings for digital images were high, the comparative ratings for the film are in general better. An analysis of the individual cases shows that: (i) most of the discrepancies probably resulted from physician inexperience in reading radiographs in digital form, (ii) the IRIS enhancement facilities significantly increase the ratings of satisfaction or perceived quality of digital images and (iii) an appropriate choice of enhancement may make visible the required diagnostic features for cases where some reviewers did not find the image/digital discrepant.

First Report of a Fatal Case Associated with EV-D68 Infection in Hong Kong and Emergence of an Interclade Recombinant in China Revealed by Genome Analysis.

PubMed

Yip, Cyril C Y; Lo, Janice Y C; Sridhar, Siddharth; Lung, David C; Luk, Shik; Chan, Kwok-Hung; Chan, Jasper F W; Cheng, Vincent C C; Woo, Patrick C Y; Yuen, Kwok-Yung; Lau, Susanna K P

2017-05-16

A fatal case associated with enterovirus D68 (EV-D68) infection affecting a 10-year-old boy was reported in Hong Kong in 2014. To examine if a new strain has emerged in Hong Kong, we sequenced the partial genome of the EV-D68 strain identified from the fatal case and the complete VP1, and partial 5'UTR and 2C sequences of nine additional EV-D68 strains isolated from patients in Hong Kong. Sequence analysis indicated that a cluster of strains including the previously recognized A2 strains should belong to a separate clade, clade D, which is further divided into subclades D1 and D2. Among the 10 EV-D68 strains, 7 (including the fatal case) belonged to the previously described, newly emerged subclade B3, 2 belonged to subclade B1, and 1 belonged to subclade D1. Three EV-D68 strains, each from subclades B1, B3, and D1, were selected for complete genome sequencing and recombination analysis. While no evidence of recombination was noted among local strains, interclade recombination was identified in subclade D2 strains detected in mainland China in 2008 with VP2 acquired from clade A. This study supports the reclassification of subclade A2 into clade D1, and demonstrates interclade recombination between clades A and D2 in EV-D68 strains from China.

Retrospective Analysis of Opioid Medication Incidents Requiring Administration of Naloxone

PubMed Central

Neil, Katherine; Marcil, Allison; Kosar, Lynette; Dumont, Zack; Ruda, Lisa; McMillan, Kaitlyn

2013-01-01

Background: Opioid analgesics are high-alert medications known to cause adverse drug events. Objectives: The purpose of this study was to determine the cause of opioid incidents requiring administration of naloxone, an opioid reversal agent. The specific objectives were to determine the number of opioid incidents and the proportion of incidents documented through occurrence reporting and to characterize the incidents by phase in the medication-use process, by type of incident, and by drug responsible for toxic effects. Methods: A retrospective chart analysis was conducted using records from 2 acute care centres in the Regina Qu’Appelle Health Region. The study included inpatients who received naloxone for reversal of opioid toxicity resulting from licit, in-hospital opioid use. Cases were classified as preventable or nonpreventable. Preventable cases were analyzed to determine the phase of the medication-use process during which the incident occurred. These cases were also grouped thematically by the type of incident. The drug most likely responsible for opioid toxicity was determined for each case. The proportion of cases documented by occurrence reporting was also noted. Results: Thirty-six cases involving administration of naloxone were identified, of which 29 (81%) were deemed preventable. Of these 29 preventable cases, the primary medication incident occurred most frequently in the prescribing phase (23 [79%]), but multiple phases were often involved. The cases were grouped into 6 themes according to the type of incident. Morphine was the drug that most frequently resulted in toxic effects (18 cases [50%]). Only two of the cases (5.6%) were documented by occurrence reports. Conclusion: Preventable opioid incidents occurred in the acute care centres under study. A combination of medication safety initiatives involving multiple disciplines may be required to decrease the incidence of these events and to better document their occurrence. PMID:24159230

Development and Evaluation of ‘Briefing Notes’ as a Novel Knowledge Translation Tool to Aid the Implementation of Sex/Gender Analysis in Systematic Reviews: A Pilot Study

PubMed Central

Doull, Marion; Welch, Vivian; Puil, Lorri; Runnels, Vivien; Coen, Stephanie E.; Shea, Beverley; O’Neill, Jennifer; Borkhoff, Cornelia; Tudiver, Sari; Boscoe, Madeline

2014-01-01

Background There is increasing recognition of sex/gender differences in health and the importance of identifying differential effects of interventions for men and women. Yet, to whom the research evidence does or does not apply, with regard to sex/gender, is often insufficiently answered. This is also true for systematic reviews which synthesize results of primary studies. A lack of analysis and reporting of evidence on sex/gender raises concerns about the applicability of systematic reviews. To bridge this gap, this pilot study aimed to translate knowledge about sex/gender analysis (SGA) into a user-friendly ‘briefing note’ format and evaluate its potential in aiding the implementation of SGA in systematic reviews. Methods Our Sex/Gender Methods Group used an interactive process to translate knowledge about sex/gender into briefing notes, a concise communication tool used by policy and decision makers. The briefing notes were developed in collaboration with three Cochrane Collaboration review groups (HIV/AIDS, Hypertension, and Musculoskeletal) who were also the target knowledge users of the briefing notes. Briefing note development was informed by existing systematic review checklists, literature on sex/gender, in-person and virtual meetings, and consultation with topic experts. Finally, we held a workshop for potential users to evaluate the notes. Results Each briefing note provides tailored guidance on considering sex/gender to reviewers who are planning or conducting systematic reviews and includes the rationale for considering sex/gender, with examples specific to each review group’s focus. Review authors found that the briefing notes provided welcome guidance on implementing SGA that was clear and concise, but also identified conceptual and implementation challenges. Conclusions Sex/gender briefing notes are a promising knowledge translation tool. By encouraging sex/gender analysis and equity considerations in systematic reviews, the briefing notes can assist systematic reviewers in ensuring the applicability of research evidence, with the goal of improved health outcomes for diverse populations. PMID:25372876

The Trade-Offs of Developing a Case Management Model for Chronically Mentally Ill People.

ERIC Educational Resources Information Center

Belcher, John R.

1993-01-01

Addresses role of case management in care of chronically mentally ill persons. Notes that case management can be effective if designed so that services match client needs and service costs are measured accurately. Contends that profit-maximizing nature of U.S. health care system makes some form of capitation likely in design of case management…

The Effectiveness of a Case Study-Based First-Year Biology Class at a Black Women's College

ERIC Educational Resources Information Center

Pai, Aditi; Benning, Tracy; Woods, Natasha; McGinnis, Gene; Chu, Joanne; Netherton, Josh; Bauerle, Cynthia

2010-01-01

The authors used a case study-based approach in the introductory biology course at Spelman College. The course taught to entering freshmen was divided into three modules--ecology, evolution, and biodiversity, each designed around a case study. They noted that (1) case study teaching was dramatically more effective than the traditional lecture…

Case Study: Crazy about Cryptids--An Ecological Hunt for Nessie and Other Legendary Creatures

ERIC Educational Resources Information Center

Rowe, Matthew P.

2015-01-01

This column provides original articles on innovations in case study teaching, assessment of the method, as well as case studies with teaching notes. This hybrid case has three overarching and interrelated goals. First, it can be used to familiarize students with a range of ecological concepts and terms. Second, it is intended to engage students in…

Teaching Business Cases Online through Discussion Boards: Strategies and Best Practices

ERIC Educational Resources Information Center

Rollag, Keith

2010-01-01

What are the most effective and efficient ways to teach business cases online, specifically in asynchronous electronic discussion boards? This article describes several design strategies and approaches used by instructors at Babson College to structure and facilitate online case discussions in our blended Fast Track MBA program. (Contains 3 notes,…

Helping Crisis Managers Protect Reputational Assets: Initial Tests of the Situational Crisis Communication Theory.

ERIC Educational Resources Information Center

Coombs, W. Timothy; Holladay, Sherry J.

2002-01-01

Explains a comprehensive, prescriptive, situational approach for responding to crises and protecting organizational reputation: the situational crisis communication theory (SCCT). Notes undergraduate students read two crisis case studies from a set of 13 cases and responded to questions following the case. Validates a key assumption in SCCT and…

Case: The Ethics and Economics of Expanding Interstate 69 in Indiana.

ERIC Educational Resources Information Center

Clapp-Itnyre, Alisa

2000-01-01

Presents and discusses a case used in a business communication class that centers on an interstate highway extension in southern Indiana. Describes the rationale for teaching the case, and student responses. Notes that, in confronting these issues, students learn to see that facts yield to different interpretations based on differing perspectives…

Monozygotic Twin Pregnancy Associated with In Vitro Fertilization: Report and Revision of Three Cases Presented in a Clinic at 10,925 Feet Above Sea Level.

PubMed

Tominaga, Luis Vargas; Cáceres, Ricardo Pella; Lechuga, Alberto Vargas; Durán, Livia Bartolo; Vargas, Mariela Serrano

2015-08-01

3 cases of monozygotic twin pregnancies associated with IVF presented at Centro de Fertilidad y Ginecología del Sur. In this study, we describe the cases and review the literature, noting possible related factors.

Use of Case Studies for Stimulating Thinking and Learning.

ERIC Educational Resources Information Center

Zeakes, Samuel J.

Noting that a case-study approach can stimulate student thinking and learning, this paper describes how students in a writing-intensive course on parasitology wrote brief medical case studies of parasites already studied for other students to read, evaluate, and identify the parasite. The paper presents a brief description of the course, an…

Intelligent Automatic Classification of True and Counterfeit Notes Based on Spectrum Analysis

NASA Astrophysics Data System (ADS)

Matsunaga, Shohei; Omatu, Sigeru; Kosaka, Toshohisa

The purpose of this paper is to classify bank notes into “true” or “counterfeit” ones faster and more precisely compared with a conventional method. We note that thin lines are represented by direct lines in the images of true notes while they are represented in the counterfeit notes by dotted lines. This is due to properties of dot printers or scanner levels. To use the properties, we propose two method to classify a note into true or counterfeited one by checking whether there exist thin lines or dotted lines of the note. First, we use Fourier transform of the note to find quantity of features for classification and we classify a note into true or counterfeit one by using the features by Fourier transform. Then we propose a classification method by using wavelet transform in place of Fourier transform. Finally, some classification results are illustrated to show the effectiveness of the proposed methods.

Immunohistochemical expression of CD-10, BCL-6 and MUM-1 antibodies and immediate clinical response in patients of diffuse large B-cell lymphomas after six cycles of chemotherapy.

PubMed

Hassan, Usman; Ishtiaq, Sheeba; Hussain, Mudassar

2014-10-01

To determine the expression of CD-10, BCL-6 and MUM-1 in patients with diffuse large B-cell lymphoma (DLBCL) and its association with immediate clinical response after six cycles of CHOP chemotherapy. Analytical study. Armed Forces Institute of Pathology (AFIP), Rawalpindi in collaboration with Nuclear medicine, Oncology and Radiotherapy Institute (NORI), Islamabad from September 2010 to September 2011. CD-10, BCL-6 and MUM-1 antibodies were applied on cases diagnosed as DLBCL. Immediate clinical response was noted after 6 cycles of chemotherapy with the help of oncologist and divided into complete response, partial response, stable disease and relapse/ progression. Patient's age, results of expression of CD-10, BCL-6 and MUM-1 and results of immediate clinical response to chemotherapy were noted. Regarding analysis of prognostic markers (CD-10, BCL-6 and MUM-1), chi-square test was used for immediate clinical response to chemotherapy in DLBCL. CD-10 was positive in 40% cases, BCL-6 in 58.7% cases and MUM-1 was positive in 46.7% cases. About 41.3% of patients showed complete response, 10.6% partial response, 17.3% stable disease and 30.8% showed relapse/progression. CD-10 expression in DLBCL was associated with better immediate clinical response (p=0.011) whereas MUM-1 expression in DLBCL was associated with poor immediate clinical response (p<0.0001). However, there was no statistically significant association of BCL-6 with immediate clinical response (p=0.22). DLBCL shows expression of CD-10, BCL-6 and MUM-1 in nearly fifty percent of the cases. CD-10 is associated with good whereas MUM is associated with poor response. However, there was no association of BCL-6 with immediate clinical response.

Malaria is associated with poor school performance in an endemic area of the Brazilian Amazon

PubMed Central

Vitor-Silva, Sheila; Reyes-Lecca, Roberto C; Pinheiro, Tamam RA; Lacerda, Marcus VG

2009-01-01

Background Approximately 40% of the world's population is at risk for malaria. In highly endemic tropical areas, malaria is a major cause of morbidity and mortality during infancy. There is a complex interrelationship between malaria, malnutrition and intestinal helminths, and this may impair cognitive development in children. The aim of this study was to determine the relationship between malaria and school performance in children living in an endemic area where Plasmodium vivax is the species responsible for most of the cases. Methods The study was conducted in the Municipality of Careiro, Amazonas, Brazil, with five to14 year-old children, studying the first eight grades of public school, during the year 2008. After an initial active case detection, during nine months of follow-up, passive malaria cases detection was instituted, through a thick blood smear performed in every child with fever. School performance was evaluated by the final notes in Mathematics and Portuguese Language. Performance was considered poor when either of the final notes in these disciplines was below the 50th percentile for the respective class and grade. Results The total number of students followed-up in the cohort was 198. Malarial attacks were reported in 70 (35.4%) of these students, with no cases of severe disease. Plasmodium vivax was detected in 69.2% of the attacks, Plasmodium falciparum in 25.5% and both species in 5.3%. In the multivariate analysis, adjusting for age, mother's education, time living in the study area and school absenteeism, presenting with at least one episode of malaria independently predicted a poor performance at school [OR = 1.91 (1.04-3.54); p = 0.039]. Conclusion Non-severe malaria compromises the school performance of children even during a nine-month follow-up, potentially contributing to the maintenance of underdevelopment in countries endemic for malaria. This is the first evidence of such impact in Latin America, where P. vivax is responsible for the majority of the cases. PMID:19835584

Effect of cysteine and cystine addition on sensory profile and potent odorants of extruded potato snacks.

PubMed

Majcher, Małgorzata A; Jeleń, Henryk H

2007-07-11

Aromas generated in extruded potato snacks without and with addition of 0.25, 0.5, and 1% (w/w) of flavor precursors, cysteine and cystine, were compared and evaluated by descriptive sensory profiling. The results showed that high addition of cysteine (0.5 and 1%) resulted in the formation of undesirable odor and taste described as mercaptanic/sulfur, onion-like, and bitter; on the contrary, addition of cystine even at high concentration gave product with pleasant odor and taste, slightly changed into breadlike notes. GC/O analysis showed cysteine to be a much more reactive flavor precursor than cystine, stimulating formation of 12 compounds with garlic, sulfury, burnt, pungent/beer, cabbage/mold, meatlike, roasted, and popcorn odor notes. Further analysis performed by the AEDA technique identified 2-methyl-3-furanthiol (FD 2048) as a most potent odorant of extruded potato snacks with 1% addition of cysteine. Other identified compounds with high FD were butanal, 3-methyl-2-butenethiol, 2-methylthiazole, methional, 2-acetyl-1-pyrroline, and 3-hydroxy-4,5-dimethyl-2(5H)-furanone. In the case of cystine addition (1%) the highest FD factors were calculated for butanal, 2-acetyl-1-pyrroline, benzenemethanethiol, methional, phenylacetaldehyde, dimethyltrisulfide, 1-octen-3-ol, 1,5-octadien-3-one, and 2-acetylpyrazine.

Something's Fishy in Paxton Lake: A Case on Speciation in Sticklebacks.

ERIC Educational Resources Information Center

Sharp, Joan

2002-01-01

Introduces a case study on speciation and evolutionary mechanisms. Teaches science process skills as well as natural selection, biological species concepts, basic genetic terminology, and classification. Includes teaching notes and classroom management strategies. (Contains 14 references.) (YDS)

Impact of fetal chromosomal disorders on maternal blood metabolome: toward new biomarkers?

PubMed

Pinto, Joana; Almeida, Lara Monteiro; Martins, Ana Sofia; Duarte, Daniela; Domingues, Maria Rosário Marques; Barros, António Sousa; Galhano, Eulália; Pita, Cristina; Almeida, Maria do Céu; Carreira, Isabel Marques; Gil, Ana Maria

2015-12-01

This study aimed at determining the relationship between fetal chromosomal disorders (CDs), including trisomy 21 (T21), and on first- and second-trimester maternal blood plasma, to identify the time-course metabolic adaptations to the conditions and the possible new plasma biomarkers. Furthermore, a definition of a joint circulatory (plasma) and excretory (urine) metabolic description of second-trimester CDs was sought. Plasma was obtained for 119 pregnant women: 74 controls and 45 CD cases, including 22 T21 cases. Plasma and lipid extracts (for T21 only) were analyzed by nuclear magnetic resonance spectroscopy, and data were handled by variable selection and multivariate analysis. Correlation analysis was used on a concatenated plasma/urine matrix descriptive of second-trimester CD, based on previously obtained urine data. CD cases were accompanied by enhanced lipid β-oxidation (increased ketone bodies) and underutilization of glucose, pyruvate, and citrate. Lower circulating high-density lipoprotein levels were noted, along with changes in the proline and methanol in the first trimester, and also the urea, creatinine, acetate, and low-density lipoprotein plus very low-density lipoprotein in the second trimester and the different urea and creatinine levels, suggesting fetal renal dysfunction. In terms of plasma composition, T21 cases were indistinguishable from other CDs in the first trimester, whereas in the second trimester, increased methanol and albumin may be T21 specific. Furthermore, first-trimester lipid extracts of T21 showed decreased levels of 18:2 fatty acids, whereas in the second trimester, lower levels of 20:4 and 22:6 fatty acids were noted, possibly indicative of inflammation mechanisms. In both trimesters, high classification rates for CDs (88-89%) and T21 (85-92%) generally relied on variable selection of nuclear magnetic resonance data. Plasma/urine correlations confirmed most metabolic deviations and unveiled possible new ones regarding low-density lipoprotein plus very low-density lipoprotein, sugar, and gut-microflora metabolisms. This work partially confirmed previously reported data on first-trimester T21 and provided additional information on time-course metabolic changes accompanying CD and T21, in particular regarding plasma lipid composition. These results demonstrate the potential of plasma metabolomics in monitoring and characterizing CD cases; however, validation in larger cohorts is desirable. Copyright © 2015 Elsevier Inc. All rights reserved.

Familial polythelia without associated anomalies.

PubMed

Casey, H D; Chasan, P E; Chick, L R

1996-01-01

Of the many forms of supernumerary breast tissue, the most common form is the isolated presence of an accessory nipple, polythelia. While familial polythelia is recognized, it is extremely rare. In the past several years, polythelia has been noted to be associated with nephrourological anomalies. All reports of such a relationship are in random, nonfamilial cases of polythelia. We report three cases of polythelia in a family over two generations who had no urinary tract abnormalities. Discussion includes a comprehensive review of familial polythelia and its association with renal anomalies. From this review, the association of familial polythelia with nephrourological abnormalities will be delineated. Although in this report of a single family with polythelia we did not demonstrate any renal anomalies, we feel that a thorough physical exam, urine analysis, and renal ultrasound should be pursued in any patient with a significant familial history of polythelia.

Evidence-based clinical hypnosis for obstetrics, labor and delivery, and preterm labor.

PubMed

Brown, Donald Corey; Hammond, D Corydon

2007-07-01

This paper reviews the benefits and effectiveness of hypnosis in obstetrics and labor and delivery, demonstrating significant reductions in the use of analgesics and anesthesia and in shorter Stages 1 and 2 labors. It presents empirical and theoretical rationales for use of hypnosis in preterm labor (PTL) and labor and delivery at term. The benefits of hypnosis in relation to labor length, pain levels, and the enjoyment of labor, as well as its effectiveness in preterm labor are noted in randomized controlled trials and in a meta-analysis. Risk factors are reported for preterm delivery; hypnosis significantly prolongs pregnancy. Six cases are presented of hypnosis stopping PTL a number of times and when indicated at term. A case report of successful use of hypnosis in quadruplets is presented with some scripts. Suggestions are made for further research.

Qualitative analysis of decision making by speech-language pathologists in the design of aided visual displays.

PubMed

McFadd, Emily; Wilkinson, Krista

2010-06-01

For children with complex communication needs, augmentative and alternative communication (AAC) devices offer a functional way to communicate thoughts and feelings. Despite many significant advances in the field, effective and efficient aided communication can remain a challenge for some clients and their partners. One critical element of aided AAC intervention is systematic attention to the design of the communication display itself. A well-designed display will foster communication outcomes; a poorly designed one might have the opposite effect. Surprisingly, to our knowledge there are no studies of the strategies that clinicians actually employ when putting together a display. In this research note, we examine, on a case-by-case basis, the strategies six clinicians used when constructing display pages, as a means of highlighting potential areas that might warrant systematic research on display design.

