Abdominoplasty: Risk Factors, Complication Rates, and Safety of Combined Procedures.

PubMed

Winocour, Julian; Gupta, Varun; Ramirez, J Roberto; Shack, R Bruce; Grotting, James C; Higdon, K Kye

2015-11-01

Among aesthetic surgery procedures, abdominoplasty is associated with a higher complication rate, but previous studies are limited by small sample sizes or single-institution experience. A cohort of patients who underwent abdominoplasty between 2008 and 2013 was identified from the CosmetAssure database. Major complications were recorded. Univariate and multivariate analysis was performed evaluating risk factors, including age, smoking, body mass index, sex, diabetes, type of surgical facility, and combined procedures. The authors identified 25,478 abdominoplasties from 183,914 procedures in the database. Of these, 8,975 patients had abdominoplasty alone and 16,503 underwent additional procedures. The number of complications recorded was 1,012 (4.0 percent overall rate versus 1.4 percent in other aesthetic surgery procedures). Of these, 31.5 percent were hematomas, 27.2 percent were infections and 20.2 percent were suspected or confirmed venous thromboembolism. On multivariate analysis, significant risk factors (p < 0.05) included male sex (relative risk, 1.8), age 55 years or older (1.4), body mass index greater than or equal to 30 (1.3), multiple procedures (1.5), and procedure performance in a hospital or surgical center versus office-based surgical suite (1.6). Combined procedures increased the risk of complication (abdominoplasty alone, 3.1 percent; with liposuction, 3.8 percent; breast procedure, 4.3 percent; liposuction and breast procedure, 4.6 percent; body-contouring procedure, 6.8 percent; liposuction and body-contouring procedure, 10.4 percent). Abdominoplasty is associated with a higher complication rate compared with other aesthetic procedures. Combined procedures can significantly increase complication rates and should be considered carefully in higher risk patients. Risk, II.

Incidence and Risk Factors for Major Hematomas in Aesthetic Surgery: Analysis of 129,007 Patients.

PubMed

Kaoutzanis, Christodoulos; Winocour, Julian; Gupta, Varun; Ganesh Kumar, Nishant; Sarosiek, Konrad; Wormer, Blair; Tokin, Christopher; Grotting, James C; Higdon, K Kye

2017-10-16

Postoperative hematomas are one of the most frequent complications following aesthetic surgery. Identifying risk factors for hematoma has been limited by underpowered studies from single institution experiences. To examine the incidence and identify independent risk factors for postoperative hematomas following cosmetic surgery utilizing a prospective, multicenter database. A prospectively enrolled cohort of patients who underwent aesthetic surgery between 2008 and 2013 was identified from the CosmetAssure database. Primary outcome was occurrence of major hematomas requiring emergency room visit, hospital admission, or reoperation within 30 days of the index operation. Univariate and multivariate analysis was used to identify potential risk factors for hematomas including age, gender, body mass index (BMI), smoking, diabetes, type of surgical facility, procedure by body region, and combined procedures. Of 129,007 patients, 1180 (0.91%) had a major hematoma. Mean age (42.0 ± 13.0 years vs 40.9 ± 13.9 years, P < 0.01) and BMI (24.5 ± 5.0 kg/m2 vs 24.3 ± 4.6 kg/m2, P < 0.01) were higher in patients with hematomas. Males suffered more hematomas than females (1.4% vs 0.9%, P < 0.01). Hematoma rates were higher in patients undergoing combined procedures compared to single procedures (1.1% vs 0.8%, P < 0.01), and breast procedures compared to body/extremity or face procedures (1.0% vs 0.8% vs 0.7%, P < 0.01). On multivariate analysis, independent predictors of hematoma included age (Relative Risk [RR] 1.01), male gender (RR 1.98), the procedure being performed in a hospital setting rather than an office-based setting (RR 1.68), combined procedures (RR 1.35), and breast procedures rather than the body/extremity and face procedures (RR 1.81). Major hematoma is the most common complication following aesthetic surgery. Male patients and those undergoing breast or combined procedures have a significantly higher risk of developing hematomas. 2. © 2017 The American Society for Aesthetic Plastic Surgery, Inc. Reprints and permission: journals.permissions@oup.com

Evaluation of Diabetes Mellitus as a Risk Factor for Major Complications in Patients Undergoing Aesthetic Surgery.

PubMed

Bamba, Ravinder; Gupta, Varun; Shack, R Bruce; Grotting, James C; Higdon, K Kye

2016-05-01

Diabetes mellitus has been linked with a variety of perioperative adverse events across surgical disciplines. There is a paucity of studies systematically examining risk factors, including diabetes, and complications of aesthetic surgical procedures. The purpose of this study was to compare incidence and type of complications between diabetic and non-diabetic patients undergoing various aesthetic surgical procedures, to identify specific procedures where diabetes significantly increases risk of complications, and to study diabetes as an independent risk factor for major complications following aesthetic surgery. A prospective cohort of 129,007 patients who enrolled into the CosmetAssure insurance program and underwent cosmetic surgical procedures between May 2008 and May 2013 were reviewed. Diabetes was evaluated as risk factor for major complications, requiring hospital admission, emergency room visit, or a reoperation within 30 days after surgery. Multivariate regression analysis was performed controlling for the effects of age, smoking, obesity, gender, type of procedures, and surgical facility. Overall, 2506 patients (1.9%) had a major complication. Diabetics had significantly more complications compared to non-diabetics (3.1% vs 1.9%, P < 0.01). In univariate analysis, infectious (1.1% vs 0.5%, P < 0.01) and pulmonary (0.3% vs 0.1%, P < 0.01) complications were significantly higher among diabetics. Notably, diabetics had higher risks of complication in body cases (4.3% vs 2.6%, P < 0.01) and specifically abdominoplasty (6.1% vs 3.0%, P < 0.01). In multivariate analysis, diabetes was found to be an independent risk factor of any complication (relative risk 1.31, P = 0.03) and infection (relative risk 1.70, P < 0.01). Diabetes is an independent risk factor of major complications, particularly infection, after aesthetic surgical procedures. © 2016 The American Society for Aesthetic Plastic Surgery, Inc. Reprints and permission: journals.permissions@oup.com.

Identification of risk factors for mucosal injury during laparoscopic Heller myotomy for achalasia.

PubMed

Tsuboi, Kazuto; Omura, Nobuo; Yano, Fumiaki; Hoshino, Masato; Yamamoto, Se-Ryung; Akimoto, Shusuke; Masuda, Takahiro; Kashiwagi, Hideyuki; Yanaga, Katsuhiko

2016-02-01

Mucosal injury during myotomy is the most frequent complication seen with the Heller-Dor procedure for achalasia. The present study aimed to examine risk factors for such mucosal injury during this procedure. This was a retrospective analysis of patients who underwent the laparoscopic Heller-Dor procedure for achalasia at a single facility. Variables for evaluation included patient characteristics, preoperative pathophysiological findings, and surgeon's operative experience. Logistic regression was used to identify risk factors. We also examined surgical outcomes and the degree of patient satisfaction in relation to intraoperative mucosal injury. Four hundred thirty-five patients satisfied study criteria. Intraoperative mucosal injury occurred in 67 patients (15.4%). In univariate analysis, mucosal injury was significantly associated with the patient age ≥60 years, disease history ≥10 years, prior history of cardiac diseases, preoperative esophageal transverse diameter ≥80 mm, and surgeon's operative experience with fewer than five cases. In multivariate analysis involving these factors, the following variables were identified as risk factors: age ≥60 years, esophageal transverse diameter ≥80 mm, and surgeon's operative experience with fewer than five cases. The mucosal injury group had significant extension of the operative time and increased blood loss. However, there were no significant differences between the two groups in the incidence of reflux esophagitis or the degree of symptom alleviation postoperatively. The fragile esophagus caused by advanced patient age and/or dilatation were risk factor for mucosal injury during laparoscopic Heller-Dor procedure. And novice surgeon was also identified as an isolated risk factor for mucosal injury.

A Study of Item Bias for Attitudinal Measurement Using Maximum Likelihood Factor Analysis.

ERIC Educational Resources Information Center

Mayberry, Paul W.

A technique for detecting item bias that is responsive to attitudinal measurement considerations is a maximum likelihood factor analysis procedure comparing multivariate factor structures across various subpopulations, often referred to as SIFASP. The SIFASP technique allows for factorial model comparisons in the testing of various hypotheses…

Establishing Factor Validity Using Variable Reduction in Confirmatory Factor Analysis.

ERIC Educational Resources Information Center

Hofmann, Rich

1995-01-01

Using a 21-statement attitude-type instrument, an iterative procedure for improving confirmatory model fit is demonstrated within the context of the EQS program of P. M. Bentler and maximum likelihood factor analysis. Each iteration systematically eliminates the poorest fitting statement as identified by a variable fit index. (SLD)

The pitfalls of hair analysis for toxicants in clinical practice: three case reports.

PubMed Central

Frisch, Melissa; Schwartz, Brian S

2002-01-01

Hair analysis is used to assess exposure to heavy metals in patients presenting with nonspecific symptoms and is a commonly used procedure in patients referred to our clinic. We are frequently called on to evaluate patients who have health-related concerns as a result of hair analysis. Three patients first presented to outside physicians with nonspecific, multisystemic symptoms. A panel of analytes was measured in hair, and one or more values were interpreted as elevated. As a result of the hair analysis and other unconventional diagnostic tests, the patients presented to us believing they suffered from metal toxicity. In this paper we review the clinical efficacy of this procedure within the context of a patient population with somatic disorders and no clear risk factors for metal intoxication. We also review limitations of hair analysis in this setting; these limitations include patient factors such as low pretest probability of disease and test factors such as the lack of validation of analytic techniques, the inability to discern between exogenous contaminants and endogenous toxicants in hair, the variability of analytic procedures, low interlaboratory reliability, and the increased likelihood of false positive test results in the measurement of panels of analytes. PMID:11940463

Quantitative analysis of crystalline pharmaceuticals in powders and tablets by a pattern-fitting procedure using X-ray powder diffraction data.

PubMed

Yamamura, S; Momose, Y

2001-01-16

A pattern-fitting procedure for quantitative analysis of crystalline pharmaceuticals in solid dosage forms using X-ray powder diffraction data is described. This method is based on a procedure for pattern-fitting in crystal structure refinement, and observed X-ray scattering intensities were fitted to analytical expressions including some fitting parameters, i.e. scale factor, peak positions, peak widths and degree of preferred orientation of the crystallites. All fitting parameters were optimized by the non-linear least-squares procedure. Then the weight fraction of each component was determined from the optimized scale factors. In the present study, well-crystallized binary systems, zinc oxide-zinc sulfide (ZnO-ZnS) and salicylic acid-benzoic acid (SA-BA), were used as the samples. In analysis of the ZnO-ZnS system, the weight fraction of ZnO or ZnS could be determined quantitatively in the range of 5-95% in the case of both powders and tablets. In analysis of the SA-BA systems, the weight fraction of SA or BA could be determined quantitatively in the range of 20-80% in the case of both powders and tablets. Quantitative analysis applying this pattern-fitting procedure showed better reproducibility than other X-ray methods based on the linear or integral intensities of particular diffraction peaks. Analysis using this pattern-fitting procedure also has the advantage that the preferred orientation of the crystallites in solid dosage forms can be also determined in the course of quantitative analysis.

Phrenic nerve injury after radiofrequency ablation of lung tumors: retrospective evaluation of the incidence and risk factors.

PubMed

Matsui, Yusuke; Hiraki, Takao; Gobara, Hideo; Uka, Mayu; Masaoka, Yoshihisa; Tada, Akihiro; Toyooka, Shinichi; Mitsuhashi, Toshiharu; Mimura, Hidefumi; Kanazawa, Susumu

2012-06-01

To retrospectively investigate the incidence of and risk factors for phrenic nerve injury after radiofrequency (RF) ablation of lung tumors. The study included 814 RF ablation procedures of lung tumors. To evaluate the development of phrenic nerve injury, chest radiographs obtained before and after the procedure were examined. Phrenic nerve injury was assumed to have developed if the diaphragmatic level was elevated after the procedure. To identify risk factors for phrenic nerve injury, multiple variables were compared between cases of phrenic nerve injury and randomly selected controls by using univariate analyses. Multivariate analysis was then performed to identify independent risk factors. Evaluation of phrenic nerve injury from chest radiographs was possible after 786 procedures. Evidence of phrenic nerve injury developed after 10 cases (1.3%). Univariate analysis revealed that larger tumor size (≥ 20 mm; P = .014), proximity of the phrenic nerve to the tumor (< 10 mm; P < .001), the use of larger electrodes (array diameter or noninsulated tip length ≥ 3 cm; P = .001), and higher maximum power applied during ablation (≥ 100 W; P < .001) were significantly associated with the development of phrenic nerve injury. Multivariate analysis demonstrated that the proximity of the phrenic nerve to the tumor (< 10 mm; P < .001) was a significant independent risk factor. The incidence of phrenic nerve injury after RF ablation was 1.3%. The proximity of the phrenic nerve to the tumor was an independent risk factor for phrenic nerve injury. Copyright © 2012 SIR. Published by Elsevier Inc. All rights reserved.

Factors that influence length of stay for in-patient gynaecology surgery: is the Case Mix Group (CMG) or type of procedure more important?

PubMed

Carey, Mark S; Victory, Rahi; Stitt, Larry; Tsang, Nicole

2006-02-01

To compare the association between the Case Mix Group (CMG) code and length of stay (LOS) with the association between the type of procedure and LOS in patients admitted for gynaecology surgery. We examined the records of women admitted for surgery in CMG 579 (major uterine/adnexal procedure, no malignancy) or 577 (major surgery ovary/adnexa with malignancy) between April 1997 and March 1999. Factors thought to influence LOS included age, weight, American Society of Anesthesiologists (ASA) score, physician, day of the week on which surgery was performed, and procedure type. Procedures were divided into six categories, four for CMG 579 and two for CMG 577. Data were abstracted from the hospital information costing system (T2 system) and by retrospective chart review. Multivariable analysis was performed using linear regression with backwards elimination. There were 606 patients in CMG 579 and 101 patients in CMG 577, and the corresponding median LOS was four days (range 1-19) for CMG 579 and nine days (range 3-30) for CMG 577. Combined analysis of both CMGs 577 and 579 revealed the following factors as highly significant determinants of LOS: procedure, age, physician, and ASA score. Although confounded by procedure type, the CMG did not significantly account for differences in LOS in the model if procedure was considered. Pairwise comparisons of procedure categories were all found to be statistically significant, even when controlled for other important variables. The type of procedure better accounts for differences in LOS by describing six statistically distinct procedure groups rather than the traditional two CMGs. It is reasonable therefore to consider changing the current CMG codes for gynaecology to a classification based on the type of procedure.

Learning the facts in medical school is not enough: which factors predict successful application of procedural knowledge in a laboratory setting?

PubMed Central

2013-01-01

Background Medical knowledge encompasses both conceptual (facts or “what” information) and procedural knowledge (“how” and “why” information). Conceptual knowledge is known to be an essential prerequisite for clinical problem solving. Primarily, medical students learn from textbooks and often struggle with the process of applying their conceptual knowledge to clinical problems. Recent studies address the question of how to foster the acquisition of procedural knowledge and its application in medical education. However, little is known about the factors which predict performance in procedural knowledge tasks. Which additional factors of the learner predict performance in procedural knowledge? Methods Domain specific conceptual knowledge (facts) in clinical nephrology was provided to 80 medical students (3rd to 5th year) using electronic flashcards in a laboratory setting. Learner characteristics were obtained by questionnaires. Procedural knowledge in clinical nephrology was assessed by key feature problems (KFP) and problem solving tasks (PST) reflecting strategic and conditional knowledge, respectively. Results Results in procedural knowledge tests (KFP and PST) correlated significantly with each other. In univariate analysis, performance in procedural knowledge (sum of KFP+PST) was significantly correlated with the results in (1) the conceptual knowledge test (CKT), (2) the intended future career as hospital based doctor, (3) the duration of clinical clerkships, and (4) the results in the written German National Medical Examination Part I on preclinical subjects (NME-I). After multiple regression analysis only clinical clerkship experience and NME-I performance remained independent influencing factors. Conclusions Performance in procedural knowledge tests seems independent from the degree of domain specific conceptual knowledge above a certain level. Procedural knowledge may be fostered by clinical experience. More attention should be paid to the interplay of individual clinical clerkship experiences and structured teaching of procedural knowledge and its assessment in medical education curricula. PMID:23433202

Evidence Regarding the Internal Structure: Confirmatory Factor Analysis

ERIC Educational Resources Information Center

Lewis, Todd F.

2017-01-01

American Educational Research Association (AERA) standards stipulate that researchers show evidence of the internal structure of instruments. Confirmatory factor analysis (CFA) is one structural equation modeling procedure designed to assess construct validity of assessments that has broad applicability for counselors interested in instrument…

Identifying Human Factors Issues in Aircraft Maintenance Operations

NASA Technical Reports Server (NTRS)

Veinott, Elizabeth S.; Kanki, Barbara G.; Shafto, Michael G. (Technical Monitor)

1995-01-01

Maintenance operations incidents submitted to the Aviation Safety Reporting System (ASRS) between 1986-1992 were systematically analyzed in order to identify issues relevant to human factors and crew coordination. This exploratory analysis involved 95 ASRS reports which represented a wide range of maintenance incidents. The reports were coded and analyzed according to the type of error (e.g, wrong part, procedural error, non-procedural error), contributing factors (e.g., individual, within-team, cross-team, procedure, tools), result of the error (e.g., aircraft damage or not) as well as the operational impact (e.g., aircraft flown to destination, air return, delay at gate). The main findings indicate that procedural errors were most common (48.4%) and that individual and team actions contributed to the errors in more than 50% of the cases. As for operational results, most errors were either corrected after landing at the destination (51.6%) or required the flight crew to stop enroute (29.5%). Interactions among these variables are also discussed. This analysis is a first step toward developing a taxonomy of crew coordination problems in maintenance. By understanding what variables are important and how they are interrelated, we may develop intervention strategies that are better tailored to the human factor issues involved.

Malodorous consequences: what comprises negligence in anosmia litigation?

PubMed

Svider, Peter F; Mauro, Andrew C; Eloy, Jean Anderson; Setzen, Michael; Carron, Michael A; Folbe, Adam J

2014-03-01

Our objectives were to evaluate factors raised in malpractice litigation in which plaintiffs alleged that physician negligence led to olfactory dysfunction. We analyzed publically available federal and court records using Westlaw, a widely used computerized legal database. Pertinent jury verdicts and settlements were comprehensively examined for alleged causes of malpractice (including procedures for iatrogenic causes), defendant specialty, patient demographics, and other factors raised in legal proceedings. Of 25 malpractice proceedings meeting inclusion criteria, 60.0% were resolved for the defendant, 12.0% were settled, and 28.0% had jury-awarded damages. Median payments were significant ($300,000 and $412,500 for settlements and awards, respectively). Otolaryngologists were the most frequently named defendants (68.0%), with the majority of iatrogenic cases (55.0%) related to rhinologic procedures. Associated medical events accompanying anosmia included dysgeusia, cerebrospinal fluid leaks, and meningitis. Other alleged factors included requiring additional surgery (80.0%), unnecessary procedures (47.4% of iatrogenic procedural cases), untimely diagnosis leading to anosmia (44.0%), inadequate informed consent (35.0%), dysgeusia (56.0%), and psychological sequelae (24.0%). Olfactory dysfunction can adversely affect quality of life and thus is a potential area for malpractice litigation. This is particularly true for iatrogenic causes of anosmia, especially following rhinologic procedures. Settlements and damages awarded were considerable, making an understanding of factors detailed in this analysis of paramount importance for the practicing otolaryngologist. This analysis reinforces the importance of explicitly including anosmia in a comprehensive informed consent process for any rhinologic procedure. © 2013 ARS-AAOA, LLC.

SPSS and SAS programs for determining the number of components using parallel analysis and velicer's MAP test.

PubMed

O'Connor, B P

2000-08-01

Popular statistical software packages do not have the proper procedures for determining the number of components in factor and principal components analyses. Parallel analysis and Velicer's minimum average partial (MAP) test are validated procedures, recommended widely by statisticians. However, many researchers continue to use alternative, simpler, but flawed procedures, such as the eigenvalues-greater-than-one rule. Use of the proper procedures might be increased if these procedures could be conducted within familiar software environments. This paper describes brief and efficient programs for using SPSS and SAS to conduct parallel analyses and the MAP test.

Exploring the Dimensionality of a Brief School Readiness Screener for Use with Latino/a Children

ERIC Educational Resources Information Center

Quirk, Matthew; Rebelez, Jennica; Furlong, Michael

2014-01-01

This study contributed to the school readiness literature by examining the factor structure and reliability of a revised version of the Kindergarten Student Entrance Profile (KSEP). Teachers rated 579 Latino/a children during the first month of kindergarten using the KSEP. Factor analysis procedures (exploratory factor analysis [EFA] and…

Risk Factors Analysis for Occurrence of Asymptomatic Bacteriuria After Endourological Procedures

PubMed Central

Junuzovic, Dzelaludin; Hasanbegovic, Munira

2014-01-01

Introduction: Endourological procedures are performed according to the principles of aseptic techniques, jet still in certain number of patients urinary tract infections may occur. Considering the risk of urinary tract infection, there is no unique opinion about the prophylactic use of antibiotics in endourological procedures. Goal: The objective of this study was to determine the connection between endourological procedures and occurrence of urinary infections and to analyze the risk factors of urinary infection for patients who were hospitalized at the Urology Clinic of the Clinical Center University of Sarajevo CCUS. Materials and Methods: The research was conducted as a prospective study on a sample of 208 patients of both genders, who were hospitalized at the Urology Clinic of the CCUS and to whom some endourological procedure was indicated for diagnostic or therapeutic purposes. We analyzed data from patient’s histories of illness, laboratory tests taken at admission and after endourological procedures, also surgical programs for endoscopic procedures. All patients were clinically examined prior to endoscopic procedures while after the treatment attention was focused to the symptoms of urinary tract infections. Results: Statistical analysis of the tested patients indicates that there is no significant difference in the presence of postoperative, compared to preoperative bacteriuria, which implies that the endourological procedures are safe procedures in terms of urinary tract infections. Preoperatively, the most commonly isolated bacteria was Escherichia coli (30.9%) and postoperatively, Enterococcus faecalis (25%). Statistically significant effect on the occurrence of postoperative bacteriuria has preoperative bacteriuria, duration of postoperative catheterization, and duration of hospitalization. Conclusion: In everyday urological practice, it is very important to identify and control risk factors for the development of urinary infection after endourological procedures, with main objective to minimize occurrence of infectious complications. PMID:25568546

Structural-Vibration-Response Data Analysis

NASA Technical Reports Server (NTRS)

Smith, W. R.; Hechenlaible, R. N.; Perez, R. C.

1983-01-01

Computer program developed as structural-vibration-response data analysis tool for use in dynamic testing of Space Shuttle. Program provides fast and efficient time-domain least-squares curve-fitting procedure for reducing transient response data to obtain structural model frequencies and dampings from free-decay records. Procedure simultaneously identifies frequencies, damping values, and participation factors for noisy multiple-response records.

Human Factors Process Task Analysis Liquid Oxygen Pump Acceptance Test Procedure for the Advanced Technology Development Center

NASA Technical Reports Server (NTRS)

Diorio, Kimberly A.

2002-01-01

A process task analysis effort was undertaken by Dynacs Inc. commencing in June 2002 under contract from NASA YA-D6. Funding was provided through NASA's Ames Research Center (ARC), Code M/HQ, and Industrial Engineering and Safety (IES). The John F. Kennedy Space Center (KSC) Engineering Development Contract (EDC) Task Order was 5SMA768. The scope of the effort was to conduct a Human Factors Process Failure Modes and Effects Analysis (HF PFMEA) of a hazardous activity and provide recommendations to eliminate or reduce the effects of errors caused by human factors. The Liquid Oxygen (LOX) Pump Acceptance Test Procedure (ATP) was selected for this analysis. The HF PFMEA table (see appendix A) provides an analysis of six major categories evaluated for this study. These categories include Personnel Certification, Test Procedure Format, Test Procedure Safety Controls, Test Article Data, Instrumentation, and Voice Communication. For each specific requirement listed in appendix A, the following topics were addressed: Requirement, Potential Human Error, Performance-Shaping Factors, Potential Effects of the Error, Barriers and Controls, Risk Priority Numbers, and Recommended Actions. This report summarizes findings and gives recommendations as determined by the data contained in appendix A. It also includes a discussion of technology barriers and challenges to performing task analyses, as well as lessons learned. The HF PFMEA table in appendix A recommends the use of accepted and required safety criteria in order to reduce the risk of human error. The items with the highest risk priority numbers should receive the greatest amount of consideration. Implementation of the recommendations will result in a safer operation for all personnel.

The use of analysis of variance procedures in biological studies

USGS Publications Warehouse

Williams, B.K.

1987-01-01

The analysis of variance (ANOVA) is widely used in biological studies, yet there remains considerable confusion among researchers about the interpretation of hypotheses being tested. Ambiguities arise when statistical designs are unbalanced, and in particular when not all combinations of design factors are represented in the data. This paper clarifies the relationship among hypothesis testing, statistical modelling and computing procedures in ANOVA for unbalanced data. A simple two-factor fixed effects design is used to illustrate three common parametrizations for ANOVA models, and some associations among these parametrizations are developed. Biologically meaningful hypotheses for main effects and interactions are given in terms of each parametrization, and procedures for testing the hypotheses are described. The standard statistical computing procedures in ANOVA are given along with their corresponding hypotheses. Throughout the development unbalanced designs are assumed and attention is given to problems that arise with missing cells.

The Structure of Self-Reported Delinquency

ERIC Educational Resources Information Center

Braithwaite, John B.; Law, Henry G.

1978-01-01

An analysis of self-report delinquency data using four non-metric procedures for structural analysis revealed support for the existence of a general delinquency factor. However, offenses of low seriousness and victimless offenses (drinking and drug-taking items) were only weakly related to this general factor. (Author/CTM)

A Comparison of Measurement Equivalence Methods Based on Confirmatory Factor Analysis and Item Response Theory.

ERIC Educational Resources Information Center

Flowers, Claudia P.; Raju, Nambury S.; Oshima, T. C.

Current interest in the assessment of measurement equivalence emphasizes two methods of analysis, linear, and nonlinear procedures. This study simulated data using the graded response model to examine the performance of linear (confirmatory factor analysis or CFA) and nonlinear (item-response-theory-based differential item function or IRT-Based…

Maximizing the Information and Validity of a Linear Composite in the Factor Analysis Model for Continuous Item Responses

ERIC Educational Resources Information Center

Ferrando, Pere J.

2008-01-01

This paper develops results and procedures for obtaining linear composites of factor scores that maximize: (a) test information, and (b) validity with respect to external variables in the multiple factor analysis (FA) model. I treat FA as a multidimensional item response theory model, and use Ackerman's multidimensional information approach based…

Exploratory Bifactor Analysis of the WJ-III Cognitive in Adulthood via the Schmid-Leiman Procedure

ERIC Educational Resources Information Center

Dombrowski, Stefan C.

2014-01-01

The Woodcock-Johnson-III cognitive in the adult time period (age 20 to 90 plus) was analyzed using exploratory bifactor analysis via the Schmid-Leiman orthogonalization procedure. The results of this study suggested possible overfactoring, a different factor structure from that posited in the Technical Manual and a lack of invariance across both…

Human Factors Analysis to Improve the Processing of Ares-1 Launch Vehicle

NASA Technical Reports Server (NTRS)

Dippolito, Gregory M.; Stambolian, Damon B.

2011-01-01

The Constellation Program (CxP) is composed of an array of vehicles used to go to the Moon and Mars. The Ares vehicle one of the components of CxP, goes through several stages of processing before it is launched at the Kennedy Space Center. In order to have efficient and effective ground processing inside and outside the vehicle, all of the ground processing activities should be analyzed. The analysis for this program was performed, by engineers, technicians, and human factors experts with spacecraft processing experience. The procedure used to gather data was accomplished by observing human activities within physical mockups. The paper will focus on the procedures, analysis and results from these observations.

CT fluoroscopy-guided preoperative short hook wire placement for small pulmonary lesions: evaluation of safety and identification of risk factors for pneumothorax.

PubMed

Iguchi, Toshihiro; Hiraki, Takao; Gobara, Hideo; Fujiwara, Hiroyasu; Matsui, Yusuke; Miyoshi, Shinichiro; Kanazawa, Susumu

2016-01-01

To retrospectively evaluate the safety of computed tomography (CT) fluoroscopy-guided short hook wire placement for video-assisted thoracoscopic surgery and the risk factors for pneumothorax associated with this procedure. We analyzed 267 short hook wire placements for 267 pulmonary lesions (mean diameter, 9.9 mm). Multiple variables related to the patients, lesions, and procedures were assessed to determine the risk factors for pneumothorax. Complications (219 grade 1 and 4 grade 2 adverse events) occurred in 196 procedures. No grade 3 or above adverse events were observed. Univariate analysis revealed increased vital capacity (odds ratio [OR], 1.518; P = 0.021), lower lobe lesion (OR, 2.343; P =0.001), solid lesion (OR, 1.845; P = 0.014), prone positioning (OR, 1.793; P = 0.021), transfissural approach (OR, 11.941; P = 0.017), and longer procedure time (OR, 1.036; P = 0.038) were significant predictors of pneumothorax. Multivariate analysis revealed only the transfissural approach (OR, 12.171; P = 0.018) and a longer procedure time (OR, 1.048; P = 0.012) as significant independent predictors. Complications related to CT fluoroscopy-guided preoperative short hook wire placement often occurred, but all complications were minor. A transfissural approach and longer procedure time were significant independent predictors of pneumothorax. Complications related to CT fluoroscopy-guided preoperative short hook wire placement often occur. Complications are usually minor and asymptomatic. A transfissural approach and longer procedure time are significant independent predictors of pneumothorax.

Safe Anesthesia for Radiotherapy in Pediatric Oncology: St. Jude Children's Research Hospital Experience, 2004-2006

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

Anghelescu, Doralina L.; Burgoyne, Laura L.; Liu Wei

2008-06-01

Purpose: To determine the incidence of anesthesia-related complications in children undergoing radiotherapy and the associated risk factors. Methods and Materials: We retrospectively investigated the incidence and types of anesthesia-related complications and examined their association with age, weight, oncology diagnosis, type of anesthetic (propofol vs. propofol and adjuncts), total propofol dose, anesthetic duration, type of radiotherapy procedure (simulation vs. radiotherapy) and patient position (prone vs. supine). Results: Between July 2004 and June 2006, propofol was used in 3,833 procedures (3,611 radiotherapy sessions and 222 simulations) in 177 patients. Complications occurred during 49 anesthetic sessions (1.3%). On univariate analysis, four factors weremore » significantly associated with the risk of complications: procedure duration (p <0.001), total propofol dose (p <0.001), use of adjunct agents (vs. propofol alone; p = 0.029), and simulation (vs. radiotherapy; p = 0.014). Patient position (prone vs. supine) was not significantly associated with the frequency of complications (odds ratio, 0.71; 95% confidence interval, 0.33-1.53; p = 0.38). On multivariate analysis, the procedure duration (p <0.0001) and total propofol dose (p {<=}0.03) were the most significant risk factors after adjustment for age, weight, anesthetic type, and procedure type. We found no evidence of the development of tolerance to propofol. Conclusion: The rate of anesthesia-related complications was low (1.3%) in our study. The significant risk factors were procedure duration, total propofol dose, the use of adjunct agents with propofol, and simulation (vs. radiotherapy)« less

Use of the Ishikawa diagram in a case-control analysis to assess the causes of a diffuse lamellar keratitis outbreak.

