Perioperative fasting in adults and children: guidelines from the European Society of Anaesthesiology.

PubMed

Smith, Ian; Kranke, Peter; Murat, Isabelle; Smith, Andrew; O'Sullivan, Geraldine; Søreide, Eldar; Spies, Claudia; in't Veld, Bas

2011-08-01

This guideline aims to provide an overview of the present knowledge on aspects of perioperative fasting with assessment of the quality of the evidence. A systematic search was conducted in electronic databases to identify trials published between 1950 and late 2009 concerned with preoperative fasting, early resumption of oral intake and the effects of oral carbohydrate mixtures on gastric emptying and postoperative recovery. One study on preoperative fasting which had not been included in previous reviews and a further 13 studies published since the most recent review were identified. The searches also identified 20 potentially relevant studies of oral carbohydrates and 53 on early resumption of oral intake. Publications were classified in terms of their evidence level, scientific validity and clinical relevance. The Scottish Intercollegiate Guidelines Network scoring system for assessing level of evidence and grade of recommendations was used. The key recommendations are that adults and children should be encouraged to drink clear fluids up to 2 h before elective surgery (including caesarean section) and all but one member of the guidelines group consider that tea or coffee with milk added (up to about one fifth of the total volume) are still clear fluids. Solid food should be prohibited for 6 h before elective surgery in adults and children, although patients should not have their operation cancelled or delayed just because they are chewing gum, sucking a boiled sweet or smoking immediately prior to induction of anaesthesia. These recommendations also apply to patients with obesity, gastro-oesophageal reflux and diabetes and pregnant women not in labour. There is insufficient evidence to recommend the routine use of antacids, metoclopramide or H2-receptor antagonists before elective surgery in non-obstetric patients, but an H2-receptor antagonist should be given before elective caesarean section, with an intravenous H2-receptor antagonist given prior to emergency caesarean section, supplemented with 30 ml of 0.3 mol l(-1) sodium citrate if general anaesthesia is planned. Infants should be fed before elective surgery. Breast milk is safe up to 4 h and other milks up to 6 h. Thereafter, clear fluids should be given as in adults. The guidelines also consider the safety and possible benefits of preoperative carbohydrates and offer advice on the postoperative resumption of oral intake.

BIS impulsivity and acute nicotine exposure are associated with discounting global consequences in the Harvard game.

PubMed

Hogarth, Lee; Stillwell, David J; Tunney, Richard J

2013-01-01

The Barratt Impulsivity Scale (BIS) provides a transdiagnostic marker for a number of psychiatric conditions and drug abuse, but the precise psychological trait(s) tapped by this questionnaire remain obscure. To address this, 51 smokers completed in counterbalanced order the BIS, a delay discounting task and a Harvard game that measured choice between a response that yielded a high immediate monetary payoff but decreased opportunity to earn money overall (local choice) versus a response that yielded a lower immediate payoff but afforded a greater opportunity to earn overall (global choice). Individual level of BIS impulsivity and self-elected smoking prior to the study were independently associated with increased preference for the local over the global choice in the Harvard game, but not delay discounting. BIS impulsivity and acute nicotine exposure reflect a bias in the governance of choice by immediate reward contingencies over global consequences, consistent with contemporary dual-process instrumental learning theories. Copyright © 2013 John Wiley & Sons, Ltd.

29 CFR 452.79 - Opportunity to campaign.

Code of Federal Regulations, 2011 CFR

2011-07-01

... ballot election a union's delay in the distribution of campaign literature until after the ballots have... literature in compliance with a reasonable request. 40 Such a delay would deny the candidate a reasonable...

29 CFR 452.79 - Opportunity to campaign.

Code of Federal Regulations, 2014 CFR

2014-07-01

... ballot election a union's delay in the distribution of campaign literature until after the ballots have... literature in compliance with a reasonable request. 40 Such a delay would deny the candidate a reasonable...

29 CFR 452.79 - Opportunity to campaign.

Code of Federal Regulations, 2012 CFR

2012-07-01

... ballot election a union's delay in the distribution of campaign literature until after the ballots have... literature in compliance with a reasonable request. 40 Such a delay would deny the candidate a reasonable...

29 CFR 452.79 - Opportunity to campaign.

Code of Federal Regulations, 2013 CFR

2013-07-01

... ballot election a union's delay in the distribution of campaign literature until after the ballots have... literature in compliance with a reasonable request. 40 Such a delay would deny the candidate a reasonable...

29 CFR 452.79 - Opportunity to campaign.

Code of Federal Regulations, 2010 CFR

2010-07-01

... ballot election a union's delay in the distribution of campaign literature until after the ballots have... literature in compliance with a reasonable request. 40 Such a delay would deny the candidate a reasonable...

47 CFR 10.220 - Withdrawal of election to participate in CMAS.

Code of Federal Regulations, 2010 CFR

2010-10-01

.... 10.220 Section 10.220 Telecommunication FEDERAL COMMUNICATIONS COMMISSION GENERAL COMMERCIAL MOBILE ALERT SYSTEM Election to Participate in Commercial Mobile Alert System § 10.220 Withdrawal of election... subscribers as well as the Federal Communications Commission at least sixty (60) days prior to the withdrawal...

26 CFR 1.466-2 - Special protective election for certain taxpayers.

Code of Federal Regulations, 2010 CFR

2010-04-01

... method of accounting reasonably similar to the method described in § 1.451-4, to elect to treat that method of accounting as a proper one for those prior years. There are several differences between this... protective election (if treated as deductible under the accounting method for such years), even though such...

[Small amounts of milk added to coffee or tea can be allowed before surgery].

PubMed

Miranda, Kenia S; Kristensen, Billy B

2018-03-26

The ingestion of milk is not allowed within six hours before elective procedures requiring anaesthesia or sedation, because milk is considered a solid food. However, the impact of milk suspended in coffee or tea consumed up to two hours before anaesthesia is less certain, yet fasting guidelines demand surgery to be delayed or rescheduled. Studies investigating ingestion of liquids with small amounts of milk have not demonstrated delayed emptying of the stomach, thereby increasing the risk of aspiration in elective procedures. Maybe it is time to adjust the fasting recommendations.

[Cardiovascular assessment and management before non-cardiac surgery].

PubMed

Schwarz, Stefanie; Bernheim, Alain M

2015-05-06

The preoperative cardiovascular risk management accounts for patient-related risk factors, the circumstances leading to the surgical procedure, and the risk of the operation. While urgent operations should not be delayed for cardiac testing, an elective surgical intervention should be postponed in unstable cardiac conditions. In stable cardiac situations, prophylactic coronary interventions to reduce the risk of perioperative complications are rarely indicated. Therefore, in most cases, the planned operation can be performed without previous cardiac stress testing or coronary angiography. Preoperative imaging stress testing is recommended for patients with poor functional capacities that are at high cardiovascular risk prior to a high-risk operation. According to the literature, preoperative prophylactic administration of betablockers and aspirin is controversial. Preoperative discontinuation of dual anti-platelet therapy within six months following drug-eluting stent implantation is not recommended.

26 CFR 11.412(c)-11 - Election with respect to bonds.

Code of Federal Regulations, 2010 CFR

2010-04-01

... amount payable at maturity (or, in the case of a bond which is callable prior to maturity, the earliest... 26 Internal Revenue 14 2010-04-01 2010-04-01 false Election with respect to bonds. 11.412(c)-11... OF 1974 § 11.412(c)-11 Election with respect to bonds. (a) In general. Section 412(c)(2)(B) provides...

Operating in an eczematous surgical field: don't be rash, delay surgery to avoid infective complications.

PubMed

Beckett, K S; Gault, D T

2006-01-01

Prominent ear correction is a common operation. Complication as a result of infection has been quoted at between 3% and 5% [Calder JC, Nasaan A. Morbidity of otoplasty: a review of 562 consecutive cases. Br J Plast Surg 1994;47:170-4 and Jeffery SLA. Complications following correction of prominent ears: an audit review of 122 cases. Br J Plast Surg 1999;52:588-90.]. We present two cases referred for ear reconstruction following catastrophic post-operative infection at the time of pinnaplasty, leaving each patient with significant helical rim deformities. Both patients displayed evidence of active post-auricular eczema at the time of their primary surgery. Dermatological research has highlighted the increased colonisation of Staphylococcus aureus in particular within areas of atopic eczema in comparison to normal skin. We advise delaying ear surgery in the presence of a rash in view of the potentially devastating complications that may result. This approach may be extended to all cutaneous surgery where treatment of the rash is advocated prior to embarking on an elective surgical procedure.

Confidence, knowledge, and skills at the beginning of residency. A survey of pathology residents.

PubMed

Hsieh, Cindy M; Nolan, Norris J

2015-01-01

To document the pathology learning experiences of pathology residents prior to residency and to determine how confident they were in their knowledge and technical skills. An online survey was distributed to all pathology residency program directors in the United States, who were requested to forward the survey link to their residents. Data were obtained on pathology electives, grossing experience, and frozen section experience. Likert scale questions assessed confidence level in knowledge and skills. In total, 201 pathology residents responded (8% of residents in the United States). Prior to starting residency, most respondents had exposure to anatomic pathology through elective rotations. Few respondents had work-related experience. Most did not feel confident in their pathology-related knowledge or skills, and many did not understand what pathology resident duties entail. Respondents gained exposure to pathology primarily through elective rotations, and most felt the elective experience prepared them for pathology residency. However, elective time may be enhanced by providing opportunities for students to increase hands-on experience and understanding of resident duties. Copyright© by the American Society for Clinical Pathology.

29 CFR 452.74 - Expenditures permitted.

Code of Federal Regulations, 2010 CFR

2010-07-01

... Regulations Relating to Labor OFFICE OF LABOR-MANAGEMENT STANDARDS, DEPARTMENT OF LABOR LABOR-MANAGEMENT STANDARDS GENERAL STATEMENT CONCERNING THE ELECTION PROVISIONS OF THE LABOR-MANAGEMENT REPORTING AND... views to the membership prior to an election. Similarly, a union may issue information sheets containing...

Number of Diverticulitis Episodes Before Resection and Factors Associated With Earlier Interventions

PubMed Central

Simianu, Vlad V.; Fichera, Alessandro; Bastawrous, Amir L.; Davidson, Giana H.; Florence, Michael G.; Thirlby, Richard C.; Flum, David R.

2016-01-01

IMPORTANCE Despite professional recommendations to delay elective colon resection for patients with uncomplicated diverticulitis, early surgery (after <3 preceding episodes) appears to be common. Several factors have been suggested to contribute to early surgery, including increasing numbers of younger patients, a lower threshold to operate laparoscopically, and growing recognition of “smoldering” (or nonrecovering) diverticulitis episodes. However, the relevance of these factors in early surgery has not been well tested, and most prior studies have focused on hospitalizations, missing outpatient events and making it difficult to assess guideline adherence in earlier interventions. OBJECTIVE To describe patterns of episodes of diverticulitis before surgery and factors associated with earlier interventions using inpatient, outpatient, and antibiotic prescription claims. DESIGN, SETTING, AND PARTICIPANTS This investigation was a nationwide retrospective cohort study from January 1, 2009, to December 31, 2012. The dates of the analysis were July 2014 to May 2015. Participants were immunocompetent adult patients (age range, 18-64 years) with incident, uncomplicated diverticulitis. EXPOSURE Elective colectomy for diverticulitis. MAIN OUTCOMES AND MEASURES Inpatient, outpatient, and antibiotic prescription claims for diverticulitis captured in the MarketScan (Truven Health Analytics) databases. RESULTS Of 87 461 immunocompetent patients having at least 1 claim for diverticulitis, 6.4% (n = 5604) underwent a resection. The final study cohort comprised 3054 nonimmunocompromised patients who underwent elective resection for uncomplicated diverticulitis, of whom 55.6% (n = 1699) were male. Before elective surgery, they had a mean (SD) of 1.0 (0.9) inpatient claims, 1.5 (1.5) outpatient claims, and 0.5 (1.2) antibiotic prescription claims related to diverticulitis. Resection occurred after fewer than 3 episodes in 94.9% (2897 of 3054) of patients if counting inpatient claims only, in 80.5% (2459 of 3054) if counting inpatient and outpatient claims only, and in 56.3% (1720 of 3054) if counting all types of claims. Based on all types of claims, patients having surgery after fewer than 3 episodes were of similar mean age compared with patients having delayed surgery (both 47.7 years, P = .91), were less likely to undergo laparoscopy (65.1% [1120 of 1720] vs 70.8% [944 of 1334], P = .001), and had more time between the last 2 episodes preceding surgery (157 vs 96 days, P < .001). Patients with health maintenance organization or capitated insurance plans had lower rates of early surgery (50.1% [247 of 493] vs 57.4% [1429 of 2490], P = .01) than those with other insurance plan types. CONCLUSIONS AND RELEVANCE After considering all types of diverticulitis claims, 56.3% (1720 of 3054) of elective resections for uncomplicated diverticulitis occurred after fewer than 3 episodes. Earlier surgery was not explained by younger age, laparoscopy, time between the last 2 episodes preceding surgery, or financial risk-bearing for patients. In delivering value-added surgical care, factors driving early, elective resection for diverticulitis need to be determined. PMID:26864286

Delayed Recall and Working Memory MMSE Domains Predict Delirium following Cardiac Surgery.

PubMed

Price, Catherine C; Garvan, Cynthia; Hizel, Loren P; Lopez, Marcos G; Billings, Frederic T

2017-01-01

Reduced preoperative cognition is a risk factor for postoperative delirium. The significance for type of preoperative cognitive deficit, however, has yet to be explored and could provide important insights into mechanisms and prediction of delirium. Our goal was to determine if certain cognitive domains from the general cognitive screener, the Mini-Mental State Exam (MMSE), predict delirium after cardiac surgery. Patients completed a preoperative MMSE prior to undergoing elective cardiac surgery. Following surgery, delirium was assessed throughout ICU stay using the Confusion Assessment Method for ICU delirium and the Richmond Agitation and Sedation Scale. Cardiac surgery patients who developed delirium (n = 137) had lower total MMSE scores than patients who did not develop delirium (n = 457). In particular, orientation to place, working memory, delayed recall, and language domain scores were lower. Of these, only the working memory and delayed recall domains predicted delirium in a regression model adjusting for history of chronic obstructive pulmonary disease, age, sex, and duration of cardiopulmonary bypass. For each word not recalled on the three-word delayed recall assessment, the odds of delirium increased by 50%. For each item missed on the working memory index, the odds of delirium increased by 36%. Of the patients who developed delirium, 47% had a primary impairment in memory, 21% in working memory, and 33% in both domains. The area under the receiver operating characteristics curve using only the working memory and delayed recall domains was 0.75, compared to 0.76 for total MMSE score. Delirium risk is greater for individuals with reduced MMSE scores on the delayed recall and working memory domains. Research should address why patients with memory and executive vulnerabilities are more prone to postoperative delirium than those with other cognitive limitations.

Orthopedic Surgeons' Management of Elective Surgery for Patients Who Use Nicotine.

PubMed

Lilley, Matthew; Krosin, Michael; Lynch, Tennyson L; Leasure, Jeremi

2017-01-01

Despite significant research documenting the detrimental effects of tobacco, the orthopedic literature lacks evidence regarding how surgeons alter their management of elective surgery when patients use nicotine. To better understand how patients' use of nicotine influences orthopedic surgeons' pre- and postoperative management of elective surgery, a 9-question paper survey was distributed at the 2012 annual meeting of the American Academy of Orthopaedic Surgeons among attending US orthopedic surgeons, including general orthopedists and specialty-trained orthopedic surgeons. Survey questions focused on attitudes and practice management regarding patients who use nicotine. Using a chi-square test, no statistically significant variation was observed between subspecialists and general orthopedists or among different subspecialties. Ninety-eight percent of the orthopedic surgeons surveyed counseled tobacco users about the adverse effects of nicotine. However, approximately half of all of the respondents spent less than 5 minutes on perioperative nicotine counseling. Forty-one percent of all of the respondents never delayed elective surgery because of a patient's nicotine use, followed closely by 39% delaying surgery for less than 3 months. Subspecialty had little influence on how orthopedic surgeons managed nicotine users. The high rate of counseling on the adverse effects of nicotine suggested agreement regarding the detrimental effects of smoking. However, the study population infrequently delayed surgery or used smoking cessation measures. Studies are needed to determine why few surgeons frequently alter the management of nicotine users and what modifications in orthopedic practice could improve outcomes for these patients. [Orthopedics. 2017; 40(1):e90-e94.]. Copyright 2016, SLACK Incorporated.

Why Some Mastectomy Patients Opt to Undergo Delayed Breast Reconstruction: Results of a Long-Term Prospective Study.

PubMed

Metcalfe, Kelly A; Semple, John; Quan, May-Lynn; Holloway, Claire; Wright, Frances; Narod, Steven; Hofer, Stefan; Bagher, Shaghayegh; Zhong, Toni

2017-02-01

Delayed breast reconstruction is an option for women who have undergone mastectomy; however, uptake is low. The purpose of this study was to identify premastectomy and postmastectomy demographic, clinical, and psychosocial predictors of uptake of delayed breast reconstruction in the long-term survivorship period. This was a prospective longitudinal survey study of mastectomy patients in which a repeated measures design was used to evaluate uptake of delayed breast reconstruction. Demographic, clinical, and psychosocial variables were collected before mastectomy and 1 year after mastectomy. Information regarding uptake of delayed breast reconstruction was collected at approximately 6 years after mastectomy. A predictive model was designed using a multivariate logistic regression model and Akiake information criterion stepwise algorithm. Ninety-six mastectomy patients were followed from before mastectomy to 75.2 months after mastectomy, and 35 women (36.5 percent) underwent delayed breast reconstruction. Women who elected for delayed breast reconstruction experienced worsening of body concerns from before mastectomy to 1 year after mastectomy, compared with women who did not elect to undergo delayed breast reconstruction (p = 0.03). Mean scores for psychological distress were significantly worse both before mastectomy and 1 year after mastectomy in women who went on to undergo delayed breast reconstruction compared with those who did not undergo delayed breast reconstruction (p = 0.034 and p = 0.022, respectively). A predictive model for the uptake of delayed breast reconstruction was developed using demographic, clinical, and psychosocial characteristics. The area under the receiver operating characteristic curve was 85 percent, indicating good precision. Women who are experiencing higher levels of distress, anxiety, and body concerns both before and after mastectomy appear to be significantly likely to select delayed breast reconstruction. This may have implications for postreconstruction satisfaction and psychosocial functioning. Risk, III.

Elective oocyte cryopreservation for deferred childbearing.

PubMed

Goldman, Kara N; Grifo, Jamie A

2016-12-01

Elective oocyte cryopreservation for deferred childbearing has gained popularity worldwide, commensurate with increased knowledge regarding age-related fertility decline. The purpose of this review is to summarize recent data regarding trends in delayed childbearing, review recent findings surrounding age-related fertility decline, acknowledge significant gaps in knowledge among patients and providers regarding fertility decline and review outcomes following elective oocyte cryopreservation. Despite an inevitable decline in fertility and increase in miscarriage with increasing female age, there is a growing worldwide trend to delay childbearing. Patients and providers alike demonstrate large gaps in knowledge surrounding age-related fertility decline. Oocyte cryopreservation is clinically approved for medically indicated fertility preservation, but a growing number of women are using oocyte cryopreservation to defer childbearing and maintain reproductive autonomy. Mounting data support the efficacy and safety of oocyte cryopreservation when used to electively defer childbearing, with recent studies demonstrating rates of euploidy, implantation and live birth rates equivalent to in-vitro fertilization (IVF) with fresh oocytes. Oocyte cryopreservation provides women with an option to defer childbearing and maintain reproductive autonomy, with IVF success rates on par with fresh IVF. However, it is critical that patients understand the limitations of oocyte cryopreservation. Greater education regarding age-related fertility decline should be geared toward patients and providers to prevent unintended childlessness.

Oocyte vitrification for elective fertility preservation: the past, present, and future.

PubMed

Gunnala, Vinay; Schattman, Glenn

2017-02-01

Oocyte cryopreservation is no longer experimental and one of its rapidly growing indications is elective fertility preservation. Currently there is no sufficient evidence to support its practice and therefore its place in IVF remains uncertain. Vitrification has superior post-thaw survival and fertilization outcomes compared with oocytes that were frozen with the slow-freeze technique. Oocyte vitrification produces similar IVF outcomes compared with fresh oocytes and is not associated with further obstetrical or perinatal morbidity. Undergoing elective oocyte cryopreservation between ages 35 and 37 will optimize live birth rates as well as cost effectiveness from mathematical models. In women who delay child bearing, elective oocyte cryopreservation in the mid 30s may be beneficial in terms of live birth rates and cost effectiveness. Prospective studies of women who have undergone oocyte cryopreservation and are now attempting conception are needed before official recommendations can be made regarding elective egg freezing.

Multigeneration data migration from legacy systems

NASA Astrophysics Data System (ADS)

Ratib, Osman M.; Liu, Brent J.; Kho, Hwa T.; Tao, Wenchao; Wang, Cun; McCoy, J. Michael

2003-05-01

The migration of image data from different generations of legacy archive systems represents a technical challenge and in incremental cost in transitions to newer generations of PACS. UCLA medical center has elected to completely replace the existing PACS infrastructure encompassing several generations of legacy systems by a new commercial system providing enterprise-wide image management and communication. One of the most challenging parts of the project was the migration of large volumes of legacy images into the new system. Planning of the migration required the development of specialized software and hardware, and included different phases of data mediation from existing databases to the new PACS database prior to the migration of the image data. The project plan included a detailed analysis of resources and cost of data migration to optimize the process and minimize the delay of a hybrid operation where the legacy systems need to remain operational. Our analysis and project planning showed that the data migration represents the most critical path in the process of PACS renewal. Careful planning and optimization of the project timeline and resources allocated is critical to minimize the financial impact and the time delays that such migrations can impose on the implementation plan.

Is Maintenance Electroconvulsive Therapy Always an Elective Procedure?: Weighing Medical Versus Psychiatric Risk.

PubMed

Rosenthal, Isobel A; Kellner, Charles H

2018-03-01

Because of the severe nature of psychiatric illness, electroconvulsive therapy (ECT) is not always an "elective procedure." The pre-ECT medical evaluation, although important, should not be an impediment to timely ECT. We argue that an arbitrary regulation requiring new assessments every 30 days may be unduly burdensome and unnecessary. The small medical risk of treatment should be weighed against the potential psychiatric risk (including suicide) of delayed treatment.

Student School Elections and Political Engagement: A Cradle of Democracy?

ERIC Educational Resources Information Center

Saha, Lawrence J.; Print, Murray

2010-01-01

Studies have found that prior involvement in student politics while in school seems to be a good predictor of adult political engagement. While most studies of adults have obtained retrospective data on participation in school elections, there have been few studies of students about this activity. We contribute to this latter relatively unexplored…

11 CFR 9428.7 - Contents of reports from the states.

Code of Federal Regulations, 2010 CFR

2010-01-01

... March 31 of each odd-numbered year beginning March 31, 1995 on a form to be provided by the Commission... two years prior to the most recent federal general election; (2) The total number of registered voters... between the past two federal general elections, including all registrations that are new to the local...

Predicted and experienced affective responses to the outcome of the 2008 U.S. presidential election.

PubMed

Kitchens, Michael B; Corser, Grant C; Gohm, Carol L; VonWaldner, Kristen L; Foreman, Elizabeth L

2010-12-01

People typically have intense feelings about politics. Therefore, it was no surprise that the campaign and eventual election of Barack Obama were highly anticipated and emotionally charged events, making it and the emotion experienced afterward a useful situation in which to replicate prior research showing that people typically overestimate the intensity and duration of their future affective states. Consequently, it was expected that Obama supporters and McCain supporters might overestimate the intensity of their affective responses to the outcome of the election. Data showed that while McCain supporters underestimated how happy they would be following the election, Obama supporters accurately predicted how happy they would be following the election. These data provide descriptive information on the accuracy of people's predicted reactions to the 2008 U.S. presidential election. The findings are discussed in the context of the broad literature and this specific and unique event.

Are We Rational or Not? The Exploration of Voter Choices during the 2016 Presidential and Legislative Elections in Taiwan

PubMed Central

Lee, I-Ching; Chen, Eva E.; Yen, Nai-Shing; Tsai, Chia-Hung; Cheng, Hsu-Po

2017-01-01

The decisions voters make—and whether those decisions are rational—have profound implications on the functionality of a democratic society. In this study, we delineated two criteria in evaluating voter rationality and weigh evidence of voter rationality versus irrationality. Furthermore, we compared models in two different elections in Taiwan to explore the reasons behind the irrational choices voters can make. Survey questions and an implicit association test (IAT) were administered prior to both elections among 197 voters in Taipei. These voters then reported their actual votes post-election. Model testing suggests that voters often are rational, but are more likely to make irrational choices in more important elections. Our findings indicate that voters generally aim to be diligent and to optimize their choices, even if they make less rational choices in the end. Further implications regarding elections and human rationality are discussed. PMID:29075215

Panama: Political and Economic Conditions and U.S. Relations

DTIC Science & Technology

2008-07-31

but the September 1, 2007 election of Pedro Miguel González to head Panama’s legislature for one year delayed consideration. González is wanted in...term. Current Assembly president Pedro Miguel González, wanted in the United States for his alleged role in the murder of a U.S. serviceman in Panama in...Administration negotiated the Panama Canal Treaties. On September 1, 2007, Panama’s Legislative Assembly elected Pedro Miguel González of the ruling PRD

The impact of obstetric mode of delivery on childhood behavior.

PubMed

Al Khalaf, Sukainah Y; O'Neill, Sinéad M; O'Keeffe, Linda M; Henriksen, Tine B; Kenny, Louise C; Cryan, John F; Khashan, Ali S

2015-10-01

We investigated the hypothesis that mode of delivery affects childhood behavior and motor development and examined whether there are sex-specific associations, i.e., whether males and females have different risk estimates. Families with infants born between December 2007 and May 2008 (N = 11,134) were randomly selected and recruited to the Growing Up in Ireland study. Mode of delivery was classified into spontaneous vaginal delivery; instrumental vaginal delivery; emergency Cesarean section (CS); and elective CS. The 'Ages and Stages Questionnaire' was completed at age 9-months and the 'Strengths and Difficulties Questionnaire' at 3 years. Data were weighted to represent the national sample (N = 73,662) and multivariate logistic regression was used for the statistical analyses. At age 9 months, elective CS was associated with a delay in personal social skills [adjusted odds ratio, aOR 1.24; (95% confidence interval, CI 1.04, 1.48)] and gross motor function [aOR 1.62, (95% CI 1.34, 1.96)], whereas emergency CS was associated with delayed gross motor function [aOR 1.30, (95% CI 1.06, 1.59)]. At age 3 years there was no significantly increased risk of an abnormal total SDQ score across all modes of delivery. Children born by elective CS may face a delay in cognitive and motor development at age 9 months. No increase in total SDQ score was found across all modes of delivery. Further investigation is needed to replicate these findings in other populations and explore the potential biological mechanisms.

26 CFR 1.614-2 - Election to aggregate separate operating mineral interests under section 614(b) prior to its...

Code of Federal Regulations, 2011 CFR

2011-04-01

...) INCOME TAXES (CONTINUED) Natural Resources § 1.614-2 Election to aggregate separate operating mineral... various natural resources industries or in any one of the natural resources industries, such as coal, oil... mine, well, or other natural deposit were in the production stage. The term does not include royalty...

The Sharpening of "The Blade," 1892-1897: A Black Newspaper and Black Consciousness.

ERIC Educational Resources Information Center

Klassen, Teresa C.; Johnson, Owen V.

A qualitative examination was made of the black newspaper, "The Blade" in Parsons, Kansas, during two six-week periods: September 24-October 29, 1892, the first available issues of the paper, appearing just prior to national elections; and October 23-November 27, 1897, which included two weeks before and four weeks after local elections.…

12 CFR 225.82 - How does a bank holding company elect to become a financial holding company?

Code of Federal Regulations, 2010 CFR

2010-01-01

... holding company to become a financial holding company shall not be effective if, during the period...) Effective date of election—(1) In general. An election filed by a bank holding company under paragraph (a... financial holding company is effective prior to the 31st day after the date that a complete declaration was...

17 CFR 1.68 - Customer election not to have funds, carried by a futures commission merchant for trading on a...

Code of Federal Regulations, 2010 CFR

2010-04-01

... futures commission merchant's business without the prior consent of the customer or any third party; (C... customer. The effective date of the abrogation shall not exceed five business days from the futures... 17 Commodity and Securities Exchanges 1 2010-04-01 2010-04-01 false Customer election not to have...

"You Have to Be Involved...to Play a Part in It": Assessing Kainai Attitudes about Voting in Canadian Elections

ERIC Educational Resources Information Center

Belanger, Yale D.

2009-01-01

Two days prior to the federal election on June 28, 2004, the "Lethbridge Herald" ran an article in which the renowned Cree leader and former Member of Parliament Elijah Harper (Churchill electoral district in Manitoba, 1993-97) publicly implored First Nations people in Canada to participate in the forthcoming vote. Citing the recent…

A first-digit anomaly in the 2009 Iranian presidential election

NASA Astrophysics Data System (ADS)

Roukema, Boudewijn F.

2014-01-01

A local bootstrap method is proposed for the analysis of electoral vote-count first-digit frequencies, complementing the Benford's Law limit. The method is calibrated on five presidential-election first rounds (2002-2006) and applied to the 2009 Iranian presidential-election first round. Candidate K has a highly significant (p < 0.15%) excess of vote counts starting with the digit 7. This leads to other anomalies, two of which are individually significant at p˜ 0.1%, and one at p sim 1%. Independently, Iranian pre-election opinion polls significantly reject the official results unless the five polls favouring candidate A are considered alone. If the latter represent normalised data and a linear, least-squares, equal-weighted fit is used, then either candidates R and K suffered a sudden, dramatic (70%pm 15%) loss of electoral support just prior to the election, or the official results are rejected (p ˜ 0.01%).

5 CFR 4701.102 - Prior approval for certain outside employment.

Code of Federal Regulations, 2012 CFR

2012-01-01

... STANDARDS OF ETHICAL CONDUCT FOR EMPLOYEES OF THE FEDERAL ELECTION COMMISSION § 4701.102 Prior approval for... or consultation, which requires advanced knowledge in a field of science or learning customarily... obtain written approval from the Designated Agency Ethics Official before engaging in outside employment...

5 CFR 4701.102 - Prior approval for certain outside employment.

Code of Federal Regulations, 2013 CFR

2013-01-01

... STANDARDS OF ETHICAL CONDUCT FOR EMPLOYEES OF THE FEDERAL ELECTION COMMISSION § 4701.102 Prior approval for... or consultation, which requires advanced knowledge in a field of science or learning customarily... obtain written approval from the Designated Agency Ethics Official before engaging in outside employment...

5 CFR 4701.102 - Prior approval for certain outside employment.

Code of Federal Regulations, 2014 CFR

2014-01-01

... STANDARDS OF ETHICAL CONDUCT FOR EMPLOYEES OF THE FEDERAL ELECTION COMMISSION § 4701.102 Prior approval for... or consultation, which requires advanced knowledge in a field of science or learning customarily... obtain written approval from the Designated Agency Ethics Official before engaging in outside employment...

Impact of mechanical bowel preparation in elective colorectal surgery: A meta-analysis.

PubMed

Rollins, Katie E; Javanmard-Emamghissi, Hannah; Lobo, Dileep N

2018-01-28

To analyse the effect of mechanical bowel preparation vs no mechanical bowel preparation on outcome in patients undergoing elective colorectal surgery. Meta-analysis of randomised controlled trials and observational studies comparing adult patients receiving mechanical bowel preparation with those receiving no mechanical bowel preparation, subdivided into those receiving a single rectal enema and those who received no preparation at all prior to elective colorectal surgery. A total of 36 studies (23 randomised controlled trials and 13 observational studies) including 21568 patients undergoing elective colorectal surgery were included. When all studies were considered, mechanical bowel preparation was not associated with any significant difference in anastomotic leak rates (OR = 0.90, 95%CI: 0.74 to 1.10, P = 0.32), surgical site infection (OR = 0.99, 95%CI: 0.80 to 1.24, P = 0.96), intra-abdominal collection (OR = 0.86, 95%CI: 0.63 to 1.17, P = 0.34), mortality (OR = 0.85, 95%CI: 0.57 to 1.27, P = 0.43), reoperation (OR = 0.91, 95%CI: 0.75 to 1.12, P = 0.38) or hospital length of stay (overall mean difference 0.11 d, 95%CI: -0.51 to 0.73, P = 0.72), when compared with no mechanical bowel preparation, nor when evidence from just randomized controlled trials was analysed. A sub-analysis of mechanical bowel preparation vs absolutely no preparation or a single rectal enema similarly revealed no differences in clinical outcome measures. In the most comprehensive meta-analysis of mechanical bowel preparation in elective colorectal surgery to date, this study has suggested that the use of mechanical bowel preparation does not affect the incidence of postoperative complications when compared with no preparation. Hence, mechanical bowel preparation should not be administered routinely prior to elective colorectal surgery.

26 CFR 301.9100-19T - Election relating to passive investment income of electing small business corporations.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 14, 1966 (Pub. L. 89-389) amends section 1372(e)(5) of the Internal Revenue Code of 1954 (relating to... section 1372(e)(5) of the Internal Revenue Code, as amended by Pub. L. 89-389, with respect to its taxable... section 1372(e)(5) of the Code prior to the enactment of Pub. L. 89-389. Therefore, notwithstanding the...

26 CFR 301.9100-19T - Election relating to passive investment income of electing small business corporations.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 14, 1966 (Pub. L. 89-389) amends section 1372(e)(5) of the Internal Revenue Code of 1954 (relating to... section 1372(e)(5) of the Internal Revenue Code, as amended by Pub. L. 89-389, with respect to its taxable... section 1372(e)(5) of the Code prior to the enactment of Pub. L. 89-389. Therefore, notwithstanding the...

Electives: isn't it time for a change?

PubMed

Dowell, Jon; Merrylees, Neil

2009-02-01

Medical student electives are memorable learning experiences, of which approximately 40% are spent in developing countries. Students often have laudable motivation but are rarely helped to learn most effectively or contribute meaningfully whilst away. Each year an estimated 350 years of elective time is spent in developing countries (by students from the UK alone), which represents substantial opportunity. We conducted a literature search prior to developing an alternative approach towards electives based upon educational and ethical principles. Despite their anecdotal value there has been little empirical research conducted into electives. From our review we identified four key learning domains (Clinical Knowledge and Skills, Attitudes, Global Perspectives, Personal and Professional Development) and two broader issues (Institutional Benefits and Moral/Ethical Considerations). Potentially beneficial and more structured alternatives are emerging and improvements appear possible through institutional collaborations and greater planning in order to maximise the educational experience, opportunities to contribute and minimise the risks involved in electives. Electives are a highlight of clinical training but probably often represent missed opportunities. There are both educational and moral reasons for seeking more considered approaches to reduce the 'medical tourism' that can result from the current largely ad hoc arrangements.

Changes in racial identity among African American college students following the election of Barack Obama.

PubMed

Fuller-Rowell, Thomas E; Burrow, Anthony L; Ong, Anthony D

2011-11-01

The current study considered the influence of the 2008 presidential election on the racial identity of African American college students (M(age) = 19.3 years; 26.3% male). The design of the study consisted of 2 components: longitudinal and daily. The longitudinal component assessed 3 dimensions of racial identity (centrality, private regard, and public regard) 2 weeks before and 5 months after the election, and the daily diary component assessed racial identity and identity exploration on the days immediately before and after the election. Daily items measuring identity exploration focused on how much individuals thought about issues relating to their race. Analyses considered the immediate effects of the election on identity exploration and the extent to which changes in exploration were shaped by racial identity measured prior to the election. We also considered immediate and longer term changes in racial identity following the election and the extent to which longer term changes were conditioned by identity exploration. Findings suggest that the election served as an "encounter" experience (Cross, 1991, 1995, pp. 60-61), which led to increases in identity exploration. Moreover, analyses confirmed that changes in identity exploration were most pronounced among those with higher levels of racial centrality. Results also suggest that the election had both an immediate and a longer term influence on racial identity, which in some instances was conditioned by identity exploration.

Pre-operative assessment and post-operative care in elective shoulder surgery.

PubMed

Akhtar, Ahsan; Macfarlane, Robert J; Waseem, Mohammad

2013-01-01

Pre-operative assessment is required prior to the majority of elective surgical procedures, primarily to ensure that the patient is fit to undergo surgery, whilst identifying issues that may need to be dealt with by the surgical or anaesthetic teams. The post-operative management of elective surgical patients begins during the peri-operative period and involves several health professionals. Appropriate monitoring and repeated clinical assessments are required in order for the signs of surgical complications to be recognised swiftly and adequately. This article examines the literature regarding pre-operative assessment in elective orthopaedic surgery and shoulder surgery, whilst also reviewing the essentials of peri- and post-operative care. The need to recognise common post-operative complications early and promptly is also evaluated, along with discussing thromboprophylaxis and post-operative analgesia following shoulder surgery.

Subinternship in Radiology - A Practical Start to the Specialization?

PubMed

Kasch, R; Wirkner, J; Hosten, N; Hinz, P; Napp, M; Kessler, R

2016-11-01

Purpose: To identify factors influencing medical students to choose radiology in the four-month clinical elective in the final year of medical school following radiology subinternships. Materials and Methods: A subsample of medical students in a nationwide German online survey evaluated a subinternship in radiology (19 items). They were divided into four groups: Students who could imagine doing a clinical elective in radiology in the practical year based on their experiences during the subinternship ("yes, based on subinternship"), students who could not ("no, based on subinternship") and students who had made this decision prior to the subinternship ("yes, prior to subinternship" and "no, prior to subinternship"). Results: 94 medical students evaluated a radiology subinternship (54.4 % females). Based on their experiences during the subinternship, 54 students (57.4 %) intended to do a final year clinical elective in radiology, 39 of them (41.5 %) being encouraged by the subinternship. 40 (42.6 %) reported having a negative attitude towards a clinical elective in radiology, 16 of them (17.0 %) having made this decision based on their subinternship experience. Groups did not differ regarding gender (p = 0.396) and age (p = 0.853). Students motivated to do a final year clinical elective in radiology experienced excellent academic teaching (p = 0.001) and practical involvement (p = 0.003), achieved their learning goals more often (p = 0.001), were better integrated into the team (p = 0.001), and acquired more practical skills (p = 0.003). Overall satisfaction was higher in these groups (p = 0.001). Conclusion: Satisfaction with a radiology subinternship is crucial for motivating medical students to do a final year clinical elective in radiology. A structured subinternship and continuous mentoring should be targeted to keep students connected to radiology. Key Points: • Radiology subinternships influence further interest in the specialization.• The quality and structure of teaching critically influence student satisfaction.• Team integration and practical involvement positively affect the attitude towards a specialization. Citation Format: • Kasch R, Wirkner J, Hosten N et al. Subinternship in Radiology - A Practical Start to the Specialization? Fortschr Röntgenstr 2016; 188: 1024 - 1030. © Georg Thieme Verlag KG Stuttgart · New York.

26 CFR 20.2056A-7 - Allowance of prior transfer credit under section 2013.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 2013. 20.2056A-7 Section 20.2056A-7 Internal Revenue INTERNAL REVENUE SERVICE, DEPARTMENT OF THE... Taxable Estate § 20.2056A-7 Allowance of prior transfer credit under section 2013. (a) Property subject to QDOT election. Section 2056(d)(3) provides special rules for computing the section 2013 credit allowed...

26 CFR 1.197-1T - Certain elections for intangible property (temporary).

Code of Federal Regulations, 2010 CFR

2010-04-01

...) to apply prior law to property acquired pursuant to a written binding contract in effect on August 10... section 13261 of OBRA '93 (e.g., the amendment of section 1253 in the case of a franchise, trademark, or... section 197 intangible with an unadjusted basis of $180. Under prior law, no amortization or depreciation...

Effect of perioperative inefficiency on neurosurgical theatre efficacy: A 15-year analysis.

PubMed

Kamat, Ameya S; Parker, Andrew

2015-01-01

Effective utilisation of operating theatre time is an important issue in neurosurgery. There is a commonly held belief amongst surgeons that throughput of theatre is decreasing secondary to worsening perioperative delays. The aim of this paper is to explore some of the factors that lead to delays in the perioperative period by determining whether there has been a trend in the increasing length of case time over a fifteen-year period. Case notes of all elective patients who consented for surgery between January 1998 and the end of 2012 were reviewed. Only patients who underwent elective surgery were included. Variables recorded included transit time from the ward to theatre, anaesthetic time, surgical time and time spent in recovery. These were compared over the 15-year period to look for apparent trends. The total number of patients who consented for elective surgery at our institution between January 1998 and December 2012 was 6760. The mean anaesthetic time considering all operations performed was 43 mins each over the 15-year period. Anaesthetic time was deemed to be trending upwards from 1998 where the mean time was 27 -60 mins in December 2012, thus reflecting an increase of 33 mins. The mean surgical times over the 15-year period were 131 mins. However in 1998, mean surgical time was 127 mins compared with 133 mins in 2012. For the operations analysed, anaesthetic time seems to be increasing and has effectively doubled over a 15-year period. Surgical time and non-clinical time are shown to be virtually constant. This delays the overall theatre list and increases the cancellation rate. For compensating this, changes need to be made when allocating resources to both elective and emergency theatres. Staff recruitment needs to be assessed and internal audits need to be conducted within institutions to analyse ways to optimise the throughput of an operation theatre. If these principles are not adhered to, it will have a negative impact as our populations, and hence our case loads increase to instrumental levels. This will in turn have a negative impact on health workers and patients alike.

Trending elective preterm deliveries using administrative data.

PubMed

Korst, Lisa M; Fridman, Moshe; Lu, Michael C; Fleege, Laura; Mitchell, Connie; Gregory, Kimberly D

2013-01-01

We propose a methodology for identifying and analysing 'elective' preterm births (PTBs) using administrative data, and apply this methodology to California data with the objective of providing a framework to further explore the potential rationales for early delivery. Using the California linked birth cohorts for 1999, 2002 and 2005, singleton PTBs were identified using birth certificate gestational age ≥ 24 and <37 weeks. Through a hierarchical scheme that first removed cases with standard or 'hard' indications for early delivery (e.g. severe preeclampsia, placenta previa), cases of 'elective' PTB were identified with coding for medical intervention, that is, elective caesarean or labour induction. We calculated rates of elective PTB, with subanalyses of early (<34 weeks of gestational age) and late PTB (34 to <37 weeks of gestational age) using hierarchical logistic regression models. Of 1 387 565 singleton deliveries, 99 614 (7.2%) were preterm. Elective PTBs increased 27.7% over the 6-year study period, with nearly all cases confined to the late PTB stratum; elective late PTB rates rose from 10.5% to 13.5% of all late PTBs (P < 0.0001). Indications for delivery in this Elective Group ('soft indications') included prior pelvic floor repair, mental health conditions, fetal anomalies, malpresentation and oligohydramnios. Six per cent of patients with a late PTB had a medical intervention with no hard or soft indication for delivery. Using administrative data, we developed a method for identifying and trending the proportion of PTBs that is 'elective'. This method can be used to explore and monitor potential strategies for the prevention of elective PTB. © 2012 Blackwell Publishing Ltd.

Improving the medical school-residency transition.

PubMed

Morgan, Helen; Skinner, Bethany; Marzano, David; Fitzgerald, James; Curran, Diana; Hammoud, Maya

2017-10-01

In response to calls to improve the continuum between undergraduate and graduate medical education, many medical schools are creating electives designed to prepare students for residency training. There is a need for data that link improvements from these residency preparation courses to residency itself. Data is needed that links improvements from these residency preparation courses to residency OBJECTIVE: To examine senior medical student performance on the Association of Professors of Gynecology and Obstetrics (APGO) Preparation for Residency Knowledge Assessment before and after an obstetrics and gynaecology residency preparation elective, and to determine whether the knowledge improvements persisted to the start of the residency. All 13 students enrolled in the course completed the APGO knowledge assessment on the first and last day of the elective. Three months later, the students were asked to re-take the assessment immediately prior to the start of their residency. There was improvement in mean scores from the pre-test score of 66.4 per cent to the post-test score of 77.4 per cent. At the time of the pre-test, three of the 13 students (23%) had passing scores (70% or greater), and at the time of the post-test, 11 of the 13 (85%) had passing scores. Nine of the 13 students (69%) completed the APGO knowledge assessment immediately prior to the start of their residency. Those nine students had a mean pre-residency score of 76.4 per cent. Eight of the nine students (89%) passed the pre-residency test. Our data support the value of residency preparation electives for improving knowledge, and suggest that senior medical school electives can help to bridge the continuum between undergraduate and graduate medical education. © 2016 John Wiley & Sons Ltd and The Association for the Study of Medical Education.

Delayed, but not immediate, feedback after multiple-choice questions increases performance on a subsequent short-answer, but not multiple-choice, exam: evidence for the dual-process theory of memory.

PubMed

Sinha, Neha; Glass, Arnold Lewis

2015-01-01

Three experiments, two performed in the laboratory and one embedded in a college psychology lecture course, investigated the effects of immediate versus delayed feedback following a multiple-choice exam on subsequent short answer and multiple-choice exams. Performance on the subsequent multiple-choice exam was not affected by the timing of the feedback on the prior exam; however, performance on the subsequent short answer exam was better following delayed than following immediate feedback. This was true regardless of the order in which immediate versus delayed feedback was given. Furthermore, delayed feedback only had a greater effect than immediate feedback on subsequent short answer performance following correct, confident responses on the prior exam. These results indicate that delayed feedback cues a student's prior response and increases subsequent recollection of that response. The practical implication is that delayed feedback is better than immediate feedback during academic testing.

26 CFR 20.2056A-7 - Allowance of prior transfer credit under section 2013.

Code of Federal Regulations, 2010 CFR

2010-04-01

... section 2013. 20.2056A-7 Section 20.2056A-7 Internal Revenue INTERNAL REVENUE SERVICE, DEPARTMENT OF THE... Taxable Estate § 20.2056A-7 Allowance of prior transfer credit under section 2013. (a) Property subject to QDOT election. Section 2056(d)(3) provides special rules for computing the section 2013 credit allowed...

77 FR 73065 - In the Matter of the Application of Miami International Securities Exchange, LLC for Registration...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-12-07

... Director that is or has served within the prior three years as an officer, director, employee, or owner of... relationship with MIAX Exchange or any affiliate of MIAX Exchange within the prior three years. See MIAX... completion of its respective duties for nominating directors for election to the Board for that year, shall...

Patient and staff satisfaction with 'day of admission' elective surgery.

PubMed

Sofela, Agbolahan A; Laban, James T; Selway, Richard P

2013-04-01

To evaluate patient and staff satisfaction with day of admission surgery in a neurosurgical unit and its effect on theatre start times. Patients were admitted to a Neurosciences admission lounge (NAL) for neurosurgery on the morning of their operation if deemed appropriate by their neurosurgical consultant. All patients in the NAL were asked to complete patient satisfaction questionnaires. Staff members involved in the care of these patients also completed a satisfaction questionnaire. Theatre start times were compared with those whose patients had been admitted prior to the day of surgery. 378 patients admitted on the day of surgery, 16 doctors (5 anaesthetists, 7 neurosurgeons and 4 neuro high dependency unit, HDU doctors) and 5 nurses. Patients completed an anonymised emotional mapping patient satisfaction questionnaire, and short interviews were carried out with staff members. Theatre start times were obtained retrospectively from the theatre database for lists starting with patients admitted on the day of surgery, and lists starting with patients admitted prior to the day of surgery. 83% of patients felt positive on arrival in the NAL and 88% felt positive on being seen by the doctors and nurses prior to surgery. Overall 79% of patients gave positive responses throughout their patient pathway. 90% of staff were positive about day of admission surgery and all staff members were satisfied that there were no negative effects on surgical outcome. Theatre start time was on average 27 minutes earlier in patients admitted on the day of surgery. Neurosurgical patients, appropriately selected, can be admitted on the day of surgery with high staff and patient satisfaction and without delaying theatre start times.

Laparoscopic transverse rectus abdominus flap delay for autogenous breast reconstruction.

PubMed

Kaddoura, I L; Khoury, G S

1998-01-01

Laparoscopic ligation of the deep and superficial inferior epigastric vessels was done for ten mastectomized patients who elected to have autogenous reconstruction of their breast. All these patients had at least one indication for the delay which included obesity, smoking, or requirement of a large volume of tissue for their reconstruction. The procedure did not add any morbidity or mortality to our patients and was found to be comparable to the "open" delay in preventing partial tissue loss in all but two patients. We describe the use of a minimally invasive procedure to augment the deep superior epigastric pedicled blood supply for the future transverse rectus abdominus flap. We have found in laparoscopic delay a safe, short procedure that is useful in high risk patients who choose the option of autologous breast reconstruction.

Observations on the Air War in Syria

DTIC Science & Technology

2013-04-01

comfortable with a trainer aircraft. In January 2012, the Syrian air force attempted to buy 40 Yak -130 trainers from Russia, but in July 2012...election-result-delay-coup-live. 32. “Russia Will Not Deliver Yak -130 Fighter Jets to Syria,” Airforce-technology.com, 9 July 2012, http://www.airforce

Early elective cesarean delivery before 36 weeks vs late spontaneous delivery in infants with gastroschisis.

PubMed

Hadidi, Ahmed; Subotic, Ulrike; Goeppl, Maximilian; Waag, Karl-L

2008-07-01

The aim of this study is to assess the value of early elective cesarean delivery for patients with gastroschisis in comparison with late spontaneous delivery. Analysis of infants with gastroschisis admitted between 1986 and 2006 at a tertiary care center was performed. The findings were analyzed statistically. Eighty-six patients were involved in the study. This included 15 patients who underwent emergency cesarean delivery (EM CD group) because of fetal distress and/or bowel ischemia. The remaining 71 patients born electively were stratified into 4 groups. The early elective cesarean delivery (ECD) group included 23 patients born by ECD before 36 weeks; late vaginal delivery (LVD) group included 23 patients who had LVD after 36 weeks; 24 patients had LCD after 36 weeks because of delayed diagnosis that resulted in late referral; and 1 patient had early spontaneous vaginal delivery (EVD group) before 36 weeks. The mean time to start oral feeding, incidence of complications, and primary closure were significantly better in the ECD group than in the LVD group. The duration of ventilation and the length of stay were shorter in ECD group, but the difference was not statistically significant. Elective cesarean delivery before 36 weeks allows earlier enteral feeding and is associated with less complications and higher incidence of primary closure (statistically significant).

76 FR 1559 - Guidelines for the Use of Electronic Voting Systems in Union Officer Elections

Federal Register 2010, 2011, 2012, 2013, 2014

2011-01-11

... voting. Id. However, there are still concerns regarding on-line computer security, viruses and attacks... casting votes at polling sites; electronic voting from remote site personal computers via the Internet..., Washington, DC 20210. Because of security precautions, the Department continues to experience delays in U.S...

Entrenched time delays versus accelerating opinion dynamics: are advanced democracies inherently unstable?

NASA Astrophysics Data System (ADS)

Gros, Claudius

2017-11-01

Modern societies face the challenge that the time scale of opinion formation is continuously accelerating in contrast to the time scale of political decision making. With the latter remaining of the order of the election cycle we examine here the case that the political state of a society is determined by the continuously evolving values of the electorate. Given this assumption we show that the time lags inherent in the election cycle will inevitable lead to political instabilities for advanced democracies characterized both by an accelerating pace of opinion dynamics and by high sensibilities (political correctness) to deviations from mainstream values. Our result is based on the observation that dynamical systems become generically unstable whenever time delays become comparable to the time it takes to adapt to the steady state. The time needed to recover from external shocks grows in addition dramatically close to the transition. Our estimates for the order of magnitude of the involved time scales indicate that socio-political instabilities may develop once the aggregate time scale for the evolution of the political values of the electorate falls below 7-15 months.

Delays before Diagnosis and Initiation of Treatment in Patients Presenting to Mental Health Services with Bipolar Disorder.

PubMed

Patel, Rashmi; Shetty, Hitesh; Jackson, Richard; Broadbent, Matthew; Stewart, Robert; Boydell, Jane; McGuire, Philip; Taylor, Matthew

2015-01-01

Bipolar disorder is a significant cause of morbidity and mortality. Although existing treatments are effective, there is often a substantial delay before diagnosis and treatment initiation. We sought to investigate factors associated with the delay before diagnosis of bipolar disorder and the onset of treatment in secondary mental healthcare. Retrospective cohort study using anonymised electronic mental health record data from the South London and Maudsley NHS Foundation Trust (SLaM) Biomedical Research Centre (BRC) Case Register on 1364 adults diagnosed with bipolar disorder between 2007 and 2012. The following predictor variables were analysed in a multivariable Cox regression analysis: age, gender, ethnicity, compulsory admission to hospital under the UK Mental Health Act, marital status and other diagnoses prior to bipolar disorder. The outcomes were time to recorded diagnosis from first presentation to specialist mental health services (the diagnostic delay), and time to the start of appropriate therapy (treatment delay). The median diagnostic delay was 62 days (interquartile range: 17-243) and median treatment delay was 31 days (4-122). Compulsory hospital admission was associated with a significant reduction in both diagnostic delay (hazard ratio 2.58, 95% CI 2.18-3.06) and treatment delay (4.40, 3.63-5.62). Prior diagnoses of other psychiatric disorders were associated with increased diagnostic delay, particularly alcohol (0.48, 0.33-0.41) and substance misuse disorders (0.44, 0.31-0.61). Prior diagnosis of schizophrenia and psychotic depression were associated with reduced treatment delay. Some individuals experience a significant delay in diagnosis and treatment of bipolar disorder after initiation of specialist mental healthcare, particularly those who have prior diagnoses of alcohol and substance misuse disorders. These findings highlight a need for further study on strategies to better identify underlying symptoms and offer appropriate treatment sooner in order to facilitate improved clinical outcomes, such as developing specialist early intervention services to identify and treat people with bipolar disorder.

Elective induction versus spontaneous labour in Latin America

PubMed Central

Guerra, Gláucia Virgínia; Souza, João Paulo; Faúndes, Aníbal; Morais, Sirlei Siani; Gülmezoglu, Ahmet Metin; Passini, Renato; Parpinelli, Mary Angela; Carroli, Guillermo

2011-01-01

Abstract Objective To assess the frequency of elective induction of labour and its determinants in selected Latin America countries; quantify success in attaining vaginal delivery, and compare rates of caesarean and adverse maternal and perinatal outcomes after elective induction versus spontaneous labour in low-risk pregnancies. Methods Of 37 444 deliveries in women with low-risk pregnancies, 1847 (4.9%) were electively induced. The factors associated with adverse maternal and perinatal outcomes among cases of spontaneous and induced onset of labour were compared. Odds ratios for factors potentially associated with adverse outcomes were calculated, as were the relative risks of having an adverse maternal or perinatal outcome (both with their 95% confidence intervals). Adjustment using multiple logistic regression models followed these analyses. Findings Of 11 077 cases of induced labour, 1847 (16.7%) were elective. Elective inductions occurred in 4.9% of women with low-risk pregnancies (37 444). Oxytocin was the most common method used (83% of cases), either alone or combined with another. Of induced deliveries, 88.2% were vaginal. The most common maternal adverse events were: (i) a higher postpartum need for uterotonic drugs, (ii) a nearly threefold risk of admission to the intensive care unit; (iii) a fivefold risk of postpartum hysterectomy, and (iv) an increased need for anaesthesia/analgesia. Perinatal outcomes were satisfactory except for a 22% higher risk of delayed breastfeeding (i.e. initiation between 1 hour and 7 days postpartum). Conclusion Caution is mandatory when indicating elective labour induction because the increased risk of maternal and perinatal adverse outcomes is not outweighed by clear benefits. PMID:21897486

26 CFR 1.9005-1 - Election relating to the determination of gross income from the property for taxable years...

Code of Federal Regulations, 2010 CFR

2010-04-01

... income from the property for taxable years beginning prior to 1961 in the case of clay and quartzite used... beginning prior to 1961 in the case of clay and quartzite used in making refractory products. (a) In general... provisions of the Internal Revenue Code of 1939) in the case of quartzite and clay used by the mine owner or...

Patient Navigation by Community Health Workers Increases Access to Surgical Care in Rural Haiti.

PubMed

Matousek, Alexi C; Addington, Stephen R; Kahan, Joseph; Sannon, Herriot; Luckner, Thelius; Exe, Chauvet; Jean Louis, Rodolphe R Eisenhower; Lipsitz, Stuart; Meara, John G; Riviello, Robert

2017-12-01

In the Hôpital Albert Schweitzer district in rural Haiti, patients from mountain areas receive fewer operations per capita than patients from the plains. Possible additional barriers for mountain patients include lower socioeconomic status, lack of awareness of financial support, illiteracy and unfamiliarity with the hospital system. We sought to increase the rate of elective surgery for a mountain population using a patient navigation program. Patient navigators were trained to guide subjects from a mountain population through the entire hospital process for elective surgery. We compared the rate of elective operations before and after the patient navigation intervention between three groups: a control group from a mountainous area, a control group from the plains and an intervention group from a mountainous area. The baseline elective operation rate differed significantly between the plains control group, the mountain control group and the mountain intervention group (361 vs. 57 vs. 68 operations per 100,000 population per year). The rate of elective surgery between the two mountain groups was not statistically different prior to the intervention. After the intervention, the elective operation rate in the mountain group that received patient navigation increased from 68 to 131 operations per 100,000 population per year (p = 0.017). Patient navigation doubled the elective operation rate for a mountain population in rural Haiti. While additional barriers to access remain for this vulnerable population, patient navigation is an essential augmentation to financial assistance programs to ensure that the poor gain access to surgical care.

Developing a bioethics curriculum for medical students from divergent geo-political regions.

PubMed

Greenberg, Rebecca A; Kim, Celine; Stolte, Helen; Hellmann, Jonathan; Shaul, Randi Zlotnik; Valani, Rahim; Scolnik, Dennis

2016-07-27

The World Health Organization calls for stronger cross-cultural emphasis in medical training. Bioethics education can build such competencies as it involves the conscious exploration and application of values and principles. The International Pediatric Emergency Medicine Elective (IPEME), a novel global health elective, brings together 12 medical students from Canada and the Middle East for a 4-week, living and studying experience. It is based at a Canadian children's hospital and, since its creation in 2004, ethics has informally been part of its curriculum. Our study sought to determine the content and format of an ideal bioethics curriculum for a culturally diverse group of medical students. We conducted semi-structured interviews with students and focus groups with faculty to examine the cultural context and ethical issues of the elective. Three areas were explored: 1) Needs Analysis - students' current understanding of bioethics, prior bioethics education and desire for a formal ethics curriculum, 2) Teaching formats - students' and faculty's preferred teaching formats, and 3) Curriculum Content - students' and faculty's preferred subjects for a curriculum. While only some students had received formal ethics training prior to this program, all understood that it was a necessary and desirable subject for formal training. Interactive teaching formats were the most preferred and truth-telling was considered the most important subject. This study helps inform good practices for ethics education. Although undertaken with a specific cohort of students engaging in a health-for-peace elective, it may be applicable to many medical education settings since diversity of student bodies is increasing world-wide.

Sophisticated approval voting, ignorance priors, and plurality heuristics: a behavioral social choice analysis in a Thurstonian framework.

PubMed

Regenwetter, Michel; Ho, Moon-Ho R; Tsetlin, Ilia

2007-10-01

This project reconciles historically distinct paradigms at the interface between individual and social choice theory, as well as between rational and behavioral decision theory. The authors combine a utility-maximizing prescriptive rule for sophisticated approval voting with the ignorance prior heuristic from behavioral decision research and two types of plurality heuristics to model approval voting behavior. When using a sincere plurality heuristic, voters simplify their decision process by voting for their single favorite candidate. When using a strategic plurality heuristic, voters strategically focus their attention on the 2 front-runners and vote for their preferred candidate among these 2. Using a hierarchy of Thurstonian random utility models, the authors implemented these different decision rules and tested them statistically on 7 real world approval voting elections. They cross-validated their key findings via a psychological Internet experiment. Although a substantial number of voters used the plurality heuristic in the real elections, they did so sincerely, not strategically. Moreover, even though Thurstonian models do not force such agreement, the results show, in contrast to common wisdom about social choice rules, that the sincere social orders by Condorcet, Borda, plurality, and approval voting are identical in all 7 elections and in the Internet experiment. PsycINFO Database Record (c) 2007 APA, all rights reserved.

Approach to inguinal hernia in high-risk geriatric patients: Should it be elective or emergent?

PubMed

Işıl, Rıza Gürhan; Yazıcı, Pınar; Demir, Uygar; Kaya, Cemal; Bostancı, Özgür; İdiz, Ufuk Oğuz; Işıl, Canan Tülay; Demircioğlu, Mahmut Kaan; Mihmanlı, Mehmet

2017-03-01

Elderly patients are more prone to have inguinal hernia due to weakened abdominal musculature. However, surgical repair of inguinal hernia (SRIH) may not be performed or may be delayed due to greater risk in presence of comorbidities. Present study is investigation of outcome of elective and emergency SRIH in geriatric patients. Records of total of 384 high-risk (American Society of Anesthesiology classification III-IV) patients aged >65 years who underwent SRIH between January 2010 and December 2014 were reviewed. Patients were divided into 2 groups according to procedure type: elective (Group EL) or emergency (Group EM). Demographic features and surgical and postoperative period data of 2 groups were recorded and compared. Demographic data were similar, but number of ASA IV patients was greater in Group EM. Frequency of intestinal resection was significantly greater in emergency surgery group (1% vs 21%; p<0.01). Length of hospital stay (1.3 days vs 7.9 days; p<0.01) and intensive care unit stay (0.17 days vs 4.04 days; p<0.01) were also greater in Group EM. Morbidity (1% vs 24%; p<0.01) and mortality (0.3% vs 11%; p<0.01) were also significantly higher in Group EM compared to elective SRIH group. Emergency inguinal hernia surgery is associated with significantly higher morbidity and mortality compared with elective SRIH in high-risk geriatric patients. Elective hernia repair in these patients should be considered to reduce risk of need for intestinal resection as well as length of hospital stay.