Note-Taking Interventions for College Students: A Synthesis and Meta-Analysis of the Literature

ERIC Educational Resources Information Center

Reed, Deborah K.; Rimel, Hillary; Hallett, Abigail

2016-01-01

Although note taking is frequently described as an important skill for postsecondary success, there have been few note-taking intervention studies involving multiple sessions spanning more than one week. In a systematic search, we identified seven peer-reviewed articles reporting 10 intervention studies published from 1990-2014. The only…

Mesalamine, but Not Sulfasalazine, Reduces the Risk of Colorectal Neoplasia in Patients with Inflammatory Bowel Disease: An Agent-specific Systematic Review and Meta-analysis.

PubMed

OʼConnor, Anthony; Packey, Christopher D; Akbari, Mona; Moss, Alan C

2015-11-01

In some studies, 5-aminosalicylates as a class have been associated with protective effects against colorectal cancer in inflammatory bowel disease. In practice, only mesalamine at doses greater than 1.2 g per day is currently widely in this setting. The specific impact of mesalamine at these doses has not has not previously been determined. We performed a systematic review and meta-analysis of the effect of mesalamine on risk of colorectal neoplasia (CRN) from prior cohort and case-control studies. Sensitivity analyses for study setting and case definition were performed. A quality assessment was made of all included studies. Mesalamine was associated with a modest reduction in the odds ratio (OR) of CRN (OR = 0.6, 95% confidence interval, 0.4-0.9, P = 0.04). This effect was only noted in hospital-based studies and only in the reduction of all CRN (not cancers alone). Patients prescribed doses >1.2 g per day had a lower risk of CRN (OR = 0.5, 95% confidence interval, 0.3-0.9, P = 0.02) than lower doses. This effect was also only present in the hospital-based studies. In contrast, there was no reduction in the risk of CRN in patients prescribed sulfasalazine (OR = 0.8, 95% confidence interval, 0.5-1.2, P = 0.3), regardless of study setting. Mesalamine, particularly at doses >1.2 g per day, produces a modest reduction in the risk of CRN in inflammatory bowel disease patient populations from referral centers. Sulfasalazine does not seem to reduce the risk. No benefit was noted in population-based studies.

Long-Term Results and Prognostic Factors of Fractionated Strontium-90 Eye Applicator for Pterygium

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

Arruda Viani, Gustavo; Stefano, Eduardo Jose; Fendi, Ligia Issa de

2008-11-15

Purpose: To evaluate the long-term safety, effectiveness, and prognostic factors of fractionated postoperative {beta}-irradiation. Methods and Materials: Between 1993 and 2005, 623 patients with 737 pterygium lesions were treated with a strontium-90 eye applicator after surgical excision. The median follow-up period was 60 months (range, 6.7-139.5). Of the 737 lesions, 644 were primary and 93 were recurrences after surgical removal alone. Fractionated radiotherapy (RT) to a total dose of 35 Gy in five to seven fractions was used. Results: A total of 73 local pterygium recurrences (9.9%) were noted. Of the recurrent cases, 80% were noted within 3 years aftermore » treatment. The 5- and 10-year probability of local control was 90% and 88%, respectively. The multivariate analysis for all cases demonstrated that gender, age, total radiation dose, recurrent pterygia, and interval between surgery and RT affected the overall local control rate. Late toxicities that might have been associated with strontium-90 RT included scleromalacia (scleral thinning) in nine eyes, adhesion of the eyelids in eight, cataracts in six, and scleral ulcer in five eyes. Conclusion: Fractionated strontium-90 RT to a total dose of approximately 35 Gy in five to seven fractions results in a similar local control rate as higher doses in other series, with an acceptable complication rate.« less

Assessment of documentation of DSM-IV-TR Criteria A for diagnosis of schizophrenia in psychiatric unit, tertiary hospital, Malaysia.

PubMed

Maung, K; Ohnmar, H; Than, W; Ramli, M; Najwa Hanim, M R; Ali Sabri, R; Ahmad Zafri, A B

The purposes of this study were to investigate the documentation of the DSM-IV-TR- Criteria A in diagnoses of schizophrenia and to identify the symptoms associated with over diagnosis of schizophrenia. This study involved a retrospective review and analysis of data from case notes. Data of 107 newly diagnosed patients with schizophrenia were keyed in and analyzed using SPSS v 19. The cases were then evaluated for the use of the DSM-IV-TR- Criteria A. Over diagnosis was noted in 37.39% of the patients. Disorganised behaviour (12.5%), affective flattening (12.5%), hallucination (16%) and non-bizarre delusion (18.3%) significantly contributed to the over-diagnosis of schizophrenia. Symptoms such as non-bizarre delusion and hallucination were the most commonly used in over-diagnosing schizophrenia and were statistically significant with p ≤0.05. There was a significant lack of DSM-IV-TR Criteria A among the data documented to diagnose schizophrenia and non-bizarre delusion and hallucination were the most commonly used in over-diagnosing schizophrenia. This key problem needs to be addressed. The reliability of a diagnosis is indispensable and achievable with the proper clinical application of DSM-IV-TR Criteria A. The DSM-IV-TR Criteria have been perceived to be useful and reliable and is most widely used throughout the world.

Physician Information Needs and Electronic Health Records (EHRs): Time to Reengineer the Clinic Note.

PubMed

Koopman, Richelle J; Steege, Linsey M Barker; Moore, Joi L; Clarke, Martina A; Canfield, Shannon M; Kim, Min S; Belden, Jeffery L

2015-01-01

Primary care physicians face cognitive overload daily, perhaps exacerbated by the form of electronic health record documentation. We examined physician information needs to prepare for clinic visits, focusing on past clinic progress notes. This study used cognitive task analysis with 16 primary care physicians in the scenario of preparing for office visits. Physicians reviewed simulated acute and chronic care visit notes. We collected field notes and document highlighting and review, and we audio-recorded cognitive interview while on task, with subsequent thematic qualitative analysis. Member checks included the presentation of findings to the interviewed physicians and their faculty peers. The Assessment and Plan section was most important and usually reviewed first. The History of the Present Illness section could provide supporting information, especially if in narrative form. Physicians expressed frustration with the Review of Systems section, lamenting that the forces driving note construction did not match their information needs. Repetition of information contained in other parts of the chart (eg, medication lists) was identified as a source of note clutter. A workflow that included a patient summary dashboard made some elements of past notes redundant and therefore a source of clutter. Current ambulatory progress notes present more information to the physician than necessary and in an antiquated format. It is time to reengineer the clinic progress note to match the workflow and information needs of its primary consumer. © Copyright 2015 by the American Board of Family Medicine.

Fracture penis: an analysis of 26 cases.

PubMed

Pandyan, G V Soundra; Zaharani, Ahmed Bakeet; Al Rashid, Mohammed

2006-01-29

The aim of this study was to review the pattern of penile fracture occurrence, its clinical presentation, diagnosis, management, and outcome at our center. A retrospective analysis of 26 patients with penile fractures treated at our hospital from January 1997 to January 2005 was carried out. We noted an incidence of 3.5 cases per year, occurring more commonly in unmarried men. Of our study group, 28 episodes of penile fractures occurred in 26 patients. Hospital presentation after trauma varied from 2 h to 21 days. Masturbation was the main initiating causative factor and penile hematoma was the most common clinical finding. Nearly 81% noticed the characteristic click prior to the fracture. Clinical diagnosis was adequate in a majority of the cases. Midshaft fractures with right-sided laterality were more frequent in this series. The tear size ranged from 0.5-2.5 cm with a mean of 1.1 cm. All cases, but one, were treated by surgical repair using absorbable sutures. Out of three cases treated conservatively, two failed to respond and had to be treated surgically. False fracture with dorsal vein tear was present in two cases. Involvement of bilateral corpora was seen in one patient. Infection was the most common early complication, while pain with deviation was the late complication. In our experience, clinical findings are adequate enough to diagnose fracture penis in a majority of cases. Surgical exploration with repair of the tear is recommended both in early and delayed presentations. There was no noticeable relationship to the time of initial presentation or with the size and site of tear to the final outcome.

A Short Note on Rules and Higher Order Rules.

ERIC Educational Resources Information Center

Scandura, Joseph M.

This brief paper argues that structural analysis--an extended form of cognitive task analysis--demonstrates that both domain dependent and domain independent knowledge can be derived from specific content domains. It is noted that the major difference between the two is that lower order rules (specific knowledge) are derived directly from specific…

Enhancing case definitions for surveillance of human monkeypox in the Democratic Republic of Congo.

PubMed

Osadebe, Lynda; Hughes, Christine M; Shongo Lushima, Robert; Kabamba, Joelle; Nguete, Beatrice; Malekani, Jean; Pukuta, Elisabeth; Karhemere, Stomy; Muyembe Tamfum, Jean-Jacques; Wemakoy Okitolonda, Emile; Reynolds, Mary G; McCollum, Andrea M

2017-09-01

Human monkeypox (MPX) occurs at appreciable rates in the Democratic Republic of Congo (DRC). Infection with varicella zoster virus (VZV) has a similar presentation to that of MPX, and in areas where MPX is endemic these two illnesses are commonly mistaken. This study evaluated the diagnostic utility of two surveillance case definitions for MPX and specific clinical characteristics associated with laboratory-confirmed MPX cases. Data from a cohort of suspect MPX cases (identified by surveillance over the course of a 42 month period during 2009-2014) from DRC were used; real-time PCR diagnostic test results were used to establish MPX and VZV diagnoses. A total of 333 laboratory-confirmed MPX cases, 383 laboratory-confirmed VZV cases, and 36 cases that were determined to not be either MPX or VZV were included in the analyses. Significant (p<0.05) differences between laboratory-confirmed MPX and VZV cases were noted for several signs/symptoms including key rash characteristics. Both surveillance case definitions had high sensitivity and low specificities for individuals that had suspected MPX virus infections. Using 12 signs/symptoms with high sensitivity and/or specificity values, a receiver operator characteristic analysis showed that models for MPX cases that had the presence of 'fever before rash' plus at least 7 or 8 of the 12 signs/symptoms demonstrated a more balanced performance between sensitivity and specificity. Laboratory-confirmed MPX and VZV cases presented with many of the same signs and symptoms, and the analysis here emphasized the utility of including 12 specific signs/symptoms when investigating MPX cases. In order to document and detect endemic human MPX cases, a surveillance case definition with more specificity is needed for accurate case detection. In the absence of a more specific case definition, continued emphasis on confirmatory laboratory-based diagnostics is warranted.

Evaluation and management of priapism in a newborn: A case report and review of the literature

PubMed Central

Dust, Nicholas; Daboval, Thierry; Guerra, Luis

2011-01-01

Idiopathic neonatal priapism is a rare and poorly understood phenomenon. The case of an otherwise healthy premature male newborn who was noted to have a persistent penile erection on the first day of life is presented. A Doppler ultrasound of the penis was performed, along with the first-ever cavernous blood gas analysis reported in a newborn. These investigations indicated that the presentation was consistent with nonischemic (arterial or high-flow) priapism. The patient was managed conservatively and the erection resolved fully on the sixth day of life. A review of the existing literature identified polycythemia as the most common identifiable cause of priapism in newborns, but the majority of cases are idiopathic. In most instances, observation alone is appropriate and spontaneous detumescence occurs. There are no published reports of erectile impairment following neonatal priapism, which suggests that this condition is relatively benign in the absence of other disease states. PMID:22211080

Operational criteria for senile dementia of Lewy body type (SDLT).

PubMed

McKeith, I G; Perry, R H; Fairbairn, A F; Jabeen, S; Perry, E K

1992-11-01

Recent reports have suggested that brain stem and cortical Lewy body formation may identify a neurodegenerative disorder in elderly demented individuals which accounts for up to 20% of cases of senile dementia coming to autopsy. Retrospective analysis of case notes of 21 autopsy patients with neuropathologically proven senile dementia of Lewy body type (SDLT) and 37 cases with neuropathologically proven Alzheimer's disease (AD) identified a characteristic clinical syndrome in SDLT. Fluctuating cognitive impairment; psychotic features including visual and auditory hallucinations, and paranoid delusions; depressive symptoms; falling and unexplained losses of consciousness were all seen significantly more often than in AD. Over half of the SDLT patients in this series who were given neuroleptics in standard dose showed acute and often irreversible adverse reactions indicative of a neuroleptic sensitivity syndrome. The survival time of drug treated patients was reduced by 50%. Operational criteria to aid in the clinical distinction between SDLT and AD patients are proposed and hypotheses regarding possible aetiology and treatment discussed.

[Hangings in the material of Department of Forensic Medicine, Nicolaus Copernicus University Collegium Medicum in Bydgoszcz, in the years 2000-2010].

PubMed

Sumińska-Ziemann, Barbara; Bloch-Bogusławska, Elzbieta

2013-01-01

This study presents an analysis of suicides based on autopsy protocols from the years 2000-2010. Out of all autopsies conducted at Department of Forensic Medicine, Nicolaus Copernicus University Collegium Medicum in Bydgoszcz, 477 cases resulted from hanging. During this period the majority of hangings were recorded in 2010 (61 cases). The parameters assessed in this study included age, sex, post-mortem blood ethanol concentration and place of death of the victims. The age range of the deceased was similar in the group of men and women. Males represented the majority of victims of hanging (89%); only 11% of all the victims were females. The authors observed differences in blood alcohol level of the victims in association with their sex. Not present ethanol was noted in approx. 42% of men and 71% of women. More than 65% cases of suicide hangings were encountered in urban areas, in living quarters and outbuildings.

National trends in minimally invasive and open operative experience of graduating general surgery residents: implications for surgical skills curricula development?

PubMed

Carson, Jeffrey S; Smith, Lynette; Are, Madhuri; Edney, James; Azarow, Kenneth; Mercer, David W; Thompson, Jon S; Are, Chandrakanth

2011-12-01

The aim of this study was to analyze national trends in minimally invasive and open cases of all graduating residents in general surgery. A retrospective analysis was performed on data obtained from Accreditation Council for Graduate Medical Education logs (1999-2008) of graduating residents from all US general surgery residency programs. Data were analyzed using Mantel-Haenszel χ(2) tests and the Bonferroni adjustment to detect trends in the number of minimally invasive and open cases. Minimally invasive procedures accounted for an increasing proportion of cases performed (3.7% to 11.1%, P < .0001), with a proportional decrease in open cases. An increase in minimally invasive procedures with a proportional decrease in open procedures was noted in subcategories such as alimentary tract, abdominal, vascular, thoracic, and pediatric surgery (P < .0001). The results of this study demonstrate that general surgery residents in the United States are performing a greater number of minimally invasive and fewer open procedures for common surgical conditions. Copyright © 2011 Elsevier Inc. All rights reserved.

33. INTERIOR VIEW LOOKING WEST IN MAIN BUILDING FROM CANT ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

33. INTERIOR VIEW LOOKING WEST IN MAIN BUILDING FROM CANT ROLL CASE IMMEDIATELY WEST OF BEAM SAW. NOTE RE-SAW AT LEFT OF ROLL CASE, TRIM SAW OPERATOR'S STATION JUST TO RIGHT OF ROLL CASE, AND TRIM SAWS AT RIGHT MIDDLE GROUND. HEAD RIG IS IN BACKGROUND DOWN ROLL CASE IN CENTER OF PHOTOGRAPH. - Hull-Oakes Lumber Company, 23837 Dawson Road, Monroe, Benton County, OR

A Meta-Analysis of Hodgkin Lymphoma Reveals 19p13.3 TCF3 as a Novel Susceptibility Locus

PubMed Central

Cozen, W; Timofeeva, MN; Li, D; Diepstra, A; Hazelett, D; Delahaye-Sourdeix, M; Edlund, CK; Franke, L; Rostgaard, K; Van Den Berg, DJ; Cortessis, VK; Smedby, KE; Glaser, SL; H-J, Westra; Robison, LL; Mack, TM; Ghesquieres, H; Hwang, AE; Nieters, A; de Sanjose, S; Lightfoot, T; Becker, N; Maynadie, M; Foretova, L; Roman, E; Benavente, Y; Rand, KA; Nathwani, BN; Glimelius, B; Staines, A; Boffetta, P; Link, BK; Kiemeney, L; Ansell, SM; Bhatia, S; Strong, LC; Galan, P; Vatten, L; Habermann, TM; Duell, EJ; Lake, A; Veenstra, RN; Visser, L; Liu, Y; Urayama, KY; Montgomery, D; Gaborieau, V; Weiss, LM; Byrnes, G; Lathrop, M; Cocco, P; Best, T; Skol, AD; H-O, Adami; Melbye, M; Cerhan, JR; Gallagher, A; Taylor, GM; Slager, SL; Brennan, P; Coetzee, GA; Conti, DV; Onel, K; Jarrett, RF; Hjalgrim, H; van den Berg, A; McKay, JD

2014-01-01

Recent genome wide association studies (GWAS) of Hodgkin lymphoma (HL) have identified associations with genetic variation at both HLA and non-HLA loci; however, much of heritable HL susceptibility remains unexplained. Here we perform a meta-analysis of three HL GWAS totaling 1,816 cases and 7,877 controls followed by replication in an independent set of 1,281 cases and 3,218 controls to find novel risk loci. We identify a novel variant at 19p13.3 associated with HL (rs1860661; odds ratio [OR] = 0.81, 95% confidence interval [95% CI] = 0.76–0.86, Pcombined = 3.5 × 10−10), located in intron 2 of TCF3 (also known as E2A), a regulator of B- and T-cell lineage commitment known to be involved in HL pathogenesis. This meta-analysis also notes associations between previously published loci at 2p16.1, 5q31, 6p31.2, 8q24.21 and 10p14 and HL subtypes. We conclude that our data suggest a link between the 19p13.3 locus, including TCF3, and HL risk PMID:24920014

Strategic Joint Staff Force Posture and Readiness Process Analysis

DTIC Science & Technology

2014-03-31

Identifiers that reflect Limitations and/or Restraints. Below is a screenshot of the View 3 worksheet for the RCN : Strategic Joint Staff Force...Commanders’ Notes M Manual N = RCN , L = CA, A = RCAF, etc. same as with current FP&R. L1 Commanders Note Commanders’ Note that describes a...Commanders’ Notes O Manual N = RCN , L = CA, A = RCAF, etc. same as with current FP&R. Mandatory if there is a Limitation and/or Restraint. Endurance

West Africa [in "State of the Climate in 2014"

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

Hagos, Samson M.; Ijampy, James A.; Sima, Fatou

This chapter provides summaries of the 2014 temperature and precipitation conditions across seven broad regions: North America, Central America and the Caribbean, South America, Africa, Europe, Asia, and Oceania. In most cases, summaries of notable weather events are also included. Local scientists provided the annual summary for their respective regions and, unless otherwise noted, the source of the data used is typically the agency affiliated with the authors. Please note that different nations, even within the same section, may use unique periods to define their normals. Section introductions will typically define the prevailing practices for that section, and exceptions willmore » be noted within the text. In a similar way, many contributing authors use languages other than English as their primary professional language. To minimize additional loss of fidelity through re-interpretation after translation, editors have been conservative and careful to preserve the voice of the author. In some cases, this may result in abrupt transitions in style from section to section.« less

Case Report Form Reporter: A Key Component for the Integration of Electronic Medical Records and the Electronic Data Capture System.

PubMed

Matsumura, Yasushi; Hattori, Atsushi; Manabe, Shiro; Takahashi, Daiyo; Yamamoto, Yuichiro; Murata, Taizo; Nakagawa, Akito; Mihara, Naoki; Takeda, Toshihiro

2017-01-01

To improve the efficiency of clinical research, we developed a system to integrate electronic medical records (EMRs) and the electronic data capture system (EDC). EDC is divided into case report form (CRF) reporter and CDMS with CRF receiver with data communication using the operational data model (ODM). The CRF reporter is incorporated into the EMR to share data witth the EMR. In the data transcription type, doctors enter data using a progress note template, which are transmitted to the reporter template. It then generates the ODM. In the direct record type, reporter templates open from the progress note and generate narrative text to make record in the progress note. The configuration files for a study are delivered from the contents server to minimize the setup. This system has been used for 15 clinical studies including 3 clinical trials. This system can save labor and financial costs in clinical research.

Electroacupuncture for children with autism spectrum disorder: pilot study of 2 cases.