PubMed

Lira, Luis Henrique; Hirai, Flávio E; Oliveira, Marivaldo; Portellinha, Waldir; Nakano, Eliane Mayumi

2017-01-01

To identify the causes of a diffuse lamellar keratitis (DLK) outbreak using a systematic search tool in a case-control analysis. An Ishikawa diagram was used to guide physicians to determine the potential risk factors involved in this outbreak. Coherence between the occurrences and each possible cause listed in the diagram was verified, and the total number of eyes at risk was used to calculate the proportion of affected eyes. Multivariate analysis was performed using logistic regression to determine the independent effect of the risk factors, after controlling for confounders and test interactions. All DLK cases were reported in 2007 between June 13 and December 21; during this period, 3,698 procedures were performed. Of the 1,682 flap-related procedures, 204 eyes of 141 individuals presented with DLK. No direct relationship was observed between the occurrence of DLK and the presence of any specific factors; however, flap-lifting enhancements, procedures performed during the morning shift, and non-use of therapeutic contact lenses after the surgery were significantly related to higher occurrence percentages of this condition. The Ishikawa diagram, like most quality tools, is a visualization and knowledge organization tool. This systematization allowed the investigators to thoroughly assess all the possible causes of DLK outbreak. A clear view of the entire surgical logistics permitted even more rigid management of the main factors involved in the process and, as a result, highlighted factors that deserved attention. The case-control analysis on every factor raised by the Ishikawa diagram indicated that the commonly suspected factors such as biofilm contamination of the water reservoir in autoclaves, the air-conditioning filter system, glove powder, microkeratome motor oil, and gentian violet markers were not related to the outbreak.

Purification and Properties of Streptococcal Competence Factor Isolated from Chemically Defined Medium

PubMed Central

Leonard, C. Gomez; Cole, Roger M.

1972-01-01

A procedure for the isolation and purification of competence factor produced in a defined medium by group H streptococci, strain Challis-6, is presented. Partial characterization and chemical analysis of the product are described. The procedure yields competence factor of high purity, as shown by homogeneity in electrofocusing, by electrophoresis in sodium dodecyl sulfate polyacrylamide gels, and by chemical analysis. The data indicate that competence factor is a small, dialyzable, highly basic compound. It is free from lipids, phosphorus, and carbohydrates, and is colorless and thermoresistant. Its biological activity is destroyed by trypsin but not by deoxyribonuclease, ribonuclease, lipase, or lysozyme. Its high isoelectric point of above pH 11.0 suggests that competence factor may be a protamine or a polymer of basic amino acids. The possibility that a polyamine may be an integral part of the polypeptide molecule has not been excluded. PMID:5018023

Cost of bariatric surgery and factors associated with increased cost: an analysis of national inpatient sample.

PubMed

Khorgami, Zhamak; Aminian, Ali; Shoar, Saeed; Andalib, Amin; Saber, Alan A; Schauer, Philip R; Brethauer, Stacy A; Sclabas, Guido M

2017-08-01

In the current healthcare environment, bariatric surgery centers need to be cost-effective while maintaining quality. The aim of this study was to evaluate national cost of bariatric surgery to identify the factors associated with a higher cost. A retrospective analysis of 2012-2013 Healthcare Cost and Utilization Project - Nationwide Inpatient Sample (HCUP-NIS). We included all patients with a diagnosis of morbid obesity (ICD9 278.01) and a Diagnosis Related Group code related to procedures for obesity, who underwent Roux-en-Y gastric bypass (RYGB), sleeve gastrectomy (SG), or adjustable gastric banding (AGB) as their primary procedure. We converted "hospital charges" to "cost," using hospital specific cost-to-charge ratio. Inflation was adjusted using the annual consumer price index. Increased cost was defined as the top 20th percentile of the expenditure and its associated factors were analyzed using the logistic regression multivariate analysis. A total of 45,219 patients (20,966 RYGBs, 22,380 SGs, and 1,873 AGBs) were included. The median (interquartile range) calculated costs for RYGB, SG, and AGB were $12,543 ($9,970-$15,857), $10,531 ($8,248-$13,527), and $9,219 ($7,545-$12,106), respectively (P<.001). Robotic-assisted procedures had the highest impact on the cost (odds ratio 3.6, 95% confidence interval 3.2-4). Hospital cost of RYGB and SG increased linearly with the length of hospital stay and almost doubled after 7 days. Furthermore, multivariate analysis showed that certain co-morbidities and concurrent procedures were associated with an increased cost. Factors contributing to the cost variation of bariatric procedures include co-morbidities, robotic platform, complexity of surgery, and hospital length of stay. Copyright © 2017 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

Concomitant apical suspensory procedures in women with anterior vaginal wall prolapse in the United States in 2011.

PubMed

Northington, Gina M; Hudson, Catherine O; Karp, Deborah R; Huber, Sarah A

2016-04-01

Although the surgical restoration of apical support has been shown to decrease reoperation rates, it is unclear whether this has been incorporated into current practice. The aims of this study were to determine the rate of concomitant apical suspensory procedures in women with anterior vaginal wall prolapse undergoing surgical repair in 2011 and to identify associated factors. This cross-sectional study queried the Nationwide Inpatient Sample for women with a primary diagnosis of cystocele who underwent prolapse repair in 2011. The study cohort was analyzed for demographics, concomitant procedures, and hospital characteristics. The rate of apical suspensory procedures was determined. Factors potentially associated with receiving concomitant apical suspensory procedure were evaluated using univariate analysis and multivariate logistic regression. A total of 2,900 women in the database had a primary diagnosis of cystocele and underwent surgical prolapse repair in 2011. 925 (31.9 %) subjects underwent a concomitant apical suspensory procedure. The mean age in the study cohort was 61.9 ± 12.8 years. Hysterectomies were performed in 11.1 % of subjects. 61.1 % were performed vaginally, 26.5 % laparoscopically, and 12.5 % abdominally. On multivariate analysis, age greater than 50 years, Caucasian race, concomitant hysterectomy, and an urban teaching hospital setting were independently associated with receiving concomitant apical suspensory procedure in 2011. Despite evidence that the restoration of apical support is important for optimal anterior support, the overall rate of concomitant apical suspensory procedures is low. Several factors may play a role in whether or not women receive an apical suspensory procedure. This study highlights opportunities to improve the quality of surgical care provided to women with anterior vaginal prolapse.

EXAMINING THE DIMENSIONALITY OF COLQUITT'S ORGANIZATIONAL JUSTICE SCALE IN A PUBLIC HEALTH SECTOR CONTEXT.

PubMed

Enoksen, Elisabeth

2015-06-01

In 2001, Colquitt developed an Organizational Justice Scale that intended to measure procedural, distributive, interpersonal, and informational justice. The dimensionality of the scale has been tested in subsequent studies with diverging results. Given the fact that contextual differences may account for more variation across research sites than individual differences, the deviating research findings may be due to context. This study examined the dimensionality of Colquitt's Organizational Justice Scale in a new context: the public health sector. The procedural and informational justice dimensions were highly correlated, but confirmatory factor analysis showed that a four-factor solution provided a better fit than a three-factor solution. All fit indices for the four-factor model were consistent with a good model. There was, however, evidence of a potential omitted factor, procedural-voice justice, which has also been found in a previous examination of the measure in the public sector.

From the operating room to the courtroom: a comprehensive characterization of litigation related to facial plastic surgery procedures.

PubMed

Svider, Peter F; Keeley, Brieze R; Zumba, Osvaldo; Mauro, Andrew C; Setzen, Michael; Eloy, Jean Anderson

2013-08-01

Malpractice litigation has increased in recent decades, contributing to higher health-care costs. Characterization of complications leading to litigation is of special interest to practitioners of facial plastic surgery procedures because of the higher proportion of elective cases relative to other subspecialties. In this analysis, we comprehensively examine malpractice litigation in facial plastic surgery procedures and characterize factors important in determining legal responsibility, as this information may be of great interest and use to practitioners in several specialties. Retrospective analysis. The Westlaw legal database was examined for court records pertaining to facial plastic surgery procedures. The term "medical malpractice" was searched in combination with numerous procedures obtained from the American Academy of Facial Plastic and Reconstructive Surgery website. Of the 88 cases included, 62.5% were decided in the physician's favor, 9.1% were resolved with an out-of-court settlement, and 28.4% ended in a jury awarding damages for malpractice. The mean settlement was $577,437 and mean jury award was $352,341. The most litigated procedures were blepharoplasties and rhinoplasties. Alleged lack of informed consent was noted in 38.6% of cases; other common complaints were excessive scarring/disfigurement, functional considerations, and postoperative pain. This analysis characterized factors in determining legal responsibility in facial plastic surgery cases. Several factors were identified as potential targets for minimizing liability. Informed consent was the most reported entity in these malpractice suits. This finding emphasizes the importance of open communication between physicians and their patients regarding expectations as well as documentation of specific risks, benefits, and alternatives. © 2013 The American Laryngological, Rhinological, and Otological Society, Inc.

Human Factors Process Task Analysis: Liquid Oxygen Pump Acceptance Test Procedure at the Advanced Technology Development Center

NASA Technical Reports Server (NTRS)

Diorio, Kimberly A.; Voska, Ned (Technical Monitor)

2002-01-01

This viewgraph presentation provides information on Human Factors Process Failure Modes and Effects Analysis (HF PFMEA). HF PFMEA includes the following 10 steps: Describe mission; Define System; Identify human-machine; List human actions; Identify potential errors; Identify factors that effect error; Determine likelihood of error; Determine potential effects of errors; Evaluate risk; Generate solutions (manage error). The presentation also describes how this analysis was applied to a liquid oxygen pump acceptance test.

Bayesian Exploratory Factor Analysis

PubMed Central

Conti, Gabriella; Frühwirth-Schnatter, Sylvia; Heckman, James J.; Piatek, Rémi

2014-01-01

This paper develops and applies a Bayesian approach to Exploratory Factor Analysis that improves on ad hoc classical approaches. Our framework relies on dedicated factor models and simultaneously determines the number of factors, the allocation of each measurement to a unique factor, and the corresponding factor loadings. Classical identification criteria are applied and integrated into our Bayesian procedure to generate models that are stable and clearly interpretable. A Monte Carlo study confirms the validity of the approach. The method is used to produce interpretable low dimensional aggregates from a high dimensional set of psychological measurements. PMID:25431517

Terrain Analysis Procedural Guide for Railroads (Report Number 10 in the ETL Series on Guides for Army Terrain Analysis).

DTIC Science & Technology

1982-12-01

study was conducted under DA Project 4A762707A855, Task C, Work 6 Unit 21, "Military Geographic Analysis Technology." This study was done under the...supplement to the Terrain Analysis Procedural Guide for Roads and Related Structures (ETL-0205, October 1979). In sparsely inhabited study areas, railroad data... study area. " W, In general, three major sources of information are available that will = be helpful in the production of factor overlays for railroads

Perioperative risk assessment in robotic general surgery: lessons learned from 884 cases at a single institution.

PubMed

Buchs, Nicolas C; Addeo, Pietro; Bianco, Francesco M; Gorodner, Veronica; Ayloo, Subhashini M; Elli, Enrique F; Oberholzer, José; Benedetti, Enrico; Giulianotti, Pier C

2012-08-01

To assess factors associated with morbidity and mortality following the use of robotics in general surgery. Case series. University of Illinois at Chicago. Eight hundred eighty-four consecutive patients who underwent a robotic procedure in our institution between April 2007 and July 2010. Perioperative morbidity and mortality. During the study period, 884 patients underwent a robotic procedure. The conversion rate was 2%, the mortality rate was 0.5%, and the overall postoperative morbidity rate was 16.7%. The reoperation rate was 2.4%. Mean length of stay was 4.5 days (range, 0.2-113 days). In univariate analysis, several factors were associated with increased morbidity and included either patient-related (cardiovascular and renal comorbidities, American Society of Anesthesiologists score ≥ 3, body mass index [calculated as weight in kilograms divided by height in meters squared] <30, age ≥ 70 years, and malignant disease) or procedure-related (blood loss ≥ 500 mL, transfusion, multiquadrant operation, and advanced procedure) factors. In multivariate analysis, advanced procedure, multiquadrant surgery, malignant disease, body mass index of less than 30, hypertension, and transfusion were factors significantly associated with a higher risk for complications. American Society of Anesthesiologists score of 3 or greater, age 70 years or older, cardiovascular comorbidity, and blood loss of 500 mL or more were also associated with increased risk for mortality. Use of the robotic approach for general surgery can be achieved safely with low morbidity and mortality. Several risk factors have been identified as independent causes for higher morbidity and mortality. These can be used to identify patients at risk before and during the surgery and, in the future, to develop a scoring system for the use of robotic general surgery

Validity and Reliability of the School Physical Activity Environment Questionnaire

ERIC Educational Resources Information Center

Martin, Jeffrey J.; McCaughtry, Nate; Flory, Sara; Murphy, Anne; Wisdom, Kimberlydawn

2011-01-01

The goal of the current study was to establish the factor validity of the Questionnaire Assessing School Physical Activity Environment (Robertson-Wilson, Levesque, & Holden, 2007) using confirmatory factor analysis procedures. Another goal was to establish internal reliability and test-retest reliability. The confirmatory factor analysis…

Incidence and Risk Factors for Perioperative Cardiovascular and Respiratory Adverse Events in Pediatric Patients With Congenital Heart Disease Undergoing Noncardiac Procedures.

PubMed

Lee, Sandra; Reddington, Elise; Koutsogiannaki, Sophia; Hernandez, Michael R; Odegard, Kirsten C; DiNardo, James A; Yuki, Koichi

2018-04-27

While mortality and adverse perioperative events after noncardiac surgery in children with a broad range of congenital cardiac lesions have been investigated using large multiinstitutional databases, to date single-center studies addressing adverse outcomes in children with congenital heart disease (CHD) undergoing noncardiac surgery have only included small numbers of patients with significant heart disease. The primary objective of this study was to determine the incidences of perioperative cardiovascular and respiratory events in a large cohort of patients from a single institution with a broad range of congenital cardiac lesions undergoing noncardiac procedures and to determine risk factors for these events. We identified 3010 CHD patients presenting for noncardiac procedures in our institution over a 5-year period. We collected demographic information, including procedure performed, cardiac diagnosis, ventricular function as assessed by echocardiogram within 6 months of the procedure, and classification of CHD into 3 groups (minor, major, or severe CHD) based on residual lesion burden and cardiovascular functional status. Characteristics related to conduct of anesthesia care were also collected. The primary outcome variables for our analysis were the incidences of intraoperative cardiovascular and respiratory events. Univariable and multivariable logistic regressions were used to determine risk factors for these 2 outcomes. The incidence of cardiovascular events was 11.5% and of respiratory events was 4.7%. Univariate analysis and multivariable analysis demonstrated that American Society of Anesthesiologists (≥3), emergency cases, major and severe CHD, single-ventricle physiology, ventricular dysfunction, orthopedic surgery, general surgery, neurosurgery, and pulmonary procedures were associated with perioperative cardiovascular events. Respiratory events were associated with American Society of Anesthesiologists (≥4) and otolaryngology, gastrointestinal, general surgery, and maxillofacial procedures. Intraoperative cardiovascular events and respiratory events in patients with CHD were relatively common. While cardiovascular events were highly associated with cardiovascular status, respiratory events were not associated with cardiovascular status.

Critical incident technique analysis applied to perianesthetic cardiac arrests at a university teaching hospital.

PubMed

Hofmeister, Erik H; Reed, Rachel A; Barletta, Michele; Shepard, Molly; Quandt, Jane

2018-05-01

To apply the critical incident technique (CIT) methodology to a series of perianesthetic cardiac arrest events at a university teaching hospital to describe the factors that contributed to cardiac arrest. CIT qualitative analysis of a case series. A group of 16 dogs and cats that suffered a perioperative cardiac arrest between November 2013 and November 2016. If an arrest occurred, the event was discussed among the anesthesiologists. The discussion included a description of the case, a description of the sequence of events leading up to the arrest and a discussion of what could have been done to affect the outcome. A written description of the case and the event including animal signalment and a timeline of events was provided by the supervising anesthesiologist following discussion among the anesthesiologists. Only dogs or cats were included. After the data collection period, information from the medical record was collected. A qualitative document analysis was performed on the summaries provided about each case by the supervising anesthesiologist, the medical record and any supporting documents. Each case was then classified into one or more of the following: animal, human, equipment, drug and procedural factors for cardiac arrest. The most common factor was animal (n=14), followed by human (n=12), procedural (n=4), drugs (n=1) and equipment (n=1). The majority (n=11) of animals had multiple factors identified. Cardiac arrests during anesthesia at a referral teaching hospital were primarily a result of animal and human factors. Arrests because of procedural, drug and equipment factors were uncommon. Most animals experienced more than one factor and two animals arrested after a change in recumbency. Future work should focus on root cause analysis and interventions designed to minimize all factors, particularly human ones. Copyright © 2018 Association of Veterinary Anaesthetists and American College of Veterinary Anesthesia and Analgesia. Published by Elsevier Ltd. All rights reserved.

Risk factors for postoperative complications in robotic general surgery.

PubMed

Fantola, Giovanni; Brunaud, Laurent; Nguyen-Thi, Phi-Linh; Germain, Adeline; Ayav, Ahmet; Bresler, Laurent

2017-03-01

The feasibility and safety of robotically assisted procedures in general surgery have been reported from various groups worldwide. Because postoperative complications may lead to longer hospital stays and higher costs overall, analysis of risk factors for postoperative surgical complications in this subset of patients is clinically relevant. The goal of this study was to identify risk factors for postoperative morbidity after robotic surgical procedures in general surgery. We performed an observational monocentric retrospective study. All consecutive robotic surgical procedures from November 2001 to December 2013 were included. One thousand consecutive general surgery patients met the inclusion criteria. The mean overall postoperative morbidity and major postoperative morbidity (Clavien >III) rates were 20.4 and 6 %, respectively. This included a conversion rate of 4.4 %, reoperation rate of 4.5 %, and mortality rate of 0.2 %. Multivariate analysis showed that ASA score >3 [OR 1.7; 95 % CI (1.2-2.4)], hematocrit value <38 [OR 1.6; 95 % CI (1.1-2.2)], previous abdominal surgery [OR 1.5; 95 % CI (1-2)], advanced dissection [OR 5.8; 95 % CI (3.1-10.6)], and multiquadrant surgery [OR 2.5; 95 % CI (1.7-3.8)] remained independent risk factors for overall postoperative morbidity. It also showed that advanced dissection [OR 4.4; 95 % CI (1.9-9.6)] and multiquadrant surgery [OR 4.4; 95 % CI (2.3-8.5)] remained independent risk factors for major postoperative morbidity (Clavien >III). This study identifies independent risk factors for postoperative overall and major morbidity in robotic general surgery. Because these factors independently impacted postoperative complications, we believe they could be taken into account in future studies comparing conventional versus robot-assisted laparoscopic procedures in general surgery.

Mean structure analysis from an IRT approach: an application in the context of organizational psychology.

PubMed

Revuelta Menéndez, Javier; Ximénez Gómez, Carmen

2012-11-01

The application of mean and covariance structure analysis with quantitative data is increasing. However, latent means analysis with qualitative data is not as widespread. This article summarizes the procedures to conduct an analysis of latent means of dichotomous data from an item response theory approach. We illustrate the implementation of these procedures in an empirical example referring to the organizational context, where a multi-group analysis was conducted to compare the latent means of three employee groups in two factors measuring personal preferences and the perceived degree of rewards from the organization. Results show that higher personal motivations are associated with higher perceived importance of the organization, and that these perceptions differ across groups, so that higher-level employees have a lower level of personal and perceived motivation. The article shows how to estimate the factor means and the factor correlation from dichotomous data, and how to assess goodness of fit. Lastly, we provide the M-Plus syntax code in order to facilitate the latent means analyses for applied researchers.

Electromagnetic tracking in the clinical environment

PubMed Central

Yaniv, Ziv; Wilson, Emmanuel; Lindisch, David; Cleary, Kevin

2009-01-01

When choosing an electromagnetic tracking system (EMTS) for image-guided procedures several factors must be taken into consideration. Among others these include the system’s refresh rate, the number of sensors that need to be tracked, the size of the navigated region, the system interaction with the environment, whether the sensors can be embedded into the tools and provide the desired transformation data, and tracking accuracy and robustness. To date, the only factors that have been studied extensively are the accuracy and the susceptibility of EMTSs to distortions caused by ferromagnetic materials. In this paper the authors shift the focus from analysis of system accuracy and stability to the broader set of factors influencing the utility of EMTS in the clinical environment. The authors provide an analysis based on all of the factors specified above, as assessed in three clinical environments. They evaluate two commercial tracking systems, the Aurora system from Northern Digital Inc., and the 3D Guidance system with three different field generators from Ascension Technology Corp. The authors show that these systems are applicable to specific procedures and specific environments, but that currently, no single system configuration provides a comprehensive solution across procedures and environments. PMID:19378748

The utility of live video capture to enhance debriefing following transcatheter aortic valve replacement.

PubMed

Seamans, David P; Louka, Boshra F; Fortuin, F David; Patel, Bhavesh M; Sweeney, John P; Lanza, Louis A; DeValeria, Patrick A; Ezrre, Kim M; Ramakrishna, Harish

2016-10-01

The surgical and procedural specialties are continually evolving their methods to include more complex and technically difficult cases. These cases can be longer and incorporate multiple teams in a different model of operating room synergy. Patients are frequently older, with comorbidities adding to the complexity of these cases. Recording of this environment has become more feasible recently with advancement in video and audio capture systems often used in the simulation realm. We began using live capture to record a new procedure shortly after starting these cases in our institution. This has provided continued assessment and evaluation of live procedures. The goal of this was to improve human factors and situational challenges by review and debriefing. B-Line Medical's LiveCapture video system was used to record successive transcatheter aortic valve replacement (TAVR) procedures in our cardiac catheterization/laboratory. An illustrative case is used to discuss analysis and debriefing of the case using this system. An illustrative case is presented that resulted in long-term changes to our approach of these cases. The video capture documented rare events during one of our TAVR procedures. Analysis and debriefing led to definitive changes in our practice. While there are hurdles to the use of this technology in every institution, the role for the ongoing use of video capture, analysis, and debriefing may play an important role in the future of patient safety and human factors analysis in the operating environment.

The utility of live video capture to enhance debriefing following transcatheter aortic valve replacement

PubMed Central

Seamans, David P.; Louka, Boshra F.; Fortuin, F. David; Patel, Bhavesh M.; Sweeney, John P.; Lanza, Louis A.; DeValeria, Patrick A.; Ezrre, Kim M.; Ramakrishna, Harish

2016-01-01

Background: The surgical and procedural specialties are continually evolving their methods to include more complex and technically difficult cases. These cases can be longer and incorporate multiple teams in a different model of operating room synergy. Patients are frequently older, with comorbidities adding to the complexity of these cases. Recording of this environment has become more feasible recently with advancement in video and audio capture systems often used in the simulation realm. Aims: We began using live capture to record a new procedure shortly after starting these cases in our institution. This has provided continued assessment and evaluation of live procedures. The goal of this was to improve human factors and situational challenges by review and debriefing. Setting and Design: B-Line Medical's LiveCapture video system was used to record successive transcatheter aortic valve replacement (TAVR) procedures in our cardiac catheterization/laboratory. An illustrative case is used to discuss analysis and debriefing of the case using this system. Results and Conclusions: An illustrative case is presented that resulted in long-term changes to our approach of these cases. The video capture documented rare events during one of our TAVR procedures. Analysis and debriefing led to definitive changes in our practice. While there are hurdles to the use of this technology in every institution, the role for the ongoing use of video capture, analysis, and debriefing may play an important role in the future of patient safety and human factors analysis in the operating environment. PMID:27762242

Functional and Structural Analyses of Behavior: Approaches Leading to Reduced Use of Punishment Procedures?

ERIC Educational Resources Information Center

Axelrod, Saul

1987-01-01

Emerging approaches for dealing with inappropriate behaviors of the disabled involve conducting a functional or structural behavior analysis to isolate the factors responsible for the aberrant behavior and implementing corrective procedures (often alternatives to punishment) relevant to the function of the inappropriate behavior. (Author/DB)

Testing for Factorial Invariance in the Context of Construct Validation

ERIC Educational Resources Information Center

Dimitrov, Dimiter M.

2010-01-01

This article describes the logic and procedures behind testing for factorial invariance across groups in the context of construct validation. The procedures include testing for configural, measurement, and structural invariance in the framework of multiple-group confirmatory factor analysis (CFA). The "forward" (sequential constraint imposition)…

Element-by-element Solution Procedures for Nonlinear Structural Analysis

NASA Technical Reports Server (NTRS)

Hughes, T. J. R.; Winget, J. M.; Levit, I.

1984-01-01

Element-by-element approximate factorization procedures are proposed for solving the large finite element equation systems which arise in nonlinear structural mechanics. Architectural and data base advantages of the present algorithms over traditional direct elimination schemes are noted. Results of calculations suggest considerable potential for the methods described.

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

PubMed

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

2012-10-01

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

Shuttle remote manipulator system mission preparation and operations

NASA Technical Reports Server (NTRS)

Smith, Ernest E., Jr.

1989-01-01

The preflight planning, analysis, procedures development, and operations support for the Space Transportation System payload deployment and retrieval missions utilizing the Shuttle Remote Manipulator System are summarized. Analysis of the normal operational loads and failure induced loads and motion are factored into all procedures. Both the astronaut flight crews and the Mission Control Center flight control teams receive considerable training for standard and mission specific operations. The real time flight control team activities are described.

The SAAS-R: A New Instrument to Assess the School Attitudes of Students with High and Low Academic Achievement in Spain

ERIC Educational Resources Information Center

Miñano Pérez, Pablo; Costa, Juan Luis Castejón; Corbi, Raquel Gilar; Iniesta, Alejandro Veas

2017-01-01

We examined the psychometric properties of the School Attitude Assessment Survey-Revised in a Spanish population (n = 1,398). Confirmatory factor analysis procedures supported the instrument's five-factor structure. The results of discriminant analysis demonstrated the predictive power of the School Attitude Assessment Survey-Revised scales as…

A procedure for landslide susceptibility zonation by the conditional analysis method1

NASA Astrophysics Data System (ADS)

Clerici, Aldo; Perego, Susanna; Tellini, Claudio; Vescovi, Paolo

2002-12-01

Numerous methods have been proposed for landslide probability zonation of the landscape by means of a Geographic Information System (GIS). Among the multivariate methods, i.e. those methods which simultaneously take into account all the factors contributing to instability, the Conditional Analysis method applied to a subdivision of the territory into Unique Condition Units is particularly straightforward from a conceptual point of view and particularly suited to the use of a GIS. In fact, working on the principle that future landslides are more likely to occur under those conditions which led to past instability, landslide susceptibility is defined by computing the landslide density in correspondence with different combinations of instability factors. The conceptual simplicity of this method, however, does not necessarily imply that it is simple to implement, especially as it requires rather complex operations and a high number of GIS commands. Moreover, there is the possibility that, in order to achieve satisfactory results, the procedure has to be repeated a few times changing the factors or modifying the class subdivision. To solve this problem, we created a shell program which, by combining the shell commands, the GIS Geographical Research Analysis Support System (GRASS) commands and the gawk language commands, carries out the whole procedure automatically. This makes the construction of a Landslide Susceptibility Map easy and fast for large areas too, and even when a high spatial resolution is adopted, as shown by application of the procedure to the Parma River basin, in the Italian Northern Apennines.

Procedures and models for estimating preconstruction costs of highway projects.

DOT National Transportation Integrated Search

2012-07-01

This study presents data driven and component based PE cost prediction models by utilizing critical factors retrieved from ten years of historical project data obtained from ODOT roadway division. The study used factor analysis of covariance and corr...

Error analysis of multi-needle Langmuir probe measurement technique.

PubMed

Barjatya, Aroh; Merritt, William

2018-04-01

Multi-needle Langmuir probe is a fairly new instrument technique that has been flown on several recent sounding rockets and is slated to fly on a subset of QB50 CubeSat constellation. This paper takes a fundamental look into the data analysis procedures used for this instrument to derive absolute electron density. Our calculations suggest that while the technique remains promising, the current data analysis procedures could easily result in errors of 50% or more. We present a simple data analysis adjustment that can reduce errors by at least a factor of five in typical operation.

Error analysis of multi-needle Langmuir probe measurement technique

NASA Astrophysics Data System (ADS)

Barjatya, Aroh; Merritt, William

2018-04-01

Multi-needle Langmuir probe is a fairly new instrument technique that has been flown on several recent sounding rockets and is slated to fly on a subset of QB50 CubeSat constellation. This paper takes a fundamental look into the data analysis procedures used for this instrument to derive absolute electron density. Our calculations suggest that while the technique remains promising, the current data analysis procedures could easily result in errors of 50% or more. We present a simple data analysis adjustment that can reduce errors by at least a factor of five in typical operation.

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

PubMed

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

2017-09-01

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

Factors affecting job satisfaction in nurse faculty: a meta-analysis.

PubMed

Gormley, Denise K

2003-04-01

Evidence in the literature suggests job satisfaction can make a difference in keeping qualified workers on the job, but little research has been conducted focusing specifically on nursing faculty. Several studies have examined nurse faculty satisfaction in relationship to one or two influencing factors. These factors include professional autonomy, leader role expectations, organizational climate, perceived role conflict and role ambiguity, leadership behaviors, and organizational characteristics. This meta-analysis attempts to synthesize the various studies conducted on job satisfaction in nursing faculty and analyze which influencing factors have the greatest effect. The procedure used for this meta-analysis consisted of reviewing studies to identify factors influencing job satisfaction, research questions, sample size reported, instruments used for measurement of job satisfaction and influencing factors, and results of statistical analysis.

Current outcomes and risk factors for the Norwood procedure.

PubMed

Stasik, Chad N; Gelehrter, S; Goldberg, Caren S; Bove, Edward L; Devaney, Eric J; Ohye, Richard G

2006-02-01

Tremendous strides have been made in the outcomes for hypoplastic left heart syndrome and other functional single-ventricle malformations over the past 25 years. This progress relates primarily to improvements in survival for patients undergoing the Norwood procedure. Previous reports on risk factors have been on smaller groups of patients or collected over relatively long periods of time, during which management has evolved. We analyzed our current results for the Norwood procedure with attention to risk factors for poor outcome. A single-institution review of all patients undergoing a Norwood procedure for a single-ventricle malformation from May 1, 2001, through April 30, 2003, was performed. Patient demographics, anatomy, clinical condition, associated anomalies, operative details, and outcomes were recorded. Of the 111 patients, there were 23 (21%) hospital deaths. Univariate analysis revealed noncardiac abnormalities (genetic or significant extracardiac diagnosis, P = .0018), gestational age (P = .03), diagnosis of unbalanced atrioventricular septal defect (P = .017), and weight of less than 2.5 kg (P = .0072) to be related to hospital death. On multivariate analysis, only weight of less than 2.5 kg and noncardiac abnormalities were found to be independent risk factors. Patients with either of these characteristics had a hospital survival of 52% (12/23), whereas those at standard risk had a survival of 86% (76/88). Although improvements in management might have lessened the effect of some of the traditionally reported risk factors related to variations in the cardiovascular anatomy, noncardiac abnormalities and low birth weight remain as a future challenge for the physician caring for the patient with single-ventricle physiology.

[Hereditary heterozygous factor VII deficiency in patients undergoing surgery : Clinical relevance].