Protecting the health of medical students on international electives in low-resource settings.

PubMed

Johnston, Niall; Sandys, Nichola; Geoghegan, Rosemary; O'Donovan, Diarmuid; Flaherty, Gerard

2018-01-01

Increasingly, medical students from developed countries are undertaking international medical electives in developing countries. Medical students understand the many benefits of these electives, such as the opportunity to develop clinical skills, to gain insight into global health issues and to travel to interesting regions of the world. However, they may be much less aware of the risk to their health and wellbeing while abroad. Compounding this problem, medical students may not seek advice from travel medicine practitioners and often receive inadequate or no information from their medical school prior to departure. The PubMed database was searched for relevant literature relating to the health of medical elective students. Combinations of the following key words were used as search terms: 'international health elective', 'medical student' and 'health risks'. Articles were restricted to those published in English from 1997 through June 2017. A secondary review of the reference lists of these articles was performed. The grey literature was also searched for relevant material. This narrative literature review outlines the risks of clinical electives in resource-poor settings which include exposure to infectious illness, trauma, sexual health problems, excessive sun exposure, mental health issues and crime. Medical students may mitigate these health risks by being informed and well prepared for high-risk situations. The authors provide evidence-based travel advice which aims to improve pre-travel preparation and maximize student traveller safety. A safer and more enjoyable elective may be achieved if students follow road safety advice, take personal safety measures, demonstrate cultural awareness, attend to their psychological wellbeing and avoid risk-taking behaviours. This article may benefit global health educators, international elective coordinators and travel medicine practitioners. For students, a comprehensive elective checklist, an inventory of health kit items and useful web-based educational resources are provided to help prepare for electives abroad. © International Society of Travel Medicine, 2017. Published by Oxford University Press. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com

Cultural effects on the association between election outcomes and face-based trait inferences

PubMed Central

Adolphs, Ralph; Alvarez, R. Michael

2017-01-01

How competent a politician looks, as assessed in the laboratory, is correlated with whether the politician wins in real elections. This finding has led many to investigate whether the association between candidate appearances and election outcomes transcends cultures. However, these studies have largely focused on European countries and Caucasian candidates. To the best of our knowledge, there are only four cross-cultural studies that have directly investigated how face-based trait inferences correlate with election outcomes across Caucasian and Asian cultures. These prior studies have provided some initial evidence regarding cultural differences, but methodological problems and inconsistent findings have complicated our understanding of how culture mediates the effects of candidate appearances on election outcomes. Additionally, these four past studies have focused on positive traits, with a relative neglect of negative traits, resulting in an incomplete picture of how culture may impact a broader range of trait inferences. To study Caucasian-Asian cultural effects with a more balanced experimental design, and to explore a more complete profile of traits, here we compared how Caucasian and Korean participants’ inferences of positive and negative traits correlated with U.S. and Korean election outcomes. Contrary to previous reports, we found that inferences of competence (made by participants from both cultures) correlated with both U.S. and Korean election outcomes. Inferences of open-mindedness and threat, two traits neglected in previous cross-cultural studies, were correlated with Korean but not U.S. election outcomes. This differential effect was found in trait judgments made by both Caucasian and Korean participants. Interestingly, the faster the participants made face-based trait inferences, the more strongly those inferences were correlated with real election outcomes. These findings provide new insights into cultural effects and the difficult question of causality underlying the association between facial inferences and election outcomes. We also discuss the implications for political science and cognitive psychology. PMID:28700647

Cultural effects on the association between election outcomes and face-based trait inferences.

PubMed

Lin, Chujun; Adolphs, Ralph; Alvarez, R Michael

2017-01-01

How competent a politician looks, as assessed in the laboratory, is correlated with whether the politician wins in real elections. This finding has led many to investigate whether the association between candidate appearances and election outcomes transcends cultures. However, these studies have largely focused on European countries and Caucasian candidates. To the best of our knowledge, there are only four cross-cultural studies that have directly investigated how face-based trait inferences correlate with election outcomes across Caucasian and Asian cultures. These prior studies have provided some initial evidence regarding cultural differences, but methodological problems and inconsistent findings have complicated our understanding of how culture mediates the effects of candidate appearances on election outcomes. Additionally, these four past studies have focused on positive traits, with a relative neglect of negative traits, resulting in an incomplete picture of how culture may impact a broader range of trait inferences. To study Caucasian-Asian cultural effects with a more balanced experimental design, and to explore a more complete profile of traits, here we compared how Caucasian and Korean participants' inferences of positive and negative traits correlated with U.S. and Korean election outcomes. Contrary to previous reports, we found that inferences of competence (made by participants from both cultures) correlated with both U.S. and Korean election outcomes. Inferences of open-mindedness and threat, two traits neglected in previous cross-cultural studies, were correlated with Korean but not U.S. election outcomes. This differential effect was found in trait judgments made by both Caucasian and Korean participants. Interestingly, the faster the participants made face-based trait inferences, the more strongly those inferences were correlated with real election outcomes. These findings provide new insights into cultural effects and the difficult question of causality underlying the association between facial inferences and election outcomes. We also discuss the implications for political science and cognitive psychology.

In the queue for coronary artery bypass grafting: patients' perceptions of risk and 'maximal acceptable waiting time'.

PubMed

Llewellyn-Thomas, H; Thiel, E; Paterson, M; Naylor, D

1999-04-01

To elicit patients' maximal acceptable waiting times (MAWT) for non-urgent coronary artery bypass grafting (CABG), and to determine if MAWT is related to prior expectations of waiting times, symptom burden, expected relief, or perceived risks of myocardial infarction while waiting. Seventy-two patients on an elective CABG waiting list chose between two hypothetical but plausible options: a 1-month wait with 2% risk of surgical mortality, and a 6-month wait with 1% risk of surgical mortality. Waiting time in the 6-month option was varied up if respondents chose the 6-month/lower risk option, and down if they chose the 1-month/higher risk option, until the MAWT switch point was reached. Patients also reported their expected waiting time, perceived risks of myocardial infarction while waiting, current function, expected functional improvement and the value of that improvement. Only 17 (24%) patients chose the 6-month/1% risk option, while 55 (76%) chose the 1-month/2% risk option. The median MAWT was 2 months; scores ranged from 1 to 12 months (with two outliers). Many perceived high cumulative risks of myocardial infarction if waiting for 1 (upper quartile, > or = 1.45%) or 6 (upper quartile, > or = 10%) months. However, MAWT scores were related only to expected waiting time (r = 0.47; P < 0.0001). Most patients reject waiting 6 months for elective CABG, even if offered along with a halving in surgical mortality (from 2% to 1%). Intolerance for further delay seems to be determined primarily by patients' attachment to their scheduled surgical dates. Many also have severely inflated perceptions of their risk of myocardial infarction in the queue. These results suggest a need for interventions to modify patients' inaccurate risk perceptions, particularly if a scheduled surgical date must be deferred.

Preoperative Education for Hip and Knee Replacement: Never Stop Learning.

PubMed

Edwards, Paul K; Mears, Simon C; Lowry Barnes, C

2017-09-01

Participation in alternative payment models has focused efforts to improve outcomes and patient satisfaction while also lowering cost for elective hip and knee replacement. The purpose of this review is to determine if preoperative education classes for elective hip and knee replacement achieve these goals. Recent literature demonstrates that patients who attend education classes prior to surgery have decreased anxiety, better post-operative pain control, more realistic expectations of surgery, and a better understanding of their surgery. As a result, comprehensive clinical pathways incorporating a preoperative education program for elective hip and knee replacement lead to lower hospital length of stay, higher home discharge, lower readmission, and improved cost. In summary, we report convincing evidence that preoperative education classes are an essential element to successful participation in alternative payment models such as the Bundle Payment Care Initiative.

The perinatal quality collaborative of North Carolina's 39 weeks project: a quality improvement program to decrease elective deliveries before 39 weeks of gestation.

PubMed

Berrien, Kate; Devente, James; French, Amanda; Cochran, Keith M; McCaffrey, Marty; Horton, Bethany J; Chescheir, Nancy

2014-01-01

Despite long-standing guidelines from the American College of Obstetricians and Gynecologists that call for avoiding elective births prior to 39 weeks of gestation, elective deliveries make up almost one-third of US births occurring in weeks 36-38. Poor outcomes are more likely for infants born electively before 39 weeks than for those born at 39 weeks. The Perinatal Quality Collaborative of North Carolina (PQCNC) undertook the 39 Weeks Project in 2009-2010 with the aim of reducing the number of early-term elective deliveries in North Carolina hospitals. Participating hospitals (N = 33) provided retrospective data on all early-term deliveries and created new policies, or amended or enforced existing policies, to accomplish the project's goals. Project activities included in-person learning sessions, regional meetings, webinars, electronic newsletters, a secure extranet Web site where participating hospitals could share relevant materials, and individual leadership consultations with hospital teams. Hospitals submitted monthly data to PQCNC, which provided ongoing training and data analysis. Elective deliveries before 39 weeks of gestation decreased 45% over the project period, from 2% to 1.1% of all deliveries. The proportion of elective deliveries among all scheduled early-term deliveries also decreased, from 23.63% to 16.19%. There was an increase in the proportion of patients with documented evidence of medical indications for early delivery, from 62.4% to 88.2%. No data were collected to determine whether outcomes changed for patients whose deliveries were deferred. The project also depended on each hospital to code its own data. The PQCNC's 39 Weeks Project successfully decreased the rate of early-term elective deliveries in participating hospitals.

The timing of drug funding announcements relative to elections: a case study involving dementia medications.

PubMed

Gill, Sudeep S; Gupta, Neeraj; Bell, Chaim M; Rochon, Paula A; Austin, Peter C; Laupacis, Andreas

2013-01-01

Following initial regulatory approval of prescription drugs, many factors may influence insurers and health systems when they decide whether to add these drugs to their formularies. The role of political pressures on drug funding announcements has received relatively little attention, and elections represent an especially powerful form of political pressure. We examined the temporal relationship between decisions to add one class of drugs to publicly funded formularies in Canada's ten provinces and elections in these jurisdictions. Dates of provincial formulary listings for cholinesterase inhibitors, which are drugs used to treat Alzheimer's disease and related dementias, were compared to the dates of provincial elections. Medical journal articles, media reports, and proceedings from provincial legislatures were reviewed to assemble information on the chronology of events. We tested whether there was a statistically significant increase in the probability of drug funding announcements within the 60-day intervals preceding provincial elections. Decisions to fund the cholinesterase inhibitors were made over a nine-year span from 1999 to 2007 in the ten provinces. In four of ten provinces, the drugs were added to formularies in a time period closely preceding a provincial election (P = 0.032); funding announcements in these provinces were made between 2 and 47 days prior to elections. Statements made in provincial legislatures highlight the key role of political pressures in these funding announcements. Impending elections appeared to affect the timing of drug funding announcements in this case study. Despite an established structure for evidence-based decision-making, drug funding remains a complex process open to influence from many sources. Awareness of such influences is critical to maintain effective drug policy and public health decision-making.

Accelerated discharge within 72 hours of colorectal cancer resection using simple discharge criteria.

PubMed

Emmanuel, A; Chohda, E; Botfield, C; Ellul, J

2018-01-01

Introduction Short hospital stays and accelerated discharge within 72 hours following colorectal cancer resections have not been widely achieved. Series reporting on accelerated discharge involve heterogeneous patient populations and exclude important groups. Strict adherence to some discharge requirements may lead to delays in discharge. The aim of this study was to evaluate the safety and feasibility of accelerated discharge within 72 hours of all elective colorectal cancer resections using simple discharge criteria. Methods Elective colorectal cancer resections performed between August 2009 and December 2015 by a single surgeon were reviewed. Perioperative care was based on an enhanced recovery programme. A set of simplified discharge criteria were used. Outcomes including postoperative complications, readmissions and reoperations were compared between patients discharged within 72 hours and those with a longer postoperative stay. Results Overall, 256 colorectal cancer resections (90% laparoscopic) were performed. The mean patient age was 70.8 years. The median length of stay was 3 days. Fifty-eight per cent of all patients and sixty-three per cent of patients undergoing laparoscopic surgery were discharged within 72 hours. Accelerated discharge was not associated with adverse outcomes compared with delayed discharge. Patients discharged within 72 hours had significantly fewer postoperative complications, readmissions and reoperations. Open surgery and stoma formation were associated with discharge after 72 hours but not age, co-morbidities, neoadjuvant chemoradiation or surgical procedure. Conclusions Accelerated discharge within 72 hours of elective colorectal resection for cancer is safely achievable for the majority of patients without compromising short-term outcomes.

Delays before Diagnosis and Initiation of Treatment in Patients Presenting to Mental Health Services with Bipolar Disorder

PubMed Central

Patel, Rashmi; Shetty, Hitesh; Jackson, Richard; Broadbent, Matthew; Stewart, Robert; Boydell, Jane; McGuire, Philip; Taylor, Matthew

2015-01-01

Background Bipolar disorder is a significant cause of morbidity and mortality. Although existing treatments are effective, there is often a substantial delay before diagnosis and treatment initiation. We sought to investigate factors associated with the delay before diagnosis of bipolar disorder and the onset of treatment in secondary mental healthcare. Method Retrospective cohort study using anonymised electronic mental health record data from the South London and Maudsley NHS Foundation Trust (SLaM) Biomedical Research Centre (BRC) Case Register on 1364 adults diagnosed with bipolar disorder between 2007 and 2012. The following predictor variables were analysed in a multivariable Cox regression analysis: age, gender, ethnicity, compulsory admission to hospital under the UK Mental Health Act, marital status and other diagnoses prior to bipolar disorder. The outcomes were time to recorded diagnosis from first presentation to specialist mental health services (the diagnostic delay), and time to the start of appropriate therapy (treatment delay). Results The median diagnostic delay was 62 days (interquartile range: 17–243) and median treatment delay was 31 days (4–122). Compulsory hospital admission was associated with a significant reduction in both diagnostic delay (hazard ratio 2.58, 95% CI 2.18–3.06) and treatment delay (4.40, 3.63–5.62). Prior diagnoses of other psychiatric disorders were associated with increased diagnostic delay, particularly alcohol (0.48, 0.33–0.41) and substance misuse disorders (0.44, 0.31–0.61). Prior diagnosis of schizophrenia and psychotic depression were associated with reduced treatment delay. Conclusions Some individuals experience a significant delay in diagnosis and treatment of bipolar disorder after initiation of specialist mental healthcare, particularly those who have prior diagnoses of alcohol and substance misuse disorders. These findings highlight a need for further study on strategies to better identify underlying symptoms and offer appropriate treatment sooner in order to facilitate improved clinical outcomes, such as developing specialist early intervention services to identify and treat people with bipolar disorder. PMID:25992560

Is employer coverage of elective egg freezing coercive?: a survey of medical students' knowledge, intentions, and attitudes towards elective egg freezing and employer coverage.

PubMed

Ikhena-Abel, Deborah E; Confino, Rafael; Shah, Nirali J; Lawson, Angela K; Klock, Susan C; Robins, Jared C; Pavone, Mary Ellen

2017-08-01

The purpose of this study was to understand medical students' knowledge, intentions, and attitudes towards oocyte cryopreservation and employer coverage of such treatment. This cross-sectional study was performed via an online cross-sectional survey distributed to 280 female medical students from March through August 2016. Demographics, attitudes towards employer coverage, and factors influencing decision-making were assessed via a self-reported multiple-choice questionnaire. The relationship between respondents' attitudes towards employer coverage and other parameters was analyzed. A total of 99 responses were obtained out of 280 female medical students. Most respondents (71%) would consider oocyte cryopreservation (potential freezers), although 8% would not consider the procedure and 21% were unsure. Seventy-six percent of respondents felt pressure to delay childbearing. Potential freezers were more likely to be single (p = 0.001), to report feeling pressure to delay childbearing (p = 0.016), and to consider egg freezing if offered by an employer (p < 0.001). Importantly, 71% percent did not view employer coverage as coercive and 77% of respondents would not delay childbearing due to employer coverage. Factors influencing decision-making in potential freezers were absence of a suitable partner (83%), likelihood of success (95%), and health of offspring (94%), among others. Knowledge about the low chance of pregnancy per oocyte (6-10%) would influence decision-making in 42% of potential freezers. Oocyte freezing is an acceptable strategy for the majority of young women surveyed. Pressure to delay childbearing was related to openness to freeze eggs. The majority of respondents did not find employer coverage for egg freezing coercive although further research is needed with larger, representative samples to ascertain the relationship between pressure to delay childbearing due to work demands and employer coverage for egg freezing.

Impact of a dermatology wiki website on dermatology education.

PubMed

Karimkhani, Chante; Boyers, Lindsay N; Ellis, Lixia Z; Brice, Sylvia; Chen, David L; Dunnick, Cory A; Dellavalle, Robert P

2015-01-15

The Dermatology Education Wiki (dermwiki) website serves as a resource platform for medical students and residents. The readily accessible interface provides dermatology articles, survival guides, didactic lectures, and links to faculty talks as well as research opportunities. To assess medical student and resident satisfaction with the dermwiki website. Fourth-year medical students taking a dermatology elective were provided with a temporary password to access relevant dermwiki information. A satisfaction survey was created to assess whether medical students found the website helpful. Second- and third-year dermatology residents were also surveyed to compare satisfaction scores prior to and after the introduction of the dermwiki website. End-of-rotation medical student exam scores were tabulated and compared to the average scores from years prior to the development of the dermwiki website. Medical students rated the dermatology elective with the dermwiki website higher than rotations without a wiki (8.12 vs 7.31). Students planning to go into dermatology were more satisfied with the dermwiki website, reported accessing the website more frequently (11 times vs 9.5 times), and reported more time spent studying (12.2 hours vs 6.7 hours) than students not going into dermatology. End-of-rotation medical student exam scores did not differ from those prior to the development of the demwiki website. Ten second- and third-year dermatology residents unanimously stated that they were more satisfied with the program after the institution of the dermwiki website. Overall, addition of the dermwiki website to the dermatology elective curriculum has improved medical student and resident satisfaction scores. The improvement is greater among students planning to enter the field of dermatology. This study serves as a model for the incorporation of internet-based interactive tools to transform and supplement the learning environment.

A national survey on current practice of preanaesthetic assessment in elective surgery patients in Spain.

PubMed

Mata, J; Cabrera, S; Valldeperas, M I; Fernández, S; Aguilar, J L; Atanassoff, P G

2012-01-01

To analyse the preanaesthetic assessment prior to elective surgery in hospitals of the Spanish National Health Care System. A prospective cross-sectional descriptive observational survey was performed. Primary variables were patient characteristics, type of preanaesthetic evaluation and the evaluator, as well as type of support the evaluator received during patient assessment. Secondary variables included the number of operating rooms available for elective surgery, as well as preanaesthesia clinic facilities. Data were analysed by univariate and bivariate descriptive analysis. A total of 214 hospitals of the Spanish Health Care System were invited to participate, and 203 centres responded, with all of them having a preanaesthesia assessment clinic. In 183 of them (90%), elective surgerypatients were interviewed prior to their surgical intervention, and in 202 hospitals (99.5%) a anaesthesiologist physician performed the interview. In 128 hospitals (63%), anaesthesiologists were helped during preoperative assessment by nurses alone (49%) or together with auxillary nurses (14%). In 68 of hospitals (33%) they were supported only by auxillary nurses and in 7 hospitals (3%) they obtained no help at all. In 14 centres (7%) anaesthesia nurses assessed patients directly (under supervision of an anaesthesiologist physician). Hospitals with a higher volume of patients performed more preanaesthesia interviews. Hospitals with more running operating rooms received more nurse support in the preanaesthesia assessment clinic. Some kind of preanaesthesia assessment clinic exists in all Anaesthesia Departments of public Spanish hospitals, although there are differences in design and organisation. Copyright © 2011 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Published by Elsevier España. All rights reserved.

Student perceptions of reproductive health education in US medical schools: a qualitative analysis of students taking family planning electives.

PubMed

Veazey, Kathryn; Nieuwoudt, Claudia; Gavito, Christina; Tocce, Kristina

2015-01-01

Abortion services will be sought by an estimated one in three US women before they reach age 45. Despite the importance of family planning (FP) care, many medical schools do not currently offer formal education in this area, and students are unable to meet associated competency standards prior to graduation. The purpose of this study was to explore students' motivations in pursuing FP electives throughout the United States, their experiences during these courses, and any impact of these rotations on their plans for future practice. We conducted a qualitative study consisting of semi-structured interviews with medical students upon completing fourth-year FP electives at US medical schools. Thirty-seven LCME-accredited US medical schools offered fourth-year FP electives. Course directors at 21 of these institutions recruited study participants between June 2012 and June 2013. Interviews were transcribed, coded, and analyzed with ATLAS/ti software to identify salient themes. We interviewed 29 students representing 14 institutions from all regions of the United States (East Coast, Midwest, South, and West Coast). Five central themes emerged. Medical students are using FP electives to fill gaps in the standard curriculum. Elective participation did not change students' pre-elective stance on abortion. Many students intend to provide abortion in the future but identified possible limiting factors. Proficiency in contraception and options counseling were top competencies desired and gained. Students reported excellent satisfaction with FP electives and would recommend it to their peers, regardless of their personal beliefs. Interview data revealed that students are using FP electives to fill gaps within preclinical and clinical medical school curriculum. Future physicians will be unable to provide comprehensive care for their female patients if they are not provided with this education. Research should be directed at development and analysis of comprehensive FP curricula, which will allow students to obtain the knowledge necessary to best care for their patients.

Student perceptions of reproductive health education in US medical schools: a qualitative analysis of students taking family planning electives.

PubMed

Veazey, Kathryn; Nieuwoudt, Claudia; Gavito, Christina; Tocce, Kristina

2015-01-01

Background Abortion services will be sought by an estimated one in three US women before they reach age 45. Despite the importance of family planning (FP) care, many medical schools do not currently offer formal education in this area, and students are unable to meet associated competency standards prior to graduation. Purpose The purpose of this study was to explore students' motivations in pursuing FP electives throughout the United States, their experiences during these courses, and any impact of these rotations on their plans for future practice. Method We conducted a qualitative study consisting of semi-structured interviews with medical students upon completing fourth-year FP electives at US medical schools. Thirty-seven LCME-accredited US medical schools offered fourth-year FP electives. Course directors at 21 of these institutions recruited study participants between June 2012 and June 2013. Interviews were transcribed, coded, and analyzed with ATLAS/ti software to identify salient themes. Results We interviewed 29 students representing 14 institutions from all regions of the United States (East Coast, Midwest, South, and West Coast). Five central themes emerged. Medical students are using FP electives to fill gaps in the standard curriculum. Elective participation did not change students' pre-elective stance on abortion. Many students intend to provide abortion in the future but identified possible limiting factors. Proficiency in contraception and options counseling were top competencies desired and gained. Students reported excellent satisfaction with FP electives and would recommend it to their peers, regardless of their personal beliefs. Conclusions Interview data revealed that students are using FP electives to fill gaps within preclinical and clinical medical school curriculum. Future physicians will be unable to provide comprehensive care for their female patients if they are not provided with this education. Research should be directed at development and analysis of comprehensive FP curricula, which will allow students to obtain the knowledge necessary to best care for their patients.

Assaults on Days of Campaign Rallies During the 2016 US Presidential Election.

PubMed

Morrison, Christopher N; Ukert, Benjamin; Palumbo, Aimee; Dong, Beidi; Jacoby, Sara F; Wiebe, Douglas J

2018-07-01

This study investigates whether assault frequency increased on days and in cities where candidates Donald Trump and Hillary Clinton held campaign rallies prior to the 2016 US Presidential election. We calculated city-level counts of police-reported assaults for 31 rallies for Donald Trump and 38 rallies for Hillary Clinton. Negative binomial models estimated the assault incidence on rally days (day 0) relative to that on eight control days for the same city (days -28, -21, -14, -7, +7, +14, +21, and +28). Cities experienced an increase in assaults (incidence rate ratio [IRR] = 1.12, 95% CI: 1.03-1.22) on the days of Donald Trump's rallies, and no change in assaults on the days of Hillary Clinton's rallies (IRR = 1.00; 95% CI: 0.94-1.06). Assaults increased on days when cities hosted Donald Trump's rallies during the 2016 Presidential election campaign.

Magnetic and electric fields induce directional response in Steinernema carpocapsae

USDA-ARS?s Scientific Manuscript database

Entomopathogenic nematode species respond directionally to various cues including electrical stimuli. For example, in prior research Steinernema carpocapsae was shown to be attracted to an electrical current that was applied to an agar dish. Thus, we hypothesized that these nematodes may use elect...

Delayed Hospital Presentation in Acute Decompensated Heart Failure: Clinical and Patient Reported Factors

PubMed Central

Darling, Chad; Saczynski, Jane S.; McManus, David D.; Lessard, Darleen; Spencer, Frederick A.; Goldberg, Robert J.

2013-01-01

Background Patients with acute decompensated heart failure (ADHF) often wait a considerable amount of time before going to the hospital. Prior studies have examined the reasons why such delays may occur, but additional studies are needed to identify modifiable factors contributing to these delays. Purpose To describe care-seeking delay times, factors associated with prolonged delay, and patient's thoughts and actions in adult men and women hospitalized with ADHF. Methods We surveyed 1,271 patients hospitalized with ADHF at 8 urban medical centers between 2007 and 2010. Results The average age of our study population was 73 years, 47% were female, and 72% had prior heart failure. The median duration of pre-hospital delay prior to hospital presentation was 5.3 hours. Patients who delayed longer than the median were older, more likely to have diabetes, peripheral edema, to have symptoms that began in the afternoon, and to have contacted their medical provider(s) about their symptoms. Prolonged care seekers were less likely to have attributed their symptoms to ADHF, less likely to want to have bothered their doctor or family, and were more likely to be concerned about missing work due to their illness (all p values<0.05). Conclusions Care-seeking delays are common among patients with ADHF. A variety of factors contribute to these delays which in some cases may represent efforts to manage ADHF symptoms at home. More research is needed to better understand the detrimental effects of these delays and how best to encourage timely care-seeking behavior in the setting of ADHF. PMID:23474108

[Delayed (tension) pneumothorax after placement of a central venous catheter].

PubMed

Tan, E C; van der Vliet, J A

1999-09-11

Laborious attempts at introducing a central venous catheter for parenteral nutrition in two women, aged 36 and 62 years, were followed by shortness of breath after 32 and 10 hours, respectively. This symptom was due to a (tension) pneumothorax not visible on earlier roentgenograms. Thoracic drainage led to recovery. In all patients with a central venous catheter an undetected delayed pneumothorax can be present. Urgent chest X-ray examination should be performed in all patients with acute respiratory symptoms. Patients undergoing elective intubation with positive pressure breathing should be examined carefully, since they are at risk of developing a late (tension) pneumothorax.

Provision of drugs for post-exposure prophylaxis of HIV for medical students on overseas electives.

PubMed

Franklin, G F; Gray, K; Nathwani, D

2001-10-01

To assess the need for, and the most practical way to provide, HIV post-exposure prophylaxis (PEP) for medical students travelling to areas where this is not readily available. Follow-up questionnaire for all 140 students from Dundee University returning from their medical elective in 2000, 22 of whom took triple therapy for PEP with them on elective. 103/140 students (74%) returned questionnaires. 76/103 (74%) were involved in exposure-prone procedures and 38/103 (37%) reported a significant exposure to potentially infective fluids. Six of this group considered PEP but none reported using it. The greatest perceived risk on elective remained road accidents. 87/103 respondents thought a 24-h helpline for health issues on electives would be useful. A high number of students report significant exposure to potentially infected fluids and this needs to be urgently addressed. There was almost unanimous endorsement of the idea of providing PEP and when it is made easily available prior to travel, students are willing to take it to areas where it is not available. In response to the survey, the investigators are looking at how to increase the current limited supply of PEP (Students may have to pay part of the cost) and the best way to provide a helpline, as it is felt that this could have a broad impact on student safety on electives, not just for issues involving PEP. Copyright 2001 The British Infection Society.

Delayed recovery of adipsic diabetes insipidus (ADI) caused by elective clipping of anterior communicating artery and left middle cerebral artery aneurysms.

PubMed

Tan, Jeffrey; Ndoro, Samuel; Okafo, Uchenna; Garrahy, Aoife; Agha, Amar; Rawluk, Danny

2016-12-16

Adipsic diabetes insipidus (ADI) is an extremely rare complication following microsurgical clipping of anterior communicating artery aneurysm (ACoA) and left middle cerebral artery (MCA) aneurysm. It poses a significant challenge to manage due to an absent thirst response and the co-existence of cognitive impairment in our patient. Recovery from adipsic DI has hitherto been reported only once. A 52-year-old man with previous history of clipping of left posterior communicating artery aneurysm 20 years prior underwent microsurgical clipping of ACoA and left MCA aneurysms without any intraoperative complications. Shortly after surgery, he developed clear features of ADI with adipsic severe hypernatraemia and hypotonic polyuria, which was associated with cognitive impairment that was confirmed with biochemical investigations and cognitive assessments. He was treated with DDAVP along with a strict intake of oral fluids at scheduled times to maintain eunatremia. Repeat assessment at six months showed recovery of thirst and a normal water deprivation test. Management of ADI with cognitive impairment is complex and requires a multidisciplinary approach. Recovery from ADI is very rare, and this is only the second report of recovery in this particular clinical setting.

77 FR 57189 - Submission for OMB Review; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2012-09-17

... currently approved collection. Title: TD 8560 (CO-30-92) Consolidated Returns--Stock Basis and Excess Loss...) allocating items between returns. The information will facilitate enforcement of consolidated return... completed prior to the effective data and to stop an election to use a historic loss payment pattern...

29 CFR 452.40 - Prior office holding.

Code of Federal Regulations, 2010 CFR

2010-07-01

... Regulations Relating to Labor OFFICE OF LABOR-MANAGEMENT STANDARDS, DEPARTMENT OF LABOR LABOR-MANAGEMENT STANDARDS GENERAL STATEMENT CONCERNING THE ELECTION PROVISIONS OF THE LABOR-MANAGEMENT REPORTING AND.... 26 26 Wirtz v. Hotel, Motel and Club Employees Union, Local 6, 391 U.S. 492 at 504. The Court stated...

29 CFR 452.40 - Prior office holding.

Code of Federal Regulations, 2011 CFR

2011-07-01

... Regulations Relating to Labor OFFICE OF LABOR-MANAGEMENT STANDARDS, DEPARTMENT OF LABOR LABOR-MANAGEMENT STANDARDS GENERAL STATEMENT CONCERNING THE ELECTION PROVISIONS OF THE LABOR-MANAGEMENT REPORTING AND.... 26 26 Wirtz v. Hotel, Motel and Club Employees Union, Local 6, 391 U.S. 492 at 504. The Court stated...

Elective repeat caesarean section versus induction of labour for women with a previous caesarean birth.

PubMed

Dodd, Jodie M; Crowther, Caroline A; Grivell, Rosalie M; Deussen, Andrea R

2014-12-19

When a woman has had a previous caesarean birth and requires induction of labour in a subsequent pregnancy there are two options for her care, an elective repeat caesarean or planned induction of labour. While there are risks and benefits for both elective repeat caesarean birth and planned induction of labour, current sources of information are limited to non-randomised cohort studies. Studies designed in this way have significant potential for bias and consequently any conclusions based on these results are limited in their reliability and should be interpreted with caution. To assess, using the best available evidence, the benefits and harms of elective repeat caesarean section and planned induction of labour for women with a previous caesarean birth, who require induction of labour in a subsequent pregnancy. We searched the Cochrane Pregnancy and Childbirth Group Trials Register (31 October 2014). Randomised controlled trials with reported data that compared outcomes in mothers and babies for women who planned an elective repeat caesarean section with outcomes in women who planned induction of labour, where a previous birth had been by caesarean. There was no data extraction performed. There were no randomised controlled trials identified. Both planned elective repeat caesarean section and planned induction of labour for women with a prior caesarean birth are associated with benefits and harms. Evidence for these care practices is drawn from non-randomised studies that are associated with potential bias. Any results and conclusions must therefore be interpreted with caution. Randomised controlled trials are required to provide the most reliable evidence regarding the benefits and harms of both planned elective repeat caesarean section and planned induction of labour for women with a previous caesarean birth.

Vaginal birth after cesarean: new insights on maternal and neonatal outcomes.

PubMed

Guise, Jeanne-Marie; Denman, Mary Anna; Emeis, Cathy; Marshall, Nicole; Walker, Miranda; Fu, Rongwei; Janik, Rosalind; Nygren, Peggy; Eden, Karen B; McDonagh, Marian

2010-06-01

To systematically review the evidence about maternal and neonatal outcomes relating to vaginal birth after cesarean (VBAC). Relevant studies were identified from multiple searches of MEDLINE, DARE, and the Cochrane databases (1980 to September 2009) and from recent systematic reviews, reference lists, reviews, editorials, Web sites, and experts. Inclusion criteria limited studies to the English-language and human studies conducted in the United States and developed countries specifically evaluating birth after previous cesarean delivery. Studies focusing on high-risk maternal or neonatal conditions, including breech vaginal delivery, or fewer than 10 patients were excluded. Poor-quality studies were not included in analyses. We identified 3,134 citations and reviewed 963 articles for inclusion; 203 articles met the inclusion criteria and were quality rated. Overall rates of maternal harms were low for both trial of labor and elective repeat cesarean delivery. Although rare in both elective repeat cesarean delivery and trial of labor, maternal mortality was significantly increased for elective repeat cesarean delivery at 0.013% compared with 0.004% for trial of labor. The rates of maternal hysterectomy, hemorrhage, and transfusions did not differ significantly between trial of labor and elective repeat cesarean delivery. The rate of uterine rupture for all women with prior cesarean was 0.30%, and the risk was significantly increased for trial of labor (0.47% compared with 0.03% for elective repeat cesarean delivery). Perinatal mortality was also significantly increased for trial of labor (0.13% compared with 0.05% for elective repeat cesarean delivery). Overall the best evidence suggests that VBAC is a reasonable choice for the majority of women. Adverse outcomes were rare for both elective repeat cesarean delivery and trial of labor. Definitive studies are lacking to identify patients who are at greatest risk for adverse outcomes.

Achieving Bidirectional Long Delays In Pulmonary Vein Antral Lines Prior To Bidirectional Block In Patients With Paroxysmal Atrial Fibrillation (The Bi-Bi Technique For Atrial Fibrillation Ablation).

PubMed

Mina, Adel F; Warnecke, Nicholas L

2016-01-01

Background: Pulmonary Vein Antral isolation (PVAI) is currently the standard of care for both paroxysmal and persistent atrial fibrillation ablation. Reconnection to the pulmonary vein is the most common cause of recurrence of atrial fibrillation. Achieving the endpoint of bidirectional block (BDB) for cavotricuspid isthmus dependant flutter has improved our outcomes for atrial flutter ablation. With this we tried to achieve long delays in the pulmonary veins antral lines prior to complete isolation comparable to those delays found in patient with bidirectional block of atrial flutter lines. Study Objective: The objective of this paper was to evaluate feasibility and efficacy of achieving Bidirectional long delays in pulmonary vein antral lines prior to Bidirectional Block in patient with paroxysmal atrial fibrillation. Method: A retrospective analysis was performed on patients who had paroxysmal atrial fibrillation procedures at Unity Point Methodist from January 2015 to January 2016. 20 consecutive patients with paroxysmal atrial fibrillation who had AF ablation using the Bi-Bi technique were evaluated. Result: Mean age was 63, number of antiarrhythmic used prior to ablation was 1.4, mean left atrial size was 38 mm. Mean chads score was 1.3. Mean EF was 53%. Long delays in the left antral circumferential lines were achieved with mean delay of 142 milliseconds +/-100. Also long delays in the right antral circumferential lines were achieved with mean delay of 150 milliseconds +/-80. 95 % (19/20) of patients were free of any atrial arrhythmias and were off antiarrhythmic medications for AF post procedure. There was only one transient complication in one patient who developed a moderate pericardial effusion that was successfully drained with no hemodynamic changes. The only patient who had recurrence was found to have asymptomatic AF with burden on his device <1%, this patient was also found to have non PV triggers for his AF. In patients with only PV triggered AF success rate was 100%. Conclusion: Achievement of Bidirectional long delays in pulmonary vein antral lines prior to Bidirectional Block in patient with paroxysmal atrial fibrillation is feasible and highly effective technique in this small cohort of patients studied. We also outlined the procedure in details.

Challenging a classic myth: pneumoperitoneum associated with acute diverticulitis is not an indication for open or laparoscopic emergency surgery in hemodynamically stable patients. A 10-year experience with a nonoperative treatment.

PubMed

Costi, Renato; Cauchy, François; Le Bian, Alban; Honart, Jean-François; Creuze, Nicolas; Smadja, Claude

2012-07-01

In patients presenting with acute diverticulitis (AD) and signs of acute peritonitis, the presence of extradigestive air (EDA) on a computer tomography (CT) scan is often considered to indicate the need for emergency surgery. Although the traditional management of "perforated" AD is open sigmoidectomy, more recently, laparoscopic drainage/lavage (usually followed by delayed elective sigmoidectomy) has been reported. The aim of this retrospective study is to evaluate the results of nonoperative management of emergency patients presenting with AD and EDA. The outcomes of 39 consecutive hemodynamically stable patients (23 men, mean age = 54.7 years) who were admitted with AD and EDA and were managed nonoperatively (antibiotic and supportive treatment) at a tertiary-care university hospital between January 2001 and June 2010 were retrospectively collected and analyzed. These included morbidity (Clavien-Dindo) and treatment failure (need for emergency surgery or death). A univariate analysis of clinical, radiological, and laboratory criteria with respect to treatment failure was performed. Results of delayed elective laparoscopic sigmoidectomy were also analyzed. There was no mortality. Thirty-six of the 39 patients (92.3%) did not need surgery (7 patients required CT-guided abscess drainage). Mean hospital stay was 8.1 days. Duration of symptoms, previous antibiotic administration, severe sepsis, PCR level, WBC concentration, and the presence of abdominal collection were associated with treatment failure, whereas "distant" location of EDA and free abdominal fluid were not. Five patients had recurrence of AD and were treated medically. Seventeen patients (47.2%) underwent elective laparoscopic sigmoidectomy for which mean operative time was 246 min (range = 100-450) and the conversion rate was 11.8%. Mortality was nil and the morbidity rate was 41.2%. Mean postoperative stay was 7.1 days (range = 4-23). Nonoperative management is a viable option in most emergency patients presenting with AD and EDA, even in the presence of symptoms of peritonitis or altered laboratory tests. Delayed laparoscopic sigmoidectomy may be useless in certain cases and its results poorer than expected.

Exploring emergency department 4-hour target performance and cancelled elective operations: a regression analysis of routinely collected and openly reported NHS trust data.

PubMed

Keogh, Brad; Culliford, David; Guerrero-Ludueña, Richard; Monks, Thomas

2018-05-24

To quantify the effect of intrahospital patient flow on emergency department (ED) performance targets and indicate if the expectations set by the National Health Service (NHS) England 5-year forward review are realistic in returning emergency services to previous performance levels. Linear regression analysis of routinely reported trust activity and performance data using a series of cross-sectional studies. NHS trusts in England submitting routine nationally reported measures to NHS England. 142 acute non-specialist trusts operating in England between 2012 and 2016. The primary outcome measures were proportion of 4-hour waiting time breaches and cancelled elective operations. Univariate and multivariate linear regression models were used to show relationships between the outcome measures and various measures of trust activity including empty day beds, empty night beds, day bed to night bed ratio, ED conversion ratio and delayed transfers of care. Univariate regression results using the outcome of 4-hour breaches showed clear relationships with empty night beds and ED conversion ratio between 2012 and 2016. The day bed to night bed ratio showed an increasing ability to explain variation in performance between 2015 and 2016. Delayed transfers of care showed little evidence of an association. Multivariate model results indicated that the ability of patient flow variables to explain 4-hour target performance had reduced between 2012 and 2016 (19% to 12%), and had increased in explaining cancelled elective operations (7% to 17%). The flow of patients through trusts is shown to influence ED performance; however, performance has become less explainable by intratrust patient flow between 2012 and 2016. Some commonly stated explanatory factors such as delayed transfers of care showed limited evidence of being related. The results indicate some of the measures proposed by NHS England to reduce pressure on EDs may not have the desired impact on returning services to previous performance levels. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

76 FR 52556 - Election To Expense Certain Refineries

Federal Register 2010, 2011, 2012, 2013, 2014

2011-08-23

... the manufacture, construction, or production of self-constructed property must begin before January 1... is entered into prior to the manufacture, construction, or production of the property for use by the... refinery be designed to serve the primary purpose of processing liquid fuel from crude oil or qualified...

26 CFR 1.148-1A - Definitions and elections.

Code of Federal Regulations, 2010 CFR

2010-04-01

....148-1A Internal Revenue INTERNAL REVENUE SERVICE, DEPARTMENT OF THE TREASURY (CONTINUED) INCOME TAX (CONTINUED) INCOME TAXES (CONTINUED) Regulations Applicable to Certain Bonds Sold Prior to July 8, 1997 § 1... average amount maintained as a working capital reserve during annual periods of at least one year, the...

24 CFR 203.50 - Eligibility of rehabilitation loans.

Code of Federal Regulations, 2010 CFR

2010-04-01

... the borrower elects to use the services of a consultant, the lender must select a consultant on the list to perform one or more of the following tasks: (1) Conduct a preliminary feasibility analysis... the date of the application for mortgage insurance and which was approved for mortgage insurance prior...

48 CFR 301.603-73 - Additional HHS training requirements.

Code of Federal Regulations, 2010 CFR

2010-10-01

... electives for the purpose of satisfying FAC-C requirements or as continuous learning for maintenance of FAC... each be 8 hours or more in length. (b) Performance based acquisition training. Effective January 1...-Based Acquisition (PBA) course prior to assuming such responsibilities. Refresher training in PBA is...

Short-term intravenous antimicrobial prophylaxis for elective rectal cancer surgery: results of a prospective randomized non-inferiority trial.

PubMed

Ishibashi, Keiichiro; Ishida, Hideyuki; Kuwabara, Kouki; Ohsawa, Tomonori; Okada, Norimichi; Yokoyama, Masaru; Kumamoto, Kensuke

2014-04-01

To investigate the non-inferiority of postoperative single-dose intravenous antimicrobial prophylaxis to multiple-dose intravenous antimicrobial prophylaxis in terms of the incidence of surgical site infections (SSIs) in patients undergoing elective rectal cancer surgery by a prospective randomized study. Patients undergoing elective surgery for rectal cancer were randomized to receive a single intravenous injection of flomoxef (group 1) or five additional doses (group 2) of flomoxef after the surgery. All the patients had received preoperative oral antibiotic prophylaxis (kanamycin and erythromycin) after mechanical cleansing within 24 h prior to surgery, and had received intravenous flomoxef during surgery. A total of 279 patients (including 139 patients in group 1 and 140 in group 2) were enrolled in the study. The incidence of SSIs was 13.7% in group 1 and 13.6% in group 2 (difference [95% confidence interval]: -0.2% [-0.9 to 0.7%]). The incidence of SSIs was not significantly different in patients undergoing elective rectal surgery who were treated using a single dose of postoperative antibiotics compared to those treated using multiple-dose antibiotics when preoperative mechanical and chemical bowel preparations were employed.

On the importance of accounting for competing risks in pediatric cancer trials designed to delay or avoid radiotherapy: I. Basic concepts and first analyses.

PubMed

Tai, Bee-Choo; Grundy, Richard G; Machin, David

2010-04-01

In trials designed to delay or avoid irradiation among children with malignant brain tumor, although irradiation after disease progression is an important event, patients who have disease progression may decline radiotherapy (RT), or those without disease progression may opt for elective RT. To accurately describe the cumulative need for RT in such instances, it is crucial to account for these distinct events and to evaluate how each contributes to the delay or advancement of irradiation via a competing risks analysis. We describe the summary of competing events in such trials using competing risks methods based on cumulative incidence functions and Gray's test. The results obtained are contrasted with standard survival methods based on Kaplan-Meier curves, cause-specific hazard functions and log-rank test. The Kaplan-Meier method overestimates all event-specific rates. The cause-specific hazard analysis showed reduction in hazards for all events (A: RT after progression; B: no RT after progression; C: elective RT) among children with ependymoma. For event A, a higher cumulative incidence was reported for ependymoma. Although Gray's test failed to detect any difference (p = 0.331) between histologic subtypes, the log-rank test suggested marginal evidence (p = 0.057). Similarly, for event C, the log-rank test found stronger evidence of reduction in hazard among those with ependymoma (p = 0.005) as compared with Gray's test (p = 0.086). To evaluate treatment differences, failing to account for competing risks using appropriate methodology may lead to incorrect interpretations.

Elective decompression of the left ventricle in pediatric patients may reduce the duration of venoarterial extracorporeal membrane oxygenation.

PubMed

Hacking, Douglas F; Best, Derek; d'Udekem, Yves; Brizard, Christian P; Konstantinov, Igor E; Millar, Johnny; Butt, Warwick

2015-04-01

We aimed to determine the effect of elective left heart decompression at the time of initiation of central venoarterial extracorporeal membrane oxygenation (VA ECMO) on VA ECMO duration and clinical outcomes in children in a single tertiary ECMO referral center with a large pediatric population from a national referral center for pediatric cardiac surgery. We studied 51 episodes of VA ECMO in a historical cohort of 49 pediatric patients treated between the years 1990 and 2013 in the Paediatric Intensive Care Unit (PICU) of the Royal Children's Hospital, Melbourne. The cases had a variety of diagnoses including congenital cardiac abnormalities, sepsis, myocarditis, and cardiomyopathy. Left heart decompression as an elective treatment or an emergency intervention for left heart distension was effectively achieved by a number of methods, including left atrial venting, blade atrial septostomy, and left ventricular cannulation. Elective left heart decompression was associated with a reduction in time on ECMO (128 h) when compared with emergency decompression (236 h) (P = 0.013). Subgroup analysis showed that ECMO duration was greatest in noncardiac patients (elective 138 h, emergency 295 h; P = 0.02) and in patients who died despite both emergency decompression and ECMO (elective 133 h, emergency 354 h; P = 0.002). As the emergency cases had a lower pH, a higher PaCO2 , and a lower oxygenation index and were treated with a higher mean airway pressure, positive end-expiratory pressure, and respiratory rate prior to receiving VA ECMO, we undertook multivariate linear regression modeling to show that only PaCO2 and the timing of left heart decompression were associated with ECMO duration. However, elective left heart decompression was not associated with a reduction in length of PICU stay, duration of mechanical ventilation, or duration of oxygen therapy. Elective left heart decompression was not associated with improved ECMO survival or survival to PICU discharge. Elective left heart decompression may reduce ECMO duration and has therefore the potential to reduce ECMO-related complications. A prospective, randomized controlled trial is indicated to study this intervention further. Copyright © 2014 International Center for Artificial Organs and Transplantation and Wiley Periodicals, Inc.

Con: bulbomembranous anastomotic urethroplasty for pelvic fracture urethral injuries

PubMed Central

Tausch, Timothy J.

2015-01-01

Current literature remains controversial regarding whether to treat patients sustaining pelvic fracture urethral injuries (PFUIs) with primary endoscopic realignment (PER) versus suprapubic tube (SPT) placement alone with elective bulbomembranous anastomotic urethroplasty (BMAU). Success rates for PER following PFUI are wide-ranging, depending on various authors’ definitions of what defines a successful outcome. At our institution, for SPT/BMAU patients, the mean time to definitive resolution of stenosis was dramatically shorter compared to PER cases. The vast majority of PER patients required multiple endoscopic urethral interventions and/or experienced various other adverse events which were rarely noted among the SPT/BMAU group. While PER does occasionally result in urethral patency without the need for further intervention, the risk of delay in definitive treatment and potential for adverse events has led to a preference for SPT and elective BMAU at our institution. PMID:26816814

Media Agendas and Human Rights: The Supreme Court Decision on Abortion.

ERIC Educational Resources Information Center

Pollock, John Crothers; And Others

1978-01-01

Examines coverage of the abortion issue prior to, during, and after the 1973 Supreme Court decision legalizing elective abortion in daily newspapers in Boston, Chicago, Los Angeles, New York, and Washington, D.C. Considers the effect on news coverage of local religious composition, income levels, race, and abortion rate. (GW)

Implementation and Modification of an Anatomy-Based Integrated Curriculum

ERIC Educational Resources Information Center

Klement, Brenda J.; Paulsen, Douglas F.; Wineski, Lawrence E.

2017-01-01

Morehouse School of Medicine elected to restructure its first-year medical curriculum by transitioning from a discipline-based to an integrated program. The anatomy course, with regional dissection at its core, served as the backbone for this integration by weaving the content from prior traditional courses into the curriculum around the anatomy…

Source, Message, Channel and Candidate Image: An Exploratory Study.

ERIC Educational Resources Information Center

Kokkeler, Larry

Designed to explore the relationship between the mass media and candidate image, a single interview questionnaire was prepared to be administered during the two weeks prior to election day, November 7, 1972. It was hypothesized that the amount of information which respondents indicated they received from paid political advertisements, editorials,…

Campaign 76: A Report of Political Attitudes and Preferences of North Carolina State University Students.

ERIC Educational Resources Information Center

Solomon, Donald H.

North Carolina State University students were surveyed to assess their political attitudes and preferences prior to the 1976 general election and to compare results with those obtained in a 1972 survey. Information was obtained on: voter registration, party affiliation, political views, candidate preference for president, candidate preference for…

22 CFR 19.11-2 - Regular survivor annuity for a former spouse.

Code of Federal Regulations, 2012 CFR

2012-04-01

... survivor annuity for a former spouse. (a) Divorce prior to retirement. If a participant or former... first date the principal becomes eligible for an annuity following the divorce) unless a different amount is elected in a spousal agreement filed with PER/ER/RET within 12 months after the divorce becomes...

22 CFR 19.11-2 - Regular survivor annuity for a former spouse.

Code of Federal Regulations, 2014 CFR

2014-04-01

... survivor annuity for a former spouse. (a) Divorce prior to retirement. If a participant or former... first date the principal becomes eligible for an annuity following the divorce) unless a different amount is elected in a spousal agreement filed with PER/ER/RET within 12 months after the divorce becomes...

22 CFR 19.11-2 - Regular survivor annuity for a former spouse.

Code of Federal Regulations, 2010 CFR

2010-04-01

... survivor annuity for a former spouse. (a) Divorce prior to retirement. If a participant or former... first date the principal becomes eligible for an annuity following the divorce) unless a different amount is elected in a spousal agreement filed with PER/ER/RET within 12 months after the divorce becomes...

22 CFR 19.11-2 - Regular survivor annuity for a former spouse.

Code of Federal Regulations, 2011 CFR

2011-04-01

... survivor annuity for a former spouse. (a) Divorce prior to retirement. If a participant or former... first date the principal becomes eligible for an annuity following the divorce) unless a different amount is elected in a spousal agreement filed with PER/ER/RET within 12 months after the divorce becomes...

26 CFR 1.168(i)-0 - Table of contents for the general asset account rules.

Code of Federal Regulations, 2010 CFR

2010-04-01

...) Assets generating foreign source income. (1) In general. (2) Source of ordinary income, gain, or loss. (i... foreign source income, gain, or loss. (3) Section 904(d) separate categories. (g) Assets subject to... of disposed or converted asset. (j) Effect of adjustments on prior dispositions. (k) Election. (1...

26 CFR 1.168(i)-0 - Table of contents for the general asset account rules.

Code of Federal Regulations, 2013 CFR

2013-04-01

...) Source of ordinary income, gain, or loss. (i) Source determined by allocation and apportionment of depreciation allowed. (ii) Formula for determining foreign source income, gain, or loss. (3) Section 904(d... disposed or converted asset. (k) Effect of adjustments on prior dispositions. (l) Election. (1) Irrevocable...

26 CFR 1.168(i)-0 - Table of contents for the general asset account rules.

Code of Federal Regulations, 2011 CFR

2011-04-01

...) Assets generating foreign source income. (1) In general. (2) Source of ordinary income, gain, or loss. (i... foreign source income, gain, or loss. (3) Section 904(d) separate categories. (g) Assets subject to... of disposed or converted asset. (j) Effect of adjustments on prior dispositions. (k) Election. (1...

26 CFR 1.168(i)-0 - Table of contents for the general asset account rules.

Code of Federal Regulations, 2014 CFR

2014-04-01

...) Source of ordinary income, gain, or loss. (i) Source determined by allocation and apportionment of depreciation allowed. (ii) Formula for determining foreign source income, gain, or loss. (3) Section 904(d... disposed or converted asset. (k) Effect of adjustments on prior dispositions. (l) Election. (1) Irrevocable...

26 CFR 1.168(i)-0 - Table of contents for the general asset account rules.

Code of Federal Regulations, 2012 CFR

2012-04-01

...) Source of ordinary income, gain, or loss. (i) Source determined by allocation and apportionment of depreciation allowed. (ii) Formula for determining foreign source income, gain, or loss. (3) Section 904(d... disposed or converted asset. (k) Effect of adjustments on prior dispositions. (l) Election. (1) Irrevocable...

Ultrasonographic diagnosis and minimally invasive treatment of a patent urachus associated with a patent omphalomesenteric duct in a newborn

PubMed Central

Bertozzi, Mirko; Recchia, Nicola; Di Cara, Giuseppe; Riccioni, Sara; Rinaldi, Victoria Elisa; Esposito, Susanna; Appignani, Antonino

2017-01-01

Abstract Rational: Patent urachus (PU) is due to an incomplete obliteration of the urachus, whereas patent omphalomesenteric duct (POMD) is due to an incomplete obliteration of the vitelline duct. These anomalies are very rarely associated with one another. We describe a case of a newborn with a PU associated with a POMD, who was diagnosed by an abdominal ultrasound (US) and laparoscopy, and managed with a minimally invasive excision. Patient concern: A 28-day-old male neonate was referred to our hospital to investigate a delay in umbilical healing, with blood-mucinous material spillage for 3 weeks prior to the referral. The baby had no symptoms and was in good general health. Diagnosis: After a thorough cleaning of the umbilical stump, a clear granuloma with a suspected fistula was evident under the seat of the ligature of the stump. An abdominal US examination revealed the formation of a full communication, starting below the umbilical stump and developing along the anterior abdominal wall that connected with the bladder dome. The US also revealed a tubular formation containing air, which was compatible with POMD, in the deepest portion of the same umbilical stump. Considering these findings, the rare diagnosis of a PU associated with a POMD duct was suspected. Interventions: The child was then hospitalized for an elective laparoscopy that confirmed the US picture, and a minimally invasive excision was performed. Outcome: The postoperative course was favorable and uneventful. Lessons: Our case underlines the importance of evaluating all persisting umbilical lesions without delay when conventional pharmacological therapies fail. Using a US as the first approach is valuable and should be supported by laparoscopy to confirm the diagnosis; a minimally invasive excision of the remnants appears to be an effective therapeutic approach. PMID:28746173

Prostatron 30-minute update: where do we stand

NASA Astrophysics Data System (ADS)

Ulchaker, James C.; Albani, Justin

2003-06-01

The urologic management of benign prostatic hyperplasia (BPH) beyond pharmaco-therapy has changed dramatically over the last decade. Open prostatectomy and transurethral resection of the prostate (TURP) have been the mainstays of surgical intervention for BPH. These procedures were initially reserved for patients with obstructive uropathy, prostatic bleeding, or bladder calculi. With improved techniques and lower morbidity, TURP is currently the "gold standard" of treatment for patients with BPH and troubling lower urinary tract symptoms (LUTS), and patients are being treated prior to the development of these adverse sequelae. Nevertheless, TURP is still major surgery, requiring either a spinal or general anesthetic and an inpatient hospital stay. Furthermore, TURP is not uniformly successful. Up to 30% of patients report dissatisfaction from the procedure. Complications have been well described and include bleeding, bladder-neck contracture, erectile dysfunction retrograde ejaculation, urinary incontinence, and fluid/electrolyte imbalance (post-TUR syndrome). The mortality rate for TURP is approx. 2 - 10/1000 cases. Over the past decade, the number of TURPs being performed has been decreasing as minimally invasive therapies, including alpha-adrenergic blockers, are being used as "first-line" management with increasing frequency and success. In addition, urologists no longer just treat ill patients in urinary retention. The treatment paradigm has evolved to include patients with persistently troubling symptoms of bladder-outlet obstruction, prior to the development of such adverse sequelae. Furthermore, patients see the care of a urologist on an elective basis, and they frequently wish to avoid surgery. As described in prior chapters, advancements in our understanding of the pathophysiology of BPH have led toimprovements in its medical management and have delayed or precluded surgery in many patients. However, when pharmacotherapy fails, further treatment options need to be discussed. Minimally invasive therapies for BPH have evolved out of this need to "bridge the gap" between medical and surgical managment. This chapter describes the current modalities of minimally invasive treatment for benign prostatic obstruction caused by prostatic lobar hyperplasia, and their respective roles in our office practice.

Graduate Global Public Health Education: Activities and Outcomes in Relation to Student Prior Experience

PubMed Central

Jackson, Suzanne F.; Cole, Donald C.

2013-01-01

The Dalla Lana School of Public Health uses an “add-on” or concentration model of global health education. Records of masters’ graduate cohorts across five disciplinary fields from 2006 to 2009 were classified as to prior experience at application and completion of global health concentration requirements. Alumni from the first two cohorts (2006-08 and 2007-09) were interviewed using a semi-structured interview guide. Prior experience was not linked consistently with the number of elective courses, location of practica or completion of requirements. Successful completion of the global health requirements depended more on the student’s base disciplinary program. Interviewed alumni with medium prior experience reported greater satisfaction with the concentration. Alumni with lower prior experience wanted more courses and support with practica. The pros and cons of a concentration model of global public health graduate education are discussed. PMID:23618475

Increasing awareness of age-related fertility and elective fertility preservation among medical students and house staff: a pre- and post-intervention analysis.

PubMed

Anspach Will, Erica; Maslow, Bat-Sheva; Kaye, Leah; Nulsen, John

2017-05-01

To assess medical students' and house staff's knowledge and personal and professional perceptions of age-related fertility and fertility preservation before and after an educational intervention. Pre-/post intervention survey. University-based medical center. Medical students and house staff. An educational session on age-related fertility decline and elective fertility preservation. Knowledge scores and perceptions assessed immediately before and after the intervention. Sixty-five surveys were administered. Of the 53 respondents, 71.7% were married or in a committed relationship; 89.4% reported that they were delaying childbearing, with career and/or education being the most frequently listed reason (85.7%); 39.5% indicated that they had both personal and professional interest in fertility preservation but identified finances (62.5%) and time (59.4%) as barriers; 86.9% indicated previous exposure, with formal education (80.0%) and social media (40.0%) being the most common sources. Mean scores on a six-question knowledge-based assessment improved significantly following the presentation (54.6 ± 19.0% vs. 78.1 ± 16.0%), as did the number of participants who indicated that they might now recommend elective oocyte cryopreservation to others (71.1% vs. 54.3%). After the intervention, 97.8% thought that it was important for medical professionals to be informed about age-related fertility decline and elective oocyte cryopreservation. Despite professional and personal interest, knowledge of age-related fertility decline and elective fertility preservation is limited among medical students and house staff. This study highlights the need for formal education across all levels of training and specialties, with even brief interventions being of potential benefit. Copyright © 2017 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

Wheels-Off Time Uncertainty Impact on Benefits of Early Call for Release Scheduling

NASA Technical Reports Server (NTRS)

Palopo, Kee; Chatterji, Gano B.; Almog, Noam

2017-01-01

Arrival traffic scenarios with 808 flights from 173 airports to Houston George Bush International airport are simulated to determine if Call For Release flights can receive a benefit in terms of less delay over other flights by scheduling prior to gate pushback (look-ahead in time) as opposed to at gate pushback. Call for Release flights are departures that require approval from Air Route Traffic Control Center prior to release. Realism is brought to the study by including gate departure delay and taxi-out delay uncertainties for the 77 major U. S. airports. Gate departure delay uncertainty is assumed to increase as a function of look-ahead time. Results show that Call For Release flights from an airport within the freeze horizon (a region surrounding the arrival airport) can get an advantage over other flights to a capacity constrained airport by scheduling prior to gate pushback, provided the wheels-off time uncertainty with respect to schedule is controlled to a small value, such as within a three-minute window. Another finding of the study is that system delay, measured as the sum of arrival delays, is smaller when flights are scheduled in the order of arrival compared to in the order of departure. Because flights from airports within the freeze horizon are scheduled in the order of departure, an increase in the number of internal airports with a larger freeze horizon increases system delay. Delay in the given scenario was found to increase by 126% (from 13.8 hours to 31.2 hours) as freeze horizon was increased from 30-minutes to 2-hours in the baseline scenario.

Effect of high up front charges on access to surgery for poor patients at a public hospital in New Mexico.

PubMed

Kaufman, Will; Chavez, Augustine S; Skipper, Betty; Kaufman, Arthur

2006-06-23

A public hospital in New Mexico required collection of 50% of estimated costs prior to elective surgeries for self-pay patients. This study assesses the impact of this policy on access to elective surgical procedures. Chi-square tests determined if there was a statistically significant difference between the number of self-pay and insured patient cancellations for financial reasons. A multivariate binomial regression model was used to calculate risk ratios and confidence limits for effects of race/ethnicity, and insurance status, controlling for gender, on these cancellations. Of the 667 cancellations, there were 99 self-pay and 568 insured patients. Cancellations for financial reasons occurred in 55.6% of self-pay and 9.3% of insured patients (p < 0.0001). Inability to pay 50% up front accounted for 76.4% of self-pay patient cancellations for financial reasons. Self-pay, non-Hispanic whites and minority race/ethnicities were 8.76 and 8.61 times more likely to cancel for financial reasons, respectively, than insured non-Hispanic whites. Self-pay patients, regardless of race/ethnicity, have elective surgical procedures cancelled for financial reasons significantly more often than insured patients. The hospital's 50% up-front payment policy represents a significant financial barrier to accessing elective surgical procedures for self-pay patients.