PubMed

Chen, Wen-Xiong; Wu-Li, Liu; Wong, Virginia C N

2008-10-01

The objective of this study was to observe for efficacy, safety, and compliance of electroacupuncture for autism spectrum disorder (ASD). Two (2) children with ASD received electroacupuncture for 24 sessions over 8 weeks and were assessed pre- and postacupuncture. We defined a positive or negative change as an improvement or deterioration of 25%, respectively, in total score or any subscales of Aberrant Behavioral Checklist (ABC), Ritvo-Freeman Real Life Scale (RFRLS), WeeFIM, and as a rating of much improved or much worse on the Clinical Global Impression-Improvement (CGI-I) scale. For ABC, positive changes in "Irritability" and "Stereotypy" was noted in case 1 but no changes occurred for case 2. For RFRLS, positive changes were found for both cases in "Sensory motor," "Sensory response," and "Total score," although negative change was noted for case 2 in "Affectual response." For WeeFIM, there were no positive or negative changes in both cases. For CGI-I, positive change in case 1 with much improved in "Social relatedness, Communication, and Stereotypy behavior" was reported. A short intensive course of electroacupuncture might improve some core features of children with ASD.

Focal cortical malformations in children with early infantile epilepsy and PCDH19 mutations: case report.

PubMed

Kurian, Mary; Korff, Christian M; Ranza, Emmanuelle; Bernasconi, Andrea; Lübbig, Anja; Nangia, Srishti; Ramelli, Gian Paolo; Wohlrab, Gabriele; Nordli, Douglas R; Bast, Thomas

2018-01-01

In this case report we assess the occurrence of cortical malformations in children with early infantile epilepsy associated with variants of the gene protocadherin 19 (PCDH19). We describe the clinical course, and electrographic, imaging, genetic, and neuropathological features in a cohort of female children with pharmacoresistant epilepsy. All five children (mean age 10y) had an early onset of epilepsy during infancy and a predominance of fever sensitive seizures occurring in clusters. Cognitive impairment was noted in four out of five patients. Radiological evidence of cortical malformations was present in all cases and, in two patients, validated by histology. Sanger sequencing and Multiplex Ligation-dependent Probe Amplification analysis of PCDH19 revealed pathogenic variants in four patients. In one patient, array comparative genomic hybridization showed a microdeletion encompassing PCDH19. We propose molecular testing and analysis of PCDH19 in patients with pharmacoresistant epilepsy, with onset in early infancy, seizures in clusters, and fever sensitivity. Structural lesions are to be searched in patients with PCDH19 pathogenic variants. Further, PCDH19 analysis should be considered in epilepsy surgery evaluation even in the presence of cerebral structural lesions. Focal cortical malformations and monogenic epilepsy syndromes may coexist. Structural lesions are to be searched for in patients with protocadherin 19 (PCDH19) pathogenic variants with refractory focal seizures. © 2017 Mac Keith Press.

Observational Analysis of Coronal Fans

NASA Technical Reports Server (NTRS)

Talpeanu, D.-C.; Rachmeler, L; Mierla, Marilena

2017-01-01

Coronal fans (see Figure 1) are bright observational structures that extend to large distances above the solar surface and can easily be seen in EUV (174 angstrom) above the limb. They have a very long lifetime and can live up to several Carrington rotations (CR), remaining relatively stationary for many months. Note that they are not off-limb manifestation of similarly-named active region fans. The solar conditions required to create coronal fans are not well understood. The goal of this research was to find as many associations as possible of coronal fans with other solar features and to gain a better understanding of these structures. Therefore, we analyzed many fans and created an overview of their properties. We present the results of this statistical analysis and also a case study on the longest living fan.

Development of an integrated BEM for hot fluid-structure interaction

NASA Technical Reports Server (NTRS)

Banerjee, P. K.; Dargush, G. F.

1989-01-01

The Boundary Element Method (BEM) is chosen as a basic analysis tool principally because the definition of quantities like fluxes, temperature, displacements, and velocities is very precise on a boundary base discretization scheme. One fundamental difficulty is, of course, that the entire analysis requires a very considerable amount of analytical work which is not present in other numerical methods. During the last 18 months all of this analytical work was completed and a two-dimensional, general purpose code was written. Some of the early results are described. It is anticipated that within the next two to three months almost all two-dimensional idealizations will be examined. It should be noted that the analytical work for the three-dimensional case has also been done and numerical implementation will begin next year.

The impact of domain knowledge on structured data collection and templated note design.

PubMed

Windle, T; McClay, J C; Windle, J R

2013-01-01

The objective of this case report is to evaluate the importance of specialized domain knowledge when designing and using structured templated notes in a clinical environment. To analyze the impact of specialization on structured note generation we compared notes generated for three scenarios: 1) We compared the templated history of present illness (HPI) for patients presenting with a dermatology concern to the dermatologist versus the emergency department. 2) We compared the evaluation of chest pain by ED physicians versus cardiologists. 3) Finally, we compared the data elements asked for in the evaluation of the gastrointestinal system between cardiologists and the liver transplant service (LTS). We used the SNOMED CT representation via BioPortal to evaluate specificity and grouping between data elements and specialized physician groups. We found few similarities in structured data elements designed by and for the specific physician groups. The distinctness represented both differences in granularity as well as fundamental differences in data elements requested. When compared to ED physicians, dermatologists had different and more granular elements while cardiologists requested much more granular data. Comparing cardiologists and LTS, there were differences in the data elements requested. This case study supports the importance of domain knowledge in EHR design and implementation. That different specialities should want and use different information is well supported by cognitive science literature. Despite this, it is rare for domain knowledge to be considered in EHR implementation. Physicians with correct domain knowledge should be involved in the design process of templated notes.

Diet and lung cancer in California Seventh-day Adventists.

PubMed

Fraser, G E; Beeson, W L; Phillips, R L

1991-04-01

The Adventist Health Study, a cohort study of 34,198 California Seventh-day Adventists, identified 61 cases of new primary lung cancer over 6 years of follow-up (1977-1982). The population studied was unique in that only 4% admitted to current cigarette smoking and about half were lacto-ovovegetarians. A total of 36% of the lung tumors were adenocarcinomas, and 19% were squamous cell carcinomas. The expected associations with cigarette smoking were noted for Kreyberg group I tumors (squamous cell, large cell, and small cell carcinoma; relative risk (RR) = 53.2 for current smokers and 7.07 for past smokers), but much lesser associations were noted for Kreyberg group II tumors (adenocarcinoma and bronchoalveolar carcinoma; RR = 1.99 for current smokers and 1.59 for past smokers). In this study, fruit consumption was the dietary constituent that showed a strong, statistically significant protective association with lung cancer that was independent of smoking (fruit consumption less than 3 times/week, RR = 1.0; 3-7 times/week, RR = 0.30; greater than or equal to 2 times/day, RR = 0.26). This association was somewhat stronger for Kreyberg group II tumors, but similar trends were also noted for Kreyberg group I tumors. Confounding with smoking seems unlikely in a population with very few current smokers and where both stratification and Cox modeling methods of analysis led to similar conclusions.

SFA Ombudsman Serving Students. Interim Report, September 1999 to March 2000.

ERIC Educational Resources Information Center

Department of Education, Washington, DC. Student Financial Assistance.

This 6-page pamphlet shares what the Student Financial Assistance (SFA) Office of the Ombudsman has learned from cases it has handled. An initial section offers information on the case management process, noting that the ombudsman process depends on the case's complexity and that many are revolved quickly. Next, it examines customer-reported case…

An Evaluation of Gender Differences in Computer-Based Case Simulations.

ERIC Educational Resources Information Center

Scheuneman, Janice Dowd; And Others

As part of the research leading to the implementation of computer-based case simulations (CCS) for the licensing examinations of the National Board of Medical Examiners, gender differences in performance were studied for one form consisting of 18 cases. A secondary purpose of the study was to note differences in style or approach that might…

Hot under the Collar: Weighing the Dangers of a Weight-Loss Drug

ERIC Educational Resources Information Center

DeSimone, Susan M.; Genereux, Annie Prud'homme

2011-01-01

This column provides original articles on innovations in case study teaching, assessment of the method, as well as case studies with teaching notes. In this month's issue the goal of the case study is for students to expand their understanding of membrane permeability and the proton motive force in mitochondria through the study of…

Language and Content: The Case of Law.

ERIC Educational Resources Information Center

Beasley, Colin J.

A discussion of the teaching and learning of English for special purposes focuses on the interrelationship of content and language, particularly in the case of education for the legal professions. It is noted that law students must both study a large corpus of case and statute law and legal principles and learn the language of the law, with its…

Freedom and Control of Student Publications in the American High School.

ERIC Educational Resources Information Center

King, Thomas J.

While noting the restrictions on the generalizability of case law, the author conducts a case-by-case review of litigation concerning student publications in the senior high school. He answers four questions: (1) May the teachers and/or administrators of a school exercise "prior censorship" or control over the content of independent-underground…

The Mathematical and Computer Aided Analysis of the Contact Stress of the Surface With 4th Order

NASA Astrophysics Data System (ADS)

Huran, Liu

Inspired from some gears with heavy power transmission in practical usage after serious plastic deformation in metallurgical industry, we believe that there must existed some kind of gear profile which is most suitable in both the contact and bending fatigue strength. From careful analysis and deep going investigation, we think that it is the profile of equal conjugate curvature with high order of contact, and analyzed the forming principle of this kind of profile. Based on the second curve and comparative analysis of fourth order curves, combined with Chebyshev polynomial terms of higher order contact with tooth contact stress formula derived. Note high exposure in the case of two extreme points of stress and extreme positions and the derived extreme contact stress formula. Finally, a pair of conjugate gear tooth profile curvature provides specific contact stress calculation.

Thematic Analysis of Medical Notes Offers Preliminary Insight into Precipitants for Asian Suicide Attempters: An Exploratory Study.

PubMed

Choo, Carol C; Ho, Roger C; Burton, André A D

2018-04-20

One important dynamic risk factor for suicide assessment includes suicide precipitant. This exploratory study used a qualitative paradigm to look into the themes surrounding precipitants for suicide attempts in Singapore. Medical records related to suicide attempters who were admitted to the emergency department of a large teaching hospital in Singapore over a three year period were subjected to analysis. A total of 666 cases were examined (69.2% females; 63.8% Chinese, 15% Malays, 15.8% Indians), ages ranged from 10 years old to 85 years old (Mean = 29.7, Standard Deviation = 16.1). The thematic analysis process that was applied to the textual data elicited key concepts labelled as Relationship issues, Financial strain, Socio-legal-academic—environmental stress, and Physical and mental illness and pain. Interpreted with other recent local research on suicide attempters in Singapore, the findings have implications for informing suicide interventions.

Protein Sectors: Statistical Coupling Analysis versus Conservation

PubMed Central

Teşileanu, Tiberiu; Colwell, Lucy J.; Leibler, Stanislas

2015-01-01

Statistical coupling analysis (SCA) is a method for analyzing multiple sequence alignments that was used to identify groups of coevolving residues termed “sectors”. The method applies spectral analysis to a matrix obtained by combining correlation information with sequence conservation. It has been asserted that the protein sectors identified by SCA are functionally significant, with different sectors controlling different biochemical properties of the protein. Here we reconsider the available experimental data and note that it involves almost exclusively proteins with a single sector. We show that in this case sequence conservation is the dominating factor in SCA, and can alone be used to make statistically equivalent functional predictions. Therefore, we suggest shifting the experimental focus to proteins for which SCA identifies several sectors. Correlations in protein alignments, which have been shown to be informative in a number of independent studies, would then be less dominated by sequence conservation. PMID:25723535

Occupant and crash characteristics for case occupants with cervical spine injuries sustained in motor vehicle collisions.

PubMed

Stein, Deborah M; Kufera, Joseph A; Ho, Shiu M; Ryb, Gabriel E; Dischinger, Patricia C; O'Connor, James V; Scalea, Thomas M

2011-02-01

Motor vehicle collisions (MVCs) are the leading cause of spine and spinal cord injuries in the United States. Traumatic cervical spine injuries (CSIs) result in significant morbidity and mortality. This study was designed to evaluate both the epidemiologic and biomechanical risk factors associated with CSI in MVCs by using a population-based database and to describe occupant and crashes characteristics for a subset of severe crashes in which a CSI was sustained as represented by the Crash Injury Research Engineering Network (CIREN) database. Prospectively collected CIREN data from the eight centers were used to identify all case occupants between 1996 and November 2009. Case occupants older than 14 years and case vehicles of the four most common vehicle types were included. The National Automotive Sampling System's Crashworthiness Data System, a probability sample of all police-reported MVCs in the United States, was queried using the same inclusion criteria between 1997 and 2008. Cervical spinal cord and spinal column injuries were identified using Abbreviated Injury Scale (AIS) score codes. Data were abstracted on all case occupants, biomechanical crash characteristics, and injuries sustained. Univariate analysis was performed using a χ analysis. Logistic regression was used to identify significant risk factors in a multivariate analysis to control for confounding associations. CSIs were identified in 11.5% of CIREN case occupants. Case occupants aged 65 years or older and those occupants involved in rollover crashes were more likely to sustain a CSI. In univariate analysis of the subset of severe crashes represented by CIREN, the use of airbag and seat belt together (reference) were more protective than seat belt alone (odds ratio [OR]=1.73, 95% confidence interval [CI]=1.32-2.27) or the use of neither restraint system (OR=1.45, 95% CI=1.02-2.07). The most frequent injury sources in CIREN crashes were roof and its components (24.8%) and noncontact sources (15.5%). In multivariate analysis, age, rollover impact, and airbag-only restraint systems were associated with an increased odds of CSI. Using the population-based National Automotive Sampling System's Crashworthiness Data System data, 0.35% of occupants sustained a CSI. In univariate analysis, older age was noted to be a significant risk factor for CSI. Airbag-only restraint systems and both rollover and lateral crashes were also identified as risk factors for CSI. In addition, increasing delta v was highly associated with CSIs. In multivariate analysis, similar risk factors were noted. Of all the restraint systems, seat belt use without airbag deployment was found to be the most protective restraint system (OR=0.29, 95% CI=0.16-0.50), whereas airbag-only restraint was associated with the highest risk of CSI (OR=3.54, 95% CI=2.29-5.46). Despite advances in automotive safety, CSIs sustained in MVC continue to occur too often. Older case occupants are at an increased risk of CSI. Rollover crashes and severe crashes led to a much higher risk of CSI than other types and severity of MVCs. Seat belt use is very effective in preventing CSI, whereas airbag deployment may increase the risk of occupants sustaining a CSI. More protection for older occupants is needed and protection in both rollover and lateral crashes should remain a focus of the automotive industry. The design of airbag restraint systems should be evaluated so that they are not causative of serious injury. In addition, engineers should continue to focus on improving automotive design to minimize the risk of spinal injury to occupants in high severity crashes.

Content Analysis of Suicide Notes as a Test of the Motivational Component of the Existential-Constructivist Model of Suicide

ERIC Educational Resources Information Center

Rogers, James R.; Bromley, Jamie L.; McNally, Christopher J.; Lester, David

2007-01-01

A sample of 40 suicide notes were analyzed for motivational content in relation to an existential-constructivist theory of suicide. Results generally supported the 4 theoretical categories of somatic, relational, spiritual, and psychological motivations, with 39 notes having content that could be classified according to the aforementioned…

Forensic entomology of high-rise buildings in Malaysia: Three case reports.

PubMed

Syamsa, R A; Omar, B; Zuha, R M; Faridah, M N; Swarhib, M S; Hidayatulfathi, O; Shahrom, A W

2015-06-01

The distributions of flies are not only confined to ground level but can also be at higher altitudes. Here, we report three forensic cases involving dipterans in high-rise buildings in Kuala Lumpur, Malaysia. Case 1 involved a corpse of adult female found at the top floor of a fifteen-story apartment. Case 2 dealt with a body of a 75-year-old female discovered in a bedroom on the eleventh floor of an eighteen-story building, while Case 3 was a 52-year-old male found in his fifth floor shop house. Interestingly, entomological analysis revealed that all corpses were infested with similar Dipterans: Megaselia scalaris (Loew) (Diptera: Phoridae), Synthesiomyia nudiseta (Wulp) (Diptera: Muscidae) and sarcophagid (Diptera: Sarcophagidae). The first two species were commonly associated with corpses found indoors at ground level. We noted the additional occurrence of blowflies Chrysomya megacephala (Fabricius) (Diptera: Calliphoridae) and Chrysomya rufifacies Macquart (Diptera: Calliphoridae) larvae in Case 2 and Case 3, respectively. Findings from this study are significant as they demonstrate that certain groups of fly can locate dead bodies even in high-rise buildings. Forensic entomofauna research on corpses found at high elevation is scarce and our study has highlighted the peculiarity of the fly species involved in Malaysia.

Unilateral Congenital Cataract: Clinical Profile and Presentation.

PubMed

Khokhar, Sudarshan; Jose, Cijin P; Sihota, Ramanjit; Midha, Neha

2018-03-01

To study the clinical profile and presentation of children with unilateral cataract. In this hospital-based, observational, cross-sectional study, patients 15 years of age or younger who presented with unilateral cataract were recruited. Cases of cataract secondary to causes such as trauma or uveitis were excluded. Age at detection and presentation, distance from the treatment center, presenting complaints, cataract morphology, and biometry were noted for each case. A total of 76 patients were recruited. Most patients presented with complaints of leukocoria. Persistent fetal vasculature accounted for 27.6% of cases and was the most common identifiable cause of cataract in this study. Subsequently, patients were divided into two groups: no persistent fetal vasculature (control) and persistent fetal vasculature. A male predominance was noted in both groups. The mean age at detection was 27.58 ± 37.02 and 6.17 ± 8.42 months and the mean age at presentation was 55.613 ± 45.21 and 14.83 ± 17.75 months in the control and persistent fetal vasculature groups, respectively. In the persistent fetal vasculature group, a significant difference was noted in the axial length, keratometry, and corneal diameter between the affected and normal eyes (P = .027, .00176, and .0114, respectively). In the control group, this difference was observed only in keratometry readings (P = .0464). The mean distance traveled by patients to reach the treatment center was 211 km. Persistent fetal vasculature is an important and less identified cause of unilateral cataract. A significant delay is noted in the detection and presentation of unilateral cataract. [J Pediatr Ophthalmol Strabismus. 2018;55(2):107-112.]. Copyright 2017, SLACK Incorporated.

Poison control center experience with tianeptine: an unregulated pharmaceutical product with potential for abuse.

PubMed

Marraffa, Jeanna M; Stork, Christine M; Hoffman, Robert S; Su, Mark K

2018-05-25

Interest in tianeptine as a potential drug of abuse is increasing in the United States. We performed a retrospective study of calls to the New York State Poison Control Centers (PCCs) designed to characterize one state's experience with tianeptine. Data were gathered from existing records utilizing the poison center data collection system, Toxicall® entered between 1 January 2000 through 1 April 2017. Information regarding patient demographics, reported dose and formulation of tianeptine, reported coingestants, brief narrative description of the case, disposition, and case outcome was collected. There were nine reported cases of tianeptine exposure. Seven were male with a mean age of 27. Three reported therapeutic use of tianeptine and five reported intentional abuse. One case was an unintentional pediatric exposure. Doses were reported in three cases; 12.5 mg in a pediatric unintentional exposure, and 5 and 10 g daily in the two reports of intentional abuse. Of note, five patients complained of symptoms consistent with opioid withdrawal. In one of two cases in which naloxone was administered, an improvement in mental status and the respiratory drive was noted. Outcomes reported in Toxicall® were minor in two cases, moderate in five cases, major in one case, and not reported in one case. These cases, reported to the New York State PCCs should alert readers to the potential for tianeptine abuse, dependence, and withdrawal.

7 CFR 160.202 - Fees generally for laboratory analysis and testing.

Code of Federal Regulations, 2012 CFR

2012-01-01

... turpentine. (See Note 3). (1) Comprehensive analysis to determine purity, specification compliance, or other... related to quality of utility. (i) Single Sample: (A) Rosin—$14.00. (B) Turpentine—$10.00. (ii) Two or more samples tested at same time: (A) Rosin—per sample—$10.00. (B) Turpentine—per sample—$8.00. Note 3...

7 CFR 160.202 - Fees generally for laboratory analysis and testing.

Code of Federal Regulations, 2011 CFR

2011-01-01

... turpentine. (See Note 3). (1) Comprehensive analysis to determine purity, specification compliance, or other... related to quality of utility. (i) Single Sample: (A) Rosin—$14.00. (B) Turpentine—$10.00. (ii) Two or more samples tested at same time: (A) Rosin—per sample—$10.00. (B) Turpentine—per sample—$8.00. Note 3...

7 CFR 160.202 - Fees generally for laboratory analysis and testing.

Code of Federal Regulations, 2013 CFR

2013-01-01

... turpentine. (See Note 3). (1) Comprehensive analysis to determine purity, specification compliance, or other... related to quality of utility. (i) Single Sample: (A) Rosin—$14.00. (B) Turpentine—$10.00. (ii) Two or more samples tested at same time: (A) Rosin—per sample—$10.00. (B) Turpentine—per sample—$8.00. Note 3...