PubMed

Woehrle, D; Martinez, M; Bolliger, D

2016-10-01

A hereditary deficiency in coagulation factor VII (FVII) may affect the international normalized ratio (INR) value. However, FVII deficiency is occasionally associated with a tendency to bleed spontaneously. We hypothesized that perioperative substitution with coagulation factor concentrates might not be indicated in most patients. In this retrospective data analysis, we included all patients with hereditary heterozygous FVII deficiency who underwent surgical procedures at the University Hospital Basel between December 2010 and November 2015. In addition, by searching the literature, we identified publications reporting patients with FVII deficiency undergoing surgical procedures without perioperative substitution. We identified 22 patients undergoing 46 surgical procedures, resulting in a prevalence of 1:1500-2000. Coagulation factor concentrates were administered during the perioperative period in 15 procedures (33 %), whereas in the other 31 procedures (66 %), FVII deficiency was not substituted. No postoperative bleeding or thromboembolic events were reported. In addition, we found no differences in pre- and postoperative hemoglobin and coagulation parameters, with the exception of an improved postoperative INR value in the substituted group. In the literature review, we identified five publications, including 125 patients with FVII deficiency, undergoing 213 surgical procedures with no perioperative substitution. Preoperative substitution using coagulation factor concentrates does not seem to be mandatory in patients with an FVII level ≥15 %. For decision-making on preoperative substitution, patient history of an increased tendency to bleed may be more important than the FVII level or increased INR value.

Cosmetic Liposuction: Preoperative Risk Factors, Major Complication Rates, and Safety of Combined Procedures.

PubMed

Kaoutzanis, Christodoulos; Gupta, Varun; Winocour, Julian; Layliev, John; Ramirez, Roberto; Grotting, James C; Higdon, Kent

2017-06-01

Liposuction is among the most commonly performed aesthetic procedures, and is being performed increasingly as an adjunct to other procedures. To report the incidence and risk factors of significant complications after liposuction, and to determine whether adding liposuction to other cosmetic surgical procedures impacts the complication risk. A prospective cohort of patients who underwent liposuction between 2008 and 2013 was identified from the CosmetAssure database. Primary outcome was occurrence of major complications requiring emergency room visit, hospital admission, or reoperation within 30 days of the operation. Univariate and multivariate analysis evaluated risk factors including age, gender, body mass index (BMI), smoking, diabetes, type of surgical facility, and combined procedures. Of the 31,010 liposuction procedures, only 11,490 (37.1%) were performed as a solitary procedure. Liposuction alone had a major complication rate of 0.7% with hematoma (0.15%), pulmonary complications (0.1%), infection (0.1%), and confirmed venous thromboembolism (VTE) (0.06%) being the most common. Independent predictors of major complications included combined procedures (Relative Risk (RR) 4.81), age (RR 1.01), BMI (RR 1.05), and procedures performed in hospitals (RR 1.36). When examining specifically other aesthetic procedures performed alone or with liposuction, combined procedures had a higher risk of confirmed VTE (RR 5.65), pulmonary complications (RR 2.72), and infection (RR 2.41), but paradoxically lower hematoma risk (RR 0.77) than solitary procedures. Liposuction performed alone is a safe procedure with a low risk of major complications. Combined procedures, especially on obese or older individuals, can significantly increase complication rates. The impact of liposuction on the risk of hematoma in combined procedures needs further investigation. © 2017 The American Society for Aesthetic Plastic Surgery, Inc. Reprints and permission: journals.permissions@oup.com

Analysis of Academic Administrators' Attitudes: Annual Evaluations and Factors That Improve Teaching

ERIC Educational Resources Information Center

Cherry, Brian D.; Grasse, Nathan; Kapla, Dale; Hamel, Brad

2017-01-01

This article examines academic administrators' attitudes towards the academic evaluation process in the US and those factors that are utilised to improve teaching. We use path regressions to examine satisfaction with evaluation procedures, as well as the direct and indirect effects of these factors on perceptions of whether the evaluation process…

Cross-Cultural Validation of the Patient Perception of Integrated Care Survey.

PubMed

Tietschert, Maike V; Angeli, Federica; van Raak, Arno J A; Ruwaard, Dirk; Singer, Sara J

2017-07-20

To test the cross-cultural validity of the U.S. Patient Perception of Integrated Care (PPIC) Survey in a Dutch sample using a standardized procedure. Primary data collected from patients of five primary care centers in the south of the Netherlands, through survey research from 2014 to 2015. Cross-sectional data collected from patients who saw multiple health care providers during 6 months preceding data collection. The PPIC survey includes 59 questions that measure patient perceived care integration across providers, settings, and time. Data analysis followed a standardized procedure guiding data preparation, psychometric analysis, and included invariance testing with the U.S. dataset. Latent scale structures of the Dutch and U.S. survey were highly comparable. Factor "Integration with specialist" had lower reliability scores and noninvariance. For the remaining factors, internal consistency and invariance estimates were strong. The standardized cross-cultural validation procedure produced strong support for comparable psychometric characteristics of the Dutch and U.S. surveys. Future research should examine the usability of the proposed procedure for contexts with greater cultural differences. © Health Research and Educational Trust.

A simple ergonomic measure reduces fluoroscopy time during ERCP: A multivariate analysis.

PubMed

Jowhari, Fahd; Hopman, Wilma M; Hookey, Lawrence

2017-03-01

Background and study aims  Endoscopic retrograde cholangiopancreatgraphy (ERCP) carries a radiation risk to patients undergoing the procedure and the team performing it. Fluoroscopy time (FT) has been shown to have a linear relationship with radiation exposure during ERCP. Recent modifications to our ERCP suite design were felt to impact fluoroscopy time and ergonomics. This multivariate analysis was therefore undertaken to investigate these effects, and to identify and validate various clinical, procedural and ergonomic factors influencing the total fluoroscopy time during ERCP. This would better assist clinicians with predicting prolonged fluoroscopic durations and to undertake relevant precautions accordingly. Patients and methods  A retrospective analysis of 299 ERCPs performed by 4 endoscopists over an 18-month period, at a single tertiary care center was conducted. All inpatients/outpatients (121 males, 178 females) undergoing ERCP for any clinical indication from January 2012 to June 2013 in the chosen ERCP suite were included in the study. Various predetermined clinical, procedural and ergonomic factors were obtained via chart review. Univariate analyses identified factors to be included in the multivariate regression model with FT as the dependent variable. Results  Bringing the endoscopy and fluoroscopy screens next to each other was associated with a significantly lesser FT than when the screens were separated further (-1.4 min, P  = 0.026). Other significant factors associated with a prolonged FT included having a prior ERCP (+ 1.4 min, P  = 0.031), and more difficult procedures (+ 4.2 min for each level of difficulty, P  < 0.001). ERCPs performed by high-volume endoscopists used lesser FT vs. low-volume endoscopists (-1.82, P = 0.015). Conclusions  Our study has identified and validated various factors that affect the total fluoroscopy time during ERCP. This is the first study to show that decreasing the distance between the endoscopy and fluoroscopy screens in the ERCP suite significantly reduces the total fluoroscopy time, and therefore radiation exposure to patients and staff involved in the procedure.

Geographic differences in the epidemiological features of HCV infection in Korea

PubMed Central

Kim, Kyung-Ah; Jang, Eun Sun; Kim, Young Seok; Lee, Youn Jae; Jung, Eun Uk; Kim, In Hee; Cho, Sung Bum; Kee, Mee-Kyung; Kang, Chun

2014-01-01

Background/Aims The prevalence of hepatitis C virus (HCV) infection in Korea exhibits significant geographic variation, with it being higher in Busan and Jeonam than in other areas. The reason for this intranational geographic difference was investigated in this study by conducting a comparative analysis of the risk factors related to HCV infection among three geographic areas: the capital (Seoul), Busan, and the province of Jeolla. Methods In total, 990 patients with chronic HCV infection were prospectively enrolled at 5 university hospitals located in Seoul (n=374), Busan (n=264), and Jeolla (n=352). A standardized questionnaire survey on the risk factors for HCV infection was administered to these three groups of patients, and a comparative analysis of the findings was performed. Results The analysis revealed significant regional differences in exposure to the risk factors of HCV infection. By comparison with patients in Seoul as a control group in the multivariate analysis, patients in Busan had significantly more experience of invasive medical procedures, acupuncture, cosmetic procedures, and multiple sex partners. In contrast, patients in Jeolla were significantly older, and they had a higher prevalence of hepatocellular carcinoma, a lower prevalence of multiple sex partners, and had experienced fewer invasive procedures. Conclusions There was a significant geographic difference in the exposure to potential risk factors of HCV infection between patients from the three studied regions. This may explain the regional variation of the prevalence of HCV infection in Korea, and should be taken into account when planning strategies for the prevention and management of HCV infection. PMID:25548742

A medical school's organizational readiness for curriculum change (MORC): development and validation of a questionnaire.

PubMed

Jippes, Mariëlle; Driessen, Erik W; Broers, Nick J; Majoor, Gerard D; Gijselaers, Wim H; van der Vleuten, Cees P M

2013-09-01

Because successful change implementation depends on organizational readiness for change, the authors developed and assessed the validity of a questionnaire, based on a theoretical model of organizational readiness for change, designed to measure, specifically, a medical school's organizational readiness for curriculum change (MORC). In 2012, a panel of medical education experts judged and adapted a preliminary MORC questionnaire through a modified Delphi procedure. The authors administered the resulting questionnaire to medical school faculty involved in curriculum change and tested the psychometric properties using exploratory and confirmatory factor analysis, and generalizability analysis. The mean relevance score of the Delphi panel (n = 19) reached 4.2 on a five-point Likert-type scale (1 = not relevant and 5 = highly relevant) in the second round, meeting predefined criteria for completing the Delphi procedure. Faculty (n = 991) from 131 medical schools in 56 countries completed MORC. Exploratory factor analysis yielded three underlying factors-motivation, capability, and external pressure-in 12 subscales with 53 items. The scale structure suggested by exploratory factor analysis was confirmed by confirmatory factor analysis. Cronbach alpha ranged from 0.67 to 0.92 for the subscales. Generalizability analysis showed that the MORC results of 5 to 16 faculty members can reliably evaluate a school's organizational readiness for change. MORC is a valid, reliable questionnaire for measuring organizational readiness for curriculum change in medical schools. It can identify which elements in a change process require special attention so as to increase the chance of successful implementation.

Cost Analysis of an Office-based Surgical Suite

PubMed Central

LaBove, Gabrielle

2016-01-01

Introduction: Operating costs are a significant part of delivering surgical care. Having a system to analyze these costs is imperative for decision making and efficiency. We present an analysis of surgical supply, labor and administrative costs, and remuneration of procedures as a means for a practice to analyze their cost effectiveness; this affects the quality of care based on the ability to provide services. The costs of surgical care cannot be estimated blindly as reconstructive and cosmetic procedures have different percentages of overhead. Methods: A detailed financial analysis of office-based surgical suite costs for surgical procedures was determined based on company contract prices and average use of supplies. The average time spent on scheduling, prepping, and doing the surgery was factored using employee rates. Results: The most expensive, minor procedure supplies are suture needles. The 4 most common procedures from the most expensive to the least are abdominoplasty, breast augmentation, facelift, and lipectomy. Conclusions: Reconstructive procedures require a greater portion of collection to cover costs. Without the adjustment of both patient and insurance remuneration in the practice, the ability to provide quality care will be increasingly difficult. PMID:27536482

Updating QR factorization procedure for solution of linear least squares problem with equality constraints.

PubMed

Zeb, Salman; Yousaf, Muhammad

2017-01-01

In this article, we present a QR updating procedure as a solution approach for linear least squares problem with equality constraints. We reduce the constrained problem to unconstrained linear least squares and partition it into a small subproblem. The QR factorization of the subproblem is calculated and then we apply updating techniques to its upper triangular factor R to obtain its solution. We carry out the error analysis of the proposed algorithm to show that it is backward stable. We also illustrate the implementation and accuracy of the proposed algorithm by providing some numerical experiments with particular emphasis on dense problems.

Microelectromechanical System (MEMS) Gyroscope Noise Analysis and Scale Factor Characterization over Temperature Variation

DTIC Science & Technology

2016-07-01

bias and scale factor tests. By testing state-of-the-art gyroscopes, the effect of input rate stability and accuracy may be examined. Based on the...tumble test or bias analysis at a tilted position to remove the effect of Earth’s rotation in the scale factor test • A rate table with better rate...format guide and test procedure for coriolis vibratory gyros. Piscataway (NJ): IEEE; 2004 Dec. 3. Maio A, Smith G, Knight R, Nothwang W, Conroy J

Lasers and losers in the eyes of the law: liability for head and neck procedures.

PubMed

Svider, Peter F; Carron, Michael A; Zuliani, Giancarlo F; Eloy, Jean Anderson; Setzen, Michael; Folbe, Adam J

2014-01-01

Although some have noted that malpractice litigation may be "plateauing," defensive medical practices are pervasive and make up a considerable proportion of the "indirect" costs medicolegal issues contribute toward our health care system. Accordingly, these trends have spurred considerable interest in characterizing factors that play a role in alleged medical negligence, along with outcomes and awards. To conduct a focused examination of malpractice litigation regarding laser procedures in the head and neck and to determine the reasons for initiating litigation as well as outcomes and awards. Retrospective analysis of the WestlawNext legal database, encompassing publicly available federal and state court records, to identify malpractice cases involving laser procedures in the head and neck. Outcomes, awards, defendant specialty, and other allegations. Most cases (28 [82%]) included in this analysis involved female plaintiffs. Of 34 cases, 19 (56%) were resolved with a defendant verdict. The median indemnity was $150 000, and dermatologists, otolaryngologists, and plastic surgeons were the most commonly named defendants. The most common procedures were performed for age-related changes, acne scarring, hair removal, and vascular lesions, although there were also several rhinologic and airway cases. Of all cases, 25 (74%) involved cutaneous procedures, and common allegations noted included permanent injury (24 cases [71%]), disfigurement/scarring (23 [68%]), inadequate informed consent (17 [50%]), unnecessary/inappropriate procedure (15 [44%]), and burns (11 [32%]). Noncutaneous procedures had higher trending median payments ($600 000 vs $103 000), although this comparison did not reach statistical significance (P = .09). Procedures using lasers represent a potential target for malpractice litigation should an adverse event occur. Although cutaneous/cosmetic procedures were noted among cases included in this analysis, as well as other head and neck interventions, otolaryngologists were more likely to be named as defendants in the latter category. Although cases had modest indemnities compared with prior analyses, the potential for significant amounts was present. Inclusion into the informed consent process of specific factors detailed in this analysis may potentially decrease liability. In addition, physicians and patients should undergo comprehensive discussion regarding expectations as well as contingencies should adverse events occur. 4.

Low-thrust mission risk analysis, with application to a 1980 rendezvous with the comet Encke

NASA Technical Reports Server (NTRS)

Yen, C. L.; Smith, D. B.

1973-01-01

A computerized failure process simulation procedure is used to evaluate the risk in a solar electric space mission. The procedure uses currently available thrust-subsystem reliability data and performs approximate simulations of the thrust sybsystem burn operation, the system failure processes, and the retargeting operations. The method is applied to assess the risks in carrying out a 1980 rendezvous mission to the comet Encke. Analysis of the results and evaluation of the effects of various risk factors on the mission show that system component failure rates are the limiting factors in attaining a high mission relability. It is also shown that a well-designed trajectory and system operation mode can be used effectively to partially compensate for unreliable thruster performance.

Risk factors for postoperative urinary tract infection following midurethral sling procedures.

PubMed

Doganay, Melike; Cavkaytar, Sabri; Kokanali, Mahmut Kuntay; Ozer, Irfan; Aksakal, Orhan Seyfi; Erkaya, Salim

2017-04-01

To identify the potential risk factors for urinary tract infections following midurethral sling procedures. 556 women who underwent midurethral sling procedure due to stress urinary incontinence over a four-year period were reviewed in this retrospective study. Of the study population, 280 women underwent TVT procedures and 276 women underwent TOT procedures. Patients were evaluated at 4-8 weeks postoperatively and were investigated for the occurrence of a urinary tract infection. Patients who experienced urinary tract infection were defined as cases, and patients who didn't were defined as controls. All data were collected from medical records. Multivariate logistic regression model was used to identify the risk factors for urinary tract infection. Of 556 women, 58 (10.4%) were defined as cases while 498 (89.6%) were controls. The mean age of women in cases (57.8±12.9years) was significantly greater than in controls (51.8±11.2years) (p<0.001). The presence of menopausal status, previous abdominal surgery, preoperative antibiotic treatment due to urinary tract infection, concomitant vaginal hysterectomy and cystocele repair, TVT procedure and postoperative postvoiding residual bladder volume ≥100ml were more common in cases than in controls. However, in multivariate regression analysis model presence of preoperative urinary tract infection [OR (95% CI)=0.1 (0.1-0.7); p=0.013], TVT procedure [OR (95% CI)=8.4 (3.1-22.3); p=0.000] and postoperative postvoiding residual bladder volume ≥100ml [OR (95% CI)=4.6 (1.1-19.2); p=0.036] were significant independent risk factors for urinary tract infection following midurethral slings CONCLUSION: Urinary tract infection after midurethral sling procedures is a relatively common complication. The presence of preoperative urinary tract infection, TVT procedure and postoperative postvoiding residual bladder volume ≥100ml may increase the risk of this complication. Identification of these factors could help surgeons to minimize this complicationby developing effective strategies. Copyright © 2017. Published by Elsevier B.V.

Bilateral effects of hospital patient-safety procedures on nurses' job satisfaction.

PubMed

Inoue, T; Karima, R; Harada, K

2017-09-01

The aim of this study was to examine how hospital patient-safety procedures affect the job satisfaction of hospital nurses. Additionally, we investigated the association between perceived autonomy and hospital patient-safety procedures and job satisfaction. Recently, measures for patient safety have been recognized as an essential requirement in hospitals. Hospital patient-safety procedures may enhance the job satisfaction of nurses by improving the quality of their work. However, such procedures may also decrease their job satisfaction by imposing excessive stress on nurses because they cannot make mistakes. The participants included 537 nurses at 10 private hospitals in Japan (The surveys were collected from March to July 2012). Factors related to hospital patient-safety procedures were demonstrated using factor analysis, and the associations between these factors and nurses' self-perceived autonomy and job satisfaction were examined using structural equation modelling. Five factors regarding hospital patient-safety procedures were extracted. Additionally, structural equation modelling revealed statistically significant associations between these factors and the nurses' self-perceived autonomy and job satisfaction. The findings showed that nurses' perceived autonomy of the workplace enhanced their job satisfaction and that their perceptions of hospital patient-safety procedures promoted their job satisfaction. However, some styles of chief nurses' leadership regarding patient safety restrict nurses' independent and autonomous decision-making and actions, resulting in a lowering of job satisfaction. This study demonstrated that hospital patient-safety procedures have ambiguous effects on nurses' job satisfaction. In particular, chief nurses' leadership relating to patient safety can have a positive or negative effect on nurses' job satisfaction. The findings indicated that hospital managers should demonstrate positive attitudes to improve patient safety for nurses' job satisfaction. In addition, policymakers in the hospitals should consider that chief nurses' leadership styles may reduce autonomy and suppress nurses' job satisfaction. © 2017 The Authors International Nursing Review published by John Wiley & Sons Ltd on behalf of International Council of Nurses.

An Examination of the Test Scores of the Folger and Konovsky Measure of Procedural Justice.

ERIC Educational Resources Information Center

DeConinck, James B.; King, Wesley C., Jr.

2002-01-01

Examined the validity of the measure of procedural justice developed by R. Folger and M. Konovsky (1989) through confirmatory factor analysis of data from 416 bank employees and 221 marketing managers. Results indicate that an underlying construct for the feedback and planning subscales is the communication relationship between manager and…

Time to Procedure, Nuclear Imaging and Clinicopathological Characteristics as Predictive Factors for Sentinel Lymph Node Metastasis in Cutaneous Melanoma: A Single-Center Analysis.

PubMed

Jaukovic, Ljiljana; Rajović, Milica; Kandolf Sekulovic, Lidija; Radulovic, Marija; Stepic, Nenad; Mijuskovic, Zeljko; Petrov, Nenad; Ajdinovic, Boris

2018-05-14

Sentinel lymph node (SLN) biopsy is a widely accepted staging procedure for cutaneous melanoma patients who are at risk of clinically occult nodal metastases. Numerous predictive factors for regional lymph node metastases have been identified; however, few have been found to be reproducibly significant. Also, the role of blue dye in identification was questioned in recent trials. Time to procedure was also found to be predictive of SLN positivity, but this was not confirmed in other studies. In our study, predictive factors for metastatic involvement of SLN were analyzed, together with the role of addition blue dye in imaging on detection rate and false-negative SLN rate. An impact of time interval to procedure on the rate of SLN positivity was also explored. Data analysis was done in 362 cutaneous melanoma patients who underwent lymphoscintigraphy and SLN biopsy at our institution from 2010 to 2016, with a median follow-up of 29 months (1-98 months). To delineate the relation of each variable (demographical, time to procedure, and clinical and pathological variables, as well as the presence of in-transit nodes, the number of draining basins, and SLN localization on scintigraphy) with positive SLN status, we used univariate logistic regression with odds ratios representing effect size. Metastatic involvement SLN was found in 67 (18.8%) of 356 patients. Detection rate was similar with or without further intraoperative SLN identification with blue dye (98.8% vs 98.17%, P > 0.05). Time to procedure was not associated with higher SLN positivity rate (P > 0.05). In univariate analysis, Breslow thickness (P < 0.001), primary ulceration lesion (P = 0.001), and lymphovascular invasion (P = 0.006) were strongly correlated with SLN positivity, as well as the site of primary tumor (P = 0.024), tumor-infiltrating lymphocytes (TILs) (P = 0.021), and sex (P = 0.026). In multivariate analysis, Breslow thickness and TILs were found to be significant independent predictors of SLN status (P < 0.05). Addition of blue dye did not improve SLN detection rate; time to procedure was not found to be associated with higher SLN biopsy positivity rates. Breslow thickness and TILs, as a marker of immune response to tumor, were consistently found to be significant independent predictors of SLN status.

Ergonomic task analysis of ultrasound-guided femoral nerve block: a pilot study.

PubMed

Ajmal, Muhammad; Power, Susan; Smith, Tim; Shorten, George D

2011-02-01

To apply ergonomic task analysis to the performance of ultrasound-guided (US-guided) femoral nerve block (FNB) in an acute hospital setting. Pilot prospective observational study. Orthopedic operating room of a regional trauma hospital. 15 anesthesiologists of various levels of experience in US-guided FNB (estimated minimum experience < 10 procedures; maximum about 50 procedures, and from basic trainees to consultants); and 15 patients (5 men and 10 women), aged 77 ± 15 (mean ± SD yrs) years. MEASUREMENTS/OBSERVATIONS: A data capture "tool", which was modified from one previously developed for ergonomic study of spinal anesthesia, was studied. Patient, operator, and heterogeneous environmental factors related to ergonomic performance of US-guided FNB were identified. The observation period started immediately before commencement of positioning the patient and ended on completion of perineural injection. Data were acquired using direct observations, photography, and application of a questionnaire. The quality of ergonomic performance was generally suboptimal and varied greatly among operators. Eight (experience < 10 procedures) of 15 operators excessively rotated their head, neck, and/or back to visualize the image on the ultrasound machine. Eight operators (experience < 10 procedures) performed the procedure with excessive thoracolumbar flexion. Performance of US-guided FNB presents ergonomic challenges and was suboptimal during most of the procedures observed. Formal training in US-guided peripheral nerve blockade should include reference to ergonomic factors. Copyright © 2011 Elsevier Inc. All rights reserved.

Measuring cognitive load during procedural skills training with colonoscopy as an exemplar.

PubMed

Sewell, Justin L; Boscardin, Christy K; Young, John Q; Ten Cate, Olle; O'Sullivan, Patricia S

2016-06-01

Few studies have investigated cognitive factors affecting learning of procedural skills in medical education. Cognitive load theory, which focuses on working memory, is highly relevant, but methods for measuring cognitive load during procedural training are not well understood. Using colonoscopy as an exemplar, we used cognitive load theory to develop a self-report instrument to measure three types of cognitive load (intrinsic, extraneous and germane load) and to provide evidence for instrument validity. We developed the instrument (the Cognitive Load Inventory for Colonoscopy [CLIC]) using a multi-step process. It included 19 items measuring three types of cognitive load, three global rating items and demographics. We then conducted a cross-sectional survey that was administered electronically to 1061 gastroenterology trainees in the USA. Participants completed the CLIC following a colonoscopy. The two study phases (exploratory and confirmatory) each lasted for 10 weeks during the 2014-2015 academic year. Exploratory factor analysis determined the most parsimonious factor structure; confirmatory factor analysis assessed model fit. Composite measures of intrinsic, extraneous and germane load were compared across years of training and with global rating items. A total of 477 (45.0%) invitees participated (116 in the exploratory study and 361 in the confirmatory study) in 154 (95.1%) training programmes. Demographics were similar to national data from the USA. The most parsimonious factor structure included three factors reflecting the three types of cognitive load. Confirmatory factor analysis verified that a three-factor model was the best fit. Intrinsic, extraneous and germane load items had high internal consistency (Cronbach's alpha 0.90, 0.87 and 0.96, respectively) and correlated as expected with year in training and global assessment of cognitive load. The CLIC measures three types of cognitive load during colonoscopy training. Evidence of validity is provided. Although CLIC items relate to colonoscopy, the development process we detail can be used to adapt the instrument for use in other learning settings in medical education. © 2016 John Wiley & Sons Ltd.

Surgical staging and prognosis in serous borderline ovarian tumours (BOT): A subanalysis of the AGO ROBOT study

PubMed Central

Trillsch, F; Mahner, S; Vettorazzi, E; Woelber, L; Reuss, A; Baumann, K; Keyver-Paik, M-D; Canzler, U; Wollschlaeger, K; Forner, D; Pfisterer, J; Schroeder, W; Muenstedt, K; Richter, B; Fotopoulou, C; Schmalfeldt, B; Burges, A; Ewald-Riegler, N; de Gregorio, N; Hilpert, F; Fehm, T; Meier, W; Hillemanns, P; Hanker, L; Hasenburg, A; Strauss, H-G; Hellriegel, M; Wimberger, P; Kommoss, S; Kommoss, F; Hauptmann, S; du Bois, A

2015-01-01

Background: Incomplete surgical staging is a negative prognostic factor for patients with borderline ovarian tumours (BOT). However, little is known about the prognostic impact of each individual staging procedure. Methods: Clinical parameters of 950 patients with BOT (confirmed by central reference pathology) treated between 1998 and 2008 at 24 German AGO centres were analysed. In 559 patients with serous BOT and adequate ovarian surgery, further recommended staging procedures (omentectomy, peritoneal biopsies, cytology) were evaluated applying Cox regression models with respect to progression-free survival (PFS). Results: For patients with one missing staging procedure, the hazard ratio (HR) for recurrence was 1.25 (95%-CI 0.66–2.39; P=0.497). This risk increased with each additional procedure skipped reaching statistical significance in case of two (HR 1.95; 95%-CI 1.06–3.58; P=0.031) and three missing steps (HR 2.37; 95%-CI 1.22–4.64; P=0.011). The most crucial procedure was omentectomy which retained a statistically significant impact on PFS in multiple analysis (HR 1.91; 95%-CI 1.15–3.19; P=0.013) adjusting for previously established prognostic factors as FIGO stage, tumour residuals, and fertility preservation. Conclusion: Individual surgical staging procedures contribute to the prognosis for patients with serous BOT. In this analysis, recurrence risk increased with each skipped surgical step. This should be considered when re-staging procedures following incomplete primary surgery are discussed. PMID:25562434

Surgical staging and prognosis in serous borderline ovarian tumours (BOT): a subanalysis of the AGO ROBOT study.

PubMed

Trillsch, F; Mahner, S; Vettorazzi, E; Woelber, L; Reuss, A; Baumann, K; Keyver-Paik, M-D; Canzler, U; Wollschlaeger, K; Forner, D; Pfisterer, J; Schroeder, W; Muenstedt, K; Richter, B; Fotopoulou, C; Schmalfeldt, B; Burges, A; Ewald-Riegler, N; de Gregorio, N; Hilpert, F; Fehm, T; Meier, W; Hillemanns, P; Hanker, L; Hasenburg, A; Strauss, H-G; Hellriegel, M; Wimberger, P; Kommoss, S; Kommoss, F; Hauptmann, S; du Bois, A

2015-02-17

Incomplete surgical staging is a negative prognostic factor for patients with borderline ovarian tumours (BOT). However, little is known about the prognostic impact of each individual staging procedure. Clinical parameters of 950 patients with BOT (confirmed by central reference pathology) treated between 1998 and 2008 at 24 German AGO centres were analysed. In 559 patients with serous BOT and adequate ovarian surgery, further recommended staging procedures (omentectomy, peritoneal biopsies, cytology) were evaluated applying Cox regression models with respect to progression-free survival (PFS). For patients with one missing staging procedure, the hazard ratio (HR) for recurrence was 1.25 (95%-CI 0.66-2.39; P=0.497). This risk increased with each additional procedure skipped reaching statistical significance in case of two (HR 1.95; 95%-CI 1.06-3.58; P=0.031) and three missing steps (HR 2.37; 95%-CI 1.22-4.64; P=0.011). The most crucial procedure was omentectomy which retained a statistically significant impact on PFS in multiple analysis (HR 1.91; 95%-CI 1.15-3.19; P=0.013) adjusting for previously established prognostic factors as FIGO stage, tumour residuals, and fertility preservation. Individual surgical staging procedures contribute to the prognosis for patients with serous BOT. In this analysis, recurrence risk increased with each skipped surgical step. This should be considered when re-staging procedures following incomplete primary surgery are discussed.

Analysis of multiple activity manual materials handling tasks using A Guide to Manual Materials Handling.

PubMed

Mital, A

1999-01-01

Manual handling of materials continues to be a hazardous activity, leading to a very significant number of severe overexertion injuries. Designing jobs that are within the physical capabilities of workers is one approach ergonomists have adopted to redress this problem. As a result, several job design procedures have been developed over the years. However, these procedures are limited to designing or evaluating only pure lifting jobs or only the lifting aspect of a materials handling job. This paper describes a general procedure that may be used to design or analyse materials handling jobs that involve several different kinds of activities (e.g. lifting, lowering, carrying, pushing, etc). The job design/analysis procedure utilizes an elemental approach (breaking the job into elements) and relies on databases provided in A Guide to Manual Materials Handling to compute associated risk factors. The use of the procedure is demonstrated with the help of two case studies.

Groin hematoma after electrophysiological procedures-incidence and predisposing factors.

PubMed

Dalsgaard, Anja Borgen; Jakobsen, Christina Spåbæk; Riahi, Sam; Hjortshøj, Søren

2014-10-01

We evaluated the incidence and predisposing factors of groin hematomas after electrophysiological (EP) procedures. Prospective, observational study, enrolling consecutive patients after EP procedures (Atrial fibrillation: n = 151; Supraventricular tachycardia/Diagnostic EP: n = 82; Ventricular tachycardia: n = 18). Patients underwent manual compression for 10 min and 3 h post procedural bed rest. AF ablations were performed with INR 2-3, ACT > 300, and no protamine sulfate. Adhesive pressure dressings (APDs) were used if sheath size ≥ 10F; procedural time > 120 min; and BMI > 30. Patient-reported hematomas were recorded by a telephone follow-up after 2 weeks. Hematoma developed immediately in 26 patients (10%) and after 14 days significant hematoma was reported in 68 patients (27%). Regression analysis on sex, age, BMI 25, ACT 300, use of APD, sheath size and number, and complicated venous access was not associated with hematoma, either immediately after the procedure or after 14 days. Any hematoma presenting immediately after procedures was associated with patient-reported hematomas after 14 days, odds ratio 18.7 (CI 95%: 5.00-69.8; P < 0.001). Any hematoma immediately after EP procedures was the sole predictor of patient-reported hematoma after 2 weeks. Initiatives to prevent groin hematoma should focus on the procedure itself as well as post-procedural care.

Endodontic interappointment flare-ups: a prospective study of incidence and related factors.