Peru action simmering despite privatization delays

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

NONE

1995-08-07

After months of delays, the sale of Petroleos del Peru SA (Petroperu) was postponed earlier this year until after the elections, which saw Peru`s incumbent President Alberto Fujimori reelected. In June, Fujimori appointed Amado Yataco Minister of Energy and Mines. Yataco, also serving as president of the privatization commission Copri, said a decision on the sale of Petroperu would be made quickly, perhaps by July 28, ahead of this report`s presstime. The uncertain status of Petroperu has not, however, slowed activity in Peru`s petroleum sector. The paper first discusses privatization plans and Petroperu`s budget, then describes exploration and development activitiesmore » in the supergiant Camisea gas/condensate fields in the central southern jungle. Activities in several smaller fields are briefly described.« less

Processing political misinformation: comprehending the Trump phenomenon

PubMed Central

Berinsky, Adam J.; Ecker, Ullrich K. H.

2017-01-01

This study investigated the cognitive processing of true and false political information. Specifically, it examined the impact of source credibility on the assessment of veracity when information comes from a polarizing source (Experiment 1), and effectiveness of explanations when they come from one's own political party or an opposition party (Experiment 2). These experiments were conducted prior to the 2016 Presidential election. Participants rated their belief in factual and incorrect statements that President Trump made on the campaign trail; facts were subsequently affirmed and misinformation retracted. Participants then re-rated their belief immediately or after a delay. Experiment 1 found that (i) if information was attributed to Trump, Republican supporters of Trump believed it more than if it was presented without attribution, whereas the opposite was true for Democrats and (ii) although Trump supporters reduced their belief in misinformation items following a correction, they did not change their voting preferences. Experiment 2 revealed that the explanation's source had relatively little impact, and belief updating was more influenced by perceived credibility of the individual initially purporting the information. These findings suggest that people use political figures as a heuristic to guide evaluation of what is true or false, yet do not necessarily insist on veracity as a prerequisite for supporting political candidates. PMID:28405366

Maternal dental history and child’s birth outcome and early cognitive development

PubMed Central

Daniels, JL; Rowland, AS; Longnecker, MP; Crawford, P; Golding, J

2013-01-01

Summary Prenatal exposure to high levels of mercury, radiation, and inflammation have been associated with adverse reproductive outcomes such as increases in preterm delivery, low birthweight, and delayed neurodevelopment. Few data are available to evaluate the potential effects of prenatal low-level exposure to these factors as might occur during dental care. We evaluated maternal dental history prior to and during pregnancy in relation to birth outcomes and early communicative development among offspring in a large cohort (n=7375) of British children born in 1991–1992. Dental history was assessed by questionnaire. The child’s communicative development was assessed using the MacArthur Communicative Development Inventory at 15 months of age. Total mercury was measured in umbilical cord tissue for a subset of the children. Overall, dental care, including amalgam fillings, was not associated with birth outcomes or language development. Having x-rays taken during pregnancy was not associated with birthweight measured continuously (β=14.7, p=0.4), but was associated with slightly increased odds of having a term, low birthweight baby (OR 1.9, 95%CI 1.0–3.4). More detailed evaluation of the potential adverse effects of elective dental treatment during pregnancy, particularly dental x-rays, may be warranted. PMID:17697075

Processing political misinformation: comprehending the Trump phenomenon.

PubMed

Swire, Briony; Berinsky, Adam J; Lewandowsky, Stephan; Ecker, Ullrich K H

2017-03-01

This study investigated the cognitive processing of true and false political information. Specifically, it examined the impact of source credibility on the assessment of veracity when information comes from a polarizing source (Experiment 1), and effectiveness of explanations when they come from one's own political party or an opposition party (Experiment 2). These experiments were conducted prior to the 2016 Presidential election. Participants rated their belief in factual and incorrect statements that President Trump made on the campaign trail; facts were subsequently affirmed and misinformation retracted. Participants then re-rated their belief immediately or after a delay. Experiment 1 found that (i) if information was attributed to Trump, Republican supporters of Trump believed it more than if it was presented without attribution, whereas the opposite was true for Democrats and (ii) although Trump supporters reduced their belief in misinformation items following a correction, they did not change their voting preferences. Experiment 2 revealed that the explanation's source had relatively little impact, and belief updating was more influenced by perceived credibility of the individual initially purporting the information. These findings suggest that people use political figures as a heuristic to guide evaluation of what is true or false, yet do not necessarily insist on veracity as a prerequisite for supporting political candidates.

26 CFR 1.955-3 - Election as to date of determining qualified investments in less developed countries.

Code of Federal Regulations, 2010 CFR

2010-04-01

... the foreign base company income of the controlled foreign corporation for all prior taxable years... countries at the close of such taxable year exceed its qualified investments in less developed countries at the close of the taxable year immediately following such taxable year, and reducing such excess by (2...

Brain Magnetic Resonance Immediately Prior To Surgery In Single Ventricles and Surgical Postponement

PubMed Central

Fogel, Mark A.; Pawlowski, Tom; Schwab, Peter J.; Nicolson, Susan C.; Montenegro, Lisa M.; Berenstein, Laura Diaz; Spray, Thomas L.; Gaynor, J William; Fuller, Stephanie; Keller, Marc S.; Harris, Matthew A.; Whitehead, Kevin K.; Vossough, Arastoo; Licht, Daniel J.

2014-01-01

Background Single ventricle patients undergoing surgical reconstruction experience a high rate of brain injury; incidental findings on pre-operative brain scans may result in safety considerations involving hemorrhage extension during cardiopulmonary bypass that result in surgical postponement. Methods Single ventricle patients were studied with brain scans immediately preoperatively as part of a National Institute of Health study and were reviewed by neuroradiology immediately prior to cardiopulmonary bypass. Results One hundred and thirty four consecutive subjects recruited into the project were studied: 33 prior to stage I (3.7±1.8 days), 34 prior to bidirectional Glenn (5.8±3.5 months) and 67 prior to Fontan (3.3±1.1 years). Six (4.5%) surgeries were postponed because of concerning imaging findings on brain MRI; 2 prior to stage I, 3 prior to bidirectional Glenn and 1 prior to Fontan. Five were due to unexpected incidental findings of acute intracranial hemorrhage and one due to diffuse cerebellar cytotoxic edema; none who proceeded to surgery had these lesions. Prematurity as well as genetic syndromes were not present in any with postponed surgery. Four of 4 prior to bidirectional Glenn/Fontan with surgical delays had hypoplastic left heart syndrome compared with 44/97 who did not (P=0.048). After observation and follow up, all eventually had successful surgeries with bypass. Conclusion Preoperative brain MRI performed in children with single ventricles disclosed injuries in 4.5% leading to surgical delay; hemorrhagic lesions were most common and raised concerns for extension during surgery. The true risk of progression and need for delay of surgery due to heparinization associated with these lesions remains uncertain. PMID:25149046

Analysis of NHSLA claims in orthopedic surgery.

PubMed

Khan, Irfan H; Jamil, Wiqqas; Lynn, Sam Mathew; Khan, Osman H; Markland, Kate; Giddins, Grey

2012-05-01

National Health Service (NHS) statistics in the United Kingdom demonstrate an increase in clinical negligence claims over the past 30 years. Reasons for this include elements of a cultural shift in attitudes toward the medical profession and the growth of the legal services industry. This issue affects medical and surgical health providers worldwide.The authors analyzed 2117 NHS Litigation Authority (NHSLA) orthopedic surgery claims between 1995 and 2001 with respect to these clinical areas: emergency department, outpatient care, surgery (elective or trauma operations), and inpatient care. The authors focused on the costs of settling and defending claims, costs attributable to clinical areas, common causes of claims, and claims relating to elective or trauma surgery. Numbers of claims and legal costs increased most notably in surgery (elective and trauma) and in the emergency department. However, claims are being defended more robustly. The annual cost for a successful defense has remained relatively stable, showing a slight decline. The common causes of claims are postoperative complication; wrong, delayed, or failure of diagnosis; inadequate consent; and wrong-site surgery. Certain surgical specialties (eg, spine and lower-limb surgery) have the most claims made during elective surgery, whereas upper-limb surgery has the most claims made during trauma surgery.The authors recommend that individual trusts liaise with orthopedic surgeons to devise strategies to address areas highlighted in our study. Despite differences in health care systems worldwide, the underlying issues are common. With improved understanding, physicians can deliver the service they promise their patients. Copyright 2012, SLACK Incorporated.

Airport Flight Departure Delay Model on Improved BN Structure Learning

NASA Astrophysics Data System (ADS)

Cao, Weidong; Fang, Xiangnong

An high score prior genetic simulated annealing Bayesian network structure learning algorithm (HSPGSA) by combining genetic algorithm(GA) with simulated annealing algorithm(SAA) is developed. The new algorithm provides not only with strong global search capability of GA, but also with strong local hill climb search capability of SAA. The structure with the highest score is prior selected. In the mean time, structures with lower score are also could be choice. It can avoid efficiently prematurity problem by higher score individual wrong direct growing population. Algorithm is applied to flight departure delays analysis in a large hub airport. Based on the flight data a BN model is created. Experiments show that parameters learning can reflect departure delay.

Operating room efficiency improvement after implementation of a postoperative team assessment.

PubMed

Porta, Christopher R; Foster, Andrew; Causey, Marlin W; Cordier, Patricia; Ozbirn, Roger; Bolt, Stephen; Allison, Dennis; Rush, Robert

2013-03-01

Operating room time is highly resource intensive, and delays can be a source of lost revenue and surgeon frustration. Methods to decrease these delays are important not only for patient care, but to maximize operating room resource utilization. The purpose of this study was to determine the root cause of operating room delays in a standardized manner to help improve overall operating room efficiency. We performed a single-center prospective observational study analyzing operating room utilization and efficiency after implementing an executive-driven standardized postoperative team debriefing system from January 2010 to December 2010. A total of 11,342 procedures were performed over the 1-y study period (elective 86%, urgent 11%, and emergent 3%), with 1.3 million min of operating room time, 865,864 min of surgeon operative time (62.5%), and 162,958 min of anesthesia time (11.8%). Overall, the average operating room delay was 18 min and varied greatly based on the surgical specialty. The longest delays were due to need for radiology (40 min); other significant delays were due to supply issues (22.7 min), surgeon issues (18 min), nursing issues (14 min), and room turnover (14 min). Over the 1-y period, there was a decrease in mean delay duration, averaging a decrease in delay of 0.147 min/mo with an overall 9% decrease in the mean delay times. With regard to overall operating room utilization, there was a 39% decrease in overall un-utilized available OR time that was due to delays, improving efficiency by 2334 min (212 min/mo). During this study interval no sentinel events occurred in the operating room. A standardized postoperative debrief tracking system is highly beneficial in identifying and reducing overall operative delays and improving operating room utilization. Published by Elsevier Inc.

Variance in elective surgery for chronic pancreatitis.

PubMed

Shah, Nehal S; Siriwardena, Ajith K

2009-01-08

Evidence to guide selection of optimal surgical treatment for patients with painful chronic pancreatitis is limited. Baseline assessment data are limited and thus patients in different centres may be presenting at different stages of their illness. This study undertakes a systematic overview of reports of elective surgical intervention in chronic pancreatitis with particular reference to reporting of quality of life and baseline assessment and relation between disease and type of procedure. A computerised search of the PubMed, Embase and Cochrane databases was undertaken for the period January 1997 to March 2007 yielding 46 manuscripts providing data on 4,626 patients undergoing elective surgery for chronic pancreatitis. The median number of patients per study was 71 (range: 4-484). The median period for recruitment of patients was 10 years (range: 2-36 years). An externally validated quality of life questionnaire is reported in 8 (17.4%) of 46 manuscripts covering 441 (9.5%) of 4,626 patients. Formal comparison of pre-operative and post-operative pain scores was provided in 15 (32.6%) of manuscripts. Only seven (15.2%) reports provide a formal rationale or indication for selection of the type of elective surgical procedure for a stated disease variant and these papers cover 481 (10.4%) patients. In conclusion, this study demonstrates that there is a lack of standardization between units of the criteria for operative intervention in painful chronic pancreatitis. At a minimum, formal quality of life testing using a validated system should be undertaken in all patients prior to elective surgery for painful chronic pancreatitis.

Methicillin-Resistant and Methicillin-Sensitive Staphylococcus aureus Screening and Decolonization to Reduce Surgical Site Infection in Elective Total Joint Arthroplasty.

PubMed

Sporer, Scott M; Rogers, Thea; Abella, Linda

2016-09-01

Deep infection after elective total joint arthroplasty remains a devastating complication. Preoperative nasal swab screening for Staphylococcus aureus colonization and subsequent treatment of colonized patients is one proposed method to identify at-risk patients and decrease surgical site infections (SSIs). The purpose of this study was to determine whether a preoperative staphylococcus screening and treatment program would decrease the incidence of SSI in elective joint arthroplasty patients. Since January 2009, a total of 9690 patients having an elective joint arthroplasty were screened before surgery for Methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-sensitive Staphylococcus aureus (MSSA) with nares swabs. All patients with positive nare colonization for MSSA and MRSA were treated with mupirocin and chlorhexidine gluconate showers for 5 days before surgery. MRSA patients received vancomycin preoperatively and were placed in contact isolation. All elective arthroplasty patients used chlorhexidine gluconate antiseptic cloths the evening prior and the day of surgery. Perioperative infection rates were compared from 1 year before implementation to 5 years after implementation of this screening protocol. SSI rates have decreased from 1.11% (prescreening) to 0.34% (nasal screening; P < .05) after initiation of the process. Staphylococcus was identified in 66.7% of the SSI infections before nasal screening and in 33.3% of the SSI after routine screening (P > .05). The addition of MRSA and/or MSSA nares screening along with a perioperative decolonization protocol has resulted in a decreased SSI rate by 69%. Copyright © 2016 Elsevier Inc. All rights reserved.

Transforming Social and Educational Governance: Trade Training Centres and the Transition to Social Investment Politics in Australia

ERIC Educational Resources Information Center

Hay, Stephen

2009-01-01

Prior to its election to office in 2007, the Australian Labor Party announced a commitment to introduce Trade Training Centres (TTCs) into all Australian secondary schools as an initiative of its Education Revolution. TTCs were proposed as a key element of Federal Labor's education and training policy that aimed to manage future risks to…

Smearing the Opposition: Implicit and Explicit Stigmatization of the 2008 U. S. Presidential Candidates and the Current U. S. President

ERIC Educational Resources Information Center

Kosloff, Spee; Greenberg, Jeff; Schmader, Toni; Dechesne, Mark; Weise, David

2010-01-01

Four studies investigated whether political allegiance and salience of outgroup membership contribute to the phenomenon of acceptance of false, stigmatizing information (smears) about political candidates. Studies 1-3 were conducted in the month prior to the 2008 U.S. Presidential election and together demonstrated that pre-standing opposition to…

11 CFR 1.8 - Agency review of request for correction or amendment of record.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 11 Federal Elections 1 2010-01-01 2010-01-01 false Agency review of request for correction or... review of request for correction or amendment of record. (a) The Commission shall, not later than ten (10... record if an accounting of the disclosure was made. The individual may request a list of prior recipients...

[The role of elective neck dissection during salvage laryngectomy - a retrospective analysis].

PubMed

Hussain, Timon; Kanaan, Oliver; Höing, Benedikt; Dominas, Nina; Lang, Stephan; Mattheis, Stefan

2018-05-16

Elective neck dissection of the N0-neck is routinely performed during salvage laryngectomy (SLE) for recurrent cancer of the larynx or hypopharynx. The therapeutic benefit of additional neck dissection must be weighed against the risk of increased morbidity. In this retrospective analysis, we assessed oncologic parameters of patients who underwent SLE with concurrent bilateral neck dissection for recurrent laryngeal or hypopharyngeal cancer. We compared these data with patients who underwent primary laryngectomy (LE) with bilateral neck dissection for laryngeal and hypopharyngeal cancer.19 patients who had undergone SLE and 83 patients after LE were included in the analysis. The majority of patients had advanced stage tumors prior to LE or primary radiation therapy, as well as advanced stage recurrent tumors prior to SLE. Prior to SLE, 5 % of all patients (n = 1) had clinically pathologic lymph nodes, compared to 47 % (n = 39) prior to LE. 17 % (n = 14) of patients with LE and bilateral neck dissection had occult lymph node metastases, compared to 5 % (n = 1) of patients who underwent SLE with bilateral neck dissection. Overall, 55 % (n = 44) of patients who underwent LE had positive cervical lymph nodes, compared to 10 % (n = 2) of SLE patients. Lymph node yield was higher in patients with LE than in SLE-patients (37.3 vs. 18.7, p < 0.001). 5-year OS was 50 % after LE and 33 % after SLE. Cervical lymph node metastases are rare in patients who undergo SLE for recurrent cancers of the larynx of hypopharynx. However, occult metastases do occur. Therefore, since SLE is the final curative therapy, additional neck dissection should be taken into consideration. © Georg Thieme Verlag KG Stuttgart · New York.

Previous pregnancy outcomes and subsequent pregnancy anxiety in a Quebec prospective cohort

PubMed Central

Shapiro, Gabriel D.; Séguin, Jean R.; Muckle, Gina; Monnier, Patricia; Fraser, William D.

2017-01-01

Introduction Pregnancy anxiety is an important psychosocial risk factor that may be more strongly associated with adverse birth outcomes than other measures of stress. Better understanding of the upstream predictors and causes of pregnancy anxiety could help to identify high-risk women for adverse maternal and infant outcomes. The objective of the present study was to measure the associations between five past pregnancy outcomes (live preterm birth (PTB), live term birth, miscarriage at <20 weeks, stillbirth at ≥20 weeks, and elective abortion) and pregnancy anxiety at three trimesters in a subsequent pregnancy. Methods Analyses were conducted using data from the 3D Cohort Study, a Canadian birth cohort. Data on maternal demographic characteristics and pregnancy history for each known previous pregnancy were collected via interviewer-administered questionnaires at study entry. Pregnancy anxiety for the index study pregnancy was measured prospectively by self-administered questionnaire following three prenatal study visits. Results Of 2366 participants in the 3D Study, 1505 had at least one previous pregnancy. In linear regression analyses with adjustment for confounding variables, prior live term birth was associated with lower pregnancy anxiety in all three trimesters, whereas prior miscarriage was significantly associated with higher pregnancy anxiety in the first trimester. Prior stillbirth was associated with greater pregnancy anxiety in the third trimester. Prior elective abortion was significantly associated with higher pregnancy anxiety scores in the first and second trimesters, with an association of similar magnitude observed in the third trimester. Discussion Our findings suggest that the outcomes of previous pregnancies should be incorporated, along with demographic and psychosocial characteristics, into conceptual models framing pregnancy anxiety. PMID:28079434

Racial attitudes and visual cues in political judgments: support for Obama during the 2008 presidential election.

PubMed

West, Tessa V; Pearson, Adam R; Dovidio, John F; Johnson, Blair T; Phills, Curtis E

2014-10-01

The present longitudinal study examined the complex role of race-including racial attitudes and visual representations of race-in White Americans' responses to Obama during the 2008 U.S. presidential election. Consistent with prior research, participants who perceived Obama as darker skinned were less likely to vote for him and generally evaluated Obama less positively. It is important to note, however, that these effects were stronger among Whites with more egalitarian expressed racial attitudes. Moreover, this pattern occurred over and above effects of political orientation and remained stable over a 2-month period, including pre- and postelection. Implications of these findings for understanding the complex and persistent influence of race in politics are considered. (PsycINFO Database Record (c) 2014 APA, all rights reserved).

Delayed Partial Nephrectomy for Hydronephrosis After Renal Trauma.

PubMed

Setia, Shaan; Jackson, Jessica Nicole; Herndon, C D Anthony; Corbett, Sean T

2017-03-01

Delayed sequelae following conservative management of renal trauma in the pediatric population are uncommon. Reports of delayed operations to manage these sequelae are even less common. Here we present the case of a 16-year-old male patient who had delayed development of upper urinary tract obstruction with recurrent infections following high-grade renal trauma managed conservatively. Ultimately, he required a robotic-assisted partial nephrectomy 2 years after initial nonoperative management. This is unique as no prior studies to our knowledge have described delayed hydronephrosis and delayed partial nephrectomy over a year following renal trauma. Copyright © 2016 Elsevier Inc. All rights reserved.

Elective neck management for high-grade salivary gland carcinoma.

PubMed

Herman, Michael P; Werning, John W; Morris, Christopher G; Kirwan, Jessica M; Amdur, Robert J; Mendenhall, William M

2013-01-01

To determine whether patients with clinically node negative (cNo) high grade salivary gland carcinomas benefit from an elective neck dissection prior to postoperative radiotherapy (RT). Between October 1964 and October 2009, 59 previously untreated patients with cNo high-grade salivary gland carcinomas (squamous cell carcinomas were excluded) were treated with curative intent using elective neck dissection (END; n=41), or elective neck irradiation (ENI; n=18) at the University of Florida College of Medicine (Gainesville, FL). All patients underwent resection of the primary cancer followed by postoperative RT. The median follow-up period was 5.2years (range, 0.3-34years). Occult metastases were found in 18 (44%) of the 41 patients in the END group. There were 4 recurrences (10%) in the END group and 0 recurrence in the ENI group. Neck control rates at 5years were: END, 90%; ENI, 100%; and overall, 93% (p=0.1879). Cause-specific survival was 94% in the ENI group, 84% in the END group, and 86% for all patients (p=0.6998). There were 3 reported grade 3 or 4 toxicities. Two patients had a postoperative fistula and one patient had a grade 4 osteoradionecrosis that required a partial mandibulectomy. Patients with cNo high grade salivary gland carcinomas who are planned to undergo surgery and postoperative RT likely do not benefit from a planned neck dissection. Copyright © 2013 Elsevier Inc. All rights reserved.

Medicare program; FY 2015 hospice wage index and payment rate update; hospice quality reporting requirements and process and appeals for Part D payment for drugs for beneficiaries enrolled in hospice. Final rule.

PubMed

2014-08-22

This final rule will update the hospice payment rates and the wage index for fiscal year (FY) 2015 and continue the phase-out of the wage index budget neutrality adjustment factor (BNAF). This rule provides an update on hospice payment reform analyses, potential definitions of "terminal illness'' and "related conditions,'' and information on potential processes and appeals for Part D payment for drugs while beneficiaries are under a hospice election. This rule will specify timeframes for filing the notice of election and the notice of termination/revocation; add the attending physician to the hospice election form, and require hospices to document changes to the attending physician; require hospices to complete their hospice aggregate cap determinations within 5 months after the cap year ends, and remit any overpayments; and update the hospice quality reporting program. In addition, this rule will provide guidance on determining hospice eligibility; information on the delay in the implementation of the International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM); and will further clarify how hospices are to report diagnoses on hospice claims. Finally, the rule will make a technical regulations text change.

An Evaluation of Constant Time Delay and Simultaneous Prompting Procedures in Skill Acquisition for Young Children with Autism

ERIC Educational Resources Information Center

Brandt, Julie A. Ackerlund; Weinkauf, Sara; Zeug, Nicole; Klatt, Kevin P.

2016-01-01

Previous research has shown that various prompting procedures are effective in teaching skills to children and adults with developmental disabilities. Simultaneous prompting includes proving a prompt immediately following an instruction; whereas constant time-delay procedures include a set time delay (i.e., 5 s or 10 s) prior to delivering a…

Child Care Providers' Competence and Confidence in Referring Children at Risk for Developmental Delays

ERIC Educational Resources Information Center

Branson, Diane; Bingham, Ann

2017-01-01

Despite the benefits of early intervention for children, the majority of children with developmental delays are not identified prior to the age of 5 years. Child care providers could aid in recognition of children at risk for developmental delays; however, there is little research on this topic. This article reports on a qualitative research study…

Bispectral index values during sevoflurane-nitrous oxide general anesthesia in women undergoing cesarean delivery: a comparison between women with and without prior labor.

PubMed

Yoo, Kyung Y; Jeong, Cheol W; Kang, Myung W; Kim, Seok J; Chung, Sung T; Shin, Min H; Lee, JongUn

2008-06-01

An end-tidal concentration of 1% sevoflurane (1% ET(SEVO)) in 50% nitrous oxide (N(2)O) during elective cesarean delivery has been associated with bispectral index (BIS) values >60, which are associated with an increased risk of awareness. We hypothesized that BIS values during sevoflurane-N(2)O general anesthesia for cesarean delivery would be lower in women with prior labor compared with women without prior labor. Forty patients undergoing cesarean delivery were enrolled in this observational study. One group had urgent surgery after labor (labor group, n = 20) and the other had elective surgery without labor (control group, n = 20). General anesthesia was induced with thiopental 4 mg/kg, followed by succinylcholine 1.5 mg/kg, and maintained with 1% ET(SEVO) and 50% N(2)O in oxygen. BIS values, systolic arterial blood pressure, heart rate, plasma stress hormone concentrations, Apgar scores, and postoperative analgesia variables were assessed and compared between groups. BIS values during the period between intubation and delivery were lower in the labor group than in the control group (P < 0.001). Plasma norepinephrine concentrations increased at delivery compared with baseline in both groups. They were higher in the labor group than in the control group both at baseline and at delivery. Systolic arterial blood pressure, heart rate, Apgar scores, surgical characteristics, and plasma concentrations of vasopressin and cortisol were not different between groups. Postoperative visual analog scale pain scores were similar between groups, while the labor group consumed less analgesics (P < 0.01) during the first 24 h after the operation. Prior labor was associated with lower intraoperative BIS values during sevoflurane/N(2)O general anesthesia and reduced postoperative analgesic consumption in women undergoing cesarean delivery compared with women without prior labor.

Predictors of outcome after elective endovascular abdominal aortic aneurysm repair and external validation of a risk prediction model.

PubMed

Wisniowski, Brendan; Barnes, Mary; Jenkins, Jason; Boyne, Nicholas; Kruger, Allan; Walker, Philip J

2011-09-01

Endovascular abdominal aortic aneurysm (AAA) repair (EVAR) has been associated with lower operative mortality and morbidity than open surgery but comparable long-term mortality and higher delayed complication and reintervention rates. Attention has therefore been directed to identifying preoperative and operative variables that influence outcomes after EVAR. Risk-prediction models, such as the EVAR Risk Assessment (ERA) model, have also been developed to help surgeons plan EVAR procedures. The aims of this study were (1) to describe outcomes of elective EVAR at the Royal Brisbane and Women's Hospital (RBWH), (2) to identify preoperative and operative variables predictive of outcomes after EVAR, and (3) to externally validate the ERA model. All elective EVAR procedures at the RBWH before July 1, 2009, were reviewed. Descriptive analyses were performed to determine the outcomes. Univariate and multivariate analyses were performed to identify preoperative and operative variables predictive of outcomes after EVAR. Binomial logistic regression analyses were used to externally validate the ERA model. Before July 1, 2009, 197 patients (172 men), who were a mean age of 72.8 years, underwent elective EVAR at the RBWH. Operative mortality was 1.0%. Survival was 81.1% at 3 years and 63.2% at 5 years. Multivariate analysis showed predictors of survival were age (P = .0126), American Society of Anesthesiologists (ASA) score (P = .0180), and chronic obstructive pulmonary disease (P = .0348) at 3 years and age (P = .0103), ASA score (P = .0006), renal failure (P = .0048), and serum creatinine (P = .0022) at 5 years. Aortic branch vessel score was predictive of initial (30-day) type II endoleak (P = .0015). AAA tortuosity was predictive of midterm type I endoleak (P = .0251). Female sex was associated with lower rates of initial clinical success (P = .0406). The ERA model fitted RBWH data well for early death (C statistic = .906), 3-year survival (C statistic = .735), 5-year survival (C statistic = .800), and initial type I endoleak (C statistic = .850). The outcomes of elective EVAR at the RBWH are broadly consistent with those of a nationwide Australian audit and recent randomized trials. Age and ASA score are independent predictors of midterm survival after elective EVAR. The ERA model predicts mortality-related outcomes and initial type I endoleak well for RBWH elective EVAR patients. Copyright © 2011 Society for Vascular Surgery. All rights reserved.

Perioperative management of vitamin K antagonists in patients with low thromboembolic risk undergoing elective surgery: A prospective experience.

PubMed

Becerra, Ana Florencia; Cornavaca, María Teresita; Revigliono, José Ignacio; Contreras, Alejandro; Albertini, Ricardo; Tabares, Aldo Hugo

2017-10-11

To quantify thromboembolic and bleeding events in patients with low thromboembolic risk, who were chronically receiving vitamin K antagonists and undergoing elective surgery. A descriptive, prospective, single-center study was conducted between December 2010 and July 2014. Patients aged over 18 years old, chronically anticoagulated with vitamin K antagonists and admitted for elective surgery were included in the study. We excluded patients with a creatinine clearance<30ml/min, a body weight>120kg, heparin-induced thrombocytopenia, pregnant women, carriers of an epidural catheter for analgesia, patients who underwent unscheduled surgery and high thromboembolic risk-patients. Vitamin K antagonists were discontinued 5 days prior to the procedure without administering anticoagulant enoxaparin. The NIR was measured 24h before the procedure. A single dose of 3mg of vitamin K was administered in cases of a NIR>1.5. Vitamin K antagonists was resumed according to the surgical bleeding risk. Events were registered between 5 days prior to the procedure until 30 days after it. A total of 75 procedures were included in the study. Fifty-six patients (74.7%) received vitamin K antagonists for atrial fibrillation, 15 suffered from venous thromboembolism (20%) and 4 had mechanical heart valves (5.3%). Twenty-six patients (34.5%) underwent high-bleeding risk surgeries and 49 (65.5%) underwent low risk procedures. No thromboembolic event was recorded. Four bleeding events (5.3%) were reported, 3 of which were considered major bleeding events (2 fatal). Suspending vitamin K antagonists with no bridging therapy performed in patients with a low thromboembolic risk does not expose such patients to a significant risk of embolic events. Copyright © 2017 Elsevier España, S.L.U. All rights reserved.

The high frequency of healthcare use in patients one year prior to a sarcoidosis diagnosis

PubMed Central

Gerke, Alicia K.; Tang, Fan; Pendergast, Jane; Cavanaugh, Joseph E.; Polgreen, Philip M.

2015-01-01

Background The clinical presentation of sarcoidosis can be varied. Prior investigations have shown that diagnosis is often delayed over six months, particularly in patients with pulmonary symptoms. Delays may lead to high healthcare use prior to diagnosis. Objective To investigate healthcare use prior to diagnosis of sarcoidosis for a cohort of insured patients. Methods We conducted a case-control study using a de-identified limited dataset of private health insurance claims. Cases were identified as persons with sarcoidosis from 2003-2009. Controls with other respiratory-related diagnoses (asthma, chronic obstructive pulmonary disease, pneumonia) were matched by age, gender, and diagnosis date. We compared frequencies of doctor visits, prescriptions, and imaging in the year prior to established diagnosis. Results We identified 206 cases and 2060 controls and compared healthcare use patterns in the year prior to diagnosis. Among those receiving prescriptions, a larger proportion of cases received two or more antibiotic courses (69% vs. 55%, p=0.0020) or two or more corticosteroid prescriptions (63% vs. 50%, p=0.0137). On average, cases had more doctor visits (14.7 vs. 7.8, p<0.0001), saw more specialties (3.9 vs. 2.1, p<0.0001), and underwent more chest x-rays (2.0 vs. 1.5, p<0.0001). A larger proportion of cases underwent two or more chest x-rays (54% vs. 24%, p<0.0001). Conclusions Patients with sarcoidosis undergo a large amount of healthcare prior to diagnosis, some of which may not be necessary, compared to controls with respiratory-related disease. These results highlight the need for improved diagnostic algorithms to identify patients with sarcoidosis and avoid potentially excessive delays in diagnosis. PMID:25363229

Cardiac magnetic resonance findings predict increased resource utilization in elective coronary artery bypass grafting.

PubMed

Berry, Colin; Zimmerli, Lukas U; Steedman, Tracey; Foster, John E; Dargie, Henry J; Berg, Geoffrey A; Dominiczak, Anna F; Delles, Christian

2008-03-01

Morbidity following CABG (coronary artery bypass grafting) is difficult to predict and leads to increased healthcare costs. We hypothesized that pre-operative CMR (cardiac magnetic resonance) findings would predict resource utilization in elective CABG. Over a 12-month period, patients requiring elective CABG were invited to undergo CMR 1 day prior to CABG. Gadolinium-enhanced CMR was performed using a trueFISP inversion recovery sequence on a 1.5 tesla scanner (Sonata; Siemens). Clinical data were collected prospectively. Admission costs were quantified based on standardized actual cost/day. Admission cost greater than the median was defined as 'increased'. Of 458 elective CABG cases, 45 (10%) underwent pre-operative CMR. Pre-operative characteristics [mean (S.D.) age, 64 (9) years, mortality (1%) and median (interquartile range) admission duration, 7 (6-8) days] were similar in patients who did or did not undergo CMR. In the patients undergoing CMR, eight (18%) and 11 (24%) patients had reduced LV (left ventricular) systolic function by CMR [LVEF (LV ejection fraction) <55%] and echocardiography respectively. LE (late enhancement) with gadolinium was detected in 17 (38%) patients. The average cost/day was $2723. The median (interquartile range) admission cost was $19059 ($10891-157917). CMR LVEF {OR (odds ratio), 0.93 [95% CI (confidence interval), 0.87-0.99]; P=0.03} and SV (stroke volume) index [OR 1.07 (95% CI, 1.00-1.14); P=0.02] predicted increased admission cost. CMR LVEF (P=0.08) and EuroScore tended to predict actual admission cost (P=0.09), but SV by CMR (P=0.16) and LV function by echocardiography (P=0.95) did not. In conclusion, in this exploratory investigation, pre-operative CMR findings predicted admission duration and increased admission cost in elective CABG surgery. The cost-effectiveness of CMR in risk stratification in elective CABG surgery merits prospective assessment.

What Limits of Legitimate Discourse? The Case of Elite Sport as "Thinkable" Official Knowledge in the Norwegian National Curriculum

ERIC Educational Resources Information Center

Kårhus, Svein

2016-01-01

In 2006, elite sport was introduced into the Norwegian national curriculum as an elective subject in the pre-tertiary school. Grades achieved in this 5-hours-a-week subject count towards school-leavers' overall attainment grades. Prior to 2006, this subject was only offered as a specially adapted, alternative pedagogy in private schools. The paper…

Incidence and root causes of delays in emergency orthopaedic procedures: a single-centre experience of 36,017 consecutive cases over seven years.

PubMed

Caesar, Ulla; Karlsson, Jon; Hansson, Elisabeth

2018-01-01

Emergency surgery is unplanned by definition and patients are scheduled for surgery with minimal preparation. Some patients who have sustained emergency orthopaedic trauma or other conditions must be operated on immediately or within a few hours, while others can wait until the hospital's resources permit and/or the patients' health status has been optimised as needed. This may affect the prioritisation procedures for both emergency and elective surgery and might result in waiting lists, not only for planned procedures but also for emergencies. The main purpose of this retrospective, observational, single-centre study was to evaluate and describe for the number and reasons of delays, as well as waiting times in emergency orthopaedic surgery using data derived from the hospital's records and registers. All the emergency patients scheduled for emergency surgery whose procedures were rescheduled and delayed between 1 January 2007 and 31 December 2013 were studied. We found that 24% (8474) of the 36,017 patients scheduled for emergency surgeries were delayed and rescheduled at least once, some several times. Eighty per cent of these delays were due to organisational causes. Twenty-one per cent of all the delayed patients had surgery within 24 h, whilst 41% waited for more than 24 h, up to 3 days. A large number of the clinic's emergency orthopaedic procedures were rescheduled and delayed and the majority of the delays were related to organisational reasons. The results can be interpreted in two ways; first, organisational reasons are avoidable and the potential for improvement is great and, secondly and most importantly, the delays might negatively affect patient outcomes.

Using the Safer Clinical Systems approach and Model for Improvement methodology to decrease Venous Thrombo-Embolism in Elective Surgical Patients.

PubMed

Humphries, Angela; Peden, Carol; Jordan, Lesley; Crowe, Josephine; Peden, Carol

2016-01-01

A significant incidence of post-procedural deep vein thrombosis (DVT) and pulmonary embolus (PE) was identified in patients undergoing surgery at our hospital. Investigation showed an unreliable peri-operative process leading to patients receiving incorrect or missed venous thromboembolism (VTE) prophylaxis. The Trust had previously participated in a project funded by the Health Foundation using the "Safer Clinical Systems" methodology to assess, diagnose, appraise options, and implement interventions to improve a high risk medication pathway. We applied the methodology from that study to this cohort of patients demonstrating that the same approach could be applied in a different context. Interventions were linked to the greatest hazards and risks identified during the diagnostic phase. This showed that many surgical elective patients had no VTE risk assessment completed pre-operatively, leading to missed or delayed doses of VTE prophylaxis post-operatively. Collaborative work with stakeholders led to the development of a new process to ensure completion of the VTE risk assessment prior to surgery, which was implemented using the Model for Improvement methodology. The process was supported by the inclusion of a VTE check in the Sign Out element of the WHO Surgical Safety Checklist at the end of surgery, which also ensured that appropriate prophylaxis was prescribed. A standardised operation note including the post-operative VTE plan will be implemented in the near future. At the end of the project VTE risk assessments were completed for 100% of elective surgical patients on admission, compared with 40% in the baseline data. Baseline data also revealed that processes for chemical and mechanical prophylaxis were not reliable. Hospital wide interventions included standardisation of mechanical prophylaxis devices and anti-thromboembolic stockings (resulting in a cost saving of £52,000), and a Trust wide awareness and education programme. The education included increased emphasis on use of mechanical prophylaxis when chemical prophylaxis was contraindicated. VTE guidelines were also included in the existing junior Doctor guideline App. and a "CLOTS" anticoagulation webpage was developed and published on the hospital intranet. The improvement in VTE processes resulted in an 80% reduction in hospital associated thrombosis following surgery from 0.2% in January 2014 to 0.04% in December 2015 and a reduction in the number of all hospital associated VTE from a baseline median of 9 per month as of January 2014 to a median of 1 per month by December 2015.

The influence on survival of delay in the presentation and treatment of symptomatic breast cancer

PubMed Central

Richards, M A; Smith, P; Ramirez, A J; Fentiman, I S; Rubens, R D

1999-01-01

The aim of this study was to examine the possible influence on survival of delays prior to presentation and/or treatment among women with breast cancer. Duration of symptoms prior to hospital referral was recorded for 2964 women who presented with any stage of breast cancer to Guy's Hospital between 1975 and 1990. Median follow-up is 12.5 years. The impact of delay (defined as having symptoms for 12 or more weeks) on survival was measured from the date of diagnosis and from the date when the patient first noticed symptoms to control for lead-time bias. Thirty-two per cent (942/2964) of patients had symptoms for 12 or more weeks before their first hospital visit and 32% (302/942) of patients with delays of 12 or more weeks had locally advanced or metastatic disease, compared with only 10% (210/2022) of those with delays of less than 12 weeks (P< 0.0001). Survival measured both from the date of diagnosis (P< 0.001) and from the onset of the patient's symptoms (P= 0.003) was worse among women with longer delays. Ten years after the onset of symptoms, survival was 52% for women with delays less than 12 weeks and 47% for those with longer delays. At 20 years the survival rates were 34% and 24% respectively. Furthermore, patients with delays of 12–26 weeks had significantly worse survival rates than those with delays of less than 12 weeks. Multivariate analyses indicated that the adverse impact of delay in presentation on survival was attributable to an association between longer delays and more advanced stage. However, within individual stages, longer delay had no adverse impact on survival. Analyses based on ‘total delay’ (i.e. the interval between a patient first noticing symptoms and starting treatment) yielded very similar results in terms of survival to those based on delay to first hospital visit (delay in presentation). © 1999 Cancer Research Campaign PMID:10070881

In the Absence of a Mechanical Bowel Prep, Does the Addition of Pre-Operative Oral Antibiotics to Parental Antibiotics Decrease the Incidence of Surgical Site Infection after Elective Segmental Colectomy?

PubMed

Atkinson, Sarah J; Swenson, Brian R; Hanseman, Dennis J; Midura, Emily F; Davis, Bradley R; Rafferty, Janice F; Abbott, Daniel E; Shah, Shimul A; Paquette, Ian M

2015-12-01

Pre-operative oral antibiotics administered the day prior to elective colectomy have been shown to decrease the incidence of surgical site infections (SSI) if a mechanical bowel prep (MBP) is used. Recently, the role for mechanical bowel prep has been challenged as being unnecessary and potentially harmful. We hypothesize that if MBP is omitted, oral antibiotics do not alter the incidence of SSI following colectomy. We selected patients who underwent an elective segmental colectomy from the 2012 and 2013 National Surgical Quality Improvement Program colectomy procedure targeted database. Indications for surgery included colon cancer, diverticulitis, inflammatory bowel disease, or benign polyp. Patients who received mechanical bowel prep were excluded. The primary outcome measured was surgical site infection, defined as the presence of superficial, deep or, organ space infection within 30 d from surgery. A total of 6,399 patients underwent elective segmental colectomy without MBP. The incidence of SSI differed substantially between patients who received oral antibiotics, versus those who did not (9.7% vs. 13.7%, p=0.01). Multivariate analysis indicated that age, smoking status, operative time, perioperative transfusions, oral antibiotics, and surgical approach were associated with post-operative SSI. When controlling for confounding factors, the use of pre-operative oral antibiotics decreased the incidence of surgical site infection (odds ratio=0.66, 95% confidence interval=0.48-0.90, p=0.01). Even in the absence of mechanical bowel prep, pre-operative oral antibiotics appear to reduce the incidence of surgical site infection following elective colectomy.

Predicting memory performance under conditions of proactive interference: immediate and delayed judgments of learning.

PubMed

Wahlheim, Christopher N

2011-07-01

Four experiments examined the monitoring accuracy of immediate and delayed judgments of learning (JOLs) under conditions of proactive interference (PI). PI was produced using paired-associate learning tasks that conformed to variations of classic A-B, A-D paradigms. Results revealed that the relative monitoring accuracy of interference items was better for delayed than for immediate JOLs. However, delayed JOLs were overconfident for interference items, but not for items devoid of interference. Intrusions retrieved prior to delayed JOLs produced inflated predictions of performance. These results show that delayed JOLs enhance monitoring accuracy in PI situations, except when intrusions are mistaken for target responses.

Using length of stay data from a hospital to evaluate whether limiting elective surgery at the hospital is an inappropriate decision.

PubMed

Dexter, Franklin; Lubarsky, David A

2004-09-01

At hospitals without detailed managerial accounting data but with overall longer than average diagnosis-related groups (DRG)-adjusted lengths of stays (LOS), some administrators do not aggressively hire the nurses needed to maintain surgical hospital capacity. The consequence of this (long-term) decision is that day-of-surgery admit cases are delayed or cancelled from a lack of beds. The anesthesiologists suffer financially. In this paper, we show how publicly released national LOS data can be applied specifically to these cases. We applied the method to 1 year of data from two academic hospitals. Each case's LOS was compared to the United States national average LOS for cases with the same DRG. A total of 8,050 and 10,099 hospitalizations, respectively. Among all surgical admissions, mean LOS was 2.5 days longer than the national average for Hospital #1 (95% confidence interval [CI], 2.1 to 2.8) and 3.1 days longer for Hospital #2 (95% CI, 2.8 to 3.4). Among patients undergoing elective, scheduled surgery with day of surgery admission, mean LOS was 0.7 days less than average for Hospital #1 (0.6 to 0.9) and 1.2 days less than average for Hospital #2 (1.1 to 1.4). This method can be used by anesthesiologists to show that LOS are not longer than average among patients whose surgeries may be cancelled or delayed for a lack of hospital ward staff.

Traumatic rupture of the aortic isthmus: program of selective management.

PubMed

Pate, J W; Gavant, M L; Weiman, D S; Fabian, T C

1999-01-01

Two hypotheses were investigated: (1) helical computed tomography (CT) of the chest on victims of decelerating trauma can yield a diagnosis of, or "rule out," a traumatic rupture of the aorta (TRA) without the need for an aortogram; and (2) selective delay of aortic repair can be safely accomplished through a medical management protocol. Screening helical CT examinations were done on 6169 victims of blunt thoracic trauma; 47 were found to have TRA; in 8, indirect but nondiagnostic findings not clarified by an aortogram led to surgical exploration. The sensitivity of helical CT was higher than that of aortograms, and a "normal" helical CT scan was never associated with a proved TRA. It is estimated that the use of helical CT has resulted in at least a 40% to 50% decrease in the need for aortograms, in addition to yielding rapid, noninvasive valuable information about other injuries. Drugs (beta-blockers +/- vasodilators) to decrease the stress in the aortic wall were used in 93 patients when the diagnosis was suspected and were continued as necessary through the evaluation, stabilization, and until the aorta was cross-clamped at operation. Elective, delayed operation was done between 2 days and 25 months in 15 patients who were deemed to be excessive risks for emergency aortic repair; there were 2 deaths (13. 3%). Eleven patients never had aortic repair. No patient maintained on this protocol, whether repaired emergently, electively, or not at all, developed free rupture of the periaortic hematoma and death from TRA.

Symptoms of post-traumatic stress following elective lumbar spinal arthrodesis.

PubMed

Deisseroth, Kate; Hart, Robert A

2012-08-15

A prospective cohort study with 100% follow-up. To assess incidence and risk factors for development of post-traumatic stress disorder (PTSD) symptoms after elective lumbar arthrodesis. Invasive medical care results in substantial physical and psychological stress to patients. The reported incidence of PTSD after medical care delivery in patients treated for trauma, cancer, and organ transplantation ranges from 5% to 51%. Similar data after elective lumbar spinal arthrodesis have not been reported. A consecutive series of 73 elective lumbar spine arthrodesis patients were evaluated prospectively, using the PTSD checklist-civilian version at 6 weeks, 3 months, 6 months, 9 months, and 12 months after surgery. Patient's sex, age, education level, job status, marital status, psychiatric history, prior surgery with general anesthetic, surgical approach, blood loss, postoperative intubation, length of intensive care unit and hospital stay, and occurrence of perioperative complications were analyzed as predictors of PTSD symptoms, using χ analyses. The overall incidence of symptoms of PTSD identified at at least 1 time point was 19.2% (14 of 73). At each time point, the percentage of the population that was positive was 7.5% (6 wk), 11.6% (3 mo), 7.8%, (6 mo), 13.6% (9 mo), and 11.0% (12 mo). The presence of a prior psychiatric diagnosis proved to be the strongest predictor of postarthrodesis symptoms of PTSD (odds ratio [OR] = 7.05, P = 0.002). Occurrence of a complication also proved to be significantly correlated with the development of PTSD symptoms (OR = 4.33, P = 0.04). Age less than 50 years, blood loss of more than 1 L, hospital stay of more than 10 days, and diagnosis trended toward but failed to reach statistical significance. None of the remaining variables approached statistical significance. Positive PTSD symptoms occurred at least once in 19.2% of patients after elective lumbar arthrodesis, with 7.5% to 13.6% of patients experiencing these symptoms at any 1 time point postoperatively. In this patient cohort, preoperative psychiatric diagnosis was the strongest predictor among tested variables of occurrence of PTSD symptoms, although occurrence of a perioperative complication was also significantly correlated with PTSD symptoms. Spine surgeons should be aware of the potential impact of lumbar arthrodesis surgery on patients' psychological state. Further investigation focusing on the impact of PTSD symptoms on clinical outcomes as well as on potential means of reducing the postoperative incidence of this disorder seems warranted.

Delayed Gastric Emptying is Associated with Early and Long-Term Hyperglycemia in Type 1 Diabetes Mellitus

PubMed Central

Bharucha, Adil E.; Batey-Schaefer, Barbara; Cleary, Patricia A.; Murray, Joseph A.; Cowie, Catherine; Lorenzi, Gayle; Driscoll, Marsha; Harth, Judy; Larkin, Mary; Christofi, Marielle; Bayless, Margaret; Wimmergren, Nyra; Herman, William; Whitehouse, Fred; Jones, Kim; Kruger, Davida; Martin, Cathy; Ziegler, Georgia; Zinsmeister, Alan R.; Nathan, David M.

2015-01-01

Background and Aims After the Diabetes Control and Complications Trial (DCCT), the Epidemiology of Diabetes Interventions and Complications (EDIC) study continued to demonstrate persistent benefit of prior intensive therapy on neuropathy, retinopathy, and nephropathy in type 1 diabetes mellitus (DM)., The relationship between control of glycemia and gastric emptying (GE) is unclear. Methods We assessed GE with a 13C-spirulina breath test and symptoms in 78 participants with type 1 diabetes at year 20 of EDIC. The relationship between delayed GE and HbA1c, complications of DM, and gastrointestinal symptoms were evaluated. Results GE was normal (37 participants, 50%), delayed (35 participants, 47%), or rapid (2 participants, 3%). The latest mean HbA1c was 7.7%. In univariate analyses, delayed GE was associated with greater DCCT baseline HbA1c and duration of DM prior to DCCT (P ≤ 0.04), greater mean HbA1c over an average of 27 years of follow up (during DCCT-EDIC, P = 0.01), lower R-R variability during deep breathing (P=0.03) and severe nephropathy (P=0.05) and a greater composite upper gastrointestinal symptom score (P<0.05). In multivariate models, retinopathy was the only complication of DM associated with delayed GE. Separately, DCCT baseline HbA1c (OR 1.6, 95% CI 1.1–2.3) and duration of DM (OR 1.2, 95%CI 1.01–1.3) prior to DCCT entry and mean HbA1c during DCCT-EDIC (OR 2.2, 95%CI 1.04–4.5) were independently associated with delayed GE. Conclusions In the DCCT/EDIC study, delayed GE was remarkably common and associated with gastrointestinal symptoms and with measures of early and long-term hyperglycemia. ClinicalTrials.gov numbers NCT00360815 and NCT00360893. PMID:25980755

Do Natural Disasters Affect Voting Behavior? Evidence from Croatian Floods

PubMed Central

Bovan, Kosta; Banai, Benjamin; Pavela Banai, Irena

2018-01-01

Introduction: Studies show that natural disasters influence voters’ perception of incumbent politicians. To investigate whether voters are prone to punish politicians for events that are out of their control, this study was conducted in the previously unstudied context of Croatia, and by considering some of the methodological issues of previous studies. Method: Matching method technique was used, which ensures that affected and non-affected areas are matched on several control variables. The cases of natural disaster in the present study were floods that affected Croatia in 2014 and 2015. Results: Main results showed that, prior to matching, floods had an impact on voting behaviour in the 2014 and 2015 elections. Voters from flooded areas decreased their support for the incumbent government and president in the elections following the floods. However, once we accounted for differences in control variables between flooded and non-flooded areas, the flood effect disappeared. Furthermore, results showed that neither the presence nor the amount of the government’s relief spending had an impact on voting behaviour. Discussion: Presented results imply that floods did not have an impact on the election outcome. Results are interpreted in light of the retrospective voter model. PMID:29770268

The Vote and Vax program: public health at polling places.

PubMed

Shenson, Douglas; Adams, Mary

2008-01-01

Although influenza-associated illness is a major cause of hospitalizations and death among older Americans, only half of adults aged 50 or older-for whom influenza vaccinations are recommended-receive an annual influenza vaccination. National elections, which draw a large number of older voters, take place during influenza vaccination season and represent an untapped opportunity for large-scale delivery of vaccinations. In 2006, the Robert Wood Johnson Foundation launched a program to evaluate the feasibility of delivering influenza vaccinations near polling places. Twenty-five public health agencies were each provided grants of $8000 and asked to implement at least two Vote and Vax clinics. Immunizers were required to obtain prior permission from local election authorities and to charge fees as they would at their other community-based clinics. Influenza vaccination had to be made available both to voters and to nonvoters. On election day, the initiative delivered 13790 influenza vaccinations at 127 polling places in 14 states. More than 80 percent of adult vaccine recipients were in the Centers for Disease Prevention and Control-defined priority groups and 28 percent were "new" influenza vaccination recipients. Vote and Vax is a potentially national strategy that could significantly expand the delivery of influenza vaccinations.

A whale better adjusts the biosonar to ordered rather than to random changes in the echo parameters.

PubMed

Supin, Alexander Ya; Nachtigall, Paul E; Breese, Marlee

2012-09-01

A false killer whale's (Pseudorca crassidens) sonar clicks and auditory evoked potentials (AEPs) were recorded during echolocation with simulated echoes in two series of experiments. In the first, both the echo delay and transfer factor (which is the dB-ratio of the echo sound-pressure level to emitted pulse source level) were varied randomly from trial to trial until enough data were collected (random presentation). In the second, a combination of the echo delay and transfer factor was kept constant until enough data were collected (ordered presentation). The mean click level decreased with shortening the delay and increasing the transfer factor, more at the ordered presentation rather than at the random presentation. AEPs to the self-heard emitted clicks decreased with shortening the delay and increasing the echo level equally in both series. AEPs to echoes increased with increasing the echo level, little dependent on the echo delay at random presentations but much more dependent on delay with ordered presentations. So some adjustment of the whale's biosonar was possible without prior information about the echo parameters; however, the availability of prior information about echoes provided additional whale capabilities to adjust both the transmitting and receiving parts of the biosonar.

Notice Requirements in Federal Acquisition Contracts.

DTIC Science & Technology

1985-01-01

oo o e o e *4 16 Development of the Court of Claims Dootrine....48 2. Impact of the Contract Disputes Act............ 56 3. Estoppel ...contractor elects Disputes Clause procedures, the waiver doctrine of Maney and Tapper is now a dead letter. 3. Estoppel Even though the government may...tative might give rise to a situation where the doctrine of equitable estoppel would preclude enforcement of the appeal period limitation. Prior to

Vibration Damping Response of Composite Materials

DTIC Science & Technology

1991-04-01

using a diamond-impregnated cutoff wheel mounted on a milling machine . This procedure was followed to minimize damage to the composite specimens prior to...Development Report Vibration Damping Response of Composite Materials by Roger M. Crane 0E DTIC0 • ELECTE 16 - MAY 28 19914S8 0 E 5; 91--00524 Approved for...Damping Response of Composite Materials by Roger M. Crane TABLE OF CONTENTS Page LIST OF TABLES

26 CFR 1.614-2 - Election to aggregate separate operating mineral interests under section 614(b) prior to its...

Code of Federal Regulations, 2010 CFR

2010-04-01

...: Example. Taxpayer A is producing from an oil and gas horizon and in 1958 he drills for the purpose of locating a deeper horizon which will be operated in the same operating unit as the upper producing horizon... deeper horizon although at such time there is no assurance that such a horizon will be found. If taxpayer...

26 CFR 1.103(n)-3T - Private activity bond limit (temporary).

Code of Federal Regulations, 2013 CFR

2013-04-01

... pursuant to a carryforward election made in a prior year. On March 1, 1988, City Q will issue $5 million of... of A-3 and A-4 of this § 1.103(n)-3T: Example 1. For 1987 State Q has a State ceiling of $200 million... Authorities M, N, or O. On January 1, 1987, Authority M issues $25 million of private activity bonds. During...

26 CFR 1.103(n)-3T - Private activity bond limit (temporary).

Code of Federal Regulations, 2014 CFR

2014-04-01

... pursuant to a carryforward election made in a prior year. On March 1, 1988, City Q will issue $5 million of... of A-3 and A-4 of this § 1.103(n)-3T: Example 1. For 1987 State Q has a State ceiling of $200 million... Authorities M, N, or O. On January 1, 1987, Authority M issues $25 million of private activity bonds. During...

26 CFR 1.103(n)-3T - Private activity bond limit (temporary).

Code of Federal Regulations, 2012 CFR

2012-04-01

... pursuant to a carryforward election made in a prior year. On March 1, 1988, City Q will issue $5 million of... of A-3 and A-4 of this § 1.103(n)-3T: Example 1. For 1987 State Q has a State ceiling of $200 million... Authorities M, N, or O. On January 1, 1987, Authority M issues $25 million of private activity bonds. During...

26 CFR 1.167(l)-2 - Public utility property; election as to post-1969 property representing growth in capacity.

Code of Federal Regulations, 2011 CFR

2011-04-01

... Capacity as of Jan. 1, 1970, plus amounts in column 7 for years prior to the year for which determination is being made. 2 Column 6 minus column 5. (v) The qualified portion of the basis for depreciation (as defined in section 167(g)) of each asset or group of assets (if group or composite accounting is used by...

26 CFR 1.167(l)-2 - Public utility property; election as to post-1969 property representing growth in capacity.

Code of Federal Regulations, 2012 CFR

2012-04-01

... Capacity as of Jan. 1, 1970, plus amounts in column 7 for years prior to the year for which determination is being made. 2 Column 6 minus column 5. (v) The qualified portion of the basis for depreciation (as defined in section 167(g)) of each asset or group of assets (if group or composite accounting is used by...

26 CFR 1.167(l)-2 - Public utility property; election as to post-1969 property representing growth in capacity.

Code of Federal Regulations, 2014 CFR

2014-04-01

... Capacity as of Jan. 1, 1970, plus amounts in column 7 for years prior to the year for which determination is being made. 2 Column 6 minus column 5. (v) The qualified portion of the basis for depreciation (as defined in section 167(g)) of each asset or group of assets (if group or composite accounting is used by...

26 CFR 1.167(l)-2 - Public utility property; election as to post-1969 property representing growth in capacity.

Code of Federal Regulations, 2013 CFR

2013-04-01

... Capacity as of Jan. 1, 1970, plus amounts in column 7 for years prior to the year for which determination is being made. 2 Column 6 minus column 5. (v) The qualified portion of the basis for depreciation (as defined in section 167(g)) of each asset or group of assets (if group or composite accounting is used by...

26 CFR 1.167(l)-2 - Public utility property; election as to post-1969 property representing growth in capacity.

Code of Federal Regulations, 2010 CFR

2010-04-01

... Capacity as of Jan. 1, 1970, plus amounts in column 7 for years prior to the year for which determination is being made. 2 Column 6 minus column 5. (v) The qualified portion of the basis for depreciation (as defined in section 167(g)) of each asset or group of assets (if group or composite accounting is used by...

The Politics of Naval Innovation.

DTIC Science & Technology

1994-08-01

18.2% of the House freshmen and three of the fourteen freshman Senators elected in 1992 have had prior military experience. 9 Consequently, there is...organizational processes by which they are employed or Stephen Rosen’s more restrictive, doctrine- oriented , definition, both the Tomahawk and Aegis systems...naval forces stationed in Southwest Asia . "Earl Rubright, the science adviser to the U.S. Central Command, which oversees operations in the Mideast

Letters, Telegrams, and Photographs Illustrating Factors That Affected the Civil War. The Constitution Community: Civil War and Reconstruction (1850-1870).

ERIC Educational Resources Information Center

Traill, David

Prior to and during the Civil War, the North and the South differed greatly in the resources they could use. Documents held by the National Archives can aid in understanding the factors that influenced the eventual outcome of the War Between the States. After Abraham Lincoln was elected President in 1860, the South seceded because they believed…

Evaluation of peripheral muscle strength of patients undergoing elective cardiac surgery: a longitudinal study

PubMed Central

Santos, Kelli Maria Souza; de Cerqueira Neto, Manoel Luiz; Carvalho, Vitor Oliveira; de Santana Filho, Valter Joviniano; da Silva Junior, Walderi Monteiro; Araújo Filho, Amaro Afrânio; Cerqueira, Telma Cristina Fontes; Cacau, Lucas de Assis Pereira

2014-01-01

Introduction Peripheral muscle strength has been little explored in the literature in the context of cardiac rehabilitation. Objective To evaluate the peripheral muscle strength of patients undergoing elective cardiac surgery. Methods This was a longitudinal observational study. The peripheral muscle strength was measured using isometric dynamometry lower limb (knee extensors and flexors) at three different times: preoperatively (M1), the day of discharge (M2) and hospital discharge (M3). Participants received physiotherapy pre and postoperatively during the days of hospitalization during the morning and afternoon. Results Twenty-two patients were evaluated. The values of peripheral muscle strength of knee extensors preoperative found were about 50% lower than those predicted for the healthy population. When comparing muscle strength prior (M1), with the remaining evaluation, found himself in a fall of 29% for the movement of knee extension and 25% for knee flexion in M2 and a decrease of 10% movement for knee extension and 13% for knee flexion in M3 when comparing with M1. Conclusion The values of peripheral muscle strength prior of the study patients were lower than predicted for the healthy population of the same age. After the surgical event this reduction is even more remarkable, being reestablished until the time of discharge, to values close to baseline. PMID:25372909

Evaluation of peripheral muscle strength of patients undergoing elective cardiac surgery: a longitudinal study.

PubMed

Santos, Kelli Maria Souza; Cerqueira Neto, Manoel Luiz de; Carvalho, Vitor Oliveira; Santana Filho, Valter Joviniano de; Silva Junior, Walderi Monteiro da; Araújo Filho, Amaro Afrânio; Cerqueira, Telma Cristina Fontes; Cacau, Lucas de Assis Pereira

2014-01-01

Peripheral muscle strength has been little explored in the literature in the context of cardiac rehabilitation. To evaluate the peripheral muscle strength of patients undergoing elective cardiac surgery. This was a longitudinal observational study. The peripheral muscle strength was measured using isometric dynamometry lower limb (knee extensors and flexors) at three different times: preoperatively (M1), the day of discharge (M2) and hospital discharge (M3). Participants received physiotherapy pre and postoperatively during the days of hospitalization during the morning and afternoon. Twenty-two patients were evaluated. The values of peripheral muscle strength of knee extensors preoperative found were about 50% lower than those predicted for the healthy population. When comparing muscle strength prior (M1), with the remaining evaluation, found himself in a fall of 29% for the movement of knee extension and 25% for knee flexion in M2 and a decrease of 10% movement for knee extension and 13% for knee flexion in M3 when comparing with M1. The values of peripheral muscle strength prior of the study patients were lower than predicted for the healthy population of the same age. After the surgical event this reduction is even more remarkable, being reestablished until the time of discharge, to values close to baseline.

