Plastic freezer bags: a cost-effective method to protect extraction sites in laparoscopic colorectal procedures?

PubMed

Huynh, Hai P; Musselman, Reilly P; Trottier, Daniel C; Soto, Claudia M; Poulin, Eric C; Mamazza, Joseph; Boushey, Robin P; Auer, Rebecca C; Moloo, Husein

2013-10-01

To review surgical-site infection (SSI) and retrieval-site tumor recurrence rates in laparoscopic colorectal procedures when using a plastic freezer bag as a wound protector. Laparoscopic colorectal procedures where a plastic freezer bag used as a wound protector at the extraction site were reviewed between 1991 and 2008 from a prospectively collected database. χ test was used to compare SSI and tumor recurrence rates between groups. Costing data were obtained from the operating room supplies department. A total of 936 cases with 51 (5.45%) surgical-site infections were identified. SSI rates did not differ when comparing groups based on demographic factors, diagnosis, or location of procedure. Retrieval-site tumor recurrence rate was 0.21% (1/474). Cost of plastic freezer bags including sterilization ranged from $0.25 to $3. Plastic freezer bags as wound protectors in laparoscopic colorectal procedures are cost effective and have SSI and retrieval-site tumor recurrence rates that compare favorably to published data.

Qualitative Determination of Nitrate with Triphenylbenzylphosphonium Chloride.

ERIC Educational Resources Information Center

Berry, Donna A.; Cole, Jerry J.

1984-01-01

Discusses two procedures for the identification of nitrate, the standard test ("Brown Ring" test) and a new procedure using triphenylbenzylphosphonium chloride (TPBPC). Effectiveness of both procedures is compared, with the TPBPC test proving to be more sensitive and accurate. (JM)

Evaluating and Comparing Interventions Designed to Enhance Math Fact Accuracy and Fluency: Cover, Copy, and Compare versus Taped Problems

ERIC Educational Resources Information Center

Poncy, Brian C.; Skinner, Christopher H.; Jaspers, Kathryn E.

2007-01-01

An adapted alternating treatments design was used to evaluate and compare the effects of two procedures designed to enhance math fact accuracy and fluency in an elementary student with low cognitive functioning. Results showed that although the cover, copy, compare (CCC) and the taped problems (TP) procedures both increased the student's math fact…

Effectiveness of concurrent procedures during high tibial osteotomy for medial compartment osteoarthritis: a systematic review and meta-analysis.

PubMed

Lee, O-Sung; Ahn, Soyeon; Ahn, Jin Hwan; Teo, Seow Hui; Lee, Yong Seuk

2018-02-01

The purpose of this systematic review and meta-analysis was to evaluate the efficacy of concurrent cartilage procedures during high tibial osteotomy (HTO) for medial compartment osteoarthritis (OA) by comparing the outcomes of studies that directly compared the use of HTO plus concurrent cartilage procedures versus HTO alone. Results that are possible to be compared in more than two articles were presented as forest plots. A 95% confidence interval was calculated for each effect size, and we calculated the I 2 statistic, which presents the percentage of total variation attributable to the heterogeneity among studies. The random effects model was used to calculate the effect size. Seven articles were included to the final analysis. Case groups were composed of HTO without concurrent procedures and control groups were composed of HTO with concurrent procedures such as marrow stimulation procedure, mesenchymal stem cell transplantation, and injection. The case group showed a higher hospital for special surgery score and mean difference was 4.10 [I 2 80.8%, 95% confidence interval (CI) - 9.02 to 4.82]. Mean difference of the mechanical femorotibial angle in five studies was 0.08° (I 2 0%, 95% CI - 0.26 to 0.43). However, improved arthroscopic, histologic, and MRI results were reported in the control group. Our analysis support that concurrent procedures during HTO for medial compartment OA have little beneficial effect regarding clinical and radiological outcomes. However, they might have some beneficial effects in terms of arthroscopic, histologic, and MRI findings even though the quality of healed cartilage is not good as that of original cartilage. Therefore, until now, concurrent procedures for medial compartment OA have been considered optional. Nevertheless, no conclusions can be drawn for younger patients with focal cartilage defects and concomitant varus deformity. This question needs to be addressed separately.

A Comparison of Class-Wide Taped Problems and Cover, Copy, and Compare for Enhancing Mathematics Fluency

ERIC Educational Resources Information Center

Poncy, Brian C.; Skinner, Christopher H.; McCallum, Elizabeth

2012-01-01

An adapted alternating treatments design was used to compare the effects of class-wide applications of Taped Problems (TP) and Cover, Copy, and Compare (CCC) procedures designed to enhance subtraction fact fluency in an intact third-grade classroom. During the TP procedure, a tape provided an auditory prompt (i.e., the problem), followed by a…

A Procedure for Testing the Difference between Effect Sizes.

ERIC Educational Resources Information Center

Lambert, Richard G.; Flowers, Claudia

A special case of the homogeneity of effect size test, as applied to pairwise comparisons of standardized mean differences, was evaluated. Procedures for comparing pairs of pretest to posttest effect sizes, as well as pairs of treatment versus control group effect sizes, were examined. Monte Carlo simulation was used to generate Type I error rates…

Stapled hemorrhoidopexy, an innovative surgical procedure for hemorrhoidal prolapse: cost-utility analysis.

PubMed

Ribarić, Goran; Kofler, Justus; Jayne, David G

2011-08-15

To undertake full economic evaluation of stapled hemorrhoidopexy (PPH) to establish its cost-effectiveness and investigate whether PPH can become cost-saving compared to conventional excisional hemorrhoidectomy (CH). A cost-utility analysis in hospital and health care system (UK) was undertaken using a probabilistic, cohort-based decision tree to compare the use of PPH with CH. Sensitivity analyses allowed showing outcomes in regard to the variations in clinical practice of PPH procedure. The participants were patients undergoing initial surgical treatment of third and fourth degree hemorrhoids within a 1-year time-horizon. Data on clinical effectiveness were obtained from a systematic review of the literature. Main outcome measures were the cost per procedure at the hospital level, total direct costs from the health care system perspective, quality adjusted life years (QALY) gained and incremental cost per QALY gained. A decrease in operating theater time and hospital stay associated with PPH led to a cost saving compared to CH of GBP 27 (US $43.11, €30.50) per procedure at the hospital level and to an incremental cost of GBP 33 (US $52.68, €37.29) after one year from the societal perspective. Calculation of QALYs induced an incremental QALY of 0.0076 and showed an incremental cost-effective ratio (ICER) of GBP 4316 (US $6890.47, €4878.37). Taking into consideration recent literature on clinical outcomes, PPH becomes cost saving compared to CH for the health care system. PPH is a cost-effective procedure with an ICER of GBP 4136 and it seems that an innovative surgical procedure could be cost saving in routine clinical practice.

Postoperative Early Major and Minor Complications in Laparoscopic Vertical Sleeve Gastrectomy (LVSG) Versus Laparoscopic Roux-en-Y Gastric Bypass (LRYGB) Procedures: A Meta-Analysis and Systematic Review.

PubMed

Osland, Emma; Yunus, Rossita Mohamad; Khan, Shahjahan; Alodat, Tareq; Memon, Breda; Memon, Muhammed Ashraf

2016-10-01

Laparoscopic Roux-en-Y gastric bypass (LRYGB) and laparoscopic vertical sleeve gastrectomy (LVSG) have been proposed as cost-effective strategies to manage obesity-related chronic disease. The aim of this meta-analysis and systematic review was to compare the "early postoperative complication rate i.e. within 30-days" reported from randomized control trials (RCTs) comparing these two procedures. RCTs comparing the early complication rates following LVSG and LRYGB between 2000 and 2015 were selected from PubMed, Medline, Embase, Science Citation Index, Current Contents, and the Cochrane database. The outcome variables analyzed included 30-day mortality, major and minor complications and interventions required for their management, length of hospital stay, readmission rates, operating time, and conversions from laparoscopic to open procedures. Six RCTs involving a total of 695 patients (LVSG n = 347, LRYGB n = 348) reported on early major complications. A statistically significant reduction in relative odds of early major complications favoring the LVSG procedure was noted (p = 0.05). Five RCTs representing 633 patients (LVSG n = 317, LRYGB n = 316) reported early minor complications. A non-statically significant reduction in relative odds of 29 % favoring the LVSG procedure was observed for early minor complications (p = 0.4). However, other outcomes directly related to complications which included reoperation rates, readmission rate, and 30-day mortality rate showed comparable effect size for both surgical procedures. This meta-analysis and systematic review of RCTs suggests that fewer early major and minor complications are associated with LVSG compared with LRYGB procedure. However, this does not translate into higher readmission rate, reoperation rate, or 30-day mortality for either procedure.

76 FR 77834 - Scientific Information Request on Intravascular Diagnostic and Imaging Medical Devices

Federal Register 2010, 2011, 2012, 2013, 2014

2011-12-14

... solicited to inform our Comparative Effectiveness Review of Intravascular Diagnostic Procedures and Imaging... scientific information on this device will improve the quality of this comparative effectiveness review. AHRQ is requesting this scientific information and conducting this comparative effectiveness review...

Effects of the Copy, Cover, and Compare Procedure on the Math and Spelling Performance of a High School Student with Behavioral Disorder: A Case Report

ERIC Educational Resources Information Center

Cieslar, Whitney; McLaughlin, T. F.; Derby, K. Mark

2008-01-01

The purpose of this study was to evaluate the effects of the copy, cover, and compare (CCC) procedure on improving the mathematics and spelling performance of a freshman attending a high school special education class. The participant was a 16-year-old high school student enrolled in special education classes for 3 periods of the school day. Math…

Working with a fixed operating room team on consecutive similar cases and the effect on case duration and turnover time.

PubMed

Stepaniak, Pieter S; Vrijland, Wietske W; de Quelerij, Marcel; de Vries, Guus; Heij, Christiaan

2010-12-01

If variation in procedure times could be controlled or better predicted, the cost of surgeries could be reduced through improved scheduling of surgical resources. This study on the impact of similar consecutive cases on the turnover, surgical, and procedure times tests the perception that repeating the same manual tasks reduces the duration of these tasks. We hypothesize that when a fixed team works on similar consecutive cases the result will be shorter turnover and procedure duration as well as less variation as compared with the situation without a fixed team. Case-control study. St Franciscus Hospital, a large general teaching hospital in Rotterdam, the Netherlands. Two procedures, inguinal hernia repair and laparoscopic cholecystectomy, were selected and divided across a control group and a study group. Patients were randomly assigned to the study or control group. Preparation time, surgical time, procedure time, and turnover time. For inguinal hernia repair, we found a significantly lower preparation time and 10 minutes less procedure time in the study group, as compared with the control group. Variation in the study group was lower, as compared with the control group. For laparoscopic cholecystectomy, preparation time was significantly lower in the study group, as compared with the control group. For both procedures, there was a significant decrease in turnover time. Scheduling similar consecutive cases and performing with a fixed team results in lower turnover times and preparation times. The procedure time of the inguinal hernia repair decreased significantly and has practical scheduling implications. For more complex surgery, like laparoscopic cholecystectomy, there is no effect on procedure time.

Endoscopic and laparoscopic treatment of gastroesophageal reflux.

PubMed

Watson, David I; Immanuel, Arul

2010-04-01

Gastroesophageal reflux is extremely common in Western countries. For selected patients, there is an established role for the surgical treatment of reflux, and possibly an emerging role for endoscopic antireflux procedures. Randomized trials have compared medical versus surgical management, laparoscopic versus open surgery and partial versus total fundoplications. However, the evidence base for endoscopic procedures is limited to some small sham-controlled studies, and cohort studies with short-term follow-up. Laparoscopic fundoplication has been shown to be an effective antireflux operation. It facilitates quicker convalescence and is associated with fewer complications, but has a similar longer term outcome compared with open antireflux surgery. In most randomized trials, antireflux surgery achieves at least as good control of reflux as medical therapy, and these studies support a wider application of surgery for the treatment of moderate-to-severe reflux. Laparoscopic partial fundoplication is an effective surgical procedure with fewer side effects, and it may achieve high rates of patient satisfaction at late follow-up. Many of the early endoscopic antireflux procedures have failed to achieve effective reflux control, and they have been withdrawn from the market. Newer procedures have the potential to fashion a surgical fundoplication. However, at present there is insufficient evidence to establish the safety and efficacy of endoscopic procedures for the treatment of gastroesophageal reflux, and no endoscopic procedure has achieved equivalent reflux control to that achieved by surgical fundoplication.

Test Equality between Three Treatments under an Incomplete Block Crossover Design.

PubMed

Lui, Kung-Jong

2015-01-01

Under a random effects linear additive risk model, we compare two experimental treatments with a placebo in continuous data under an incomplete block crossover trial. We develop three test procedures for simultaneously testing equality between two experimental treatments and a placebo, as well as interval estimators for the mean difference between treatments. We apply Monte Carlo simulations to evaluate the performance of these test procedures and interval estimators in a variety of situations. We note that the bivariate test procedure accounting for the dependence structure based on the F-test is preferable to the other two procedures when there is only one of the two experimental treatments has a non-zero effect vs. the placebo. We note further that when the effects of the two experimental treatments vs. a placebo are in the same relative directions and are approximately of equal magnitude, the summary test procedure based on a simple average of two weighted-least-squares (WLS) estimators can outperform the other two procedures with respect to power. When one of the two experimental treatments has a relatively large effect vs. the placebo, the univariate test procedure with using Bonferroni's equality can be still of use. Finally, we use the data about the forced expiratory volume in 1 s (FEV1) readings taken from a double-blind crossover trial comparing two different doses of formoterol with a placebo to illustrate the use of test procedures and interval estimators proposed here.

Movement suppression time-out for undesirable behavior in psychotic and severely developmentally delayed children.

PubMed

Rolider, A; Van Houten, R

1985-01-01

The effects of a movement suppression time-out, which involved punishing any movement or verbalization while a client is in the time-out area, were evaluated in four experiments. The first experiment examined the effects of a DRO procedure and movement suppression plus DRO in suppressing self-injurious behavior in a psychotic child in three different situations. In Experiment 2, the results of the previous experiment were replicated with two dangerous behaviors in a second psychotic child. In a third experiment, movement suppression plus DRO was compared with contingent restraint in reducing inappropriate poking behavior in two settings. The movement suppression procedure eliminated poking whereas contingent restraint had little effect. In the final experiment, movement suppression time-out alone was compared with exclusionary time-out alone and simple corner time-out alone. Self-stimulation occurred at high levels during the exclusionary and simple corner time-out procedures. Self-stimulation was either suppressed or reduced during movement suppression time-out. The movement suppression time-out procedure produced a larger reduction in the target behavior in all three children. The effectiveness of the movement suppression procedure was explained in terms of the suppression of self-stimulation while the time-out procedure was being applied.

Parallel Treatments Design: A Nested Single Subject Design for Comparing Instructional Procedures.

ERIC Educational Resources Information Center

Gast, David L.; Wolery, Mark

1988-01-01

This paper describes the parallel treatments design, a nested single subject experimental design that combines two concurrently implemented multiple probe designs, allows control for effects of extraneous variables through counterbalancing, and replicates its effects across behaviors. Procedural guidelines for the design's use and issues related…

Detailed analysis of CAMS procedures for phase 3 using ground truth inventories

NASA Technical Reports Server (NTRS)

Carnes, J. G.

1979-01-01

The results of a study of Procedure 1 as used during LACIE Phase 3 are presented. The study was performed by comparing the Procedure 1 classification results with digitized ground-truth inventories. The proportion estimation accuracy, dot labeling accuracy, and clustering effectiveness are discussed.

Comparison of 2015 Medicare relative value units for gender-specific procedures: Gynecologic and gynecologic-oncologic versus urologic CPT coding. Has time healed gender-worth?

PubMed

Benoit, M F; Ma, J F; Upperman, B A

2017-02-01

In 1992, Congress implemented a relative value unit (RVU) payment system to set reimbursement for all procedures covered by Medicare. In 1997, data supported that a significant gender bias existed in reimbursement for gynecologic compared to urologic procedures. The present study was performed to compare work and total RVU's for gender specific procedures effective January 2015 and to evaluate if time has healed the gender-based RVU worth. Using the 2015 CPT codes, we compared work and total RVU's for 50 pairs of gender specific procedures. We also evaluated 2015 procedure related provider compensation. The groups were matched so that the procedures were anatomically similar. We also compared 2015 to 1997 RVU and fee schedules. Evaluation of work RVU's for the paired procedures revealed that in 36 cases (72%), male vs female procedures had a higher wRVU and tRVU. For total fee/reimbursement, 42 (84%) male based procedures were compensated at a higher rate than the paired female procedures. On average, male specific surgeries were reimbursed at an amount that was 27.67% higher for male procedures than for female-specific surgeries. Female procedure based work RVU's have increased minimally from 1997 to 2015. Time and effort have trended towards resolution of some gender-related procedure worth discrepancies but there are still significant RVU and compensation differences that should be further reviewed and modified as surgical time and effort highly correlate. Copyright © 2016. Published by Elsevier Inc.

Relaxation and Distraction in Experimental Desensitization.

ERIC Educational Resources Information Center

Weir, R. O.; Marshall, W. L.

1980-01-01

Compared experimental desensitization with a procedure that replaced relaxation with a distraction task and with an approach that combined both relaxation and distraction. Desensitization generally was more effective than the other two procedures. (Author)

Comparison of vocal outcomes after angiolytic laser surgery and microflap surgery for vocal polyps.

PubMed

Mizuta, Masanobu; Hiwatashi, Nao; Kobayashi, Toshiki; Kaneko, Mami; Tateya, Ichiro; Hirano, Shigeru

2015-12-01

The microflap technique is a standard procedure for the treatment of vocal fold polyps. Angiolytic laser surgery carried out under topical anesthesia is an alternative method for vocal polyp removal. However, it is not clear whether angiolytic laser surgery has the same effects on vocal outcomes as the microflap technique because of a lack of studies comparing both procedures. In the current study, vocal outcomes after both procedures were compared to clarify the effects of angiolytic laser surgery for vocal polyp removal. Vocal outcomes were reviewed for patients who underwent angiolytic laser surgery (n=20, laser group) or microflap surgery (n=34, microflap group) for vocal polyp removal. The data analyzed included patient and lesion characteristics, number of surgeries required for complete resolution, and aerodynamic and acoustic examinations before and after surgery. In the laser surgery group, complete resolution of the lesion was achieved with a single procedure in 17 cases (85%) and with two procedures in 3 cases (15%). Postoperative aerodynamic and acoustic parameters demonstrated significant improvement compared to preoperative parameters in both the laser surgery group and the microflap surgery group. There were no significant differences in any postoperative aerodynamic and acoustic parameters between the two groups. The current retrospective study demonstrated that angiolytic laser surgery achieved complete resolution of vocal polyps within two procedures. Postoperative effects on aerodynamic and acoustic functions were similar to those after microflap surgery. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

An Investigation of the Effects of Opportunities to Respond and Intelligence on Sight Word Retention Using Incremental Rehearsal

ERIC Educational Resources Information Center

Johnson, Kade Ryan

2012-01-01

High opportunities to respond (OTR) have been touted as being a key factor in a popular and effective drill procedure called incremental rehearsal (IR). However, IR has also been criticized because it takes more instructional time than other drill procedures and can be less time efficient. The current study compared the effectiveness and…

Blinded and unblinded internal pilot study designs for clinical trials with count data.

PubMed

Schneider, Simon; Schmidli, Heinz; Friede, Tim

2013-07-01

Internal pilot studies are a popular design feature to address uncertainties in the sample size calculations caused by vague information on nuisance parameters. Despite their popularity, only very recently blinded sample size reestimation procedures for trials with count data were proposed and their properties systematically investigated. Although blinded procedures are favored by regulatory authorities, practical application is somewhat limited by fears that blinded procedures are prone to bias if the treatment effect was misspecified in the planning. Here, we compare unblinded and blinded procedures with respect to bias, error rates, and sample size distribution. We find that both procedures maintain the desired power and that the unblinded procedure is slightly liberal whereas the actual significance level of the blinded procedure is close to the nominal level. Furthermore, we show that in situations where uncertainty about the assumed treatment effect exists, the blinded estimator of the control event rate is biased in contrast to the unblinded estimator, which results in differences in mean sample sizes in favor of the unblinded procedure. However, these differences are rather small compared to the deviations of the mean sample sizes from the sample size required to detect the true, but unknown effect. We demonstrate that the variation of the sample size resulting from the blinded procedure is in many practically relevant situations considerably smaller than the one of the unblinded procedures. The methods are extended to overdispersed counts using a quasi-likelihood approach and are illustrated by trials in relapsing multiple sclerosis. © 2013 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

Inside-out: comparing internally generated and externally generated basic emotions.

PubMed

Salas, Christian E; Radovic, Darinka; Turnbull, Oliver H

2012-06-01

A considerable number of mood induction (MI) procedures have been developed to elicit emotion in normal and clinical populations. Although external procedures (e.g., film clips, pictures) are widely used, a number of experiments elicit emotion by using self-generated procedures (e.g., recalling an emotional personal episode). However, no study has directly compared the effectiveness of two types of internal versus external MI across multiple discrete emotions. In the present experiment, 40 undergraduate students watched film clips (external procedure) and recalled personal events (internal procedure) inducing 4 basic emotions (fear, anger, joy, sadness) and later completed a self-report questionnaire. Remarkably, both internal and external procedures elicited target emotions selectively, compared with nontarget emotions. When contrasting the intensity of target emotions, both techniques showed no significant differences, with the exception of Joy, which was more intensely elicited by the internal procedure. Importantly, when considering the overall level of intensity, it was always greater in the internal procedure, for each stimulus. A more detailed investigation of the data suggest that recalling personal events (a type of internal procedure) generates more negative and mixed blends of emotions, which might account for the overall higher intensity of the internal mood induction.

Effective and efficient learning in the operating theater with intraoperative video-enhanced surgical procedure training.

PubMed

van Det, M J; Meijerink, W J H J; Hoff, C; Middel, B; Pierie, J P E N

2013-08-01

INtraoperative Video Enhanced Surgical procedure Training (INVEST) is a new training method designed to improve the transition from basic skills training in a skills lab to procedural training in the operating theater. Traditionally, the master-apprentice model (MAM) is used for procedural training in the operating theater, but this model lacks uniformity and efficiency at the beginning of the learning curve. This study was designed to investigate the effectiveness and efficiency of INVEST compared to MAM. Ten surgical residents with no laparoscopic experience were recruited for a laparoscopic cholecystectomy training curriculum either by the MAM or with INVEST. After a uniform course in basic laparoscopic skills, each trainee performed six cholecystectomies that were digitally recorded. For 14 steps of the procedure, an observer who was blinded for the type of training determined whether the step was performed entirely by the trainee (2 points), partially by the trainee (1 point), or by the supervisor (0 points). Time measurements revealed the total procedure time and the amount of effective procedure time during which the trainee acted as the operating surgeon. Results were compared between both groups. Trainees in the INVEST group were awarded statistically significant more points (115.8 vs. 70.2; p < 0.001) and performed more steps without the interference of the supervisor (46.6 vs. 18.8; p < 0.001). Total procedure time was not lengthened by INVEST, and the part performed by trainees was significantly larger (69.9 vs. 54.1 %; p = 0.004). INVEST enhances effectiveness and training efficiency for procedural training inside the operating theater without compromising operating theater time efficiency.

Configural and component processing in simultaneous and sequential lineup procedures.

PubMed

Flowe, Heather D; Smith, Harriet M J; Karoğlu, Nilda; Onwuegbusi, Tochukwu O; Rai, Lovedeep

2016-01-01

Configural processing supports accurate face recognition, yet it has never been examined within the context of criminal identification lineups. We tested, using the inversion paradigm, the role of configural processing in lineups. Recent research has found that face discrimination accuracy in lineups is better in a simultaneous compared to a sequential lineup procedure. Therefore, we compared configural processing in simultaneous and sequential lineups to examine whether there are differences. We had participants view a crime video, and then they attempted to identify the perpetrator from a simultaneous or sequential lineup. The test faces were presented either upright or inverted, as previous research has shown that inverting test faces disrupts configural processing. The size of the inversion effect for faces was the same across lineup procedures, indicating that configural processing underlies face recognition in both procedures. Discrimination accuracy was comparable across lineup procedures in both the upright and inversion condition. Theoretical implications of the results are discussed.

Critical Emergency Medicine Procedural Skills: A Comparative Study of Methods for Teaching and Assessment.

ERIC Educational Resources Information Center

Chapman, Dane M.; And Others

Three critical procedural skills in emergency medicine were evaluated using three assessment modalities--written, computer, and animal model. The effects of computer practice and previous procedure experience on skill competence were also examined in an experimental sequential assessment design. Subjects were six medical students, six residents,…

A Comparison of Error-Correction Procedures on Skill Acquisition during Discrete-Trial Instruction

ERIC Educational Resources Information Center

Carroll, Regina A.; Joachim, Brad T.; St. Peter, Claire C.; Robinson, Nicole

2015-01-01

Previous research supports the use of a variety of error-correction procedures to facilitate skill acquisition during discrete-trial instruction. We used an adapted alternating treatments design to compare the effects of 4 commonly used error-correction procedures on skill acquisition for 2 children with attention deficit hyperactivity disorder…

A Comparison of Intraverbal Training Procedures for Children with Autism

ERIC Educational Resources Information Center

Kodak, Tiffany; Fuchtman, Rashea; Paden, Amber

2012-01-01

We compared the effectiveness of three training procedures, echoic and tact prompting plus error correction and a cues-pause-point (CPP) procedure, for increasing intraverbals in 2 children with autism. We also measured echoic behavior that may have interfered with appropriate question answering. Results indicated that echoic prompting with error…

Effect of lower limb Sofield procedure on ambulation in osteogenesis imperfecta.

PubMed

Khoshhal, K I; Ellis, R D

2001-01-01

Ambulation status was evaluated in 34 patients pre- and post-Sofield procedure in patients with osteogenesis imperfecta. Three percent had improved ambulation, 42.4% remained the same and 54.6% were worse. Only 41.2% were ambulating postoperatively compared to 73.5% preoperatively. The Sofield procedure did not improve ambulation status.

Endurance of Multiplication Fact Fluency for Students with Attention Deficit Hyperactivity Disorder

ERIC Educational Resources Information Center

Brady, Kelly K.; Kubina, Richard M., Jr.

2010-01-01

This study examines the relationship between a critical learning outcome of behavioral fluency and endurance, by comparing the effects of two practice procedures on multiplication facts two through nine. The first procedure, called whole time practice trial, consisted of an uninterrupted 1 minute practice time. The second procedure, endurance…

Effects of anesthesia and blood sampling techniques on plasma metabolites and corticosterone in the rat.

PubMed

Arnold, Myrtha; Langhans, Wolfgang

2010-04-19

Blood is routinely sampled from laboratory animals in biomedical research, and many of the commonly applied sampling techniques require anesthesia. Acute effects of many sampling and anesthesia procedures may confound the results, but those effects are incompletely characterized. We here compare the effects of four common anesthesia procedures (inhalation anesthesia with ether (EA) or isoflurane (IA) and intraperitoneal injection anesthesia with xylazin/ketamine (XKA) or medetomidine/midazolam/fentanyl (MMFA)) on plasma concentrations of glucose, lactate, non-esterified fatty acids (NEFAs), and corticosterone in blood obtained from a previously implanted jugular vein (JV) catheter with the effect of JV blood sampling from non-anesthetized, freely-moving rats (JV-NA). Also, we included in the comparison two other blood sampling procedures usually performed without anesthesia (NA), i.e., puncture of the saphenic vein (SV) and tail incision (TI). Whereas the control procedure (JV-NA) did not significantly affect any of the target parameters, plasma glucose increased from 14 (JV-IA) to 44 (JV-MMFA) % (all Ps=0.05 when compared with the control procedure) in all blood samples collected in anesthesia and was 12 and 14% lower (both Ps<0.05) in SV-NA and TI-NA samples, respectively. Plasma lactate increased from 74 (JV-IA) to 226% (SV-NA) (all Ps<0.05) with all sampling and anesthesia procedures except for JV-XKA and JV-MMF. Plasma NEFAs increased to 52% (P<0.05) with the TI-NA procedure and appeared to decrease with the JV-IA and JV-MMFA procedures (both Ps>0.05). Finally, only the JV-EA and the JV-MMFA procedures increased plasma corticosterone (+525 and +353%, respectively, both Ps< 0.05). The JV-IA and JV-XKA procedures appeared to increase it as well, but these differences did not reach statistical significance. Thus, anesthesia and blood sampling procedures can have profound acute effects on plasma metabolite and hormone concentrations. This must be considered for the design and interpretation of blood sampling experiments in laboratory animals. (c) 2010. Published by Elsevier Inc.

Measuring automatic retrieval: a comparison of implicit memory, process dissociation, and speeded response procedures.

PubMed

Horton, Keith D; Wilson, Daryl E; Vonk, Jennifer; Kirby, Sarah L; Nielsen, Tina

2005-07-01

Using the stem completion task, we compared estimates of automatic retrieval from an implicit memory task, the process dissociation procedure, and the speeded response procedure. Two standard manipulations were employed. In Experiment 1, a depth of processing effect was found on automatic retrieval using the speeded response procedure although this effect was substantially reduced in Experiment 2 when lexical processing was required of all words. In Experiment 3, the speeded response procedure showed an advantage of full versus divided attention at study on automatic retrieval. An implicit condition showed parallel effects in each study, suggesting that implicit stem completion may normally provide a good estimate of automatic retrieval. Also, we replicated earlier findings from the process dissociation procedure, but estimates of automatic retrieval from this procedure were consistently lower than those from the speeded response procedure, except when conscious retrieval was relatively low. We discuss several factors that may contribute to the conflicting outcomes, including the evidence for theoretical assumptions and criterial task differences between implicit and explicit tests.

The Comparing Options for Management: Patient-centered Results for Uterine Fibroids (COMPARE-UF) Registry: Rationale and Design.

PubMed

Stewart, Elizabeth A; Lytle, Barbara L; Thomas, Laine; Wegienka, Ganesa R; Jacoby, Vanessa; Diamond, Michael P; Nicholson, Wanda K; Anchan, Raymond M; Venable, Sateria; Wallace, Kedra; Marsh, Erica E; Maxwell, George L; Borah, Bijan J; Catherino, William H; Myers, Evan R

2018-05-08

To design and establish a uterine fibroid (UF) registry based in the United States (US) to provide comparative effectiveness data regarding UF treatment. We report here the design and initial recruitment for the Comparing Options for Management: Patient-centered Results for Uterine Fibroids (COMPARE-UF) registry (Clinicaltrials.gov, NCT02260752), funded by the Agency for Healthcare Research and Quality (AHRQ) in collaboration with the-Patient-Centered Outcomes Research Institute (PCORI). COMPARE-UF is designed to help answer critical questions about treatment options for women with symptomatic UF. Women undergoing a procedure for UF (hysterectomy, myomectomy [abdominal, hysteroscopic, vaginal and laparoscopic/robotic], endometrial ablation, radiofrequency fibroid ablation, uterine artery embolization, magnetic resonance guided focused ultrasound or progestin-releasing intrauterine device insertion) at one of the COMPARE-UF sites are invited to participate in a prospective registry with three years follow-up for post-procedural outcomes. Enrolled participants provide annual follow-up through an online portal or through traditional phone contact. A central data abstraction center provides information obtained from imaging, operative or procedural notes and pathology reports. Women with uterine fibroids and other stakeholders are a key part of the COMPARE-UF registry and participate at all points from study design to dissemination of results. We built a network of nine clinical sites across the US with expertise in the care of women with UF to capture geographic, racial, ethnic and procedural diversity. Of the initial 2031 women enrolled in COMPARE-UF, 42% are self-identified as Black or African-American and 40% are age 40 years or younger with 16% of participants under age 35. Women undergoing myomectomy comprise the largest treatment group at 46% of all procedures with laparoscopic or robotic myomectomy comprising the largest subset of myomectomies at 19% of all procedures. Hysterectomy is the second most common treatment within the registry at 38%. In response to priorities identified by our patient stakeholders, the initial aims within COMPARE-UF will address how different procedures used to treat UF compare in terms of long-lasting symptom relief, potential for recurrence, medical complications, improvement in quality of life and sexual function, age at menopause, and fertility and pregnancy outcomes. COMPARE-UF will generate evidence on the comparative effectiveness of different procedural options for UF, in order to help patients and their caregivers make informed decisions that best meet an individual patient's short- and long-term preferences. Building upon this infrastructure, the COMPARE-UF team of investigators and stakeholders, including patients, collaborate to identify future priorities for expanding the registry, such assessing the efficacy of medical therapies for UF. COMPARE-UF results will be disseminated directly to patients, providers, and other stakeholders using traditional academic pathways, as well as innovative methods, including a variety of social media platforms. Given demographic differences among women undergoing different UF treatments, assessing comparative effectiveness for this disease through clinical trials will remain difficult. Therefore, this registry provides optimized evidence to help patients and their providers better understand the pros and cons of different treatment options so that they can make more informed decisions. Copyright © 2018. Published by Elsevier Inc.

Understanding the "Weekend Effect" for Emergency General Surgery.

PubMed

Hoehn, Richard S; Go, Derek E; Dhar, Vikrom K; Kim, Young; Hanseman, Dennis J; Wima, Koffi; Shah, Shimul A

2018-02-01

Several studies have identified a "weekend effect" for surgical outcomes, but definitions vary and the cause is unclear. Our aim was to better characterize the weekend effect for emergency general surgery using mortality as a primary endpoint. Using data from the University HealthSystem Consortium from 2009 to 2013, we identified urgent/emergent hospital admissions for seven procedures representing 80% of the national burden of emergency general surgery. Patient characteristics and surgical outcomes were compared between cases that were performed on weekdays vs weekends. Hospitals varied widely in the proportion of procedures performed on the weekend. Of the procedures examined, four had higher mortality for weekend cases (laparotomy, lysis of adhesions, partial colectomy, and small bowel resection; p < 0.01), while three did not (appendectomy, cholecystectomy, and peptic ulcer disease repair). Among the four procedures with increased weekend mortality, patients undergoing weekend procedures also had increased severity of illness and shorter time from admission to surgery (p < 0.01). Multivariate analysis adjusting for patient characteristics demonstrated independently higher mortality on weekends for these same four procedures (p < 0.01). For the first time, we have identified specific emergency general surgery procedures that incur higher mortality when performed on weekends. This may be due to acute changes in patient status that require weekend surgery or indications for urgent procedures (ischemia, obstruction) compared to those without a weekend mortality difference (infection). Hospitals that perform weekend surgery must acknowledge and identify ways to manage this increased risk.

Effect of Direct Ligament Repair and Tenodesis Reconstruction on Simulated Subtalar Joint Instability.

PubMed

Choisne, Julie; Hoch, Matthew C; Alexander, Ian; Ringleb, Stacie I

2017-03-01

Subtalar instability is associated with up to 80% of patients presenting with chronic ankle instability but is often not considered in the diagnosis or treatment. Operative procedures to repair ankle instability have shown good clinical results, but the effects of these reconstruction procedures on isolated subtalar instability are not well understood. The goal of this study was to investigate the effect of the Gould modification of the Broström procedure and a new tenodesis reconstruction procedure on ankle and subtalar joint kinematics after simulating a subtalar injury. Kinematic data were collected on 7 cadaveric ankles during inversion through the range of ankle flexion and during internal rotation. Testing was performed on the intact foot; after sectioning the calcaneofibular ligament, cervical ligament, and interosseous talocalcaneal ligament; after the Gould modification of the Broström procedure was performed; and after tenodesis was performed and sutures from the Gould modification removed. The Gould modification of the Broström procedure significantly decreased subtalar and ankle inversion motion and subtalar internal rotation compared to the unstable condition. The tenodesis method restricted internal rotation at the subtalar joint and ankle inversion compared to the intact state. Both operative procedures improved stability of the ankle complex, but tenodesis was unable to restore subtalar inversion and restricted ankle inversion in maximum plantarflexion. The Gould modification of Broström ligament repair may be a favorable operative procedure for the restoration of subtalar and ankle joint kinematics.

The Effect of Listening to Music During Percutaneous Nephrostomy Tube Placement on Pain, Anxiety, and Success Rate of Procedure: A Randomized Prospective Study.

PubMed

Hamidi, Nurullah; Ozturk, Erdem

2017-05-01

To evaluate the effect of listening to music on pain, anxiety, and success of procedure during office-based percutaneous nephrostomy tube placement (PNTP). One hundred consecutive patients (age >18 years) with hydronephrosis were prospectively enrolled in this study. All patients were prospectively randomized to undergo office-based PNTP with (Group I, n = 50) or without music (Group II, n = 50). Anxiety levels were evaluated with State Trait Anxiety Inventory. A visual analog scale was used to evaluate pain levels, patient's satisfaction, and willingness to undergo the procedure. We also compared success rates of procedures. The mean age, duration of procedure, and gender distribution were statistically similar between the two groups. The mean postprocedural heart rates and systolic blood pressures in Group I patients were significantly lower than Group II patients (p = 0.01 and p = 0.028, respectively), whereas preprocedural pulse rate and systolic blood pressure were similar. The mean anxiety level and mean pain score of Group I were significantly lower than those of Group II (p = 0.008 and p < 0.001, respectively). Group I also carried a significant greater mean satisfaction score and willingness to undergo repeat procedure compared with Group II (p < 0.001 for both). Success rate of nephrostomy tube placement in Group I was significantly higher compared with Group II (92% vs 66%, p = 0.04). The present randomized prospective study demonstrates that listening to music during office-based PNTP decreases anxiety or pain and increases success rate of procedure. As an alternative to sedation or general anesthesia, music is easily accessible without side effect and cost.

Comparing five alternative methods of breast reconstruction surgery: a cost-effectiveness analysis.

PubMed

Grover, Ritwik; Padula, William V; Van Vliet, Michael; Ridgway, Emily B

2013-11-01

The purpose of this study was to assess the cost-effectiveness of five standardized procedures for breast reconstruction to delineate the best reconstructive approach in postmastectomy patients in the settings of nonirradiated and irradiated chest walls. A decision tree was used to model five breast reconstruction procedures from the provider perspective to evaluate cost-effectiveness. Procedures included autologous flaps with pedicled tissue, autologous flaps with free tissue, latissimus dorsi flaps with breast implants, expanders with implant exchange, and immediate implant placement. All methods were compared with a "do-nothing" alternative. Data for model parameters were collected through a systematic review, and patient health utilities were calculated from an ad hoc survey of reconstructive surgeons. Results were measured in cost (2011 U.S. dollars) per quality-adjusted life-year. Univariate sensitivity analyses and Bayesian multivariate probabilistic sensitivity analysis were conducted. Pedicled autologous tissue and free autologous tissue reconstruction were cost-effective compared with the do-nothing alternative. Pedicled autologous tissue was the slightly more cost-effective of the two. The other procedures were not found to be cost-effective. The results were robust to a number of sensitivity analyses, although the margin between pedicled and free autologous tissue reconstruction is small and affected by some parameter values. Autologous pedicled tissue was slightly more cost-effective than free tissue reconstruction in irradiated and nonirradiated patients. Implant-based techniques were not cost-effective. This is in agreement with the growing trend at academic institutions to encourage autologous tissue reconstruction because of its natural recreation of the breast contour, suppleness, and resiliency in the setting of irradiated recipient beds.

Economic Assessment and Budgetary Impact of a Telemedicine Procedure and Spirometry Quality Control in the Primary Care Setting.

PubMed

Marina, Nuria; Bayón, Juan Carlos; López de Santa María, Elena; Gutiérrez, Asunción; Inchausti, Marta; Bustamante, Victor; Gáldiz, Juan B

2016-01-01

To evaluate the economic impact of a telemedicine procedure designed to improve the quality of lung function testing (LFT) in primary care in a public healthcare system, compared with the standard method. The economic impact of 9,039 LFTs performed in 51 health centers (2010-2013) using telespirometry (TS) compared to standard spirometry (SS) was studied. TS costs more per unit than SS (€47.80 vs. €39.70) (2013), but the quality of the TS procedure is superior (84% good quality, compared to 61% using the standard procedure). Total cost of TS was €431,974 (compared with €358,306€ for SS), generating an economic impact of €73,668 (2013). The increase in cost for good quality LFT performed using TS was €34,030 (2010) and €144,295 (2013), while the costs of poor quality tests fell by €15,525 (2010) and 70,627€ (2013). The cost-effectiveness analysis concludes that TS is 23% more expensive and 46% more effective. Healthcare costs consequently fall as the number of LFTs performed by TS rises. Avoiding poor quality, invalid LFTs generates savings that compensate for the increased costs of performing LFTs with TS, making it a cost-effective method. Copyright © 2014 SEPAR. Published by Elsevier Espana. All rights reserved.

A comparative study of female sterilization via modified Uchida and silver clip techniques in rural China.

PubMed

Qiu, Hongyan; Li, Li; Wu, Shangchun; Liang, Hong; Yuan, Wei; He, Yingqin

2011-03-01

To compare the specific effects of 2 female sterilization methods: the modified Uchida technique and the application of silver clips. A total of 2198 women living in rural areas who were still of reproductive age but opting for sterilization were enrolled. The participants were randomly divided into 2 groups, and underwent sterilization by either modified Uchida technique or silver clips. Information on acceptability, operation conditions, effectiveness, adverse effects, and complaints was collected 3, 6, and 12 months after the procedure. No significant difference in effectiveness, adverse effects or chief complaints between the 2 procedures was found. Differences in operative outcome, bleeding volume during the procedure, and operation time were found. A shorter operation time and less bleeding for the silver clip method indicated that female sterilization by this technique was as safe as that by modified Uchida technique. Copyright © 2010 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

Co-Creation Learning Procedures: Comparing Interactive Language Lessons for Deaf and Hearing Students.

PubMed

Hosono, Naotsune; Inoue, Hiromitsu; Tomita, Yutaka

2017-01-01

This paper discusses co-creation learning procedures of second language lessons for deaf students, and sign language lessons by a deaf lecturer. The analyses focus on the learning procedure and resulting assessment, considering the disability. Through questionnaires ICT-based co-creative learning technologies are effective and efficient and promote spontaneous learning motivation goals.

The Effects of Value Confrontation and Reinforcement Counseling on the Career Planning Attitudes and Behavior of Adolescent Males.

ERIC Educational Resources Information Center

Young, Richard A.

1979-01-01

Post-tests show that the value confrontation procedure resulted in significantly greater frequency of information seeking for internally controlled subjects when compared to the reinforcement counseling and control procedures. Examines two procedures designed to enhance the career planning attitudes and behavior of rural adolescent males.…

Comparison of Direct Instruction and Simultaneous Prompting Procedure on Teaching Concepts to Individuals with Intellectual Disability

ERIC Educational Resources Information Center

Celik, Semiha; Vuran, Sezgin

2014-01-01

The purpose of this study was to compare the efficiency, effectiveness, maintenance effects and social validity of two instructional methods, Direct Instruction and Simultaneous Prompting Procedure, on teaching concepts (long, old, few and thick) using a parallel treatments design. All sessions were conducted at a private special education center…

Contraception Update: Sterilization.

PubMed

Antell, Karen; Deshmukh, Prium; Brown, Elizabeth J

2017-11-01

Female sterilization procedures include postpartum partial salpingectomy via cesarean or minilaparotomy incision, interval laparoscopic procedures, or hysteroscopic placement of microinserts. Rates of failure and serious complications are low and comparable among the various methods. A hysteroscopic procedure requires a 3-month confirmatory hysterosalpingogram before it is considered effective for contraception. Hysteroscopic sterilization has been shown to be associated with a higher reoperation rate than laparoscopic procedures. For male sterilization, vasectomy is a noninvasive and highly effective method. Vasectomy is an outpatient procedure performed under local anesthesia. The procedure requires confirmation of azoospermia with a semen analysis 8 to 16 weeks after the procedure. Patients who are considering sterilization should be counseled about all the available options and the permanent nature of such procedures. Written permission from the American Academy of Family Physicians is required for reproduction of this material in whole or in part in any form or medium.

Evaluation of DOTD's Existing Queue Estimation Procedures : Research Project Capsule

DOT National Transportation Integrated Search

2017-10-01

The primary objective of this study is to evaluate the effectiveness of DOTDs queue estimation procedures by comparing results with those obtained directly from site observations through video camera footage or other means. Actual queue start time...

A Comparison of Math Cover, Copy, Compare Intervention Procedures for Children with Autism Spectrum Disorder.

PubMed

Morton, Reeva C; Gadke, Daniel L

2018-03-01

Cover, Copy, Compare (CCC) and Copy, Cover, Compare (MCCC) procedures are effective interventions for improving math fluency. However, there is a gap in literature exploring the use of these interventions for children with autism spectrum disorders (ASD). The purpose of the current study was to compare the use of CCC and MCCC for children with ASD using a multi-component single-case experimental design. The results showed no notable difference between the interventions. Implications and limitations, particularly surrounding experimental control, are discussed in detail.

[Multimodal distraction to relieve pain in children undergoing acute medical procedures].

PubMed

Miller, Kate; Rodger, Sylvia; Bucolo, Sam; Wang, Xue-Qing; Kimble, Roy M

2009-10-01

Non-pharmacological approaches to pain management have been used by therapists for decades to reduce the anxiety and pain experienced by children during burn care procedures. With a greater understanding of pain and the principles behind what causes a child to be distracted, combined with access to state of the art technology, we have developed an easy to use, hand held multimodal distraction device (MMD). MMD is an interactive device that prepares the child for a procedure and uses developmentally appropriate distraction stories and games during the procedures to alleviate anxiety and pain. This paper summarizes the results of three randomized control trials. The trials aimed to understand the effectiveness of MMD as a distraction and preparation tool in reducing anxiety and pain in children undergoing burns and non-burns medical procedures compared to pure pharmacological approaches Standard Distraction (SD) and off the shelf video games (VG). Three separate prospective randomized control trials involving 182 children having 354 dressing changes were conducted in the burns and orthopedic departments at Royal Children's Hospital, Brisbane, Australia, to address the above aims. Pain and anxiety scores were completed for the child, caregiver and nursing staff according to the Modified Faces, Legs, Activity, Cry and Consolability Scale, Faces Pain Scale-Revised, Visual Analogue Scale and Wong-Baker Faces Pain Rating Scale. Procedural length was recorded. MMD as a preparation and distraction tool were shown to have a significant impact on child, parent and nursing staff reported anxiety and pain during procedures compared to standard care and video games (P < 0.01). The MMD had a positive effect on clinical time and was shown to sustain its impact on pain and time with further dressing changes. MMD is more effective in reducing the pain and anxiety experienced by children in acute medical procedures as compared with SD and VG. MMD is continuing to be trialed and is continuing to show positive clinical outcomes.

Analgesic effects of breast-feeding or pacifier use with maternal holding in term infants.

PubMed

Phillips, Raylene M; Chantry, Caroline J; Gallagher, Michael P

2005-01-01

First, to compare analgesic effects of breast-feeding versus pacifier use in newborn infants undergoing blood collection via heel sticks. Second, to compare analgesic effects of pacifier use with maternal holding versus nonmaternal holding. A prospective, randomized, controlled trial. Normal newborn nursery at academic teaching hospital. Full-term breast-feeding infants scheduled for routine newborn screening blood test via heel stick (n = 96). Interventions.-Infants randomized to 3 groups for analgesia: 1) breast-feeding, 2) pacifier use while held by mothers, 3) pacifier use while held by research assistants (nonmothers). Primary outcome was crying (percent of infants who cried during the procedure and mean percent of procedure time that infants cried). Secondary outcomes were physiologic measures. Fewer breast-feeding infants cried than infants using a pacifier while held by nonmothers both during the procedure (69% vs 100%, P < .01) and after the procedure (28% vs 60%, P = .03). Those infants crying during the procedure cried for less time if held by their mothers either breast-feeding (33%, P < .01) or using a pacifier (45%, P = .03) than those using a pacifier while being held by nonmothers (66%). Breast-feeding is more analgesic than pacifier use with nonmaternal holding. Maternal holding with either breast-feeding or pacifier use is more analgesic than nonmaternal holding with pacifier use, suggesting that maternal holding itself has an analgesic effect. Breast-feeding and maternal holding should be considered as pain-control measures for the neonate during heel-stick procedures.

[Comparative study of the cost/effectiveness of surgical wash with various antiseptics].

PubMed

Tapia-Jurado, Jesús; Reyes-Arellano, Wulfrano; García-García, Juan José; Jiménez-Corona, José Luis; Peña-Jiménez, Carmen Magdalena; León-Mancilla, Benjamín

2011-01-01

"Surgical scrub" of the hands and arms is a fundamental procedure for reducing infection risk. We undertook this study in order to compare different antiseptics and their microbicidal effects, costs and times of the procedures. Thirty students followed the surgical scrub procedure using benzalkonium chloride. Seven days later the students used povidone-iodine and, 7 days after that, they used chlorhexidine/alcohol. After the surgical scrub, cultures were obtained from the palms of their hands and from their nail beds. The students wore sterile gloves, which were removed 30 min later to obtain new cultures from the same sites. The cost of the products was calculated in Mexican pesos and the time of each procedure was measured in minutes. There was a statistically significant difference in the number of colony-forming units (CFUs). The number of CFUs was lower in the groups of students who used chlorhexidine/alcohol and povidone-iodine as compared to the benzalkonium chloride group. There was no difference between chlorhexidine/alcohol and povidone-iodine. Costs were higher for povidone-iodine and benzalkonium chloride compared to chlorhexidine/alcohol. Procedure times were similar with povidone-iodine and benzalkonium chloride but the time was reduced approximately five times when using chlorhexidine/alcohol. It is a proven fact that the lack of surgical scrub favors wound infections, longer hospital stays and increased costs. Therefore, further studies are needed to determine the best antiseptic according to cost/benefit. Chlorhexidine/alcohol proved to be the superior antiseptic in terms of cost/benefit compared to povidone-iodine and benzalkonium chloride.

Reliability Stress-Strength Models for Dependent Observations with Applications in Clinical Trials

NASA Technical Reports Server (NTRS)

Kushary, Debashis; Kulkarni, Pandurang M.

1995-01-01

We consider the applications of stress-strength models in studies involving clinical trials. When studying the effects and side effects of certain procedures (treatments), it is often the case that observations are correlated due to subject effect, repeated measurements and observing many characteristics simultaneously. We develop maximum likelihood estimator (MLE) and uniform minimum variance unbiased estimator (UMVUE) of the reliability which in clinical trial studies could be considered as the chances of increased side effects due to a particular procedure compared to another. The results developed apply to both univariate and multivariate situations. Also, for the univariate situations we develop simple to use lower confidence bounds for the reliability. Further, we consider the cases when both stress and strength constitute time dependent processes. We define the future reliability and obtain methods of constructing lower confidence bounds for this reliability. Finally, we conduct simulation studies to evaluate all the procedures developed and also to compare the MLE and the UMVUE.

Cost-Effectiveness of Procedures for Treatment of Ostium Secundum Atrial Septal Defects Occlusion Comparing Conventional Surgery and Septal Percutaneous Implant

PubMed Central

da Costa, Márcia Gisele Santos; Santos, Marisa da Silva; Sarti, Flávia Mori; Senna, Kátia Marie Simões e.; Tura, Bernardo Rangel; Goulart, Marcelo Correia

2014-01-01

Objectives The study performs a cost-effectiveness analysis of procedures for atrial septal defects occlusion, comparing conventional surgery to septal percutaneous implant. Methods A model of analytical decision was structured with symmetric branches to estimate cost-effectiveness ratio between the procedures. The decision tree model was based on evidences gathered through meta-analysis of literature, and validated by a panel of specialists. The lower number of surgical procedures performed for atrial septal defects occlusion at each branch was considered as the effectiveness outcome. Direct medical costs and probabilities for each event were inserted in the model using data available from Brazilian public sector database system and information extracted from the literature review, using micro-costing technique. Sensitivity analysis included price variations of percutaneous implant. Results The results obtained from the decision model demonstrated that the percutaneous implant was more cost effective in cost-effectiveness analysis at a cost of US$8,936.34 with a reduction in the probability of surgery occurrence in 93% of the cases. Probability of atrial septal communication occlusion and cost of the implant are the determinant factors of cost-effectiveness ratio. Conclusions The proposal of a decision model seeks to fill a void in the academic literature. The decision model proposed includes the outcomes that present major impact in relation to the overall costs of the procedure. The atrial septal defects occlusion using percutaneous implant reduces the physical and psychological distress to the patients in relation to the conventional surgery, which represent intangible costs in the context of economic evaluation. PMID:25302806

Cost-effectiveness of procedures for treatment of ostium secundum atrial septal defects occlusion comparing conventional surgery and septal percutaneous implant.

PubMed

da Costa, Márcia Gisele Santos; Santos, Marisa da Silva; Sarti, Flávia Mori; Simões e Senna, Kátia Marie; Tura, Bernardo Rangel; Correia, Marcelo Goulart; Goulart, Marcelo Correia

2014-01-01

The study performs a cost-effectiveness analysis of procedures for atrial septal defects occlusion, comparing conventional surgery to septal percutaneous implant. A model of analytical decision was structured with symmetric branches to estimate cost-effectiveness ratio between the procedures. The decision tree model was based on evidences gathered through meta-analysis of literature, and validated by a panel of specialists. The lower number of surgical procedures performed for atrial septal defects occlusion at each branch was considered as the effectiveness outcome. Direct medical costs and probabilities for each event were inserted in the model using data available from Brazilian public sector database system and information extracted from the literature review, using micro-costing technique. Sensitivity analysis included price variations of percutaneous implant. The results obtained from the decision model demonstrated that the percutaneous implant was more cost effective in cost-effectiveness analysis at a cost of US$8,936.34 with a reduction in the probability of surgery occurrence in 93% of the cases. Probability of atrial septal communication occlusion and cost of the implant are the determinant factors of cost-effectiveness ratio. The proposal of a decision model seeks to fill a void in the academic literature. The decision model proposed includes the outcomes that present major impact in relation to the overall costs of the procedure. The atrial septal defects occlusion using percutaneous implant reduces the physical and psychological distress to the patients in relation to the conventional surgery, which represent intangible costs in the context of economic evaluation.

Comparison of "saw and seal" procedure and performance grade binder to minimize thermal cracking.

DOT National Transportation Integrated Search

2001-04-01

In an effort to compare performance and cost effectiveness of the Saw and : Seal procedure and Performance Grade (PG) binders, the Maine Department Of : Transportation (MDOT) constructed an experimental project in Weston, Maine : during the fal...

Effectiveness and Efficiency of Flashcard Drill Instructional Methods on Urban First-Graders' Word Recognition, Acquisition, Maintenance, and Generalization

ERIC Educational Resources Information Center

Nist, Lindsay; Joseph, Laurice M.

2008-01-01

This investigation built upon previous studies that compared effectiveness and efficiency among instructional methods. Instructional effectiveness and efficiency were compared among three conditions: an incremental rehearsal, a more challenging ratio of known to unknown interspersal word procedure, and a traditional drill and practice flashcard…

Enamel color changes following orthodontic treatment.

PubMed

Pandian, Akshaya; Ranganathan, Sukanya; Padmanabhan, Sridevi

2017-01-01

To evaluate and compare the effect of various orthodontic bonding systems and clean up procedures on quantitative enamel colour change. A literature search was done to identify the studies that assessed the quantitative enamel colour change associated with the various bonding systems and cleanup procedures. Electronic database (Pub Med, Cochrane and Google Scholar) were searched. First stage screening was performed and the abstracts were selected according to the initial selection criteria. Full text articles were retrieved and analyzed during second stage screening. The bibliographies were reviewed to identify additional relevant studies. Sixteen full text articles were retrieved. Six were rejected because the methodology was different. There was significant enamel colour change following orthodontic bonding, debonding and clean up procedures. Self-etching primers produce less enamel colour change compared to conventional etching. Resin Modified GIC produces least colour change compared to other light cure and chemical cure systems. Polishing following the clean-up procedure reduces the colour change of the enamel.

Comparison of VFA titration procedures used for monitoring the biogas process.

PubMed

Lützhøft, Hans-Christian Holten; Boe, Kanokwan; Fang, Cheng; Angelidaki, Irini

2014-05-01

Titrimetric determination of volatile fatty acids (VFAs) contents is a common way to monitor a biogas process. However, digested manure from co-digestion biogas plants has a complex matrix with high concentrations of interfering components, resulting in varying results when using different titration procedures. Currently, no standardized procedure is used and it is therefore difficult to compare the performance among plants. The aim of this study was to evaluate four titration procedures (for determination of VFA-levels of digested manure samples) and compare results with gas chromatographic (GC) analysis. Two of the procedures are commonly used in biogas plants and two are discussed in literature. The results showed that the optimal titration results were obtained when 40 mL of four times diluted digested manure was gently stirred (200 rpm). Results from samples with different VFA concentrations (1-11 g/L) showed linear correlation between titration results and GC measurements. However, determination of VFA by titration generally overestimated the VFA contents compared with GC measurements when samples had low VFA concentrations, i.e. around 1 g/L. The accuracy of titration increased when samples had high VFA concentrations, i.e. around 5 g/L. It was further found that the studied ionisable interfering components had lowest effect on titration when the sample had high VFA concentration. In contrast, bicarbonate, phosphate and lactate had significant effect on titration accuracy at low VFA concentration. An extended 5-point titration procedure with pH correction was best to handle interferences from bicarbonate, phosphate and lactate at low VFA concentrations. Contrary, the simplest titration procedure with only two pH end-points showed the highest accuracy among all titration procedures at high VFA concentrations. All in all, if the composition of the digested manure sample is not known, the procedure with only two pH end-points should be the procedure of choice, due to its simplicity and accuracy. Copyright © 2014 Elsevier Ltd. All rights reserved.

The Effect of Geographic Units of Analysis on Measuring Geographic Variation in Medical Services Utilization.

PubMed

Kim, Agnus M; Park, Jong Heon; Kang, Sungchan; Hwang, Kyosang; Lee, Taesik; Kim, Yoon

2016-07-01

We aimed to evaluate the effect of geographic units of analysis on measuring geographic variation in medical services utilization. For this purpose, we compared geographic variations in the rates of eight major procedures in administrative units (districts) and new areal units organized based on the actual health care use of the population in Korea. To compare geographic variation in geographic units of analysis, we calculated the age-sex standardized rates of eight major procedures (coronary artery bypass graft surgery, percutaneous transluminal coronary angioplasty, surgery after hip fracture, knee-replacement surgery, caesarean section, hysterectomy, computed tomography scan, and magnetic resonance imaging scan) from the National Health Insurance database in Korea for the 2013 period. Using the coefficient of variation, the extremal quotient, and the systematic component of variation, we measured geographic variation for these eight procedures in districts and new areal units. Compared with districts, new areal units showed a reduction in geographic variation. Extremal quotients and inter-decile ratios for the eight procedures were lower in new areal units. While the coefficient of variation was lower for most procedures in new areal units, the pattern of change of the systematic component of variation between districts and new areal units differed among procedures. Geographic variation in medical service utilization could vary according to the geographic unit of analysis. To determine how geographic characteristics such as population size and number of geographic units affect geographic variation, further studies are needed.

Comparison of "saw and seal" procedure and performance grade binder to minimize thermal cracking : first interim report.

DOT National Transportation Integrated Search

2002-06-01

In an effort to compare performance and cost effectiveness of the Saw and Seal procedure and : Performance Grade (PG) binders, the Maine Department of Transportation (MDOT) constructed an : experimental project in Weston, Maine during the fall ...

Further evaluation of response interruption and redirection as treatment for stereotypy.

PubMed

Ahrens, Erin N; Lerman, Dorothea C; Kodak, Tiffany; Worsdell, April S; Keegan, Courtney

2011-01-01

The effects of 2 forms of response interruption and redirection (RIRD)-motor RIRD and vocal RIRD-were examined with 4 boys with autism to evaluate further the effects of this intervention and its potential underlying mechanisms. In Experiment 1, the effects of motor RIRD and vocal RIRD on vocal stereotypy and appropriate vocalizations were compared for 2 participants. In Experiment 2, the effects of both RIRD procedures on both vocal and motor stereotypy and appropriate vocalizations were compared with 2 additional participants. Results suggested that RIRD was effective regardless of the procedural variation or topography of stereotypy and that vocal RIRD functioned as a punisher. This mechanism was further explored with 1 participant by manipulating the schedule of RIRD in Experiment 3. Results were consistent with the punishment interpretation.

FURTHER EVALUATION OF RESPONSE INTERRUPTION AND REDIRECTION AS TREATMENT FOR STEREOTYPY

PubMed Central

Ahrens, Erin N; Lerman, Dorothea C; Kodak, Tiffany; Worsdell, April S; Keegan, Courtney

2011-01-01

The effects of 2 forms of response interruption and redirection (RIRD)—motor RIRD and vocal RIRD—were examined with 4 boys with autism to evaluate further the effects of this intervention and its potential underlying mechanisms. In Experiment 1, the effects of motor RIRD and vocal RIRD on vocal stereotypy and appropriate vocalizations were compared for 2 participants. In Experiment 2, the effects of both RIRD procedures on both vocal and motor stereotypy and appropriate vocalizations were compared with 2 additional participants. Results suggested that RIRD was effective regardless of the procedural variation or topography of stereotypy and that vocal RIRD functioned as a punisher. This mechanism was further explored with 1 participant by manipulating the schedule of RIRD in Experiment 3. Results were consistent with the punishment interpretation. PMID:21541130

The Impact of Incentives on Exercise Behavior: A Systematic Review of Randomized Controlled Trials

PubMed Central

Strohacker, Kelley; Galarraga, Omar; Williams, David M.

2015-01-01

Background The effectiveness of reinforcing exercise behavior with material incentives is unclear. Purpose Conduct a systematic review of existing research on material incentives for exercise, organized by incentive strategy. Methods Ten studies conducted between January 1965 and June 2013 assessed the impact of incentivizing exercise compared to a non-incentivized control. Results There was significant heterogeneity between studies regarding reinforcement procedures and outcomes. Incentives tended to improve behavior during the intervention while findings were mixed regarding sustained behavior after incentives were removed. Conclusions The most effective incentive procedure is unclear given the limitations of existing research. The effectiveness of various incentive procedures in promoting initial behavior change and habit formation, as well as the use of sustainable incentive procedures should be explored in future research. PMID:24307474

The Impact of Biosampling Procedures on Molecular Data Interpretation*

PubMed Central

Sköld, Karl; Alm, Henrik; Scholz, Birger

2013-01-01

The separation between biological and technical variation without extensive use of technical replicates is often challenging, particularly in the context of different forms of protein and peptide modifications. Biosampling procedures in the research laboratory are easier to conduct within a shorter time frame and under controlled conditions as compared with clinical sampling, with the latter often having issues of reproducibility. But is the research laboratory biosampling really less variable? Biosampling introduces within minutes rapid tissue-specific changes in the cellular microenvironment, thus inducing a range of different pathways associated with cell survival. Biosampling involves hypoxia and, depending on the circumstances, hypothermia, circumstances for which there are evolutionarily conserved defense strategies in the range of species and also are relevant for the range of biomedical conditions. It remains unclear to what extent such adaptive processes are reflected in different biosampling procedures or how important they are for the definition of sample quality. Lately, an increasing number of comparative studies on different biosampling approaches, post-mortem effects and pre-sampling biological state, have investigated such immediate early biosampling effects. Commonalities between biosampling effects and a range of ischemia/reperfusion- and hypometabolism/anoxia-associated biological phenomena indicate that even small variations in post-sampling time intervals are likely to introduce a set of nonrandom and tissue-specific effects of experimental importance (both in vivo and in vitro). This review integrates the information provided by these comparative studies and discusses how an adaptive biological perspective in biosampling procedures may be relevant for sample quality issues. PMID:23382104

Mayo Clinic experience with modified Vecchietti procedure for vaginal agenesis: it is easy, safe, and effective.

PubMed

Nahas, Samar; Yi, Johnny; Magrina, Javier

2013-01-01

To evaluate the surgical outcome and the anatomic and sexual function in 10 women with Rokitansky syndrome who underwent the laparoscopic Vecchietti procedure at our center. Retrospective analysis. Data were analyzed on the basis of short-term and long-term surgical outcome and sexual function. All patients underwent clinical follow-up at 1, 2, and 6 months after surgery. In all 10 patients, the procedure produced anatomic and functional success. The laparoscopic Vecchietti technique is safe, simple, and effective for treatment of vaginal agenesis. Results are comparable to those of all European studies, and the procedure should gain more popularity in North America. Copyright © 2013 AAGL. All rights reserved.

Balancing Flexible Constraints and Measurement Precision in Computerized Adaptive Testing

ERIC Educational Resources Information Center

Moyer, Eric L.; Galindo, Jennifer L.; Dodd, Barbara G.

2012-01-01

Managing test specifications--both multiple nonstatistical constraints and flexibly defined constraints--has become an important part of designing item selection procedures for computerized adaptive tests (CATs) in achievement testing. This study compared the effectiveness of three procedures: constrained CAT, flexible modified constrained CAT,…

Comparison of "saw and seal" procedure and performance grade binder to minimize thermal cracking : interim report - third year.

DOT National Transportation Integrated Search

2004-12-01

In an effort to compare performance and cost effectiveness of the Saw and Seal procedure and : Performance Grade (PG) binders, the Maine Department of Transportation (MDOT) constructed an : experimental project in Weston, Maine during the fall ...

Comparison of "saw and seal" procedure and performance grade binder to minimize thermal cracking : interim report - second year.

DOT National Transportation Integrated Search

2004-07-01

In an effort to compare performance and cost effectiveness of the Saw and Seal procedure and : Performance Grade (PG) binders, the Maine Department of Transportation (MDOT) constructed an : experimental project in Weston, Maine during the fall ...

Job-Seeking Interview Skills Training: A Comparison of Four Instructional Techniques.

ERIC Educational Resources Information Center

Speas, Carol Mendenhall

1979-01-01

Compared model exposure (MOD), role playing (RP), model exposure plus role playing (MRP), and model exposure role playing with videotape feedback (VIDEO). MRP and VIDEO treatments were greater than control procedures. RP treatment was more effective than control procedures on two criteria. (Author/BEF)

An Assessment of Differential Reinforcement Procedures for Learners with Autism Spectrum Disorder

ERIC Educational Resources Information Center

Johnson, Kate A.; Vladescu, Jason C.; Kodak, Tiffany; Sidener, Tina M.

2017-01-01

Differential reinforcement procedures may promote unprompted correct responding, resulting in a quicker transfer of stimulus control than nondifferential reinforcement. Recent studies that have compared reinforcement arrangements have found that the most effective arrangement may differ across participants. The current study conducted an…

Computer tablet distraction reduces pain and anxiety in pediatric burn patients undergoing hydrotherapy: A randomized trial.

PubMed

Burns-Nader, Sherwood; Joe, Lindsay; Pinion, Kelly

2017-09-01

Distraction is often used in conjunction with analgesics to minimize pain in pediatric burn patients during treatment procedures. Computer tablets provide many options for distraction items in one tool and are often used during medical procedures. Few studies have examined the effectiveness of tablet distraction in improving the care of pediatric burn patients. This study examines the effectiveness of tablet distraction provided by a child life specialist to minimize pain and anxiety in pediatric burn patients undergoing hydrotherapy. Thirty pediatric patients (4-12) undergoing hydrotherapy for the treatment of burns participated in this randomized clinical trial. The tablet distraction group received tablet distraction provided by a child life specialist while those in the control group received standard care. Pain was assessed through self-reports and observation reports. Anxiety was assessed through behavioral observations. Length of procedure was also recorded. Nurses reported significantly less pain for the tablet distraction group compared to the control group. There was no significant difference between groups on self-reported pain. The tablet distraction group displayed significantly less anxiety during the procedure compared to the control group. Also, the tablet distraction group returned to baseline after the procedure while those in the control group displayed higher anxiety post-procedure. There was no difference in the length of the procedure between groups. These findings suggest tablet distraction provided by a child life specialist may be an effective method for improving pain and anxiety in children undergoing hydrotherapy treatment for burns. Copyright © 2017 Elsevier Ltd and ISBI. All rights reserved.

Feature Screening in Ultrahigh Dimensional Cox's Model.

PubMed

Yang, Guangren; Yu, Ye; Li, Runze; Buu, Anne

Survival data with ultrahigh dimensional covariates such as genetic markers have been collected in medical studies and other fields. In this work, we propose a feature screening procedure for the Cox model with ultrahigh dimensional covariates. The proposed procedure is distinguished from the existing sure independence screening (SIS) procedures (Fan, Feng and Wu, 2010, Zhao and Li, 2012) in that the proposed procedure is based on joint likelihood of potential active predictors, and therefore is not a marginal screening procedure. The proposed procedure can effectively identify active predictors that are jointly dependent but marginally independent of the response without performing an iterative procedure. We develop a computationally effective algorithm to carry out the proposed procedure and establish the ascent property of the proposed algorithm. We further prove that the proposed procedure possesses the sure screening property. That is, with the probability tending to one, the selected variable set includes the actual active predictors. We conduct Monte Carlo simulation to evaluate the finite sample performance of the proposed procedure and further compare the proposed procedure and existing SIS procedures. The proposed methodology is also demonstrated through an empirical analysis of a real data example.

A comperative study for short-term surgical outcomes of midurethral sling procedures in obese and non-obese women with stress urinary incontinence.

PubMed

Kokanalı, Mahmut Kuntay; Cavkaytar, Sabri; Kokanalı, Demet; Aksakal, Orhan; Doganay, Melike

2016-11-01

There is little data comparing the surgical outcomes of tension-free vaginal tape (TVT) and transobturator tape (TOT) procedures in obese women. Therefore, we aimed to compare the surgical outcomes of TOT and TVT procedures among obese women with a diagnosis of stress urinary incontinence (SUI). One hundred and eighty-nine women who underwent TVT or TOT procedures due to pure SUI were included. Women in whom the body mass index (BMI) was ≥30 kg/m 2 were considered as obese, while <30 kg/m 2 were non-obese. And women with BMI ≥35 kg/m 2 was defined as morbidly obese. At sixth month postoperative follow-up, neither the comparison of TVT and TOT results in obese women nor the comparison of TVT or TOT results between obese and non-obese women showed any significant differences in terms of objective and subjective cure rates, quality of life improvements, or intra/postoperative complications. TVT and TOT procedures also have similar effectiveness among morbidly obese women. We have concluded that TVT and TOT operations seem to be equally effective and safe surgical treatment procedures for female SUI regardless of BMI.

Effective Components of Contingency Contracts with Academic Behaviors of College Students

ERIC Educational Resources Information Center

McCoy, James F.; And Others

1977-01-01

Investigates the comparative effects of written as opposed to verbally stated instructions and specification of contingencies, with the written contract containing the typically used written agreement. These procedures were applied to self-managed, naturalistic behaviors, and compared to self-monitoring alone. Study-question answering and amount…

Analogue Evaluation of the Effects of Opportunities to Respond and Ratios of Known Items within Drill Rehearsal of Esperanto Words

ERIC Educational Resources Information Center

Szadokierski, Isadora; Burns, Matthew K.

2008-01-01

Drill procedures have been used to increase the retention of various types of information, but little is known about the causal mechanisms of these techniques. The current study compared the effect of two key features of drill procedures, a large number of opportunities to respond (OTR) and a drill ratio that maintains a high percentage of known…

Comparing preference assessments: selection- versus duration-based preference assessment procedures.

PubMed

Kodak, Tiffany; Fisher, Wayne W; Kelley, Michael E; Kisamore, April

2009-01-01

In the current investigation, the results of a selection- and a duration-based preference assessment procedure were compared. A Multiple Stimulus With Replacement (MSW) preference assessment [Windsor, J., Piché, L. M., & Locke, P. A. (1994). Preference testing: A comparison of two presentation methods. Research in Developmental Disabilities, 15, 439-455] and a variation of a Free-Operant (FO) preference assessment procedure [Roane, H. S., Vollmer, T. R., Ringdahl, J. E., & Marcus, B. A. (1998). Evaluation of a brief stimulus preference assessment. Journal of Applied Behavior Analysis, 31, 605-620] were conducted with four participants. A reinforcer assessment was conducted to determine which preference assessment procedure identified the item that produced the highest rates of responding. The items identified as most highly preferred were different across preference assessment procedures for all participants. Results of the reinforcer assessment showed that the MSW identified the item that functioned as the most effective reinforcer for two participants.

Cost-Effectiveness Analysis of Diagnostic Options for Pneumocystis Pneumonia (PCP)

PubMed Central

Harris, Julie R.; Marston, Barbara J.; Sangrujee, Nalinee; DuPlessis, Desiree; Park, Benjamin

2011-01-01

Background Diagnosis of Pneumocystis jirovecii pneumonia (PCP) is challenging, particularly in developing countries. Highly sensitive diagnostic methods are costly, while less expensive methods often lack sensitivity or specificity. Cost-effectiveness comparisons of the various diagnostic options have not been presented. Methods and Findings We compared cost-effectiveness, as measured by cost per life-years gained and proportion of patients successfully diagnosed and treated, of 33 PCP diagnostic options, involving combinations of specimen collection methods [oral washes, induced and expectorated sputum, and bronchoalveolar lavage (BAL)] and laboratory diagnostic procedures [various staining procedures or polymerase chain reactions (PCR)], or clinical diagnosis with chest x-ray alone. Our analyses were conducted from the perspective of the government payer among ambulatory, HIV-infected patients with symptoms of pneumonia presenting to HIV clinics and hospitals in South Africa. Costing data were obtained from the National Institutes of Communicable Diseases in South Africa. At 50% disease prevalence, diagnostic procedures involving expectorated sputum with any PCR method, or induced sputum with nested or real-time PCR, were all highly cost-effective, successfully treating 77–90% of patients at $26–51 per life-year gained. Procedures using BAL specimens were significantly more expensive without added benefit, successfully treating 68–90% of patients at costs of $189–232 per life-year gained. A relatively cost-effective diagnostic procedure that did not require PCR was Toluidine Blue O staining of induced sputum ($25 per life-year gained, successfully treating 68% of patients). Diagnosis using chest x-rays alone resulted in successful treatment of 77% of patients, though cost-effectiveness was reduced ($109 per life-year gained) compared with several molecular diagnostic options. Conclusions For diagnosis of PCP, use of PCR technologies, when combined with less-invasive patient specimens such as expectorated or induced sputum, represent more cost-effective options than any diagnostic procedure using BAL, or chest x-ray alone. PMID:21858013

Comparison of "saw and seal" procedure and performance grade binder to minimize thermal cracking : interim report - fourth year/final report.

DOT National Transportation Integrated Search

2008-12-01

In an effort to compare performance and cost effectiveness of the Saw and Seal procedure and : Performance Grade (PG) binders, the Maine Department of Transportation (MaineDOT) constructed an : experimental project in Weston, Maine during the f...

Developing Mathematical Fluency: Comparing Exercises and Rich Tasks

ERIC Educational Resources Information Center

Foster, Colin

2018-01-01

Achieving fluency in important mathematical procedures is fundamental to students' mathematical development. The usual way to develop procedural fluency is to practise repetitive exercises, but is this the only effective way? This paper reports three quasi-experimental studies carried out in a total of 11 secondary schools involving altogether 528…

Intranasal Dexmedetomidine for Procedural Sedation in Children, a Suitable Alternative to Chloral Hydrate.

PubMed

Cozzi, Giorgio; Norbedo, Stefania; Barbi, Egidio

2017-04-01

Sedation is often required for children undergoing diagnostic procedures. Chloral hydrate has been one of the sedative drugs most used in children over the last 3 decades, with supporting evidence for its efficacy and safety. Recently, chloral hydrate was banned in Italy and France, in consideration of evidence of its carcinogenicity and genotoxicity. Dexmedetomidine is a sedative with unique properties that has been increasingly used for procedural sedation in children. Several studies demonstrated its efficacy and safety for sedation in non-painful diagnostic procedures. Dexmedetomidine's impact on respiratory drive and airway patency and tone is much less when compared to the majority of other sedative agents. Administration via the intranasal route allows satisfactory procedural success rates. Studies that specifically compared intranasal dexmedetomidine and chloral hydrate for children undergoing non-painful procedures showed that dexmedetomidine was as effective as and safer than chloral hydrate. For these reasons, we suggest that intranasal dexmedetomidine could be a suitable alternative to chloral hydrate.

The Effect of Heart Disease on Anesthetic Complications During Routine Dental Procedures in Dogs.

PubMed

Carter, Jennifer E; Motsinger-Reif, Alison A; Krug, William V; Keene, Bruce W

Dental procedures are a common reason for general anesthesia, and there is widespread concern among veterinarians that heart disease increases the occurrence of anesthetic complications. Anxiety about anesthetizing dogs with heart disease is a common cause of referral to specialty centers. To begin to address the potential effect of heart disease on anesthetic complications in dogs undergoing anesthesia for routine dental procedures, we compared anesthetic complications in 100 dogs with heart disease severe enough to trigger referral to a specialty center (cases) to those found in 100 dogs without cardiac disease (controls) that underwent similar procedures at the same teaching hospital. Medical records were reviewed to evaluate the occurrence of anesthetic complications. No dogs died in either group, and no significant differences were found between the groups in any of the anesthetic complications evaluated, although dogs in the heart disease group were significantly older with higher American Society of Anesthesiologists scores. Midazolam and etomidate were used more frequently, and alpha-2 agonists used less frequently, in the heart disease group compared to controls. This study suggests dogs with heart disease, when anesthetized by trained personnel and carefully monitored during routine dental procedures, are not at significantly increased risk for anesthetic complications.