7 CFR 160.202 - Fees generally for laboratory analysis and testing.

Code of Federal Regulations, 2010 CFR

2010-01-01

... turpentine. (See Note 3). (1) Comprehensive analysis to determine purity, specification compliance, or other... related to quality of utility. (i) Single Sample: (A) Rosin—$14.00. (B) Turpentine—$10.00. (ii) Two or more samples tested at same time: (A) Rosin—per sample—$10.00. (B) Turpentine—per sample—$8.00. Note 3...

7 CFR 160.202 - Fees generally for laboratory analysis and testing.

Code of Federal Regulations, 2014 CFR

2014-01-01

... turpentine. (See Note 3). (1) Comprehensive analysis to determine purity, specification compliance, or other... related to quality of utility. (i) Single Sample: (A) Rosin—$14.00. (B) Turpentine—$10.00. (ii) Two or more samples tested at same time: (A) Rosin—per sample—$10.00. (B) Turpentine—per sample—$8.00. Note 3...

LUVOIR Tech Notes

NASA Technical Reports Server (NTRS)

Bolcar, Matthew R.; Shaklan, Stuart; Roberge, Aki; Rioux, Norman; Feinberg, Lee; Werner, Michael; Rauscher, Bernard; Mandell, Avi; France, Kevin; Schiminovich, David

2016-01-01

We present nine "tech notes" prepared by the Large UV/Optical/Infrared (LUVOIR) Science and Technology Definition Team (STDT), Study Office, and Technology Working Group. These tech notes are intended to highlight technical challenges that represent boundaries in the trade space for developing the LUVOIR architecture that may impact the science objectives being developed by the STDT. These tech notes are intended to be high-level discussions of the technical challenges and will serve as starting points for more in-depth analysis as the LUVOIR study progresses.

[Technical notes on mastectomy performed as part of transsexualism F to M].

PubMed

Roffé, J-L

2012-08-01

Mastectomy in case of large breast should use a particular technique. The principle of mastectomy by periareolar flap or higher in MAP must be abandoned in favor of mastectomy by lower horizontal with the office of the WFP transformed by a tummy. Main technical note contains the plasty in MAP because the conventional mastectomy is well known. Copyright © 2011 Elsevier Masson SAS. All rights reserved.

Higher Education.

ERIC Educational Resources Information Center

Hendrickson, Robert M.

This chapter reports 1982 cases involving aspects of higher education. Interesting cases noted dealt with the federal government's authority to regulate state employees' retirement and raised the questions of whether Title IX covers employment, whether financial aid makes a college a program under Title IX, and whether sex segregated mortality…

Tumour necrosis factor-alpha and nitric oxide response in different categories of tuberculosis patients.

PubMed

Chakraborty, U; Goswami, A; Saha, S; Mukherjee, T; Dey, S K; Majumdar, S; Pal, N K

2013-04-01

To compare the magnitude of tumour necrosis factor alpha (TNF-α) and nitric oxide (NO) response in different categories of active tuberculosis (TB) patients by ex vivo experiment. New, relapsed (recurrent), miliary and pleural effusion TB cases were recruited with matched healthy controls. TNF-α and NO were measured from the culture supernatant of peripheral blood monocytes derived from cases and controls with and without challenge with live Mycobacterium tuberculosis H37Rv. TNF-α and NO production varied significantly among the different categories of TB patients. The magnitude was highest among patients with pleural effusion and lowest in miliary TB cases. In between, progressive decreases in response were noted in new and relapse cases. Overall, positive correlations between TNF-α and NO were noted among the diseased and healthy groups. Distinct TNF-α and NO levels appear to be associated with different clinical forms of TB and might help to assess prognosis and contribute to a better understanding of underlying immunopathological mechanisms.

Sudden or unnatural deaths involving anabolic-androgenic steroids.

PubMed

Darke, Shane; Torok, Michelle; Duflou, Johan

2014-07-01

Anabolic-androgenic steroids (AASs) are frequently misused. To determine causes of death, characteristics, toxicology, and pathology of AAS positive cases, all cases (n = 24) presenting to the New South Wales Department of Forensic Medicine (1995-2012) were retrieved. All were male, and the mean age was 31.7 years. Deaths were mainly due to accidental drug toxicity (62.5%), then suicide (16.7%) and homicide (12.5%). Abnormal testosterone/epitestosterone ratios were reported in 62.5%, followed by metabolites of nandrolone (58.3%), stanozolol (33.3%), and methandienone (20.8%). In 23 of 24 cases, substances other than steroids were detected, most commonly psychostimulants (66.7%). In nearly half, testicular atrophy was noted, as was testicular fibrosis and arrested spermatogenesis. Left ventricular hypertrophy was noted in 30.4%, and moderate to severe narrowing of the coronary arteries in 26.1%. To summarize, the typical case was a male polydrug user aged in their thirties, with death due to drug toxicity. Extensive cardiovascular disease was particularly notable. © 2014 American Academy of Forensic Sciences.

Employment discrimination implications of genetic screening in the workplace under Title VII and the Rehabilitation Act.

PubMed

Canter, E F

1984-01-01

The emergence of genetic screening techniques will permit employers to exclude hypersusceptible individuals from potentially hazardous workplace environments. The denial of employment opportunities to these individuals, however, may constitute discrimination. This Note analyzes genetic screening cases with respect to currently available remedies contained in Title VII of the Civil Rights Act of 1964 and the Rehabilitation Act of 1973. The Note concludes that Title VII claims may succeed but only in limited circumstances and that Rehabilitation Act claims will encounter numerous obstacles to relief. Additionally, the Note discusses some of the implications of the use of genetic screening in the workplace.

A Note About HARP's State Trimming Method

NASA Technical Reports Server (NTRS)

Butler, Ricky W.; Hayhurst, Kelly J.; Johnson, Sally C.

1998-01-01

This short note provides some additional insight into how the HARP program works. In some cases, it is possible for HARP to tdm away too many states and obtain an optimistic result. The HARP Version 7.0 manual warns the user that 'Unlike the ALL model, the SAME model can automatically drop failure modes for certain system models. The user is cautioned to insure that no important failure modes are dropped; otherwise, a non-conservative result can be given.' This note provides an example of where this occurs and a pointer to further documentation that gives a means of bounding the error associated with trimming these states.

Primary Spinal Cord Melanoma: A Case Report and a Systemic Review of Overall Survival.

PubMed

Zhang, Mingzhe; Liu, Raynald; Xiang, Yi; Mao, Jianhui; Li, Guangjie; Ma, Ronghua; Sun, Zhaosheng

2018-06-01

The incidence of primary spinal cord melanoma (PSCM) is rare. Several case series and case reports have been published in the literature. However, the predictive factors of PSCM survival and management options are not discussed in detail. We present a case of PSCM; total resection was achieved and chemotherapy was given postoperatively. A comprehensive search was performed on PubMed's electronic database using the words "primary spinal cord melanoma." Survival rates with various gender, location, treatment, and metastasis condition were collected from the published articles and analyzed. Fifty nine cases were eligible for the survival analysis; 54% were male and 46% were female. Patient sex did not influence overall survival. The most common location was the thorax. Patient sex and tumor location did not influence overall survival. The major presenting symptoms were weakness and paresthesia of the extremities. Metastasis or dissemination was noted in 45.16% of 31 patients. In the Kaplan-Meier survival analysis, patients who had metastasis had the worst prognosis. Extent of resection was not related to mortality. Patients who received surgery and surgery with adjuvant therapy had a better median survival than did those who had adjuvant therapy alone. Prognosis was worst in those patients who underwent only adjuvant therapy without surgery (5 months). Surgery is the first treatment of choice in treating PSCM. The goal of tumor resection is to reduce symptoms. Adjuvant therapy after surgery had a beneficial effect on limiting the metastasis. Copyright © 2018 Elsevier Inc. All rights reserved.

Poor quality data challenges conclusion and decision making: timely analysis of measles confirmed and suspected cases line list in Southern Nations Nationalities and People's Region, Ethiopia.

PubMed

Endriyas, Misganu; Solomon, Tarekegn; Belayhun, Bekele; Mekonnen, Emebet

2018-02-12

Measles is one of the leading causes of death among young children even though a safe and cost-effective vaccine is available. Timely analysis of measles surveillance data is crucial for epidemic control and can show disease control program status. Therefore, this study aimed to show vaccination status and delay in seeking health care using surveillance data. A retrospective study was carried out in Southern Nations Nationalities and People's Region (SNNPR), Ethiopia. We reviewed 2132 records from measles surveillance line list data from July 2013 to January 2014. Descriptive statistics were performed using SPSS 20 for Windows. From a total of 2132 confirmed and suspected measles cases, 1319 (61.9%), had at least one dose of measles containing vaccine; the rest 398 (18.7%) and 415 (19.5%) were unvaccinated and had unknown status respectively. About two fifth, 846 (39.7%), cases visited health facilities within 48 h of onset of clinical signs/symptoms with a median of 2.0 days, IQR (1.0, 3.0). Majority of the measles cases were vaccinated with at least one dose of measles containing vaccine and vaccination data or vaccine potency at lower level was unclear. Delay in seeking healthcare was noted as only about two fifth of cases visited health facilities within 48 h of clinical manifestation. Vaccination and surveillance data quality and factors associated with delay in seeking health care should be investigated.

Nonlinear aerodynamics of two-dimensional airfoils in severe maneuver

NASA Technical Reports Server (NTRS)

Scott, Matthew T.; Mccune, James E.

1988-01-01

This paper presents a nonlinear theory of forces and moment acting on a two-dimensional airfoil in unsteady potential flow. Results are obtained for cases of both large and small amplitude motion. The analysis, which is based on an extension of Wagner's integral equation to the nonlinear regime, takes full advantage of the trailing wake's tendency to deform under local velocities. Interactive computational results are presented that show examples of wake-induced lift and moment augmentation on the order of 20 percent of quasi-static values. The expandability and flexibility of the present computational method are noted, as well as the relative speed with which solutions are obtained.

[: an expert report by Dr. Egas Moniz on homosexuality].

PubMed

Molina Artaloytia, Francisco

2016-01-01

At the beginning of the 20th century, the noted Nobel prize-winning Portuguese neurologist Egas Moniz made an expert analysis on homosexuality in a marriage annulment case of major value as an example of the effective application of sexological knowledge of that period. Contemporary republican legislation established marriage annulment in medical terms and punished relations between persons of the same sex, or contra natura. In his report, Moniz attempted to interpret distinctive elements of the life of the subject using sexological categories, illustrating the interaction between these categories and the changing forms adopted by homosexuality (or homosexual people) of the time.

Association study of schizophrenia and IL-2 receptor {beta} chain gene

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

Nimgaonkar, V.L.; Yang, Z.W.; Zhang, X.R.

1995-10-09

A case-control association study was conducted in Caucasian patients with schizophrenia (DSM-III-R, n = 42) and unaffected controls (n = 47) matched for ethnicity and area of residence. Serum interleukin-2 receptor (IL-2R) concentrations, as well as a dinucleotide repeat polymorphism in the IL-2RP chain gene, were examined in both groups. No significant differences in IL-2R concentrations or in the distribution of the polymorphism were noted. This study does not support an association between schizophrenia and the IL-2RP gene locus, contrary to the suggestive evidence from linkage analysis in multicase families. 17 refs., 2 tabs.

Electron microscopic examination of the anterior lens capsule in a case of Alport's syndrome.

PubMed

Citirik, Mehmet; Batman, Cosar; Men, Gamze; Tuncel, Murvet; Zilelioglu, Orhan

2007-09-01

To report a case of Alport's syndrome and to present electronmicroscopic examination findings of the anterior lens capsule of this patient. A 21-year-old man was referred for low visual acuity and retinal pigment epithelial changes in the left eye. The patient and his relatives underwent detailed ophthalmological examination, including electrophysiological testing. The patient also underwent electronmicroscopic examination of the anterior lens capsule. His visual acuity was 6/18 OD and 6/15 OS. Anterior lenticonus and subcapsular opacities were observed in the left eye. Cataract extraction by phacoemulsification with intraocular lens implantation was performed for his poor visual performance. During the capsulorhexis, the remarkably thin and fragile anterior capsule was noted and removed. Ultrastructural analysis of the anterior lens capsule showed a thinner central zone compared with the periphery. The course of Alport's syndrome can be ameliorated by early diagnosis. Therefore, the ophthalmological examination of a patient with anterior lenticonus must be combined with a detailed medical evaluation. Ultrastructural analysis of the lens capsule can support the diagnosis of Alport's syndrome.

Concomitant medication of psychoses in a lifetime perspective.

PubMed

Vares, Maria; Saetre, Peter; Strålin, Pontus; Levander, Sten; Lindström, Eva; Jönsson, Erik G

2011-01-01

Patients treated with antipsychotic drugs often receive concomitant psychotropic compounds. Few studies address this issue from a lifetime perspective. Here, an analysis is presented of the prescription pattern of such concomitant medication from the first contact with psychiatry until the last written note in the case history documents, in patients with a diagnosis of psychotic illness. A retrospective descriptive analysis of all case history data of 66 patients diagnosed with schizophrenia or schizophrenia-like psychotic disorders. Benzodiazepines and benzodiazepine-related anxiolytic drugs had been prescribed to 95% of the patients, other anxiolytics, sedatives or hypnotic drugs to 61%, anti-parkinsonism drugs to 86%, and antidepressants to 56% of the patients. However, lifetime doses were small and most of the time patients had no concomitant medication. The prescribed lifetime dose of anti-parkinsonism drugs was associated with that of prescribed first-generation but not second-generation antipsychotics. Most psychosis patients are sometimes treated with concomitant drugs but mainly over short periods. Lifetime concomitant add-on medication at the individual patient level is variable and complex but not extensive. Copyright © 2011 John Wiley & Sons, Ltd.

A comparative ecotoxicity analysis of α- and γ-phase aluminium oxide nanoparticles towards a freshwater bacterial isolate Bacillus licheniformis.

PubMed

Pakrashi, Sunandan; Kumar, Deepak; Iswarya, V; Bhuvaneshwari, M; Chandrasekaran, N; Mukherjee, Amitava

2014-12-01

Crystalline structure of nanoparticles may influence their physicochemical behaviour as well as their toxicological impact on biota. The differences in orientation of the atoms result in the variations in chemical stability. Thus, toxicological impacts of different crystalline phases of aluminium oxide nanoparticles are expected to vary. The present study brings out a comparative toxicity analysis of γ-phase and α-phase aluminium oxide nanoparticles of comparable hydrodynamic size range towards a freshwater bacterial isolate Bacillus licheniformis at low exposure concentrations (5, 1, 0.5 and 0.05 µg/mL). Upon 2-h exposure, the α-aluminium oxide particles showed lower toxicity than the γ-phase aluminium oxide. The lower level of oxidative stress generation and cell membrane damage in case of the α-phase aluminium oxide nanoparticles substantiated the toxicity results. The involvement of protein, lipopolysaccharides in nanoparticle-cell surface interaction, was noted in both the cases. To conclude, the crystallinity of aluminium oxide nanoparticles played an important role in the interaction and the toxicity response.

Needs analysis for developing a virtual-reality NOTES simulator.

PubMed

Sankaranarayanan, Ganesh; Matthes, Kai; Nemani, Arun; Ahn, Woojin; Kato, Masayuki; Jones, Daniel B; Schwaitzberg, Steven; De, Suvranu

2013-05-01

INTRODUCTION AND STUDY AIM: Natural orifice translumenal endoscopic surgery (NOTES) is an emerging surgical technique that requires a cautious adoption approach to ensure patient safety. High-fidelity virtual-reality-based simulators allow development of new surgical procedures and tools and train medical personnel without risk to human patients. As part of a project funded by the National Institutes of Health, we are developing the virtual transluminal endoscopic surgery trainer (VTEST) for this purpose. The objective of this study is to conduct a structured needs analysis to identify the design parameters for such a virtual-reality-based simulator for NOTES. A 30-point questionnaire was distributed at the 2011 National Orifice Surgery Consortium for Assessment and Research meeting to obtain responses from experts. Ordinal logistic regression and the Wilcoxon rank-sum test were used for analysis. A total of 22 NOTES experts participated in the study. Cholecystectomy (CE, 68 %) followed by appendectomy (AE, 63 %) (CE vs AE, p = 0.0521) was selected as the first choice for simulation. Flexible (FL, 47 %) and hybrid (HY, 47 %) approaches were equally favorable compared with rigid (RI, 6 %) with p < 0.001 for both FL versus RI and HY versus RI. The transvaginal approach was preferred 3 to 1 to the transgastric. Most participants preferred two-channel (2C) scopes (65 %) compared with single (1C) or three (3C) or more channels with p < 0.001 for both 2C versus 1C and 2C versus 3C. The importance of force feedback and the utility of a virtual NOTES simulator in training and testing new tools for NOTES were rated very high by the participants. Our study reinforces the importance of developing a virtual NOTES simulator and clearly presents expert preferences. The results of this analysis will direct our initial development of the VTEST platform.

CFL3D Version 6.4-General Usage and Aeroelastic Analysis

NASA Technical Reports Server (NTRS)

Bartels, Robert E.; Rumsey, Christopher L.; Biedron, Robert T.

2006-01-01

This document contains the course notes on the computational fluid dynamics code CFL3D version 6.4. It is intended to provide from basic to advanced users the information necessary to successfully use the code for a broad range of cases. Much of the course covers capability that has been a part of previous versions of the code, with material compiled from a CFL3D v5.0 manual and from the CFL3D v6 web site prior to the current release. This part of the material is presented to users of the code not familiar with computational fluid dynamics. There is new capability in CFL3D version 6.4 presented here that has not previously been published. There are also outdated features no longer used or recommended in recent releases of the code. The information offered here supersedes earlier manuals and updates outdated usage. Where current usage supersedes older versions, notation of that is made. These course notes also provides hints for usage, code installation and examples not found elsewhere.

[A case of the Hallermann-Streiff syndrome].

PubMed

Higashi, M; Hara, M; Michimata, H; Nishimura, K; Kurihara, Y

1990-01-01

The Hallermann-Streiff Syndrome has been characterized and established according to 7 positive and 5 negative signs, which were described by François. We encountered an 11 year, 5 months old boy who had 7 positive symptoms of this syndrome in our clinic. In this study, we reported on this typical patient focusing on his dental view. 1) Prolonged retention of the primary teeth which involved microdontia were noted. Congenitally missing teeth were also seen. 2) The occlusal relationship indicated open bite, and also the mandibular function was impaired. 3) The measurements of the length and width of the dental arch were smaller than that of a normal subject, and the dental arch of the maxilla was V-shaped. 4) According to X-ray cephalometric analysis, (a) the dental calculus and the alveolar bone absorption were very evident. (b) abnormal morphologic of the glenoid fossa, mandibulars condyle and the neck of mandibula were seen. These conditions were very evident on the left side. 5) The growth obstade of the maxilla and mandibla and the left shift of the mandible were found. 6) According to histological study, enamel hypoplasia was noted.

Press releases: translating research into news.

PubMed

Woloshin, Steven; Schwartz, Lisa M

2002-06-05

While medical journals strive to ensure accuracy and the acknowledgment of limitations in articles, press releases may not reflect these efforts. Telephone interviews conducted in January 2001 with press officers at 9 prominent medical journals and analysis of press releases (n = 127) about research articles for the 6 issues of each journal preceding the interviews. Seven of the 9 journals routinely issue releases; in each case, the editor with the press office selects articles based on perceived newsworthiness and releases are written by press officers trained in communications. Journals have general guidelines (eg, length) but no standards for acknowledging limitations or for data presentation. Editorial input varies from none to intense. Of the 127 releases analyzed, 29 (23%) noted study limitations and 83 (65%) reported main effects using numbers; 58 reported differences between study groups and of these, 26 (55%) provided the corresponding base rate, the format least prone to exaggeration. Industry funding was noted in only 22% of 23 studies receiving such funding. Press releases do not routinely highlight study limitations or the role of industry funding. Data are often presented using formats that may exaggerate the perceived importance of findings.

Ecological effects of a deodorant and a plain soap upon human skin bacteria.

PubMed Central

Bibel, D. J.

1977-01-01

The effects of a commercial trichlorocarbanilide-containing deodorant soap and a commercial plain soap upon the cutaneous flora of individuals were compared. Using a cross-over design, 21 volunteers (10 women and 11 men) washed their forearms at least once a day with one soap for 3 weeks and then switched soaps for another 4 weeks use. By analysis of variance no significant difference in total colony counts was noted among individuals in their use of the two soaps. With the exception of individual variation, neither sequence of use, sex, nor any combination was influential. However, in 20 of 21 subjects an alteration in the composition of skin flora was observed. The deodorant soap, which in six cases increased total flora, tended to reduce or eliminate diphtheroids in 12 to 17 carriers (71%). Fewer kinds of bacteria were also noted. More Staphylococcus epidermidis was seen with the plain soap, but washing with the deodorant soap seemed to favour Acinetobacter calcoaceticus and Micrococcus luteus. The impact of this alteration and the use of total counts to measure effectiveness of deodorant soaps were brought into question. PMID:264493

Prevalence of Asperger syndrome among patients of an Early Intervention in Psychosis team.