New Utility for an Old Tool

PubMed Central

Odonkor, Charles A.; Schonberger, Robert B.; Dai, Feng; Shelley, Kirk H.; Silverman, David G.; Barash, Paul G.

2013-01-01

Objective The primary aim of this study was to design prediction models based on a functional marker (preoperative gait-speed) to predict readiness for home discharge time of ≤ 90 minutes, and to identify those at risk for unplanned admissions, after elective ambulatory surgery. Design This prospective observational cohort study evaluated all patients scheduled for elective ambulatory surgery. Home discharge readiness and unplanned admissions were the primary outcomes. Independent variables included preoperative gait speed, heart rate, and total anesthesia time. The relationship between all predictors and each primary outcome was determined in separate multivariable logistic regression models. Results After adjustment for covariates, gait speed with adjusted odds ratio = 3.71 (95% CI: 1.21-11.26), p=0.02; was independently associated with early home discharge readiness ≤90 minutes. Importantly, gait speed dichotomized as greater or less than 1 m/s predicted unplanned admissions with odds ratio = 0.35 (95% CI: 0.16 to 0.76, p=0.008) for those with speeds ≥ 1 m/s in comparison to those with speed < 1 m/s. In a separate model, prior history of cardiac surgery with adjusted odds ratio =7.5 (95% CI: 2.34-24.41)(p=0.001) was independently associated with unplanned admissions after elective ambulatory surgery, when other covariates were held constant. Conclusions This study demonstrates use of novel prediction models based on gait speed testing to predict early home discharge and to identify those patients at risk for unplanned admissions, after elective ambulatory surgery. PMID:24051992

Optimal Timing of Delivery among Low-Risk Women with Prior Caesarean Section: A Secondary Analysis of the WHO Multicountry Survey on Maternal and Newborn Health.

PubMed

Ganchimeg, Togoobaatar; Nagata, Chie; Vogel, Joshua P; Morisaki, Naho; Pileggi-Castro, Cynthia; Ortiz-Panozo, Eduardo; Jayaratne, Kapila; Mittal, Suneeta; Ota, Erika; Souza, João Paulo; Mori, Rintaro

2016-01-01

To investigate optimal timing of elective repeat caesarean section among low-risk pregnant women with prior caesarean section in a multicountry sample from largely low- and middle-income countries. Secondary analysis of a cross-sectional study. Twenty-nine countries from the World Health Organization Multicountry Survey on Maternal and Newborn Health. 29,647 women with prior caesarean section and no pregnancy complications in their current pregnancy who delivered a term singleton (live birth and stillbirth) at gestational age 37-41 weeks by pre-labour caesarean section, intra-partum caesarean section, or vaginal birth following spontaneous onset of labour. We compared the rate of short-term adverse maternal and newborn outcomes following pre-labour caesarean section at a given gestational age, to those following ongoing pregnancies beyond that gestational age. Severe maternal outcomes, neonatal morbidity, and intra-hospital early neonatal mortality. Odds of neonatal morbidity and intra-hospital early neonatal mortality were 0.48 (95% confidence interval [CI] 0.39-0.60) and 0.31 (95% CI 0.16-0.58) times lower for ongoing pregnancies compared to pre-labour caesarean section at 37 weeks. We did not find any significant change in the risk of severe maternal outcomes between pre-labour caesarean section at a given gestational age and ongoing pregnancies beyond that gestational age. Elective repeat caesarean section at 37 weeks had higher risk of neonatal morbidity and mortality compared to ongoing pregnancy, however risks at later gestational ages did not differ between groups.

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

Patel, Rakesh P., E-mail: rpatel9@nhs.net; Katsargyris, Athanasios, E-mail: kthanassos@yahoo.com; Verhoeven, Eric L. G., E-mail: Eric.Verhoeven@klinikum-nuernberg.de

The chimney technique in endovascular aortic aneurysm repair (Ch-EVAR) involves placement of a stent or stent-graft parallel to the main aortic stent-graft to extend the proximal or distal sealing zone while maintaining side branch patency. Ch-EVAR can facilitate endovascular repair of juxtarenal and aortic arch pathology using available standard aortic stent-grafts, therefore, eliminating the manufacturing delays required for customised fenestrated and branched stent-grafts. Several case series have demonstrated the feasibility of Ch-EVAR both in acute and elective cases with good early results. This review discusses indications, technique, and the current available clinical data on Ch-EVAR.

Colorectal cancer associated with abdominal aortic aneurysm: results of EVAR followed by colectomy.

PubMed

Illuminati, Giulio; Ceccanei, Gianluca; Pacilè, Maria A; Pizzardi, Giulia; Palumbo, Piergaspare; Vietri, Francesco

2013-01-01

The association of colorectal cancer and abdominal aortic aneurysm (AAA) is infrequent but poses special problems of priority of treatment under elective circumstances. The purpose of this study was to retrospectively evaluate the outcome of 16 consecutive patients undergoing endovascular aneurysm repair (EVAR) followed by colectomy. Operative mortality was nil. Operative morbidity included two transient rise of serum creatinine level and one extraperitoneal anastomotic leakage which evolved favourably with conservative treatment. EVAR allowed a very short delay of treatment of colorectal cancer after aneurysm repair, minimizing operative complications.

Does use of intraoperative cell-salvage delay recovery in patients undergoing elective abdominal aortic surgery?

PubMed

Tavare, Aniket N; Parvizi, Nassim

2011-06-01

A best evidence topic in vascular surgery was written according to a structured protocol. The question addressed was whether the use of intraoperative cell-salvage (ICS) leads to negative outcomes in patients undergoing elective abdominal aortic surgery? Altogether 305 papers were found using the reported search, of which 10 were judged to represent the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers were tabulated. None of the 10 papers included in the analysis demonstrated that ICS use led to significantly higher incidence of cardiac or septic postoperative complications. Similarly, length of intensive treatment unit (ITU) or hospital stay and mortality in elective abdominal aortic surgery were not adversely affected. Indeed two trials actually show a significantly shorter hospital stay after ICS use, one a shorter ITU stay and another suggests lower rates of chest sepsis. Based on these papers, we concluded that the use of ICS does not cause increased morbidity or mortality when compared to standard practise of transfusion of allogenic blood, and may actually improve some clinical outcomes. As abdominal aortic surgery inevitably causes significant intraoperative blood loss, in the range of 661-3755 ml as described in the papers detailed in this review, ICS is a useful and safe strategy to minimise use of allogenic blood.

The case against primary endoscopic realignment of pelvic fracture urethral injuries

PubMed Central

Tausch, Timothy J.; Morey, Allen F.

2015-01-01

Objectives To review previous reports and present our experience on the outcomes after treating pelvic fracture urethral injuries (PFUIs) with primary endoscopic realignment (PER) vs. placing a suprapubic tube (SPT) with elective bulbomembranous anastomotic urethroplasty (BMAU). Methods We reviewed previous reports and identified articles that reported outcomes after PER vs. SPT and elective BMAU for patients who sustained PFUIs. We also present our institutional experience of treating patients who were referred after undergoing either form of treatment. Results The success rates for PER after PFUI are wide-ranging (11–86%), with variable definitions for a successful outcome. At our institution, for patients treated by SPT/BMAU, the mean time to a definitive resolution of stenosis was dramatically shorter (6 months, range 3–15) than for those treated with PER (122 months, range 4–574; P < 0.01). The vast majority of patients treated by PER required multiple endoscopic urethral interventions (median 4, range 1–36;P < 0.01) and/or had various other adverse events that were rare among the SPT/BMAU group (14/17, 82%, vs. 2/23, 9%;P < 0.05). Conclusion While PER occasionally results in urethral patency with no need for further intervention, the risk of delay in definitive treatment and the potential for adverse events have led to a preference for SPT and elective BMAU at our institution. PMID:26019972

Modified M505A3 Fuze with Delay Function

DTIC Science & Technology

1974-10-01

forward initiation on the firing pin entrance hole to the rotor cavity. The triple staked detonator also functioned on the 0.063-inch target at 75... effectiveness of this projectile against aircraft targets by Incorporating a time delay which enables the projectile to penetrate the aircraft skin...prior to detonation. This effort required the design of modifications to the M505A3 fuze to achieve a delay function without modifying the rotor

Discriminative stimuli that follow a delay have added value for pigeons.

PubMed

DiGian, Kelly A; Friedrich, Andrea M; Zentall, Thomas R

2004-10-01

Clement, Feltus, Kaiser, and Zentall (2000) reported that pigeons prefer discriminative stimuli that require greater effort (more pecks) to obtain over those that require less effort. In the present experiment, we examined two variables associated with this phenomenon. First, we asked whether delay of reinforcement, presumably a relatively aversive event similar to effort, would produce similar effects. Second, we asked whether the stimulus preference produced by a prior relatively aversive event depends on its anticipation. Anticipation of delay was accomplished by signaling its occurrence. Results indicated that delays can produce preferences similar to those produced by increased effort, but only if the delays are signaled.

The Heart Trumps the Head: Desirability Bias in Political Belief Revision

PubMed Central

2017-01-01

Understanding how individuals revise their political beliefs has important implications for society. In a preregistered study (N = 900), we experimentally separated the predictions of 2 leading theories of human belief revision—desirability bias and confirmation bias—in the context of the 2016 U.S. presidential election. Participants indicated who they desired to win, and who they believed would win, the election. Following confrontation with evidence that was either consistent or inconsistent with their desires or beliefs, they again indicated who they believed would win. We observed a robust desirability bias—individuals updated their beliefs more if the evidence was consistent (vs. inconsistent) with their desired outcome. This bias was independent of whether the evidence was consistent or inconsistent with their prior beliefs. In contrast, we found limited evidence of an independent confirmation bias in belief updating. These results have implications for the relevant psychological theories and for political belief revision in practice. PMID:28557511

British Columbia's health reform: "new directions" and accountability.

PubMed

Davidson, A R

1999-01-01

The health policy New Directions committed the British Columbia government to a population health perspective and extensive community involvement in the health services reform process. The policy envisaged elected citizen boards with authority to raise revenues and exercise a significant degree of local autonomy. Academic and public attention has been paid to the decision in November 1996 to collapse New Directions' two-tier governance structure into a single level. Less attention has been paid to the profound changes that occurred prior to the government's reversal on the question of governance. This paper focuses on those changes. During the critical three years between the 1993 launch of the reform and its formal revision in 1996, the government's positions on elections, taxation power, local autonomy and scope of action for regional boards all changed. Those changes marked a retreat from political accountability to the community and an advance towards managerial accountability to the government.

Recent developments: Washington focus

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

Gunter, L.L.

A new US president, as well as an altered balance of power in Congress, has changed the political landscape in Washington. In the overall composition of Congress, Republicans improved their position, the House gaining seven Republican seats. While the Democrats gained one seat in the Senate, they do not have the 60 votes necessary to defeat a filibuster. Of the 110 new congressmen and women arriving for the 103rd Congress next year, the freshmen are more liberal than President-elect Clinton or, if Republican, much more conservative than he. It is likely the Senate will be more liberal than the 102ndmore » Congress, and the House may move toward the middle of the road. It is uncertain how the new Congress will address nuclear-related issues. Prior to the election, Johns Hopkins Univ. sponsored a conference addressing the topic of the future of nuclear power in the US.« less

JPRS Report, Near East & South Asia, Bangladesh

DTIC Science & Technology

1991-08-13

General Secretary of She however alleged that Avhi circle, the accused killers of the DUCSU, a competently source close to the high Dr. Milon are now...prior to the February 27 parliamentary elections were not Milon is now indulging in hooliganism on the campuses yet materialised. Even the 10-point...result, unemployment has been gradually taking a very serious shape, she added. Replying a question he firmly said unless the killers of Dr. Milon who were

Disability inquiries shorn from Chicago's judicial review process.

PubMed

1997-03-07

The Chicago Bar Association changed the wording of the questions it routinely asks judicial candidates for election and appointment to the bench. Prior to the change, the request for information was so broad that the bar association could learn the candidate's HIV status through a questionnaire that gave the result of the candidate's last physical examination. The new wording better reflects the spirit and intent of the Americans with Disabilities Act (ADA).

AdVEGF-All6A+ Preconditioning of Murine Ischemic Skin Flaps Is Comparable to Surgical Delay.

PubMed

Gersch, Robert P; Fourman, Mitchell S; Phillips, Brett T; Nasser, Ahmed; McClain, Steve A; Khan, Sami U; Dagum, Alexander B; Bui, Duc T

2015-08-01

Surgical flap delay is commonly used in preconditioning reconstructive flaps to prevent necrosis. However, staged procedures are not ideal. Pharmacologic up-regulation of angiogenic and arteriogenic factors before flap elevation poses a nonsurgical approach to improve flap survival. Male Sprague Dawley rats were divided into control (n = 16), surgical delay (Delay), AdNull, AdEgr-1, and AdVEGF (n ≥ 9/group) groups. Delay rats had a 9 cm × 3 cm cranial based pedicle skin flap incised 10 days prior to elevation. Adenoviral groups received 28 intradermal injections (10(9) pu/animal total) throughout the distal two thirds of the flap 1 week prior to elevation. At postoperative day (POD) 0 flaps were elevated and silicone sheeting was placed between flap and wound bed. Perfusion analysis in arbitrary perfusion units of the ischemic middle third of the flap using laser Doppler imaging was conducted preoperatively and on POD 0, 3, and 7. Clinical and histopathologic assessments of the skin flaps were performed on POD 7. AdVEGF (50.8 ± 10.9 APU) and AdEgr-1 (39.3 ± 10.6 APU) perfusion levels were significantly higher than controls (16.5 ± 4.2 APU) on POD 7. Delay models were equivalent to controls (25.9 ± 6.8 APU). AdVEGF and Delay animals showed significantly more viable surface area on POD 7 (14.4 ± 1.3 cm(2), P < 0.01 and 12.4 ± 1.2 cm(2), P < 0.05, respectively) compared with Controls (8.7 ± 0.7 cm(2)). AdVEGF preconditioning resulted in flap survival comparable to surgical delay. Adenoviral preconditioning maintained perfusion levels postoperatively while surgical delay did not.

AdVEGF-All6A+ Preconditioning of Murine Ischemic Skin Flaps Is Comparable to Surgical Delay

PubMed Central

Gersch, Robert P.; Fourman, Mitchell S.; Phillips, Brett T.; Nasser, Ahmed; McClain, Steve A.; Khan, Sami U.; Dagum, Alexander B.

2015-01-01

Background: Surgical flap delay is commonly used in preconditioning reconstructive flaps to prevent necrosis. However, staged procedures are not ideal. Pharmacologic up-regulation of angiogenic and arteriogenic factors before flap elevation poses a nonsurgical approach to improve flap survival. Methods: Male Sprague Dawley rats were divided into control (n = 16), surgical delay (Delay), AdNull, AdEgr-1, and AdVEGF (n ≥ 9/group) groups. Delay rats had a 9 cm × 3 cm cranial based pedicle skin flap incised 10 days prior to elevation. Adenoviral groups received 28 intradermal injections (109 pu/animal total) throughout the distal two thirds of the flap 1 week prior to elevation. At postoperative day (POD) 0 flaps were elevated and silicone sheeting was placed between flap and wound bed. Perfusion analysis in arbitrary perfusion units of the ischemic middle third of the flap using laser Doppler imaging was conducted preoperatively and on POD 0, 3, and 7. Clinical and histopathologic assessments of the skin flaps were performed on POD 7. Results: AdVEGF (50.8 ± 10.9 APU) and AdEgr-1 (39.3 ± 10.6 APU) perfusion levels were significantly higher than controls (16.5 ± 4.2 APU) on POD 7. Delay models were equivalent to controls (25.9 ± 6.8 APU). AdVEGF and Delay animals showed significantly more viable surface area on POD 7 (14.4 ± 1.3 cm2, P < 0.01 and 12.4 ± 1.2 cm2, P < 0.05, respectively) compared with Controls (8.7 ± 0.7 cm2). Conclusions: AdVEGF preconditioning resulted in flap survival comparable to surgical delay. Adenoviral preconditioning maintained perfusion levels postoperatively while surgical delay did not. PMID:26495207

Effects of Annealing Treatment Prior to Cold Rolling on Delayed Fracture Properties in Ferrite-Austenite Duplex Lightweight Steels

NASA Astrophysics Data System (ADS)

Sohn, Seok Su; Song, Hyejin; Kim, Jung Gi; Kwak, Jai-Hyun; Kim, Hyoung Seop; Lee, Sunghak

2016-02-01

Tensile properties of recently developed automotive high-strength steels containing about 10 wt pct of Mn and Al are superior to other conventional steels, but the active commercialization has been postponed because they are often subjected to cracking during formation or to the delayed fracture after formation. Here, the delayed fracture behavior of a ferrite-austenite duplex lightweight steel whose microstructure was modified by a batch annealing treatment at 1023 K (750 °C) prior to cold rolling was examined by HCl immersion tests of cup specimens, and was compared with that of an unmodified steel. After the batch annealing, band structures were almost decomposed as strong textures of {100}<011> α-fibers and {111}<112> γ-fibers were considerably dissolved, while ferrite grains were refined. The steel cup specimen having this modified microstructure was not cracked when immersed in an HCl solution for 18 days, whereas the specimen having unmodified microstructure underwent the delayed fracture within 1 day. This time delayed fracture was more critically affected by difference in deformation characteristics such as martensitic transformation and deformation inhomogeneity induced from concentration of residual stress or plastic strain, rather than the difference in initial microstructures. The present work gives a promise for automotive applications requiring excellent mechanical and delayed fracture properties as well as reduced specific weight.

Double Dissociation of Amygdala and Hippocampal Contributions to Trace and Delay Fear Conditioning

PubMed Central

Raybuck, Jonathan D.; Lattal, K. Matthew

2011-01-01

A key finding in studies of the neurobiology of learning memory is that the amygdala is critically involved in Pavlovian fear conditioning. This is well established in delay-cued and contextual fear conditioning; however, surprisingly little is known of the role of the amygdala in trace conditioning. Trace fear conditioning, in which the CS and US are separated in time by a trace interval, requires the hippocampus and prefrontal cortex. It is possible that recruitment of cortical structures by trace conditioning alters the role of the amygdala compared to delay fear conditioning, where the CS and US overlap. To investigate this, we inactivated the amygdala of male C57BL/6 mice with GABA A agonist muscimol prior to 2-pairing trace or delay fear conditioning. Amygdala inactivation produced deficits in contextual and delay conditioning, but had no effect on trace conditioning. As controls, we demonstrate that dorsal hippocampal inactivation produced deficits in trace and contextual, but not delay fear conditioning. Further, pre- and post-training amygdala inactivation disrupted the contextual but the not cued component of trace conditioning, as did muscimol infusion prior to 1- or 4-pairing trace conditioning. These findings demonstrate that insertion of a temporal gap between the CS and US can generate amygdala-independent fear conditioning. We discuss the implications of this surprising finding for current models of the neural circuitry involved in fear conditioning. PMID:21283812

Delayed recall, hippocampal volume and Alzheimer neuropathology: findings from the Nun Study.

PubMed

Mortimer, J A; Gosche, K M; Riley, K P; Markesbery, W R; Snowdon, D A

2004-02-10

To examine the associations of hippocampal volume and the severity of neurofibrillary lesions determined at autopsy with delayed verbal recall performance evaluated an average of 1 year prior to death. Hippocampal volumes were computed using postmortem brain MRI from the first 56 scanned participants of the Nun Study. Quantitative neuropathologic studies included lesion counts, Braak staging, and determination of whether neuropathologic criteria for Alzheimer disease (AD) were met. Multiple regression was used to assess the association of hippocampal volume and neuropathologic lesions with the number of words (out of 10) recalled on the Consortium to Establish a Registry for Alzheimer's Disease Delayed Word Recall Test administered an average of 1 year prior to death. When entered separately, hippocampal volume, Braak stage, and the mean neurofibrillary tangle counts in the CA-1 region of the hippocampus and the subiculum were strongly associated with the number of words recalled after a delay, adjusting for age and education. When hippocampal volume was entered together with each neuropathologic index, only hippocampal volume retained a significant association with the delayed recall measure. The association between hippocampal volume and the number of words recalled was present in both demented and nondemented individuals as well as in those with and without substantial AD neurofibrillary pathology. The association of neurofibrillary tangles with delayed verbal recall may reflect associated hippocampal atrophy.

Delayed Self-Recognition in Autism: A Unique Difficulty?

ERIC Educational Resources Information Center

Dunphy-Lelii, Sarah; Wellman, Henry M.

2012-01-01

Achieving a sense of self is a crucial task of ordinary development. With which aspects of self do children with autism have particular difficulty? Two prior studies concluded that children with autism are unimpaired in delayed self-recognition; we confirm and clarify this conclusion by examining it in conjunction with another key aspect of self…

Steps in Theory-of-Mind Development for Children with Deafness or Autism

ERIC Educational Resources Information Center

Peterson, Candida C.; Wellman, Henry M.; Liu, David

2005-01-01

Prior research demonstrates that understanding theory of mind (ToM) is seriously and similarly delayed in late-signing deaf children and children with autism. Are these children simply delayed in timing relative to typical children, or do they demonstrate different patterns of development? The current research addressed this question by testing…

The Association between Delay Discounting and Schizotypal Personality Characteristics in a Nonclinical Sample

ERIC Educational Resources Information Center

Weatherly, Jeffrey N.

2012-01-01

Immediacy theory of schizophrenia posits that the behavior of individuals with schizophrenia is controlled to a greater degree by stimuli in the current environment relative to individuals without schizophrenia. Prior research supports this idea by finding that individuals with schizophrenia display steeper rates of delay discounting than those…

46 CFR 95.15-30 - Alarms.

Code of Federal Regulations, 2010 CFR

2010-10-01

... navigated, other than paint and lamp lockers and similar small spaces, shall be fitted with an approved... only for systems required to be fitted with a delayed discharge. Such alarms shall be so arranged as to sound during the 20 second delay period prior to the discharge of carbon dioxide into the space, and the...

46 CFR 76.15-30 - Alarms.

Code of Federal Regulations, 2010 CFR

2010-10-01

... than paint and lamp lockers and similar small spaces, shall be fitted with an approved audible alarm in... required to be fitted with a delayed discharge. Such alarms shall be so arranged as to sound during the 20 second delay period prior to the discharge of carbon dioxide into the space, and the alarm shall depend...

Time Delay Embedding Increases Estimation Precision of Models of Intraindividual Variability

ERIC Educational Resources Information Center

von Oertzen, Timo; Boker, Steven M.

2010-01-01

This paper investigates the precision of parameters estimated from local samples of time dependent functions. We find that "time delay embedding," i.e., structuring data prior to analysis by constructing a data matrix of overlapping samples, increases the precision of parameter estimates and in turn statistical power compared to standard…

Methods of and apparatus for recording images occurring just prior to a rapid, random event

DOEpatents

Kelley, Edward F.

1994-01-01

An apparatus and a method are disclosed for recording images of events in a medium wherein the images that are recorded are of conditions existing just prior to and during the occurrence of an event that triggers recording of these images. The apparatus and method use an optical delay path that employs a spherical focusing mirror facing a circular array of flat return mirrors around a central flat mirror. The image is reflected in a symmetric pattern which balances astigmatism which is created by the spherical mirror. Delays on the order of hundreds of nanoseconds are possible.

Timing of birth for women with a twin pregnancy at term: a randomised controlled trial

PubMed Central

2010-01-01

Background There is a well recognized risk of complications for both women and infants of a twin pregnancy, increasing beyond 37 weeks gestation. Preterm birth prior to 37 weeks gestation is a recognized complication of a twin pregnancy, however, up to 50% of twins will be born after this time. The aims of this randomised trial are to assess whether elective birth at 37 weeks gestation compared with standard care in women with a twin pregnancy affects the risk of perinatal death, and serious infant complications. Methods/Design Design: Multicentred randomised trial. Inclusion Criteria: women with a twin pregnancy at 366 weeks or more without contraindication to continuation of pregnancy. Trial Entry & Randomisation: Following written informed consent, eligible women will be randomised from 36+6 weeks gestation. The randomisation schedule uses balanced variable blocks, with stratification for centre of birth and planned mode of birth. Women will be randomised to either elective birth or standard care. Treatment Schedules: Women allocated to the elective birth group will be planned for elective birth from 37 weeks gestation. Where the plan is for vaginal birth, this will involve induction of labour. Where the plan is for caesarean birth, this will involve elective caesarean section. For women allocated to standard care, birth will be planned for 38 weeks gestation or later. Where the plan is for vaginal birth, this will involve either awaiting the spontaneous onset of labour, or induction of labour if required. Where the plan is for caesarean birth, this will involve elective caesarean section (after 38 and as close to 39 weeks as possible). Primary Study Outcome: A composite of perinatal mortality or serious neonatal morbidity. Sample Size: 460 women with a twin pregnancy to show a reduction in the composite outcome from 16.3% to 6.7% with adjustment for the clustering of twin infants within mothers (p = 0.05, 80% power). Discussion This is a protocol for a randomised trial, the findings of which will contribute information about the optimal time of birth for women with an uncomplicated multiple pregnancy at and beyond 37 weeks gestation. Clinical Trial Registration Current Controlled Trials ISRCTN15761056 PMID:20973989

The effectiveness of graded activity for low back pain in occupational healthcare.

PubMed

Steenstra, I A; Anema, J R; Bongers, P M; de Vet, H C W; Knol, D L; van Mechelen, W

2006-11-01

Low back pain is a common medical and social problem associated with disability and absence from work. Knowledge on effective return to work (RTW) interventions is scarce. To determine the effectiveness of graded activity as part of a multistage RTW programme. Randomised controlled trial. Occupational healthcare. 112 workers absent from work for more than eight weeks due to low back pain were randomised to either graded activity (n = 55) or usual care (n = 57). Graded activity, a physical exercise programme aimed at RTW based on operant-conditioning behavioural principles. The number of days off work until first RTW for more then 28 days, total number of days on sick leave during follow up, functional status, and severity of pain. Follow up was 26 weeks. Graded activity prolonged RTW. Median time until RTW was equal to the total number of days on sick leave and was 139 (IQR = 69) days in the graded activity group and 111 (IQR = 76) days in the usual care group (hazard ratio = 0.52, 95% CI 0.32 to 0.86). An interaction between a prior workplace intervention and graded activity, together with a delay in the start of the graded activity intervention, explained most of the delay in RTW (hazard ratio = 0.86, 95% CI 0.40 to 1.84 without prior intervention and 0.39, 95% CI 0.19 to 0.81 with prior intervention). Graded activity did not improve pain or functional status clinically significantly. Graded activity was not effective for any of the outcome measures. Different interventions combined can lead to a delay in RTW. Delay in referral to graded activity delays RTW. In implementing graded activity special attention should be paid to the structure and process of care.

Electronic capture of patient-reported and clinician-reported outcome measures in an elective orthopaedic setting: a retrospective cohort analysis.

PubMed

Malhotra, Karan; Buraimoh, Olatunbosun; Thornton, James; Cullen, Nicholas; Singh, Dishan; Goldberg, Andrew J

2016-06-20

To determine whether an entirely electronic system can be used to capture both patient-reported outcomes (electronic Patient-Reported Outcome Measures, ePROMs) as well as clinician-validated diagnostic and complexity data in an elective surgical orthopaedic outpatient setting. To examine patients' experience of this system and factors impacting their experience. Retrospective analysis of prospectively collected data. Single centre series. Outpatient clinics at an elective foot and ankle unit in the UK. All new adult patients attending elective orthopaedic outpatient clinics over a 32-month period. All patients were invited to complete ePROMs prior to attending their outpatient appointment. At their appointment, those patients who had not completed ePROMs were offered the opportunity to complete it on a tablet device with technical support. Matched diagnostic and complexity data were captured by the treating consultant during the appointment. Capture rates of patient-reported and clinician-reported data. All information and technology (IT) failures, language and disability barriers were captured. Patients were asked to rate their experience of using ePROMs. The scoring systems used included EQ-5D-5L, the Manchester-Oxford Foot Questionnaire (MOxFQ) and the Visual Analogue Scale (VAS) pain score. Out of 2534 new patients, 2176 (85.9%) completed ePROMs, of whom 1090 (50.09%) completed ePROMs at home/work prior to their appointment. 31.5% used a mobile (smartphone/tablet) device. Clinician-reported data were captured on 2491 patients (98.3%). The mean patient experience score of using Patient-Reported Outcome Measures (PROMs) was 8.55±1.85 out of 10 and 666 patients (30.61%) left comments. Of patients leaving comments, 214 (32.13%) felt ePROMs did not adequately capture their symptoms and these patients had significantly lower patient experience scores (p<0.001). This study demonstrates the successful implementation of technology into a service improvement programme. Excellent capture rates of ePROMs and clinician-validated diagnostic data can be achieved within a National Health Service setting. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Does age at the time of elective cardiac surgery or catheter intervention in children influence the longitudinal development of psychological distress and styles of coping of parents?

PubMed

Utens, Elisabeth M; Versluis-Den Bieman, Herma J; Witsenburg, Maarten; Bogers, Ad J J C; Hess, John; Verhulst, Frank C

2002-12-01

To assess the influence of age at a cardiac procedure of children, who underwent elective cardiac surgery or interventional cardiac catheterisation for treatment of congenital cardiac defects between 3 months and 7 years of age, on the longitudinal development of psychological distress and styles of coping of their parents. We used the General Health Questionnaire to measure psychological distress, and the Utrecht Coping List to measure styles of coping. Parents completed questionnaires on average respectively 5 weeks prior to, and 18.7 months after, cardiac surgery or catheter intervention for their child. Apart from one exception, no significant influence was found of the age at which children underwent elective cardiac surgery or catheter intervention on the pre- to postprocedural course of psychological distress and the styles of coping of their parents. Across time, parents of children undergoing surgery reported, on average, significantly higher levels of psychological distress than parents of children who underwent catheter intervention. After the procedure, parents of children who underwent either procedure reported significantly lower levels of psychological distress, and showed a weaker tendency to use several styles of coping, than did their reference groups. Age of the children at the time of elective cardiac surgery or catheter intervention did not influence the course of psychological distress of their parents, nor the styles of coping used by the parents. Future research should investigate in what way the age at which these cardiac procedures are performed influences the emotional and cognitive development of the children.

Validation of risk assessment scoring systems for an audit of elective surgery for gastrointestinal cancer in elderly patients: an audit.

PubMed

Wakabayashi, Hisao; Sano, Takanori; Yachida, Shinichi; Okano, Keiichi; Izuishi, Kunihiko; Suzuki, Yasuyuki

2007-10-01

The goal of this study was to validate the usefulness of risk assessment scoring systems for a surgical audit in elective digestive surgery for elderly patients. The validated scoring systems used were the Physiological and Operative Severity Score for enUmeration of Mortality and morbidity (POSSUM) and the Portsmouth predictor equation for mortality (P-POSSUM). This study involved 153 consecutive patients aged 75 years and older who underwent elective gastric or colorectal surgery between July 2004 and June 2006. A retrospective analysis was performed on data collected prior to each surgery. The predicted mortality and morbidity risks were calculated using each of the scoring systems and were used to obtain the observed/predicted (O/E) mortality and morbidity ratios. New logistic regression equations for morbidity and mortality were then calculated using the scores from the POSSUM system and applied retrospectively. The O/E ratio for morbidity obtained from POSSUM score was 0.23. The O/E ratios for mortality from the POSSUM score and the P-POSSUM were 0.15 and 0.38, respectively. Utilizing the new equations using scores from the POSSUM, the O/E ratio increased to 0.88. Both the POSSUM and P-POSSUM over-predicted the morbidity and mortality in elective gastrointestinal surgery for malignant tumors in elderly patients. However, if a surgical unit makes appropriate calculations using its own patient series and updates these equations, the POSSUM system can be useful in the risk assessment for surgery in elderly patients.

Impact of sleep disordered breathing on short-term post-operative outcome after elective coronary artery bypass graft surgery: a prospective observational study.

PubMed

Rupprecht, Sven; Schultze, Torsten; Nachtmann, Andreas; Rastan, Ardawan Julian; Doenst, Torsten; Schwab, Matthias; Witte, Otto W; Rohe, Sebastian; Zwacka, Isabelle; Hoyer, Heike

2017-04-01

Sleep disordered breathing (SDB) is common in patients with coronary disease, but its impact on post-operative recovery after coronary artery bypass graft surgery (CABG) is unclear. We therefore determined the effects of SDB on post-operative outcome after elective CABG.In this prospective two-centre study, 219 patients due to receive elective CABG underwent cardiorespiratory polygraphy for SDB prior to surgery and were monitored for post-operative complications. The primary end-point was a composite of 30-day mortality or major post-operative complications (cardiac, respiratory, surgical, infectious, acute renal failure or stroke). Key secondary end-points were single components of the primary end-point.SDB was present in 69% and moderate/severe SDB in 43% of the CABG patients. There was no difference in the composite of 30-day mortality or major postoperative complications between patients with and without SDB (OR 0.97, 95% CI 0.49-1.96) and between patients with moderate/severe SDB and no/mild SDB (OR 1.07, 95% CI 0.55-2.06). However, moderate/severe SDB was associated with higher rates of mortality (crude OR 10.1, 95% CI 1.22-83.5), sepsis (OR 2.96, 95% CI 1.17-7.50) and respiratory complications (OR 2.85, 95% CI 1.46-5.55).Although SDB was not associated with higher overall morbidity/mortality, moderate/severe SDB may increase the risk of death, and septic and respiratory complications, after elective CABG. Copyright ©ERS 2017.

High-Dose Statin Pretreatment Decreases Periprocedural Myocardial Infarction and Cardiovascular Events in Patients Undergoing Elective Percutaneous Coronary Intervention: A Meta-Analysis of Twenty-Four Randomized Controlled Trials

PubMed Central

Wang, Le; Peng, Pingan; Zhang, Ou; Xu, Xiaohan; Yang, Shiwei; Zhao, Yingxin; Zhou, Yujie

2014-01-01

Background Evidence suggests that high-dose statin pretreatment may reduce the risk of periprocedural myocardial infarction (PMI) and major adverse cardiac events (MACE) for certain patients; however, previous analyses have not considered patients with a history of statin maintenance treatment. In this meta-analysis of randomized controlled trials (RCTs), we reevaluated the efficacy of short-term high-dose statin pretreatment to prevent PMI and MACE in an expanded set of patients undergoing elective percutaneous coronary intervention. Methods We searched the PubMed/Medline database for RCTs that compared high-dose statin pretreatment with no statin or low-dose statin pretreatment as a prevention of PMI and MACE. We evaluated the incidence of PMI and MACE, including death, spontaneous myocardial infarction, and target vessel revascularization at the longest follow-up for each study for subgroups stratified by disease classification and prior low-dose statin treatment. Results Twenty-four RCTs with a total of 5,526 patients were identified. High-dose statin pretreatment was associated with 59% relative reduction in PMI (odds ratio [OR]: 0.41; 95% confidence interval [CI]: 0.34–0.49; P<0.00001) and 39% relative reduction in MACE (OR: 0.61; 95% CI: 0.45–0.83; P = 0.002). The benefit of high-dose statin pretreatment on MACE was significant for statin-naive patients (OR: 0.69; 95% CI: 0.50–0.95; P = 0.02) and prior low dose statin-treated patients (OR: 0.28; 95% CI: 0.12–0.65; P = 0.003); and for patients with acute coronary syndrome (OR: 0.52; 95% CI: 0.34–0.79; P = 0.003), but not for patients with stable angina (OR: 0.71; 95% CI 0.45–1.10; P = 0.12). Long-term effects on survival were less obvious. Conclusions High-dose statin pretreatment can result in a significant reduction in PMI and MACE for patients undergoing elective PCI. The positive effect of high-dose statin pretreatment on PMI and MACE is significant for statin-naïve patients and patients with prior treatment. The positive effect of high-dose statin pretreatment on MACE is significant for patients with acute coronary syndrome. PMID:25473831

Preoperative conditioning with oral carbohydrate loading and oral nutritional supplements can be combined with mechanical bowel preparation prior to elective colorectal resection.

PubMed

Hendry, P O; Balfour, A; Potter, M A; Mander, B J; Bartolo, D C C; Anderson, D N; Fearon, K C H

2008-11-01

Preoperative conditioning with oral fluid and carbohydrate (CHO) loading allows the patient to undergo surgery in the fed state and is associated with reduced postoperative insulin resistance. Further benefit may accrue from oral nutritional supplements (ONS) to counteract the fasting associated with mechanical bowel preparation (MBP). In this study we assess the ability to prescribe, dispense and have patients comply with a protocol combining preoperative ONS and CHO/fluid loading during MBP. One hundred and forty-seven patients undergoing elective left colonic or rectal resection were recruited to an Enhanced Recovery after Surgery (ERAS) programme. All patients were prescribed MBP (2 sachets Picolax). On the daytime prior to surgery, eligible patients were prescribed 2 x 200 ml of ONS (Fortijuice, Nutricia) and in the evening 800 ml oral CHO/fluid loading (Preop(R), Nutricia,). Patients were prescribed a further 400 ml of oral/CHO/fluid on the morning of surgery 2 h prior to induction of anaesthesia. Protocol compliance was audited prospectively. One hundred and forty-seven patients received MBP. Twenty-three patients were ineligible for oral CHO/fluid loading [diabetes (n = 22), allergy to lemon flavoured drinks (n = 1)]. Fourteen patients did not receive the preoperative CHO drinks due to failure to prescribe (n = 8) or dispense (n = 6). One hundred and ten patients were dispensed the combined ONS and CHO/fluid loading regimen, compliance rates were 83% with ONS, 80% with CHO/fluid loading and 74% with both. Approximately 74% of patients undergoing MBP can comply with preoperative conditioning with ONS and CHO/fluid loading. Prescription and dispensing requires close attention to detail.

Effect of the duration of food withholding prior to anesthesia on gastroesophageal reflux and regurgitation in healthy dogs undergoing elective orthopedic surgery.

PubMed

Viskjer, Sivert; Sjöström, Lennart

2017-02-01

OBJECTIVE To compare the incidence of and risk factors for gastroesophageal reflux (GER) and regurgitation associated with preanesthetic food withholding for periods of 18 hours (overnight) and 3 hours in healthy dogs undergoing elective orthopedic surgery. ANIMALS 82 healthy (American Society of Anesthesiologists physical status classification I or II) client-owned dogs. PROCEDURES Food was withheld for 18 hours (18-hour group [n = 41]) or each dog was allowed to consume half its daily ration of canned food approximately 3 hours (3-hour group [n = 41]) prior to induction of anesthesia. In each anesthetized dog, a pH catheter was introduced through the oropharynx into the distal portion of the esophagus; the pH was continuously recorded throughout the period of anesthesia. Gastroesophageal reflux was defined as pH < 4.0. RESULTS Gastroesophageal reflux was significantly associated with age, dorsal recumbency, and duration of preanesthetic food withholding. Regurgitation was significantly associated with duration of GER and duration of preanesthetic food withholding. During anesthesia, 25 (61%) dogs in the 3-hour group had GER and 12 (48%) of those dogs regurgitated gastric content; 18 (43.9%) dogs in the 18-hour group had GER and 2 (11.1%) of those dogs regurgitated gastric content. The mean lowest pH measured in the refluxate in the 3-hour group (2.3) was significantly greater than that in the 18-hour group (1.3). CONCLUSIONS AND CLINICAL RELEVANCE Among the study dogs undergoing orthopedic surgery, consumption of a light meal 3 hours prior to anesthesia was associated with significantly greater odds of reflux and regurgitation, compared with overnight food withholding.

The use of picture prompts and prompt delay to teach receptive labeling.

PubMed

Vedora, Joseph; Barry, Tiffany

2016-12-01

The current study extended research on picture prompts by using them with a progressive prompt delay to teach receptive labeling of pictures to 2 teenagers with autism. The procedure differed from prior research because the auditory stimulus was not presented or was presented only once during the picture-prompt condition. The results indicated that the combination of picture prompts and prompt delay was effective, although 1 participant required a procedural modification. © 2016 Society for the Experimental Analysis of Behavior.

Obstetrics and Gynecology Resident Interest and Participation in Global Health.

PubMed

Stagg, Amy R; Blanchard, May Hsieh; Carson, Sandra A; Peterson, Herbert B; Flynn, Erica B; Ogburn, Tony

2017-05-01

To evaluate obstetrics and gynecology resident interest and participation in global health experiences and elucidate factors associated with resident expectation for involvement. A voluntary, anonymous survey was administered to U.S. obstetrics and gynecology residents before the 2015 Council on Resident Education in Obstetrics and Gynecology in-training examination. The 23-item survey gathered demographic data and queried resident interest and participation in global health. Factors associated with resident expectation for participation in global health were analyzed by Pearson χ tests. Of the 5,005 eligible examinees administered the survey, 4,929 completed at least a portion of the survey for a response rate of 98.5%. Global health was rated as "somewhat important" or "very important" by 96.3% (3,761/3,904) of residents. "Educational opportunity" (69.2%) and "humanitarian effort" (17.7%) were cited as the two most important aspects of a global health experience. Residents with prior global health experience rated the importance of global health more highly and had an increased expectation for future participation. Global health electives were arranged by residency programs for 18.0% (747/4,155) of respondents, by residents themselves as an elective for 44.0% (1,828/4,155), and as a noncredit experience during vacation time for 36.4% (1,514/4,155) of respondents. Female gender, nonpartnered status, no children, prior global health experience, and intention to incorporate global health in future practice were associated with expectations for a global health experience. Most obstetrics and gynecology residents rate a global health experience as somewhat or very important, and participation before or during residency increases the perceived importance of global health and the likelihood of expectation for future participation. A majority of residents report arranging their own elective or using vacation time to participate, suggesting that residency programs have limited structured opportunities.

[Preoperative evaluation of adult patients before elective, noncardiothoracic surgery : Joint recommendation of the German Society of Anesthesiology and Intensive Care Medicine, the German Society of Surgery, and the German Society of Internal Medicine].

PubMed

Zwissler, B

2017-06-01

Evaluation of the patient's medical history and a physical examination are the cornerstones of risk assessment prior to elective surgery and may help to optimize the patient's preoperative medical condition and to guide perioperative management. Whether the performance of additional technical tests (e. g. blood chemistry, ECG, spirometry, chest x‑ray) can contribute to a reduction of perioperative risk is often not very well known or is controversial. Similarly, there is considerable uncertainty among anesthesiologists, internists and surgeons with respect to the perioperative management of the patient's long-term medication. Therefore, the German Scientific Societies of Anesthesiology and Intensive Care Medicine (DGAI), Internal Medicine (DGIM) and Surgery (DGCH) have joined to elaborate recommendations on the preoperative evaluation of adult patients prior to elective, noncardiothoracic surgery, which were initially published in 2010. These recommendations have now been updated based on the current literature and existing international guidelines. In the first part the general principles of preoperative evaluation are described (part A). The current concepts for extended evaluation of patients with known or suspected major cardiovascular disease are presented in part B. Finally, the perioperative management of patients' long-term medication is discussed (part C). The concepts proposed in these interdisciplinary recommendations endorsed by the DGAI, DGIM and DGCH provide a common basis for a structured preoperative risk assessment and management. These recommendations aim to ensure that surgical patients undergo a rational preoperative assessment and at the same time to avoid unnecessary, costly and potentially dangerous testing. The joint recommendations reflect the current state-of-the-art knowledge as well as expert opinions because scientific-based evidence is not always available. These recommendations will be subject to regular re-evaluation and updating when new validated evidence becomes available.

Delayed treatment of ruptured brain AVMs: is it ok to wait?

PubMed

Beecher, Jeffrey S; Lyon, Kristopher; Ban, Vin Shen; Vance, Awais; McDougall, Cameron M; Whitworth, Louis A; White, Jonathan A; Samson, Duke; Batjer, H Hunt; Welch, Babu G

2018-04-01

OBJECTIVE Despite a hemorrhagic presentation, many patients with arteriovenous malformations (AVMs) do not require emergency resection. The timing of definitive management is not standardized in the cerebrovascular community. This study was designed to evaluate the safety of delaying AVM treatment in clinically stable patients with a new hemorrhagic presentation. The authors examined the rate of rehemorrhage or neurological decline in a cohort of patients with ruptured brain AVMs during a period of time posthemorrhage. METHODS Patients presenting to the authors' institution from January 2000 to December 2015 with ruptured brain AVMs treated at least 4 weeks posthemorrhage were included in this analysis. Exclusion criteria were ruptured AVMs that required emergency surgery involving resection of the AVM, prior treatment of AVM at another institution, or treatment of lesions within 4 weeks for other reasons (subacute surgery). The primary outcome measure was time from initial hemorrhage to treatment failure (defined as rehemorrhage or neurological decline as a direct result of the AVM). Patient-days were calculated from the day of initial rupture until the day AVM treatment was initiated or treatment failed. RESULTS Of 102 ruptured AVMs in 102 patients meeting inclusion criteria, 7 (6.9%) failed the treatment paradigm. Six patients (5.8%) had a new hemorrhage within a median of 248 days (interquartile range 33-1364 days). The total "at risk" period was 18,740 patient-days, yielding a rehemorrhage rate of 11.5% per patient-year, or 0.96% per patient-month. Twelve (11.8%) of 102 patients were found to have an associated aneurysm. In this group there was a single (8.3%) new hemorrhage during a total at-risk period of 263 patient-days until the aneurysm was secured, yielding a rehemorrhage risk of 11.4% per patient-month. CONCLUSIONS It is the authors' practice to rehabilitate patients after brain AVM rupture with a plan for elective treatment of the AVM. The present data are useful in that the findings quantify the risk of the authors' treatment strategy. These findings indicate that delaying intervention for at least 4 weeks after the initial hemorrhage subjects the patient to a low (< 1%) risk of rehemorrhage. The authors modified the treatment paradigm when a high-risk feature, such as an associated intracranial aneurysm, was identified.

An Inflight Recorder Prototype for the Inflight Physiological Data Acquisition System III.

DTIC Science & Technology

1982-02-01

ELECTE ~AUG 1 11982 DEPARTMENT OF THE AIR FORCE W AIR UNIVERSITY (ATC| ).- ’--- AIR FORCE INSTITUTE OF TECHNOLOGY Wright-Patterson Air Force Base, Ohio 82...v ! w - I List of Figures Figure Page 1. A Preliminary IR PMS ..... ............... 13 2. The Proposed New IR ...... ................ 36 3. Major...prior theses showed that it was feasible to construct a system w ith characteristics based on the following requirements. The first requirement is that

High-dose, single-bolus eptifibatide: a safe and cost-effective alternative to conventional glycoprotein IIb/IIIa inhibitor use for elective coronary interventions.

PubMed

Fischell, Tim A; Attia, Tamer; Rane, Santosh; Salman, Waddah

2006-10-01

Adjunctive pharmacotherapy with eptifibatide, a glycoprotein (GP) IIb/IIIa inhibitor, as an intravenous bolus followed by infusion has been shown to improve outcomes in elective coronary interventions (PCI). However, bleeding complications and costs have limited the routine adoption of this regimen. The goal of this study was to examine the safety, efficacy and cost-effectiveness of high-dose, single-bolus eptifibatide, without post-intervention infusion, in "real-world" patients undergoing elective PCI. We studied 401 patients with stable and unstable angina who were treated with a high-dose (20 mg), single bolus of eptifibatide plus heparin prior to the start of elective PCI. Exclusion criteria included recent MI, stenting of bypass graft(s), rotational atherectomy and/or brachytherapy. The primary study endpoints were major adverse clinical events (MACE), defined as the in-hospital and 30-day incidence of death from any cause, Q-wave or non-Q-wave MI, repeat target vessel revascularization and/or major bleeding complications. Relevant demographic and procedural characteristics included mean age: 66.4 +/- 11.2; male gender: 242/401 (61%); number of vessels treated per patient: 1.46 +/- 0.42; and number of stents deployed per patient: 1.82 +/- 0.65. In-hospital non-Q-wave MI (CPK and/or CPK-MB > 3 times the upper limit of normal) occurred in 7/401 patients (1.75%) and MACE was 2.25%. Major bleeding complications were seen in 2/401 patients (0.49%). There were 4 additional MACE events at 30-day follow up (total MACE and bleeding = 3.25%). The average anticoagulation cost was 66 dollars/patient. Intravenous eptifibatide, administered as a high-dose (20 mg) single-vial bolus, is a safe, effective and highly cost-effective alternative to the conventional regimens of bolus plus prolonged intravenous GP IIb/IIIa inhibitor infusion for patients undergoing elective PCI.

The Use of Picture Prompts and Prompt Delay to Teach Receptive Labeling

ERIC Educational Resources Information Center

Vedora, Joseph; Barry, Tiffany

2016-01-01

The current study extended research on picture prompts by using them with a progressive prompt delay to teach receptive labeling of pictures to 2 teenagers with autism. The procedure differed from prior research because the auditory stimulus was not presented or was presented only once during the picture-prompt condition. The results indicated…

Source Test Report for the 205 Delayed Coking Unit Drum 205-1201 and Drum 205-1202 Depressurization Vents (Marathon Petroleum Company LLC)

EPA Pesticide Factsheets

The 2010 Source Test was performed during the atmospheric depressurization step of the delayed coking process prior to the removal of petroleum coke from the coke drum. The 205 DCU was operated under a variety of conditions during the 2010 Source Test.

46 CFR 34.15-30 - Alarms-T/ALL.

Code of Federal Regulations, 2010 CFR

2010-10-01

... Systems, Details § 34.15-30 Alarms—T/ALL. (a) Spaces required to have a delayed discharge by § 34.15-10(f... board while the vessel is being navigated, other than paint and lamp lockers and similar small spaces... to sound during the 20-second delay period prior to the discharge of carbon dioxide into the space...

Diagnostic pathways and direct medical costs incurred by new adult pulmonary tuberculosis patients prior to anti-tuberculosis treatment – Tamil Nadu, India

PubMed Central

Veesa, Karun Sandeep; John, Kamalabhai Russell; Moonan, Patrick K.; Kaliappan, Saravanakumar Puthupalayam; Manjunath, Krishna; Sagili, Karuna D.; Ravichandra, Chinnappareddy; Menon, Pradeep Aravindan; Dolla, Chandrakumar; Luke, Nancy; Munshi, Kaivan; George, Kuryan; Minz, Shantidani

2018-01-01

Background Tuberculosis (TB) patients face substantial delays prior to treatment initiation, and out of pocket (OOP) expenditures often surpass the economic productivity of the household. We evaluated the pre-diagnostic cost and health seeking behaviour of new adult pulmonary TB patients registered at Primary Health Centres (PHCs) in Vellore district, Tamil Nadu, India. Methods This descriptive study, part of a randomised controlled trial conducted in three rural Tuberculosis Units from Dec 2012 to Dec 2015, collected data on number of health facilities, dates of visits prior to the initiation of anti-tuberculosis treatment, and direct OOP medical costs associated with TB diagnosis. Logistic regression analysis examined the factors associated with delays in treatment initiation and OOP expenditures. Results Of 880 TB patients interviewed, 34.7% presented to public health facilities and 65% patients sought private health facilities as their first point of care. The average monthly individual income was $77.79 (SD 57.14). About 69% incurred some pre-treatment costs at an average of $39.74. Overall, patients experienced a median of 6 days (3–11 IQR) of time to treatment initiation and 21 days (10–30 IQR) of health systems delay. Age ≤ 40 years (aOR: 1.73; CI: 1.22–2.44), diabetes (aOR: 1.63; CI: 1.08–2.44) and first visit to a private health facility (aOR: 17.2; CI: 11.1–26.4) were associated with higher direct OOP medical costs, while age ≤ 40 years (aOR: 0.64; CI: 0.48–0.85) and first visit to private health facility (aOR: 1.79, CI: 1.34–2.39) were associated with health systems delay. Conclusion The majority of rural TB patients registering at PHCs visited private health facilities first and incurred substantial direct OOP medical costs and delays prior to diagnosis and anti-tuberculosis treatment initiation. This study highlights the need for PHCs to be made as the preferred choice for first point of contact, to combat TB more efficiently. PMID:29414980

Diagnostic pathways and direct medical costs incurred by new adult pulmonary tuberculosis patients prior to anti-tuberculosis treatment - Tamil Nadu, India.

PubMed

Veesa, Karun Sandeep; John, Kamalabhai Russell; Moonan, Patrick K; Kaliappan, Saravanakumar Puthupalayam; Manjunath, Krishna; Sagili, Karuna D; Ravichandra, Chinnappareddy; Menon, Pradeep Aravindan; Dolla, Chandrakumar; Luke, Nancy; Munshi, Kaivan; George, Kuryan; Minz, Shantidani

2018-01-01

Tuberculosis (TB) patients face substantial delays prior to treatment initiation, and out of pocket (OOP) expenditures often surpass the economic productivity of the household. We evaluated the pre-diagnostic cost and health seeking behaviour of new adult pulmonary TB patients registered at Primary Health Centres (PHCs) in Vellore district, Tamil Nadu, India. This descriptive study, part of a randomised controlled trial conducted in three rural Tuberculosis Units from Dec 2012 to Dec 2015, collected data on number of health facilities, dates of visits prior to the initiation of anti-tuberculosis treatment, and direct OOP medical costs associated with TB diagnosis. Logistic regression analysis examined the factors associated with delays in treatment initiation and OOP expenditures. Of 880 TB patients interviewed, 34.7% presented to public health facilities and 65% patients sought private health facilities as their first point of care. The average monthly individual income was $77.79 (SD 57.14). About 69% incurred some pre-treatment costs at an average of $39.74. Overall, patients experienced a median of 6 days (3-11 IQR) of time to treatment initiation and 21 days (10-30 IQR) of health systems delay. Age ≤ 40 years (aOR: 1.73; CI: 1.22-2.44), diabetes (aOR: 1.63; CI: 1.08-2.44) and first visit to a private health facility (aOR: 17.2; CI: 11.1-26.4) were associated with higher direct OOP medical costs, while age ≤ 40 years (aOR: 0.64; CI: 0.48-0.85) and first visit to private health facility (aOR: 1.79, CI: 1.34-2.39) were associated with health systems delay. The majority of rural TB patients registering at PHCs visited private health facilities first and incurred substantial direct OOP medical costs and delays prior to diagnosis and anti-tuberculosis treatment initiation. This study highlights the need for PHCs to be made as the preferred choice for first point of contact, to combat TB more efficiently.

Simultaneous repair of abdominal aortic aneurysm and resection of unexpected, associated abdominal malignancies.

PubMed

Illuminati, Giulio; Calio', Francesco G; D'Urso, Antonio; Lorusso, Riccardo; Ceccanei, Gianluca; Vietri, Francesco

2004-12-15

The management of unexpected intra-abdominal malignancy, discovered at laparotomy for elective treatment of an abdominal aortic aneurysm (AAA), is controversial. It is still unclear whether both conditions should be treated simultaneously or a staged approach is to be preferred. To contribute in improving treatment guidelines, we retrospectively reviewed the records of patients undergoing laparotomy for elective AAA repair. From January 1994 to March 2003, 253 patients underwent elective, trans-peritoneal repair of an AAA. In four patients (1.6%), an associated, unexpected neoplasm was detected at abdominal exploration, consisting of one renal, one gastric, one ileal carcinoid, and one ascending colon tumor. All of them were treated at the same operation, after aortic repair and careful isolation of the prosthetic graft. The whole series' operative mortality was 3.6%. None of the patients simultaneously treated for AAA and tumor resection died in the postoperative period. No graft-related infections were observed. Simultaneous treatment of AAA and tumor did not prolong significantly the mean length of stay in the hospital, compared to standard treatment of AAA alone. Except for malignancies of organs requiring major surgical resections, simultaneous AAA repair and resection of an associated, unexpected abdominal neoplasm can be safely performed, in most of the patients, sparing the need for a second procedure. Endovascular grafting of the AAA can be a valuable tool in simplifying simultaneous treatment, or in staging the procedures with a very short delay.

The use of urological hospital services by nonagenarians

PubMed Central

Pridgeon, S; Nagarajan, E; Ellis, G; Green, JS

2016-01-01

Introduction The super-elderly population is a small but expanding group of patients who will pose a significant challenge to future healthcare resources. A snapshot audit was completed of all emergency and elective urological nonagenarian activity in a UK general hospital, including surgical outcomes in this group of patients. Methods Prospective and retrospective databases and clinical records were examined to identify all patients aged 90–99 years who had patient episodes between January 2006 and August 2012. Patient outcomes were compared with those for a similar cohort of 80–89-year-olds during the same time period. Results A total of 653 nonagenarian patient episodes were identified (including 138 emergency admissions, 25 emergency surgical procedures, 71 elective surgical procedures, 173 local anaesthetic procedures and 270 outpatient visits). The in-hospital mortality rate for emergency admissions was 10%. The mean length of hospital stay was significantly longer for nonagenarians than for octogenarians (14.4 vs 6.5 days, p<0.00001). The postoperative mortality rate following emergency and elective surgery was 16% and 1% for nonagenarians and octogenarians respectively. Conclusions Nonagenarian patients often have complex medical co-morbidities and challenging social circumstances that contribute to delayed recovery from acute illness and surgery as well as long periods of hospitalisation. Adopting a multidisciplinary approach with formal input from specialist geriatric surgical services may improve patient outcomes and allow patients to be discharged to their former places of residence. PMID:26673045

24 CFR 954.504 - Closeout.

Code of Federal Regulations, 2010 CFR

2010-04-01

... be received by HUD. If the audit review by the Department of Interior (DOI) results in significant delays, the Area ONAP may request a signed copy of the audit prior to DOI review and use it as the document needed prior to closeout. If the audit does not cover all funds to be closed out, the closeout may...

The option value of delay in health technology assessment.

PubMed

Eckermann, Simon; Willan, Andrew R

2008-01-01

Processes of health technology assessment (HTA) inform decisions under uncertainty about whether to invest in new technologies based on evidence of incremental effects, incremental cost, and incremental net benefit monetary (INMB). An option value to delaying such decisions to wait for further evidence is suggested in the usual case of interest, in which the prior distribution of INMB is positive but uncertain. of estimating the option value of delaying decisions to invest have previously been developed when investments are irreversible with an uncertain payoff over time and information is assumed fixed. However, in HTA decision uncertainty relates to information (evidence) on the distribution of INMB. This article demonstrates that the option value of delaying decisions to allow collection of further evidence can be estimated as the expected value of sample of information (EVSI). For irreversible decisions, delay and trial (DT) is demonstrated to be preferred to adopt and no trial (AN) when the EVSI exceeds expected costs of information, including expected opportunity costs of not treating patients with the new therapy. For reversible decisions, adopt and trial (AT) becomes a potentially optimal strategy, but costs of reversal are shown to reduce the EVSI of this strategy due to both a lower probability of reversal being optimal and lower payoffs when reversal is optimal. Hence, decision makers are generally shown to face joint research and reimbursement decisions (AN, DT and AT), with the optimal choice dependent on costs of reversal as well as opportunity costs of delay and the distribution of prior INMB.

Update on the slow delayed rectifier potassium current (I(Ks)): role in modulating cardiac function.

PubMed

Liu, Zhenzhen; Du, Lupei; Li, Minyong

2012-01-01

The slow delayed rectifier current (I(Ks)) is the slow component of cardiac delayed rectifier current and is critical for the late phase repolarization of cardiac action potential. This current is also an important target for Sympathetic Nervous System (SNS) to regulate the cardiac electivity to accommodate to heart rate alterations in response to exercise or emotional stress and can be up-regulated by β- adrenergic or other signal molecules. I(Ks) channel is originated by the co-assembly of pore-forming KCNQ1 α-subunit and accessory KCNE1 β-subunit. Mutations in any subunit can bring about severe long QT syndrome (LQT-1, LQT-5) as characterized by deliquium, seizures and sudden death. This review summarizes the normal physiological functions and molecular basis of I(Ks) channels, as well as illustrates up-to-date development on its blockers and activators. Therefore, the current extensive survey should generate fundamental understanding of the role of I(Ks) channel in modulating cardiac function and donate some instructions to the progression of I(Ks) blockers and activators as potential antiarrhythmic agents or pharmacological tools to determine the physiological and pathological function of I(Ks).

Distorted retrospective eyewitness reports as functions of feedback and delay.

PubMed

Wells, Gary L; Olson, Elizabeth A; Charman, Steve D

2003-03-01

Participant-witnesses viewed a crime video and attempted to identify the culprit from a culprit-absent lineup. The 253 mistaken-identification eyewitnesses were randomly given confirming, disconfirming, or no feedback regarding their identifications. Feedback was immediate or delayed 48 hr, and measures were immediate or delayed 48 hr. Confirming, but not disconfirming, feedback led to distortions of eyewitnesses' recalled confidence, amount of attention paid during witnessing, goodness of view, ability to make out facial details, length of time to identification, and other measures related to the witnessing experience. Unexpectedly, neither delaying the measures nor delaying feedback for 48 hr moderated these effects. The results underscore the need for double-blind lineups and neutral assessments of eyewitnesses' certainty and other judgments prior to feedback.

Some tests of wet tropospheric calibration for the CASA Uno Global Positioning System experiment

NASA Technical Reports Server (NTRS)

Dixon, T. H.; Wolf, S. Kornreich

1990-01-01

Wet tropospheric path delay can be a major error source for Global Positioning System (GPS) geodetic experiments. Strategies for minimizing this error are investigted using data from CASA Uno, the first major GPS experiment in Central and South America, where wet path delays may be both high and variable. Wet path delay calibration using water vapor radiometers (WVRs) and residual delay estimation is compared with strategies where the entire wet path delay is estimated stochastically without prior calibration, using data from a 270-km test baseline in Costa Rica. Both approaches yield centimeter-level baseline repeatability and similar tropospheric estimates, suggesting that WVR calibration is not critical for obtaining high precision results with GPS in the CASA region.

Further evidence for the role of gap junctions in the delayed antiarrhythmic effect of cardiac pacing.