PubMed

Walton, R; Fouad, A

1992-04-01

Severe pain and/or swelling following a root canal treatment appointment are serious sequelae. Information varies or is incomplete as to the incidence of these conditions and related factors. In this study, data were collected at root canal treatment appointments on demographics, pulp/periapical diagnoses, presenting symptoms, treatment procedures, and number of appointments. Patients that then experienced a flare-up (a severe problem requiring an unscheduled visit and treatment) had the correlating factors examined. Statistical determinations were by chi-square analysis with significance at 0.05 or less. Nine hundred forty-six visits resulted in an incidence of 3.17% flare-ups. Flare-ups were positively correlated with more severe presenting symptoms, pulp necrosis with painful apical pathosis, and patients on analgesics. Fewer flare-ups occurred in undergraduate patients and following obturation procedures. There was no correlation between patient demographics or systemic conditions, number of appointments, treatment procedures, or taking antibiotics.

Detailed Analysis of Peri-Procedural Strokes in Patients Undergoing Intracranial Stenting in SAMMPRIS

PubMed Central

Fiorella, David; Derdeyn, Colin P; Lynn, Michael J; Barnwell, Stanley L; Hoh, Brian L.; Levy, Elad I.; Harrigan, Mark R.; Klucznik, Richard P.; McDougall, Cameron G.; Pride, G. Lee; Zaidat, Osama O.; Lutsep, Helmi L.; Waters, Michael F.; Hourihane, J. Maurice; Alexandrov, Andrei V.; Chiu, David; Clark, Joni M.; Johnson, Mark D.; Torbey, Michel T.; Rumboldt, Zoran; Cloft, Harry J.; Turan, Tanya N.; Lane, Bethany F.; Janis, L. Scott; Chimowitz, Marc I.

2012-01-01

Background and Purpose Enrollment in the SAMMPRIS trial was halted due to the high risk of stroke or death within 30 days of enrollment in the percutaneous transluminal angioplasty and stenting (PTAS) arm relative to the medical arm. This analysis focuses on the patient and procedural factors that may have been associated with peri-procedural cerebrovascular events in the trial. Methods Bivariate and multivariate analyses were performed to evaluate whether patient and procedural variables were associated with cerebral ischemic or hemorrhagic events occurring within 30 days of enrollment (termed peri-procedural) in the PTAS arm. Results Of 224 patients randomized to PTAS, 213 underwent angioplasty alone (n=5) or with stenting (n=208). Of these, 13 had hemorrhagic strokes (7 parenchymal, 6 subarachnoid), 19 had ischemic stroke, and 2 had cerebral infarcts with temporary signs (CITS) within the peri-procedural period. Ischemic events were categorized as perforator occlusions (13), embolic (4), mixed perforator and embolic (2), and delayed stent occlusion (2). Multivariate analyses showed that higher percent stenosis, lower modified Rankin score, and clopidogrel load associated with an activated clotting time above the target range were associated (p ≤ 0.05) with hemorrhagic stroke. Non-smoking, basilar artery stenosis, diabetes, and older age were associated (p ≤ 0.05) with ischemic events. Conclusions Peri-procedural strokes in SAMMPRIS had multiple causes with the most common being perforator occlusion. Although risk factors for peri-procedural strokes could be identified, excluding patients with these features from undergoing PTAS to lower the procedural risk would limit PTAS to a small subset of patients. Moreover, given the small number of events, the present data should be used for hypothesis generation rather than to guide patient selection in clinical practice. PMID:22984008

Prognostic factors in patients with malignant pleural effusion: Is it possible to predict mortality in patients with good performance status?

PubMed

Abrao, Fernando Conrado; Peixoto, Renata D'Alpino; de Abreu, Igor Renato Louro Bruno; Janini, Maria Cláudia; Viana, Geisa Garcia; de Oliveira, Mariana Campello; Younes, Riad Naim

2016-04-01

The aim of this study was to identify predictors of mortality only in patients with malignant pleural effusion (MPE) showing good performance status which required pleural palliative procedures. All patients with MPE submitted to pleural palliative procedure were enrolled in a prospective study between 2013 and 2014. Patients with Eastern cooperative oncology group (ECOG) score zero, one, and two were considered with good performance status. The possible prognostic factors were tested for significance using the log-rank test (Kaplan-Meier method) and those with significance on univariate analysis were entered into a multivariable Cox model. A total of 64 patients were included in the analysis. Median follow-up time for surviving patients was 263 days. Median survival for the entire cohort was not reached yet. In the multivariate analysis, gastrointestinal primary site (P = 0.006), low albumin concentration in the pleural fluid (P = 0.017), and high serum NLR (P = 0.007) were associated with mortality. In our cohort of ECOG 0-2 patients with MPE submitted to pleural palliative procedures, gastrointestinal malignancy compared to other sites, low pleural fluid albumin and high NLR were significantly associated with mortality. The identification of these prognostic factors may assist the choice of the optimal palliative technique. J. Surg. Oncol. 2016;113:570-574. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

Technical note: Design flood under hydrological uncertainty

NASA Astrophysics Data System (ADS)

Botto, Anna; Ganora, Daniele; Claps, Pierluigi; Laio, Francesco

2017-07-01

Planning and verification of hydraulic infrastructures require a design estimate of hydrologic variables, usually provided by frequency analysis, and neglecting hydrologic uncertainty. However, when hydrologic uncertainty is accounted for, the design flood value for a specific return period is no longer a unique value, but is represented by a distribution of values. As a consequence, the design flood is no longer univocally defined, making the design process undetermined. The Uncertainty Compliant Design Flood Estimation (UNCODE) procedure is a novel approach that, starting from a range of possible design flood estimates obtained in uncertain conditions, converges to a single design value. This is obtained through a cost-benefit criterion with additional constraints that is numerically solved in a simulation framework. This paper contributes to promoting a practical use of the UNCODE procedure without resorting to numerical computation. A modified procedure is proposed by using a correction coefficient that modifies the standard (i.e., uncertainty-free) design value on the basis of sample length and return period only. The procedure is robust and parsimonious, as it does not require additional parameters with respect to the traditional uncertainty-free analysis. Simple equations to compute the correction term are provided for a number of probability distributions commonly used to represent the flood frequency curve. The UNCODE procedure, when coupled with this simple correction factor, provides a robust way to manage the hydrologic uncertainty and to go beyond the use of traditional safety factors. With all the other parameters being equal, an increase in the sample length reduces the correction factor, and thus the construction costs, while still keeping the same safety level.

Accuracy of the Parallel Analysis Procedure with Polychoric Correlations

ERIC Educational Resources Information Center

Cho, Sun-Joo; Li, Feiming; Bandalos, Deborah

2009-01-01

The purpose of this study was to investigate the application of the parallel analysis (PA) method for choosing the number of factors in component analysis for situations in which data are dichotomous or ordinal. Although polychoric correlations are sometimes used as input for component analyses, the random data matrices generated for use in PA…

Text mining factor analysis (TFA) in green tea patent data

NASA Astrophysics Data System (ADS)

Rahmawati, Sela; Suprijadi, Jadi; Zulhanif

2017-03-01

Factor analysis has become one of the most widely used multivariate statistical procedures in applied research endeavors across a multitude of domains. There are two main types of analyses based on factor analysis: Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA). Both EFA and CFA aim to observed relationships among a group of indicators with a latent variable, but they differ fundamentally, a priori and restrictions made to the factor model. This method will be applied to patent data technology sector green tea to determine the development technology of green tea in the world. Patent analysis is useful in identifying the future technological trends in a specific field of technology. Database patent are obtained from agency European Patent Organization (EPO). In this paper, CFA model will be applied to the nominal data, which obtain from the presence absence matrix. While doing processing, analysis CFA for nominal data analysis was based on Tetrachoric matrix. Meanwhile, EFA model will be applied on a title from sector technology dominant. Title will be pre-processing first using text mining analysis.

Round-off errors in cutting plane algorithms based on the revised simplex procedure

NASA Technical Reports Server (NTRS)

Moore, J. E.

1973-01-01

This report statistically analyzes computational round-off errors associated with the cutting plane approach to solving linear integer programming problems. Cutting plane methods require that the inverse of a sequence of matrices be computed. The problem basically reduces to one of minimizing round-off errors in the sequence of inverses. Two procedures for minimizing this problem are presented, and their influence on error accumulation is statistically analyzed. One procedure employs a very small tolerance factor to round computed values to zero. The other procedure is a numerical analysis technique for reinverting or improving the approximate inverse of a matrix. The results indicated that round-off accumulation can be effectively minimized by employing a tolerance factor which reflects the number of significant digits carried for each calculation and by applying the reinversion procedure once to each computed inverse. If 18 significant digits plus an exponent are carried for each variable during computations, then a tolerance value of 0.1 x 10 to the minus 12th power is reasonable.

Critical Thinking on the Introduction of Digitization Within Engineering Training Systems in the Manufacturing Stage of Cast Parts

NASA Astrophysics Data System (ADS)

Lehene, T. R.; Samoilă, V.; Soporan, V. F.; Pădurețu, S.; Vescan, M. M.

2018-06-01

The paper aims to present a methodology for the analysis of the engineering training systems at the manufacturing stage of castings through critical engineering thinking. Its use [4, 5] requires the development of procedures capable of responding to the problems faced by engineering training in terms of acquiring the tools and procedures. The structure of the analysis took into consideration the following aspects: the motivation to use the proposed procedure, considerations on the engineering behavior, the design of the reasoning adapted to the analysis of the engineering training systems, the determination of the correlations in the processes of obtaining the cast products, the definition and calibration of the digital experiment, the definition and analysis of the factors influencing the last solidification area (the nature of the alloy, the shape of the mold and the casting geometry).

TETRA-COM: a comprehensive SPSS program for estimating the tetrachoric correlation.

PubMed

Lorenzo-Seva, Urbano; Ferrando, Pere J

2012-12-01

We provide an SPSS program that implements descriptive and inferential procedures for estimating tetrachoric correlations. These procedures have two main purposes: (1) bivariate estimation in contingency tables and (2) constructing a correlation matrix to be used as input for factor analysis (in particular, the SPSS FACTOR procedure). In both cases, the program computes accurate point estimates, as well as standard errors and confidence intervals that are correct for any population value. For purpose (1), the program computes the contingency table together with five other measures of association. For purpose (2), the program checks the positive definiteness of the matrix, and if it is found not to be Gramian, performs a nonlinear smoothing procedure at the user's request. The SPSS syntax, a short manual, and data files related to this article are available as supplemental materials from brm.psychonomic-journals.org/content/supplemental.

Risk Factors for Failure of Male Slings and Artificial Urinary Sphincters: Results from a Large Middle European Cohort Study.

PubMed

Hüsch, Tanja; Kretschmer, Alexander; Thomsen, Frauke; Kronlachner, Dominik; Kurosch, Martin; Obaje, Alice; Anding, Ralf; Pottek, Tobias; Rose, Achim; Olianas, Roberto; Friedl, Alexander; Hübner, Wilhelm; Homberg, Roland; Pfitzenmaier, Jesco; Grein, Ulrich; Queissert, Fabian; Naumann, Carsten Maik; Schweiger, Josef; Wotzka, Carola; Nyarangi-Dix, Joanne; Hofmann, Torben; Ulm, Kurt; Bauer, Ricarda M; Haferkamp, Axel

2017-01-01

We analysed the impact of predefined risk factors: age, diabetes, history of pelvic irradiation, prior surgery for stress urinary incontinence (SUI), prior urethral stricture, additional procedure during SUI surgery, duration of incontinence, ASA-classification and cause for incontinence on failure and complications in male SUI surgery. We retrospectively identified 506 patients with an artificial urinary sphincter (AUS) and 513 patients with a male sling (MS) in a multicenter cohort study. Complication rates were correlated to the risk factors in univariate analysis. Subsequently, a multivariate logistic regression adjusted to the risk factors was performed. A p value <0.05 was considered statistically significant. A history of pelvic irradiation was an independent risk factor for explantation in AUS (p < 0.001) and MS (p = 0.018). Moreover, prior urethral stricture (p = 0.036) and higher ASA-classification (p = 0.039) were positively correlated with explantation in univariate analysis for AUS. Urethral erosion was correlated with prior urethral stricture (p < 0.001) and a history of pelvic irradiation (p < 0.001) in AUS. Furthermore, infection was correlated with additional procedures during SUI surgery in univariate analysis (p = 0.037) in MS. We first identified the correlation of higher ASA-classification and explantation in AUS. Nevertheless, only a few novel risk factors had a significant influence on the failure of MS or AUS. © 2016 S. Karger AG, Basel.

Exploring item and higher order factor structure with the Schmid-Leiman solution: syntax codes for SPSS and SAS.

PubMed

Wolff, Hans-Georg; Preising, Katja

2005-02-01

To ease the interpretation of higher order factor analysis, the direct relationships between variables and higher order factors may be calculated by the Schmid-Leiman solution (SLS; Schmid & Leiman, 1957). This simple transformation of higher order factor analysis orthogonalizes first-order and higher order factors and thereby allows the interpretation of the relative impact of factor levels on variables. The Schmid-Leiman solution may also be used to facilitate theorizing and scale development. The rationale for the procedure is presented, supplemented by syntax codes for SPSS and SAS, since the transformation is not part of most statistical programs. Syntax codes may also be downloaded from www.psychonomic.org/archive/.

Frequencies and Flutter Speed Estimation for Damaged Aircraft Wing Using Scaled Equivalent Plate Analysis

NASA Technical Reports Server (NTRS)

Krishnamurthy, Thiagarajan

2010-01-01

Equivalent plate analysis is often used to replace the computationally expensive finite element analysis in initial design stages or in conceptual design of aircraft wing structures. The equivalent plate model can also be used to design a wind tunnel model to match the stiffness characteristics of the wing box of a full-scale aircraft wing model while satisfying strength-based requirements An equivalent plate analysis technique is presented to predict the static and dynamic response of an aircraft wing with or without damage. First, a geometric scale factor and a dynamic pressure scale factor are defined to relate the stiffness, load and deformation of the equivalent plate to the aircraft wing. A procedure using an optimization technique is presented to create scaled equivalent plate models from the full scale aircraft wing using geometric and dynamic pressure scale factors. The scaled models are constructed by matching the stiffness of the scaled equivalent plate with the scaled aircraft wing stiffness. It is demonstrated that the scaled equivalent plate model can be used to predict the deformation of the aircraft wing accurately. Once the full equivalent plate geometry is obtained, any other scaled equivalent plate geometry can be obtained using the geometric scale factor. Next, an average frequency scale factor is defined as the average ratio of the frequencies of the aircraft wing to the frequencies of the full-scaled equivalent plate. The average frequency scale factor combined with the geometric scale factor is used to predict the frequency response of the aircraft wing from the scaled equivalent plate analysis. A procedure is outlined to estimate the frequency response and the flutter speed of an aircraft wing from the equivalent plate analysis using the frequency scale factor and geometric scale factor. The equivalent plate analysis is demonstrated using an aircraft wing without damage and another with damage. Both of the problems show that the scaled equivalent plate analysis can be successfully used to predict the frequencies and flutter speed of a typical aircraft wing.

The effects of physical activity on impulsive choice: Influence of sensitivity to reinforcement amount and delay

PubMed Central

Strickland, Justin C.; Feinstein, Max A.; Lacy, Ryan T.; Smith, Mark A.

2016-01-01

Impulsive choice is a diagnostic feature and/or complicating factor for several psychological disorders and may be examined in the laboratory using delay-discounting procedures. Recent investigators have proposed using quantitative measures of analysis to examine the behavioral processes contributing to impulsive choice. The purpose of this study was to examine the effects of physical activity (i.e., wheel running) on impulsive choice in a single-response, discrete-trial procedure using two quantitative methods of analysis. To this end, rats were assigned to physical activity or sedentary groups and trained to respond in a delay-discounting procedure. In this procedure, one lever always produced one food pellet immediately, whereas a second lever produced three food pellets after a 0, 10, 20, 40, or 80-second delay. Estimates of sensitivity to reinforcement amount and sensitivity to reinforcement delay were determined using (1) a simple linear analysis and (2) an analysis of logarithmically transformed response ratios. Both analyses revealed that physical activity decreased sensitivity to reinforcement amount and sensitivity to reinforcement delay. These findings indicate that (1) physical activity has significant but functionally opposing effects on the behavioral processes that contribute to impulsive choice and (2) both quantitative methods of analysis are appropriate for use in single-response, discrete-trial procedures. PMID:26964905

Discriminatory Analysis II. Factor Analysis and Discrimination

DTIC Science & Technology

1950-10-01

present In a given-’test. The last phase of factor ana2lysis is concerned -- -kv’-~ ’psyc Ig hological-siLr ifi-cance to the rectors, extract -, aed*-hee...tests. However, as IHotelling t s procedu~re is an iterative ~ one,.it can be stopped after the extraction of’ any nuLmber of coiuponenta if., one -deems...need not extract 22 ’l p factors and that one can factior R1 by this method as well as R, However, the fact remains that the coomrponents do not have

Risk factors for surgical site infection following nonshunt pediatric neurosurgery: a review of 9296 procedures from a national database and comparison with a single-center experience

PubMed Central

Sherrod, Brandon A.; Arynchyna, Anastasia A.; Johnston, James M.; Rozzelle, Curtis J.; Blount, Jeffrey P.; Oakes, W. Jerry; Rocque, Brandon G.

2017-01-01

Objective Surgical site infection (SSI) following CSF shunt operations has been well studied, yet risk factors for nonshunt pediatric neurosurgery are less well understood. The purpose of this study was to determine SSI rates and risk factors following nonshunt pediatric neurosurgery using a nationwide patient cohort and an institutional dataset specifically for better understanding SSI. Methods The authors reviewed the American College of Surgeons National Surgical Quality Improvement Program Pediatric (ACS NSQIP-P) database for the years 2012–2014, including all neurosurgical procedures performed on pediatric patients except CSF shunts and hematoma evacuations. SSI included deep (intracranial abscesses, meningitis, osteomyelitis, and ventriculitis) and superficial wound infections. The authors performed univariate analyses of SSI association with procedure, demographic, comorbidity, operative, and hospital variables, with subsequent multivariate logistic regression analysis to determine independent risk factors for SSI within 30 days of the index procedure. A similar analysis was performed using a detailed institutional infection database from Children’s Hospital of Alabama (COA). Results A total of 9296 nonshunt procedures were identified in NSQIP-P with an overall 30-day SSI rate of 2.7%. The 30-day SSI rate in the COA institutional database was similar (3.3% of 1103 procedures, p = 0.325). Postoperative time to SSI in NSQIP-P and COA was 14.6 ± 6.8 days and 14.8 ± 7.3 days, respectively (mean ± SD). Myelomeningocele (4.3% in NSQIP-P, 6.3% in COA), spine (3.5%, 4.9%), and epilepsy (3.4%, 3.1%) procedure categoriess had the highest SSI rates by procedure category in both NSQIP-P and COA. Independent SSI risk factors in NSQIP-P included postoperative pneumonia (OR 4.761, 95% CI 1.269–17.857, p = 0.021), immune disease/immunosuppressant use (OR 3.671, 95% CI 1.371–9.827, p = 0.010), cerebral palsy (OR 2.835, 95% CI 1.463–5.494, p = 0.002), emergency operation (OR 1.843, 95% CI 1.011–3.360, p = 0.046), spine procedures (OR 1.673, 95% CI 1.036–2.702, p = 0.035), acquired CNS abnormality (OR 1.620, 95% CI 1.085–2.420, p = 0.018), and female sex (OR 1.475, 95% CI 1.062–2.049, p = 0.021). The only COA factor independently associated with SSI in the COA database included clean-contaminated wound classification (OR 3.887, 95% CI 1.354–11.153, p = 0.012), with public insurance (OR 1.966, 95% CI 0.957–4.041, p = 0.066) and spine procedures (OR 1.982, 95% CI 0.955–4.114, p = 0.066) approaching significance. Both NSQIP-P and COA multivariate model C-statistics were > 0.7. Conclusions NSQIP-P SSI rates, but not risk factors, were similar to data from a single center. PMID:28186476

Assessment and clinical factors associated with pain in patients undergoing transrectal prostate biopsy.

PubMed

Gómez-Gómez, E; Ramírez, M; Gómez-Ferrer, A; Rubio-Briones, J; Iborra, I; J Carrasco-Valiente; Campos, J P; Ruiz-García, J; Requena-Tapia, M J; Solsona, E

2015-09-01

To quantify the degree of pain experienced by patients who undergo ultrasound-guided transrectal prostate biopsy in standard clinical practice and assess the clinical factors associated with increased pain. Analysis of a multicenter series of patients with prostate biopsy according to standard clinical practice. The biopsy was performed transrectally with a protocol of local anesthesia on the posterolateral nerve bundle. The pain was assessed at 20minutes into the procedure using the visual analog scale (0-10). The degree of pain was analyzed, and the association was studied using a univariate/multivariate analysis of selected clinical variables and the degree of pain. A total of 1188 patients with a median age of 64 years were analyzed. Thirty percent of the biopsies were diagnosed with a tumor. The median pain score was 2, with 65% of the patients reporting a pain score ≤2. The multivariate analysis showed that the prostate volume (RR, 1.34; 95% CI 1.01-1.77; P=.04), having a previous biopsy (RR, 2.25; 95% CI 1.44-3.52; P<.01), age (RR, .63; 95% CI .47-.85; P<.01) and feel palpation (RR, 1.95; 95% CI 1.28-2.96; P<.01) were factors independently associated with greater pain during the procedure. Transrectal biopsy with local anesthesia is a relatively painless technique. Factors such as age, a previous biopsy, pain on being touched and prostate volume were associated with the presence of greater pain during the procedure. Copyright © 2014 AEU. Publicado por Elsevier España, S.L.U. All rights reserved.

A model of objective weighting for EIA.

PubMed

Ying, L G; Liu, Y C

1995-06-01

In spite of progress achieved in the research of environmental impact assessment (EIA), the problem of weight distribution for a set of parameters has not as yet, been properly solved. This paper presents an approach of objective weighting by using a procedure of P ij principal component-factor analysis (P ij PCFA), which suits specifically those parameters measured directly by physical scales. The P ij PCFA weighting procedure reforms the conventional weighting practice in two aspects: first, the expert subjective judgment is replaced by the standardized measure P ij as the original input of weight processing and, secondly, the principal component-factor analysis is introduced to approach the environmental parameters for their respective contributions to the totality of the regional ecosystem. Not only is the P ij PCFA weighting logical in theoretical reasoning, it also suits practically all levels of professional routines in natural environmental assessment and impact analysis. Having been assured of objectivity and accuracy in the EIA case study of the Chuansha County in Shanghai, China, the P ij PCFA weighting procedure has the potential to be applied in other geographical fields that need assigning weights to parameters that are measured by physical scales.

Pilot Task Profiles, Human Factors, And Image Realism

NASA Astrophysics Data System (ADS)

McCormick, Dennis

1982-06-01

Computer Image Generation (CIG) visual systems provide real time scenes for state-of-the-art flight training simulators. The visual system reauires a greater understanding of training tasks, human factors, and the concept of image realism to produce an effective and efficient training scene than is required by other types of visual systems. Image realism must be defined in terms of pilot visual information reauirements. Human factors analysis of training and perception is necessary to determine the pilot's information requirements. System analysis then determines how the CIG and display device can best provide essential information to the pilot. This analysis procedure ensures optimum training effectiveness and system performance.

Evaluating measurement models in clinical research: covariance structure analysis of latent variable models of self-conception.

PubMed

Hoyle, R H

1991-02-01

Indirect measures of psychological constructs are vital to clinical research. On occasion, however, the meaning of indirect measures of psychological constructs is obfuscated by statistical procedures that do not account for the complex relations between items and latent variables and among latent variables. Covariance structure analysis (CSA) is a statistical procedure for testing hypotheses about the relations among items that indirectly measure a psychological construct and relations among psychological constructs. This article introduces clinical researchers to the strengths and limitations of CSA as a statistical procedure for conceiving and testing structural hypotheses that are not tested adequately with other statistical procedures. The article is organized around two empirical examples that illustrate the use of CSA for evaluating measurement models with correlated error terms, higher-order factors, and measured and latent variables.

The detection and analysis of point processes in biological signals

NASA Technical Reports Server (NTRS)

Anderson, D. J.; Correia, M. J.

1977-01-01

A pragmatic approach to the detection and analysis of discrete events in biomedical signals is taken. Examples from both clinical and basic research are provided. Introductory sections discuss not only discrete events which are easily extracted from recordings by conventional threshold detectors but also events embedded in other information carrying signals. The primary considerations are factors governing event-time resolution and the effects limits to this resolution have on the subsequent analysis of the underlying process. The analysis portion describes tests for qualifying the records as stationary point processes and procedures for providing meaningful information about the biological signals under investigation. All of these procedures are designed to be implemented on laboratory computers of modest computational capacity.

Critical evaluation of sample pretreatment techniques.

PubMed

Hyötyläinen, Tuulia

2009-06-01

Sample preparation before chromatographic separation is the most time-consuming and error-prone part of the analytical procedure. Therefore, selecting and optimizing an appropriate sample preparation scheme is a key factor in the final success of the analysis, and the judicious choice of an appropriate procedure greatly influences the reliability and accuracy of a given analysis. The main objective of this review is to critically evaluate the applicability, disadvantages, and advantages of various sample preparation techniques. Particular emphasis is placed on extraction techniques suitable for both liquid and solid samples.

Risk factors for indications of intraoperative blood transfusion among patients undergoing surgical treatment for colorectal adenocarcinoma.

PubMed

Gonçalves, Iara; Linhares, Marcelo; Bordin, Jose; Matos, Delcio

2009-01-01

Identification of risk factors for requiring transfusions during surgery for colorectal cancer may lead to preventive actions or alternative measures, towards decreasing the use of blood components in these procedures, and also rationalization of resources use in hemotherapy services. This was a retrospective case-control study using data from 383 patients who were treated surgically for colorectal adenocarcinoma at 'Fundação Pio XII', in Barretos-SP, Brazil, between 1999 and 2003. To recognize significant risk factors for requiring intraoperative blood transfusion in colorectal cancer surgical procedures. Univariate analyses were performed using Fisher's exact test or the chi-squared test for dichotomous variables and Student's t test for continuous variables, followed by multivariate analysis using multiple logistic regression. In the univariate analyses, height (P = 0.06), glycemia (P = 0.05), previous abdominal or pelvic surgery (P = 0.031), abdominoperineal surgery (P<0.001), extended surgery (P<0.001) and intervention with radical intent (P<0.001) were considered significant. In the multivariate analysis using logistic regression, intervention with radical intent (OR = 10.249, P<0.001, 95% CI = 3.071-34.212) and abdominoperineal amputation (OR = 3.096, P = 0.04, 95% CI = 1.445-6.623) were considered to be independently significant. This investigation allows the conclusion that radical intervention and the abdominoperineal procedure in the surgical treatment of colorectal adenocarcinoma are risk factors for requiring intraoperative blood transfusion.

On a Modern Philosophy of Evaluating Scientific Publications

NASA Astrophysics Data System (ADS)

Guz, A. N.; Rushchitsky, J. J.; Chernyshenko, I. S.

2005-10-01

Current approaches to the citation analysis of scientific publications are outlined. Science Citation Index, Impact Factor, Immediacy Index, and the selection procedure for Essential Science Indicators—a relatively new citation analysis tool—are described. The new citation evaluation tool has yet not been discussed adequately by mechanicians

Automated magnification calibration in transmission electron microscopy using Fourier analysis of replica images.

PubMed

van der Laak, Jeroen A W M; Dijkman, Henry B P M; Pahlplatz, Martin M M

2006-03-01

The magnification factor in transmission electron microscopy is not very precise, hampering for instance quantitative analysis of specimens. Calibration of the magnification is usually performed interactively using replica specimens, containing line or grating patterns with known spacing. In the present study, a procedure is described for automated magnification calibration using digital images of a line replica. This procedure is based on analysis of the power spectrum of Fourier transformed replica images, and is compared to interactive measurement in the same images. Images were used with magnification ranging from 1,000 x to 200,000 x. The automated procedure deviated on average 0.10% from interactive measurements. Especially for catalase replicas, the coefficient of variation of automated measurement was considerably smaller (average 0.28%) compared to that of interactive measurement (average 3.5%). In conclusion, calibration of the magnification in digital images from transmission electron microscopy may be performed automatically, using the procedure presented here, with high precision and accuracy.

A Bayesian Multinomial Probit MODEL FOR THE ANALYSIS OF PANEL CHOICE DATA.

PubMed

Fong, Duncan K H; Kim, Sunghoon; Chen, Zhe; DeSarbo, Wayne S

2016-03-01

A new Bayesian multinomial probit model is proposed for the analysis of panel choice data. Using a parameter expansion technique, we are able to devise a Markov Chain Monte Carlo algorithm to compute our Bayesian estimates efficiently. We also show that the proposed procedure enables the estimation of individual level coefficients for the single-period multinomial probit model even when the available prior information is vague. We apply our new procedure to consumer purchase data and reanalyze a well-known scanner panel dataset that reveals new substantive insights. In addition, we delineate a number of advantageous features of our proposed procedure over several benchmark models. Finally, through a simulation analysis employing a fractional factorial design, we demonstrate that the results from our proposed model are quite robust with respect to differing factors across various conditions.

Determining the Number of Factors to Retain in EFA: Using the SPSS R-Menu v2.0 to Make More Judicious Estimations

ERIC Educational Resources Information Center

Courtney, Matthew Gordon Ray

2013-01-01

Exploratory factor analysis (EFA) is a common technique utilized in the development of assessment instruments. The key question when performing this procedure is how to best estimate the number of factors to retain. This is especially important as under- or over-extraction may lead to erroneous conclusions. Although recent advancements have been…

The Applicability of the ISD 4-Factor Model of Job Analysis in Identifying Task Training Priority in Nine Technical Military Occupational Specialties.

ERIC Educational Resources Information Center

Siebold, Guy L.

Research was conducted to assess the applicability of the Instructional Systems Development (ISD) job analysis procedures to nine technical aviation maintenance military occupational specialties (MOS). Job analysis questionnaires were developed for each of the nine aviation maintenance MOS's. Research teams administered the questionnaires to…

Variations in Reading Achievement across 14 Southern African School Systems: Which Factors Matter?

ERIC Educational Resources Information Center

Hungi, Njora; Thuku, Florence W.

2010-01-01

In this study the authors employed a multilevel analysis procedure in order to examine the pupil and school levels factors that contributed to variation in reading achievement among Grade 6 primary school pupils in 14 southern African school systems (Botswana, Kenya, Lesotho, Malawi, Mauritius, Mozambique, Namibia, Seychelles, South Africa,…

Assessment of economic factors affecting the satellite power system. Volume 1: System cost factors

NASA Technical Reports Server (NTRS)

Hazelrigg, G. A., Jr.

1978-01-01

The factors relevant to SPS costing and selection of preferred SPS satellite configurations were studied. The issues discussed are: (1) consideration of economic factors in the SPS system that relate to selection of SPS satellite configuration; (2) analysis of the proper rate of interest for use in SPS system definition studies; and (3) the impacts of differential inflation on SPS system definition costing procedures. A cost-risk comparison of the SPS satellite configurations showed a significant difference in the levelized cost of power from them. It is concluded, that this difference is the result more of differences in the procedures for assessing costs rather than in the satellite technologies required or of any advantages of one satellite configuration over the other. Analysis of the proper rate of interest for use in SPS system is 4 percent. The major item of differential inflation to be expected over this period of time is the real cost of labor. This cost is likely to double between today and the period of SPS construction.

Confirmatory factor analysis using Microsoft Excel.

PubMed

Miles, Jeremy N V

2005-11-01

This article presents a method for using Microsoft (MS) Excel for confirmatory factor analysis (CFA). CFA is often seen as an impenetrable technique, and thus, when it is taught, there is frequently little explanation of the mechanisms or underlying calculations. The aim of this article is to demonstrate that this is not the case; it is relatively straightforward to produce a spreadsheet in MS Excel that can carry out simple CFA. It is possible, with few or no programming skills, to effectively program a CFA analysis and, thus, to gain insight into the workings of the procedure.