Cost-effectiveness of robotic surgery in gynecologic oncology.

PubMed

Xie, Yue

2015-02-01

Robotically assisted surgeries have flourished in the United States, especially in gynecological procedures. Current robotic systems have high upfront and procedure costs that have led many in the medical community to question the new technology's cost-effectiveness. Recent research continues to find that robotically assisted gynecological cancer treatments have comparable outcomes to traditional laparoscopy and similar or better outcomes than that of laparotomy in the cases studied. However, robotic surgery costs remain higher than that of traditional laparoscopy. Under the current reimbursement climate, practicing physicians and hospitals should collaborate on identifying cost-effective uses of robotic systems and pushing manufacturers to lower purchase and procedure costs to a level that may be accepted by all stakeholders.

Cost-effectiveness of PET and PET/computed tomography: a systematic review.

PubMed

Gerke, Oke; Hermansson, Ronnie; Hess, Søren; Schifter, Søren; Vach, Werner; Høilund-Carlsen, Poul Flemming

2015-01-01

The development of clinical diagnostic procedures comprises early-phase and late-phase studies to elucidate diagnostic accuracy and patient outcome. Economic assessments of new diagnostic procedures compared with established work-ups indicate additional cost for 1 additional unit of effectiveness measure by means of incremental cost-effectiveness ratios when considering the replacement of the standard regimen by a new diagnostic procedure. This article discusses economic assessments of PET and PET/computed tomography reported until mid-July 2014. Forty-seven studies on cancer and noncancer indications were identified but, because of the widely varying scope of the analyses, a substantial amount of work remains to be done. Copyright © 2015 Elsevier Inc. All rights reserved.

Assessment of reinforcement enhancing effects of toluene vapor and nitrous oxide in intracranial self-stimulation

PubMed Central

Tracy, Matthew E.; Slavova-Hernandez, Galina G.; Shelton, Keith L.

2013-01-01

Rationale Despite widespread abuse there are few validated methods to study the rewarding effects of inhalants. One model that that may have utility for this purpose is intracranial self-stimulation (ICSS). Objectives We wished to compare and contrast the ICSS reward-facilitating effects of abused inhalants to other classes of abused drugs. Compounds were examined using two different ICSS procedures in mice to determine the generality of each drug's effects on ICSS and the sensitivity of the procedures. Methods Male C57BL/6J mice with electrodes implanted in the medial forebrain bundle were trained under a three component rate-frequency as well as a progressive ratio (PR) ICSS procedure. The effects of nitrous oxide, toluene vapor, cocaine and diazepam on ICSS were then examined. Results Concentrations of 1360-2900 ppm inhaled toluene vapor significantly facilitated ICSS in the rate frequency procedure and 1360 ppm increased PR breakpoint. A concentration of 40% nitrous oxide facilitated ICSS in the rate-frequency procedure but reduced PR breakpoint. Doses of 3-18 mg/kg cocaine facilitated ICSS in the rate frequency procedure and 10 and 18 mg/kg increased PR breakpoint. Doses of 1 and 3 mg/kg diazepam facilitated ICSS in the rate frequency procedure and 3 mg/kg increased PR breakpoint. Conclusions The reinforcement facilitating effect of toluene in ICSS is at least as great as diazepam. In contrast, nitrous oxide weakly enhances ICSS in only the rate frequency procedure. The data suggest that the rate frequency procedure may be more sensitive than the PR schedule to the reward facilitating effects of abused inhalants. PMID:24186077

Skin-to-skin care for procedural pain in neonates.

PubMed

Johnston, Celeste; Campbell-Yeo, Marsha; Fernandes, Ananda; Inglis, Darlene; Streiner, David; Zee, Rebekah

2014-01-23

Skin-to-skin care (SSC), otherwise known as Kangaroo Care (KC) due to its similarity with marsupial behaviour of ventral maternal-infant contact, is one non-pharmacological intervention for pain control in infants. The primary objectives were to determine the effect of SSC alone on pain from medical or nursing procedures in neonates undergoing painful procedures compared to no intervention, sucrose or other analgesics, or additions to simple SSC such as rocking; and the effects of the amount of SSC (duration in minutes) and the method of administration (who provided the SSC, positioning of caregiver and neonate pair).The secondary objectives were to determine the incidence of untoward effects of SSC and to compare the SSC effect in different postmenstrual age subgroups of infants. The standard methods of the Cochrane Neonatal Collaborative Review Group were used. Databases searched in August 2011: Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library); Evidence-Based Medicine Reviews; MEDLINE (1950 onwards); PubMed (1975 onwards); EMBASE (1974 onwards); CINAHL (1982 onwards); Web of Science (1980 onwards); LILACS database (1982 onwards); SCIELO database (1982 onwards); PsycInfo (1980 onwards); AMED (1985 onwards); Dissertation-Abstracts International (1980 onwards). Searches were conducted throughout September 2012. Studies with randomisation or quasi-randomisation, double or single-blinded, involving term infants (> 37 completed weeks postmenstrual age (PMA)) to a maximum of 44 weeks PMA and preterm infants (< 37 completed weeks PMA) receiving SSC for painful procedures conducted by doctors, nurses, or other healthcare professionals. The main outcome measures were physiological or behavioural pain indicators and composite pain scores. A weighted mean difference (WMD) with 95% confidence interval (CI) using a fixed-effect model was reported for continuous outcome measures. We included variations on type of tissue-damaging procedure, provider of care, and duration of SSC. Nineteen studies (n = 1594 infants) were included. Fifteen studies (n = 744) used heel lance as the painful procedure, one study combined venepuncture and heel stick (n = 50), two used intramuscular injection, and one used 'vaccination' (n = 80). The studies that were included were generally strong and free from bias.Eleven studies (n = 1363) compared SSC alone to a no-treatment control. Although 11 studies measured heart rate during painful procedures, data from only four studies (n = 121) could be combined to give a mean difference (MD) of 0.35 beats per minute (95% CI -6.01 to 6.71). Three other studies that were not included in meta-analyses also reported no difference in heart rate after the painful procedure. Two studies reported heart rate variability outcomes and found no significant differences. Five studies used the Premature Infant Pain Profile (PIPP) as a primary outcome, which favoured SCC at 30 seconds (n = 268) (MD -3.21, 95% CI -3.94 to -2.48), 60 seconds (n = 164) (MD -1.85, 95% CI -3.03 to -0.68), and 90 seconds (n = 163) (MD -1.34, 95% CI -2.56 to -0.13), but at 120 seconds (n = 157) there was no difference. No studies provided findings on return of heart rate to baseline level, oxygen saturation, cortisol levels, duration of crying, and facial actions that could be combined for analysis.Eight studies compared SSC to another intervention with or without a no-treatment control. Two cross-over studies (n = 80) compared mother versus other provider on PIPP scores at 30, 60, 90, and 120 seconds with no significant difference. When SSC was compared to other interventions, there were not enough similar studies to pool results in an analysis. One study compared SSC with and without dextrose and found that the combination was most effective and that SSC alone was more effective than dextrose alone. Similarly, in another study SSC was more effective than oral glucose for heart rate but not oxygen saturation. SSC either in combination with breastfeeding or alone was favoured over a no-treatment control, but was not different to breastfeeding. There were not enough participants with similar outcomes and painful procedures to compare age groups or duration of SSC. No adverse events were reported in any of the studies. SSC appears to be effective, as measured by composite pain indicators and including both physiological and behavioural indicators, and safe for a single painful procedure such as a heel lance. Purely behavioural indicators tended to favour SSC but there remains questionable bias regarding behavioural indicators. Physiological indicators were typically not different between conditions. Only two studies compared mother providers to others, with non-significant results. There was more heterogeneity in the studies with behavioural or composite outcomes. There is a need for replication studies that use similar, clearly defined outcomes. New studies examining optimal duration of SSC, gestational age groups, repeated use, and long-term effects of SSC are needed.

The neural bases of the multiplication problem-size effect across countries

PubMed Central

Prado, Jérôme; Lu, Jiayan; Liu, Li; Dong, Qi; Zhou, Xinlin; Booth, James R.

2013-01-01

Multiplication problems involving large numbers (e.g., 9 × 8) are more difficult to solve than problems involving small numbers (e.g., 2 × 3). Behavioral research indicates that this problem-size effect might be due to different factors across countries and educational systems. However, there is no neuroimaging evidence supporting this hypothesis. Here, we compared the neural correlates of the multiplication problem-size effect in adults educated in China and the United States. We found a greater neural problem-size effect in Chinese than American participants in bilateral superior temporal regions associated with phonological processing. However, we found a greater neural problem-size effect in American than Chinese participants in right intra-parietal sulcus (IPS) associated with calculation procedures. Therefore, while the multiplication problem-size effect might be a verbal retrieval effect in Chinese as compared to American participants, it may instead stem from the use of calculation procedures in American as compared to Chinese participants. Our results indicate that differences in educational practices might affect the neural bases of symbolic arithmetic. PMID:23717274

The effect of music on preprocedure anxiety in Hong Kong Chinese day patients.

PubMed

Lee, David; Henderson, Amanda; Shum, David

2004-03-01

To identify the effect of music on preprocedure anxiety levels of Hong Kong Chinese patients undergoing day procedures in a local community based hospital. Pre and post-test quasi experimental design with non-random assignment. A total of 113 participants were assigned to the control group or intervention group depending on the day of their procedure. Participants' anxiety levels were measured objectively by comparing their vital signs and subjectively by the Spielberger State Trait Anxiety Scale. Participants' physiological parameters (blood pressure, pulse and respiration) and State Trait Anxiety Scale were measured at two time periods. The control group undertook the usual relaxing activities provided in the waiting room compared with the intervention group who listened to music of their own choice in reclining chairs while waiting for the procedure. The physiological parameters for both the control and intervention groups dropped significantly during the waiting period, however, only the intervention group had a significant reduction in reported anxiety levels. These results suggest that providing self-selected music to day procedure patients in the preprocedure period assists in the reduction of physiological parameters and anxiety, yet, a relaxing environment can assist in the reduction of physiological parameters. The administration of self-selected music to day procedure patients in the preprocedure period can be effective in the reduction of physiological parameters and anxiety.

The Effect of "Cover, Copy, and Compare" on Spelling Accuracy of High School Students with Learning Disabilities

ERIC Educational Resources Information Center

Zielinski, Katie; McLaughlin, T. F.; Derby, K. Mark

2012-01-01

The purpose of this study was to evaluate the effectiveness of cover, copy, and compare (CCC) on spelling accuracy for three high school aged students with learning disabilities. CCC is a student-managed procedure that teaches discrete skills through self-tutoring and error correction. The effectiveness of CCC was evaluated using a multiple…

Testing equality and interval estimation in binary responses when high dose cannot be used first under a three-period crossover design.

PubMed

Lui, Kung-Jong; Chang, Kuang-Chao

2015-01-01

When comparing two doses of a new drug with a placebo, we may consider using a crossover design subject to the condition that the high dose cannot be administered before the low dose. Under a random-effects logistic regression model, we focus our attention on dichotomous responses when the high dose cannot be used first under a three-period crossover trial. We derive asymptotic test procedures for testing equality between treatments. We further derive interval estimators to assess the magnitude of the relative treatment effects. We employ Monte Carlo simulation to evaluate the performance of these test procedures and interval estimators in a variety of situations. We use the data taken as a part of trial comparing two different doses of an analgesic with a placebo for the relief of primary dysmenorrhea to illustrate the use of the proposed test procedures and estimators.

Evaluation of the effectiveness and efficiency of two stimulus prompt strategies with severely handicapped students.

PubMed Central

Steege, M W; Wacker, D P; McMahon, C M

1987-01-01

In this study we compared the effectiveness and efficiency of two treatment packages that used stimulus prompt sequences and task analyses for teaching community living skills to severely handicapped students. Four severely and multiply handicapped students were trained to perform four tasks: (a) making toast, (b) making popcorn, (c) operating a clothes dryer, and (d) operating a washing machine. Following baseline, each student was exposed to two types of training procedures, each involving a task analysis of the target behavior. Training Procedure 1 (Traditional) utilized a least-to-most restrictive prompt sequence. Training Procedure 2 (Prescriptive) utilized ongoing behavioral assessment data to identify discriminative stimuli. The assessment data were used to prescribe instructional prompts across successive training trials. Performance on the tasks was evaluated within a combination multiple baseline (across subjects) and probe (across tasks) design. Training conditions were counterbalanced across subjects and tasks. Results indicated that both training procedures were equally effective in increasing independent task acquisition for subjects on all tasks; however, the prescriptive procedure was the more efficient procedure. PMID:3667479

Effects on pain and anxiety of patients viewing their cystoscopy in addition to a detailed explanation: a controlled study.

PubMed

Kesari, D; Kovisman, V; Cytron, S; Benjamin, J

2003-11-01

To compare the effect of allowing patients to watch their cystoscopy on closed-circuit television and with an explanation during the procedure, with an explanation alone, as involving patients in the process of minimally invasive procedures like colonoscopy or colposcopy has been reported to alleviate pain and anxiety, but these effects may differ in patients who desire participation and those who do not. Of 51 patients undergoing cystoscopy for the first time, 27 watched the procedure and received explanations, and 24 received explanations alone. They completed an anxiety questionnaire and visual analogue scales (VAS) of anxiety before and after the procedure. Before the procedure they also completed an assessment of desire to be involved in medical decisions and procedures (Kranz Health Opinion Survey, KHOS), and afterwards recorded the pain they had experienced on a scale of 1-10. Anxiety (assessed by VAS) declined after the procedure (P < 0.001) but the anxiety questionnaire showed no change. There was a positive correlation between the KHOS and VAS after the procedure; the more the patient was an 'information seeker' the higher the anxiety. Neither pain nor anxiety were affected by watching the monitor, whether or not KHOS scores were entered as a cofactor. Age and sex had no effect on the results. There were no complications. There was no effect of watching the cystoscopy on anxiety and pain. Possibly the explanation received by both groups left no room for further improvement in the intervention group.

Skin-to-skin care for procedural pain in neonates.

PubMed

Johnston, Celeste; Campbell-Yeo, Marsha; Disher, Timothy; Benoit, Britney; Fernandes, Ananda; Streiner, David; Inglis, Darlene; Zee, Rebekah

2017-02-16

Skin-to-skin care (SSC), often referred to as 'kangaroo care' (KC) due to its similarity with marsupial behaviour of ventral maternal-infant contact, is one non-pharmacological intervention for pain control in infants. The primary objectives were to determine the effect of SSC alone on pain from medical or nursing procedures in neonates compared to no intervention, sucrose or other analgesics, or additions to simple SSC such as rocking; and to determine the effects of the amount of SSC (duration in minutes), method of administration (e.g. who provided the SSC) of SSC in reducing pain from medical or nursing procedures in neonatesThe secondary objectives were to determine the safety of SSC care for relieving procedural pain in infants; and to compare the SSC effect in different postmenstrual age subgroups of infants. For this update, we used the standard search strategy of the Cochrane Neonatal Review group to search the Cochrane Central Register of Controlled Trials (CENTRAL; 2016, Issue 1); MEDLINE via PubMed (1966 to 25 February 2016); Embase (1980 to 25 February 2016); and CINAHL (1982 to 25 February 2016). We also searched clinical trials' databases, conference proceedings, and the reference lists of retrieved articles for randomized controlled trials and quasi-randomized trials. Studies with randomisation or quasi-randomisation, double- or single-blinded, involving term infants (≥ 37 completed weeks' postmenstrual age (PMA) to a maximum of 44 weeks' PMA and preterm infants (< 37 completed weeks PMA) receiving SSC for painful procedures conducted by healthcare professionals. The main outcome measures were physiological or behavioural pain indicators and composite pain scores. A mean difference (MD) with 95% confidence interval (CI) using a fixed-effect model was reported for continuous outcome measures. We included variations on type of tissue-damaging procedure, provider of care, and duration of SSC. Twenty-five studies (n = 2001 infants) were included. Nineteen studies (n = 1065) used heel lance as the painful procedure, one study combined venepuncture and heel stick (n = 50), three used intramuscular injection (n = 776), one used 'vaccination' (n = 60), and one used tape removal (n = 50). The studies were generally strong and had low or uncertain risk of bias. Blinding of the intervention was not possible, making them subject to high risk, depending on the method of scoring outcomes.Seventeen studies (n = 810) compared SSC to a no-treatment control. Although 15 studies measured heart rate during painful procedures, data from only five studies (n = 161) could be combined for a mean difference (MD) of -10.78 beats per minute (95% CI -13.63 to -7.93) favouring SSC. Meta-analysis of four studies (n = 120) showed no difference in heart rate following the painful procedure (MD 0.08, 95% CI -4.39 to 4.55). Two studies (n = 38) reported heart rate variability with no significant differences. Two studies (n = 101) in a meta-analysis on oxygen saturation at 30 and 60 seconds following the painful procedure did not show a difference. Duration of crying meta-analysis was performed on four studies (n = 133): two (n = 33) investigated response to heel lance (MD = -34.16, 95% CI -42.86 to -25.45), and two (n = 100) following IM injection (MD = -8.83, 95% CI -14.63 to -3.02), favouring SSC. Five studies, one consisting of two substudies (n = 267), used the Premature Infant Pain Profile (PIPP) as a primary outcome, which favoured SCC at 30 seconds (MD -3.21, 95% CI -3.94 to -2.47), at 60 seconds (3 studies; n = 156) (MD -1.64, 95% CI -2.86 to -0.43), and at 90 seconds (n = 156) (MD -1.28, 95% CI -2.53 to -0.04); but at 120 seconds there was no difference (n = 156) (MD 0.07, 95% CI -1.11 to 1.25). No studies on return of heart rate to baseline level, cortisol levels, and facial actions could be combined for meta-analysis findings.Eight studies compared SSC to another intervention with or without a no-treatment control. Two cross-over studies (n = 80) compared mother versus other provider (father, another female) on PIPP scores at 30, 60, 90, and 120 seconds with no significant difference. When SSC was compared to other interventions, there were not enough similar studies to pool results in an analysis. One study compared SSC (n = 640) with and without dextrose and found that the combination was most effective and that SSC alone was more effective than dextrose alone. Similarly, in another study SSC was more effective than oral glucose for heart rate (n = 95). SSC either in combination with breastfeeding or alone was favoured over a no-treatment control, but not different to breastfeeding. One study compared SSC alone and in combination with both sucrose and breastfeeding on heart rate (HR), NIPS scores, and crying time (n = 127). The combinations were more effective than SSC alone for NIPS and crying. Expressed breast milk was compared to SSC in one study (n = 50) and found both equally effective on PIPP scores. There were not enough participants with similar outcomes and painful procedures to compare age groups or duration of SSC. No adverse events were reported in any of the studies. SSC appears to be effective as measured by composite pain indicators with both physiological and behavioural indicators and, independently, using heart rate and crying time; and safe for a single painful procedure. Purely behavioural indicators tended to favour SSC but with facial actions there is greater possibility of observers not being blinded. Physiological indicators were mixed although the common measure of heart rate favoured SSC. Two studies compared mother-providers to others, with non-significant results. There was more heterogeneity in the studies with behavioural or composite outcomes. There is a need for replication studies that use similar, clearly defined outcomes. Studies examining optimal duration of SSC, gestational age groups, repeated use, and long-term effects of SSC are needed. Of interest would be to study synergistic effects of SSC with other interventions.

Comparative effectiveness analysis of anticoagulant strategies in a large observational database of percutaneous coronary interventions.

PubMed

Wise, Gregory R; Schwartz, Brian P; Dittoe, Nathaniel; Safar, Ammar; Sherman, Steven; Bowdy, Bruce; Hahn, Harvey S

2012-06-01

Percutaneous coronary intervention (PCI) is the most commonly used procedure for coronary revascularization. There are multiple adjuvant anticoagulation strategies available. In this era of cost containment, we performed a comparative effectiveness analysis of clinical outcomes and cost of the major anticoagulant strategies across all types of PCI procedures in a large observational database. A retrospective, comparative effectiveness analysis of the Premier observational database was conducted to determine the impact of anticoagulant treatment on outcomes. Multiple linear regression and logistic regression models were used to assess the association of initial antithrombotic treatment with outcomes while controlling for other factors. A total of 458,448 inpatient PCI procedures with known antithrombotic regimen from 299 hospitals between January 1, 2004 and March 31, 2008 were identified. Compared to patients treated with heparin plus glycoprotein IIb/IIIa inhibitor (GPI), bivalirudin was associated with a 41% relative risk reduction (RRR) for inpatient mortality, a 44% RRR for clinically apparent bleeding, and a 37% RRR for any transfusion. Furthermore, treatment with bivalirudin alone resulted in a cost savings of $976 per case. Similar results were seen between bivalirudin and heparin in all end-points. Combined use of both bivalirudin and GPI substantially attenuated the cost benefits demonstrated with bivalirudin alone. Bivalirudin use was associated with both improved clinical outcomes and decreased hospital costs in this large "real-world" database. To our knowledge, this study is the first to demonstrate the ideal comparative effectiveness end-point of both improved clinical outcomes with decreased costs in PCI. ©2012, Wiley Periodicals, Inc.

Effects of RVP, T50, and Oxygenates on Hot-Start and Driveability Performance at High and Low Altitude

DTIC Science & Technology

1993-05-01

Fury 5.2 23115 Carbureted 1991 Oldsmobile Cutlass Ciera 3.3 27585 Port-Fuel-Injected 1992 Nissan Sentra 1.6 16220 Port-Fuel-Injected 1992 Toyota Camry...data; however, the R2 method was only used at low altitude. In order to compare the driveability procedure with the alternate driveability procedure...the high-temperature data at low altitude were also analyzed after removing sufficient data to make the data sets comparable in size. This was done by

A Comparison of Coverage Restrictions for Biopharmaceuticals and Medical Procedures.

PubMed

Chambers, James; Pope, Elle; Bungay, Kathy; Cohen, Joshua; Ciarametaro, Michael; Dubois, Robert; Neumann, Peter J

2018-04-01

Differences in payer evaluation and coverage of pharmaceuticals and medical procedures suggest that coverage may differ for medications and procedures independent of their clinical benefit. We hypothesized that coverage for medications is more restricted than corresponding coverage for nonmedication interventions. We included top-selling medications and highly utilized procedures. For each intervention-indication pair, we classified value in terms of cost-effectiveness (incremental cost per quality-adjusted life-year), as reported by the Tufts Medical Center Cost-Effectiveness Analysis Registry. For each intervention-indication pair and for each of 10 large payers, we classified coverage, when available, as either "more restrictive" or as "not more restrictive," compared with a benchmark. The benchmark reflected the US Food and Drug Administration label information, when available, or pertinent clinical guidelines. We compared coverage policies and the benchmark in terms of step edits and clinical restrictions. Finally, we regressed coverage restrictiveness against intervention type (medication or nonmedication), controlling for value (cost-effectiveness more or less favorable than a designated threshold). We identified 392 medication and 185 procedure coverage decisions. A total of 26.3% of the medication coverage and 38.4% of the procedure coverage decisions were more restrictive than their corresponding benchmarks. After controlling for value, the odds of being more restrictive were 42% lower for medications than for procedures. Including unfavorable tier placement in the definition of "more restrictive" greatly increased the proportion of medication coverage decisions classified as "more restrictive" and reversed our findings. Therapy access depends on factors other than cost and clinical benefit, suggesting potential health care system inefficiency. Copyright © 2018 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Utility of Pamphlets in Promoting Knowledge and Positive Attitudes about Two Early Cancer Detection Procedures.

ERIC Educational Resources Information Center

Marty, Phillip J.; McDermott, Robert J.

Informational pamphlets about breast self-examination (BSE) and testicular self-examination (TSE) are widely distributed in health care settings, but the pamphlets' effectiveness in promoting knowledge and positive attitudes about these early cancer detection procedures is largely unknown. A study compared pamphlets with alternative methods of…

The Effects of Item by Item Feedback Given during an Ability Test.

ERIC Educational Resources Information Center

Whetton, C.; Childs, R.

1981-01-01

Answer-until-correct (AUC) is a procedure for providing feedback during a multiple-choice test, giving an increased range of scores. The performance of secondary students on a verbal ability test using AUC procedures was compared with a group using conventional instructions. AUC scores considerably enhanced reliability but not validity.…

Applied Comparative Effectiveness Researchers Must Measure Learning Rates: A Commentary on Efficiency Articles

ERIC Educational Resources Information Center

Skinner, Christopher H.

2010-01-01

Almost all academic skills deficits can be conceptualized as learning rate problems as students are not failing to learn, but not learning rapidly enough. Thus, when selecting among various possible remedial procedures, educators need an evidence base that indicates which procedure results in the greatest increases in learning rates. Previous…

A Comparison of Simultaneous Prompting and Constant Time Delay Procedures in Teaching State Capitals

ERIC Educational Resources Information Center

Head, Kenneth David; Collins, Belva C.; Schuster, John W.; Ault, Melinda Jones

2011-01-01

This investigation compared the effectiveness and efficiency of constant time delay (CTD) and simultaneous prompting (SP) procedures in teaching discrete social studies facts to 4 high school students with learning and behavior disorders using an adapted alternating treatments design nested within a multiple probe design. The results indicated…

The Effect of Word- And Comprehension-Emphasis Instruction on Reading Performance.

ERIC Educational Resources Information Center

Fleisher, Lisa S.; Jenkins, Joseph R.

1983-01-01

The effects of three instructional procedures on reading comprehension and word recognition were compared with 21 learning disabled elementary school students. No differences were found among treatment effects on comprehension and oral reading. (Author/SW)

42 CFR 488.61 - Special procedures for approval and re-approval of organ transplant centers.

Code of Federal Regulations, 2014 CFR

2014-10-01

... governing body on a sustainable basis, and has requested more time to design or implement additional... months of the Systems Improvement Agreement; (v) A comparative effectiveness analysis that compares...

EX-PRESS Glaucoma Filtration Device: efficacy, safety, and predictability

PubMed Central

Chan, Jessica E; Netland, Peter A

2015-01-01

Trabeculectomy has been the traditional primary surgical therapy for open-angle glaucoma. While trabeculectomy is effective in lowering intraocular pressure, complications associated with the procedure have motivated the development of alternative techniques and devices, including the EX-PRESS Glaucoma Filtration Device. This review describes the efficacy, safety, complication rates, and potential advantages and disadvantages of the EX-PRESS Glaucoma Filtration Device. EX-PRESS implantation is technically simpler compared with that of trabeculectomy, with fewer surgical steps. Vision recovery has been more rapid after EX-PRESS implantation compared with trabeculectomy. Intraocular pressure variation is lower during the early postoperative period, indicating a more predictable procedure. While efficacy of the EX-PRESS implant has been comparable to trabeculectomy, postoperative complications appear less common after EX-PRESS implantation compared with trabeculectomy. The EX-PRESS Glaucoma Filtration Device appears to be safe and effective in the surgical management of open-angle glaucoma. PMID:26366105

Place prioritization for biodiversity content.

PubMed

Sarkar, Sahotra; Aggarwal, Anshu; Garson, Justin; Margules, Chris R; Zeidler, Juliane

2002-07-01

The prioritization of places on the basis of biodiversity content is part of any systematic biodiversity conservation planning process. The place prioritization procedure implemented in the ResNet software package is described. This procedure is primarily based on the principles of rarity and complementarity. Application of the procedure is demonstrated with two analyses, one data set consisting of the distributions of termite genera in Namibia, and the other consisting of the distributions of bird species in the Islas Malvinas/Falkland Islands. The attributes that data sets should have for the effective and reliable application of such procedures are discussed. The procedure used here is compared to some others that are also currently in use.

Mobility of arsenic and its compounds in soil and soil solution: the effect of soil pretreatment and extraction methods.

PubMed

Száková, J; Tlustos, P; Goessler, W; Frková, Z; Najmanová, J

2009-12-30

The effect of soil extraction procedures and/or sample pretreatment (drying, freezing of the soil sample) on the extractability of arsenic and its compounds was tested. In the first part, five extraction procedures were compared with following order of extractable arsenic portions: 2M HNO(3)>0.43 M CH(3)COOH>or=0.05 M EDTA>or=Mehlich III (0.2M CH(3)COOH+0.25 M NH(4)NO(3)+0.013 M HNO(3)+0.015 M NH(4)F+0.001 M EDTA) extraction>water). Additionally, two methods of soil solution sampling were compared, centrifugation of saturated soil and the use of suction cups. The results showed that different sample pretreatments including soil solution sampling could lead to different absolute values of mobile arsenic content in soils. However, the interpretation of the data can lead to similar conclusions as apparent from the comparison of the soil solution sampling methods (r=0.79). For determination of arsenic compounds mild extraction procedures (0.05 M (NH(4))(2)SO(4), 0.01 M CaCl(2), and water) and soil solution sampling using suction cups were compared. Regarding the real soil conditions the extraction of fresh samples and/or in situ collection of soil solution are preferred among the sample pretreatments and/or soil extraction procedures. However, chemical stabilization of the solutions should be allowed and included in the analytical procedures for determination of individual arsenic compounds.

Nicotine enhances the locomotor stimulating but not the conditioned rewarding effect of ethanol in DBA/2J mice.

PubMed

Gubner, Noah R; Cunningham, Christopher L; Phillips, Tamara J

2015-01-01

One hypothesis to explain the high rate of nicotine and alcohol (ethanol [EtOH]) co-abuse is that these drugs have enhanced rewarding effects when taken together. The goal of this work was to use the conditioned place preference (CPP) procedure to determine whether nicotine would enhance the development of EtOH-induced CPP. The conditioned rewarding effects of nicotine (1 or 2 mg/kg of nicotine tartrate), EtOH (1 g/kg), and nicotine plus EtOH in combination were assessed using a well-established CPP procedure chosen specifically for examining alterations in the development of EtOH-induced CPP by nicotine. In addition, the reference dose procedure was used to directly compare the conditioned rewarding effect of EtOH versus nicotine plus EtOH. DBA/2J mice were used because they are an inbred strain that has repeatedly been shown to develop CPP to EtOH. Neither dose of nicotine alone produced CPP, whereas EtOH did, using the standard EtOH CPP procedure. The magnitude of EtOH-induced CPP was not affected by co-administration of 1 mg/kg nicotine, but 2 mg/kg nicotine interfered with the development of EtOH-induced CPP. Using the reference dose procedure, there was no significant preference or aversion for either nicotine + EtOH dose combination versus EtOH alone. However, combined nicotine and EtOH had a larger effect on locomotor activity, during the conditioning trials, compared to their additive effect when given alone, consistent with previous data. These data do not support the hypothesis that nicotine enhances the conditioned rewarding effect of EtOH. This finding differs from the combined locomotor stimulant effects of nicotine and EtOH that were observed in this study and in our previously published work, and suggests that combined stimulant effects of nicotine and EtOH do not predict enhanced reward. Copyright © 2015 by the Research Society on Alcoholism.

Effectiveness of radio waves application in modern general dental procedures: An update.

PubMed

Qureshi, Arslan; Kellesarian, Sergio Varela; Pikos, Michael A; Javed, Fawad; Romanos, Georgios E

2017-01-01

The purpose of the present study was to review indexed literature and provide an update on the effectiveness of high-frequency radio waves (HRW) application in modern general dentistry procedures. Indexed databases were searched to identify articles that assessed the efficacy of radio waves in dental procedures. Radiosurgery is a refined form of electrosurgery that uses waves of electrons at a radiofrequency ranging between 2 and 4 MHz. Radio waves have also been reported to cause much less thermal damage to peripheral tissues compared with electrosurgery or carbon dioxide laser-assisted surgery. Formation of reparative dentin in direct pulp capping procedures is also significantly higher when HRW are used to achieve hemostasis in teeth with minimally exposed dental pulps compared with traditional techniques for achieving hemostasis. A few case reports have reported that radiosurgery is useful for procedures such as gingivectomy and gingivoplasty, stage-two surgery for implant exposure, operculectomy, oral biopsy, and frenectomy. Radiosurgery is a relatively modern therapeutic methodology for the treatment of trigeminal neuralgia; however, its long-term efficacy is unclear. Radio waves can also be used for periodontal procedures, such as gingivectomies, coronal flap advancement, harvesting palatal grafts for periodontal soft tissue grafting, and crown lengthening. Although there are a limited number of studies in indexed literature regarding the efficacy of radio waves in modern dentistry, the available evidence shows that use of radio waves is a modernization in clinical dentistry that might be a contemporary substitute for traditional clinical dental procedures.

Recent developments in nickel electrode analysis

NASA Technical Reports Server (NTRS)

Whiteley, Richard V.; Daman, M. E.; Kaiser, E. Q.

1991-01-01

Three aspects of nickel electrode analysis for Nickel-Hydrogen and Nickel-Cadmium battery cell applications are addressed: (1) the determination of active material; (2) charged state nickel (as NiOOH + CoOOH); and (3) potassium ion content in the electrode. Four deloading procedures are compared for completeness of active material removal, and deloading conditions for efficient active material analyses are established. Two methods for charged state nickel analysis are compared: the current NASA procedure and a new procedure based on the oxidation of sodium oxalate by the charged material. Finally, a method for determining potassium content in an electrode sample by flame photometry is presented along with analytical results illustrating differences in potassium levels from vendor to vendor and the effects of stress testing on potassium content in the electrode. The relevance of these analytical procedures to electrode performance is reviewed.

Robust estimation of the proportion of treatment effect explained by surrogate marker information.

PubMed

Parast, Layla; McDermott, Mary M; Tian, Lu

2016-05-10

In randomized treatment studies where the primary outcome requires long follow-up of patients and/or expensive or invasive obtainment procedures, the availability of a surrogate marker that could be used to estimate the treatment effect and could potentially be observed earlier than the primary outcome would allow researchers to make conclusions regarding the treatment effect with less required follow-up time and resources. The Prentice criterion for a valid surrogate marker requires that a test for treatment effect on the surrogate marker also be a valid test for treatment effect on the primary outcome of interest. Based on this criterion, methods have been developed to define and estimate the proportion of treatment effect on the primary outcome that is explained by the treatment effect on the surrogate marker. These methods aim to identify useful statistical surrogates that capture a large proportion of the treatment effect. However, current methods to estimate this proportion usually require restrictive model assumptions that may not hold in practice and thus may lead to biased estimates of this quantity. In this paper, we propose a nonparametric procedure to estimate the proportion of treatment effect on the primary outcome that is explained by the treatment effect on a potential surrogate marker and extend this procedure to a setting with multiple surrogate markers. We compare our approach with previously proposed model-based approaches and propose a variance estimation procedure based on a perturbation-resampling method. Simulation studies demonstrate that the procedure performs well in finite samples and outperforms model-based procedures when the specified models are not correct. We illustrate our proposed procedure using a data set from a randomized study investigating a group-mediated cognitive behavioral intervention for peripheral artery disease participants. Copyright © 2015 John Wiley & Sons, Ltd.

Activity based costing of diagnostic procedures at a nuclear medicine center of a tertiary care hospital

PubMed Central

Hada, Mahesh Singh; Chakravarty, Abhijit; Mukherjee, Partha

2014-01-01

Context: Escalating health care expenses pose a new challenge to the health care environment of becoming more cost-effective. There is an urgent need for more accurate data on the costs of health care procedures. Demographic changes, changing morbidity profile, and the rising impact of noncommunicable diseases are emphasizing the role of nuclear medicine (NM) in the future health care environment. However, the impact of emerging disease load and stagnant resource availability needs to be balanced by a strategic drive towards optimal utilization of available healthcare resources. Aim: The aim was to ascertain the cost of diagnostic procedures conducted at the NM Department of a tertiary health care facility by employing activity based costing (ABC) method. Materials and Methods: A descriptive cross-sectional study was carried out over a period of 1 year. ABC methodology was utilized for ascertaining unit cost of different diagnostic procedures and such costs were compared with prevalent market rates for estimating cost effectiveness of the department being studied. Results: The cost per unit procedure for various procedures varied from Rs. 869 (USD 14.48) for a thyroid scan to Rs. 11230 (USD 187.16) for a meta-iodo-benzyl-guanidine (MIBG) scan, the most cost-effective investigations being the stress thallium, technetium-99 m myocardial perfusion imaging (MPI) and MIBG scan. The costs obtained from this study were observed to be competitive when compared to prevalent market rates. Conclusion: ABC methodology provides precise costing inputs and should be used for all future costing studies in NM Departments. PMID:25400363

New image-processing and noise-reduction software reduces radiation dose during complex endovascular procedures.

PubMed

Kirkwood, Melissa L; Guild, Jeffrey B; Arbique, Gary M; Tsai, Shirling; Modrall, J Gregory; Anderson, Jon A; Rectenwald, John; Timaran, Carlos

2016-11-01

A new proprietary image-processing system known as AlluraClarity, developed by Philips Healthcare (Best, The Netherlands) for radiation-based interventional procedures, claims to lower radiation dose while preserving image quality using noise-reduction algorithms. This study determined whether the surgeon and patient radiation dose during complex endovascular procedures (CEPs) is decreased after the implementation of this new operating system. Radiation dose to operators, procedure type, reference air kerma, kerma area product, and patient body mass index were recorded during CEPs on two Philips Allura FD 20 fluoroscopy systems with and without Clarity. Operator dose during CEPs was measured using optically stimulable, luminescent nanoDot (Landauer Inc, Glenwood, Ill) detectors placed outside the lead apron at the left upper chest position. nanoDots were read using a microStar ii (Landauer Inc) medical dosimetry system. For the CEPs in the Clarity group, the radiation dose to surgeons was also measured by the DoseAware (Philips Healthcare) personal dosimetry system. Side-by-side measurements of DoseAware and nanoDots allowed for cross-calibration between systems. Operator effective dose was determined using a modified Niklason algorithm. To control for patient size and case complexity, the average fluoroscopy dose rate and the dose per radiographic frame were adjusted for body mass index differences and then compared between the groups with and without Clarity by procedure. Additional factors, for example, physician practice patterns, that may have affected operator dose were inferred by comparing the ratio of the operator dose to procedural kerma area product with and without Clarity. A one-sided Wilcoxon rank sum test was used to compare groups for radiation doses, reference air kermas, and operating practices for each procedure type. The analysis included 234 CEPs; 95 performed without Clarity and 139 with Clarity. Practice patterns of operators during procedures with and without Clarity were not significantly different. For all cases, procedure radiation dose to the patient and the primary and assistant operators were significantly decreased in the Clarity group by 60% compared with the non-Clarity group. By procedure type, fluorography dose rates decreased from 44% for fenestrated endovascular repair and up to 70% with lower extremity interventions. Fluoroscopy dose rates also significantly decreased, from about 37% to 47%, depending on procedure type. The AlluraClarity system reduces the patient and primary operator's radiation dose by more than half during CEPs. This feature appears to be an effective tool in lowering the radiation dose while maintaining image quality. Copyright © 2016 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.

A Randomized Prospective Study Of The Use Of Ipads In Reducing Anxiety During Cast Room Procedures

PubMed Central

Ko, Justine S.; Whiting, Zachariah; Nguyen, Cynthia; Liu, Raymond W; Gilmore, Allison

2016-01-01

Background Cast room procedures can be a source of anxiety for children. Various techniques, including music therapy, have been evaluated as a way to ease this anxiety. The use of iPads as a form of distraction during cast room procedures has not previously been evaluated and was the purpose of the current study. Methods 146 children and adolescents who underwent cast room procedures during June- August 2015 were randomly assigned to one of three groups: no-iPad, iPad with video, or iPad with game. Patient heart rates were measured using a pulse oximeter in the waiting room, before the procedure, during the procedure, and after the procedure. Mean values for each group were calculated at each time interval and compared both between groups and within groups over time. Results There were no significant differences in baseline (waiting room) heart rate between the no-iPad and iPad groups. When compared with the no-iPad group, there was a trend toward decreased heart rate in the video group (p=0.13) and a significant increase in heart rate in the game group (p=0.026) before the procedure. There were no significant decreases in heart rate within any of the groups when comparing the waiting room heart rates with the during procedure heart rates. There was a significant difference between the no-iPad and video groups (p=0.047) when comparing the change in heart rate from baseline to before the procedure, with a decreased heart rate observed in the video group. Conclusions The results of this study show a significant decrease in heart rate when transitioning from the waiting room to the cast room while watching videos on the iPad. iPad-based video delivery appears to decrease anxiety prior to cast room procedures. iPad-based game play is difficult to assess as elevations in heart rate prior to the procedure are presumed to be related to game play and confound the observed effect it may have on anxiety related to the procedure. PMID:27528849

SSET Project: Cost-effectiveness Analysis of Surgical Specialty Emergency Trays in the Emergency Department.

PubMed

Humphries, Laura S; Shenaq, Deana S; Teven, Chad M; Park, Julie E; Song, David H

2018-01-01

We hypothesize that reusable, on-site specialty instrument trays available to plastic surgery residents in the emergency department (ED) for bedside procedures are more cost-effective than disposable on-site and remote re-usable operating room (OR) instruments at our institution. We completed a cost-effectiveness analysis comparing the use of disposable on-site kits and remote OR trays to a hypothetical, custom, reusable tray for ED procedures completed by PRS residents. Material costs of existing OR trays were used to estimate the purchasing and use-cost of a custom on-site tray for the same procedures. Cost of per procedure 'consult time' was estimated using procedure and resident salary. Sixteen bedside procedures were completed over a 4.5 month period. A mean of 2.14 disposable kits were used per-procedure. Mean consultation time was 1.66 hours. Procedures that used OR trays took 3 times as long as procedures that used on-site kits (4 vs. 1.1 hours). Necessary, additional instruments were unavailable for 75% of procedures. Mean cost of using disposable kits and OR trays was $115.03/procedure versus an estimated $26.67/procedure cost of using a custom tray, yielding $88.36/procedure cost-savings. Purchase of a single custom tray ($1,421.55) would be redeemed after 2.3 weeks at 1 procedure/day. Purchasing 4 trays has projected annual cost-savings of $26,565.20. The purchase of specialized procedure trays will yield valuable time and cost-savings while providing quality patient care. Improving time efficiency will help achieve the Accreditation Council of Graduate Medical Education (ACGME) goals of maintaining resident well-being and developing quality improvement competency.

Changes in Non-Diabetic Comorbid Disease Status Following Laparoscopic Vertical Sleeve Gastrectomy (LVSG) Versus Laparoscopic Roux-En-Y Gastric Bypass (LRYGB) Procedures: a Systematic Review of Randomized Controlled Trials.

PubMed

Osland, Emma; Yunus, Rossita Mohamad; Khan, Shahjahan; Memon, Breda; Memon, Muhammed Ashraf

2017-05-01

Laparoscopic Roux-en-Y gastric bypass (LRYGB) and laparoscopic vertical sleeve gastrectomy (LVSG) have been proposed as cost-effective strategies to manage obesity-related chronic disease. The aim of this systematic review was to study the peer review literature regarding postoperative nondiabetic comorbid disease resolution or improvement reported from randomized controlled trials (RCTs) comparing LVSG and LRYGB procedures. RCTs comparing postoperative comorbid disease resolution such as hypertension, dyslipidemia, obstructive sleep apnea, joint and musculoskeletal conditions, gastroesophageal reflux disease, and menstrual irregularities following LVSG and LRYGB were included for analysis. The studies were selected from PubMed, Medline, EMBASE, Science Citation Index, Current Contents, and the Cochrane database and reported on at least one comorbidity resolution or improvement. The present work was undertaken according to the Preferred Reporting Items of Systematic Reviews and Meta-Analyses (PRISMA). The Jadad method for assessment of methodological quality was applied to the included studies. Six RCTs performed between 2005 and 2015 involving a total of 695 patients (LVSG n = 347, LRYGB n = 348) reported on the resolution or improvement of comorbid disease following LVSG and LRYGB procedures. Both bariatric procedures provide effective and almost comparable results in improving or resolving these comorbidities. This systematic review of RCTs suggests that both LVSG and LRYGB are effective in resolving or improving preoperative nondiabetic comorbid diseases in obese patients. While results are not conclusive at this time, LRYGB may provide superior results compared to LVSG in mediating the remission and/or improvement in some conditions such as dyslipidemia and arthritis.

How the measurement of memory processes can affect memory performance: the case of remember/know judgments.

PubMed

Naveh-Benjamin, Moshe; Kilb, Angela

2012-01-01

Relatively little attention has been paid thus far in memory research to the effects of measurement instruments intended to assess memory processes on the constructs being measured. The current article investigates the influence of employing the popular remember/know (R/K) measurement procedure on memory performance itself. This measurement procedure was extensively used in the past to assess the respective contributions of 2 processes to memory judgments, one based on familiarity and the other on recollection. Two experiments using unrelated word pairs showed that the use of an R/K procedure can alter memory performance. Specifically, the R/K procedure improved associative memory among older but not younger adults compared to conditions in which participants were not asked to provide R/K judgments. Such an effect was not observed in item memory performance. Potential mechanisms mediating these differential memory measurement effects are outlined, and the measurement effects' implications for memory and cognitive research are discussed.

Comparison of resource utilization of pulmonary vein isolation: cryoablation versus RF ablation with three-dimensional mapping in the Value PVI Study.

PubMed

DeVille, J Brian; Svinarich, J Thomas; Dan, Dan; Wickliffe, Andrew; Kantipudi, Charan; Lim, Hae W; Plummer, Lisa; Baker, James; Kowalski, Marcin; Baydoun, Hassan; Jenkins, Mark; Chang-Sing, Peter

2014-06-01

Point-to-point focal radiofrequency (RF) catheter ablation for aberrant pulmonary vein triggers that manifest into atrial fibrillation (AF) is the traditional method for treating symptomatic drug-resistant paroxysmal AF (PAF) when an ablation procedure is warranted. More recently, pulmonary vein isolation (PVI) using the cryoballoon has been demonstrated to be safe and effective (STOP AF clinical trial). Currently, two small studies have reviewed the procedural efficiency when comparing cryoballoon to focal RF catheter ablation procedures; however, no multicenter study has yet reported on this comparison of the two types of ablation catheters. A multicenter retrospective chart extraction and evaluation was conducted at seven geographically mixed cardiac care centers. The study examined procedural variables during ablation for PVI in PAF patients. In several procedural measurements, the two modalities were comparable in efficiencies, including: acute PVI >96%; length of hospital stay at approximately 27 hours; and about 30% usage of adenosine after procedural testing. However, when compared to RF catheters, the cryoballoon procedure demonstrated a 13% reduction in laboratory occupancy time (247 min vs 283 min), a 13% reduction in procedure time (174 min vs 200 min), and a 21% reduction in fluoroscopy time (33 min vs 42 min). Additionally, when comparing the material usage of both cryoballoon and RF catheters, the cryoballoon used more radiopaque contrast agent (78 cc vs 29 cc) while using less intraprocedural saline (1234 cc vs 2386 cc), intracardiac echocardiography (88% vs 99%), three-dimensional electroanatomic mapping (30% vs 87%), and fewer transseptal punctures (1.5 vs 1.9). This study is the first United States multicenter examination to report the procedural comparisons between the cryoballoon and focal RF catheters when used for the treatment of PAF patients. In this hospital chart review study, potential advantages were found when operating the cryoballoon with regard to hospital resource allocation. There was no statistical difference between cryoballoon and RF catheters for acute PVI success during the ablation procedure.

The use of EMDR in positive verbal material: results from a patient study

PubMed Central

Matthijssen, Suzy Johanna Martina Adriana; van den Hout, Marcel

2016-01-01

Background According to the working memory (WM) theory of eye movement desensitisation and reprocessing (EMDR), dual tasks that tax WM during memory recall reduce image vividness and emotionality of memory during future recalls when no dual task is carried out. There is some evidence that WM taxing also reduces vividness and emotionality of auditory or verbal imagery. Objective The present study tests the effect of eye movements (EM) on positive verbal material (verbal imagery), which is used in different parts of the EMDR protocol. In the Dutch version of the standard EMDR protocol, a procedure “Positive Closure” (PC) is performed, which uses verbal imagery under dual task condition (EM). The value of EM in this procedure has not been established and according to the WM account would be counterproductive. Two earlier studies with undergraduates, with a set-up comparable to the present one, showed no additive value of the EM in the procedure, but no counterproductive effect either. Method Thirty-six patients rated the belief in possessing two positive personality traits and emotionality of the traits. They then had an EMDR session targeting a negative memory and recalled and re-rated the belief and emotionality of the traits afterward. Subsequently, they recalled one trait while dual tasking (EM) and the other trait without dual tasking. Afterward, they re-rated the belief and emotionality. Results EM did not affect the belief in possessing the trait or the emotionality. Secondary analysis shows an effective EMDR session itself enhances the belief in the traits, compared to a less or non-effective EMDR session. Conclusions EM are not effective in enhancing the belief in possessing a personality trait or the emotionality. If replicated by other patient studies, this suggests elimination of the PC procedure. Highlights of the article In this study the additive value of EM on verbal material (in the procedure Positive Closure) is not found. No effect of the procedure Positive Closure on the Belief in a personality trait nor the emotional intensity of the trait was found. An effective EMDR session (large reduction of the SUD during the session) was effective in changing the Belief in personality traits. PMID:27387844

Effectiveness of nonpharmacological interventions to reduce procedural anxiety in children and adolescents undergoing treatment for cancer: A systematic review and meta-analysis.

PubMed

Nunns, Michael; Mayhew, Dominic; Ford, Tamsin; Rogers, Morwenna; Curle, Christine; Logan, Stuart; Moore, Darren

2018-04-30

Children and young people (CYP) with cancer undergo painful and distressing procedures. We aimed to systematically review the effectiveness of nonpharmacological interventions to reduce procedural anxiety in CYP. Extensive literature searches sought randomised controlled trials that quantified the effect of any nonpharmacological intervention for procedural anxiety in CYP with cancer aged 0 to 25. Study selection involved independent title and abstract screening and full text screening by two reviewers. Anxiety, distress, fear, and pain outcomes were extracted from included studies. Where similar intervention, comparator, and outcomes presented, meta-analysis was performed, producing pooled effect sizes (Cohen's d) and 95% confidence intervals (95% CI). All other data were narratively described. Quality and risk of bias appraisal was performed, based on the Cochrane risk of bias tool. Screening of 11 727 records yielded 56 relevant full texts. There were 15 included studies, eight trialling hypnosis, and seven nonhypnosis interventions. There were large, statistically significant reductions in anxiety and pain for hypnosis, particularly compared with treatment as usual (anxiety: d = 2.30; 95% CI, 1.30-3.30; P < .001; pain: d = 2.16; 95% CI, 1.41-2.92; P < .001). Evidence from nonhypnosis interventions was equivocal, with some promising individual studies. There was high risk of bias across included studies limiting confidence in some positive effects. Evidence suggests promise for hypnosis interventions to reduce procedural anxiety in CYP undergoing cancer treatment. These results largely emerge from one research group, therefore wider research is required. Promising evidence for individual nonhypnosis interventions must be evaluated through rigorously conducted randomised controlled trials. Copyright © 2018 John Wiley & Sons, Ltd.

Differences in utilization of dental procedures by children enrolled in Wisconsin Medicaid and Delta Dental insurance plans.

PubMed

Bhagavatula, Pradeep; Xiang, Qun; Szabo, Aniko; Eichmiller, Fredrick; Okunseri, Christopher

2017-12-01

Few studies have directly compared dental procedures provided in public and private insurance plans for enrollees living in dental health professional shortage areas (DHPSAs). We examined the rates for the different types of dental procedures received by 0-18-year-old children living in DHPSAs and non-DHPSAs who were enrolled in Medicaid and those enrolled under Delta Dental of Wisconsin (DDW) for years 2002 to 2008. Medicaid and DDW dental claims data for 2002 to 2008 was analyzed. Enrollees were divided into DDW-DHPSA and non-DHPSA and Medicaid-DHPSA and non-DHPSA groups. Descriptive and multivariable analyses using over-dispersed Poisson regression were performed to examine the effect of living in DHPSAs and insurance type in relation to the number of procedures received. Approximately 49 and 65 percent of children living in non-DHPSAs that were enrolled in Medicaid and DDW received at least one preventive dental procedure annually, respectively. Children in DDW non-DHPSA group had 1.79 times as many preventive, 0.27 times fewer complex restorative and 0.51 times fewer endodontic procedures respectively, compared to those in Medicaid non-DHPSA group. Children enrolled in DDW-DHPSA group had 1.53 times as many preventive and 0.25 times fewer complex restorative procedures, compared to children in Medicaid-DHPSA group. DDW enrollees had significantly higher utilization rates for preventive procedures than children in Medicaid. There were significant differences across Medicaid and DDW between non-DHPSA and DHPSA for most dental procedures received by enrollees. © 2016 American Association of Public Health Dentistry.

The Effect of Special Reduction Procedures of IFU Observations from Gemini-NIFS on Dynamical Measurements of Nearby AGN

NASA Astrophysics Data System (ADS)

Pope, Crystal L.; Crenshaw, D. Michael; Fischer, Travis C.

2016-01-01

We present a preliminary analysis of the inflows and outflows in the narrow-line regions of nearby (z<0.1) AGN using observations from the Gemini-North telescope's Near-Infared Integral Field Spectrograph (NIFS). In addition to the standard reduction procedure for NIFS data cubes, these observations were treated for multiple sources of noise and artifacts from the adaptive optics observations and the NIFS instrument. This procedure included the following steps: correction of the differential atmospheric refraction, spatial resampling, low-pass Butterworth spatial filtering, removal of the "instrumental fingerprint", and the Richardson-Lucy deconvolution. We compare measurements from NIFS data cubes with and without the additional correction procedures to determine the effect of this data treatment on our scientific results.

Using Cover, Copy, and Compare Spelling with and without Timing for Elementary Students with Behavior Disorders

ERIC Educational Resources Information Center

Darrow, Danette; McLaughlin, T. F.; Derby, K. Mark; Johnson, Kathy

2012-01-01

The purpose of this study was to determine the effectiveness of cover, copy, and compare (CCC) procedures on spelling performance with two students. The participants were two elementary students enrolled in a self-contained behavior intervention classroom. A multiple baseline design across participants was employed to evaluate the effects of CCC…

Effect of Preoperative Low Maximal Flow Rate on Postoperative Voiding Trials after the Midurethral Sling Procedure in Women with Stress Urinary Incontinence.

PubMed

Chae, Ji Y; Bae, Jae H; Lee, Jeong G; Park, Hong S; Moon, Du G; Oh, Mi M

2017-06-02

To evaluate the effects of preoperative low maximal flow rate (Qmax) on voiding trials after the midurethral sling (MUS) procedure in women with stress urinary incontinence (SUI). One hundred and sixty-eight women who underwent MUS procedure were enrolled. Preoperative free uroflowmetry was performed and patients were divided by Qmax. Low Qmax was defined as a Qmax under 15 mL/sec with voided volume at least 150 mL. Surgical results, failure of voiding trial, and postoperative uroflowmetry parameters were compared between the groups. Failure of voiding trial was defined by a PVR more than 100 mL on postoperative uroflowmetry. At the discharge day, there were 42 cases showing failure of voiding trial and 33 cases requiring CIC, but only one patient showed failure of voiding trial at 12 months postoperatively. Overall, 48 patients had preoperative low Qmax. Low Qmax group showed lower Qmax in all of postoperative uroflowmetry, but there were no significant differences in the rate of postoperative voiding trial failure or CIC. The low Qmax group was then divided into two groups according to the preoperative detrusor pressure at Qmax over and under 20 cmH 2 O in pressure flow study. Comparing the two groups, no significant differences were observed in the cure rate, voiding trial failure or CIC. Our results suggest that women with preoperative low Qmax experienced no definite unfavorable voiding problem from the MUS procedure compared to those with normal voiding function. MUS procedure may be regarded as a safe and successful procedure in SUI women with low Qmax. © 2017 John Wiley & Sons Australia, Ltd.

An integrated computer-based procedure for teamwork in digital nuclear power plants.

PubMed

Gao, Qin; Yu, Wenzhu; Jiang, Xiang; Song, Fei; Pan, Jiajie; Li, Zhizhong

2015-01-01

Computer-based procedures (CBPs) are expected to improve operator performance in nuclear power plants (NPPs), but they may reduce the openness of interaction between team members and harm teamwork consequently. To support teamwork in the main control room of an NPP, this study proposed a team-level integrated CBP that presents team members' operation status and execution histories to one another. Through a laboratory experiment, we compared the new integrated design and the existing individual CBP design. Sixty participants, randomly divided into twenty teams of three people each, were assigned to the two conditions to perform simulated emergency operating procedures. The results showed that compared with the existing CBP design, the integrated CBP reduced the effort of team communication and improved team transparency. The results suggest that this novel design is effective to optim team process, but its impact on the behavioural outcomes may be moderated by more factors, such as task duration. The study proposed and evaluated a team-level integrated computer-based procedure, which present team members' operation status and execution history to one another. The experimental results show that compared with the traditional procedure design, the integrated design reduces the effort of team communication and improves team transparency.

Comparison of two procedures for predicting rocket engine nozzle performance

NASA Technical Reports Server (NTRS)

Davidian, Kenneth J.

1987-01-01

Two nozzle performance prediction procedures which are based on the standardized JANNAF methodology are presented and compared for four rocket engine nozzles. The first procedure required operator intercedence to transfer data between the individual performance programs. The second procedure is more automated in that all necessary programs are collected into a single computer code, thereby eliminating the need for data reformatting. Results from both procedures show similar trends but quantitative differences. Agreement was best in the predictions of specific impulse and local skin friction coefficient. Other compared quantities include characteristic velocity, thrust coefficient, thrust decrement, boundary layer displacement thickness, momentum thickness, and heat loss rate to the wall. Effects of wall temperature profile used as an input to the programs was investigated by running three wall temperature profiles. It was found that this change greatly affected the boundary layer displacement thickness and heat loss to the wall. The other quantities, however, were not drastically affected by the wall temperature profile change.

Fine fuel moisture measured and estimated in dead Andropogon virginicus in Hawaii

Treesearch

Francis M. Fujioka

1976-01-01

Fuel moisture estimates generated by the National Fire-Danger Rating System procedure were compared with actual fuel moisture measurements determined from laboratory analysis. Meteorological data required for the NFDRS procedure were collected at two heights to assess the effect of temperature and humidity lapse rates. Standard measurements gave the best results, but...

Effective Learning and Retention of Braille Letter Tactile Discrimination Skills in Children with Developmental Dyslexia

ERIC Educational Resources Information Center

Hayek, Maisam; Dorfberger, Shoshi; Karni, Avi

2016-01-01

Children with developmental dyslexia (DD) may differ from typical readers in aspects other than reading. The notion of a general deficit in the ability to acquire and retain procedural ("how to") knowledge as long-term procedural memory has been proposed. Here, we compared the ability of elementary school children, with and without…

Factor Retention in Exploratory Factor Analysis: A Comparison of Alternative Methods.

ERIC Educational Resources Information Center

Mumford, Karen R.; Ferron, John M.; Hines, Constance V.; Hogarty, Kristine Y.; Kromrey, Jeffery D.

This study compared the effectiveness of 10 methods of determining the number of factors to retain in exploratory common factor analysis. The 10 methods included the Kaiser rule and a modified Kaiser criterion, 3 variations of parallel analysis, 4 regression-based variations of the scree procedure, and the minimum average partial procedure. The…

Procedures for shape optimization of gas turbine disks

NASA Technical Reports Server (NTRS)

Cheu, Tsu-Chien

1989-01-01

Two procedures, the feasible direction method and sequential linear programming, for shape optimization of gas turbine disks are presented. The objective of these procedures is to obtain optimal designs of turbine disks with geometric and stress constraints. The coordinates of the selected points on the disk contours are used as the design variables. Structural weight, stress and their derivatives with respect to the design variables are calculated by an efficient finite element method for design senitivity analysis. Numerical examples of the optimal designs of a disk subjected to thermo-mechanical loadings are presented to illustrate and compare the effectiveness of these two procedures.

Interprofessional and interdisciplinary simulation-based training leads to safe sedation procedures in the emergency department.

PubMed

Sauter, Thomas C; Hautz, Wolf E; Hostettler, Simone; Brodmann-Maeder, Monika; Martinolli, Luca; Lehmann, Beat; Exadaktylos, Aristomenis K; Haider, Dominik G

2016-08-02

Sedation is a procedure required for many interventions in the Emergency department (ED) such as reductions, surgical procedures or cardioversions. However, especially under emergency conditions with high risk patients and rapidly changing interdisciplinary and interprofessional teams, the procedure caries important risks. It is thus vital but difficult to implement a standard operating procedure for sedation procedures in any ED. Reports on both, implementation strategies as well as their success are currently lacking. This study describes the development, implementation and clinical evaluation of an interprofessional and interdisciplinary simulation-based sedation training concept. All physicians and nurses with specialised training in emergency medicine at the Berne University Department of Emergency Medicine participated in a mandatory interdisciplinary and interprofessional simulation-based sedation training. The curriculum consisted of an individual self-learning module, an airway skill training course, three simulation-based team training cases, and a final practical learning course in the operating theatre. Before and after each training session, self-efficacy, awareness of emergency procedures, knowledge of sedation medication and crisis resource management were assessed with a questionnaire. Changes in these measures were compared via paired tests, separately for groups formed based on experience and profession. To assess the clinical effect of training, we collected patient and team satisfaction as well as duration and complications for all sedations in the ED within the year after implementation. We further compared time to beginning of procedure, time for duration of procedure and time until discharge after implementation with the one year period before the implementation. Cohen's d was calculated as effect size for all statistically significant tests. Fifty staff members (26 nurses and 24 physicians) participated in the training. In all subgroups, there is a significant increase in self-efficacy and knowledge with high effect size (d z  = 1.8). The learning is independent of profession and experience level. In the clinical evaluation after implementation, we found no major complications among the sedations performed. Time to procedure significantly improved after the introduction of the training (d = 0.88). Learning is independent of previous working experience and equally effective in raising the self-efficacy and knowledge in all professional groups. Clinical outcome evaluation confirms the concepts safety and feasibility. An interprofessional and interdisciplinary simulation-based sedation training is an efficient way to implement a conscious sedation concept in an ED.

The Comparison of Thyroarytenoid Muscle Myectomy and Type II Thyroplasty for Spasmodic Dysphonia.

PubMed

Nomoto, Masaki; Tokashiki, Ryoji; Hiramatsu, Hiroyuki; Konomi, Ujimoto; Motohashi, Rei; Sakurai, Eriko; Toyomura, Fumimasa; Ueda, Yuri; Inoue, Shun; Tsukahara, Kiyoaki; Suzuki, Mamoru

2015-07-01

Surgical treatments for adductor spasmodic dysphonia include bilateral thyroarytenoid muscle myectomy (TAM) and type II thyroplasty (TPII), both of which are commonly performed. The present study aimed to compare the effects of TAM and TPII. Retrospective study. Subjects were 30 and 35 patients who underwent TAM and TPII, between March 2008 and November 2012. Voice quality was evaluated based on "voice handicap index 10 (VHI10)" and auditory impressions before and 6 months after surgery using five parameters: "strangulation," "interruption," "tremor," "grade," and "breathiness." Comparison of the two procedures revealed significant improvements in VHI10, strangulation, interruption, and tremor, and a significant decline in breathiness after surgery. In particular, VHI10 was improved by more than six points in 90% of patients with TAM, and 96% with TPII. No significant difference was observed between the severities of two procedures preoperatively. Comparison of each postoperative score between the two procedures revealed that TAM significantly improved strangulation, interruption, and tremor, and significantly worsened breathiness, with no significant difference in VHI10. Scatter plots (x: preoperative scores; y: postoperative scores) and regression lines of evaluation items demonstrated that TAM is more effective than TPII in severe cases. Compared with TPII, TAM tends to improve strangulation, interruption, and tremor; however, it tends to worsen breathiness postoperatively. Postoperative VHI10 scores did not differ significantly between the two procedures. Given favorable improvement rates, both surgical procedures were considered effective. Copyright © 2015 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

Ground experiments for finding principles and working out methods for preventing adverse effects of weightlessness on the human organism

NASA Technical Reports Server (NTRS)

Kakurin, L. I.; Gregoryev, A. I.; Mikhailov, V. M.; Tishler, V. A.

1980-01-01

A comparative assessment of the effectiveness of different prophylactic procedures to prevent the adverse effects of weightlessness is presented. It is concluded that: physical training is most effective but no single method by itself produces the full effect, and an adjustment of regimes to one another enhances the effect. The approved complex of prophylactic procedures affected basic changes occurring in hypokinesia: deficit of muscular activity, no or reduced BP hydrostatic component, reduced volume of blood circulation, reduced hydration level, and the application of various prophylactic complexes during 49 day antiorthostatic hypodynamia eliminated or reduced the adverse effects of weightlessness in simulation.

Extraction of DNA from forensic-type sexual assault specimens using simple, rapid sonication procedures.

PubMed

Crouse, C A; Ban, J D; D'Alessio, J K

1993-10-01

Sonication procedures for the extraction of DNA from forensic-type semen specimens have been developed, which, when compared to currently utilized sperm DNA extraction techniques, are simple, rapid and result in comparable DNA yields. Sperm DNA extraction by sonication was performed on whole semen, seminal stains, buccal swabs and post-coital specimens. Ultrasound disruption of sperm cells and their ultimate release of cellular DNA has been conducted in the presence of sperm wash buffers followed by organic extraction or Chelex 100 with little or no compromise to DNA quality, quantity or amplifiability. Two advantages of sonication over currently used forensic techniques to extract sperm DNA include 1) sperm DNA extraction that occurs within five minutes of sonication compared with an hour or greater for water bath incubations in classic enzyme digestion DNA extractions and 2) one less preparatory step with the Chelex/sonication protocol and three less steps with the sonication/organic protocol compared with other procedures thus eliminating potential sample-to-sample cross-contamination. Sperm DNA extracted by optimum sonication procedures was used for forensic HLA DQ alpha typing and restriction fragment length polymorphisms analysis without any adverse effects on typing results.

Resident versus no resident: a single institutional study on operative complications, mortality, and cost.

PubMed

Hwang, Christine S; Pagano, Christina R; Wichterman, Keith A; Dunnington, Gary L; Alfrey, Edward J

2008-08-01

Previous studies have demonstrated an increase in surgical morbidity, mortality, duration of stay, and costs in teaching hospitals. These studies are confounded by many variables. Controlling for these variables, we studied the effect of surgical residents on these outcomes during rotations with non-academic-based teaching faculty at a teaching hospital. Patients received care at a single teaching hospital from a group of 8 surgeons. Four surgeons did not have resident coverage (group 1) and the other 4 had coverage (group 2). Continuous severity adjusted complications, mortality, length of stay, cost, and hospital margin data were collected and compared. Five common procedures were examined: bowel resection, laparoscopic cholecystectomy, hernia, mastectomy, and appendectomy. Comparing all procedures together, there were no differences in complications between the groups, although there was greater mortality, a greater duration of stay, and higher costs in group 2. When comparing the 5 most common procedures individually, there was no difference in complications or mortality, although a greater length of stay and higher costs in group 2. Comparing the most common procedures performed individually, patients cared for by surgeons with surgical residents at a teaching hospital have an increase in duration of stay and cost, although no difference in complications or mortality compared to surgeons without residents.

Markov chain decision model for urinary incontinence procedures.

PubMed

Kumar, Sameer; Ghildayal, Nidhi; Ghildayal, Neha

2017-03-13

Purpose Urinary incontinence (UI) is a common chronic health condition, a problem specifically among elderly women that impacts quality of life negatively. However, UI is usually viewed as likely result of old age, and as such is generally not evaluated or even managed appropriately. Many treatments are available to manage incontinence, such as bladder training and numerous surgical procedures such as Burch colposuspension and Sling for UI which have high success rates. The purpose of this paper is to analyze which of these popular surgical procedures for UI is effective. Design/methodology/approach This research employs randomized, prospective studies to obtain robust cost and utility data used in the Markov chain decision model for examining which of these surgical interventions is more effective in treating women with stress UI based on two measures: number of quality adjusted life years (QALY) and cost per QALY. Treeage Pro Healthcare software was employed in Markov decision analysis. Findings Results showed the Sling procedure is a more effective surgical intervention than the Burch. However, if a utility greater than certain utility value, for which both procedures are equally effective, is assigned to persistent incontinence, the Burch procedure is more effective than the Sling procedure. Originality/value This paper demonstrates the efficacy of a Markov chain decision modeling approach to study the comparative effectiveness analysis of available treatments for patients with UI, an important public health issue, widely prevalent among elderly women in developed and developing countries. This research also improves upon other analyses using a Markov chain decision modeling process to analyze various strategies for treating UI.

An improved filter elution and cell culture assay procedure for evaluating public groundwater systems for culturable enteroviruses.

PubMed

Dahling, Daniel R

2002-01-01

Large-scale virus studies of groundwater systems require practical and sensitive procedures for both sample processing and viral assay. Filter adsorption-elution procedures have traditionally been used to process large-volume water samples for viruses. In this study, five filter elution procedures using cartridge filters were evaluated for their effectiveness in processing samples. Of the five procedures tested, the third method, which incorporated two separate beef extract elutions (one being an overnight filter immersion in beef extract), recovered 95% of seeded poliovirus compared with recoveries of 36 to 70% for the other methods. For viral enumeration, an expanded roller bottle quantal assay was evaluated using seeded poliovirus. This cytopathic-based method was considerably more sensitive than the standard plaque assay method. The roller bottle system was more economical than the plaque assay for the evaluation of comparable samples. Using roller bottles required less time and manipulation than the plaque procedure and greatly facilitated the examination of large numbers of samples. The combination of the improved filter elution procedure and the roller bottle assay for viral analysis makes large-scale virus studies of groundwater systems practical. This procedure was subsequently field tested during a groundwater study in which large-volume samples (exceeding 800 L) were processed through the filters.

Report on the study of the tax and rate treatment of renewable energy projects

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

Hadley, S.W.; Hill, L.J.; Perlack, R.D.

1993-12-01

This study was conducted in response to the requirements of Section 1205 of the Energy Policy Act of 1992 (EPACT), which states: The Secretary (of Energy), in conjunction with State regulatory commissions, shall undertake a study to determine if conventional taxation and ratemaking procedures result in economic barriers to or incentives for renewable energy power plants compared to conventional power plants. The purpose of the study, therefore, is not to compare the cost-effectiveness of different types of renewable and conventional electric generating plants. Rather, it is to determine the relative impact of conventional ratemaking and taxation procedures on the selectionmore » of renewable power plants compared to conventional ones. To make this determination, we quantify the technical and financial parameters of renewable and conventional electric generating technologies, and hold them fixed throughout the study. Then, we vary taxation and ratemaking procedures to determine their effects on the financial criteria that investor-owned electric utilities (IOUs) and nonutility electricity generators (NUGs) use to make technology-adoption decisions. In the planning process of a typical utility, the opposite is usually the case. That is, utilities typically hold ratemaking and taxation procedures constant and look for the least-cost mix of resources, varying the values of engineering and financial parameters of generating plants in the process.« less

Direct versus indirect revascularization procedures for moyamoya disease: a comparative effectiveness study.

PubMed

Macyszyn, Luke; Attiah, Mark; Ma, Tracy S; Ali, Zarina; Faught, Ryan; Hossain, Alisha; Man, Karen; Patel, Hiren; Sobota, Rosanna; Zager, Eric L; Stein, Sherman C

2017-05-01

OBJECTIVE Moyamoya disease (MMD) is a chronic cerebrovascular disease that can lead to devastating neurological outcomes. Surgical intervention is the definitive treatment, with direct, indirect, and combined revascularization procedures currently employed by surgeons. The optimal surgical approach, however, remains unclear. In this decision analysis, the authors compared the effectiveness of revascularization procedures in both adult and pediatric patients with MMD. METHODS A comprehensive literature search was performed for studies of MMD. Using complication and success rates from the literature, the authors constructed a decision analysis model for treatment using a direct and indirect revascularization technique. Utility values for the various outcomes and complications were extracted from the literature examining preferences in similar clinical conditions. Sensitivity analysis was performed. RESULTS A structured literature search yielded 33 studies involving 4197 cases. Cases were divided into adult and pediatric populations. These were further subdivided into 3 different treatment groups: indirect, direct, and combined revascularization procedures. In the pediatric population at 5- and 10-year follow-up, there was no significant difference between indirect and combination procedures, but both were superior to direct revascularization. In adults at 4-year follow-up, indirect was superior to direct revascularization. CONCLUSIONS In the absence of factors that dictate a specific approach, the present decision analysis suggests that direct revascularization procedures are inferior in terms of quality-adjusted life years in both adults at 4 years and children at 5 and 10 years postoperatively, respectively. These findings were statistically significant (p < 0.001 in all cases), suggesting that indirect and combination procedures may offer optimal results at long-term follow-up.

Avagard hand antisepsis vs. traditional scrub in 3600 pediatric urologic procedures.

PubMed

Weight, Christopher J; Lee, Michael C; Palmer, Jeffrey S

2010-07-01

Avagard is a waterless, scrubless, and brushless hand antiseptic approved by the Food and Drug Administration as a replacement for traditional presurgical brush hand scrubbing. We evaluated the use of Avagard compared with hand brush scrub preparation for inpatient and outpatient pediatric urological operations. We evaluated the first 1800 patients for whom we used Avagard as a preoperative hand antiseptic and compared them with the last 1800 consecutive patients for whom we performed traditional antiseptic-impregnated hand-brush scrubbing. All patients underwent a variety of inpatient and outpatient open, endoscopic, and laparoscopic pediatric urological procedures. Patients were monitored postoperatively for wound infection, and patients and surgeon were monitored for side effects. A cost analysis was performed. The incidence of wound infection was 2/1800 (0.11%) in the Avagard group and 3/1800 (0.17%) in the hand-scrub group (P > .99 Fisher's exact test). All wound infections were successfully treated with a single course of oral antibiotics. No side effects for the patients or surgeon were noted, including skin irritations or allergic reactions in either group. The traditional hand scrub is nearly 2 times more expensive per application than Avagard. The incidence of wound infections in pediatric urological procedures is low (0.09%). We observe that Avagard provides comparable hand antisepsis to the traditional surgical scrub in a variety of pediatric urological procedures. Avagard is superior to the surgical hand scrub in cost-effectiveness and time efficiency. Urologists should consider using Avagard for hand antisepsis before surgery. Copyright 2010 Elsevier Inc. All rights reserved.

Autoshaping in adolescence enhances sign-tracking behavior in adulthood: Impact on ethanol consumption

PubMed Central

Anderson, Rachel I.; Spear, Linda P.

2011-01-01

Autoshaping refers to a procedure during which a cue repeatedly paired with a reward elicits a conditioned response directed at either the reward delivery location (“goal-tracking”) or the cue itself (“sign-tracking”). Individual differences in expression of sign-tracking behavior may be predictive of voluntary ethanol intake. The present study was designed to explore the development of differences in sign-tracking behavior in adolescent and adult male and female rats in an 8-day autoshaping procedure. Consistency of sign-tracking and goal-tracking across age was examined by retesting adolescents again in adulthood and comparing their adult data with animals tested only as adults to explore pre-exposure effects on adult responding. In order to assess the relationship between sign-tracking and ethanol intake, voluntary ethanol consumption was measured in an 8-day, 2-hr limited access drinking paradigm following the 8-day autoshaping procedure in adulthood. Animals tested as adolescents showed notably less sign-tracking behavior than animals tested as adults, and sign-tracking behavior was not correlated across age. Animals exposed to the autoshaping procedure as adolescents demonstrated greater sign-tracking behavior as adults when compared to control animals tested only in adulthood. When examining the relationship in adulthood between sign-tracking and ethanol intake, an increase in ethanol intake among sign-trackers was found only in animals pre-exposed to autoshaping as adolescents. Whether or not these results reflect an adolescent-specific experience effect is unclear without further work to determine whether comparable pre-exposure effects are seen if the initial autoshaping sessions are delayed into adulthood. PMID:21238477

Comparing the Effectiveness of Error-Correction Strategies in Discrete Trial Training

ERIC Educational Resources Information Center

Turan, Michelle K.; Moroz, Lianne; Croteau, Natalie Paquet

2012-01-01

Error-correction strategies are essential considerations for behavior analysts implementing discrete trial training with children with autism. The research literature, however, is still lacking in the number of studies that compare and evaluate error-correction procedures. The purpose of this study was to compare two error-correction strategies:…

Office-based procedures for diagnosis and treatment of esophageal pathology.

PubMed

Wellenstein, David J; Schutte, Henrieke W; Marres, Henri A M; Honings, Jimmie; Belafsky, Peter C; Postma, Gregory N; Takes, Robert P; van den Broek, Guido B

2017-09-01

Diagnostic and therapeutic office-based procedures under topical anesthesia are emerging in the daily practice of laryngologists and head and neck surgeons. Since the introduction of the transnasal esophagoscope, office-based procedures for the esophagus are increasingly performed. We conducted a systematic review of literature on office-based procedures under topical anesthesia for the esophagus. Transnasal esophagoscopy is an extensively investigated office-based procedure. This procedure shows better patient tolerability and equivalent accuracy compared to conventional transoral esophagoscopy, as well as time and cost savings. Secondary tracheoesophageal puncture, esophageal dilatation, esophageal sphincter injection, and foreign body removal are less investigated, but show promising results. With the introduction of the transnasal esophagoscope, an increasing number of diagnostic and therapeutic office-based procedures for the esophagus are possible, with multiple advantages. Further investigation must prove the clinical feasibility and effectiveness of the therapeutic office-based procedures. © 2017 Wiley Periodicals, Inc.