PubMed

Davidson, Conor; Greenwood, Nick; Stansfield, Alison; Wright, Stephen

2014-05-01

There is a lack of systematic studies into comorbidity of Asperger syndrome and psychosis. To determine the prevalence of Asperger syndrome among patients of an early intervention in psychosis service. This study was a cross-sectional survey consisting of three phases: screening, case note review and diagnostic interviews. All patients on caseload (n = 197) were screened using the Autism Spectrum Disorder in Adults Screening Questionnaire. The case notes of patients screened positive were then reviewed for information relevant to Asperger syndrome. Those suspected of having Asperger syndrome were invited for a diagnostic interview. Thirty patients were screened positive. Three of them already had a diagnosis of Asperger syndrome made by child and adolescent mental health services. After case note review, 13 patients were invited to interview. Four did not take part, so nine were interviewed. At interview, four were diagnosed with Asperger syndrome. In total, seven patients had Asperger syndrome. Thus, the prevalence rate in this population is at least 3.6%. The results suggest that the prevalence of Asperger syndrome in first-episode psychosis is considerably higher than that in the general population. Clinicians working in early intervention teams need to be alert to the possibility of Asperger syndrome when assessing patients. © 2013 Wiley Publishing Asia Pty Ltd.

Use of a combined oxygen/nitrous oxide/morphine chlorydrate protocol for analgesia in burned children requiring painful local care.

PubMed

Ozil, Camille; Vialle, Raphaël; Thevenin-Lemoine, Camille; Conti, Elvira; Annequin, Daniel

2010-03-01

We present the results of the use of a protocol of inhalational oxygen/nitrous oxide mixtures associated with oral opioids on a prospective cohort of 33 children undergoing local care for acute but limited burned skin lesions. All the children were orally administered 0.4 mg/kg morphine chlorydrate, and nitrous oxide was administered as an equimolar mixture (50% N2O, 50% O2) via a face mask during the procedure. Pain and comfort of the patient were evaluated by the use of a validated behavioural score. After the end of the procedure, child and parent satisfactions were noted. Mean age was 3 years 6 months (10 months-11 years). A successful detersion procedure was performed in all the cases. Behavioural score was 6 in 15 cases out of 33, comprising between 7 and 9 in 15 patients and 10 in three patients. Subjective satisfaction of pain management was noted in 16 out of 20 patients after the procedure. Subjective satisfaction of the parents was noted in all the cases. Our study demonstrates that the use of a simple protocol of inhalational oxygen/nitrous oxide mixtures associated with oral opioids could be safe and effective. This association was well tolerated without any adverse effect.

Models of the First-Term Reenlistment Decision.

DTIC Science & Technology

1980-09-01

cases in each cell . bIncludes 41 cases indicated as E2 in survey. elncludes 18 cases indicated as E6 in survey. creases. For example, among E-4...1876) (4078) oThe numbers in parentheses show the number of cases in each cell . Clearly, the extent to which these correlations reflect causal...101) NOTE: Numbers in parentheses show the number of cases in each cell . aAmount computed from October 1975 pay tables based on the individual’s

Relationships between Spontaneous Note-Taking, Self-Reported Strategies and Comprehension When Reading Multiple Texts in Different Task Conditions

ERIC Educational Resources Information Center

Hagen, Åste M.; Braasch, Jason L. G.; Bråten, Ivar

2014-01-01

This study investigated note-taking during multiple-text reading across two different task conditions in relation to comprehension performance and self-reports of strategy use. Forty-four undergraduates read multiple texts about climate change to write an argument or a summary. Analysis of students' spontaneous note-taking during reading…

The Treatment of Anorexia Nervosa in a General Hospital: A Case Vignette of a Multi-Disciplinary General Hospital-Based Approach.

ERIC Educational Resources Information Center

Kronenberg, J.; And Others

1994-01-01

Describes anorexia nervosa as condition variable in etiology and resistant to treatment, which may lead to mortality in 5% of treated cases. Notes that efforts have been made for treating disorder in nonstigmatizing medical units outside psychiatric hospitals. Describes, through presentation of short case vignette, advantages of treating…

Motor carrier case study evaluation report : appendix C, Vol. 2 : case study field notes, the Crescent Evaluation

DOT National Transportation Integrated Search

1994-02-01

The Crescent Project element of the HELP Program is a bi-national multi-jurisdictional : cooperative research and demonstration initiative involving the public and private sectors in an : application of advanced technologies for the creation of an in...

Psychiatric comorbidity may not predict suicide during and after hospitalization. A nested case-control study with blinded raters.

PubMed

Walby, Fredrik A; Odegaard, Erik; Mehlum, Lars

2006-06-01

To investigate the differential impact of DSM-IV axis-I and axis-II disorders on completed suicide and to study if psychiatric comorbidity increases the risk of suicide in currently and previously hospitalized psychiatric patients. A nested case-control design based on case notes from 136 suicides and 166 matched controls. All cases and controls were rediagnosed using the SCID-CV for axis-I and the DSM-IV criteria for axis-II disorders and the inter-rater reliability was satisfactory. Raters were blind to the case and control status and the original hospital diagnoses. Depressive disorders and bipolar disorders were associated with an increased risk of suicide. No such effect was found for comorbidity between axis-I disorders and for comorbidity between axis-I and axis-II disorders. Psychiatric diagnoses, although made using a structured and criteria-based approach, was based on information recorded in case notes. Axis-II comorbidity could only be investigated at an aggregated level. Psychiatric comorbidity did not predict suicide in this sample. Mood disorders did, however, increase the risk significantly independent of history of previous suicide attempts. Both findings can inform identification and treatment of patients at high risk for completed suicide.

Combining QMRA and Epidemiology to Estimate Campylobacteriosis Incidence.

PubMed

Evers, Eric G; Bouwknegt, Martijn

2016-10-01

The disease burden of pathogens as estimated by QMRA (quantitative microbial risk assessment) and EA (epidemiological analysis) often differs considerably. This is an unsatisfactory situation for policymakers and scientists. We explored methods to obtain a unified estimate using campylobacteriosis in the Netherlands as an example, where previous work resulted in estimates of 4.9 million (QMRA) and 90,600 (EA) cases per year. Using the maximum likelihood approach and considering EA the gold standard, the QMRA model could produce the original EA estimate by adjusting mainly the dose-infection relationship. Considering QMRA the gold standard, the EA model could produce the original QMRA estimate by adjusting mainly the probability that a gastroenteritis case is caused by Campylobacter. A joint analysis of QMRA and EA data and models assuming identical outcomes, using a frequentist or Bayesian approach (using vague priors), resulted in estimates of 102,000 or 123,000 campylobacteriosis cases per year, respectively. These were close to the original EA estimate, and this will be related to the dissimilarity in data availability. The Bayesian approach further showed that attenuating the condition of equal outcomes immediately resulted in very different estimates of the number of campylobacteriosis cases per year and that using more informative priors had little effect on the results. In conclusion, EA was dominant in estimating the burden of campylobacteriosis in the Netherlands. However, it must be noted that only statistical uncertainties were taken into account here. Taking all, usually difficult to quantify, uncertainties into account might lead to a different conclusion. © 2016 Society for Risk Analysis.

Airport noise and teratogenesis.

PubMed

Edmonds, L D; Layde, P M; Erickson, J D

1979-01-01

It has been suggested that exposures to high-noise levels near major airports may cause increased incidence of birth defects in the offspring of parents residing near these airports. Using data gathered in Metropolitan Atlanta during 1970 to 1972, we compared the rates of seventeen categories of defects in high- and low-noise census tracts. No significant differences were observed. However, when we subdivided the category of central nervous system defects into several subcategories of specific defects, we noted a significantly increased incidence of spina bifida without hydrocephalus in the high-noise areas. Because the small number of cases associated with this finding we did a matched case-control study using all cases of central nervous system defects born during the years 1968 to 1976. No significantly increased risk for residents in the high-noise areas was noted in this study. It is our opinion that noise or other factors associated with residence near airports are unlikely to be important environmental teratogens.

Toxic leucoencephalopathy after 'chasing the dragon'.

PubMed

Singh, Rajinder; Saini, Monica

2015-06-01

Toxic leucoencephalopathy (TLE) is a rare neurological complication of heroin abuse. 'Chasing the dragon' is an inhalational mode of heroin abuse that originated in Southeast Asia. Intriguingly, no cases of TLE have been reported from this region, although the inhalational mode of heroin abuse is common. We herein report the case of a middle-aged man with a history of polysubstance abuse who presented with progressive neurological symptoms and progressed to an uncommunicative state. While the initial impression was that of iatrogenic parkinsonism, diffuse leucoencephalopathy with sparing of the cerebellum was noted on magnetic resonance imaging. In view of his history of inhalational heroin abuse close to the onset of the neurological symptoms, a diagnosis of TLE was made. No clinical improvement was noted with administration of a dopaminergic agent. This is the first known case of delayed TLE following heroin inhalation from Southeast Asia with the unusual feature of cerebellar sparing.

A comparative study of primary and secondary stereotypies.

PubMed

Ghosh, Debabrata; Rajan, Prashant V; Erenberg, Gerald

2013-12-01

This study compares primary stereotypies (repetitive, self-stimulating, and seemingly nonsensical movements that can occur within typically developing children) and secondary stereotypies (those occurring within autistic or mentally retarded children). Utilizing a retrospective chart review from 1995 to 2010, the current study compares primary and secondary stereotypies by the application of a classification system that organizes the movement by its type (motor only, phonic only, mixed) and complexity. In addition, it investigates other parameters associated with the movements such as duration, frequency, age, functional impairment, and progression. The sample group consisted of 28 primary and 28 secondary cases. Primary stereotypies were predominantly motor, simple, of shorter duration, and of less frequency, whereas secondary stereotypies had more vocalization, complexity, longer durations, and higher frequencies. Moreover, functional impairment due to stereotypies was noted in 3 primary and 7 secondary cases, and worsening of stereotypies was noted in 70% of primary versus 44% of secondary cases.

Sierra Structural Dynamics Theory Manual

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

Reese, Garth M.

Sierra/SD provides a massively parallel implementation of structural dynamics finite element analysis, required for high fidelity, validated models used in modal, vibration, static and shock analysis of structural systems. This manual describes the theory behind many of the constructs in Sierra/SD. For a more detailed description of how to use Sierra/SD , we refer the reader to Sierra/SD, User's Notes . Many of the constructs in Sierra/SD are pulled directly from published material. Where possible, these materials are referenced herein. However, certain functions in Sierra/SD are specific to our implementation. We try to be far more complete in those areas.more » The theory manual was developed from several sources including general notes, a programmer notes manual, the user's notes and of course the material in the open literature. This page intentionally left blank.« less

Use of Electronic Health Record Simulation to Understand the Accuracy of Intern Progress Notes

PubMed Central

March, Christopher A.; Scholl, Gretchen; Dversdal, Renee K.; Richards, Matthew; Wilson, Leah M.; Mohan, Vishnu; Gold, Jeffrey A.

2016-01-01

Background With the widespread adoption of electronic health records (EHRs), there is a growing awareness of problems in EHR training for new users and subsequent problems with the quality of information present in EHR-generated progress notes. By standardizing the case, simulation allows for the discovery of EHR patterns of use as well as a modality to aid in EHR training. Objective To develop a high-fidelity EHR training exercise for internal medicine interns to understand patterns of EHR utilization in the generation of daily progress notes. Methods Three months after beginning their internship, 32 interns participated in an EHR simulation designed to assess patterns in note writing and generation. Each intern was given a simulated chart and instructed to create a daily progress note. Notes were graded for use of copy-paste, macros, and accuracy of presented data. Results A total of 31 out of 32 interns (97%) completed the exercise. There was wide variance in use of macros to populate data, with multiple macro types used for the same data category. Three-quarters of notes contained either copy-paste elements or the elimination of active medical problems from the prior days' notes. This was associated with a significant number of quality issues, including failure to recognize a lack of deep vein thrombosis prophylaxis, medications stopped on admission, and issues in prior discharge summary. Conclusions Interns displayed wide variation in the process of creating progress notes. Additional studies are being conducted to determine the impact EHR-based simulation has on standardization of note content. PMID:27168894

Use of Electronic Health Record Simulation to Understand the Accuracy of Intern Progress Notes.

PubMed

March, Christopher A; Scholl, Gretchen; Dversdal, Renee K; Richards, Matthew; Wilson, Leah M; Mohan, Vishnu; Gold, Jeffrey A

2016-05-01

Background With the widespread adoption of electronic health records (EHRs), there is a growing awareness of problems in EHR training for new users and subsequent problems with the quality of information present in EHR-generated progress notes. By standardizing the case, simulation allows for the discovery of EHR patterns of use as well as a modality to aid in EHR training. Objective To develop a high-fidelity EHR training exercise for internal medicine interns to understand patterns of EHR utilization in the generation of daily progress notes. Methods Three months after beginning their internship, 32 interns participated in an EHR simulation designed to assess patterns in note writing and generation. Each intern was given a simulated chart and instructed to create a daily progress note. Notes were graded for use of copy-paste, macros, and accuracy of presented data. Results A total of 31 out of 32 interns (97%) completed the exercise. There was wide variance in use of macros to populate data, with multiple macro types used for the same data category. Three-quarters of notes contained either copy-paste elements or the elimination of active medical problems from the prior days' notes. This was associated with a significant number of quality issues, including failure to recognize a lack of deep vein thrombosis prophylaxis, medications stopped on admission, and issues in prior discharge summary. Conclusions Interns displayed wide variation in the process of creating progress notes. Additional studies are being conducted to determine the impact EHR-based simulation has on standardization of note content.

Facial nerve palsy: analysis of cases reported in children in a suburban hospital in Nigeria.

PubMed

Folayan, M O; Arobieke, R I; Eziyi, E; Oyetola, E O; Elusiyan, J

2014-01-01

The study describes the epidemiology, treatment, and treatment outcomes of the 10 cases of facial nerve palsy seen in children managed at the Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife over a 10 year period. It also compares findings with report from developed countries. This was a retrospective cohort review of pediatric cases of facial nerve palsy encountered in all the clinics run by specialists in the above named hospital. A diagnosis of facial palsy was based on International Classification of Diseases, Ninth Revision, Clinical Modification codes. Information retrieved from the case note included sex, age, number of days with lesion prior to presentation in the clinic, diagnosis, treatment, treatment outcome, and referral clinic. Only 10 cases of facial nerve palsy were diagnosed in the institution during the study period. Prevalence of facial nerve palsy in this hospital was 0.01%. The lesion more commonly affected males and the right side of the face. All cases were associated with infections: Mainly mumps (70% of cases). Case management include the use of steroids and eye pads for cases that presented within 7 days; and steroids, eye pad, and physical therapy for cases that presented later. All cases of facial nerve palsy associated with mumps and malaria infection fully recovered. The two cases of facial nerve palsy associated with otitis media only partially recovered. Facial nerve palsy in pediatric patients is more commonly associated with mumps in the study environment. Successes are recorded with steroid therapy.

Anatomical variations in lymphatic drainage of the right lung: applications in lung cancer surgery.

PubMed

Ndiaye, Assane; Di-Marino, V; Ba, P S; Ndiaye, Aï; Gaye, M; Nazarian, S

2016-12-01

To specify the topography and variations in lymphatic drainage of the right lung to the mediastinum and their therapeutic implications in non-small cell lung cancers (NSCLC). We injected a dye into the subpleural lymphatic vessels in 65 right lung segments, followed by dissection in 22 subjects. At the upper lobe, we had injected 32 segments. We noted extrasegmental overflow in one case; extrasegmental and extralobar drainage in two cases; drainage to the lymph nodes of another lobe in one case. Fifty-six percent of the segments drained directly (skipping intrapulmonary and hilar lymph nodes) into the right paratracheal lymph nodes, and one dorsal segment drained into the thoracic duct. A ventral segment drained into the inferior tracheobronchial lymph nodes. A contralateral drainage to the recurrent chain was observed in two cases. Sixteen segments of the middle lobe were injected and mainly drained into the inferior tracheobronchial lymph nodes with six direct paths; one medial segment drained into the right anterior mediastinal chain. We noted three contralateral drainages and eight downward abdominal drainages. Out of the 17 segments of the lower lobe injected, 6 segments drained into the lymph nodes of another lobe, 5 segments showed a direct route to the lower quadrant chains. We noted one time a drainage into the paraesophageal lymph nodes. The variations in lymphatic drainage of the right lung require to carry out systematically a radical mediastinal lymphadenectomy during the removal of non-small cell lung cancers and to associate an adjuvant treatment.

A survey of adult referrals to specialist attention-deficit/hyperactivity disorder clinics in Canada

PubMed Central

Klassen, Larry J; Blackwood, C Matthew; Reaume, Christopher J; Schaffer, Samuel; Burns, James G

2018-01-01

Background Canadian guidelines encourage family physicians to diagnose/manage adults with uncomplicated attention-deficit/hyperactivity disorder (ADHD); specialist referral is recommended only for complex cases. This retrospective case review investigated adults referred to Canadian ADHD clinics. Methods Adult ADHD specialists reviewed referral letters/charts of patients (aged ≥18 years and no family history/known/expressed childhood ADHD) from family physicians/psychiatrists over 2 years. Results Data on 515 referrals (mean age 33 years, 60% males) were collected (December 2014 to September 2015); 472/515 (92%) were made by family physicians. No psychiatric comorbid symptoms were noted in 344/515 (67%) referrals. ADHD was confirmed by a specialist in 483/515 (94%) cases, whether comorbid symptoms were noted at referral (155/171 [91%]) or not (328/344 [95%]). ADHD was reported to impact “work” (251/317 [79%]), “school” (121/166 [73%]), “social/friends” (260/483 [54%]), and “spouse/family” (231/483 [48%]). Overall, 335/483 (69%) patients had more than or equal to one comorbid symptom (diagnosed by referring physician or specialist). Stimulant monotherapy was recommended for 383/483 (79%) patients, non-stimulant monotherapy for 41/483 (8%) patients, and stimulant plus non-stimulant monotherapy for 39/483 (8%) patients. Almost half of patients were returned for referring physician’s follow-up, either before treatment initiation (102/483 [21%]) or after treatment stabilization (99/483 [20%]). Follow-up was by a specialist for 282/483 (58%) patients. Conclusion ADHD diagnosis was specialist confirmed in most cases. Although most referrals (67%) noted no psychiatric comorbid symptoms, 69% of patients had ≥1 such symptom (diagnosed by a referring physician or specialist), so comorbid symptoms although not always noted at referral, may have contributed to the decision to refer. ADHD has a wide-ranging impact on patients’ daily lives. It is possible that greater confidence of family physicians to diagnose and treat adult ADHD could help to meet patients’ needs. PMID:29317844

Hybrid NOTES transvaginal cholecystectomy: operative and long-term results after 18 cases.

PubMed

Pugliese, Raffaele; Forgione, Antonello; Sansonna, Fabio; Ferrari, Giovanni Carlo; Di Lernia, Stefano; Magistro, Carmelo

2010-03-01

Natural orifice transluminal endoscopic surgery (NOTES) is a novel technique that aims at reducing or abolishing skin incisions and potentially also postoperative pain. The purpose of this study was to analyse operative and long-term results of a series of hybrid transvaginal cholecystectomy. Between July 2007 and May 2009, transvaginal NOTES cholecystectomy for symptomatic cholelithiasis was performed by a hybrid technique in 18 women (mean age 54 years), including four women with a body mass index >30 kg/m(2). Dissection was conducted in the first four cases by a round-tip unipolar electrode (UE) introduced through the operative channel of the endoscope coming from the vagina and in the last 14 cases by a ultrasonic scalpel (US) introduced through a 5-mm abdominal port. The short-term outcomes and the long-term results of the two methods were compared. The transvaginal approach entailed no intraoperative complication and no conversion. The overall mean duration of procedures was 75 min (range 40-190). In the first four cases (UE), the operating time was 148 min (range 140-190), whilst in the last 14 (US), it was considerably shorter, 53 min (range 40-60, p < 0.01). We experienced one biliary leak in the UE group, whilst morbidity with US was nil (p < 0.005). The biliary leak healed in 7 days with nasobiliary drainage. No other complications were encountered in either group. The mean follow-up was 12 months (range 1-22), and none of the patients has complained of dyspareunia or other colpotomy-related complications so far. Until specifically designed endoscopic tools are available for NOTES, the hybrid technique with US dissection conducted through a 5-mm port should be preferred in transvaginal cholecystectomy in order to shorten the duration of surgery and make this approach effective, safe and reproducible. After a mean follow-up of 1 year, none of our patients has complained of any problem related to transvaginal approach.