Perioperative outcomes for pediatric neurosurgical procedures: analysis of the National Surgical Quality Improvement Program-Pediatrics.

PubMed

Kuo, Benjamin J; Vissoci, Joao Ricardo N; Egger, Joseph R; Smith, Emily R; Grant, Gerald A; Haglund, Michael M; Rice, Henry E

2017-03-01

OBJECTIVE Existing studies have shown a high overall rate of adverse events (AEs) following pediatric neurosurgical procedures. However, little is known regarding the morbidity of specific procedures or the association with risk factors to help guide quality improvement (QI) initiatives. The goal of this study was to describe the 30-day mortality and AE rates for pediatric neurosurgical procedures by using the American College of Surgeons (ACS) National Surgical Quality Improvement Program-Pediatrics (NSQIP-Peds) database platform. METHODS Data on 9996 pediatric neurosurgical patients were acquired from the 2012-2014 NSQIP-Peds participant user file. Neurosurgical cases were analyzed by the NSQIP-Peds targeted procedure categories, including craniotomy/craniectomy, defect repair, laminectomy, shunts, and implants. The primary outcome measure was 30-day mortality, with secondary outcomes including individual AEs, composite morbidity (all AEs excluding mortality and unplanned reoperation), surgical-site infection, and unplanned reoperation. Univariate analysis was performed between individual AEs and patient characteristics using Fischer's exact test. Associations between individual AEs and continuous variables (duration from admission to operation, work relative value unit, and operation time) were examined using the Student t-test. Patient characteristics and continuous variables associated with any AE by univariate analysis were used to develop category-specific multivariable models through backward stepwise logistic regression. RESULTS The authors analyzed 3383 craniotomy/craniectomy, 242 defect repair, 1811 laminectomy, and 4560 shunt and implant cases and found a composite overall morbidity of 30.2%, 38.8%, 10.2%, and 10.7%, respectively. Unplanned reoperation rates were highest for defect repair (29.8%). The mortality rate ranged from 0.1% to 1.2%. Preoperative ventilator dependence was a significant predictor of any AE for all procedure groups, whereas admission from outside hospital transfer was a significant predictor of any AE for all procedure groups except craniotomy/craniectomy. CONCLUSIONS This analysis of NSQIP-Peds, a large risk-adjusted national data set, confirms low perioperative mortality but high morbidity for pediatric neurosurgical procedures. These data provide a baseline understanding of current expected clinical outcomes for pediatric neurosurgical procedures, identify the need for collecting neurosurgery-specific risk factors and complications, and should support targeted QI programs and clinical management interventions to improve care of children.

Evaluation of standardized and applied variables in predicting treatment outcomes of polytrauma patients.

PubMed

Aksamija, Goran; Mulabdic, Adi; Rasic, Ismar; Muhovic, Samir; Gavric, Igor

2011-01-01

Polytrauma is defined as an injury where they are affected by at least two different organ systems or body, with at least one life-threatening injuries. Given the multilevel model care of polytrauma patients within KCUS are inevitable weaknesses in the management of this category of patients. To determine the dynamics of existing procedures in treatment of polytrauma patients on admission to KCUS, and based on statistical analysis of variables applied to determine and define the factors that influence the final outcome of treatment, and determine their mutual relationship, which may result in eliminating the flaws in the approach to the problem. The study was based on 263 polytrauma patients. Parametric and non-parametric statistical methods were used. Basic statistics were calculated, based on the calculated parameters for the final achievement of research objectives, multicoleration analysis, image analysis, discriminant analysis and multifactorial analysis were used. From the universe of variables for this study we selected sample of n = 25 variables, of which the first two modular, others belong to the common measurement space (n = 23) and in this paper defined as a system variable methods, procedures and assessments of polytrauma patients. After the multicoleration analysis, since the image analysis gave a reliable measurement results, we started the analysis of eigenvalues, that is defining the factors upon which they obtain information about the system solve the problem of the existing model and its correlation with treatment outcome. The study singled out the essential factors that determine the current organizational model of care, which may affect the treatment and better outcome of polytrauma patients. This analysis has shown the maximum correlative relationships between these practices and contributed to development guidelines that are defined by isolated factors.

Do instability markers predict satisfactory reduction and requirement for later surgery in emergency department patients with wrist fracture?

PubMed

Winayak, Amar; Gossat, Alyza; Cooper, Jenny; Ritchie, Peter; Lim, Wei; Klim, Sharon; Kelly, Anne-Maree

2018-02-01

Research suggests that the presence of instability markers in patients with displaced distal radial fractures is associated with poorer outcome. Our aims were to determine whether the presence of previously defined instability markers could predict the likelihood of successful ED reduction and requirement for a secondary procedure after ED reduction. Retrospective cohort study performed by medical record review. Adult ED patients coded as having an isolated wrist fracture and having fracture reduction in ED were eligible for inclusion. Data collected included demographics, history of osteoporosis, mechanism of injury, radiological features on X-rays and performance of a secondary procedure. Outcomes of interest were the rate of successful fracture reduction in ED (against defined radiological criteria), the rate of secondary procedures and the association between the number of defined instability risk factors and successful reduction and performance of a secondary surgical procedure. Analysis was by χ 2 test, receiver operating characteristic curve, logistic regression analyses. Three hundred and nineteen patients were studied; median age 62 years, 77% female. Sixty-five per cent of patients had satisfactory fracture reduction in ED (95% CI 59%-70%). Eighty-six patients underwent a secondary procedure to reduce/stabilise their fracture (28%, 95% CI 23%-33%). Younger age, lack of satisfactory ED reduction and increased number of instability factors were independently predictive of the performance of a secondary procedure. Instability risk factors are common in patients with wrist fractures requiring reduction in ED. The number of instability factors is not a strong predictor of the performance of secondary procedures. © 2017 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

Refinements of Stout’s Procedure for Assessing Latent Trait Unidimensionality

DTIC Science & Technology

1992-08-01

in the presence of guessing when coupled with many high-discriminating items. A revision of DIMTEST is proposed to overcome this limitation. Also, an...used for factor analysis. When guessing is present in the responses to items, however, linear factor analysis of tetrachoric correlations can produce...significance when d=1 and maintaining good power when d=2, even when the correlation between the abilities is as high as .7. The present study provides a

Dimensionality Assessment of Ordered Polytomous Items with Parallel Analysis

ERIC Educational Resources Information Center

Timmerman, Marieke E.; Lorenzo-Seva, Urbano

2011-01-01

Parallel analysis (PA) is an often-recommended approach for assessment of the dimensionality of a variable set. PA is known in different variants, which may yield different dimensionality indications. In this article, the authors considered the most appropriate PA procedure to assess the number of common factors underlying ordered polytomously…

The Circumplex Pattern of the Life Styles Inventory: A Reanalysis.

ERIC Educational Resources Information Center

Levin, Joseph

1991-01-01

A reanalysis of the intercorrelation matrix from a principal components analysis of the Life Styles Inventory was conducted using a Canadian sample. Using nonmetric multidimensional scaling, analyses show an almost perfect circumplex pattern. Results illustrate the inadequacy of factor analytic procedures for the analysis and representation of a…

RANDOMIZATION PROCEDURES FOR THE ANALYSIS OF EDUCATIONAL EXPERIMENTS.

ERIC Educational Resources Information Center

COLLIER, RAYMOND O.

CERTAIN SPECIFIC ASPECTS OF HYPOTHESIS TESTS USED FOR ANALYSIS OF RESULTS IN RANDOMIZED EXPERIMENTS WERE STUDIED--(1) THE DEVELOPMENT OF THE THEORETICAL FACTOR, THAT OF PROVIDING INFORMATION ON STATISTICAL TESTS FOR CERTAIN EXPERIMENTAL DESIGNS AND (2) THE DEVELOPMENT OF THE APPLIED ELEMENT, THAT OF SUPPLYING THE EXPERIMENTER WITH MACHINERY FOR…

Aeroservoelasticity

NASA Technical Reports Server (NTRS)

Noll, Thomas E.

1990-01-01

The paper describes recent accomplishments and current research projects along four main thrusts in aeroservoelasticity at NASA Langley. One activity focuses on enhancing the modeling and analysis procedures to accurately predict aeroservoelastic interactions. Improvements to the minimum-state method of approximating unsteady aerodynamics are shown to provide precise low-order models for design and simulation tasks. Recent extensions in aerodynamic correction-factor methodology are also described. With respect to analysis procedures, the paper reviews novel enhancements to matched filter theory and random process theory for predicting the critical gust profile and the associated time-correlated gust loads for structural design considerations. Two research projects leading towards improved design capability are also summarized: (1) an integrated structure/control design capability and (2) procedures for obtaining low-order robust digital control laws for aeroelastic applications.

Reliability and validity of the Japanese version of the Organizational Justice Questionnaire.

PubMed

Inoue, Akiomi; Kawakami, Norito; Tsutsumi, Akizumi; Shimazu, Akihito; Tsuchiya, Masao; Ishizaki, Masao; Tabata, Masaji; Akiyama, Miki; Kitazume, Akiko; Kuroda, Mitsuyo; Kivimäki, Mika

2009-01-01

Previous European studies reporting low procedural justice and low interactional justice were associated with increased health problems have used a modified version of the Moorman's Organizational Justice Questionnaire (OJQ, Elovainio et al., 2002) to assess organizational justice. We translated the modified OJQ into the Japanese language and examined the internal consistency reliability, and factor-based and construct validity of this measure. A back-translation procedure confirmed that the translation was appropriate, pending a minor revision. A total of 185 men and 58 women at a manufacturing factory in Japan were surveyed using a mailed questionnaire including the OJQ and other job stressors. Cronbach alpha coefficients of the two OJQ subscales were high (0.85-0.94) for both sexes. The hypothesized two factors (i.e., procedural justice and interactional justice) were extracted by the factor analysis for men; for women, procedural justice was further split into two separate dimensions supporting a three- rather than two-factor structure. Convergent validity was supported by expected correlations of the OJQ with job control, supervisor support, effort-reward imbalance, and job future ambiguity in particular among the men. The present study shows that the Japanese version of the OJQ has acceptable levels of reliability and validity at least for male employees.

Prognostic Factors for Neurologic Outcome in Patients with Carotid Artery Stenting

PubMed Central

Hung, Chi-Sheng; Lin, Mao-Shin; Chen, Ying-Hsien; Huang, Ching-Chang; Li, Hung-Yuan; Kao, Hsien-Li

2016-01-01

Background Carotid artery stenting (CAS) is a valid treatment for patients with carotid artery stenosis. The long-term outcome and prognostic factors in Asian population after CAS are not clear. This study aimed to identify the prognostic factors among Asian patients who have undergone CAS. Methods We retrospectively analyzed 246 patients with CAS. Annual carotid duplex ultrasound was used to identify restenosis. Peri-procedural complications, restenosis, neurologic outcomes, and mortality were recorded. Cox regression analyses were used to identify prognostic factors. Results The mean follow-up time was 49.2 months. Procedural success was achieved in 237 patients (98.3%), and protection devices were used in 208 patients (84.5%). Within 30 days of CAS, 13 (4.3% per procedure) peri-procedural complications occurred. During the follow-up period, 24 (9.7%) patients developed restenosis, and 37 (15.0%) developed ischemic strokes. In a multiple logistic regression analysis, head and neck radiotherapy [hazard ratio (HR) = 9.9, 95% confidence interval (CI), 3.38-29.1, p < .001], stent diameter (HR = 0.72, 95% CI, 0.58-0.89, p = .003), and predilatation (HR = 3.08 95% CI, 1.21-7.81, p = .018) were independent predictors for restenosis. In Cox regression analysis, hypercholesterolemia (HR = 0.25, 95% CI, 0.07-0.94, p = .04), head and neck radiotherapy (HR = 6.2, 95% CI, 1.8-21.3, p = .004), and restenosis (HR = 3.6, 95% CI, 1.1-11.18, p = .04) were predictors for recurrent ipsilateral ischemic stroke. Conclusions CAS provides reliable long-term results in Asian patients with carotid stenosis. Restenosis is associated with an increased rate of recurrent stroke and should be monitored carefully following CAS. PMID:27122951

Unanticipated hospital admission in pediatric patients with congenital heart disease undergoing ambulatory noncardiac surgical procedures.

PubMed

Yuki, Koichi; Koutsogiannaki, Sophia; Lee, Sandra; DiNardo, James A

2018-05-18

An increasing number of surgical and nonsurgical procedures are being performed on an ambulatory basis in children. Analysis of a large group of pediatric patients with congenital heart disease undergoing ambulatory procedures has not been undertaken. The objective of this study was to characterize the profile of children with congenital heart disease who underwent noncardiac procedures on an ambulatory basis at our institution, to determine the incidence of adverse cardiovascular and respiratory adverse events, and to determine the risk factors for unscheduled hospital admission. This is a retrospective study of children with congenital heart disease who underwent noncardiac procedures on an ambulatory basis in a single center. Using the electronic preoperative anesthesia evaluation form, we identified 3010 patients with congenital heart disease who underwent noncardiac procedures of which 1028 (34.1%) were scheduled to occur on an ambulatory basis. Demographic, echocardiographic and functional status data, cardiovascular and respiratory adverse events, and reasons for postprocedure admission were recorded. Univariable analysis was conducted. The unplanned hospital admission was 2.7% and univariable analysis demonstrated that performance of an echocardiogram within 6 mo of the procedure and procedures performed in radiology were associated with postoperative admission. Cardiovascular adverse event incidence was 3.9%. Respiratory adverse event incidence was 1.8%. Ambulatory, noncomplex procedures can be performed in pediatric patients with congenital heart disease and good functional status with a relatively low unanticipated hospital admission rate. © 2018 John Wiley & Sons Ltd.

Evaluation of results of US corn and soybeans exploratory experiment: Classification procedures verification test. [Missouri, Iowa, Indiana, and Illinois

NASA Technical Reports Server (NTRS)

Carnes, J. G.; Baird, J. E. (Principal Investigator)

1980-01-01

The classification procedure utilized in making crop proportion estimates for corn and soybeans using remotely sensed data was evaluated. The procedure was derived during the transition year of the Large Area Crop Inventory Experiment. Analysis of variance techniques were applied to classifications performed by 3 groups of analysts who processed 25 segments selected from 4 agrophysical units (APU's). Group and APU effects were assessed to determine factors which affected the quality of the classifications. The classification results were studied to determine the effectiveness of the procedure in producing corn and soybeans proportion estimates.

14 CFR 25.331 - Symmetric maneuvering conditions.

Code of Federal Regulations, 2011 CFR

2011-01-01

... Conditions § 25.331 Symmetric maneuvering conditions. (a) Procedure. For the analysis of the maneuvering... factor (at point A2 in § 25.333(b)), or the resulting tailplane normal load reaches its maximum...

Lead-Dependent Infective Endocarditis: The Role of Factors Predisposing to Its Development in an Analysis of 414 Clinical Cases.

PubMed

Polewczyk, Anna; Jacheć, Wojciech; Janion, Marianna; Podlaski, Rafał; Kutarski, Andrzej

2015-07-01

Lead-dependent infective endocarditis (LDIE) is a serious and insidious infective disease spreading along the leads to valve leaflets and endocardial surface. LDIE is still a lesser known disease with unclear risk factors, most often evaluated jointly for all infectious complications. Clinical data from 414 patients with the diagnosis of LDIE according to the Modified Duke Leads Criteria were analyzed. Patients with LDIE were identified in a population of 1,426 subjects submitted to transvenous lead extraction (TLE) in the Reference Center on Lead Extraction in Lublin, Poland, between March 2006 and July 2013 due to infectious (619 patients-43.4%) and noninfectious (807-56.6% of patients) reasons. During the period of 2006-2011, the analysis was conducted retrospectively; from early 2012 on, patients were enrolled prospectively. The effect of potential risk factors on the development of the disease was evaluated in a comparative analysis of clinical data from the LDIE patients and from 807 subjects with noninfectious indications for TLE. Additionally, in order to identify the factors predisposing to the development of LDIE, the population of infectious patients was divided into three subgroups: with isolated LDIE (157 patients), with LDIE and pocket infection (PI; 257 patients), and with isolated PI (205 patients). The groups and subgroups were analyzed for the presence of patient-dependent risk factors (age, gender, accompanying diseases, anticoagulation, or antiplatelet therapy) and procedure-related risk factors (the number and lead dwell time, pacing system, prior procedures, lead loops, and intracardiac abrasion of the leads). Furthermore, microbes' identification was conducted. The LDIE patients were older (67.3 vs 62.3; P = 0.001) and were more frequently male (68.6% vs 55.0%; P = 0.001) as compared with patients submitted to TLE for noninfectious reasons, but not in comparison with subjects diagnosed with isolated LDIE. In univariate analysis, the independent prognostic factors of LDIE were: type 2 diabetes-increase of risk by 37.7% (hazard ratio [HR] = 1,377; 95% confidence interval [CI] [1,088-1,742]), elevated above 2 mg% creatinine level-increase of risk by 61.5% (HR = 1,615; 95% CI [1,96-2,182]), antiplatelet therapy (HR = 1,285; 95% CI [1,052-1,057]), number of intracardiac leads prior to TLE (HR = 1,199; 95% CI [1,075-1,337]), intracardiac device with implantable cardioverter defibrillator (ICD) lead (HR = 1,909; 95% CI [1,492-2,444]), intracardiac device with coronary sinus lead (HR = 1,411; 95% CI [1,099-1,810]), number of procedures prior to TLE (HR = 1,092; 95% CI [1,017-1,172]), and abrasion of intracardiac leads (HR = 1,350; 95% CI [1,097-1,662]). Multivariate logistic regression demonstrated that the independent risk factors of LDIE were: chronic renal failure (HR = 1,406; 95% CI [1,033-1,915]), number of intracardiac leads prior to TLE (HR = 1,152; 95% CI [1,017-1,305]), intracardiac devices with ICD leads (HR = 1,719; 95% CI [1,330-2,223]), and presence of abrasion of intracardiac leads (HR = 1,405; 95% CI [1,129-1,750]). Microbiological analysis showed the domination of coagulase-negative staphylococci with relative advantage of Staphylococcus epidermidis in pathogenesis of LDIE. The factors predisposing to LDIE are mainly related to procedures performed on the patients. LDIE develops more frequently in patients with multiple leads, especially ICD. An important, until now lesser known, risk factor for LDIE is intracardiac abrasion of the leads strongly connected with procedural agents and properties of specific kind of bacteries. A new concept of the pathogenesis of LDIE was proposed on the basis of present analysis. ©2015 Wiley Periodicals, Inc.

Using factor analysis to identify neuromuscular synergies during treadmill walking

NASA Technical Reports Server (NTRS)

Merkle, L. A.; Layne, C. S.; Bloomberg, J. J.; Zhang, J. J.

1998-01-01

Neuroscientists are often interested in grouping variables to facilitate understanding of a particular phenomenon. Factor analysis is a powerful statistical technique that groups variables into conceptually meaningful clusters, but remains underutilized by neuroscience researchers presumably due to its complicated concepts and procedures. This paper illustrates an application of factor analysis to identify coordinated patterns of whole-body muscle activation during treadmill walking. Ten male subjects walked on a treadmill (6.4 km/h) for 20 s during which surface electromyographic (EMG) activity was obtained from the left side sternocleidomastoid, neck extensors, erector spinae, and right side biceps femoris, rectus femoris, tibialis anterior, and medial gastrocnemius. Factor analysis revealed 65% of the variance of seven muscles sampled aligned with two orthogonal factors, labeled 'transition control' and 'loading'. These two factors describe coordinated patterns of muscular activity across body segments that would not be evident by evaluating individual muscle patterns. The results show that factor analysis can be effectively used to explore relationships among muscle patterns across all body segments to increase understanding of the complex coordination necessary for smooth and efficient locomotion. We encourage neuroscientists to consider using factor analysis to identify coordinated patterns of neuromuscular activation that would be obscured using more traditional EMG analyses.

On the stability analysis of approximate factorization methods for 3D Euler and Navier-Stokes equations

NASA Technical Reports Server (NTRS)

Demuren, A. O.; Ibraheem, S. O.

1993-01-01

The convergence characteristics of various approximate factorizations for the 3D Euler and Navier-Stokes equations are examined using the von-Neumann stability analysis method. Three upwind-difference based factorizations and several central-difference based factorizations are considered for the Euler equations. In the upwind factorizations both the flux-vector splitting methods of Steger and Warming and van Leer are considered. Analysis of the Navier-Stokes equations is performed only on the Beam and Warming central-difference scheme. The range of CFL numbers over which each factorization is stable is presented for one-, two-, and three-dimensional flow. Also presented for each factorization is the CFL number at which the maximum eigenvalue is minimized, for all Fourier components, as well as for the high frequency range only. The latter is useful for predicting the effectiveness of multigrid procedures with these schemes as smoothers. Further, local mode analysis is performed to test the suitability of using a uniform flow field in the stability analysis. Some inconsistencies in the results from previous analyses are resolved.

Dimensions of patient satisfaction with comprehensive abortion care in Addis Ababa, Ethiopia.

PubMed

Mossie Chekol, Bekalu; Abera Abdi, Dame; Andualem Adal, Tamirie

2016-12-07

Patient satisfaction is a measure of the extent to which a patient is content with the health care received from health care providers. It has been recognized as one of the most vital indicators of quality. Hence, it has been studied and measured extensively as part of service quality and as a standalone construct. In spite of this, there has been limited or no studies in Ethiopia that describe factors of abortion care contributed to women's satisfaction. This study aimed to identifying the underlying factors that contribute to patient satisfaction with comprehensive abortion care and at exploring relationships between total satisfaction scores and socio-demographic and care-related variables in Addis Ababa, Ethiopia. At the beginning of the study in-depth interviews with 16 participants and a focus group discussion of 8 participants were conducted consecutively at the time of discharge to generate questions used to evaluate women's satisfaction with abortion care. Following generation of the perceived indicators, expert review, pilot study, and item analysis were performed in order to produce the reduced and better 26 items used to measure abortion care satisfaction. A total sample size of 450 participants from eight health facilities completed the survey. Principal component exploratory factor analysis and confirmatory factor analysis were conducted respectively to identify and confirm the factors of abortion care contributing to women's satisfaction. Mean satisfaction scores were compared across socio demographic and care-related variables such as age, educational level, gestational age (first trimester and second trimester), and facility type using analysis of variance. Exploratory factor analysis of the 26 items indicated that satisfaction with abortion care consisted of five main components accounting for 60.48% of the variance in total satisfaction scores. Factor loadings of all items were found to be greater than 0.4. These factors are named as follows: "art of care" which means interpersonal relationships with the care-provider, "physical environment" which means the perceived quality of physical surroundings in which care is delivered, including cleanliness of facilities and equipment, "information" which means the information received related to abortion procedures, "privacy and confidentiality", "quality of care" which refers to technical quality of the care provider. Furthermore, analysis of variance showed that overall satisfaction is found to be related to facility type, relationship status, gestational age, and procedural type. The findings provided support that women's satisfaction with comprehensive abortion care has five major factors. Therefore, to improve the overall quality of comprehensive abortion care, attention should be given to the advancement of these components namely, positive interpersonal communication with care-receiver, pleasantness of physical environment, offering enough information related to the procedure, securing clients' privacy during counseling and treatment, and technical quality of the providers.

Vocational students' learning preferences: the interpretability of ipsative data.

PubMed

Smith, P J

2000-02-01

A number of researchers have argued that ipsative data are not suitable for statistical procedures designed for normative data. Others have argued that the interpretability of such analyses of ipsative data are little affected where the number of variables and the sample size are sufficiently large. The research reported here represents a factor analysis of the scores on the Canfield Learning Styles Inventory for 1,252 students in vocational education. The results of the factor analysis of these ipsative data were examined in a context of existing theory and research on vocational students and lend support to the argument that the factor analysis of ipsative data can provide sensibly interpretable results.

The effects of physical activity on impulsive choice: Influence of sensitivity to reinforcement amount and delay.

PubMed

Strickland, Justin C; Feinstein, Max A; Lacy, Ryan T; Smith, Mark A

2016-05-01

Impulsive choice is a diagnostic feature and/or complicating factor for several psychological disorders and may be examined in the laboratory using delay-discounting procedures. Recent investigators have proposed using quantitative measures of analysis to examine the behavioral processes contributing to impulsive choice. The purpose of this study was to examine the effects of physical activity (i.e., wheel running) on impulsive choice in a single-response, discrete-trial procedure using two quantitative methods of analysis. To this end, rats were assigned to physical activity or sedentary groups and trained to respond in a delay-discounting procedure. In this procedure, one lever always produced one food pellet immediately, whereas a second lever produced three food pellets after a 0, 10, 20, 40, or 80-s delay. Estimates of sensitivity to reinforcement amount and sensitivity to reinforcement delay were determined using (1) a simple linear analysis and (2) an analysis of logarithmically transformed response ratios. Both analyses revealed that physical activity decreased sensitivity to reinforcement amount and sensitivity to reinforcement delay. These findings indicate that (1) physical activity has significant but functionally opposing effects on the behavioral processes that contribute to impulsive choice and (2) both quantitative methods of analysis are appropriate for use in single-response, discrete-trial procedures. Copyright © 2016 Elsevier B.V. All rights reserved.

Impact of Job Design Problems and Lack of Support. Draft Version. Working Paper #6.

ERIC Educational Resources Information Center

Gersten, Russell; And Others

This paper presents implications of the path analysis procedures used to interpret data from a study of urban special education teachers' perceptions of working conditions. The analysis looked at a broad range of factors that could affect teacher plans to leave the field. An overall finding emerging from the analysis was that the same fundamental…

Data-Mining Techniques in Detecting Factors Linked to Academic Achievement

ERIC Educational Resources Information Center

Martínez Abad, Fernando; Chaparro Caso López, Alicia A.

2017-01-01

In light of the emergence of statistical analysis techniques based on data mining in education sciences, and the potential they offer to detect non-trivial information in large databases, this paper presents a procedure used to detect factors linked to academic achievement in large-scale assessments. The study is based on a non-experimental,…

Bloody traditional procedures performed during infancy in the oropharyngeal area among HIV+ children: implication from the perspective of mother-to-child transmission of HIV.

PubMed

Mitke, Yifru Berhan

2010-12-01

Although bloody traditional procedures are very common in Ethiopia, this is the first report on infants. None of the literature attributed such practices as risk factor for mother-to-child transmission (MTCT) of HIV. Analysis was done to 1,163 children and found that 552 (47.5%) bloody traditional procedures were performed in the oral cavity to 399 (34.3%): uvulectomy 41.8%, milk tooth extraction 33.7% and tonsillectomy 24.5%. Multinomial logistic regression showed strong association of uvulectomy with Tigray ethnicity. Milk teeth extractions were highest among girls, rural residence, Tigray and Amhara ethnicity. When procedures performed, children were under 1 month (88.9% of tonsillectomies), under 6 months (83.5% of uvulectomies) and 4-6 months (54.3% of milk tooth extractions) of age. More than 97% for whom procedures performed were breast fed, and about 88% were from the northern part of the country. Taking into account the deep invasiveness of the procedures, they are assumed as one of the strong risk factors for MTCT of HIV during lactation.

Neotectonic control on drainage systems: GIS-based geomorphometric and morphotectonic assessment for Crete, Greece

NASA Astrophysics Data System (ADS)

Argyriou, Athanasios V.; Teeuw, Richard M.; Soupios, Pantelis; Sarris, Apostolos

2017-11-01

Geomorphic indices can be used to examine the geomorphological and tectonic processes responsible for the development of the drainage basins. Such indices can be dependent on tectonics, erosional processes and other factors that control the morphology of the landforms. The inter-relationships between geomorphic indices can determine the influence of regional tectonic activity in the shape development of drainage basins. A Multi-Criteria Decision Analysis (MCDA) procedure has been used to perform an integrated cluster analysis that highlights information associated with the dominant regional tectonic activity. Factor Analysis (FA) and Analytical Hierarchy Process (AHP) were considered within that procedure, producing a representation of the distributed regional tectonic activity of the drainage basins studied. The study area is western Crete, located in the outer fore-arc of the Hellenic subduction zone, one of the world's most tectonically active regions. The results indicate that in the landscape evolution of the study area (especially the western basins) tectonic controls dominate over lithological controls.

Railroad Classification Yard Technology Manual. Volume III. Freight Car Rollability

DOT National Transportation Integrated Search

1981-07-01

The report presents a survey of rolling resistance research, histograms of rolling resistance from five yards, a statistical regression analysis of causal factors affecting rolling resistance, procedures for constructing a rolling resistance histogra...

High Cost of Hospitalization for Colonic Diverticular Bleeding Depended on Repeated Bleeding and Blood Transfusion: Analysis with Diagnosis Procedure Combination Data in Japan.

PubMed

Ito, Yoichiro; Sakata, Yasuhisa; Yoshida, Hisako; Nonaka, Sayuri; Fujii, Susumu; Tanaka, Yuichiro; Shirai, Shimpei; Takeshita, Eri; Akutagawa, Takashi; Kawakubo, Hiroharu; Yamamoto, Koji; Tsuruoka, Nanae; Shimoda, Ryo; Iwakiri, Ryuichi; Fujimoto, Kazuma

2017-01-01

Bleeding from a colonic diverticulum is serious in aged patients. The aim of this study was to determine the risk factors for high-cost hospitalization of colonic diverticular bleeding using the diagnosis procedure combination (DPC) data. From January 2009 to December 2015, 78 patients with colonic diverticular bleeding were identified by DPC data in Saga Medical School Hospital. All patients underwent colonic endoscopy within 3 days. The patients were divided into 2 groups: the low-cost group (DPC cost of <500,000 yen) and the high-cost group (DPC cost of >500,000 yen). Univariate analysis revealed that aging, hypertension, rebleeding, a low hemoglobin concentration at admission, and blood transfusion were risk factors for high hospitalization cost. Multivariate analysis revealed that rebleeding (OR 5.3; 95% CI 1.3-21.3; p = 0.017) and blood transfusion (OR 3.8; 95% CI 1.01-14.2; p = 0.048) were definite risk factors for high hospitalization cost. Rebleeding and blood transfusion were related to high hospitalization cost for colonic diverticular bleeding. © 2017 S. Karger AG, Basel.

Multilevel Structural Equation Models for the Analysis of Comparative Data on Educational Performance

ERIC Educational Resources Information Center

Goldstein, Harvey; Bonnet, Gerard; Rocher, Thierry

2007-01-01

The Programme for International Student Assessment comparative study of reading performance among 15-year-olds is reanalyzed using statistical procedures that allow the full complexity of the data structures to be explored. The article extends existing multilevel factor analysis and structural equation models and shows how this can extract richer…

Avoiding overstating the strength of forensic evidence: Shrunk likelihood ratios/Bayes factors.

PubMed

Morrison, Geoffrey Stewart; Poh, Norman

2018-05-01

When strength of forensic evidence is quantified using sample data and statistical models, a concern may be raised as to whether the output of a model overestimates the strength of evidence. This is particularly the case when the amount of sample data is small, and hence sampling variability is high. This concern is related to concern about precision. This paper describes, explores, and tests three procedures which shrink the value of the likelihood ratio or Bayes factor toward the neutral value of one. The procedures are: (1) a Bayesian procedure with uninformative priors, (2) use of empirical lower and upper bounds (ELUB), and (3) a novel form of regularized logistic regression. As a benchmark, they are compared with linear discriminant analysis, and in some instances with non-regularized logistic regression. The behaviours of the procedures are explored using Monte Carlo simulated data, and tested on real data from comparisons of voice recordings, face images, and glass fragments. Copyright © 2018 The Authors. Published by Elsevier B.V. All rights reserved.