PubMed

Miskolczi, Gottfried; Gönczi, Márton; Kovács, Mária; Seprényi, György; Végh, Ágnes

2015-07-01

The objective of this study was to provide evidence that gap junctions are involved in the delayed antiarrhythmic effect of cardiac pacing. Twenty-four dogs were paced through the right ventricle (4 × 5 min, rate of 240 beats/min) 24 h prior to a 25 min occlusion of the left anterior descending coronary artery. Some of these paced dogs were infused with 50 (n = 7) or 100 μmol/L (n = 7) of the gap junction uncoupler carbenoxolone (CBX), prior to and during the occlusion. Ten sham-paced dogs, subjected only to occlusion, served as the controls. Cardiac pacing markedly reduced the number of ectopic beats and episodes of ventricular tachycardia (VT), as well the incidence of VT and ventricular fibrillation during occlusion. The changes in severity of ischaemia and tissue electrical resistance were also less marked compared with the unpaced controls. Pacing also preserved the permeability of gap junctions, the phosphorylation of connexin43, and the structural integrity of the intercalated discs. The closing of gap junctions with CBX prior to and during ischaemia markedly attenuated or even abolished these protective effects of pacing. Our results support the previous findings that gap junctions play a role in the delayed antiarrhythmic effect of cardiac pacing.

The Prachanda Path and Oglaigh na hEireann: A Comparative Case Study of the Insurgencies in Nepal and Northern Ireland

DTIC Science & Technology

2008-05-22

Prior to the 1980s, politicians aligned with the PIRA conducted an activity called “ abstentionism ,” which meant that they participated in elections... The Prachanda Path and Óglaigh na hÉireann: A Comparative Case Study of the Insurgencies in Nepal and Northern Ireland A Monograph by MAJOR...burden for this collection of information is estimated to average 1 hour per response, including the time for reviewing instructions, searching existing

Saudi Arabia: Islamic Threat, Political Reform, and the Global War on Terror

DTIC Science & Technology

2005-03-01

actions seen through the lens of anti-Saudi sentiment in the United States, stoked by the fi lm, “ Farenheit 9/11” 4 and books attacking politicians...Kingdom. However, 13 pro-reform activists, who called for a transition from absolute to constitutional monarchy and for a governmentally provided...situation prior to the 2004 elections, by certain books,99 and by the fi lm, Farenheit 9/11, that sought to provide Americans a simple explanation for the

High risk endovascular aneurysm repair: a case report.

PubMed

De Silva, Samanthi

2017-10-01

Mr AB is a 66-year old gentleman who presented for elective endovascular aneurysm repair (EVAR) following a routine screening scan identifying a 5.5cm abdominal aortic aneurysm (AAA). He had a past history of chronic obstructive pulmonary disease (COPD) with FEV1/FVC ratio of 48% on pre-assessment. He was hypertensive with a history of ischaemic heart disease (IHD), which has remained asymptomatic following coronary artery bypass grafting (CABG) eight years prior to this presentation. Copyright the Association for Perioperative Practice.

Investigation of change in cardinal symptoms of chronic rhinosinusitis after surgical or ongoing medical management.

PubMed

DeConde, Adam S; Mace, Jess C; Alt, Jeremiah A; Soler, Zachary M; Orlandi, Richard R; Smith, Timothy L

2015-01-01

Chronic rhinosinusitis (CRS) has been defined as inflammation of the paranasal sinuses lasting at least 12 weeks with corresponding 2 or more "cardinal symptoms" that include: (1) nasal obstruction; (2) thick nasal discharge; (3) facial pain/pressure; and (4) reduction or loss of sense of smell. Although prior studies have investigated symptoms of CRS after sinus surgery, none have compared the outcomes of these specific symptoms to ongoing medical therapy. Patients with CRS were prospectively enrolled into a multi-institutional, comparative effectiveness, cohort study. Subjects elected either continued medical management or endoscopic sinus surgery (ESS). Baseline characteristics and objective clinical findings were collected. Cardinal symptoms of CRS were operationalized by 4 questions on the 22-item Sino-Nasal Outcome Test (SNOT-22). Symptom improvement was evaluated in subjects with at least 6-month follow-up. A total of 342 subjects were enrolled, with 69 (20.2%) electing continued medical management, whereas 273 (79.8%) elected ESS. Subjects electing surgical therapy were more likely to have a higher baseline aggregate SNOT-22 score (44.3 (18.9) vs 53.6 (18.8); p < 0.001). All subjects improved across all cardinal symptoms; however, subjects undergoing ESS were significantly more likely (p ≤ 0.013) to experience improvement in thick nasal discharge (odds ratio [OR] = 4.36), facial pain/pressure (OR = 3.56), and blockage/congestion of nose (OR = 2.76). Subjects with nasal polyposis were significantly more likely to report complete resolution of smell/taste following ESS compare to medical management (23.8% vs 4.0%; p = 0.026). Across a large population, surgical management is more effective at resolving the cardinal symptoms of CRS than ongoing medical management with the exception of sense of smell/taste. © 2014 ARS-AAOA, LLC.

Childhood ADHD and Delayed Reinforcement: A Direct Comparison of Performance on Hypothetical and Real-Time Delay Tasks.

PubMed

Yu, Xue; Sonuga-Barke, Edmund

2016-07-28

Individuals with ADHD have been shown to prefer smaller sooner over larger later rewards. This has been explained in terms of abnormally steeper discounting of the value of delayed reinforcers. Evidence for this comes from different experimental paradigms. In some, participants experience delay in the laboratory (real-time delay tasks; R-TD), in others they imagine the delay to reinforcers (hypothetical delay tasks; HD). We directly contrasted the performance of 7- to 12-year-old children with ADHD (n = 23) and matched controls (n = 23) on R-TD and HD tasks with monetary rewards. Children with ADHD displayed steeper temporal discounting on the R-TD, but not the HD tasks. These findings suggest that the experience of waiting prior to the delivery of rewards is an important determinant of heightened temporal discounting in ADHD-a finding consistent with models that emphasize the aversive nature of delay for children. © The Author(s) 2016.

Does the addition of deep breathing exercises to physiotherapy-directed early mobilisation alter patient outcomes following high-risk open upper abdominal surgery? Cluster randomised controlled trial.

PubMed

Silva, Y R; Li, S K; Rickard, M J F X

2013-09-01

To investigate whether the inclusion of deep breathing exercises in physiotherapy-directed early mobilisation confers any additional benefit in reducing postoperative pulmonary complications (PPCs) when patients are treated once daily after elective open upper abdominal surgery. This study also compared postoperative outcomes following early and delayed mobilisation. Cluster randomised controlled trial. Single-centre study in a teaching hospital. Eighty-six high-risk patients undergoing elective open upper abdominal surgery. Three groups: early mobilisation (Group A), early mobilisation plus breathing exercises (Group B), and delayed mobilisation (mobilised from third postoperative day) plus breathing exercises (Group C). PPCs and postoperative outcomes [number of days until discharge from physiotherapy, physiotherapy input and length of stay (LOS)]. There was no significant difference in PPCs between Groups A and B. The LOS for Group A {mean 10.7 [standard deviation (SD) 5.0] days} was significantly shorter than the LOS for Groups B [mean 16.7 (SD 9.7) days] and C [mean 15.2 (SD 9.8) days; P=0.036]. The greatest difference was between Groups A and B (mean difference -5.93, 95% confidence interval -10.22 to -1.65; P=0.008). Group C had fewer smokers (26%) and patients with chronic obstructive pulmonary disease (0%) compared with Group B (53% and 14%, respectively). This may have led to fewer PPCs in Group C, but the difference was not significant. Despite Group C having fewer PPCs and less physiotherapy input, the number of days until discharge from physiotherapy and LOS were similar to Group B. The addition of deep breathing exercises to physiotherapy-directed early mobilisation did not further reduce PPCs compared with mobility alone. PPCs can be reduced with once-daily physiotherapy if the patients are mobilised to a moderate level of exertion. Delayed mobilisation tended to increase physiotherapy input and the number of days until discharge from physiotherapy compared with early mobilisation. Crown Copyright © 2012. Published by Elsevier Ltd. All rights reserved.

Anaesthesia for Caesarean section in a patient with Parkinson's disease.

PubMed

Ward, V D

2018-05-01

Parkinson's disease is prevalent worldwide but mainly affects the elderly and is rarely seen in women of child-bearing age. The clinical signs and symptoms, the physiological changes of pregnancy, and drug interactions, pose unique challenges for the anaesthetic management of patients with Parkinson's disease who present for delivery. A 36-year-old primigravid woman at 36 weeks' gestation, with Parkinson's disease, presented for pre-anaesthesia assessment prior to elective caesarean section. Her Parkinson's disease had been diagnosed four years previously and was treated with Sinemet (levodopa/carbidopa) and pramipexole. Despite maximum allowable drug doses in pregnancy, she reported disease progression, with right-sided weakness in the upper and lower limbs and an altered gait. Spinal anaesthesia for elective Caesarean section was performed in the sitting position, using 0.5% hyperbaric bupivacaine, morphine 150 µg and fentanyl 25 µg. The anaesthesia and Caesarean section were uneventful. She was discharged home with a healthy baby on the fourth postoperative day. Copyright © 2017 Elsevier Ltd. All rights reserved.

Limited effects of micronutrient supplementation on strength and physical function after abdominal aortic aneurysmectomy.

PubMed

Watters, James M; Vallerand, Andrew; Kirkpatrick, Susan M; Abbott, Heather E; Norris, Sonya; Wells, George; Barber, Graeme G

2002-08-01

Tissue injury following ischemia-reperfusion is mediated in part by free oxygen radicals. We hypothesized that perioperative micronutrient supplementation would augment antioxidant defenses, minimize muscle injury, and minimize postoperative decreases in muscle strength and physical function following abdominal aortic aneurysmectomy. A university-affiliated hospital and regional referral center. A randomized, double-blind, placebo-controlled trial of supplementation with beta-carotene, vitamins C and E, zinc, and selenium for a period of 2-3 weeks prior to surgery and 1 week thereafter. Patients undergoing elective abdominal aortic aneurysmectomy (n=18 per group). Handgrip and other measures of strength and physical function. Handgrip and quadriceps strength decreased following surgery, but not to a significantly different extent in the placebo and supplemented groups. Self-rated physical function decreased following surgery in the placebo group and was preserved in the supplemented group. Perioperative supplementation with micronutrients with antioxidant properties has limited effects on strength and physical function following major elective surgery.

Retrospective cohort study of an enhanced recovery programme in oesophageal and gastric cancer surgery

PubMed Central

Gatenby, PAC; Shaw, C; Hine, C; Scholtes, S; Koutra, M; Andrew, H; Hacking, M; Allum, WH

2015-01-01

Introduction Enhanced recovery programmes have been established in some areas of elective surgery. This study applied enhanced recovery principles to elective oesophageal and gastric cancer surgery. Methods An enhanced recovery programme for patients undergoing open oesophagogastrectomy, total and subtotal gastrectomy for oesophageal and gastric malignancy was designed. A retrospective cohort study compared length of stay on the critical care unit (CCU), total length of inpatient stay, rates of complications and in-hospital mortality prior to (35 patients) and following (27 patients) implementation. Results In the cohort study, the median total length of stay was reduced by 3 days following oesophagogastrectomy and total gastrectomy. The median length of stay on the CCU remained the same for all patients. The rates of complications and mortality were the same. Conclusions The standardised protocol reduced the median overall length of stay but did not reduce CCU stay. Enhanced recovery principles can be applied to patients undergoing major oesophagogastrectomy and total gastrectomy as long as they have minimal or reversible co-morbidity. PMID:26414360

The Effects of Behavioral History on Response Acquisition with Immediate and Delayed Reinforcement

ERIC Educational Resources Information Center

Snycerski, Susan; Laraway, Sean; Huitema, Bradley E.; Poling, Alan

2004-01-01

Effects of prior exposure to the experimental chamber with levers present or absent and variable-time (VT) 60-s water deliveries arranged during one, five, or no 1-hr sessions were examined in rats during a 6-hr response-acquisition session in which presses on one lever produced water delivery immediately or after a 15-s resetting delay, and…

Academic Delay of Gratification and Children's Study Time Allocation as a Function of Proximity to Consequential Academic Goals

ERIC Educational Resources Information Center

Zhang, Lili; Karabenick, Stuart A.; Maruno, Shun'ichi; Lauermann, Fani

2011-01-01

Students (N=302) in Chinese elementary schools were assessed regarding their academic delay of gratification (ADOG) and reported the time they devoted to non-school study and playtime during an extended interval prior to taking a high-stakes final exam. Students high compared those low in ADOG were more likely to spend time studying and less time…

The effects of preoperative cardiology consultation prior to elective abdominal aortic aneurysm repair on patient morbidity.

PubMed

Boniakowski, Anna E; Davis, Frank M; Phillips, Amanda R; Robinson, Adina B; Coleman, Dawn M; Henke, Peter K

2017-08-01

Objectives The relationship between preoperative medical consultations and postoperative complications has not been extensively studied. Thus, we investigated the impact of preoperative consultation on postoperative morbidity following elective abdominal aortic aneurysm repair. Methods A retrospective review was conducted on 469 patients (mean age 72 years, 20% female) who underwent elective abdominal aortic aneurysm repair from June 2007 to July 2014. Data elements included detailed medical history, preoperative cardiology consultation, and postoperative complications. Primary outcomes included 30-day morbidity, consult-specific morbidity, and mortality. A bivariate probit regression model accounting for the endogeneity of binary preoperative medical consult and patient variability was estimated with a maximum likelihood function. Results Eighty patients had preoperative medical consults (85% cardiology); thus, our analysis focuses on the effect of cardiac-related preoperative consults. Hyperlipidemia, increased aneurysm size, and increased revised cardiac risk index increased likelihood of referral to cardiology preoperatively. Surgery type (endovascular versus open repair) was not significant in development of postoperative complications when controlling for revised cardiac risk index ( p = 0.295). After controlling for patient comorbidities, there was no difference in postoperative cardiac-related complications between patients who did and did not undergo cardiology consultation preoperatively ( p = 0.386). Conclusions When controlling for patient disease severity using revised cardiac risk index risk stratification, preoperative cardiology consultation is not associated with postoperative cardiac morbidity.

It's complicated: Facebook users' political participation in the 2008 election.

PubMed

Vitak, Jessica; Zube, Paul; Smock, Andrew; Carr, Caleb T; Ellison, Nicole; Lampe, Cliff

2011-03-01

In the 2008 U.S. presidential election, social network sites such as Facebook allowed users to share their political beliefs, support specific candidates, and interact with others on political issues. But do political activities on Facebook affect political participation among young voters, a group traditionally perceived as apathetic in regard to civic engagement? Or do these activities represent another example of feel-good participation that has little real-world impact, a concept often referred to as "slacktivism"? Results from a survey of undergraduate students (N = 683) at a large public university in the Midwestern United States conducted in the month prior to the election found that students tend to engage in lightweight political participation both on Facebook and in other venues. Furthermore, two OLS regressions found that political activity on Facebook (e.g., posting a politically oriented status update, becoming a "fan" of a candidate) is a significant predictor of other forms of political participation (e.g., volunteering for an organizing, signing a paper or online petition), and that a number of factors--including intensity of Facebook use and the political activity users see their friends performing on the site--predict political activity on Facebook. Students' perceptions regarding the appropriateness of political activity on Facebook, as well as the specific kinds of political activities they engaged in and witnessed within the site, were also explored.

Internet use for prediagnosis symptom appraisal by colorectal cancer patients.

PubMed

Thomson, Maria D; Siminoff, Laura A; Longo, Daniel R

2012-10-01

This study explored the characteristics of colorectal cancer (CRC) patients who accessed Internet-based health information as part of their symptom appraisal process prior to consulting a health care provider. Newly diagnosed CRC patients who experienced symptoms prior to diagnosis were interviewed. Brief COPE was used to measure patient coping. Logistic and linear regressions were used to assess Internet use and appraisal delay. Twenty-five percent of the sample (61/242) consulted the Internet prior to visiting a health care provider. Internet use was associated with having private health insurance (odds ratio [OR] = 2.55; 95% confidence interval [CI] = 1.20-5.43) and experiencing elimination symptoms (OR = 1.43; 95% CI = 1.14-1.80) and was marginally associated with age (OR = 0.96; 95% CI = 0.93-0.99). Internet use was not related to delayed medical care seeking. Internet use did not influence decisions to seek medical care. The Internet provided a preliminary information resource for individuals who experienced embarrassing CRC symptoms, had private health insurance, and were younger.

Intake-dependent effects of cocaine self-administration on impulsive choice in a delay discounting task

PubMed Central

Mitchell, Marci R.; Weiss, Virginia G.; Ouimet, Dominique J.; Fuchs, Rita A.; Morgan, Drake; Setlow, Barry

2014-01-01

Cocaine use is associated with high levels of impulsive choice (greater discounting of delayed rewards) in humans, but the cause/effect relationships between cocaine use and impulsive choice are not fully understood. In previous work, we found that both experimenter- and self-administration of fixed quantities of cocaine caused lasting increases in impulsive choice in rats. The present study extended these findings by taking into account baseline impulsive choice prior to self-administration, and by allowing rats free access to cocaine. Male Long-Evans rats were trained in a delay discounting task in which they made discrete-trial choices between small immediate and large delayed food rewards. Half of the rats were then implanted with intravenous catheters and, following recovery, allowed to self-administer cocaine HCl (1.0 mg/kg/infusion) in 6 hour sessions over 14 days. Control rats orally self-administered a sucrose solution under similar conditions. Upon completion of self-administration training, rats remained abstinent for 3 weeks before retesting in the delay discounting task. Cocaine and control groups did not differ prior to self-administration, but afterward, the cocaine group showed greater impulsive choice (fewer choices of large, delayed rewards) than controls. Additional analyses revealed that the effects of cocaine on impulsive choice were intake-dependent; rats classified as “low intake” did not differ from controls, whereas rats classified as “high intake” were significantly more impulsive than both controls and their pre-cocaine baseline. These findings are consistent with the idea that cocaine-induced, pharmacologically based neural adaptations promote the development of impulsive decision making. PMID:24841739

Are there optimal numbers of oocytes, spermatozoa and embryos in assisted reproduction?

PubMed

Milachich, Tanya; Shterev, Atanas

2016-08-01

The aim of this overview is to discuss the current information about the search for the optimum yield of gametes in assisted reproduction, as one of the major pillars of IVF success. The first topic is focused on the number of male gametes and the possible impact of some genetic traits on these parameters. The number of spermatozoa did not seem to be crucial when there is no severe male factor of infertility. Genetic testing prior to using those sperm cells is very important. Different methods were applied in order to elect the "best" spermatozoa according to specific indications. The next problem discussed is the importance of the number of oocytes collected. Several studies have agreed that "15 oocytes is the perfect number," as the number of mature oocytes is more important. However, if elective single embryo transfer is performed, the optimal number of oocytes will enable a proper embryo selection. The third problem discussed concerns fertility preservation. Many educational programs promote and encourage procreation at maternal ages between 20-35 years, since assisted reproduction is unable to fully overcome the effects of female aging and fertility loss after that age. It is also strongly recommended to ensure a reasonable number of cryopreserved mature oocytes, preferably in younger ages (<35), for which an average of two stimulation cycles are likely required. For embryo cryopreservation, the "freeze all" strategy suggests the vitrification of good embryos, therefore quality is prior to number and patient recruitment for this strategy should be performed cautiously.

Magnetic resonance imaging in interventional therapy of patients with acute myocardial infarction prior to and after treatment

PubMed Central

Li, Yuzhou; Li, Chunrong; Jin, Hongrui; Huang, Wenqi

2016-01-01

The aim of the study was to investigate the cardiac magnetic resonance (CMR) imaging in interventional therapy of patients with acute myocardial infarction prior to and after treatment. Fifty-six cases of AMI patients with elective treatment by percutaneous coronary intervention (PCI) were continuously selected. Patients with an incidence of 7–10 days were treated with CMR and echocardiography to evaluate the quality of myocardial infarction, visual score method (VSM), wall motion score abnormality, left ventricular end-diastolic diameter (LVEDD), left ventricular end-systolic diameter (LVESD) and left ventricular ejection fraction (LVEF). Patients with an incidence of 10–14 days were treated with PCI, and CMR and echocardiography were evaluated after 6 months, after which the occurrence of major adverse cardiac events (MACE) were compared. The infarction quality, VSM score and wall motion abnormality (WMA) score were significantly reduced following surgery, and the difference was statistically significant (P<0.05). Ultrasound evaluation of LVEDD, LVESD, and LVEF prior to and after surgery was compared, and the difference was not statistically significant (P>0.05). Evaluation of the magnetic resonance imaging (MRI) in LVEDD prior to surgery was increased compared with that of the ultrasound in LVEDD, whereas MRI in LVESD and LVEF was decreased compared to that of the ultrasound obtained for LVESD and LVEF. Additionally, postoperative LVEDD was reduced compared with preoperative LVEDD, whereas LVEF was increased, and the difference was statistically significant (P<0.05). However, the evaluation of LVESD using the two methods exhibited no significant change. MACE occurred in 7 (12.5%) of 56 cases. The infarction quality of patients in the MACE group following surgery indicated that VSM and WMA scores were significantly higher than the group without MACE, while LVEF was lower than the MACE group following surgery, and the difference was statistically significant (P<0.05), albeit the ultrasound results of LVEF indicated no difference. In conclusion, CMR evaluation of AMI patients with elective PCI treatment in myocardial remodeling and cardiac function were more sensitive and accurate than with cardiac ultrasound. PMID:27588093

Endovascular aortic aneurysm repair with chimney and snorkel grafts: indications, techniques and results.

PubMed

Patel, Rakesh P; Katsargyris, Athanasios; Verhoeven, Eric L G; Adam, Donald J; Hardman, John A

2013-12-01

The chimney technique in endovascular aortic aneurysm repair (Ch-EVAR) involves placement of a stent or stent-graft parallel to the main aortic stent-graft to extend the proximal or distal sealing zone while maintaining side branch patency. Ch-EVAR can facilitate endovascular repair of juxtarenal and aortic arch pathology using available standard aortic stent-grafts, therefore, eliminating the manufacturing delays required for customised fenestrated and branched stent-grafts. Several case series have demonstrated the feasibility of Ch-EVAR both in acute and elective cases with good early results. This review discusses indications, technique, and the current available clinical data on Ch-EVAR.

A third world international health elective for U.S. medical students: the 25-year experience of the State University of New York, Downstate Medical Center.

PubMed

Imperato, Pascal James

2004-10-01

The Department of Preventive Medicine and Community Health at the State University of New York, Downstate Medical Center instituted a 6-8 weeks third world international health elective for fourth year medical students in 1980. Since that time, some 217 students have participated in a score of third world countries. However, the most popular sites have been India, Kenya and Thailand. The purposes of this elective are to provide fourth year medical students with an opportunity to observe and study the structure and functions of a health care delivery system in a third world country, to provide medical service, and to have a cross-cultural experience. The emphasis in this elective is on public health, preventive medicine and primary care. There are high levels of student competition for this elective. However, interest in it has been affected by world events such as the terrorist attacks of September 11, 2001 and the recent outbreak of Severe Acute Respiratory Syndrome (SARS) in Asia. Recent annual applications for this elective have been twenty-five and more out of a class of two hundred students. Annual acceptance rates vary considerably, ranging from as low as 27.2% in 1995-1996 to a high of 81.8% in 1987-1988. Careful screening, including an examination of academic records and personal interviews, has resulted in the selection of highly mature, adaptable, and dedicated students who overall have performed well at overseas sites. Student rated satisfaction levels with this elective are extremely high, with most rating it the best experience of their medical school years. Students undergo extensive preparation prior to going overseas. This includes individual health and safety issues, travel and lodging, and the nature of the host country culture, health care system, and assignment site. Our students are especially experienced in cross-cultural understanding because of the unusual diversity of the patients they treat in Brooklyn, and the ethnic diversity of local hospital staff and the medical school class. This Brooklyn experience in cross-cultural understanding has been cited by many participants as having been the best preparation for functioning in a foreign culture. In the late 1990s, we revised our procedures concerning health preparations so as to address the risk of HIV/AIDS and other blood borne diseases. In addition, we also adopted an Agreement and Release form containing 15 provisions requiring risk and responsibility assumption on the part of the student participants. The Alumni Fund of the College of Medicine has steadfastly supported this elective with both a philosophical commitment and financial grants to help defray travel costs. In 1998, Joshua H. Weiner of the class of 1941 created a sizeable endowment in the Alumni Fund of the College of Medicine to support students participating in this elective. In 2001, Sonja K. Binkhorst, Assistant Professor of Psychiatry at the Downstate Medical Center, arranged for some financial support for women medical students through the LSK Foundation and the American Medical Women's Association. During the years that this elective has been offered, overseas preceptors have willingly given of their time and institutional resources to make these experiences available and meaningful for students.

CNS neuroplasticity and salt-sensitive hypertension induced by prior treatment with subpressor doses of ANG II or aldosterone.

PubMed

Clayton, Sarah C; Zhang, Zhongming; Beltz, Terry; Xue, Baojian; Johnson, Alan Kim

2014-06-15

Although sensitivity to high dietary NaCl is regarded to be a risk factor for cardiovascular disease, the causes of salt-sensitive hypertension remain elusive. Previously, we have shown that rats pretreated with subpressor doses of either ANG II or aldosterone (Aldo) show sensitized hypertensive responses to a mild pressor dose of ANG II when tested after an intervening delay. The current studies investigated whether such treatments will induce salt sensitivity. In studies employing an induction-delay-expression experimental design, male rats were instrumented for chronic mean arterial pressure (MAP) recording. In separate experiments, ANG II, Aldo, or vehicle was delivered either subcutaneously or intracerebroventricularly during the induction. There were no sustained differences in BP during the delay prior to being given 2% saline. While consuming 2% saline during the expression, both ANG II- and Aldo-pretreated rats showed significantly greater hypertension. When hexamethonium was used to assess autonomic control of MAP, no differences in the decrease of MAP in response to ganglionic blockade were detected during the induction. However, during the expression, the fall was greater in sensitized rats. In separate experiments, brain tissue that was collected at the end of delay showed increases in message or activation of putative markers of neuroplasticity (i.e., brain-derived neurotrophic factor, p38 mitogen-activated protein kinase, and cAMP response element-binding protein). These experiments demonstrate that prior administration of nonpressor doses of either ANG II or Aldo will induce salt sensitivity. Collectively, our findings indicate that treatment with subpressor doses of ANG II and Aldo initiate central neuroplastic changes that are involved in hypertension of different etiologies. Copyright © 2014 the American Physiological Society.

Medical and nonmedical factors influencing utilization of delayed pushing in the second stage.

PubMed

Frey, Heather A; Tuuli, Methodius G; Cortez, Sarah; Odibo, Anthony O; Roehl, Kimberly A; Shanks, Anthony L; Macones, George A; Cahill, Alison G

2013-08-01

To evaluate factors impacting selection to delayed pushing in the second stage of labor. This case-control study was a secondary analysis of a large retrospective cohort study. Cases included women who delayed pushing for 60 minutes or more in the second stage of labor. Controls began pushing prior to 60 minutes from the time of diagnosis of complete dilation. Demographic, labor, and nonmedical factors were compared among cases and controls. Logistic regression modeling was used to identify factors independently associated with delayed pushing. We identified 471 women who delayed pushing and 4819 controls. Nulliparity, maternal body mass index > 25, high fetal station at complete dilation, regional anesthesia use, and start of second stage during staffing shift change were independent factors associated with increased use of delayed pushing. On the other hand, black race and second-stage management during night shift were associated with lower odds of employing delayed pushing. Delayed pushing was more commonly employed in nulliparous women, but 38.9% of multiparous women also delayed pushing. We identified multiple factors associated with use of delayed pushing. This study helps to define current patterns of second-stage labor management. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Medical and Non-Medical Factors Influencing Utilization of Delayed Pushing in the Second Stage

PubMed Central

FREY, Heather A.; TUULI, Methodius G.; CORTEZ, Sarah; ODIBO, Anthony O.; ROEHL, Kimberly A.; SHANKS, Anthony L.; MACONES, George A.; CAHILL, Alison G.

2014-01-01

Objective To evaluate factors impacting selection to delayed pushing in the second stage of labor. Study design This case-control study was a secondary analysis of a large retrospective cohort study. Cases included women who delayed pushing for 60 minutes or more in the second stage of labor. Controls began pushing prior to 60 minutes from the time of diagnosis of complete dilation. Demographic, labor, and nonmedical factors were compared among cases and controls. Logistic regression modelling was used to identify factors independently associated with delayed pushing. Results We identified 471 women who delayed pushing and 4,819 controls. Nulliparity, maternal body mass index > 25, high fetal station at complete dilation, regional anesthesia use, and start of second stage during staffing shift change were independent factors associated with increased use of delayed pushing. On the other hand, black race and second stage management during night shift were associated with lower odds of employing delayed pushing. Delayed pushing was more commonly employed in nulliparous women, but 38.9% of multiparous women also delayed pushing. Conclusion We identified multiple factors associated with use of delayed pushing. This study helps to define current patterns of second stage labor management. PMID:23208765

Evaluation of the value of ENI in radiotherapy for cervical and upper thoracic esophageal cancer: a retrospective analysis.

PubMed

Liu, Mina; Zhao, Kuaile; Chen, Yun; Jiang, Guo-Liang

2014-10-25

A retrospective study to compare the failure patterns and effects of elective nodal irradiation (ENI) or involved field irradiation (IFI) for cervical and upper thoracic esophageal squamous cell carcinoma (SCC) patients. One hundred and sixty nine patients with the cervical and upper thoracic esophageal SCC were analyzed retrospectively; 99 patients (59%) underwent IFI and 70 patients (41%) received ENI. We defined "Out-PTVifi in-PTVeni metastasis" as lymph node metastasis occurring in the cervical prophylactic field of PTVeni thus out of PTVifi. Out-PTVifi in-PTVeni cervical node metastasis occurred in 8% of patients in the IFI group, all within 2 years after treatment. However, it occurred in 10% of patients in the ENI group, and these failures happened gradually since one year after treatments. No difference was found in OS and the incidences of Grade ≥ 3 treatment-related esophageal and lung toxicities between the two groups. ENI for cervical and upper thoracic esophageal SCC patients did not bring longer OS and better long-term control of cervical lymph nodes. Although ENI might delay cervical nodes progression in elective field; it could not decrease the incidence of these failures.

Developmental delay and failure to thrive in a 7-month-old baby boy with spontaneous transient Graves' thyrotoxicosis: a case report.

PubMed

Yatsuga, Shuichi; Saikusa, Tomoko; Sasaki, Takako; Ushijima, Kikumi; Kitamura, Miyuki; Nishioka, Junko; Koga, Yasutoshi

2016-08-10

Thyroid dysfunction can induce developmental delay and failure to thrive in infancy. Congenital hypothyroidism is one of the common causes of these symptoms in infancy. By contrast, hyperthyroidism is a rare cause of these symptoms in infancy. A 7-month-old Japanese baby boy was examined for developmental delay and failure to thrive. Blood tests were performed, which showed low levels of thyroid-stimulating hormone (<0.01 μU/mL) and high levels of free thyroxine (2.14 pg/mL). He was referred to our hospital at 8 months of age. His height was 64 cm (-2.7 standard deviation) and his weight was 6085 g (-2.5 standard deviation). No goiter was detected on examination. His thyrotropin receptor antibody was slightly high (3.9 IU/L), whereas thyroid stimulating antibody, anti-thyroglobulin antibody, and thyroid peroxidase antibody were within normal range. These blood findings indicated hyperthyroidism, most likely Graves' disease. His free thyroxine level decreased in the first month after our examination. No increased vascularity of his thyroid gland was noted. The technetium uptake of his thyroid gland in scintigraphy was relatively increased compared to the intake of his salivary gland. We elected to observe rather than treat with anti-thyroid medications. We have to rule out spontaneous transient Graves' thyrotoxicosis when babies have symptoms of developmental delay and fail to thrive.

Attention-deficit/hyperactivity disorder, delay discounting, and risky financial behaviors: A preliminary analysis of self-report data.

PubMed

Beauchaine, Theodore P; Ben-David, Itzhak; Sela, Aner

2017-01-01

Delay discounting-often referred to as hyperbolic discounting in the financial literature-is defined by a consistent preference for smaller, immediate rewards over larger, delayed rewards, and by failure of future consequences to curtail current consummatory behaviors. Previous research demonstrates (1) excessive delay discounting among individuals with attention-deficit/hyperactivity disorder (ADHD), (2) common neural substrates of delay discounting and hyperactive-impulsive symptoms of ADHD, and (3) associations between delay discounting and both debt burden and high interest rate borrowing. This study extends prior research by examining associations between ADHD symptoms, delay discounting, and an array of previously unevaluated financial outcomes among 544 individuals (mean age 35 years). Controlling for age, income, sex, education, and substance use, ADHD symptoms were associated with delay discounting, late credit card payments, credit card balances, use of pawn services, personal debt, and employment histories (less time spent at more jobs). Consistent with neural models of reward processing and associative learning, more of these relations were attributable to hyperactive-impulsive symptoms than inattentive symptoms. Implications for financial decision-making and directions for future research are discussed.

Face distinctiveness and delayed testing: differential effects on performance and confidence.

PubMed

Metzger, Mitchell M

2006-04-01

The author investigated the effect of delayed testing on participants' memory for distinctive and typical faces. Participants viewed distinctive and typical faces and were then tested for recognition immediately or after a delay of 3, 6, or 12 weeks. Consistent with prior research, analysis of measure of sensitivity (d') showed that participants performed better on distinctive rather than typical faces, and memory performance declined with longer retention intervals between study and testing. Furthermore, the superior performance on distinctive faces had vanished by the 12-week test. Contrary to d' data, however, an analysis of confidence scores indicated that participants were still significantly more confident on trials depicting distinctive faces, even with a 12-week delay between study and recognition testing.

Longitudinal Associations Among Religiousness, Delay Discounting, and Substance Use Initiation in Early Adolescence.

PubMed

Kim-Spoon, Jungmeen; McCullough, Michael E; Bickel, W K; Farley, Julee P; Longo, Gregory S

2015-03-01

Prior research indicates that religiousness is related negatively to adolescent health risk behaviors, yet how such protective effects operate is not well understood. This study examined the longitudinal associations among organizational and personal religiousness, delay discounting, and substance use initiation (alcohol, cigarette, and marijuana use). The sample comprised 106 early adolescents (10-13 years of age, 52% female) who were not using substances at Time 1. Path analyses suggested that high levels of personal religiousness at Time 1 were related to low levels of substance use at Time 2 (2.4 years later), mediated by low levels of delay discounting. Delay discounting appears to be an important contributor to the protective effect of religiousness on the development of substance use among adolescents.

Coast Guard: Opportunities Exist to Further Improve Acquisition Management Capabilities

DTIC Science & Technology

2011-04-01

Coast Guard’s significant acquisition challenges, including project challenges in its Deepwater program. GAO’s prior work on the Coast Guard...to defense readiness. We have reported extensively on the Coast Guard’s significant acquisition challenges, including its Deepwater program, which...prior work on the Deepwater acquisition program identified problems in costs, management, and oversight that have led to delivery delays and other

Identification of Infants at Risk for Autism Spectrum Disorder and Developmental Language Delay Prior to 12 Months

ERIC Educational Resources Information Center

Samango-Sprouse, Carole A.; Stapleton, Emily J.; Aliabadi, Farhad; Graw, Robert; Vickers, Rebecca; Haskell, Kathryn; Sadeghin, Teresa; Jameson, Robert; Parmele, Charles L.; Gropman, Andrea L.

2015-01-01

Studies have shown an increased head circumference and the absence of the head tilt reflex as possible risk factors for autism spectrum disorder, allowing for early detection at 12 months in typically developing population of infants. Our aim was to develop a screening tool to identify infants prior to 12 months at risk for autism spectrum…

PROGRESS ON THE STUDY OF BETA TREATMENT OF URANIUM, AUGUST 1, 1961-NOVEMBER 30, 1961

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

Russell, R.B.; Wolff, A.K.

Variables affecting the texture and grain size of uranium during beta treatment are summarized. The effects of composition (ingot versus dingot), prior delta condition, prior texture, pre-quenching air delay, rod or tube size, quenching medium and applied stress on grain size, distontion, and G/sub 3/ gradients in the final beta-treated shapes are described. (N.W.R.)

78 FR 46807 - Mixed Straddles; Straddle-by-Straddle Identification Under Section 1092(b)(2)(A)(i)(I)

Federal Register 2010, 2011, 2012, 2013, 2014

2013-08-02

...This document contains guidance for those taxpayers electing to establish a mixed straddle using straddle-by-straddle identification. These temporary regulations explain how to account for unrealized gain or loss on a position held by a taxpayer prior to the time the taxpayer establishes a mixed straddle using straddle-by- straddle identification. The text of these temporary regulations also serves as the text of the proposed regulations (REG-112815-12) set forth in the Proposed Rules section in this issue of the Federal Register.

Catecholamine crisis during induction of general anesthesia : A case report.

PubMed

Sonntagbauer, M; Koch, A; Strouhal, U; Zacharowski, K; Weber, C F

2018-03-01

Catecholamine crises associated with pheochromocytoma may cause life-threatening cardiovascular conditions. We report the case of a 75-year-old male who developed a hypertensive crisis during induction of general anesthesia for elective resection of a cervical neuroma due to an undiagnosed pheochromocytoma. Hemodynamic instability occurred immediately after the injection of fentanyl, propofol and rocuronium, prior to laryngoscopy and in the absence of any manipulation of the abdomen. In this case report, we present the management of this incident and discuss the underlying pathophysiology triggering a catecholamine crisis.

Health and human rights in eastern Myanmar prior to political transition: a population-based assessment using multistaged household cluster sampling.

PubMed

Parmar, Parveen K; Benjamin-Chung, Jade; Smith, Linda S; Htoo, Saw Nay; Laeng, Sai; Lwin, Aye; Mahn, Mahn; Maung, Cynthia; Reh, Daniel; Shwe Oo, Eh Kalu; Lee, Thomas; Richards, Adam K

2014-05-05

Myanmar/Burma has received increased development and humanitarian assistance since the election in November 2010. Monitoring the impact of foreign assistance and economic development on health and human rights requires knowledge of pre-election conditions. From October 2008-January 2009, community-based organizations conducted household surveys using three-stage cluster sampling in Shan, Kayin, Bago, Kayah, Mon and Tanintharyi areas of Myanmar. Data was collected from 5,592 heads of household on household demographics, reproductive health, diarrhea, births, deaths, malaria, and acute malnutrition of children 6-59 months and women aged 15-49 years. A human rights focused survey module evaluated human rights violations (HRVs) experienced by household members during the previous year. Estimated infant and under-five rates were 77 (95% CI 56 to 98) and 139 (95% CI 107 to 171) deaths per 1,000 live births; and the crude mortality rate was 13 (95% CI 11 to 15) deaths per thousand persons. The leading respondent-reported cause of death was malaria, followed by acute respiratory infection and diarrhea, causing 21.2% (95% CI 16.5 to 25.8), 16.6% (95% CI 11.8 to 21.4), and 12.3% (95% CI 8.7 to 15.8), respectively. Over a third of households suffered at least one human rights violation in the preceding year (36.2%; 30.7 to 41.7). Household exposure to forced labor increased risk of death among infants (rate ratio (RR) = 2.2; 95% CI 1.1 to 4.4) and children under five (RR = 2.1; 95% CI 1.3 to 3.6). The proportion of children suffering from moderate to severe acute malnutrition was higher among households that were displaced (prevalence ratio (PR) = 3.3; 95% CI 1.9 to 5.6). Prior to the 2010 election, populations of eastern Myanmar experienced high rates of disease and death and high rates of HRVs. These population-based data provide a baseline that can be used to monitor national and international efforts to improve the health and human rights situation in the region.

Health and human rights in eastern Myanmar prior to political transition: a population-based assessment using multistaged household cluster sampling

PubMed Central

2014-01-01

Background Myanmar/Burma has received increased development and humanitarian assistance since the election in November 2010. Monitoring the impact of foreign assistance and economic development on health and human rights requires knowledge of pre-election conditions. Methods From October 2008-January 2009, community-based organizations conducted household surveys using three-stage cluster sampling in Shan, Kayin, Bago, Kayah, Mon and Tanintharyi areas of Myanmar. Data was collected from 5,592 heads of household on household demographics, reproductive health, diarrhea, births, deaths, malaria, and acute malnutrition of children 6–59 months and women aged 15–49 years. A human rights focused survey module evaluated human rights violations (HRVs) experienced by household members during the previous year. Results Estimated infant and under-five rates were 77 (95% CI 56 to 98) and 139 (95% CI 107 to 171) deaths per 1,000 live births; and the crude mortality rate was 13 (95% CI 11 to 15) deaths per thousand persons. The leading respondent-reported cause of death was malaria, followed by acute respiratory infection and diarrhea, causing 21.2% (95% CI 16.5 to 25.8), 16.6% (95% CI 11.8 to 21.4), and 12.3% (95% CI 8.7 to 15.8), respectively. Over a third of households suffered at least one human rights violation in the preceding year (36.2%; 30.7 to 41.7). Household exposure to forced labor increased risk of death among infants (rate ratio (RR) = 2.2; 95% CI 1.1 to 4.4) and children under five (RR = 2.1; 95% CI 1.3 to 3.6). The proportion of children suffering from moderate to severe acute malnutrition was higher among households that were displaced (prevalence ratio (PR) = 3.3; 95% CI 1.9 to 5.6). Conclusions Prior to the 2010 election, populations of eastern Myanmar experienced high rates of disease and death and high rates of HRVs. These population-based data provide a baseline that can be used to monitor national and international efforts to improve the health and human rights situation in the region. PMID:24885540

Randomized trial of one-hour sodium bicarbonate vs standard periprocedural saline hydration in chronic kidney disease patients undergoing cardiovascular contrast procedures.

PubMed

Kooiman, Judith; de Vries, Jean-Paul P M; Van der Heyden, Jan; Sijpkens, Yvo W J; van Dijkman, Paul R M; Wever, Jan J; van Overhagen, Hans; Vahl, Antonie C; Aarts, Nico; Verberk-Jonkers, Iris J A M; Brulez, Harald F H; Hamming, Jaap F; van der Molen, Aart J; Cannegieter, Suzanne C; Putter, Hein; van den Hout, Wilbert B; Kilicsoy, Inci; Rabelink, Ton J; Huisman, Menno V

2018-01-01

Guidelines advise periprocedural saline hydration for prevention of contrast induced-acute kidney injury (CI-AKI). We analysed whether 1-hour sodium bicarbonate hydration administered solely prior to intra-arterial contrast exposure is non-inferior to standard periprocedural saline hydration in chronic kidney disease (CKD) patients undergoing elective cardiovascular diagnostic or interventional contrast procedures. We performed an open-label multicentre non-inferiority trial between 2011-2014. Patients were randomized to 1 hour pre-procedure sodium bicarbonate hydration (250 ml 1.4%, N = 168) or 4-12 hours saline hydration (1000 ml 0.9%, N = 165) prior to and following contrast administration (2000 ml of saline total). Primary outcome was the relative serum creatinine increase (%) 48-96 hours post contrast exposure. Secondary outcomes were: incidence of CI-AKI (serum creatinine increase>25% or >44μmol/L), recovery of renal function, the need for dialysis, and hospital costs within two months follow-up. Mean relative creatinine increase was 3.1% (95%CI 0.9 to 5.2%) in the bicarbonate and 1.1% (95%CI -1.2 to 3.5%) in the saline arm, mean difference 1.9% (95%CI -1.2 to 5.1%, p-non-inferiority <0.001). CI-AKI occurred in 11 (6.7%) patients randomized to sodium bicarbonate and 12 (7.5%) to saline (p = 0.79). Renal function did not fully recover in 40.0% and 44.4% of CI-AKI patients, respectively (p = 0.84). No patient required dialysis. Mean costs for preventive hydration and clinical preparation for the contrast procedure were $1158 for sodium bicarbonate vs. $1561 for saline (p < 0.001). Short hydration with sodium bicarbonate prior to elective cardiovascular diagnostic or therapeutic contrast procedures is non-inferior to standard periprocedural saline hydration in CKD patients with respect to renal safety and results in considerable healthcare savings. Netherlands Trial Register (http://www.trialregister.nl/trialreg/index.asp), Nr NTR2699.

A low-dose, dual-phase cardiovascular CT protocol to assess left atrial appendage anatomy and exclude thrombus prior to left atrial intervention.

PubMed

Lazoura, Olga; Ismail, Tevfik F; Pavitt, Christopher; Lindsay, Alistair; Sriharan, Mona; Rubens, Michael; Padley, Simon; Duncan, Alison; Wong, Tom; Nicol, Edward

2016-02-01

Assessment of the left atrial appendage (LAA) for thrombus and anatomy is important prior to atrial fibrillation (AF) ablation and LAA exclusion. The use of cardiovascular CT (CCT) to detect LAA thrombus has been limited by the high incidence of pseudothrombus on single-pass studies. We evaluated the diagnostic accuracy of a two-phase protocol incorporating a limited low-dose delayed contrast-enhanced examination of the LAA, compared with a single-pass study for LAA morphological assessment, and transesophageal echocardiography (TEE) for the exclusion of thrombus. Consecutive patients (n = 122) undergoing left atrial interventions for AF were assessed. All had a two-phase CCT protocol (first-past scan plus a limited, 60-s delayed scan of the LAA) and TEE. Sensitivity, specificity, diagnostic accuracy, positive (PPV) and negative predictive values (NPV) were calculated for the detection of true thrombus on first-pass and delayed scans, using TEE as the gold standard. Overall, 20/122 (16.4 %) patients had filling defects on the first-pass study. All affected the full delineation of the LAA morphology; 17/20 (85 %) were confirmed as pseudo-filling defects. Three (15 %) were seen on late-pass and confirmed as true thrombi on TEE; a significant improvement in diagnostic performance relative to a single-pass scan (McNemar Chi-square 17, p < 0.001). The sensitivity, specificity, diagnostic accuracy, PPV and NPV was 100, 85.7, 86.1, 15.0 and 100 % respectively for first-pass scans, and 100 % for all parameters for the delayed scans. The median (range) additional radiation dose for the delayed scan was 0.4 (0.2-0.6) mSv. A low-dose delayed scan significantly improves the identification of true LAA anatomy and thrombus in patients undergoing LA intervention.

Strokes after cardioversion of atrial fibrillation--The FibStroke study.

PubMed

Palomäki, Antti; Mustonen, Pirjo; Hartikainen, Juha E K; Nuotio, Ilpo; Kiviniemi, Tuomas; Ylitalo, Antti; Hartikainen, Päivi; Lehtola, Heidi; Luite, Riho; Airaksinen, K E Juhani

2016-01-15

Cardioversion of atrial fibrillation (AF) is associated with an increased risk for stroke. We identified all cardioversions during the 30 days preceding stroke or transient ischemic attack (TIA) in patients with a previously diagnosed AF, and sought to assess the characteristics of cardioversions leading to stroke or TIA. FibStroke is a cross-sectional observational multicenter registry that included AF patients with an ischemic stroke or intracranial bleed identified from a discharge registry of four Finnish hospitals. In total 3677 consecutive AF patients suffered 3252 strokes and 956 TIA episodes during 2003–2012. This pre-specified analysis focused on the 1644 events that occurred to patients with paroxysmal or persistent AF at the time of stroke/TIA. A total of 78 strokes and 22 TIA episodes were preceded by a cardioversion. Post-cardioversion strokes accounted for 6.4% of strokes in patients with paroxysmal/persistent AF. Of the 100 cardioversions leading to an ischemic event, 77 were acute and 23 were elective, 63 events occurred in patients not using anticoagulation, and 5 patients had periprocedural INR < 2. Importantly, 21 patients were in low risk of stroke, i.e. CHA2DS2-VASc score < 2. The median delay from cardioversion to event was 2 days. All nine patients who after an unsuccessful cardioversion developed a stroke had a spontaneous cardioversion prior to stroke. Every sixteenth stroke of patients with paroxysmal/persistent AF is preceded by a cardioversion. Most post-cardioversion strokes occur in patients not using oral anticoagulation before cardioversion of acute AF.

The hybrid delay task: Can capuchin monkeys (Cebus apella) sustain a delay after an initial choice to do so?

PubMed Central

Paglieri, Fabio; Focaroli, Valentina; Bramlett, Jessica; Tierno, Valeria; McIntyre, Joseph M.; Addessi, Elsa; Evans, Theodore A.; Beran, Michael J.

2013-01-01

Choosing to wait for a better outcome (delay choice) and sustaining the delay prior to that outcome (delay maintenance) are both prerequisites for successful self control in intertemporal choices. However, most existing experimental methods test these skills in isolation from each other, and no significant correlation has been observed in performance across these tasks. In this study we introduce a new paradigm, the hybrid delay task, which combines an initial delay choice with a subsequent delay maintenance stage. This allows testing how often choosing to wait is paired with the actual ability to do so. We tested 18 capuchin monkeys (Cebus apella) from two laboratories in various conditions, and we found that subjects frequently chose the delayed reward but then failed to wait for it, due to poor delay maintenance. However, performance improved with experience and different behavioral responses for error correction were evident. These findings have far reaching implications: if such a high error rate was observed also in other species (possibly including Homo sapiens), this may indicate that delay choice tasks that make use of salient, prepotent stimuli do not reliably assess generalized self control, insofar as choosing to wait does not entail always being able to do so. PMID:23274585

Building Schema through Writing: The Effects of Writing as a Pre-Reading Activity on Delayed Recall of Narrative Text.

ERIC Educational Resources Information Center

Marino, Jacqueline L.; And Others

Drawing upon research on the composing process and schema theory, a study explored the effects of a generative writing task presented prior to reading on the delayed recall of fourth grade students. The purpose of the study was to determine if a writing task that required the learner to identify with events in a text to be read later would assist…

Race and time from diagnosis to radical prostatectomy: does equal access mean equal timely access to the operating room?--Results from the SEARCH database.

PubMed

Bañez, Lionel L; Terris, Martha K; Aronson, William J; Presti, Joseph C; Kane, Christopher J; Amling, Christopher L; Freedland, Stephen J

2009-04-01

African American men with prostate cancer are at higher risk for cancer-specific death than Caucasian men. We determine whether significant delays in management contribute to this disparity. We hypothesize that in an equal-access health care system, time interval from diagnosis to treatment would not differ by race. We identified 1,532 African American and Caucasian men who underwent radical prostatectomy (RP) from 1988 to 2007 at one of four Veterans Affairs Medical Centers that comprise the Shared Equal-Access Regional Cancer Hospital (SEARCH) database with known biopsy date. We compared time from biopsy to RP between racial groups using linear regression adjusting for demographic and clinical variables. We analyzed risk of potential clinically relevant delays by determining odds of delays >90 and >180 days. Median time interval from diagnosis to RP was 76 and 68 days for African Americans and Caucasian men, respectively (P = 0.004). After controlling for demographic and clinical variables, race was not associated with the time interval between diagnosis and RP (P = 0.09). Furthermore, race was not associated with increased risk of delays >90 (P = 0.45) or >180 days (P = 0.31). In a cohort of men undergoing RP in an equal-access setting, there was no significant difference between racial groups with regard to time interval from diagnosis to RP. Thus, equal-access includes equal timely access to the operating room. Given our previous finding of poorer outcomes among African Americans, treatment delays do not seem to explain these observations. Our findings need to be confirmed in patients electing other treatment modalities and in other practice settings.

Internet stream synchronization using Concord

NASA Astrophysics Data System (ADS)

Sreenan, Cormac J.; Narendran, B.; Agrawal, Prathima; Shivakumar, Narayanan

1996-03-01

Using packet networks to transport multimedia introduces delay variations within and across streams, necessitating synchronization at the receiver. This requires stream data to be buffered prior to presentation, which also increases its total end to end delay. Concord recognizes that applications may wish to influence the underlying synchronization policy in terms of its effect on quality of service. It provides a single framework for synchronization within and across streams and employs an application specific tradeoff between packet losses, delay and inter- stream skew. We present a new predictive approach for synchronization and a selection of results from an extensive evaluation of Concord for use in the Internet. A trace driven simulator is used, allowing a direct comparison with alternative approaches. We demonstrate that Concord can operate with lower maximum delay and less variation in total end to end delay, which in turn can allow receiver buffer requirements to be reduced.

Short-term memory for responses: the "choose-small" effect.

PubMed Central

Fetterman, J G; MacEwen, D

1989-01-01

Pigeons' short-term memory for fixed-ratio requirements was assessed using a delayed symbolic matching-to-sample procedure. Different choices were reinforced after fixed-ratio 10 and fixed-ratio 40 requirements, and delays of 0, 5, or 20 s were sometimes placed between sample ratios and choice. All birds made disproportionate numbers of responses to the small-ratio choice alternative when delays were interposed between ratios and choice, and this bias increased as a function of delay. Preference for the small fixed-ratio alternative was also observed on "no-sample" trials, during which the choice alternatives were presented without a prior sample ratio. This "choose-small" bias is analogous to results obtained by Spetch and Wilkie (1983) with event duration as the discriminative stimulus. The choose-small bias was attenuated when the houselight was turned on during delays, but overall accuracy was not influenced systematically by the houselight manipulation. PMID:2584917

Risk assessment and risk scores in the management of aortic aneurysms.

PubMed

Von Meijenfeldt, Gerdine C I; Van Der Laan, Maarten J; Zeebregts, Clark J; Balm, Ron; Verhagen, Hence J M

2016-04-01

The decision whether to operate a patient or not can be challenging for a clinician for both ruptured abdominal aortic aneurysms (AAAs) as well as elective AAAs. Prior to surgical intervention it would be preferable that the clinician exactly knows which clinical variables lower or increase the chances of morbidity and mortality postintervention. To help in the preoperative counselling and shared decision making several clinical variables can be identified as risk factors and with these, risk models can be developed. An ideal risk score for aneurysm repair includes routinely obtained physiological and anatomical variables, has excellent discrimination and calibration, and is validated in different geographical areas. For elective AAA repair, several risk scores are available, for ruptured AAA treatment, these scores are far less well developed. In this manuscript, we describe the designs and results of published risk scores for elective and open repair. Also, suggestions for uniformly reporting of risk factors and their statistical analyses are described. Furthermore, the preliminary results of a new risk model for ruptured aortic aneurysm will be discussed. This score identifies age, hemoglobin, cardiopulmonary resuscitation and preoperative systolic blood pressure as risk factors after multivariate regression analysis. This new risk score can help to identify patients that would not benefit from repair, but it can also potentially identify patients who would benefit and therefore lower turndown rates. The challenge for further research is to expand on validation of already existing promising risk scores in order to come to a risk model with optimal discrimination and calibration.

Elective surgical patients' narratives of hospitalization: the co-construction of safety.

PubMed

Doherty, Carole; Saunders, Mark N K

2013-12-01

This research explores how elective surgical patients make sense of their hospitalization experiences. We explore sensemaking using longitudinal narrative interviews (n=72) with 38 patients undergoing elective surgical procedures between June 2010 and February 2011. We consider patients' narratives, the stories they tell of their prior expectations, and subsequent post-surgery experiences of their care in a United Kingdom (UK) hospital. An emergent pre-surgery theme is that of a paradoxical position in which they choose to make themselves vulnerable by agreeing to surgery to enhance their health, this necessitating trust of clinicians (doctors and nurses). To make sense of their situation, patients draw on technical (doctors' expert knowledge and skills), bureaucratic (National Health Service as a revered institution) and ideological (hospitals as places of safety), discourses. Post-operatively, themes of 'chaos' and 'suffering' emerge from the narratives of patients whose pre-surgery expectations (and trust) have been violated. Their stories tell of unmet expectations and of inability to make shared sense of experiences with clinicians who are responsible for their care. We add to knowledge of how patients play a critical part in the co-construction of safety by demonstrating how patient-clinician intersubjectivity contributes to the type of harm that patients describe. Our results suggest that approaches to enhancing patients' safety will be limited if they fail to reflect patients' involvement in the negotiated process of healthcare. We also provide further evidence of the contribution narrative inquiry can make to patient safety. Copyright © 2013 Elsevier Ltd. All rights reserved.

Gender differences in reasons patients delay in seeking treatment for acute myocardial infarction symptoms.

PubMed

Moser, Debra K; McKinley, Sharon; Dracup, Kathleen; Chung, Misook L

2005-01-01

Patients (n = 194) with confirmed acute myocardial infarction (AMI) were interviewed to determine sociodemographic, clinical, social, behavioral, cognitive and emotional factors that contribute to delay in seeking treatment for their symptoms. Initial symptom experience was similar for men and women: both were most commonly at home when symptoms began; both were most commonly in the presence of their spouse or other family member; few patients (<10%) called the emergency medical system as their first reaction. Several factors contributed similarly to delay in men and women. Factors that exerted a differential effect on delay between men and women were age, history of AMI, type of AMI (Q-wave and non-Q-wave), concerns about not wanting to trouble others, and prior knowledge of thrombolytics. There was no difference in delay between men and women (median 3.08 versus 3.10 h), but there are important gender differences in the reasons patients delay and in their patterns of decision-making that may assist clinicians trying to tailor interventions.

Use of the Impella 2.5 for prophylactic circulatory support during elective high-risk percutaneous coronary intervention.

PubMed

Alasnag, Mirvat A; Gardi, Delair O; Elder, Mahir; Kannam, Hari; Ali, Farhan; Petrina, Mircea; Kheterpal, Vipin; Hout, Mariah S; Schreiber, Theodore L

2011-01-01

Patients undergoing percutaneous coronary intervention (PCI) who are at high risk for cardiovascular collapse during the procedure may benefit from prophylactic circulatory support. The objective was to evaluate the safety and feasibility of prophylactic use of the Impella 2.5 during high-risk PCI. We used the Impella 2.5 for partial circulatory support during 60 consecutive elective high-risk PCI cases over 20 months. All patients either were deemed inoperable by the cardiac surgeons or were offered bypass surgery but declined. The patients had multiple risk factors including hypertension (95%), diabetes (52%), chronic pulmonary disease (23%), prior myocardial infarction (62%) and prior bypass surgery (18%). Forty-five percent presented with acute coronary syndrome. The mean left ventricular ejection fraction was 23%±15%. Nearly all patients had multivessel disease (93%), and 60% had left main disease. The average SYNTAX score was 30±9. Despite lesion complexity and high-risk factors, we achieved an angiographic success rate of 96%. Left main lesions were treated in 55% of the patients, and 83% of patients had multiple lesions treated. There was one procedural death. At 30 days postintervention, mortality was 5%, and rates of myocardial infarction, stroke, target vessel revascularization and urgent bypass surgery were 0%. The single-center experience reported here demonstrates that use of the Impella 2.5 during high-risk PCI in the "real world" - outside the controlled environment of a clinical trial - is safe and feasible. Copyright © 2011 Elsevier Inc. All rights reserved.

Informed decision-making in elective major vascular surgery: analysis of 145 surgeon-patient consultations.

PubMed

Etchells, Edward; Ferrari, Michel; Kiss, Alex; Martyn, Nikki; Zinman, Deborah; Levinson, Wendy

2011-06-01

Prior studies show significant gaps in the informed decision-making process, a central goal of surgical care. These studies have been limited by their focus on low-risk decisions, single visits rather than entire consultations, or both. Our objectives were, first, to rate informed decision-making for major elective vascular surgery based on audiotapes of actual physician-patient conversations and, second, to compare ratings of informed decision-making for first visits to ratings for multiple visits by the same patient over time. We prospectively enrolled patients for whom vascular surgical treatment was a potential option at a tertiary care outpatient vascular surgery clinic. We audio-taped all surgeon-patient conversations, including multiple visits when necessary, until a decision was made. Using an existing method, we evaluated the transcripts for elements of decision-making, including basic elements (e.g., an explanation of the clinical condition), intermediate elements (e.g., risks and benefits) and complex elements (e.g., uncertainty around the decision). We analyzed 145 surgeon-patient consultations. Overall, 45% of consultations contained complex elements, whereas 23% did not contain the basic elements of decision-making. For the 67 consultations that involved multiple visits, ratings were significantly higher when evaluating all visits (50% complex elements) compared with evaluating only the first visit (33% complex elements, p < 0.001.) We found that 45% of consultations contained complex elements, which is higher than prior studies with similar methods. Analyzing decision-making over multiple visits yielded different results than analyzing decision-making for single visits.

Use of viscoelastic haemostatic assay in emergency and elective surgery.

PubMed

Yeung, Maximus C F; Tong, Steven Y T; Tong, Paul Y W; Cheung, Billy H H; Ng, Joanne Y W; Leung, Gilberto K K

2015-02-01

To review the current evidence for the use of viscoelastic haemostatic assays in different surgical settings including trauma, cardiac surgery, liver transplantation, as well as the monitoring of antiplatelet agents and anticoagulants prior to surgery. PubMed database. Key words for the literature search were "thromboelastography" or "ROTEM" in combination with "trauma", "antiplatelet", "cardiac surgery", "liver transplantation" or "anticoagulants". Original and major review articles related to the use of viscoelastic haemostatic assays. Haemostatic function is a critical factor determining patient outcomes in emergency or elective surgery. The increasing use of antiplatelet agents and anticoagulants has potentially increased the risks of haemorrhages and the need for transfusion. Conventional coagulation tests have limitations in detecting haemostatic dysfunctions in subgroups of patients and are largely ineffective in diagnosing hyperfibrinolysis. The viscoelastic haemostatic assays are potentially useful point-of-care tools that provide information on clot formation, clot strength, and fibrinolysis, as well as to guide goal-directed transfusion and antifibrinolytic therapy. They may also be used to monitor antiplatelet and anticoagulant therapy. However, standardisation of techniques and reference ranges is required before these tests can be widely used in different clinical settings. Viscoelastic haemostatic assays, as compared with conventional coagulation tests, are better for detecting coagulopathy and are the only tests that can provide rapid diagnosis of hyperfibrinolysis. Goal-directed administration of blood products based on the results of viscoelastic haemostatic assays was associated with reduction in allogeneic blood product transfusions in trauma, cardiac surgery, and liver transplantation cases. However, there is currently no evidence to support the routine use of viscoelastic haemostatic assays for monitoring platelet function prior to surgery.