Evaluation of a novel very high sun-protection-factor moisturizer in adults with rosacea-prone sensitive skin.

PubMed

Grivet-Seyve, Mathieu; Santoro, Francine; Lachmann, Nadège

2017-01-01

Rosacea-prone sensitive skin requires high sun-protection factor (SPF) moisturizers. This study evaluated Daylong Extreme SPF 50+ lotion, a novel cream containing five ultraviolet filters, two emollients, and three skin conditioners. This was an open-label, single-center study. On day 1, before treatment, subjects answered a questionnaire on their skin conditions and sunscreen habits, and both subjects and dermatologist evaluated skin status. Subjects applied the product once daily in the morning to the face for 21 days, and after approximately 3-5 minutes they assessed tolerability and short-term cosmetic acceptability in a questionnaire and daily diary. On day 22, the dermatologist and subjects evaluated skin status for long-term tolerance and cosmetic acceptability. The study enrolled 44 individuals (mean age 58.8 years, 91% female). At baseline, most subjects (39 of 44) showed erythema, and ~30% showed dryness and scaling. Dermatologists noted four cases of pustules and one case of papules. After 21 days' treatment with the product, the dermatologist reported significantly less erythema, dryness and scaling, three cases of pustules and two cases of papules. At baseline, ~75% of subjects noted a feeling of dryness, >50% reported tension, and nearly 25% reported tickling. After using the product for 21 days, subjects reported significantly less tension, dryness, and tickling. Some subjects noted itching and burning before and after using the product. One subject noted papules during treatment. Most subjects said that the product was pleasant, did not irritate the skin or cause stinging/burning, was easy to apply, quickly absorbed, and nongreasy, improved skin moisturization, helped prevent sun-provoked facial redness, did not worsen rosacea, and was easily incorporated into their skincare regimen. Half would switch to the product, and 80% of subjects would buy and recommend the product. The product was well tolerated in rosacea-prone subjects, producing objective and subjective improvements in skin status and symptoms.

Evaluation of a novel very high sun-protection-factor moisturizer in adults with rosacea-prone sensitive skin

PubMed Central

Grivet-Seyve, Mathieu; Santoro, Francine; Lachmann, Nadège

2017-01-01

Background/objective Rosacea-prone sensitive skin requires high sun-protection factor (SPF) moisturizers. This study evaluated Daylong Extreme SPF 50+ lotion, a novel cream containing five ultraviolet filters, two emollients, and three skin conditioners. Subjects and methods This was an open-label, single-center study. On day 1, before treatment, subjects answered a questionnaire on their skin conditions and sunscreen habits, and both subjects and dermatologist evaluated skin status. Subjects applied the product once daily in the morning to the face for 21 days, and after approximately 3–5 minutes they assessed tolerability and short-term cosmetic acceptability in a questionnaire and daily diary. On day 22, the dermatologist and subjects evaluated skin status for long-term tolerance and cosmetic acceptability. Results The study enrolled 44 individuals (mean age 58.8 years, 91% female). At baseline, most subjects (39 of 44) showed erythema, and ~30% showed dryness and scaling. Dermatologists noted four cases of pustules and one case of papules. After 21 days’ treatment with the product, the dermatologist reported significantly less erythema, dryness and scaling, three cases of pustules and two cases of papules. At baseline, ~75% of subjects noted a feeling of dryness, >50% reported tension, and nearly 25% reported tickling. After using the product for 21 days, subjects reported significantly less tension, dryness, and tickling. Some subjects noted itching and burning before and after using the product. One subject noted papules during treatment. Most subjects said that the product was pleasant, did not irritate the skin or cause stinging/burning, was easy to apply, quickly absorbed, and nongreasy, improved skin moisturization, helped prevent sun-provoked facial redness, did not worsen rosacea, and was easily incorporated into their skincare regimen. Half would switch to the product, and 80% of subjects would buy and recommend the product. Conclusion The product was well tolerated in rosacea-prone subjects, producing objective and subjective improvements in skin status and symptoms. PMID:28652793

Identification of forged Bank of England £20 banknotes using IR spectroscopy

NASA Astrophysics Data System (ADS)

Sonnex, Emily; Almond, Matthew J.; Baum, John V.; Bond, John W.

2014-01-01

Bank of England notes of £20 denomination have been studied using infrared spectroscopy in order to generate a method to identify forged notes. An aim of this work was to develop a non-destructive method so that a small, compact Fourier transform infrared spectrometer (FT-IR) instrument could be used by bank workers, police departments or others such as shop assistants to identify forged notes in a non-lab setting. The ease of use of the instrument is the key to this method, as well as the relatively low cost. The presence of a peak at 1400 cm-1 arising from νasym (CO32-) from the blank paper section of a forged note proved to be a successful indicator of the note's illegality for the notes that we studied. Moreover, differences between the spectra of forged and genuine £20 notes were observed in the ν(OH) (ca. 3500 cm-1), ν(Csbnd H) (ca. 2900 cm-1) and ν(Cdbnd O) (ca. 1750 cm-1) regions of the IR spectrum recorded for the polymer film covering the holographic strip. In cases where these simple tests fail, we have shown how an infrared microscope can be used to further differentiate genuine and forged banknotes by producing infrared maps of selected areas of the note contrasting inks with background paper.

Identification of forged Bank of England £20 banknotes using IR spectroscopy.

PubMed

Sonnex, Emily; Almond, Matthew J; Baum, John V; Bond, John W

2014-01-24

Bank of England notes of £20 denomination have been studied using infrared spectroscopy in order to generate a method to identify forged notes. An aim of this work was to develop a non-destructive method so that a small, compact Fourier transform infrared spectrometer (FT-IR) instrument could be used by bank workers, police departments or others such as shop assistants to identify forged notes in a non-lab setting. The ease of use of the instrument is the key to this method, as well as the relatively low cost. The presence of a peak at 1400 cm(-1) arising from νasym (CO3(2-)) from the blank paper section of a forged note proved to be a successful indicator of the note's illegality for the notes that we studied. Moreover, differences between the spectra of forged and genuine £20 notes were observed in the ν(OH) (ca. 3500 cm(-1)), ν(C-H) (ca. 2900 cm(-1)) and ν(C=O) (ca. 1750 cm(-1)) regions of the IR spectrum recorded for the polymer film covering the holographic strip. In cases where these simple tests fail, we have shown how an infrared microscope can be used to further differentiate genuine and forged banknotes by producing infrared maps of selected areas of the note contrasting inks with background paper. Copyright © 2013 Elsevier B.V. All rights reserved.

Regression Patterns of Iris Melanoma after Palladium-103 (103Pd) Plaque Brachytherapy.

PubMed

Chaugule, Sonal S; Finger, Paul T

2017-07-01

To evaluate the patterns of regression of iris melanoma after treatment with palladium-103 ( 103 Pd) plaque brachytherapy. Retrospective, nonrandomized, interventional case series. Fifty patients with primary malignant melanoma of the iris. Palladium-103 plaque brachytherapy. Changes in tumor size, pigmentation, and vascularity; incidence of iris neovascularization; and radiation-related complications. The mean age in the case series was 61.2±14.9 years. The mean tumor thickness was 1.4±0.6 mm. According to the American Joint Committee on Cancer, eighth edition, staging criteria for iris melanoma, 21 tumors (42%) were T1a, 5 tumors (10%) were T1b, and 24 tumors (48%) were T2a. The tumor was melanotic in 37 cases (74%) and amelanotic in 13 cases (26%); of these, 13 tumors (26%) showed variable pigmentation. After brachytherapy, mean tumor thickness decreased to 0.9±0.2 mm. Pigmentation increased in 32 tumors (64%), decreased in 11 tumors (22%), and was unchanged in 6 tumors (12%). For intrinsic vascularity (n = 19), 12 tumors (63%) showed decrease and 7 tumors (37%) showed complete resolution. Appearance of ectropion uveae showed diminution in 15 tumors (43%); newly present corectopia was observed in 6 patients (12%). On high-frequency ultrasound imaging, of the 42 tumors (84%) with low to moderate internal reflectivity, 30 tumors (60%) showed an increase in internal reflectivity on regression. Iris stromal atrophy was noted in 26 patients (52%), progression or new-onset cataract was noted in 22 patients (44%), neovascular glaucoma was noted in 1 patient (2%), and there were no cases of corneal opacity. There was no clinical evidence (0%) of radiation-induced retinopathy, maculopathy, or optic neuropathy. Mean follow-up in this series was 5.2 years (range, 0.5-17 years). The most common findings related to iris melanoma regression after 103 Pd plaque brachytherapy included decreased intrinsic tumor vascularity, increased tumor pigmentation, and decreased tumor thickness with synchronous increase in internal ultrasonographic reflectivity. No irreversible sight-limiting complications were noted. Copyright © 2017 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.

Penile fracture at Tribhuvan University Teaching Hospital: a retrospective analysis.

PubMed

Athar, Z; Chalise, P R; Sharma, U K; Gyawali, P R; Shrestha, G K; Joshi, B R

2010-06-01

Fracture of the penis is rupture of the tunica albuginea and the usual cause is abrupt bending of the erect penis by blunt trauma. Trauma during sexual relation is responsible for approximately one third of all cases. The incidence of urethral injuries associated with this condition ranged from 2.0% to 38.0%. Twelve patients who presented to emergency over a period of 4 years with diagnosis of penile fracture were reviewed retrospectively. Patient's profile and all relevant data were noted from charts. The etiology of fracture was related to coital activity in 6 (50.0%) cases while other denied such act. Surgery was performed on all the patients and discharged from hospital on removal of urethral catheter. Follow up continued until restoration of normal penile function without complaint. So fracture of the penis is an injury that can be diagnosed clinically and needs emergency surgical correction for better result.

An 11-year and 10-month-old girl with purpura and chest pain.

PubMed

Chen, Pei-Hsuan; Chiang, Bor-Luen; Lu, Meng-Yao; Yang, Yao-Hsu

2014-10-01

Mucosa-associated lymphoid tissue lymphoma (MALToma) is a type of B-cell lymphoma. Case reports of childhood thymic MALToma and its association with vasculitis are rarely found in the related literature. Herein, we present a report of an 11-year and 10-month-old girl who was initially diagnosed with cutaneous vasculitis characterized by nonthrombocytopenic palpable purpura, positive antinuclear antibody and anti-SSA (Ro) antibody. Eight months later, a thymic mediastinal mass was found. Surgical excision was performed and results of pathological analysis revealed an extranodal marginal zone CD20(+) B-cell MALToma. Benign response to the chemotherapeutic regimen of Berlin-Frankfurt-Münster group NHL-BFM 90 R2 without relapse was noted in 2 years of follow-up. For the first time, our case demonstrated some clinical evidence of the association between vasculitis and childhood MALToma. Copyright © 2012. Published by Elsevier B.V.

[Awake craniotomy: analysis of complicated cases].

PubMed

Kulikov, A S; Kobyakov, G L; Gavrilov, A G; Lubnin, A Yu

2015-01-01

Awake craniotomy is recognized as method that can decrease the frequency of neurological complications after surgery for gliomas located near eloquent brain regions. Unfortunately good neurological outcome can't be ensured even by using of this technique. This paper discusses reasons and possible ways of prevention of such complications. 162 awake craniotomies were performed in our clinic. 152 of patients were discharged from the clinic with good outcome. In 10 (6%) cases sustained severe neurological deficit was noted. These complications were associated with anatomic or ischemic injury of subcortical pathways and internal capsule. Awake craniotomy is effective instrument of brain language mapping and prevention of neurological deterioration. Severe neurological complications of awake craniotomy are associated with underestimate neurosurgical risks, especially in terms of blood vessel injury and depth of resection. The main way of prevention of such complications is meticulous planning of operation and adequate using of mapping facilities.

The implications of starvation induced psychological changes for the ethical treatment of hunger strikers

PubMed Central

Fessler, D

2003-01-01

Design: Electronic databases were searched for (a) editorials and ethical proclamations on hunger strikers and their treatment; (b) studies of voluntary and involuntary starvation, and (c) legal cases pertaining to hunger striking. Additional studies were gathered in a snowball fashion from the published material cited in these databases. Material was included if it (a) provided ethical or legal guidelines; (b) shed light on psychological changes accompanying starvation, or (c) illustrated the practice of hunger striking. Authors' observations, opinions, and conclusions were noted. Conclusions: Although the heterogeneous nature of the sources precluded statistical analysis, starvation appears to be accompanied by marked psychological changes. Some changes clearly impair competence, in which case physicians are advised to follow advance directives obtained early in the hunger strike. More problematic are increases in impulsivity and aggressivity, changes which, while not impairing competence, enhance the likelihood that patients will starve themselves to death. PMID:12930863

Freud's Rat Man from the perspective of an early-life variant of the Oedipus complex.

PubMed

Osman, Marvin P

2009-07-01

In the spirit of Freud's invitation to other investigators to elaborate on his "Notes Upon a Case of Obsessional Neurosis" (1909), the author offers additional and differing views on the case of the Rat Man (Dr. Ernst Langer). These views have been informed by the evolution of psychoanalysis over the past 100 years, especially by the perspective provided by an early-life variant on the Oedipus complex (Osman 2000). The author postulates that an important reason for the happy conclusion of this analysis, surprising for its brevity, was that it expedited a mourning process that released a primitive bond to the patient's father, and also, in doing so, facilitated the emergence of a less encumbered and more individuated identity. While accomplishing this, constricting bonds to his late sister Katherine and to his mother were loosened as well.

Science, safety, and trust: the case of transgenic food.

PubMed

Martinelli, Lucia; Karbarz, Małgorzata; Siipi, Helena

2013-02-01

Genetically modified (GM) food is discussed as an example of the controversial relation between the intrinsic uncertainty of the scientific approach and the demand of citizen-consumers to use products of science innovation that are known to be safe. On the whole, peer-reviewed studies on GM food safety do not note significant health risks, with a few exceptions, like the most renowned "Pusztai affair" and the recent "Seralini case." These latter studies have been disregarded by the scientific community, based on incorrect experimental designs and statistic analysis. Such contradictory results show the complexity of risk evaluation, and raise concerns in the citizen-consumers against the GM food. A thoughtful consideration by scientific community and decision makers of the moral values that are present in risk evaluation and risk management should be the most trustable answer to citizen-consumers to their claim for clear and definitive answers concerning safety/un-safety of GM food.

Solutions of the equation of heat flow. [in and around sunspots

NASA Technical Reports Server (NTRS)

Margolis, S. H.; Knobloch, E.

1980-01-01

The geometry of sunspots has been used to suggest a problem in heat flow. The equation of heat transport is solved for the case of a cylinder with a given thermal conductivity imbedded in an otherwise uniform medium with different conductivity. The surface of this region radiates heat with flux proportional to temperature. At a lower surface, either in heat flux or temperature is held constant. The cylinder can have an anisotropic thermal conductivity. The variations in temperature along the radiating surface have been determined. A simple approximation is noted which has been found to give a general solution with acceptable accuracy. This method may be of some use in other situations requiring the solution of Laplace's equation with a free surface. The analysis is used to set limits on the ratio of diameter to depth for cases which preserve the sharp surface temperature transition across the cylinder.

Diagnosis and management of primary hepatic pregnancy: literature review of 31 cases.

PubMed

Wang, Jicai; Su, Zhilei; Lu, Shounan; Fu, Wen; Liu, Zhifa; Jiang, Xingming; Tai, Sheng

2018-05-21

To summarize the appropriate diagnostic methods and therapeutic options for primary hepatic pregnancy (PHP). Literature searches were performed in Pubmed, Web of Science, Cochrane Library and Embase databases (1956-2017), using the following search terms: primary hepatic pregnancy, hepatic pregnancy, liver pregnancy, hepatic ectopic pregnancy and intrahepatic pregnancy. Further literature was confirmed through cross-referencing. Thirty-one cases were reviewed and collected. The site mostly described in literatures is the right lobe of liver (93.5%). Main symptoms of PHP included abdominal pain (77.4%), amenorrhea (45.2%), acuteperitonism (32.3%), shock (25.8%) and vomit (16.1%). Majority of patients (83.9%) were treated by laparotomy. Less-invasive approaches (16.1%) such as laparoscopy or combination of postoperative injection of methotrexate were used less frequently. The outcome was acceptable at the end of the follow-up period in ten cases (1-72 months) and the recovery rate was 96.7%. One patient died and other complications were noted in three patients during the postoperative period. The clinical diagnosis of PHP can be settled up by comprehensive analysis of serum HCG levels, ultrasound and imaging. The analysis should be assessed carefully before therapeutic procedure. Invasive methods should be preferential. Less-invasive approaches can be selected when the patients have stable hemodynamics and non-acute abdomen.

Atherectomy using a solid-state laser at 355 nm wavelength.

PubMed

Herzog, Amir; Oszkinis, Grzegorz; Planer, David; Ziaja, Krzysztof; Kruszyna, Łukasz; Stanisić, Michał Goran; Ziaja, Damian; Ishaaya, Amiel A; Kuczmik, Wacław

2017-10-01

Peripheral arterial disease (PAD), caused by atherosclerotic processes, is allied with an increased risk of ischemic events, limb loss, and death. Recently, the use of a solid-state laser at 355 nm within a hybrid catheter was suggested for that purpose. In this work, short nanosecond pulses of a solid-state laser at 355 nm delivered through a hybrid catheter, composed of optical fibers and a blunt mechanical blade, are used to conduct a pre-clinical study and two clinical cases. The pre-clinical study consisted of an atherosclerotic calcified cadaveric leg and a porcine in vivo trial within the iliac artery, respectively. The clinical cases include chronic total occlusions with a calcified lesion. The occluded cadaveric leg is recanalized successfully and no evidence of thermal necrosis is indicated in the histopathology analysis of the porcine study. No arterial wall damage is demonstrated on the animals' treated arteries and no significant impact on blood count and biochemistry analysis is noted in the animal trial. Successful recanalization of the occluded arteries followed by balloon angioplasty is obtained in both clinical cases. Our work constitutes a proof of concept for using a solid-state pulsed laser at 355 nm in atherectomy. © 2017 Wiley-VCH Verlag GmbH & Co. KGaA, Weinheim.

Teaching points-do they occur and what do they contain? An observation study concerning the general practice rotation.

PubMed

Duncan, Gertrude Florence; Roth, Lisa Marie; Donner-Banzhoff, Nobert; Boesner, Stefan

2016-04-18

A general practice rotation is mandatory in most undergraduate medical education programs. However, little is known about the student-teacher interaction which takes place in this setting. In this study we analyzed occurrence and content of teaching points. From April to December 2012, 410 individual patient consultations were observed in twelve teaching practices associated with the Philipps University Marburg, Germany. Material was collected using structured field-note forms and videotaping. Data analysis was descriptive in form. A teaching point is defined here as a general rule or specific, case-related information divulged by the teaching practitioner. According to the analysis of 410 consultations, teaching points were made in 66.3% of consultations. During these consultations, 74.3% general- and 46.3% case related teaching points occurred; multiple categorizations were possible. Of seven possible topics, therapy was most common, followed, in frequency of occurrence, by patient history, diagnostic procedure, physical examination, disease pathology, differential diagnosis, risk factors and case presentation. The majority of consultations conducted within student presence contained teaching points, most frequently concerning therapy. General teaching points were more common than specific teaching points. Whilst it is encouraging that most consultations included teaching points, faculty development aimed at raising awareness for teaching and learning techniques is important.

A survey of current practices for genomic sequencing test interpretation and reporting processes in US laboratories.