Ultrasound-guided shoulder MR arthrography: comparison of rotator interval and posterior approach.

PubMed

Ogul, Hayri; Bayraktutan, Ummugulsum; Ozgokce, Mesut; Tuncer, Kutsi; Yuce, Ihsan; Yalcin, Ahmet; Pirimoglu, Berhan; Sagsoz, Erdem; Kantarci, Mecit

2014-01-01

The purpose of this study was to prospectively evaluate the two different ultrasound-guided injection techniques for magnetic resonance (MR) arthrography of the shoulder. This study included 100 patients [50 rotator interval group (n=50) vs. 50 posterior approach group (n=50)]. All procedures were performed by the same radiologist. The two injection techniques were compared. The discomfort during and after arthrography was evaluated. Extraarticular contrast media extravasation was graded according to the MRI findings. The number of injection attempts, effect of contrast media extravasation rate on diagnostic quality and procedure times were recorded. There were no significant difference between the posterior and rotator interval puncture groups with regard to pain (P=.915), procedure times (P=.401) or attempt scores (P=.182). There were significantly more contrast media extravasations with rotator interval approach than posterior approach (P<.05). Both techniques were successful and well tolerated by patients. Posterior injection technique provided a more effective route with decreased extravasation rate and easier approach compared to the rotator interval approach. © 2014.

Re-evaluation of constant versus varied punishers using empirically derived consequences.

PubMed

Toole, Lisa M; DeLeon, Iser G; Kahng, SungWoo; Ruffin, Geri E; Pletcher, Carrie A; Bowman, Lynn G

2004-01-01

Charlop, Burgio, Iwata, and Ivancic [J. Appl. Behav. Anal. 21 (1988) 89] demonstrated that varied punishment procedures produced greater or more consistent reductions of problem behavior than a constant punishment procedure. More recently, Fisher and colleagues [Res. Dev. Disabil. 15 (1994) 133; J. Appl. Behav. Anal. 27 (1994) 447] developed a systematic methodology for predicting the efficacy of various punishment procedures. Their procedure identified reinforcers and punishers (termed "empirically derived consequences" or EDC) that, when used in combination, reduced the destructive behavior of individuals with developmental disabilities who displayed automatically maintained destructive behavior. The current investigation combines these two lines of research by comparing the effects of constant versus varied punishers on the self-injury of two individuals with developmental disabilities. The punishing stimuli were selected via the procedures described by Fisher et al. and were predicted to be at varying levels of effectiveness. The varied presentation of punishers resulted in enhanced suppressive effects over the constant presentation of a punisher for one of two individuals, but only in comparison to a single stimulus predicted to be minimally effective. Even then, the differences were small. These results suggest that the additive effects of varied punishment are negligible if clinicians use stimuli predicted to be effective and are discussed in terms of the conditions under which stimulus variation could potentially enhance the effects of punishers.

Balloon enteroscopy versus spiral enteroscopy for small-bowel disorders: a systematic review and meta-analysis.

PubMed

Baniya, Ramkaji; Upadhaya, Sunil; Subedi, Subash Chandra; Khan, Jahangir; Sharma, Prabin; Mohammed, Tabrez Shaik; Bachuwa, Ghassan; Jamil, Laith H

2017-12-01

Two novel enteroscopic procedures, balloon enteroscopy and spiral enteroscopy, have revolutionized the diagnostic and therapeutic approach to small-bowel disorders. These disorders that historically required surgical interventions are now investigated and managed nonsurgically. Only a few weakly powered studies have compared the outcomes of spiral enteroscopy and balloon enteroscopy. We conducted a systematic review and meta-analysis to compare the efficacy and safety of these 2 procedures. PubMed, Cochrane Library, Scopus, and clinicaltrials.gov databases were searched for all studies published up to January 12, 2017 comparing the efficacy and safety of balloon enteroscopy (single or double) and spiral enteroscopy. Primary outcomes of interest were diagnostic and therapeutic success rates. Other outcomes included procedure length, depth of maximal insertion (DMI), rate of complete enteroscopy, and adverse events. We calculated Odds ratios (ORs) for categorical variables and mean difference (MD) for continuous variables. The Mantel-Haenszel method was used to analyze the data. Fixed and random effect models were used for <50% heterogeneity and >50% heterogeneity, respectively. Eight studies met the inclusion criteria for this meta-analysis. A total of 615 procedures were analyzed, which included 394 balloon enteroscopy and 221 spiral enteroscopy procedures. There were no significant differences in diagnostic and therapeutic success rates (OR, 1.27; 95% confidence interval [CI], .86-1.88; P = .22; and OR, 1.23; 95% CI, .82-1.84; P = .32, respectively) between the 2 procedures. Similarly, DMI was not significantly different between the 2 groups (MD, 26.29; 95% CI, 20.92-73.49; P = .28). However, the procedure time was significantly shorter for the spiral enteroscopy group compared with the balloon enteroscopy group (MD, 11.26; 95% CI, 2.72-19.79; P = .010). A subgroup analysis comparing double balloon enteroscopy with spiral enteroscopy yielded similar results. Both procedures achieved similar diagnostic and therapeutic outcomes and with similar depth of insertion. Spiral enteroscopy has the benefit of shorter procedural time. Copyright © 2017 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.

Geometric correction of satellite data using curvilinear features and virtual control points

NASA Technical Reports Server (NTRS)

Algazi, V. R.; Ford, G. E.; Meyer, D. I.

1979-01-01

A simple, yet effective procedure for the geometric correction of partial Landsat scenes is described. The procedure is based on the acquisition of actual and virtual control points from the line printer output of enhanced curvilinear features. The accuracy of this method compares favorably with that of the conventional approach in which an interactive image display system is employed.

A Comparison of Discrete Trial Teaching with and without Gestures/Signs in Teaching Receptive Language Skills to Children with Autism

ERIC Educational Resources Information Center

Kurt, Onur

2011-01-01

The present study was designed to compare the effectiveness and efficiency of two discrete trial teaching procedures for teaching receptive language skills to children with autism. While verbal instructions were delivered alone during the first procedure, all verbal instructions were combined with simple gestures and/or signs during the second…

Reducing Seclusion Timeout and Restraint Procedures with At-Risk Youth

ERIC Educational Resources Information Center

Ryan, Joseph B.; Peterson, Reece; Tetreault, George; Hagen, Emily Vander

2007-01-01

The purpose of this pilot study was to review the effects of professional staff training in crisis management and de-escalation techniques on the use of seclusion timeout and restraint procedures with at-risk students in a K-12 special day school. An exploratory pre-post study was conducted over a two-year period, comparing the use of these…

Effects of model error on control of large flexible space antenna with comparisons of decoupled and linear quadratic regulator control procedures

NASA Technical Reports Server (NTRS)

Hamer, H. A.; Johnson, K. G.

1986-01-01

An analysis was performed to determine the effects of model error on the control of a large flexible space antenna. Control was achieved by employing two three-axis control-moment gyros (CMG's) located on the antenna column. State variables were estimated by including an observer in the control loop that used attitude and attitude-rate sensors on the column. Errors were assumed to exist in the individual model parameters: modal frequency, modal damping, mode slope (control-influence coefficients), and moment of inertia. Their effects on control-system performance were analyzed either for (1) nulling initial disturbances in the rigid-body modes, or (2) nulling initial disturbances in the first three flexible modes. The study includes the effects on stability, time to null, and control requirements (defined as maximum torque and total momentum), as well as on the accuracy of obtaining initial estimates of the disturbances. The effects on the transients of the undisturbed modes are also included. The results, which are compared for decoupled and linear quadratic regulator (LQR) control procedures, are shown in tabular form, parametric plots, and as sample time histories of modal-amplitude and control responses. Results of the analysis showed that the effects of model errors on the control-system performance were generally comparable for both control procedures. The effect of mode-slope error was the most serious of all model errors.

Nitrous oxide for pain management during in-office hysteroscopic sterilization: a randomized controlled trial.

PubMed

Schneider, Emily N; Riley, Regan; Espey, Eve; Mishra, Shiraz I; Singh, Rameet H

2017-03-01

To evaluate whether inhaled nitrous oxide with oxygen (N 2 O/O 2 ) is associated with less pain compared to oral sedation for pain management during in-office hysteroscopic sterilization. This double blinded randomized controlled trial enrolled women undergoing in-office hysteroscopic sterilization. All participants received pre-procedure intramuscular ketorolac and a standardized paracervical block. The intervention group also received N 2 O/O 2 via a nasal mask titrated to a maximum 70%:30% mixture by a nurse during the procedure and placebo pills pre-procedure and the active control group received inhaled O 2 during the procedure and 5/325 mg hydrocodone/acetaminophen and 1 mg lorazepam pre-procedure. The primary outcome was maximum procedure pain on a 100 mm Visual Analog Scale (VAS with anchors at 0=no pain and 100=worst imaginable pain) assessed 3-5 min post procedure. Thirty women per treatment arm were required to detect a clinically significant pain difference of 20 mm. Seventy-two women, 36 per study arm, were randomized. Mean age of participants was 34.1±5.7 years and mean BMI was 30.1±6.6kg/m 2 . Mean maximum procedure pain scores were 22.8±27.6 mm and 54.5±32.7 mm for intervention and control groups, respectively (p<.001). Most study participants (97%) stated N 2 O/O 2 should be offered for gynecologic office procedures and 86% would pay for it if not a covered benefit. N 2 O/O 2 decreased pain with in-office hysteroscopic sterilization compared to oral sedation and is an effective pain management option for this procedure. Given its safety and favorable side effect profile, N 2 O/O 2 can be used for pain management for in-office hysteroscopic sterilization and adds a safe, easily administered option to currently available strategies. Copyright © 2016 Elsevier Inc. All rights reserved.

Breastfeeding or breast milk for procedural pain in neonates.

PubMed

Shah, Prakeshkumar S; Herbozo, Cecilia; Aliwalas, Lucia Liz; Shah, Vibhuti S

2012-12-12

Physiological changes brought about by pain may contribute to the development of morbidity in neonates. Clinical studies have shown reduction in changes in physiological parameters and pain score measurements following pre-emptive analgesic administration in situations where the neonate is experiencing pain or stress. Non-pharmacological measures (such as holding, swaddling and breastfeeding) and pharmacological measures (such as acetaminophen, sucrose and opioids) have been used for this purpose. The primary objective was to evaluate the effectiveness of breastfeeding or supplemental breast milk in reducing procedural pain in neonates. The secondary objective was to conduct subgroup analyses based on the type of control intervention, gestational age and the amount of supplemental breast milk given. We performed a literature search using the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2011, Issue 10), MEDLINE (1966 to February 2011), EMBASE (1980 to February 2011), CINAHL (1982 to February 2011), abstracts from the annual meetings of the Society for Pediatric Research (1994 to 2011), and major paediatric pain conference proceedings. We did not apply any language restrictions. Randomised controlled trials (RCTs) or quasi-RCTs of breastfeeding or supplemental breast milk versus no treatment/other measures in neonates were eligible for inclusion in this review. The study must have reported on either physiologic markers of pain or validated pain scores. We assessed the methodological quality of the trials using the information provided in the studies and by personal communication with the authors. We extracted data on relevant outcomes, estimated the effect size and reported this as a risk ratio (RR), risk difference (RD) and weighted mean difference (MD) as appropriate. Of twenty eligible studies, ten evaluated breastfeeding and ten evaluated supplemental breast milk. Sixteen studies analysed used heel lance and four used venepuncture as procedure. We noted marked heterogeneity in control intervention and pain assessment measures among the studies. Neonates in the breastfeeding group had statistically a significantly lower increase in heart rate, reduced proportion of crying time and reduced duration of first cry and total crying time compared to positioning (swaddled and placed in a crib), holding by mother, placebo, pacifier use, no intervention or oral sucrose group, or both.Premature Infant Pain Profile (PIPP) scores were significantly lower in the breastfeeding group compared to positioning, placebo or oral sucrose group, or both. However, there was no statistically significant difference in PIPP scores when compared to no intervention. Douleur Aigue Nouveau-ne scores (DAN) were significantly lower in the breastfeeding group compared to the placebo group and the group held in mother's arms, but not when compared to the glucose group. Neonatal Infant Pain Scale (NIPS) was significantly lower in the breastfeeding group compared to the no intervention group, but there was no difference when compared to the oral sucrose group. The Neonatal Facial Coding System (NFCS) was significantly lower in the breastfeeding group when compared to oral glucose, pacifier use, holding by mother and no intervention, but no difference was found when compared to formula feeding.Supplemental breast milk yielded variable results. Neonates in the supplemental breast milk group had a significantly lower increase in heart rate, a reduction in duration of crying and a lower NFCS compared to the placebo group. Neonates in the supplemental breast milk group had a significantly higher increase in heart rate changes when compared to the sucrose group. Sucrose (in any concentration, i.e. 12.5%, 20%, 25%) was found to reduce the duration of cry when compared to breast milk, as did glycine, pacifier use, rocking, or no intervention. Breast milk was found not to be effective in reducing validated and non-validated pain scores such as NIPS, NFCS, and DAN; only being significantly better when compared to placebo (water) or massage. We did not identify any study that has evaluated safety/effectiveness of repeated administration of breastfeeding or supplemental breast milk for pain relief. If available, breastfeeding or breast milk should be used to alleviate procedural pain in neonates undergoing a single painful procedure rather than placebo, positioning or no intervention. Administration of glucose/sucrose had similar effectiveness as breastfeeding for reducing pain. The effectiveness of breast milk for painful procedure should be studied in the preterm population, as there are currently a limited number of studies in the literature that have assessed it's effectiveness in this population.

Meta-analyzing dependent correlations: an SPSS macro and an R script.

PubMed

Cheung, Shu Fai; Chan, Darius K-S

2014-06-01

The presence of dependent correlation is a common problem in meta-analysis. Cheung and Chan (2004, 2008) have shown that samplewise-adjusted procedures perform better than the more commonly adopted simple within-sample mean procedures. However, samplewise-adjusted procedures have rarely been applied in meta-analytic reviews, probably due to the lack of suitable ready-to-use programs. In this article, we compare the samplewise-adjusted procedures with existing procedures to handle dependent effect sizes, and present the samplewise-adjusted procedures in a way that will make them more accessible to researchers conducting meta-analysis. We also introduce two tools, an SPSS macro and an R script, that researchers can apply to their meta-analyses; these tools are compatible with existing meta-analysis software packages.

[The transrectus sheath preperitoneal procedure: a safe, effective and cheap surgical approach to inguinal hernia?].

PubMed

Prins, M W Wiesje; Voropai, D A Dasha; van Laarhoven, C J H M Kees; Akkersdijk, Willem L

2013-01-01

The main complication of surgery for inguinal hernia is chronic postoperative pain. This is often reported following the Lichtenstein procedure. A new, open surgical technique for the repair of inguinal hernia has been developed. This procedure is called the transrectus sheath preperitoneal procedure (TREPP). At TREPP a lightweight mesh with a ring made of memory metal is introduced into the preperitoneal space through the transrectus sheath. The first results of this operative technique are very promising: short operation time, short learning curve and not many patients with chronic postoperative pain. In a randomised, multi-centre study which will start mid-2013 (ISRCTN18591339), the TREPP procedure is compared with the transinguinal preperitoneal procedure. The primary outcome measure of this study is chronic postoperative pain.

Comparative Evaluation of Effects of Laser Modalities on Shear Bond Strengths of Veneering Porcelains to Laser Sintered Substructures: An In Vitro Study.

PubMed

Gorler, Oguzhan; Saygin, Aysegul Goze

2017-06-01

Laser modalities and direct metal laser sintering (DMLS) have a potential to enhance micromechanical bonding between dental super- and infrastructures. However, the effect of different manufacturing methods on the metal-ceramic bond strength needs further evaluation. We investigated the effect of surface treatment with Er:YAG, Nd:YAG, and Ho:YAG lasers on the shear bond strength (SBS) of high-fusion dental porcelains (Vita and G-Ceram) to infrastructures prepared with DMLS in vitro settings. Study specimens (n = 128) were randomly divided into study subsets (n = 8), considering treatment types applied on the surface of infrastructures, including sandblasting and selected laser modalities; infrastructure types as direct laser sintered (DLS) and Ni-Cr based; and superstructure porcelains as Vita and G-Ceram. The SBS test was performed to assess the effectiveness of surface modifications that were also examined with a stereo microscope. Considering laser procedure types, the highest SBS values were obtained by Er:YAG laser, followed by, with a decreasing efficiency, Ho:YAG laser and sandblasting procedures, and Nd:YAG laser procedure (p < 0.05). Nd:YAG laser decreases the bonding of Vita and G-Ceram in all the infrastructures compared with sandblasting. Considering porcelains, the highest SBS values were obtained by Vita (p < 0.05). Considering infrastructures, the highest SBS values were obtained by DMLS procedure (p < 0.05). The laser procedures caused surface irregularities as revealed by the stereo microscopic examination. In current experimental settings, Er:YAG laser applied to DLS infrastructure veneered with Vita porcelain increases bonding strength more distinctly, and Nd:YAG laser applied to Ni-Cr-based infrastructure veneered with G-Ceram porcelain alters bonding strength unfavorably.

Recollection and familiarity for words and faces: a study comparing Remember-Know judgements and the Process Dissociation Procedure.

PubMed

Espinosa-García, María; Vaquero, Joaquín M M; Milliken, Bruce; Tudela, Pío

2017-01-01

Measures of recollection and familiarity often differ depending on the paradigm utilised. Remember-Know (R-K) and Process Dissociation Procedure (PDP) methods have been commonly used but rarely compared within a single study. In the current experiments, R-K and PDP were compared by examining the effect of attention at study and time to respond at test on recollection and familiarity using the same experimental procedures for each paradigm. We also included faces in addition to words to test the generality of the findings often obtained using words. The results from the R-K paradigm revealed that recollection and familiarity were similarly affected by attention at study and time to respond at test. However, in the case of PDP, the measures of recollection and familiarity showed a different pattern of results. The effects observed for recollection were similar to those obtained with the R-K method, whereas familiarity was affected by time to respond but not by attention at study. These results are discussed in relation to the controlled-automatic processing distinction and the contribution of each paradigm to research on recognition memory.

Bayesian parameter estimation for chiral effective field theory

NASA Astrophysics Data System (ADS)

Wesolowski, Sarah; Furnstahl, Richard; Phillips, Daniel; Klco, Natalie

2016-09-01

The low-energy constants (LECs) of a chiral effective field theory (EFT) interaction in the two-body sector are fit to observable data using a Bayesian parameter estimation framework. By using Bayesian prior probability distributions (pdfs), we quantify relevant physical expectations such as LEC naturalness and include them in the parameter estimation procedure. The final result is a posterior pdf for the LECs, which can be used to propagate uncertainty resulting from the fit to data to the final observable predictions. The posterior pdf also allows an empirical test of operator redundancy and other features of the potential. We compare results of our framework with other fitting procedures, interpreting the underlying assumptions in Bayesian probabilistic language. We also compare results from fitting all partial waves of the interaction simultaneously to cross section data compared to fitting to extracted phase shifts, appropriately accounting for correlations in the data. Supported in part by the NSF and DOE.

Effect of Kangaroo mother care in reducing pain due to heel prick among preterm neonates: a crossover trial.

PubMed

Chidambaram, Ambika Gnanam; Manjula, S; Adhisivam, B; Bhat, B Vishnu

2014-03-01

Preterm neonates undergo several painful procedures in NICU including heel prick for blood sugar monitoring. Nonpharmacological interventions have been tried to decrease this procedural pain. There are only few studies on Kangaroo mother care (KMC) in reducing pain among preterm neonates. This crossover trial was conducted at a tertiary care teaching hospital in south India. Premature Infant Pain Profile (PIPP) related to heel prick was assessed in 50 preterm neonates undergoing KMC and compared with 50 preterm babies without KMC. PIPP scores at 15 minutes and 30 minutes after heel prick were significantly less in KMC group compared to control group. Mean PIPP difference between baseline and 30 minutes after heel prick was also significantly low in KMC group compared to control group. KMC is effective in reducing pain due to heel prick among preterm babies.

47 CFR 22.935 - Procedures for comparative renewal proceedings.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 47 Telecommunication 2 2014-10-01 2014-10-01 false Procedures for comparative renewal proceedings... SERVICES PUBLIC MOBILE SERVICES Cellular Radiotelephone Service § 22.935 Procedures for comparative renewal proceedings. The procedures in this section apply to comparative renewal proceedings in the Cellular...

47 CFR 22.935 - Procedures for comparative renewal proceedings.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 47 Telecommunication 2 2013-10-01 2013-10-01 false Procedures for comparative renewal proceedings... SERVICES PUBLIC MOBILE SERVICES Cellular Radiotelephone Service § 22.935 Procedures for comparative renewal proceedings. The procedures in this section apply to comparative renewal proceedings in the Cellular...

47 CFR 22.935 - Procedures for comparative renewal proceedings.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 47 Telecommunication 2 2011-10-01 2011-10-01 false Procedures for comparative renewal proceedings... SERVICES PUBLIC MOBILE SERVICES Cellular Radiotelephone Service § 22.935 Procedures for comparative renewal proceedings. The procedures in this section apply to comparative renewal proceedings in the Cellular...

47 CFR 22.935 - Procedures for comparative renewal proceedings.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 47 Telecommunication 2 2010-10-01 2010-10-01 false Procedures for comparative renewal proceedings... SERVICES PUBLIC MOBILE SERVICES Cellular Radiotelephone Service § 22.935 Procedures for comparative renewal proceedings. The procedures in this section apply to comparative renewal proceedings in the Cellular...

47 CFR 22.935 - Procedures for comparative renewal proceedings.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 47 Telecommunication 2 2012-10-01 2012-10-01 false Procedures for comparative renewal proceedings... SERVICES PUBLIC MOBILE SERVICES Cellular Radiotelephone Service § 22.935 Procedures for comparative renewal proceedings. The procedures in this section apply to comparative renewal proceedings in the Cellular...

Amnioinfusion in preterm PROM: effects on amnion and cord histology.

PubMed

Locatelli, A; Andreani, M; Ghidini, A; Verderio, M; Pizzardi, A; Vergani, P; Salafia, C M

2008-02-01

To investigate the effects of transabdominal amnioinfusion (TA) on the histology of amnion (A) and umbilical cord (UC). From a cohort of 56 singleton pregnancies with premature rupture of membranes (PROM) at

An integer batch scheduling model considering learning, forgetting, and deterioration effects for a single machine to minimize total inventory holding cost

NASA Astrophysics Data System (ADS)

Yusriski, R.; Sukoyo; Samadhi, T. M. A. A.; Halim, A. H.

2018-03-01

This research deals with a single machine batch scheduling model considering the influenced of learning, forgetting, and machine deterioration effects. The objective of the model is to minimize total inventory holding cost, and the decision variables are the number of batches (N), batch sizes (Q[i], i = 1, 2, .., N) and the sequence of processing the resulting batches. The parts to be processed are received at the right time and the right quantities, and all completed parts must be delivered at a common due date. We propose a heuristic procedure based on the Lagrange method to solve the problem. The effectiveness of the procedure is evaluated by comparing the resulting solution to the optimal solution obtained from the enumeration procedure using the integer composition technique and shows that the average effectiveness is 94%.

Adoption of endovenous laser treatment as the primary treatment modality for varicose veins: the Auckland City Hospital experience.

PubMed

Fernando, Ruchira S W; Muthu, Carl

2014-08-01

To assess the effectiveness of adopting endovenous laser treatment (EVLT) as the primary treatment modality for varicose veins at Auckland City Hospital (Auckland, New Zealand). The outcomes of 354 consecutive EVLT procedures performed between 2007 and 2013 were reviewed. Data was collected from a prospectively maintained procedural database and by retrospective chart review. Of the 319 patients who had an ultrasound, at 1 month post-procedure there was a saphenous vein occlusion rate of 96%. Side effects were minimal with no cases of DVT or skin burns and one case of self-limiting neuralgia. The procedure was well tolerated with a median pain score of 3. Since the adoption of EVLT there has been a large increase in the number of patients treated for varicose veins (28 in 2007 compared to 176 in 2013). EVLT is a safe and effective treatment for varicose veins and its adoption has allowed a large increase in the number of varicose vein patients treated at Auckland City Hospital.

A novel tree-based procedure for deciphering the genomic spectrum of clinical disease entities.

PubMed

Mbogning, Cyprien; Perdry, Hervé; Toussile, Wilson; Broët, Philippe

2014-01-01

Dissecting the genomic spectrum of clinical disease entities is a challenging task. Recursive partitioning (or classification trees) methods provide powerful tools for exploring complex interplay among genomic factors, with respect to a main factor, that can reveal hidden genomic patterns. To take confounding variables into account, the partially linear tree-based regression (PLTR) model has been recently published. It combines regression models and tree-based methodology. It is however computationally burdensome and not well suited for situations for which a large number of exploratory variables is expected. We developed a novel procedure that represents an alternative to the original PLTR procedure, and considered different selection criteria. A simulation study with different scenarios has been performed to compare the performances of the proposed procedure to the original PLTR strategy. The proposed procedure with a Bayesian Information Criterion (BIC) achieved good performances to detect the hidden structure as compared to the original procedure. The novel procedure was used for analyzing patterns of copy-number alterations in lung adenocarcinomas, with respect to Kirsten Rat Sarcoma Viral Oncogene Homolog gene (KRAS) mutation status, while controlling for a cohort effect. Results highlight two subgroups of pure or nearly pure wild-type KRAS tumors with particular copy-number alteration patterns. The proposed procedure with a BIC criterion represents a powerful and practical alternative to the original procedure. Our procedure performs well in a general framework and is simple to implement.

Comparing Eye Tracking with Electrooculography for Measuring Individual Sentence Comprehension Duration

PubMed Central

Müller, Jana Annina; Wendt, Dorothea; Kollmeier, Birger; Brand, Thomas

2016-01-01

The aim of this study was to validate a procedure for performing the audio-visual paradigm introduced by Wendt et al. (2015) with reduced practical challenges. The original paradigm records eye fixations using an eye tracker and calculates the duration of sentence comprehension based on a bootstrap procedure. In order to reduce practical challenges, we first reduced the measurement time by evaluating a smaller measurement set with fewer trials. The results of 16 listeners showed effects comparable to those obtained when testing the original full measurement set on a different collective of listeners. Secondly, we introduced electrooculography as an alternative technique for recording eye movements. The correlation between the results of the two recording techniques (eye tracker and electrooculography) was r = 0.97, indicating that both methods are suitable for estimating the processing duration of individual participants. Similar changes in processing duration arising from sentence complexity were found using the eye tracker and the electrooculography procedure. Thirdly, the time course of eye fixations was estimated with an alternative procedure, growth curve analysis, which is more commonly used in recent studies analyzing eye tracking data. The results of the growth curve analysis were compared with the results of the bootstrap procedure. Both analysis methods show similar processing durations. PMID:27764125

Societal and Economic Effect of Meniscus Scaffold Procedures for Irreparable Meniscus Injuries.

PubMed

Rongen, Jan J; Govers, Tim M; Buma, Pieter; Grutters, Janneke P C; Hannink, Gerjon

2016-07-01

Meniscus scaffolds are currently evaluated clinically for their efficacy in preventing the development of osteoarthritis as well as for their efficacy in treating patients with chronic symptoms. Procedural costs, therapeutic consequences, clinical efficacy, and future events should all be considered to maximize the monetary value of this intervention. To examine the socioeconomic effect of treating patients with irreparable medial meniscus injuries with a meniscus scaffold. Economic and decision analysis; Level of evidence, 2. Two Markov simulation models for patients with an irreparable medial meniscus injury were developed. Model 1 was used to investigate the lifetime cost-effectiveness of a meniscus scaffold compared with standard partial meniscectomy by the possibility of preventing the development of osteoarthritis. Model 2 was used to investigate the short-term (5-year) cost-effectiveness of a meniscus scaffold compared with standard partial meniscectomy by alleviating clinical symptoms, specifically in chronic patients with previous meniscus surgery. For both models, probabilistic Monte Carlo simulations were applied. Treatment effectiveness was expressed as quality-adjusted life-years (QALYs), while costs (estimated in euros) were assessed from a societal perspective. We assumed €20,000 as a reference value for the willingness to pay per QALY. Next, comprehensive sensitivity analyses were performed to identify the most influential variables on the cost-effectiveness of meniscus scaffolds. Model 1 demonstrated an incremental cost-effectiveness ratio of a meniscus scaffold treatment of €54,463 per QALY (€5991/0.112). A threshold analysis demonstrated that a meniscus scaffold should offer a relative risk reduction of at least 0.34 to become cost-effective, assuming a willingness to pay of €20,000. Decreasing the costs of the meniscus scaffold procedure by 33% (€10,160 instead of €15,233; an absolute change of €5073) resulted in an incremental cost-effectiveness ratio of €7876 per QALY. Model 2 demonstrated an incremental cost-effectiveness ratio of a meniscus scaffold treatment of €297,727 per QALY (€9825/0.033). On the basis of the current efficacy data, a meniscus scaffold provides a relative risk reduction of "limited benefit" postoperatively of 0.37 compared with standard treatment. A threshold analysis revealed that assuming a willingness to pay of €20,000, a meniscus scaffold would not be cost-effective within a period of 5 years. Most influential variables on the cost-effectiveness of meniscus scaffolds were the cost of the scaffold procedure, cost associated with osteoarthritis, and quality of life before and after the scaffold procedure. Results of the current health technology assessment emphasize that the monetary value of meniscus scaffold procedures is very much dependent on a number of influential variables. Therefore, before implementing the technology in the health care system, it is important to critically assess these variables in a relevant context. The models can be improved as additional clinical data regarding the efficacy of the meniscus scaffold become available. © 2016 The Author(s).

Longitudinal trends with improvement in quality of life after TVT, TVT O and Burch colposuspension procedures.

PubMed

Drahoradova, Petra; Martan, Alois; Svabik, Kamil; Zvara, Karel; Otava, Martin; Masata, Jaromir

2011-02-01

Comparison of the quality of life (QoL) trends after TVT, TVT O and Burch colposuspension (BCS) procedures and comparison of long-term subjective and objective outcomes. The study included 215 women who underwent a TVT, TVT O or BCS procedure. We monitored QoL after each procedure and the effect of complications on the QoL as assessed by the IQOL questionnaire over a 3-year period. The study was completed by 74.5% of women after TVT, 74.5% after TVT O, and 65.2% after BCS procedure. In the long-term, the QoL improved from 46.9 to 88.7 and remained stable after BCS; after TVT and TVT O, it declined, but only after TVT O was the decline statistically significant compared to BCS. The IQOL for women with post-operative complications has a clear descending tendency. The effect of the complications is highly significant (p<0.001). Only the OAB complication had a statistically significant effect on QoL p<0.001. Preexistent OAB does not negatively affect postoperative results of anti-incontinence surgery. There was a statistically significant decline with the longitudinal values of IQOL with TVT O, but not with TVT or BCS. Anti-incontinence operations significantly improve quality of life for women with MI, but compared to the SI group, the quality of life is worse when measured at a longer time interval after the operation. Anti-incontinence operations significantly improve quality of life, and the difference in preoperative status in the long-term follow-up is demonstrable.

A comparative study of coarse-graining methods for polymeric fluids: Mori-Zwanzig vs. iterative Boltzmann inversion vs. stochastic parametric optimization

NASA Astrophysics Data System (ADS)

Li, Zhen; Bian, Xin; Yang, Xiu; Karniadakis, George Em

2016-07-01

We construct effective coarse-grained (CG) models for polymeric fluids by employing two coarse-graining strategies. The first one is a forward-coarse-graining procedure by the Mori-Zwanzig (MZ) projection while the other one applies a reverse-coarse-graining procedure, such as the iterative Boltzmann inversion (IBI) and the stochastic parametric optimization (SPO). More specifically, we perform molecular dynamics (MD) simulations of star polymer melts to provide the atomistic fields to be coarse-grained. Each molecule of a star polymer with internal degrees of freedom is coarsened into a single CG particle and the effective interactions between CG particles can be either evaluated directly from microscopic dynamics based on the MZ formalism, or obtained by the reverse methods, i.e., IBI and SPO. The forward procedure has no free parameters to tune and recovers the MD system faithfully. For the reverse procedure, we find that the parameters in CG models cannot be selected arbitrarily. If the free parameters are properly defined, the reverse CG procedure also yields an accurate effective potential. Moreover, we explain how an aggressive coarse-graining procedure introduces the many-body effect, which makes the pairwise potential invalid for the same system at densities away from the training point. From this work, general guidelines for coarse-graining of polymeric fluids can be drawn.

Probability and Visual Aids for Assessing Intervention Effectiveness in Single-Case Designs: A Field Test.

PubMed

Manolov, Rumen; Jamieson, Matthew; Evans, Jonathan J; Sierra, Vicenta

2015-09-01

Single-case data analysis still relies heavily on visual inspection, and, at the same time, it is not clear to what extent the results of different quantitative procedures converge in identifying an intervention effect and its magnitude when applied to the same data; this is the type of evidence provided here for two procedures. One of the procedures, included due to the importance of providing objective criteria to visual analysts, is a visual aid fitting and projecting split-middle trend while taking into account data variability. The other procedure converts several different metrics into probabilities making their results comparable. In the present study, we expore to what extend these two procedures coincide in the magnitude of intervention effect taking place in a set of studies stemming from a recent meta-analysis. The procedures concur to a greater extent with the values of the indices computed and with each other and, to a lesser extent, with our own visual analysis. For distinguishing smaller from larger effects, the probability-based approach seems somewhat better suited. Moreover, the results of the field test suggest that the latter is a reasonably good mechanism for translating different metrics into similar labels. User friendly R code is provided for promoting the use of the visual aid, together with a quantification based on nonoverlap and the label provided by the probability approach. © The Author(s) 2015.

A comparative study of coarse-graining methods for polymeric fluids: Mori-Zwanzig vs. iterative Boltzmann inversion vs. stochastic parametric optimization.

PubMed

Li, Zhen; Bian, Xin; Yang, Xiu; Karniadakis, George Em

2016-07-28

We construct effective coarse-grained (CG) models for polymeric fluids by employing two coarse-graining strategies. The first one is a forward-coarse-graining procedure by the Mori-Zwanzig (MZ) projection while the other one applies a reverse-coarse-graining procedure, such as the iterative Boltzmann inversion (IBI) and the stochastic parametric optimization (SPO). More specifically, we perform molecular dynamics (MD) simulations of star polymer melts to provide the atomistic fields to be coarse-grained. Each molecule of a star polymer with internal degrees of freedom is coarsened into a single CG particle and the effective interactions between CG particles can be either evaluated directly from microscopic dynamics based on the MZ formalism, or obtained by the reverse methods, i.e., IBI and SPO. The forward procedure has no free parameters to tune and recovers the MD system faithfully. For the reverse procedure, we find that the parameters in CG models cannot be selected arbitrarily. If the free parameters are properly defined, the reverse CG procedure also yields an accurate effective potential. Moreover, we explain how an aggressive coarse-graining procedure introduces the many-body effect, which makes the pairwise potential invalid for the same system at densities away from the training point. From this work, general guidelines for coarse-graining of polymeric fluids can be drawn.

Creating Tic Suppression: Comparing the Effects of Verbal Instruction to Differential Reinforcement

ERIC Educational Resources Information Center

Woods, Douglas W.; Himle, Michael B.

2004-01-01

The purpose of this study was to compare two methods designed to produce tic reduction in 4 children with Tourette's syndrome. Specifically, a verbal instruction not to engage in tics was compared to a verbal instruction plus differential reinforcement of zero-rate behavior (DRO). Results showed that the DRO-enhanced procedure yielded greater…

A Comparative Study of Test Data Dimensionality Assessment Procedures Under Nonparametric IRT Models

ERIC Educational Resources Information Center

van Abswoude, Alexandra A. H.; van der Ark, L. Andries; Sijtsma, Klaas

2004-01-01

In this article, an overview of nonparametric item response theory methods for determining the dimensionality of item response data is provided. Four methods were considered: MSP, DETECT, HCA/CCPROX, and DIMTEST. First, the methods were compared theoretically. Second, a simulation study was done to compare the effectiveness of MSP, DETECT, and…

Failure mode and effects analysis: an empirical comparison of failure mode scoring procedures.

PubMed

Ashley, Laura; Armitage, Gerry

2010-12-01

To empirically compare 2 different commonly used failure mode and effects analysis (FMEA) scoring procedures with respect to their resultant failure mode scores and prioritization: a mathematical procedure, where scores are assigned independently by FMEA team members and averaged, and a consensus procedure, where scores are agreed on by the FMEA team via discussion. A multidisciplinary team undertook a Healthcare FMEA of chemotherapy administration. This included mapping the chemotherapy process, identifying and scoring failure modes (potential errors) for each process step, and generating remedial strategies to counteract them. Failure modes were scored using both an independent mathematical procedure and a team consensus procedure. Almost three-fifths of the 30 failure modes generated were scored differently by the 2 procedures, and for just more than one-third of cases, the score discrepancy was substantial. Using the Healthcare FMEA prioritization cutoff score, almost twice as many failure modes were prioritized by the consensus procedure than by the mathematical procedure. This is the first study to empirically demonstrate that different FMEA scoring procedures can score and prioritize failure modes differently. It found considerable variability in individual team members' opinions on scores, which highlights the subjective and qualitative nature of failure mode scoring. A consensus scoring procedure may be most appropriate for FMEA as it allows variability in individuals' scores and rationales to become apparent and to be discussed and resolved by the team. It may also yield team learning and communication benefits unlikely to result from a mathematical procedure.

Sequence-specific procedural learning deficits in children with specific language impairment.

PubMed

Hsu, Hsinjen Julie; Bishop, Dorothy V M

2014-05-01

This study tested the procedural deficit hypothesis of specific language impairment (SLI) by comparing children's performance in two motor procedural learning tasks and an implicit verbal sequence learning task. Participants were 7- to 11-year-old children with SLI (n = 48), typically developing age-matched children (n = 20) and younger typically developing children matched for receptive grammar (n = 28). In a serial reaction time task, the children with SLI performed at the same level as the grammar-matched children, but poorer than age-matched controls in learning motor sequences. When tested with a motor procedural learning task that did not involve learning sequential relationships between discrete elements (i.e. pursuit rotor), the children with SLI performed comparably with age-matched children and better than younger grammar-matched controls. In addition, poor implicit learning of word sequences in a verbal memory task (the Hebb effect) was found in the children with SLI. Together, these findings suggest that SLI might be characterized by deficits in learning sequence-specific information, rather than generally weak procedural learning. © 2014 The Authors. Developmental Science Published by John Wiley & Sons Ltd.

Comparison of hand hygiene procedures for removing Bacillus cereus spores.

PubMed

Sasahara, Teppei; Hayashi, Shunji; Hosoda, Kouichi; Morisawa, Yuji; Hirai, Yoshikazu

2014-01-01

Bacillus cereus is a spore-forming bacterium. B. cereus occasionally causes nosocomial infections, in which hand contamination with the spores plays an important role. Therefore, hand hygiene is the most important practice for controlling nosocomial B. cereus infections. This study aimed to determine the appropriate hand hygiene procedure for removing B. cereus spores. Thirty volunteers' hands were experimentally contaminated with B. cereus spores, after which they performed 6 different hand hygiene procedures. We compared the efficacy of the procedures in removing the spores from hands. The alcohol-based hand-rubbing procedures scarcely removed them. The soap washing procedures reduced the number of spores by more than 2 log10. Extending the washing time increased the spore-removing efficacy of the washing procedures. There was no significant difference in efficacy between the use of plain soap and antiseptic soap. Handwashing with soap is appropriate for removing B. cereus spores from hands. Alcohol-based hand-rubbing is not effective.

Frictionless contact of aircraft tires

NASA Technical Reports Server (NTRS)

Kim, Kyun O.; Tanner, John A.; Noor, Ahmed K.

1989-01-01

A computational procedure for the solution of frictionless contact problems of spacecraft tires was developed using a two-dimensional laminated anisotropic shell theory incorporating the effects of variations in material and geometric parameters, transverse shear deformation, and geometric nonlinearities to model the nose-gear tire of a space shuttle. Numerical results are presented for the case when the nose-gear tire is subjected to inflation pressure and pressed against a rigid pavement. The results are compared with experimental results obtained at NASA Langley, demonstrating a high accuracy of the model and the effectiveness of the computational procedure.

Oral versus intravenous premedication for small bowel biopsy in children: effect on procedure and fluoroscopy times.

PubMed

Stenhammar, L; Wärngård, O; Lewander, P; Nordvall, M

1993-01-01

Oral alimemazine and cisapride, or diazepam and cisapride, or iv midazolam and metoclopramide were given as premedication for small bowel biopsy to three groups of children from a total population of 185 individuals. The biopsy procedures were performed under intermittent fluoroscopy and times for both were recorded. The median biopsy procedure time was significantly shorter in children given iv midazolam and metoclopramide (6 min) compared to those given oral premedication (10 min) (p < 0.001). The median fluoroscopy time was very short in all groups, ranging between 3 and 6 s. It is concluded that iv premedication is superior to oral premedication for small bowel biopsy in children because more effective sedation is obtained.

Effects of Radiation Exposure From Cardiac Imaging: How Good Are the Data?

PubMed Central

Einstein, Andrew J.

2012-01-01

Concerns about medical exposure to ionizing radiation have become heightened in recent years due to rapid growth in procedure volumes and the high radiation doses incurred from some procedures. This article summarizes the evidence base undergirding concerns about radiation exposure in cardiac imaging. After classifying radiation effects, explaining terminology used to quantify the radiation received by patients, and describing typical doses from cardiac imaging procedures, I address the major epidemiological studies having bearing on radiation effects at doses comparable to those received by patients undergoing cardiac imaging. These include studies of atomic bomb survivors, nuclear industry workers, and children exposed in utero to x-rays, all of which have evidenced increased cancer risks at low doses. Additional higher dose epidemiological studies of cohorts exposed to radiation in the context of medical treatment are described and found to be generally compatible with these cardiac-dose-level studies, albeit with exceptions. Using risk projection models developed by the US National Academies that incorporate these data and reflect several evidence-based assumptions, cancer risk from cardiac imaging can be estimated and compared to benefits from imaging. Several ongoing epidemiological studies will provide better understanding of radiation-associated cancer risks. PMID:22300689

Transdermal Nicotine for Smoking Cessation.

ERIC Educational Resources Information Center

Hughes, John R.; Glaser, Mitchell

1993-01-01

Discusses the use of transdermal nicotine (TN) in smoking cessation and its value as an effective procedure. The article reveals that, compared to a placebo, TN has double the quit rate percentages, and less than 5% of smokers quit TN due to side effects. (GLR)

The efficacy, safety, effectiveness, and cost-effectiveness of ultrasound and shock wave therapies for low back pain: a systematic review.

PubMed

Seco, Jesús; Kovacs, Francisco M; Urrutia, Gerard

2011-10-01

Shock wave and especially ultrasound are commonly used to treat low back pain (LBP) in routine practice. To assess the evidence on the efficacy, effectiveness, cost-effectiveness, and safety of ultrasound and shock wave to treat LBP. Systematic review. An electronic search was performed in MEDLINE, EMBASE, and the Cochrane Library databases up to July 2009 to identify randomized controlled trials (RCTs) comparing vibrotherapy with placebo or with other treatments for LBP. No language restrictions were applied. Additional data were requested from the authors of the original studies. The risk of bias of each study was assessed following the criteria recommended by the Cochrane Back Review Group. Thirteen studies were identified. The four RCTs complying with the inclusion criteria included 252 patients. Two of the three RCTs on ultrasound had a high risk of bias. For acute patients with LBP and leg pain attributed to disc herniation, ultrasound, traction, and low-power laser obtained similar results. For chronic LBP patients without leg pain, ultrasound was less effective than spinal manipulation, whereas a shock wave device and transcutaneous electrical nerve stimulation led to similar results. Results from the only study comparing ultrasound versus a sham procedure are unreliable because of the inappropriateness of the sham procedure, low sample size, and lack of adjustment for potential confounders. No study assessed cost-effectiveness. No adverse events were reported. The available evidence does not support the effectiveness of ultrasound or shock wave for treating LBP. High-quality RCTs are needed to assess their efficacy versus appropriate sham procedures, and their effectiveness and cost-effectiveness versus other procedures shown to be effective for LBP. In the absence of such evidence, the clinical use of these forms of treatment is not justified and should be discouraged. Copyright © 2011 Elsevier Inc. All rights reserved.

Retrospective Evaluation of Safety, Efficacy and Risk Factors for Pneumothorax in Simultaneous Localizations of Multiple Pulmonary Nodules Using Hook Wire System.

PubMed

Zhong, Yan; Xu, Xiao-Quan; Pan, Xiang-Long; Zhang, Wei; Xu, Hai; Yuan, Mei; Kong, Ling-Yan; Pu, Xue-Hui; Chen, Liang; Yu, Tong-Fu

2017-09-01

To evaluate the safety and efficacy of the hook wire system in the simultaneous localizations for multiple pulmonary nodules (PNs) before video-assisted thoracoscopic surgery (VATS), and to clarify the risk factors for pneumothorax associated with the localization procedure. Between January 2010 and February 2016, 67 patients (147 nodules, Group A) underwent simultaneous localizations for multiple PNs using a hook wire system. The demographic, localization procedure-related information and the occurrence rate of pneumothorax were assessed and compared with a control group (349 patients, 349 nodules, Group B). Multivariate logistic regression analyses were used to determine the risk factors for pneumothorax during the localization procedure. All the 147 nodules were successfully localized. Four (2.7%) hook wires dislodged before VATS procedure, but all these four lesions were successfully resected according to the insertion route of hook wire. Pathological diagnoses were acquired for all 147 nodules. Compared with Group B, Group A demonstrated significantly longer procedure time (p < 0.001) and higher occurrence rate of pneumothorax (p = 0.019). Multivariate logistic regression analysis indicated that position change during localization procedure (OR 2.675, p = 0.021) and the nodules located in the ipsilateral lung (OR 9.404, p < 0.001) were independent risk factors for pneumothorax. Simultaneous localizations for multiple PNs using a hook wire system before VATS procedure were safe and effective. Compared with localization for single PN, simultaneous localizations for multiple PNs were prone to the occurrence of pneumothorax. Position change during localization procedure and the nodules located in the ipsilateral lung were independent risk factors for pneumothorax.

Transoral Incisionless Fundoplication (TIF 2.0): A Meta-Analysis of Three Randomized, Controlled Clinical Trials.

PubMed

Gerson, Lauren; Stouch, Bruce; Lobonţiu, Adrian

2018-01-01

The TIF procedure has emerged as an endoscopic treatment for patients with refractory gastro-esophageal reflux disease (GERD). Previous systematic reviews of the TIF procedure conflated findings from studies with modalities that do not reflect the current 2.0 procedure technique or refined data-backed patient selection criteria. A meta-analysis was conducted using data only from randomized studies that assessed the TIF 2.0 procedure compared to a control. The purpose of the meta-analysis was to determine the efficacy and long-term outcomes associated with performance of the TIF 2.0 procedure in patients with chronic long-term refractory GERD on optimized PPI therapy, including esophageal pH, PPI utilization and quality of life. Methods: Three prospective research questions were predicated on the outcomes of the TIF procedure compared to patients who received PPI therapy or sham, concomitant treatment for GERD, and the patient-reported quality of life. Event rates were calculated using the random effect model. Since the time of follow-up post-TIF procedure was variable, analysis was performed to incorporate the time of follow-up for each individual patient at the 3-year time point. Results: Results from this meta-analysis, including data from 233 patients, demonstrated that TIF subjects at 3 years had improved esophageal pH, a decrease in PPI utilization, and improved quality of life. Conclusions: In a meta-analysis of randomized, controlled trials (RCTs), the TIF procedure data for patients with GERD refractory to PPI's produces significant changes, compared with sham or PPI therapy, in esophageal pH, decreased PPI utilization, and improved quality of life. Celsius.

Identification of potential neuromotor mechanisms of manual therapy in patients with musculoskeletal disablement: rationale and description of a clinical trial.

PubMed

Fisher, Beth E; Davenport, Todd E; Kulig, Kornelia; Wu, Allan D

2009-05-21

Many health care practitioners use a variety of hands-on treatments to improve symptoms and disablement in patients with musculoskeletal pathology.Research to date indirectly suggests a potentially broad effect of manual therapy on the neuromotor processing of functional behavior within the supraspinal central nervous system (CNS) in a manner that may be independent of modification at the level of local spinal circuits. However, the effect of treatment speed, as well as the specific mechanism and locus of CNS changes, remain unclear. We developed a placebo-controlled, randomized study to test the hypothesis that manual therapy procedures directed to the talocrural joint in individuals with post-acute ankle sprain induce a change in corticospinal excitability that is relevant to improve the performance of lower extremity functional behavior. This study is designed to identify potential neuromotor changes associated with manual therapy procedures directed to the appendicular skeleton, compare the relative effect of treatment speed on potential neuromotor effects of manual therapy procedures, and determine the behavioral relevance of potential neuromotor effects of manual therapy procedures. http://www.clinicaltrials.gov identifier NCT00847769.

Identification of potential neuromotor mechanisms of manual therapy in patients with musculoskeletal disablement: rationale and description of a clinical trial

PubMed Central

Fisher, Beth E; Davenport, Todd E; Kulig, Kornelia; Wu, Allan D

2009-01-01

Background Many health care practitioners use a variety of hands-on treatments to improve symptoms and disablement in patients with musculoskeletal pathology. Research to date indirectly suggests a potentially broad effect of manual therapy on the neuromotor processing of functional behavior within the supraspinal central nervous system (CNS) in a manner that may be independent of modification at the level of local spinal circuits. However, the effect of treatment speed, as well as the specific mechanism and locus of CNS changes, remain unclear. Methods/Design We developed a placebo-controlled, randomized study to test the hypothesis that manual therapy procedures directed to the talocrural joint in individuals with post-acute ankle sprain induce a change in corticospinal excitability that is relevant to improve the performance of lower extremity functional behavior. Discussion This study is designed to identify potential neuromotor changes associated with manual therapy procedures directed to the appendicular skeleton, compare the relative effect of treatment speed on potential neuromotor effects of manual therapy procedures, and determine the behavioral relevance of potential neuromotor effects of manual therapy procedures. Trial Registration identifier NCT00847769. PMID:19460169

Surgical treatment of tricuspid valve insufficiency promotes early reverse remodeling in patients with axial-flow left ventricular assist devices.

PubMed

Maltais, Simon; Topilsky, Yan; Tchantchaleishvili, Vakhtang; McKellar, Stephen H; Durham, Lucian A; Joyce, Lyle D; Daly, Richard C; Park, Soon J

2012-06-01

The HeartMate II (Thoratec Corp, Pleasanton, Calif) continuous-flow left ventricular assist device has emerged as the standard of care for patients with advanced heart failure. The objective of this study was to assess the safety and early effectiveness of concomitant tricuspid valve procedures in patients undergoing implantation of a HeartMate II device. From February 2007 to April 2010, 83 patients underwent HeartMate II left ventricular assist device implantation. Of these, 37 patients had concomitant tricuspid valve procedures (32 repairs, 5 replacements) for severe tricuspid regurgitation. The effects of a tricuspid valve procedure on tricuspid regurgitation and right ventricular remodeling were assessed comparing echocardiographic findings at baseline and 30 days after left ventricular assist device implantation. Overall survival was also compared. Patients undergoing a concomitant tricuspid valve procedure had more tricuspid regurgitation (vena contracta, 5.6 ± 2.1 mm vs 2.9 ± 2.0 mm; P < .001), worse right ventricular dysfunction (right ventricular end-diastolic area, 33.6 ± 6.2 mm vs 31.6 ± 8.5 mm; P = .05), higher mean right atrial pressure (17.4 ± 7.1 mm Hg vs 14.9 ± 5.1 mm Hg; P = .03), and a higher Kormos score (2.6 ± 2.1 vs 1.2 ± 1.4; P = .0008) preoperatively. One month after surgery, tricuspid regurgitation was worse in patients who underwent left ventricular assist device implantation alone (+18.6%), whereas it improved significantly in patients undergoing a concomitant tricuspid valve procedure (-50.2%) (P = .005). A corresponding significant reduction in right ventricular end-diastolic area (33.6% ± 6.2% vs 30.1% ± 9.7%; P = .03) and a trend toward better right ventricular function (55.5% ± 79.7% vs 35.7% ± 60.5%; P = .28) were noted in patients undergoing a concomitant tricuspid valve procedure. Survival was comparable between the 2 groups. In patients with severe tricuspid regurgitation undergoing left ventricular assist device implantation, a concomitant tricuspid valve procedure effectively reduces tricuspid regurgitation and promotes reverse remodeling of the right ventricle. Copyright © 2012 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.

Electrophysiological gap detection thresholds: effects of age and comparison with a behavioral measure.

PubMed

Palmer, Shannon B; Musiek, Frank E

2014-01-01

Temporal processing ability has been linked to speech understanding ability and older adults often complain of difficulty understanding speech in difficult listening situations. Temporal processing can be evaluated using gap detection procedures. There is some research showing that gap detection can be evaluated using an electrophysiological procedure. However, there is currently no research establishing gap detection threshold using the N1-P2 response. The purposes of the current study were to 1) determine gap detection thresholds in younger and older normal-hearing adults using an electrophysiological measure, 2) compare the electrophysiological gap detection threshold and behavioral gap detection threshold within each group, and 3) investigate the effect of age on each gap detection measure. This study utilized an older adult group and younger adult group to compare performance on an electrophysiological and behavioral gap detection procedure. The subjects in this study were 11 younger, normal-hearing adults (mean = 22 yrs) and 11 older, normal-hearing adults (mean = 64.36 yrs). All subjects completed an adaptive behavioral gap detection procedure in order to determine their behavioral gap detection threshold (BGDT). Subjects also completed an electrophysiologic gap detection procedure to determine their electrophysiologic gap detection threshold (EGDT). Older adults demonstrated significantly larger gap detection thresholds than the younger adults. However, EGDT and BGDT were not significantly different in either group. The mean difference between EGDT and BGDT for all subjects was 0.43 msec. Older adults show poorer gap detection ability when compared to younger adults. However, this study shows that gap detection thresholds can be measured using evoked potential recordings and yield results similar to a behavioral measure. American Academy of Audiology.

Effect of intraoperative analgesia on children's pain perception during recovery after painful dental procedures performed under general anaesthesia.

PubMed

El Batawi, H Y

2015-02-01

To investigate the possible effect of intraoperative analgesia, namely diclofenac sodium compared to acetaminophen on post-recovery pain perception in children undergoing painful dental procedures under general anaesthesia. A double-blind randomised clinical trial. A sample of 180 consecutive cases of children undergoing full dental rehabilitation under general anaesthesia in a private hospital in Saudi Arabia during 2013 was divided into three groups (60 children each) according to the analgesic used prior to extubation. Group A, children had diclofenac sodium suppository. Group B, children received acetaminophen suppository and Group C, the control group. Using an authenticated Arabic version of the Wong and Baker faces Pain assessment Scale, patients were asked to choose the face that suits best the pain he/she is suffering. Data were collected and recorded for statistical analysis. Student's t test was used for comparison of sample means. A preliminary F test to compare sample variances was carried out to determine the appropriate t test variant to be used. A "p" value less than 0.05 was considered significant. More than 93% of children had post-operative pain in varying degrees. High statistical significance was observed between children in groups A and B compared to control group C with the later scoring high pain perception. Diclofenac showed higher potency in multiple painful procedures, while the statistical difference was not significant in children with three or less painful dental procedures. Diclophenac sodium is more potent than acetaminophen, especially for multiple pain-provoking or traumatic procedures. A timely use of NSAID analgesia just before extubation helps provide adequate coverage during recovery. Peri-operative analgesia is to be recommended as an essential treatment adjunct for child dental rehabilitation under general anaesthesia.

Pneumoperitoneum pressures during pelvic laparoscopic surgery: a systematic review and meta-analysis.

PubMed

Bogani, Giorgio; Martinelli, Fabio; Ditto, Antonino; Chiappa, Valentina; Lorusso, Domenica; Ghezzi, Fabio; Raspagliesi, Francesco

2015-12-01

Growing evidence suggests that the level of pneumoperitoneal pressure is directly correlated with postoperative pain in patients undergoing laparoscopic procedures. However, only limited evidence is available in the field of gynaecologic surgery. Therefore, this study aimed to compare the effects of low (8mmHg), standard (12mmHg) and high (15mmHg) pneumoperitoneal pressures (LPP

A prospective outcome and cost-effectiveness comparison between two ligament reattachment techniques using suture anchors for chronic ankle instability.

PubMed

Cho, Byung-Ki; Kim, Yong-Min; Park, Kyoung-Jin; Park, Ji-Kang; Kim, Do-Kyoon

2015-02-01

There are various ligament reattachment techniques for the modified Brostrom procedure. There have been few comparative studies on recently developed techniques. This prospective study was performed to compare the functional outcomes of 2 different ligament reattachment techniques using suture anchors. We furthermore evaluated the cost-effectiveness of the suture bridge technique. Forty-five amateur athletes under 30 years of age were followed for more than 2 years. Twenty-four procedures with the suture anchor technique and 21 procedures with the suture bridge technique were performed by one surgeon. The functional evaluation consisted of the American Orthopaedic Foot & Ankle Society (AOFAS) score, Foot and Ankle Outcome Score (FAOS), Karlsson score, Sefton grading system, and the period to return to various forms of exercise (jogging, spurt running, jumping, one leg standing for >1 minute, walking on uneven ground, and going down stairs). Measurement of talar tilt angle and anterior talar translation was obtained from stress radiographs to evaluate mechanical stability. There were no significant differences on AOFAS score, FAOS, Karlsson score, Sefton grade, and stress radiographs. There were no significant differences on the return to exercises, except for jumping. As the most common complication, there were 3 cases of skin irritation by suture materials in the suture anchor group and 2 cases of intraoperative breakage of the suture anchor in suture bridge group. Both ligament reattachment techniques using suture anchors showed similar functional outcomes. Considering the additional medical expenses incurred by more suture anchors, the modified Brostrom procedure using the suture bridge technique had low cost-effectiveness. Proper indication and clinical usefulness of suture bridge technique for chronic ankle instability will be addressed in further studies. Level II, prospective comparative study. © The Author(s) 2014.

Autoshaping in adolescence enhances sign-tracking behavior in adulthood: impact on ethanol consumption.

PubMed

Anderson, Rachel I; Spear, Linda P

2011-04-01

Autoshaping refers to a procedure during which a cue repeatedly paired with a reward elicits a conditioned response directed at either the reward delivery location ("goal-tracking") or the cue itself ("sign- tracking"). Individual differences in expression of sign-tracking behavior may be predictive of voluntary ethanol intake. The present study was designed to explore the development of differences in sign-tracking behavior in adolescent and adult male and female rats in an 8-day autoshaping procedure. Consistency of sign-tracking and goal-tracking across age was examined by retesting adolescents again in adulthood and comparing their adult data with animals tested only as adults to explore pre-exposure effects on adult responding. In order to assess the relationship between sign-tracking and ethanol intake, voluntary ethanol consumption was measured in an 8-day, 2-hr limited access drinking paradigm following the 8-day autoshaping procedure in adulthood. Animals tested as adolescents showed notably less sign-tracking behavior than animals tested as adults, and sign-tracking behavior was not correlated across age. Animals exposed to the autoshaping procedure as adolescents demonstrated greater sign-tracking behavior as adults when compared to control animals tested only in adulthood. When examining the relationship in adulthood between sign-tracking and ethanol intake, an increase in ethanol intake among sign-trackers was found only in animals pre-exposed to autoshaping as adolescents. Whether or not these results reflect an adolescent-specific experience effect is unclear without further work to determine whether comparable pre-exposure effects are seen if the initial autoshaping sessions are delayed into adulthood. Copyright © 2011 Elsevier Inc. All rights reserved.

Effects of euthanasia on brain physiological activities monitored in real-time.

PubMed

Mayevsky, Avraham; Barbiro-Michaely, Efrat; Ligeti, Laszlo; MacLaughlin, Alan C

2002-10-01

Animal experimentation is terminated by the euthanasia procedure in order to avoid pain and minimize suffering. Very little is known about the real time physiological changes taking place in the brain of animals during the euthanasia. Since there is no way to evaluate the suffering of animals under euthanasia, it is assumed that objective physiological changes taking place could serve as a good way to compare various types of euthanasia procedures. In the present study we compared the effect of euthanasia induced by i. v. injection of concentrated KCL to that of Taxan T-61 (a standard mixture used by veterinarians). The responses of the cat brain were evaluated by monitoring the hemodynamic (CBF), metabolic (NADH redox state), electrical (EcoG) and extracellular ion levels, as an indicator to the ionic homeostasis.

TU-D-209-05: Automatic Calculation of Organ and Effective Dose for CBCT and Interventional Fluoroscopic Procedures

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

Xiong, Z; Vijayan, S; Oines, A

Purpose: To compare PCXMC and EGSnrc calculated organ and effective radiation doses from cone-beam computed tomography (CBCT) and interventional fluoroscopically-guided procedures using automatic exposure-event grouping. Methods: For CBCT, we used PCXMC20Rotation.exe to automatically calculate the doses and compared the results to those calculated using EGSnrc with the Zubal patient phantom. For interventional procedures, we use the dose tracking system (DTS) which we previously developed to produce a log file of all geometry and exposure parameters for every x-ray pulse during a procedure, and the data in the log file is input into PCXMC and EGSnrc for dose calculation. A MATLABmore » program reads data from the log files and groups similar exposures to reduce calculation time. The definition files are then automatically generated in the format used by PCXMC and EGSnrc. Processing is done at the end of the procedure after all exposures are completed. Results: For the Toshiba Infinix CBCT LCI-Middle-Abdominal protocol, most organ doses calculated with PCXMC20Rotation closely matched those calculated with EGSnrc. The effective doses were 33.77 mSv with PCXMC20Rotation and 32.46 mSv with EGSnrc. For a simulated interventional cardiac procedure, similar close agreement in organ dose was obtained between the two codes; the effective doses were 12.02 mSv with PCXMC and 11.35 mSv with EGSnrc. The calculations can be completed on a PC without manual intervention in less than 15 minutes with PCXMC and in about 10 hours with EGSnrc, depending on the level of data grouping and accuracy desired. Conclusion: Effective dose and most organ doses in CBCT and interventional radiology calculated by PCXMC closely match those calculated by EGSnrc. Data grouping, which can be done automatically, makes the calculation time with PCXMC on a standard PC acceptable. This capability expands the dose information that can be provided by the DTS. Partial support from NIH Grant R01-EB002873 and Toshiba Medical Systems Corp.« less

Developing a Clinical-Grade Cryopreservation Protocol for Human Testicular Tissue and Cells

PubMed Central

Pacchiarotti, Jason; Ramos, Thomas; Howerton, Kyle; Greilach, Scott; Zaragoza, Karina; Olmstead, Marnie; Izadyar, Fariborz

2013-01-01

Recent work in preservation of female fertility as well as new information on the nature of spermatogonial stem cells has prompted an investigation into the possibility of an effective clinical-grade procedure for the cryopreservation of testicular cells and/or tissue. Clinical-grade reagents, validated equipment, and protocols consistent with cGTP/cGMP standards were used in developing a procedure suitable for the safe and effective cryopreservation of human testicular cells and tissues. These procedures were designed to be compliant with the relevant FDA regulations. The procedure proved to effectively cryopreserve both testicular cells and tissue. The cryopreservation of testicular tissue was comparable in most aspects we measured to the cryopreservation of isolated cells, except that the viability of the cells from cryopreserved testicular tissue was found to be significantly higher. On the other hand, cryopreservation of cells is preferred for cell analysis, quality control, and sterility testing. This study demonstrates that testicular tissue and cells from sexual reassignment patients can be successfully cryopreserved with a clinical-grade procedure and important cell populations are not only preserved but also enriched by the process. Further studies will determine whether these findings from hormone-treated patients can be generalized to other patients. PMID:23509810

A study for high accuracy measurement of residual stress by deep hole drilling technique

NASA Astrophysics Data System (ADS)

Kitano, Houichi; Okano, Shigetaka; Mochizuki, Masahito

2012-08-01

The deep hole drilling technique (DHD) received much attention in recent years as a method for measuring through-thickness residual stresses. However, some accuracy problems occur when residual stress evaluation is performed by the DHD technique. One of the reasons is that the traditional DHD evaluation formula applies to the plane stress condition. The second is that the effects of the plastic deformation produced in the drilling process and the deformation produced in the trepanning process are ignored. In this study, a modified evaluation formula, which is applied to the plane strain condition, is proposed. In addition, a new procedure is proposed which can consider the effects of the deformation produced in the DHD process by investigating the effects in detail by finite element (FE) analysis. Then, the evaluation results obtained by the new procedure are compared with that obtained by traditional DHD procedure by FE analysis. As a result, the new procedure evaluates the residual stress fields better than the traditional DHD procedure when the measuring object is thick enough that the stress condition can be assumed as the plane strain condition as in the model used in this study.

Descriptive analysis and comparison of strategic incremental rehearsal to "Business as Usual" sight-word instruction for an adult nonreader with intellectual disability.

PubMed

Richman, David M; Grubb, Laura; Thompson, Samuel

2018-01-01

Strategic Incremental Rehearsal (SIR) is an effective method for teaching sight-word acquisition, but has neither been evaluated for use in adults with an intellectual disability, nor directly compared to the ongoing instruction in the natural environment. Experimental analysis of sight word acquisition via an alternating treatment design was conducted with a 23-year-old woman with Down syndrome. SIR was compared to the current reading instruction (CRI) in a classroom for young adults with intellectual disabilities. CRI procedures included non-contingent praise, receptive touch prompts ("touch the word bat"), echoic prompts ("say bat"), textual prompts ("read the word"), and pre-determined introduction of new words. SIR procedures included textual prompts on flash cards, contingent praise, corrective feedback, and mastery-based introduction of new words. The results indicated that SIR was associated with more rapid acquisition of sight words than CRI. Directions for future research could include systematic comparisons to other procedures, and evaluations of procedural permutations of SIR.

New fixation method for maxillary distraction osteogenesis using locking attachments.

PubMed

Suzuki, Eduardo Yugo; Buranastidporn, Boonsiva; Ishii, Masatoshi

2006-10-01

The external traction hooks of the intraoral splint used in the rigid external distraction (RED) system for maxillary distraction osteogenesis interfere with the surgical procedures. The purpose of this study is to introduce an innovative splint fixation method for maxillary distraction osteogenesis with Locking Attachments and evaluate their advantages, such as reduction of operating time compared with the traditional intraoral splint method. Retrospective comparison of operative times of maxillary Le Fort I osteotomy procedures was carried out with the traditional protocol using the intraoral splint cemented to the maxillary dentition (n = 14), and a removable intraoral splint that is inserted postsurgically (n = 14). Operative procedure times were compared and analyzed statistically using the data extracted from the surgical records. There were no complications inserting the removable splint postsurgically, including pain, discomfort, or time-consuming procedure. Stable and secure splint fixation was obtained before the distraction procedure and the desired treatment goals were obtained in all patients. The total operative procedure times were significantly reduced in the Locking Attachments group by 24% to 41% (approximately 65 minutes) compared with earlier operations involving the conventional splints (P < .05). Maxillary distraction osteogenesis with the Locking Attachments is a highly effective fixation approach to manage severe hypoplastic maxilla, eliminating lip constraints resulting from scarring and allowing for easier, more deliberate and careful dissection. The use of the Locking Attachments is reliable in craniofacial surgery and has proved to be advantageous in the reduction of the operating time and surgical risks.

Analysis of turbojet-engine controls for afterburning starting

NASA Technical Reports Server (NTRS)

Phillips, W E , Jr

1956-01-01

A simulation procedure is developed for studying the effects of an afterburner start on a controlled turbojet engine. The afterburner start is represented by introducing a step decrease in the effective exhaust-nozzle area, after which the control returns the controlled engine variables to their initial values. The degree and speed with which the control acts are a measure of the effectiveness of the particular control system. Data are presented from five systems investigated using an electronic analog computer and the developed simulation procedure. These systems are compared with respect to steady-state errors, speed of response, and transient deviations of the system variables.

Breastfeeding or breast milk for procedural pain in neonates.

PubMed

Shah, P S; Aliwalas, L I; Shah, V

2006-07-19

Physiological changes brought about by pain may contribute to the development of morbidity in neonates. Clinical studies have shown reduction in the changes in physiological parameters and pain score measurements following pre-emptive analgesic administration in situations where the neonate is experiencing pain or stress. Nonpharmacological measures (such as holding, swaddling, breastfeeding) and pharmacological measures (such as acetaminophen, sucrose and opioids) have been used for this purpose. The primary objective of this review was to evaluate the effectiveness of breastfeeding or supplemental breast milk in reducing procedural pain in neonates. The secondary objective was to conduct subgroup analyses based on the type of control intervention, type of painful procedure, gestational age and the amount of supplemental breast milk given. A literature search was performed using MEDLINE (1966 - Feb 2006), EMBASE (1980 - Feb 2006), CINAHL (1982 - Feb 2006), Cochrane Central Register of Controlled Trials (Issue 4, 2005 of Cochrane Library), abstracts from the annual meetings of the Society for Pediatric Research (1994 - 2006) and major pediatric pain conference proceedings. No language restrictions were applied. Randomized or quasi-randomized controlled trials of breastfeeding or supplemental breast milk versus no treatment/other measures in neonates were eligible for inclusion in this review. The study must have reported on either physiologic markers of pain or validated pain scores. The methodological quality of the trials was assessed using the information provided in the studies and by personal communication with the authors. Data on relevant outcomes were extracted and the effect size was estimated and reported as relative risk (RR), risk difference (RD) and weighted mean difference (MD) as appropriate. Eleven eligible studies were identified. Marked heterogeneity in terms of control intervention and pain assessment measures were noted among the studies. Neonates in the breastfeeding group had statistically significantly less increase in the heart rate, reduced proportion of crying time and reduced duration of crying compared to swaddled group or pacifier group. Neonates in the breastfeeding group had a significant reduction in duration of crying compared to fasting (no intervention) group, but there was no significant difference when compared to glucose group. Premature Infant Pain Profile scores were significantly different between the breastfeeding group when compared to placebo group and the group positioned in mother's arms. However, these scores were not statistically significantly different in the breastfeeding group when compared to the no treatment group and the glucose group. Douleur Aigue Nouveau-ne scores were significantly different in the breastfeeding group when compared to the placebo group and the group positioned in mother's arms, but not when compared to the glucose group. Neonates in the supplemental breast milk group had significantly less increase in the heart rate and Neonatal Facial Coding Score compared to the placebo group. The differences in the duration of crying time and oxygen saturation change between supplemental breast milk group and the placebo group were not statistically significant. Neonates in the supplemental breast milk group had significantly higher increase in the heart rate changes and duration of crying time compared to glucose/sucrose group. No study was identified that has evaluated safety/effectiveness of repeated administration of breastfeeding or supplemental breast milk for pain relief. If available, breastfeeding or breast milk should be used to alleviate procedural pain in neonates undergoing a single painful procedure compared to placebo, positioning or no intervention. Administration of glucose/sucrose had similar effectiveness as breastfeeding for reducing pain. The effectiveness of breast milk for repeated painful procedures is not established and further research is needed. These studies should include various control interventions including glucose/ sucrose and should target preterm neonates.

Impact of Fellowship Training Level on Colonoscopy Quality and Efficiency Metrics.

PubMed

Bitar, Hussein; Zia, Hassaan; Bashir, Muhammad; Parava, Pratyusha; Hanafi, Muhammad; Tierney, William; Madhoun, Mohammad

2018-04-18

Previous studies have described variable effects of fellow involvement on the adenoma detection rate (ADR), but few have stratified this effect by level of training. We aimed to evaluate the "fellow effect" on multiple procedural metrics including a newly defined adenoma management efficiency index, which may have a role in documenting colonoscopy proficiency for trainees. We also describe the impact of level of training on moderate sedation use. We performed a retrospective review of 2024 patients (mean age 60.9 ± 10. 94% males) who underwent outpatient colonoscopy between June 2012 and December 2014 at our Veterans Affairs Medical Center. Colonoscopies were divided into 5 groups. The first 2 groups were first year fellows in the first 6 months and last 6 months of the training year. Second and third year fellows and attending only procedures accounted for one group each. We collected data on doses of sedatives used, frequency of adjunctive agent use, procedural times as well as location, size and histology of polyps. We defined the adenoma management efficiency index as average time required per adenoma resected during withdrawal. 1675 colonoscopies involved a fellow. 349 were performed by the attending alone. There was no difference in ADR between fellows according to level of training (P=0.8), or between fellows compared with attending-only procedures (P=0.67). Procedural times decreased consistently during training, and declined further for attending only procedures. This translated into improvement in the adenoma management efficiency index (fellow groups by ascending level of training 23.5 minutes vs 18.3 minutes vs 13.7 minutes vs 13.4 minutes vs attending group 11.7 minutes; P<0.001). There was no difference in the average doses of midazolam and fentanyl used among fellow groups (P=0.16 and P=0.1, respectively). Compared with attending-only procedures, fellow involvement was associated with higher doses of fentanyl and midazolam and more frequent use of diphenhydramine and glucagon (P<0.0001; P=0.0002; P<0.0001; and P=0.01, respectively). ADR was similar at different stages of fellowship training and comparable with the attending group. Efficiency of detecting and resecting polyps improved throughout training without reaching attending level. Fellow involvement led to greater use of moderate sedation, which may relate to a longer procedure duration and an evolving experience in endoscopic technique. Copyright © 2018 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.

Wrist electrogoniometry: are current mathematical correction procedures effective in reducing crosstalk in functional assessment?

PubMed

Foltran, Fabiana A; Silva, Luciana C C B; Sato, Tatiana O; Coury, Helenice J C G

2013-01-01

The recording of human movement is an essential requirement for biomechanical, clinical, and occupational analysis, allowing assessment of postural variation, occupational risks, and preventive programs in physical therapy and rehabilitation. The flexible electrogoniometer (EGM), considered a reliable and accurate device, is used for dynamic recordings of different joints. Despite these advantages, the EGM is susceptible to measurement errors, known as crosstalk. There are two known types of crosstalk: crosstalk due to sensor rotation and inherent crosstalk. Correction procedures have been proposed to correct these errors; however no study has used both procedures in clinical measures for wrist movements with the aim to optimize the correction. To evaluate the effects of mathematical correction procedures on: 1) crosstalk due to forearm rotation, 2) inherent sensor crosstalk; and 3) the combination of these two procedures. 43 healthy subjects had their maximum range of motion of wrist flexion/extension and ulnar/radials deviation recorded by EGM. The results were analyzed descriptively, and procedures were compared by differences. There was no significant difference in measurements before and after the application of correction procedures (P<0.05). Furthermore, the differences between the correction procedures were less than 5° in most cases, having little impact on the measurements. Considering the time-consuming data analysis, the specific technical knowledge involved, and the inefficient results, the correction procedures are not recommended for wrist recordings by EGM.

Comparison of Constant Time Delay and Simultaneous Prompting Procedures: Teaching Functional Sight Words to Students with Intellectual Disabilities and Autism Spectrum Disorder

ERIC Educational Resources Information Center

Swain, Rasheeda; Lane, Justin D.; Gast, David L.

2015-01-01

Constant time delay (CTD) and simultaneous prompting (SP) are effective response prompting procedures for teaching students with moderate to severe disabilities. The purpose of this study was to compare the efficiency of CTD and SP when teaching functional sight words to four students, 8-11 years of age, with moderate intellectual disability (ID)…

Ankle manual therapy for individuals with post-acute ankle sprains: description of a randomized, placebo-controlled clinical trial.

PubMed

Davenport, Todd E; Kulig, Kornelia; Fisher, Beth E

2010-10-19

Ankle sprains are common within the general population and can result in prolonged disablement. Limited talocrural dorsiflexion range of motion (DF ROM) is a common consequence of ankle sprain. Limited talocrural DF ROM may contribute to persistent symptoms, disability, and an elevated risk for re-injury. As a result, many health care practitioners use hands-on passive procedures with the intention of improving talocrural joint DF ROM in individuals following ankle sprains. Dosage of passive hands-on procedures involves a continuum of treatment speeds. Recent evidence suggests both slow- and fast-speed treatments may be effective to address disablement following ankle sprains. However, these interventions have yet to be longitudinally compared against a placebo study condition. We developed a randomized, placebo-controlled clinical trial designed to test the hypotheses that hands-on treatment procedures administered to individuals following ankle sprains during the post-acute injury period can improve short-, intermediate-, and long-term disablement, as well as reduce the risk for re-injury. This study is designed to measure the clinical effects of hands-on passive stretching treatment procedures directed to the talocrural joint that vary in treatment speed during the post-acute injury period, compared to hands-on placebo control intervention. http://www.clinicaltrials.gov identifier NCT00888498.