Association between participation and compliance with Continuing Medical Education and care production by physicians: a cross-sectional study

PubMed Central

Carrera, Renato Melli; Cendoroglo, Miguel; Gonçales, Paulo David Scatena; Marques, Flavio Rocha Brito; Sardenberg, Camila; Glezer, Milton; dos Santos, Oscar Fernando Pavão; Rizzo, Luiz Vicente; Lottenberg, Claudio Luiz; Schvartsman, Cláudio

2015-01-01

Objective Physician participation in Continuing Medical Education programs may be influenced by a number of factors. To evaluate the factors associated with compliance with the Continuing Medical Education requirements at a private hospital, we investigated whether physicians’ activity, measured by volumes of admissions and procedures, was associated with obtaining 40 Continuing Medical Education credits (40 hours of activities) in a 12-month cycle. Methods In an exclusive and non-mandatory Continuing Medical Education program, we collected physicians’ numbers of hospital admissions and numbers of surgical procedures performed. We also analyzed data on physicians’ time since graduation, age, and gender. Results A total of 3,809 credentialed, free-standing, private practice physicians were evaluated. Univariate analysis showed that the Continuing Medical Education requirements were more likely to be achieved by male physicians (odds ratio 1.251; p=0.009) and who had a higher number of hospital admissions (odds ratio 1.022; p<0.001). Multivariate analysis showed that age and number of hospital admissions were associated with achievement of the Continuing Medical Education requirements. Each hospital admission increased the chance of achieving the requirements by 0.4%. Among physicians who performed surgical procedures, multivariate analysis showed that male physicians were 1.3 time more likely to achieve the Continuing Medical Education requirements than female physicians. Each surgical procedure performed increased the chance of achieving the requirements by 1.4%. Conclusion The numbers of admissions and number of surgical procedures performed by physicians at our hospital were associated with the likelihood of meeting the Continuing Medical Education requirements. These findings help to shed new light on our Continuing Medical Education program. PMID:25807247

The learning curve to achieve satisfactory completion rates in upper GI endoscopy: an analysis of a national training database.

PubMed

Ward, S T; Hancox, A; Mohammed, M A; Ismail, T; Griffiths, E A; Valori, R; Dunckley, P

2017-06-01

The aim of this study was to determine the number of OGDs (oesophago-gastro-duodenoscopies) trainees need to perform to acquire competency in terms of successful unassisted completion to the second part of the duodenum 95% of the time. OGD data were retrieved from the trainee e-portfolio developed by the Joint Advisory Group on GI Endoscopy (JAG) in the UK. All trainees were included unless they were known to have a baseline experience of >20 procedures or had submitted data for <20 procedures. The primary outcome measure was OGD completion, defined as passage of the endoscope to the second part of the duodenum without physical assistance. The number of OGDs required to achieve a 95% completion rate was calculated by the moving average method and learning curve cumulative summation (LC-Cusum) analysis. To determine which factors were independently associated with OGD completion, a mixed effects logistic regression model was constructed with OGD completion as the outcome variable. Data were analysed for 1255 trainees over 288 centres, representing 243 555 OGDs. By moving average method, trainees attained a 95% completion rate at 187 procedures. By LC-Cusum analysis, after 200 procedures, >90% trainees had attained a 95% completion rate. Total number of OGDs performed, trainee age and experience in lower GI endoscopy were factors independently associated with OGD completion. There are limited published data on the OGD learning curve. This is the largest study to date analysing the learning curve for competency acquisition. The JAG competency requirement for 200 procedures appears appropriate. 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/.

Examination of Factors that Influence the Operation Income and Expenditure Balance Difference Rate of 20 Educational Foundation Universities.

PubMed

Nakajima, Hisato; Yano, Kouya; Nagasawa, Kaoko; Katou, Satoka; Yokota, Kuninobu

2017-01-01

The objective of this study is to examine the factors that influence the operation income and expenditure balance ratio of school corporations running university hospitals by multiple regression analysis. 1. We conducted cluster analysis of the financial ratio and classified the school corporations into those running colleges and universities.2. We conducted multiple regression analysis using the operation income and expenditure balance ratio of the colleges as the variables and the Diagnosis Procedure Combination data as the explaining variables.3. The predictive expression was used for multiple regression analysis. 1. The school corporations were divided into those running universities (7), colleges (20) and others. The medical income ratio and the debt ratio were high and the student payment ratio was low in the colleges.2. The numbers of emergency care hospitalizations, operations, radiation therapies, and ambulance conveyances, and the complexity index had a positive influence on the operation income and expenditure balance ratio. On the other hand, the number of general anesthesia procedures, the cover rate index, and the emergency care index had a negative influence.3. The predictive expression was as follows.Operation income and expenditure balance ratio = 0.027 × number of emergency care hospitalizations + 0.005 × number of operations + 0.019 × number of radiation therapies + 0.007 × number of ambulance conveyances - 0.003 × number of general anesthesia procedures + 648.344 × complexity index - 5877.210 × cover rate index - 2746.415 × emergency care index - 38.647Conclusion: In colleges, the number of emergency care hospitalizations, the number of operations, the number of radiation therapies, and the number of ambulance conveyances and the complexity index were factors for gaining ordinary profit.

Man-machine analysis of translation and work tasks of Skylab films

NASA Technical Reports Server (NTRS)

Hosler, W. W.; Boelter, J. G.; Morrow, J. R., Jr.; Jackson, J. T.

1979-01-01

An objective approach to determine the concurrent validity of computer-graphic models is real time film analysis. This technique was illustrated through the procedures and results obtained in an evaluation of translation of Skylab mission astronauts. The quantitative analysis was facilitated by the use of an electronic film analyzer, minicomputer, and specifically supportive software. The uses of this technique for human factors research are: (1) validation of theoretical operator models; (2) biokinetic analysis; (3) objective data evaluation; (4) dynamic anthropometry; (5) empirical time-line analysis; and (6) consideration of human variability. Computer assisted techniques for interface design and evaluation have the potential for improving the capability for human factors engineering.

Faying Surface Lubrication Effects on Nut Factors

NASA Technical Reports Server (NTRS)

Taylor, Deneen M.; Morrison, Raymond F.

2006-01-01

Bolted joint analysis typically is performed using nut factors derived from textbooks and procedures from program requirement documents. Joint specific testing was performed for a critical International Space Station (ISS) joint. Test results indicate that for some configurations the nut factor may be significantly different than accepted textbook values. This paper presents results of joint specific testing to aid in determining if joint specific testing should be performed to insure required preloads are obtained.

Profile: a computer program for displaying the geometric relationships of the responses in a factorial design

Treesearch

Stanford L. Arner

1974-01-01

One procedure in analyzing the responses to factors in an experiment is to construct profiles of the means. Profiles are plots of the sample means of each level of one factor at each level of one or more of the other factors in the experiment. The construction of these profiles and tests of hypotheses about the mean responses is called profile analysis. This paper...

Unscaled Bayes factors for multiple hypothesis testing in microarray experiments.

PubMed

Bertolino, Francesco; Cabras, Stefano; Castellanos, Maria Eugenia; Racugno, Walter

2015-12-01

Multiple hypothesis testing collects a series of techniques usually based on p-values as a summary of the available evidence from many statistical tests. In hypothesis testing, under a Bayesian perspective, the evidence for a specified hypothesis against an alternative, conditionally on data, is given by the Bayes factor. In this study, we approach multiple hypothesis testing based on both Bayes factors and p-values, regarding multiple hypothesis testing as a multiple model selection problem. To obtain the Bayes factors we assume default priors that are typically improper. In this case, the Bayes factor is usually undetermined due to the ratio of prior pseudo-constants. We show that ignoring prior pseudo-constants leads to unscaled Bayes factor which do not invalidate the inferential procedure in multiple hypothesis testing, because they are used within a comparative scheme. In fact, using partial information from the p-values, we are able to approximate the sampling null distribution of the unscaled Bayes factor and use it within Efron's multiple testing procedure. The simulation study suggests that under normal sampling model and even with small sample sizes, our approach provides false positive and false negative proportions that are less than other common multiple hypothesis testing approaches based only on p-values. The proposed procedure is illustrated in two simulation studies, and the advantages of its use are showed in the analysis of two microarray experiments. © The Author(s) 2011.

Preoperative short hookwire placement for small pulmonary lesions: evaluation of technical success and risk factors for initial placement failure.

PubMed

Iguchi, Toshihiro; Hiraki, Takao; Matsui, Yusuke; Fujiwara, Hiroyasu; Masaoka, Yoshihisa; Tanaka, Takashi; Sato, Takuya; Gobara, Hideo; Toyooka, Shinichi; Kanazawa, Susumu

2018-05-01

To retrospectively evaluate the technical success of computed tomography fluoroscopy-guided short hookwire placement before video-assisted thoracoscopic surgery and to identify the risk factors for initial placement failure. In total, 401 short hookwire placements for 401 lesions (mean diameter 9.3 mm) were reviewed. Technical success was defined as correct positioning of the hookwire. Possible risk factors for initial placement failure (i.e., requirement for placement of an additional hookwire or to abort the attempt) were evaluated using logistic regression analysis for all procedures, and for procedures performed via the conventional route separately. Of the 401 initial placements, 383 were successful and 18 failed. Short hookwires were finally placed for 399 of 401 lesions (99.5%). Univariate logistic regression analyses revealed that in all 401 procedures only the transfissural approach was a significant independent predictor of initial placement failure (odds ratio, OR, 15.326; 95% confidence interval, CI, 5.429-43.267; p < 0.001) and for the 374 procedures performed via the conventional route only lesion size was a significant independent predictor of failure (OR 0.793, 95% CI 0.631-0.996; p = 0.046). The technical success of preoperative short hookwire placement was extremely high. The transfissural approach was a predictor initial placement failure for all procedures and small lesion size was a predictor of initial placement failure for procedures performed via the conventional route. • Technical success of preoperative short hookwire placement was extremely high. • The transfissural approach was a significant independent predictor of initial placement failure for all procedures. • Small lesion size was a significant independent predictor of initial placement failure for procedures performed via the conventional route.

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

PubMed

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

2017-05-01

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

Multicriteria decision analysis in ranking of analytical procedures for aldrin determination in water.

PubMed

Tobiszewski, Marek; Orłowski, Aleksander

2015-03-27

The study presents the possibility of multi-criteria decision analysis (MCDA) application when choosing analytical procedures with low environmental impact. A type of MCDA, Preference Ranking Organization Method for Enrichment Evaluations (PROMETHEE), was chosen as versatile tool that meets all the analytical chemists--decision makers requirements. Twenty five analytical procedures for aldrin determination in water samples (as an example) were selected as input alternatives to MCDA analysis. Nine different criteria describing the alternatives were chosen from different groups--metrological, economical and the most importantly--environmental impact. The weights for each criterion were obtained from questionnaires that were sent to experts, giving three different scenarios for MCDA results. The results of analysis show that PROMETHEE is very promising tool to choose the analytical procedure with respect to its greenness. The rankings for all three scenarios placed solid phase microextraction and liquid phase microextraction--based procedures high, while liquid-liquid extraction, solid phase extraction and stir bar sorptive extraction--based procedures were placed low in the ranking. The results show that although some of the experts do not intentionally choose green analytical chemistry procedures, their MCDA choice is in accordance with green chemistry principles. The PROMETHEE ranking results were compared with more widely accepted green analytical chemistry tools--NEMI and Eco-Scale. As PROMETHEE involved more different factors than NEMI, the assessment results were only weakly correlated. Oppositely, the results of Eco-Scale assessment were well-correlated as both methodologies involved similar criteria of assessment. Copyright © 2015 Elsevier B.V. All rights reserved.

Pedestrian injury causation parameters. Phase 2

DOT National Transportation Integrated Search

1981-10-01

This report describes data collection, quality control and data analysis procedures for a five-team program to study pedestrian injury causation factors. The data file contains 1,997 pedestrian accidents collected during a two and one-half year perio...

CT fluoroscopy-guided renal tumour cutting needle biopsy: retrospective evaluation of diagnostic yield, safety, and risk factors for diagnostic failure.

PubMed

Iguchi, Toshihiro; Hiraki, Takao; Matsui, Yusuke; Fujiwara, Hiroyasu; Sakurai, Jun; Masaoka, Yoshihisa; Gobara, Hideo; Kanazawa, Susumu

2018-01-01

To evaluate retrospectively the diagnostic yield, safety, and risk factors for diagnostic failure of computed tomography (CT) fluoroscopy-guided renal tumour biopsy. Biopsies were performed for 208 tumours (mean diameter 2.3 cm; median diameter 2.1 cm; range 0.9-8.5 cm) in 199 patients. One hundred and ninety-nine tumours were ≤4 cm. All 208 initial procedures were divided into diagnostic success and failure groups. Multiple variables related to the patients, lesions, and procedures were assessed to determine the risk factors for diagnostic failure. After performing 208 initial and nine repeat biopsies, 180 malignancies and 15 benign tumours were pathologically diagnosed, whereas 13 were not diagnosed. In 117 procedures, 118 Grade I and one Grade IIIa adverse events (AEs) occurred. Neither Grade ≥IIIb AEs nor tumour seeding were observed within a median follow-up period of 13.7 months. Logistic regression analysis revealed only small tumour size (≤1.5 cm; odds ratio 3.750; 95% confidence interval 1.362-10.326; P = 0.011) to be a significant risk factor for diagnostic failure. CT fluoroscopy-guided renal tumour biopsy is a safe procedure with a high diagnostic yield. A small tumour size (≤1.5 cm) is a significant risk factor for diagnostic failure. • CT fluoroscopy-guided renal tumour biopsy has a high diagnostic yield. • CT fluoroscopy-guided renal tumour biopsy is safe. • Small tumour size (≤1.5 cm) is a risk factor for diagnostic failure.

Risk Factors for Urinary Tract Infections in Cardiac Surgical Patients

PubMed Central

Gillen, Jacob R.; Isbell, James M.; Michaels, Alex D.; Lau, Christine L.

2015-01-01

Abstract Background: Risk factors for catheter-associated urinary tract infections (CAUTIs) in patients undergoing non-cardiac surgical procedures have been well documented. However, the variables associated with CAUTIs in the cardiac surgical population have not been clearly defined. Therefore, the purpose of this study was to investigate risk factors associated with CAUTIs in patients undergoing cardiac procedures. Methods: All patients undergoing cardiac surgery at a single institution from 2006 through 2012 (4,883 patients) were reviewed. Patients with U.S. Centers for Disease Control (CDC) criteria for CAUTI were identified from the hospital's Quality Assessment database. Pre-operative, operative, and post-operative patient factors were evaluated. Univariate and multivariable analyses were used to identify significant correlations between perioperative characteristics and CAUTIs. Results: There were 55 (1.1%) documented CAUTIs in the study population. On univariate analysis, older age, female gender, diabetes mellitus, cardiogenic shock, urgent or emergent operation, packed red blood cell (PRBC) units transfused, and intensive care unit length of stay (ICU LOS) were all significantly associated with CAUTI [p<0.05]. On multivariable logistic regression, older age, female gender, diabetes mellitus, and ICU LOS remained significantly associated with CAUTI. Additionally, there was a significant association between CAUTI and 30-d mortality on univariate analysis. However, when controlling for common predictors of operative mortality on multivariable analysis, CAUTI was no longer associated with mortality. Conclusions: There are several identifiable risk factors for CAUTI in patients undergoing cardiac procedures. CAUTI is not independently associated with increased mortality, but it does serve as a marker of sicker patients more likely to die from other comorbidities or complications. Therefore, awareness of the high-risk nature of these patients should lead to increased diligence and may help to improve peri-operative outcomes. Recognizing patients at high risk for CAUTI may lead to improved measures to decrease CAUTI rates within this population. PMID:26115336

Risk Factors for Urinary Tract Infections in Cardiac Surgical Patients.

PubMed

Gillen, Jacob R; Isbell, James M; Michaels, Alex D; Lau, Christine L; Sawyer, Robert G

2015-10-01

Risk factors for catheter-associated urinary tract infections (CAUTIs) in patients undergoing non-cardiac surgical procedures have been well documented. However, the variables associated with CAUTIs in the cardiac surgical population have not been clearly defined. Therefore, the purpose of this study was to investigate risk factors associated with CAUTIs in patients undergoing cardiac procedures. All patients undergoing cardiac surgery at a single institution from 2006 through 2012 (4,883 patients) were reviewed. Patients with U.S. Centers for Disease Control (CDC) criteria for CAUTI were identified from the hospital's Quality Assessment database. Pre-operative, operative, and post-operative patient factors were evaluated. Univariate and multivariable analyses were used to identify significant correlations between perioperative characteristics and CAUTIs. There were 55 (1.1%) documented CAUTIs in the study population. On univariate analysis, older age, female gender, diabetes mellitus, cardiogenic shock, urgent or emergent operation, packed red blood cell (PRBC) units transfused, and intensive care unit length of stay (ICU LOS) were all significantly associated with CAUTI [p<0.05]. On multivariable logistic regression, older age, female gender, diabetes mellitus, and ICU LOS remained significantly associated with CAUTI. Additionally, there was a significant association between CAUTI and 30-d mortality on univariate analysis. However, when controlling for common predictors of operative mortality on multivariable analysis, CAUTI was no longer associated with mortality. There are several identifiable risk factors for CAUTI in patients undergoing cardiac procedures. CAUTI is not independently associated with increased mortality, but it does serve as a marker of sicker patients more likely to die from other comorbidities or complications. Therefore, awareness of the high-risk nature of these patients should lead to increased diligence and may help to improve peri-operative outcomes. Recognizing patients at high risk for CAUTI may lead to improved measures to decrease CAUTI rates within this population.

A scaling procedure for the response of an isolated system with high modal overlap factor

NASA Astrophysics Data System (ADS)

De Rosa, S.; Franco, F.

2008-10-01

The paper deals with a numerical approach that reduces some physical sizes of the solution domain to compute the dynamic response of an isolated system: it has been named Asymptotical Scaled Modal Analysis (ASMA). The proposed numerical procedure alters the input data needed to obtain the classic modal responses to increase the frequency band of validity of the discrete or continuous coordinates model through the definition of a proper scaling coefficient. It is demonstrated that the computational cost remains acceptable while the frequency range of analysis increases. Moreover, with reference to the flexural vibrations of a rectangular plate, the paper discusses the ASMA vs. the statistical energy analysis and the energy distribution approach. Some insights are also given about the limits of the scaling coefficient. Finally it is shown that the linear dynamic response, predicted with the scaling procedure, has the same quality and characteristics of the statistical energy analysis, but it can be useful when the system cannot be solved appropriately by the standard Statistical Energy Analysis (SEA).

Academic Rigor and Economic Value: GED[R] and High School Students' Perceptions and Misperceptions of the GED[R] vs. the High School Diploma

ERIC Educational Resources Information Center

Horne, Lela M.; Rachal, John R.; Shelley, Kyna

2012-01-01

A mixed methods framework utilized quantitative and qualitative data to determine whether statistically significant differences existed between high school and GED[R] student perceptions of credential value. An exploratory factor analysis (n=326) extracted four factors and then a MANOVA procedure was performed with a stratified quota sample…

Validation of the Adolescent Concerns Measure (ACM): evidence from exploratory and confirmatory factor analysis.

PubMed

Ang, Rebecca P; Chong, Wan Har; Huan, Vivien S; Yeo, Lay See

2007-01-01

This article reports the development and initial validation of scores obtained from the Adolescent Concerns Measure (ACM), a scale which assesses concerns of Asian adolescent students. In Study 1, findings from exploratory factor analysis using 619 adolescents suggested a 24-item scale with four correlated factors--Family Concerns (9 items), Peer Concerns (5 items), Personal Concerns (6 items), and School Concerns (4 items). Initial estimates of convergent validity for ACM scores were also reported. The four-factor structure of ACM scores derived from Study 1 was confirmed via confirmatory factor analysis in Study 2 using a two-fold cross-validation procedure with a separate sample of 811 adolescents. Support was found for both the multidimensional and hierarchical models of adolescent concerns using the ACM. Internal consistency and test-retest reliability estimates were adequate for research purposes. ACM scores show promise as a reliable and potentially valid measure of Asian adolescents' concerns.

Is isomerism a risk factor for intestinal volvulus?

PubMed

Landisch, Rachel M; Loomba, Rohit S; Salazar, Jose H; Buelow, Matthew W; Frommelt, Michele; Anderson, Robert H; Wagner, Amy J

2018-03-06

Isomerism, or heterotaxy syndrome, affects many organ systems anatomically and functionally. Intestinal malrotation is common in patients with isomerism. Despite a low reported risk of volvulus, some physicians perform routine screening and prophylactic Ladd procedures on asymptomatic patients with isomerism who are found to have intestinal malrotation. The primary aim of this study was to determine if isomerism is an independent risk factor for volvulus. Kid's Inpatient Database data from 1997 to 2012 was utilized for this study. Characteristics of admissions with and without isomerism were compared with a particular focus on intestinal malrotation, volvulus, and Ladd procedure. A logistic regression was conducted to determine independent risk factors for volvulus with respect to isomerism. 15,962,403 inpatient admissions were included in the analysis, of which 7970 (0.05%) patients had isomerism, and 6 patients (0.1%) developed volvulus. Isomerism was associated with a 52-fold increase in the odds of intestinal malrotation by univariate analysis. Of 251 with isomerism and intestinal malrotation, only 2.4% experienced volvulus. Logistic regression demonstrated that isomerism was not an independent risk factor for volvulus. Isomerism is associated with an increased risk of intestinal malrotation but is not an independent risk factor for volvulus. Prognosis study. Level III. Copyright © 2018 Elsevier Inc. All rights reserved.

Optimizing modality selection for image-guided procedures: an analysis of the challenges to ultrasound guidance.

PubMed

Beland, Michael D; Sternick, Laura A; Baird, Grayson L; Dupuy, Damian E; Cronan, John J; Mayo-Smith, William W

2016-04-01

Selection of the most appropriate modality for image guidance is essential for procedural success. We identified specific factors contributing to failure of ultrasound-guided procedures that were subsequently performed using CT guidance. This single-center, retrospective study included 164 patients who underwent a CT-guided biopsy, aspiration/drainage, or ablation after initially having the same procedure attempted unsuccessfully with ultrasound guidance. Review of the procedure images, reports, biopsy results, and clinical follow-up was performed and the reasons for inability to perform the procedure with ultrasound guidance were recorded. Patient cross-sectional area and depth to target were calculated. Differences in area and depth were compared using general linear modeling. Depth as a predictor of an unfavorable body habitus designation was modeled using logistic regression. US guidance was successful in the vast majority of cases (97%). Of the 164 procedures, there were 92 (56%) biopsies, 63 (38%) aspirations/drainages, and 9 (5%) ablations. The most common reason for procedure failure was poor acoustic window (83/164, 51%). Other reasons included target lesion being poorly discerned from adjacent tissue (61/164, 37%), adjacent bowel gas (34/164, 21%), body habitus (27/164, 16%), and gas-containing collection (22/164, 13%). Within the biopsy subgroup, patients for whom body habitus was a limiting factor were found to have on average a larger cross-sectional area and lesion depth relative to patients whose body habitus was not a complicating factor (p < 0.0001 and p = 0.0009). Poor acoustic window was the most common reason for procedural failure with ultrasound guidance. In addition, as lesion depth increased, the odds that body habitus would limit the procedure also increased. If preliminary imaging suggests a limited sonographic window, particularly for deeper lesions, proceeding directly to CT guidance should be considered.

Parallel-vector solution of large-scale structural analysis problems on supercomputers

NASA Technical Reports Server (NTRS)

Storaasli, Olaf O.; Nguyen, Duc T.; Agarwal, Tarun K.

1989-01-01

A direct linear equation solution method based on the Choleski factorization procedure is presented which exploits both parallel and vector features of supercomputers. The new equation solver is described, and its performance is evaluated by solving structural analysis problems on three high-performance computers. The method has been implemented using Force, a generic parallel FORTRAN language.

Analysis of indication for laparoscopic right colectomy and conversion risks.

PubMed

Del Rio, Paolo; Bertocchi, Elisa; Madoni, Cristiana; Viani, Lorenzo; Dell'Abate, Paolo; Sianesi, Mario

2016-01-01

Laparoscopic surgery developed continuously over the past years becoming the gold standard for some surgical interventions. Laparoscopic colorectal surgery is well established as a safe and feasible procedure to treat benign and malignant pathologies. In this paper we studied in deep the role of laparoscopic right colectomy analysing the indications to this surgical procedure and the factors related to the conversion from laparoscopy to open surgery. We described the different surgical techniques of laparoscopic right colectomy comparing extra to intracorporeal anastomosis and we pointed out the different ways to access to the abdomen (multiport VS single incision). The indications for laparoscopic right colectomy are benign (inflammatory bowel disease and rare right colonic diverticulitis) and malignant diseases (right colon cancer and appendiceal neuroendocrine neoplasm): we described the good outcomes of laparoscopic right colectomy in all these illnesses. Laparoscopic conversion rates in right colectomy are reported as 12-16%; we described the different type of risk factors related to open conversion: patient-related, disease-related and surgeon-related factors, procedural factors and intraoperative complications. We conclude that laparoscopic right colectomy is considered superior to open surgery in the shortterm outcomes without difference in long-term outcomes. Conversion risks, Indication to treatment, Laparoscopy, Post-operative pain, Right colectomy.

Risk factors for early post-operative neurological deterioration in dogs undergoing a cervical dorsal laminectomy or hemilaminectomy: 100 cases (2002-2014).

PubMed

Taylor-Brown, F E; Cardy, T J A; Liebel, F X; Garosi, L; Kenny, P J; Volk, H A; De Decker, S

2015-12-01

Early post-operative neurological deterioration is a well-known complication following dorsal cervical laminectomies and hemilaminectomies in dogs. This study aimed to evaluate potential risk factors for early post-operative neurological deterioration following these surgical procedures. Medical records of 100 dogs that had undergone a cervical dorsal laminectomy or hemilaminectomy between 2002 and 2014 were assessed retrospectively. Assessed variables included signalment, bodyweight, duration of clinical signs, neurological status before surgery, diagnosis, surgical site, type and extent of surgery and duration of procedure. Outcome measures were neurological status immediately following surgery and duration of hospitalisation. Univariate statistical analysis was performed to identify variables to be included in a multivariate model. Diagnoses included osseous associated cervical spondylomyelopathy (OACSM; n = 41), acute intervertebral disk extrusion (IVDE; 31), meningioma (11), spinal arachnoid diverticulum (10) and vertebral arch anomalies (7). Overall 54% (95% CI 45.25-64.75) of dogs were neurologically worse 48 h post-operatively. Multivariate statistical analysis identified four factors significantly related to early post-operative neurological outcome. Diagnoses of OACSM or meningioma were considered the strongest variables to predict early post-operative neurological deterioration, followed by higher (more severely affected) neurological grade before surgery and longer surgery time. This information can aid in the management of expectations of clinical staff and owners with dogs undergoing these surgical procedures. Copyright © 2015 Elsevier Ltd. All rights reserved.

Old and New Ideas for Data Screening and Assumption Testing for Exploratory and Confirmatory Factor Analysis

PubMed Central

Flora, David B.; LaBrish, Cathy; Chalmers, R. Philip

2011-01-01

We provide a basic review of the data screening and assumption testing issues relevant to exploratory and confirmatory factor analysis along with practical advice for conducting analyses that are sensitive to these concerns. Historically, factor analysis was developed for explaining the relationships among many continuous test scores, which led to the expression of the common factor model as a multivariate linear regression model with observed, continuous variables serving as dependent variables, and unobserved factors as the independent, explanatory variables. Thus, we begin our paper with a review of the assumptions for the common factor model and data screening issues as they pertain to the factor analysis of continuous observed variables. In particular, we describe how principles from regression diagnostics also apply to factor analysis. Next, because modern applications of factor analysis frequently involve the analysis of the individual items from a single test or questionnaire, an important focus of this paper is the factor analysis of items. Although the traditional linear factor model is well-suited to the analysis of continuously distributed variables, commonly used item types, including Likert-type items, almost always produce dichotomous or ordered categorical variables. We describe how relationships among such items are often not well described by product-moment correlations, which has clear ramifications for the traditional linear factor analysis. An alternative, non-linear factor analysis using polychoric correlations has become more readily available to applied researchers and thus more popular. Consequently, we also review the assumptions and data-screening issues involved in this method. Throughout the paper, we demonstrate these procedures using an historic data set of nine cognitive ability variables. PMID:22403561

14 CFR 23.621 - Casting factors.

Code of Federal Regulations, 2013 CFR

2013-01-01

... either magnetic particle, penetrant or other approved equivalent non-destructive inspection method; or... percent approved non-destructive inspection. When an approved quality control procedure is established and an acceptable statistical analysis supports reduction, non-destructive inspection may be reduced from...

14 CFR 23.621 - Casting factors.

Code of Federal Regulations, 2012 CFR

2012-01-01

... either magnetic particle, penetrant or other approved equivalent non-destructive inspection method; or... percent approved non-destructive inspection. When an approved quality control procedure is established and an acceptable statistical analysis supports reduction, non-destructive inspection may be reduced from...

14 CFR 23.621 - Casting factors.

Code of Federal Regulations, 2014 CFR

2014-01-01

... either magnetic particle, penetrant or other approved equivalent non-destructive inspection method; or... percent approved non-destructive inspection. When an approved quality control procedure is established and an acceptable statistical analysis supports reduction, non-destructive inspection may be reduced from...

14 CFR 23.621 - Casting factors.

Code of Federal Regulations, 2010 CFR

2010-01-01

... either magnetic particle, penetrant or other approved equivalent non-destructive inspection method; or... percent approved non-destructive inspection. When an approved quality control procedure is established and an acceptable statistical analysis supports reduction, non-destructive inspection may be reduced from...

Safety climate and the distracted driving experiences of truck drivers.

PubMed

Swedler, David I; Pollack, Keshia M; Agnew, Jacqueline

2015-07-01

For truck drivers, distracted driving is a workplace behavior that increases occupational injury risk. We propose safety climate as an appropriate lens through which researchers can examine occupational distracted driving. Using a mixed methods study design, we surveyed truck drivers using the Safety Climate Questionnaire (SCQ) complemented by semi-structured interviews of experts on distracted driving and truck safety. Safety climate was assessed by using the entire SCQ as an overall climate score, followed by factor analysis that identified the following safety climate factors: Communications and Procedures; Management Commitment; and Work Pressure. In multivariate regression, the overall safety climate scale was associated with having ever experienced a crash and/or distraction-involved swerving. Interview participants described how these SCQ constructs could affect occupational distracted driving. To reduce distraction-related crashes in their organizations, management can adhere to safe policies and procedures, invest in engineering controls, and develop safer communication procedures. © 2015 Wiley Periodicals, Inc.

Applying Latent Class Analysis to Risk Stratification for Perioperative Mortality in Patients Undergoing Intraabdominal General Surgery.

PubMed

Kim, Minjae; Wall, Melanie M; Li, Guohua

2016-07-01

Perioperative risk stratification is often performed using individual risk factors without consideration of the syndemic of these risk factors. We used latent class analysis (LCA) to identify the classes of comorbidities and risk factors associated with perioperative mortality in patients presenting for intraabdominal general surgery. The 2005 to 2010 American College of Surgeons National Surgical Quality Improvement Program was used to obtain a cohort of patients undergoing intraabdominal general surgery. Risk factors and comorbidities were entered into LCA models to identify the latent classes, and individuals were assigned to a class based on the highest posterior probability of class membership. Relative risk regression was used to determine the associations between the latent classes and 30-day mortality, with adjustments for procedure. A 9-class model was fit using LCA on 466,177 observations. After combining classes with similar adjusted mortality risks, 5 risk classes were obtained. Compared with the class with average mortality risk (class 4), the risk ratios (95% confidence interval) ranged from 0.020 (0.014-0.027) in the lowest risk class (class 1) to 6.75 (6.46-7.02) in the highest risk class. After adjusting for procedure and ASA physical status, the latent classes remained significantly associated with 30-day mortality. The addition of the risk class variable to a model containing ASA physical status and surgical procedure demonstrated a significant increase in the area under the receiver operator characteristic curve (0.892 vs 0.915; P < 0.0001). Latent classes of risk factors and comorbidities in patients undergoing intraabdominal surgery are predictive of 30-day mortality independent of the ASA physical status and improve risk prediction with the ASA physical status.