PubMed

O'Daniel, Julianne M; McLaughlin, Heather M; Amendola, Laura M; Bale, Sherri J; Berg, Jonathan S; Bick, David; Bowling, Kevin M; Chao, Elizabeth C; Chung, Wendy K; Conlin, Laura K; Cooper, Gregory M; Das, Soma; Deignan, Joshua L; Dorschner, Michael O; Evans, James P; Ghazani, Arezou A; Goddard, Katrina A; Gornick, Michele; Farwell Hagman, Kelly D; Hambuch, Tina; Hegde, Madhuri; Hindorff, Lucia A; Holm, Ingrid A; Jarvik, Gail P; Knight Johnson, Amy; Mighion, Lindsey; Morra, Massimo; Plon, Sharon E; Punj, Sumit; Richards, C Sue; Santani, Avni; Shirts, Brian H; Spinner, Nancy B; Tang, Sha; Weck, Karen E; Wolf, Susan M; Yang, Yaping; Rehm, Heidi L

2017-05-01

While the diagnostic success of genomic sequencing expands, the complexity of this testing should not be overlooked. Numerous laboratory processes are required to support the identification, interpretation, and reporting of clinically significant variants. This study aimed to examine the workflow and reporting procedures among US laboratories to highlight shared practices and identify areas in need of standardization. Surveys and follow-up interviews were conducted with laboratories offering exome and/or genome sequencing to support a research program or for routine clinical services. The 73-item survey elicited multiple choice and free-text responses that were later clarified with phone interviews. Twenty-one laboratories participated. Practices highly concordant across all groups included consent documentation, multiperson case review, and enabling patient opt-out of incidental or secondary findings analysis. Noted divergence included use of phenotypic data to inform case analysis and interpretation and reporting of case-specific quality metrics and methods. Few laboratory policies detailed procedures for data reanalysis, data sharing, or patient access to data. This study provides an overview of practices and policies of experienced exome and genome sequencing laboratories. The results enable broader consideration of which practices are becoming standard approaches, where divergence remains, and areas of development in best practice guidelines that may be helpful.Genet Med advance online publication 03 Novemeber 2016.

Agreement between routine electronic hospital discharge and Scottish Stroke Care Audit (SSCA) data in identifying stroke in the Scottish population.

PubMed

Turner, Melanie; Barber, Mark; Dodds, Hazel; Dennis, Martin; Langhorne, Peter; Macleod, Mary-Joan

2015-12-30

In Scotland all non-obstetric, non-psychiatric acute inpatient and day case stays are recorded by an administrative hospital discharge database, the Scottish Morbidity Record (SMR01). The Scottish Stroke Care Audit (SSCA) collects data from all hospitals managing acute stroke in Scotland to support and improve quality of stroke care. The aim was to assess whether there were discrepancies between these data sources for admissions from 2010 to 2011. Records were matched when admission dates from the two data sources were within two days of each other and if an International Classification of Diseases (ICD) code of I61, I63, I64, or G45 was in the primary or secondary diagnosis field on SMR01. We also carried out a linkage analysis followed by a case-note review within one hospital in Scotland. There were a total of 22 416 entries on SSCA and 22 200 entries on SMR01. The concordance between SSCA and SMR01 was 16 823. SSCA contained 5593 strokes that were not present in SMR01, whereas SMR01 contained 185 strokes that were not present in SSCA. In the case-note review the concordance was 531, with SSCA containing 157 strokes that were not present in SMR01 and SMR01 containing 32 strokes that were not present in SSCA. When identifying strokes, hospital administrative discharge databases should be used with caution. Our results demonstrate that SSCA most accurately represents the number of strokes occurring in Scotland. This resource is useful for determining the provision of adequate patient care, stroke services and resources, and as a tool for research.

Primary hyperoxaluria in populations of Pakistan origin: results from a literature review and two major registries.

PubMed

Talati, Jamsheer Jehangir; Hulton, Sally-Anne; Garrelfs, Sander F; Aziz, Wajahat; Rao, Shoaib; Memon, Amanullah; Nazir, Zafar; Biyabani, Raziuddin; Qazi, Saqib; Azam, Iqbal; Khan, Aysha Habib; Ahmed, Jamil; Jafri, Lena; Zeeshan, Mohammad

2018-04-01

Primary hyperoxalurias (PH) are devastating, autosomal recessive diseases causing renal stones. Undifferentiated hyperoxaluria is seen in up to 43% of Pakistani paediatric stone patients. High rates of consanguinity in Pakistan suggest significant local prevalence. There is no detailed information regarding number of cases, clinical features, and genetics in Pakistan-origin (P-o) patients. We reviewed available information on P-o PH patients recorded in the literature as well as from two major PH registries (the Rare Kidney Stone Consortium PH Registry (RKSCPHR) and the OxalEurope PH Registry (OxER); and the Aga Khan University Hospital in Pakistan. After excluding overlaps, we noted 217 P-o PH subjects (42 in OxER and 4 in RKSCPHR). Presentations were protean. Details of mutations were available for 94 patients of 201 who had genetic analyses. Unique mutations were noted. Mutation [c.508G>A (p. Gly170Arg)] (present in up to 25% in the West) was reported in only one case. In one series, only 30% had mutations on exons 1,4,7 of AGXT. Of 42 P-o patients in OxER, 52.4% were PH1, 45.2% PH2, and 2.4% PH3. Of concern is that diagnosis was made after renal transplant rejection (four cases) and on bone-marrow aspiration (in five). Lack of consideration of PH as a diagnosis, late diagnosis, and loss of transplanted kidneys mandates that PH be searched for diligently. Mutation analysis will need to extend to all exons and include PH 1,2,3. There is a need to spread awareness and identify patients through a scoring or screening system that alerts physicians to consider a diagnosis of PH.

Clinical profile of dengue among children according to revised WHO classification: analysis of a 2012 outbreak from Southern India.

PubMed

Sahana, K S; Sujatha, R

2015-02-01

To study the clinical profile of dengue fever and its outcome in children with application of revised WHO classification and to identify risk factors for severe dengue. This study was a prospective observational study of children diagnosed with dengue from July 2012 through February 2013 at a tertiary care hospital in Bangalore, Karnataka (South India). Eighty one children including 55(67.9 %) boys and 26(32.1 %) girls were diagnosed with dengue. Mean age of presentation was 8 y. Vomiting (60.5 %), pain abdomen (32 %), headache (30.9 %), myalgia (23.5 %) and bleeding manifestations (16 %) were the common presenting complaints. Facial puffiness (63 %), hepatomegaly (51.9 %), ascites (48.1 %), pleural effusion (39.5 %) and petechiae (14.8 %) were noted during examination. Dengue NS1 antigen, IgM, IgG were positive in 66.7 %, 29.6 % and 18.5 % of cases respectively. Investigations showed hemoconcentration in 72.8 %, leucopenia (34.5 %), thrombocytopenia (82.7 %), abnormal liver function test (LFT) (33.3 %). USG abdomen was suggestive of dengue in 66.7 % and gall bladder edema was noted in 53.1 %. Two patients died out of the total 81 patients with mortality rate of 2.5 %. Number of cases classified as Dengue without warning signs (D), Dengue with warning signs (DW) and Severe Dengue (SD) were 48.1 %, 27.2 % and 24.7 % respectively. Children between 5 and 15 y were most affected by dengue fever. Pain abdomen and vomiting were most common presenting symptoms. Ascites, plerural effusion, hepatomegaly, gall bladder wall thickening and abnormal LFT were found significantly high in severe dengue cases.

Laparoscopic cholecystectomy under spinal anaesthesia: A prospective, randomised study

PubMed Central

Tiwari, Sangeeta; Chauhan, Ashutosh; Chaterjee, Pallab; Alam, Mohammed T

2013-01-01

CONTEXT: Spinal anaesthesia has been reported as an alternative to general anaesthesia for performing laparoscopic cholecystectomy (LC). AIMS: Study aimed to evaluate efficacy, safety and cost benefit of conducting laparoscopic cholecystectomy under spinal anaesthesia (SA) in comparison to general anaesthesia(GA) SETTINGS AND DESIGN: A prospective, randomised study conducted over a two year period at an urban, non teaching hospital. MATERIALS AND METHODS: Patients meeting inclusion criteria e randomised into two groups. Group A and Group B received general and spinal anaesthesia by standardised techniques. Both groups underwent standard four port laparoscopic cholecystectomy. Mean anaesthesia time, pneumoperitoneum time and surgery time defined primary outcome measures. Intraoperative events and post operative pain score were secondary outcome measure. STATISTICAL ANALYSIS USED: The Student t test, Pearson′s chi-square test and Fisher exact test. RESULTS: Out of 235 cases enrolled in the study, 114 cases in Group A and 110 in Group B analysed. Mean anaesthesia time appeared to be more in the GA group (49.45 vs. 40.64, P = 0.02) while pneumoperitoneum time and corresponding the total surgery time was slightly longer in the SA group. 27/117 cases who received SA experienced intraoperative events, four significant enough to convert to GA. No postoperative complications noted in either group. Pain relief significantly more in SA group in immediate post operative period (06 and 12 hours) but same as GA group at time of discharge (24 hours). No late postoperative complication or readmission noted in either group. CONCLUSION: Laparoscopic cholecystectomy done under spinal anaesthesia as a routine anaesthesia of choice is feasible and safe. Spinal anaesthesia can be recommended to be the anaesthesia technique of choice for conducting laparoscopic cholecystectomy in hospital setups in developing countries where cost factor is a major factor. PMID:23741111

Sarah's birth. How the medicalisation of childbirth may be shaped in different settings: Vignette from a study of routine intervention in Jeddah, Saudi Arabia.

PubMed

Scamell, Mandie; Altaweli, Roa; McCourt, Christine

2017-02-01

The expansion of the medicalisation of childbirth has been described in the literature as being a global phenomenon. The vignette described in this paper, selected from an ethnographic study of routine intervention in Saudi Arabian hospitals illustrates how the worldwide spread of the bio-medical model does not take place within a cultural vacuum. To illuminate the ways in which the medicalisation of birth may be understood and practised in different cultural settings, through a vignette of a specific birth, drawn as a typical case from an ethnographic study that investigated clinical decision-making in the second stage of labour in Saudi Arabia. Ethnographic data collection methods, including participant observation and interviews. The data presented in this paper are drawn from ethnographic field notes collected during field work in Saudi Arabia, and informed by analysis of a wider set of field notes and interviews with professionals working in this context. While the medicalisation of care is a universal phenomenon, the ways in which the care of women is managed using routine medical intervention are framed by the local cultural context in which these practices take place. The ethnographic data presented in this paper shows the medicalisation of birth thesis to be incomplete. The evidence presented in this paper illustrates how local belief systems are not so much subsumed by the expansion of the bio-medical model of childbirth, rather they may actively facilitate a process of localised reinterpretation of such universalised and standardised practices. In this case, aspects of the social and cultural context of Jeddah operates to intensify the biomedical model at the expense of respectful maternity care. In this article, field note data on the birth of one Saudi Arabian woman is used as an illustration of how the medicalisation of childbirth has been appropriated and reinterpreted in Jeddah, Saudi Arabia. Copyright © 2016 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.

[Damage to cranial and peripheral nerves following patency restoration of the internal carotid artery].

PubMed

Myrcha, P; Ciostek, P; Szopiński, P; Noszczyk, W

2001-01-01

The aim of the study was an assessment of the incidence of injury to cranial and peripheral nerves as complication of patency restoration of the internal carotid artery, and analysis of the effect of peripheral nerve injury on the results of carotid patency restoration. From Oct 1987 to Sept 1999 543 procedures were carried out for restoration of patency of the internal carotid artery. After the operation hypoglossus nerve injury was found in 7 cases (1.4%), vagus injury in 9 (1.8%). Signs of exclusively recurrent laryngeal nerve damage were found in 6 cases (1.2%). Glossopharyngeus nerve was damaged in 2 cases (0.4%), transient phrenic nerve palsy as a result of conduction anaesthesia was noted in 2 cases (0.4%). Damage to the transverse cervical nerve was found in 96 cases (60%). In 2 patients (1.2%) lower position of mouth angle was due to section of the mandibular ramus of the facial nerve. In another 2 cases skin sensation disturbances were a consequence of lesion of the auricularis magnus nerve and always they coexisted with signs of transverse cervical nerve damage. damage to the cranial nerves during operation for carotid patency restoration are frequent but mostly they are not connected with any health risks and often they regress spontaneously.

Suicide and Fire: A 20-Year Study of Self-Immolation Death in Sousse, Tunisia.

PubMed

Jedidi, Maher; El Khal, Mohamed Cherif; Mlayeh, Souheil; Masmoudi, Tasnim; Mahjoub, Mohamed; Brahem, Mohamed Yassine; Ben Dhiab, Mohamed; Zemni, Majed; Souguir, Mohamed Kamel

Self-immolation is a self-destructive conduct described since antiquity. Its frequency is variable from one country to another and it is a real public health problem in parts of the world. In Tunisia, after the 2011 revolution the problem of self-immolation protest has been highly publicized giving the impression of an increase in this phenomenon. This is a retrospective analysis of all fatal self-immolation cases, collected over a 20-year period (1996-2015) at the Forensic Medicine Department of the Farhat Hached University Hospital, Sousse, Tunisia. A total of 41 cases were collected, of which 23 were men (56%). The mean age was 36.1 years. Prior to 2011, 78.9% of the victims of self-immolation were women and after 2011, 86.4% were men. The rural origin of the victims was found in 56.25% of the cases. History of psychiatric illness was found in four individuals. The self-immolation took place in the victims' homes in 19 cases (46.3%). It came after a conjugal or family conflict in 14 cases (34.1%) and it is of protest character in 8 cases (19.5%). This study confirmed the increasing frequency of self-immolation in Tunisia after the 2011 revolution and noted a change in the victims' profiles.

Shared written case formulations and weight change in outpatient therapy for anorexia nervosa: a naturalistic single case series.

PubMed

Gladwin, Alice M; Evangeli, Michael

2013-01-01

The therapeutic effects of written shared case formulations are underexplored and have not been examined in anorexia nervosa. This study explored the relationship between (a) the delivery (b) the quality of a shared written case formulation and weight in outpatient psychological therapy for anorexia nervosa. A naturalistic single case series approach was used to examine the case notes of women who had attended a specialist eating disorders service over a 2-year period. The case notes of 15 adult women who had undergone outpatient psychological therapy for anorexia nervosa with a shared written case formulation component were reviewed. The impact of the quality of the case formulation on weekly weight was examined for 14 of the clients where the case formulation was available. The nature of the relationship between the delivery of the written shared case formulation and weight was examined for all 15 clients. There was some evidence to support an association between delivery of the shared written case formulation and weight changes (both weight gain [five out of 15 clients] and weight loss [three out of 15 clients]) in individual cases. Higher case formulation quality was related to cases where weight change did not occur. The delivery of case formulations can be associated with important therapeutic change (both beneficial and potentially harmful) in anorexia nervosa. Future research into the causal mechanisms associated with sharing formulations will face the challenge of adopting strategies that allow for an in-depth exploration of complex therapy variables whilst overcoming methodological challenges. Copyright © 2012 John Wiley & Sons, Ltd.

Urothelial melanosis of the bladder.

PubMed

Valente, Sara L; Bieniek, Jared M; Kesler, Stuart S

2017-10-01

Urothelial melanosis is a rare finding characterized by abnormal pigmentation noted on cystoscopic evaluation and histologically defined by melanin deposition in the urothelium. Although generally considered benign, few cases of urothelial melanosis have been reported in the literature and the risk of recurrence or progression remains largely unknown. Four cases associated with urothelial cell carcinoma have been previously described. Here, we report a case of urothelial melanosis and review previously published cases in the literature.

Sporotrichosis as an unusual case of osteomyelitis: A case report and review of the literature.

PubMed

Lederer, Henry T; Sullivan, Eva; Crum-Cianflone, Nancy F

2016-03-01

Sporotrichosis is an infection of worldwide distribution caused by the dimorphic fungus, Sporothrix schenckii. Acquisition typically occurs via cutaneous inoculation with development of a localized cutaneous and/or lymphocutaneous infection. We present a rare case of osteoarticular sporotrichosis in a 39-year-old man and review the literature noting only 20 published cases since 1980. Recommendations on the diagnosis and management of this unusual infection are provided.

Evolutionary Trends and the Salience Bias (with Apologies to Oil Tankers, Karl Marx, and Others).

ERIC Educational Resources Information Center

McShea, Daniel W.

1994-01-01

Examines evolutionary trends, specifically trends in size, complexity, and fitness. Notes that documentation of these trends consists of either long lists of cases, or descriptions of a small number of salient cases. Proposes the use of random samples to avoid this "saliency bias." (SR)

Autism in a Child with Congenital Cytomegalovirus Infection.

ERIC Educational Resources Information Center

Markowitz, Phillip I.

1983-01-01

A case study is described in which early infantile autism was diagnosed in a child with congenital cytomegalovirus (CMU) infection. It is suggested that congenital infection should be considered as an etiological agent in autism. The case's synergistic effect of CMU-induced brain damage, deafness, and maternal deprivation in noted. (CL)

Media Incitement: The "Born Innocent" Case.

ERIC Educational Resources Information Center

Stevens, George E.

1979-01-01

Concludes from a review of court cases that recovery of damages from a mass medium for an alleged incitement of antisocial behavior is unlikely under traditional negligence rules, even without a consideration of constitutional questions. Notes that the expense of litigation may cause the media to avoid potentially provocative communication. (GT)

Enhancing Leadership in Colleges and Universities: A Case Approach

ERIC Educational Resources Information Center

Sandeen, Arthur

2011-01-01

In view of the serious challenges facing college and university administrators, it is encouraging to note the increased interest in improving leadership knowledge and skills. This book presents an additional option to college and university administrators in their efforts to enhance their leadership skills. The case study approach to improving…

The Zoom Lens: A Case Study in Geometrical Optics.

ERIC Educational Resources Information Center

Cheville, Alan; Scepanovic, Misa

2002-01-01

Introduces a case study on a motion picture company considering the purchase of a newly developed zoom lens in which students act as the engineers designing the zoom lens based on the criteria of company's specifications. Focuses on geometrical optics. Includes teaching notes and classroom management strategies. (YDS)

High and Low Visualization Skills and Pedagogical Decision of Preservice Secondary Mathematics Teachers

ERIC Educational Resources Information Center

Unal, Hasan

2011-01-01

The purpose of this study was to investigate the preservice secondary mathematics teachers' development of pedagogical understanding in the teaching of modular arithmetic problems. Data sources included, written assignments, interview transcripts and filed notes. Using case study and action research approaches cases of three preservice teachers…

Professional Identity of an Early Childhood Black Teacher in a Predominantly White School: A Case Study

ERIC Educational Resources Information Center

Al-Khatib, Amal J.; Lash, Martha J.

2017-01-01

This qualitative case study investigated the role of race, school context, and personal and professional experiences in the formation of an early childhood minority teacher's professional identity. Data sources included interviews, observations, conversations, field notes and school artefacts. Member checking, triangulation and extended…

Who Are Equals?

ERIC Educational Resources Information Center

Cohen, Carl

1978-01-01

The problem of affirmative action in college admission policies is addressed in view of the case of The Regents of the University of California v. Allan Bakke. It is noted that the essence of the case is preference by race and that official favoritism by race or national origin is poison to American society. (LBH)

Embarrassing Pronoun Case Errors [and] When Repeating It's Not Necessary To Use Past Tense.

ERIC Educational Resources Information Center

Arnold, George

2002-01-01

Discusses how to help journalism students avoid pronoun case errors. Notes that many students as well as broadcast journalism professionals make the error of using the past tense when referring to a previous expression or situation that remains current in meaning. (RS)

Hong Kong's Cross-System University Partnerships

ERIC Educational Resources Information Center

Postiglione, Gerard A.; Yunyun, Qin; Te, Alice Y. C.

2016-01-01

The authors examine the special case of Hong Kong higher education's institutional partnerships in the Chinese mainland. After noting the rise of cross-system university partnership in Asia, it provides a neoinstitutional perspective on the differences between the two China higher education systems. Finally, a case study of the experience of the…

Teaching Deanna to Read: A Case Study.

ERIC Educational Resources Information Center

Tiwald, Jeanette M.

1995-01-01

Describes a Reading Recovery case study involving a first-grade student who was at risk for learning how to read and write. Notes that this student learned to read strategically and was accelerated to the average band in her classroom after 81 Reading Recovery lessons, without first knowing the alphabet. (SR)

INTERNAL LIMITING MEMBRANE PEELING-DEPENDENT RETINAL STRUCTURAL CHANGES AFTER VITRECTOMY IN RHEGMATOGENOUS RETINAL DETACHMENT.

PubMed

Hisatomi, Toshio; Tachibana, Takashi; Notomi, Shoji; Koyanagi, Yoshito; Murakami, Yusuke; Takeda, Atsunobu; Ikeda, Yasuhiro; Yoshida, Shigeo; Enaida, Hiroshi; Murata, Toshinori; Sakamoto, Taiji; Sonoda, Koh-Hei; Ishibashi, Tatsuro

2018-03-01

To examine retinal changes after vitrectomy with internal limiting membrane (ILM) peeling, we used 3-dimensional optical coherence tomography (3D-OCT) in rhegmatogenous retinal detachment cases. The 68 eyes from 67 patients with rhegmatogenous retinal detachment were studied, including 35 detached macula cases (51%) and 33 attached macula cases. Internal limiting membrane peeling was performed with fine forceps after brilliant blue G staining. The 3D-OCT images were obtained with volume-rendering technologies from cross-sectional OCT images. The 3D-OCT detected 45 eyes (66%) with ILM peeling-dependent retinal changes, including dissociated optic nerve fiber layer appearance, dimple sign, temporal macular thinning, ILM peeling area thinning, or forceps-related retinal thinning. The ILM peeled area was detectable in only 9 eyes with 3D-OCT, whereas it was undetectable in other 59 eyes. The dissociated optic nerve fiber layer appearance was detected in 8 of the total cases (12%), and dimple signs were observed in 14 cases (21%). Forceps-related thinning was also noted in eight cases (24%) of attached macula cases and in four cases (11%) of detached macula cases. No postoperative macular pucker was noted in the observational period. The 3D-OCT clearly revealed spatial and time-dependent retinal changes after ILM peeling. The changes occurred in 2 months and remained thereafter.