Current Trends in the Management of Abdominal Aortic Aneurysms

PubMed Central

Harris, K.A.; Ameli, F. Michael; Louis, E.L. St.

1987-01-01

The treatment of abdominal aortic aneurysm has undergone dramatic changes over the last three decades. More sophisticated diagnostic techniques have allowed early elective repair to be carried out. Improvement has resulted in both morbidity and mortality rates. Investigations such as ultrasound, computerized tomographic scanning and arteriography allow easy confirmation of the diagnosis of aortic aneurysms and permit a better assessment of the extent prior to surgical intervention. Improvement in the pre-operative management, particularly in relation to cardiac, renal, and pulmonary disease, has led to greatly improved results. The most important change in surgical technique has been repair of the aneurysm rather than resection. Combined with better post-operative intensive care units, this development has contributed to the improved morbidity and mortality rates. Although the complication rate of elective repair is low, the major cause of death remains myocardial infarction. As a result of all these improvements, indication for repair of abdominal aortic aneurysms has been extended to patients over the age of 80. Following surgical repair, most patients can be expected to return to normal lifestyles and lifespans. ImagesFigure 2Figure 3Figure 4 PMID:21263973

Patients' perception of physician-initiated prayer prior to elective ophthalmologic surgery.

PubMed

Siatkowski, R Michael; Cannon, Sterling L; Farris, Bradley K

2008-02-01

Prayer is an important part of many patients' and physicians' lives. There is little data in the literature regarding patients' perception of prayer from or with their doctors. To assess in a masked fashion patients' impression of prayer's role in a medical setting, and their perception of being offered and receiving prayer from their physician. Confidential survey of 567 consecutive patients who were offered prayer by their physician before elective eye surgery. Proportion of patients favoring physician-initiated prayer and weighted Likert responses to various positive and negative sentiments regarding their experience. Survey response rate was 53% (300 patients). Ninety-six percent of patients identified themselves as Christian. At least 90% of Christian patients responded favorably toward their prayer experience to each Likert question. Among the non-Christian patients, the proportion of negative impressions to the prayer experience ranged from 0 to 25%. Physician-initiated Christian-based prayer before surgery is well-received by a strong majority of Christian patients. Although the data are few, only a minority of non-Christians felt negatively regarding this experience.

Draining the swamp while making America great: senior dissonance in the age of Trump.

PubMed

Hudson, Robert B

2018-04-13

In his surprise election as President, Donald Trump enjoyed disproportionate electoral support from older voters, many of whom saw in Trump a person who would work to reverse demographic, economic, and cultural forces that had transformed American life as they had long seen it. Yet, Trump's campaign and incumbency has also been very much about gutting the Washington policy establishment of officials, bureaucrats, and lobbyists (aka, the Swamp) which, for over half a century, has been instrumental in enacting and expanding legislation that has benefitted older Americans, far more than any other social policy constituency in the country. This article contrasts the value-oriented electoral support Trump enjoyed from older Americans with their interest concerns centered on policies such as the Affordable Care Act, Medicaid, and a host of smaller grant-in-aid programs. It then reviews the strong institutional base seniors and their advocates have in Washington, posing whether interest-oriented concerns may outweigh ideological ones as policy options emerge from a Republican-controlled government prior to the 2018 elections.

Effect of post-encoding emotion on recollection and familiarity for pictures.

PubMed

Wang, Bo; Ren, Yanju

2017-07-01

Although prior studies have examined the effect of post-encoding emotional arousal on recognition memory for words, it is unknown whether the enhancement effect observed on words generalizes to pictures. Furthermore, prior studies using words have showed that the effect of emotional arousal can be modulated by stimuli valence and delay in emotion induction, but it is unclear whether such modulation can extend to pictures and whether other factors such as encoding method (incidental vs. intentional encoding) can be modulatory. Five experiments were conducted to answer these questions. In Experiment 1, participants encoded a list of neutral and negative pictures and then watched a 3-min neutral or negative video. The delayed test showed that negative arousal impaired recollection regardless of picture valence but had no effect on familiarity. Experiment 2 replicated the above findings. Experiment 3 was similar to Experiment 1 except that participants watched a 3-min neutral, negative, or positive video and conducted free recall before the recognition test. Unlike the prior two experiments, the impairment effect of negative arousal disappeared. Experiment 4, where the free recall task was eliminated, replicated the results from Experiment 3. Experiment 5 replicated Experiments 1 and 2 and further showed that the impairment effects of negative arousal could be modulated by delay in emotion induction but not by encoding method or stimuli valence. Taken together, the current study suggests that the enhancement effect observed on words may not generalize to pictures.

Geodesy by radio interferometry - Effects of atmospheric modeling errors on estimates of baseline length

NASA Technical Reports Server (NTRS)

Davis, J. L.; Herring, T. A.; Shapiro, I. I.; Rogers, A. E. E.; Elgered, G.

1985-01-01

Analysis of very long baseline interferometry data indicates that systematic errors in prior estimates of baseline length, of order 5 cm for approximately 8000-km baselines, were due primarily to mismodeling of the electrical path length of the troposphere and mesosphere ('atmospheric delay'). Here observational evidence for the existence of such errors in the previously used models for the atmospheric delay is discussed, and a new 'mapping' function for the elevation angle dependence of this delay is developed. The delay predicted by this new mapping function differs from ray trace results by less than approximately 5 mm, at all elevations down to 5 deg elevation, and introduces errors into the estimates of baseline length of less than about 1 cm, for the multistation intercontinental experiment analyzed here.

Longitudinal Associations Among Religiousness, Delay Discounting, and Substance Use Initiation in Early Adolescence

PubMed Central

Kim-Spoon, Jungmeen; McCullough, Michael E.; Bickel, W. K.; Farley, Julee P.; Longo, Gregory S.

2014-01-01

Prior research indicates that religiousness is related negatively to adolescent health risk behaviors, yet how such protective effects operate is not well understood. This study examined the longitudinal associations among organizational and personal religiousness, delay discounting, and substance use initiation (alcohol, cigarette, and marijuana use). The sample comprised 106 early adolescents (10-13 years of age, 52% female) who were not using substances at Time 1. Path analyses suggested that high levels of personal religiousness at Time 1 were related to low levels of substance use at Time 2 (2.4 years later), mediated by low levels of delay discounting. Delay discounting appears to be an important contributor to the protective effect of religiousness on the development of substance use among adolescents. PMID:25750491

[Observational study of craniofacial growth and development in Mexican children].

PubMed

Fijikami, T K; Cedeño Pacheco, E

1991-01-01

The election of a investigation about craniofacial growing and development in Mexican children, was done due to a lack of national information in this rubric and as a fundamental part of the "growing and development in the scholastic" module of the Universidad Autónoma Metropolitana-Xochimilco, which work hypothesis was that "craniofacial growing and development in Mexican, 6 to 12 children in Xochimilco area are due to nutritional deficiency, second dentition eruption delay and dental maloclution "which was totality confirmed in a 100 Mexican facial characteristic children field work study, with cephalometric studies which permit to determine the craniofacial growing standard. This study was corroborated with a 40 children, 4 years later follow up.

Long-term follow-up of aneurysms treated electively with woven stent-assisted coiling.

PubMed

Cheung, Nicholas K; Chiu, Albert Hy; Cheung, Andrew K; Wenderoth, Jason D

2017-12-15

Preliminary short-term results for stent-assisted coil embolization (SACE) using woven/braided stents have been promising. However, evidence supporting mid- to long-term efficacy and durability is lacking. To report the long-term results for the durability of elective intracranial aneurysms treated with woven stents. Between May 2012 and May 2015, 98 consecutive patients with 103 aneurysms underwent elective woven SACE across three Australian neurovascular centres. All patients had immediate, 6- and 18-month clinical and radiological follow-up. Radiological assessment was performed with modified Raymond-Roy occlusion scores based on angiography results, while clinical assessment was based on the modified Rankin Scale. Six-month follow-up was available in 100 aneurysms, and an 18-month follow-up in 97 aneurysms. Total occlusion rates of 82% were achieved at inception, 82% at 6 months, and 90% at 18 months. Satisfactory occlusion with small neck remnants was present in 17% at inception, 16% at 6 months, and 9% at 18 months. Good neurological outcomes were achieved in 95% at 18 months. Intraprocedural thromboembolic events were recorded in 3% and delayed events in 1% (all in patients taking clopidogrel). Aneurysm recurrence occurred in one patient (1%). Technical complications occurred in 5%. The total complication rate was 10%. Woven SACE is safe, efficacious, and durable at long-term 18-month follow-up, with very low recurrence and re-treatment rates. Preliminary results appear better than those for traditional laser-cut stents. © 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.

Ultrasound assessment of gastric volume in children after drinking carbohydrate-containing fluids.

PubMed

Song, I-K; Kim, H-J; Lee, J-H; Kim, E-H; Kim, J-T; Kim, H-S

2016-04-01

Gastric ultrasound is a valid tool for non-invasive assessment of the nature and volume of gastric contents in adults and children. Perioperative fasting guidelines recommend oral carbohydrates up to 2 h before elective surgery. We evaluated gastric volume in children using ultrasound before and after drinking carbohydrate fluids before surgery. Paediatric patients younger than 18 yr old undergoing elective surgery were enrolled. Initial ultrasound assessment of gastric volume was performed after fasting for 8 h. Two hours before surgery, patients were given carbohydrate drinks: 15 ml kg(-1) for patients younger than 3 yr old and 10 ml kg(-1) for those more than 3 yr old. Before induction of general anaesthesia, the gastric volume was reassessed. Parental satisfaction scores (0=totally satisfied, 10=totally dissatisfied) and complications were recorded. Of the 86 enrolled patients, 79 completed the study; three refused to ingest the requested volume, and surgery was delayed for more than 2 h in four patients. The mean (sd) of the initial and second ultrasound measurements were 2.09 (0.97) and 1.85 (0.94) cm(2), respectively (P=0.01; mean difference 0.24 cm(2), 95% confidence interval 0.06-0.43). The median (interquartile range) satisfaction score was 2.4 (0-6). Two instances of postoperative vomiting and one instance of postoperative nausea occurred. Carbohydrate fluids ingested 2 h before surgery reduced the gastric volume and did not cause serious complications in paediatric patients. Parents were satisfied with the preoperative carbohydrate drink. Children may benefit from drinking carbohydrate fluids up to 2 h before elective surgery. cris.nih.go.kr (KCT0001546). © The Author 2016. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Early Postoperative Perils of Intraventricular Tumors: An Observational Comparative Study.

PubMed

Schär, Ralph T; Schwarz, Christa; Söll, Nicole; Raabe, Andreas; Z'Graggen, Werner J; Beck, Jürgen

2018-05-01

Early postoperative patient surveillance after removal of intraventricular tumors is often hindered by delayed awakening and prolonged somnolence. The objective of this study was to analyze the incidence of early critical postoperative events after elective craniotomy for intraventricular tumors in adults compared with extraventricular lesions. An observational comparative study was conducted on adult patients who had undergone first-time elective craniotomy between November 2011 and August 2016. Patients were stratified into extraventricular lesions (group 1) and intraventricular tumors (group 2). The rates of late extubation, early postoperative seizures, emergency head computed tomography (CT) scans, and urgent surgical intervention within 48 hours and mortality within 30 days of surgery were analyzed from a prospective database. A total of 977 elective craniotomies were analyzed, including 951 (97.3%) in group 1 and 26 (2.7%) in group 2. Emergency CT scans were ordered significantly more frequently in group 2 (34.6% vs. 8.4%; odds ratio, 5.76; 95% confidence interval [CI], 2.49-13.35; P = 0.0002), and the incidence of urgent surgical intervention was significantly higher in group 2 (11.5% vs. 0.8%; odds ratio, 15.38; 95% CI, 3.83-61.72; P = 0.002). The main reason for urgent surgical intervention in group 2 was acute obstructive hydrocephalus. Overall surgical mortality after 30 days was 0.3% (3 cases in group 1, no cases in group 2). Intraventricular tumors are at significantly higher risk for early emergency head CT and urgent surgical intervention. This patient cohort might benefit from routine intraoperative and early postoperative imaging, as well as intraoperative extraventricular drain placement. Copyright © 2018 Elsevier Inc. All rights reserved.

Immediate and delayed incorporations of events into dreams: further replication and implications for dream function.

PubMed

Nielsen, Tore A; Kuiken, Don; Alain, Geneviève; Stenstrom, Philippe; Powell, Russell A

2004-12-01

The incorporation of memories into dreams is characterized by two types of temporal effects: the day-residue effect, involving immediate incorporations of events from the preceding day, and the dream-lag effect, involving incorporations delayed by about a week. This study was designed to replicate these two effects while controlling several prior methodological problems and to provide preliminary information about potential functions of delayed event incorporations. Introductory Psychology students were asked to recall dreams at home for 1 week. Subsequently, they were instructed to select a single dream and to retrieve past events related to it that arose from one of seven randomly determined days prior to the dream (days 1-7). They then rated both their confidence in recall of events and the extent of correspondence between events and dreams. Judges evaluated qualities of the reported events using scales derived from theories about the function of delayed incorporations. Average ratings of correspondences between dreams and events were high for predream days 1 and 2, low for days 3 and 4 and high again for days 5-7, but only for participants who rated their confidence in recall of events as high and only for females. Delayed incorporations were more likely than immediate incorporations to refer to events characterized by interpersonal interactions, spatial locations, resolved problems and positive emotions. The findings are consistent with the possibility that processes with circaseptan (about 7 days) morphology underlie dream incorporation and that these processes subserve the functions of socio-emotional adaptation and memory consolidation.

Delayed treatment of tuberculosis patients in rural areas of Yogyakarta province, Indonesia

PubMed Central

Mahendradhata, Yodi; Syahrizal, Bobby M; Utarini, Adi

2008-01-01

Background In year 2000, the entire population in Indonesia was 201 million and 57.6 percent of that was living in rural areas. This paper reports analyses that address to what extent the rural structure influence the way TB patients seek care prior to diagnosis by a DOTS facility. Methods We documented healthcare utilization pattern of smear positive TB patients prior to diagnosis and treatment by DOTS services (health centre, chest clinic, public and private hospital) in Yogyakarta province. We calculated the delay in treatment as the number of weeks between the onset of symptoms and the start of DOTS treatment. Statistical analysis was carried out with Epi Info version 3.3 (October 5, 2004). Results The only factor which was significantly associated with total delay was urban-rural setting (p = < 0.0001). The median total delay for TB patients in urban districts was 8 (1st Quartile = 4; 3rd Quartile = 12) weeks compared to 12 (1st Quartile = 7; 3rd Quartile = 23) weeks for patients in rural districts. Multivariate analysis suggested no confounding between individual factors and urban-rural setting remained as the main factor for total delay (p = < 0.0001). Primary health centre was the first choice provider for most (38.7%) of these TB patients. Urban-rural setting was also the only factor which was significantly associated with choice of first provider (p = 0.03). Conclusion Improving access to DOTS services in rural areas is an area of vital importance in aiming to make progress toward achieving TB control targets in Indonesia. PMID:19036164

Is pre-operative imaging essential prior to ureteric stone surgery?

PubMed

Youssef, F R; Wilkinson, B A; Hastie, K J; Hall, J

2012-09-01

The aim of this study was to identify patients not requiring ureteric stone surgery based on pre-operative imaging (within 24 hours) prior to embarking on semirigid ureteroscopy (R-URS) for urolithiasis. The imaging of all consecutive patients on whom R-URS for urolithiasis was performed over a 12-month period was reviewed. All patients had undergone a plain x-ray of the kidney, ureters and bladder (KUB), abdominal non-contrast computed tomography (NCCT-KUB) or both on the day of surgery. A total of 96 patients were identified for the study. Stone sizes ranged from 3 mm to 20 mm. Thirteen patients (14%) were cancelled as no stone(s) were identified on pre-operative imaging. Of the patients cancelled, 8 (62%) required NCCT-KUB to confirm spontaneous stone passage. One in seven patients were stone free on the day of surgery. This negates the need for unnecessary anaesthetic and instrumentation of the urinary tract, with the associated morbidity. Up-to-date imaging prior to embarking on elective ureteric stone surgery is highly recommended.

Attention-deficit/hyperactivity disorder, delay discounting, and risky financial behaviors: A preliminary analysis of self-report data

PubMed Central

2017-01-01

Delay discounting—often referred to as hyperbolic discounting in the financial literature—is defined by a consistent preference for smaller, immediate rewards over larger, delayed rewards, and by failure of future consequences to curtail current consummatory behaviors. Previous research demonstrates (1) excessive delay discounting among individuals with attention-deficit/hyperactivity disorder (ADHD), (2) common neural substrates of delay discounting and hyperactive-impulsive symptoms of ADHD, and (3) associations between delay discounting and both debt burden and high interest rate borrowing. This study extends prior research by examining associations between ADHD symptoms, delay discounting, and an array of previously unevaluated financial outcomes among 544 individuals (mean age 35 years). Controlling for age, income, sex, education, and substance use, ADHD symptoms were associated with delay discounting, late credit card payments, credit card balances, use of pawn services, personal debt, and employment histories (less time spent at more jobs). Consistent with neural models of reward processing and associative learning, more of these relations were attributable to hyperactive-impulsive symptoms than inattentive symptoms. Implications for financial decision-making and directions for future research are discussed. PMID:28481903

Tricuspid valve endocarditis with Group B Streptococcus after an elective abortion: the need for new data.

PubMed

Palys, Erica E; Li, John; Gaut, Paula L; Hardy, W David

2006-01-01

Streptococcus agalactiae, commonly known as Group B streptococcus (GBS), was originally discovered as a cause of bovine mastitis. GBS colonizes the genital tract of up to 40% of women and has become a major pathogen in neonatal meningitis. GBS endocarditis is thought to be an uncommon manifestation of this infection and carries a higher mortality compared to other streptococcal pathogens. Studies have shown that endocarditis after abortion has an incidence of about one per million. However, this figure was published prior to routine use of echocardiography for diagnosis. The American Heart Association has recently declared transesophageal echocardiography the gold standard for endocarditis diagnosis. This case report illustrates that, given the potentially devastating consequences of endocarditis, there is a need for updated studies to adequately assess the true incidence of this infection. Pending the outcome of these studies, routine GBS screening and prophylactic antibiotics prior to abortion should be recommended.

Effects of intensivist coverage in a post-anaesthesia care unit on surgical patients' case mix and characteristics of the intensive care unit.

PubMed

Kastrup, Marc; Seeling, Matthes; Barthel, Stefan; Bloch, Andy; le Claire, Marie; Spies, Claudia; Scheller, Matthias; Braun, Jan

2012-07-18

There is an increasing demand for intensive care in hospitals, which can lead to capacity limitations in the intensive care unit (ICU). Due to postponement of elective surgery or delayed admission of emergency patients, outcome may be negatively influenced. To optimize the admission process to intensive care, the post-anaesthesia care unit (PACU) was staffed with intensivist coverage around the clock. The aim of this study is to demonstrate the impact of the PACU on the structure of ICU-patients and the contribution to overall hospital profit in terms of changes in the case mix index for all surgical patients. The administrative data of all surgical patients (n = 51,040) 20 months prior and 20 months after the introduction of a round-the-clock intensivist staffing of the PACU were evaluated and compared. The relative number of patients with longer length of stay (LOS) (more than seven days) in the ICU increased after the introduction of the PACU. The average monthly number of treatment days of patients staying less than 24 hours in the ICU decreased by about 50% (138.95 vs. 68.19 treatment days, P <0.005). The mean LOS in the PACU was 0.45 (± 0.41) days, compared to 0.27 (± 0.2) days prior to the implementation. The preoperative times in the hospital decreased significantly for all patients. The case mix index (CMI) per hospital day for all surgical patients was significantly higher after the introduction of a PACU: 0.286 (± 0.234) vs. 0.309 (± 0.272) P <0.001 CMI/hospital day. The introduction of a PACU and the staffing with intensive care staff might shorten the hospital LOS for surgical patients. The revenues for the hospital, as determined by the case mix index of the patients per hospital day, increased after the implementation of a PACU and more patients can be treated in the same time, due to a better use of resources.

Parent Experience of Care and Decision Making for Children Who Snore.

PubMed

Boss, Emily F; Links, Anne R; Saxton, Ron; Cheng, Tina L; Beach, Mary Catherine

2017-03-01

Sleep-disordered breathing (SDB) is prevalent and has an impact on the physical and behavioral health of children. Adenotonsillectomy (AT), the primary treatment, is subject to unexplained variation in utilization, which may be reduced by improving physician-patient communication and decision quality for this elective procedure. To identify factors are associated with parental experience and decision making in pediatric SDB and AT surgery. In this qualitative study, parents of children with prior SDB evaluation participated in semistructured, audiorecorded interviews. Open-ended questions regarded experiences of having a child with SDB, communication with pediatric clinicians and surgeons, and experiences with AT surgery. Recordings were transcribed and analyzed for emergent themes using grounded theory methodology. Eleven parents of children ages 2 to 17 years who had previously been diagnosed or treated for SDB were identified via purposive sampling and interviewed between January and April 2015. Interviews were conducted at locations convenient for the participants and separate from the pediatric clinic. A goal of this study was to ascertain how parents perceived sharing decisions with their physicians. Themes of parental experiences and treatment decision-making processes with pediatric SDB. Overarching themes were inclusive of (1) clinical factors of SDB and AT and (2) clinician interpersonal behaviors and communication. Parents described an urgency that led them to seek evaluation or treatment, including fear that the child would stop breathing, or behavioral and/or cognitive delays. Parents often viewed surgery as a "last resort" and had explored alternate therapies prior to seeing the surgeon. Nearly all parents feared anesthesia more than AT surgery itself. Parents described satisfaction when physicians provided them with options, engaged their child in conversation, depicted SDB visually, and were responsive or accessible to questions. Parents regarded a trusting relationship with their pediatrician, confidence in the surgeon, and inclusion in decision making as important. While clinical factors were influential for decision making, interpersonal factors helped parents feel comfortable and influenced their overall experience. Shared decision making, in which parents receive evidence-based information allowing them to accurately perceive risks, benefits, and alternatives about SDB treatment in the setting of trusting clinician-family relationships, may reduce parental decision conflict and improve decision quality toward AT surgery.

Maternal Obesity: Risks for Developmental Delays in Early Childhood.

PubMed

Duffany, Kathleen O'Connor; McVeigh, Katharine H; Kershaw, Trace S; Lipkind, Heather S; Ickovics, Jeannette R

2016-02-01

To assess the risk for neurodevelopmental delays for children of mothers who were obese (≥200 pounds) prior to pregnancy, and to characterize delays associated with maternal obesity among children referred to and found eligible to receive Early Intervention Program services. We conducted a retrospective cohort study (N = 541,816) using a population-based New York City data warehouse with linked birth and Early Intervention data. Risks for children suspected of a delay and 'significantly delayed', with two moderate or one severe delay, were calculated. Among the group of children eligible by delay for Early Intervention, analyses assessed risk for being identified with a moderate-to-severe delay across each of five functional domains as well as risks for multiple delays. Children of mothers who were obese were more likely to be suspected of a delay (adjusted RR 1.19 [CI 1.15-1.22]) and borderline association for 'significantly delayed' (adjusted RR 1.01 [CI 1.00-1.02). Among children eligible by delay, children of mothers who were obese evidenced an increased risk for moderate-to-severe cognitive (adjusted RR 1.04 [CI 1.02-1.07]) and physical (adjusted RR 1.04 [CI 1.01-1.08]) delays and for global developmental delay (adjusted RR 1.05 [CI 1.01-1.08]). Maternal obesity is associated with increased risk of developmental delay in offspring. Among children with moderate or severe delays, maternal obesity is associated with increased risk of cognitive and physical delays as well as with increased risk for global developmental delay. While causation remains uncertain, this adds to the growing body of research reporting an association between maternal obesity and neurodevelopmental delays in offspring.

Risk factors for superficial surgical site infection after elective rectal cancer resection: a multivariate analysis of 8880 patients from the American College of Surgeons National Surgical Quality Improvement Program database.

PubMed

Sutton, Elie; Miyagaki, Hiromichi; Bellini, Geoffrey; Shantha Kumara, H M C; Yan, Xiaohong; Howe, Brett; Feigel, Amanda; Whelan, Richard L

2017-01-01

Superficial surgical site infection (sSSI) is one of the most common complications after colorectal resection. The goal of this study was to determine the comorbidities and operative characteristics that place patients at risk for sSSI in patients who underwent rectal cancer resection. The American College of Surgeons National Surgical Quality Improvement Program database was queried (via diagnosis and Current Procedural Terminology codes) for patients with rectal cancer who underwent elective resection between 2005 and 2012. Patients for whom data concerning 27 demographic factors, comorbidities, and operative characteristics were available were eligible. A univariate and multivariate analysis was performed to identify possible risk factors for sSSI. A total of 8880 patients met the entry criteria and were included. sSSIs were diagnosed in 861 (9.7%) patients. Univariate analysis found 14 patients statistically significant risk factors for sSSI. Multivariate analysis revealed the following risk factors: male gender, body mass index (BMI) >30, current smoking, history of chronic obstructive pulmonary disease (COPD), American Society of Anesthesiologists III/IV, abdominoperineal resection (APR), stoma formation, open surgery (versus laparoscopic), and operative time >217 min. The greatest difference in sSSI rates was noted in patients with COPD (18.9 versus 9.5%). Of note, 54.2% of sSSIs was noted after hospital discharge. With regard to the timing of presentation, univariate analysis revealed a statistically significant delay in sSSI presentation in patients with the following factors and/or characteristics: BMI <30, previous radiation therapy (RT), APR, minimally invasive surgery, and stoma formation. Multivariate analysis suggested that only laparoscopic surgery (versus open) and preoperative RT were risk factors for delay. Rectal cancer resections are associated with a high incidence of sSSIs, over half of which are noted after discharge. Nine patient and operative characteristics, including smoking, BMI, COPD, APR, and open surgery were found to be significant risk factors for SSI on multivariate analysis. Furthermore, sSSI presentation in patients who had laparoscopic surgery and those who had preoperative RT is significantly delayed for unclear reasons. Copyright © 2016 Elsevier Inc. All rights reserved.

Gender and socio-cultural determinants of delay to diagnosis of TB in Bangladesh, India and Malawi.

PubMed

Gosoniu, G D; Ganapathy, S; Kemp, J; Auer, C; Somma, D; Karim, F; Weiss, M G

2008-07-01

Tuberculosis (TB) control programmes in Bangladesh, India and Malawi. To compare the interval from symptom onset to diagnosis of TB for men and women, and to assess socio-cultural and gender-related features of illness explaining diagnostic delay. Semi-structured Explanatory Model Interview Catalogue (EMIC) interviews were administered to 100 or more patients at each site, assessing categories of distress, perceived causes and help seeking. Based on time from initial symptoms to diagnosis of TB, patients were classified with problem delay (>90 days), timely diagnosis (< or =30 days) or moderate delay. EMIC interview data were analysed to explain problem delay. The median interval from symptom onset to diagnosis was longest in India and shortest in Malawi. With adjustment for confounding, female sex (Bangladesh), and status of married woman (India) and housewife (Malawi) were associated with problem delay. Prominent non-specific symptoms--chest pain (Bangladesh) and breathlessness (Malawi)--were also significant. Cough in India, widely associated with TB, was associated with timely diagnosis. Sanitation as a perceived cause linked to poor urban conditions was associated with delayed diagnosis in India. Specific prior help seeking with circuitous referral patterns was identified. The study identified gender- and illness-related features of diagnostic delay. Further research distinguishing patient and provider delay is needed.

26 CFR 15.1-1 - Elections to deduct.

Code of Federal Regulations, 2010 CFR

2010-04-01

.... (2) Election to deduct under section 615—(i) General rule. The election to deduct exploration... 26 Internal Revenue 14 2010-04-01 2010-04-01 false Elections to deduct. 15.1-1 Section 15.1-1... Elections to deduct. (a) Manner of making election—(1) Election to deduct under section 617(a). The election...

Patient-reported treatment satisfaction and budget impact with rivaroxaban vs. standard therapy in elective cardioversion of atrial fibrillation: a post hoc analysis of the X-VeRT trial

PubMed Central

Hohnloser, Stefan H.; Cappato, Riccardo; Ezekowitz, Michael D.; Evers, Thomas; Sahin, Kurtulus; Kirchhof, Paulus; Meng, Isabelle Ling; van Eickels, Martin; Camm, A. John

2016-01-01

Abstract Aims We compared patient-reported treatment satisfaction and the economic impact of anticoagulation therapy with rivaroxaban vs. vitamin K antagonists (VKAs) in patients with non-valvular atrial fibrillation undergoing elective cardioversion procedures. Methods and results The current study is a post hoc analysis of the prospective, multicentre X-VeRT (EXplore the efficacy and safety of once-daily oral riVaroxaban for the prevention of caRdiovascular events in subjects with non-valvular aTrial fibrillation scheduled for cardioversion) trial. Patient-reported treatment satisfaction with anticoagulation therapy was assessed using the Treatment Satisfaction Questionnaire for Medication version II in seven countries (US, UK, Canada, Germany, France, Italy, and the Netherlands). An economic model was also developed to estimate the impact of postponed cardioversions for two countries (UK and Italy). This model estimated the total costs of cardioversion, taking into consideration the costs for drug therapy (including extended treatment duration due to cardioversion postponement), international normalized ratio monitoring of VKAs, the cardioversion procedure, and rescheduling the procedure. These costs were linked to the respective X-VeRT study data to estimate the total costs. Patients receiving rivaroxaban in the delayed cardioversion group had significantly higher scores for Convenience, Effectiveness, and Global satisfaction (81.74 vs. 65.78; 39.41 vs. 32.95; and 82.07 vs. 66.74, respectively; P < 0.0001). Based on the total patient population included in the treatment satisfaction substudy (n = 632) in the delayed cardioversion group in X-VeRT, the use of rivaroxaban was estimated to result in a saving of £421 and €360 per patient in UK and Italian settings, respectively. Conclusion The use of rivaroxaban in the setting of cardioversion resulted in greater patient satisfaction and cost savings, compared with that of VKA. PMID:26487668

A traffic-light coding system to organize emergency surgery across surgical disciplines.

PubMed

Leppäniemi, A; Jousela, I

2014-01-01

Emergency surgery is associated with night-time procedures and disruption of elective surgery. An analysis was undertaken of the effect of classifying emergency operations uniformly with a three-tier urgency colour code and the use of dedicated daytime operating rooms. Observed changes from 2001 to 2012 in the number, timing and ability to meet the urgency-designated colour code deadline were retrieved from the computer-based operating theatre organization system for all emergency operations. The number of emergency operations performed annually ranged from 3330 to 4341, with an increasing trend. The proportion of night-time emergency operations decreased from 27.4 per cent (2563 of 9347) before to 23.5 per cent (7731 of 32,959) after introduction of the colour coding system in 2004 (χ2  = 61.94, 1 d.f., P < 0.001). In 2007, owing to long preoperative delays in patients with acute appendicitis and acute cholecystitis, colour codes for these patients were upgraded from 'orange' to 'red' and from 'yellow' to 'orange' respectively. The proportion of patients operated on with a red code before and after this change increased from 45.2 per cent (5831 of 12,907 operations) to 62.7 per cent (13,020 of 20,778 operations; χ2  = 986.99, 1 d.f., P < 0.001). In 2012, the office-hours raw utilization time for the principal emergency operation theatre was 85.4 per cent. The structural separation of elective and emergency surgery, the use of dedicated daytime operating theatres and the implementation of a universal classification of emergency operations reduced night-time surgery, improved the efficiency of operating theatre utilization during daytime, shortened preoperative delay in patients requiring urgent surgery, and enabled monitoring and corrective actions for providing emergency surgery services. © 2013 BJS Society Ltd. Published by John Wiley & Sons Ltd.

Patient-reported treatment satisfaction and budget impact with rivaroxaban vs. standard therapy in elective cardioversion of atrial fibrillation: a post hoc analysis of the X-VeRT trial.

PubMed

Hohnloser, Stefan H; Cappato, Riccardo; Ezekowitz, Michael D; Evers, Thomas; Sahin, Kurtulus; Kirchhof, Paulus; Meng, Isabelle Ling; van Eickels, Martin; Camm, A John

2016-02-01

We compared patient-reported treatment satisfaction and the economic impact of anticoagulation therapy with rivaroxaban vs. vitamin K antagonists (VKAs) in patients with non-valvular atrial fibrillation undergoing elective cardioversion procedures. The current study is a post hoc analysis of the prospective, multicentre X-VeRT (EXplore the efficacy and safety of once-daily oral riVaroxaban for the prevention of caRdiovascular events in subjects with non-valvular aTrial fibrillation scheduled for cardioversion) trial. Patient-reported treatment satisfaction with anticoagulation therapy was assessed using the Treatment Satisfaction Questionnaire for Medication version II in seven countries (US, UK, Canada, Germany, France, Italy, and the Netherlands). An economic model was also developed to estimate the impact of postponed cardioversions for two countries (UK and Italy). This model estimated the total costs of cardioversion, taking into consideration the costs for drug therapy (including extended treatment duration due to cardioversion postponement), international normalized ratio monitoring of VKAs, the cardioversion procedure, and rescheduling the procedure. These costs were linked to the respective X-VeRT study data to estimate the total costs. Patients receiving rivaroxaban in the delayed cardioversion group had significantly higher scores for Convenience, Effectiveness, and Global satisfaction (81.74 vs. 65.78; 39.41 vs. 32.95; and 82.07 vs. 66.74, respectively; P < 0.0001). Based on the total patient population included in the treatment satisfaction substudy (n = 632) in the delayed cardioversion group in X-VeRT, the use of rivaroxaban was estimated to result in a saving of £421 and €360 per patient in UK and Italian settings, respectively. The use of rivaroxaban in the setting of cardioversion resulted in greater patient satisfaction and cost savings, compared with that of VKA. © The Author 2015. Published by Oxford University Press on behalf of the European Society of Cardiology.

Supervising Remote Humanoids Across Intermediate Time Delay

NASA Technical Reports Server (NTRS)

Hambuchen, Kimberly; Bluethmann, William; Goza, Michael; Ambrose, Robert; Rabe, Kenneth; Allan, Mark

2006-01-01

The President's Vision for Space Exploration, laid out in 2004, relies heavily upon robotic exploration of the lunar surface in early phases of the program. Prior to the arrival of astronauts on the lunar surface, these robots will be required to be controlled across space and time, posing a considerable challenge for traditional telepresence techniques. Because time delays will be measured in seconds, not minutes as is the case for Mars Exploration, uploading the plan for a day seems excessive. An approach for controlling humanoids under intermediate time delay is presented. This approach uses software running within a ground control cockpit to predict an immersed robot supervisor's motions which the remote humanoid autonomously executes. Initial results are presented.

Freezing the biological clock: a viable fertility preservation option for young Singapore women?

PubMed

Blyth, Eric; Yee, Samantha; Lee, Geok Ling

2013-09-01

In March 2012, an article in The Straits Times entitled 'Freezing eggs could reverse falling birth rate' suggested that employing the latest oocyte cryopreservation techniques could both foster individual women's reproductive autonomy and impact Singapore's fertility rate, which in recent years has consistently been among the world's lowest. The article cited both local and international fertility specialists' approval of elective oocyte cryopreservation for young women wishing to protect their reproductive potential against ageing and as a potential antidote to the contemporary 'delay and defer' model of family-building. Later in 2012, the Ministry of Health announced a review of oocyte cryopreservation policy taking into account related medical, scientific and ethical issues, while the Singapore College of Obstetricians and Gynaecologists endorsed oocyte cryopreservation as an "important, safe and efficient technology". This paper outlines and analyses the arguments and empirical evidence used both to support and oppose offering elective oocyte cryopreservation as a routine fertility service, before concluding that this remains unjustifiable on the basis of insufficient evidence of its clinical efficacy and safety as regards either pregnancy rates or birth outcomes. If it is to be made available at all for these reasons in Singapore, it should be subjected to rigorous clinic-specific evaluation in accordance with accepted clinical and ethical norms.

Iatrogenic popliteal artery injury in non arthroplasty knee surgery.

PubMed

Bernhoff, K; Björck, M

2015-02-01

We have investigated iatrogenic popliteal artery injuries (PAI) during non arthroplasty knee surgery regarding mechanism of injury, treatment and outcomes, and to identify successful strategies when injury occurs. In all, 21 iatrogenic popliteal artery injuries in 21 patients during knee surgery other than knee arthroplasty were identified from the Swedish Vascular Registry (Swedvasc) between 1987 and 2011. Prospective registry data were supplemented with case-records, including long-term follow-up. In total, 13 patients suffered PAI during elective surgery and eight during urgent surgery such as fracture fixation or tumour resection. Nine injuries were detected intra-operatively, five within 12 to 48 hours and seven > 48 hours post-operatively (two days to 23 years). There were 19 open vascular and two endovascular surgical repairs. Two patients died within six months of surgery. One patient required amputation. Only six patients had a complete recovery of whom had the vascular injury detected at time of injury and repaired by a vascular surgeon. Patients sustaining vascular injury during elective procedures are more likely to litigate (p = 0.029). We conclude that outcomes are poorer when there is a delay of diagnosis and treatment, and that orthopaedic surgeons should develop strategies to detect PAI early and ensure rapid access to vascular surgical support. ©2015 The British Editorial Society of Bone & Joint Surgery.

21 CFR 172.165 - Quaternary ammonium chloride combination.

Code of Federal Regulations, 2014 CFR

2014-04-01

... this chapter, in raw sugar cane juice. It is added prior to clarification when further processing of the sugar cane juice must be delayed. (d) The additive is applied to the sugar juice in the following...

Hands-On Defibrillation Skills of Pediatric Acute Care Providers During a Simulated Ventricular Fibrillation Cardiac Arrest Scenario

PubMed Central

Bhalala, Utpal S.; Balakumar, Niveditha; Zamora, Maria; Appachi, Elumalai

2018-01-01

Introduction: Timely defibrillation in ventricular fibrillation cardiac arrest (VFCA) is associated with good outcome. While defibrillation skills of pediatric providers have been reported to be poor, the factors related to poor hands-on defibrillation skills of pediatric providers are largely unknown. The aim of our study was to evaluate delay in individual steps of the defibrillation and human and non-human factors associated with poor hands-on defibrillation skills among pediatric acute care providers during a simulated VFCA scenario. Methods: We conducted a prospective observational study of video evaluation of hands-on defibrillation skills of pediatric providers in a simulated VFCA in our children's hospital. Each provider was asked to use pads followed by paddles to provide 2 J/kg shock to an infant mannequin in VFCA. The hands-on skills were evaluated for struggle with any step of defibrillation, defined a priori as >10 s delay with particular step. The data was analyzed using chi-square test with significant p-value < 0.05. Results: A total of 68 acute care providers were evaluated. Median time to first shock was 97 s (IQR: 60–122.5 s) and did not correlate with provider factors, except previous experience with the defibrillator used in study. The number of providers who struggled (>10 s delay) with each of connecting the pads/paddles to the device, using pads/paddles on the mannequin and using buttons on the machine was 34 (50%), 26 (38%), and 31 (46%), respectively. Conclusions: The defibrillation skills of providers in a tertiary care children's hospital are poor. Both human and machine-related factors are associated with delay in defibrillation. Prior use of the study defibrillator is associated with a significantly shorter time-to-first shock as compared to prior use of any other defibrillator or no prior use of any defibrillator. PMID:29740571

Hands-On Defibrillation Skills of Pediatric Acute Care Providers During a Simulated Ventricular Fibrillation Cardiac Arrest Scenario.

PubMed

Bhalala, Utpal S; Balakumar, Niveditha; Zamora, Maria; Appachi, Elumalai

2018-01-01

Introduction: Timely defibrillation in ventricular fibrillation cardiac arrest (VFCA) is associated with good outcome. While defibrillation skills of pediatric providers have been reported to be poor, the factors related to poor hands-on defibrillation skills of pediatric providers are largely unknown. The aim of our study was to evaluate delay in individual steps of the defibrillation and human and non-human factors associated with poor hands-on defibrillation skills among pediatric acute care providers during a simulated VFCA scenario. Methods: We conducted a prospective observational study of video evaluation of hands-on defibrillation skills of pediatric providers in a simulated VFCA in our children's hospital. Each provider was asked to use pads followed by paddles to provide 2 J/kg shock to an infant mannequin in VFCA. The hands-on skills were evaluated for struggle with any step of defibrillation, defined a priori as >10 s delay with particular step. The data was analyzed using chi-square test with significant p -value < 0.05. Results: A total of 68 acute care providers were evaluated. Median time to first shock was 97 s (IQR: 60-122.5 s) and did not correlate with provider factors, except previous experience with the defibrillator used in study. The number of providers who struggled (>10 s delay) with each of connecting the pads/paddles to the device, using pads/paddles on the mannequin and using buttons on the machine was 34 (50%), 26 (38%), and 31 (46%), respectively. Conclusions: The defibrillation skills of providers in a tertiary care children's hospital are poor. Both human and machine-related factors are associated with delay in defibrillation. Prior use of the study defibrillator is associated with a significantly shorter time-to-first shock as compared to prior use of any other defibrillator or no prior use of any defibrillator.

Causes of delay in door-to-balloon time in south-east Asian patients undergoing primary percutaneous coronary intervention.

PubMed

Sim, Wen Jun; Ang, An Shing; Tan, Mae Chyi; Xiang, Wen Wei; Foo, David; Loh, Kwok Kong; Jafary, Fahim Haider; Watson, Timothy James; Ong, Paul Jau Lueng; Ho, Hee Hwa

2017-01-01

To evaluate causes and impact of delay in the door-to-balloon (D2B) time for patients undergoing primary percutaneous coronary intervention (PPCI). From January 2009 to December 2012, 1268 patients (86% male, mean age of 58 ± 12 years) presented to our hospital for ST-elevation myocardial infarction (STEMI) and underwent PPCI. They were divided into two groups: Non-delay defined as D2B time ≤ 90 mins and delay group defined as D2B time > 90 mins. Data were collected retrospectively on baseline clinical characteristics, mode of presentation, angiographic findings, therapeutic modality and inhospital outcome. 202 patients had delay in D2B time. There were more female patients in the delay group. They were older and tend to self-present to hospital. They were less likely to be smokers and have a higher prevalence of prior MI. The incidence of posterior MI was higher in the delay group. They also had a higher incidence of triple vessel disease. The 3 most common reasons for D2B delay was delay in the emergency department (39%), atypical clinical presentation (37.6%) and unstable medical condition requiring stabilisation/computed tomographic imaging (26.7%). The inhospital mortality was numerically higher in the delay group (7.4% versus 4.8%, p = 0.12). Delay in D2B occurred in 16% of our patients undergoing PPCI. Several key factors for delay were identified and warrant further intervention.

5 CFR 891.201 - Election.

Code of Federal Regulations, 2011 CFR

2011-01-01

... Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT (CONTINUED) CIVIL SERVICE REGULATIONS (CONTINUED) RETIRED FEDERAL EMPLOYEES HEALTH BENEFITS Election and Change of Election § 891.201 Election. (a) The original... election. For any other retired employee receiving compensation, changes of election made under this...

Waiting to see the doctor: understanding appraisal and utilization components of consultation delay for new breast symptoms in Chinese women.

PubMed

Li, Wylie W Y; Lam, Wendy W T; Wong, Jennifer H F; Chiu, April; Chan, Miranda; Or, Amy; Kwong, Ava; Suen, Dacita; Chan, Sharon W W; Fielding, Richard

2012-12-01

Delayed consultation for potential cancer symptoms influences treatment outcomes and remains problematic. Delay components (Appraisal versus Utilization) and respective associations are poorly understood. Eligible participants were Cantonese-speaking Chinese women, ≥21 years old, with self-discovered breast symptoms, recruited in surgical clinics before their first consultation, and naïve to their diagnosis. Overall 425/433 (98%) women completed a questionnaire on psychosocial, demographic and medical factors, how and when women discovered their breast symptom(s), and their subsequent decision making; 135/425 women (32%) were later diagnosed with breast cancer. Twenty-two per cent of women delayed >3 months before consultation. Women with breast cancer (28%) more often had prolonged delay than women with benign disease (19%). Attributing symptom to a non-cancerous condition, low fear on symptom discovery, not disclosing symptoms to others, and no prior breast symptom history predicted prolonged (>60 days) Appraisal Delay. Low fear on symptom discovery, seldom thinking about the symptom, and consultation for other reasons predicted prolonged (>14 days) Utilization Delay. Factors predicting Appraisal and Utilization Delays differentiated cancer from non-cancer groups. Indecision over symptom meaning comprised the main component of Appraisal and Total Delay, suggesting that educational strategies targeting atypical symptoms should reduce avoidable delays following self-discovered breast symptoms. Copyright © 2011 John Wiley & Sons, Ltd.

Restoring Function after Volumetric Muscle Loss: Extracellular Matrix Allograft or Minced Muscle Autograft

DTIC Science & Technology

2017-10-01

at the site of the VML. Prior small and large animal studies in our laboratory have demonstrated that minced muscle autograft (MMA), by virtue of...minced and placed intramuscularly at the site of the VML. Prior small and large animal studies in our laboratory have demonstrated that minced muscle...significant delay in the project initiation. First, a large animal study at the ISR indicated some concerns with the extra cellular matrix allograft that

Delayed plumage maturation and delayed reproductive investment in birds.

PubMed

Hawkins, Gerard L; Hill, Geoffrey E; Mercadante, Austin

2012-05-01

Delayed plumage maturation is the delayed acquisition of a definitive colour and pattern of plumage until after the first potential breeding period in birds. Here we provide a comprehensive overview of the numerous studies of delayed plumage maturation and a revised theoretical framework for understanding the function of delayed plumage maturation in all birds. We first distinguish between hypotheses that delayed plumage maturation is attributable to a moult constraint with no adaptive function and hypotheses that propose that delayed plumage maturation is a component of an adaptive life-history strategy associated with delayed reproductive investment. We then recognize three potential benefits of delayed plumage maturation: crypsis, mimicry and status signaling. Evidence suggests that delayed plumage maturation is not a consequence of developmental constraints and instead represents a strategy to maximize reproductive success in circumstances where young adults cannot effectively compete with older adults for limited resources, particularly breeding opportunities. A multi-factorial explanation that takes into account lifespan and the degree of competition for limited breeding resources and that combines the benefits of an inconspicuous appearance with the benefits of honest signaling of reduced competitiveness provides a general explanation for the function of delayed plumage maturation in most bird species. Delayed plumage maturation should be viewed as a component of alternative reproductive strategies that can include delay in both plumage and sexual development. Such strategies are frequently facultative, with individuals breeding prior to the acquisition of definitive plumages when conditions are favourable. Presumably, the benefits of delayed plumage maturation ultimately enhance lifetime reproductive success, and studying delayed plumage maturation within the context of lifetime reproductive success should be a goal of future studies. © 2011 The Authors. Biological Reviews © 2011 Cambridge Philosophical Society.

Using optical coherence tomography (OCT) to evaluate the status of human donor kidneys (Conference Presentation)

NASA Astrophysics Data System (ADS)

Andrews, Peter M.; Konkel, Brandon; Anderson, Erik; Stein, Matthew; Cooper, Matthew; Verbesey, Jennifer E.; Ghasemian, Seyed; Chen, Yu

2016-02-01

The main cause of delayed renal function following the transplant of donor kidneys is ischemic induced acute tubular necrosis (ATN). The ability to determine the degree of ATN suffered by donor kidneys prior to their transplant would enable transplant surgeons to use kidneys that might otherwise be discarded and better predict post-transplant renal function. Currently, there are no reliable tests to determine the extent of ATN of donor kidneys prior to their transplant. In ongoing clinical trials, we have been using optical coherence tomography (OCT) to non-invasively image the superficial proximal tubules of human donor kidneys prior to and following transplant, and correlate these observations with post-transplant renal function. Thus far we have studied over 40 living donor kidneys and 10 cadaver donor kidneys, and demonstrated that this imaging can be performed in a sterile and expeditious fashion in the operating room (OR). Because of many variables associated with a diverse population of donors/recipients and transplant operation parameters, more transplant data must be collected prior to drawing definite conclusions. Nevertheless, our observations have thus far mirrored our previously published laboratory results indicating that damage to the kidney proximal tubules as indicated by tubule swelling is a good measure of post-transplant ATN and delayed graft function. We conclude that OCT is a useful procedure for analyzing human donor kidneys.

29 CFR 452.103 - Primary elections.

Code of Federal Regulations, 2010 CFR

2010-07-01

... fifteen-day election notice requirement applies to any runoff election which may be held after an... election advises the members of the possibility of a runoff election and specifies such details as the time and place of such runoff election as may be necessary. ...

Does delaying early intravenous fat emulsion during parenteral nutrition reduce infections during critical illness?

PubMed

Gerlach, Anthony T; Thomas, Sheela; Murphy, Claire V; Stawicki, P Stanislaw P; Whitmill, Melissa L; Pourzanjani, Lydia; Steinberg, Steven M; Cook, Charles H

2011-02-01

Because early administration of intravenous fat emulsions (IVFEs) has been linked to infectious complications in trauma patients, we began withholding IVFE for the first seven to ten days of parenteral nutrition (PN) in all surgical intensive care unit (SICU) patients. Prior to this, IVFE had been infused from the start of PN. To evaluate the influence of delaying IVFE on infectious complications in SICU patients. Retrospective review from October 2006 to June 2009 of SICU patients before and after a change in IVFE practice patterns in a 44-bed SICU at an academic medical center. Adult patients who received PN for more than six days were included. Patients receiving PN with IVFE prior to SICU admission or being given other lipid emulsion therapy were excluded. The data collected included demographics, transfusion requirements, nutritional assessments, and laboratory and microbiology results. The infectious complications studied were pneumonia, urinary tract infections (UTIs), blood stream infections (BSIs), and catheter-related blood stream infections (CRBSIs). Sixty-four patients received IVFE; 30 at initiation of PN and 34 starting after seven to ten days. The two groups had similar demographics, severity of illness, transfusion requirements, and duration of PN. Infectious complications occurred in 65.6% of patients (63.3% having immediate IVFE vs. 67.6% having delayed IVFE; p = 0.79). Seventeen patients developed BSI or CRBSI while receiving PN (26.7% immediate IVFE vs. 26.5% delayed IVFE; p > 0.99). The mortality rates were 63.3% and 55.9%, respectively (p = 0.63). Withholding IVFE therapy during the first seven to ten days of PN did not influence infectious complications or the mortality rate in SICU patients. The benefits of delaying IVFE therefore may not be generalizable to all critically ill patients.

Why trace and delay conditioning are sometimes (but not always) hippocampal dependent: A computational model

PubMed Central

Moustafa, Ahmed A.; Wufong, Ella; Servatius, Richard J.; Pang, Kevin C. H.; Gluck, Mark A.; Myers, Catherine E.

2013-01-01

A recurrent-network model provides a unified account of the hippocampal region in mediating the representation of temporal information in classical eyeblink conditioning. Much empirical research is consistent with a general conclusion that delay conditioning (in which the conditioned stimulus CS and unconditioned stimulus US overlap and co-terminate) is independent of the hippocampal system, while trace conditioning (in which the CS terminates before US onset) depends on the hippocampus. However, recent studies show that, under some circumstances, delay conditioning can be hippocampal-dependent and trace conditioning can be spared following hippocampal lesion. Here, we present an extension of our prior trial-level models of hippocampal function and stimulus representation that can explain these findings within a unified framework. Specifically, the current model includes adaptive recurrent collateral connections that aid in the representation of intra-trial temporal information. With this model, as in our prior models, we argue that the hippocampus is not specialized for conditioned response timing, but rather is a general-purpose system that learns to predict the next state of all stimuli given the current state of variables encoded by activity in recurrent collaterals. As such, the model correctly predicts that hippocampal involvement in classical conditioning should be critical not only when there is an intervening trace interval, but also when there is a long delay between CS onset and US onset. Our model simulates empirical data from many variants of classical conditioning, including delay and trace paradigms in which the length of the CS, the inter-stimulus interval, or the trace interval is varied. Finally, we discuss model limitations, future directions, and several novel empirical predictions of this temporal processing model of hippocampal function and learning. PMID:23178699

Pre-surgery education for elective cardiac surgery patients: a survey from the patient's perspective.

PubMed

O'Brien, Lisa; McKeough, Carly; Abbasi, Randa

2013-12-01

Multidisciplinary pre-admission patient education is commonly recommended for elective surgery patients, and may involve the provision of written information and presentations from the health team. However, the occupational therapy role with elective sternotomy patients in our setting is confined to the post-operative period. We aimed to evaluate cardiac surgery patients' perception of the effectiveness and timing of pre-admission multidisciplinary written information and post-operative verbal education provided by occupational therapy. This cross-sectional study involved a written survey, which was posted to 375 people who had undergone cardiac surgery in 2009-2010. Questions were designed to elicit patient perceptions of both pre-operative written information and post-operative education relating to post-operative precautions and return to activity received from occupational therapy. There were 118 surveys returned equalling a 31.4% response rate. Eighty-nine per cent of respondents recalled receiving and reading the pre-surgery information booklet, and this was significantly correlated with feeling prepared for the post-operative experience and adherence with precautions (P < 0.0001). Exactly 30.4% of respondents stated that they experienced stress and anxiety in relation to post-operative expectations, and 47.3% felt the information provided in the occupational therapy education sessions would have been more beneficial for their understanding and coping if provided prior to surgery. Multidisciplinary written pre-surgery education appears to be providing patients with a good understanding of what to expect following surgery. The results suggest that pre-operative verbal education from occupational therapy would assist in reducing anxiety in a subgroup of patients. © 2013 Occupational Therapy Australia.

High Disparity Between Orthopedic Resident Interest and Participation in International Health Electives.

PubMed

Zhang, Steven; Shultz, Paul; Daniels, Alan; Ackelman, Edward; Kamal, Robin N

2016-07-01

Few orthopedic surgical residency programs offer international health electives (IHEs). Efforts to expand these programs have been increasing across medical disciplines. Whether orthopedic residents will participate remains unknown. This study quantified and characterized orthopedic resident interest and barriers to IHEs in US residency programs. A web-based survey was administered to residents from 154 US orthopedic residency programs accredited by the Accreditation Council for Graduate Medical Education 2014 to 2015. Questions assessed demographics and program background, previous medical experience abroad, barriers to participation, and level of interest in participating in an international health elective during their training and beyond. Twenty-seven (17.5%) residency programs responded. Chi-square analysis showed that residents who expressed interest in participating were significantly more likely to have experience abroad compared with those who expressed no interest (P<.004). Analysis using Mann-Whitney U test suggested that those who expressed interest were more likely to believe IHEs are important to resident training (P<.0011; mean Likert scale score of 3.7 vs 2.6), provide valuable experience (P<.001; mean Likert scale score of 4.2 vs 3.2), and should be required for orthopedic residencies (P<.001; mean Likert scale score of 2.8 vs 1.9). Residents are strongly interested in participating in IHEs during their training, and many may integrate global health into future practices. Residents perceive lack of funding and scheduling flexibility as barriers preventing them from participating. Prior experience abroad influences level of interest, and international clinical experience may enhance future perception of its value. [Orthopedics. 2016; 39(4):e680-e686.]. Copyright 2016, SLACK Incorporated.

Induction of labor in women with a history of fast labor.

PubMed

Kenny, Tiffany H; Fenton, Bradford W; Melrose, Erica L; McCarroll, Michele L; von Gruenigen, Vivian E

2016-01-01

History of fast labor is currently subjectively defined and inductions for non-medical indications are becoming restricted. We hypothesized that women induced for a history of fast labor do not have faster previous labors and do not deliver more quickly. A retrospective case-control cohort design studied multiparas undergoing elective induction at one high risk center. Outcomes of dyads electively induced for a history of previous fast labor indication (PFast) were compared to controls with a psychosocial indication. A total of 612 elective inductions with 1074 previous deliveries were evaluated: 81 (13%) PFast and 531 (87%) control. PFast had faster previous labors (median 5.5 h, IQR: 4.5-6) versus. control (10 h, IQR: 9-10.5; p < 0.001). Subsequent delivery time from start to expulsion was shorter for PFast (median 7 h, IQR: 5-9, p < 0.001) than controls with and without a previous labor <5.5 h (8.6 h, IQR: 6-14 and 9.5 h, IQR: 7-15, respectively). PFast were less likely to have a serious maternal complication. Neonatal complications were similar. Patients induced for a history of fast labor do have faster previous labors, suggesting a significant history of fast labor can be defined as <5.5 h. These women deliver more quickly and with lower morbidity than controls when subsequently induced, therefore the benefit may warrant the risk for a select number of women with a history of a prior labor length <5.5 h.

Twitter analysis of California’s failed campaign to raise the state’s tobacco tax by popular vote in 2012

PubMed Central

Feng, Miao; Pierce, John P; Szczypka, Glen; Vera, Lisa; Emery, Sherry

2017-01-01

Background The rapid diffusion of social media in the past decade has allowed community members to sway the discourse on elections. We use analyses of social media to provide insight into why the strong public support 1 year prior to the election did not result in an increased tobacco tax from the 2012 California Proposition 29 vote. Methods Using the Twitter historical Firehose, we chose all tweets on Proposition 29 posted between 1 January and 5 June 2012 differentiating between early and late campaign periods. Tweets were coded for valence, theme and source. We analysed metadata to characterise accounts. Television ratings data in 9 major California media markets were used to show the strength of the 2 campaigns. Results ‘No on 29’ launched television advertising earlier and with much higher household gross rating points (GRPs) than the ‘Yes on 29’ campaign. Among 17 099 relevant tweets from 8769 unique accounts, 53% supported Proposition 29, 27% opposed and 20% were neutral. Just under half (43%) were from accounts affiliated with the campaigns. Two-thirds of campaign messages originated outside California. The ‘Yes’ campaign focused on simple health messages, which were equally represented in both campaign periods. However, anti-tax tweets increased at relative to pro-tax tweets in the second period. Conclusions Although the Prop 29 campaigns did not effectively engage the Californian twitter communities, analysis of tweets provided an earlier indication than public polls of the loss of public supporting this election. Prospective Twitter analysis should be added to campaign evaluation strategies. PMID:27601452

Management Strategies to Facilitate Optimal Outcomes for Patients Treated with Delayed-release Dimethyl Fumarate.

PubMed

Mayer, Lori; Fink, Mary Kay; Sammarco, Carrie; Laing, Lisa

2018-04-01

Delayed-release dimethyl fumarate is an oral disease-modifying therapy that has demonstrated significant efficacy in adults with relapsing-remitting multiple sclerosis. Incidences of flushing and gastrointestinal adverse events are common in the first month after delayed-release dimethyl fumarate initiation. Our objective was to propose mitigation strategies for adverse events related to initiation of delayed-release dimethyl fumarate in the treatment of patients with multiple sclerosis. Studies of individually developed mitigation strategies and chart reviews were evaluated. Those results, as well as mitigation protocols developed at multiple sclerosis care centers, are summarized. Key steps to optimize the effectiveness of delayed-release dimethyl fumarate treatment include education prior to and at the time of delayed-release dimethyl fumarate initiation, initiation dose protocol gradually increasing to maintenance dose, dietary suggestions for co-administration with food, gastrointestinal symptom management with over-the-counter medications, flushing symptom management with aspirin, and temporary dose reduction. Using the available evidence from clinical trials and evaluations of post-marketing studies, these strategies to manage gastrointestinal and flushing symptoms can be effective and helpful to the patient when initiating delayed-release dimethyl fumarate.

Microlensing makes lensed quasar time delays significantly time variable

NASA Astrophysics Data System (ADS)

Tie, S. S.; Kochanek, C. S.

2018-01-01

The time delays of gravitationally lensed quasars are generally believed to be unique numbers whose measurement is limited only by the quality of the light curves and the models for the contaminating contribution of gravitational microlensing to the light curves. This belief is incorrect - gravitational microlensing also produces changes in the actual time delays on the ∼day(s) light-crossing time-scale of the emission region. This is due to a combination of the inclination of the disc relative to the line of sight and the differential magnification of the temperature fluctuations producing the variability. We demonstrate this both mathematically and with direct calculations using microlensing magnification patterns. Measuring these delay fluctuations can provide a physical scale for microlensing observations, removing the need for priors on either the microlens masses or the component velocities. That time delays in lensed quasars are themselves time variable likely explains why repeated delay measurements of individual lensed quasars appear to vary by more than their estimated uncertainties. This effect is also a new important systematic problem for attempts to use time delays in lensed quasars for cosmology or to detect substructures (satellites) in lens galaxies.

Impulsive Choice, Alcohol Consumption, and Pre-Exposure to Delayed Rewards: II. Potential Mechanisms

PubMed Central

Stein, Jeffrey S.; Renda, C. Renee; Hinnenkamp, Jay E.; Madden, Gregory J.

2014-01-01

In a prior study (Stein et al., 2013), we reported that rats pre-exposed to delayed rewards made fewer impulsive choices, but consumed more alcohol (12% wt/vol), than rats pre-exposed to immediate rewards. To understand the mechanisms that produced these findings, we again pre-exposed rats to either delayed (17.5 s; n = 32) or immediate (n = 30) rewards. In post-tests, delay-exposed rats made significantly fewer impulsive choices at both 15- and 30-s delays to a larger, later food reward than the immediacy-exposed comparison group. Behavior in an open-field test provided little evidence of differential stress exposure between groups. Further, consumption of either 12% alcohol or isocaloric sucrose in subsequent tests did not differ between groups. Because Stein et al. introduced alcohol concentration gradually (3–12%), we speculate that their group differences in 12% alcohol consumption were not determined by alcohol’s pharmacological effects, but by another variable (e.g., taste) that was preserved as an artifact from lower concentrations. We conclude that pre-exposure to delayed rewards generalizes beyond the pre-exposure delay; however, this same experimental variable does not robustly influence alcohol consumption. PMID:25418607

It's about time: Earlier rewards increase intrinsic motivation.