Free vibration of arches flexible in shear.

NASA Technical Reports Server (NTRS)

Austin, W. J.; Veletsos, A. S.

1973-01-01

An analysis reported by Veletsos et al. (1972) concerning the free vibrational characteristics of circular arches vibrating in their own planes is considered. The analysis was based on a theory which neglects the effects of rotatory inertia and shearing deformation. A supplementary investigation is conducted to assess the effects of the previously neglected factors and to identify the conditions under which these effects are of practical significance or may be neglected. A simple approximate procedure is developed for estimating the natural frequencies of arches, giving due consideration to the effects of the previously neglected factors.

Human Factors Analysis to Improve the Processing of Ares-1 Launch Vehicle

NASA Technical Reports Server (NTRS)

Stambolian, Damon B.; Dippolito, Gregory M.; Nyugen, Bao; Dischinger, Charles; Tran, Donald; Henderson, Gena; Barth, Tim

2011-01-01

This slide presentation reviews the use of Human Factors analysis in improving the ground processing procedures for the Ares-1 launch vehicle. The light vehicle engineering designers for Ares-l launch vehicle had to design the flight vehicle for effective, efficient and safe ground operations in the cramped dimensions in a rocket design. The use of a mockup of the area where the technician would be required to work proved to be a very effective method to promote the collaboration between the Ares-1 designers and the ground operations personnel.

Behavioral and Healthcare-Associated Risk Factors for Chronic Hepatitis C Virus Infection in Korea

PubMed Central

Kim, Jong Yeop; Cho, Juhee; Hwang, Sung Ho; Kil, Ho; Bae, Si Hyun; Kim, Young Seok; Lee, Han Chu

2012-01-01

The risk factors related to hepatitis C virus (HCV) infection showed geographic and temporal differences. We investigated HCV-related risk factors in Korea where intravenous drug use (IVDU) is uncommon. The HCV-related risk factors were investigated in a prospective, multicenter chronic HCV cohort (n = 711) using a standardized questionnaire in four university hospitals. The results were compared with those of 206 patients with chronic liver diseases not related to either of HCV or hepatitis B virus infection (comparison group). The IVDU was found in 3.9% and remote blood transfusion (≥ 20 yr ago) in 18.3% in HCV cohort group, while that in comparison group was in none and 5.3%, respectively. In a multivariate logistic analysis, transfusion in the remote past (odds ratio [OR], 2.99), needle stick injury (OR, 4.72), surgery (OR, 1.89), dental procedures (OR, 2.96), tattooing (OR, 2.07), and multiple sexual partners (2-3 persons; OR, 2.14, ≥ 4 persons; OR, 3.19), were independent risk factors for HCV infection. In conclusion, the major risk factors for HCV infection in Korea are mostly related to conventional or alterative healthcare procedures such as blood transfusion in the remote past, needle stick injury, surgery, dental procedure, and tattooing although multiple sex partners or IVDU plays a minor role. PMID:23166420

Four points function fitted and first derivative procedure for determining the end points in potentiometric titration curves: statistical analysis and method comparison.

PubMed

Kholeif, S A

2001-06-01

A new method that belongs to the differential category for determining the end points from potentiometric titration curves is presented. It uses a preprocess to find first derivative values by fitting four data points in and around the region of inflection to a non-linear function, and then locate the end point, usually as a maximum or minimum, using an inverse parabolic interpolation procedure that has an analytical solution. The behavior and accuracy of the sigmoid and cumulative non-linear functions used are investigated against three factors. A statistical evaluation of the new method using linear least-squares method validation and multifactor data analysis are covered. The new method is generally applied to symmetrical and unsymmetrical potentiometric titration curves, and the end point is calculated using numerical procedures only. It outperforms the "parent" regular differential method in almost all factors levels and gives accurate results comparable to the true or estimated true end points. Calculated end points from selected experimental titration curves compatible with the equivalence point category of methods, such as Gran or Fortuin, are also compared with the new method.

Risk factors for early cytologic abnormalities after loop electrosurgical excision procedure.

PubMed

Dietrich, Charles S; Yancey, Michael K; Miyazawa, Kunio; Williams, David L; Farley, John

2002-02-01

To evaluate risk factors for early cytologic abnormalities and recurrent cervical dysplasia after loop electrosurgical excision procedure (LEEP). A retrospective analysis was performed of all pathology records for LEEPs performed at our institution from January 1996 through July 1998. Follow-up cytology from 2 through 12 months after LEEP was reviewed. Patients with abnormal cytology were referred for further colposcopic evaluation. Statistical analysis using chi2 test for trend, proportional hazards model test, Fisher exact tests, and life table analysis were performed to identify risk factors for early cytologic abnormalities after LEEP and to determine relative risk of recurrent dysplasia. A total of 298 women underwent LEEP during the study period, and 29% of these had cytologic abnormalities after LEEP. Grade of dysplasia, ectocervical marginal status, endocervical marginal status, and glandular involvement with dysplasia were not found to be independent risk factors for early cytologic abnormalities. However, when risk factors were analyzed cumulatively, the abnormal cytology rate increased from 24% with no risk factors to 67% with three risk factors present (P =.037). Of patients with abnormal cytology after LEEP, 40% developed subsequent dysplasia, and the mean time to diagnosis was approximately 6 months. The relative risk of subsequent dysplasia ranged from a 20% increase to twice the risk if post-LEEP cytology was low-grade squamous intraepithelial lesion or high-grade squamous intraepithelial lesion, respectively. Based on these results, consideration should be given for early colposcopic examination of patients who have evidence of marginal involvement or endocervical glandular involvement with dysplasia. These patients are at increased risk for abnormal cytology and recurrent dysplasia. This initial visit should occur at 6 months, as the mean time to recurrence of dysplasia was 6.5 months.

[Analysis of the incidence and causes of repeated surgical interventions in patients with early complications electrotherapy - 1 center experience from the period 2012-2015].

PubMed

Piątek, Łukasz; Polewczyk, Anna; Kurzawski, Jacek; Zachura, Małgorzata; Kaczmarczyk, Małgorzata; Janion, Marianna

Due to increasing number of patients treated by cardiac implantable electronic devices we observe increasing number of complications after these procedures We analysed causes of early surgical revision of implantable devices connected with 1673 procedures of implantation (871 procedures) or exchange (802 procedures) of pacing systems (PM), cardioverter-difibrillators (ICD) and resynchronisation systems (CRT) in one local centre of electrotherapy in years 2012 to 2015. We characterised risk factors and its influence on encountered complications. In analysed period 72 reinterventions after implantations or exchanges of PM/ICD/CRT were performed. Main causes of early complications were: lead malfunction (2.5%), including the dislodgement of the leads in 1.9%, pocket hematoma (1.4%) and other abnormalities of the pocket (0.4 %), including pocket infections in 0.2%. The most important risk factors of early complications were often implantations of the leads with passive fixation and anticoagulation therapy in perioperative period. The knowledge of the early complications after implantations and exchanges of PM/ICD/CRT should improve the safety of procedures through more often used of the leads with active fixation and properly preparation of the patients requering the antithrombic therapy.

Bayesian hypothesis testing for human threat conditioning research: an introduction and the condir R package

PubMed Central

Krypotos, Angelos-Miltiadis; Klugkist, Irene; Engelhard, Iris M.

2017-01-01

ABSTRACT Threat conditioning procedures have allowed the experimental investigation of the pathogenesis of Post-Traumatic Stress Disorder. The findings of these procedures have also provided stable foundations for the development of relevant intervention programs (e.g. exposure therapy). Statistical inference of threat conditioning procedures is commonly based on p-values and Null Hypothesis Significance Testing (NHST). Nowadays, however, there is a growing concern about this statistical approach, as many scientists point to the various limitations of p-values and NHST. As an alternative, the use of Bayes factors and Bayesian hypothesis testing has been suggested. In this article, we apply this statistical approach to threat conditioning data. In order to enable the easy computation of Bayes factors for threat conditioning data we present a new R package named condir, which can be used either via the R console or via a Shiny application. This article provides both a non-technical introduction to Bayesian analysis for researchers using the threat conditioning paradigm, and the necessary tools for computing Bayes factors easily. PMID:29038683

Investigation of effects of process parameters on properties of friction stir welded joints

NASA Astrophysics Data System (ADS)

Chauhan, Atul; Soota, Tarun; Rajput, S. K.

2018-03-01

This work deals with application of friction stir welding (FSW) using application of Taguchi orthogonal array. FSW procedure is used for joining the aluminium alloy AA6063-T0 plates in butt configuration with orthogonal combination of factors and their levels. The combination of factors involving tool rotation speed, tool travel speed and tool pin profile are used in three levels. Grey relational analysis (GRA) has been applied to select optimum level of factors for optimising UTS, ductility and hardness of joint. Experiments have been conducted with two different tool materials (HSS and HCHCr steel) with various factors level combinations for joining AA6063-T0. On the basis of grey relational grades at different levels of factors and analysis of variance (ANOVA) ideal combination of factors are determined. The influence of tool material is also studied.

When procedures meet practice in community pharmacies: qualitative insights from pharmacists and pharmacy support staff

PubMed Central

Ashcroft, Darren M

2016-01-01

Objectives Our aim was to explore how members of community pharmacy staff perceive and experience the role of procedures within the workplace in community pharmacies. Setting Community pharmacies in England and Wales. Participants 24 community pharmacy staff including pharmacists and pharmacy support staff were interviewed regarding their view of procedures in community pharmacy. Transcripts were analysed using thematic analysis. Results 3 main themes were identified. According to the ‘dissemination and creation of standard operating procedures’ theme, community pharmacy staff were required to follow a large amount of procedures as part of their work. At times, complying with all procedures was not possible. According to the ‘complying with procedures’ theme, there are several factors that influenced compliance with procedures, including work demands, the high workload and the social norm within the pharmacy. Lack of staff, pressure to hit targets and poor communication also affected how able staff felt to follow procedures. The third theme ‘procedural compliance versus using professional judgement’ highlighted tensions between the standardisation of practice and the professional autonomy of pharmacists. Pharmacists feared being unsupported by their employer for working outside of procedures, even when acting for patient benefit. Some support staff believed that strictly following procedures would keep patients and themselves safe. Dispensers described following the guidance of the pharmacist which sometimes meant working outside of procedures, but occasionally felt unable to voice concerns about not working to rule. Conclusions Organisational resilience in community pharmacy was apparent and findings from this study should help to inform policymakers and practitioners regarding factors likely to influence the implementation of procedures in community pharmacy settings. Future research should focus on exploring community pharmacy employees' intentions and attitudes towards rule-breaking behaviour and the impact this may have on patient safety. PMID:27266770

Exchange nailing for nonunion of diaphyseal fractures of the tibia: our results and an analysis of the risk factors for failure.

PubMed

Tsang, S T J; Mills, L A; Frantzias, J; Baren, J P; Keating, J F; Simpson, A H R W

2016-04-01

The aim of this study was to identify risk factors for the failure of exchange nailing in nonunion of tibial diaphyseal fractures. A cohort of 102 tibial diaphyseal nonunions in 101 patients with a mean age of 36.9 years (15 to 74) were treated between January 1992 and December 2012 by exchange nailing. Of which 33 (32%) were initially open injuries. The median time from primary fixation to exchange nailing was 6.5 months (interquartile range (IQR) 4.3 to 9.8 months). The main outcome measures were union, number of secondary fixation procedures required to achieve union and time to union. Univariate analysis and multiple regression were used to identify risk factors for failure to achieve union. Multiple causes for the primary nonunion were found for 28 (27%) tibiae, with infection present in 32 (31%). Six patients were lost to follow-up. Further surgical procedures were required in 35 (36%) nonunions. Other fixation modalities were required in five fractures. A single nail exchange procedure achieved union in 60/96 (63%) of all nonunions. Only 11 out of 31 infected nonunions (35.4%) healed after one exchange nail procedure. Up to five repeated exchange nailings, with or without bone grafting, ultimately achieved union in 89 (93%) fractures. The median time to union after exchange nailing was 8.7 months (IQR 5.7 to 14.0 months). Univariate analysis confirmed that an oligotrophic/atrophic pattern of nonunion (p = 0.002), a bone gap of 5 mm or more (p = 0.04) and infection (p < 0.001), were predictive for failure of exchange nailing Multiple regression analysis found that infection was the strongest predictor of failure (p < 0.001). Exchange nailing is an effective treatment for aseptic tibial diaphyseal nonunion. However, in the presence of severe infection with a highly resistant organism, or extensive sclerosis of the bone, other fixation modalities, such as Ilizarov treatment, should be considered. Exchange nailing is an effective treatment for aseptic tibial diaphyseal nonunion. ©2016 The British Editorial Society of Bone & Joint Surgery.

Predicting the difficulty of a lead extraction procedure: the LED index.

PubMed

Bontempi, Luca; Vassanelli, Francesca; Cerini, Manuel; D'Aloia, Antonio; Vizzardi, Enrico; Gargaro, Alessio; Chiusso, Francesco; Mamedouv, Rashad; Lipari, Alessandro; Curnis, Antonio

2014-08-01

According to recent surveys, many sites performing permanent lead extractions do not meet the minimum prerequisites concerning personnel training, procedures' volume, or facility requirements. The current Heart Rhythm Society consensus on lead extractions suggests that patients should be referred to more experienced sites when a better outcome could be achieved. The purpose of this study was to develop a score aimed at predicting the difficulty of a lead extraction procedure through the analysis of a high-volume center database. This score could help to discriminate patients who should be sent to a referral site. A total of 889 permanent leads were extracted from 469 patients. All procedures were performed from January 2009 to May 2012 by two expert electrophysiologists, at the University Hospital of Brescia. Factors influencing the difficulty of a procedure were assessed using a univariate and a multivariate logistic regression model. The fluoroscopy time of the procedure was taken as an index of difficulty. A Lead Extraction Difficulty (LED) score was defined, considering the strongest predictors. Overall, 873 of 889 (98.2%) leads were completely removed. Major complications were reported in one patient (0.2%) who manifested cardiac tamponade. Minor complications occurred in six (1.3%) patients. No deaths occurred. Median fluoroscopic time was 8.7 min (3.3-17.3). A procedure was classified as difficult when fluoroscopy time was more than 31.2 min [90th percentile (PCTL)].At a univariate analysis, the number of extracted leads and years from implant were significantly associated with an increased risk of fluoroscopy time above 90th PCTL [odds ratio (OR) 1.51, 95% confidence interval (CI) 1.08-2.11, P = 0.01; and OR 1.19, 95% CI 1.12-1.25, P < 0.001, respectively). After adjusting for patient age and sex, and combining with other covariates potentially influencing the extraction procedure, a multivariate analysis confirmed a 71% increased risk of fluoroscopy time above 90th PCTL for each additional lead extracted (OR 1.71, 95% CI 1.06-2.77, P = 0.028) and a 23% increased risk for each year of lead age (OR 1.23, 95% CI 1.15-1.31, P < 0.001). Further nonindependent factors increasing the risk were the presence of active fixation leads and dual-coil implantable cardiac defibrillator leads. Conversely, vegetations significantly favored lead extraction.The LED score was defined as: number of extracted leads within a procedure + lead age (years from implant) + 1 if dual-coil - 1 if vegetation. The LED score independently predicted complex procedure (with fluoroscopic time >90th PCTL) both at univariate and multivariate analysis. A receiver-operating characteristic analysis showed an area under the curve of 0.81. A LED score greater than 10 could predict fluoroscopy time above 90th PCTL with a sensitivity of 78.3% and a specificity of 76.7%. The LED score is easy to compute and potentially predicts fluoroscopy time above 90th PCTL with a relatively high accuracy.

Model wall and recovery temperature effects on experimental heat transfer data analysis

NASA Technical Reports Server (NTRS)

Throckmorton, D. A.; Stone, D. R.

1974-01-01

Basic analytical procedures are used to illustrate, both qualitatively and quantitatively, the relative impact upon heat transfer data analysis of certain factors which may affect the accuracy of experimental heat transfer data. Inaccurate knowledge of adiabatic wall conditions results in a corresponding inaccuracy in the measured heat transfer coefficient. The magnitude of the resulting error is extreme for data obtained at wall temperatures approaching the adiabatic condition. High model wall temperatures and wall temperature gradients affect the level and distribution of heat transfer to an experimental model. The significance of each of these factors is examined and its impact upon heat transfer data analysis is assessed.

Thermal Adaptation Methods of Urban Plaza Users in Asia's Hot-Humid Regions: A Taiwan Case Study.

PubMed

Wu, Chen-Fa; Hsieh, Yen-Fen; Ou, Sheng-Jung

2015-10-27

Thermal adaptation studies provide researchers great insight to help understand how people respond to thermal discomfort. This research aims to assess outdoor urban plaza conditions in hot and humid regions of Asia by conducting an evaluation of thermal adaptation. We also propose that questionnaire items are appropriate for determining thermal adaptation strategies adopted by urban plaza users. A literature review was conducted and first hand data collected by field observations and interviews used to collect information on thermal adaptation strategies. Item analysis--Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA)--were applied to refine the questionnaire items and determine the reliability of the questionnaire evaluation procedure. The reliability and validity of items and constructing process were also analyzed. Then, researchers facilitated an evaluation procedure for assessing the thermal adaptation strategies of urban plaza users in hot and humid regions of Asia and formulated a questionnaire survey that was distributed in Taichung's Municipal Plaza in Taiwan. Results showed that most users responded with behavioral adaptation when experiencing thermal discomfort. However, if the thermal discomfort could not be alleviated, they then adopted psychological strategies. In conclusion, the evaluation procedure for assessing thermal adaptation strategies and the questionnaire developed in this study can be applied to future research on thermal adaptation strategies adopted by urban plaza users in hot and humid regions of Asia.

Optimized Standard Operating Procedures for the Analysis of Cerebrospinal Fluid Aβ42 and the Ratios of Aβ Isoforms Using Low Protein Binding Tubes.

PubMed

Vanderstichele, Hugo Marcel Johan; Janelidze, Shorena; Demeyer, Leentje; Coart, Els; Stoops, Erik; Herbst, Victor; Mauroo, Kimberley; Brix, Britta; Hansson, Oskar

2016-05-31

Reduced cerebrospinal fluid (CSF) concentration of amyloid-β1-42 (Aβ1-42) reflects the presence of amyloidopathy in brains of subjects with Alzheimer's disease (AD). To qualify the use of Aβ1-42/Aβ1-40 for improvement of standard operating procedures (SOP) for measurement of CSF Aβ with a focus on CSF collection, storage, and analysis. Euroimmun ELISAs for CSF Aβ isoforms were used to set up a SOP with respect to recipient properties (low binding, polypropylene), volume of tubes, freeze/thaw cycles, addition of detergents (Triton X-100, Tween-20) in collection or storage tubes or during CSF analysis. Data were analyzed with linear repeated measures and mixed effects models. Optimization of CSF analysis included a pre-wash of recipients (e.g., tubes, 96-well plates) before sample analysis. Using the Aβ1-42/Aβ1-40 ratio, in contrast to Aβ1-42, eliminated effects of tube type, additional freeze/thaw cycles, or effect of CSF volumes for polypropylene storage tubes. 'Low binding' tubes reduced the loss of Aβ when aliquoting CSF or in function of additional freeze/thaw cycles. Addition of detergent in CSF collection tubes resulted in an almost complete absence of variation in function of collection procedures, but affected the concentration of Aβ isoforms in the immunoassay. The ratio of Aβ1-42/Aβ1-40 is a more robust biomarker than Aβ1-42 toward (pre-) analytical interfering factors. Further, 'low binding' recipients and addition of detergent in collection tubes are able to remove effects of SOP-related confounding factors. Integration of the Aβ1-42/Aβ1-40 ratio and 'low-binding tubes' into guidance criteria may speed up worldwide standardization of CSF biomarker analysis.

Surgical risk factors associated with lung transplantation.

PubMed

Paradela, M; González, D; Parente, I; Fernández, R; De La Torre, M M; Delgado, M; García, J A; Fieira, E; Bonhome, C; Maté, J M B

2009-01-01

Despite years of experience with lung transplantation, perioperative morbidity rates remain high. The objective of this study was to analyze our series of lung transplant recipients, seeking to identify possible intra- and postoperative risk factors associated with mortality. We performed a descriptive, retrospective study of 224 consecutive patients undergoing lung transplantation over a period of 112 months; we excluded retransplant procedures. We gathered details of the surgical procedure and postoperative period in the recovery unit. Univariate analysis using the chi-square test identified variables associated with the incidence of mortality. From 1999 to 2008, we performed 224 lung transplants, including 66% in men and 34% in women. Their overall mean age was 49.9 +/- 13.5 years. The conditions that led to transplantation were pulmonary fibrosis (38.4%); chronic obstructive pulmonary disease emphysema (29%); cystic fibrosis (10.7%); bronchiectasis (8.9%); pulmonary hypertension (3.1%); and other diseases (9.9%). A total of 124 (55.4%) patients underwent single and 100 (44.6%) received sequential bilateral lung transplantations. Surgical risk factors were identified in 51.3% of the cases, the most frequent being hemorrhage (25.3%), followed by severe pulmonary hypertension (14.7%) and cardiopulmonary bypass (12.1%). Greater perioperative mortality was detected among patients with surgical risk factors, namely, significantly related to cardiopulmonary bypass, pulmonary hypertension, and air leak. A higher frequency of surgical risk factors was observed among patients with bilateral lung transplantations and longer procedures, but they were not associated with greater perioperative mortality. Reoperation was necessary in 16 patients (7.2%), mainly owing to bleeding, it was not significantly related to mortality risk. The incidence of surgical risk factors in lung transplantation was high, especially in bilateral lung transplantations and prolonged procedures. Postoperative bleeding requiring reoperation was not frequent and not associated with increased preoperative mortality in our series.

Post-ERCP acute pancreatitis and its risk factors.

PubMed

Iorgulescu, A; Sandu, I; Turcu, F; Iordache, N

2013-03-15

Endoscopic retrograde cholangiopancreatography (ERCP) is a complex endoscopic technique that evolved from a diagnostic to a mainly therapeutic procedure. This was due to the identification of post-procedural complications that can follow both simple ERCP and that associated with the instrumentation of the biliary and pancreatic ductals. The identification of post ERCP complications in a proportion of 5 to 10% of cases, with a mortality rate of 0.33%, imposed their analysis and study of risk factors involved in their occurrence. The significance of post ERCP complications reveals the necessity of their avoidance by adopting additional measures if risk factors are identified. We have retrospectively analyzed 900 cases that underwent ERCP in the Surgery Department of "Sf. Ioan" Clinical Hospital in a period of 17 years. The complications of the procedure were studied. Among them, a special attention was given to post-ERCP acute pancreatitis (pERCP-AP), the most common complication that occurred in the study group. We also tried to find out and highlight the risk factors for this complication. ERCP is a relatively safe invasive procedure, yet it has complications (8% of cases), some of them potentially fatal (mortality 0.43%). The most common complications after ERCP are acute pancreatitis (3.7%), papillary bleeding (1.04%), retroperitoneal duodenal perforation (0.69%) and biliary septic complications like acute cholecystitis and cholangitis (1.21%). Acute pancreatitis is by far the most common complication. Risk factors for its occurrence are difficult sphincterotomy with precut use, failure of CBD desobstruction, pancreatic sphincterotomy, repeated injection of contrast in the pancreatic ductal system, dysfunction of the sphincter of Oddi and the absence of changes of chronic pancreatitis. When risk factors are identified, the patients' selection must be very strict and diagnostic ERCP should be avoided in favor of non-invasive diagnostic methods (MRI-cholangiography, echo-endoscopy).

Investigation of the factor structure of the Wechsler Adult Intelligence Scale--Fourth Edition (WAIS-IV): exploratory and higher order factor analyses.

PubMed

Canivez, Gary L; Watkins, Marley W

2010-12-01

The present study examined the factor structure of the Wechsler Adult Intelligence Scale--Fourth Edition (WAIS-IV; D. Wechsler, 2008a) standardization sample using exploratory factor analysis, multiple factor extraction criteria, and higher order exploratory factor analysis (J. Schmid & J. M. Leiman, 1957) not included in the WAIS-IV Technical and Interpretation Manual (D. Wechsler, 2008b). Results indicated that the WAIS-IV subtests were properly associated with the theoretically proposed first-order factors, but all but one factor-extraction criterion recommended extraction of one or two factors. Hierarchical exploratory analyses with the Schmid and Leiman procedure found that the second-order g factor accounted for large portions of total and common variance, whereas the four first-order factors accounted for small portions of total and common variance. It was concluded that the WAIS-IV provides strong measurement of general intelligence, and clinical interpretation should be primarily at that level.

High-dose-rate Intracavitary Radiotherapy in the Management of Cervical Intraepithelial Neoplasia 3 and Carcinoma In Situ Presenting With Poor Histologic Factors After Undergoing Excisional Procedures

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

Kim, Yong Bae, E-mail: ybkim3@yuhs.ac; Kim, Young Tae; Cho, Nam Hoon

2012-09-01

Purpose: To assess the effectiveness of high-dose-rate intracavitary radiotherapy (HDR-ICR) in patients with cervical intraepithelial neoplasia 3 (CIN 3) and carcinoma in situ (CIS) presenting with poor histologic factors for predicting residual disease after undergoing diagnostic excisional procedures. Methods and Materials: This study was a retrospective analysis of 166 patients with CIN 3 (n=15) and CIS (n=151) between October 1986 and December 2005. They were diagnosed by conization (n=158) and punch biopsy (n=8). Pathologic analysis showed 135 cases of endocervical gland involvement (81.4%), 74 cases of positive resection margins (44.5%), and 52 cases of malignant cells on endocervical curettage (31.3%).more » All patients were treated with HDR-ICR using Co{sup 60} or Ir{sup 192} at a cancer center. The dose was prescribed at point A located 2 cm superior to the external os and 2 cm lateral to the axis of the tandem for intact uterus. Results: Median age was 61 years (range, 29-77). The median total dose of HDR-ICR was 30 Gy/6 fractions (range, 30-52). At follow-up (median, 152 months), 2 patients developed recurrent diseases: 1 CIN 2 and 1 invasive carcinoma. One hundred and forty patients survived and 26 patients died, owing to nonmalignant intercurrent disease. Rectal bleeding occurred in one patient; however, this symptom subsided with conservative management. Conclusions: Our data showed HDR-ICR is an effective modality for CIN 3 and CIS patients presenting with poor histologic factors after excisional procedures. HDR-ICR should be considered as a definitive treatment in CIN 3 and CIS patients with possible residual disease after undergoing excisional procedures.« less

Identifying factors that predict the choice and success rate of radial artery catheterisation in contemporary real world cardiology practice: a sub-analysis of the PREVAIL study data.

PubMed

Pristipino, Christian; Roncella, Adriana; Trani, Carlo; Nazzaro, Marco S; Berni, Andrea; Di Sciascio, Germano; Sciahbasi, Alessandro; Musarò, Salvatore Donato; Mazzarotto, Pietro; Gioffrè, Gaetano; Speciale, Giulio

2010-06-01

To assess: the reasons behind an operator choosing to perform radial artery catheterisation (RAC) as against femoral arterial catheterisation, and to explore why RAC may fail in the real world. A pre-determined analysis of PREVAIL study database was performed. Relevant data were collected in a prospective, observational survey of 1,052 consecutive patients undergoing invasive cardiovascular procedures at nine Italian hospitals over a one month observation period. By multivariate analysis, the independent predictors of RAC choice were having the procedure performed: (1) at a high procedural volume centre; and (2) by an operator who performs a high volume of radial procedures; clinical variables played no statistically significant role. RAC failure was predicted independently by (1) a lower operator propensity to use RAC; and (2) the presence of obstructive peripheral artery disease. A 10-fold lower rate of RAC failure was observed among operators who perform RAC for > 85% of their personal caseload than among those who use RAC < 25% of the time (3.8% vs. 33.0%, respectively); by receiver operator characteristic (ROC) analysis, no threshold value for operator RAC volume predicted RAC failure. A routine RAC in all-comers is superior to a selective strategy in terms of feasibility and success rate.

The vehicle design evaluation program - A computer-aided design procedure for transport aircraft

NASA Technical Reports Server (NTRS)

Oman, B. H.; Kruse, G. S.; Schrader, O. E.

1977-01-01

The vehicle design evaluation program is described. This program is a computer-aided design procedure that provides a vehicle synthesis capability for vehicle sizing, external load analysis, structural analysis, and cost evaluation. The vehicle sizing subprogram provides geometry, weight, and balance data for aircraft using JP, hydrogen, or methane fuels. The structural synthesis subprogram uses a multistation analysis for aerodynamic surfaces and fuselages to develop theoretical weights and geometric dimensions. The parts definition subprogram uses the geometric data from the structural analysis and develops the predicted fabrication dimensions, parts material raw stock buy requirements, and predicted actual weights. The cost analysis subprogram uses detail part data in conjunction with standard hours, realization factors, labor rates, and material data to develop the manufacturing costs. The program is used to evaluate overall design effects on subsonic commercial type aircraft due to parameter variations.

Enhanced Multiobjective Optimization Technique for Comprehensive Aerospace Design. Part A

NASA Technical Reports Server (NTRS)

Chattopadhyay, Aditi; Rajadas, John N.

1997-01-01

A multidisciplinary design optimization procedure which couples formal multiobjectives based techniques and complex analysis procedures (such as computational fluid dynamics (CFD) codes) developed. The procedure has been demonstrated on a specific high speed flow application involving aerodynamics and acoustics (sonic boom minimization). In order to account for multiple design objectives arising from complex performance requirements, multiobjective formulation techniques are used to formulate the optimization problem. Techniques to enhance the existing Kreisselmeier-Steinhauser (K-S) function multiobjective formulation approach have been developed. The K-S function procedure used in the proposed work transforms a constrained multiple objective functions problem into an unconstrained problem which then is solved using the Broyden-Fletcher-Goldfarb-Shanno (BFGS) algorithm. Weight factors are introduced during the transformation process to each objective function. This enhanced procedure will provide the designer the capability to emphasize specific design objectives during the optimization process. The demonstration of the procedure utilizes a computational Fluid dynamics (CFD) code which solves the three-dimensional parabolized Navier-Stokes (PNS) equations for the flow field along with an appropriate sonic boom evaluation procedure thus introducing both aerodynamic performance as well as sonic boom as the design objectives to be optimized simultaneously. Sensitivity analysis is performed using a discrete differentiation approach. An approximation technique has been used within the optimizer to improve the overall computational efficiency of the procedure in order to make it suitable for design applications in an industrial setting.

Variations in hospitals costs for surgical procedures: inefficient care or sick patients?

PubMed

Gani, Faiz; Hundt, John; Daniel, Michael; Efron, Jonathan E; Makary, Martin A; Pawlik, Timothy M

2017-01-01

Reducing unwanted variations has been identified as an avenue for cost containment. We sought to characterize variations in hospital costs after major surgery and quantitate the variability attributable to the patient, procedure, and provider. A total of 22,559 patients undergoing major surgical procedure at a tertiary-care center between 2009 and 2013 were identified. Hierarchical linear regression analysis was performed to calculate risk-adjusted fixed, variable and total costs. The median cost of surgery was $23,845 (interquartile ranges, 13,353 to 43,083). Factors associated with increased costs included insurance status (Medicare vs private; coefficient: 14,934; 95% CI = 12,445.7 to 17,422.5, P < .001), preoperative comorbidity (Charlson Comorbidity Index = 1; coefficient: 10,793; 95% CI = 8,412.7 to 13,174.2; Charlson Comorbidity Index ≥2; coefficient: 24,468; 95% CI = 22,552.7 to 26,383.6; both P < .001) and the development of a postoperative complication (coefficient: 58,624.1; 95% CI = 56,683.6 to 60,564.7; P < .001). Eighty-six percent of total variability was explained by patient-related factors, whereas 8% of the total variation was attributed to surgeon practices and 6% due to factors at the level of surgical specialty. Although inpatient costs varied markedly between procedures and providers, the majority of variation in costs was due to patient-level factors and should be targeted by future cost containment strategies. Copyright © 2016 Elsevier Inc. All rights reserved.