Learning from Worked-Examples in Mathematics: Students Relate Procedures to Principles

ERIC Educational Resources Information Center

Renkl, Alexander

2017-01-01

This article discusses the relevance of the worked-example effect for mathematics education. This effect refers to the finding that, in initial cognitive skill acquisition, students profit more from studying worked examples as compared to solving problems. One reason for the effectiveness of worked examples is that the students get the opportunity…

Cost-effective fire management for southern California's chaparral wilderness: an analytical procedure

Treesearch

Chris A. Childers; Douglas D. Piirto

1989-01-01

Fire management has always meant fire suppression to the managers of the chaparral covered southern California National Forests. Today, Forest Service fire management programs must be cost effective, while wilderness fire management objectives are aimed at recreating natural fire regimes. A cost-effectiveness analysis has been developed to compare fire management...

The Effects of Expansions, Questions and Cloze Procedures on Children's Conversational Skills

ERIC Educational Resources Information Center

Wong, Tze-Peng; Moran, Catherine; Foster-Cohen, Susan

2012-01-01

The effectiveness of expansion as a technique for facilitating children's language and conversational skills is well known (Scherer and Olswang, 1984). Expansion, however, can appear alone or in combination with other techniques. Using a repeated measures design, this study aimed to compare the effects of expansion alone (EA); expansion combined…

Comparison of 1997 Medicare relative value units for gender-specific procedures: is Adam still worth more than Eve?

PubMed

Goff, B A; Muntz, H G; Cain, J M

1997-08-01

On January 1, 1992, Congress implemented a Medicare payment system based on relative value units (RVUs). The total RVU (which is made up of work, practice, and malpractice RVUs) is multiplied by a dollar conversion factor to set the reimbursement for all procedures covered by Medicare. In a previous study, we found that significant gender bias exists in Medicare reimbursement for female-specific services. Recently, HCFA approved increases (beginning January 1997) in the work RVU for many gynecologic procedures. This study was undertaken to compare work and total RVUs for gender-specific procedures effective January 1, 1997. Using the May 1996 Federal Register, we compared work and total RVUs for 24 pairs of gender-specific procedures. The groups were matched so that the amount of work and level of difficulty would be similar, if not identical. We validated our selection of procedures for comparison by also evaluating the average time required to perform these procedures. Comparison of work RVUs for the 24 paired procedures revealed that in 19 cases (80%), male-specific procedures had a higher RVU; in 3 cases (12%), female-specific procedures were higher; and in 2 cases, there was no difference. On average, work RVUs were 49% higher for urologic procedures than for gynecologic procedures. Comparison of total RVUs revealed that in 20 cases (83%), urologic procedures had a higher total RVU and in 3 cases (12%), gynecologic procedures were higher. On average, male-specific surgeries are reimbursed at an amount which is 37% higher than that for female-specific surgeries. Recent increases in work RVUs for many gynecologic procedures have resulted in improved reimbursement. However, even with these improvements, significant gender bias still exists in the Medicare reimbursement of female-specific procedures. This gender bias is further magnified as more private insurance carriers use the system to set reimbursement.

Safety and cost-effectiveness of bridge therapies for invasive dental procedures in patients with mechanical heart valves.

PubMed

Won, Ki-Bum; Lee, Seung-Hyun; Chang, Hyuk-Jae; Shim, Chi-Young; Hong, Gue-Ru; Ha, Jong-Won; Chung, Namsik

2014-07-01

Bridge anticoagulation therapy is mostly utilized in patients with mechanical heart valves (MHV) receiving warfarin therapy during invasive dental procedures because of the risk of excessive bleeding related to highly vascular supporting dental structures. Bridge therapy using low molecular weight heparin may be an attractive option for invasive dental procedures; however, its safety and cost-effectiveness compared with unfractionated heparin (UFH) is uncertain. This study investigated the safety and cost-effectiveness of enoxaparin in comparison to UFH for bridge therapy in 165 consecutive patients (57±11 years, 35% men) with MHV who underwent invasive dental procedures. This study included 75 patients treated with UFH-based bridge therapy (45%) and 90 patients treated with enoxaparin-based bridge therapy (55%). The bleeding risk of dental procedures and the incidence of clinical adverse outcomes were not significantly different between the UFH group and the enoxaparin group. However, total medical costs were significantly lower in the enoxaparin group than in the UFH group (p<0.001). After multivariate adjustment, old age (≥65 years) was significantly associated with an increased risk of total bleeding independent of bridging methods (odds ratio, 2.51; 95% confidence interval, 1.15-5.48; p=0.022). Enoxaparin-based bridge therapy (β=-0.694, p<0.001) and major bleeding (β=0.296, p=0.045) were significantly associated with the medical costs within 30 days after dental procedures. Considering the benefit of enoxaparin in cost-effectiveness, enoxaparin may be more efficient than UFH for bridge therapy in patients with MHV who required invasive dental procedures.

Individualizing drug dosage with longitudinal data.

PubMed

Zhu, Xiaolu; Qu, Annie

2016-10-30

We propose a two-step procedure to personalize drug dosage over time under the framework of a log-linear mixed-effect model. We model patients' heterogeneity using subject-specific random effects, which are treated as the realizations of an unspecified stochastic process. We extend the conditional quadratic inference function to estimate both fixed-effect coefficients and individual random effects on a longitudinal training data sample in the first step and propose an adaptive procedure to estimate new patients' random effects and provide dosage recommendations for new patients in the second step. An advantage of our approach is that we do not impose any distribution assumption on estimating random effects. Moreover, the new approach can accommodate more general time-varying covariates corresponding to random effects. We show in theory and numerical studies that the proposed method is more efficient compared with existing approaches, especially when covariates are time varying. In addition, a real data example of a clozapine study confirms that our two-step procedure leads to more accurate drug dosage recommendations. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

Efficacy of Sleeve Gastrectomy with Duodenal-Jejunal Bypass for the Treatment of Obese Severe Diabetes Patients in Japan: a Retrospective Multicenter Study.

PubMed

Naitoh, Takeshi; Kasama, Kazunori; Seki, Yosuke; Ohta, Masayuki; Oshiro, Takashi; Sasaki, Akira; Miyazaki, Yasuhiro; Yamaguchi, Tsuyoshi; Hayashi, Hideki; Imoto, Hirofumi; Tanaka, Naoki; Unno, Michiaki

2018-02-01

The incidence of obesity with type 2 diabetes (T2DM) is increasing in Japan. The main bariatric surgery procedures in Japan are laparoscopic sleeve gastrectomy (LSG) and LSG with duodenal-jejunal bypass (LSG/DJB) because of the high incidence of gastric cancer and difficulty exploring a remnant stomach after gastric bypass. However, few studies have compared the antidiabetic effect of LSG/DJB with LSG alone. The purpose of this study is to compare the antidiabetic effect of LSG/DJB with that of LSG alone in Japanese obese diabetic patients. This was a retrospective multicenter study including 298 cases: 177 and 121 LSG and LSG/DJB cases, respectively. We investigated the antidiabetic effect of these two procedures at 12 months after surgery. Univariate and multivariate analyses were done to evaluate the predictive factors of T2DM remission. The diabetes remission rate at 12 months after surgery was 80.8% for LSG and 86.0% for LSG/DJB. Insulin use and HbA1c ≤ 6.7% were significant predictive factors in multivariate analysis for all patients. In patients with ABCD score ≥ 6, the diabetes remission rate was 94.8% and there was no difference between procedures. Only duration of diabetes and insulin use were significant predictive factors both in univariate and multivariate analyses. However, in cases with ABCD score ≤ 5, the remission rate was 70.3% and procedure type was the most significant predictive factor for diabetes remission (odds ratio [OR] 5.140). Although both LSG and LSG/DJB have good antidiabetic effects in Japanese obese patients, LSG/DJB is more effective for patients with lower ABCD scores.

Comparison of methods applied in photoinduced transient spectroscopy to determining the defect center parameters: The correlation procedure and the signal analysis based on inverse Laplace transformation

NASA Astrophysics Data System (ADS)

Suproniuk, M.; Pawłowski, M.; Wierzbowski, M.; Majda-Zdancewicz, E.; Pawłowski, Ma.

2018-04-01

The procedure for determination of trap parameters by photo-induced transient spectroscopy is based on the Arrhenius plot that illustrates a thermal dependence of the emission rate. In this paper, we show that the Arrhenius plot obtained by the correlation method is shifted toward lower temperatures as compared to the one obtained with the inverse Laplace transformation. This shift is caused by the model adequacy error of the correlation method and introduces errors to a calculation procedure of defect center parameters. The effect is exemplified by comparing the results of the determination of trap parameters with both methods based on photocurrent transients for defect centers observed in tin-doped neutron-irradiated silicon crystals and in gallium arsenide grown with the Vertical Gradient Freeze method.

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

Mendoza-Moctezuma, A. I.; Aguilar, J. Garcia; Garcia-Garduno, O. A.

Interventional cardiology procedures are an effective alternative for the reestablishment of correct sanguineous circulation in the heart. However, this kind of procedures exposes to the patients to a relatively high radiation doses. Usually, the surface peak skin dose is evaluated using a visual scale with a comparator strip, nevertheless, even if the comparator strip provides a simple and quick method for estimating the dose it has an uncertainty of {+-}25%. For this reason, a better evaluation method is needed. The objective of our project is to determine the surface peak skin dose of interventional cardiology procedures using GafChromic XR-RV2 filmmore » together with a commercial flatbed scanner in reflection mode. Here we report a protocol to handle GafChromic XR-RV2 film using a commercial flat bed scanner in reflection mode aiming at an uncertainty of {+-}3%.« less

A cost and time analysis of laryngology procedures in the endoscopy suite versus the operating room.

PubMed

Hillel, Alexander T; Ochsner, Matthew C; Johns, Michael M; Klein, Adam M

2016-06-01

To assess the costs, charges, reimbursement, and efficiency of performing awake laryngology procedures in an endoscopy suite (ES) compared with like procedures performed in the operating room (OR). Retrospective review of billing records. Cost, charges, and reimbursements for the hospital, surgeon, and anesthesiologist were compared between ES injection laryngoplasty and laser excision procedures and matched case controls in the OR. Time spent in 1) the preoperative unit, 2) the operating or endoscopy suite, and 3) recovery unit were compared between OR and ES procedures. Hospital expenses were significantly less for ES procedures when compared to OR procedures. Reimbursement was similar for ES and OR injection laryngoplasty, though greater for OR laser excisions. Net balance (reimbursement-expenses) was greater for ES procedures. A predictive model of payer costs over a 3-year period showed similar costs for ES and OR laser procedures and reduced costs for ES compared to OR injection laryngoplasty. Times spent preoperatively and the procedure were significantly less for ES procedures. For individual laryngology procedures, the ES reduces time and costs compared to the OR, increasing otolaryngologist and hospital efficiency. This reveals cost and time savings of ES injection laryngoplasty, which occurs at a similar frequency as OR injection laryngoplasty. Given the increased frequency for ES laser procedures, total costs are similar for ES and OR laser excision of papilloma, which usually require repeated procedures. When regulated office space is unavailable, endoscopy rooms represent an alternative setting for unsedated laryngology procedures. NA Laryngoscope, 126:1385-1389, 2016. © 2015 The American Laryngological, Rhinological and Otological Society, Inc.

Cognitive procedural learning among children and adolescents with or without spastic cerebral palsy: the differential effect of age.

PubMed

Gofer-Levi, M; Silberg, T; Brezner, A; Vakil, E

2014-09-01

Children learn to engage their surroundings skillfully, adopting implicit knowledge of complex regularities and associations. Probabilistic classification learning (PCL) is a type of cognitive procedural learning in which different cues are probabilistically associated with specific outcomes. Little is known about the effects of developmental disorders on cognitive skill acquisition. Twenty-four children and adolescents with cerebral palsy (CP) were compared to 24 typically developing (TD) youth in their ability to learn probabilistic associations. Performance was examined in relation to general cognitive abilities, level of motor impairment and age. Improvement in PCL was observed for all participants, with no relation to IQ. An age effect was found only among TD children. Learning curves of children with CP on a cognitive procedural learning task differ from those of TD peers and do not appear to be age sensitive. Copyright © 2014 Elsevier Ltd. All rights reserved.

Effects of laser-aided circumferential supracrestal fiberotomy on root surfaces.

PubMed

Lee, Ji-Won; Park, Ki-Ho; Chung, Jong-Hyuk; Kim, Su-Jung

2011-11-01

To evaluate and compare the effects of circumferential supracrestal fiberotomy in vivo (using diode, CO(2), and Er∶YAG lasers) on the morphology and chemical composition of the root surface. Forty healthy premolar teeth, intended for extraction for orthodontic reasons, were used in this study. Root surfaces were treated using different laser methods, as follows: (1) control; (2) Er∶YAG laser (2.94 µm, 100 mJ, 10 Hz); (3) diode laser (808 nm, 1.2 W, continuous wave); and (4) CO(2) laser (10.6 µm, 3 W, continuous wave). Subsequently, the teeth were removed and subjected to scanning electron microscopic (SEM) examination and energy dispersive x-ray (EDX) spectrometric analysis. SEM analysis indicated that no thermal changes, including melting or carbonization, were observed following the lasing procedures. EDX analysis showed that the laser procedures resulted in similar mineral contents (weight % of calcium and phosphate) as compared to those in the control group. Based on these findings, we concluded that laser-aided procedures, when used at appropriate laser settings, preserve the original morphology and chemical composition of cementum.

Storage of cell samples for ToF-SIMS experiments-How to maintain sample integrity.

PubMed

Schaepe, Kaija; Kokesch-Himmelreich, Julia; Rohnke, Marcus; Wagner, Alena-Svenja; Schaaf, Thimo; Henss, Anja; Wenisch, Sabine; Janek, Jürgen

2016-06-25

In order to obtain comparable and reproducible results from time-of-flight secondary ion mass spectrometry (ToF-SIMS) analysis of biological cells, the influence of sample preparation and storage has to be carefully considered. It has been previously shown that the impact of the chosen preparation routine is crucial. In continuation of this work, the impact of storage needs to be addressed, as besides the fact that degradation will unavoidably take place, the effects of different storage procedures in combination with specific sample preparations remain largely unknown. Therefore, this work examines different wet (buffer, water, and alcohol) and dry (air-dried, freeze-dried, and critical-point-dried) storage procedures on human mesenchymal stem cell cultures. All cell samples were analyzed by ToF-SIMS immediately after preparation and after a storage period of 4 weeks. The obtained spectra were compared by principal component analysis with lipid- and amino acid-related signals known from the literature. In all dry storage procedures, notable degradation effects were observed, especially for lipid-, but also for amino acid-signal intensities. This leads to the conclusion that dried samples are to some extent easier to handle, yet the procedure is not the optimal storage solution. Degradation proceeds faster, which is possibly caused by oxidation reactions and cleaving enzymes that might still be active. Just as well, wet stored samples in alcohol struggle with decreased signal intensities from lipids and amino acids after storage. Compared to that, the wet stored samples in a buffered or pure aqueous environment revealed no degradation effects after 4 weeks. However, this storage bears a higher risk of fungi/bacterial contamination, as sterile conditions are typically not maintained. Thus, regular solution change is recommended for optimized storage conditions. Not directly exposing the samples to air, wet storage seems to minimize oxidation effects, and hence, buffer or water storage with regular renewal of the solution is recommended for short storage periods.

Storage of cell samples for ToF-SIMS experiments—How to maintain sample integrity

PubMed Central

Schaepe, Kaija; Kokesch-Himmelreich, Julia; Rohnke, Marcus; Wagner, Alena-Svenja; Schaaf, Thimo; Henss, Anja; Wenisch, Sabine; Janek, Jürgen

2016-01-01

In order to obtain comparable and reproducible results from time-of-flight secondary ion mass spectrometry (ToF-SIMS) analysis of biological cells, the influence of sample preparation and storage has to be carefully considered. It has been previously shown that the impact of the chosen preparation routine is crucial. In continuation of this work, the impact of storage needs to be addressed, as besides the fact that degradation will unavoidably take place, the effects of different storage procedures in combination with specific sample preparations remain largely unknown. Therefore, this work examines different wet (buffer, water, and alcohol) and dry (air-dried, freeze-dried, and critical-point-dried) storage procedures on human mesenchymal stem cell cultures. All cell samples were analyzed by ToF-SIMS immediately after preparation and after a storage period of 4 weeks. The obtained spectra were compared by principal component analysis with lipid- and amino acid-related signals known from the literature. In all dry storage procedures, notable degradation effects were observed, especially for lipid-, but also for amino acid-signal intensities. This leads to the conclusion that dried samples are to some extent easier to handle, yet the procedure is not the optimal storage solution. Degradation proceeds faster, which is possibly caused by oxidation reactions and cleaving enzymes that might still be active. Just as well, wet stored samples in alcohol struggle with decreased signal intensities from lipids and amino acids after storage. Compared to that, the wet stored samples in a buffered or pure aqueous environment revealed no degradation effects after 4 weeks. However, this storage bears a higher risk of fungi/bacterial contamination, as sterile conditions are typically not maintained. Thus, regular solution change is recommended for optimized storage conditions. Not directly exposing the samples to air, wet storage seems to minimize oxidation effects, and hence, buffer or water storage with regular renewal of the solution is recommended for short storage periods. PMID:26810048

Evaluation of abalone β-glucuronidase substitution in current urine hydrolysis procedures.

PubMed

Malik-Wolf, Brittany; Vorce, Shawn; Holler, Justin; Bosy, Thomas

2014-04-01

This study examined the potential of abalone β-glucuronidase as a viable and cost effective alternative to current hydrolysis procedures using acid, Helix pomatia β-glucuronidase and Escherichia coli β-glucuronidase. Abalone β-glucuronidase successfully hydrolyzed oxazepam-glucuronide and lorazepam-glucuronide within 5% of the spiked control concentration. Benzodiazepines present in authentic urine specimens were within 20% of the concentrations obtained with the current hydrolysis procedure using H. pomatia β-glucuronidase. JWH 018 N-(5-hydroxypentyl) β-d-glucuronide was hydrolyzed within 10% of the control concentration. Authentic urine specimens showed improved glucuronide cleavage using abalone β-glucuronidase with up to an 85% increase of drug concentration, compared with the results obtained using E. coli β-glucuronidase. The JWH 018 and JWH 073 carboxylic acid metabolites also showed increased drug concentrations of up to 24%. Abalone β-glucuronidase was able to completely hydrolyze a morphine-3-glucuronide control, but only 82% of total morphine was hydrolyzed in authentic urine specimens compared with acid hydrolysis results. Hydrolysis of codeine and hydromorphone varied between specimens, suggesting that abalone β-glucuronidase may not be as efficient in hydrolyzing the glucuronide linkages in opioid compounds compared with acid hydrolysis. Abalone β-glucuronidase demonstrates effectiveness as a low cost option for enzyme hydrolysis of benzodiazepines and synthetic cannabinoids.

Is the Stretta procedure as effective as the best medical and surgical treatments for gastro-oesophageal reflux disease? A best evidence topic.

PubMed

Das, Bibek; Reddy, Marcus; Khan, Omar A

2016-06-01

A best evidence topic in surgery was written according to a structured protocol. The question addressed whether the Stretta(®) procedure is as effective as the best medical and surgical treatments for patients with symptoms of gastro-oesophageal reflux disease (GORD). One hundred and forty Stretta-related papers were identified using the reported search, of which five represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group, study type, relevant outcomes and results of these papers are tabulated. One study was a randomised controlled trial comparing Stretta with proton pump inhibitors (PPIs), and four were prospective observational studies that compared Stretta with laparoscopic fundoplication. These studies provide limited evidence that Stretta is as effective as medical therapy at controlling symptoms of GORD and may allow some patients to reduce their PPI use, but laparoscopic fundoplication appears to be more effective than Stretta though with a higher rate of adverse events. Further studies are required to determine the long-term efficacy of Stretta compared to the current best medical and surgical treatments. Copyright © 2016. Published by Elsevier Ltd.

Longitudinal trends with Improvement in Quality of Life after TVT, TVT O and Burch Colposuspension Procedures

PubMed Central

Drahoradova, Petra; Martan, Alois; Svabik, Kamil; Zvara, Karel; Otava, Martin; Masata, Jaromir

2011-01-01

Summary Background Comparison of the quality of life (QoL) trends after TVT, TVT O and Burch colposuspension (BCS) procedures and comparison of long-term subjective and objective outcomes. Material/Methods The study included 215 women who underwent a TVT, TVT O or BCS procedure. We monitored QoL after each procedure and the effect of complications on the QoL as assessed by the IQOL questionnaire over a 3-year period. Results The study was completed by 74.5% of women after TVT, 74.5% after TVT O, and 65.2% after BCS procedure. In the long-term, the QoL improved from 46.9 to 88.7 and remained stable after BCS; after TVT and TVT O, it declined, but only after TVT O was the decline statistically significant compared to BCS. The IQOL for women with post-operative complications has a clear descending tendency. The effect of the complications is highly significant (p<0.001). Only the OAB complication had a statistically significant effect on QoL p<0.001. Preexistent OAB does not negatively affect postoperative results of anti-incontinence surgery. Conclusions There was a statistically significant decline with the longitudinal values of IQOL with TVT O, but not with TVT or BCS. Anti-incontinence operations significantly improve quality of life for women with MI, but compared to the SI group, the quality of life is worse when measured at a longer time interval after the operation. Anti-incontinence operations significantly improve quality of life, and the difference in preoperative status in the long-term follow-up is demonstrable. PMID:21278690

Effects of music therapy on pain and anxiety in patients undergoing port catheter placement procedure.

PubMed

Zengin, Suat; Kabul, Sinem; Al, Behcet; Sarcan, Emine; Doğan, Mehmet; Yildirim, Cuma

2013-12-01

Patients scheduled to invasive medical procedures experience high levels of anxiety, which may lead to increased perceptions of pain and vital sign instability throughout. To examine the effect of a music intervention (MI) on stress hormones, physiologic parameters, pain, and anxiety state before and during port catheter placement procedures (PCPPs). We conducted a prospective, randomized, controlled study in 100 oncology patients, who were randomly assigned to an MI group (n=50) or a control group (n=50). The effects of music were assessed by determination of serum cortisol and adrenocorticotropic hormone (ACTH) levels, heart and respiratory rate (HR, RR) and systolic and diastolic blood pressure (SBP, DBP), on arrival in the surgical intervention room, as well as immediately prior to and immediately after the PCPP, in both groups. Furthermore, pain and anxiety levels were identified using visual analogue scale and state-trait anxiety inventory scales. On arrival, there were no differences between the patients in terms of serum cortisol and ACTH levels, HR, RR, SBP, DBP and anxiety levels. There were significant reductions in hormone levels (p<0.05 for all), HR (p<0.001), RR (p<0.001), SBP (p<0.05) and DBP (p<0.05), immediately prior to and immediately after the PCPP in participants in the MI group compared to those in the control group. Furthermore, music led to a significant reduction in pain (p<0.05) and anxiety scores (p<0.05) in the MI group compared to control group. During invasive medical procedures, MI significantly decreases stress hormone levels, physiological parameters, acute procedural pain and anxiety. Copyright © 2013 Elsevier Ltd. All rights reserved.

Evidence-based knowledge on the aesthetics and maintenance of peri-implant soft tissues: Osteology Foundation Consensus Report Part 1-Effects of soft tissue augmentation procedures on the maintenance of peri-implant soft tissue health.

PubMed

Giannobile, William V; Jung, Ronald E; Schwarz, Frank

2018-03-01

The goal of Working Group 1 at the 2nd Consensus Meeting of the Osteology Foundation was to comprehensively assess the effects of soft tissue augmentation procedures on peri-implant health or disease. A systematic review and meta-analysis on the effects of soft tissue augmentation procedures included a total of 10 studies (mucosal thickness: n = 6; keratinized tissue: n = 4). Consensus statements, clinical recommendations, and implications for future research were based on structured group discussions and a plenary session approval. Soft tissue grafting to increase the width of keratinized tissue around implants was associated with greater reductions in gingival and plaque indices when compared to non-augmented sites. Statistically significant differences were noted for final marginal bone levels in favor of an apically positioned flap plus autogenous graft vs. all standard-of-care control treatments investigated. Soft tissue grafting (i.e., autogenous connective tissue) to increase the mucosal thickness around implants in the aesthetic zone was associated with significantly less marginal bone loss over time, but no significant changes in bleeding on probing, probing depths, or plaque scores when compared to sites without grafting. The limited evidence available supports the use of soft tissue augmentation procedures to promote peri-implant health. © 2018 The Authors. Clinical Oral Implants Research Published by John Wiley & Sons Ltd.

Contact stresses in meshing spur gear teeth: Use of an incremental finite element procedure

NASA Technical Reports Server (NTRS)

Hsieh, Chih-Ming; Huston, Ronald L.; Oswald, Fred B.

1992-01-01

Contact stresses in meshing spur gear teeth are examined. The analysis is based upon an incremental finite element procedure that simultaneously determines the stresses in the contact region between the meshing teeth. The teeth themselves are modeled by two dimensional plain strain elements. Friction effects are included, with the friction forces assumed to obey Coulomb's law. The analysis assumes that the displacements are small and that the tooth materials are linearly elastic. The analysis procedure is validated by comparing its results with those for the classical two contacting semicylinders obtained from the Hertz method. Agreement is excellent.

Improved system for floor cleaning in health care facilities.

PubMed Central

Schmidt, E A; Coleman, D L; Mallison, G F

1984-01-01

A new system has been developed for sanitizing floors in hospitals; this system replaces the traditional procedure of daily dusting and wet mopping with a disinfectant-detergent solution and periodic buffing . This new system relies on a sequence of procedures consisting of dust mopping using a chemically treated dust mop, machine buffing of a sprayed-on polymer treatment, and a second dust mopping . The effectiveness of the procedures was evaluated by means of surface sampling for bacterial contamination and air sampling for airborne bacteria and dust. The level of bacterial contamination on the floors was reduced by 93.6% by using the new system, compared with 79.8% by using the conventional process of dust mopping and wet mopping with a disinfectant solution. The levels of airborne bacteria during and after the individual procedures did not vary significantly from the initial level (123.6 CFU/per m3 of air). A survey of representative colonies from air samples revealed staphylococci, gram-positive bacilli, gram-positive diplococci, yeast cells, and infrequent gram-negative rods. The distribution at the conclusion of the sanitizing process was similar to that at the outset. Similarly, the levels of airborne dust measured during and after the individual procedures did not vary significantly from the initial level. When compared with the traditional method of cleaning by wet mopping , the new method was significantly more effective in removal of microbial contamination and required less labor. PMID:6742835

Efficacy and adverse events of cold vs hot polypectomy: A meta-analysis.

PubMed

Fujiya, Mikihiro; Sato, Hiroki; Ueno, Nobuhiro; Sakatani, Aki; Tanaka, Kazuyuki; Dokoshi, Tatsuya; Fujibayashi, Shugo; Nomura, Yoshiki; Kashima, Shin; Gotoh, Takuma; Sasajima, Junpei; Moriichi, Kentaro; Watari, Jiro; Kohgo, Yutaka

2016-06-21

To compare previously reported randomized controlled studies (RCTs) of cold and hot polypectomy, we systematically reviewed and clarify the utility of cold polypectomy over hot with respect to efficacy and adverse events. A meta-analysis was conducted to evaluate the predominance of cold and hot polypectomy for removing colon polyps. Published articles and abstracts from worldwide conferences were searched using the keywords "cold polypectomy". RCTs that compared either or both the effects or adverse events of cold polypectomy with those of hot polypectomy were collected. The patients' demographics, endoscopic procedures, No. of examined lesions, lesion size, macroscopic and histologic findings, rates of incomplete resection, bleeding amount, perforation, and length of procedure were extracted from each study. A forest plot analysis was used to verify the relative strength of the effects and adverse events of each procedure. A funnel plot was generated to assess the possibility of publication bias. Ultimately, six RCTs were selected. No significant differences were noted in the average lesion size (less than 10 mm) between the cold and hot polypectomy groups in each study. Further, the rates of complete resection and adverse events, including delayed bleeding, did not differ markedly between cold and hot polypectomy. The average procedural time in the cold polypectomy group was significantly shorter than in the hot polypectomy group. Cold polypectomy is a time-saving procedure for removing small polyps with markedly similar curability and safety to hot polypectomy.

Skin-to-skin contact and/or oral 25% dextrose for procedural pain relief for term newborn infants.

PubMed

Chermont, Aurimery Gomes; Falcão, Luis Fábio Magno; de Souza Silva, Eduardo Henrique Laurindo; de Cássia Xavier Balda, Rita; Guinsburg, Ruth

2009-12-01

The goal was to compare the efficacy of oral 25% dextrose treatment and/or skin-to-skin contact for analgesia in term newborns during intramuscular injection of a hepatitis B vaccine. A prospective, randomized, partially blinded, clinical trial was performed with 640 healthy term newborns. Infants at 12 to 72 hours of life were assigned randomly to receive an intramuscular injection of hepatitis B vaccine in the right thigh according to 4 analgesia groups, that is, no analgesia (routine); oral 25% dextrose treatment, given 2 minutes before the injection; skin-to-skin contact, initiated 2 minutes before the injection and persisting throughout the procedure; and a combination of the oral dextrose treatment and skin-to-skin contact strategies. For all groups, Neonatal Facial Coding System and Neonatal Infant Pain Scale scores were evaluated before the procedure, during thigh cleansing, during the injection, and 2 minutes after the injection. Premature Infant Pain Profile scores also were assessed for all infants. Pain scores were compared among the 4 groups. The use of oral 25% dextrose treatment reduced the duration of procedural pain in the studied population. Skin-to-skin contact decreased injection pain and duration. The combination of the 2 analgesic measures was more effective than either measure separately for term newborns. Nonpharmacologic analgesic measures were effective for the treatment of procedural pain in term infants. The combination of oral 25% dextrose treatment and skin-to-skin contact acted synergistically to decrease acute pain in healthy neonates.

Combining Heterogeneous Correlation Matrices: Simulation Analysis of Fixed-Effects Methods

ERIC Educational Resources Information Center

Hafdahl, Adam R.

2008-01-01

Monte Carlo studies of several fixed-effects methods for combining and comparing correlation matrices have shown that two refinements improve estimation and inference substantially. With rare exception, however, these simulations have involved homogeneous data analyzed using conditional meta-analytic procedures. The present study builds on…

Effective Instructional Characteristics of Teachers of Junior High School Gifted Students.

ERIC Educational Resources Information Center

Wendel, Robert; Heiser, Sandra

1989-01-01

An ethnographic study analyzed videotapes using simulated recall procedure and comparative analysis of a student opinionnaire to determine effective characteristics of teachers of gifted junior high schools students. Desirable traits noted were humor, enthusiasm, creativity, care and respect for students, and high expectations. (MSE)

The effects of divided attention at study and reporting procedure on regulation and monitoring for episodic recall.

PubMed

Sauer, James; Hope, Lorraine

2016-09-01

Eyewitnesses regulate the level of detail (grain size) reported to balance competing demands for informativeness and accuracy. However, research to date has predominantly examined metacognitive monitoring for semantic memory tasks, and used relatively artificial phased reporting procedures. Further, although the established role of confidence in this regulation process may affect the confidence-accuracy relation for volunteered responses in predictable ways, previous investigations of the confidence-accuracy relation for eyewitness recall have largely overlooked the regulation of response granularity. Using a non-phased paradigm, Experiment 1 compared reporting and monitoring following optimal and sub-optimal (divided attention) encoding conditions. Participants showed evidence of sacrificing accuracy for informativeness, even when memory quality was relatively weak. Participants in the divided (cf. full) attention condition showed reduced accuracy for fine- but not coarse-grained responses. However, indices of discrimination and confidence diagnosticity showed no effect of divided attention. Experiment 2 compared the effects of divided attention at encoding on reporting and monitoring using both non-phased and 2-phase procedures. Divided attention effects were consistent with Experiment 1. However, compared to those in the non-phased condition, participants in the 2-phase condition displayed a more conservative control strategy, and confidence ratings were less diagnostic of accuracy. When memory quality was reduced, although attempts to balance informativeness and accuracy increased the chance of fine-grained response errors, confidence provided an index of the likely accuracy of volunteered fine-grained responses for both condition. Copyright © 2016 Elsevier B.V. All rights reserved.

The Effect of an Orthopaedic Surgical Procedure in the National Basketball Association.

PubMed

Minhas, Shobhit V; Kester, Benjamin S; Larkin, Kevin E; Hsu, Wellington K

2016-04-01

Professional basketball players have a high incidence of injuries requiring surgical intervention. However, no studies in the current literature have compared postoperative performance outcomes among common injuries to determine high- and low-risk procedures to these athletes' careers. To compare return-to-play (RTP) rates and performance-based outcomes after different orthopaedic procedures in National Basketball Association (NBA) players and to determine which surgeries are associated with the worst postoperative change in performance. Cohort study; Level of evidence, 3. Athletes in the NBA undergoing anterior cruciate ligament reconstruction, Achilles tendon repair, lumbar discectomy, microfracture, meniscus surgery, hand/wrist or foot fracture fixation, and shoulder stabilization were identified through team injury reports and archives on public record. The RTP rate, games played per season, and player efficiency rating (PER) were determined before and after surgery. Statistical analysis was used to compare the change between pre- and postsurgical performance among the different injuries. A total of 348 players were included. The RTP rates were highest in patients with hand/wrist fractures (98.1%; mean age, 27.0 years) and lowest for those with Achilles tears (70.8%; mean age, 28.4 years) (P = .005). Age ≥30 years (odds ratio [OR], 3.85; 95% CI, 1.24-11.91) and body mass index ≥27 kg/m(2) (OR, 3.46; 95% CI, 1.05-11.40) were predictors of not returning to play. Players undergoing Achilles tendon repair and arthroscopic knee surgery had a significantly greater decline in postoperative performance outcomes at the 1- and 3-year time points and had shorter career lengths compared with the other procedures. NBA players undergoing Achilles tendon rupture repair or arthroscopic knee surgery had significantly worse performance postoperatively compared with other orthopaedic procedures. © 2016 The Author(s).

Effect of Audioanalgesia in 6- to 12-year-old Children during Dental Treatment Procedure.

PubMed

Ramar, Kavitha; Hariharavel, V P; Sinnaduri, Gayathri; Sambath, Gayathri; Zohni, Fathima; Alagu, Palani J

2016-12-01

To evaluate the effect of audioanalgesia in 6- to 12-year-old children during dental treatment procedure. A total of 40 children were selected and divided into two groups, study group - with audioanalgesia and control group - without audioanalgesia. The value of their pain was evaluated using Venham's pain rating scale. Data were compared using one-sample t-test using Statistical Package for the Social Sciences (SPSS) (Inc.; Chicago, IL, USA), version 17.0. The difference in the control group and study group was statistically significant (p < 0.05). The method of distraction using audioanalgesia instills better positive dental attitude in children and decreases their pain perception. Playing or hearing music during dental procedure significantly alters the perception of pain in 6- to 12-year-old children.

Is There Room for Prevention? Examining the Effect of Outpatient Facility Type on the Risk of Surgical Site Infection.

PubMed

Parikh, Rishi; Pollock, Daniel; Sharma, Jyotirmay; Edwards, Jonathan

2016-10-01

OBJECTIVE We compared risk for surgical site infection (SSI) following surgical breast procedures among 2 patient groups: those whose procedures were performed in ambulatory surgery centers (ASCs) and those whose procedures were performed in hospital-based outpatient facilities. DESIGN Cohort study using National Healthcare Safety Network (NHSN) SSI data for breast procedures performed from 2010 to 2014. METHODS Unconditional multivariate logistic regression was used to examine the association between facility type and breast SSI, adjusting for American Society of Anesthesiologists (ASA) Physical Status Classification, patient age, and duration of procedure. Other potential adjustment factors examined were wound classification, anesthesia use, and gender. RESULTS Among 124,021 total outpatient breast procedures performed between 2010 and 2014, 110,987 procedure reports submitted to the NHSN provided complete covariate data and were included in the analysis. Breast procedures performed in ASCs carried a lower risk of SSI compared with those performed in hospital-based outpatient settings. For patients aged ≤51 years, the adjusted risk ratio was 0.36 (95% CI, 0.25-0.50) and for patients >51 years old, the adjusted risk ratio was 0.32 (95% CI, 0.21-0.49). CONCLUSIONS SSI risk following breast procedures was significantly lower among ASC patients than among hospital-based outpatients. These findings should be placed in the context of study limitations, including the possibility of incomplete ascertainment of SSIs and shortcomings in the data available to control for differences in patient case mix. Additional studies are needed to better understand the role of procedural settings in SSI risk following breast procedures and to identify prevention opportunities. Infect Control Hosp Epidemiol 2016;1-7.

A vertical-energy-thresholding procedure for data reduction with multiple complex curves.

PubMed

Jung, Uk; Jeong, Myong K; Lu, Jye-Chyi

2006-10-01

Due to the development of sensing and computer technology, measurements of many process variables are available in current manufacturing processes. It is very challenging, however, to process a large amount of information in a limited time in order to make decisions about the health of the processes and products. This paper develops a "preprocessing" procedure for multiple sets of complicated functional data in order to reduce the data size for supporting timely decision analyses. The data type studied has been used for fault detection, root-cause analysis, and quality improvement in such engineering applications as automobile and semiconductor manufacturing and nanomachining processes. The proposed vertical-energy-thresholding (VET) procedure balances the reconstruction error against data-reduction efficiency so that it is effective in capturing key patterns in the multiple data signals. The selected wavelet coefficients are treated as the "reduced-size" data in subsequent analyses for decision making. This enhances the ability of the existing statistical and machine-learning procedures to handle high-dimensional functional data. A few real-life examples demonstrate the effectiveness of our proposed procedure compared to several ad hoc techniques extended from single-curve-based data modeling and denoising procedures.

Use of Nitrous Oxide in Dermatology: A Systematic Review.

PubMed

Brotzman, Erica A; Sandoval, Laura F; Crane, Jonathan

2018-05-01

Many dermatologic procedures are painful and can be distressing to patients. To determine whether nitrous oxide has been used in dermatology and whether literature supports its use in terms of providing analgesia and anxiety associated with dermatologic procedures. A search of PubMed and Cochrane databases was conducted through July 15, 2016, to identify studies involving nitrous oxide use in dermatology. Eight studies were identified and reviewed. The use of nitrous oxide/oxygen mixture resulted in a significant reduction in pain when used for photodynamic therapy, botulinum toxin therapy for hyperhidrosis of both the palms and axilla, aesthetic procedures involving various laser procedures, and in the treatment of bed sores and leg ulcers. However, pain scores were higher when nitrous oxide/oxygen was used in the debridement of chronic ulcers when compared with the use of topical anesthesia. In addition, nitrous oxide has been reported effective at reducing pain in hair transplants, dermabrasion, excision and repairs, and pediatric procedures. Current literature provides some evidence that nitrous oxide, used alone or as adjunct anesthesia, is effective at providing analgesia for many dermatologic procedures. Nitrous oxide has many potential applications in dermatology; however, further evidence from randomized controlled trials is needed.

Medicare's Hospital Compare quality reports appear to have slowed price increases for two major procedures.

PubMed

Dor, Avi; Encinosa, William E; Carey, Kathleen

2015-01-01

Previous research has found that Hospital Compare, Medicare's public reporting initiative, has had little impact on patient outcomes. However, little is known about the initiative's impact on hospital prices, which may be significant because private insurers are generally well positioned to respond to quality information when negotiating prices with hospitals. We estimated difference-in-differences models of the effects of Hospital Compare quality reporting on transaction prices for two major cardiac procedures, coronary artery bypass graft (CABG) and percutaneous coronary intervention (PCI). States that had mandated their own public reporting systems before the implementation of Hospital Compare formed the control group. We found that prices for these procedures continued to increase overall after the initiation of Hospital Compare quality scores, but the rate of increase was significantly lower in states with no quality reporting metrics of their own before Hospital Compare, when compared to the control states (annual rates of increase of 4.4 percent versus 8.7 percent for PCI, and 3.9 percent versus 10.6 percent for CABG, adjusted for overall inflation). This finding implies that Hospital Compare provided leverage to purchasers in moderating price increases, while adding competitive pressures on hospitals. Providing accurate quality information on both hospitals and health plans could benefit consumers. Project HOPE—The People-to-People Health Foundation, Inc.

Adjacent level effects of bi level disc replacement, bi level fusion and disc replacement plus fusion in cervical spine--a finite element based study.

PubMed

Faizan, Ahmad; Goel, Vijay K; Biyani, Ashok; Garfin, Steven R; Bono, Christopher M

2012-03-01

Studies delineating the adjacent level effect of single level disc replacement systems have been reported in literature. The aim of this study was to compare the adjacent level biomechanics of bi-level disc replacement, bi-level fusion and a construct having adjoining level disc replacement and fusion system. In total, biomechanics of four models- intact, bi level disc replacement, bi level fusion and fusion plus disc replacement at adjoining levels- was studied to gain insight into the effects of various instrumentation systems on cranial and caudal adjacent levels using finite element analysis (73.6N+varying moment). The bi-level fusion models are more than twice as stiff as compared to the intact model during flexion-extension, lateral bending and axial rotation. Bi-level disc replacement model required moments lower than intact model (1.5Nm). Fusion plus disc replacement model required moment 10-25% more than intact model, except in extension. Adjacent level motions, facet loads and endplate stresses increased substantially in the bi-level fusion model. On the other hand, adjacent level motions, facet loads and endplate stresses were similar to intact for the bi-level disc replacement model. For the fusion plus disc replacement model, adjacent level motions, facet loads and endplate stresses were closer to intact model rather than the bi-level fusion model, except in extension. Based on our finite element analysis, fusion plus disc replacement procedure has less severe biomechanical effects on adjacent levels when compared to bi-level fusion procedure. Bi-level disc replacement procedure did not have any adverse mechanical effects on adjacent levels. Copyright © 2011 Elsevier Ltd. All rights reserved.

Yttrium-90 Resin Microsphere Radioembolization Using an Antireflux Catheter: An Alternative to Traditional Coil Embolization for Nontarget Protection

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

Morshedi, Maud M., E-mail: maud.morshedi@my.rfums.org; Bauman, Michael, E-mail: mbauman@ucsd.edu; Rose, Steven C., E-mail: scrose@ucsd.edu

2015-04-15

PurposeSerious complications can result from nontarget embolization during yttrium-90 (Y-90) transarterial radioembolization. Hepatoenteric artery coil embolization has been traditionally performed to prevent nontarget radioembolization. The U.S. Food and Drug Administration–approved Surefire Infusion System (SIS) catheter, designed to prevent reflux, is an alternative to coils. The hypothesis that quantifiable SIS procedural parameters are comparable to coil embolization was tested.MethodsFourteen patients aged 36–79 years with colorectal, neuroendocrine, hepatocellular, and other predominantly bilobar hepatic tumors who underwent resin microsphere Y-90 radioembolization using only the SIS catheter (n = 7) versus only detachable coils (n = 7) for nontarget protection were reviewed retrospectively. Procedure time, fluoroscopy time, contrast dose,more » radiation dose, and cost were evaluated.ResultsMultivariate analysis identified significant cohort differences in the procedural parameters evaluated (F(10, 3) = 10.39, p = 0.04). Between-group comparisons of the pretreatment planning procedure in the SIS catheter group compared to the coil embolization group demonstrated a significant reduction in procedure time (102.6 vs. 192.1 min, respectively, p = 0.0004), fluoroscopy time (14.3 vs. 49.7 min, respectively, p = 0.0016), and contrast material dose (mean dose of 174.3 vs. 265.0 mL, respectively, p = 0.0098). Procedural parameters were not significantly different between the two groups during subsequent dose delivery procedures. Overall cost of combined first-time radioembolization procedures was significantly less in the SIS group ($4252) compared to retrievable coil embolization ($11,123; p = 0.001).ConclusionThe SIS catheter results in a reduction in procedure time, fluoroscopy time, and contrast material dose and may be an attractive cost-effective alternative to detachable coil embolization for prevention of nontarget radioembolization.« less

Cocaine Versus Food Choice Procedure in Rats: Environmental Manipulations and Effects of Amphetamine

PubMed Central

Thomsen, Morgane; Barrett, Andrew C.; Negus, S. Stevens; Caine, S. Barak

2014-01-01

We have adapted a nonhuman primate model of cocaine versus food choice to the rat species. To evaluate the procedure, we tested cocaine versus food choice under a variety of environmental manipulations as well as pharmacological pretreatments. Complete cocaine-choice dose-effect curves (0–1.0 mg/kg/infusion) were obtained for each condition under concurrent fixed ratio schedules of reinforcement. Percentage of responding emitted on the cocaine-reinforced lever was not affected significantly by removal of cocaine-associated visual or auditory cues, but it was decreased after removal of response-contingent or response-independent cocaine infusions. Cocaine choice was sensitive to the magnitude and fixed ratio requirement of both the cocaine and food reinforcers. We also tested the effects of acute (0.32, 0.56, 1.0, 1.8 mg/kg) and chronic (0.1, 0.32 mg/kg/hr) d-amphetamine treatment on cocaine choice. Acute and chronic d-amphetamine had opposite effects, with acute increasing and chronic decreasing cocaine choice, similar to observations in humans and in nonhuman primates. The results suggest feasibility and utility of the choice procedure in rats and support its comparability to similar procedures used in humans and monkeys. PMID:23319458

Comparison of acceptance, preference and efficacy between pressure anesthesia and classical needle infiltration anesthesia for dental restorative procedures in adult patients

PubMed Central

Makade, Chetana Sachin; Shenoi, Pratima R; Gunwal, Mohit K

2014-01-01

Introduction: Intraoral local anesthesia is essential for delivering dental care. Needless devices have been developed to provide anesthesia without injections. Little controlled research is available on its use in dental restorative procedures in adult patients. The aims of this study were to compare adult patients acceptability and preference for needleless jet injection with classical local infiltration as well as to evaluate the efficacy of the needleless anesthesia. Materials and Methods: Twenty non fearful adults with no previous experience of dental anesthesia were studied using split-mouth design. The first procedure was performed with classical needle infiltration anesthesia. The same amount of anesthetic solution was administered using MADA jet needleless device in a second session one week later, during which a second dental restorative procedure was performed. Patients acceptance was assessed using Universal pain assessment tool while effectiveness was recorded using soft tissue anesthesia and pulpal anesthesia. Patients reported their preference for the anesthetic method at the third visit. The data was evaluated using chi square test and student's t-test. Results: Pressure anesthesia was more accepted and preferred by 70% of the patients than traditional needle anesthesia (20%). Both needle and pressure anesthesia was equally effective for carrying out the dental procedures. Conclusion: Patients experienced significantly less pain and fear (p<0.01) during anesthetic procedure with pressure anesthesia. However, for more invasive procedures needle anesthesia will be more effective. PMID:24778516

Randomised controlled trial to assess the effect of a Just-in-Time training on procedural performance: a proof-of-concept study to address procedural skill decay.

PubMed

Branzetti, Jeremy B; Adedipe, Adeyinka A; Gittinger, Matthew J; Rosenman, Elizabeth D; Brolliar, Sarah; Chipman, Anne K; Grand, James A; Fernandez, Rosemarie

2017-11-01

A subset of high-risk procedures present significant safety threats due to their (1) infrequent occurrence, (2) execution under time constraints and (3) immediate necessity for patient survival. A Just-in-Time (JIT) intervention could provide real-time bedside guidance to improve high-risk procedural performance and address procedural deficits associated with skill decay. To evaluate the impact of a novel JIT intervention on transvenous pacemaker (TVP) placement during a simulated patient event. This was a prospective, randomised controlled study to determine the effect of a JIT intervention on performance of TVP placement. Subjects included board-certified emergency medicine physicians from two hospitals. The JIT intervention consisted of a portable, bedside computer-based procedural adjunct. The primary outcome was performance during a simulated patient encounter requiring TVP placement, as assessed by trained raters using a technical skills checklist. Secondary outcomes included global performance ratings, time to TVP placement, number of critical omissions and System Usability Scale scores (intervention only). Groups were similar at baseline across all outcomes. Compared with the control group, the intervention group demonstrated statistically significant improvement in the technical checklist score (11.45 vs 23.44, p<0.001, Cohen's d effect size 4.64), the global rating scale (2.27 vs 4.54, p<0.001, Cohen's d effect size 3.76), and a statistically significant reduction in critical omissions (2.23 vs 0.68, p<0.001, Cohen's d effect size -1.86). The difference in time to procedural completion was not statistically significant between conditions (11.15 min vs 12.80 min, p=0.12, Cohen's d effect size 0.65). System Usability Scale scores demonstrated excellent usability. A JIT intervention improved procedure perfromance, suggesting a role for JIT interventions in rarely performed procedures. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Frameless robotically targeted stereotactic brain biopsy: feasibility, diagnostic yield, and safety.

PubMed

Bekelis, Kimon; Radwan, Tarek A; Desai, Atman; Roberts, David W

2012-05-01

Frameless stereotactic brain biopsy has become an established procedure in many neurosurgical centers worldwide. Robotic modifications of image-guided frameless stereotaxy hold promise for making these procedures safer, more effective, and more efficient. The authors hypothesized that robotic brain biopsy is a safe, accurate procedure, with a high diagnostic yield and a safety profile comparable to other stereotactic biopsy methods. This retrospective study included 41 patients undergoing frameless stereotactic brain biopsy of lesions (mean size 2.9 cm) for diagnostic purposes. All patients underwent image-guided, robotic biopsy in which the SurgiScope system was used in conjunction with scalp fiducial markers and a preoperatively selected target and trajectory. Forty-five procedures, with 50 supratentorial targets selected, were performed. The mean operative time was 44.6 minutes for the robotic biopsy procedures. This decreased over the second half of the study by 37%, from 54.7 to 34.5 minutes (p < 0.025). The diagnostic yield was 97.8% per procedure, with a second procedure being diagnostic in the single nondiagnostic case. Complications included one transient worsening of a preexisting deficit (2%) and another deficit that was permanent (2%). There were no infections. Robotic biopsy involving a preselected target and trajectory is safe, accurate, efficient, and comparable to other procedures employing either frame-based stereotaxy or frameless, nonrobotic stereotaxy. It permits biopsy in all patients, including those with small target lesions. Robotic biopsy planning facilitates careful preoperative study and optimization of needle trajectory to avoid sulcal vessels, bridging veins, and ventricular penetration.

How to Modify (Implicit) Evaluations of Fear-Related Stimuli: Effects of Feature-Specific Attention Allocation

PubMed Central

Vanaelst, Jolien; Spruyt, Adriaan; De Houwer, Jan

2016-01-01

We demonstrate that feature-specific attention allocation influences the way in which repeated exposure modulates implicit and explicit evaluations toward fear-related stimuli. During an exposure procedure, participants were encouraged to assign selective attention either to the evaluative meaning (i.e., Evaluative Condition) or a non-evaluative, semantic feature (i.e., Semantic Condition) of fear-related stimuli. The influence of the exposure procedure was captured by means of a measure of implicit evaluation, explicit evaluative ratings, and a measure of automatic approach/avoidance tendencies. As predicted, the implicit measure of evaluation revealed a reduced expression of evaluations in the Semantic Condition as compared to the Evaluative Condition. Moreover, this effect generalized toward novel objects that were never presented during the exposure procedure. The explicit measure of evaluation mimicked this effect, although it failed to reach conventional levels of statistical significance. No effects were found in terms of automatic approach/avoidance tendencies. Potential implications for the treatment of anxiety disorders are discussed. PMID:27242626

Mixed model approaches for diallel analysis based on a bio-model.

PubMed

Zhu, J; Weir, B S

1996-12-01

A MINQUE(1) procedure, which is minimum norm quadratic unbiased estimation (MINQUE) method with 1 for all the prior values, is suggested for estimating variance and covariance components in a bio-model for diallel crosses. Unbiasedness and efficiency of estimation were compared for MINQUE(1), restricted maximum likelihood (REML) and MINQUE theta which has parameter values for the prior values. MINQUE(1) is almost as efficient as MINQUE theta for unbiased estimation of genetic variance and covariance components. The bio-model is efficient and robust for estimating variance and covariance components for maternal and paternal effects as well as for nuclear effects. A procedure of adjusted unbiased prediction (AUP) is proposed for predicting random genetic effects in the bio-model. The jack-knife procedure is suggested for estimation of sampling variances of estimated variance and covariance components and of predicted genetic effects. Worked examples are given for estimation of variance and covariance components and for prediction of genetic merits.

How to Modify (Implicit) Evaluations of Fear-Related Stimuli: Effects of Feature-Specific Attention Allocation.

PubMed

Vanaelst, Jolien; Spruyt, Adriaan; De Houwer, Jan

2016-01-01

We demonstrate that feature-specific attention allocation influences the way in which repeated exposure modulates implicit and explicit evaluations toward fear-related stimuli. During an exposure procedure, participants were encouraged to assign selective attention either to the evaluative meaning (i.e., Evaluative Condition) or a non-evaluative, semantic feature (i.e., Semantic Condition) of fear-related stimuli. The influence of the exposure procedure was captured by means of a measure of implicit evaluation, explicit evaluative ratings, and a measure of automatic approach/avoidance tendencies. As predicted, the implicit measure of evaluation revealed a reduced expression of evaluations in the Semantic Condition as compared to the Evaluative Condition. Moreover, this effect generalized toward novel objects that were never presented during the exposure procedure. The explicit measure of evaluation mimicked this effect, although it failed to reach conventional levels of statistical significance. No effects were found in terms of automatic approach/avoidance tendencies. Potential implications for the treatment of anxiety disorders are discussed.

Evaluation of sedation for standing clinical procedures in horses using detomidine combined with buprenorphine.

PubMed

Taylor, Polly; Coumbe, Karen; Henson, Frances; Scott, David; Taylor, Alan

2014-01-01

To examine the effect of including buprenorphine with detomidine for sedation of horses undergoing clinical procedures. Partially blinded, randomised, prospective clinical field trial. Eighty four client-owned horses scheduled for minor surgery or diagnostic investigation under standing sedation. The effects of buprenorphine (5 μg kg(-1) ) (Group B, n = 46) or placebo (5% glucose solution) (Group C, n = 38) in combination with detomidine (10 μg kg(-1) ) were compared in standing horses undergoing minor clinical procedures. The primary outcome measure was successful completion of the procedure. The degree of sedation and ataxia were scored using simple descriptive scales. Heart and respiratory rates were recorded at 15-30 minute intervals. Parametric data from each group were compared using anova or t-test and non parametric data using the Mann-Whitney U test. The procedure was carried out successfully in 91% of Group B and 63% of Group C (p < 0.01). Repeat dosing was required in 24% of Group B and 32% of Group C (p < 0.05). Sedation was more profound and lasted longer (60 versus 45 minutes) in Group B (p < 0.01). Ataxia occurred after detomidine, increased after buprenorphine but not glucose administration, was more profound in group B and lasted longer (60 versus 30 minutes) p < 0.001). Heart and respiratory rates remained within normal limits in both groups and there were no serious adverse events. Buprenorphine 5 and 10 μg kg(-1) enhanced the sedation produced by detomidine 10 and 20 μg kg(-1) with minor side effects similar to other alpha2 agonist/opioid combinations. Detomidine-buprenorphine sedation is suitable for standing procedures in horses. © 2013 Association of Veterinary Anaesthetists and the American College of Veterinary Anesthesia and Analgesia.

[Rapid identification of microorganisms by mass spectrometry in a blood culture system. Comparison of two procedures].

PubMed

Cattani, María E; Posse, Tamara; Hermes, Ricardo L; Kaufman, Sara C

2015-01-01

Rapid identification of microorganisms is critical in hospitalized infected patients. Blood culture is currently the gold standard for detecting and identifying microorganisms causing bacteremia or sepsis. The introduction of mass spectrometry by matrix-assisted laser desorption/ionization time-of-flight (MALDI-TOF MS) in microbiology laboratories, especially in microorganisms growing in blood culture bottles, provides rapid identification. This study evaluates the performance of the Maldi Sepsityper Biotyper procedure (hereinafter, MS) compared to that of an in-home method (hereinafter, HF). Eight hundred and forty (840) positive blood culture bottles were processed using the HF procedure, 542 of which were also processed using MS. The organisms were identified in 670 (79.76%) and 391 (72.14%) bottles respectively (p = 0,0013). This study demonstrates the effectiveness of both procedures for identifying microorganisms directly from positive blood culture bottles. However, the HF procedure proved to be more effective than MS, especially in the presence of Gram positive organisms. Copyright © 2015 Asociación Argentina de Microbiología. Publicado por Elsevier España, S.L.U. All rights reserved.

Cost and robotic surgery in gynecology.

PubMed

Knight, Jason; Escobar, Pedro F

2014-01-01

Since the introduction of robotic technology, there have been significant changes to the field of gynecology. The number of minimally invasive procedures has drastically increased, with robotic procedures rising remarkably. To date several authors have published cost analyses demonstrating that robotic hysterectomy for benign and oncologic indications is more costly compared to the laparoscopic approach. Despite being more expensive than laparoscopy, other studies have found robotics to be less expensive and more effective than laparotomy. In this review, controversies surrounding cost-effectiveness studies are explored. © 2013 The Authors. Journal of Obstetrics and Gynaecology Research © 2013 Japan Society of Obstetrics and Gynecology.

ICA-based artefact and accelerated fMRI acquisition for improved Resting State Network imaging

PubMed Central

Griffanti, Ludovica; Salimi-Khorshidi, Gholamreza; Beckmann, Christian F.; Auerbach, Edward J.; Douaud, Gwenaëlle; Sexton, Claire E.; Zsoldos, Enikő; Ebmeier, Klaus P; Filippini, Nicola; Mackay, Clare E.; Moeller, Steen; Xu, Junqian; Yacoub, Essa; Baselli, Giuseppe; Ugurbil, Kamil; Miller, Karla L.; Smith, Stephen M.

2014-01-01

The identification of resting state networks (RSNs) and the quantification of their functional connectivity in resting-state fMRI (rfMRI) are seriously hindered by the presence of artefacts, many of which overlap spatially or spectrally with RSNs. Moreover, recent developments in fMRI acquisition yield data with higher spatial and temporal resolutions, but may increase artefacts both spatially and/or temporally. Hence the correct identification and removal of non-neural fluctuations is crucial, especially in accelerated acquisitions. In this paper we investigate the effectiveness of three data-driven cleaning procedures, compare standard against higher (spatial and temporal) resolution accelerated fMRI acquisitions, and investigate the combined effect of different acquisitions and different cleanup approaches. We applied single-subject independent component analysis (ICA), followed by automatic component classification with FMRIB’s ICA-based X-noiseifier (FIX) to identify artefactual components. We then compared two first-level (within-subject) cleaning approaches for removing those artefacts and motion-related fluctuations from the data. The effectiveness of the cleaning procedures were assessed using timeseries (amplitude and spectra), network matrix and spatial map analyses. For timeseries and network analyses we also tested the effect of a second-level cleaning (informed by group-level analysis). Comparing these approaches, the preferable balance between noise removal and signal loss was achieved by regressing out of the data the full space of motion-related fluctuations and only the unique variance of the artefactual ICA components. Using similar analyses, we also investigated the effects of different cleaning approaches on data from different acquisition sequences. With the optimal cleaning procedures, functional connectivity results from accelerated data were statistically comparable or significantly better than the standard (unaccelerated) acquisition, and, crucially, with higher spatial and temporal resolution. Moreover, we were able to perform higher dimensionality ICA decompositions with the accelerated data, which is very valuable for detailed network analyses. PMID:24657355

ICA-based artefact removal and accelerated fMRI acquisition for improved resting state network imaging.

PubMed

Griffanti, Ludovica; Salimi-Khorshidi, Gholamreza; Beckmann, Christian F; Auerbach, Edward J; Douaud, Gwenaëlle; Sexton, Claire E; Zsoldos, Enikő; Ebmeier, Klaus P; Filippini, Nicola; Mackay, Clare E; Moeller, Steen; Xu, Junqian; Yacoub, Essa; Baselli, Giuseppe; Ugurbil, Kamil; Miller, Karla L; Smith, Stephen M

2014-07-15

The identification of resting state networks (RSNs) and the quantification of their functional connectivity in resting-state fMRI (rfMRI) are seriously hindered by the presence of artefacts, many of which overlap spatially or spectrally with RSNs. Moreover, recent developments in fMRI acquisition yield data with higher spatial and temporal resolutions, but may increase artefacts both spatially and/or temporally. Hence the correct identification and removal of non-neural fluctuations is crucial, especially in accelerated acquisitions. In this paper we investigate the effectiveness of three data-driven cleaning procedures, compare standard against higher (spatial and temporal) resolution accelerated fMRI acquisitions, and investigate the combined effect of different acquisitions and different cleanup approaches. We applied single-subject independent component analysis (ICA), followed by automatic component classification with FMRIB's ICA-based X-noiseifier (FIX) to identify artefactual components. We then compared two first-level (within-subject) cleaning approaches for removing those artefacts and motion-related fluctuations from the data. The effectiveness of the cleaning procedures was assessed using time series (amplitude and spectra), network matrix and spatial map analyses. For time series and network analyses we also tested the effect of a second-level cleaning (informed by group-level analysis). Comparing these approaches, the preferable balance between noise removal and signal loss was achieved by regressing out of the data the full space of motion-related fluctuations and only the unique variance of the artefactual ICA components. Using similar analyses, we also investigated the effects of different cleaning approaches on data from different acquisition sequences. With the optimal cleaning procedures, functional connectivity results from accelerated data were statistically comparable or significantly better than the standard (unaccelerated) acquisition, and, crucially, with higher spatial and temporal resolution. Moreover, we were able to perform higher dimensionality ICA decompositions with the accelerated data, which is very valuable for detailed network analyses. Copyright © 2014 Elsevier Inc. All rights reserved.

Optimization of reinforced concrete slabs

NASA Technical Reports Server (NTRS)

Ferritto, J. M.

1979-01-01

Reinforced concrete cells composed of concrete slabs and used to limit the effects of accidental explosions during hazardous explosives operations are analyzed. An automated design procedure which considers the dynamic nonlinear behavior of the reinforced concrete of arbitrary geometrical and structural configuration subjected to dynamic pressure loading is discussed. The optimum design of the slab is examined using an interior penalty function. The optimization procedure is presented and the results are discussed and compared with finite element analysis.

Sleep-related memory consolidation in primary insomnia.

PubMed

Nissen, Christoph; Kloepfer, Corinna; Feige, Bernd; Piosczyk, Hannah; Spiegelhalder, Kai; Voderholzer, Ulrich; Riemann, Dieter

2011-03-01

It has been suggested that healthy sleep facilitates the consolidation of newly acquired memories and underlying brain plasticity. The authors tested the hypothesis that patients with primary insomnia (PI) would show deficits in sleep-related memory consolidation compared to good sleeper controls (GSC). The study used a four-group parallel design (n=86) to investigate the effects of 12 h of night-time, including polysomnographically monitored sleep ('sleep condition' in PI and GSC), versus 12 h of daytime wakefulness ('wake condition' in PI and GSC) on procedural (mirror tracing task) and declarative memory consolidation (visual and verbal learning task). Demographic characteristics and memory encoding did not differ between the groups at baseline. Polysomnography revealed a significantly disturbed sleep profile in PI compared to GSC in the sleep condition. Night-time periods including sleep in GSC were associated with (i) a significantly enhanced procedural and declarative verbal memory consolidation compared to equal periods of daytime wakefulness in GSC and (ii) a significantly enhanced procedural memory consolidation compared to equal periods of daytime wakefulness and night-time sleep in PI. Across retention intervals of daytime wakefulness, no differences between the experimental groups were observed. This pattern of results suggests that healthy sleep fosters the consolidation of new memories, and that this process is impaired for procedural memories in patients with PI. Future work is needed to investigate the impact of treatment on improving sleep and memory. © 2010 European Sleep Research Society.

Anesthesia and sedation in pediatric gastrointestinal endoscopic procedures: A review

PubMed Central

Dar, Abdul Q; Shah, Zahoor A

2010-01-01

Gastrointestinal (GI) endoscopic procedure has become an essential modality for evaluation and treatment of GI diseases. Intravenous (IV) sedation and General Anesthesia (GA) have both been employed to minimize discomfort and provide amnesia. Both these procedures require, at the very least, monitoring of the level of consciousness, pulmonary ventilation, oxygenation and hemodynamics. Although GI endoscopy is considered safe, the procedure has a potential for complications. Increased awareness of the complications associated with sedation during GI endoscopy in children, and involving the anesthesiologists in caring for these children, may be optimal for safety. Belonging to a younger age group, having a higher ASA class and undergoing IV sedation were identified as risk factors for developing complications. Reported adverse events included inadequate sedation, low oxygen saturation, airway obstruction, apnea needing bag mask ventilation, excitement and agitation, hemorrhage and perforation. A complication rate of 1.2% was associated with procedures performed under GA, as compared to 3.7% of complications associated with IV sedation. IV sedation was seen to be independently associated with a cardiopulmonary complication rate 5.3% times higher when compared to GA. GA can therefore be considered safer and more effective in providing comfort and amnesia. PMID:21160616

Roux-en-Y Gastric Bypass vs. Sleeve Gastrectomy vs. Gastric Banding: The First Multicenter Retrospective Comparative Cohort Study in Obese Korean Patients.

PubMed

Lee, Sang Kuon; Heo, Yoonseok; Park, Joong Min; Kim, Yong Jin; Kim, Seong Min; Park, Do Joong; Han, Sang Moon; Shim, Kyung Won; Lee, Yeon Ji; Lee, Ja Youn; Kwon, Jin Won

2016-07-01

Bariatric surgery is relatively new in Korea, and studies comparing different bariatric procedures in Koreans are lacking. This study aimed to compare the clinical outcomes of laparoscopic adjustable gastric banding (LAGB), Roux-en-Y gastric bypass (RYGB), and sleeve gastrectomy (SG) for treating morbidly obese Korean adults. In this multicenter retrospective cohort study, we reviewed the medical records of 261 obese patients who underwent different bariatric procedures. Clinical outcomes were measured in terms of weight loss and resolution of comorbidities, such as diabetes, hypertension, and dyslipidemia. Safety profiles for the procedures were also evaluated. In terms of weight loss, the three procedures showed similar results at 18 months (weight loss in 52.1% for SG, 61.0% for LAGB, and 69.2% for RYGB). Remission of diabetes, hypertension, and dyslipidemia was more frequent in patients who underwent RYGB (65.9%, 63.6%, and 100% of patients, respectively). Safety profiles were similar among groups. Early complications occurred in 26 patients (9.9%) and late complications in 32 (12.3%). In the LAGB group, five bands (6.9%) were removed. Among all patients, one death (1/261=0.38%) occurred in the RYGB group due to aspiration pneumonia. The three bariatric procedures were comparable in regards to weight-loss outcomes; nevertheless, RYGB showed a higher rate of comorbidity resolution. Bariatric surgery is effective and relatively safe; however, due to complications, some bands had to be removed in the LAGB group and a relatively high rate of reoperations was observed in the RYGB group.

Acellular dermal matrix for mucogingival surgery: a meta-analysis.

PubMed

Gapski, Ricardo; Parks, Christopher Allen; Wang, Hom-Lay

2005-11-01

Many clinical studies revealed the effectiveness of acellular dermal matrix (ADM) in the treatment of mucogingival defects. The purpose of this meta-analysis was to compare the efficacy of ADM-based root coverage (RC) and ADM-based increase in keratinized tissues to other commonly used mucogingival surgeries. Meta-analysis was limited to randomized clinical trials (RCT). Articles from January 1, 1990 to October 2004 related to ADM were searched utilizing the MEDLINE database from the National Library of Medicine, the Cochrane Oral Health Group Specialized Trials Registry, and through hand searches of reviews and recent journals. Relevant studies were identified, ranked independently, and mean data from each were weighted accordingly. Selected outcomes were analyzed using a meta-analysis software program. The significant estimates of the treatment effects from different trials were assessed by means of Cochrane's test of heterogeneity. 1) Few RCT studies were found to compile the data. In summary, selection identified eight RCT that met the inclusion criteria. There were four studies comparing ADM versus a connective tissue graft for root coverage procedures, two studies comparing ADM versus coronally advanced flap (CAF) for root coverage procedures, and two studies comparing ADM to free gingival graft in augmentation of keratinized tissue. 2) There were no statistically significant differences between groups for any of the outcomes measured (recession coverage, keratinized tissue formation, probing depths, and clinical attachment levels). 3) The majority of the analyses demonstrated moderate to high levels of heterogeneity. 4) Considering the heterogeneity values found among the studies, certain trends could be found: a) three out of four studies favored the ADM-RC group for recession coverage; b) a connective tissue graft tended to increase keratinized tissue compared to ADM (0.52-mm difference; P = 0.11); c) there were trends of increased clinical attachment gains comparing ADM to CAF procedures (0.56-mm difference; P = 0.16). Differences in study design and lack of data precluded an adequate and complete pooling of data for a more comprehensive analysis. Therefore, considering the trends presented in this study, there is a need for further randomized clinical studies of ADM procedures in comparison to common mucogingival surgical procedures to confirm our findings. It is difficult to draw anything other than tentative conclusions from this meta-analysis of ADM for mucogingival surgery, primarily because of the weakness in the design and reporting of existing trials.

A Comparison between the Effect of Free Time and Daily Report Cards on the Academic Behavior of Junior High School Students.

ERIC Educational Resources Information Center

Martin, R. C.; McLaughlin, T. F.

1981-01-01

When the effectiveness of free time and daily report card systems on assignment completion and accuracy of four junior high school special education students were compared, results indicated that both procedures improved students' performance. (Author)

The Effect of Joint Control Training on the Acquisition and Durability of a Sequencing Task

ERIC Educational Resources Information Center

DeGraaf, Allison; Schlinger, Henry D., Jr.

2012-01-01

Gutierrez (2006) experimentally demonstrated the effects of joint control and particularly the role of response mediation in the sequencing behavior of adults using an unfamiliar language. The purpose of the current study was to replicate and extend the procedures used by Gutierrez by comparing the effects of joint control training with the…

Effectiveness of Student-Generated Video as a Teaching Tool for an Instrumental Technique in the Organic Chemistry Laboratory

ERIC Educational Resources Information Center

Jordan, Jeremy T.; Box, Melinda C.; Eguren, Kristen E.; Parker, Thomas A.; Saraldi-Gallardo, Victoria M.; Wolfe, Michael I.; Gallardo-Williams, Maria T.

2016-01-01

Multimedia instruction has been shown to serve as an effective learning aid for chemistry students. In this study, the viability of student-generated video instruction for organic chemistry laboratory techniques and procedure was examined and its effectiveness compared to instruction provided by a teaching assistant (TA) was evaluated. After…

Has Metal-On-Metal Resurfacing Been a Cost-Effective Intervention for Health Care Providers?-A Registry Based Study.

PubMed

Pulikottil-Jacob, Ruth; Connock, Martin; Kandala, Ngianga-Bakwin; Mistry, Hema; Grove, Amy; Freeman, Karoline; Costa, Matthew; Sutcliffe, Paul; Clarke, Aileen

2016-01-01

Total hip replacement for end stage arthritis of the hip is currently the most common elective surgical procedure. In 2007 about 7.5% of UK implants were metal-on-metal joint resurfacing (MoM RS) procedures. Due to poor revision performance and concerns about metal debris, the use of RS had declined by 2012 to about a 1% share of UK hip procedures. This study estimated the lifetime cost-effectiveness of metal-on-metal resurfacing (RS) procedures versus commonly employed total hip replacement (THR) methods. We performed a cost-utility analysis using a well-established multi-state semi-Markov model from an NHS and personal and social services perspective. We used individual patient data (IPD) from the National Joint Registry (NJR) for England and Wales on RS and THR surgery for osteoarthritis recorded from April 2003 to December 2012. We used flexible parametric modelling of NJR RS data to guide identification of patient subgroups and RS devices which delivered revision rates within the NICE 5% revision rate benchmark at 10 years. RS procedures overall have an estimated revision rate of 13% at 10 years, compared to <4% for most THR devices. New NICE guidance now recommends a revision rate benchmark of <5% at 10 years. 60% of RS implants in men and 2% in women were predicted to be within the revision benchmark. RS devices satisfying the 5% benchmark were unlikely to be cost-effective compared to THR at a standard UK willingness to pay of £20,000 per quality-adjusted life-year. However, the probability of cost effectiveness was sensitive to small changes in the costs of devices or in quality of life or revision rate estimates. Our results imply that in most cases RS has not been a cost-effective resource and should probably not be adopted by decision makers concerned with the cost effectiveness of hip replacement, or by patients concerned about the likelihood of revision, regardless of patient age or gender.

Implication of surgical procedure in the induction of headache and generalized painful sensation in a fluid percussion injury model in rats.

PubMed

da SilvaFiorin, Fernando; do Espírito Santo, Caroline Cunha; Santos, Adair Roberto Soares; Fighera, Michele Rechia; Royes, Luiz Fernando Freire

2018-06-13

This study demonstrated the effects of traumatic brain injury (TBI) and each step of the surgical procedure for a fluid percussion injury (FPI) model on periorbital allodynia. Adult male Wistar rats were divided in naive, incision, scraping, sham-TBI and TBI groups. Periorbital allodynia was evaluated using von Frey filaments, and heat hyperalgesia of the hindpaws was evaluated by a Plantar Test Apparatus. The statistical analyses revealed that the surgical procedure decreased von Frey filaments thresholds twenty-four hours after the surgery in all groups when compared to the naive group (p < 0.0001). Scraping, sham-TBI and TBI groups showed a decrease in the periorbital mechanical threshold for 35 days compared with the naive and incision groups (p < 0.0001). Only the TBI group demonstrated a significant difference in periorbital allodynia at 45 and 60 days after the injury (p < 0.01). A significant decrease in the thermal withdrawal latency of the hindpaw contralateral to the lesion was observed in the TBI group compared with the naïve group at 7 days and 28 days after the lesion (p < 0.05). This study presented in detail the effects of each stage of the surgical procedure for a FPI model on periorbital allodynia over time and characterized the TBI model for this evaluation. The FPI model is relevant for the study of headache and generalized pain in both acute and chronic phases after an injury. Copyright © 2018 Elsevier B.V. All rights reserved.

Cost-effectiveness of botulinum toxin a versus anticholinergic medications for idiopathic urge incontinence.

PubMed

Wu, Jennifer M; Siddiqui, Nazema Y; Amundsen, Cindy L; Myers, Evan R; Havrilesky, Laura J; Visco, Anthony G

2009-05-01

We assessed the cost-effectiveness of botulinum toxin A injection compared to anticholinergic medications for the treatment of idiopathic urge incontinence. A Markov decision analysis model was developed to compare the costs in 2008 U. S. dollars and effectiveness in quality adjusted life-years of botulinum toxin A injection and anticholinergic medications. The analysis was conducted from a societal perspective with a 2-year time frame using 3-month cycles. The primary outcome was the incremental cost-effectiveness ratio, defined as the difference in cost (botulinum toxin A cost--anticholinergic cost) divided by the difference in effectiveness (botulinum toxin A quality adjusted life-years--anticholinergic quality adjusted life-years). While the botulinum strategy was more expensive ($4,392 vs $2,563) it was also more effective (1.63 vs 1.50 quality adjusted life-years) compared to the anticholinergic regimen. The calculated incremental cost-effectiveness ratio was $14,377 per quality adjusted life-year, meaning that botulinum toxin A cost $14,377 per quality adjusted life-year gained. A strategy is often considered cost-effective when the incremental cost-effectiveness ratio is less than $50,000 per quality adjusted life-year. Given this definition botulinum toxin A is cost-effective compared to anticholinergics. To determine if there are situations in which anticholinergics would become cost-effective we performed sensitivity analyses. Anticholinergics become cost-effective if compliance exceeds 75% (33% in the base case) and if the botulinum toxin A procedure cost exceeds $3,875 ($1,690 in the base case). For the remainder of the sensitivity analyses botulinum toxin A remained cost-effective. Botulinum toxin A injection was cost-effective compared to anticholinergic medications for the treatment of refractory urge incontinence. Anticholinergics become cost-effective if patients are highly compliant with medications or if the botulinum procedure costs increase substantially.

Surgical correction of female urinary incontinence: comparison of colporrhaphy, sling and suspension procedures.

PubMed

Yumru, A E; Dinçgez Çakmak, B; Öndeş, B; Ergez, M

2012-01-01

To analyse clinical outcomes of three types of pelvic surgery for the correction of female mixed or stress urinary incontinence. Women who underwent surgery for urinary incontinence between January 2000 and June 2010 were included in the study (n = 268). Patients were nonrandomly assigned to undergo colporrhaphy, suspension procedure or sling procedure according to their clinical situation. Perioperative parameters were recorded. Short- (< 5 years) and long-term (5-10 years) success rates were determined for each group. The short- and long-term complete cure rates were significantly lower, and the duration of catheterization significantly longer, in patients who underwent colporrhaphy compared with both other groups, but there were no significant differences between suspension or sling procedures. Sling and suspension procedures were equally effective in this study, and both were preferable to colporrhaphy.

[Osteosynthesis of distal radius fractures by doral plate: advantages and disadvantages].