Case Management in Primary Care for Frequent Users of Health Care Services: A Mixed Methods Study.

PubMed

Hudon, Catherine; Chouinard, Maud-Christine; Dubois, Marie-France; Roberge, Pasquale; Loignon, Christine; Tchouaket, Éric; Lambert, Mireille; Hudon, Émilie; Diadiou, Fatoumata; Bouliane, Danielle

2018-05-01

This study aimed to evaluate the effects of the V1SAGES case management intervention (Vulnerable Patients in Primary Care: Nurse Case Management and Self-management Support) for frequent users of health care services with chronic disease and complex care needs on psychological distress and patient activation. We used a 2-phase sequential mixed methods design. The first phase was a pragmatic randomized controlled trial with intention-to-treat analysis that measured the effects of the intervention compared with usual care on psychological distress and patient activation before and after 6 months. The second phase had a qualitative descriptive design and entailed thematic analysis of in-depth interviews (25 patients, 6 case management nurses, 9 health managers) and focus groups (8 patients' spouses, 21 family physicians) to understand stakeholders' perceived effects of the intervention on patients. A total of 247 patients were randomized into the intervention group (n = 126) or the control group (n = 121). Compared with usual care, the intervention reduced psychological distress (odds ratio = 0.43; 95% CI, 0.19-0.95, P = .04), but did not have any significant effect on patient activation ( P = .43). Qualitative results suggested that patients and their spouses benefitted from the case management intervention, gaining a sense of security, and stakeholders noted better patient self-management of health. Together, our study's quantitative and qualitative results suggest that case management reduces psychological distress, making patients and caregivers feel more secure, whereas impact on self-management is unclear. Case management is a promising avenue to improve outcomes among frequent users of health care with complex needs. © 2018 Annals of Family Medicine, Inc.

A Guide to Field Notes for Qualitative Research: Context and Conversation.

PubMed

Phillippi, Julia; Lauderdale, Jana

2018-02-01

Field notes are widely recommended in qualitative research as a means of documenting needed contextual information. With growing use of data sharing, secondary analysis, and metasynthesis, field notes ensure rich context persists beyond the original research team. However, while widely regarded as essential, there is not a guide to field note collection within the literature to guide researchers. Using the qualitative literature and previous research experience, we provide a concise guide to collection, incorporation, and dissemination of field notes. We provide a description of field note content for contextualization of an entire study as well as individual interviews and focus groups. In addition, we provide two "sketch note" guides, one for study context and one for individual interviews or focus groups for use in the field. Our guides are congruent with many qualitative and mixed methodologies and ensure contextual information is collected, stored, and disseminated as an essential component of ethical, rigorous qualitative research.

Comparison of Forecast and Observed Energetics

NASA Technical Reports Server (NTRS)

Baker, W. E.; Brin, Y.

1985-01-01

An energetics analysis scheme was developed to compare the observed kinetic energy balance over North America with that derived from forecast cyclone case. It is found that: (1) the observed and predicted kinetic energy and eddy conversion are in good qualitative agreement, although the model eddy conversion tends to be 2 to 3 times stronger than the observed values. The eddy conversion which is stronger in the 12 h forecast than in observations and may be due to several factors is studied; (2) vertical profiles of kinetic energy generation and dissipation exhibit lower and upper tropospheric maxima in both the forecast and observations; and (3) a lag in the observational analysis with the maximum in the observed kinetic energy occurring at 0000 GMT 14 January over the same region as the maximum Eddy conversion 12 h earlier is noted.

Microbiology, infection control and infection related outcome in pediatric patients in an oncology center in Eastern India: Experience from Tata Medical Center, Kolkata.

PubMed

Bhattacharyya, Arpita; Krishnan, Shekhar; Saha, Vaskar; Goel, Gaurav; Bhattacharya, Sanjay; Hmar, Lalawmpuia

2014-01-01

Infection is a major determinant in the outcome of patients with cancer. The aim was to know the epidemiology and outcome of patients with cancer in a cancer care center in Eastern India. Retrospective study of pediatric patients in Tata Medical Center, Kolkata, India. Patients (n = 262) between the age group of 0 and 18 years were reviewed for infections and infection-related outcome (January to December 2013). Modified Wald method was used to determine confidence interval of proportions. Gram-negative bacteria were found to be the most common cause of bloodstream infections (BSIs) (56.4%), followed by Gram-positive cocci (34.5%), and Candida species (9.1%). Carbapenem-resistance was noted among 24% of Gram-negative bacilli (GNB), and extended-spectrum beta-lactamase among 64% of GNBs. A single case of Vibrio cholerae septicemia was also noted. No case of vancomycin-resistant Enterococcus was observed, whereas only two cases of methicillin-resistant Staphylococcus aureus bacteremia (1/3 of all Staphylococcus aureus bacteremia) were detected. Escherichia coli, followed by Klebsiella, Pseudomonas, and Acinetobacter were the predominant organisms detected in BSIs. Among Candida spp. BSIs no resistance to caspofungin, amphotericin B, Voriconazole was noted. Candida tropicalis was the most common isolate, and 1 isolate of Candida glabrata showed dose-dependent sensitivity to fluconazole. Three out of 25 patients died of multi-drug resistant Gram-negative bacteria (12%) in 2013. Seventeen patients had radiological evidence of invasive fungal infections (no mortality was noted). Periodic review of infection-related data, as well as infection control practices, is essential to optimize clinical outcome in patients with pediatric malignancies.

Analysis of patients with good uncorrected distance and near vision after monofocal intraocular lens implantation.

PubMed

Nanavaty, Mayank A; Vasavada, Abhay R; Patel, Anil S; Raj, Shetal M; Desai, Tejas H

2006-07-01

To analyze factors contributing to uncorrected visual acuity of at least 6/12 for distance and at least J4 for near (pseudoaccommodation) after monofocal intraocular lens (IOL) implantation. Iladevi Cataract and IOL Research Center, Ahmedabad, India. In a case-controlled study of 30 eyes (30 patients) that had phacoemulsification, those with pseudoaccommodation were assigned to cases and 30 eyes (30 patients) without pseudoaccommodation were designated as controls. Controls were matched by identical best corrected visual acuity, age, and postoperative duration. Subjective refraction was done with retinoscopy. Factors analyzed included corneal astigmatism, pupil size, axial IOL movement, amplitude of accommodation, axial length (AL), and age. Corneal astigmatism was noted on topography and interpreted as against the rule (ATR) (180 +/- 15 degrees), with the rule (WTR) (90 +/- 15 degrees), and oblique (OB) (45/135 +/- 30 degrees). Pupil size was noted on topographic display and AL and anterior chamber depth (ACD) on immersion A-scan. The axial IOL movement was calculated as the difference in ACD after instillation of cyclopentolate 1% (Cyclopent) and subsequently pilocarpine nitrate 2% (Carpinol) at separate visits, and amplitude of accommodation was measured with static and dynamic retinoscopy. Multivariate logistic regression and odds ratio with 95% confidence intervals were determined. Mean spherical equivalent was -0.45 +/- 0.63 diopter (D) in cases and -0.35 +/- 0.83 D (P = .61) in controls. Multivariate logistic regression in cases versus controls: corneal astigmatism (ATR versus WTR and OB collectively): 10.19 [1.8,57.44], P = .009; pupil size: 0.45 [0.07,2.71], P = .38; axial IOL movement: 1.39 [0.51,0.77], P = .514; amplitude of accommodation: 2.95 [0.93,9.3], P = .065; AL: 0.55 [0.29,1.02], P = .058; and age: 0.98 [0.5,1.95], P = .963. The study suggests a significant role of ATR corneal astigmatism in good uncorrected distance and near vision after monofocal IOL implantation.

Surrogacy and the ECtHR: Reflections on Paradiso and Campanelli v Italy.

PubMed

Iliadou, Marianna

2018-02-21

This case note analyses the recent judgment of the European Court of Human Rights in Paradiso and Campanelli v Italy and examines its implications for cross-border surrogacy in Europe. It is argued that this judgment is highly significant, because it sets new standards in terms of the concept of family life under Article 8 of the European Convention on Human Rights. This judgment, it is argued, only appears to bring a halt to the (seemingly) backdoor legitimacy of commercial surrogacy established by the findings of the Second Section and previous judgments of the Court. Finally, this case note critiques the Grand Chamber's findings and examines its likely impact on the problem of cross-border surrogacy.

[Fever-shivers reaction and standard platelet concentrates transfusion: a prospective study].

PubMed

Houissa, B; Abdelkefi, S; Bouslama, M; Zaeir, M; Chakroun, T; Ghachem, L; Yacoub, S

2003-09-01

Fever-shivers reaction (FSR) is the most frequent transfusion immediate incident related to platelet transfusions. The aim of our prospective study was to assess the frequency of the different immediate incidents, especially the frequency and the causes of the FSR, observed during the transfusion of standard platelet concentrates (SPC). For each FSR, analysis of causes included: a bacterial culture of the implicated SPC, a blood culture and HLA antibody screening (lymphocytotoxicity assay) among the patients. In the study period, 34 patients were followed during 74 transfusions. Ten immediate incidents were noted; FSR: N = 8, erythema-urticaria: N = 1 and nausea-vomit: N = 1. The FSR was observed in 6 patients who received 56 SPC. Analysis of causes of this reaction revealed that: HLA antibodies were present in one patient; bacterial contamination was not found neither among the patients nor in the implicated SPC, and the risk of the FSR occurrence rose with increased storage time of the SPC transfused. Indeed, a significant difference was noted between the mean age of the SPC implicated in the FSR and the mean age of those not implicated (P = 0,0028). In conclusion, the FSR is a frequent incident observed during SPC transfusions. In the majority of cases, the cause of this reaction was not identified. Further studies will be necessary to better understand the physiological mechanisms of the FSR.

Descemet’s stripping and non-Descemet’s stripping automated endothelial keratoplasty for microcornea using 6.0 mm donor grafts

PubMed Central

Yokogawa, Hideaki; Kobayashi, Akira; Yamazaki, Natsuko; Ueta, Yoshiki; Hashimoto, Yoshihiro; Tachi, Naoko; Sugiyama, Kazuhisa

2013-01-01

Background The purpose of this paper is to report our experience of Descemet’s stripping and non-Descemet’s stripping automated endothelial keratoplasty (DSAEK/nDSAEK) for microcorneas using 6.0 mm donor grafts. Methods Three eyes of two patients (a 56-year-old woman and a 59-year-old woman) with microcornea and suffering from bullous keratopathy were treated with either DSAEK or nDSAEK. A small donor graft (6.0 mm) was inserted into the anterior chamber using a double glide (Busin glide and intraocular lens sheet glide) donor insertion technique. Both patients were followed for at least 12 months. Clinical outcomes, including intraoperative and postoperative complications, visual acuity, and endothelial cell density were evaluated. Results In all three cases (100%), no intraoperative complications were noted. In one case with a flat keratometry value (32.13 D), a partial donor detachment was noted one day postoperatively, but it was reattached by rebubbling. In another case, rejection was noted 8 months postoperatively, but treatment with systemic corticosteroids was successful. A clear cornea remained in all three cases (100%), with best-corrected visual acuity greater than 20/100 (mean 20/50) at 12 months. Mean postoperative endothelial cell counts were 2,603 ± 18 cells/mm2 at 6 months (7.4% decrease from preoperative donor cell counts) and 1,799 ± 556 cells/mm2 at 12 months (36.5% decrease). Conclusion We report for the first time the successful use of a small donor graft (6.0 mm) for DSAEK/nDSAEK in cases of microcornea. Additional stud ies using a large number of patients are required to evaluate fully the potential advantages and drawbacks of small diameter donor grafts for microcornea. PMID:24109176

Dilemmas of Transfer Pricing Comparability Analysis in Manufacturing Entities. Polish-Czech Case Study

NASA Astrophysics Data System (ADS)

Sulik-Górecka, Aleksandra

2018-06-01

Modern manufacturing entities often operate in capital groups, and their role is sometimes limited to the function of cost centers. From the legal point of view, however, they are separate entities obliged to apply transfer pricing regulations. Meeting the requirements of the arm's length principle can be very difficult at this time, given the relationships and conflicts of interest in the capital group. Complexity increases in capital groups operating in different countries, due to differences in tax regulations. The main purpose of the paper is to demonstrate that the need to valuate the sale of finished goods to a manufacturing entity, which is a subject to a different tax jurisdiction, may lead to a problem of compliance with the arm's length principle. In addition, the paper proposes a methodology for comparability analysis that may be used by manufacturing entities to defend conditions of setting transfer pricing. The paper presents the different functional profiles of manufacturing entities and points out the difficulties that they may encounter when preparing the comparability analysis. It has also been noted that there are differences in transfer pricing regulations in different countries, for example by analyzing Polish and Czech regulations. The lack of uniform benchmarking legislation can cause inconsistencies in the selection of comparable data, resulting in differences in transfer pricing. The paper uses the method of legal regulation review and analysis of results of published studies concerning the scope of transfer pricing and comparability analysis. The paper also adopts a case study analysis.

Echoes Across the Pond: Understanding EU-US Defense Industrial Relationships

DTIC Science & Technology

2009-08-05

industry in the F-18 offset program, Molas -Gallart notes that “there were, in fact, cases of Spanish firms building areas of expertise which they would... Molas -Gallart, 2006, p. 97). It should also be noted that the Spanish aerospace firm CASA currently is a junior partner in the European aerospace... Molas -Gallart has observed, This is not to say that offsets are a thing of the past. Although their relative importance is diminishing, Spain has

Impact of maternal education, employment and family size on nutritional status of children.

PubMed

Iftikhar, Aisha; Bari, Attia; Bano, Iqbal; Masood, Qaisar

2017-01-01

To determine the impact of maternal education, employment, and family size on nutritional status of children. It was case control study conducted at OPD of children Hospital Lahore, from September 2015 to April 2017. Total 340 children (170 cases and 170 controls) with age range of six months to five years along with their mothers were included. Anthropometric measurements were plotted against WHO growth Charts. 170 wasted (<-2 SD) were matched with 170 controls (≥ -2 SD). Maternal education, employment and family size were compared between the cases and control. Confounding variables noted and dichotomized. Univariate analysis was carried out for factors under consideration i.e.; Maternal Education, employment and family size to study the association of each factor. Logistic regression analysis was applied to study the independent association. Maternal education had significant association with growth parameters; OR of 1.32 with confidence interval of (CI= 1.1 to 1.623). Employment status of mothers had OR of 1.132 with insignificant confidence interval of (CI=0.725 to 1.768). Family size had OR of one with insignificant confidence interval (CI=0.8 -1.21). Association remained same after applying bivariate logistic regression analysis. Maternal education has definite and significant effect on nutritional status of children. This is the key factor to be addressed for prevention or improvement of childhood malnutrition. For this it is imperative to launch sustainable programs at national and regional level to uplift women educational status to combat this ever increasing burden of malnutrition.

An integrated framework for the geographic surveillance of chronic disease

PubMed Central

2009-01-01

Background Geographic public health surveillance is concerned with describing and disseminating geographic information about disease and other measures of health to policy makers and the public. While methodological developments in the geographical analysis of disease are numerous, few have been integrated into a framework that also considers the effects of case ascertainment bias on the effectiveness of chronic disease surveillance. Results We present a framework for the geographic surveillance of chronic disease that integrates methodological developments in the spatial statistical analysis and case ascertainment. The framework uses an hierarchical approach to organize and model health information derived from an administrative health data system, and importantly, supports the detection and analysis of case ascertainment bias in geographic data. We test the framework on asthmatic data from Alberta, Canada. We observe high prevalence in south-western Alberta, particularly among Aboriginal females. We also observe that persons likely mistaken for asthmatics tend to be distributed in a pattern similar to asthmatics, suggesting that there may be an underlying social vulnerability to a variety of respiratory illnesses, or the presence of a diagnostic practice style effect. Finally, we note that clustering of asthmatics tends to occur at small geographic scales, while clustering of persons mistaken for asthmatics tends to occur at larger geographic scales. Conclusion Routine and ongoing geographic surveillance of chronic diseases is critical to developing an understanding of underlying epidemiology, and is critical to informing policy makers and the public about the health of the population. PMID:19948046

Bisphosphonates and risk of atrial fibrillation: a meta-analysis

PubMed Central

2010-01-01

Introduction Bisphosphonates are the most commonly used drugs for the prevention and treatment of osteoporosis. Although a recent FDA review of the results of clinical trials reported no clear link between bisphosphonates and serious or non-serious atrial fibrillation (AF), some epidemiologic studies have suggested an association between AF and bisphosphonates. Methods We conducted a meta-analysis of non-experimental studies to evaluate the risk of AF associated with bisphosphonates. Studies were identified by searching MEDLINE and EMBASE using a combination of the Medical Subject Headings and keywords. Our search was limited to English language articles. The pooled estimates of odds ratios (OR) as a measure of effect size were calculated using a random effects model. Results Seven eligible studies with 266,761 patients were identified: three cohort, three case-control, and one self-controlled case series. Bisphosphonate exposure was not associated with an increased risk of AF [pooled multivariate OR 1.04, 95% confidence interval (CI) 0.92-1.16] after adjusting for known risk factors. Moderate heterogeneity was noted (I-squared score = 62.8%). Stratified analyses by study design, cohort versus case-control studies, yielded similar results. Egger's and Begg's tests did not suggest an evidence of publication bias (P = 0.90, 1.00 respectively). No clear asymmetry was observed in the funnel plot analysis. Few studies compared risk between bisphosphonates or by dosing. Conclusions Our study did not find an association between bisphosphonate exposure and AF. This finding is consistent with the FDA's statement. PMID:20170505

Hyperspectral imaging of polymer banknotes for building and analysis of spectral library

NASA Astrophysics Data System (ADS)

Lim, Hoong-Ta; Murukeshan, Vadakke Matham

2017-11-01

The use of counterfeit banknotes increases crime rates and cripples the economy. New countermeasures are required to stop counterfeiters who use advancing technologies with criminal intent. Many countries started adopting polymer banknotes to replace paper notes, as polymer notes are more durable and have better quality. The research on authenticating such banknotes is of much interest to the forensic investigators. Hyperspectral imaging can be employed to build a spectral library of polymer notes, which can then be used for classification to authenticate these notes. This is however not widely reported and has become a research interest in forensic identification. This paper focuses on the use of hyperspectral imaging on polymer notes to build spectral libraries, using a pushbroom hyperspectral imager which has been previously reported. As an initial study, a spectral library will be built from three arbitrarily chosen regions of interest of five circulated genuine polymer notes. Principal component analysis is used for dimension reduction and to convert the information in the spectral library to principal components. A 99% confidence ellipse is formed around the cluster of principal component scores of each class and then used as classification criteria. The potential of the adopted methodology is demonstrated by the classification of the imaged regions as training samples.

Epiretinal proliferation in lamellar macular holes and full-thickness macular holes: clinical and surgical findings.

PubMed

Lai, Tso-Ting; Chen, San-Ni; Yang, Chung-May

2016-04-01

To report the clinical findings and surgical outcomes of lamellar macular holes (LMH) with or without lamellar hole-associated epiretinal proliferation (LHEP), and those of full-thickness macular holes (FTMH) presenting with LHEP. From 2009 to 2013, consecutive cases of surgically treated LMH, and all FTMH cases with LHEP were reviewed, given a follow-up time over 1 year. In the LMH group (43 cases), those with LHEP (19 cases) had significantly thinner bases and larger openings than those without (24 cases). The rate of disrupted IS/OS line was higher in the LHEP subgroup preoperatively (68.4 % vs 37.5 %), but similar between subgroups postoperatively (36.8 % and 33.3 %). The preoperative and postoperative visual acuity showed no significant difference between two subgroups. In the FTMH group (13 cases), the average hole size was 219.2 ± 92.1 μm. Permanent or transient spontaneous hole closure was noted in 69.2 % of cases. An intact IS-OS line was found in only 23 % of cases at the final follow-up. In the LMH group, LHEP was associated with a more severe defect but didn't affect surgical outcomes. In the FTMH group, spontaneous hole closure was frequently noted. Despite small holes, disruption of IS-OS line was common after hole closure.