PubMed

Woolley, Kaitlin; Fishbach, Ayelet

2018-06-01

Can immediate (vs. delayed) rewards increase intrinsic motivation? Prior research compared the presence versus absence of rewards. By contrast, this research compared immediate versus delayed rewards, predicting that more immediate rewards increase intrinsic motivation by creating a perceptual fusion between the activity and its goal (i.e., the reward). In support of the hypothesis, framing a reward from watching a news program as more immediate (vs. delayed) increased intrinsic motivation to watch the program (Study 1), and receiving more immediate bonus (vs. delayed, Study 2; and vs. delayed and no bonus, Study 3) increased intrinsic motivation in an experimental task. The effect of reward timing was mediated by the strength of the association between an activity and a reward, and was specific to intrinsic (vs. extrinsic) motivation-immediacy influenced the positive experience of an activity, but not perceived outcome importance (Study 4). In addition, the effect of the timing of rewards was independent of the effect of the magnitude of the rewards (Study 5). (PsycINFO Database Record (c) 2018 APA, all rights reserved).

LIGHT EXPOSURE AMONG ADOLESCENTS WITH DELAYED SLEEP PHASE DISORDER: A PROSPECTIVE COHORT STUDY

PubMed Central

Auger, R. Robert; Burgess, Helen J.; Dierkhising, Ross A.; Sharma, Ruchi G.; Slocumb, Nancy L.

2012-01-01

Our study objective was to compare light exposure and sleep parameters between adolescents with delayed sleep phase disorder (n=16, 15.3 ± 1.8 years) and unaffected controls (n=22, 13.7 ± 2.4 years) using a prospective cohort design. Participants wore wrist actigraphs with photosensors for 14 days. Mean hourly lux levels from 20:00-05:00 h and 05:00-14:00 h were examined, in addition to the 9-hour intervals prior to sleep onset and after sleep offset. Sleep parameters were compared separately, and were also included as covariates within models that analyzed associations with specified light intervals. Additional covariates included group and school night status. Adolescent subjects with delayed sleep phase disorder received more evening (p<0.02, 22:00-02:00 h) and less morning light (p<0.05, 08:00-09:00 h and 10:00-12:00 h) than controls, but had less pre-sleep exposure with adjustments for the time of sleep onset (p<0.03, fifth-seventh hours prior to onset hour). No differences were identified with respect to the sleep offset interval. Increased total sleep time and later sleep offset times were associated with decreased evening (p<0.001 and p=0.02, respectively) and morning (p=0.01 and p<0.001, respectively) exposure, and later sleep onset times were associated with increased evening exposure (p<0.001). Increased total sleep time also correlated with increased exposure during the 9 hours before sleep-onset (p=0.01), and a later sleep onset time corresponded with decreased exposure during the same interval (p<0.001). Outcomes persisted regardless of school night status. In conclusion, light exposure interpretation requires adjustments for sleep timing among adolescents with delayed sleep phase disorder. Pre- and post-sleep exposure do not appear to contribute directly to phase delays. Sensitivity to morning light may be reduced among adolescents with delayed sleep phase disorder. PMID:22080736

11 CFR 9002.5 - Fund.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 11 Federal Elections 1 2011-01-01 2011-01-01 false Fund. 9002.5 Section 9002.5 Federal Elections FEDERAL ELECTION COMMISSION PRESIDENTIAL ELECTION CAMPAIGN FUND: GENERAL ELECTION FINANCING DEFINITIONS § 9002.5 Fund. Fund means the Presidential Election Campaign Fund established by 26 U.S.C. 9006(a). ...

11 CFR 9002.5 - Fund.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 11 Federal Elections 1 2010-01-01 2010-01-01 false Fund. 9002.5 Section 9002.5 Federal Elections FEDERAL ELECTION COMMISSION PRESIDENTIAL ELECTION CAMPAIGN FUND: GENERAL ELECTION FINANCING DEFINITIONS § 9002.5 Fund. Fund means the Presidential Election Campaign Fund established by 26 U.S.C. 9006(a). ...

Are elected health boards an effective mechanism for public participation in health service governance?

PubMed Central

Gauld, Robin

2010-01-01

Abstract Background  There is growing interest in the idea of elected members on health service governing boards as a means to induce public participation in planning and decision making, yet studies of elected boards are limited. Whether elected boards are an effective mechanism for public participation remains unclear. Setting and participants  This article discusses the experiences of New Zealand where, since 2001, there have been three sets of elections for District Health Boards. Information on candidates and election results is presented along with data gathered via post‐election voter surveys. The article also considers the broader regulatory context within which the elected boards must operate. Discussion and conclusions  The New Zealand experience illustrates that elected health boards may not be an effective mechanism for public participation. Voter turnout has declined since the inaugural elections of 2001, and non‐voters form the majority. Reasons for not voting include failure to receive voting papers, a lack of interest, or no knowledge of elections. The elections have also failed to produce minority representation, while the capacity for elected members to represent their communities is subject to constraints. On the upside, elections have enabled public involvement in various dimensions of participation, including oversight and processes of governance. New Zealand’s mixed performance suggests that elected boards may need to be complemented with other participatory channels, if increased public participation is the goal. PMID:20579118

Are elected health boards an effective mechanism for public participation in health service governance?

PubMed

Gauld, Robin

2010-12-01

There is growing interest in the idea of elected members on health service governing boards as a means to induce public participation in planning and decision making, yet studies of elected boards are limited. Whether elected boards are an effective mechanism for public participation remains unclear. This article discusses the experiences of New Zealand where, since 2001, there have been three sets of elections for District Health Boards. Information on candidates and election results is presented along with data gathered via post-election voter surveys. The article also considers the broader regulatory context within which the elected boards must operate. The New Zealand experience illustrates that elected health boards may not be an effective mechanism for public participation. Voter turnout has declined since the inaugural elections of 2001, and non-voters form the majority. Reasons for not voting include failure to receive voting papers, a lack of interest, or no knowledge of elections. The elections have also failed to produce minority representation, while the capacity for elected members to represent their communities is subject to constraints. On the upside, elections have enabled public involvement in various dimensions of participation, including oversight and processes of governance. New Zealand's mixed performance suggests that elected boards may need to be complemented with other participatory channels, if increased public participation is the goal. © 2010 Blackwell Publishing Ltd.

26 CFR 1.4-2 - Elections.

Code of Federal Regulations, 2010 CFR

2010-04-01

... INTERNAL REVENUE SERVICE, DEPARTMENT OF THE TREASURY INCOME TAX INCOME TAXES Normal Taxes and Surtaxes § 1.4-2 Elections. (a) Making of election. The election to pay the optional tax imposed under section 3... tax under section 3 as an election to take the standard deduction, and for treating an election to...

The mass-sheet degeneracy and time-delay cosmography: analysis of the strong lens RXJ1131-1231

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

Birrer, Simon; Amara, Adam; Refregier, Alexandre, E-mail: simon.birrer@phys.ethz.ch, E-mail: adam.amara@phys.ethz.ch, E-mail: alexandre.refregier@phys.ethz.ch

We present extended modelling of the strong lens system RXJ1131-1231 with archival data in two HST bands in combination with existing line-of-sight contribution and velocity dispersion estimates. Our focus is on source size and its influence on time-delay cosmography. We therefore examine the impact of mass-sheet degeneracy and especially the degeneracy pointed out by Schneider and Sluse (2013) [1] using the source reconstruction scale. We also extend on previous work by further exploring the effects of priors on the kinematics of the lens and the external convergence in the environment of the lensing system. Our results coming from RXJ1131-1231 aremore » given in a simple analytic form so that they can be easily combined with constraints coming from other cosmological probes. We find that the choice of priors on lens model parameters and source size are subdominant for the statistical errors for H {sub 0} measurements of this systems. The choice of prior for the source is sub-dominant at present (2% uncertainty on H {sub 0}) but may be relevant for future studies. More importantly, we find that the priors on the kinematic anisotropy of the lens galaxy have a significant impact on our cosmological inference. When incorporating all the above modeling uncertainties, we find H {sub 0} = 86.6{sup +6.8}{sub -6.9} km s{sup -1} Mpc{sup -1}, when using kinematic priors similar to other studies. When we use a different kinematic prior motivated by Barnabè et al. (2012) [2] but covering the same anisotropic range, we find H {sub 0} = 74.5{sup +8.0}{sub -7.8} km s{sup -1} Mpc{sup -1}. This means that the choice of kinematic modeling and priors have a significant impact on cosmographic inferences. The way forward is either to get better velocity dispersion measures which would down weight the impact of the priors or to construct physically motivated priors for the velocity dispersion model.« less

Consent for pediatric anesthesia: an observational study.

PubMed

Lagana, Zoe; Foster, Andrew; Bibbo, Adriana; Dowling, Kate; Cyna, Allan M

2012-08-01

Informed consent prior to anesthesia is an important part of the pediatric pre-anesthetic consultation. This study aimed to observe and identify the number and nature of the anesthesia risks considered and communicated to parents/guardians and children during the pediatric informed consent process on the day of elective surgery. A convenience sample of anesthetists had their pre-anesthesia consultations voice recorded, prior to elective surgery, during a 4-month period at the largest tertiary referral centre for pediatric care in South Australia. A data collection form was used to note baseline demographic data, and voice recording transcripts were independently documented by two researchers and subsequently compared for accuracy regarding the number and nature of risks discussed. Of the 96 voice recordings, 91 (92%) were suitable for the analysis. The five most commonly discussed risks were as follows: nausea and vomiting (36%); sore throat (35%); allergy (29%); hypoxia (25%); and emergence delirium (19%). Twenty-seven pre-anesthetic consultations (30%) were found to have had no discussion of anesthetic risk at all while a further 23 consultations (26%) incorporated general statements inferring that anesthesia carried risks, but with no elaboration about their nature, ramifications or incidence. The median number of risks (IQR) specifically mentioned per consultation was higher, 3 (1) vs 1 (1), P < 0.05, when the consultation was performed by a trainee rather than a consultant anesthetist and when the patient had previous anesthesia experience odds ratio 0.34, 95% CI [0.13, 0.87], P = 0.025. The pediatric anesthesia risk discussion is very variable. Trainees tend to discuss more specific risks than consultants and a patient's previous experience of anesthesia was associated with a more limited discussion of anesthesia risk. © 2011 Blackwell Publishing Ltd.

[Features of sexual development of adolescent boys in cities of Caspian region of the Republic of Kazakhstan].

PubMed

Kurmangaliev, O M; Gumarova, Zh Zh; Zasorin, B V

2014-01-01

The complex estimation of parameters of the sexual development of adolescent boys aged 14-16 years had been done in cities of Aktay and Atyrau, in Caspian region of Western Kazakhstan. Adolescent boys in cities of Caspian region of the Republic of Kazakhstan were found to have tendency to the delayed puberty according to Tanner score. Retarded sexual development is manifested by the some retardation in growth of genitals and escutcheon, in comparison with their peers from control group. The absence of differences in general physical development, as evidenced by anthropometry data, does not exclude the specific (elective) character of the impact of urbanogenic factors on growing male body, which is typical impact of hard metals salts.

A 45-year-old man presenting with anterior compartment syndrome three weeks following conservative treatment of an Achilles tendon rupture.

PubMed

van Niekerk, Michael; Jawad, Farrah; Huntley, James S; McCowan, Stuart

2011-05-01

Compartment syndrome complicating a ruptured Achilles tendon has previously been reported in a surgically treated patient. However--to our knowledge--this is the first report of compartment syndrome following conservative treatment. A 45-year-old man ruptured his Achilles tendon and elected to have treatment in an equinus cast. Three weeks later, he developed compartment syndrome and despite fasciotomy, required surgical debridement of his anterior compartment. Delay in both diagnosis and subsequent fasciotomy resulted in a poor outcome. Any suspicion of compartment syndrome mandates early compartmental pressure monitoring. The exact aetiology is uncertain but we speculate that the equinus position of his ankle combined with weight-bearing, was a major contributing factor.

5 CFR 839.621 - Can I cancel my FERS election if I was in the wrong retirement plan at the time I elected FERS...

Code of Federal Regulations, 2010 CFR

2010-01-01

... 5 Administrative Personnel 2 2010-01-01 2010-01-01 false Can I cancel my FERS election if I was in the wrong retirement plan at the time I elected FERS coverage and I have an election opportunity under... ERRONEOUS RETIREMENT COVERAGE CORRECTIONS ACT Making an Election Fers Elections § 839.621 Can I cancel my...

Highly Superior Autobiographical Memory: Quality and Quantity of Retention Over Time

PubMed Central

LePort, Aurora K. R.; Stark, Shauna M.; McGaugh, James L.; Stark, Craig E. L.

2016-01-01

Individuals who have Highly Superior Autobiographical Memory (HSAM) are able to recall, with considerable accuracy, details of daily experiences that occurred over many previous decades. The present study parametrically investigates the quantity and quality of details of autobiographical memories acquired 1-week, 1-month, 1-year, and 10-years prior in HSAMs and controls. In addition, we tested the consistency of details provided at the 1-week delay by testing the subjects 1 month later with a surprise assessment. At the 1-week delay, HSAMs and controls recalled an equivalent number of events. In contrast, HSAM recall performance was superior at more remote delays, with remarkable consistency following a 1-month delay. Further, we revealed a relationship between the consistency of recall and HSAMs’ obsessive–compulsive tendencies. These data suggest that HSAMs experience normal encoding, yet enhanced consolidation and later recall of autobiographical events. PMID:26834661

Testing pigeon memory in a change detection task.

PubMed

Wright, Anthony A; Katz, Jeffrey S; Magnotti, John; Elmore, L Caitlin; Babb, Stephanie; Alwin, Sarah

2010-04-01

Six pigeons were trained in a change detection task with four colors. They were shown two colored circles on a sample array, followed by a test array with the color of one circle changed. The pigeons learned to choose the changed color and transferred their performance to four unfamiliar colors, suggesting that they had learned a generalized concept of color change. They also transferred performance to test delays several times their 50-msec training delay without prior delay training. The accurate delay performance of several seconds suggests that their change detection was memory based, as opposed to a perceptual attentional capture process. These experiments are the first to show that an animal species (pigeons, in this case) can learn a change detection task identical to ones used to test human memory, thereby providing the possibility of directly comparing short-term memory processing across species.

Do Aging and Dual-Tasking Impair the Capacity to Store and Retrieve Visuospatial Information Needed to Guide Perturbation-Evoked Reach-To-Grasp Reactions?

PubMed Central

Cheng, Kenneth C.; Pratt, Jay; Maki, Brian E.

2013-01-01

A recent study involving young adults showed that rapid perturbation-evoked reach-to-grasp balance-recovery reactions can be guided successfully with visuospatial-information (VSI) retained in memory despite: 1) a reduction in endpoint accuracy due to recall-delay (time between visual occlusion and perturbation-onset, PO) and 2) slowing of the reaction when performing a concurrent cognitive task during the recall-delay interval. The present study aimed to determine whether this capacity is compromised by effects of aging. Ten healthy older adults were tested with the previous protocol and compared with the previously-tested young adults. Reactions to recover balance by grasping a small handhold were evoked by unpredictable antero-posterior platform-translation (barriers deterred stepping reactions), while using liquid-crystal goggles to occlude vision post-PO and for varying recall-delay times (0-10s) prior to PO (the handhold was moved unpredictably to one of four locations 2s prior to vision-occlusion). Subjects also performed a spatial- or non-spatial-memory cognitive task during the delay-time in a subset of trials. Results showed that older adults had slower reactions than the young across all experimental conditions. Both age groups showed similar reduction in medio-lateral end-point accuracy when recall-delay was longest (10s), but differed in the effect of recall delay on vertical hand elevation. For both age groups, engaging in either the non-spatial or spatial-memory task had similar (slowing) effects on the arm reactions; however, the older adults also showed a dual-task interference effect (poorer cognitive-task performance) that was specific to the spatial-memory task. This provides new evidence that spatial working memory plays a role in the control of perturbation-evoked balance-recovery reactions. The delays in completing the reaction that occurred when performing either cognitive task suggest that such dual-task situations in daily life could increase risk of falling in seniors, particularly when combined with the general age-related slowing that was observed across all experimental conditions. PMID:24223942

78 FR 51189 - Filing Dates for the Alabama Special Elections in the 1st Congressional District

Federal Register 2010, 2011, 2012, 2013, 2014

2013-08-20

... 1st Congressional District AGENCY: Federal Election Commission. ACTION: Notice of filing dates for... Congressional District vacated by Representative Jo Bonner. There are three possible special elections, but only... Election, the top two vote-getters will participate in a Special Runoff Election. General Election...

4 CFR 28.116 - Conduct of elections.

Code of Federal Regulations, 2010 CFR

2010-01-01

... collective bargaining agent, or withdraw such a designation; (3) Order a runoff or an additional election, if... runoff election may be held. (i) Runoff election. The Board may order a runoff election where one or more... employees eligible to vote, but none has gained a majority of the votes cast. The runoff election will be...

77 FR 56208 - Filing Dates for the Kentucky Special Election in the 4th Congressional District

Federal Register 2010, 2011, 2012, 2013, 2014

2012-09-12

... FEDERAL ELECTION COMMISSION [Notice 2012-06] Filing Dates for the Kentucky Special Election in the 4th Congressional District AGENCY: Federal Election Commission. ACTION: Notice of filing dates for special election. SUMMARY: Kentucky has scheduled a general election on November 6, 2012, to fill the U.S...

Influence of UAS Pilot Communication and Execution Delay on Controller's Acceptability Ratings of UAS-ATC Interactions

NASA Technical Reports Server (NTRS)

Vu, Kim-Phuong L.; Morales, Gregory; Chiappe, Dan; Strybel, Thomas Z.; Battiste, Vernol; Shively, Jay; Buker, Timothy J

2013-01-01

Successful integration of UAS in the NAS will require that UAS interactions with the air traffic management system be similar to interactions between manned aircraft and air traffic management. For example, UAS response times to air traffic controller (ATCo) clearances should be equivalent to those that are currently found to be acceptable with manned aircraft. Prior studies have examined communication delays with manned aircraft. Unfortunately, there is no analogous body of research for UAS. The goal of the present study was to determine how UAS pilot communication and execution delays affect ATCos' acceptability ratings of UAS pilot responses when the UAS is operating in the NAS. Eight radar-certified controllers managed traffic in a modified ZLA sector with one UAS flying in it. In separate scenarios, the UAS pilot verbal communication and execution delays were either short (1.5 s) or long (5 s) and either constant or variable. The ATCo acceptability of UAS pilot communication and execution delays were measured subjectively via post trial ratings. UAS verbal pilot communication delay, were rated as acceptable 92% of the time when the delay was short. This acceptability level decreased to 64% when the delay was long. UAS pilot execution delay had less of an influence on ATCo acceptability ratings in the present stimulation. Implications of these findings for UAS in the NAS integration are discussed.

Inactivation of the Nucleus Reuniens/Rhomboid Causes a Delay-dependent Impairment of Spatial Working Memory

PubMed Central

Layfield, Dylan M.; Patel, Monica; Hallock, Henry; Griffin, Amy

2015-01-01

Inactivation of the rodent medial prefrontal cortex (mPFC) and hippocampus or disconnection of the hippocampus from the mPFC produces deficits in spatial working memory tasks. Previous studies have shown that delay length determines the extent to which mPFC and hippocampus functionally interact, with both structures being necessary for tasks with longer delays and either structure being sufficient for tasks with shorter delays. In addition, inactivation of the nucleus reuniens (Re) / rhomboid nucleus (Rh) of the thalamus, which has bidirectional connections with the mPFC and hippocampus, also produces deficits in these tasks. However, it is unknown how delay duration relates to the function of Re/Rh. If Re/Rh are critical in modulating mPFC-hippocampus interactions, inactivation of the RE/Rh should produce a delay-dependent impairment in spatial working memory performance. To investigate this question, groups of rats were trained on one of three different spatial working memory tasks: continuous alternation (CA), delayed alternation with a five-second delay (DA5), or with a thirty-second delay (DA30). The Re/Rh were inactivated with muscimol infusions prior to testing. The results demonstrate that inactivation of RE/Rh produces a deficit only on the two DA tasks, supporting the notion that the Re/Rh is a critical orchestrator of mPFC-HC interactions. PMID:26391450

7 CFR 273.14 - Recertification.

Code of Federal Regulations, 2010 CFR

2010-01-01

... forms, scheduling interviews, and recertifying eligible households prior to the expiration of certification periods. Households must apply for recertification and comply with interview and verification... attend an interview may result in delay or denial of benefits; and (J) Notice that the household is...

Towards Supervising Remote Dexterous Robots Across Time Delay

NASA Technical Reports Server (NTRS)

Hambuchen, Kimberly; Bluethmann, William; Goza, Michael; Ambrose, Robert; Wheeler, Kevin; Rabe, Ken

2006-01-01

The President s Vision for Space Exploration, laid out in 2004, relies heavily upon robotic exploration of the lunar surface in early phases of the program. Prior to the arrival of astronauts on the lunar surface, these robots will be required to be controlled across space and time, posing a considerable challenge for traditional telepresence techniques. Because time delays will be measured in seconds, not minutes as is the case for Mars Exploration, uploading the plan for a day seems excessive. An approach for controlling dexterous robots under intermediate time delay is presented, in which software running within a ground control cockpit predicts the intention of an immersed robot supervisor, then the remote robot autonomously executes the supervisor s intended tasks. Initial results are presented.

26 CFR 1.1335-1 - Elective method; time and manner of making election and effect thereof.

Code of Federal Regulations, 2010 CFR

2010-04-01

... Elective method; time and manner of making election and effect thereof. (a) In general. If the taxpayer... election and effect thereof. 1.1335-1 Section 1.1335-1 Internal Revenue INTERNAL REVENUE SERVICE... election to all taxable years of the taxpayer beginning after December 31, 1941. Thus, the taxpayer need...

78 FR 7781 - Filing Dates for the South Carolina Special Elections in the 1st Congressional District

Federal Register 2010, 2011, 2012, 2013, 2014

2013-02-04

... in the 1st Congressional District AGENCY: Federal Election Commission. ACTION: Notice of filing dates... Primary Election, the top two vote-getters will participate in a Special Runoff Election. General Election... participating in the South Carolina Special Primary and Special General Elections shall file a 12-day Pre...

26 CFR 1.1291-10 - Deemed sale election.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 26 Internal Revenue 11 2013-04-01 2013-04-01 false Deemed sale election. 1.1291-10 Section 1.1291... Deemed sale election. (a) Deemed sale election. This section provides rules for making the election under section 1291(d)(2)(A) (deemed sale election). Under that section, a shareholder (as defined in § 1.1291-9...

26 CFR 1.1291-10 - Deemed sale election.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 26 Internal Revenue 11 2012-04-01 2012-04-01 false Deemed sale election. 1.1291-10 Section 1.1291... Deemed sale election. (a) Deemed sale election. This section provides rules for making the election under section 1291(d)(2)(A) (deemed sale election). Under that section, a shareholder (as defined in § 1.1291-9...

42 CFR 422.62 - Election of coverage under an MA plan.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 42 Public Health 3 2013-10-01 2013-10-01 false Election of coverage under an MA plan. 422.62... Enrollment § 422.62 Election of coverage under an MA plan. (a) General: Coverage election periods—(1) Initial coverage election period for MA. The initial coverage election period is the period during which a newly MA...

42 CFR 422.62 - Election of coverage under an MA plan.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 42 Public Health 3 2010-10-01 2010-10-01 false Election of coverage under an MA plan. 422.62... § 422.62 Election of coverage under an MA plan. (a) General: Coverage election periods—(1) Initial coverage election period for MA. The initial coverage election period is the period during which a newly MA...

42 CFR 422.62 - Election of coverage under an MA plan.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 42 Public Health 3 2011-10-01 2011-10-01 false Election of coverage under an MA plan. 422.62... § 422.62 Election of coverage under an MA plan. (a) General: Coverage election periods—(1) Initial coverage election period for MA. The initial coverage election period is the period during which a newly MA...

42 CFR 422.62 - Election of coverage under an MA plan.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 42 Public Health 3 2014-10-01 2014-10-01 false Election of coverage under an MA plan. 422.62... Enrollment § 422.62 Election of coverage under an MA plan. (a) General: Coverage election periods—(1) Initial coverage election period for MA. The initial coverage election period is the period during which a newly MA...

42 CFR 422.62 - Election of coverage under an MA plan.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 42 Public Health 3 2012-10-01 2012-10-01 false Election of coverage under an MA plan. 422.62... Enrollment § 422.62 Election of coverage under an MA plan. (a) General: Coverage election periods—(1) Initial coverage election period for MA. The initial coverage election period is the period during which a newly MA...

26 CFR 12.4 - Election of Class Life Asset Depreciation Range System (ADR).

Code of Federal Regulations, 2011 CFR

2011-04-01

... 26 Internal Revenue 14 2011-04-01 2010-04-01 true Election of Class Life Asset Depreciation Range... Election of Class Life Asset Depreciation Range System (ADR). (a) Elections filed before February 1, 1972... election will be treated as an election under the Class Life Asset Depreciation Range System (ADR) as...

75 FR 12544 - Filing Dates for the Hawaii Special Election In the 1st Congressional District

Federal Register 2010, 2011, 2012, 2013, 2014

2010-03-16

... FEDERAL ELECTION COMMISSION [Notice 2010-07] Filing Dates for the Hawaii Special Election In the... special election. SUMMARY: Hawaii has scheduled a Special General Election on May 22, 2010, to fill the U... campaign committees of candidates who participate in the Hawaii Special General Election shall file a 12...

26 CFR 12.4 - Election of Class Life Asset Depreciation Range System (ADR).

Code of Federal Regulations, 2010 CFR

2010-04-01

... 26 Internal Revenue 14 2010-04-01 2010-04-01 false Election of Class Life Asset Depreciation Range... Election of Class Life Asset Depreciation Range System (ADR). (a) Elections filed before February 1, 1972... election will be treated as an election under the Class Life Asset Depreciation Range System (ADR) as...

Randomized trial of one-hour sodium bicarbonate vs standard periprocedural saline hydration in chronic kidney disease patients undergoing cardiovascular contrast procedures

PubMed Central

de Vries, Jean-Paul P. M.; Van der Heyden, Jan; Sijpkens, Yvo W. J.; van Dijkman, Paul R. M.; Wever, Jan J.; van Overhagen, Hans; Vahl, Antonie C.; Aarts, Nico; Verberk-Jonkers, Iris J. A. M.; Brulez, Harald F. H.; Hamming, Jaap F.; van der Molen, Aart J.; Cannegieter, Suzanne C.; Putter, Hein; van den Hout, Wilbert B.; Kilicsoy, Inci; Rabelink, Ton J.; Huisman, Menno V.

2018-01-01

Background Guidelines advise periprocedural saline hydration for prevention of contrast induced-acute kidney injury (CI-AKI). We analysed whether 1-hour sodium bicarbonate hydration administered solely prior to intra-arterial contrast exposure is non-inferior to standard periprocedural saline hydration in chronic kidney disease (CKD) patients undergoing elective cardiovascular diagnostic or interventional contrast procedures. Methods We performed an open-label multicentre non-inferiority trial between 2011–2014. Patients were randomized to 1 hour pre-procedure sodium bicarbonate hydration (250 ml 1.4%, N = 168) or 4–12 hours saline hydration (1000 ml 0.9%, N = 165) prior to and following contrast administration (2000 ml of saline total). Primary outcome was the relative serum creatinine increase (%) 48–96 hours post contrast exposure. Secondary outcomes were: incidence of CI-AKI (serum creatinine increase>25% or >44μmol/L), recovery of renal function, the need for dialysis, and hospital costs within two months follow-up. Results Mean relative creatinine increase was 3.1% (95%CI 0.9 to 5.2%) in the bicarbonate and 1.1% (95%CI -1.2 to 3.5%) in the saline arm, mean difference 1.9% (95%CI -1.2 to 5.1%, p-non-inferiority <0.001). CI-AKI occurred in 11 (6.7%) patients randomized to sodium bicarbonate and 12 (7.5%) to saline (p = 0.79). Renal function did not fully recover in 40.0% and 44.4% of CI-AKI patients, respectively (p = 0.84). No patient required dialysis. Mean costs for preventive hydration and clinical preparation for the contrast procedure were $1158 for sodium bicarbonate vs. $1561 for saline (p < 0.001). Conclusion Short hydration with sodium bicarbonate prior to elective cardiovascular diagnostic or therapeutic contrast procedures is non-inferior to standard periprocedural saline hydration in CKD patients with respect to renal safety and results in considerable healthcare savings. Trial registration Netherlands Trial Register (http://www.trialregister.nl/trialreg/index.asp), Nr NTR2699 PMID:29420536

Association between angiotensin converting enzyme inhibitor or angiotensin receptor blocker use prior to major elective surgery and the risk of acute dialysis

PubMed Central

2014-01-01

Background Some studies but not others suggest angiotensin converting enzyme inhibitor (ACEi) or angiotensin receptor blocker (ARB) use prior to major surgery associates with a higher risk of postoperative acute kidney injury (AKI) and death. Methods We conducted a large population-based retrospective cohort study of patients aged 66 years or older who received major elective surgery in 118 hospitals in Ontario, Canada from 1995 to 2010 (n = 237,208). We grouped the cohort into ACEi/ARB users (n = 101,494) and non-users (n = 135,714) according to whether the patient filled at least one prescription for an ACEi or ARB (or not) in the 120 days prior to surgery. Our study outcomes were acute kidney injury treated with dialysis (AKI-D) within 14 days of surgery and all-cause mortality within 90 days of surgery. Results After adjusting for potential confounders, preoperative ACEi/ARB use versus non-use was associated with 17% lower risk of post-operative AKI-D (adjusted relative risk (RR): 0.83; 95% confidence interval (CI): 0.71 to 0.98) and 9% lower risk of all-cause mortality (adjusted RR: 0.91; 95% CI: 0.87 to 0.95). Propensity score matched analyses provided similar results. The association between ACEi/ARB and AKI-D was significantly modified by the presence of preoperative chronic kidney disease (CKD) (P value for interaction < 0.001) with the observed association evident only in patients with CKD (CKD - adjusted RR: 0.62; 95% CI: 0.50 to 0.78 versus No CKD: adjusted RR: 1.00; 95% CI: 0.81 to 1.24). Conclusions In this cohort study, preoperative ACEi/ARB use versus non-use was associated with a lower risk of AKI-D, and the association was primarily evident in patients with CKD. Large, multi-centre randomized trials are needed to inform optimal ACEi/ARB use in the peri-operative setting. PMID:24694072

Smearing the opposition: implicit and explicit stigmatization of the 2008 U.S. Presidential candidates and the current U.S. President.

PubMed

Kosloff, Spee; Greenberg, Jeff; Schmader, Toni; Dechesne, Mark; Weise, David

2010-08-01

Four studies investigated whether political allegiance and salience of outgroup membership contribute to the phenomenon of acceptance of false, stigmatizing information (smears) about political candidates. Studies 1-3 were conducted in the month prior to the 2008 U.S. Presidential election and together demonstrated that pre-standing opposition to John McCain or Barack Obama, as well as the situational salience of differentiating social categories (i.e., for Obama, race; for McCain, age), contributed to the implicit activation and explicit endorsement of smearing labels (i.e., Obama is Muslim; McCain is senile). The influence of salient differentiating categories on smear acceptance was particularly pronounced among politically undecided individuals. Study 4 clarified that social category differences heighten smear acceptance, even if the salient category is semantically unrelated to the smearing label, showing that, approximately 1 year after the election, the salience of race amplified belief that Obama is a socialist among undecided people and McCain supporters. Taken together, these findings suggest that, at both implicit and explicit cognitive levels, social category differences and political allegiance contribute to acceptance of smears against political candidates. 2010 APA, all rights reserved

Monitoring trends in waiting periods in Canada for elective surgery: validation of a method using administrative data.

PubMed

Shortt, Samuel E D; Shaw, Ralph A; Elliott, David; Mackillop, William J

2004-06-01

Provincial governments require timely, economical methods to monitor surgical waiting periods. Although use of prospective procedure-specific registers would be the ideal method, a less elaborate system has been proposed that is based on physician billing data. This study assessed the validity of using the date of the last service billed prior to surgery as a proxy for the beginning of the post-referral, pre-surgical waiting period. We examined charts for 31,824 elective surgical encounters between 1992 and 1996 at an Ontario teaching hospital. The date of the last service before surgery (the last billing date) was compared with the date of the consultant's letter indicating a decision to book surgery (i.e., to begin waiting). Several surgical specialties (but excluding cardiac, orthopedic and gynecologic) had a close correlation between the dates of the last pre-surgery visit and those of the actual decision to place the patient on the waiting list. Similar results were found for 12 of 15 individually studied procedures, including some orthopedic and gynecological procedures. Used judiciously, billing data is a timely, inexpensive and generally accurate method by which provincial governments could monitor trends in waiting times for appropriately selected surgical procedures.

Effects of metoprolol therapy on cardiac troponin-I levels after elective percutaneous coronary interventions.

PubMed

Atar, Ilyas; Korkmaz, Mehmet Emin; Atar, Inci Asli; Gulmez, Oyku; Ozin, Bulent; Bozbas, Huseyin; Erol, Tansel; Aydinalp, Alp; Yildirir, Aylin; Yucel, Muammer; Muderrisoglu, Haldun

2006-03-01

Beta-blockers (BBs) have been shown to improve survival and reduce the risk of re-infarction in patients following myocardial infarction. There are conflicting data about the effects of BB therapy on cardiac biomarkers after percutaneous coronary interventions (PCIs). The aim of the study was to investigate the effects of BB use on cardiac troponin-I (cTnI) levels in patients who had undergone elective PCI. In this prospective study, 287 patients with coronary artery disease were included. Patients were randomized either to BB or control groups prior to the intervention. Blood samples for cTnI were obtained before and at 6, 24, and 36 h after the procedure. Of the 287 patients included, 143 received metoprolol succinate 100 mg/day, and 144 received no BB and served as the control group. Baseline clinical characteristics of both groups, except for history of coronary artery bypass graft surgery, were similar. We observed no significant difference in the elevation of cTnI levels between the two groups after PCI (BB group, 17 patients, 11.9%; control group, 10 patients, 6.9%; P=0.2). Metoprolol succinate therapy seems to have no cardioprotective effect in limiting troponin-I rise after PCI.

Do heads of government age more quickly? Observational study comparing mortality between elected leaders and runners-up in national elections of 17 countries

PubMed Central

Olenski, Andrew R; Abola, Matthew V

2015-01-01

Objectives To determine whether being elected to head of government is associated with accelerated mortality by studying survival differences between people elected to office and unelected runner-up candidates who never served. Design Observational study. Setting Historical survival data on elected and runner-up candidates in parliamentary or presidential elections in Australia, Austria, Canada, Denmark, Finland, France, Germany, Greece, Ireland, Italy, New Zealand, Norway, Poland, Spain, Sweden, United Kingdom, and United States, from 1722 to 2015. Participants Elected and runner-up political candidates. Main outcome measure Observed number of years alive after each candidate’s last election, relative to what would be expected for an average person of the same age and sex as the candidate during the year of the election, based on historical French and British life tables. Observed post-election life years were compared between elected candidates and runners-up, adjusting for life expectancy at time of election. A Cox proportional hazards model (adjusted for candidate’s life expectancy at the time of election) considered years until death (or years until end of study period for those not yet deceased by 9 September 2015) for elected candidates versus runners-up. Results The sample included 540 candidates: 279 winners and 261 runners-up who never served. A total of 380 candidates were deceased by 9 September 2015. Candidates who served as a head of government lived 4.4 (95% confidence interval 2.1 to 6.6) fewer years after their last election than did candidates who never served (17.8 v 13.4 years after last election; adjusted difference 2.7 (0.6 to 4.8) years). In Cox proportional hazards analysis, which considered all candidates (alive or deceased), the mortality hazard for elected candidates relative to runners-up was 1.23 (1.00 to 1.52). Conclusions Election to head of government is associated with a substantial increase in mortality risk compared with candidates in national elections who never served. PMID:26666894

Do heads of government age more quickly? Observational study comparing mortality between elected leaders and runners-up in national elections of 17 countries.

PubMed

Olenski, Andrew R; Abola, Matthew V; Jena, Anupam B

2015-12-14

To determine whether being elected to head of government is associated with accelerated mortality by studying survival differences between people elected to office and unelected runner-up candidates who never served. Observational study. Historical survival data on elected and runner-up candidates in parliamentary or presidential elections in Australia, Austria, Canada, Denmark, Finland, France, Germany, Greece, Ireland, Italy, New Zealand, Norway, Poland, Spain, Sweden, United Kingdom, and United States, from 1722 to 2015. Elected and runner-up political candidates. Observed number of years alive after each candidate's last election, relative to what would be expected for an average person of the same age and sex as the candidate during the year of the election, based on historical French and British life tables. Observed post-election life years were compared between elected candidates and runners-up, adjusting for life expectancy at time of election. A Cox proportional hazards model (adjusted for candidate's life expectancy at the time of election) considered years until death (or years until end of study period for those not yet deceased by 9 September 2015) for elected candidates versus runners-up. The sample included 540 candidates: 279 winners and 261 runners-up who never served. A total of 380 candidates were deceased by 9 September 2015. Candidates who served as a head of government lived 4.4 (95% confidence interval 2.1 to 6.6) fewer years after their last election than did candidates who never served (17.8 v 13.4 years after last election; adjusted difference 2.7 (0.6 to 4.8) years). In Cox proportional hazards analysis, which considered all candidates (alive or deceased), the mortality hazard for elected candidates relative to runners-up was 1.23 (1.00 to 1.52). Election to head of government is associated with a substantial increase in mortality risk compared with candidates in national elections who never served. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

40 CFR 81.302 - Alaska.

Code of Federal Regulations, 2011 CFR

2011-07-01

... District Northwest Arctic Borough Southeast Fairbanks Election District Upper Yukon Election District Yukon... Election District Northwest Arctic Borough Southeast Fairbanks Election District Upper Yukon Election... Nome Census Area North Slope Borough Northwest Arctic Borough Southeast Fairbanks Census Area Yukon...

A Study of Global Health Elective Outcomes

PubMed Central

Russ, Christiana M.; Tran, Tony; Silverman, Melanie; Palfrey, Judith

2017-01-01

Background and Objectives: To identify the effects of global health electives over a decade in a pediatric residency program. Methods: This was an anonymous email survey of the Boston Combined Residency alumni funded for global health electives from 2002 to 2011. A test for trend in binomial proportions and logistic regression were used to document associations between elective and participant characteristics and the effects of the electives. Qualitative data were also analyzed. Results: Of the 104 alumni with available email addresses, 69 (66%) responded, describing 94 electives. Elective products included 27 curricula developed, 11 conference presentations, and 7 academic publications. Thirty-two (46%) alumni continued global health work. Previous experience, previous travel to the site, number of global electives, and cumulative global elective time were associated with postresidency work in global health or with the underserved. Conclusions: Resident global electives resulted in significant scholarship and teaching and contributed to long-term career trajectories. PMID:28229096

Effect of 4% chlorhexidine gluconate predisinfection skin scrub prior to hepatectomy: a double-blinded, randomized control study.

PubMed

Hsieh, Ching-Shui; Cheng, Hsiu-Chi; Lin, Jen-Shiou; Kuo, Shou-Jen; Chen, Yao-Li

2014-01-01

This trial was designed to compare the efficacy of 4% chlorhexidine gluconate (CHG) with normal saline (NS) as a predisinfection skin-scrub solution prior to standard presurgical skin preparation. Data was collected at a single transplantation center where patients electing resection of hepatic tumors were recruited between October 2011 and September 2012. In total, 100 patients were consecutively enrolled for random assignment to either 4% CHG or NS as a predisinfection skin-scrub solution prior to surgery. Our aim was to assess the comparative antiseptic efficacy of CHG in this setting, focusing on cutaneous microbial colonization (at baseline, preoperatively, and postoperatively) and postsurgical site infections as primary outcome measures. Positivity rates of baseline, preoperative, and postoperative cultures were similar for both groups, showing significant declines (relative to baseline) after skin preparation and no significant postsurgical rebound. Rates of surgical site infection were also similar in both groups (CHG, 6.0%; NS, 4.1%; P = 1.0). For patients with hepatic tumors undergoing hepatectomy, the effect of 4% CHG as a predisinfection scrub solution was similar to that of NS in terms of skin decontamination and surgical site infections.

Delayed Union of a Jones Fracture in a Patient With Rothmund-Thomson Syndrome: A Case Report and Review of the Literature.

PubMed

Barisonek, Kirsten L; Protzman, Nicole M; Wobst, Garrett M; Brigido, Stephen A

2016-01-01

Rothmund-Thomson syndrome is a rare autosomal recessive genodermatosis, characterized by poikiloderma, small stature, juvenile cataracts, sparse hair, skeletal abnormalities, and a predisposition to osteogenic sarcomas and skin cancers. Although numerous skeletal abnormalities have been described in patients with Rothmund-Thomson syndrome, to our knowledge, only 1 study has shown evidence of delayed fracture healing in a patient with Rothmund-Thomson syndrome. We present the case of a 13-year-old female diagnosed with Rothmund-Thomson syndrome who demonstrated delayed union of her fifth metatarsal after a Jones fracture. She was treated conservatively for 6 weeks with non-weightbearing cast immobilization and was then transitioned to a controlled ankle motion walker for an additional 4 weeks. Two months later, however, she continued to experience pain, and, on radiographic examination, the fracture remained unchanged. Therefore, with her guardian's consent, the patient elected to undergo open reduction and internal fixation of the fifth metatarsal fracture. At 8 weeks postoperatively, the patient reported a subsidence of symptoms and had returned to normal activity. With our report, we hope to increase practitioner awareness that delayed bone healing could be a possibility in patients with Rothmund-Thomson syndrome and encourage consideration of routine imaging and supplementation with calcium and vitamin D. Additionally, the present findings suggest that patients with Rothmund-Thomson syndrome could benefit from early surgical intervention, given their poor bone healing capacity and high likelihood of nonunion. Although the association between impaired bone healing and Rothmund-Thomson syndrome is rational, additional studies are needed to determine the prevalence of chronic nonunion in this patient population. Copyright © 2016 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

11 CFR 9002.14 - Secretary.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 11 Federal Elections 1 2012-01-01 2012-01-01 false Secretary. 9002.14 Section 9002.14 Federal Elections FEDERAL ELECTION COMMISSION PRESIDENTIAL ELECTION CAMPAIGN FUND: GENERAL ELECTION FINANCING DEFINITIONS § 9002.14 Secretary. Secretary means the Secretary of the Treasury. ...

11 CFR 9002.14 - Secretary.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 11 Federal Elections 1 2011-01-01 2011-01-01 false Secretary. 9002.14 Section 9002.14 Federal Elections FEDERAL ELECTION COMMISSION PRESIDENTIAL ELECTION CAMPAIGN FUND: GENERAL ELECTION FINANCING DEFINITIONS § 9002.14 Secretary. Secretary means the Secretary of the Treasury. ...

11 CFR 9002.14 - Secretary.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 11 Federal Elections 1 2014-01-01 2014-01-01 false Secretary. 9002.14 Section 9002.14 Federal Elections FEDERAL ELECTION COMMISSION PRESIDENTIAL ELECTION CAMPAIGN FUND: GENERAL ELECTION FINANCING DEFINITIONS § 9002.14 Secretary. Secretary means the Secretary of the Treasury. ...

11 CFR 9002.14 - Secretary.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 11 Federal Elections 1 2010-01-01 2010-01-01 false Secretary. 9002.14 Section 9002.14 Federal Elections FEDERAL ELECTION COMMISSION PRESIDENTIAL ELECTION CAMPAIGN FUND: GENERAL ELECTION FINANCING DEFINITIONS § 9002.14 Secretary. Secretary means the Secretary of the Treasury. ...

11 CFR 9002.14 - Secretary.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 11 Federal Elections 1 2013-01-01 2012-01-01 true Secretary. 9002.14 Section 9002.14 Federal Elections FEDERAL ELECTION COMMISSION PRESIDENTIAL ELECTION CAMPAIGN FUND: GENERAL ELECTION FINANCING DEFINITIONS § 9002.14 Secretary. Secretary means the Secretary of the Treasury. ...

26 CFR 1.861-9 - Allocation and apportionment of interest expense.

Code of Federal Regulations, 2010 CFR

2010-04-01

... of such an election, other than in conjunction with an election to use the fair market value method... further guidance, see § 1.861-9T(a) through (f)(3)(i). (f)(3)(ii) Manner of election. The election shall... corporate shareholders. (ii) Manner of election. The election to use the asset method described in § 1.861...

11 CFR 9004.2 - Pre-election payments for minor and new party candidates.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 11 Federal Elections 1 2010-01-01 2010-01-01 false Pre-election payments for minor and new party... § 9004.2 Pre-election payments for minor and new party candidates. (a) Candidate of a minor party in the preceding election. An eligible candidate of a minor party is entitled to pre-election payments: (1) If he...

11 CFR 9004.2 - Pre-election payments for minor and new party candidates.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 11 Federal Elections 1 2011-01-01 2011-01-01 false Pre-election payments for minor and new party... § 9004.2 Pre-election payments for minor and new party candidates. (a) Candidate of a minor party in the preceding election. An eligible candidate of a minor party is entitled to pre-election payments: (1) If he...

29 CFR 452.30 - Run-off elections.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 29 Labor 2 2011-07-01 2011-07-01 false Run-off elections. 452.30 Section 452.30 Labor Regulations... OF 1959 Frequency and Kinds of Elections § 452.30 Run-off elections. A run-off election must meet the... example, if the run-off is to be held at the same meeting as the original election, the original notice of...

Dissemination of Election Returns Information: The News Election Service during Election 1980.

ERIC Educational Resources Information Center

Garrison, Bruce

In 1964, the Associated Press, ABC News, CBS News, NBC News, and United Press International formed a consortium called the News Election Service (NES) that was designed to collect one set of election returns for the entire United States. A study was made of NES operations during the presidential election year of 1980 to determine (1) the nature of…

29 CFR 452.30 - Run-off elections.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 29 Labor 2 2010-07-01 2010-07-01 false Run-off elections. 452.30 Section 452.30 Labor Regulations... OF 1959 Frequency and Kinds of Elections § 452.30 Run-off elections. A run-off election must meet the... example, if the run-off is to be held at the same meeting as the original election, the original notice of...

Neurologic outcome of urea cycle disorder liver transplant recipients may be predicted by pretransplant neurological imaging.

PubMed

Bolton, Scott M; Campbell, Kathleen M; Kukreja, Marcia; Kohli, Rohit

2015-08-01

Liver transplantation treats the hepatic affectation of UCDs; however, irreversible neurologic damage pretransplant is difficult to assess providing transplant teams with ethical dilemmas for liver transplantation. The purpose of our study was to determine whether pretransplant neuroimaging can predict developmental outcomes post-liver-transplant in children with UCDs. Patients undergoing liver transplantation for UCDs at Cincinnati Children's Hospital Medical Center between 2002 and 2012 were identified. Neurologic assessments prior to and after transplantation were categorized into mild, moderate, or severe disability. Neuroimaging data were categorized into mild, moderate, or severe by a single pediatric neuroradiologist. Fifteen patients were identified of whom eight had neuroimaging prior to transplantation. Of the eight patients that had neuroimaging, four were categorized as severe, one moderate, and three no-to-mild delay. All four patients whose imaging was severe were found to have moderate-to-severe neurologic delay. Of the three patients with no-to-mild changes on neuroimaging two of three were found to have no-to-mild delay on developmental assessments after transplantation. Neuroimaging may be a helpful tool in determining developmental prognosis and outcomes post-liver-transplantation for UCDs. Further studies maybe needed to validate our preliminary findings. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Characteristics of an Optical Delay Line for Radar Testing

DTIC Science & Technology

2016-04-12

MANUFACTURER PERFORMANCE MEASUREMENT ....................................... 2 3 NRL PERFORMANCE MEASUREMENT ...Third-Order-Intercept (TOI) ................... 7 3.4 Phase Noise Measurement ...MANUFACTURER PERFORMANCE MEASUREMENT Figures 3 to 5 are the Miteq’s FODL performance measured by the manufacturer prior to shipping the system to NRL

Characteristic illness behaviour in assault patients: DATES syndrome.

PubMed Central

Shepherd, J P; Peak, J D; Haria, S; Sleeman, F

1995-01-01

Violent crime has become a public health issue, not least because the needs of victims have been neglected in the criminal justice system. Since this group suffer more psychological distress than victims of accidents, we compared illness experience in 433 adult assault victims with paired victims of accidents in a case control study. In the 10 year period prior to injury, there was a significant excess of hospital contacts in the assault group in relation to trauma, elective surgery and drug abuse but not to other psychiatric or medical conditions. This spectrum of disorders constitutes a previously unrecognized syndrome in young adults, probably representing the manifestations of antisocial personality. PMID:7769600

Erotic imagery and self-castration in transvestism/transsexualism: a case report.

PubMed

van Kammen, D P; Money, J

1977-01-01

After nearly 30 years of marriage, a 51-year-old man castrated himself in order to fulfill a long-standing fantasy of being a girl. There was a prior history of cross-dressing since childhood, and a reversed erotic role imagery during coitus. There was no history of schizophrenia or psychotic depression. Pair bonding with the wife was very strong. It led the patient to elect low-dose maintenance on androgen so as to permit some degree of continued marital sex. Otherwise the patient would have preferred estrogenization and, perhaps, eventual sex reassignment. The rehabilitative program as a transvestite man has continued for 3 years.

Solitary breast mass as initial presentation of clinically silent metastatic renal cell carcinoma.

PubMed

McLauglin, Sarah A; Thiel, David D; Smith, Stephen L; Wehle, Michael J; Menke, David M

2006-06-01

Metastasis to the breast from extramammary tumors is rare. Breast metastases of renal cell carcinoma (RCC) origin have been described in sporadic case reports. We present a patient with a solitary breast mass representing the manifestation of clinically silent, metastatic RCC. A 76-year-old female was 12 years prior removed from radical nephrectomy for localized RCC. Her new breast mass was identified on physical examination. Pathology of the resected mass was diagnostic of metastatic RCC and subsequent imaging studies demonstrated a 1.9 cm renal mass in her solitary kidney. The patient elected subcutaneous Interleukin-2 immunotherapy as primary treatment for her recurrent RCC.

11 CFR 9007.7 - Administrative record.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 11 Federal Elections 1 2010-01-01 2010-01-01 false Administrative record. 9007.7 Section 9007.7 Federal Elections FEDERAL ELECTION COMMISSION PRESIDENTIAL ELECTION CAMPAIGN FUND: GENERAL ELECTION... properly subject to privileges such as an attorney-client privilege, or items constituting attorney work...

Masked Ballot Voting for Receipt-Free Online Elections

NASA Astrophysics Data System (ADS)

Wen, Roland; Buckland, Richard

To prevent bribery and coercion attacks on voters, current online election schemes rely on strong physical assumptions during the election. We introduce Masked Ballot, an online voting scheme that mitigates these attacks while using a more practical assumption: untappable channels are available but only before the election. During the election voters cast ballots over completely public channels without relying on untappable channels, anonymous channels or trusted devices. Masked Ballot performs only the voting part of an election and is designed to integrate with counting schemes that compute the final election result.

Health of children adopted from Ethiopia.

PubMed

Miller, Laurie C; Tseng, Beverly; Tirella, Linda G; Chan, Wilma; Feig, Emily

2008-09-01

Since 2000, American families have adopted 1,700 children from Ethiopia. Little is known about the health and development of these children. Retrospective chart review of the arrival health status of all 50 (26F:24M) children from Ethiopia/Eritrea seen in the International Adoption Clinic. Prior to adoption, most children resided with relatives; 36% were >18 months old prior to entry into care. More than 50% were true orphans, often due to HIV. Arrival age ranged from 3 months to 15 years (mean +/- SD 4 years +/- 43.8 months). At arrival, growth z scores were near-average (weight -.59, height -.64, head circumference -.09); significantly better than adopted children Guatemala, China, or Russia seen in our clinic. However, some Ethiopian children were significantly growth delayed (WAZ < or =-2, 8%, HAZ 12%, HCZ 18%). Age at adoption did not relate to growth delays. Medical issues on arrival included intestinal parasites (53%, [14% with > or =3 types]), skin infections (45%), dental caries (25%), elevated liver transaminases (20%), latent tuberculosis (18%), and hepatitis B (2%). Age-appropriate vaccines had been administered in 15-77% of children (depending on specific vaccine). Behavior problems were uncommon. Gross/fine motor and cognitive skills were approximately 86% of expected for age. Age correlated inversely with developmental scores for cognition (r = -.49, P = .003). Five children had age reassignments. Ethiopian/Eritean adoptees differ from other groups of internationally adopted children: they reside for relatively long periods of time with relatives prior to institutionalization, often have uncertain ages, exhibit few behavioral problems at arrival, have better growth, and may have less severe developmental delays. Whether these differences at arrival predict better outcomes for the Ethiopian/Eritrean children is unknown.

78 FR 10170 - Filing Dates for the Massachusetts Senate Special Elections

Federal Register 2010, 2011, 2012, 2013, 2014

2013-02-13

... FEDERAL ELECTION COMMISSION [Notice 2013-06] Filing Dates for the Massachusetts Senate Special Elections AGENCY: Federal Election Commission. ACTION: Notice of filing dates for special election. SUMMARY... for the closing date for each report.) All principal campaign committees of candidates participating...

Impact of formulary restriction with prior authorization by an antimicrobial stewardship program

PubMed Central

Reed, Erica E.; Stevenson, Kurt B.; West, Jessica E.; Bauer, Karri A.; Goff, Debra A.

2013-01-01

In an era of increasing antimicrobial resistance and few antimicrobials in the developmental pipeline, many institutions have developed antimicrobial stewardship programs (ASPs) to help implement evidence-based (EB) strategies for ensuring appropriate utilization of these agents. EB strategies for accomplishing this include formulary restriction with prior authorization. Potential limitations to this particular strategy include delays in therapy, prescriber pushback, and unintended increases in use of un-restricted antimicrobials; however, our ASP found that implementing prior authorization for select antimicrobials along with making a significant effort to educate clinicians on criteria for use ensured more appropriate prescribing of these agents, hopefully helping to preserve their utility for years to come. PMID:23154323

Impact of formulary restriction with prior authorization by an antimicrobial stewardship program.

PubMed

Reed, Erica E; Stevenson, Kurt B; West, Jessica E; Bauer, Karri A; Goff, Debra A

2013-02-15

In an era of increasing antimicrobial resistance and few antimicrobials in the developmental pipeline, many institutions have developed antimicrobial stewardship programs (ASPs) to help implement evidence-based (EB) strategies for ensuring appropriate utilization of these agents. EB strategies for accomplishing this include formulary restriction with prior authorization. Potential limitations to this particular strategy include delays in therapy, prescriber pushback, and unintended increases in use of un-restricted antimicrobials; however, our ASP found that implementing prior authorization for select antimicrobials along with making a significant effort to educate clinicians on criteria for use ensured more appropriate prescribing of these agents, hopefully helping to preserve their utility for years to come.

Factors associated with nonunion, delayed union, and malunion in foot and ankle surgery in diabetic patients.

PubMed

Shibuya, Naohiro; Humphers, Jon M; Fluhman, Benjamin L; Jupiter, Daniel C

2013-01-01

The incidence of bone healing complications in diabetic patients is believed to be high after foot and ankle surgery. Although the association of hyperglycemia with bone healing complications has been well documented, little clinical information is available to show which diabetes-related comorbidities directly affect bone healing. Our goal was to better understand the risk factors associated with poor bone healing in the diabetic population through an exploratory, observational, retrospective, cohort study. To this end, 165 diabetic patients who had undergone arthrodesis, osteotomy, or fracture reduction were enrolled in the study to assess the risk factors associated with nonunion, delayed union, and malunion after elective and nonelective foot and/or ankle surgery. Bivariate analyses showed that a history of foot ulcer, peripheral neuropathy, and surgery duration were statistically significantly associated with bone healing complications. After adjusting for other covariates, only peripheral neuropathy, surgery duration, and hemoglobin A1c levels >7% were significantly associated statistically with bone healing complications. Of the risk factors we considered, peripheral neuropathy had the strongest association with bone healing complications. Copyright © 2013 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

Depression and anxiety diagnoses are not associated with delayed resolution of abnormal mammograms and pap tests among vulnerable women.

PubMed

Kronman, Andrea C; Freund, Karen M; Heeren, Tim; Beaver, Kristine A; Flynn, Mary; Battaglia, Tracy A

2012-04-01

Delays in care after abnormal cancer screening contribute to disparities in cancer outcomes. Women with psychiatric disorders are less likely to receive cancer screening and may also have delays in diagnostic resolution after an abnormal screening test. To determine if depression and anxiety are associated with delays in resolution after abnormal mammograms and Pap tests in a vulnerable population of urban women. We conducted retrospective chart reviews of electronic medical records to identify women who had a diagnosis of depression or anxiety in the year prior to the abnormal mammogram or Pap test. We used time-to-event analysis to analyze the outcome of time to resolution after abnormal cancer screening, and Cox proportional hazards regression modeling to control for confounding. Women receiving care in six Boston-area community health centers 2004-2005: 523 with abnormal mammograms, 474 with abnormal Pap tests. Of the women with abnormal mammogram and pap tests, 19% and 16%, respectively, had co-morbid depression. There was no difference in time to diagnostic resolution between depressed and not-depressed women for those with abnormal mammograms (aHR = 0.9, 95 CI 0.7,1.1) or Pap tests (aHR = 0.9, 95 CI 0.7,1.3). An active diagnosis of depression and/or anxiety in the year prior to an abnormal mammogram or Pap test was not associated with a prolonged time to diagnostic resolution. Our findings imply that documented mood disorders do not identify an additional barrier to resolution after abnormal cancer screening in a vulnerable population of women.

75 FR 49931 - Filing Dates for the Illinois Senate Special Election

Federal Register 2010, 2011, 2012, 2013, 2014

2010-08-16

... FEDERAL ELECTION COMMISSION [Notice 2010--16] Filing Dates for the Illinois Senate Special Election AGENCY: Federal Election Commission. ACTION: Notice of filing dates for special election. SUMMARY... date for each report). Note that these reports are in addition to the campaign committee's quarterly...

11 CFR 9006.2 - Filing dates.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 11 Federal Elections 1 2010-01-01 2010-01-01 false Filing dates. 9006.2 Section 9006.2 Federal Elections FEDERAL ELECTION COMMISSION PRESIDENTIAL ELECTION CAMPAIGN FUND: GENERAL ELECTION FINANCING REPORTS AND RECORDKEEPING § 9006.2 Filing dates. The reports required to be filed under 11 CFR 9006.1...

11 CFR 9002.7 - Minor party.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 11 Federal Elections 1 2011-01-01 2011-01-01 false Minor party. 9002.7 Section 9002.7 Federal Elections FEDERAL ELECTION COMMISSION PRESIDENTIAL ELECTION CAMPAIGN FUND: GENERAL ELECTION FINANCING DEFINITIONS § 9002.7 Minor party. Minor party means a political party whose candidate for the office of...

11 CFR 9002.7 - Minor party.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 11 Federal Elections 1 2010-01-01 2010-01-01 false Minor party. 9002.7 Section 9002.7 Federal Elections FEDERAL ELECTION COMMISSION PRESIDENTIAL ELECTION CAMPAIGN FUND: GENERAL ELECTION FINANCING DEFINITIONS § 9002.7 Minor party. Minor party means a political party whose candidate for the office of...

Changes in oral anticoagulation for elective cardioversion: results from a European cardioversion registry

PubMed Central

Papp, Judit; Zima, Endre; Bover, Ramon; Karaliute, Rasa; Rossi, Andrea; Szymanski, Catherine; Troccoli, Rossella; Schneider, Jonas; Fagerland, Morten Wang; Camm, A John; Atar, Dan

2017-01-01

Abstract Aims In patients with atrial fibrillation (AF) pharmacological or electrical cardioversion may be performed to restore sinus rhythm. The procedure is associated with an increased risk of thromboembolic events, which can be significantly reduced by adequate anticoagulation (OAC). Our aim was to create a partly prospective, partly retrospective cardioversion registry, particularly focusing on OAC strategies in different European countries, and on emerging choice of OAC over time. Methods From September 2014 to October 2015, cardioversions due to AF performed in six European city hospitals in five European countries (Hungary: Budapest-1 and -2; Italy: Bari and Pisa; France: Amiens; Spain: Madrid; and Lithuania: Kaunas) were recorded in the registry. Results A total of 1101 patients (retrospective/prospective: 679/422, male/female: 742/359, mean age: 67.3 years ± 11.2) were registered. Most of the cardioversions were electrical (97%). Oral anticoagulants were administered in 87% of the patient, the usage of non-VKA oral anticoagulants (NOACs) vs Vitamin K antagonists (VKA) was 31.5% vs 68.5%, respectively. Seventy seven percent of the patients were given oral anticoagulants more than 3 weeks prior to the procedure, and 86% more than 4 weeks after the procedure. When using VKA, international normalized ratio (INR) at cardioversion was above 2.0 in 76% of the cases. A decline in VKA usage (P = 0.033) in elective cardioversion over approximately 1 year was observed. During the observation period, there was an increase in apixaban (P < 0.001), a slight increase in rivaroxaban (P = 0.028) and no changes in dabigatran (P = 0.34) usage for elective cardioversion. There were differences in use of OAC between the countries: Spain used most VKA (89%), while France used least VKA (39%, P < 0.001). Conclusion According to current AF guidelines, NOACs are adequate alternatives to VKA for thromboembolic prevention in AF patients undergoing elective cardioversion. Our results indicate that NOAC use is increasing and there is a significant decrease in VKA use. PMID:28329309

Changes in oral anticoagulation for elective cardioversion: results from a European cardioversion registry.