PubMed

Obert, L; Vichard, P; Garbuio, P; Tropet, Y

2001-12-01

Distal radius fractures remain a challenge. No one osteosynthesis procedure can solve all the problems. A method of analysis is necessary in order to choose the best tools. Open treatment of the fracture is logical but rarely performed. A review of the literature and the experience of the authors are reported in order to analyse the correct place of dorsal plating in distal radius fracture with dorsal displacement. The learning curve of the operative procedure and the design of the implants can explain the occurrence of several complications. The dorsal plate is effective against secondary dorsal displacement. This demanding procedure must be compared with other reported procedures (pining and external fixator) to define the advantages and disadvantages.

Central venous access by trainees: a systematic review and meta-analysis of the use of simulation to improve success rate on patients.

PubMed

Madenci, Arin L; Solis, Carolina V; de Moya, Marc A

2014-02-01

Simulation training for invasive procedures may improve patient safety by enabling efficient training. This study is a meta-analysis with rigorous inclusion and exclusion criteria designed to assess the real patient procedural success of simulation training for central venous access. Published randomized controlled trials and prospective 2-group cohort studies that used simulation for the training of procedures involving central venous access were identified. The quality of each study was assessed. The primary outcome was the proportion of trainees who demonstrated the ability to successfully complete the procedure. Secondary outcomes included the mean number of attempts to procedural success and periprocedural adverse events. Proportions were compared between groups using risk ratios (RRs), whereas continuous variables were compared using weighted mean differences. Random-effects analysis was used to determine pooled effect sizes. We identified 550 studies, of which 5 (3 randomized controlled trials, 2 prospective 2-group cohort studies) studies of central venous catheter (CVC) insertion were included in the meta-analysis, composed of 407 medical trainees. The simulation group had a significantly larger proportion of trainees who successfully placed CVCs (RR, 1.09; 95% confidence interval [CI], 1.03-1.16, P<0.01). In addition, the simulation group had significantly fewer mean attempts to CVC insertion (weighted mean difference, -1.42; 95% CI, -2.34 to -0.49, P<0.01). There was no significant difference in the rate of adverse events between the groups (RR, 0.50; 95% CI, 0.19-1.29; P=0.15). Training programs should consider adopting simulation training for CVC insertion to improve the real patient procedural success of trainees.

Short and long-term post-operative outcomes of duodenum preserving pancreatic head resection for chronic pancreatitis affecting the head of pancreas: a systematic review and meta-analysis.

PubMed

Jawad, Zaynab A R; Tsim, Nicole; Pai, Madhava; Bansi, Dev; Westaby, David; Vlavianos, Panagiotis; Jiao, Long R

2016-02-01

To evaluate the short and long term outcomes of duodenum preserving pancreatic head resection (DPPHR) procedures in the treatment of painful chronic pancreatitis. A systematic literature search was performed to identify all comparative studies evaluating long and short term postoperative outcomes (pain relief, morbidity and mortality, pancreatic exocrine and endocrine function). Five published studies fulfilled the inclusion criteria including 1 randomized controlled trial comparing the Beger and Frey procedure. In total, 323 patients underwent surgical procedures for chronic pancreatitis, including Beger (n = 138) and Frey (n = 99), minimal Frey (n = 32), modified Frey (n = 25) and Berne's modification (n = 29). Two studies comparing the Beger and Frey procedure were entered into a meta-analysis and showed no difference in post-operative pain (RD = -0.06; CI -0.21 to 0.09), mortality (RD = 0.01; CI -0.03 to 0.05), morbidity (RD = 0.12; CI -0.00 to 0.24), exocrine insufficiency (RD = 0.04; CI -0.10 to 0.18) and endocrine insufficiency (RD = -0.14 CI -0.28 to 0.01). All procedures are equally effective for the management of pain for chronic pancreatitis. The choice of procedure should be determined by other factors including the presence of secondary complications of pancreatitis and intra-operative findings. Registration number CRD42015019275. Centre for Reviews and Dissemination, University of York, 2009. Copyright © 2015 International Hepato-Pancreato-Biliary Association Inc. Published by Elsevier Ltd. All rights reserved.

Effects of radiation exposure from cardiac imaging: how good are the data?

PubMed

Einstein, Andrew J

2012-02-07

Concerns about medical exposure to ionizing radiation have become heightened in recent years as a result of rapid growth in procedure volumes and the high radiation doses incurred from some procedures. This paper summarizes the evidence base undergirding concerns about radiation exposure in cardiac imaging. After classifying radiation effects, explaining terminology used to quantify the radiation received by patients, and describing typical doses from cardiac imaging procedures, this paper will address the major epidemiological studies having bearing on radiation effects at doses comparable to those received by patients undergoing cardiac imaging. These include studies of atomic bomb survivors, nuclear industry workers, and children exposed in utero to x-rays, all of which have evidenced increased cancer risks at low doses. Additional higher-dose epidemiological studies of cohorts exposed to radiation in the context of medical treatment are described and found to be generally compatible with these cardiac dose-level studies, albeit with exceptions. Using risk projection models developed by the U.S. National Academies that incorporate these data and reflect several evidence-based assumptions, cancer risk from cardiac imaging can be estimated and compared with the benefits from imaging. Several ongoing epidemiological studies will provide better understanding of radiation-associated cancer risks. Copyright © 2012 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Cost-effectiveness of open versus arthroscopic rotator cuff repair.

PubMed

Adla, Deepthi N; Rowsell, Mark; Pandey, Radhakant

2010-03-01

Economic evaluation of surgical procedures is necessary in view of more expensive newer techniques emerging in an increasingly cost-conscious health care environment. This study compares the cost-effectiveness of open rotator cuff repair with arthroscopic repair for moderately size tears. This was a prospective study of 30 consecutive patients, of whom 15 had an arthroscopic repair and 15 had an open procedure. Clinical effectiveness was assessed using Oxford and Constant shoulder scores. Costs were estimated from departmental and hospital financial data. At last follow-up, no difference Oxford and Constant shoulder scores was noted between the 2 methods of repair. There was no significant difference between the groups in the cost of time in the operating theater, inpatient time, amount of postoperative analgesia, number of postoperative outpatient visits, physiotherapy costs, and time off work. The incremental cost of each arthroscopic rotator cuff repair was pound675 ($1248.75) more than the open procedure. This was mainly in the area of direct health care costs, instrumentation in particular. Health care policy makers are increasingly demanding evidence of cost-effectiveness of a procedure. This study showed both methods of repair provide equivalent clinical results. Open cuff repair is more cost-effective than arthroscopic repair and is likely to have lower cost-utility ratio. In addition, the tariff for the arthroscopic procedure in some health care systems is same as open repair. Copyright 2010 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Mosby, Inc. All rights reserved.

Prime-, Stress- and Cue-Induced Reinstatement of Extinguished Drug-Reinforced Responding in Rats: Cocaine as the Prototypical Drug of Abuse

PubMed Central

Beardsley, Patrick M.; Shelton, Keith L.

2012-01-01

This unit describes the testing of rats in prime-, footshock- and cue-induced reinstatement procedures. Evaluating rats in these procedures enables the assessment of treatments on behavior thought to model drug relapse precipitated by re-contact with an abused drug (prime-induced), induced by stress (footshock-induced), or by stimuli previously associated with drug administration (cue-induced). For instance, levels of reinstatement under the effects of test compound administration could be compared to levels under vehicle administration to help identify potential treatments for drug relapse, or reinstatement levels of different rat strains could be compared to identify potential genetic determinants of perseverative drug-seeking behavior. Cocaine is used as a prototypical drug of abuse, and relapse to its use serves as the model in this unit, but other self-administered drugs could readily be substituted with little modification to the procedures. PMID:23093352

Identification of site frequencies from building records

USGS Publications Warehouse

Celebi, M.

2003-01-01

A simple procedure to identify site frequencies using earthquake response records from roofs and basements of buildings is presented. For this purpose, data from five different buildings are analyzed using only spectral analyses techniques. Additional data such as free-field records in close proximity to the buildings and site characterization data are also used to estimate site frequencies and thereby to provide convincing evidence and confirmation of the site frequencies inferred from the building records. Furthermore, simple code-formula is used to calculate site frequencies and compare them with the identified site frequencies from records. Results show that the simple procedure is effective in identification of site frequencies and provides relatively reliable estimates of site frequencies when compared with other methods. Therefore the simple procedure for estimating site frequencies using earthquake records can be useful in adding to the database of site frequencies. Such databases can be used to better estimate site frequencies of those sites with similar geological structures.

Comparison of Procedures for Dual and Triple Closely Spaced Parallel Runways

NASA Technical Reports Server (NTRS)

Verma, Savita; Ballinger, Deborah; Subramanian Shobana; Kozon, Thomas

2012-01-01

A human-in-the-loop high fidelity flight simulation experiment was conducted, which investigated and compared breakout procedures for Very Closely Spaced Parallel Approaches (VCSPA) with two and three runways. To understand the feasibility, usability and human factors of two and three runway VCSPA, data were collected and analyzed on the dependent variables of breakout cross track error and pilot workload. Independent variables included number of runways, cause of breakout and location of breakout. Results indicated larger cross track error and higher workload using three runways as compared to 2-runway operations. Significant interaction effects involving breakout cause and breakout location were also observed. Across all conditions, cross track error values showed high levels of breakout trajectory accuracy and pilot workload remained manageable. Results suggest possible avenues of future adaptation for adopting these procedures (e.g., pilot training), while also showing potential promise of the concept.

Cost-utility analysis for bariatric surgery compared with usual care for the treatment of obesity in Australia.

PubMed

James, Robbie; Salton, Ryan Ishmael; Byrnes, Joshua Michael; Scuffham, Paul Anthony

2017-12-01

The uptake of bariatric surgery in Australia has been hampered by the lack of funding and lack of evidence on relative value for money. To determine the cost-effectiveness of adjustable gastric banding (AGB), Roux-En-Y gastric bypass (RYGB), and sleeve gastrectomy (SG) versus usual care (UC). Perspective of the Australian public healthcare system. A Markov model was constructed to simulate the costs and outcomes for 4 approaches to managing obesity. The base-case was a 30-year-old Australian female with a body-mass index>35. Subgroup analysis was conducted to account for the effect of diabetes as well as various differences in cohort characteristics. Uncertainty was characterised by one-way and probabilistic sensitivity analyses. All bariatric surgeries were effective. The incremental cost-effectiveness ratios were similar at $24,454 for AGB, $22,645 for RYGB, and $27,523 for SG, compared with UC. At a willingness to pay threshold of $70,000 per quality-adjusted life year, the probabilities of being cost-effective were 64%, 75%, and 71% for AGB, RYGB, and SG, respectively. Subgroup analysis showed that bariatric procedures are less cost-effective for older cohorts. For those with diabetes, all the procedures were dominant in comparison with UC. This model shows that all bariatric procedures are a cost-effective treatment for the management of obese patients. When given to a subgroup with diabetes, bariatric interventions become cost-saving. Copyright © 2017 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

Comparative Effect of Contrast Media Type on the Incidence of Contrast-Induced Nephropathy: A Systematic Review and Meta-analysis.

PubMed

Eng, John; Wilson, Renee F; Subramaniam, Rathan M; Zhang, Allen; Suarez-Cuervo, Catalina; Turban, Sharon; Choi, Michael J; Sherrod, Cheryl; Hutfless, Susan; Iyoha, Emmanuel E; Bass, Eric B

2016-03-15

Iodine contrast media are essential components of many imaging procedures. An important potential side effect is contrast-induced nephropathy (CIN). To compare CIN risk for contrast media within and between osmolality classes in patients receiving diagnostic or therapeutic imaging procedures. PubMed, EMBASE, Cochrane Library, Clinical Trials.gov, and Scopus through June 2015. Randomized, controlled trials that reported CIN-related outcomes in patients receiving low-osmolar contrast media (LOCM) or iso-osmolar contrast media for imaging. Independent study selection and quality assessment by 2 reviewers and dual extraction of study characteristics and results. None of the 5 studies that compared types of LOCM reported a statistically significant or clinically important difference among study groups, but the strength of evidence was low. Twenty-five randomized, controlled trials found a slight reduction in CIN risk with the iso-osmolar contrast media agent iodixanol compared with a diverse group of LOCM that just reached statistical significance in a meta-analysis (pooled relative risk, 0.80 [95% CI, 0.65 to 0.99]; P = 0.045). This comparison's strength of evidence was moderate. In a meta regression of randomized, controlled trials of iodixanol, no relationship was found between route of administration and comparative CIN risk. Few studies compared LOCM. Procedural details about contrast administration were not uniformly reported. Few studies specified clinical indications or severity of baseline renal impairment. No differences were found in CIN risk among types of LOCM. Iodixanol had a slightly lower risk for CIN than LOCM, but the lower risk did not exceed a criterion for clinical importance. Agency for Healthcare Research and Quality.

Reduced contamination of pig carcasses using an alternative pluck set removal procedure during slaughter.

PubMed

Biasino, W; De Zutter, L; Woollard, J; Mattheus, W; Bertrand, S; Uyttendaele, M; Van Damme, I

2018-05-26

This study compared the current pig slaughter procedure where the pluck set is completely removed with a procedure where the pluck set is partially removed, leaving the highly contaminated oral cavity, tonsils and tongue untouched. The effect on carcass contamination was investigated by enumerating hygiene indicator bacteria (total aerobic count, Enterobacteriaceae and E. coli) and cefotaxime-resistant E. coli (CREC) as well as assessing Salmonella and Yersinia enterocolitica presence on the sternum, elbow and throat of pig carcasses. Using the alternative pluck set removal, significantly lower mean numbers of hygiene indicator bacteria on throat samples and E. coli on elbow samples were found. Less pig carcasses were highly contaminated and a lower presence and level of CREC was observed. No difference in Salmonella or Yersinia enterocolitica presence was seen. The data in this study can help to assess the effect of this alternative procedure on the safety of pork and subsequently public health. Copyright © 2018 Elsevier Ltd. All rights reserved.

Real-time fluoroscopic needle guidance in the interventional radiology suite using navigational software for percutaneous bone biopsies in children.

PubMed

Shellikeri, Sphoorti; Setser, Randolph M; Hwang, Tiffany J; Srinivasan, Abhay; Krishnamurthy, Ganesh; Vatsky, Seth; Girard, Erin; Zhu, Xiaowei; Keller, Marc S; Cahill, Anne Marie

2017-07-01

Navigational software provides real-time fluoroscopic needle guidance for percutaneous procedures in the Interventional Radiology (IR) suite. We describe our experience with navigational software for pediatric percutaneous bone biopsies in the IR suite and compare technical success, diagnostic accuracy, radiation dose and procedure time with that of CT-guided biopsies. Pediatric bone biopsies performed using navigational software (Syngo iGuide, Siemens Healthcare) from 2011 to 2016 were prospectively included and anatomically matched CT-guided bone biopsies from 2008 to 2016 were retrospectively reviewed with institutional review board approval. C-arm CT protocols used for navigational software-assisted cases included institution-developed low-dose (0.1/0.17 μGy/projection), regular-dose (0.36 μGy/projection), or a combination of low-dose/regular-dose protocols. Estimated effective radiation dose and procedure times were compared between software-assisted and CT-guided biopsies. Twenty-six patients (15 male; mean age: 10 years) underwent software-assisted biopsies (15 pelvic, 7 lumbar and 4 lower extremity) and 33 patients (13 male; mean age: 9 years) underwent CT-guided biopsies (22 pelvic, 7 lumbar and 4 lower extremity). Both modality biopsies resulted in a 100% technical success rate. Twenty-five of 26 (96%) software-assisted and 29/33 (88%) CT-guided biopsies were diagnostic. Overall, the effective radiation dose was significantly lower in software-assisted than CT-guided cases (3.0±3.4 vs. 6.6±7.7 mSv, P=0.02). The effective dose difference was most dramatic in software-assisted cases using low-dose C-arm CT (1.2±1.8 vs. 6.6±7.7 mSv, P=0.001) or combined low-dose/regular-dose C-arm CT (1.9±2.4 vs. 6.6±7.7 mSv, P=0.04), whereas effective dose was comparable in software-assisted cases using regular-dose C-arm CT (6.0±3.5 vs. 6.6±7.7 mSv, P=0.7). Mean procedure time was significantly lower for software-assisted cases (91±54 vs. 141±68 min, P=0.005). In our experience, navigational software technology in the IR suite is a promising alternative to CT guidance for pediatric bone biopsies providing comparable technical success and diagnostic accuracy with lower radiation dose and procedure time, in addition to providing real-time fluoroscopic needle guidance.

The efficacy of conventional radiofrequency denervation in patients with chronic low back pain originating from the facet joints: a meta-analysis of randomized controlled trials.

PubMed

Lee, Chang-Hyun; Chung, Chun Kee; Kim, Chi Heon

2017-11-01

Radiofrequency denervation is commonly used for the treatment of chronic facet joint pain that has been refractory to more conservative treatments, although the evidence supporting this treatment has been controversial. We aimed to elucidate the precise effects of radiofrequency denervation in patients with low back pain originating from the facet joints relative to those obtained using control treatments, with particular attention to consistency in the denervation protocol. A meta-analysis of randomized controlled trials was carried out. Adult patients undergoing radiofrequency denervation or control treatments (sham or epidural block) for facet joint disease of the lumbar spine comprised the patient sample. Visual analog scale (VAS) pain scores were measured and stratified by response of diagnostic block procedures. We searched PubMed, Embase, Web of Science, and the Cochrane Database for randomized controlled trials regarding radiofrequency denervation and control treatments for back pain. Changes in VAS pain scores of the radiofrequency group were compared with those of the control group as well as the minimal clinically important difference (MCID) for back pain VAS. Meta-regression model was developed to evaluate the effect of radiofrequency treatment according to responses of diagnostic block while controlling for other variables. We then calculated mean differences and 95% confidence intervals (CIs) using random-effects models. We included data from seven trials involving 454 patients who had undergone radiofrequency denervation (231 patients) and control treatments such as sham or epidural block procedures (223 patients). The radiofrequency group exhibited significantly greater improvements in back pain score when compared with the control group for 1-year follow-up. Although the average improvement in VAS scores exceeded the MCID, the lower limit of the 95% CI encompassed the MCID. A subgroup of patients who responded very well to diagnostic block procedures demonstrated significant improvements in back pain relative to the control group at all times. When placed into our meta-regression model, the response to diagnostic block procedure was responsible for a statistically significant portion of treatment effect. Studies published over the last two decades revealed that radiofrequency denervation reduced back pain significantly in patients with facet joint disease compared with the MCID and control treatments. Conventional radiofrequency denervation resulted in significant reductions in low back pain originating from the facet joints in patients showing the best response to diagnostic block over the first 12 months when compared with sham procedures or epidural nerve blocks. Copyright © 2017 Elsevier Inc. All rights reserved.

A single pre-operative antibiotic dose is as effective as continued antibiotic prophylaxis in implant-based breast reconstruction: A matched cohort study.

PubMed

Townley, William A; Baluch, Narges; Bagher, Shaghayegh; Maass, Saskia W M C; O'Neill, Anne; Zhong, Toni; Hofer, Stefan O P

2015-05-01

Infections following implant-based breast reconstruction can lead to devastating consequences. There is currently no consensus on the need for post-operative antibiotics in preventing immediate infection. This study compared two different methods of infection prevention in this group of patients. A retrospective matched cohort study was performed on consecutive women undergoing implant-based breast reconstruction at University Health Network, Toronto (November 2008-December 2012). All patients received a single pre-operative intravenous antibiotic dose. Group A received minimal interventions and Group B underwent maximal prophylactic measures. Patient (age, smoking, diabetes, co-morbidities), oncologic and procedural variables (timing and laterality) were collected. Univariate and multivariate logistic regression were performed to compare outcomes between the two groups. Two hundred and eight patients underwent 647 implant procedures. After matching the two treatment groups by BMI, 94 patients in each treatment group yielding a total of 605 implant procedures were selected for analysis. The two groups were comparable in terms of patient and disease variables. Post-operative wound infection was similar in Group A (n = 11, 12%) compared with Group B (n = 9, 10%; p = 0.8). Univariate analysis revealed only pre-operative radiotherapy to be associated with the development of infection (0.004). Controlling for the effect of radiotherapy, multivariate analysis demonstrated that there was no statistically significant difference between the two methods for infection prevention. Our findings suggest that a single pre-operative dose of intravenous antibiotics is equally as effective as continued antibiotic prophylaxis in preventing immediate infection in patients undergoing implant-based breast reconstructions. Copyright © 2015 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

Vertebral Augmentation Involving Vertebroplasty or Kyphoplasty for Cancer-Related Vertebral Compression Fractures: An Economic Analysis.

PubMed

2016-01-01

Untreated vertebral compression fractures can have serious clinical consequences and impose a considerable impact on patients' quality of life and on caregivers. Since non-surgical management of these fractures has limited effectiveness, vertebral augmentation procedures are gaining acceptance in clinical practice for pain control and fracture stabilization. The objective of this analysis was to determine the cost-effectiveness and budgetary impact of kyphoplasty or vertebroplasty compared with non-surgical management for the treatment of vertebral compression fractures in patients with cancer. We performed a systematic review of health economic studies to identify relevant studies that compare the cost-effectiveness of kyphoplasty or vertebroplasty with non-surgical management for the treatment of vertebral compression fractures in adults with cancer. We also performed a primary cost-effectiveness analysis to assess the clinical benefits and costs of kyphoplasty or vertebroplasty compared with non-surgical management in the same population. We developed a Markov model to forecast benefits and harms of treatments, and corresponding quality-adjusted life years and costs. Clinical data and utility data were derived from published sources, while costing data were derived using Ontario administrative sources. We performed sensitivity analyses to examine the robustness of the results. In addition, a 1-year budget impact analysis was performed using data from Ontario administrative sources. Two scenarios were explored: (a) an increase in the total number of vertebral augmentation procedures performed among patients with cancer in Ontario, maintaining the current proportion of kyphoplasty versus vertebroplasty; and (b) no increase in the total number of vertebral augmentation procedures performed among patients with cancer in Ontario but an increase in the proportion of kyphoplasties versus vertebroplasties. The base case considered each of kyphoplasty and vertebroplasty versus non-surgical management. Kyphoplasty and vertebroplasty were associated with an incremental cost-effectiveness ratio of $33,471 and $17,870, respectively, per quality-adjusted life-year gained. The budgetary impact of funding vertebral augmentation procedures for the treatment of vertebral compression fractures in adults with cancer in Ontario was estimated at about $2.5 million in fiscal year 2014/15. More widespread use of vertebral augmentation procedures raised total expenditures under a number of scenarios, with costs increasing by $67,302 to $913,386. Our findings suggest that the use of kyphoplasty or vertebroplasty in the management of vertebral compression fractures in patients with cancer may be a cost-effective strategy at commonly accepted willingness-to-pay thresholds. Nonetheless, more widespread use of kyphoplasty (and vertebroplasty to a lesser extent) would likely be associated with net increases in health care costs.

Relieving patients' pain with expectation interventions: a meta-analysis.

PubMed

Peerdeman, Kaya J; van Laarhoven, Antoinette I M; Keij, Sascha M; Vase, Lene; Rovers, Maroeska M; Peters, Madelon L; Evers, Andrea W M

2016-06-01

Patients' expectations are important predictors of the outcome of analgesic treatments, as demonstrated predominantly in research on placebo effects. Three commonly investigated interventions that have been found to induce expectations (verbal suggestion, conditioning, and mental imagery) entail promising, brief, and easy-to-implement adjunctive procedures for optimizing the effectiveness of analgesic treatments. However, evidence for their efficacy stems mostly from research on experimentally evoked pain in healthy samples, and these findings might not be directly transferable to clinical populations. The current meta-analysis investigated the effects of these expectation inductions on patients' pain relief. Five bibliographic databases were systematically searched for studies that assessed the effects of brief verbal suggestion, conditioning, or imagery interventions on pain in clinical populations, with patients experiencing experimental, acute procedural, or chronic pain, compared with no treatment or control treatment. Of the 15,955 studies retrieved, 30 met the inclusion criteria, of which 27 provided sufficient data for quantitative analyses. Overall, a medium-sized effect of the interventions on patients' pain relief was observed (Hedges g = 0.61, I = 73%), with varying effects of verbal suggestion (k = 18, g = 0.75), conditioning (always paired with verbal suggestion, k = 3, g = 0.65), and imagery (k = 6, g = 0.27). Subset analyses indicated medium to large effects on experimental and acute procedural pain and small effects on chronic pain. In conclusion, patients' pain can be relieved with expectation interventions; particularly, verbal suggestion for acute procedural pain was found to be effective.

[The CASS-CHOU study of mesenteric angina. The comparative effects of cassoulet and sauerkraut with sausages].

PubMed

Danchin, N; Juillière, Y; de la Chaise, A T; Selton-Suty, C

1999-04-01

The goal of study was evaluate in 1,837 consecutive patients the comparative effects of French cassoulet (CASS) and international sauerkraut (CHOU). After procedures of exclusion classical, 8 patients could be evaluated and received in a randomised, doubleblind, crossover protocol an mouth dose of 22.5 g/kg of CASS or CHOU. The results show a very significative difference between the 2 products. A regular absorption of couscous is therefore recommended.

Decoupled and linear quadratic regulator control of a large, flexible space antenna with an observer in the control loop

NASA Technical Reports Server (NTRS)

Hamer, H. A.; Johnson, K. G.; Young, J. W.

1985-01-01

An analysis is performed to compare decoupled and linear quadratic regulator (LQR) procedures for the control of a large, flexible space antenna. Control objectives involve: (1) commanding changes in the rigid-body modes, (2) nulling initial disturbances in the rigid-body modes, or (3) nulling initial disturbances in the first three flexible modes. Control is achieved with two three-axis control-moment gyros located on the antenna column. Results are presented to illustrate various effects on control requirements for the two procedures. These effects include errors in the initial estimates of state variables, variations in the type, number, and location of sensors, and deletions of state-variable estimates for certain flexible modes after control activation. The advantages of incorporating a time lag in the control feedback are also illustrated. In addition, the effects of inoperative-control situations are analyzed with regard to control requirements and resultant modal responses. Comparisons are included which show the effects of perfect state feedback with no residual modes (ideal case). Time-history responses are presented to illustrate the various effects on the control procedures.

The cost effectiveness of intracyctoplasmic sperm injection (ICSI).

PubMed

Hollingsworth, Bruce; Harris, Anthony; Mortimer, Duncan

2007-12-01

To estimate the incremental cost effectiveness of ICSI, and total costs for the population of Australia. Treatment effects for three patient groups were drawn from a published systematic review and meta-analysis of trials comparing fertilisation outcomes for ICSI. Incremental costs derived from resource-based costing of ICSI and existing practice comparators for each patient group. Incremental cost per live birth for patients unsuited to IVF is estimated between A$8,500 and 13,400. For the subnormal semen indication, cost per live birth could be as low as A$3,600, but in the worst case scenario, there would just be additional incremental costs of A$600 per procedure. Multiplying out the additional costs of ICSI over the relevant target populations in Australia gives potential total financial implications of over A$31 million per annum. While there are additional benefits from ICSI procedure, particularly for those with subnormal sperm, the additional cost for the health care system is substantial.

A prospective, randomized, double-blinded single-site control study comparing blood loss prevention of tranexamic acid (TXA) to epsilon aminocaproic acid (EACA) for corrective spinal surgery.

PubMed

Verma, Kushagra; Errico, Thomas J; Vaz, Kenneth M; Lonner, Baron S

2010-04-06

Multilevel spinal fusion surgery has typically been associated with significant blood loss. To limit both the need for transfusions and co-morbidities associated with blood loss, the use of anti-fibrinolytic agents has been proposed. While there is some literature comparing the effectiveness of tranexamic acid (TXA) to epsilon aminocaproic acid (EACA) in cardiac procedures, there is currently no literature directly comparing TXA to EACA in orthopedic surgery. Here we propose a prospective, randomized, double-blinded control study evaluating the effects of TXA, EACA, and placebo for treatment of adolescent idiopathic scoliosis (AIS), neuromuscular scoliosis (NMS), and adult deformity (AD) via corrective spinal surgery. Efficacy will be determined by intraoperative and postoperative blood loss. Other clinical outcomes that will be compared include transfusion rates, preoperative and postoperative hemodynamic values, and length of hospital stay after the procedure. The primary goal of the study is to determine perioperative blood loss as a measure of the efficacy of TXA, EACA, and placebo. Based on current literature and the mechanism by which the medications act, we hypothesize that TXA will be more effective at reducing blood loss than EACA or placebo and result in improved patient outcomes. ClinicalTrials.gov ID: NCT00958581.

Using Procedure Codes to Define Radiation Toxicity in Administrative Data: The Devil is in the Details.

PubMed

Meyer, Anne-Marie; Kuo, Tzy-Mey; Chang, YunKyung; Carpenter, William R; Chen, Ronald C; Sturmer, Til

2017-05-01

Systematic coding systems are used to define clinically meaningful outcomes when leveraging administrative claims data for research. How and when these codes are applied within a research study can have implications for the study validity and their specificity can vary significantly depending on treatment received. Data are from the Surveillance, Epidemiology, and End Results-Medicare linked dataset. We use propensity score methods in a retrospective cohort of prostate cancer patients first examined in a recently published radiation oncology comparative effectiveness study. With the narrowly defined outcome definition, the toxicity event outcome rate ratio was 0.88 per 100 person-years (95% confidence interval, 0.71-1.08). With the broadly defined outcome, the rate ratio was comparable, with 0.89 per 100 person-years (95% confidence interval, 0.76-1.04), although individual event rates were doubled. Some evidence of surveillance bias was suggested by a higher rate of endoscopic procedures the first year of follow-up in patients who received proton therapy compared with those receiving intensity-modulated radiation treatment (11.15 vs. 8.90, respectively). This study demonstrates the risk of introducing bias through subjective application of procedure codes. Careful consideration is required when using procedure codes to define outcomes in administrative data.

Effects of trypsinization and of a combined trypsin, collagenase, and DNase digestion on liberation and in vitro function of satellite cells isolated from juvenile porcine muscles.

PubMed

Miersch, Claudia; Stange, Katja; Röntgen, Monika

2018-06-01

Muscle stem cells, termed satellite cells (SC), and SC-derived myogenic progenitor cells (MPC) are involved in postnatal muscle growth, regeneration, and muscle adaptability. They can be released from their natural environment by mechanical disruption and tissue digestion. The literature contains several isolation protocols for porcine SC/MPC including various digestion procedures, but comparative studies are missing. In this report, classic trypsinization and a more complex trypsin, collagenase, and DNase (TCD) digestion were performed with skeletal muscle tissue from 4- to 5-d-old piglets. The two digestion procedures were compared regarding cell yield, viability, myogenic purity, and in vitro cell function. The TCD digestion tended to result in higher cell yields than digestion with solely trypsin (statistical trend p = 0.096), whereas cell size and viability did not differ. Isolated myogenic cells from both digestion procedures showed comparable proliferation rates, expressed the myogenic marker Desmin, and initiated myogenic differentiation in vitro at similar levels. Thus, TCD digestion tended to liberate slightly more cells without changes in the tested in vitro properties of the isolated cells. Both procedures are adequate for the isolation of SC/MPC from juvenile porcine muscles but the developmental state of the animal should always be considered.

Does Comparing Solution Methods Facilitate Conceptual and Procedural Knowledge? An Experimental Study on Learning to Solve Equations

ERIC Educational Resources Information Center

Rittle-Johnson, Bethany; Star, Jon R.

2007-01-01

Encouraging students to share and compare solution methods is a key component of reform efforts in mathematics, and comparison is emerging as a fundamental learning mechanism. To experimentally evaluate the effects of comparison for mathematics learning, the authors randomly assigned 70 seventh-grade students to learn about algebra equation…

Continuum modeling of the mechanical and thermal behavior of discrete large structures

NASA Technical Reports Server (NTRS)

Nayfeh, A. H.; Hefzy, M. S.

1980-01-01

In the present paper we introduce a rather straightforward construction procedure in order to derive continuum equivalence of discrete truss-like repetitive structures. Once the actual structure is specified, the construction procedure can be outlined by the following three steps: (a) all sets of parallel members are identified, (b) unidirectional 'effective continuum' properties are derived for each of these sets and (c) orthogonal transformations are finally used to determine the contribution of each set to the 'overall effective continuum' properties of the structure. Here the properties includes mechanical (stiffnesses), thermal (coefficients of thermal expansions) and material densities. Once expanded descriptions of the steps (b) and (c) are done, the construction procedure will be applied to a wide variety of discrete structures and the results will be compared with those of other existing methods.

Distinct patterns in the gut microbiota after surgical or medical therapy in obese patients.

PubMed

Medina, Daniel A; Pedreros, Juan P; Turiel, Dannae; Quezada, Nicolas; Pimentel, Fernando; Escalona, Alex; Garrido, Daniel

2017-01-01

Bariatric surgery is highly successful in improving health compared to conventional dietary treatments. It has been suggested that the gut microbiota is a relevant factor in weight loss after bariatric surgery. Considering that bariatric procedures cause different rearrangements of the digestive tract, they probably have different effects on the gut microbiota. In this study, we compared the impact of medical treatment, sleeve gastrectomy and Roux-en-Y gastric bypass on the gut microbiota from obese subjects. Anthropometric and clinical parameters were registered before, 6 and 12 months after treatment. Fecal samples were collected and microbiota composition was studied before and six months post treatment using 16S rRNA gene sequencing and qPCR. In comparison to dietary treatment, changes in intestinal microbiota were more pronounced in patients subjected to surgery, observing a bloom in Proteobacteria . Interestingly, Bacteroidetes abundance was largely different after six months of each surgical procedure. Furthermore, changes in weight and BMI, or glucose metabolism, correlated positively with changes in these two phyla in these surgical procedures. These results indicate that distinct surgical procedures alter the gut microbiota differently, and changes in gut microbiota might contribute to health improvement. This study contributes to our understanding of the impact of weight loss surgery on the gut microbiota, and could be used to replicate this effect using targeted therapies.

Effect of kangaroo mother care vs expressed breast milk administration on pain associated with removal of adhesive tape in very low birth weight neonates: a randomized controlled trial.

PubMed

Nanavati, Ruchi N; Balan, Rajiv; Kabra, Nandkishor S

2013-11-08

To compare the pain relief effect of Kangaroo Mother Care (KMC) and Expressed Breast Milk (EBM) on the pain associated with adhesive tape removal in very low birth weight (VLBW) neonates. Randomized Controlled Trial. Neonatal intensive care unit of a tertiary care teaching hospital. 15 VLBW neonates who needed adhesive tape removal for the first part and 50 VLBW neonates needing adhesive tape removal for the second part. In first stage of the study, we studied whether adhesive tape removal in VLBW neonates was painful. In the second stage, eligible VLBW neonates were randomised to compare the efficacy of KMC and EBM in reducing the pain during the procedure of adhesive tape removal. Premature Infant Pain Profile (PIPP) Score, heart rate, oxygen saturation. There was significant increase in pain associated with the removal of adhesive tape (Mean pre-procedure PIPP score 3.47 ± 0.74; post-procedure mean PIPP score 12.13 ± 2.59; P<0.0001). The post intervention mean PIPP pain score was not significantly different between the KMC and EBM groups (P= 0.62). Removal of adhesive tape is a painful procedure for VLBW neonates. There was no difference between KMC and EBM in relieving pain associated with adhesive tape removal.

Ankle manual therapy for individuals with post-acute ankle sprains: description of a randomized, placebo-controlled clinical trial

PubMed Central

2010-01-01

Background Ankle sprains are common within the general population and can result in prolonged disablement. Limited talocrural dorsiflexion range of motion (DF ROM) is a common consequence of ankle sprain. Limited talocrural DF ROM may contribute to persistent symptoms, disability, and an elevated risk for re-injury. As a result, many health care practitioners use hands-on passive procedures with the intention of improving talocrural joint DF ROM in individuals following ankle sprains. Dosage of passive hands-on procedures involves a continuum of treatment speeds. Recent evidence suggests both slow- and fast-speed treatments may be effective to address disablement following ankle sprains. However, these interventions have yet to be longitudinally compared against a placebo study condition. Methods/Design We developed a randomized, placebo-controlled clinical trial designed to test the hypotheses that hands-on treatment procedures administered to individuals following ankle sprains during the post-acute injury period can improve short-, intermediate-, and long-term disablement, as well as reduce the risk for re-injury. Discussion This study is designed to measure the clinical effects of hands-on passive stretching treatment procedures directed to the talocrural joint that vary in treatment speed during the post-acute injury period, compared to hands-on placebo control intervention. Trial Registration http://www.clinicaltrials.gov identifier NCT00888498. PMID:20958995

Constraining response output on conjunctive fixed-ratio 1 fixed-time reinforcement schedules: Effects on the postreinforcement pause.

PubMed

Lopez, F; Pereira, C

1985-03-01

Two experiments used response-restriction procedures in order to test the independence of the factors determining response rate and the factors determining the size of the postreinforcement pause on interval schedules. Responding was restricted by response-produced blackout or by retracting the lever. In Experiment 1 with a Conjunctive FR 1 FT schedule, the blackout procedure reduced the postreinforcement pause more than the lever-retraction procedure did, and both procedures produced shorter pauses than did the schedule without response restriction. In Experiment 2 the interreinforcement interval was also manipulated, and the size of the pause was an increasing function of the interreinforcement interval, but the rate of increase was lower than that produced by fixed interval schedules of comparable interval durations. The assumption of functional independence of the postreinforcement pause and terminal rate in fixed interval schedules is questioned since data suggest that pause reductions resulted from constraining variation in response number compared to equivalent periodic schedules in which response number was allowed to vary. Copyright © 1985. Published by Elsevier B.V.

Comparison of local anesthetic effects of lidocaine versus tramadol and effect of child anxiety on pain level in circumcision procedure.

PubMed

Polat, Fazli; Tuncel, Altug; Balci, Melih; Aslan, Yilmaz; Sacan, Ozlem; Kisa, Cebrail; Kayali, Mustafa; Atan, Ali

2013-10-01

To compare the local anesthetic effects of tramadol hydrochloride with those of lidocaine in circumcision procedures. We also investigated the effect of child anxiety on pain level. A total of 70 children were included in this study. The children were randomized into 3 groups. Group 1 (n = 26) received lidocaine hydrochloride + epinephrine and they underwent circumcision using Ali's clamp(®). Group 2 (n = 35) received lidocaine hydrochloride + epinephrine and group 3 (n = 12) 5% tramadol. The last two groups underwent conventional circumcision. The mean anxiety score was 22.6. We did not find significant differences in terms of anxiety score among the groups (p = 0.761). When the pain scores of the groups during injection were compared, it was found that there were no significant differences. However, the pain score of the third group was significantly high when it was compared with the first and second group 2 and 10 min after injection. In the correlation analysis, we found a positive correlation between children's anxiety scores and the pain degree during injection (r = 0.373, p = 0.001). Tramadol may not provide effective local anesthesia in male circumcision. The child's anxiety before the circumcision seems to have a negative effect on pain level. Copyright © 2012 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.

Finite-difference solution for turbulent swirling compressible flow in axisymmetric ducts with struts

NASA Technical Reports Server (NTRS)

Anderson, O. L.

1974-01-01

A finite-difference procedure for computing the turbulent, swirling, compressible flow in axisymmetric ducts is described. Arbitrary distributions of heat and mass transfer at the boundaries can be treated, and the effects of struts, inlet guide vanes, and flow straightening vanes can be calculated. The calculation procedure is programmed in FORTRAN 4 and has operated successfully on the UNIVAC 1108, IBM 360, and CDC 6600 computers. The analysis which forms the basis of the procedure, a detailed description of the computer program, and the input/output formats are presented. The results of sample calculations performed with the computer program are compared with experimental data.

Music during interventional radiological procedures, effect on sedation, pain and anxiety: a randomised controlled trial

PubMed Central

Kulkarni, S; Johnson, P C D; Kettles, S; Kasthuri, R S

2012-01-01

Objective : To assess the effects of playing patient-selected music during interventional procedures on (1) the doses of sedation and analgesia and (2) anxiety levels. Methods : Patients undergoing interventional radiological procedures were randomised to either the intervention (music) or the control (no music) group. Patients in the intervention group had music of their choice played via headphones during the procedure. The primary outcomes were reductions in the doses of drugs for sedation (midazolam) and analgesia (fentanyl). Anxiety levels were assessed both before and after the procedure using the validated State Anxiety Inventory. Mean pulse rate and average of mean blood pressures were also recorded before and during the procedures as surrogate indicators of anxiety levels. Results : 100 patients were randomised in a 1:1 ratio. There were 58 males and 42 females, with a mean age of 58 years. Sedation was required in 21 (42%) patients in the music group compared with 30 (60%) patients in the control group (p=0.046). The mean [standard deviation (SD)] midazolam dose was 2.1 mg (2.3 mg) in the control group and 1.3 mg (2.2 mg) in the music group (p=0.027). The mean (SD) fentanyl dose was 29 mg (40 mg) in the control group and 18 mg (34 mg) in the music group (p=0.055). There was no significant effect of music on the change from baseline in anxiety levels (p=0.74), pulse rate (p=0.56) or blood pressure (p=0.34). Conclusion : Sedation requirements are significantly reduced by playing self-selected music to the patient during interventional radiology procedures. By lowering sedation during interventional radiology, music makes the procedure safer. It also contributes favourably to the overall patient experience. PMID:22422386

Comparative evaluation of bispectral index system after sedation with midazolam and propofol combined with remifentanil versus ketamine in uncooperative during dental procedures

PubMed Central

Eshghi, Alireza; Mohammadpour, Mehrnaz; Kaviani, Nasser; Tahririan, Dana; Akhlaghi, Najmeh

2016-01-01

Background: Proper analgesic agents should be used in combination with sedative agents. Remifentanil is a synthetic narcotic/analgesic agent with a short duration effect and decreases the risk of apnea during recovery. Bispectral index system (BIS) is a new noninvasive technique for the evaluation of the depth of sedation. The aim of present clinical trial was to evaluate and compare the efficacy of intravenous sedation with propofol/midazolam/remifentanil (PMR) in comparison to propofol/midazolam/ketamine (PMK) for dental procedures in children 3-7 years of age. Materials and Methods: In this clinical trial, 32 healthy uncooperative children who were candidates for dental treatments under sedation were randomly divided into two groups. Intravenous sedation was induced with PMR in one group and with PMK in the other group. After injection and during procedure BIS index, heart rate and respiratory rate, blood pressure, and oxygen saturation was evaluated every 5 min. After the procedure, recovery time was measured. Data were analyzed with ANOVA, Friedman, Wilcoxon, and t-test. Results: The BIS value was significantly low in ketamin group (P = 0.003) but respiratory rates and heart rates were same in both groups with no statistical difference (P = 0.884, P = 0.775). The recovery time was significantly shorter in remifentanil group (P = 0.008 and P = 0.003). Conclusion: It can be concluded that intravenous sedation technique with PMR combination induces effective and safe sedation, with less pain and more forgetfulness and a shorter recovery time for children 3-7 years of age during dental procedures. PMID:26962308

Medical personnel and patient dosimetry during coronary angiography and intervention

NASA Astrophysics Data System (ADS)

Efstathopoulos, Efstathios P.; Makrygiannis, Stamatis S.; Kottou, Sofia; Karvouni, Evangelia; Giazitzoglou, Eleftherios; Korovesis, Socrates; Tzanalaridou, Efthalia; Raptou, Panagiota D.; Katritsis, Demosthenes G.

2003-09-01

Percutaneous coronary interventions are associated with increased radiation exposure compared to most radiological examinations. This prospective study aimed at (1) measuring entrance doses for all in-room personnel, (2) performing an assessment of patient effective dose and intracoronary doses, (3) investigating the contribution of each projection to kerma-area product (KAP) and irradiation time, (4) comparing results with established DRL values in this clinical setting and (5) estimating the risk for fatal cancer to patients and operators. Measurements were performed during 40 consecutive procedures of coronary angiography (CA), half of which were followed by ad hoc coronary angioplasty (PTCA). KAP measurements were used for patients and thermoluminescent dosimetry for the in-room personnel. The mean KAP value per procedure for CA was 29 +/- 9 Gy cm2. Thirty four per cent of KAP was due to fluoroscopy, whereas the remainder (66%) was due to digital cine. Accordingly, the mean KAP value per PTCA procedure was 75 +/- 30 Gy cm2, and contribution of fluoroscopy is 57%. Effective dose per year was estimated to be 0.04-0.05 mSv y-1 for the primary operator, and 0.03-0.04 mSv y-1 for those assisting. Corresponding measurements for radiographer and nurse were below detectable level, implying minimal radiation hazards for them. Regarding radiation exposure, coronary intervention is considered a quite safe procedure for both patients and personnel in laboratories with modern equipment and experienced operators as long as standard safety precautions are considered. Exposure optimization though should be constantly sought through continuous review of procedures.

Comparison of treatment outcomes of transnasal vocal fold polypectomy versus microlaryngoscopic surgery.

PubMed

Wang, Chi-Te; Liao, Li-Jen; Huang, Tsung-Wei; Lo, Wu-Chia; Cheng, Po-Wen

2015-05-01

Office-based procedures have been proposed for the treatment of vocal polyps, including indirect laryngoscopic surgery and angiolytic laser photocoagulation. Our previous report documented good treatment outcomes by combining the two aforementioned procedures. This study was intended to further compare the treatment outcomes of office transnasal vocal fold polypectomy (VFP) with those of microlaryngoscopic surgery (MLS). A matched cohort study. This study retrospectively enrolled 50 age-, gender-, and size-matched patients with vocal polyps treated by VFP or MLS at a tertiary teaching hospital from January 2012 to October 2013. Treatment outcomes were evaluated before, 2 weeks, and 6 weeks after the procedures via perceptual rating of voice quality, acoustic measurement of the speech signal, 10-item voice-handicap index, maximal phonation time, subjective rating of voice quality, and videolaryngostroboscopic evaluation. Both VFP and MLS resulted in significant clinical improvements 2 and 6 weeks postoperatively. Study results exhibited similar objective outcomes between VFP and MLS, whereas patients who received VFP reported higher subjective voice quality than those receiving MLS 2 weeks postoperatively. Six weeks after the procedures, the objective and subjective treatment outcomes were not significantly different between the two treatment groups. This study shows that transnasal VFP may be used as an effective alternative treatment for small vocal polyps. Patients who received office VFP experienced rapid symptomatic relief with a higher degree of subjective effectiveness than MLS 2 weeks postoperatively, whereas the overall treatment outcomes showed a comparable level of effectiveness for both modalities. 3B. © 2014 The American Laryngological, Rhinological and Otological Society, Inc.

Interventions to improve patient comprehension in informed consent for medical and surgical procedures: a systematic review.

PubMed

Schenker, Yael; Fernandez, Alicia; Sudore, Rebecca; Schillinger, Dean

2011-01-01

Patient understanding in clinical informed consent is often poor. Little is known about the effectiveness of interventions to improve comprehension or the extent to which such interventions address different elements of understanding in informed consent. . To systematically review communication interventions to improve patient comprehension in informed consent for medical and surgical procedures. Data Sources. A systematic literature search of English-language articles in MEDLINE (1949-2008) and EMBASE (1974-2008) was performed. In addition, a published bibliography of empirical research on informed consent and the reference lists of all eligible studies were reviewed. Study Selection. Randomized controlled trials and controlled trials with nonrandom allocation were included if they compared comprehension in informed consent for a medical or surgical procedure. Only studies that used a quantitative, objective measure of understanding were included. All studies addressed informed consent for a needed or recommended procedure in actual patients. Data Extraction. Reviewers independently extracted data using a standardized form. All results were compared, and disagreements were resolved by consensus. Data Synthesis. Forty-four studies were eligible. Intervention categories included written information, audiovisual/multimedia, extended discussions, and test/feedback techniques. The majority of studies assessed patient understanding of procedural risks; other elements included benefits, alternatives, and general knowledge about the procedure. Only 6 of 44 studies assessed all 4 elements of understanding. Interventions were generally effective in improving patient comprehension, especially regarding risks and general knowledge. Limitations. Many studies failed to include adequate description of the study population, and outcome measures varied widely. . A wide range of communication interventions improve comprehension in clinical informed consent. Decisions to enhance informed consent should consider the importance of different elements of understanding, beyond procedural risks, as well as feasibility and acceptability of the intervention to clinicians and patients. Conceptual clarity regarding the key elements of informed consent knowledge will help to focus improvements and standardize evaluations.

Interventions to Improve Patient Comprehension in Informed Consent for Medical and Surgical Procedures: A Systematic Review

PubMed Central

Schenker, Yael; Fernandez, Alicia; Sudore, Rebecca; Schillinger, Dean

2017-01-01

Background Patient understanding in clinical informed consent is often poor. Little is known about the effectiveness of interventions to improve comprehension or the extent to which such interventions address different elements of understanding in informed consent. Purpose To systematically review communication interventions to improve patient comprehension in informed consent for medical and surgical procedures. Data Sources A systematic literature search of English-language articles in MEDLINE (1949–2008) and EMBASE (1974–2008) was performed. In addition, a published bibliography of empirical research on informed consent and the reference lists of all eligible studies were reviewed. Study Selection Randomized controlled trials and controlled trials with non-random allocation were included if they compared comprehension in informed consent for a medical or surgical procedure. Only studies that used a quantitative, objective measure of understanding were included. All studies addressed informed consent for a needed or recommended procedure in actual patients. Data Extraction Reviewers independently extracted data using a standardized form. All results were compared, and disagreements were resolved by consensus. Data Synthesis Forty-four studies were eligible. Intervention categories included written information, audiovisual/multimedia, extended discussions, and test/feedback techniques. The majority of studies assessed patient understanding of procedural risks; other elements included benefits, alternatives, and general knowledge about the procedure. Only 6 of 44 studies assessed all 4 elements of understanding. Interventions were generally effective in improving patient comprehension, especially regarding risks and general knowledge. Limitations Many studies failed to include adequate description of the study population, and outcome measures varied widely. Conclusions A wide range of communication interventions improve comprehension in clinical informed consent. Decisions to enhance informed consent should consider the importance of different elements of understanding, beyond procedural risks, as well as feasibility and acceptability of the intervention to clinicians and patients. Conceptual clarity regarding the key elements of informed consent knowledge will help to focus improvements and standardize evaluations. PMID:20357225

14 CFR 1216.205 - Procedures for evaluating NASA actions impacting floodplains and wetlands.

Code of Federal Regulations, 2013 CFR

2013-01-01

... effects or even taking no action. (6) If, upon completing the comparative evaluation, the Field... Federal Register or other appropriate vehicle. (B) A description of how the activity will be designed or...

14 CFR 1216.205 - Procedures for evaluating NASA actions impacting floodplains and wetlands.

Code of Federal Regulations, 2012 CFR

2012-01-01

... effects or even taking no action. (6) If, upon completing the comparative evaluation, the Field... Federal Register or other appropriate vehicle. (B) A description of how the activity will be designed or...

14 CFR 1216.205 - Procedures for evaluating NASA actions impacting floodplains and wetlands.

Code of Federal Regulations, 2011 CFR

2011-01-01

... effects or even taking no action. (6) If, upon completing the comparative evaluation, the Field... Federal Register or other appropriate vehicle. (B) A description of how the activity will be designed or...

14 CFR 1216.205 - Procedures for evaluating NASA actions impacting floodplains and wetlands.

Code of Federal Regulations, 2010 CFR

2010-01-01

... effects or even taking no action. (6) If, upon completing the comparative evaluation, the Field... Federal Register or other appropriate vehicle. (B) A description of how the activity will be designed or...

TVT-Exact and midurethral sling (SLING-IUFT) operative procedures: a randomized study

PubMed Central

Aniulis, Povilas; Skaudickas, Darijus

2015-01-01

Objectives The aim of the study is to compare results, effectiveness and complications of TVT exact and midurethral sling (SLING-IUFT) operations in the treatment of female stress urinary incontinence (SUI). Methods A single center nonblind, randomized study of women with SUI who were randomized to TVT-Exact and SLING-IUFT was performed by one surgeon from April 2009 to April 2011. SUI was diagnosed on coughing and Valsalva test and urodynamics (cystometry and uroflowmetry) were assessed before operation and 1 year after surgery. This was a prospective randomized study. The follow up period was 12 months. 76 patients were operated using the TVT-Exact operation and 78 patients – using the SLING-IUFT operation. There was no statistically significant differences between groups for BMI, parity, menopausal status and prolapsed stage (no patients had cystocele greater than stage II). Results Mean operative time was significantly shorter in the SLING-IUFT group (19 ± 5.6 min.) compared with the TVT-Exact group (27 ± 7.1 min.). There were statistically significant differences in the effectiveness of both procedures: TVT-Exact – at 94.5% and SLING-IUFT – at 61.2% after one year. Hospital stay was statistically significantly shorter in the SLING-IUFT group (1. 2 ± 0.5 days) compared with the TVT-Exact group (3.5 ± 1.5 days). Statistically significantly fewer complications occurred in the SLING-IUFT group. Conclusion the TVT-Exact and SLING-IUFT operations are both effective for surgical treatment of female stress urinary incontinence. The SLING-IUFT involved a shorter operation time and lower complications rate., the TVT-Exact procedure had statistically significantly more complications than the SLING-IUFT operation, but a higher effectiveness. PMID:28352711

TVT-Exact and midurethral sling (SLING-IUFT) operative procedures: a randomized study.

PubMed

Aniuliene, Rosita; Aniulis, Povilas; Skaudickas, Darijus

2015-01-01

The aim of the study is to compare results, effectiveness and complications of TVT exact and midurethral sling (SLING-IUFT) operations in the treatment of female stress urinary incontinence (SUI). A single center nonblind, randomized study of women with SUI who were randomized to TVT-Exact and SLING-IUFT was performed by one surgeon from April 2009 to April 2011. SUI was diagnosed on coughing and Valsalva test and urodynamics (cystometry and uroflowmetry) were assessed before operation and 1 year after surgery. This was a prospective randomized study. The follow up period was 12 months. 76 patients were operated using the TVT-Exact operation and 78 patients - using the SLING-IUFT operation. There was no statistically significant differences between groups for BMI, parity, menopausal status and prolapsed stage (no patients had cystocele greater than stage II). Mean operative time was significantly shorter in the SLING-IUFT group (19 ± 5.6 min.) compared with the TVT-Exact group (27 ± 7.1 min.). There were statistically significant differences in the effectiveness of both procedures: TVT-Exact - at 94.5% and SLING-IUFT - at 61.2% after one year. Hospital stay was statistically significantly shorter in the SLING-IUFT group (1. 2 ± 0.5 days) compared with the TVT-Exact group (3.5 ± 1.5 days). Statistically significantly fewer complications occurred in the SLING-IUFT group. the TVT-Exact and SLING-IUFT operations are both effective for surgical treatment of female stress urinary incontinence. The SLING-IUFT involved a shorter operation time and lower complications rate., the TVT-Exact procedure had statistically significantly more complications than the SLING-IUFT operation, but a higher effectiveness.

Comparison of local and general anaesthesia for arthrocentesis of the temporomandibular joint.

PubMed

Tuz, H H; Baslarli, O; Adiloglu, S; Gokturk, T; Meral, S E

2016-10-01

Arthrocentesis of the temporomandibular joint is an effective treatment for some disorders, and is usually done under local anaesthesia. We know of few studies that have compared the ease of arthrocentesis and its outcomes under local or general anaesthesia, so we studied 32 patients (n=16 in each group). Postoperative oedema and pain, maximum mouth opening, duration of arthrocentesis, and ease of operation were assessed to compare the relative effectiveness of the two types of anaesthetic. Scores for duration of arthrocentesis (p=0.003) and ease of procedure (0.004) differed significantly, while the other results were similar in the two groups. We noticed some superior outcomes when the procedure was done under general anaesthesia, but because of its limitations, selection of patients becomes more important. Copyright © 2016 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

Identifying Effective Spelling Interventions Using a Brief Experimental Analysis and Extended Analysis

ERIC Educational Resources Information Center

McCurdy, Merilee; Clure, Lynne F.; Bleck, Amanda A.; Schmitz, Stephanie L.

2016-01-01

Spelling is an important skill that is crucial to effective written communication. In this study, brief experimental analysis procedures were used to examine spelling instruction strategies (e.g., whole word correction; word study strategy; positive practice; and cover, copy, and compare) for four students. In addition, an extended analysis was…

Do Dynamic Work Instructions Provide an Advantage over Static Instructions in a Small Scale Assembly Task?

ERIC Educational Resources Information Center

Watson, Gareth; Butterfield, Joe; Curran, Ricky; Craig, Cathy

2010-01-01

Recent studies exploring the effects of instructional animations on learning compared to static graphics have yielded mixed results. Few studies have explored their effectiveness in portraying procedural-motor information. Opportunities exist within an applied (manufacturing) context for instructional animations to be used to facilitate build…

Rhetorical Structure and Graphic Organizers: Effects on Learning from a History Text

ERIC Educational Resources Information Center

Montanero, Manuel; Lucero, Manuel

2012-01-01

This paper describes the effects of different methods to enhance students' understanding and learning from a text. We compared the efficiency of a text revision procedure ("from the text") and inferential activity engagement "toward the text") in the comprehension and recall of a History text. A total of 338 undergraduate…

Study of Visual and Auditory Presentation in Dental Lecture and Laboratory Instruction. Final Report.

ERIC Educational Resources Information Center

Allen, William H.; And Others

This study compared the relative effectiveness of an automated teaching machine with instructor presented instruction in graduate dental teaching. The objectives were to: (1) determine the effects of 3 laboratory instructional procedures used in combination with 2 lectures on the acquisition of manual operative skills, the learning of information…

Effect of X-Word Grammar and Traditional Grammar Instruction on Grammatical Accuracy

ERIC Educational Resources Information Center

Livingston, Sue; Toce, Andi; Casey, Toce; Montoya, Fernando; Hart, Bonny R.; O'Flaherty, Carmela

2018-01-01

This study first briefly describes an instructional approach to teaching grammar known as X-Word Grammar and then compares its effectiveness in assisting students in achieving grammatical accuracy with traditionally taught grammar. Two groups of L2 pre-college students were taught using curricula and practice procedures in two different grammar…

Quantifying the Diversity and Similarity of Surgical Procedures Among Hospitals and Anesthesia Providers.

PubMed

Dexter, Franklin; Ledolter, Johannes; Hindman, Bradley J

2016-01-01

In this Statistical Grand Rounds, we review methods for the analysis of the diversity of procedures among hospitals, the activities among anesthesia providers, etc. We apply multiple methods and consider their relative reliability and usefulness for perioperative applications, including calculations of SEs. We also review methods for comparing the similarity of procedures among hospitals, activities among anesthesia providers, etc. We again apply multiple methods and consider their relative reliability and usefulness for perioperative applications. The applications include strategic analyses (e.g., hospital marketing) and human resource analytics (e.g., comparisons among providers). Measures of diversity of procedures and activities (e.g., Herfindahl and Gini-Simpson index) are used for quantification of each facility (hospital) or anesthesia provider, one at a time. Diversity can be thought of as a summary measure. Thus, if the diversity of procedures for 48 hospitals is studied, the diversity (and its SE) is being calculated for each hospital. Likewise, the effective numbers of common procedures at each hospital can be calculated (e.g., by using the exponential of the Shannon index). Measures of similarity are pairwise assessments. Thus, if quantifying the similarity of procedures among cases with a break or handoff versus cases without a break or handoff, a similarity index represents a correlation coefficient. There are several different measures of similarity, and we compare their features and applicability for perioperative data. We rely extensively on sensitivity analyses to interpret observed values of the similarity index.

Radiofrequency microtenotomy is as effective as plantar fasciotomy in the treatment of recalcitrant plantar fasciitis.

PubMed

Chou, Andrew Chia Chen; Ng, Sean Yung Chuan; Su, David Hsien Ching; Singh, Inderjeet Rikhraj; Koo, Kevin

2016-12-01

Radiofrequency microtenotomy (RM) is effective for treating plantar fasciitis. No studies have compared it to the plantar fasciotomy (PF). We hypothesized that RM is equally effective and provides no additional benefit when performed with PF. Between 2007 and 2014, all patients who underwent either or both procedures concurrently at our institution were analyzed. Data collected included demographics, SF-36 Health Survey, AOFAS Ankle-Hindfoot Scale, and two questions regarding satisfaction and expectations, all of which were assessed pre-operatively and post-operatively at 6-months and 1-year. ANOVA with Bonferroni correction was used to compare scores at each interval. Logistic regression was used to identify pre-operative factors that predicted for satisfaction and expectations. There were no differences in patient outcomes. No pre-operative factors predicted for satisfaction and expectations. RM is as effective as PF in the treatment of plantar fasciitis. Patients who underwent both procedures experienced no benefit and a higher rate of complications. Copyright © 2015 European Foot and Ankle Society. Published by Elsevier Ltd. All rights reserved.

Outcomes of Surgeries Performed in Physician Offices Compared With Ambulatory Surgery Centers and Hospital Outpatient Departments in Florida

PubMed Central

Ohsfeldt, Robert L; Li, Pengxiang; Schneider, John E; Stojanovic, Ivana; Scheibling, Cara M

2017-01-01

Background: The proportion of outpatient surgeries performed in physician offices has been increasing over time, raising concern about the impact on outcomes. Objective: To use a private insurance claims database to compare 7-day and 30-day hospitalization rates following relatively complex outpatient surgical procedures across physician offices, freestanding ambulatory surgery centers (ASCs), and hospital outpatient departments (HOPDs). Methods: A multivariable logistic regression model was used to compare the risk-adjusted probability of hospitalization among patients after any of the 88 study outpatient procedures at physician offices, ASCs, and HOPDs over 2008-2012 in Florida. Results: Risk-adjusted hospitalization rates were higher following procedures performed in physician offices compared with ASCs for all procedures grouped together, for most procedures grouped by type, and for many individual procedures. Conclusions: Hospitalizations following surgery were more likely for procedures performed in physician offices compared with ASCs, which highlights the need for ongoing research on the safety and efficacy of office-based surgery. PMID:28469457

Optimization in the utility maximization framework for conservation planning: a comparison of solution procedures in a study of multifunctional agriculture

PubMed Central

Stoms, David M.; Davis, Frank W.

2014-01-01

Quantitative methods of spatial conservation prioritization have traditionally been applied to issues in conservation biology and reserve design, though their use in other types of natural resource management is growing. The utility maximization problem is one form of a covering problem where multiple criteria can represent the expected social benefits of conservation action. This approach allows flexibility with a problem formulation that is more general than typical reserve design problems, though the solution methods are very similar. However, few studies have addressed optimization in utility maximization problems for conservation planning, and the effect of solution procedure is largely unquantified. Therefore, this study mapped five criteria describing elements of multifunctional agriculture to determine a hypothetical conservation resource allocation plan for agricultural land conservation in the Central Valley of CA, USA. We compared solution procedures within the utility maximization framework to determine the difference between an open source integer programming approach and a greedy heuristic, and find gains from optimization of up to 12%. We also model land availability for conservation action as a stochastic process and determine the decline in total utility compared to the globally optimal set using both solution algorithms. Our results are comparable to other studies illustrating the benefits of optimization for different conservation planning problems, and highlight the importance of maximizing the effectiveness of limited funding for conservation and natural resource management. PMID:25538868

Optimization in the utility maximization framework for conservation planning: a comparison of solution procedures in a study of multifunctional agriculture

USGS Publications Warehouse

Kreitler, Jason R.; Stoms, David M.; Davis, Frank W.

2014-01-01

Quantitative methods of spatial conservation prioritization have traditionally been applied to issues in conservation biology and reserve design, though their use in other types of natural resource management is growing. The utility maximization problem is one form of a covering problem where multiple criteria can represent the expected social benefits of conservation action. This approach allows flexibility with a problem formulation that is more general than typical reserve design problems, though the solution methods are very similar. However, few studies have addressed optimization in utility maximization problems for conservation planning, and the effect of solution procedure is largely unquantified. Therefore, this study mapped five criteria describing elements of multifunctional agriculture to determine a hypothetical conservation resource allocation plan for agricultural land conservation in the Central Valley of CA, USA. We compared solution procedures within the utility maximization framework to determine the difference between an open source integer programming approach and a greedy heuristic, and find gains from optimization of up to 12%. We also model land availability for conservation action as a stochastic process and determine the decline in total utility compared to the globally optimal set using both solution algorithms. Our results are comparable to other studies illustrating the benefits of optimization for different conservation planning problems, and highlight the importance of maximizing the effectiveness of limited funding for conservation and natural resource management.

A prospective randomized comparison between pylorus- and subtotal stomach-preserving pancreatoduodenectomy on postoperative delayed gastric emptying occurrence and long-term nutritional status.

PubMed

Matsumoto, Ippei; Shinzeki, Makoto; Asari, Sadaki; Goto, Tadahiro; Shirakawa, Sachiyo; Ajiki, Tetsuo; Fukumoto, Takumi; Suzuki, Yasuyuki; Ku, Yonson

2014-06-01

Pylorus-preserving pancreatoduodenectomy (PPPD) has been associated with a high incidence of delayed gastric emptying (DGE). There are few studies comparing DGE associated with PPPD and subtotal stomach-preserving pancreatoduodenectomy (SSPPD). Moreover, differences between the procedures with respect to long-term results have not been reported. A prospective randomized study was conducted to compare perioperative complications and long-term nutritional status with PPPD and SSPPD. One hundred patients with periampullary lesions were randomized to receive either PPPD (n = 50) or SSPPD (n = 50). All patients were followed up for 3 years after surgery or to the time of recurrence to evaluate nutritional status for the study. The effects of the procedure, age, and malignancy on changes in nutritional indicators were estimated with linear mixed models. This study was registered at UMIN Clinical Trials Registry (UMIN 000012337). The incidence of DGE assessed by the International Study Group of Pancreatic Surgery was 20% with PPPD and 12% with SSPPD (P = 0.414). There were no significant differences between the two procedures on postoperative serum albumin levels, serum total cholesterol levels, and body mass index during the 3-year follow-up period. SSPPD is equally effective in DGE occurrence rate and long-term nutritional status comparing to PPPD. © 2014 Wiley Periodicals, Inc.

A Review of the Ahmed Glaucoma Valve Implant and Comparison with Other Surgical Operations.

PubMed

Riva, Ivano; Roberti, Gloria; Katsanos, Andreas; Oddone, Francesco; Quaranta, Luciano

2017-04-01

The Ahmed glaucoma valve (AGV) is a popular glaucoma drainage implant used for the control of intraocular pressure in patients with glaucoma. While in the past AGV implantation was reserved for glaucoma patients poorly controlled after one or more filtration procedures, mounting evidence has recently encouraged its use as a primary surgery in selected cases. AGV has been demonstrated to be safe and effective in reducing intraocular pressure in patients with primary or secondary refractory glaucoma. Compared to other glaucoma surgeries, AGV implantation has shown favorable efficacy and safety. The aim of this article is to review the results of studies directly comparing AGV with other surgical procedures in patients with glaucoma.

INVO procedure: minimally invasive IVF as an alternative treatment option for infertile couples.

PubMed

Lucena, Elkin; Saa, Angela M; Navarro, Doris E; Pulido, Carlos; Lombana, Oscar; Moran, Abby

2012-01-01

Intravaginal culture (IVC), also called INVO (intravaginal culture of oocytes), is an assisted reproduction procedure where oocyte fertilization and early embryo development are carried out within a gas permeable air-free plastic device, placed into the maternal vaginal cavity for incubation. In the present study we assessed the outcome of the INVO procedure, using the recently designed INVOcell device, in combination with a mild ovarian stimulation protocol. A total of 125 cycles were performed. On average 6.5 oocytes per cycle were retrieved, and a mean of 4.2 were placed per INVOcell device. The cleavage rate obtained after the INVO culture was 63%. The procedure yielded 40%, 31.2%, and 24% of clinical pregnancy, live birth, and single live birth rates per cycle, respectively. Our results suggest that the INVO procedure is an effective alternative treatment option in assisted reproduction that shows comparable results to those reported for existing IVF techniques.

INVO Procedure: Minimally Invasive IVF as an Alternative Treatment Option for Infertile Couples

PubMed Central

Lucena, Elkin; Saa, Angela M.; Navarro, Doris E.; Pulido, Carlos; Lombana, Oscar; Moran, Abby

2012-01-01

Intravaginal culture (IVC), also called INVO (intravaginal culture of oocytes), is an assisted reproduction procedure where oocyte fertilization and early embryo development are carried out within a gas permeable air-free plastic device, placed into the maternal vaginal cavity for incubation. In the present study we assessed the outcome of the INVO procedure, using the recently designed INVOcell device, in combination with a mild ovarian stimulation protocol. A total of 125 cycles were performed. On average 6.5 oocytes per cycle were retrieved, and a mean of 4.2 were placed per INVOcell device. The cleavage rate obtained after the INVO culture was 63%. The procedure yielded 40%, 31.2%, and 24% of clinical pregnancy, live birth, and single live birth rates per cycle, respectively. Our results suggest that the INVO procedure is an effective alternative treatment option in assisted reproduction that shows comparable results to those reported for existing IVF techniques. PMID:22645435

Combining abdominal and cosmetic breast surgery does not increase short-term complication rates: a comparison of each individual procedure and pretreatment risk stratification tool.

PubMed

Khavanin, Nima; Jordan, Sumanas W; Vieira, Brittany L; Hume, Keith M; Mlodinow, Alexei S; Simmons, Christopher J; Murphy, Robert X; Gutowski, Karol A; Kim, John Y S

2015-11-01

Combined abdominal and breast surgery presents a convenient and relatively cost-effective approach for accomplishing both procedures. This study is the largest to date assessing the safety of combined procedures, and it aims to develop a simple pretreatment risk stratification method for patients who desire a combined procedure. All women undergoing abdominoplasty, panniculectomy, augmentation mammaplasty, and/or mastopexy in the TOPS database were identified. Demographics and outcomes for combined procedures were compared to individual procedures using χ(2) and Student's t-tests. Multiple logistic regression provided adjusted odds ratios for the effect of a combined procedure on 30-day complications. Among combined procedures, a logistic regression model determined point values for pretreatment risk factors including diabetes (1 point), age over 53 (1), obesity (2), and 3+ ASA status (3), creating a 7-point pretreatment risk stratification tool. A total of 58,756 cases met inclusion criteria. Complication rates among combined procedures (9.40%) were greater than those of aesthetic breast surgery (2.66%; P < .001) but did not significantly differ from abdominal procedures (9.75%; P = .530). Nearly 77% of combined cases were classified as low-risk (0 points total) with a 9.78% complication rates. Medium-risk patients (1 to 3 points) had a 16.63% complication rate, and high-risk (4 to 7 points) 38.46%. Combining abdominal and breast procedures is safe in the majority of patients and does not increase 30-day complications rates. The risk stratification tool can continue to ensure favorable outcomes for patients who may desire a combined surgery. 4 Risk. © 2015 The American Society for Aesthetic Plastic Surgery, Inc. Reprints and permission: journals.permissions@oup.com.

Perivascular radiofrequency renal denervation lowers blood pressure and ameliorates cardiorenal fibrosis in spontaneously hypertensive rats

PubMed Central

Zhang, Yan; Su, Linan; Zhang, Yunrong; Wang, Qiang; Yang, Dachun; Li, De; Yang, Yongjian; Ma, Shuangtao

2017-01-01

Background Catheter-based renal denervation (RDN) is a promising approach to treat hypertension, but innervation patterns limit the response to endovascular RDN and the post-procedural renal artery narrowing or stenosis questions the endovascular ablation strategy. This study was performed to investigate the anti-hypertensive and target organ protective effects of perivascular RDN in spontaneously hypertensive rats (SHR). Methods SHR and normotensive Wistar-Kyoto (WKY) rats were divided into sham group (n = 10), radiofrequency ablation group (n = 20) in which rats received bilateral perivascular ablation with radiofrequency energy (2 watts), and chemical (10% phenol in 95% ethanol) ablation group (n = 12). The tail-cuff blood pressure was measured before the ablation and on day 14 and day 28 after the procedure. The plasma levels of creatinine, urea nitrogen, and catecholamines, urinary excretion of electrolytes and protein, and myocardial and glomerular fibrosis were analyzed and compared among the groups on day 28 after the procedure. Results We identified that 2-watt is the optimal radiofrequency power for perivascular RDN in rats. Perivascular radiofrequency and chemical ablation achieved roughly comparable blood pressure reduction in SHR but not in WKY on day 14 and day 28 following the procedure. Radiofrequency-mediated ablation substantially destroyed the renal nerves surrounding the renal arteries of both SHR and WKY without damaging the renal arteries and diminished the expression of tyrosine hydroxylase, the enzyme marker for postganglionic sympathetic nerves. Additionally, perivascular radiofrequency ablation also decreased the plasma catecholamines of SHR. Interestingly, both radiofrequency and chemical ablation decreased the myocardial and glomerular fibrosis of SHR, while neither increased the plasma creatinine and blood urea nitrogen nor affected the urinary excretion of electrolytes and protein when compared to sham group. Conclusions Radiofrequency-mediated perivascular RDN may become a feasible procedure against hypertension, and provide similar anti-hypertensive and target organ protective effects as does the chemical ablation. PMID:28453557

Perivascular radiofrequency renal denervation lowers blood pressure and ameliorates cardiorenal fibrosis in spontaneously hypertensive rats.

PubMed

Wei, Shujie; Li, Dan; Zhang, Yan; Su, Linan; Zhang, Yunrong; Wang, Qiang; Yang, Dachun; Li, De; Yang, Yongjian; Ma, Shuangtao

2017-01-01

Catheter-based renal denervation (RDN) is a promising approach to treat hypertension, but innervation patterns limit the response to endovascular RDN and the post-procedural renal artery narrowing or stenosis questions the endovascular ablation strategy. This study was performed to investigate the anti-hypertensive and target organ protective effects of perivascular RDN in spontaneously hypertensive rats (SHR). SHR and normotensive Wistar-Kyoto (WKY) rats were divided into sham group (n = 10), radiofrequency ablation group (n = 20) in which rats received bilateral perivascular ablation with radiofrequency energy (2 watts), and chemical (10% phenol in 95% ethanol) ablation group (n = 12). The tail-cuff blood pressure was measured before the ablation and on day 14 and day 28 after the procedure. The plasma levels of creatinine, urea nitrogen, and catecholamines, urinary excretion of electrolytes and protein, and myocardial and glomerular fibrosis were analyzed and compared among the groups on day 28 after the procedure. We identified that 2-watt is the optimal radiofrequency power for perivascular RDN in rats. Perivascular radiofrequency and chemical ablation achieved roughly comparable blood pressure reduction in SHR but not in WKY on day 14 and day 28 following the procedure. Radiofrequency-mediated ablation substantially destroyed the renal nerves surrounding the renal arteries of both SHR and WKY without damaging the renal arteries and diminished the expression of tyrosine hydroxylase, the enzyme marker for postganglionic sympathetic nerves. Additionally, perivascular radiofrequency ablation also decreased the plasma catecholamines of SHR. Interestingly, both radiofrequency and chemical ablation decreased the myocardial and glomerular fibrosis of SHR, while neither increased the plasma creatinine and blood urea nitrogen nor affected the urinary excretion of electrolytes and protein when compared to sham group. Radiofrequency-mediated perivascular RDN may become a feasible procedure against hypertension, and provide similar anti-hypertensive and target organ protective effects as does the chemical ablation.

Space stable thermal control coatings

NASA Technical Reports Server (NTRS)

Harada, Y.

1982-01-01

A specification quality zinc orthotitanate coating was developed. This silicate-bonded Zn2TiO4 coating is discussed. The effects of precursor chemistry, precursor mixing procedures, stoichiometry variations, and of different heat treatments on the physical and optical properties of Zn2TiO4 are investigated. Inorganic silicates are compared to organic silicone binder systems. The effects of pigment to binder ratio, water content, and of different curing procedures on the optical and physical properties of Zn2TiO4 potassium silicate coatings are also studied. Environmental tests were conducted to determine the UV vacuum stability of coatings for durations up to 5000 equivalent Sun hours.

Effectiveness of ketamine as an adjuvant to opioid-based therapy in decreasing pain associated with opioid tolerance in adults undergoing orthopedic surgery: a systematic review protocol.

PubMed

Bennett, Marsha; Bonanno, Laura; Kuhn, William

2016-10-01

The objective of this systematic review is to examine the best available evidence on the clinical effectiveness of ketamine as an adjuvant to opioid-based therapy versus opioid-based therapy alone in decreasing perioperative pain associated with opioid tolerance in adult patients, aged 18-70 years, undergoing orthopedic surgical procedures.The following question guides the systematic review: does the administration of ketamine as an adjuvant to opioid-based therapy, compared to opioid-based therapy alone, improve perioperative pain relief in opioid-tolerant adult patients undergoing orthopedic surgical procedures?

Numerical solution of the hypersonic viscous-shock-layer equations for laminar, transitional, and turbulent flows of a perfect gas over blunt axially symmetric bodies

NASA Technical Reports Server (NTRS)

Anderson, E. C.; Moss, J. N.

1975-01-01

The viscous shock layer equations applicable to hypersonic laminar, transitional, and turbulent flows of a perfect gas over two-dimensional plane or axially symmetric blunt bodies are presented. The equations are solved by means of an implicit finite difference scheme, and the results are compared with a turbulent boundary layer analysis. The agreement between the two solution procedures is satisfactory for the region of flow where streamline swallowing effects are negligible. For the downstream regions, where streamline swallowing effects are present, the expected differences in the two solution procedures are evident.

Variability in Non-Cardiac Surgical Procedures in Children with Congenital Heart Disease

PubMed Central

Sulkowski, Jason P.; Cooper, Jennifer N.; McConnell, Patrick I.; Pasquali, Sara K.; Shah, Samir S.; Minneci, Peter C.; Deans, Katherine J.

2014-01-01

Background The purpose of this study was to examine the volume and variability of non-cardiac surgeries performed in children with congenital heart disease (CHD) requiring cardiac surgery in the first year of life. Methods Patients who underwent cardiac surgery by 1 year of age and had a minimum 5-year follow-up at 22 of the hospitals contributing to the Pediatric Health Information System database between 2004–2012 were included. Frequencies of non-cardiac surgical procedures by age 5 years were determined and categorized by subspecialty. Patients were stratified according to their maximum RACHS-1 (Risk Adjustment in Congenital Heart Surgery) category. The proportions of patients across hospitals who had a non-cardiac surgical procedure for each subspecialty were compared using logistic mixed effects models. Results 8,857 patients underwent congenital heart surgery during the first year of life, 3,621 (41%) of whom had 13,894 non-cardiac surgical procedures by 5 years. Over half of all procedures were in general surgery (4,432; 31.9%) or otolaryngology (4,002; 28.8%). There was significant variation among hospitals in the proportion of CHD patients having non-cardiac surgical procedures. Compared to children in the low risk group (RACHS-1 categories 1–3), children in the high-risk group (categories 4–6) were more likely to have general, dental, orthopedic, and thoracic procedures. Conclusions Children with CHD requiring cardiac surgery frequently also undergo non-cardiac surgical procedures; however, considerable variability in the frequency of these procedures exists across hospitals. This suggests a lack of uniformity in indications used for surgical intervention. Further research should aim to better standardize care for this complex patient population. PMID:25475794

Safety and Efficacy of Modified Preoperative Lung Nodule Microcoil Localization Without Pleural Marking: A Pilot Study.

PubMed

Kha, Lan-Chau T; Hanneman, Kate; Donahoe, Laura; Chung, Taebong; Pierre, Andrew F; Yasufuku, Kazuhiro; Keshavjee, Shafique; Mayo, John R; Paul, Narinder S; Nguyen, Elsie T

2016-01-01

The purpose of this pilot study was to evaluate the safety and efficacy of preoperative computed tomography (CT)-guided percutaneous microcoil lung nodule localization without pleural marking compared with the established technique with pleural marking. Sixty-three consecutive patients (66.7% female, mean age 61.6±11.4 y) with 64 lung nodules resected between October 2008 and January 2014 were retrospectively evaluated. Of the nodules, 29.7% (n=19) had microcoil deployment with pleural marking (control group) and 70.3% (n=45) had microcoil deployment without pleural marking (pilot group). Clinical, pathologic, and imaging characteristics, radiation dose, CT procedure and operating room time, and complete resection and complication rates were compared between the pilot and control groups. There was no significant difference in nodule size (P=0.552) or distance from the pleural surface (P=0.222) between the pilot and control groups. However, mean procedure duration (53.6±18.3 vs. 72.8±25.3 min, P=0.001) and total effective radiation dose (5.1±2.6 vs. 7.1±4.9 mSv, P=0.039) were significantly lower in the pilot group compared with the control group. CT procedure-related complications (P=0.483) [including pneumothoraces (P=0.769) and pulmonary hemorrhage (P=1.000)], operating room time (P=0.926), complete resection rates (P=0.520), intraoperative complications (P=0.549), and postoperative complications (P=1.000) were similar between the pilot and control groups. Preoperative CT-guided lung nodule microcoil localization performed without visceral pleural marking appears to decrease the CT procedure time and radiation dose while maintaining equivalent complete resection rates and procedural and surgical complications, when compared with microcoil localization performed with pleural marking.

Comparison between ultrasound-guided compression and para-aneurysmal saline injection in the treatment of postcatheterization femoral artery pseudoaneurysms.

PubMed

ElMahdy, Mahmoud Farouk; Kassem, Hussien Heshmat; Ewis, Essam Baligh; Mahdy, Soliman Gharieb

2014-03-01

Management of postcatheterization femoral artery pseudoaneurysm (FAP) is problematic. Ultrasound-guided compression (UGC) is painful and cumbersome. Thrombin injection is costly and may cause thromboembolism. Ultrasound-guided para-aneurysmal saline injection (PASI) has been described but was never compared against other treatment methods of FAP. We aimed at comparing the success rate and complications of PASI versus UGC. We randomly assigned 80 patients with postcatheterization FAPs to either UGC (40 patients) or PASI (40 patients). We compared the 2 procedures regarding successful obliteration of the FAP, incidence of vasovagal attacks, procedure time, discontinuation of antiplatelet and/or anticoagulants, and the Doppler waveform in the ipsilateral pedal arteries at the end of the procedure. There was no significant difference between patients in both groups regarding clinical and vascular duplex data. The mean durations of UGC and PASI procedures were 58.14 ± 28.45 and 30.33 ± 8.56 minutes, respectively (p = 0.045). Vasovagal attacks were reported in 10 (25%) and 2 patients (5%) treated with UGC and PASI, respectively (p = 0.05). All patients in both groups had triphasic Doppler waveform in the infrapopliteal arteries before and after the procedure. The primary and final success rates were 75%, 92.5%, 87.5%, and 95% for UGC and PASI, respectively (p = 0.43). In successfully treated patients, there was no reperfusion of the FAP in the follow-up studies (days 1 and 7) in both groups. In conclusion, ultrasound-guided PASI is an effective method for the treatment of FAP. Compared with UGC, PASI is faster, less likely to cause vasovagal reactions, and can be more convenient to patients and physicians. Copyright © 2014 Elsevier Inc. All rights reserved.

(99m)Tc-MAG3 diuretic renography in diagnosis of obstructive nephropathy in adults: a comparison between F-15 and a new procedure F+10(sp) in seated position.

PubMed

Tartaglione, Girolamo; D'Addessi, Alessandro; De Waure, Chiara; Pagan, Marco; Raccioppi, Marco; Sacco, Emilio; Cadeddu, Chiara; Vittori, Matteo; Bassi, Pier Francesco; Ferretti, Alice; Al-Nahhas, Adil; Rubello, Domenico

2013-06-01

The objective of this study was to compare 2 diuretic renography procedures: F-15 versus F+10(sp) for diagnosis of obstructive uropathy in adults. Thirty-six patients with unilateral or bilateral hydronephrosis had 2 consecutive Tc-MAG3 diuretic renograms within 7 days, using the widely used procedure F-15 in supine position, and a new seated-position procedure whereby the patient drinks 400 to 500 mL of water at 5 minutes and receives an injection of 20 mg of furosemide at 10 minutes [F+10 (sp)]. F-15 showed nonobstructive results in 63.9% of kidneys, obstruction in 26.4%, and equivocal findings in 6.9% and was not applicable in 2.8%. F+10(sp) showed nonobstructive results in 70.9%, obstruction in 27.8%, and equivocal result in 1.4% of kidneys. Nephroptosis was observed by F+10(sp) in 22.2% of kidneys. Adverse effects reported for the F-15 were hypotension in 2 patients, renal colic in 3 patients, and interruption due to voiding in 5 patients. No adverse effects were reported for F+10(sp). This study shows that the F+10(sp) procedure reduces the equivocal findings of F-15 procedure in 36 patients. It can improve the accuracy and compliance, avoiding adverse effects and reducing bladder filling-related problems.

A quasi randomized-controlled trial to evaluate the effectiveness of clowntherapy on children's anxiety and pain levels in emergency department.

PubMed

Felluga, Margherita; Rabach, Ingrid; Minute, Marta; Montico, Marcella; Giorgi, Rita; Lonciari, Isabella; Taddio, Andrea; Barbi, Egidio

2016-05-01

The aim of the study is to investigate if the presence of medical clowns during painful procedures in the emergency department (ED) affects children's anxiety and pain. Forty children (4-11 years) admitted to the ED with the need of painful procedures were prospectively enrolled. They were randomly assigned to the clown group, where children interacted with clowns or to the control group in which they were entertained by parents and ED nurses. The children's anxiety was assessed by the Children's Anxiety and Pain Scales; pain was evaluated with the Numerical Rating Scale and Wong-Backer Scale, according to the children's age. Staff and clown's opinions were evaluated by means of dedicated questionnaires. Children's anxiety levels in the clown group were significantly lower than those compared with the control group, while children's pain levels did not change between the two groups. The presence of clowns in the ED before and during painful procedures was effective in reducing children's anxiety. • Anxiety and fear caused by medical procedures exacerbate children's pain and may interfere with the procedure. • To reduce anxiety, fear, and pain and to facilitate patient's evaluation, different non-pharmacological approaches have been proposed and positive effects of laughter and humor have been reported. What is New: • The presence of clowns in the waiting room and in the ED during medical evaluation and painful procedures helps to reduce children's anxiety.

Cocaine versus food choice procedure in rats: environmental manipulations and effects of amphetamine.

PubMed

Thomsen, Morgane; Barrett, Andrew C; Negus, S Stevens; Caine, S Barak

2013-03-01

We have adapted a nonhuman primate model of cocaine versus food choice to the rat species. To evaluate the procedure, we tested cocaine versus food choice under a variety of environmental manipulations as well as pharmacological pretreatments. Complete cocaine-choice dose-effect curves (0-1.0 mg/kg/infusion) were obtained for each condition under concurrent fixed ratio schedules of reinforcement. Percentage of responding emitted on the cocaine-reinforced lever was not affected significantly by removal of cocaine-associated visual or auditory cues, but it was decreased after removal of response-contingent or response-independent cocaine infusions. Cocaine choice was sensitive to the magnitude and fixed ratio requirement of both the cocaine and food reinforcers. We also tested the effects of acute (0.32, 0.56, 1.0, 1.8 mg/kg) and chronic (0.1, 0.32 mg/kg/hr) d-amphetamine treatment on cocaine choice. Acute and chronic d-amphetamine had opposite effects, with acute increasing and chronic decreasing cocaine choice, similar to observations in humans and in nonhuman primates. The results suggest feasibility and utility of the choice procedure in rats and support its comparability to similar procedures used in humans and monkeys. © Society for the Experimental Analysis of Behavior.

Effectiveness of surgery for adults with hallux valgus deformity: a systematic review.

PubMed

Klugarova, Jitka; Hood, Victoria; Bath-Hextall, Fiona; Klugar, Miloslav; Mareckova, Jana; Kelnarova, Zuzana

2017-06-01

Hallux valgus (HV) is a common foot deformity. In severe stages of this condition, surgery is often necessary. Currently, there is no systematic review comparing the effectiveness of surgery over conservative treatment. The objective of this review was to establish the effectiveness of surgery compared to conservatory management for adults with HV. The current review included adults (18 years or over) with HV deformity, excluding adults with neurological problems causing foot deformities, for example, cerebral palsy, neuropathy, stroke and multiple sclerosis. The review included any type of HV surgery compared to no surgery, conservative treatment or different types of HV surgeries. The primary outcome was gait measurement, and secondary outcomes included quality of life, patient satisfaction, pain assessed using any validated assessment tool and adverse events. The review included randomized controlled trials. The search strategy aimed to find both published and unpublished studies. A three-step search strategy was utilized in 16 databases without language and date limitations. Papers selected for retrieval were assessed by two independent reviewers for methodological validity prior to inclusion in the review using standardized critical appraisal instruments developed by the Joanna Briggs Institute (JBI). Data were extracted from papers included in the review using the standardized data extraction tool developed by the JBI. Quantitative data were, where possible, pooled in statistical meta-analysis using RevMan5 (Copenhagen: The Nordic Cochrane Centre, Cochrane). Effect sizes expressed as risk ratio (for categorical data) and mean differences (MD) or standardized MD (for continuous data) and their 95% confidence intervals were calculated for analysis. Where statistical pooling was not possible, the findings have been presented in narrative form. Searching identified 2412 citations. After removal of duplicates, paper retrieval and critical appraisal, 25 studies were included in the review. The included trials were of medium-to-poor quality.Twenty-four trials compared the effectiveness of different types of surgeries. Meta-analysis revealed no difference in level of pain between distal chevron-type osteotomy and other surgical procedures (standard mean difference [SMD] 0.02, 95% confidence interval [CI] -0.24 to 0.28). One single trial reported that distal chevron osteotomy is more effective than Lindgren osteotomy in terms of walking speed (MD -0.24, 95% CI -0.43 to -0.05).One medium quality trial assessed the effectiveness of HV surgery compared to conservative or no treatment. This trial showed that surgery, specifically distal chevron osteotomy of the first metatarsal, is a more effective procedure for pain compared to conservative treatment (MD -15.00, 95% CI -22.79 to -7.21) and also no treatment in the first year (MD -18.00, 95% CI -25.62 to -10.38). The current systematic review showed that differences between various types of surgical procedures, specifically osteotomies of the first metatarsal on clinical outcomes, are minimal. There is evidence from one study, that surgery, specifically distal chevron osteotomy of the first metatarsal is a more effective procedure than conservative or no treatment in reducing pain in the first year following surgery. However, this systematic review has identified that there is a lack of high-quality studies comparing similar types of HV treatments that assess the same outcomes.

Blood-Brain Barrier Opening in Behaving Non-Human Primates via Focused Ultrasound with Systemically Administered Microbubbles

NASA Astrophysics Data System (ADS)

Downs, Matthew E.; Buch, Amanda; Karakatsani, Maria Eleni; Konofagou, Elisa E.; Ferrera, Vincent P.

2015-10-01

Over the past fifteen years, focused ultrasound coupled with intravenously administered microbubbles (FUS) has been proven an effective, non-invasive technique to open the blood-brain barrier (BBB) in vivo. Here we show that FUS can safely and effectively open the BBB at the basal ganglia and thalamus in alert non-human primates (NHP) while they perform a behavioral task. The BBB was successfully opened in 89% of cases at the targeted brain regions of alert NHP with an average volume of opening 28% larger than prior anesthetized FUS procedures. Safety (lack of edema or microhemorrhage) of FUS was also improved during alert compared to anesthetized procedures. No physiological effects (change in heart rate, motor evoked potentials) were observed during any of the procedures. Furthermore, the application of FUS did not disrupt reaching behavior, but in fact improved performance by decreasing reaction times by 23 ms, and significantly decreasing touch error by 0.76 mm on average.

Degradation of learned skills. Effectiveness of practice methods on simulated space flight skill retention

NASA Technical Reports Server (NTRS)

Sitterley, T. E.; Berge, W. A.

1972-01-01

Manual flight control and emergency procedure task skill degradation was evaluated after time intervals of from 1 to 6 months. The tasks were associated with a simulated launch through the orbit insertion flight phase of a space vehicle. The results showed that acceptable flight control performance was retained for 2 months, rapidly deteriorating thereafter by a factor of 1.7 to 3.1 depending on the performance measure used. Procedural task performance showed unacceptable degradation after only 1 month, and exceeded an order of magnitude after 4 months. The effectiveness of static rehearsal (checklists and briefings) and dynamic warmup (simulator practice) retraining methods were compared for the two tasks. Static rehearsal effectively countered procedural skill degradation, while some combination of dynamic warmup appeared necessary for flight control skill retention. It was apparent that these differences between methods were not solely a function of task type or retraining method, but were a function of the performance measures used for each task.

[Cost-effectiveness of laparoscopic versus open cholecystectomy].

PubMed

Fajardo, Roosevelt; Valenzuela, José Ignacio; Olaya, Sandra Catalina; Quintero, Gustavo; Carrasquilla, Gabriel; Pinzón, Carlos Eduardo; López, Catalina; Ramírez, Juan Camilo

2011-01-01

Cholecystectomy has been the subject of several clinical and cost comparison studies. The results of open or laparoscopy cholecystectomy were compared in terms of cost and effectiveness from the perspective of health care institutions and from that of the patients. The cost-effectiveness study was undertaken at two university hospitals in Bogotá, Colombia. The approach was to select the type of cholecystectomy retrospectively and then assess the result prospectively. The cost analysis used the combined approach of micro-costs and daily average cost. Patient resource consumption was gathered from the time of surgery room entry to time of discharge. A sample of 376 patients with cholelithiasis/cystitis (May 2005-June 2006) was selected--156 underwent open cholecystectomy and 220 underwent laparoscopic cholecystectomy. The following data were tabulated: (1) frequency of complications and mortality, post-surgical hospital stay, (2) reincorporation to daily activities, (3) surgery duration, (4) direct medical costs, (5) costs to the patient, and (6) mean and incremental cost-effectiveness ratios. Frequency of complications was 13.5% for open cholecystectomy and 6.4% for laparoscopic cholecystectomy (p=0.02); hospital stay was longer in open cholecystectomy than in laparoscopic cholecystectomy (p=0.003) as well as the reincorporation to daily activities reported by the patients (p<0.001). The duration of open cholecystectomy was 22 min longer than laparoscopic cholecystectomy (p<0.001). The average cost of laparoscopic cholecystectomy was lower than open cholecystectomy and laparoscopic cholecystectomy was more cost-effective than open cholecystectomy (US$ 995 vs. US$ 1,048, respectively). The patient out-of-pocket expenses were greater in open cholecystectomy compared to laparoscopic cholecystectomy (p=0.015). Mortality was zero. The open laparoscopy procedure was associated with longer hospital stays, where as the cholecystectomy procedure required a longer surgical duration. The direct cost of the latter was lower for both for the health care institution and patients. The cost-effectiveness for both procedures was comparable.

Procedural performance following sleep deprivation remains impaired despite extended practice and an afternoon nap

PubMed Central

Kurniawan, Irma Triasih; Cousins, James Nicholas; Chong, Pearlynne L. H.; Chee, Michael W. L.

2016-01-01

The negative impact of sleep loss on procedural memory is well established, yet it remains unclear how extended practice opportunities or daytime naps can modulate the effect of a night of sleep deprivation. Here, participants underwent three training and test conditions on a sequential finger tapping task (SFTT) separated by at least one week. In the first condition they were trained in the evening followed by a night of sleep. Two further conditions took place where evening training was followed by a night of total sleep deprivation (TSD). One of the TSD conditions included a one-hour nap opportunity (15:00). Compared to the condition in which sleep was permitted, a night of TSD resulted in poorer performance across 4 practices the following day (10:00–19:00). The deleterious effect of a single night of TSD on procedural performance, was neither clearly alleviated by an afternoon nap nor by multiple practice opportunities. Interestingly, significant gains in performance were observed in all conditions after a one-week delay. Recovery sleep on subsequent nights thus appeared to nullify the effect of a single night of sleep deprivation, underscoring the importance of offline consolidation on the acquisition of procedural skill. PMID:27782172

An economic analysis of adherence engineering to improve use of best practices during central line maintenance procedures.

PubMed

Nelson, Richard E; Angelovic, Aaron W; Nelson, Scott D; Gleed, Jeremy R; Drews, Frank A

2015-05-01

Adherence engineering applies human factors principles to examine non-adherence within a specific task and to guide the development of materials or equipment to increase protocol adherence and reduce human error. Central line maintenance (CLM) for intensive care unit (ICU) patients is a task through which error or non-adherence to protocols can cause central line-associated bloodstream infections (CLABSIs). We conducted an economic analysis of an adherence engineering CLM kit designed to improve the CLM task and reduce the risk of CLABSI. We constructed a Markov model to compare the cost-effectiveness of the CLM kit, which contains each of the 27 items necessary for performing the CLM procedure, compared with the standard care procedure for CLM, in which each item for dressing maintenance is gathered separately. We estimated the model using the cost of CLABSI overall ($45,685) as well as the excess LOS (6.9 excess ICU days, 3.5 excess general ward days). Assuming the CLM kit reduces the risk of CLABSI by 100% and 50%, this strategy was less costly (cost savings between $306 and $860) and more effective (between 0.05 and 0.13 more quality-adjusted life-years) compared with not using the pre-packaged kit. We identified threshold values for the effectiveness of the kit in reducing CLABSI for which the kit strategy was no longer less costly. An adherence engineering-based intervention to streamline the CLM process can improve patient outcomes and lower costs. Patient safety can be improved by adopting new approaches that are based on human factors principles.

Effects of medical school selection on student motivation: a PhD thesis report.

PubMed

Wouters, Anouk

2018-02-01

High stakes are involved in student selection, for both medical schools and applicants. This thesis investigated the effects of selection on the medical student population and applicant pool in the Dutch setting. This thesis consists of six papers: two quantitative studies, one qualitative study, two mixed methods studies and one perspective paper based on a review of the literature. (1) Compared with a lottery, selection does not result in a student population with better motivation, engagement and performance, both in the clinical and pre-clinical phases of the study. (2) Selection seems to have a temporary stimulating effect on student motivation through enhancing perceived autonomy, competence and relatedness. (3) Applicants adopt a strategic approach, based on the selection procedure, in their choice of medical school. (4) The description of an applicant's motivation is not a reliable and valid tool to assess motivation during selection. (5) Gaining healthcare experience is crucial for applicants' motivation, but inequalities in access to such experiences can demotivate certain student groups from applying to medical school. (6) The gains yielded from selection compared with a lottery seem to be small. Unintentionally induced self-selection among certain groups of students and biased selection procedures may compromise student diversity. The added value of selection procedures compared with a weighted lottery for admitting students to medical school is questionable. Students are generally motivated and perform well, irrespective of how they enrolled in medical school. Selection yields only small gains, while student diversity may be hampered.

Randomized comparative evaluation of endoscopic submucosal dissection self-learning software in France and Japan.

PubMed

Pioche, Mathieu; Rivory, Jérôme; Nishizawa, Toshihiro; Uraoka, Toshio; Touzet, Sandrine; O'Brien, Marc; Saurin, Jean-Christophe; Ponchon, Thierry; Denis, Angélique; Yahagi, Naohisa

2016-12-01

Background and study aim: Endoscopic submucosal dissection (ESD) is currently the reference method to achieve an en bloc resection for large lesions; however, the technique is difficult and risky, with a long learning curve. In order to reduce the morbidity, training courses that use animal models are recommended. Recently, self-learning software has been developed to assist students in their training. The aim of this study was to evaluate the impact of this tool on the ESD learning curve. Methods: A prospective, randomized, comparative study enrolled 39 students who were experienced in interventional endoscopy. Each student was randomized to one of two groups and performed 30 ESDs of 30 mm standardized lesions in a bovine colon model. The software group used the self-learning software whereas the control group only observed an ESD procedure video. The primary outcome was the rate of successful ESD procedures, defined as complete en bloc resection without any perforation and performed in less than 75 minutes. Results: A total of 39 students performed 1170 ESDs. Success was achieved in 404 (70.9 %) in the software group and 367 (61.2 %) in the control group ( P  = 0.03). Among the successful procedures, there were no significant differences between the software and control groups in terms of perforation rate (22 [4.0 %] vs. 29 [5.1 %], respectively; P  = 0.27) and mean (SD) procedure duration (34.1 [13.4] vs. 32.3 [14.0] minutes, respectively; P  = 0.52). For the 30th procedure, the rate of complete resection was superior in the software group (84.2 %) compared with the control group (50.0 %; P  = 0.01). Conclusion: ESD self-learning software was effective in improving the quality of resection compared with a standard teaching method using procedure videos. This result suggests the benefit of incorporating such software into teaching programs. © Georg Thieme Verlag KG Stuttgart · New York.

Hospital volume and the risk of revision in Oxford unicompartmental knee arthroplasty in the Nordic countries -an observational study of 14,496 cases.

PubMed

Badawy, Mona; Fenstad, Anne M; Bartz-Johannessen, Christoffer A; Indrekvam, Kari; Havelin, Leif I; Robertsson, Otto; W-Dahl, Annette; Eskelinen, Antti; Mäkelä, Keijo; Pedersen, Alma B; Schrøder, Henrik M; Furnes, Ove

2017-09-07

High procedure volume and dedication to unicompartmental knee arthroplasty (UKA) has been suggested to improve revision rates. This study aimed to quantify the annual hospital volume effect on revision risk in Oxfordu nicompartmental knee arthroplasty in the Nordic countries. 14,496 cases of cemented medial Oxford III UKA were identified in 126 hospitals in the four countries included in the Nordic Arthroplasty Register Association (NARA) database from 2000 to 2012. Hospitals were divided by quartiles into 4 annual procedure volume groups (≤11, 12-23, 24-43 and ≥44). The outcome was revision risk after 2 and 10 years calculated using Kaplan Meier method. Multivariate Cox regression analysis was used to assess the Hazard Ratio (HR) of any revision due to specific reasons with 95% confidence intervals (CI). The implant survival was 80% at 10 years in the volume group ≤11 procedures per year compared to 83% in other volume groups. The HR adjusted for age category, sex, year of surgery and nation was 0.87 (95% CI: 0.76-0.99, p = 0.036) for the group 12-23 procedures per year, 0.78 (95% CI: 0.68-0.91, p = 0.002) for the group 24-43 procedures per year and 0.82 (95% CI: 0.70-0.94, p = 0.006) for the group ≥44 procedures per year compared to the low volume group. Log-rank test was p = 0.003. The risk of revision for unexplained pain was 40-50% higher in the low compared with other volume groups. Low volume hospitals performing ≤11 Oxford III UKAs per year were associated with an increased risk of revision compared to higher volume hospitals, and unexplained pain as revision cause was more common in low volume hospitals.

Effects of delay and probability combinations on discounting in humans

PubMed Central

Cox, David J.; Dallery, Jesse

2017-01-01

To determine discount rates, researchers typically adjust the amount of an immediate or certain option relative to a delayed or uncertain option. Because this adjusting amount method can be relatively time consuming, researchers have developed more efficient procedures. One such procedure is a 5-trial adjusting delay procedure, which measures the delay at which an amount of money loses half of its value (e.g., $1000 is valued at $500 with a 10-year delay to its receipt). Experiment 1 (n = 212) used 5-trial adjusting delay or probability tasks to measure delay discounting of losses, probabilistic gains, and probabilistic losses. Experiment 2 (n = 98) assessed combined probabilistic and delayed alternatives. In both experiments, we compared results from 5-trial adjusting delay or probability tasks to traditional adjusting amount procedures. Results suggest both procedures produced similar rates of probability and delay discounting in six out of seven comparisons. A magnitude effect consistent with previous research was observed for probabilistic gains and losses, but not for delayed losses. Results also suggest that delay and probability interact to determine the value of money. Five-trial methods may allow researchers to assess discounting more efficiently as well as study more complex choice scenarios. PMID:27498073

Enforcing positivity in intrusive PC-UQ methods for reactive ODE systems

DOE PAGES

Najm, Habib N.; Valorani, Mauro

2014-04-12

We explore the relation between the development of a non-negligible probability of negative states and the instability of numerical integration of the intrusive Galerkin ordinary differential equation system describing uncertain chemical ignition. To prevent this instability without resorting to either multi-element local polynomial chaos (PC) methods or increasing the order of the PC representation in time, we propose a procedure aimed at modifying the amplitude of the PC modes to bring the probability of negative state values below a user-defined threshold. This modification can be effectively described as a filtering procedure of the spectral PC coefficients, which is applied on-the-flymore » during the numerical integration when the current value of the probability of negative states exceeds the prescribed threshold. We demonstrate the filtering procedure using a simple model of an ignition process in a batch reactor. This is carried out by comparing different observables and error measures as obtained by non-intrusive Monte Carlo and Gauss-quadrature integration and the filtered intrusive procedure. Lastly, the filtering procedure has been shown to effectively stabilize divergent intrusive solutions, and also to improve the accuracy of stable intrusive solutions which are close to the stability limits.« less

An Analytical Singularity-Free Solution to the J2 Perturbation Problem

NASA Technical Reports Server (NTRS)

Bond, V. R.

1979-01-01

The development of a singularity-free solution of the J2 problem in satellite theory is presented. The procedure resembles that of Lyndane who rederives Brouwer's satellite theory using Poincare elements. A comparable procedure is used in this report in which the satellite theory of Scheifele, who used elements similar to the Delaunay elements but in the extended phase space, is rederived using Poincare elements also in the extended phase space. Only the short-period effects due to J2 are included.

14 CFR § 1216.205 - Procedures for evaluating NASA actions impacting floodplains and wetlands.

Code of Federal Regulations, 2014 CFR

2014-01-01

... effects or even taking no action. (6) If, upon completing the comparative evaluation, the Field... Federal Register or other appropriate vehicle. (B) A description of how the activity will be designed or...

50 CFR 300.207 - Alternative procedures for bycatch of PLMRs.

Code of Federal Regulations, 2012 CFR

2012-10-01

...— (1) Are comparable to those of the United States, taking into account different conditions, and which....) specified by NMFS. Effective Date Note: At 76 FR 2024, Jan. 12, 2011, § 302.207 was added. This section...

Learning Word Meanings: A Comparison of Instructional Procedures

ERIC Educational Resources Information Center

Pany, Darlene; Jenkins, Joseph R.

1978-01-01

Available from: Council for Exceptional Children, 1920 Association Drive, Reston, Virginia 22091. Compared were the effects of three instructional strategies on the reading comprehension of six 9- to 11-year-old learning disabled students in a resource program. (BD)

Technology and surgery. Dilemma of the gimmick, true advances, and cost effectiveness.

PubMed

Traverso, L W

1996-02-01

The key to evaluating a procedure in regard to a true advance versus a gimmick is to determine its value. This can be done only by physicians cognizant of a disease process. The value is determined by assessing a procedure's utilization, outcomes, and costs. Utilization allows early treatment and avoids neglected disease. Therefore, the appropriateness of the utilization can be determined only by an outcome study. An outcome study is another term for quality assessment. Outcomes deal with morbidity, mortality, and also the long- and short-term effects of the procedure on the disease. Overall, an increase of quality in a global perspective decreases the costs of the procedure to the health care community. Costs must remain secondary to outcomes. An attempt to decrease costs directly is a maneuver that, when applied by nonmedical individuals, will most likely decrease quality. When the quality can be maintained (as assessed only by a practitioner), then a decrease in global costs will increase value. The concept of increasing value by increasing quality without an attempt to decrease costs is a very important principle that the health care system must learn in our ever-challenging medical environment. Is a new procedure a gimmick or a true advance? The decision is made jointly by the stakeholders in our health care system--the patient, provider, payer, employer, and industry. If the procedure does not receive negative votes, then its adoption is almost assured. Comparing two procedures through these perspectives ultimately allows us to determine the potential for new procedures. A procedure not adopted through this method could be called a gimmick.

Radiation dose of nurses during IR procedures: a controlled trial evaluating operator alerts before nursing tasks.

PubMed

Komemushi, Atsushi; Suzuki, Satoshi; Sano, Akira; Kanno, Shohei; Kariya, Shuji; Nakatani, Miyuki; Yoshida, Rie; Kono, Yumiko; Ikeda, Koshi; Utsunomiya, Keita; Harima, Yoko; Komemushi, Sadao; Tanigawa, Noboru

2014-08-01

To compare radiation exposure of nurses when performing nursing tasks associated with interventional procedures depending on whether or not the nurses called out to the operator before approaching the patient. In a prospective study, 93 interventional radiology procedures were randomly divided into a call group and a no-call group; there were 50 procedures in the call group and 43 procedures in the no-call group. Two monitoring badges were used to calculate effective dose of nurses. In the call group, the nurse first told the operator she was going to approach the patient each time she was about to do so. In the no-call group, the nurse did not say anything to the operator when she was about to approach the patient. In all the nursing tasks, the equivalent dose at the umbilical level inside the lead apron was below the detectable limit. The equivalent dose at the sternal level outside the lead apron was 0.16 μSv ± 0.41 per procedure in the call group and 0.51 μSv ± 1.17 per procedure in the no-call group. The effective dose was 0.018 μSv ± 0.04 per procedure in the call group and 0.056 μSv ± 0.129 per procedure in the no-call group. The call group had a significantly lower radiation dose (P = .034). Radiation doses of nurses were lower in the group in which the nurse called to the operator before she approached the patient. Copyright © 2014 SIR. Published by Elsevier Inc. All rights reserved.

Evaluating Active Parental Consent Procedures for School Programming: Addressing the Sensitive Topic of Suicide Prevention.

PubMed

Totura, Christine M Wienke; Kutash, Krista; Labouliere, Christa D; Karver, Marc S

2017-02-01

Suicide is the second leading cause of death for adolescents. Whereas school-based prevention programs are effective, obtaining active consent for youth participation in public health programming concerning sensitive topics is challenging. We explored several active consent procedures for improving participation rates. Five active consent methods (in-person, students taking forms home, mailing, mailing preceded by primers, mailing followed by reminder calls) were compared against passive consent procedures to evaluate recruitment success, as determined by participation (proportion who responded yes) and response (proportion who returned any response) rates. Participation acceptance rates ranged from 38 to 100% depending on consent method implemented. Compared with passive consent, active consent procedures were more variable in response and participation rates. In-person methods provided higher rates than less interpersonal methods, such as mailing or students taking consents home. Mailed primers before or reminder calls after consent forms were mailed increased response but not participation rates. Students taking consents home resulted in the lowest rates. Although passive consent produces the highest student participation, these methods are not always appropriate for programs addressing sensitive topics in schools. In-person active consent procedures may be the best option when prioritizing balance between parental awareness and successful student recruitment. © 2017, American School Health Association.

Teaching Daily Living Skills to Seven Individuals with Severe Intellectual Disabilities: A Comparison of Video Prompting to Video Modeling

ERIC Educational Resources Information Center

Cannella-Malone, Helen I.; Fleming, Courtney; Chung, Yi-Cheih; Wheeler, Geoffrey M.; Basbagill, Abby R.; Singh, Angella H.

2011-01-01

We conducted a systematic replication of Cannella-Malone et al. by comparing the effects of video prompting to video modeling for teaching seven students with severe disabilities to do laundry and wash dishes. The video prompting and video modeling procedures were counterbalanced across tasks and participants and compared in an alternating…

Compared with What? The Effects of Different Comparisons on Conceptual Knowledge and Procedural Flexibility for Equation Solving

ERIC Educational Resources Information Center

Rittle-Johnson, Bethany; Star, Jon R.

2009-01-01

Researchers in both cognitive science and mathematics education emphasize the importance of comparison for learning and transfer. However, surprisingly little is known about the advantages and disadvantages of what types of things are being compared. In this experimental study, 162 seventh- and eighth-grade students learned to solve equations (a)…

Hausdorff clustering

NASA Astrophysics Data System (ADS)

Basalto, Nicolas; Bellotti, Roberto; de Carlo, Francesco; Facchi, Paolo; Pantaleo, Ester; Pascazio, Saverio

2008-10-01

A clustering algorithm based on the Hausdorff distance is analyzed and compared to the single, complete, and average linkage algorithms. The four clustering procedures are applied to a toy example and to the time series of financial data. The dendrograms are scrutinized and their features compared. The Hausdorff linkage relies on firm mathematical grounds and turns out to be very effective when one has to discriminate among complex structures.

Randomised Comparative Study on Propofol and Diazepam as a Sedating Agent in Day Care Surgery.

PubMed

Nirwan, Amit S; Jain, Neha; Pragasm, Micheal; Kamblimath, Deepashri; Bhargava, Anurag; Tiwari, Saba

2014-12-01

The study was conducted to assess the usefulness by qualitative comparison between the two intravenous sedative drugs, Diazepam and Propofol and to provide sedation in apprehensive and uncooperative patients undergoing day care oral surgical procedures. The present study was conducted on 20 adult patients, 10 in each group (Propofol and Diazepam) irrespective of age and sex. Intravenous sedation of Propofol compared with Diazepam in terms of onset of action, recovery, and anterograde amnesia, patient co-operation, surgeon's convenience and side effects and other parameters. Propofol was found to be the superior sedating agent compared to Diazepam, having rapid onset and predictability of action, profoundness of amnesia and a faster recovery period, offering advantages of early patient discharge and better patient compliance. Propofol was found to be an ideal sedating agent in day care oral surgical procedures.

A randomized controlled study comparing intrathecal hyperbaric bupivacaine-fentanyl mixture and isobaric bupivacaine-fentanyl mixture in common urological procedures

PubMed Central

Upadya, Madhusudan; Neeta, S; Manissery, Jesni Joseph; Kuriakose, Nigel; Singh, Rakesh Raushan

2016-01-01

Background and Aims: Bupivacaine is available in isobaric and hyperbaric forms for intrathecal use and opioids are used as additives to modify their effects. The aim of this study was to compare the efficacy and haemodynamic effect of intrathecal isobaric bupivacaine-fentanyl mixture and hyperbaric bupivacaine-fentanyl mixture in common urological procedures. Methods: One hundred American Society of Anesthesiologists physical status 1 and 2 patients undergoing urological procedures were randomized into two groups. Group 1 received 3 ml of 0.5% isobaric bupivacaine with 25 μg fentanyl while Group 2 received 3 ml of 0.5% hyperbaric bupivacaine with 25 μg fentanyl. The parameters measured include heart rate, blood pressure, respiratory rate, onset and duration of motor and sensory blockade. Student's unpaired t-test and the χ2 test were used to analyse the results, using the SPSS version 11.5 software. Results: The haemodynamic stability was better with isobaric bupivacaine fentanyl mixture (Group 1) than with hyperbaric bupivacaine fentanyl mixture (Group 2). The mean onset time in Group 1 for both sensory block (4 min) and motor block (5 min) was longer compared with Group 2. The duration of sensory block (127.8 ± 38.64 min) and motor block (170.4 ± 27.8 min) was less with isobaric bupivacaine group compared with hyperbaric bupivacaine group (sensory blockade 185.4 ± 16.08 min and motor blockade 201.6 ± 14.28 min). Seventy percent of patients in Group 2 had maximum sensory block level of T6 whereas it was 53% in Group 1. More patients in Group 1 required sedation compared to Group 2. Conclusion: Isobaric bupivacaine fentanyl mixture was found to provide adequate anaesthesia with minimal incidence of haemodynamic instability. PMID:26962255

A preregistered, direct replication attempt of the retrieval-extinction effect in cued fear conditioning in rats.

PubMed

Luyten, Laura; Beckers, Tom

2017-10-01

In 2009, Monfils and colleagues proposed a behavioral procedure that was said to result in a permanent attenuation of a previously established fear memory, thereby precluding a possible return of fear after extinction (Monfils, Cowansage, Klann, & LeDoux, 2009). By presenting a single retrieval trial one hour before standard extinction training, they found an enduring reduction of fear. The retrieval-extinction procedure holds great clinical potential, particularly for anxiety patients, but the findings are not undisputed, and several conceptual replications have failed to reproduce the effect. These failures have largely been attributed to small procedural differences. This preregistered study is the first endeavor to exactly replicate three key experiments of the original report by Monfils et al. (2009), thereby gauging the robustness of their seminal findings. Despite adhering to the original procedures as closely as possible, we did not find any evidence for reduced return of fear with the retrieval-extinction procedure relative to regular extinction training, as assessed through spontaneous recovery, reinstatement and renewal. Behavior of animals in the control condition (extinction only) was comparable to that in the original studies and provided an adequate baseline to reveal differences with the retrieval-extinction condition. Our null findings indicate that the effect sizes in the original paper may have been inflated and question the legitimacy of previously proposed moderators of the retrieval-extinction effect. We argue that direct experimental evaluation of purported moderators of the retrieval-extinction effect will be key to shed more light on its nature and prerequisites. Copyright © 2017 Elsevier Inc. All rights reserved.

Tolerance and safety of superficial chemical peeling with salicylic acid in various facial dermatoses.

PubMed

Bari, Arfan Ul; Iqbal, Zafar; Rahman, Simeen Ber

2005-01-01

Chemical peeling is a skin-wounding procedure that may have some potentially undesirable side-effects. The present study is directed towards safety concerns associated with superficial chemical peeling with salicylic acid in various facial dermatoses. The study was a non-comparative and a prospective one. Two hundred and sixty-eight patients of either sex, aged between 10 to 60 years, undergoing superficial chemical peeling for various facial dermatoses (melasma, acne vulgaris, freckles, post-inflammatory scars/pigmentation, actinic keratoses, plane facial warts, etc.) were included in the study. Eight weekly peeling sessions were carried out in each patient. Tolerance to the procedure and any undesirable effects noted during these sessions were recorded. Almost all the patients tolerated the procedure well. Mild discomfort, burning, irritation and erythema were quite common but the incidence of major side-effects was very low and these too, were easily manageable. There was no significant difference in the incidence of side-effects between facial dermatoses (melasma, acne and other pigmentary disorders). Chemical peeling with salicylic acid is a well tolerated and safe treatment modality in many superficial facial dermatoses.

Mediation Analysis with Survival Outcomes: Accelerated Failure Time vs. Proportional Hazards Models.

PubMed

Gelfand, Lois A; MacKinnon, David P; DeRubeis, Robert J; Baraldi, Amanda N

2016-01-01

Survival time is an important type of outcome variable in treatment research. Currently, limited guidance is available regarding performing mediation analyses with survival outcomes, which generally do not have normally distributed errors, and contain unobserved (censored) events. We present considerations for choosing an approach, using a comparison of semi-parametric proportional hazards (PH) and fully parametric accelerated failure time (AFT) approaches for illustration. We compare PH and AFT models and procedures in their integration into mediation models and review their ability to produce coefficients that estimate causal effects. Using simulation studies modeling Weibull-distributed survival times, we compare statistical properties of mediation analyses incorporating PH and AFT approaches (employing SAS procedures PHREG and LIFEREG, respectively) under varied data conditions, some including censoring. A simulated data set illustrates the findings. AFT models integrate more easily than PH models into mediation models. Furthermore, mediation analyses incorporating LIFEREG produce coefficients that can estimate causal effects, and demonstrate superior statistical properties. Censoring introduces bias in the coefficient estimate representing the treatment effect on outcome-underestimation in LIFEREG, and overestimation in PHREG. With LIFEREG, this bias can be addressed using an alternative estimate obtained from combining other coefficients, whereas this is not possible with PHREG. When Weibull assumptions are not violated, there are compelling advantages to using LIFEREG over PHREG for mediation analyses involving survival-time outcomes. Irrespective of the procedures used, the interpretation of coefficients, effects of censoring on coefficient estimates, and statistical properties should be taken into account when reporting results.

A comparison of vowel normalization procedures for language variation research

NASA Astrophysics Data System (ADS)

Adank, Patti; Smits, Roel; van Hout, Roeland

2004-11-01

An evaluation of vowel normalization procedures for the purpose of studying language variation is presented. The procedures were compared on how effectively they (a) preserve phonemic information, (b) preserve information about the talker's regional background (or sociolinguistic information), and (c) minimize anatomical/physiological variation in acoustic representations of vowels. Recordings were made for 80 female talkers and 80 male talkers of Dutch. These talkers were stratified according to their gender and regional background. The normalization procedures were applied to measurements of the fundamental frequency and the first three formant frequencies for a large set of vowel tokens. The normalization procedures were evaluated through statistical pattern analysis. The results show that normalization procedures that use information across multiple vowels (``vowel-extrinsic'' information) to normalize a single vowel token performed better than those that include only information contained in the vowel token itself (``vowel-intrinsic'' information). Furthermore, the results show that normalization procedures that operate on individual formants performed better than those that use information across multiple formants (e.g., ``formant-extrinsic'' F2-F1). .

A comparison of vowel normalization procedures for language variation research.

PubMed

Adank, Patti; Smits, Roel; van Hout, Roeland

2004-11-01

An evaluation of vowel normalization procedures for the purpose of studying language variation is presented. The procedures were compared on how effectively they (a) preserve phonemic information, (b) preserve information about the talker's regional background (or sociolinguistic information), and (c) minimize anatomical/physiological variation in acoustic representations of vowels. Recordings were made for 80 female talkers and 80 male talkers of Dutch. These talkers were stratified according to their gender and regional background. The normalization procedures were applied to measurements of the fundamental frequency and the first three formant frequencies for a large set of vowel tokens. The normalization procedures were evaluated through statistical pattern analysis. The results show that normalization procedures that use information across multiple vowels ("vowel-extrinsic" information) to normalize a single vowel token performed better than those that include only information contained in the vowel token itself ("vowel-intrinsic" information). Furthermore, the results show that normalization procedures that operate on individual formants performed better than those that use information across multiple formants (e.g., "formant-extrinsic" F2-F1).

Hands-on 2.0: improving transfer of training via the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) Acquisition of Data for Outcomes and Procedure Transfer (ADOPT) program.

PubMed

Dort, Jonathan; Trickey, Amber; Paige, John; Schwarz, Erin; Dunkin, Brian

2017-08-01

Practicing surgeons commonly learn new procedures and techniques by attending a "hands-on" course, though trainings are often ineffective at promoting subsequent procedure adoption in practice. We describe implementation of a new program with the SAGES All Things Hernia Hands-On Course, Acquisition of Data for Outcomes and Procedure Transfer (ADOPT), which employs standardized, proven teaching techniques, and 1-year mentorship. Attendee confidence and procedure adoption are compared between standard and ADOPT programs. For the pilot ADOPT course implementation, a hands-on course focusing on abdominal wall hernia repair was chosen. ADOPT participants were recruited among enrollees for the standard Hands-On Hernia Course. Enrollment in ADOPT was capped at 10 participants and limited to a 2:1 student-to-faculty ratio, compared to the standard course 22 participants with a 4:1 student-to-faculty ratio. ADOPT mentors interacted with participants through webinars, phone conferences, and continuous email availability throughout the year. All participants were asked to provide pre- and post-course surveys inquiring about the number of targeted hernia procedures performed and related confidence level. Four of 10 ADOPT participants (40%) and six of 22 standard training participants (27%) returned questionnaires. Over the 3 months following the course, ADOPT participants performed more ventral hernia mesh insertion procedures than standard training participants (median 13 vs. 0.5, p = 0.010) and considerably more total combined procedures (median 26 vs. 7, p = 0.054). Compared to standard training, learners who participated in ADOPT reported greater confidence improvements in employing a components separation via an open approach (p = 0.051), and performing an open transversus abdominis release, though the difference did not achieve statistical significance (p = 0.14). These results suggest that the ADOPT program, with standardized and structured teaching, telementoring, and a longitudinal educational approach, is effective and leads to better transfer of learned skills and procedures to clinical practice.

The effect of vasodilatory medications on radial artery spasm in patients undergoing transradial coronary artery procedures: a systematic review.

PubMed

Curtis, Elizabeth; Fernandez, Ritin; Lee, Astin

2017-07-01

The uptake of percutaneous coronary procedures via the radial artery has increased internationally due to the decreased risk of complications and increased patient satisfaction. The increased susceptibility of the radial artery to spasm however presents a potential risk for procedural failure. Although most experts agree on the need for prophylactic medications to reduce radial artery spasm, currently there is inconsistency in literature regarding the most effective vasodilatory medication or combination of medications. The objective of this study is to identify the effectiveness of vasodilatory medications on radial artery spasm in patients undergoing transradial coronary artery procedures. This review considered studies that included participants aged 18 years and over undergoing non-emergent transradial percutaneous coronary artery procedures. This review considered studies that used vasodilating intravenous and intra-arterial medications or combinations of medications prior to commencing and during transradial coronary approaches to reduce radial artery spasm. The outcomes of interest were the incidence of radial artery spasm during percutaneous coronary procedure using objective and/or subjective measures and its effect on the successful completion of the procedure. Randomized controlled trials published in the English language between 1989 to date were considered for inclusion. The search strategy aimed to find both published and unpublished studies. A three-step search strategy was utilized in this review. An initial search of MEDLINE, CINAHL and Scopus was undertaken, followed by a search for unpublished studies. Papers selected for retrieval were assessed by two independent reviewers for methodological validity prior to inclusion in the review using standardized critical appraisal instruments. Any disagreements that arose between the reviewers were resolved through discussion. Quantitative data was extracted from papers included in the review using the standardized data extraction tool from RevMan5 (Copenhagen: The Nordic Cochrane Centre, Cochrane). Quantitative data, where possible, was pooled in statistical meta-analysis using RevMan5. All results were subject to double data entry. Effect sizes expressed as risk ratio (for categorical data) and weighted mean differences (for continuous data) and their 95% confidence intervals were calculated for analysis. Nine trials involving 3614 patients were included in the final review. Pooled data involving 992 patients on the effect of calcium channel blockers demonstrated a statistically significant reduction in the incidence of vasospasm in patients who received verapamil 5 mg compared to those who received a placebo (OR 0.33; 95%CI 0.19, 0.58). Similarly patients who received verapamil 2.5 mg or 1.25 mg had significantly fewer incidences of vasospasm when compared to those who received a placebo. Nitroglycerine 100mcg was demonstrated to be associated with a statistically significant reduction in the incidence of vasospasm. The evidence demonstrates a benefit in the use of vasodilatory medications for the reduction of vasospasm in patients having radial coronary procedures. Further large-scale multi-center trials are needed to determine the preferred medication.

Visual distraction alone for the improvement of colonoscopy-related pain and satisfaction.

PubMed

Umezawa, Shotaro; Higurashi, Takuma; Uchiyama, Shiori; Sakai, Eiji; Ohkubo, Hidenori; Endo, Hiroki; Nonaka, Takashi; Nakajima, Atsushi

2015-04-21

To evaluate the effect of a relaxing visual distraction alone on patient pain, anxiety, and satisfaction during colonoscopy. This study was designed as an endoscopist-blinded randomized controlled trial with 60 consecutively enrolled patients who underwent elective colonoscopy at Yokohama City University Hospital, Japan. Patients were randomly assigned to two groups: group 1 watched a silent movie using a head-mounted display, while group 2 only wore the display. All of the colonoscopies were performed without sedation. We examined pain, anxiety, and the satisfaction of patients before and after the procedure using questionnaires that included the Visual Analog Scale. Patients were also asked whether they would be willing to use the same method for a repeat procedure. A total of 60 patients were allocated to two groups. Two patients assigned to group 1 and one patient assigned to group 2 were excluded after the randomization. Twenty-eight patients in group 1 and 29 patients in group 2 were entered into the final analysis. The groups were similar in terms of gender, age, history of prior colonoscopy, and pre-procedural anxiety score. The two groups were comparable in terms of the cecal insertion rate, the time to reach the cecum, the time needed for the total procedure, and vital signs. The median anxiety score during the colonoscopy did not differ significantly between the two groups (median scores, 20 vs 24). The median pain score during the procedure was lower in group 1, but the difference was not significant (median scores, 24.5 vs 42). The patients in group 1 reported significantly higher median post-procedural satisfaction levels, compared with the patients in group 2 (median scores, 89 vs 72, P = 0.04). Nearly three-quarters of the patients in group 1 wished to use the same method for repeat procedures, and the difference in rates between the two groups was statistically significant (75.0% vs 48.3%, P = 0.04). Patients with greater levels of anxiety before the procedure tended to feel a painful sensation. Among patients with a pre-procedural anxiety score of 50 or higher, the anxiety score during the procedure was significantly lower in the group that received the visual distraction (median scores, 20 vs 68, P = 0.05); the pain score during the colonoscopy was also lower (median scores, 23 vs 57, P = 0.04). No adverse effects arising from the visual distraction were recognized. Visual distraction alone improves satisfaction in patients undergoing colonoscopy and decreases anxiety and pain during the procedure among patients with a high pre-procedural anxiety score.

Modeling and analysis of the space shuttle nose-gear tire with semianalytic finite elements

NASA Technical Reports Server (NTRS)

Kim, Kyun O.; Noor, Ahmed K.; Tanner, John A.

1990-01-01

A computational procedure is presented for the geometrically nonlinear analysis of aircraft tires. The Space Shuttle Orbiter nose gear tire was modeled by using a two-dimensional laminated anisotropic shell theory with the effects of variation in material and geometric parameters included. The four key elements of the procedure are: (1) semianalytic finite elements in which the shell variables are represented by Fourier series in the circumferential direction and piecewise polynominals in the meridional direction; (2) a mixed formulation with the fundamental unknowns consisting of strain parameters, stress-resultant parameters, and generalized displacements; (3) multilevel operator splitting to effect successive simplifications, and to uncouple the equations associated with different Fourier harmonics; and (4) multilevel iterative procedures and reduction techniques to generate the response of the shell. Numerical results of the Space Shuttle Orbiter nose gear tire model are compared with experimental measurements of the tire subjected to inflation loading.

Best Linear Unbiased Prediction (BLUP) for regional yield trials: a comparison to additive main effects and multiplicative interaction (AMMI) analysis.

PubMed

Piepho, H P

1994-11-01

Multilocation trials are often used to analyse the adaptability of genotypes in different environments and to find for each environment the genotype that is best adapted; i.e. that is highest yielding in that environment. For this purpose, it is of interest to obtain a reliable estimate of the mean yield of a cultivar in a given environment. This article compares two different statistical estimation procedures for this task: the Additive Main Effects and Multiplicative Interaction (AMMI) analysis and Best Linear Unbiased Prediction (BLUP). A modification of a cross validation procedure commonly used with AMMI is suggested for trials that are laid out as a randomized complete block design. The use of these procedure is exemplified using five faba bean datasets from German registration trails. BLUP was found to outperform AMMI in four of five faba bean datasets.

Single-stage laparoscopic common bile duct exploration and cholecystectomy versus two-stage endoscopic stone extraction followed by laparoscopic cholecystectomy for patients with concomitant gallbladder stones and common bile duct stones: a randomized controlled trial.

PubMed

Bansal, Virinder Kumar; Misra, Mahesh C; Rajan, Karthik; Kilambi, Ragini; Kumar, Subodh; Krishna, Asuri; Kumar, Atin; Pandav, Chandrakant S; Subramaniam, Rajeshwari; Arora, M K; Garg, Pramod Kumar

2014-03-01

The ideal method for managing concomitant gallbladder stones and common bile duct (CBD) stones is debatable. The currently preferred method is two-stage endoscopic stone extraction followed by laparoscopic cholecystectomy (LC). This prospective randomized trial compared the success and cost effectiveness of single- and two-stage management of patients with concomitant gallbladder and CBD stones. Consecutive patients with concomitant gallbladder and CBD stones were randomized to either single-stage laparoscopic CBD exploration and cholecystectomy (group 1) or endoscopic retrograde cholangiopancreatography (ERCP) for endoscopic extraction of CBD stones followed by LC (group 2). Success was defined as complete clearance of CBD and cholecystectomy by the intended method. Cost effectiveness was measured using the incremental cost-effectiveness ratio. Intention-to-treat analysis was performed to compare outcomes. From February 2009 to October 2012, 168 patients were randomized: 84 to the single-stage procedure (group 1) and 84 to the two-stage procedure (group 2). Both groups were matched with regard to demographic and clinical parameters. The success rates of laparoscopic CBD exploration and ERCP for clearance of CBD were similar (91.7 vs. 88.1 %). The overall success rate also was comparable: 88.1 % in group 1 and 79.8 % in group 2 (p = 0.20). Direct choledochotomy was performed in 83 of the 84 patients. The mean operative time was significantly longer in group 1 (135.7 ± 36.6 vs. 72.4 ± 27.6 min; p ≤ 0.001), but the overall hospital stay was significantly shorter (4.6 ± 2.4 vs. 5.3 ± 6.2 days; p = 0.03). Group 2 had a significantly greater number of procedures per patient (p < 0.001) and a higher cost (p = 0.002). The two groups did not differ significantly in terms of postoperative wound infection rates or major complications. Single- and two-stage management for uncomplicated concomitant gallbladder and CBD stones had similar success and complication rates, but the single-stage strategy was better in terms of shorter hospital stay, need for fewer procedures, and cost effectiveness.

Cervical degenerative disease: systematic review of economic analyses.

PubMed

Alvin, Matthew D; Qureshi, Sheeraz; Klineberg, Eric; Riew, K Daniel; Fischer, Dena J; Norvell, Daniel C; Mroz, Thomas E

2014-10-15

Systematic review. To perform an evidence-based synthesis of the literature assessing the cost-effectiveness of surgery for patients with symptomatic cervical degenerative disc disease (DDD). Cervical DDD is a common cause of clinical syndromes such as neck pain, cervical radiculopathy, and myelopathy. The appropriate surgical intervention(s) for a given problem is controversial, especially with regard to quality-of-life outcomes, complications, and costs. Although there have been many studies comparing outcomes and complications, relatively few have compared costs and, more importantly, cost-effectiveness of the interventions. We conducted a systematic search in PubMed/MEDLINE, EMBASE, the Cochrane Collaboration Library, the Cost-Effectiveness Analysis registry database, and the National Health Service Economic Evaluation Database for full economic evaluations published through January 16, 2014. Identification of full economic evaluations that were explicitly designed to evaluate and synthesize the costs and consequences of surgical procedures or surgical intervention with nonsurgical management in patients with cervical DDD were considered for inclusion, based on 4 key questions. Five studies were included, each specific to 1 or more of our focus questions. Two studies suggested that cervical disc replacement may be more cost-effective compared with anterior cervical discectomy and fusion. Two studies comparing anterior with posterior surgical procedures for cervical spondylotic myelopathy suggested that anterior surgery was more cost-effective than posterior surgery. One study suggested that posterior cervical foraminotomy had a greater net economic benefit than anterior cervical discectomy and fusion in a military population with unilateral cervical radiculopathy. No studies assessed the cost-effectiveness of surgical intervention compared with nonoperative treatment of cervical myelopathy or radiculopathy, although it is acknowledged that existing studies demonstrate the cost-effectiveness of surgical intervention for these 2 clinical entities. A paucity of high-quality economic literature exists regarding cost-effectiveness of surgical intervention for cervical DDD. Future research is necessary to validate the findings of the few studies that do exist to guide decisions for surgery by the physician and patient with respect to cost-effectiveness. 2.

Hypnosis for the control of pain associated with external cephalic version: a comparative study.

PubMed

Guittier, Marie-Julia; Guillemin, Francis; Farinelli, Edith Brandao; Irion, Olivier; Boulvain, Michel; de Tejada, Begoña Martinez

2013-10-01

To assess the effectiveness of hypnosis to reduce pain and facilitate external cephalic version (ECV). Cohort study. Geneva University Hospitals, Switzerland. 63 women attempting ECV under hypnosis from 2010 to 2011 were compared with 122 women who received standard care from 2005 through 2008. Immediately after the ECV attempt, both groups completed the same questionnaire evaluating the participants' pain (visual analogue and verbal rating scales) and experience with the procedure. Physicians also completed a questionnaire that elicited their views on the effect of hypnosis on the intervention. A chi-squared test was used to compare differences in proportions, and the Mann-Whitney U test was used for differences in continuous variables. A thematic content analysis of the obstetricians' responses to the open question regarding their experience of hypnotist accompaniment was also performed. Pain evaluated by women (visual analogue and verbal rating scales) and success rate of ECV. Pain intensity reported by women did not significantly differ between the hypnosis group and the standard care group (visual analogue scale score, 6.0 versus 6.3, respectively; p=.25; difference for verbal rating scale, p=0.31. In 72% of cases, physicians reported that hypnosis facilitated the procedure. The success rates in both groups were not significantly different (30% with hypnosis compared with 38% without; p=.31). Most women in both groups found the ECV attempt painful and a source of anxiety but would undergo it again if necessary. Hypnosis accompaniment during ECV does not reduce pain intensity associated with the procedure or improve the probability of a successful version.

A preliminary study of painless and effective transdermal botulinum toxin A delivery by jet nebulization for treatment of primary hyperhidrosis.

PubMed

Iannitti, Tommaso; Palmieri, Beniamino; Aspiro, Anna; Di Cerbo, Alessandro

2014-01-01

Hyperhidrosis is a chronic disease characterized by increased sweat production. Local injections of botulinum toxin A (BTX-A) have been extensively used for treatment of primary hyperhidrosis (idiopathic). The current treatment for this condition involves several intradermal injections, resulting in poor patient compliance due to injection-related pain. Therefore, new protocols, including an improved anesthetic regimen, are required. We designed the present study to determine whether JetPeel™-3, a medical device used for transdermal delivery of drugs by jet nebulization, could be used to deliver lidocaine prior to the standard multiple BTX-A injections or deliver lidocaine together with BTX-A in order to determine the protocol giving better results in terms of procedure-related pain, sweating, and patient satisfaction in subjects affected by primary axillary, palmar or plantar hyperhidrosis. Twenty patients with a visual analog scale (VAS) sweating score ≥ 8 cm were randomized to receive lidocaine 2% (5 mL) delivered by JetPeel™-3 followed by multiple injections of BTX-A (100 units) or lidocaine 2% (5 mL) and BTX-A (50 units) delivered together by JetPeel™-3. Effect of treatment on sweating was measured by VAS (0= minimum sweating; 10= maximum sweating) at 3-month follow-up. Pain induced by the procedure was assessed by VAS (0= minimum pain; 10= maximum pain) immediately after the procedure. Patient satisfaction was assessed at 3-month follow-up using a 5-point scale (1= not at all satisfied; 2= not satisfied; 3= partially satisfied; 4= satisfied; 5= highly satisfied). Both treatment modalities reduced sweating at 3-month follow-up, if compared with baseline (all P<0.001). Delivery of lidocaine and BTX-A by JetPeel™-3 resulted in lower procedure-related pain and reduced sweating, if compared with lidocaine delivered by JetPeel™-3 followed by multiple BTX-A injections (all P<0.001). Patient satisfaction with the procedure was higher in the group receiving lidocaine and BTX-A treatment by JetPeel™-3, if compared with lidocaine delivered by JetPeel™-3 followed by multiple BTX-A injections (P<0.001). No side effects were observed in both groups. Lidocaine and BTX-A can be safely delivered together by JetPeel™-3 to treat primary palmar, plantar and axillary hyperhidrosis, resulting in lower procedure-related pain, improved sweating and higher patient satisfaction, if compared with lidocaine delivered by JetPeel™-3 followed by standard BTX-A injection therapy. Our protocol delivering lidocaine and BTX-A together by JetPeel™-3 requires a reduced quantity of BTX-A, further supporting the use of the transdermal drug delivery by jet nebulization over standard injection therapy for treatment of primary hyperhidrosis.

Standardization of the manufacturing procedure for Pinelliae Rhizoma Praeparatum cum Zingibere et Alumine.

PubMed

Su, Tao; Zhang, Wei-Wei; Zhang, Ya-Ming; Cheng, Brian Chi-Yan; Fu, Xiu-Qiong; Li, Ting; Guo, Hui; Li, Ya-Xi; Zhu, Pei-Li; Cao, Hui; Yu, Zhi-Ling

2016-12-04

Pinelliae Rhizoma (PR), the dried tuber of Pinellia ternata (Thunb.) Breit., is a traditional Chinese medicinal herb. It is commonly used for treating cancer, cough and phlegm. To treat cancer, Chinese medicine practitioners often use raw PR; while to treat cough and phlegm, they usually use Pinelliae Rhizoma Praeparatum cum Zingibere et Alumine (PRZA, raw PR processed with ginger juice and alumen as adjuvant materials). Currently, the producing protocol of PRZA varies greatly among different places in China. This study aims to standardize the manufacturing procedure for PRZA. We also evaluated the impact of processing on the bioactivities and chemical profile of raw PR. We used the orthogonal design to optimize the manufacturing procedure of PRZA at bench scale, and validated the optimized procedure in pilot-scale production. The MTT assay was used to compare the cytotoxicities of raw PR and PRZA in hepatocellular carcinoma HepG2 cells. Animal models (ammonia liquor-induced cough model and phenol red secretion model) were used to compare the antitussive and expectorant effects of raw PR and PRZA, respectively. The chemical profiles of raw PR and PRZA samples were compared using a newly developed ultra-performance liquid chromatography/quadrupole-time-of-flight mass spectrometry (UPLC/Q-TOF-MS) method. The standardized manufacturing procedure for PRZA is as follows: soak raw PR in water until the center of the cut surface is devoid of a dry core, after that, boil the herb in water (for each 100kg raw PR, 12.5kg alumen and 25L freshly squeezed ginger juice are added) for 6h, and then take out and dry them. The cytotoxicity of PRZA was less potent than that of raw PR. Intragastric administration of raw PR or PRZA demonstrated antitussive and expectorant effects in mice. These effects of PRZA were more potent than that of raw PR at the dose of 3g/kg. By comparing the chemical profiles, we found that six peaks were lower, while nine other peaks were higher in PRZA than in raw PR. Six compounds corresponding to six individual changed peaks were tentatively identified by matching with empirical molecular formulae and mass fragments. The manufacturing procedure for PRZA was standardized. This protocol can be used for PRZA industrial production. The bioactivity assay results of raw PR and PRZA (produced using the standardized protocol) support the common practice for the clinical applications of these two decoction pieces. Moreover, raw PR and PRZA showed different chemical profiles. Further studies are warranted to establish the relationship between the alteration of chemical profiles and the changes of medicinal properties caused by processing. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Comparative study of state-of-the-art myoelectric controllers for multigrasp prosthetic hands.

PubMed

Segil, Jacob L; Controzzi, Marco; Weir, Richard F ff; Cipriani, Christian

2014-01-01

A myoelectric controller should provide an intuitive and effective human-machine interface that deciphers user intent in real-time and is robust enough to operate in daily life. Many myoelectric control architectures have been developed, including pattern recognition systems, finite state machines, and more recently, postural control schemes. Here, we present a comparative study of two types of finite state machines and a postural control scheme using both virtual and physical assessment procedures with seven nondisabled subjects. The Southampton Hand Assessment Procedure (SHAP) was used in order to compare the effectiveness of the controllers during activities of daily living using a multigrasp artificial hand. Also, a virtual hand posture matching task was used to compare the controllers when reproducing six target postures. The performance when using the postural control scheme was significantly better (p < 0.05) than the finite state machines during the physical assessment when comparing within-subject averages using the SHAP percent difference metric. The virtual assessment results described significantly greater completion rates (97% and 99%) for the finite state machines, but the movement time tended to be faster (2.7 s) for the postural control scheme. Our results substantiate that postural control schemes rival other state-of-the-art myoelectric controllers.

Treatment of Escape-Maintained Challenging Behavior Using Chained Schedules: An Evaluation of the Effects of Thinning Positive plus Negative Reinforcement During Functional Communication Training.

PubMed

Zangrillo, Amanda N; Fisher, Wayne W; Greer, Brian D; Owen, Todd M; DeSouza, Andresa A

2016-01-01

Previous research has supported functional communication training (FCT) as an effective intervention for reducing challenging behavior. Clinicians often program schedule-thinning procedures to increase the portability of the treatment (i.e., reinforcement is provided less frequently). For individuals with escape-maintained problem behavior, chained schedules have proven effective in increasing task completion and supplemental procedures may ameliorate reemergence of challenging behavior as access to reinforcement is decreased. The present study compared the use of a chained schedule-thinning procedure with and without alternative reinforcement (e.g., toys and activities) embedded in an intervention in which escape from the task is provided contingent on a request for a break. Two individuals with escape-maintained challenging behavior participated. We compared two treatment conditions, escape-only and escape-to-tangibles, using a single-subject, alternating treatments design with each treatment implemented in a distinct academic context. With the escape-to-tangibles treatment, we reached the final schedule in both contexts with both participants (4 successes out of 4 applications). We did not reach the final schedule with either participant with the escape-only intervention (0 successes out of 2 applications). The current results provided preliminary confirmation that providing positive plus negative reinforcement would decrease destructive behavior, increase compliance, and facilitate reinforcer-schedule thinning.

Treatment of Escape-Maintained Challenging Behavior Using Chained Schedules: An Evaluation of the Effects of Thinning Positive plus Negative Reinforcement During Functional Communication Training

PubMed Central

Zangrillo, Amanda N.; Fisher, Wayne W.; Greer, Brian D.; Owen, Todd M.; DeSouza, Andresa A.

2016-01-01

Objective Previous research has supported functional communication training (FCT) as an effective intervention for reducing challenging behavior. Clinicians often program schedule-thinning procedures to increase the portability of the treatment (i.e., reinforcement is provided less frequently). For individuals with escape-maintained problem behavior, chained schedules have proven effective in increasing task completion and supplemental procedures may ameliorate reemergence of challenging behavior as access to reinforcement is decreased. The present study compared the use of a chained schedule-thinning procedure with and without alternative reinforcement (e.g., toys and activities) embedded in an intervention in which escape from the task is provided contingent on a request for a break. Method Two individuals with escape-maintained challenging behavior participated. We compared two treatment conditions, escape-only and escape-to-tangibles, using a single-subject, alternating treatments design with each treatment implemented in a distinct academic context. Results With the escape-to-tangibles treatment, we reached the final schedule in both contexts with both participants (4 successes out of 4 applications). We did not reach the final schedule with either participant with the escape-only intervention (0 successes out of 2 applications). Conclusion The current results provided preliminary confirmation that providing positive plus negative reinforcement would decrease destructive behavior, increase compliance, and facilitate reinforcer-schedule thinning. PMID:28626579

Lunar cycle may have an effect on Shock Wave Lithotripsy related pain outcome.

PubMed

Tokgöz, Hüsnü; Yalçınkaya, Soner; İslamoğlu, Ekrem; Karamık, Kaan; Tokgöz, Özlem; Savaş, Murat

2017-12-01

We tried to investigate the effects of lunar phase on Shock Wave Lithotripsy (SWL) related pain. In addition, correlation of various clinical parameters with the pain perception during SWL procedure, were also investigated. A total of 378 patients who underwent first SWL sessions for renal or ureteral stones were prospectively enrolled in the study. The degree of pain perception during the procedure was evaluated with 10-point visual analog scale (VAS) and pain questionnaires. The date of SWL was allocated to dates and times of lunar phases as: newmoon, waxing crescent, first quarter, waxing gibbus, fullmoon, waning gibbus, last quarter and waning gibbus. Mean VAS scores in first quarter (2,41±1,06) were significantly lower when compared to mean VAS scores in waning crescent (3,58±1,83) and waning gibbus (3,42±1,98) ( p=0,005 and 0,041 , respectively). No statistically significant differences were observed when other lunar phases were compared between each other. Mean pain scores were not affected from gender, age, body mass index (BMI) and stone characteristics (stone laterality, burden and location). SWL procedure performed in first quarter of the lunar phase may become less painful. To the best of our knowledge, this is the first study which evaluated the effect of lunar phase on post-SWL pain outcome. Thus, additional randomized studies with larger series may be more informative.

The Effects of Time Delay and Increasing Prompt Hierarchy Strategies on the Acquisition of Purchasing Skills by Students with Severe Handicaps.

ERIC Educational Resources Information Center

McDonnell, John

1987-01-01

Two teaching strategies (constant time delay and increasing prompt hierarchy assistance) were compared in teaching four severely handicapped high school students to purchase snack items at a convenience store and fast food restaurant. Results indicated the time delay procedure was more effective. (DB)

Practicing versus Inventing with Contrasting Cases: The Effects of Telling First on Learning and Transfer

ERIC Educational Resources Information Center

Schwartz, Daniel L.; Chase, Catherine C.; Oppezzo, Marily A.; Chin, Doris B.

2011-01-01

Being told procedures and concepts before problem solving can inadvertently undermine the learning of deep structures in physics. If students do not learn the underlying structure of physical phenomena, they will exhibit poor transfer. Two studies on teaching physics to adolescents compared the effects of "telling" students before and after…

Variable Differential Reinforcement of Other Behavior (VDRO): Its Effectiveness as a Modification Procedure.

ERIC Educational Resources Information Center

Reuter, Katherine E.; LeBlanc, Judith M.

Two groups of five preschool children were trained to press a key for marbles for four sessions of variable ratio reinforcement (VR6). Subsequently, response decrement for the groups was compared during conditions of fixed and variable differential reinforcement of other behavior (DRO and VDRO). Fixed DRO was more effective for decreasing response…

Short-term effect of TVT-SECUR procedure on quality of life and sexual function in women with stress urinary incontinence.

PubMed

Tang, Xiang; Zhu, Lan; Zhong, Wen; Li, Bin; Lang, Jinghe

2013-01-01

To investigate whether patient quality of life and sexual function are improved after the tension-free vaginal tape SECUR (TVT-S) procedure (H-type). Prospective study (Canadian Task Force classification II-3). Single-center hospital. Thirty-three women with stress urinary incontinence (SUI) (high urethral mobility) and no concomitant pelvic floor prolapse underwent TVT-S between October 2009 and October 2011. TVT-S procedure. Before and after surgery(6 and 12 months), all patients completed the Chinese version of the Incontinence Quality of Life Questionnaire (I-QOL). In addition, 28 sexually active patients who underwent the TVT-S procedure completed the short-form Pelvic Organ Prolapse/Urinary Incontinence Sexual Function Questionnaire (PISQ-12) before and after surgery (6 and 12 months). We used a paired t test to compare I-QOL scores before and after surgery. The Wilcoxon signed-rank test was used to compare the preoperative and postoperative PISQ scores. The objective cure rate was 78% (26 of 33 patients) at 12 months after surgery. The objective improvement rate was 12.1% (4 of 33 patients). The subjective satisfaction rate was 90%. Three operations (9.1%) were considered failures. Two patients underwent a TVT procedure after TVT-S because of recurrence. No patients reported severe pain; the mean (SD) visual analog scale pain score was 1.8 (1.2) after surgery. Only 1 patient (3%) was found to have sling erosion at 12 months postoperatively. The I-QOL score was 28.3 (14.2) before surgery and increased to 69.5 (18.9) at 12 months after the TVT-S procedure. The I-QOL score improved significantly after surgery (p <.001). The total PISQ-12 score at 6 months after surgery in all sexually active patients was 33.82 (0.87), compared with 31.57 (1.20) before surgery (p <.05). Physical domain scores on the PISQ-12 demonstrated significant improvement, increasing from 12.61 (0.75) to 14.36 (0.49) (p <.05). No significant difference was found between I-QOL and PISQ-12 scores at 6 and 12 months after surgery. There was no significant difference in total PISQ-12 scores in premenopausal patients before and after surgery (p >.05). Although the objective cure rate was not high, the TVT-S procedure is a minimally invasive, safe, and effective surgical procedure for treatment of SUI (high urethral mobility) and can improve the quality of life and sexual function in women with SUI. Copyright © 2013 AAGL. Published by Elsevier Inc. All rights reserved.

Propofol-alfentanyl versus midazolam-alfentanyl in inducing procedural amnesia of upper gastrointestinal endoscopy in children--blind randomised trial.

PubMed

Sienkiewicz, Edyta; Albrecht, Piotr; Ziółkowski, Janusz; Dziechciarz, Piotr

2015-11-01

In paediatric patients, esophagogastroduodenoscopy (EGD) is commonly performed with the use of sedation. The aim of the study was to compare the effectiveness of propofol and midazolam in providing procedural amnesia and controlling behaviour in children undergoing diagnostic EGD. Children (9-16 years), classified to the first or second class of the American Society of Anaesthesiologists' physical status classification referred for EGD, were randomly assigned to receive propofol with alfentanyl or midazolam with alfentanyl for sedation during the procedure. Within 120 min after the procedure, patients were repeatedly investigated for memory of the procedure and for memory of pain intensity during EGD with the use of the visual analogue scale. Activity and cooperation of the patient during the procedure was assessed with the relative adequacy scale. Of the 51 children, 48 completed the study. Propofol was significantly better than midazolam in inducing amnesia of procedural pain (mean difference 11.53 mm; 95 % confidence interval [CI] 0.96 to 22.10), loss of memory of the procedure (relative risk 0.4; 95 % CI 0.21 to 0.59) and controlling behaviour (relative risk 2.12; 95 % CI 1.33 to 3.36). In children sedated for EGD, propofol is significantly better than midazolam at providing procedural amnesia and controlling behaviour during the procedure.

Determination of the Kwall correction factor for a cylindrical ionization chamber to measure air-kerma in 60Co gamma beams.

PubMed

Laitano, R F; Toni, M P; Pimpinella, M; Bovi, M

2002-07-21

The factor Kwall to correct for photon attenuation and scatter in the wall of ionization chambers for 60Co air-kerma measurement has been traditionally determined by a procedure based on a linear extrapolation of the chamber current to zero wall thickness. Monte Carlo calculations by Rogers and Bielajew (1990 Phys. Med. Biol. 35 1065-78) provided evidence, mostly for chambers of cylindrical and spherical geometry, of appreciable deviations between the calculated values of Kwall and those obtained by the traditional extrapolation procedure. In the present work an experimental method other than the traditional extrapolation procedure was used to determine the Kwall factor. In this method the dependence of the ionization current in a cylindrical chamber was analysed as a function of an effective wall thickness in place of the physical (radial) wall thickness traditionally considered in this type of measurement. To this end the chamber wall was ideally divided into distinct regions and for each region an effective thickness to which the chamber current correlates was determined. A Monte Carlo calculation of attenuation and scatter effects in the different regions of the chamber wall was also made to compare calculation to measurement results. The Kwall values experimentally determined in this work agree within 0.2% with the Monte Carlo calculation. The agreement between these independent methods and the appreciable deviation (up to about 1%) between the results of both these methods and those obtained by the traditional extrapolation procedure support the conclusion that the two independent methods providing comparable results are correct and the traditional extrapolation procedure is likely to be wrong. The numerical results of the present study refer to a cylindrical cavity chamber like that adopted as the Italian national air-kerma standard at INMRI-ENEA (Italy). The method used in this study applies, however, to any other chamber of the same type.

Doctors or mid-level providers for abortion.