PubMed

Papp, Judit; Zima, Endre; Bover, Ramon; Karaliute, Rasa; Rossi, Andrea; Szymanski, Catherine; Troccoli, Rossella; Schneider, Jonas; Fagerland, Morten Wang; Camm, A John; Atar, Dan

2017-07-01

In patients with atrial fibrillation (AF) pharmacological or electrical cardioversion may be performed to restore sinus rhythm. The procedure is associated with an increased risk of thromboembolic events, which can be significantly reduced by adequate anticoagulation (OAC). Our aim was to create a partly prospective, partly retrospective cardioversion registry, particularly focusing on OAC strategies in different European countries, and on emerging choice of OAC over time. From September 2014 to October 2015, cardioversions due to AF performed in six European city hospitals in five European countries (Hungary: Budapest-1 and -2; Italy: Bari and Pisa; France: Amiens; Spain: Madrid; and Lithuania: Kaunas) were recorded in the registry. A total of 1101 patients (retrospective/prospective: 679/422, male/female: 742/359, mean age: 67.3 years ± 11.2) were registered. Most of the cardioversions were electrical (97%). Oral anticoagulants were administered in 87% of the patient, the usage of non-VKA oral anticoagulants (NOACs) vs Vitamin K antagonists (VKA) was 31.5% vs 68.5%, respectively. Seventy seven percent of the patients were given oral anticoagulants more than 3 weeks prior to the procedure, and 86% more than 4 weeks after the procedure. When using VKA, international normalized ratio (INR) at cardioversion was above 2.0 in 76% of the cases. A decline in VKA usage (P = 0.033) in elective cardioversion over approximately 1 year was observed. During the observation period, there was an increase in apixaban (P < 0.001), a slight increase in rivaroxaban (P = 0.028) and no changes in dabigatran (P = 0.34) usage for elective cardioversion. There were differences in use of OAC between the countries: Spain used most VKA (89%), while France used least VKA (39%, P < 0.001). According to current AF guidelines, NOACs are adequate alternatives to VKA for thromboembolic prevention in AF patients undergoing elective cardioversion. Our results indicate that NOAC use is increasing and there is a significant decrease in VKA use. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2017. For permissions, please email: journals.permissions@oup.com.

Management of major vascular injury during pedicle screw instrumentation of thoracolumbar spine.

PubMed

Mirza, Aleem K; Alvi, Mohammed Ali; Naylor, Ryan M; Kerezoudis, Panagiotis; Krauss, William E; Clarke, Michelle J; Shepherd, Daniel L; Nassr, Ahmad; DeMartino, Randall R; Bydon, Mohamad

2017-12-01

Vascular injury is a rare complication of spinal instrumentation. Presentation can vary from immediate hemorrhage to pseudoaneurysm formation. In the literature, surgical approach to repair has varied based on anatomy, acuity of diagnosis, infection, and available technology. In this manuscript, we aim to describe our institutional experience with vascular injuries in thoraco-lumbar spine surgery. We report our institutional experience of three cases of vascular injury secondary to pedicle screw misplacement and their management, as well as a review of the literature. The first case had a history of previous instrumentation and presented with back pain and fever. The patient was taken for instrumentation exploration via a posterior approach. Aortic violation was discovered at T6 intraoperatively during instrumentation removal and the patient underwent emergent endovascular repair. The second case presented with chronic back pain after multiple prior posterior fusions and CT angiogram showing screw perforation on the aorta at T10. The patient underwent elective endovascular repair with synchronous removal of the instrumentation. The third case presented with radicular leg pain 6 months after L4-S1 posterior lumbar interbody fusion, with CT scan demonstrating the left S1 screw abutting the L5 nerve root and common iliac vein. The patient underwent elective instrumentation revision with intraoperative venography. Major vascular injury is a known complication of spinal surgery, especially if it involves instrumentation with pedicle screws. Treatment approach has evolved with the advancement of endovascular technology; however, open surgery remains an option when anatomy or infection is prohibitive. In the elective setting, preoperative planning with attention to surgical approach, positioning, and contingencies, should occur in a multidisciplinary fashion. Repair with an aortic stent-graft cuff may minimize unnecessary coverage of the descending thoracic aorta and intercostal arteries. Copyright © 2017 Elsevier B.V. All rights reserved.

Vascular access site complication in transfemoral coronary angiography between uninterrupted warfarin and heparin bridging.

PubMed

Wongcharoen, Wanwarang; Pinyosamosorn, Kittipong; Gunaparn, Siriluck; Boonnayhun, Suchada; Thonghong, Tasalak; Suwannasom, Pannipa; Phrommintikul, Arintaya

2017-08-01

Warfarin discontinuation with heparin bridging is a common practice in patients receiving warfarin prior to elective coronary angiography (CAG). The uninterrupted warfarin strategy has been suggested to be alternative option for patients with high thromboembolic risk. Therefore, we aimed to assess the safety of elective transfemoral CAG during uninterrupted warfarin therapy compared to heparin bridging. This study was a randomized open-label design with blinded event evaluation. The 110 consecutive patients (age ≥ 18 years) receiving warfarin before the planned transfemoral CAG were randomly assigned to either heparin bridging or uninterrupted warfarin with targeted INR (2.0-3.0). The primary outcome was the incidence of major vascular access site complications. The baseline characteristics were comparable between two groups (mean age was 60.1 ± 7.8 years, 49 males). The mean INR on the day of CAG of heparin bridging and uninterrupted warfarin groups was 1.2 ± 0.3 and 2.2 ± 0.5 (P < 0.001). The major vascular access site complications occurred in 3 of 55 (5.5%) heparin-bridging patients and in none of 55 uninterrupted warfarin patients (P = 0.243). The total vascular access site complications occurred in 6 (10.9%) heparin-bridging and one (1.8%) uninterrupted warfarin patients (P = 0.113). No patient developed either other bleeding or thromboembolic events during 7 days after CAG. We demonstrated that an uninterrupted warfarin strategy did not increase vascular access site complications in patients undergoing transfemoral CAG compared to heparin bridging therapy. Due to the safety and the ease of uninterrupted warfarin strategy, this approach should be encouraged in patients receiving long-term warfarin who undergo elective transfemoral CAG. © 2017, Wiley Periodicals, Inc.

Term Elective Induction of Labor and Perinatal Outcomes in Obese Women: Retrospective Cohort Study

PubMed Central

Lee, Vanessa R.; Darney, Blair G.; Snowden, Jonathan M.; Main, Elliott K.; Gilbert, William; Chung, Judith; Caughey, Aaron B.

2015-01-01

Objective To compare perinatal outcomes between elective induction of labor (eIOL) and expectant management in obese women. Design Retrospective cohort study. Setting Deliveries in California in 2007. Population Term, singleton, vertex, nonanomalous deliveries among obese women (n=74,725). Methods Women who underwent eIOL at 37 weeks were compared with women who were expectantly managed at that gestational age. Similar comparisons were made at 38, 39, and 40 weeks. Results were stratified by parity. Chi-square tests and multivariable logistic regression were used for statistical comparison. Main Outcome Measures Method of delivery, severe perineal lacerations, postpartum hemorrhage, chorioamnionitis, macrosomia, shoulder dystocia, brachial plexus injury, respiratory distress syndrome. Results The odds of cesarean delivery were lower among nulliparous women with eIOL at 37 weeks (odds ratio [OR] 0.55, 95% confidence interval [CI] 0.34–0.90) and 39 weeks (OR 0.77, 95% CI 0.63–0.95) compared to expectant management. Among multiparous women with a prior vaginal delivery, eIOL at 37 (OR 0.39, 95% CI 0.24–0.64), 38 (OR 0.65, 95% CI 0.51–0.82), and 39 weeks (OR 0.67, 95% CI 0.56–0.81) was associated with lower odds of cesarean. Additionally, eIOL at 38, 39, and 40 weeks was associated with lower odds of macrosomia. There were no differences in the odds of operative vaginal delivery, lacerations, brachial plexus injury, or respiratory distress syndrome. Conclusions In obese women, term eIOL may decrease the risk of cesarean delivery, particularly in multiparas, without increasing the risks of other adverse outcomes when compared with expectant management. Tweetable Abstract Elective induction of labor in obese women does not increase risk of cesarean or other perinatal morbidities. PMID:26840780

Twitter analysis of California's failed campaign to raise the state's tobacco tax by popular vote in 2012.

PubMed

Feng, Miao; Pierce, John P; Szczypka, Glen; Vera, Lisa; Emery, Sherry

2017-07-01

The rapid diffusion of social media in the past decade has allowed community members to sway the discourse on elections. We use analyses of social media to provide insight into why the strong public support 1 year prior to the election did not result in an increased tobacco tax from the 2012 California Proposition 29 vote. Using the Twitter historical Firehose, we chose all tweets on Proposition 29 posted between 1 January and 5 June 2012 differentiating between early and late campaign periods. Tweets were coded for valence, theme and source. We analysed metadata to characterise accounts. Television ratings data in 9 major California media markets were used to show the strength of the 2 campaigns. 'No on 29' launched television advertising earlier and with much higher household gross rating points (GRPs) than the 'Yes on 29' campaign. Among 17 099 relevant tweets from 8769 unique accounts, 53% supported Proposition 29, 27% opposed and 20% were neutral. Just under half (43%) were from accounts affiliated with the campaigns. Two-thirds of campaign messages originated outside California. The 'Yes' campaign focused on simple health messages, which were equally represented in both campaign periods. However, anti-tax tweets increased at relative to pro-tax tweets in the second period. Although the Prop 29 campaigns did not effectively engage the Californian twitter communities, analysis of tweets provided an earlier indication than public polls of the loss of public supporting this election. Prospective Twitter analysis should be added to campaign evaluation strategies. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Implementation of Preoperative Screening Criteria Lowers Infection and Complication Rates Following Elective Total Hip Arthroplasty and Total Knee Arthroplasty in a Veteran Population.

PubMed

Nussenbaum, Fernando D; Rodriguez-Quintana, David; Fish, Sara M; Green, David M; Cahill, Catherine W

2018-01-01

Total hip arthroplasty (THA) and total knee arthroplasty (TKA) are common procedures with a risk of complications. Attempting to minimize complications, our institution implemented preoperative screening criteria for patients undergoing elective total joint replacement. Our study aimed to determine if screening criteria lowered total complications and/or surgical site infections (SSI). Two groups of consecutive patients undergoing TKA and THA at a single Veterans Affairs facility were evaluated prior to and after implementation of screening criteria, 520 and 475 respectively. Screening criteria included hemoglobin A1c ≤7, hemoglobin ≥11, body mass index ≤35, and albumin ≥3.5. Groups were analyzed for demographics, preoperative comorbidities, and postoperative complications. Rates of total complications and SSI were compared. Average follow-up was at least 2 years with minimum of 1 year. Demographics and comorbidities outside the screening criteria were similar. Total complication rate was reduced from 35.4% to 14.8% (P < .01) after implementation of screening criteria. For TKA, total complications were reduced from 33.1% to 15.0% (P < .01) and for THA they were reduced from 42.4% to 14.2% (P < .01). SSI rates for combined TKA and THA were reduced from 4.4% to 1.3% (P < .01). For knees, SSI was reduced from 4.6% to 1.3% (P = .01) and was statistically significant. For THA, SSI decreased from 3.8% to 1.2% (P < .05). Our institution saw a statistically significant decrease in both SSI and total complications following implementation of preoperative screening criteria for elective TKA and THA. Published by Elsevier Inc.

Behavioural, educational and respiratory outcomes of antenatal betamethasone for term caesarean section (ASTECS trial)

PubMed Central

Stutchfield, Peter Roy; Whitaker, Rhiannon; Gliddon, Angela E; Hobson, Lucie; Kotecha, Sailesh; Doull, Iolo J M

2013-01-01

Objectives To determine whether antenatal betamethasone prior to elective term caesarean section (CS) affects long term behavioural, cognitive or developmental outcome, and whether the risk of asthma or atopic disease is reduced. Design A questionnaire based follow-up of a multicentre randomised controlled trial (Antenatal Steroids for Term Elective Caesarean Section, BMJ 2005). Setting Four UK study centres from the original trial. Participants 862 participants from the four largest recruiting centres, 92% of the original study. 824 (96%) were traced and 799 (93%) were successfully contacted. Fifty-one percent (407/799) completed and returned the questionnaire. The children were aged 8–15 years (median 12.2 years, 52% girls). 386 gave consent to contact schools with 352 (91%) reports received. Main outcome measures Questionnaires including a strengths and difficulties questionnaire, International Study of Asthma and Allergies in Childhood, general health and school performance. Results There were no significant differences between children whose mothers received betamethasone and controls for the mean total strengths and difficulties questionnaire scores and subscores for hyperactivity, emotional symptoms, prosocial behaviour, conduct or peer problems. 25 (12%) children whose mothers received betamethasone had reported learning difficulties compared with 27 (14%) control children. The proportion of children who achieved standard assessment tests KS2 exams level 4 or above for mathematics, English or science was similar as were the rates of ever reported wheeze (30% vs 30%), asthma (24% vs 21%), eczema (34% vs 37%) and hay fever (25% vs 27%). Conclusions Antenatal betamethasone did not result in any adverse outcomes or reduction in asthma or atopy. It should be considered for elective CS at 37–38 weeks of gestation. Trial registration: Original trial was preregistration, the trial publication is BMJ. 2005 Sep 24;331(7518):662. PMID:23424017

Impact on Patient Safety and Satisfaction of Implementation of an Outpatient Clinic in Interventional Radiology (IPSIPOLI-Study): A Quasi-Experimental Prospective Study

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

Lutjeboer, Jacob, E-mail: j.lutjeboer@lumc.nl; Burgmans, Mark Christiaan, E-mail: m.c.burgmans@lumc.nl, E-mail: mburgmans@hotmail.com; Chung, Kaman, E-mail: kaman.chung10@gmail.com

PurposeInterventional radiology (IR) procedures are associated with high rates of preparation and planning errors. In many centers, pre-procedural consultation and screening of patients is performed by referring physicians. Interventional radiologists have better knowledge about procedure details and risks, but often only get acquainted with the patient in the procedure room. We hypothesized that patient safety (PS) and patient satisfaction (PSAT) in elective IR procedures would improve by implementation of a pre-procedural visit to an outpatient IR clinic.Material and MethodsIRB approval was obtained and informed consent was waived. PS and PSAT were measured in patients undergoing elective IR procedures before (controlmore » group; n = 110) and after (experimental group; n = 110) implementation of an outpatient IR clinic. PS was measured as the number of process deviations. PSAT was assessed using a questionnaire measuring Likert scores of three dimensions: interpersonal care aspects, information/communication, and patient participation. Differences in PS and PSAT between the two groups were compared using an independent t test.ResultsThe average number of process deviations per patient was 0.39 in the control group compared to 0.06 in the experimental group (p < 0.001). In 9.1 % patients in the control group, no legal informed consent was obtained compared to 0 % in the experimental group. The mean overall Likert score was significantly higher in the experimental group compared to the control group: 2.68 (SD 0.314) versus 2.48 (SD 0.381) (p < 0.001).ConclusionPS and PSAT improve significantly if patients receive consultation and screening in an IR outpatient clinic prior to elective IR procedures.« less

Venous thromboembolism: patient awareness and education in the pre-operative assessment clinic.

PubMed

Haymes, Adam

2016-04-01

Each year venous thromboembolism (VTE) causes up to 60,000 deaths in the UK, many resulting from hospital-acquired thromboses following elective surgery. National Institute for Health and Clinical Excellence (NICE) guidelines state that all elective surgical patients should receive verbal and written information pre-operatively regarding the risks of developing VTE. This audit assessed elective surgical patient's prior awareness of VTE and examined how effective targeted patient education during the pre-operative assessment is in increasing this awareness. A 13 point questionnaire designed to assess a pre-operative patient's understanding of topics relating to VTE was provided to consecutive patients identified as being at risk of developing VTE at the end of their pre-operative assessment over a two-week period. A total of 68 questionnaires were completed. Provision of verbal and written information was poor (47 %, n = 32 and 47 %, n = 32 respectively). Despite this, 71 % (n = 48) of patients were aware of the consequences of developing VTE. Many patients correctly identified surgery (71 %, n = 48), immobility (71 %, n = 48) and being overweight (68 %, n = 46) as risk factors, but not dehydration (47 %, n = 32). Lack of awareness regarding personal methods to reduce the risk of developing a VTE post-operatively (24 %, n = 16) and potential side-effects of medical prophylaxis (32 %, n = 22) were also identified. Many patients already possess an awareness of VTE, however, specific knowledge regarding its risk factors and methods of prevention is lacking. Provision of targeted written and verbal educational information during the pre-operative assessment is an effective method of increasing a patient's awareness of these topics. Increased patient awareness may empower patients in their post-operative recovery and enable them to make more informed decisions regarding VTE prophylaxis options.

Global Health Education in Gastroenterology Fellowship: A National Survey.

PubMed

Jirapinyo, Pichamol; Hunt, Rachel S; Tabak, Ying P; Proctor, Deborah D; Makrauer, Frederick L

2016-12-01

Interest in global health (GH) education is increasing across disciplines. To assess exposure to and perception of GH training among gastroenterology fellows and program directors across the USA. Design: Electronic survey study. The questionnaire was circulated to accredited US gastroenterology fellowship programs, with the assistance of the American Gastroenterological Association. Gastroenterology program directors and fellows. The questionnaire was returned by 127 respondents (47 program directors, 78 fellows) from 55 training programs (36 % of all training programs). 61 % of respondents had prior experience in GH. 17 % of programs offered GH curriculum with international elective (13 %), didactic (9 %), and research activity (7 %) being the most common. Fellows had adequate experience managing hepatitis B (93 %), cholangiocarcinoma (84 %), and intrahepatic duct stones (84 %). 74, 69 and 68 % reported having little to no experience managing hepatitis E, tuberculosis mesenteritis, or epidemic infectious enteritis, respectively. Most fellows would participate in an elective in an underserved area locally (81 %) or a 4-week elective abroad (71 %), if available. 44 % of fellows planned on working or volunteering abroad after fellowship. Barriers to establishing GH curriculum included funding (94 %), scheduling (88 %), and a lack of standardized objectives (78 %). Lack of interest, however, was not a concern. Fellows (49 %), more than faculty (29 %) (χ 2  = 21.9; p = 0.03), believed that GH education should be included in fellowship curriculum. Program directors and trainees recognize the importance of GH education. However, only 17 % of ACGME-approved fellowship programs offer the opportunity. Global health curriculum may enhance gastroenterology training.

Impact of Child Life Services on Children and Families Admitted to Start the Ketogenic Diet.

PubMed

Kossoff, Eric H; Sutter, Lindsay; Doerrer, Sarah C; Haney, Courtney A; Turner, Zahava

2017-08-01

Traditionally the ketogenic diet is started as an inpatient admission to the hospital. Starting in January 2015, child life services were made formally available during ketogenic diet admissions to help families cope. One-page surveys were then provided to 15 parents on the day of discharge and again after 3 months. Every family believed that the child life services were helpful. Children who were developmentally appropriate/mildly delayed had higher parent-reported anxiety scores than those who were moderate to severely delayed (4.4 vs 1.0, P = .02). At 3 months, child life services were deemed very helpful for the parents (mean score: 8.9, range: 5-10), and were more helpful for the parent than the child (mean 6.2, range 1-10, P = .047). One of the most helpful services was a prior phone call to parents 1 week prior. In this small pilot study, child life involvement during the start of the ketogenic diet was highly useful.

Working Memory Delay Activity Predicts Individual Differences in Cognitive Abilities

PubMed Central

Unsworth, Nash; Fukuda, Keisuke; Awh, Edward; Vogel, Edward K.

2015-01-01

A great deal of prior research has examined the relation between estimates of working memory and cognitive abilities. Yet, the neural mechanisms that account for these relations are still not very well understood. The current study explored whether individual differences in working memory delay activity would be a significant predictor of cognitive abilities. A large number of participants performed multiple measures of capacity, attention control, long-term memory, working memory span, and fluid intelligence, and latent variable analyses were used to examine the data. During two working memory change detection tasks, we acquired EEG data and examined the contra-lateral delay activity. The results demonstrated that the contralateral delay activity was significantly related to cognitive abilities, and importantly these relations were because of individual differences in both capacity and attention control. These results suggest that individual differences in working memory delay activity predict individual differences in a broad range of cognitive abilities, and this is because of both differences in the number of items that can be maintained and the ability to control access to working memory. PMID:25436671

Controlling state explosion during automatic verification of delay-insensitive and delay-constrained VLSI systems using the POM verifier

NASA Technical Reports Server (NTRS)

Probst, D.; Jensen, L.

1991-01-01

Delay-insensitive VLSI systems have a certain appeal on the ground due to difficulties with clocks; they are even more attractive in space. We answer the question, is it possible to control state explosion arising from various sources during automatic verification (model checking) of delay-insensitive systems? State explosion due to concurrency is handled by introducing a partial-order representation for systems, and defining system correctness as a simple relation between two partial orders on the same set of system events (a graph problem). State explosion due to nondeterminism (chiefly arbitration) is handled when the system to be verified has a clean, finite recurrence structure. Backwards branching is a further optimization. The heart of this approach is the ability, during model checking, to discover a compact finite presentation of the verified system without prior composition of system components. The fully-implemented POM verification system has polynomial space and time performance on traditional asynchronous-circuit benchmarks that are exponential in space and time for other verification systems. We also sketch the generalization of this approach to handle delay-constrained VLSI systems.

Mechanism of delayed intracranial hypertension after cerebroventricular infusions in conscious rats

NASA Technical Reports Server (NTRS)

Morrow, B. A.; Holt, M. R.; Starcevic, V. P.; Keil, L. C.; Severs, W. B.

1992-01-01

Prior studies showed that cerebroventricular infusions of artificial cerebrospinal fluid, 8 microliter/min for 10 min, followed by a 10 min rest and a 24 h infusion of 0.5 microliters/min, raised cerebrospinal fluid pressure (CSFp) of conscious, unrestrained rats after about 2 h. Here, we report that the 10 min infusion alone evoked a delayed, prolonged rise in CSFp. Pressure during the infusion itself rose and recovered quickly, as is usually reported. Pressure/volume tests, used to calculate resistance to outflow (Ro) and compliance (C), revealed that infusions increased Ro and decreased C, after a delay (P less than 0.05). The rise in CSFp after infusion was blocked by pretreatment with acetazolamide + ouabain (P less than 0.05), but the delayed changes in Ro and C were unaffected. We suggest that the 10 min infusion of a sterile, balanced salt solution has a primary effect that increases Ro; as CSF synthesis continues, C is exhausted and the delayed rise in CSFp ensues. This non-traumatic method of raising CSFp may be a useful method to study intracranial fluid dynamics.

Working memory delay activity predicts individual differences in cognitive abilities.

PubMed

Unsworth, Nash; Fukuda, Keisuke; Awh, Edward; Vogel, Edward K

2015-05-01

A great deal of prior research has examined the relation between estimates of working memory and cognitive abilities. Yet, the neural mechanisms that account for these relations are still not very well understood. The current study explored whether individual differences in working memory delay activity would be a significant predictor of cognitive abilities. A large number of participants performed multiple measures of capacity, attention control, long-term memory, working memory span, and fluid intelligence, and latent variable analyses were used to examine the data. During two working memory change detection tasks, we acquired EEG data and examined the contralateral delay activity. The results demonstrated that the contralateral delay activity was significantly related to cognitive abilities, and importantly these relations were because of individual differences in both capacity and attention control. These results suggest that individual differences in working memory delay activity predict individual differences in a broad range of cognitive abilities, and this is because of both differences in the number of items that can be maintained and the ability to control access to working memory.

5 CFR 733.101 - Definitions.

Code of Federal Regulations, 2010 CFR

2010-01-01

... includes a primary, special, runoff, or general election. Employee means: Any individual (other than the... election to any elective office whether or not the person is elected. An individual is deemed to be a...'s nomination or election. Campaign means all acts done by a candidate and his or her adherents to...

29 CFR 452.23 - Frequency of elections.

Code of Federal Regulations, 2010 CFR

2010-07-01

... STANDARDS GENERAL STATEMENT CONCERNING THE ELECTION PROVISIONS OF THE LABOR-MANAGEMENT REPORTING AND DISCLOSURE ACT OF 1959 Frequency and Kinds of Elections § 452.23 Frequency of elections. The Act requires... 29 Labor 2 2010-07-01 2010-07-01 false Frequency of elections. 452.23 Section 452.23 Labor...

11 CFR 102.5 - Organizations financing political activity in connection with Federal and non-Federal elections...

Code of Federal Regulations, 2010 CFR

2010-01-01

...: Accounts and accounting. 102.5 Section 102.5 Federal Elections FEDERAL ELECTION COMMISSION GENERAL... connection with non-Federal elections. Administrative expenses for State, district, and local party... 11 Federal Elections 1 2010-01-01 2010-01-01 false Organizations financing political activity in...

5 CFR 2422.28 - Runoff elections.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 5 Administrative Personnel 3 2010-01-01 2010-01-01 false Runoff elections. 2422.28 Section 2422.28... FEDERAL LABOR RELATIONS AUTHORITY REPRESENTATION PROCEEDINGS § 2422.28 Runoff elections. (a) When a runoff may be held. A runoff election is required in an election involving at least three (3) choices, one of...

11 CFR 9428.6 - Chief state election official.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 11 Federal Elections 1 2011-01-01 2011-01-01 false Chief state election official. 9428.6 Section 9428.6 Federal Elections ELECTION ASSISTANCE COMMISSION NATIONAL VOTER REGISTRATION ACT (42 U.S.C... constitution or statutory citations, including but not limited to the specific state requirements, if any...

11 CFR 9428.6 - Chief state election official.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 11 Federal Elections 1 2014-01-01 2014-01-01 false Chief state election official. 9428.6 Section 9428.6 Federal Elections ELECTION ASSISTANCE COMMISSION NATIONAL VOTER REGISTRATION ACT (42 U.S.C... constitution or statutory citations, including but not limited to the specific state requirements, if any...

11 CFR 9428.6 - Chief state election official.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 11 Federal Elections 1 2010-01-01 2010-01-01 false Chief state election official. 9428.6 Section 9428.6 Federal Elections ELECTION ASSISTANCE COMMISSION NATIONAL VOTER REGISTRATION ACT (42 U.S.C... constitution or statutory citations, including but not limited to the specific state requirements, if any...

5 CFR 891.202 - Change of election.

Code of Federal Regulations, 2010 CFR

2010-01-01

... (CONTINUED) RETIRED FEDERAL EMPLOYEES HEALTH BENEFITS Election and Change of Election § 891.202 Change of election. (a) When used in this section, “month” includes the 4-week period for which a retired employee... private health benefits plan for all persons covered by the election but the retired employee making the...

5 CFR 891.201 - Election.

Code of Federal Regulations, 2010 CFR

2010-01-01

... FEDERAL EMPLOYEES HEALTH BENEFITS Election and Change of Election § 891.201 Election. (a) The original period for election by each eligible retired employee was during the months of March and April 1961... failure is determined by the retirement office to be for cause beyond the control of the retired employee...

75 FR 44964 - Filing Dates for the West Virginia Senate Special Election

Federal Register 2010, 2011, 2012, 2013, 2014

2010-07-30

... FEDERAL ELECTION COMMISSION [Notice 2010-15] Filing Dates for the West Virginia Senate Special Election AGENCY: Federal Election Commission. ACTION: Notice of filing dates for special election. SUMMARY... Report on December 2, 2010. (See chart below for the closing date for each report). All principal...

78 FR 78345 - Proposed Information Collection-2014 Election Administration and Voting Survey; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2013-12-26

... Voting Survey; Comment Request AGENCY: U.S. Election Assistance Commission (EAC). ACTION: Notice. SUMMARY... Survey) to the Director of the Office of Management and Budget for approval. The 2014 Election Administration and Voting Survey (Survey) asks election officials questions concerning voting and election...

Teaching about Presidential Elections. ERIC Digest.

ERIC Educational Resources Information Center

Vontz, Thomas S.; Nixon, William A.

Although elections are an annual theme in many social studies classrooms, presidential election years prompt increased interest among students in the electoral process and offer an opportunity to teach about a national election as it happens. This ERIC Digest describes the legal requirements and traditions of U.S. presidential elections, processes…

The European System for Electing University Presidents and University Governance

ERIC Educational Resources Information Center

Ma, Huaide

2014-01-01

The system of electing university presidents in Spain, Switzerland, Italy, and the United Kingdom has distinctive characteristics. Almost all university presidents are elected by teachers and students, either directly or indirectly through elections with government approval of the appointment a mere formality. Principles of these elections include…

75 FR 1614 - Submission for OMB Review-2010 Election Administration and Voting Survey; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2010-01-12

... EAC (including your address and phone number) at U.S. Election Assistance Commission, 1225 New York... ELECTION ASSISTANCE COMMISSION Submission for OMB Review--2010 Election Administration and Voting... voters; (c) Number of new registrations in jurisdictions with Same Day Registration or Election Day...

26 CFR 701.9006-1 - Presidential Election Campaign Fund.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 26 Internal Revenue 20 2010-04-01 2010-04-01 false Presidential Election Campaign Fund. 701.9006-1...) INTERNAL REVENUE PRACTICE PRESIDENTIAL ELECTION CAMPAIGN FUND § 701.9006-1 Presidential Election Campaign Fund. (a) Transfer of amounts to the Presidential Election Campaign Fund. The Secretary shall determine...

Elective ventilation for organ donation: law, policy and public ethics.

PubMed

Coggon, John

2013-03-01

This paper examines questions concerning elective ventilation, contextualised within English law and policy. It presents the general debate with reference both to the Exeter Protocol on elective ventilation, and the considerable developments in legal principle since the time that that protocol was declared to be unlawful. I distinguish different aspects of what might be labelled elective ventilation policies under the following four headings: 'basic elective ventilation'; 'epistemically complex elective ventilation'; 'practically complex elective ventilation'; and 'epistemically and practically complex elective ventilation'. I give a legal analysis of each. In concluding remarks on their potential practical viability, I emphasise the importance not just of ascertaining the legal and ethical acceptability of these and other forms of elective ventilation, but also of assessing their professional and political acceptability. This importance relates both to the successful implementation of the individual practices, and to guarding against possible harmful effects in the wider efforts to increase the rates of posthumous organ donation.

Young adults' psychological and physiological reactions to the 2016 U.S. presidential election.

PubMed

Hoyt, Lindsay T; Zeiders, Katharine H; Chaku, Natasha; Toomey, Russell B; Nair, Rajni L

2018-06-01

Elections present unique opportunities to study how sociopolitical events influence individual processes. The current study examined 286 young adults' mood and diurnal cortisol responses to the 2016 U.S. presidential election in real-time: two days before the election, election night, and two days after the election of Donald Trump, with the goal of understanding whether (and the extent to which) the election influenced young adults' affective and biological states. Utilizing piecewise trajectory analyses, we observed high, and increasing, negative affect leading up to the election across all participants. Young adults who had negative perceptions of Trump's ability to fulfill the role of president and/or were part of a non-dominant social group (i.e., women, ethnic/racial minority young adults) reported increased signs of stress before the election and on election night. After the election, we observed a general "recovery" in self-reported mood; however, diurnal cortisol indicators suggested that there was an increase in biological stress among some groups. Overall, findings underscore the role of macro-level factors in individuals' health and well-being via more proximal attitudes and physiological functioning. Copyright © 2018 Elsevier Ltd. All rights reserved.

[Improving pre- and perioperative hospital care : Major elective surgery].

PubMed

Punt, Ilona M; van der Most, Roel; Bongers, Bart C; Didden, Anouk; Hulzebos, Erik H J; Dronkers, Jaap J; van Meeteren, Nico L U

2017-04-01

Surgery is aimed at improving a patient's health. However, surgery is plagued with a risk of negative consequences, such as perioperative complications and prolonged hospitalization. Also, achieving preoperative levels of physical functionality may be delayed. Above all, the "waiting" period before the operation and the period of hospitalisation endanger the state of health, especially in frail patients.The Better in Better out™ (BiBo™) strategy is aimed at reducing the risk of a complicated postoperative course through the optimisation and professionalisation of perioperative treatment strategies in a physiotherapy activating context. BiBo™ includes four steps towards optimising personalised health care in patients scheduled for elective surgery: 1) preoperative risk assessment, 2) preoperative patient education, 3) preoperative exercise therapy for high-risk patients (prehabilitation) and 4) postoperative mobilisation and functional exercise therapy.Preoperative screening is aimed at identifying frail, high-risk patients at an early stage, and advising these high-risk patients to participate in outpatient exercise training (prehabilitation) as soon as possible. By improving preoperative physical fitness, a patient is able to better withstand the impact of major surgery and this will lead to both a reduced risk of negative side effects and better short-term outcomes as a result. Besides prehabilitation, treatment culture and infrastructure should be inherently changing in such a way that patients stay as active as they can, socially, mentally and physically after discharge.

Waiting time distribution in public health care: empirics and theory.

PubMed

Dimakou, Sofia; Dimakou, Ourania; Basso, Henrique S

2015-12-01

Excessive waiting times for elective surgery have been a long-standing concern in many national healthcare systems in the OECD. How do the hospital admission patterns that generate waiting lists affect different patients? What are the hospitals characteristics that determine waiting times? By developing a model of healthcare provision and analysing empirically the entire waiting time distribution we attempt to shed some light on those issues. We first build a theoretical model that describes the optimal waiting time distribution for capacity constraint hospitals. Secondly, employing duration analysis, we obtain empirical representations of that distribution across hospitals in the UK from 1997-2005. We observe important differences on the 'scale' and on the 'shape' of admission rates. Scale refers to how quickly patients are treated and shape represents trade-offs across duration-treatment profiles. By fitting the theoretical to the empirical distributions we estimate the main structural parameters of the model and are able to closely identify the main drivers of these empirical differences. We find that the level of resources allocated to elective surgery (budget and physical capacity), which determines how constrained the hospital is, explains differences in scale. Changes in benefits and costs structures of healthcare provision, which relate, respectively, to the desire to prioritise patients by duration and the reduction in costs due to delayed treatment, determine the shape, affecting short and long duration patients differently. JEL Classification I11; I18; H51.

Emotional arousal predicts intertemporal choice

PubMed Central

Lempert, Karolina M.; Johnson, Eli; Phelps, Elizabeth A.

2016-01-01

People generally prefer immediate rewards to rewards received after a delay, often even when the delayed reward is larger. This phenomenon is known as temporal discounting. It has been suggested that preferences for immediate rewards may be due to their being more concrete than delayed rewards. This concreteness may evoke an enhanced emotional response. Indeed, manipulating the representation of a future reward to make it more concrete has been shown to heighten the reward’s subjective emotional intensity, making people more likely to choose it. Here we use an objective measure of arousal – pupil dilation – to investigate if emotional arousal mediates the influence of delayed reward concreteness on choice. We recorded pupil dilation responses while participants made choices between immediate and delayed rewards. We manipulated concreteness through time interval framing: delayed rewards were presented either with the date on which they would be received (e.g., “$30, May 3”; DATE condition, more concrete) or in terms of delay to receipt (e.g., “$30, 7 days; DAYS condition, less concrete). Contrary to prior work, participants were not overall more patient in the DATE condition. However, there was individual variability in response to time framing, and this variability was predicted by differences in pupil dilation between conditions. Emotional arousal increased as the subjective value of delayed rewards increased, and predicted choice of the delayed reward on each trial. This study advances our understanding of the role of emotion in temporal discounting. PMID:26882337

Women who are well informed about prenatal genetic screening delay emotional attachment to their fetus.

PubMed

Rowe, Heather; Fisher, Jane; Quinlivan, Julie

2009-03-01

Prenatal maternal serum screening allows assessment of risk of chromosomal abnormalities in the fetus and is increasingly being offered to all women regardless of age or prior risk. However ensuring informed choice to participate in screening is difficult and the psychological implications of making an informed decision are uncertain. The aim of this study was to compare the growth of maternal-fetal emotional attachment in groups of women whose decisions about participation in screening were informed or not informed. A prospective longitudinal design was used. English speaking women were recruited in antenatal clinics prior to the offer of second trimester maternal screening. Three self-report questionnaires completed over the course of pregnancy used validated measures of informed choice and maternal-fetal emotional attachment. Attachment scores throughout pregnancy in informed and not-informed groups were compared in repeated measures analysis. 134 completed the first assessment (recruitment 73%) and 68 (58%) provided compete data. The informed group had significantly lower attachment scores (p = 0.023) than the not-informed group prior to testing, but scores were similar (p = 0.482) after test results were known. The findings raise questions about the impact of delayed maternal-fetal attachment and appropriate interventions to facilitate informed choice to participate in screening.

Predictive and postdictive mechanisms jointly contribute to visual awareness.

PubMed

Soga, Ryosuke; Akaishi, Rei; Sakai, Katsuyuki

2009-09-01

One of the fundamental issues in visual awareness is how we are able to perceive the scene in front of our eyes on time despite the delay in processing visual information. The prediction theory postulates that our visual system predicts the future to compensate for such delays. On the other hand, the postdiction theory postulates that our visual awareness is inevitably a delayed product. In the present study we used flash-lag paradigms in motion and color domains and examined how the perception of visual information at the time of flash is influenced by prior and subsequent visual events. We found that both types of event additively influence the perception of the present visual image, suggesting that our visual awareness results from joint contribution of predictive and postdictive mechanisms.

Negative pressure wound treatment improves Acute Physiology and Chronic Health Evaluation II score in mediastinitis allowing a successful elective pectoralis muscle flap closure: six-year experience of a single protocol.

PubMed

Salica, Andrea; Weltert, Luca; Scaffa, Raffaele; Guerrieri Wolf, Lorenzo; Nardella, Saverio; Bellisario, Alessandro; De Paulis, Ruggero

2014-11-01

Optimal management of poststernotomy mediastinitis is controversial. Negative pressure wound treatment improves wound environment and sternal stability with low surgical invasiveness. Our protocol was based on negative pressure followed by delayed surgical closure. The aim of this study was to provide the results at early follow-up and to identify the risk factors for adverse outcome. In 5400 cardiac procedures, 44 consecutive patients with mediastinitis were enrolled in the study. Mediastinitis treatment was based on urgent debridement and negative pressure as the first-line approach. After wound sterilization, chest closure was achieved by elective pectoralis muscle advancement flap. Each patient's hospital data were collected prospectively. Variables included patient demographics and clinical and biological data. Acute Physiology and Chronic Health Evaluation (APACHE) II score was calculated at the time of diagnosis and 48 hours after debridement. Focus outcome measures were mediastinitis-related death and need for reintervention after pectoralis muscle closure. El Oakley type I and type IIIA mediastinitis were the most frequent types (63.6%). Methicillin-resistant Staphylococcus aureus was present in 25 patients (56.8%). Mean APACHE II score was 19.4±4 at the time of diagnosis, and 30 patients (68.2%) required intensive care unit transfer before surgical debridement. APACHE II score improved 48 hours after wound debridement and negative pressure application (mean value, 19.4±4 vs 7.2±2; P=.005) independently of any other variables included in the study. One patient in septic shock at the time of diagnosis died (2.2%). Negative pressure promotes a significant improvement in clinical status according to APACHE II score and allows a successful elective surgical closure. Copyright © 2014 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

75 FR 34450 - Filing Dates for the Indiana Special Election in the 3rd Congressional District

Federal Register 2010, 2011, 2012, 2013, 2014

2010-06-17

... 3rd Congressional District AGENCY: Federal Election Commission. ACTION: Notice of filing dates for special election. SUMMARY: Indiana has scheduled a Special General Election on November 2, 2010, to fill.... Committees required to file reports in connection with the Special General Election on November 2, 2010...

75 FR 10483 - Filing Dates for the Pennsylvania Special Election in the 12th Congressional District

Federal Register 2010, 2011, 2012, 2013, 2014

2010-03-08

... in the 12th Congressional District AGENCY: Federal Election Commission. ACTION: Notice of filing dates for special election. SUMMARY: Pennsylvania has scheduled a Special General Election on May 18... John P. Murtha. Committees required to file reports in connection with the Special General Election on...

76 FR 17124 - Filing Dates for the California Special Election in the 36th Congressional District

Federal Register 2010, 2011, 2012, 2013, 2014

2011-03-28

... the 36th Congressional District AGENCY: Federal Election Commission. ACTION: Notice of filing dates for special election. SUMMARY: California has scheduled a special general election on May 17, 2011, to... committees of candidates who participate in the California Special General and Special Runoff Elections shall...

76 FR 29750 - Filing Dates for the Nevada Special Election in the 2nd Congressional District

Federal Register 2010, 2011, 2012, 2013, 2014

2011-05-23

... 2nd Congressional District AGENCY: Federal Election Commission. ACTION: Notice of filing dates for special election. SUMMARY: Nevada has scheduled a Special General Election on September 13, 2011, to fill... Heller. Committees required to file reports in connection with the Special General Election on September...

76 FR 45797 - Filing Dates for the New York Special Election in the 9th Congressional District

Federal Register 2010, 2011, 2012, 2013, 2014

2011-08-01

... 9th Congressional District AGENCY: Federal Election Commission. ACTION: Notice of filing dates for special election. SUMMARY: New York has scheduled a Special General Election on September 13, 2011, to.... Committees required to file reports in connection with the Special General Election on September 13, 2011...

Internet: Teaching about the 1996 Elections with the World Wide Web.

ERIC Educational Resources Information Center

Risinger, C. Frederick

1996-01-01

Briefly explores a number of World Wide Web sites devoted to providing information about the 1996 elections. Evaluates web sites maintained by the Atlantic Monthly, Congressional Quarterly, CNN, and MTV. While most sites cover the national election, at least one, ElectNet, focuses on state and local elections. (MJP)

29 CFR 452.26 - Elections in local labor organizations.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 29 Labor 2 2011-07-01 2011-07-01 false Elections in local labor organizations. 452.26 Section 452... REPORTING AND DISCLOSURE ACT OF 1959 Frequency and Kinds of Elections § 452.26 Elections in local labor organizations. Local labor organizations must conduct their regular elections of officers by secret ballot among...

25 CFR 81.23 - Posting and certifying election results.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 25 Indians 1 2013-04-01 2013-04-01 false Posting and certifying election results. 81.23 Section 81... REORGANIZATION UNDER A FEDERAL STATUTE § 81.23 Posting and certifying election results. (a) The results of the... appropriate public places determined by the election board. (b) The election board shall certify the results...

25 CFR 81.23 - Posting and certifying election results.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 25 Indians 1 2010-04-01 2010-04-01 false Posting and certifying election results. 81.23 Section 81... REORGANIZATION UNDER A FEDERAL STATUTE § 81.23 Posting and certifying election results. (a) The results of the... appropriate public places determined by the election board. (b) The election board shall certify the results...

25 CFR 81.23 - Posting and certifying election results.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 25 Indians 1 2012-04-01 2011-04-01 true Posting and certifying election results. 81.23 Section 81... REORGANIZATION UNDER A FEDERAL STATUTE § 81.23 Posting and certifying election results. (a) The results of the... appropriate public places determined by the election board. (b) The election board shall certify the results...

25 CFR 81.22 - Contesting of election results.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 25 Indians 1 2010-04-01 2010-04-01 false Contesting of election results. 81.22 Section 81.22... A FEDERAL STATUTE § 81.22 Contesting of election results. Any qualified voter, within three days following the posting of the results of an election, may challenge the election results by filing with the...

25 CFR 81.22 - Contesting of election results.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 25 Indians 1 2012-04-01 2011-04-01 true Contesting of election results. 81.22 Section 81.22... A FEDERAL STATUTE § 81.22 Contesting of election results. Any qualified voter, within three days following the posting of the results of an election, may challenge the election results by filing with the...

25 CFR 81.22 - Contesting of election results.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 25 Indians 1 2011-04-01 2011-04-01 false Contesting of election results. 81.22 Section 81.22... A FEDERAL STATUTE § 81.22 Contesting of election results. Any qualified voter, within three days following the posting of the results of an election, may challenge the election results by filing with the...

25 CFR 81.22 - Contesting of election results.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 25 Indians 1 2013-04-01 2013-04-01 false Contesting of election results. 81.22 Section 81.22... A FEDERAL STATUTE § 81.22 Contesting of election results. Any qualified voter, within three days following the posting of the results of an election, may challenge the election results by filing with the...

25 CFR 81.22 - Contesting of election results.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 25 Indians 1 2014-04-01 2014-04-01 false Contesting of election results. 81.22 Section 81.22... A FEDERAL STATUTE § 81.22 Contesting of election results. Any qualified voter, within three days following the posting of the results of an election, may challenge the election results by filing with the...

25 CFR 81.23 - Posting and certifying election results.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 25 Indians 1 2011-04-01 2011-04-01 false Posting and certifying election results. 81.23 Section 81... REORGANIZATION UNDER A FEDERAL STATUTE § 81.23 Posting and certifying election results. (a) The results of the... appropriate public places determined by the election board. (b) The election board shall certify the results...

25 CFR 81.23 - Posting and certifying election results.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 25 Indians 1 2014-04-01 2014-04-01 false Posting and certifying election results. 81.23 Section 81... REORGANIZATION UNDER A FEDERAL STATUTE § 81.23 Posting and certifying election results. (a) The results of the... appropriate public places determined by the election board. (b) The election board shall certify the results...

5 CFR 842.605 - Election of insurable interest rate.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 5 Administrative Personnel 2 2012-01-01 2012-01-01 false Election of insurable interest rate. 842... Election of insurable interest rate. (a) At the time of retirement, an employee or Member in good health and who is applying for a non-disability annuity may elect an insurable interest rate. An election...

5 CFR 842.605 - Election of insurable interest rate.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 5 Administrative Personnel 2 2011-01-01 2011-01-01 false Election of insurable interest rate. 842... Election of insurable interest rate. (a) At the time of retirement, an employee or Member in good health and who is applying for a non-disability annuity may elect an insurable interest rate. An election...

5 CFR 842.605 - Election of insurable interest rate.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 5 Administrative Personnel 2 2010-01-01 2010-01-01 false Election of insurable interest rate. 842... Election of insurable interest rate. (a) At the time of retirement, an employee or Member in good health and who is applying for a non-disability annuity may elect an insurable interest rate. An election...

26 CFR 1.338(i)-1 - Effective/applicability date.

Code of Federal Regulations, 2014 CFR

2014-04-01

... target election for retroactive application—(i) Availability of election. New target may make an... 10, 2006 for which a section 338 election is made, provided that new target's first taxable year and... section 338(h)(10) election is made (or a section 338 election for a foreign target), new target may make...

26 CFR 1.1361-4 - Effect of QSub election.

Code of Federal Regulations, 2014 CFR

2014-04-01

... paragraph (a)(2) of this section occurs immediately after the deemed asset purchase by the new target... election. An S corporation that makes a qualified stock purchase of a target may make an election under... QSub election with respect to the target. If an S corporation makes an election under section 338 with...

26 CFR 1.338(i)-1 - Effective/applicability date.

Code of Federal Regulations, 2012 CFR

2012-04-01

... target election for retroactive application—(i) Availability of election. New target may make an... 10, 2006 for which a section 338 election is made, provided that new target's first taxable year and... section 338(h)(10) election is made (or a section 338 election for a foreign target), new target may make...

26 CFR 1.1361-4 - Effect of QSub election.

Code of Federal Regulations, 2013 CFR

2013-04-01

... paragraph (a)(2) of this section occurs immediately after the deemed asset purchase by the new target... election. An S corporation that makes a qualified stock purchase of a target may make an election under... QSub election with respect to the target. If an S corporation makes an election under section 338 with...

26 CFR 1.338(i)-1 - Effective/applicability date.

Code of Federal Regulations, 2013 CFR

2013-04-01

... target election for retroactive application—(i) Availability of election. New target may make an... 10, 2006 for which a section 338 election is made, provided that new target's first taxable year and... section 338(h)(10) election is made (or a section 338 election for a foreign target), new target may make...

29 CFR 44.2 - Election cycle and tenure of representatives.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 29 Labor 1 2010-07-01 2010-07-01 true Election cycle and tenure of representatives. 44.2 Section... REPRESENTATIVES FOR CONSULTATIONS WITH DEPARTMENT OF LABOR § 44.2 Election cycle and tenure of representatives. (a) Election cycle. The States located within each Federal region, as defined in this paragraph, shall elect...

Impaired flexibility in decision making in rats after administration of the pharmacological stressor yohimbine.

PubMed

Schwager, Andrea L; Haack, Andrew K; Taha, Sharif A

2014-10-01

Stress-induced disruption of decision making has been hypothesized to contribute to drug-seeking behaviors and addiction. Noradrenergic signaling plays a central role in mediating stress responses. However, the effects of acute stress on decision making, and the role of noradrenergic signaling in regulating these effects, have not been well characterized. To characterize changes in decision making caused by acute pharmacological stress, the effects of yohimbine (an α2-adrenergic antagonist) were examined in a delay discounting task. Noradrenergic contributions to decision making were further characterized by examining the effects of propranolol (a β antagonist), prazosin (an α1 antagonist), and guanfacine (an α2 agonist). Sprague-Dawley rats were administered drugs prior to performance on a delay discounting task, in which the delay preceding the large reward increased within each session (ascending delays). To dissociate drug-induced changes in delay sensitivity from behavioral inflexibility, drug effects were subsequently tested in a modified version of the discounting task, in which the delay preceding the large reward decreased within each session (descending delays). Yohimbine increased choice of the large reward when tested with ascending delays but decreased choice of the same large reward when tested with descending delays, suggesting that drug effects could be attributed to perseverative choice of the lever preferred at the beginning of the session. Propranolol increased choice of the large reward when tested with ascending delays. Prazosin and guanfacine had no effect on reward choice. The stress-like effects of yohimbine administration may impair decision making by causing inflexible, perseverative behavior.

Democratising health care governance? New Zealand's inaugural district health board elections, 2001.

PubMed

Gauld, Robin

2002-01-01

New Zealand's 'district health board' (DHB) system has been under implementation since the 1999 general election. A key factor motivating the change to DHBs is the democratisation of health care governance. A majority of the new DHB members are popularly elected. Previously, hospital board members were government appointees. Inaugural DHB elections were held in October 2001. This article reports on the election results and the wider operating context for DHBs. It notes organisational issues to be considered for the next DHB elections in 2004, and questions the extent to which the elections and DHB governance structure will enhance health care democratisation in New Zealand.

75 FR 65230 - Drawbridge Operation Regulation; Arkansas Waterway, Pine Bluff, AR

Federal Register 2010, 2011, 2012, 2013, 2014

2010-10-22

... requesting a draw opening. This keying will activate an indicator on the remote drawbridge operator's console... operated. Vessels requesting an opening shall establish contact by radio/telephone with the remote... drawspan opening delays experienced previously from missed calls under the prior regulatory guidance...

75 FR 66306 - Drawbridge Operation Regulation; Arkansas Waterway, Little Rock, AR

Federal Register 2010, 2011, 2012, 2013, 2014

2010-10-28

... a draw opening. This keying will activate an indicator on the remote drawbridge operator's console... position and is remotely operated. Vessels requesting an opening shall establish contact by radio/telephone... drawspan opening delays experienced previously from missed calls under the prior regulatory guidance...

Analysis of Navy Delayed Entry Program and Recruit Training Center Attrition

DTIC Science & Technology

1998-06-01

training which are not consistent with military service (e.g., sleepwalking , suicidal behavior, bedwetting). "Screen" encompasses the prior problems...Non-Academic Psych-Personality Disorder I Behavior 193 Non-Academic Psych-Enuresis I Behavior 194 Non-Academic Psych- Sleepwalk I Behavior 43

Changes in subjective well-being following the U.S. Presidential election of 2016.

PubMed

Lench, Heather C; Levine, Linda J; Perez, Kenneth A; Carpenter, Zari Koelbel; Carlson, Steven J; Tibbett, Tom

2018-03-01

This investigation examined predictors of changes over time in subjective well-being (SWB) after the 2016 United States presidential election. Two indicators of SWB-general happiness and life satisfaction-were assessed three weeks before the election, the week of the election, three weeks later, and six months later. Partisanship predicted both indicators of SWB, with Trump supporters experiencing improved SWB after the election, Clinton supporters experiencing worsened SWB after the election, and those who viewed both candidates as bad also experiencing worsened SWB after the election. The impact of the election on SWB decreased over time, with all participants returning to baseline life satisfaction six months after the election. Trump supporters and those who viewed both candidates as bad for the country also returned to baseline general happiness six months after the election. Clinton supporters, in contrast, remained below baseline levels of general happiness six months after the election. Moral and political values, and exposure to media inconsistent with those values, predicted lasting change in subjective well-being. National events can affect how people perceive the overall quality of their lives and these effects are exacerbated when moral and political values are involved. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

25 CFR 81.10 - District Election Boards.

Code of Federal Regulations, 2013 CFR

2013-04-01

... FEDERAL STATUTE § 81.10 District Election Boards. (a) Where voting districts have been established by the tribal constitution, ordinance, resolution, or by the election board, the election board shall appoint...

75 FR 62131 - Filing Dates for the New York Special Election in the 29th Congressional District

Federal Register 2010, 2011, 2012, 2013, 2014

2010-10-07

... 29th Congressional District AGENCY: Federal Election Commission. ACTION: Notice of filing dates for special election. SUMMARY: New York has scheduled a Special General Election on November 2, 2010, to fill.... Committees required to file reports in connection with the Special General Election on November 2, 2010...

78 FR 53454 - Filing Dates for the Louisiana Special Elections in the 5th Congressional District

Federal Register 2010, 2011, 2012, 2013, 2014

2013-08-29

... the 5th Congressional District AGENCY: Federal Election Commission. ACTION: Notice of filing dates for special election. SUMMARY: Louisiana has scheduled a Special General Election on October 19, 2013, to fill... Special General and Special Runoff Elections shall file a 12-day Pre-General Report on October 7, 2013; a...

26 CFR 1.856-8 - Revocation or termination of election.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 26 Internal Revenue 9 2010-04-01 2010-04-01 false Revocation or termination of election. 1.856-8... election. (a) Revocation of an election to be a real estate investment trust. A corporation, trust, or association that has made an election under section 856(c)(1) to be a real estate investment trust may revoke...

75 FR 17742 - Filing Dates for the Georgia Special Election in the 9th Congressional District

Federal Register 2010, 2011, 2012, 2013, 2014

2010-04-07

... 9th Congressional District AGENCY: Federal Election Commission. ACTION: Notice of filing dates for special election. SUMMARY: Georgia has scheduled a special general election on May 11, 2010, to fill the U... participate in the Georgia Special General and Special Runoff Elections shall file a 12-day Pre-General Report...

76 FR 16419 - Filing Dates for the New York Special Election in the 26th Congressional District

Federal Register 2010, 2011, 2012, 2013, 2014

2011-03-23

... 26th Congressional District AGENCY: Federal Election Commission. ACTION: Notice of filing dates for special election. SUMMARY: New York has scheduled a Special General Election on May 24, 2011, to fill the.... Committees required to file reports in connection with the Special General Election on May 24, 2011, shall...

26 CFR 1.169-4 - Time and manner of making elections.

Code of Federal Regulations, 2010 CFR

2010-04-01

...-4 Time and manner of making elections. (a) Election of amortization—(1) In general. Under section 169(b), an election by the taxpayer to take an amortization deduction with respect to a certified... 26 Internal Revenue 2 2010-04-01 2010-04-01 false Time and manner of making elections. 1.169-4...

78 FR 9916 - Filing Dates for the Missouri Special Election in the 8th Congressional District

Federal Register 2010, 2011, 2012, 2013, 2014

2013-02-12

... 8th Congressional District AGENCY: Federal Election Commission. ACTION: Notice of filing dates for special election. SUMMARY: Missouri has scheduled a Special General Election on June 4, 2013, to fill the.... Committees required to file reports in connection with the Special General Election on June 4, 2013, shall...

25 CFR 90.43 - Canvass of election returns.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 25 Indians 1 2011-04-01 2011-04-01 false Canvass of election returns. 90.43 Section 90.43 Indians BUREAU OF INDIAN AFFAIRS, DEPARTMENT OF THE INTERIOR TRIBAL GOVERNMENT ELECTION OF OFFICERS OF THE OSAGE TRIBE Elections § 90.43 Canvass of election returns. (a) Immediately after the polls are closed at 8 p.m...

Safety of zoster vaccine in elderly adults following documented herpes zoster.

PubMed

Morrison, Vicki A; Oxman, Michael N; Levin, Myron J; Schmader, Kenneth E; Guatelli, John C; Betts, Robert F; Gelb, Larry D; Pachucki, Constance T; Keay, Susan K; Menzies, Barbara; Griffin, Marie R; Kauffman, Carol A; Marques, Adriana R; Toney, John F; Simberkoff, Michael S; Serrao, Richard; Arbeit, Robert D; Gnann, John W; Greenberg, Richard N; Holodniy, Mark; Keitel, Wendy A; Yeh, Shingshing S; Davis, Larry E; Crawford, George E; Neuzil, Kathy M; Johnson, Gary R; Zhang, Jane H; Harbecke, Rith; Chan, Ivan S F; Keller, Paul M; Williams, Heather M; Boardman, Kathy D; Silber, Jeffrey L; Annunziato, Paula W

2013-08-15

After completion of the Shingles Prevention Study (SPS; Department of Veterans Affairs Cooperative Studies Program Number 403), SPS participants who had initially received placebo were offered investigational zoster vaccine without charge. This provided an opportunity to determine the relative safety of zoster vaccine in older adults following documented herpes zoster (HZ). A total of 13 681 SPS placebo recipients who elected to receive zoster vaccine were followed for serious adverse events (SAE) for 28 days after vaccination. In contrast to the SPS, a prior episode of HZ was not a contraindication to receiving zoster vaccine. The SPS placebo recipients who received zoster vaccine included 420 who had developed documented HZ during the SPS. The mean interval between the onset of HZ and the receipt of zoster vaccine in the 420 recipients with prior HZ was 3.61 years (median interval, 3.77 years [range, 3-85 months]); the interval was <5 years for approximately 80% of recipients. The proportion of vaccinated SPS placebo recipients with prior HZ who developed ≥ 1 SAE (0.95%) was not significantly different from that of vaccinated SPS placebo recipients with no prior history of HZ (0.66%), and the distribution of SAEs in the 2 groups was comparable. These results demonstrate that the general safety of zoster vaccine in older persons is not altered by a recent history of documented HZ, supporting the safety aspect of the Centers for Disease Control and Prevention Advisory Committee on Immunization Practices recommendation to administer zoster vaccine to all persons ≥ 60 years of age with no contraindications, regardless of a prior history of HZ.

Cardiovascular Events During General Elections In Bayamon, Puerto Rico

PubMed Central

Pérez-Mercado, Arnaldo E.; Maldonado-Martínez, Gerónimo; del Rio, José Rivera; Mellado, Robert F. Hunter

2013-01-01

Emotional stress has been linked to acute coronary events. We examined whether the emotional response to elections in Puerto Rico induced a similar response. Methods We reviewed records at HIMA San Pablo Hospital (HIMASP) and Ramon Ruiz Arnau University Hospital (HURRA) in Bayamón and identified patients admitted with ICD-9 codes 410, 411, and 413 or corresponding diagnoses during a period surrounding the general elections and compared them with the same time period in non-election years. Results Cardiovascular events accounted for 3.24% of election-year admissions vs. 5.51% during non-election years in HURRA (p=0.036, N=37), while accounting for 2.86% of election-year admissions in HIMASP vs. 3.27% during non-election years (non-significant). Discussion There was a trend towards a lower rate of admission for cardiovascular events during general elections in both hospitals, reaching statistical significance at HURRA. Further study may elucidate reasons for this behavior and determine whether similar trends hold true in other populations. PMID:23875518

Using Elicited Choice Probabilities in Hypothetical Elections to Study Decisions to Vote

PubMed Central

Delavande, Adeline; Manski, Charles F.

2015-01-01

This paper demonstrates the feasibility and usefulness of survey research asking respondents to report voting probabilities in hypothetical election scenarios. Posing scenarios enriches the data available for studies of voting decisions, as a researcher can pose many more and varied scenarios than the elections that persons actually face. Multiple scenarios were presented to over 4,000 participants in the American Life Panel (ALP). Each described a hypothetical presidential election, giving characteristics measuring candidate preference, closeness of the election, and the time cost of voting. Persons were asked the probability that they would vote in this election and were willing and able to respond. We analyzed the data through direct study of the variation of voting probabilities with election characteristics and through estimation of a random utility model of voting. Voting time and election closeness were notable determinants of decisions to vote, but not candidate preference. Most findings were corroborated through estimation of a model fit to ALP data on respondents' actual voting behavior in the 2012 election. PMID:25705068

Prognosis and delay of diagnosis among Kaposi’s sarcoma patients in Uganda: a cross-sectional study

PubMed Central

2014-01-01

Background In low- and middle-income countries, the association between delay to treatment and prognosis for Kaposi’s sarcoma (KS) patients is yet to be studied. Methods This is a prospective study of HIV-infected adults with histologically-confirmed KS treated at the Uganda Cancer Institute (UCI). Standardized interviews were conducted in English or Luganda. Medical records were abstracted for KS stage at admission to UCI. Multivariable logistic regression assessed relationships between diagnostic delay and stage at diagnosis. Results Of 161 patients (90% response rate), 69% were men, and the mean age was 34.0 years (SD 7.7). 26% had been seen in an HIV clinic within 3 months, 72% were on antiretroviral therapy, and 26% had visited a traditional healer prior to diagnosis. 45% delayed seeking care at UCI for ≥3 months from symptom onset. Among those who delayed, 36% waited 6 months, and 25% waited 12 months. Common reasons for delay were lack of pain (48%), no money (32%), and distance to UCI (8%). In adjusted analysis patients who experienced diagnostic delay were more likely than those who did not delay to have poor-risk KS stage (OR 3.41, p = 0.002, 95% CI: 1.46-7.45). In adjusted analyses visiting a traditional healer was the only variable associated with greater likelihood of delay (OR 2.69, p = 0.020, 95% CI: 1.17-6.17). Conclusions Diagnostic delay was associated with poor-risk stage at diagnosis, and visiting a traditional healer was associated with higher odds of delay. The relationship between traditional and Western medicine presents a critical intervention point to improve KS-related outcomes in Uganda. PMID:24904686