PubMed

Barnard, Sharmani; Kim, Caron; Park, Min Hae; Ngo, Thoai D

2015-07-27

The World Health Organization recommends that abortion can be provided at the lowest level of the healthcare system. Training mid-level providers, such as midwives, nurses and other non-physician providers, to conduct first trimester aspiration abortions and manage medical abortions has been proposed as a way to increase women's access to safe abortion procedures. To assess the safety and effectiveness of abortion procedures administered by mid-level providers compared to doctors. We searched the CENTRAL Issue 7, MEDLINE and POPLINE databases for comparative studies of doctor and mid-level providers of abortion services. We searched for studies published in any language from January 1980 until 15 August 2014. Randomised controlled trials (RCTs) (clustered or not clustered), prospective cohort studies or observational studies that compared the safety or effectiveness (or both) of any type of first trimester abortion procedure, administered by any type of mid-level provider or doctors, were eligible for inclusion in the review. Two independent review authors screened abstracts for eligibility and double-extracted data from the included studies using a pre-tested form. We meta-analysed primary outcome data using both fixed-effect and random-effects models to obtain pooled risk ratios (RR) with 95% confidence intervals (CIs). We carried out separate analyses by study design (RCT or cohort) and type of abortion procedure (medical versus surgical). Eight studies involving 22,018 participants met our eligibility criteria. Five studies (n = 18,962) assessed the safety and effectiveness of surgical abortion procedures administered by mid-level providers compared to doctors. Three studies (n = 3056) assessed the safety and effectiveness of medical abortion procedures. The surgical abortion studies (one RCT and four cohort studies) were carried out in the United States, India, South Africa and Vietnam. The medical abortion studies (two RCTs and one cohort study) were carried out in India, Sweden and Nepal. The studies included women with gestational ages up to 14 weeks for surgical abortion and nine weeks for medical abortion.Risk of selection bias was considered to be low in the three RCTs, unclear in four observational studies and high in one observational study. Concealment bias was considered to be low in the three RCTs and high in all five observational studies. Although none of the eight studies performed blinding of the participants to the provider type, we considered the performance bias to be low as this is part of the intervention. Detection bias was considered to be high in all eight studies as none of the eight studies preformed blinding of the outcome assessment. Attrition bias was low in seven studies and high in one, with over 20% attrition. We considered six studies to have unclear risk of selective reporting bias as their protocols had not been published. The remaining two studies had published their protocols. Few other sources of bias were found.Based on an analysis of three cohort studies, the risk of surgical abortion failure was significantly higher when provided by mid-level providers than when procedures were administered by doctors (RR 2.25, 95% CI 1.38 to 3.68), however the quality of evidence for this outcome was deemed to be very low. For surgical abortion procedures, we found no significant differences in the risk of complications between mid-level providers and doctors (RR 0.99, 95% CI 0.17 to 5.70 from RCTs; RR 1.38, 95% CI 0.70 to 2.72 from observational studies). When we combined the data for failure and complications for surgical abortion we found no significant differences between mid-level providers and doctors in both the observational study analysis (RR 1.36, 95% CI 0.86 to 2.14) and the RCT analysis (RR 3.07, 95% CI 0.16 to 59.08). The quality of evidence of the outcome for RCT studies was considered to be low and for observational studies very low. For medical abortion procedures the risk of failure was not different for mid-level providers or doctors (RR 0.81, 95% CI 0.48 to 1.36 from RCTs; RR 1.09, 95% CI 0.63 to 1.88 from observational studies). The quality of evidence of this outcome for the RCT analysis was considered to be high, although the quality of evidence of the observational studies was considered to be very low. There were no complications reported in the three medical abortion studies. There was no statistically significant difference in the risk of failure for medical abortions performed by mid-level providers compared with doctors. Observational data indicate that there may be a higher risk of abortion failure for surgical abortion procedures administered by mid-level providers, but the number of studies is small and more robust data from controlled trials are needed. There were no statistically significant differences in the risk of complications for first trimester surgical abortions performed by mid-level providers compared with doctors.

Encoding-Imagery Specificity in Alcohol State-Dependent Learning

ERIC Educational Resources Information Center

Weingartner, Herbert; And Others

1976-01-01

A free-recall procedure demonstrated state-dependent learning using alcohol. Information encoded and stored while intoxicated was more effectively retrieved when later tests of recall were performed while intoxicated, as compared to recall accomplished in the sober state. (Editor/RK)

Influences of palatoplasty by the push-back procedure on craniofacial morphology and growth.

PubMed

Iwasaki, Hiroshi; Kudo, Motonori; Yamamoto, Yuko

2012-12-01

For patients with a cleft palate, the push-back procedure which accompanies posterior shifting of palatal flap is thought to be most effective way of. achieving adequate velopharyngeal function. In this study, we aimed to evaluate the influences of the push-back procedure on the craniofacial morphology and its growth. Using cephalometry we compared the craniofacial morphology and growth of three groups of Japanese children, living in the same region (Hokkaido, Japan). 1) 28 children (13 girls and 15 boys) with operated submucous cleft palates at the ages of 9 and 14 respectively. 2) 12 age-matched children (7 girls and 5 boys) with unoperated submucous cleft palates. 3) 60 age-matched non-cleft children (30 girls and 30 boys) with normal occlusion. None of them received dentofacial orthopaedic treatment. While the patients who had been operated on had significant differences in posterior upper facial height and inclination of the palatal plane when compared with non-cleft children or unoperated cleft children, they showed no statistically significant difference in anteroposterior positioning of anterior part of the maxilla, compared with the unoperated. The influences of palatoplasty by the push-back procedure with posterior positioning of the palatal flaps on craniofacial morphology are additional to the cleft palate, and of minor concern. Crown Copyright © 2011. Published by Elsevier Ltd. All rights reserved.

Comparing two methods of thoracoscopic sympathectomy for palmar hyperhidrosis.

PubMed

Ibrahim, Magdi; Allam, Abdulla

2014-09-01

Hyperhidrosis can cause significant professional and social handicaps. Thoracic endoscopic sympathectomy has become the surgical technique of choice for treating intractable palmar hyperhidrosis and can be performed through multiple ports or a single port. This prospective study compares outcomes between the two methods. The study followed 71 consecutive patients who underwent video-assisted sympathectomy for palmar hyperhidrosis between January 2008 and June 2012. In all patients, the procedure was bilateral and performed in one stage. The multiple-port method was used in 35 patients (group A) and the single-port method in 36 patients (group B). Preoperative, intraoperative, and postoperative variables; morbidity, recurrence; and survival were compared in both groups. The procedure was successful in 100% of the patients; none experienced a recurrence of palmar hyperhidrosis, Horner syndrome (oculosympathetic palsy), or serious postoperative complications, and none died. No patients required conversion to an open procedure. Residual minimal pneumothorax occurred in two patients (5.7%) in group A and in one patient (2.8%) in group B. Minimal hemothorax occurred in one patient (2.9%) in group A and in three patients (8.3%) in group B. Compensatory hyperhidrosis occurred in seven patients (20%) in group A and in eight patients (22.2%) in group B. No difference was found between the multiple- and single-port methods. Both are effective, safe minimally invasive procedures that permanently improve quality of life in patients with palmar hyperhidrosis.

A comparison of parecoxib and thoracic epidural analgesia for postoperative analgesia following Nuss procedure.

PubMed

Yang, Wendy; Ming, Yung-Ching; Kau, Yi-Chuan; Liao, Chia-Chih; Tsai, Shih-Chang; Wong, Kit-Man; Wong, Shu-Yam; Lai, Jin-Yao

2015-12-01

The purpose of this study was to compare the results of thoracic epidural analgesia (TEA) and parecoxib in controlling postoperative pain after the Nuss procedure. Between August 2005 and July 2014, 120 adolescents and adults underwent Nuss procedures and received either TEA or parecoxib for postoperative pain control. Demographic data, preoperative preparation times, visual analog scale (VAS) pain scores from postoperative day 1 to day 5, medical costs of pain control, days to Foley catheter removal, days to being able to sit up, days to being able to walk, days of hospital stay, nausea/vomiting scores, and complications related to pain control were compared. A total of 106 patients received TEA, and 14 received parecoxib. No between-group differences in demographics were observed. Patients in the parecoxib group had shorter preparation times (p<0.001), lower VAS pain scores from postoperative day 2 to day 5 (day 2, p=0.006; day 3, p=0.006; day 4, p<0.001; day 5, p<0.001), shorter hospital stays (p<0.001), lower pain control costs (p<0.001), and lower nausea/vomiting scores (p=0.046). For adolescents and adults undergoing the Nuss procedure, parecoxib affords better pain control efficacy, a shorter hospital stay, lower medical pain control costs, and fewer side effects compared with TEA. Copyright © 2015 Elsevier Inc. All rights reserved.

Navigated Pattern Laser System versus Single-Spot Laser System for Postoperative 360-Degree Laser Retinopexy.

PubMed

Kulikov, Alexei N; Maltsev, Dmitrii S; Boiko, Ernest V

2016-01-01

Purpose . To compare three 360°-laser retinopexy (LRP) approaches (using navigated pattern laser system, single-spot slit-lamp (SL) laser delivery, and single-spot indirect ophthalmoscope (IO) laser delivery) in regard to procedure duration, procedural pain score, technical difficulties, and the ability to achieve surgical goals. Material and Methods . Eighty-six rhegmatogenous retinal detachment patients (86 eyes) were included in this prospective randomized study. The mean procedural time, procedural pain score (using 4-point Verbal Rating Scale), number of laser burns, and achievement of the surgical goals were compared between three groups (pattern LRP (Navilas® laser system), 36 patients; SL-LRP, 28 patients; and IO-LRP, 22 patients). Results . In the pattern LRP group, the amount of time needed for LRP and pain level were statistically significantly lower, whereas the number of applied laser burns was higher compared to those in the SL-LRP group and in the IO-LRP group. In the pattern LRP, SL-LRP, and IO-LRP groups, surgical goals were fully achieved in 28 (77.8%), 17 (60.7%), and 13 patients (59.1%), respectively ( p > 0.05). Conclusion . The navigated pattern approach allows improving the treatment time and pain in postoperative 360° LRP. Moreover, 360° pattern LRP is at least as effective in achieving the surgical goal as the conventional (slit-lamp or indirect ophthalmoscope) approaches with a single-spot laser.

Assessment of liver ablation using cone beam computed tomography.

PubMed

Abdel-Rehim, Mohamed; Ronot, Maxime; Sibert, Annie; Vilgrain, Valérie

2015-01-14

To investigate the feasibility and accuracy of cone beam computed tomography (CBCT) in assessing the ablation zone after liver tumor ablation. Twenty-three patients (17 men and 6 women, range: 45-85 years old, mean age 65 years) with malignant liver tumors underwent ultrasound-guided percutaneous tumor ablation [radiofrequency (n = 14), microwave (n = 9)] followed by intravenous contrast-enhanced CBCT. Baseline multidetector computed tomography (MDCT) and peri-procedural CBCT images were compared. CBCT image quality was assessed as poor, good, or excellent. Image fusion was performed to assess tumor coverage, and quality of fusion was rated as bad, good, or excellent. Ablation zone volumes on peri-procedural CBCT and post-procedural MDCT were compared using the non-parametric paired Wilcoxon t-test. Rate of primary ablation effectiveness was 100%. There were no complications related to ablation. Local tumor recurrence and new liver tumors were found 3 mo after initial treatment in one patient (4%). The ablation zone was identified in 21/23 (91.3%) patients on CBCT. The fusion of baseline MDCT and peri-procedural CBCT images was feasible in all patients and showed satisfactory tumor coverage (at least 5-mm margin). CBCT image quality was poor, good, and excellent in 2 (9%), 8 (35%), and 13 (56%), patients respectively. Registration quality between peri-procedural CBCT and post-procedural MDCT images was good to excellent in 17/23 (74%) patients. The median ablation volume on peri-procedural CBCT and post-procedural MDCT was 30 cm(3) (range: 4-95 cm(3)) and 30 cm(3) (range: 4-124 cm(3)), respectively (P-value > 0.2). There was a good correlation (r = 0.79) between the volumes of the two techniques. Contrast-enhanced CBCT after tumor ablation of the liver allows early assessment of the ablation zone.

Recovery process and determinants of adverse event occurrence in bronchoscopic procedures performed under general anaesthesia.

PubMed

Özden Omaygenç, Derya; Ünal, Nermin; Edipoğlu, Saadet İpek; Barca Şeker, Tuğçe; Özgül, Mehmet Akif; Turan, Demet; Özdemir, Cengiz; Karaca, İbrahim Oğuz; Çetinkaya, Erdoğan

2018-04-16

Regarding the fact that rigid bronchoscopy is generally performed under general anaesthesia and this patient subgroup is remarkably morbid, encountering procedure and/or anaesthesia related complications are highly likely. Here, we aimed to assess factors influencing recovery and detect possible determinants of adverse event occurrence during these operations performed in a tertiary referral centre. Eighty-one consecutive ASA I-IV patients were recruited for this investigation. In the operating theatre after induction of anaesthesia and advancement of the device, maintenance was provided with total intravenous anaesthesia. Neuromuscular blockage was invariably administered, and patients were ventilated manually. In addition to preoperative demographic and procedural characteristics, perioperative hemodynamic variables, recovery times and observed adverse events were noted. Basic demographic properties, ASA and Mallampati scores, and procedure specific variables as lesion localization, lesion and procedure type were comparable among groups assembled with reference to event occurrence. Patients who had experienced adverse event had higher heart rates. Recovery times were comparable between Event (-) and Event (+) groups. Relationship of recovery process were individually tested with all variables and only lesion type was detected to have an effect on respiration and extubation times. Among all parameters only procedural time seemed to be associated with adverse event occurrence (mins, 22.9 ± 11.9 vs 41.6 ± 28.8, P < .001). Recovery times related with return of spontaneous respiration were significantly lower in procedures performed for treatment of tumoral diseases in this study and procedure length was determined to be the ultimate factor which had an impact on adverse event occurrence. © 2018 John Wiley & Sons Ltd.

Ketamine versus alfentanil combined with propofol for sedation in colonoscopy procedures: a randomized prospective study.

PubMed

Türk, Hacer Şebnem; Aydoğmuş, Meltem; Ünsal, Oya; Işıl, Canan Tülay; Citgez, Bülent; Oba, Sibel; Açık, Mehmet Eren

2014-12-01

Different drug combinations are used for sedation in colonoscopy procedures. A ketamine-propofol (ketofol) mixture provides effective sedation and has minimal adverse effects. Alfentanil also provides anesthesia for short surgical procedures by incremental injection as an adjunct. However, no study has investigated the use of ketofol compared with an opioid-propofol combination in colonoscopic procedures. A total of 70 patients, ASA physical status I-II, scheduled to undergo elective colonoscopy, were enrolled in this prospective randomized study and allocated to two groups. After premedication, sedation induction was performed with 0.5 mg/kg ketamine +1 mg/kg propofol in Group KP, and 10 mg/kg alfentanil +1 mg/kg propofol in Group AP. Propofol was added when required. Demographic data, colonoscopy duration, recovery time, discharge time, mean arterial pressure (MAP), heart rate (HR), peripheral oxygen saturation, Ramsey Sedation Scale values, colonoscopy patients' satisfaction scores, and complications were recorded. The need for additional propofol doses was significantly higher in Group AP than in Group KP. MAP at minute 1 and 5, Ramsey Sedation Scale at minute 5, and discharge time were significantly higher in Group KP than in Group AP. Additional propofol doses and total propofol dose were significantly lower in Group KP than in Group AP. Ketofol provided better hemodynamic stability and quality of sedation compared with alfentanil-propofol combination in elective colonoscopy, and required fewer additional propofol; however, it prolonged discharge time. Both combinations can safely be used in colonoscopy sedation.

Remifentanil maintains lower initial delayed nonmatching-to-sample accuracy compared to food pellets in male rhesus monkeys.

PubMed

Hutsell, Blake A; Banks, Matthew L

2017-12-01

Emerging human laboratory and preclinical drug self-administration data suggest that a history of contingent abused drug exposure impairs performance in operant discrimination procedures, such as delayed nonmatching-to-sample (DNMTS), that are hypothesized to assess components of executive function. However, these preclinical discrimination studies have exclusively used food as the reinforcer and the effects of drugs as reinforcers in these operant procedures are unknown. The present study determined effects of contingent intravenous remifentanil injections on DNMTS performance hypothesized to assess 1 aspect of executive function, working memory. Daily behavioral sessions consisted of 2 components with sequential intravenous remifentanil (0, 0.01-1.0 μg/kg/injection) or food (0, 1-10 pellets) availability in nonopioid dependent male rhesus monkeys (n = 3). Remifentanil functioned as a reinforcer in the DNMTS procedure. Similar delay-dependent DNMTS accuracy was observed under both remifentanil- and food-maintained components, such that higher accuracies were maintained at shorter (0.1-1.0 s) delays and lower accuracies approaching chance performance were maintained at longer (10-32 s) delays. Remifentanil maintained significantly lower initial DNMTS accuracy compared to food. Reinforcer magnitude was not an important determinant of DNMTS accuracy for either remifentanil or food. These results extend the range of experimental procedures under which drugs function as reinforcers. Furthermore, the selective remifentanil-induced decrease in initial DNMTS accuracy is consistent with a selective impairment of attentional, but not memorial, processes. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

A prospective, randomized, double-blinded single-site control study comparing blood loss prevention of tranexamic acid (TXA) to epsilon aminocaproic acid (EACA) for corrective spinal surgery

PubMed Central

2010-01-01

Background Multilevel spinal fusion surgery has typically been associated with significant blood loss. To limit both the need for transfusions and co-morbidities associated with blood loss, the use of anti-fibrinolytic agents has been proposed. While there is some literature comparing the effectiveness of tranexamic acid (TXA) to epsilon aminocaproic acid (EACA) in cardiac procedures, there is currently no literature directly comparing TXA to EACA in orthopedic surgery. Methods/Design Here we propose a prospective, randomized, double-blinded control study evaluating the effects of TXA, EACA, and placebo for treatment of adolescent idiopathic scoliosis (AIS), neuromuscular scoliosis (NMS), and adult deformity (AD) via corrective spinal surgery. Efficacy will be determined by intraoperative and postoperative blood loss. Other clinical outcomes that will be compared include transfusion rates, preoperative and postoperative hemodynamic values, and length of hospital stay after the procedure. Discussion The primary goal of the study is to determine perioperative blood loss as a measure of the efficacy of TXA, EACA, and placebo. Based on current literature and the mechanism by which the medications act, we hypothesize that TXA will be more effective at reducing blood loss than EACA or placebo and result in improved patient outcomes. Trial Registration ClinicalTrials.gov ID: NCT00958581 PMID:20370916

The motivation to self-administer is increased after a history of spiking brain levels of cocaine.

PubMed

Zimmer, Benjamin A; Oleson, Erik B; Roberts, David Cs

2012-07-01

Recent attempts to model the addiction process in rodents have focused on cocaine self-administration procedures that provide extended daily access. Such procedures produce a characteristic loading phase during which blood levels rapidly rise and then are maintained within an elevated range for the duration of the session. The present experiments tested the hypothesis that multiple fast-rising spikes in cocaine levels contribute to the addiction process more robustly than constant, maintained drug levels. Here, we compared the effects of various cocaine self-administration procedures that produced very different patterns of drug intake and drug dynamics on Pmax, a behavioral economic measure of the motivation to self-administer drug. Two groups received intermittent access (IntA) to cocaine during daily 6-h sessions. Access was limited to twelve 5-min trials that alternated with 25-min timeout periods, using either a hold-down procedure or a fixed ratio 1 (FR1). Cocaine levels could not be maintained with this procedure; instead the animals experienced 12 fast-rising spikes in cocaine levels each day. The IntA groups were compared with groups given 6-h FR1 long access and 2-h short access sessions and two other control groups. Here, we report that cocaine self-administration procedures resulting in repeatedly spiking drug levels produce more robust increases in Pmax than procedures resulting in maintained high levels of cocaine. These results suggest that rapid spiking of brain-cocaine levels is sufficient to increase the motivation to self-administer cocaine.

Comparison of the efficacy of articaine and prilocaine local anaesthesia for pulpotomy of maxillary and mandibular primary molars.

PubMed

Yilmaz, Y; Eyuboglu, O; Keles, S

2011-06-01

The aim of this study was to compare the local anaesthetic efficacy of articaine HCl and prilocaine HCl during an operative procedure after their administration by either mandibular nerve block or maxillary infiltration. The study was a double-blind clinical study which comprised 162 children (81 boys and 81 girls), who required a pulpotomy on their primary molars. Pain-related behaviours were used to assess the severity of pain during the injection of either prilocaine HCl or articaine HCl and the operative procedures following either a maxillary infiltration or mandibular nerve block of the two local anaesthetic agents. The frequencies of post-procedural adverse events in the prilocaine and articaine anaesthetised groups were also determined. Significantly more discomfort (p<0.05) was observed following maxillary infiltration compared to mandibular nerve block. There were no significant differences in the pain-related behaviours scores between the two local anaesthetic agents administered during the dental operative procedures, except for the removal of the coronal pulp. For this latter procedure, the pain-related behaviour score was 1.5- times higher in the prilocain-anaesthetised children than in the articaine-anaesthetised children. The frequencies of post- procedural adverse events in the prilocaine-treated children were similar to those found in the articaine-treated children. We concluded that local anaesthesia following mandibular nerve block is more effective than that following maxillary infiltration in 6-8-year-old children. However, the intensity of pain that was experienced by the children during administration of either prilocaine or articaine and some of the dental procedures after their administration were similar.

Is bioresorbable vascular scaffold acute recoil affected by baseline renal function and scaffold selection?

PubMed

Gunes, Haci Murat; Yılmaz, Filiz Kizilirmak; Gokdeniz, Tayyar; Demir, Gultekin Gunhan; Guler, Ekrem; Guler, Gamze Babur; Karaca, Oğuz; Cakal, Beytullah; İbişoğlu, Ersin; Boztosun, Bilal

2016-12-01

The aim of the present study was to investigate the relationship between glomerular filtration rate (GFR) and acute post-scaffold recoil (PSR) in patients undergoing bioresorbable scaffold (BVS) implantation. We included 130 patients who underwent everolimus-eluting BVS device (Absorb BVS; Abbott Vascular, Santa Clara, CA, USA) or the novolimus-eluting BVS device (Elixir Medical Corporation) implantations for single or multi-vessel disease. Clinical, angiographic variables and procedural characteristics were defined and pre-procedural GFR was calculated for each patient. Post-procedural angiographic parameters of each patient were analyzed. Primary objective of the study was to evaluate the effect of GFR on angiographic outcomes after BVS implantation while secondary objective was to compare post-procedural angiographic results between the two BVS device groups. Baseline clinical characteristics and angiographic parameters were similar between the two BVS groups. Post-procedural angiographic analysis revealed significantly lower PSR in the DESolve group than the Absorb group (0.10±0.04 vs. 0.13±0.05, p: 0.003). When PSR in the whole study population was evaluated, it was positively correlated with age, tortuosity , calcification and PBR as there was a negative correlation between GFR. Besides GFR were found to be independent predictors for PSR in all groups and the whole study population. In patients undergoing BVS implantation, pre-procedural low GFR is associated with increased post-procedural PSR. Calcification, age, PBR, dyslipidemia and tortuosity are other independent risk factors for PSR. DESolve has lower PSR when compared with Absorb. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Outcomes of proximal chevron osteotomy for moderate versus severe hallux valgus deformities.

PubMed

Moon, Jae-Young; Lee, Keun-Bae; Seon, Jong Keun; Moon, Eun-Sun; Jung, Sung-Taek

2012-08-01

Proximal chevron osteotomy with a distal soft tissue procedure has been widely used to treat moderate to severe hallux valgus deformities. However, there have been no studies comparing the results of proximal chevron osteotomy between patients with moderate and severe hallux valgus. We compared the results of this procedure among these groups. A retrospective review of 95 patients (108 feet) that underwent proximal chevron osteotomy and distal soft tissue procedure for moderate and severe hallux valgus was conducted. The 108 feet were divided into two groups: moderate hallux valgus (Group A) and severe hallux valgus (Group B). Group A was composed of 57 feet (52 patients) and Group B of 51 feet (43 patients). Average followup was 45 months. Mean American Orthopedic Foot and Ankle Society hallux metatarsophalangeal-interphalangeal scores were 54.1 points in Group A and 53.0 points in Group B preoperatively, and these improved to 90.8 and 92.6, respectively, at the last followup. Mean hallux valgus angles in Groups A and B reduced from 32.3 and 40.8 degrees, preoperatively to 10.7 and 13.2 degrees, postoperatively. Similarly, mean first intermetatarsal angles in Groups A and B reduced from 15.0 and 19.2 degrees, preoperatively to 9.0 and 9.2 degrees, postoperatively. The clinical and radiographic outcomes of proximal chevron osteotomy with a distal soft tissue procedure were found to be comparable for moderate and severe hallux valgus. Accordingly, our results suggest that this procedure provides an effective and reliable means of correcting hallux valgus regardless of severity of deformity.

Root-coverage procedures for the treatment of localized recession-type defects: a Cochrane systematic review.

PubMed

Chambrone, Leandro; Sukekava, Flávia; Araújo, Maurício G; Pustiglioni, Francisco E; Chambrone, Luiz Armando; Lima, Luiz A

2010-04-01

The purpose of this review is to evaluate the effectiveness of different root-coverage procedures in the treatment of recession-type defects. The Cochrane Oral Health Group Trials Register, Cochrane Central Register of Controlled Trials, MEDLINE, and EMBASE were searched for entries up to October 2008. There were no restrictions regarding publication status or the language of publication. Only clinical randomized controlled trials (RCTs) with a duration > or = 6 months that evaluated recession areas (Miller Class I or II > or = 3 mm) that were treated by means of periodontal plastic surgery procedures were included. Twenty-four RCTs provided data. Only one trial was considered to be at low risk of bias. The remaining trials were considered to be at high risk of bias. The results indicated a significantly greater reduction in gingival recession and gain in keratinized tissue for subepithelial connective tissue grafts (SCTGs) compared to guided tissue regeneration (GTR) with bioabsorbable membranes (GTR bms). A significantly greater gain in keratinized tissue was found for enamel matrix protein compared to a coronally advanced flap (0.40 mm) and for SCTGs compared to GTR bms plus bone substitutes. Limited data exist on the changes of esthetic conditions as related to the opinions and preferences of patients for specific procedures. SCTGs, coronally advanced flaps alone or associated with other biomaterial, and GTR may be used as root-coverage procedures for the treatment of localized recession-type defects. In cases where root coverage and gain in keratinized tissue are expected, the use of SCTGs seems to be more adequate.

Variation in levels of some leaf enzymes.

PubMed

Downton, J; Slatyer, R O

1971-03-01

Several procedures were compared for efficiency in the extraction of certain leaf enzymes (phosphoenolpyruvate carboxylase, ribulose 1,5-diphosphate carboxylase and malate dehydrogenase) in Atriplex hastata (a "C3" species exhibiting conventional photosynthetic metabolism), and in A. spongiosa (a "C4" species in which the initial photosynthetic products are C4 dicarboxylic acids). Glycolate oxidase was also assayed in some cases, and Atriplex nummularia and Sorghum bicolor were also used as test material. A simple procedure, involving a mortar and pestle grind with carborundum added to the grinding mixture, was found to be as effective as glass bead grind procedures. In addition, it was more rapid and showed less variability with different operations.Using the carborundum grind procedure, sources of variability in enzyme activity in apparently uniform leaves were compared, as were effects of time of day, leaf age and storage procedure. In general, if apparently uniform leaves could be selected, variability in levels of enzyme activity appeared to be relatively small, not exceeding about 12%. Time of day also appeared to be relatively unimportant for the enzymes examined. However, the ontogentic status of the plant was found to be an important source of variability. Leaf age was also a major source of variability where the activity was expressed on a fresh weight basis, but specific activity (i.e. activity expressed on a protein basis) was relatively constant, at least with the range of species and leaf ages examined here.Storage of fresh samples in liquid nitrogen for 24 h, prior to extraction and assay, led to only a small reduction in activity, but substantial changes occurred if storage was in dry ice or in ice and also where extracts were stored in a deep freeze.

Optimization of synthesis process of thermally-responsive poly-n-isopropylacrylamide nanoparticles for controlled release of antimicrobial hydrophobic compounds

NASA Astrophysics Data System (ADS)

Hill, Laura E.; Gomes, Carmen L.

2014-12-01

The goal of this study was to develop an effective method to synthesize poly-n-isopropylacrylamide (PNIPAAM) nanoparticles with entrapped cinnamon bark extract (CBE) to improve its delivery to foodborne pathogens and control its release with temperature stimuli. CBE was used as a model for hydrophobic natural antimicrobials. A top-down procedure using crosslinked PNIPAAM was compared to a bottom-up procedure using NIPAAM monomer. Both processes relied on self-assembly of the molecules into micelles around the CBE at 40 °C. Processing conditions were compared including homogenization time of the polymer, hydration time prior to homogenization, lyophilization, and the effect of particle ultrafiltration. The top-down versus bottom-up synthesis methods yielded particles with significantly different characteristics, especially their release profiles and antimicrobial activities. The synthesis methods affected particle size, with the bottom-up procedure resulting in smaller (P < 0.05) diameters than the top-down procedure. The controlled release profile of CBE from nanoparticles was dependent on the release media temperature. A faster, burst release was observed at 40 °C and a slower, more sustained release was observed at lower temperatures. PNIPAAM particles containing CBE were analyzed for their antimicrobial activity against Salmonella enterica serovar Typhimurium LT2 and Listeria monocytogenes Scott A. The PNIPAAM particles synthesized via the top-down procedure had a much faster release, which led to a greater (P < 0.05) antimicrobial activity. Both of the top-down nanoparticles performed similarly, therefore the 7 min homogenization time nanoparticles would be the best for this application, as the process time is shorter and little improvement was seen by using a slightly longer homogenization.

Uncertainty Analysis of A Flood Risk Mapping Procedure Applied In Urban Areas

NASA Astrophysics Data System (ADS)

Krause, J.; Uhrich, S.; Bormann, H.; Diekkrüger, B.

In the framework of IRMA-Sponge program the presented study was part of the joint research project FRHYMAP (flood risk and hydrological mapping). A simple con- ceptual flooding model (FLOODMAP) has been developed to simulate flooded areas besides rivers within cities. FLOODMAP requires a minimum of input data (digital el- evation model (DEM), river line, water level plain) and parameters and calculates the flood extent as well as the spatial distribution of flood depths. of course the simulated model results are affected by errors and uncertainties. Possible sources of uncertain- ties are the model structure, model parameters and input data. Thus after the model validation (comparison of simulated water to observed extent, taken from airborne pictures) the uncertainty of the essential input data set (digital elevation model) was analysed. Monte Carlo simulations were performed to assess the effect of uncertain- ties concerning the statistics of DEM quality and to derive flooding probabilities from the set of simulations. The questions concerning a minimum resolution of a DEM re- quired for flood simulation and concerning the best aggregation procedure of a given DEM was answered by comparing the results obtained using all available standard GIS aggregation procedures. Seven different aggregation procedures were applied to high resolution DEMs (1-2m) in three cities (Bonn, Cologne, Luxembourg). Basing on this analysis the effect of 'uncertain' DEM data was estimated and compared with other sources of uncertainties. Especially socio-economic information and monetary transfer functions required for a damage risk analysis show a high uncertainty. There- fore this study helps to analyse the weak points of the flood risk and damage risk assessment procedure.

Improved Silica-Guanidiniumthiocyanate DNA Isolation Procedure Based on Selective Binding of Bovine Alpha-Casein to Silica Particles

PubMed Central

Boom, René; Sol, Cees; Beld, Marcel; Weel, Jan; Goudsmit, Jaap; Wertheim-van Dillen, Pauline

1999-01-01

DNA purified from clinical cerebrospinal fluid and urine specimens by a silica-guanidiniumthiocyanate procedure frequently contained an inhibitor(s) of DNA-processing enzymes which may have been introduced by the purification procedure itself. Inhibition could be relieved by the use of a novel lysis buffer containing alpha-casein. When the novel lysis buffer was used, alpha-casein was bound by the silica particles in the first step of the procedure and eluted together with DNA in the last step, after which it exerted its beneficial effects for DNA-processing enzymes. In the present study we have compared the novel lysis buffer with the previously described lysis buffer with respect to double-stranded DNA yield (which was nearly 100%) and the performance of DNA-processing enzymes. PMID:9986822

Hybrid Position/Force Control of an Active Handheld Micromanipulator for Membrane Peeling

PubMed Central

Wells, Trent S.; Yang, Sungwook; MacLachlan, Robert A.; Lobes, Louis A.; Martel, Joseph N.; Riviere, Cameron N.

2015-01-01

Background Peeling procedures in retinal surgery require micron-scale manipulation and control of sub-tactile forces. Methods Hybrid position/force control of an actuated handheld microsurgical instrument is presented as a means for simultaneously improving positioning accuracy and reducing forces to prevent avoidable trauma to tissue. The system response was evaluated, and membrane-peeling trials were performed by four test subjects in both artificial and animal models. Results Maximum force was reduced by 56% in both models as compared to position control. No statistically significant effect on procedure duration was observed. Conclusions A hybrid position/force control system has been implemented that successfully attenuates forces and minimizes unwanted excursions during microsurgical procedures such as membrane peeling. Results also suggest that improvements in safety using this technique may be attained without increasing the duration of the procedure. PMID:25962836

Comparing the Teaching Interaction Procedure to Social Stories: A Replication Study

ERIC Educational Resources Information Center

Kassardjian, Alyne; Leaf, Justin B.; Ravid, Daniel; Leaf, Jeremy A.; Alcalay, Aditt; Dale, Stephanie; Tsuji, Kathleen; Taubman, Mitchell; Leaf, Ronald; McEachin, John; Oppenheim-Leaf, Misty L.

2014-01-01

This study compared the teaching interaction procedure to social stories implemented in a group setting to teach social skills to three children diagnosed with autism spectrum disorder. The researchers taught each participant one social skill with the teaching interaction procedure, one social skill with the social story procedure, and one social…

The effect of the liquid-solid system properties on the interline heat transfer coefficient

NASA Technical Reports Server (NTRS)

Wayner, P. C., Jr.

1977-01-01

A theoretical procedure to determine the heat transfer characteristics of the interline region of an evaporating meniscus using the macroscopic optical and thermophysical properties of the system is outlined. The analysis is based on the premise that the interline transport processes are controlled by the London-van der Waals forces between condensed phases (solid and liquid). The procedure is used to compare the relative size of the interline heat sink of various systems using a constant heat flux model. This solution demonstrates the importance of the interline heat flow number which is evaluated for various systems. The heat transfer characteristics of the decane-steel system are numerically compared with those of the carbon tetrachloride-quartz system.

Cell-Free DNA-Based Non-invasive Prenatal Screening for Common Aneuploidies in a Canadian Province: A Cost-Effectiveness Analysis.

PubMed

Nshimyumukiza, Léon; Beaumont, Jean-Alexandre; Duplantie, Julie; Langlois, Sylvie; Little, Julian; Audibert, François; McCabe, Christopher; Gekas, Jean; Giguère, Yves; Gagné, Christian; Reinharz, Daniel; Rousseau, François

2018-01-01

Yearly, 450 000 pregnant Canadians are eligible for voluntary prenatal screening for trisomy 21. Different screening strategies select approximately 4% of women for invasive fetal chromosome testing. Non-invasive prenatal testing (NIPT) using maternal blood cell-free DNA could reduce those invasive procedures but is expensive. This study evaluated the cost-effectiveness of NIPT strategies compared with conventional strategies. This study used a decision analytic model to estimate the cost-effectiveness of 13 prenatal screening strategies for fetal aneuploidies: six frequently used strategies, universal NIPT, and six strategies incorporating NIPT as a second-tier test. The study considered a virtual cohort of pregnant women of similar size and age as women in Quebec. Model data were obtained from published sources and government databases. The study predicted the number of chromosomal anomalies detected (trisomies 21, 13, and 18), invasive procedures and euploid fetal losses, direct costs, and incremental cost-effectiveness ratios. Of the 13 strategies compared, eight identified fewer cases at a higher cost than at least one of the remaining five strategies. Integrated serum screening with conditional NIPT had the lowest cost, and the cost per case detected was $63 139, with a 90% reduction of invasive procedures. The number of cases identified was improved with four other screening strategies, but with increasing of incremental costs per case (from $61 623 to $1 553 615). Results remained robust, except when NIPT costs and risk cut-offs varied. NIPT as a second-tier test for high-risk women is likely to be cost-effective as compared with screening algorithms not involving NIPT. Copyright © 2018 The Society of Obstetricians and Gynaecologists of Canada/La Société des obstétriciens et gynécologues du Canada. Published by Elsevier Inc. All rights reserved.

Contrasting Views of Risk Perception and Influence of Financial Compensation Between Adolescent Research Participants and Their Parents

PubMed Central

Wiener, Lori; Viola, Adrienne; Wilfond, Benjamin S.; Wendler, David; Grady, Christine

2017-01-01

U.S. regulations governing pediatric research do not specify the assent process. To identify best practices, it is important to examine parents’ and adolescents’ views. The present study focuses on parents’ and adolescents’ views regarding possible research risks and the influence of financial compensation on their willingness to accept research procedures. Interviews were conducted with 177 adolescents participating in clinical research for a medical or psychiatric illness, or as healthy volunteers, and a parent. Significant discordance was found between how bothered the teen would feel from research-related side effects and procedures compared with parental report. Most teens were willing to accept non-beneficial procedures without compensation. Payment had significantly greater influence on healthy volunteers and their parents compared with those with a medical or psychiatric illness. Discordance between adolescent and parental views about risks recommends obtaining direct input from adolescents during the assent process. Modest payments should not raise concerns of undue inducement, especially in teens with pre-existing conditions. PMID:25742666

Vertebral Augmentation Involving Vertebroplasty or Kyphoplasty for Cancer-Related Vertebral Compression Fractures: An Economic Analysis

PubMed Central

2016-01-01

Background Untreated vertebral compression fractures can have serious clinical consequences and impose a considerable impact on patients' quality of life and on caregivers. Since non-surgical management of these fractures has limited effectiveness, vertebral augmentation procedures are gaining acceptance in clinical practice for pain control and fracture stabilization. The objective of this analysis was to determine the cost-effectiveness and budgetary impact of kyphoplasty or vertebroplasty compared with non-surgical management for the treatment of vertebral compression fractures in patients with cancer. Methods We performed a systematic review of health economic studies to identify relevant studies that compare the cost-effectiveness of kyphoplasty or vertebroplasty with non-surgical management for the treatment of vertebral compression fractures in adults with cancer. We also performed a primary cost-effectiveness analysis to assess the clinical benefits and costs of kyphoplasty or vertebroplasty compared with non-surgical management in the same population. We developed a Markov model to forecast benefits and harms of treatments, and corresponding quality-adjusted life years and costs. Clinical data and utility data were derived from published sources, while costing data were derived using Ontario administrative sources. We performed sensitivity analyses to examine the robustness of the results. In addition, a 1-year budget impact analysis was performed using data from Ontario administrative sources. Two scenarios were explored: (a) an increase in the total number of vertebral augmentation procedures performed among patients with cancer in Ontario, maintaining the current proportion of kyphoplasty versus vertebroplasty; and (b) no increase in the total number of vertebral augmentation procedures performed among patients with cancer in Ontario but an increase in the proportion of kyphoplasties versus vertebroplasties. Results The base case considered each of kyphoplasty and vertebroplasty versus non-surgical management. Kyphoplasty and vertebroplasty were associated with an incremental cost-effectiveness ratio of $33,471 and $17,870, respectively, per quality-adjusted life-year gained. The budgetary impact of funding vertebral augmentation procedures for the treatment of vertebral compression fractures in adults with cancer in Ontario was estimated at about $2.5 million in fiscal year 2014/15. More widespread use of vertebral augmentation procedures raised total expenditures under a number of scenarios, with costs increasing by $67,302 to $913,386. Conclusions Our findings suggest that the use of kyphoplasty or vertebroplasty in the management of vertebral compression fractures in patients with cancer may be a cost-effective strategy at commonly accepted willingness-to-pay thresholds. Nonetheless, more widespread use of kyphoplasty (and vertebroplasty to a lesser extent) would likely be associated with net increases in health care costs. PMID:27293494

A meta-analysis of manual versus remote magnetic navigation for ventricular tachycardia ablation.

PubMed

Turagam, Mohit K; Atkins, Donita; Tung, Roderick; Mansour, Moussa; Ruskin, Jeremy; Cheng, Jie; Di Biase, Luigi; Natale, Andrea; Lakkireddy, Dhanunjaya

2017-09-01

There are limited studies on the safety and efficacy of remote magnetic navigation (RMN) versus manual navigation (MAN) in ventricular tachycardia (VT) ablation. A comprehensive literature search was performed using the keywords VT ablation, stereotaxis, RMN and MAN in Pubmed, Ebsco, Web of Science, Cochrane, and Google scholar databases. The analysis included seven studies (one randomized, three prospective observational, and three retrospective) including 779 patients [both structural heart disease (SHD) and idiopathic VT] comparing RMN (N = 433) and MAN (N = 339) in VT ablation. The primary end point of long-term VT recurrence was significantly lower with RMN (OR 0.61, 95% CI 0.44-0.85, p = 0.003) compared with MAN. Other end points of acute procedural success (OR 2.13, 95% CI 1.40-3.23, p = 0.0004) was significantly higher with RMN compared with MAN. Fluoroscopy [mean difference -10.42, 95% CI -12.7 to -8.1, p < 0.0001], procedural time [mean difference -9.79, 95% CI -19.27 to -0.3, p = 0.04] and complications (OR 0.35, 95% CI 0.17-0.74, p = 0.0006) were also significantly lower in RMN when compared with MAN. In a subgroup analysis SHD, there was no significant difference in VT recurrence or acute procedural success with RMN vs. MAN. In idiopathic VT, RMN significantly increased acute procedural success with no difference in VT recurrence. The results demonstrate that RMN is safe and effective when compared with MAN in patients with both SHD and idiopathic VT undergoing catheter ablation. Further prospective studies are needed to further verify the safety and efficacy of RMN.

Tracking hand movements captures the response dynamics of the evaluative priming effect.

PubMed

Kawakami, Naoaki; Miura, Emi

2018-06-08

We tested the response dynamics of the evaluative priming effect (i.e. facilitation of target responses following evaluatively congruent compared with evaluatively incongruent primes) using a mouse tracking procedure that records hand movements during the execution of categorisation tasks. In Experiment 1, when participants performed the evaluative categorisation task but not the non-evaluative semantic categorisation task, their mouse trajectories for evaluatively incongruent trials curved more toward the opposite response than those for evaluatively congruent trials, indicating the emergence of evaluative priming effects based on response competition. In Experiment 2, implementing a task-switching procedure in which evaluative and non-evaluative categorisation tasks were intermixed, we obtained reliable evaluative priming effects in the non-evaluative semantic categorisation task as well as in the evaluative categorisation task when participants assigned attention to the evaluative stimulus dimension. Analyses of hand movements revealed that the evaluative priming effects in the evaluative categorisation task were reflected in the mouse trajectories, while evaluative priming effects in the non-evaluative categorisation tasks were reflected in initiation times (i.e. the time elapsed between target onset and first mouse movement). Based on these findings, we discuss the methodological benefits of the mouse tracking procedure and the underlying processes of evaluative priming effects.

Fractionation of distillers dried grains with solubles (DDGS) by sieving and winnowing.

PubMed

Liu, KeShun

2009-12-01

Four commercial samples of distillers dried grains with solubles (DDGS) were sieved. All sieved fractions except for the pan fraction, constituting about 90% of original mass, were then winnowed with an air blast seed cleaner. Sieving was effective in producing fractions with varying composition. As the particle size decreased, protein and ash contents increased, and total carbohydrate (CHO) decreased. Winnowing sieved fractions was also effective in shifting composition, particularly for larger particle classes. Heavy sub-fractions were enriched in protein, oil and ash, while light sub-fractions were enriched for CHO. For protein, the combination of the two procedures resulted in a maximum 56.4% reduction in a fraction and maximum 60.2% increase in another fraction. As airflow velocity increased, light sub-fraction mass increased, while the compositional difference between the heavy and light sub-fractions decreased. Winnowing three times at a lower velocity was as effective as winnowing one time at a medium velocity. Winnowing the whole DDGS was much less effective than winnowing sieved fractions in changing composition, but sieving winnowed fractions was more effective than sieving whole DDGS. The two combination sequences gave comparable overall effects but sieving followed by winnowing is recommended because it requires less time. Regardless of combinational sequence, the second procedure was more effective in shifting composition than the first procedure.

The learning effect of intraoperative video-enhanced surgical procedure training.

PubMed

van Det, M J; Meijerink, W J H J; Hoff, C; Middel, L J; Koopal, S A; Pierie, J P E N

2011-07-01

The transition from basic skills training in a skills lab to procedure training in the operating theater using the traditional master-apprentice model (MAM) lacks uniformity and efficiency. When the supervising surgeon performs parts of a procedure, training opportunities are lost. To minimize this intervention by the supervisor and maximize the actual operating time for the trainee, we created a new training method called INtraoperative Video-Enhanced Surgical Training (INVEST). Ten surgical residents were trained in laparoscopic cholecystectomy either by the MAM or with INVEST. Each trainee performed six cholecystectomies that were objectively evaluated on an Objective Structured Assessment of Technical Skills (OSATS) global rating scale. Absolute and relative improvements during the training curriculum were compared between the groups. A questionnaire evaluated the trainee's opinion on this new training method. Skill improvement on the OSATS global rating scale was significantly greater for the trainees in the INVEST curriculum compared to the MAM, with mean absolute improvement 32.6 versus 14.0 points and mean relative improvement 59.1 versus 34.6% (P=0.02). INVEST significantly enhances technical and procedural skill development during the early learning curve for laparoscopic cholecystectomy. Trainees were positive about the content and the idea of the curriculum.

Litigation and complaints procedures: objectives, effectiveness and alternatives.

PubMed Central

Whelan, C J

1988-01-01

Recent debates about redress mechanisms for medical accident victims have been sidetracked by fears of an American-style medical malpractice crisis. What is required is a framework within which the debate can resume. This paper proposes such a framework by focusing on the compensation and deterrence objectives and placing them in the wider context of the social costs of providing medical services. The framework is then used to assess and compare the effectiveness of differing approaches. In particular, the American and British experiences of litigation, including the concept of 'defensive medicine', are evaluated. Also discussed briefly are alternatives to court-based complaints procedures including 'no-fault' schemes, professional ethics and internal complaints mechanisms. PMID:3392721

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

Ryan, E. Ronan, E-mail: ronan@ronanryan.com; Thornton, Raymond; Sofocleous, Constantinos T.

PurposeTo quantify radiation exposure to the primary operator and staff during PET/CT-guided interventional procedures.MethodsIn this prospective study, 12 patients underwent PET/CT-guided interventions over a 6 month period. Radiation exposure was measured for the primary operator, the radiology technologist, and the nurse anesthetist by means of optically stimulated luminescence dosimeters. Radiation exposure was correlated with the procedure time and the use of in-room image guidance (CT fluoroscopy or ultrasound).ResultsThe median effective dose was 0.02 (range 0-0.13) mSv for the primary operator, 0.01 (range 0-0.05) mSv for the nurse anesthetist, and 0.02 (range 0-0.05) mSv for the radiology technologist. The median extremitymore » dose equivalent for the operator was 0.05 (range 0-0.62) mSv. Radiation exposure correlated with procedure duration and with the use of in-room image guidance. The median operator effective dose for the procedure was 0.015 mSv when conventional biopsy mode CT was used, compared to 0.06 mSv for in-room image guidance, although this did not achieve statistical significance as a result of the small sample size (p = 0.06).ConclusionThe operator dose from PET/CT-guided procedures is not significantly different than typical doses from fluoroscopically guided procedures. The major determinant of radiation exposure to the operator from PET/CT-guided interventional procedures is time spent in close proximity to the patient.« less

Trends in radiation exposure from clinical nuclear medicine procedures in Shanghai, China.

PubMed

Yi, Yanling; Zheng, Junzheng; Zhuo, Weihai; Gao, Linfeng

2012-03-01

This study was designed to assess the trends in the frequencies of nuclear medicine procedures in Shanghai, China, and to determine their contributions to the per capita effective dose to the Shanghai population. The mean activities of radionuclides administered by nuclear medicine departments were compared with the Chinese national guidelines on diagnostic reference levels. On the basis of the three surveys carried out by Shanghai Municipal Center for Disease Control and Prevention in 1996, 1998, and 2008, the typically administered radiopharmaceuticals, levels of activity, the number of procedures, and population were systematically analyzed to assess the frequencies of nuclear medicine procedures and the per capita effective dose. The frequencies were approximately 2.77, 3.46, and 6.63 per 1000 people in 1996, 1998, and 2008, respectively. The annual per capita doses from diagnostic nuclear medicine were estimated to be 0.016, 0.022, and 0.032 mSv in 1996, 1998, and 2008, respectively. The annual frequency of therapeutic nuclear medicine procedures increased from 0.131 to 0.430 per 1000 people in the intervening 12 years. In the 12 years before 2008, diagnostic and therapeutic procedures in nuclear medicine in Shanghai increased continuously, and the annual per capita dose doubled. Increases in PET imaging and bone scans were the major contributors to the increasing frequency and magnitude of radiation exposure to the population. The activities administered for most diagnostic procedures were generally consistent with the designated reference levels.

Consequences of common data analysis inaccuracies in CNS trauma injury basic research.

PubMed

Burke, Darlene A; Whittemore, Scott R; Magnuson, David S K

2013-05-15

The development of successful treatments for humans after traumatic brain or spinal cord injuries (TBI and SCI, respectively) requires animal research. This effort can be hampered when promising experimental results cannot be replicated because of incorrect data analysis procedures. To identify and hopefully avoid these errors in future studies, the articles in seven journals with the highest number of basic science central nervous system TBI and SCI animal research studies published in 2010 (N=125 articles) were reviewed for their data analysis procedures. After identifying the most common statistical errors, the implications of those findings were demonstrated by reanalyzing previously published data from our laboratories using the identified inappropriate statistical procedures, then comparing the two sets of results. Overall, 70% of the articles contained at least one type of inappropriate statistical procedure. The highest percentage involved incorrect post hoc t-tests (56.4%), followed by inappropriate parametric statistics (analysis of variance and t-test; 37.6%). Repeated Measures analysis was inappropriately missing in 52.0% of all articles and, among those with behavioral assessments, 58% were analyzed incorrectly. Reanalysis of our published data using the most common inappropriate statistical procedures resulted in a 14.1% average increase in significant effects compared to the original results. Specifically, an increase of 15.5% occurred with Independent t-tests and 11.1% after incorrect post hoc t-tests. Utilizing proper statistical procedures can allow more-definitive conclusions, facilitate replicability of research results, and enable more accurate translation of those results to the clinic.

On the relation between trust and fairness in environmental risk management.

PubMed

Earle, Timothy C; Siegrist, Michael

2008-10-01

In this study, we empirically examine the relations between trust, fairness, and cooperation within two environmental risk management contexts, one in which the focal issue is of high personal moral importance and the other in which the focal issue is of low moral importance. Using an experimental design embedded in two parallel survey questionnaires, one mailed to residents of Washington State, the other to German-speaking residents of Switzerland, we either manipulated or constructed three factors, issue importance (high/low), procedural fairness (fair/unfair), and policy outcome (risk averse/risk accepting). This design enabled us to compare the predictions of the standard account of procedural fairness, that trust and cooperation are determined by judgments of fairness, with the predictions of an alternative account, that trust and cooperation will be determined by judgments of procedural fairness only when the issue involved is not morally important. Results for the American case showed that under conditions of high issue importance, policy outcome affected judged fairness, trust, and cooperation. Under conditions of low issue importance, policy outcome had no effect on judged fairness or trust but did have a moderate impact on cooperation. Analyses also showed that when issue importance was high, procedural fairness had no effects. When issue importance was low, procedural fairness had moderate effects on judged fairness and trust. Results for the Swiss case replicated the main findings for the American case. Together, these results support the alternative model of the relation between trust and fairness, suggesting that the efficacy of fair procedures is strictly limited.

10 CFR 436.10 - Purpose.

Code of Federal Regulations, 2010 CFR

2010-01-01

... Cycle Cost Analyses § 436.10 Purpose. This subpart establishes a methodology and procedures for estimating and comparing the life cycle costs of Federal buildings, for determining the life cycle cost effectiveness of energy conservation measures and water conservation measures, and for rank ordering life cycle...

Neuroleptics and learning: effects of haloperidol, molindone, mesoridazine and thioridazine on the behavior of pigeons under a repeated acquisition procedure.

PubMed

Poling, A; Cleary, J; Berens, K; Thompson, T

1990-12-01

The purpose of the present study was to examine the effects of haloperidol (0.3-10 mg/kg), molindone (0.3-5.6 mg/kg), mesoridazine (0.3-10) and thioridazine (0.3-25 mg/kg) on the behavior of pigeons exposed to a repeated acquisition procedure. At sufficiently high doses, each of these neuroleptics increased error rates (interfered with learning) and reduced rate of responding. When the drugs were compared on the basis of absolute doses administered, haloperidol disrupted behavior at doses considerably lower than the other drugs. If, however, chlorpromazine equivalent doses were examined, haloperidol was the least disruptive of the four drugs. Comparing the degree of behavioral disruption produced by the four drugs with their relative neuroreceptor affinities for dopamine D-2, cholinergic muscarinic, histamine H1, alpha-1 adrenergic and alpha-2 adrenergic receptors suggests that behavioral disruption cannot be attributed in any simple way to dopamine or acetylcholine receptor blockade. The relationship between the behavioral effects of neuroleptics and their simple neuropharmacological actions must be considered as highly tentative.

Hard ceramic coatings: an experimental study on a novel damping treatment

NASA Astrophysics Data System (ADS)

Patsias, Sophoclis; Tassini, Nicola; Stanway, Roger

2004-07-01

This paper describes a novel damping treatment, namely hard ceramic coatings. These materials can be applied on almost any surface (internal or external) of a component. Their effect is the significant reduction of vibration levels and hence the extension of life expectancy of the component. The damping features of air-plasma-sprayed ceramic coatings (for example amplitude dependence, influence of initial amplitude) are discussed and the experimental procedure employed for testing and characterising such materials is also described. This test procedure is based around a custom-developed rig that allows one to measure the damping (internal friction) of specimens at controlled frequencies, strain amplitudes and, if required, various temperatures. A commonly used Thermal Barrier Coating, Yttria Stabilised Zirconia (8%), is used to demonstrate the above mentioned features. The damping effectiveness of this coating is then compared against two established damping treatments: polymer Free Layer Damping (FLD) and Constrained Layer Damping (CLD). The paper discusses the major issues in characterising ceramic damping coatings and their damping effectiveness when compared against the "traditional" approaches. Finally, the paper concludes with suggestions for further research.

Role of diode lasers in oro-facial pain management.

PubMed

Javed, F; Kellesarian, S V; Romanos, G E

2017-01-01

With the increasing use of low level laser therapy (LLLT) in clinical dentistry, the aim of the present study was to assess the effectiveness of diode lasers in the management of orofacial pain. Indexed databases were searched without language and time restrictions up to and including July 2016 using different combinations of the following key words: oral, low level laser therapy, dental, pain, diode lasers, discomfort and analgesia. From the literature reviewed it is evident that LLLT is effective compared to traditional procedures in the management of oro-facial pain associated to soft tissue and hard tissue conditions such as premalignant lesions, gingival conditions and dental extractions. However, it remains to be determined which particular wavelength will produce the more favorable and predictable outcome in terms of pain reduction. It is highly recommended that further randomized control trials with well-defined control groups should be performed to determine the precise wavelengths of the diode lasers for the management of oro-facial pain. Within the limits of the present review, it is concluded that diode lasers therapy is more effective in the management of oro-facial pain compared to traditional procedures.

Surgical strategies in the treatment of chronic pancreatitis: An updated systematic review and meta-analysis of randomized controlled trials.

PubMed

Zhao, Xin; Cui, Naiqiang; Wang, Ximo; Cui, Yunfeng

2017-03-01

Chronic pancreatitis (CP) is a common and frequently occurring disease. Pancreaticoduodenectomy (PD), pylorus-preserving pancreaticoduodenectomy (PPPD), and duodenum-preserving pancreatic head resection (DPPHR) are important treatment options for patients with chronic pancreatitis. The Beger and Frey procedures are 2 main duodenum-preserving techniques in duodenum-preserving pancreatic head resection (DPPHR) strategies. We conducted this systematic review and meta-analysis to compare the clinical efficacy of DPPHR versus PD, the Beger procedure versus PD, the Frey procedure versus PD, and the Beger procedure versus the Frey procedure in the treatment of pancreatitis. The optimal surgical option for chronic pancreatitis is still under debate. The aim of this systematic review and meta-analysis was to evaluate the clinical efficacy of different surgical strategies for chronic pancreatitis. Five databases (PubMed, Medline, SinoMed, Embase, and Cochrane Library) were searched with the limitations of human subjects and randomized controlled trials (RCTs) text. Data were extracted by 2 of the coauthors independently and analyzed using the RevMan statistical software, version 5.3. Weighted mean differences (WMDs), risk ratios (RRs), and 95% confidence intervals (CIs) were calculated. Cochrane Collaboration's Risk of Bias Tool was used to assess the risk of bias. Seven studies involving a total of 385 patients who underwent the surgical treatments were assessed. The methodological quality of the trials ranged from low to moderate and included PD (n = 134) and DPPHR (n = 251 [Beger procedure = 100; Frey procedure = 109; Beger or Frey procedure = 42]). There were no significant differences between DPPHR and PD in post-operation mortality (RR = 2.89, 95% CI = 0.31-26.87, P = 0.36), pain relief (RR = 1.09, 95% CI = 0.94-1.25, P = 0.26), exocrine insufficiency (follow-up time > 60 months: RR = 0.91, 95% CI = 0.72-1.15, P = 0.41), and endocrine insufficiency (RR = 0.75, 95% CI = 0.52-1.08, P = 0.12). Concerning the follow-up time < 60 months, the DPPHR group had better results of exocrine insufficiency (RR = 0.22, 95% CI = 0.08-0.62, P = 0.04). However, operation time (P < 0.0001), blood transfusion (P = 0.02), hospital stay (P = 0.0002), postoperation morbidity (P = 0.0007), weight gain (P < 0.00001), quality of life (P = 0.01), and occupational rehabilitation (P = 0.007) were significantly better for patients who underwent the DPPHR procedure compared with the PD procedure. The comparison results of the Frey procedure and PD showed that both procedures had an equal effect in the pain relief, postoperation mortality, exocrine and endocrine function, and quality of life (QoL) (P > 0.05), whereas patients who underwent the Frey procedure had significantly reduced operative times (P < 0.05) and less blood transfusions (P < 0.05). Comparing the Beger procedure to the PD procedure, there were no significant differences in hospital stay, blood transfusion, postoperation morbidity or mortality, pain relief, weight gain, exocrine insufficiency, and occupational rehabilitation (P > 0.05). Two studies comparing the Beger and Frey procedures showed no differences in postoperative morbidity, pain relief, exocrine insufficiency, and quality of life (P > 0.05). In terms of operative time, blood transfusion, hospital stay, postoperation morbidity, weight gain, quality of life, and occupational rehabilitation, the results also favored duodenum-preserving pancreatic head resection (DPPHR) strategies. All procedures are equally effective for the management of pain, postoperation morbidity, exocrine insufficiency, and endocrine insufficiency for chronic pancreatitis. Improved short- and long-term outcomes, including operative time, blood transfusion, hospital stay, quality of life, weight gain, and occupational rehabilitation make DPPHR a more favorable surgical strategy for patients with chronic pancreatitis. Further, relevant trails are eager to prove these findings.

A comparison of case volumes among urologic surgeons identified on an industry-sponsored website to an all provider peer group.

PubMed

See, William A; Jacobson, Kenneth; Derus, Sue; Langenstroer, Peter

2014-11-01

Industry-sponsored websites for robotic surgery direct to surgeons listed as performing specific robotic surgical procedures. The purpose of this study was to compare average annual, surgeon-specific, case volumes for those procedures for which they were listed as performing on the commercial website with the volumes of all providers performing these same procedures across a defined geographic region. A list of providers within the state of Wisconsin cited as performing specific urologic procedures was obtained through the Intuitive Surgical website 〈http://www.davincisurgery.com/da-vinci-urology/〉. Surgeon-specific annual case volumes from 2009 to 2013 for these same cases were obtained for all Wisconsin providers through DataBay Resources (Warrendale, PA) based on International classification of diseases-9 codes. Procedural activity was rank ordered, and surgeons were placed in "volume deciles" derived from the total annual number of cases performed by all surgeons. The distribution of commercially listed surgeon volumes, both 5-year average and most recent year, was compared with the average and 2013 volumes of all surgeons performing a specific procedure. A total of 35 individual urologic surgeons listed as performing robotic surgery in Wisconsin were identified through a "search" using the Intuitive Surgical website. Specific procedure analysis returned 5, 12, 9, and 15 surgeon names for cystectomy, partial nephrectomy, radical nephrectomy, and prostatectomy, respectively. This compared with the total number of surgeons who had performed the listed procedure in Wisconsin at least 1 time during the prior 5 years of 123, 153, 242, and 165, respectively. When distributed by surgeon-volume deciles, surgeons listed on industry-sponsored sites varied widely in their respective volume decile. More than half of site-listed, procedure-specific surgeons fell below the fifth decile for surgeon volume. Data analysis based solely on 2013 case volumes had no effect on the number of website-listed surgeons whose volumes fell below the fifth decile. Surgeons listed on an industry-sponsored website demonstrate wide variation in the actual volume of specific procedures performed. The inferred endorsement of competence by commercial sites has the potential to mislead patients seeking surgical expertise. Providers should consider the ethical and legal implications of these commercial advertising that do not have volume or outcome data. Published by Elsevier Inc.

Valuing Equal Protection in Aviation Security Screening.

PubMed

Nguyen, Kenneth D; Rosoff, Heather; John, Richard S

2017-12-01

The growing number of anti-terrorism policies has elevated public concerns about discrimination. Within the context of airport security screening, the current study examines how American travelers value the principle of equal protection by quantifying the "equity premium" that they are willing to sacrifice to avoid screening procedures that result in differential treatments. In addition, we applied the notion of procedural justice to explore the effect of alternative selective screening procedures on the value of equal protection. Two-hundred and twenty-two respondents were randomly assigned to one of three selective screening procedures: (1) randomly, (2) using behavioral indicators, or (3) based on demographic characteristics. They were asked to choose between airlines using either an equal or a discriminatory screening procedure. While the former requires all passengers to be screened in the same manner, the latter mandates all passengers undergo a quick primary screening and, in addition, some passengers are selected for a secondary screening based on a predetermined selection criterion. Equity premiums were quantified in terms of monetary cost, wait time, convenience, and safety compromise. Results show that equity premiums varied greatly across respondents, with many indicating little willingness to sacrifice to avoid inequitable screening, and a smaller minority willing to sacrifice anything to avoid the discriminatory screening. The selective screening manipulation was effective in that equity premiums were greater under selection by demographic characteristics compared to the other two procedures. © 2017 Society for Risk Analysis.

Age-related changes in the cerebral substrates of cognitive procedural learning.

PubMed

Hubert, Valérie; Beaunieux, Hélène; Chételat, Gaël; Platel, Hervé; Landeau, Brigitte; Viader, Fausto; Desgranges, Béatrice; Eustache, Francis

2009-04-01

Cognitive procedural learning occurs in three qualitatively different phases (cognitive, associative, and autonomous). At the beginning of this process, numerous cognitive functions are involved, subtended by distinct brain structures such as the prefrontal and parietal cortex and the cerebellum. As the learning progresses, these cognitive components are gradually replaced by psychomotor abilities, reflected by the increasing involvement of the cerebellum, thalamus, and occipital regions. In elderly subjects, although cognitive studies have revealed a learning effect, performance levels differ during the acquisition of a procedure. The effects of age on the learning of a cognitive procedure have not yet been examined using functional imaging. The aim of this study was therefore to characterize the cerebral substrates involved in the learning of a cognitive procedure, comparing a group of older subjects with young controls. For this purpose, we performed a positron emission tomography activation study using the Tower of Toronto task. A direct comparison of the two groups revealed the involvement of a similar network of brain regions at the beginning of learning (cognitive phase). However, the engagement of frontal and cingulate regions persisted in the older group as learning continued, whereas it ceased in the younger controls. We assume that this additional activation in the older group during the associative and autonomous phases reflected compensatory processes and the fact that some older subjects failed to fully automate the procedure. 2008 Wiley-Liss, Inc.

Interventions for preventing and treating incontinence-associated dermatitis in adults.

PubMed

Beeckman, Dimitri; Van Damme, Nele; Schoonhoven, Lisette; Van Lancker, Aurélie; Kottner, Jan; Beele, Hilde; Gray, Mikel; Woodward, Sue; Fader, Mandy; Van den Bussche, Karen; Van Hecke, Ann; De Meyer, Dorien; Verhaeghe, Sofie

2016-11-10

Incontinence-associated dermatitis (IAD) is one of the most common skin problems in adults who are incontinent for urine, stool, or both. In practice, products and procedures are the same for both prevention and treatment of IAD. The objective of this review was to assess the effectiveness of various products and procedures to preventand treat incontinence-associated dermatitis in adults. We searched the Cochrane Incontinence Group Specialised Trials Register, which contains trials identified from the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, MEDLINE In-Process, MEDLINE Epub Ahead of Print, CINAHL, ClinicalTrials.gov, WHO ICTRP and handsearching of journals and conference proceedings (searched 28 September 2016). Additionally we searched other electronic databases: CENTRAL(2015, Issue 4), MEDLINE (January 1946 to May Week 3 2015), MEDLINE In-Process (inception to 26 May 2015), CINAHL(December 1981 to 28 May 2015), Web of Science (WoS; inception to 28 May 2015) and handsearched conference proceedings (to June 2015) and the reference lists of relevant articles, and contacted authors and experts in the field. We selected randomised controlled trials (RCTs) and quasi-RCTs, performed in any healthcare setting, with included participants over 18 years of age, with or without IAD. We included trials comparing the (cost) effectiveness of topical skin care products such as skin cleansers, moisturisers, and skin protectants of different compositions and skin care procedures aiming to prevent and treat IAD. Two review authors independently screened titles, abstracts and full-texts, extracted data, and assessed the risk of bias of the included trials. We included 13 trials with 1295 participants in a qualitative synthesis. Participants were incontinent for urine, stool, or both, and were residents in a nursing home or were hospitalised.Eleven trials had a small sample size and short follow-up periods. .The overall risk of bias in the included studies was high. The data were not suitable for meta-analysis due to heterogeneity in participant population, skin care products, skin care procedures, outcomes, and measurement tools.Nine trials compared different topical skin care products, including a combination of products. Two trials tested a structured skin care procedure. One trial compared topical skin care products alongside frequencies of application. One trial compared frequencies of application of topical skin care products.We found evidence in two trials, being of low and moderate quality, that soap and water performed poorly in the prevention and treatment of IAD (primary outcomes of this review). The first trial indicated that the use of a skin cleanser might be more effective than the use of soap and water (risk ratio (RR) 0.39, 95% confidence interval (CI) 0.17 to 0.87; low quality evidence). The second trial indicated that a structured skin care procedure, being a washcloth with cleansing, moisturising, and protecting properties, might be more effective than soap and water (RR 0.31, 95% CI 0.12 to 0.79; moderate quality evidence). Findings from the other trials, all being of low to very low quality, suggest that applying a leave-on product (moisturiser, skin protectant, or a combination) might be more effective than not applying a leave-on product. No trial reported on the third primary outcome 'number of participants not satisfied with treatment' or on adverse effects. Little evidence, of very low to moderate quality, exists on the effects of interventions for preventing and treating IAD in adults. Soap and water performed poorly in the prevention and treatment of IAD. Application of leave-on products (moisturisers, skin protectants, or a combination) and avoiding soap seems to be more effective than withholding these products. The performance of leave-on products depends on the combination of ingredients, the overall formulation and the usage (e.g. amount applied). High quality confirmatory trials using standardised, and comparable prevention and treatment regimens in different settings/regions are required. Furthermore, to increase the comparability of trial results, we recommend the development of a core outcome set, including validated measurement tools. The evidence in this review is current up to 28 September 2016.

Cost-effectiveness of unicondylar versus total knee arthroplasty: a Markov model analysis.

PubMed

Peersman, Geert; Jak, Wouter; Vandenlangenbergh, Tom; Jans, Christophe; Cartier, Philippe; Fennema, Peter

2014-01-01

Unicondylar knee arthroplasty (UKA) is believed to lead to less morbidity and enhanced functional outcomes when compared with total knee arthroplasty (TKA). Conversely, UKA is also associated with a higher revision risk than TKA. In order to further clarify the key differences between these separate procedures, the current study assessing the cost-effectiveness of UKA versus TKA was undertaken. A state-transition Markov model was developed to compare the cost-effectiveness of UKA versus TKA for unicondylar osteoarthritis using a Belgian payer's perspective. The model was designed to include the possibility of two revision procedures. Model estimates were obtained through literature review and revision rates were based on registry data. Threshold analysis and probabilistic sensitivity analysis were performed to assess the model's robustness. UKA was associated with a cost reduction of €2,807 and a utility gain of 0.04 quality-adjusted life years in comparison with TKA. Analysis determined that the model is sensitive to clinical effectiveness, and that a marginal reduction in the clinical performance of UKA would lead to TKA being the more cost-effective solution. UKA yields clear advantages in terms of costs and marginal advantages in terms of health effects, in comparison with TKA. © 2014 Elsevier B.V. All rights reserved.

Affective associative learning modifies the sensory perception of nociceptive stimuli without participant's awareness.

PubMed

Wunsch, Annabel; Philippot, Pierre; Plaghki, Léon

2003-03-01

The present experiment examined the possibility to change the sensory and/or the affective perception of thermal stimuli by an emotional associative learning procedure known to operate without participants' awareness (evaluative conditioning). In a mixed design, an aversive conditioning procedure was compared between subjects to an appetitive conditioning procedure. Both groups were also compared within-subject to a control condition (neutral conditioning). The aversive conditioning was induced by associating non-painful and painful thermal stimuli - delivered on the right forearm - with unpleasant slides. The appetitive conditioning consisted in an association between thermal stimuli - also delivered on the right forearm - and pleasant slides. The control condition consisted in an association between thermal stimuli - delivered for all participants on the left forearm - and neutral slides. The effects of the conditioning procedures on the sensory and affective dimensions were evaluated with visual analogue scale (VAS)-intensity and VAS-unpleasantness. Startle reflex was used as a physiological index of emotional valence disposition. Results confirmed that no participants were aware of the conditioning procedure. After unpleasant slides (aversive conditioning), non-painful and painful thermal stimuli were judged more intense and more unpleasant than when preceded by neutral slides (control condition) or pleasant slides (appetitive conditioning). Despite a strong correlation between the intensity and the unpleasantness scales, effects were weaker for the affective scale and, became statistically non-significant when VAS-intensity was used as covariate. This experiment shows that it is possible to modify the perception of intensity of thermal stimuli by a non-conscious learning procedure based on the transfer of the valence of the unconditioned stimuli (pleasant or unpleasant slides) towards the conditioned stimuli (non-painful and painful thermal stimuli). These results plead for a conception of pain as a conscious output of complex informational processes all of which are not accessible to participants' awareness. Mechanisms by which affective input may influence sensory experience and clinical implications of the present study are discussed.

Non invasive evaluation of cardiomechanics in patients undergoing MitrClip procedure

PubMed Central

2013-01-01

Background In the last recent years a new percutaneous procedure, the MitraClip, has been validated for the treatment of mitral regurgitation. MitraClip procedure is a promising alternative for patients unsuitable for surgery as it reduces the risk of death related to surgery ensuring a similar result. Few data are present in literature about the variation of hemodynamic parameters and ventricular coupling after Mitraclip implantation. Methods Hemodynamic data of 18 patients enrolled for MitraClip procedure were retrospectively reviewed and analyzed. Echocardiographic measurements were obtained the day before the procedure (T0) and 21 ± 3 days after the procedure (T1), including evaluation of Ejection Fraction, mitral valve regurgitation severity and mechanism, forward Stroke Volume, left atrial volume, estimated systolic pulmonary pressure, non invasive echocardiographic estimation of single beat ventricular elastance (Es(sb)), arterial elastance (Ea) measured as systolic pressure • 0.9/ Stroke Volume, ventricular arterial coupling (Ea/Es(sb) ratio). Data were expressed as median and interquartile range. Measures obtained before and after the procedure were compared using Wilcoxon non parametric test for paired samples. Results Mitraclip procedure was effective in reducing regurgitation. We observed an amelioration of echocardiographic parameters with a reduction of estimated systolic pulmonary pressure (45 to 37,5 p = 0,0002) and left atrial volume (110 to 93 p = 0,0001). Despite a few cases decreasing in ejection fraction (37 to 35 p = 0,035), the maintained ventricular arterial coupling after the procedure (P = 0,67) was associated with an increasing in forward stroke volume (60,3 to 78 p = 0,05). Conclusion MitraClip is effective in reducing mitral valve regurgitation and determines an amelioration of hemodynamic parameters with preservation of ventricular arterial coupling. PMID:23642140

Bone implant sockets made using three different procedures: a stability study in dogs

PubMed Central

Campo, Julián

2012-01-01

Objective: This study compared the effects of three different methods of preparing bone implant sockets (drilling, osteotomes, and piezoelectric device) on osseointegration using resonance frequency analysis (RFA). Study Design: An experimental prospective study was designed. Material and Methods: Ten adult beagle dogs were studied. After 5 weeks, 23 out of 28 initially placed implants in the iliac crest were evaluated, comparing these three different procedures of bone implant socket. Student’s t-test (paired, two-tailed) was used to reveal differences among the three groups at each time point (SPSS 16.0, IL, USA). Results: After a 5-week healing period, the implants placed in sockets that were made using an osteotome or piezoelectric device were slightly more stable than those made by drilling. Reduced mechanical and heat injury to the bone is beneficial for maintaining and improving stability during the critical early healing period. Conclusion: Using RFA, there was evidence of a slight increase in implant stability in the iliac crest after 5 weeks of healing when the implant socket was made using a piezoelectric device or expansion procedure as compare with the drilling method. Key words:Bone implant sockets, drilling, osteotomes, piezoelectric, resonance frequency analysis, stability. PMID:24558558

Is minimal access spine surgery more cost-effective than conventional spine surgery?

PubMed

Lubelski, Daniel; Mihalovich, Kathryn E; Skelly, Andrea C; Fehlings, Michael G; Harrop, James S; Mummaneni, Praveen V; Wang, Michael Y; Steinmetz, Michael P

2014-10-15

Systematic review. To summarize and critically review the economic literature evaluating the cost-effectiveness of minimal access surgery (MAS) compared with conventional open procedures for the cervical and lumbar spine. MAS techniques may improve perioperative parameters (length of hospital stay and extent of blood loss) compared with conventional open approaches. However, some have questioned the clinical efficacy of these differences and the associated cost-effectiveness implications. When considering the long-term outcomes, there seem to be no significant differences between MAS and open surgery. PubMed, EMBASE, the Cochrane Collaboration database, University of York, Centre for Reviews and Dissemination (NHS-EED and HTA), and the Tufts CEA Registry were reviewed to identify full economic studies comparing MAS with open techniques prior to December 24, 2013, based on the key questions established a priori. Only economic studies that evaluated and synthesized the costs and consequences of MAS compared with conventional open procedures (i.e., cost-minimization, cost-benefit, cost-effectiveness, or cost-utility) were considered for inclusion. Full text of the articles meeting inclusion criteria were reviewed by 2 independent investigators to obtain the final collection of included studies. The Quality of Health Economic Studies instrument was scored by 2 independent reviewers to provide an initial basis for critical appraisal of included economic studies. The search strategy yielded 198 potentially relevant citations, and 6 studies met the inclusion criteria, evaluating the costs and consequences of MAS versus conventional open procedures performed for the lumbar spine; no studies for the cervical spine met the inclusion criteria. Studies compared MAS tubular discectomy with conventional microdiscectomy, minimal access transforaminal lumbar interbody fusion versus open transforaminal lumbar interbody fusion, and multilevel hemilaminectomy via MAS versus open approach. Overall, the included cost-effectiveness studies generally supported no significant differences between open surgery and MAS lumbar approaches. However, these conclusions are preliminary because there was a paucity of high-quality evidence. Much of the evidence lacked details on methodology for modeling, related assumptions, justification of economic model chosen, and sources and types of included costs and consequences. The follow-up periods were highly variable, indirect costs were not frequently analyzed or reported, and many of the studies were conducted by a single group, thereby limiting generalizability. Prospective studies are needed to define differences and optimal treatment algorithms. 3.

Improving conceptual and procedural knowledge: The impact of instructional content within a mathematics lesson.

PubMed

Rittle-Johnson, Bethany; Fyfe, Emily R; Loehr, Abbey M

2016-12-01

Students, parents, teachers, and theorists often advocate for direct instruction on both concepts and procedures, but some theorists suggest that including instruction on procedures in combination with concepts may limit learning opportunities and student understanding. This study evaluated the effect of instruction on a math concept and procedure within the same lesson relative to a comparable amount of instruction on the concept alone. Direct instruction was provided before or after solving problems to evaluate whether the type of instruction interacted with the timing of instruction within a lesson. We worked with 180 second-grade children in the United States. In a randomized experiment, children received a classroom lesson on mathematical equivalence in one of four conditions that varied in instruction type (conceptual or combined conceptual and procedural) and in instruction order (instruction before or after solving problems). Children who received two iterations of conceptual instruction had better retention of conceptual and procedural knowledge than children who received both conceptual and procedural instruction in the same lesson. Order of instruction did not impact outcomes. Findings suggest that within a single lesson, spending more time on conceptual instruction may be more beneficial than time spent teaching a procedure when the goal is to promote more robust understanding of target concepts and procedures. © 2016 The British Psychological Society.

Systematic review of operative outcomes of robotic surgical procedures performed with endoscopic linear staplers or robotic staplers.

PubMed

Gutierrez, Mario; Ditto, Richard; Roy, Sanjoy

2018-05-09

A comprehensive review of operative outcomes of robotic surgical procedures performed with the da Vinci robotic system using either endoscopic linear staplers (ELS) or robotic staplers is not available in the published literature. We conducted a literature search to identify publications of robotic surgical procedures in all specialties performed with either ELS or robotic staplers. Twenty-nine manuscripts and six abstracts with relevant information on operative outcomes published from January 2011 to September 2017 were identified. Given the relatively recent market release of robotic staplers in 2014, comparative perioperative clinical outcomes data on the performance of ELS vs. robotic staplers in robotic surgery is very sparse in the published literature. Only three comparative studies of surgeries with the da Vinci robotic system plus ELS vs. da Vinci plus robotic staplers were identified; two in robotic colorectal surgery and the other in robotic gastric bypass surgery. These comparative studies illustrate some nuances in device design and usability, which may impact outcomes and cost, and therefore may be important to consider when selecting the appropriate stapling technologies/technique for different robotic surgeries. Comparative perioperative data on the use of ELS vs. robotic staplers in robotic surgery is scarce (three studies), and current literature identifies both types of devices as safe and effective. Given the longer clinical history of ELS and its relatively more robust evidence base, there may be trade-offs to consider before switching to robotic staplers in certain robotic procedures. However, this literature review may serve as an initial reference for future research.

Differential Effects of Activity-Oriented vs. Textbook-Oriented Mathematics Instruction for Elementary School Children with Learning and Behavior Problems. Monograph No. 4.

ERIC Educational Resources Information Center

Dunlap, William; And Others

Compared were the effects of two experimental arithmetic treatments, called Laboratory and Textbook, upon achievement and attitude development of fourth grade children. Prior to the study, the experimenter employed task analysis procedures to develop hierarchies of skills for the four operations on whole numbers. During the instructional phase of…

Differential Effects of a Food-Based Conditioned Inhibitor on Food- or Cocaine-Seeking Behavior

ERIC Educational Resources Information Center

Lombas, Andres S.; Kearns, David N.; Weiss, Stanley J.

2008-01-01

The present experiment compared the effects of a food-based conditioned inhibitor on food seeking vs. cocaine seeking behavior. In two groups of rats, the A+/AB- Pavlovian conditioned inhibition procedure was used to create a conditioned inhibitor for food. Then, for one group of rats (Food-Food Group), a click stimulus was established as an…

Procedures for the computation of unsteady transonic flows including viscous effects

NASA Technical Reports Server (NTRS)

Rizzetta, D. P.

1982-01-01

Modifications of the code LTRAN2, developed by Ballhaus and Goorjian, which account for viscous effects in the computation of planar unsteady transonic flows are presented. Two models are considered and their theoretical development and numerical implementation is discussed. Computational examples employing both models are compared with inviscid solutions and with experimental data. Use of the modified code is described.

The Effects of Certain and Uncertain Reinforcement Procedures on the Quiz Submission and Performance of College Students

ERIC Educational Resources Information Center

Berkovits, Shira Melody

2011-01-01

College instructors often provide homework so that their students can review class material; however some students do not take advantage of these review opportunities. This study compared the effects of a certain reward and a lottery reward on the quiz submission rates and accuracy of 112 college students. In Baseline, quizzes were for practice…

The Effects of Two Student Monitoring Procedures and Contingency Reinforcement on Three Task-Attending Behaviors.

ERIC Educational Resources Information Center

Rucker, Douglas; Feldman, David

The comparative effectiveness of two student monitoring and reinforcement strategies was assessed among primary school students. The 50 participating students met in a multi-purpose instructional center during one of two sessions for academic periods of 30 minutes, three times a week. Students were assigned to one of six study groups in the…

A Comparison of Grade Achievement of Students Using a Programmed Mathematics Text Versus Students Using a Traditional Mathematics Text.

ERIC Educational Resources Information Center

Raines, Roy H.

The effectiveness of a basic college mathematics course consisting of lecture-discussion classroom procedures and homework assignments from a traditional text was compared to the effectiveness of a course designed to combat low grade achievement and a high dropout rate by allowing for individual differences. The revised course consisted of…

Placebo studies and ritual theory: a comparative analysis of Navajo, acupuncture and biomedical healing

PubMed Central

Kaptchuk, Ted J.

2011-01-01

Using a comparative analysis of Navajo healing ceremonials, acupuncture and biomedical treatment, this essay examines placebo studies and ritual theory as mutually interpenetrating disciplines. Healing rituals create a receptive person susceptible to the influences of authoritative culturally sanctioned ‘powers’. The healer provides the sufferer with imaginative, emotional, sensory, moral and aesthetic input derived from the palpable symbols and procedures of the ritual process—in the process fusing the sufferer's idiosyncratic narrative unto a universal cultural mythos. Healing rituals involve a drama of evocation, enactment, embodiment and evaluation in a charged atmosphere of hope and uncertainty. Experimental research into placebo effects demonstrates that routine biomedical pharmacological and procedural interventions contain significant ritual dimensions. This research also suggests that ritual healing not only represents changes in affect, self-awareness and self-appraisal of behavioural capacities, but involves modulations of symptoms through neurobiological mechanisms. Recent scientific investigations into placebo acupuncture suggest several ways that observations from ritual studies can be verified experimentally. Placebo effects are often described as ‘non-specific’; the analysis presented here suggests that placebo effects are the ‘specific’ effects of healing rituals. PMID:21576142

Identifying reprioritization response shift in a stroke caregiver population: a comparison of missing data methods.

PubMed

Sajobi, Tolulope T; Lix, Lisa M; Singh, Gurbakhshash; Lowerison, Mark; Engbers, Jordan; Mayo, Nancy E

2015-03-01

Response shift (RS) is an important phenomenon that influences the assessment of longitudinal changes in health-related quality of life (HRQOL) studies. Given that RS effects are often small, missing data due to attrition or item non-response can contribute to failure to detect RS effects. Since missing data are often encountered in longitudinal HRQOL data, effective strategies to deal with missing data are important to consider. This study aims to compare different imputation methods on the detection of reprioritization RS in the HRQOL of caregivers of stroke survivors. Data were from a Canadian multi-center longitudinal study of caregivers of stroke survivors over a one-year period. The Stroke Impact Scale physical function score at baseline, with a cutoff of 75, was used to measure patient stroke severity for the reprioritization RS analysis. Mean imputation, likelihood-based expectation-maximization imputation, and multiple imputation methods were compared in test procedures based on changes in relative importance weights to detect RS in SF-36 domains over a 6-month period. Monte Carlo simulation methods were used to compare the statistical powers of relative importance test procedures for detecting RS in incomplete longitudinal data under different missing data mechanisms and imputation methods. Of the 409 caregivers, 15.9 and 31.3 % of them had missing data at baseline and 6 months, respectively. There were no statistically significant changes in relative importance weights on any of the domains when complete-case analysis was adopted. But statistical significant changes were detected on physical functioning and/or vitality domains when mean imputation or EM imputation was adopted. There were also statistically significant changes in relative importance weights for physical functioning, mental health, and vitality domains when multiple imputation method was adopted. Our simulations revealed that relative importance test procedures were least powerful under complete-case analysis method and most powerful when a mean imputation or multiple imputation method was adopted for missing data, regardless of the missing data mechanism and proportion of missing data. Test procedures based on relative importance measures are sensitive to the type and amount of missing data and imputation method. Relative importance test procedures based on mean imputation and multiple imputation are recommended for detecting RS in incomplete data.

Effect of lower limb muscle fatigue induced by high-level isometric contractions on postural maintenance and postural adjustments associated with bilateral forward-reach task.

PubMed

Yiou, E; Heugas, A M; Mezaour, M; Le Bozec, S

2009-01-01

This study tested the effect of lower limb muscle fatigue induced by series of high-level isometric contractions (IC) on postural adjustments and maintenance of erect posture. Subjects (N=7) displaced a bar (grasp-bar) forward with both hands at maximal velocity towards a target ("bilateral forward-reach" task, BFR), before and after a procedure designed to induce fatigue in dorsal leg muscles. This procedure included IC at 60% of maximum. Postural joint and grasp-bar motion, along with electrical activity of postural and focal muscles were recorded. Integrated electromyographical (EMG) activity per 20 ms period ranging from 400 ms before BFR onset (t0) to 400 ms after t0 was compared before and after the fatiguing procedure. This time-window included "anticipatory", "on-line" and "corrective" postural adjustments, i.e. those postural adjustments occurring before (APAs), during (OPAs) and after (CPAs) BFR, respectively. In contrast to the literature, results showed that the fatiguing procedure had no effect on muscle excitation or timing in any of the recorded postural muscles, regardless of APA, OPA or CPA-related time-window. Therefore, the postural drive did not change with fatigue. Furthermore, the peak-to-peak motion at postural joints did not change. Postural maintenance was therefore not additionally challenged. These results are in line with the hypothesis that the effect of fatigue on postural adjustments is dependent on the adequacy between fatigued motor units (MUs) and MUs recruited during the postural adjustments. Increasing IC intensity during the fatiguing procedure might therefore not necessarily exacerbate the effect of fatigue on postural control highlighted during lower level IC.

Effects of obesity surgery on non-insulin-dependent diabetes mellitus.

PubMed

Greenway, Scott E; Greenway, Frank L; Klein, Stanley

2002-10-01

Most individuals who have non-insulin-dependent diabetes mellitus are obese. The obese population has proved a frustrating entity regarding weight loss and diabetes control. Results of medical weight loss programs, medications, and behavior therapy have proved disappointing. Bariatric surgery is the most effective method of diabetes management and cure in the morbidly obese population. Surgical procedures to cause malabsorption provide a more dramatic effect on diabetes owing to the imparted bypass of the hormonally active foregut. Pertinent journal articles spanning the last 40 years, as well as textbooks. Bariatric surgical procedures have proven a much more successful method of weight loss and diabetes control in the obese population than conservative methods. These surgical procedures have proven safe with reported mortality rates of 0% to 1.5%. Bariatric operations may be divided based on the method of weight loss and effect on diabetes. The first category is restrictive and includes vertical banded gastroplasty and adjustable silicone gastric banding. These operations improve diabetes by decreasing food intake and body weight with a slowing of gastric emptying. The second category not only contains restrictive components but also elements of malabsorption. This category includes the Roux-en-Y gastric bypass and biliary-pancreatic diversion, which bypass the foregut. Although all of the surgical procedures for obesity offer improved weight loss and diabetes control compared with conservative methods, the Roux-en-Y gastric bypass and biliary-pancreatic diversion offer superior weight loss and resolution of diabetes. The more dramatic effect seen in the surgical procedures to cause malabsorption is likely secondary to the bypass of the foregut resulting in increased weight loss and elevation of the enteroglucagon level.

Effects of chlorhexidine preprocedural rinse on bacteremia in periodontal patients: a randomized clinical trial

PubMed Central

Balejo, Rodrigo Dalla Pria; Cortelli, José Roberto; Costa, Fernando Oliveira; Cyrino, Renata Magalhães; Aquino, Davi Romeiro; Cogo-Müller, Karina; Miranda, Taís Browne; Moura, Sara Porto; Cortelli, Sheila Cavalca

2017-01-01

Abstract Objective: Single dose of systemic antibiotics and short-term use of mouthwashes reduce bacteremia. However, the effects of a single dose of preprocedural rinse are still controversial. This study evaluated, in periodontally diseased patients, the effects of a pre-procedural mouth rinse on induced bacteremia. Material and Methods: Systemically healthy individuals with gingivitis (n=27) or periodontitis (n = 27) were randomly allocated through a sealed envelope system to: 0.12% chlorhexidine pre-procedural rinse (13 gingivitis and 13 periodontitis patients) or no rinse before dental scaling (14 gingivitis and 15 periodontitis patients). Periodontal probing depth, clinical attachment level, plaque, and gingival indices were measured and subgingival samples were collected. Blood samples were collected before dental scaling, 2 and 6 minutes after scaling. Total bacterial load and levels of P. gingivalis were determined in oral and blood samples by real-time polymerase chain reaction, while aerobic and anaerobic counts were determined by culture in blood samples. The primary outcome was the antimicrobial effect of the pre-procedural rinse. Data was compared by Mann-Whitney and Signal tests (p<0.05). Results: In all sampling times, polymerase chain reaction revealed higher blood bacterial levels than culture (p<0.0001), while gingivitis patients presented lower bacterial levels in blood than periodontitis patients (p<0.0001). Individuals who experienced bacteremia showed worse mean clinical attachment level (3.4 mm vs. 1.1 mm) and more subgingival bacteria (p<0.005). The pre-procedural rinse did not reduce induced bacteremia. Conclusions: Bacteremia was influenced by periodontal parameters. In periodontally diseased patients, pre-procedural rinsing showed a discrete effect on bacteremia control. PMID:29211279

LC-MS metabolic profiling of Arabidopsis thaliana plant leaves and cell cultures: optimization of pre-LC-MS procedure parameters.

PubMed

t'Kindt, Ruben; De Veylder, Lieven; Storme, Michael; Deforce, Dieter; Van Bocxlaer, Jan

2008-08-01

This study treats the optimization of methods for homogenizing Arabidopsis thaliana plant leaves as well as cell cultures, and extracting their metabolites for metabolomics analysis by conventional liquid chromatography electrospray ionization mass spectrometry (LC-ESI/MS). Absolute recovery, process efficiency and procedure repeatability have been compared between different pre-LC-MS homogenization/extraction procedures through the use of samples fortified before extraction with a range of representative metabolites. Hereby, the magnitude of the matrix effect observed in the ensuing LC-MS based metabolomics analysis was evaluated. Based on relative recovery and repeatability of key metabolites, comprehensiveness of extraction (number of m/z-retention time pairs) and clean-up potential of the approach (minimum matrix effects), the most appropriate sample pre-treatment was adopted. It combines liquid nitrogen homogenization for plant leaves with thermomixer based extraction using MeOH/H(2)O 80/20. As such, an efficient and highly reproducible LC-MS plant metabolomics set-up is achieved, as illustrated by the obtained results for both LC-MS (8.88%+/-5.16 versus 7.05%+/-4.45) and technical variability (12.53%+/-11.21 versus 9.31%+/-6.65) data in a comparative investigation of A. thaliana plant leaves and cell cultures, respectively.

The Effects of Clinical Hypnosis versus Neurolinguistic Programming (NLP) before External Cephalic Version (ECV): A Prospective Off-Centre Randomised, Double-Blind, Controlled Trial

PubMed Central

Reinhard, Joscha; Peiffer, Swati; Sänger, Nicole; Herrmann, Eva; Yuan, Juping; Louwen, Frank

2012-01-01

Objective. To examine the effects of clinical hypnosis versus NLP intervention on the success rate of ECV procedures in comparison to a control group. Methods. A prospective off-centre randomised trial of a clinical hypnosis intervention against NLP of women with a singleton breech fetus at or after 370/7 (259 days) weeks of gestation and normal amniotic fluid index. All 80 participants heard a 20-minute recorded intervention via head phones. Main outcome assessed was success rate of ECV. The intervention groups were compared with a control group with standard medical care alone (n = 122). Results. A total of 42 women, who received a hypnosis intervention prior to ECV, had a 40.5% (n = 17), successful ECV, whereas 38 women, who received NLP, had a 44.7% (n = 17) successful ECV (P > 0.05). The control group had similar patient characteristics compared to the intervention groups (P > 0.05). In the control group (n = 122) 27.3% (n = 33) had a statistically significant lower successful ECV procedure than NLP (P = 0.05) and hypnosis and NLP (P = 0.03). Conclusions. These findings suggest that prior clinical hypnosis and NLP have similar success rates of ECV procedures and are both superior to standard medical care alone. PMID:22778774

The Effects of Clinical Hypnosis versus Neurolinguistic Programming (NLP) before External Cephalic Version (ECV): A Prospective Off-Centre Randomised, Double-Blind, Controlled Trial.

PubMed

Reinhard, Joscha; Peiffer, Swati; Sänger, Nicole; Herrmann, Eva; Yuan, Juping; Louwen, Frank

2012-01-01

Objective. To examine the effects of clinical hypnosis versus NLP intervention on the success rate of ECV procedures in comparison to a control group. Methods. A prospective off-centre randomised trial of a clinical hypnosis intervention against NLP of women with a singleton breech fetus at or after 37(0/7) (259 days) weeks of gestation and normal amniotic fluid index. All 80 participants heard a 20-minute recorded intervention via head phones. Main outcome assessed was success rate of ECV. The intervention groups were compared with a control group with standard medical care alone (n = 122). Results. A total of 42 women, who received a hypnosis intervention prior to ECV, had a 40.5% (n = 17), successful ECV, whereas 38 women, who received NLP, had a 44.7% (n = 17) successful ECV (P > 0.05). The control group had similar patient characteristics compared to the intervention groups (P > 0.05). In the control group (n = 122) 27.3% (n = 33) had a statistically significant lower successful ECV procedure than NLP (P = 0.05) and hypnosis and NLP (P = 0.03). Conclusions. These findings suggest that prior clinical hypnosis and NLP have similar success rates of ECV procedures and are both superior to standard medical care alone.

The Effect of Intraoperative Sounds of Saw and Hammer on Psychological Condition in Patients with Total Knee Arthroplasty: Prospective Randomized Study

PubMed Central

Kömürcü, Erkam; Kaymaz, Burak; Gölge, Umut Hatay; Nusran, Gürdal; Göksel, Ferdi; Şahin, Hasan; Ömür, Dilek; Hancı, Volkan

2015-01-01

Purpose. Surgical procedures are likely to be stressful for patients and their families. Total knee arthroplasty (TKA) is a major surgical procedure used in the treatment of osteoarthritis. During this procedure the sounds of the saw and hammer may irritate the patient and adversely affect mood. The present study examines the effect of these intraoperative sounds during TKA on postoperative mood and anxiety, by comparing two different anesthetic procedures. Methods. A total of 40 patients who underwent TKA for grade IV gonarthrosis participated in the study. Patients were randomly divided into two groups: 20 patients in the general anesthesia group and 20 patients in the spinal anesthesia group. Mood and anxiety changes were evaluated using the Profile of Mood States (POMS) and State-Trait Anxiety Inventory (STAI) instruments, respectively. Results. The postoperative POMS value in the spinal anesthesia group was definitively higher than the general anesthesia group, though the difference in preoperative and postoperative POMS and STAI scores between the two groups was not significant. Conclusion. It would seem that sounds of hammer and saw have no evident negative effect on patient's mood. Regional anesthesia is advisable for TKA patients and appropriate sedation can be administered during the operation if needed. PMID:25793222

Comparative study of neurohormonal effects of low-energy laser acupuncture and traditional reflex therapy in the treatment of male hypofertility

NASA Astrophysics Data System (ADS)

Pupkova, Ludmila S.; Reznikov, Leonid L.; Bell, H.; Riazankin, V. P.

1995-05-01

Reflex therapy is one of numerous applications of low-energy laser radiation in medical treatment. The advantages of this therapy in comparison with traditional acupuncture include technical simplicity, absence of pain, and, as a consequence of the complete noninvasiveness of the procedure, the absence of risk of contracting AIDS or other infectious diseases. However, no definitive results have been published regarding the comparative effectiveness of the two approaches to reflex therapy. In view of the neurohumoral role in the curative effects of reflex therapy, we compared laser acupuncture and the traditional needle technique in relation to changes in the serum concentrations of the principal sexual and gonadotropic hormones in hypofertile men.

Comparison between intravenous paracetamol and fentanyl for intraoperative and postoperative pain relief in dilatation and evacuation: Prospective, randomized interventional trial.

PubMed

Ali, Muhammad Asghar; Shamim, Faisal; Chughtai, Shakaib

2015-01-01

Dilatation and Evacuation procedure involves pain, for which pain control measures need to be undertaken. The purpose of this study was to compare paracetamol with fentanyl for pain relief in dilatation and curettage procedures. Sixty female patients were randomly included during the period from March 1, 2012 to February 28, 2013. All patients had received oral midazolam 7.5 mg as a premedication 30 min before procedure in the ward. Group P had received intravenous (IV) paracetamol 15 mg/kg in the waiting area of the operating room 15 min before starting the procedure. Group F had received IV fentanyl 2 ug/kg/min at induction of anesthesia. Pain scores on a numerical rating scale at 5, 15, and 30 min intervals after surgery were recorded. Mild pain was commonly observed in both groups, an insignificant difference between groups. The study demonstrates the usefulness of IV paracetamol which may be as effective as fentanyl in dilation and curettage procedures.

Use of robotic-assisted laparoscopic Mitrofanoff appendicovesicostomy in a paediatric patient: problem encountered.

PubMed

Chan, Ivy H Y; Li, Florence H Q; Lan, Lawrence C L; Wong, Kenneth K Y; Yip, Peter K F; Tam, Paul K H

2015-10-01

This report is of robotic-assisted laparoscopic Mitrofanoff appendicovesicostomy in a 12-year-old patient with detrusor underactivity and hereditary sensory neuropathy. The whole operation was performed in 555 minutes with no open conversion. The patient experienced one episode of stomal stenosis, which required dilatation. At 3-year follow-up, the patient had both stomal and urinary continence. This is a safe and effective procedure to create a means of urinary catheterisation with avoidance of a large unsightly scar and comparable clinical outcome to an open procedure.

Staphylococcus Aureus Prevention Strategies in Cardiac Surgery: A Cost-Effectiveness Analysis.

PubMed

Hong, Jonathan C; Saraswat, Manoj K; Ellison, Trevor A; Magruder, J Trent; Crawford, Todd; Gardner, Julia M; Padula, William V; Whitman, Glenn J

2018-01-01

Cardiac surgery patients colonized with Staphylococcus aureus have a greater risk of surgical site infection (SSI). The purpose of this study was to evaluate the cost-effectiveness of decolonization strategies to prevent SSIs. We compared three decolonization strategies: universal decolonization (UD), all subjects treated; targeted decolonization (TD), only S aureus carriers treated; and no decolonization (ND). Decolonization included mupirocin, chlorhexidine, and vancomycin. We implemented a decision tree comparing the costs and quality-adjusted life-years (QALYs) of these strategies on SSI over a 1-year period for subjects undergoing coronary artery bypass graft surgery from a US health sector perspective. Deterministic and probabilistic sensitivity analyses were conducted to address the uncertainty in the variables. Universal decolonization was the dominant strategy because it resulted in reduced costs at near-equal QALYs compared with TD and ND. Compared with ND, UD decreased costs by $462 and increased QALYs by 0.002 per subject, whereas TD decreased costs by $205 and increased QALYs by 0.001 per subject. For 1,000 subjects, UD prevented 19 SSI and TD prevented 10 SSI compared with ND. Sensitivity analysis showed UD to be the most cost-effective strategy in more than 91% of simulations. For the 220,000 coronary artery bypass graft procedures performed yearly in the United States, UD would save $102 million whereas TD would save $45 million compared with ND. Universal decolonization outperforms other strategies. However, the potential costs savings of $57 million per 220,000 coronary artery bypass graft procedures comparing UD versus TD must be weighed against the potential risk of developing resistance associated with universal decolonization. Copyright © 2018 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

Electromagnetic navigation reduces surgical time and radiation exposure for proximal interlocking in retrograde femoral nailing.

PubMed

Somerson, Jeremy S; Rowley, David; Kennedy, Chad; Buttacavoli, Frank; Agarwal, Animesh

2014-07-01

To compare the time required for proximal locking screw placement between a standard freehand technique and the navigated technique, and to quantify the reduction in ionizing radiation exposure. A fresh frozen cadaver model was used for 48 proximal interlocking screw procedures. Each procedure consisted of insertion of 2 anteroposterior locking screws. Standard fluoroscopic technique was used for 24 procedures, and an electromagnetic navigation system was used for the remaining 24 procedures. Procedure duration was recorded using an electronic timer and radiation doses were documented. Mean total insertion time for both proximal interlocking screws was 405 ± 165.7 seconds with the freehand technique and 311 ± 78.3 seconds in the navigation group (P = 0.002). All procedures resulted in successful locking screw placement. Mean ionizing radiation exposure time for proximal locking was 29.5 ± 12.8 seconds. Proximal locking screw insertion using the navigation technique evaluated in this work was significantly faster than the standard fluoroscopic method. The navigated technique is effective and has the potential to prevent ionizing radiation exposure.

Frey's procedure for chronic pancreatitis improves the nutritional status of these patients.

PubMed

Sato, Hideaki; Ishida, Masaharu; Motoi, Fuyuhiko; Sakata, Naoaki; Aoki, Takeshi; Kudoh, Katsuyoshi; Ohtsuka, Hideo; Mizuma, Masamichi; Morikawa, Takanori; Hayashi, Hiroki; Nakagawa, Kei; Naitoh, Takeshi; Egawa, Shinich; Unno, Michiaki

2018-01-01

The aim of surgical intervention for chronic pancreatitis (CP) is to relieve symptoms and improve quality of life. However, the precise effect of surgery on the nutritional status of CP patients, which is often impaired by exocrine and endocrine pancreatic dysfunction, has not been elucidated. We conducted this study to evaluate whether Frey's procedure improves the nutritional status of CP patients. The nutritional status of 35 patients who underwent Frey's procedure for CP at our institute between April 2005 and December 2014, was assessed by the controlling nutritional status (CONUT) scoring before and 1 year after the surgery, and compared with that of seven CP patients who underwent pancreatoduodenectomy. The occurrence of postoperative hepatic steatosis was also monitored. The nutritional status improved after Frey's procedure, but not after pancreatoduodenectomy. The median postoperative CONUT score after Frey's procedure was significantly lower than the preoperative score (1.0 ± 0.5 vs. 4.0 ± 2.5; p < 0.001). Frey's procedure is superior to pancreatoduodenectomy for improving the nutritional status of CP patients.

From Laser Scanning to Finite Element Analysis of Complex Buildings by Using a Semi-Automatic Procedure.

PubMed

Castellazzi, Giovanni; D'Altri, Antonio Maria; Bitelli, Gabriele; Selvaggi, Ilenia; Lambertini, Alessandro

2015-07-28

In this paper, a new semi-automatic procedure to transform three-dimensional point clouds of complex objects to three-dimensional finite element models is presented and validated. The procedure conceives of the point cloud as a stacking of point sections. The complexity of the clouds is arbitrary, since the procedure is designed for terrestrial laser scanner surveys applied to buildings with irregular geometry, such as historical buildings. The procedure aims at solving the problems connected to the generation of finite element models of these complex structures by constructing a fine discretized geometry with a reduced amount of time and ready to be used with structural analysis. If the starting clouds represent the inner and outer surfaces of the structure, the resulting finite element model will accurately capture the whole three-dimensional structure, producing a complex solid made by voxel elements. A comparison analysis with a CAD-based model is carried out on a historical building damaged by a seismic event. The results indicate that the proposed procedure is effective and obtains comparable models in a shorter time, with an increased level of automation.

Reducing Pain and Anxiety during Second Trimester Genetic Amniocentesis Using Aromatic Therapy: A Randomized Trial.

PubMed

Hanprasertpong, Tharangrut; Kor-anantakul, Ounjai; Leetanaporn, Roengsak; Suwanrath, Chitkasaem; Suntharasaj, Thitima; Pruksanusak, Ninlapa; Pranpanus, Savitree

2015-08-01

To evaluate the benefit of aromatic therapy using menthol for decrease pain perception during amniocentesis. A prospective randomized study was conducted to compare pain level between groups ofpregnant women who underwent amniocentesis with and without aromatic therapy using menthol. Visual analogue scale (VAS) was usedfor pain assessment. The participants were askedfor their anticipated pain and anxiety level and level ofpain before and immediately after the procedure. Three hundred seventeen pregnant women were recruited into the present study, 158 in the menthol group and 159 in the non-menthol group. Mean VAS score of the post-procedure pain and anxiety did not differ significantly between the two groups. Mean VAS score of the anticipated pain influenced the mean VAS score of the pre-procedure anxiety and post-procedure pain and anxiety irrespective of the group. Mean VAS score of the pre-procedure anxiety and post-procedure pain and anxiety increased about 0.3 cm for each 1 cm of increasing mean VAS score of anticipated pain. Aromatic therapy using menthol was not significantly effective in reducing pain and anxiety during second trimester genetic amniocentesis.

Effects of delay and probability combinations on discounting in humans.

PubMed

Cox, David J; Dallery, Jesse

2016-10-01

To determine discount rates, researchers typically adjust the amount of an immediate or certain option relative to a delayed or uncertain option. Because this adjusting amount method can be relatively time consuming, researchers have developed more efficient procedures. One such procedure is a 5-trial adjusting delay procedure, which measures the delay at which an amount of money loses half of its value (e.g., $1000 is valued at $500 with a 10-year delay to its receipt). Experiment 1 (n=212) used 5-trial adjusting delay or probability tasks to measure delay discounting of losses, probabilistic gains, and probabilistic losses. Experiment 2 (n=98) assessed combined probabilistic and delayed alternatives. In both experiments, we compared results from 5-trial adjusting delay or probability tasks to traditional adjusting amount procedures. Results suggest both procedures produced similar rates of probability and delay discounting in six out of seven comparisons. A magnitude effect consistent with previous research was observed for probabilistic gains and losses, but not for delayed losses. Results also suggest that delay and probability interact to determine the value of money. Five-trial methods may allow researchers to assess discounting more efficiently as well as study more complex choice scenarios. Copyright © 2016 Elsevier B.V. All rights reserved.

An Optimal Bahadur-Efficient Method in Detection of Sparse Signals with Applications to Pathway Analysis in Sequencing Association Studies.

PubMed

Dai, Hongying; Wu, Guodong; Wu, Michael; Zhi, Degui

2016-01-01

Next-generation sequencing data pose a severe curse of dimensionality, complicating traditional "single marker-single trait" analysis. We propose a two-stage combined p-value method for pathway analysis. The first stage is at the gene level, where we integrate effects within a gene using the Sequence Kernel Association Test (SKAT). The second stage is at the pathway level, where we perform a correlated Lancaster procedure to detect joint effects from multiple genes within a pathway. We show that the Lancaster procedure is optimal in Bahadur efficiency among all combined p-value methods. The Bahadur efficiency,[Formula: see text], compares sample sizes among different statistical tests when signals become sparse in sequencing data, i.e. ε →0. The optimal Bahadur efficiency ensures that the Lancaster procedure asymptotically requires a minimal sample size to detect sparse signals ([Formula: see text]). The Lancaster procedure can also be applied to meta-analysis. Extensive empirical assessments of exome sequencing data show that the proposed method outperforms Gene Set Enrichment Analysis (GSEA). We applied the competitive Lancaster procedure to meta-analysis data generated by the Global Lipids Genetics Consortium to identify pathways significantly associated with high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, triglycerides, and total cholesterol.

JJ Stent Removal under Ultrasound Guidance in Women: It is Simple and Safe.

PubMed

Amer, Bernard; Gupta, Sandeep; Kanwar, Vijayendra S; Lodh, Bijit; Khumukcham, Somarendra; Akoijam, Kaku Singh

2014-12-01

With the increase in number of patients treated for urological problems with endoscopic procedures, the number of patients with JJ stent is also increasing. The amount of workload thus incurred multiplies, even to the point that, sometimes we waste more time in the operating room removing JJ stents than the actual endourological procedures. Here in our institute, we have devised a very simple and effective way of removing JJ stents in women and also determined the efficacy, safety and cost of JJ stent removal under ultrasound guidance in women in comparison to cystoscopic removal. Two hundred women attending the Department of Urology from July 2012 to July 2013 at RIMS hospital were randomly divided into two arms. One hundred women had their JJ stent removed with cystoscope and another 100 women had their JJ stent removed under ultrasound guidance using simple surgical tools available at the hospital. The primary comparative points were waiting time for operating room appointment date, cost of the procedure, time taken for the procedure, discomfort or pain felt by the patient and urethral injuries. In all the parameters, stent removal under ultrasound guidance was significantly better except for urethral injuries where both the procedures had similar outcomes. We concluded that JJ stent removal under ultrasound guidance in women was simple, effective and safe.

Carbon Dioxide Versus Air Insufflation for Elective Colonoscopy: A Meta-Analysis and Systematic Review of Randomized Controlled Trials.

PubMed

Memon, Muhammed A; Memon, Breda; Yunus, Rossita M; Khan, Shahjahan

2016-04-01

The aim of this study was to conduct a meta-analysis and systematic review of randomized controlled trials (RCTs) comparing 2 methods of colonic insufflation for elective colonoscopy, that is, carbon dioxide (CO2) or air, and to evaluate their efficiency, safety, and side effects. Prospective RCTs comparing CO2 versus air insufflation for colonic distension during colonoscopy were selected by searching PubMed, Medline, Embase, Science Citation Index, Current Contents, and the Cochrane Central Register of Controlled Trials published between January 1980 and October 2014. The outcome variables analyzed included procedural and immediate postprocedural pain (during, end, or within 15 min after procedure), early postprocedural pain (between 30 and 120 min), intermediate postprocedural pain (360 min) and late postprocedural pain (720 to 1140 min), cecal/ileal intubation rate, cecal/ileal intubation time, and total colonoscopy examination time. These outcomes were unanimously decided to be important as they influence the practical approach toward patient management within and outside of hospital. Random effects model was used to calculate the effect size of both binary and continuous data. Heterogeneity among the outcome variables of these trials was determined by the Cochran Q statistic and I2 index. The meta-analysis was prepared in accordance with PRISMA guidelines. Twenty-four RCTs totaling 3996 patients (CO2=2017, Air=1979) were analyzed. Statistically significant differences for the pooled effect size were observed for procedural and immediate postprocedural pain [weighted mean difference (WMD)=0.49; 95% confidence interval (CI), 0.32, 0.73; P=0.0005], early postprocedural pain between 30 and 120 minutes (WMD=0.25; 95% CI, 0.12, 0.49; P<0.0001), intermediate postprocedural pain, that is, 360 minutes after completion (WMD=0.35; 95% CI, 0.23, 0.52; P<0.0001), and late postprocedural pain between 720 and 1440 minutes (WMD=0.53; 95% CI, 0.34, 0.84; P=0.0061). Comparable effects were noted for cecal/ileal intubation rate (WMD=0.86; 95% CI, 0.61, 1.22; P=0.3975), cecal/ileal intubation time (WMD=-0.64; 95% CI, -1.38, 0.09; P=0.0860), and total examination time (WMD=-0.20; 95% CI, -0.96, 0.57; P=0.6133). On the basis of our meta-analysis and systematic review, we conclude that CO2 insufflation significantly reduces abdominal pain during and following the procedure lasting up to 24 hours. There is no difference in the cecal/ileal intubation rate and time and total examination time between the 2 methods. CO2 retention with CO2 insufflation during and after the colonoscopy shows inconsequential variation compared with air insufflation and has no adverse effect on patients. CO2 instead of air should be routinely utilized for colonoscopy.

Improved Survival After the Ross Procedure Compared With Mechanical Aortic Valve Replacement.

PubMed

Buratto, Edward; Shi, William Y; Wynne, Rochelle; Poh, Chin L; Larobina, Marco; O'Keefe, Michael; Goldblatt, John; Tatoulis, James; Skillington, Peter D

2018-03-27

It is unclear whether the Ross procedure offers superior survival compared with mechanical aortic valve replacement (AVR). This study evaluated experience and compared long-term survival between the Ross procedure and mechanical AVR. Between 1992 and 2016, a total of 392 Ross procedures were performed. These were compared with 1,928 isolated mechanical AVRs performed during the same time period as identified using the University of Melbourne and Australia and New Zealand Society of Cardiac and Thoracic Surgeons' Cardiac Surgery Databases. Only patients between 18 and 65 years of age were included. Propensity-score matching was performed for risk adjustment. Ross procedure patients were younger, and had fewer cardiovascular risk factors. The Ross procedure was associated with longer cardiopulmonary bypass and aortic cross-clamp times. Thirty-day mortality was similar (Ross, 0.3%; mechanical, 0.8%; p = 0.5). Ross procedure patients experienced superior unadjusted long-term survival at 20 years (Ross, 95%; mechanical, 68%; p < 0.001). Multivariable analysis showed the Ross procedure to be associated with a reduced risk of late mortality (hazard ratio: 0.34; 95% confidence internal: 0.17 to 0.67; p < 0.001). Among 275 propensity-score matched pairs, Ross procedure patients had superior survival at 20 years (Ross, 94%; mechanical, 84%; p = 0.018). In this Australian, propensity-score matched study, the Ross procedure was associated with better long-term survival compared with mechanical AVR. In younger patients, with a long life expectancy, the Ross procedure should be considered in centers with sufficient expertise. Crown Copyright © 2018. Published by Elsevier Inc. All rights reserved.

An Investigation of the Effect of Body Mass on Resting Heart Rate in Dogs.

ERIC Educational Resources Information Center

Woodhead, Vanessa; Reiss, Michael

1991-01-01

A student project that investigated the relationship between resting heart beat frequency and body mass of adult dogs is described. The results are compared to those of other mammals and birds. The procedure and results are included. (KR)

A comparative analysis of clinical outcomes and disposable costs of different catheter ablation methods for the treatment of atrioventricular nodal reentrant tachycardia.

PubMed

Berman, Adam E; Rivner, Harold; Chalkley, Robin; Heboyan, Vahé

2017-01-01

Catheter ablation of atrioventricular nodal reentrant tachycardia (AVNRT) is a commonly performed electrophysiology (EP) procedure. Few data exist comparing conventional (CONV) versus novel ablation strategies from both clinical and direct cost perspectives. We sought to investigate the disposable costs and clinical outcomes associated with three different ablation methodologies used in the ablation of AVNRT. We performed a retrospective review of AVNRT ablations performed at Augusta University Medical Center from 2006 to 2014. A total of 183 patients were identified. Three different ablation techniques were compared: CONV manual radiofrequency (RF) (n=60), remote magnetic navigation (RMN)-guided RF (n=67), and cryoablation (CRYO) (n=56). Baseline demographics did not differ between the three groups except for a higher prevalence of cardiomyopathy in the RMN group ( p <0.01). The clinical end point of interest was recurrent AVNRT following the index ablation procedure. A significantly higher number of recurrent AVNRT cases occurred in the CRYO group as compared to CONV and RMN ( p =0.003; OR =7.75) groups. Cost-benefit analysis showed both CONV and RMN to be dominant compared to CRYO. Cost-minimization analysis demonstrated the least expensive ablation method to be CONV (mean disposable catheter cost = CONV US$2340; CRYO US$3515; RMN US$5190). Despite comparable clinical outcomes, the incremental cost of RMN over CONV averaged US$3094 per procedure. AVNRT ablation using either CONV or RMN techniques is equally effective and associated with lower AVNRT recurrence rates than CRYO. CONV ablation carries significant disposable cost savings as compared to RMN, despite similar efficacy.

Effect of anxiety on cortical cerebral blood flow and metabolism

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

Gur, R.C.; Gur, R.E.; Resnick, S.M.

1987-04-01

The relation between anxiety and cortical activity was compared in two samples of normal volunteers. One group was studied with the noninvasive xenon-133 inhalation technique for measuring cerebral blood flow (CBF) and the other with positron emission tomography (PET) using /sup 18/Flurodeoxyglucose (/sup 18/FDG) for measuring cerebral metabolic rates (CMR) for glucose. The inhalation technique produced less anxiety than the PET procedure, and for low anxiety subjects, there was a linear increase in CBF with anxiety. For higher anxiety subjects, however, there was a linear decrease in CBF with increased anxiety. The PET group manifested a linear decrease in CMRmore » with increased anxiety. The results indicate that anxiety can have systematic effects on cortical activity, and this should be taken into consideration when comparing data from different procedures. They also suggest a physiologic explanation of a fundamental behavioral law that stipulates a curvilinear, inverted-U relationship between anxiety and performance.« less

Use of Avagard in pediatric urologic procedures.

PubMed

Palmer, Jeffrey S

2006-09-01

To evaluate the use of Avagard compared with a hand-brush scrub preparation by the urologist in preparation for inpatient and outpatient pediatric urologic operations. Avagard (chlorhexidine gluconate 1% solution and ethyl alcohol 61% wt/wt) is a waterless, brushless, and scrubless hand antiseptic indicated as a replacement for traditional preoperative brush hand scrubbing. We evaluated the first 550 patients for whom we used Avagard as a preoperative hand antiseptic and compared them with the last 550 consecutive patients for whom we performed traditional antiseptic-impregnated hand-brush scrubbing. All patients underwent pediatric urologic procedures. Patients were monitored postoperatively for signs of wound infection, and patients and the surgeon were monitored for side effects. A cost analysis was performed to compare the use of Avagard as a preoperative hand preparation with that of an antiseptic-impregnated hand-brush. The incidence of wound infection was one in the Avagard group and two in the hand-scrub group, not a statistically significant difference. All wound infections were successfully treated with a single course of oral antibiotics without any long-term sequelae. No side effects for the patients or surgeon were noted, including skin irritations or allergic reactions in either group. The use of Avagard was more time efficient and cost effective. To our knowledge, this is the first study demonstrating that Avagard is a fast, effective, easy to apply, and safe surgical hand preparation for pediatric urologic surgery. Its use is cost effective, as well as time efficient, in relation to the traditional surgical scrub.

Mediation Analysis with Survival Outcomes: Accelerated Failure Time vs. Proportional Hazards Models

PubMed Central

Gelfand, Lois A.; MacKinnon, David P.; DeRubeis, Robert J.; Baraldi, Amanda N.

2016-01-01

Objective: Survival time is an important type of outcome variable in treatment research. Currently, limited guidance is available regarding performing mediation analyses with survival outcomes, which generally do not have normally distributed errors, and contain unobserved (censored) events. We present considerations for choosing an approach, using a comparison of semi-parametric proportional hazards (PH) and fully parametric accelerated failure time (AFT) approaches for illustration. Method: We compare PH and AFT models and procedures in their integration into mediation models and review their ability to produce coefficients that estimate causal effects. Using simulation studies modeling Weibull-distributed survival times, we compare statistical properties of mediation analyses incorporating PH and AFT approaches (employing SAS procedures PHREG and LIFEREG, respectively) under varied data conditions, some including censoring. A simulated data set illustrates the findings. Results: AFT models integrate more easily than PH models into mediation models. Furthermore, mediation analyses incorporating LIFEREG produce coefficients that can estimate causal effects, and demonstrate superior statistical properties. Censoring introduces bias in the coefficient estimate representing the treatment effect on outcome—underestimation in LIFEREG, and overestimation in PHREG. With LIFEREG, this bias can be addressed using an alternative estimate obtained from combining other coefficients, whereas this is not possible with PHREG. Conclusions: When Weibull assumptions are not violated, there are compelling advantages to using LIFEREG over PHREG for mediation analyses involving survival-time outcomes. Irrespective of the procedures used, the interpretation of coefficients, effects of censoring on coefficient estimates, and statistical properties should be taken into account when reporting results. PMID:27065906

The impact of minimally invasive surgeries for the treatment of symptomatic benign prostatic hyperplasia on male sexual function: a systematic review.

PubMed

Frieben, Ryan W; Lin, Hao-Cheng; Hinh, Peter P; Berardinelli, Francesco; Canfield, Steven E; Wang, Run

2010-07-01

A systematic review of randomized controlled trials and cohort studies was conducted to evaluate data for the effects of minimally invasive procedures for treatment of symptomatic benign prostatic hyperplasia (BPH) on male sexual function. The studies searched were trials that enrolled men with symptomatic BPH who were treated with laser surgeries, transurethral microwave therapy (TUMT), transurethral needle ablation of the prostate (TUNA), transurethral ethanol ablation of the prostate (TEAP) and high-intensity frequency ultrasound (HIFU), in comparison with traditional transurethral resection of the prostate (TURP) or sham operations. A total of 72 studies were identified, of which 33 met the inclusion criteria. Of the 33 studies, 21 were concerned with laser surgeries, six with TUMT, four with TUNA and two with TEAP containing information regarding male sexual function. No study is available regarding the effect of HIFU for BPH on male sexual function. Our analysis shows that minimally invasive surgeries for BPH have comparable effects to those of TURP on male erectile function. Collectively, less than 15.4% or 15.2% of patients will have either decrease or increase, respectively, of erectile function after laser procedures, TUMT and TUNA. As observed with TURP, a high incidence of ejaculatory dysfunction (EjD) is common after treatment of BPH with holmium, potassium-titanyl-phosphate and thulium laser therapies (> 33.6%). TUMT, TUNA and neodymium:yttrium aluminum garnet visual laser ablation or interstitial laser coagulation for BPH has less incidence of EjD, but these procedures are considered less effective for BPH treatment when compared with TURP.

The impact of minimally invasive surgeries for the treatment of symptomatic benign prostatic hyperplasia on male sexual function: a systematic review

PubMed Central

Frieben, Ryan W.; Lin, Hao-Cheng; Hinh, Peter P.; Berardinelli, Francesco; Canfield, Steven E.; Wang, Run

2010-01-01

A systematic review of randomized controlled trials and cohort studies was conducted to evaluate data for the effects of minimally invasive procedures for treatment of symptomatic benign prostatic hyperplasia (BPH) on male sexual function. The studies searched were trials that enrolled men with symptomatic BPH who were treated with laser surgeries, transurethral microwave therapy (TUMT), transurethral needle ablation of the prostate (TUNA), transurethral ethanol ablation of the prostate (TEAP) and high-intensity frequency ultrasound (HIFU), in comparison with traditional transurethral resection of the prostate (TURP) or sham operations. A total of 72 studies were identified, of which 33 met the inclusion criteria. Of the 33 studies, 21 were concerned with laser surgeries, six with TUMT, four with TUNA and two with TEAP containing information regarding male sexual function. No study is available regarding the effect of HIFU for BPH on male sexual function. Our analysis shows that minimally invasive surgeries for BPH have comparable effects to those of TURP on male erectile function. Collectively, less than 15.4% or 15.2% of patients will have either decrease or increase, respectively, of erectile function after laser procedures, TUMT and TUNA. As observed with TURP, a high incidence of ejaculatory dysfunction (EjD) is common after treatment of BPH with holmium, potassium-titanyl-phosphate and thulium laser therapies (> 33.6%). TUMT, TUNA and neodymium:yttrium aluminum garnet visual laser ablation or interstitial laser coagulation for BPH has less incidence of EjD, but these procedures are considered less effective for BPH treatment when compared with TURP. PMID:20473318

[The most effective dosage in the administration of PGF2-alpha for interruption of pregnancy during the 2d trimester].

PubMed

Herczeg, J; Szontágh, F

1974-06-23

Artificial interruption of pregnancy contains too many risks from the 12th week of pregnancy. The authors have been working at finding the most suitable and effective dosage of prostaglandin for the interruption of pregnancy during the 2nd trimester. The new dosage experimented was 25 mg of prostaglandin F2alpha, followed by another 25 mg 6 hours later. The clinical efficiency of this dosage was tested. This procedures was used in 45 cases. The efficiency of the method was compared to the efficiency of the previously used dosage, which was 25 mg of prostaglandin F2alpha, followed by 25 mg 24 hours later. The new dosage was evaluated 91% efficient, while the previous dosage was found to be 75% efficient. The side effects were rated as acceptable by the patients. There was no case of infection. Two undeniable advantages were found with this new dosage: the duration of the actual procedure is considerably reduced, and the method appears to be much safer. The authors conclude that this new procedure offers numerous clinical advantages.

Mini-Craniotomy Under Local Anesthesia for Chronic Subdural Hematoma: An Effective Choice for Elderly Patients and for Patients in a Resource-Strained Environment.

PubMed

Mahmood, Shaikh Danish; Waqas, Muhammad; Baig, Mirza Zain; Darbar, Aneela

2017-10-01

Mini-craniotomy for chronic subdural hematoma (CSDH) is associated with lower rates of recurrence. However, the procedure is performed mostly with the patient under general anesthesia (GA) and therefore frequently requires an intensive care unit (ICU) facility, especially in the elderly population. Because of the unavailability of ICU beds, and to avoid GA, we started to perform this procedure with the patient under local anesthesia (LA). This was a retrospective medical chart review conducted in the section of Neurosurgery at the Aga Khan Hospital in Karachi, Pakistan. The study duration was 1 year. We included patients aged 55 years or older undergoing surgery for CSDH. Clinical characteristics, hospital stay, and recurrence rates were compared between 2 groups, local versus general anesthesia. Thirty-five patients underwent mini-craniotomy for CSDH in the study period. Sixteen patients underwent mini-craniotomy under LA versus 19 patients for GA. Median age for the LA group was 67 years compared with 70 years in the GA group. Four patients from the LA group experienced postoperative complications versus 7 from the GA group. Only one patient in the LA group required an ICU bed in the postoperative period. There was no recurrence in LA group. The overall recurrence was 2.86%. Mini-craniotomy for CSDH under LA is an equally effective procedure compared with mini-craniotomy under GA. In addition, it minimizes the risks of GA in the elderly population and obviates the need of a postoperative ICU bed. It also reduces operative time and hospital stay as compared with GA. Copyright © 2017 Elsevier Inc. All rights reserved.

A comparison of ketamine + midazolam to propofol for procedural sedation for lumbar puncture in pediatric oncology by nonanesthesiologists-a randomized comparative trial.

PubMed

Chayapathi, Varsha; Kalra, Manas; Bakshi, Anita S; Mahajan, Amita

2018-05-04

Both ketamine-midazolam and propofol are frequently used in pediatric oncology units for procedural sedation. However, there are no prospective, randomized comparative trials (RCT) comparing the two groups when the procedure is performed by nonanesthesiologists. To compare ketamine + midazolam (group A) and propofol (group B) as sedative agents for intrathecal chemotherapy with regard to efficacy, side effects, time to induction, time to recovery, and smoothness of recovery. A partially-blinded RCT was conducted between August 2015 and March 2017 after gaining institutional ethics committee approval. Children aged 1-12 years requiring intravenous sedation for intrathecal chemotherapy were included. Patients were allocated to two treatment arms using computer-generated randomization tables, after obtaining written consent. The initial doses used were: ketamine 2 mg/kg, midazolam 0.2 mg/kg, and propofol 2.5 mg/kg, as per standard recommendations. The patient, parents, and person analyzing the data were blinded. Time to sedation, dose required, depth of sedation, vital parameters, time and smoothness of recovery, and emergence phenomena were documented. We enrolled 152 patients (76 each in group A and B). Nine patients had a failure of sedation (all in group B). Mean time to sedation and recovery was shorter in group B (P < 0.001). Transient drop in saturation was more frequent in group B, without statistical significance (P = 0.174). Mean depth of sedation was greater in group A (P < 0.001). Emergence symptoms were more frequently experienced in group A (P < 0.001). Ketamine-midazolam combination is safer and more effective. Propofol is faster in onset and recovery, and has smoother emergence with poor efficacy at recommended initial doses. © 2018 Wiley Periodicals, Inc.

Decision rules for unbiased inventory estimates

NASA Technical Reports Server (NTRS)

Argentiero, P. D.; Koch, D.

1979-01-01

An efficient and accurate procedure for estimating inventories from remote sensing scenes is presented. In place of the conventional and expensive full dimensional Bayes decision rule, a one-dimensional feature extraction and classification technique was employed. It is shown that this efficient decision rule can be used to develop unbiased inventory estimates and that for large sample sizes typical of satellite derived remote sensing scenes, resulting accuracies are comparable or superior to more expensive alternative procedures. Mathematical details of the procedure are provided in the body of the report and in the appendix. Results of a numerical simulation of the technique using statistics obtained from an observed LANDSAT scene are included. The simulation demonstrates the effectiveness of the technique in computing accurate inventory estimates.

Atrial Fibrillation Ablation and its Impact on Stroke.

PubMed

Graves, Kevin G; Jacobs, Victoria; May, Heidi T; Cutler, Michael J; Day, John D; Bunch, T Jared

2018-01-24

Atrial fibrillation (AF) is a commonly encountered arrhythmia, which is not yet fully understood. Catheter ablation has shown to be an effective strategy for rhythm management and several small or retrospective studies have shown that stroke rates are decreased in ablated AF patients compared to those medically managed. Several studies even show that ablation returns stroke risk to that of non-AF patients. Large scale, prospective trials will further illuminate this connection and provide mechanistic understanding of the role of the procedure versus the process of selection for the procedure and peri- and post-procedural therapy and management. Furthermore, modification of risk factors associated with AF show a significant increase in the sustained success of AF ablation and can also moderate the progression of AF.

Anterior cruciate ligament (ACL) autograft reconstruction with hamstring tendons: clinical research among three rehabilitation procedures.

PubMed

Zhu, Weimin; Wang, Daping; Han, Yun; Zhang, Na; Zeng, Yanjun

2013-12-01

To compare the effects of the three rehabilitation procedures following anterior cruciate ligament (ACL) autograft reconstruction with hamstring tendons. An observational and retrospective case-controlled series. The Department of Sports Medicine, Shenzhen Second People Hospital, Shenzhen, PR China. Forty-five patients who were made to undergo ACL reconstructions by using quadrupled semitendinosus and gracilis tendons were divided into three groups: accelerated rehabilitation procedures group, aggressive rehabilitation procedures group, and self-made rehabilitation procedures group. The knee range of motion, thigh perimeter, IKDC score, and bone tunnel diameter in 3D-CT films were evaluated 3 and 6 months and 1 year later. The knee range of motion and thigh perimeter of group A were higher than those of group B and group C at 3, 6, and 12 months. IKDC scores of group C were better than those of groups A and B. The bone tunnel widening with group B was larger than that with groups A and C, and the differences were statistically significant (P < 0.05). Early rehabilitation is beneficial for restoration of knee function after ACL reconstruction. Moderate procedure is better than accelerated procedure.

Ankle Block vs Single-Shot Popliteal Fossa Block as Primary Anesthesia for Forefoot Operative Procedures: Prospective, Randomized Comparison.

PubMed

Schipper, Oliver N; Hunt, Kenneth J; Anderson, Robert B; Davis, W Hodges; Jones, Carroll P; Cohen, Bruce E

2017-11-01

Postoperative pain is often difficult to control with oral medications, requiring large doses of opioid analgesia. Regional anesthesia may be used for primary anesthesia, reducing the need for general anesthetic and postoperative pain medication requirements in the immediate postoperative period. The purpose of this study was to compare the analgesic effects of an ankle block (AB) to a single-shot popliteal fossa block (PFB) for patients undergoing orthopedic forefoot procedures. All patients having elective outpatient orthopedic forefoot procedures were invited to participate in the study. Patients were prospectively randomized to receive either an ultrasound-guided AB or PFB by a board-certified anesthesiologist prior to their procedure. Intraoperative conversion to general anesthesia and postanesthesia care unit (PACU) opioid requirements were recorded. Postoperative pain was assessed using the visual analog scale (VAS) at regular time intervals until 8 am on postoperative day (POD) 2. Patients rated the effectiveness of the block on a 1 to 5 scale, with 5 being very effective. A total of 167 patients participated in the study with 88 patients (53%) receiving an AB and 79 (47%) receiving a single-shot PFB. There was no significant difference in the rate of conversion to general anesthesia between the 2 groups (13.6% [12/88] AB vs 12.7% [10/79] PFB). PACU morphine requirements and doses were significantly reduced in the PFB group ( P = .004) when compared to the AB group. The VAS was also significantly lower for the PFB patients at 10 pm on POD 0 (4.6 vs 1.6, P < .001), 8 am on POD 1 (5.9 vs 4.2, P = .003), and 12 pm on POD 1 (5.4 vs 4.1, P = .01). Overall complication rates were similar between the groups (AB 9% vs PFB 10.1%, P = .51) and there were no significant differences in residual sensory paresthesias (AB 2.3% [2/88] vs PFB 5.1% [4/79], P = .29), motor loss (0% vs 0%), or block site pain and/or erythema (AB 6.9% [6/88] vs PFB 5.1% [4/79], P = .44). The analgesic effect of the PFB lasted significantly longer when compared to the ankle block (AB 14.5 hours vs PFB 20.9 hours, P < .001). There was no significant difference in patient-perceived effectiveness of the block between the 2 groups, with both blocks being highly effective (AB 4.79/5 vs PFB 4.82/5, P = .68). Regional anesthesia was a safe and reliable adjunct to perioperative pain management and highly effective in patients undergoing elective orthopedic forefoot procedures. However, patients who received a PFB had significantly better pain management and decreased opioid requirements in the immediate perioperative period than patients who received an ankle block. Level I, prospective randomized study.

Effect of proximal versus distal 50% enterectomy on nutritional parameters in rats preconditioned with a high-fat diet or regular chow.

PubMed

Yanala, Ujwal R; Reidelberger, Roger D; Thompson, Jon S; Shostrom, Valerie K; Carlson, Mark A

2015-11-27

Obesity may protect against the nutritional consequences of short bowel syndrome. We hypothesized that rats preconditioned with an obesogenic diet would have better outcomes after surgical induction of short bowel syndrome compared to rats on regular chow. Rats were fed a high-fat diet or regular rat chow for six months, and then underwent 50% proximal, 50% distal, or sham enterectomy. Food intake, weight, and body composition were monitored before and for 4 weeks after surgery. The high-fat diet consistently produced obesity (>25% body fat). All procedures induced weight loss, but there was no discernable difference between resection vs. sham resection. Rats on the high-fat diet had a greater post-resection loss of body fat compared to rats on chow (36 vs. 26 g, respectively). There was a nonsignificant trend of less lean mass loss in the former compared to the latter rats (16 vs. 33 g, respectively). Enterectomy moderated serum ghrelin, GIP, PPY, insulin, and leptin. Intestinal adaptation was not different between obese vs. non-obese rats. Rats preconditioned with the high-fat diet may have had better retention of lean body mass after a surgical procedure compared to rats on chow. The effect of 50% enterectomy was less than expected.

A prospective randomized study comparing laparoscopic transabdominal preperitoneal (TAPP) versus Lichtenstein repair for bilateral inguinal hernias.

PubMed

Ielpo, Benedetto; Duran, Hipolito; Diaz, Eduardo; Fabra, Isabel; Caruso, Riccardo; Malavé, Luis; Ferri, Valentina; Lazzaro, Sara; Kalivaci, Denis; Quijano, Yolanda; Vicente, Emilio

2017-07-19

In literature, only a few studies have prospectively compared the results of laparoscopic with open inguinal hernia repair yet none have compared bilateral inguinal hernia repair. The aim of this study is to compare the open Lichtenstein repair (OLR) with laparoscopic trans-abdominal preperitoneal (TAPP) repair in patients undergoing surgery for bilateral inguinal hernia. Patients were prospectively randomized between March 2013 and March 2015. Outcome parameters included hospital stay, operation time, postoperative complications, immediate postoperative pain and chronic pain, recurrence and quality of life. Sixty-one patients underwent TAPP repair and 73 underwent OLR. TAPP procedure had less early post-operative pain up to 7 days from surgery (p = 0.003), a shorter length of hospital stay (p = 0.001), less postoperative complications (p = 0.012) and less chronic pain (0.04) when compared with the OLR approach. TAPP procedure for bilateral inguinal hernia effectively reduces early postoperative pain, hospital stay and postoperative complications. Copyright © 2017 Elsevier Inc. All rights reserved.

Laparoscopic sleeve gastrectomy and gastroesophageal reflux

PubMed Central

Stenard, Fabien; Iannelli, Antonio

2015-01-01

Bariatric surgery is the only effective procedure that provides long-term sustained weight loss. Sleeve gastrectomy (SG) has emerged over the last few years to be an ideal bariatric procedure because it has several advantages compared to more complex bariatric procedures, including avoiding an intestinal bypass. However, several published follow-up studies report an increased rate of gastroesophageal reflux (GERD) after a SG. GERD is described as either de novo or as being caused by aggravation of preexisting symptoms. However, the literature on this topic is ambivalent despite the potentially increased rate of GERDs that may occur after this common bariatric procedure. This article reviews the mechanisms responsible for GERD in obese subjects as well as the results after a SG with respect to GERD. Future directions for clinical research are discussed along with the current surgical options for morbidly obese patients with GERD and undergoing bariatric surgery. PMID:26420961

Numerical simulation of aerothermal loads in hypersonic engine inlets due to shock impingement

NASA Technical Reports Server (NTRS)

Ramakrishnan, R.

1992-01-01

The effect of shock impingement on an axial corner simulating the inlet of a hypersonic vehicle engine is modeled using a finite-difference procedure. A three-dimensional dynamic grid adaptation procedure is utilized to move the grids to regions with strong flow gradients. The adaptation procedure uses a grid relocation stencil that is valid at both the interior and boundary points of the finite-difference grid. A linear combination of spatial derivatives of specific flow variables, calculated with finite-element interpolation functions, are used as adaptation measures. This computational procedure is used to study laminar and turbulent Mach 6 flows in the axial corner. The description of flow physics and qualitative measures of heat transfer distributions on cowl and strut surfaces obtained from the analysis are compared with experimental observations. Conclusions are drawn regarding the capability of the numerical scheme for enhanced modeling of high-speed compressible flows.

Support for the Development of Technological Innovations: Promoting Responsible Social Uses.

PubMed

Legault, Georges A; Verchère, Céline; Patenaude, Johane

2018-04-01

How can technological development, economic development, and the claims from society be reconciled? How should responsible innovation be promoted? The "responsible social uses" approach proposed here was devised with these considerations in view. In this article, a support procedure for promoting responsible social uses (RSU) is set out and presented. First, the context in which this procedure emerged, which incorporates features of both the user-experience approach and that of ethical acceptability in technological development, is specified. Next, the characteristic features of the procedure are presented, that is, its purpose, fundamental orientation, and component parts as experimented by partners. Third, the RSU approach is compared with other support approaches and considered in term of how each approach assumes responsible innovation. Briefly, the RSU procedure is a way of addressing the issue of responsible innovation through an effective integration of social concerns.

The cost-effectiveness of cefepime plus metronidazole versus imipenem/cilastatin in the treatment of complicated intra-abdominal infection.

PubMed

Barie, Philip S; Rotstein, Ori D; Dellinger, E Patchen; Grasela, Thaddeus H; Walawander, Cynthia A

2004-01-01

Our objective was to compare the economic benefits of cefepime plus metronidazole with those of imipenem/cilastatin in the treatment of complicated intra-abdominal infections. We used a retrospective analysis of clinical outcomes and health resource utilization data collected during a randomized, double-blind, multi-center clinical trial. Seventeen university-affiliated hospitals in the United States and Canada participated, as did 323 patients with complicated intra-abdominal infections. Decision analysis was conducted using a decision node of cefepime vs. imipenem, and chance nodes that included an Acute Physiology and Chronic Health Evaluation (APACHE) II score of #15 versus .15; a need for posttreatment surgical procedures; and clinical outcomes. Effectiveness of treatment was measured by differences in the length and cost of hospital stays, the number and cost of surgical procedures after treatment, cure rates, and the cost of antibiotics. Also evalulated were the incremental costs of cure (i.e., the costs of additional cures). Comparing cefepime plus metronidazole with imipenem/cilastatin, the expected cost of patient care was $8,218 versus $10,414, respectively, and the cost-effectiveness ratio per cure was $10,058 versus $13,685. For severely ill patients (APACHE II score .15), the expected cost was $12,962 versus $23,153, and the cost-effectiveness ratio per cure was $15,321 versus $64,313. Cefepime plus metronidazole was more cost-effective than imipenem/cilastatin in the treatment of complicated intra-abdominal infections, primarily because of fewer post-treatment surgical procedures and shorter hospital stays. The primary advantage accrued to severely ill patients who had an APACHE II score .15.

The effects of uncinectomy and natural ostial dilatation on maxillary sinus ventilation: a clinical experimental study.

PubMed

Kutluhan, Ahmet; Şalvız, Mehti; Bozdemir, Kazım; Kanbak, Orhan; Ulu, Mustafa; Yalçıner, Gökhan; Bilgen, Akif Sinan

2011-04-01

The purpose of this study was to determine the effect of uncinectomy without sinusotomy and natural ostial dilatation on maxillary sinus ventilation in chronic rhinosinusitis. Twenty patients with chronic rhinosinusitis were included in this study. The patients were randomly divided into two groups. Group 1 consisted of patients with uncinectomy (n = 10), while group 2 was made up of patients treated with natural ostial dilatation (n = 10). The CO(2) tension and pressure levels of the maxillary sinus during inspiration and expiration phases were obtained and compared before and after the procedures within and between the groups. The mean CO(2) tension levels in both groups were significantly decreased after the procedures. The mean maxillary sinus pressure during inspiration was significantly decreased to a negative value after uncinectomy; however, no significant change was observed during expiration. There were no significant changes in maxillary sinus pressures after natural ostial dilatation procedure. Both uncinectomy and natural ostial dilatation seem to be equally effective in decreasing maxillary sinus pCO(2) levels. The effects of decreased maxillary sinus pressure during inspiration after uncinectomy on mucociliary clearance and development mechanisms of chronic rhinosinusitis seem to be worth investigating.

Persistent Atrial Fibrillation Ablation in Females: Insight from the MAGIC-AF Trial.

PubMed

Singh, Sheldon M; D'Avila, Andre; Aryana, Arash; Kim, Young-Hoon; Mangrum, J Michael; Michaud, Gregory F; Dukkipati, Srinivas R; Heist, E Kevin; Barrett, Conor D; Thorpe, Kevin E; Reddy, Vivek Y

2016-07-27

Atrial fibrillation (AF) ablation is less frequently performed in women when compared to men. There are conflicting data on the safety and efficacy of AF ablation in women. The objective of this study was to compare the clinical characteristics and outcomes in a contemporary cohort of men and women undergoing persistent AF ablation procedures. A total of 182 men and 53 women undergoing a first-ever persistent AF catheter ablation procedure in The Modified Ablation Guided by Ibutilide Use in Chronic Atrial Fibrillation (MAGIC-AF) trial were evaluated. Clinical and procedural characteristics were compared between each gender. The primary efficacy endpoint was the 1-year single procedure freedom from atrial arrhythmia off anti-arrhythmic drugs. Women undergoing catheter ablation procedures were older than men (P < 0.001). The duration of AF and associated co-morbidities were similar between both genders. Single procedure drug-free atrial arrhythmia recurrence occurred in 53% of the cohort with no difference based on gender (men = 54%, women = 53%; P = 1.0). Procedural (P = 0.04), fluoroscopic (P = 0.02), and ablation times (P = 0.003) were shorter in women compared to men. Periprocedural complications and postablation improvement in quality of life were similar between men and women. Women undergoing a first-ever persistent AF ablation procedure were older but had similar clinical outcomes and complications when compared with men. © 2016 Wiley Periodicals, Inc.

Hysteroscopic Tubal Sterilization

PubMed Central

McMartin, K

2013-01-01

Background Hysteroscopic tubal sterilization is a minimally invasive alternative to laparoscopic tubal ligation for women who want permanent contraception. The procedures involves non-surgical placement of permanent microinserts into both fallopian tubes. Patients must use alternative contraception for at least 3 months postprocedure until tubal occlusion is confirmed. Compared to tubal ligation, potential advantages of the hysteroscopic procedure are that it can be performed in 10 minutes in an office setting without the use of general or even local anesthesia. Objective The objective of this analysis was to determine the effectiveness and safety of hysteroscopic tubal sterilization compared with tubal ligation for permanent female sterilization. Data Sources A standard systematic literature search was conducted for studies published from January 1, 2008, until December 11, 2012. Review Methods Observational studies, randomized controlled trials (RCTs), systematic reviews and meta-analyses with 1 month or more of follow-up were examined. Outcomes included failure/pregnancy rates, adverse events, and patient satisfaction. Results No RCTs were identified. Two systematic reviews covered 22 observational studies of hysteroscopic sterilization. Only 1 (N = 93) of these 22 studies compared hysteroscopic sterilization to laparoscopic tubal ligation. Two other noncomparative case series not included in the systematic reviews were also identified. In the absence of comparative studies, data on tubal ligation were derived for this analysis from the CREST study, a large, multicentre, prospective, noncomparative observational study in the United States (GRADE low). Overall, hysteroscopic sterilization is associated with lower pregnancy rates and lower complication rates compared to tubal ligation. No deaths have been reported for hysteroscopic sterilization. Limitations A lack of long-term follow-up for hysteroscopic sterilization and a paucity of studies that directly compare the two procedures limit this assessment. In addition, optimal placement of the microinsert at the time of hysteroscopy varied among studies. Conclusions Hysteroscopic sterilization is associated with: lower pregnancy rates compared to tubal ligation (GRADE very low) lower complication rates compared to tubal ligation (GRADE very low) no significant improvement in patient satisfaction compared to tubal ligation (GRADE very low) Plain Language Summary Hysteroscopic tubal sterilization is a minimally invasive alternative to conventional tubal ligation for women who want a permanent method of contraception. Both approaches involve closing off the fallopian tubes, preventing the egg from moving down the tube and the sperm from reaching the egg. Tubal ligation is a surgical procedure to tie or seal the fallopian tubes, and it usually requires general anesthesia. In contrast, hysteroscopic tubal sterilization can be performed in 10 minutes in an office setting without general or even local anesthesia. A tiny device called a microinsert is inserted into each fallopian tube through the vagina, cervix, and uterus without surgery. An instrument called a hysteroscope allows the doctor to see inside the body for the procedure. Once the microinserts are in place, scar tissue forms around them and blocks the fallopian tubes. Health Quality Ontario conducted a review of the effectiveness and safety of hysteroscopic tubal sterilization compared to tubal ligation. This review indicates that hysteroscopic tubal sterilization is associated with: lower pregnancy rates compared to tubal ligation lower complication rates compared to tubal ligation no significant improvement in patient satisfaction compared to tubal ligation However, we found a number of limitations to the studies available on hysteroscopic tubal sterilization. Among other concerns, most studies did not include long-term follow-up and only 1 study directly compared hysteroscopic tubal sterilization to tubal ligation. PMID:24228084

Visual distraction alone for the improvement of colonoscopy-related pain and satisfaction

PubMed Central

Umezawa, Shotaro; Higurashi, Takuma; Uchiyama, Shiori; Sakai, Eiji; Ohkubo, Hidenori; Endo, Hiroki; Nonaka, Takashi; Nakajima, Atsushi

2015-01-01

AIM: To evaluate the effect of a relaxing visual distraction alone on patient pain, anxiety, and satisfaction during colonoscopy. METHODS: This study was designed as an endoscopist-blinded randomized controlled trial with 60 consecutively enrolled patients who underwent elective colonoscopy at Yokohama City University Hospital, Japan. Patients were randomly assigned to two groups: group 1 watched a silent movie using a head-mounted display, while group 2 only wore the display. All of the colonoscopies were performed without sedation. We examined pain, anxiety, and the satisfaction of patients before and after the procedure using questionnaires that included the Visual Analog Scale. Patients were also asked whether they would be willing to use the same method for a repeat procedure. RESULTS: A total of 60 patients were allocated to two groups. Two patients assigned to group 1 and one patient assigned to group 2 were excluded after the randomization. Twenty-eight patients in group 1 and 29 patients in group 2 were entered into the final analysis. The groups were similar in terms of gender, age, history of prior colonoscopy, and pre-procedural anxiety score. The two groups were comparable in terms of the cecal insertion rate, the time to reach the cecum, the time needed for the total procedure, and vital signs. The median anxiety score during the colonoscopy did not differ significantly between the two groups (median scores, 20 vs 24). The median pain score during the procedure was lower in group 1, but the difference was not significant (median scores, 24.5 vs 42). The patients in group 1 reported significantly higher median post-procedural satisfaction levels, compared with the patients in group 2 (median scores, 89 vs 72, P = 0.04). Nearly three-quarters of the patients in group 1 wished to use the same method for repeat procedures, and the difference in rates between the two groups was statistically significant (75.0% vs 48.3%, P = 0.04). Patients with greater levels of anxiety before the procedure tended to feel a painful sensation. Among patients with a pre-procedural anxiety score of 50 or higher, the anxiety score during the procedure was significantly lower in the group that received the visual distraction (median scores, 20 vs 68, P = 0.05); the pain score during the colonoscopy was also lower (median scores, 23 vs 57, P = 0.04). No adverse effects arising from the visual distraction were recognized. CONCLUSION: Visual distraction alone improves satisfaction in patients undergoing colonoscopy and decreases anxiety and pain during the procedure among patients with a high pre-procedural anxiety score. PMID:25914482

Differentiating the effects of status and power: a justice perspective.

PubMed

Blader, Steven L; Chen, Ya-Ru

2012-05-01

Few empirical efforts have been devoted to differentiating status and power, and thus significant questions remain about differences in how status and power impact social encounters. We conducted 5 studies to address this gap. In particular, these studies tested the prediction that status and power would have opposing effects on justice enacted toward others. In the first 3 studies, we directly compared the effects of status and power on people's enactment of distributive (Study 1) and procedural (Studies 2 and 3) justice. In the last 2 studies, we orthogonally manipulated status and power and examined their main and interactive effects on people's enactment of distributive (Study 4) and procedural (Study 5) justice. As predicted, all 5 studies showed consistent evidence that status is positively associated with justice toward others, while power is negatively associated with justice toward others. The effects of power are moderated, however, by an individual's other orientation (Studies 2, 3, 4, and 5), and the effects of status are moderated by an individual's dispositional concern about status (Study 5). Furthermore, Studies 4 and 5 also demonstrated that status and power interact, such that the positive effect of status on justice emerges when power is low and not when power is high, providing further evidence for differential effects between power and status. Theoretical implications for the literatures on status, power, and distributive/procedural justice are discussed.

The Effect of ODC-Free Cleaning Techniques on Bearing Lifetimes in the Parched Elastohydrodynamic Regime

NASA Technical Reports Server (NTRS)

Jones, William R., Jr.; Toddy, Thomas J.; Predmore, Roamer; Shogrin, Bradley; Herrera-Fierro Pilar

1997-01-01

A parched elastohydrodynamic rig was used to determine relative bearing lifetimes as a function of cleaning procedures in a series of accelerated tests. Two ODC-free cleaning procedures (super critical CO2 and ultraviolet-ozone) were compared to a CFC-113 control. Bearings (52100 steel) were run in the counter rotating mode (equivalent to 4600 rpm) with a full complement (i.e. no retainer) and a single charge of lubricant (Krytox 143 AC). Test conditions included: an air atmosphere, 445N load, approx. 1.0 GPa mean Hertz stress. There was approximately a 50% reduction in life with bearings cleaned with UV/ozone and a 70% reduction in life with SFE CO2 when compared to the Freon control. Possible reasons for these decreases in lifetimes are presented.

The Effect of ODC-Free Cleaning Techniques on Bearing Lifetimes in the Parched Elastohydrodynamic Regime

NASA Technical Reports Server (NTRS)

Jones, William R., Jr.; Toddy, Thomas J.; Predmore, Roamer; Shogrin, Bradley; Herrera-Fierro, Pilar

1996-01-01

A parched elastohydrodynamic rig was used to determine relative bearing lifetimes as a function of cleaning procedures in a series of accelerated tests. Two ODC-free cleaning procedures (super critical CO2 and ultraviolet-ozone) were compared to a CFC-113 control. Bearings (52100 steel) were run in the counter rotating mode (equivalent to 4600 rpm) with a full complement (i.e. no retainer) and a single charge of lubricant (Krytox 143 AC). Test conditions included: an air atmosphere, 445 N load, approx. 1.0 GPa mean Hertz stress. There was approximately a 50% reduction in life with bearings cleaned with UV/ozone and a 70% reduction in life with SFE CO2 when compared to the Freon control. Possible reasons for these decreases in lifetimes are presented.

Response to actual and simulated recordings of conventional takeoff and landing jet aircraft

NASA Technical Reports Server (NTRS)

Mabry, J. E.; Sullivan, B. M.

1978-01-01

Comparability between noise characteristics of synthesized recordings of aircraft in flight and actual recordings were investigated. Although the synthesized recordings were more smoothly time-varying than the actual recordings and the synthesizer could not produce a comb-filter effect that was present in the actual recordings, results supported the conclusion that annoyance response is comparable to the synthesized and actual recordings. A correction for duration markedly improved the validity of engineering calculation procedures designed to measure noise annoyance. Results led to the conclusion that the magnitude estimation psychophysical method was a highly reliable approach for evaluating engineering calculation procedures designed to measure noise annoyance. For repeated presentations of pairs of actual recordings, differences between judgment results for identical signals ranged from 0.0 to 0.5 db.