Improved Cloud Detection Utilizing Defense Meteorological Satellite Program near Infrared Measurements

DTIC Science & Technology

1982-01-27

Visible 3. 3 Ea r th Location, Colocation, and Normalization 4. IMAGE ANALYSIS 4. 1 Interactive Capabilities 4.2 Examples 5. AUTOMATED CLOUD...computer Interactive Data Access System (McIDAS) before image analysis and algorithm development were done. Earth-location is an automated procedure to...the factor l / s in (SSE) toward the gain settings given in Table 5. 4. IMAGE ANALYSIS 4.1 Interactive Capabilities The development of automated

Risk factors for technical failure of endoscopic double self-expandable metallic stent placement by partial stent-in-stent method.

PubMed

Kawakubo, Kazumichi; Kawakami, Hiroshi; Toyokawa, Yoshihide; Otani, Koichi; Kuwatani, Masaki; Abe, Yoko; Kawahata, Shuhei; Kubo, Kimitoshi; Kubota, Yoshimasa; Sakamoto, Naoya

2015-01-01

Endoscopic double self-expandable metallic stent (SEMS) placement by the partial stent-in-stent (PSIS) method has been reported to be useful for the management of unresectable hilar malignant biliary obstruction. However, it is technically challenging, and the optimal SEMS for the procedure remains unknown. The aim of this study was to identify the risk factors for technical failure of endoscopic double SEMS placement for unresectable malignant hilar biliary obstruction (MHBO). Between December 2009 and May 2013, 50 consecutive patients with MHBO underwent endoscopic double SEMS placement by the PSIS method. We retrospectively evaluated the rate of successful double SEMS placement and identified the risk factors for technical failure. The technical success rate for double SEMS placement was 82.0% (95% confidence interval [CI]: 69.2-90.2). On univariate analysis, the rate of technical failure was high in patients with metastatic disease and unilateral placement. Multivariate analysis revealed that metastatic disease was a significant risk factor for technical failure (odds ratio: 9.63, 95% CI: 1.11-105.5). The subgroup analysis after double guidewire insertion showed that the rate of technical success was higher in the laser-cut type SEMS with a large mesh and thick delivery system than in the braided type SEMS with a small mesh and thick delivery system. Metastatic disease was a significant risk factor for technical failure of double SEMS placement for unresectable MHBO. The laser-cut type SEMS with a large mesh and thin delivery system might be preferable for the PSIS procedure. © 2014 Japanese Society of Hepato-Biliary-Pancreatic Surgery.

Random vibration analysis of space flight hardware using NASTRAN

NASA Technical Reports Server (NTRS)

Thampi, S. K.; Vidyasagar, S. N.

1990-01-01

During liftoff and ascent flight phases, the Space Transportation System (STS) and payloads are exposed to the random acoustic environment produced by engine exhaust plumes and aerodynamic disturbances. The analysis of payloads for randomly fluctuating loads is usually carried out using the Miles' relationship. This approximation technique computes an equivalent load factor as a function of the natural frequency of the structure, the power spectral density of the excitation, and the magnification factor at resonance. Due to the assumptions inherent in Miles' equation, random load factors are often over-estimated by this approach. In such cases, the estimates can be refined using alternate techniques such as time domain simulations or frequency domain spectral analysis. Described here is the use of NASTRAN to compute more realistic random load factors through spectral analysis. The procedure is illustrated using Spacelab Life Sciences (SLS-1) payloads and certain unique features of this problem are described. The solutions are compared with Miles' results in order to establish trends at over or under prediction.

Identification and Development of Leaders in the Navy Medical Department

DTIC Science & Technology

1990-07-20

multivariate normal population) and the Kaiser - Meyer - Olkin measure of sampling a-equacy (Norusis, 1988b). To allow further analysis of the factors...the Leadership Attribute domain and one from the Leadership Development domain). All factoring procedures passed the Kaiser - Meyer - Olkin Measure of...1.00000 DEVELI .47065 1.00000 MENTOR1 .45338 .69967 1.00000 Kaiser - Meyer - Olkin Measure of Sampling Adequacy = .69463 Bartlett Test of Sphericity

Vortex-assisted magnetic β-cyclodextrin/attapulgite-linked ionic liquid dispersive liquid-liquid microextraction coupled with high-performance liquid chromatography for the fast determination of four fungicides in water samples.

PubMed

Yang, Miyi; Xi, Xuefei; Wu, Xiaoling; Lu, Runhua; Zhou, Wenfeng; Zhang, Sanbing; Gao, Haixiang

2015-02-13

A novel microextraction technique combining magnetic solid-phase microextraction (MSPME) with ionic liquid dispersive liquid-liquid microextraction (IL-DLLME) to determine four fungicides is presented in this work for the first time. The main factors affecting the extraction efficiency were optimized by the one-factor-at-a-time approach and the impacts of these factors were studied by an orthogonal design. Without tedious clean-up procedure, analytes were extracted from the sample to the adsorbent and organic solvent and then desorbed in acetonitrile prior to chromatographic analysis. Under the optimum conditions, good linearity and high enrichment factors were obtained for all analytes, with correlation coefficients ranging from 0.9998 to 1.0000 and enrichment factors ranging 135 and 159 folds. The recoveries for proposed approach were between 98% and 115%, the limits of detection were between 0.02 and 0.04 μg L(-1) and the RSDs changed from 2.96 to 4.16. The method was successfully applied in the analysis of four fungicides (azoxystrobin, chlorothalonil, cyprodinil and trifloxystrobin) in environmental water samples. The recoveries for the real water samples ranged between 81% and 109%. The procedure proved to be a time-saving, environmentally friendly, and efficient analytical technique. Copyright © 2015 Elsevier B.V. All rights reserved.

Factors Influencing Cecal Intubation Time during Retrograde Approach Single-Balloon Enteroscopy

PubMed Central

Chen, Peng-Jen; Shih, Yu-Lueng; Huang, Hsin-Hung; Hsieh, Tsai-Yuan

2014-01-01

Background and Aim. The predisposing factors for prolonged cecal intubation time (CIT) during colonoscopy have been well identified. However, the factors influencing CIT during retrograde SBE have not been addressed. The aim of this study was to determine the factors influencing CIT during retrograde SBE. Methods. We investigated patients who underwent retrograde SBE at a medical center from January 2011 to March 2014. The medical charts and SBE reports were reviewed. The patients' characteristics and procedure-associated data were recorded. These data were analyzed with univariate analysis as well as multivariate logistic regression analysis to identify the possible predisposing factors. Results. We enrolled 66 patients into this study. The median CIT was 17.4 minutes. With univariate analysis, there was no statistical difference in age, sex, BMI, or history of abdominal surgery, except for bowel preparation (P = 0.021). Multivariate logistic regression analysis showed that inadequate bowel preparation (odds ratio 30.2, 95% confidence interval 4.63–196.54; P < 0.001) was the independent predisposing factors for prolonged CIT during retrograde SBE. Conclusions. For experienced endoscopist, inadequate bowel preparation was the independent predisposing factor for prolonged CIT during retrograde SBE. PMID:25505904

Assessment of Various Risk Factors for Success of Delayed and Immediate Loaded Dental Implants: A Retrospective Analysis.

PubMed

Prasant, M C; Thukral, Rishi; Kumar, Sachin; Sadrani, Sannishth M; Baxi, Harsh; Shah, Aditi

2016-10-01

Ever since its introduction in 1977, a minimum of few months of period is required for osseointegration to take place after dental implant surgery. With the passage of time and advancements in the fields of dental implant, this healing period is getting smaller and smaller. Immediate loading of dental implants is becoming a very popular procedure in the recent time. Hence, we retrospectively analyzed the various risk factors for the failure of delayed and immediate loaded dental implants. In the present study, retrospective analysis of all the patients was done who underwent dental implant surgeries either by immediate loading procedure or by delayed loading procedures. All the patients were divided broadly into two groups with one group containing patients in which delayed loaded dental implants were placed while other consisted of patients in whom immediate loaded dental implants were placed. All the patients in whom follow-up records were missing and who had past medical history of any systemic diseases were excluded from the present study. Evaluation of associated possible risk factors was done by classifying the predictable factors as primary and secondary factors. All the results were analyzed by Statistical Package for the Social Sciences (SPSS) software. Kaplan-Meier survival analyses and chi-square test were used for assessment of level of significance. In delayed and immediate group of dental implants, mean age of the patients was 54.2 and 54.8 years respectively. Statistically significant results were obtained while comparing the clinical parameters of the dental implants in both the groups while demographic parameters showed nonsignificant correlation. Significant higher risk of dental implant failure is associated with immediate loaded dental implants. Tobacco smoking, shorter implant size, and other risk factors play a significant role in predicting the success and failure of dental implants. Delayed loaded dental implant placement should be preferred as they are associated with decreased risk of implant failure.

Epidemiologic Analysis of Elective Operative Procedures in Infants Less Than 6 Months of Age in the United States.

PubMed

Einhorn, Lisa M; Young, Brian J; Routh, Jonathan C; Allori, Alexander C; Tracy, Elisabeth T; Greene, Nathaniel H

2017-11-01

This study uses publicly available data to analyze the total number of elective, potentially deferrable operative procedures involving infants <6 months of age in the United States. We investigated the factors associated with the performance of these procedures in this population. The State Ambulatory Surgery Database was used to identify patients in California, North Carolina, New York, and Utah during the years of 2007-2010 who were younger than 6 months of age at the time that they underwent outpatient (ambulatory) surgery. Operations that could reasonably be postponed until 6 months of age were classified as potentially deferrable procedures. Hernia repairs were analyzed separately from other deferrable procedures. Primary outcomes included the total number of elective procedures and the number and rates of potentially deferrable procedures per state per year in this population. Over the study period, a total of 27,540 procedures were identified as meeting inclusion criteria; of those, 7832 (28%) were classified as potentially deferrable, 4315 of which were hernia repairs. The average rates of potentially deferrable nonhernia procedures in California, North Carolina, New York, and Utah were 8.3, 43.8, 30.0, and 11.7 per 10,000 person-years, respectively. In multivariable analysis, private insurance (odds ratio [OR] = 1.36), self-pay status (OR = 1.50), and treatment in a different state (OR = 0.48-3.16) were independent predictors of a potentially deferrable procedure being performed on an infant younger than 6 months. Potentially deferrable procedures are still performed in infants <6 months of age. There appears to be significant variation in timing of these procedures among states. Insurance status and geography may be independent predictors of a procedure being potentially deferrable.

A new technique for ordering asymmetrical three-dimensional data sets in ecology.

PubMed

Pavoine, Sandrine; Blondel, Jacques; Baguette, Michel; Chessel, Daniel

2007-02-01

The aim of this paper is to tackle the problem that arises from asymmetrical data cubes formed by two crossed factors fixed by the experimenter (factor A and factor B, e.g., sites and dates) and a factor which is not controlled for (the species). The entries of this cube are densities in species. We approach this kind of data by the comparison of patterns, that is to say by analyzing first the effect of factor B on the species-factor A pattern, and second the effect of factor A on the species-factor B pattern. The analysis of patterns instead of individual responses requires a correspondence analysis. We use a method we call Foucart's correspondence analysis to coordinate the correspondence analyses of several independent matrices of species x factor A (respectively B) type, corresponding to each modality of factor B (respectively A). Such coordination makes it possible to evaluate the effect of factor B (respectively A) on the species-factor A (respectively B) pattern. The results obtained by such a procedure are much more insightful than those resulting from a classical single correspondence analysis applied to the global matrix that is obtained by simply unrolling the data cube, juxtaposing for example the individual species x factor A matrices through modalities of factor B. This is because a single global correspondence analysis combines three effects of factors in a way that cannot be determined from factorial maps (factor A, factor B, and factor A x factor B interaction) whereas the applications of Foucart's correspondence analysis clearly discriminate two different issues. Using two data sets, we illustrate that this technique proves to be particularly powerful in the analyses of ecological convergence which include several distinct data sets and in the analyses of spatiotemporal variations of species distributions.

Confirmatory factor analysis of the Child Oral Health Impact Profile (Korean version).

PubMed

Cho, Young Il; Lee, Soonmook; Patton, Lauren L; Kim, Hae-Young

2016-04-01

Empirical support for the factor structure of the Child Oral Health Impact Profile (COHIP) has not been fully established. The purposes of this study were to evaluate the factor structure of the Korean version of the COHIP (COHIP-K) empirically using confirmatory factor analysis (CFA) based on the theoretical framework and then to assess whether any of the factors in the structure could be grouped into a simpler single second-order factor. Data were collected through self-reported COHIP-K responses from a representative community sample of 2,236 Korean children, 8-15 yr of age. Because a large inter-factor correlation of 0.92 was estimated in the original five-factor structure, the two strongly correlated factors were combined into one factor, resulting in a four-factor structure. The revised four-factor model showed a reasonable fit with appropriate inter-factor correlations. Additionally, the second-order model with four sub-factors was reasonable with sufficient fit and showed equal fit to the revised four-factor model. A cross-validation procedure confirmed the appropriateness of the findings. Our analysis empirically supported a four-factor structure of COHIP-K, a summarized second-order model, and the use of an integrated summary COHIP score. © 2016 Eur J Oral Sci.

Classification of municipal occupations.

PubMed

Ilmarinen, J; Suurnäkki, T; Nygård, C H; Landau, K

1991-01-01

Eighty-eight job titles were analyzed with the "ergonomic job analysis procedure" [Arbeitswissenschaftliche Erhebungsverfahren zur Tätigkeits-analyse abbreviated (AET) in German]. The objective was to classify the wide range of municipal jobs into homogeneous groups according to job demand and to provide better possibilities to study the relationships between work and health among the aging municipal working population. Altogether 216 items were classified. First, a hierarchical cluster analysis was made, and a dendrogram of the analyzed job titles was drawn. Second, a profile analysis was done in which the single items were grouped into 39 sum items, and a graphic profile was drawn. Finally, the stress factors were listed and drawn in ranking order. The cluster analysis formed 13 groups. Groups exposed to the highest stress factor level were kitchen supervisors, dentists, and physicians. More than 10 stress factors (greater than 50% of the maximum) were found in nursing, administration, installation, transport, and technical supervision.

A search for parenting style: a cross-situational analysis of parental behavior.

PubMed

Metsäpelto, R L; Pulkkinen, L; Poikkeus, A M

2001-05-01

Cross-situational stability in parents' emotional warmth and guidance was studied by observing parents (N = 77, M age = 38 years) with their school-aged child in 2 dyadic problem-solving situations and in a family discussion concerning a moral dilemma. The observational data were coded by independent observers using dimensional ratings and dichotomous frequency counts as the 2 coding procedures. These procedures yielded a similar pattern of findings. Parents tended to behave consistently across situations, although the type of situation did affect the amount of emotional warmth and guidance manifested by the parent. Stability was further analyzed by means of structural equation modeling to test whether variance in parents' emotional warmth and guidance across situations was attributable to a generalized parenting style factor. A Parenting Style factor was identified that reflected the parents' child-centeredness; this factor explained, in part, parental behavior within each situation, although contextual factors also contributed to situation-specific variations from task to task.

Patient-related and ENT-related predictive factors based on the pain experienced during flexible nasendoscopy.

PubMed

Seccia, Veronica; Dallan, Iacopo; Massimetti, Gabriele; Segnini, Giovanni; Navari, Elena; Fortunato, Susanna; Bajraktari, Arisa; Lenzi, Riccardo; Muscatello, Luca; Sellari-Franceschini, Stefano

2014-07-01

The objective was to explore the role of specific patient-related and operator-related factors in pain perception during flexible laryngoscopy, which is one of the most common ENT procedures. Monocentric, randomized, individual prospective study. A total of 532 patients (145 men and 387 women), without any relevant ENT diseases, underwent laryngoscopy performed by otolaryngologists with various degrees of experience. Patient discomfort was reported using visual analog scores, and willingness to repeat the experience was also recorded. Statistical analysis showed that greater pain was significantly associated with female patients and female otolaryngologists, whereas the pain was less severe in the cases of experienced laryngologists and older patients. Pain plays an important role in determining the willingness to repeat the examination; in fact, patients who experienced lower levels of pain during laryngoscopy were more prone to repeat the experience. This article explores the importance of the extrinsic factors that are related to the patient and the otolaryngologist in determining the level of pain associated with laryngoscopy. Our study indicated that laryngoscopy is generally a well-tolerated procedure, causing little overall discomfort, but that a subgroup of patients may experience more pain than others, which may affect the patient's perspective toward undergoing a similar future experience. Our analysis may be helpful for clinicians in understanding pain perception during a routine procedure, enabling them to focus more on that subgroup of patients who are more prone to pain. 1b. © 2013 The American Laryngological, Rhinological and Otological Society, Inc.

Access to Care Under Physician Payment Reform: A Physician-Based Analysis

PubMed Central

Meadow, Ann

1995-01-01

This article reports physician-based measures of access to care during the 3 years surrounding the 1989 physician payment reforms. Analysis was facilitated by a new system of physician identifiers in Medicare claims. Access measures include caseload per physician and related measures of the demographic composition of physicians' clientele, the proportion of physicians performing surgical and other procedures, and the assignment rate. The caseload and assignment measures were stable or improving over time, suggesting that reforms did not harm access. Procedure performance rates tended to decline between 1992 and 1993, but reductions were inversely related to the estimated fee changes, and several may be explainable by other factors. PMID:10172615

Feasibility study for ergonomic analysis and design of future helicopter cockpit systems

NASA Technical Reports Server (NTRS)

Hawkins, H. L.

1985-01-01

The Army's light scout-attack helicopters (LHXs), planned for deployment in the 1990's, will fly nap-of-the-earth (NOE) missions in high threat environments, often under poor visibility and adverse atmospheric conditions, and probably with a one man crew. A procedure for the analysis of pilot workload that will identify and explicate the main characteristics of those LHX mission components holding overload potential is described. A principled, in-depth, explication of the cognitive demans of LHX piloting is essential to any effective effort to address the human factors issues. A task-analytic procedure that will yield the detail and organizstion needed to achieve these goals is examined.

Multiple Interacting Risk Factors: On Methods for Allocating Risk Factor Interactions.

PubMed

Price, Bertram; MacNicoll, Michael

2015-05-01

A persistent problem in health risk analysis where it is known that a disease may occur as a consequence of multiple risk factors with interactions is allocating the total risk of the disease among the individual risk factors. This problem, referred to here as risk apportionment, arises in various venues, including: (i) public health management, (ii) government programs for compensating injured individuals, and (iii) litigation. Two methods have been described in the risk analysis and epidemiology literature for allocating total risk among individual risk factors. One method uses weights to allocate interactions among the individual risk factors. The other method is based on risk accounting axioms and finding an optimal and unique allocation that satisfies the axioms using a procedure borrowed from game theory. Where relative risk or attributable risk is the risk measure, we find that the game-theory-determined allocation is the same as the allocation where risk factor interactions are apportioned to individual risk factors using equal weights. Therefore, the apportionment problem becomes one of selecting a meaningful set of weights for allocating interactions among the individual risk factors. Equal weights and weights proportional to the risks of the individual risk factors are discussed. © 2015 Society for Risk Analysis.

Multivariate analysis of fears in dental phobic patients according to a reduced FSS-II scale.

PubMed

Hakeberg, M; Gustafsson, J E; Berggren, U; Carlsson, S G

1995-10-01

This study analyzed and assessed dimensions of a questionnaire developed to measure general fears and phobias. A previous factor analysis among 109 dental phobics had revealed a five-factor structure with 22 items and an explained total variance of 54%. The present study analyzed the same material using a multivariate statistical procedure (LISREL) to reveal structural latent variables. The LISREL analysis, based on the correlation matrix, yielded a chi-square of 216.6 with 195 degrees of freedom (P = 0.138) and showed a model with seven latent variables. One was a general fear factor correlated to all 22 items. The other six factors concerned "Illness & Death" (5 items), "Failures & Embarrassment" (5 items), "Social situations" (5 items), "Physical injuries" (4 items), "Animals & Natural phenomena" (4 items). One item (opposite sex) was included in both "Failures & Embarrassment" and "Social situations". The last factor, "Social interaction", combined all the items in "Failures & Embarrassment" and "Social situations" (9 items). In conclusion, this multivariate statistical analysis (LISREL) revealed and confirmed a factor structure similar to our previous study, but added two important dimensions not shown with a traditional factor analysis. This reduced FSS-II version measures general fears and phobias and may be used on a routine clinical basis as well as in dental phobia research.

[Cost analysis for navigation in knee endoprosthetics].

PubMed

Cerha, O; Kirschner, S; Günther, K-P; Lützner, J

2009-12-01

Total knee arthroplasty (TKA) is one of the most frequent procedures in orthopaedic surgery. The outcome depends on a range of factors including alignment of the leg and the positioning of the implant in addition to patient-associated factors. Computer-assisted navigation systems can improve the restoration of a neutral leg alignment. This procedure has been established especially in Europe and North America. The additional expenses are not reimbursed in the German DRG system (Diagnosis Related Groups). In the present study a cost analysis of computer-assisted TKA compared to the conventional technique was performed. The acquisition expenses of various navigation systems (5 and 10 year depreciation), annual costs for maintenance and software updates as well as the accompanying costs per operation (consumables, additional operating time) were considered. The additional operating time was determined on the basis of a meta-analysis according to the current literature. Situations with 25, 50, 100, 200 and 500 computer-assisted TKAs per year were simulated. The amount of the incremental costs of the computer-assisted TKA depends mainly on the annual volume and the additional operating time. A relevant decrease of the incremental costs was detected between 50 and 100 procedures per year. In a model with 100 computer-assisted TKAs per year an additional operating time of 14 mins and a 10 year depreciation of the investment costs, the incremental expenses amount to 300-395 depending on the navigation system. Computer-assisted TKA is associated with additional costs. From an economical point of view an amount of more than 50 procedures per year appears to be favourable. The cost-effectiveness could be estimated if long-term results will show a reduction of revisions or a better clinical outcome.

NASA Johnson Space Center Usability Testing and Analysis Facility (UTAF) Overview

NASA Technical Reports Server (NTRS)

Whitmore, M.

2004-01-01

The Usability Testing and Analysis Facility (UTAF) is part of the Space Human Factors Laboratory at the NASA Johnson Space Center in Houston, Texas. The facility provides support to the Office of Biological and Physical Research, the Space Shuttle Program, the International Space Station Program, and other NASA organizations. In addition, there are ongoing collaborative research efforts with external businesses and universities. The UTAF provides human factors analysis, evaluation, and usability testing of crew interfaces for space applications. This includes computer displays and controls, workstation systems, and work environments. The UTAF has a unique mix of capabilities, with a staff experienced in both cognitive human factors and ergonomics. The current areas of focus are: human factors applications in emergency medical care and informatics; control and display technologies for electronic procedures and instructions; voice recognition in noisy environments; crew restraint design for unique microgravity workstations; and refinement of human factors processes. This presentation will provide an overview of ongoing activities, and will address how the projects will evolve to meet new space initiatives.

NASA Johnson Space Center Usability Testing and Analysis Facility (WAF) Overview

NASA Technical Reports Server (NTRS)

Whitmore, M.

2004-01-01

The Usability Testing and Analysis Facility (UTAF) is part of the Space Human Factors Laboratory at the NASA Johnson Space Center in Houston, Texas. The facility provides support to the Office of Biological and Physical Research, the Space Shuttle Program, the International Space Station Program, and other NASA organizations. In addition, there are ongoing collaborative research efforts with external businesses and universities. The UTAF provides human factors analysis, evaluation, and usability testing of crew interfaces for space applications. This includes computer displays and controls, workstation systems, and work environments. The UTAF has a unique mix of capabilities, with a staff experienced in both cognitive human factors and ergonomics. The current areas of focus are: human factors applications in emergency medical care and informatics; control and display technologies for electronic procedures and instructions; voice recognition in noisy environments; crew restraint design for unique microgravity workstations; and refinement of human factors processes. This presentation will provide an overview of ongoing activities, and will address how the projects will evolve to meet new space initiatives.

Setting Achievement Targets for School Children.

ERIC Educational Resources Information Center

Thanassoulis, Emmanuel

1999-01-01

Develops an approach for setting performance targets for schoolchildren, using data-envelopment analysis to identify benchmark pupils who achieve the best observed performance (allowing for contextual factors). These pupils' achievement forms the basis of targets estimated. The procedure also identifies appropriate role models for weaker students'…

Preliminary development of the adolescent students' basic psychological needs at school scale.

PubMed

Tian, Lili; Han, Mengmeng; Huebner, E Scott

2014-04-01

The aim of the present study was to develop and provide evidence for the validity of a new measure of adolescent students' psychological need satisfaction at school, using a sample of Chinese students. We conducted four studies with four independent samples (total n = 1872). The first study aimed to develop items for the new instrument and to ascertain its factorial structure using exploratory factor analysis procedures. The second study aimed to examine the instrument's factorial structure using confirmatory factor analysis procedures as well as to assess its internal consistency reliability, convergent and divergent validity. The third study aimed to assess its measurement invariance across gender and age. The fourth study aimed to test its test-retest reliability over time and predictive validity. These preliminary results showed that the new instrument has promising psychometric properties. The potential contributions of the new instrument for future research and educational practices were discussed. Copyright © 2014 The Foundation for Professionals in Services for Adolescents. Published by Elsevier Ltd. All rights reserved.

Probabilistic analysis of a materially nonlinear structure

NASA Technical Reports Server (NTRS)

Millwater, H. R.; Wu, Y.-T.; Fossum, A. F.

1990-01-01

A probabilistic finite element program is used to perform probabilistic analysis of a materially nonlinear structure. The program used in this study is NESSUS (Numerical Evaluation of Stochastic Structure Under Stress), under development at Southwest Research Institute. The cumulative distribution function (CDF) of the radial stress of a thick-walled cylinder under internal pressure is computed and compared with the analytical solution. In addition, sensitivity factors showing the relative importance of the input random variables are calculated. Significant plasticity is present in this problem and has a pronounced effect on the probabilistic results. The random input variables are the material yield stress and internal pressure with Weibull and normal distributions, respectively. The results verify the ability of NESSUS to compute the CDF and sensitivity factors of a materially nonlinear structure. In addition, the ability of the Advanced Mean Value (AMV) procedure to assess the probabilistic behavior of structures which exhibit a highly nonlinear response is shown. Thus, the AMV procedure can be applied with confidence to other structures which exhibit nonlinear behavior.

Risk factors for unplanned readmission within 30 days after pediatric neurosurgery: a nationwide analysis of 9799 procedures from the American College of Surgeons National Surgical Quality Improvement Program

PubMed Central

Sherrod, Brandon A.; Johnston, James M.; Rocque, Brandon G.

2017-01-01

Objective Readmission rate is increasingly used as a quality outcome measure after surgery. The purpose of this study was to establish, using a national database, the baseline readmission rates and risk factors for readmission after pediatric neurosurgical procedures. Methods The American College of Surgeons National Surgical Quality Improvement Program–Pediatric database was queried for pediatric patients treated by a neurosurgeon from 2012 to 2013. Procedures were categorized by current procedural terminology code. Patient demographics, comorbidities, preoperative laboratory values, operative variables, and postoperative complications were analyzed via univariate and multivariate techniques to find associations with unplanned readmission within 30 days of the primary procedure. Results A total of 9799 cases met the inclusion criteria, 1098 (11.2%) of which had an unplanned readmission within 30 days. Readmission occurred 14.0 ± 7.7 days postoperatively (mean ± standard deviation). The 4 procedures with the highest unplanned readmission rates were CSF shunt revision (17.3%), repair of myelomeningocele > 5 cm in diameter (15.4%), CSF shunt creation (14.1%), and craniectomy for infratentorial tumor excision (13.9%). Spine (6.5%), craniotomy for craniosynostosis (2.1%), and skin lesion (1.0%) procedures had the lowest unplanned readmission rates. On multivariate regression analysis, the odds of readmission were greatest in patients experiencing postoperative surgical site infection (SSI; deep, organ/space, superficial SSI and wound disruption: OR > 12 and p < 0.001 for each). Postoperative pneumonia (OR 4.294, p < 0.001), urinary tract infection (OR 4.262, p < 0.001), and sepsis (OR 2.616, p = 0.006) also independently increased the readmission risk. Independent patient risk factors for unplanned readmission included Native American race (OR 2.363, p = 0.019), steroid use > 10 days (OR 1.411, p = 0.010), oxygen supplementation (OR 1.645, p = 0.010), nutritional support (OR 1.403, p = 0.009), seizure disorder (OR 1.250, p = 0.021), and longer operative time (per hour increase, OR 1.059, p = 0.014). Conclusions This study may aid in identifying patients at risk for unplanned readmission following pediatric neurosurgery, potentially helping to focus efforts at lowering readmission rates, minimizing patient risk, and lowering costs for health care systems. PMID:27184348

Risk factors for unplanned readmission within 30 days after pediatric neurosurgery: a nationwide analysis of 9799 procedures from the American College of Surgeons National Surgical Quality Improvement Program.

PubMed

Sherrod, Brandon A; Johnston, James M; Rocque, Brandon G

2016-09-01

OBJECTIVE Hospital readmission rate is increasingly used as a quality outcome measure after surgery. The purpose of this study was to establish, using a national database, the baseline readmission rates and risk factors for patient readmission after pediatric neurosurgical procedures. METHODS The American College of Surgeons National Surgical Quality Improvement Program-Pediatric database was queried for pediatric patients treated by a neurosurgeon between 2012 and 2013. Procedures were categorized by current procedural terminology (CPT) code. Patient demographics, comorbidities, preoperative laboratory values, operative variables, and postoperative complications were analyzed via univariate and multivariate techniques to find associations with unplanned readmissions within 30 days of the primary procedure. RESULTS A total of 9799 cases met the inclusion criteria, 1098 (11.2%) of which had an unplanned readmission within 30 days. Readmission occurred 14.0 ± 7.7 days postoperatively (mean ± standard deviation). The 4 procedures with the highest unplanned readmission rates were CSF shunt revision (17.3%; CPT codes 62225 and 62230), repair of myelomeningocele > 5 cm in diameter (15.4%), CSF shunt creation (14.1%), and craniectomy for infratentorial tumor excision (13.9%). The lowest unplanned readmission rates were for spine (6.5%), craniotomy for craniosynostosis (2.1%), and skin lesion (1.0%) procedures. On multivariate regression analysis, the odds of readmission were greatest in patients experiencing postoperative surgical site infection (SSI; deep, organ/space, superficial SSI, and wound disruption: OR > 12 and p < 0.001 for each). Postoperative pneumonia (OR 4.294, p < 0.001), urinary tract infection (OR 4.262, p < 0.001), and sepsis (OR 2.616, p = 0.006) also independently increased the readmission risk. Independent patient risk factors for unplanned readmission included Native American race (OR 2.363, p = 0.019), steroid use > 10 days (OR 1.411, p = 0.010), oxygen supplementation (OR 1.645, p = 0.010), nutritional support (OR 1.403, p = 0.009), seizure disorder (OR 1.250, p = 0.021), and longer operative time (per hour increase, OR 1.059, p = 0.029). CONCLUSIONS This study may aid in identifying patients at risk for unplanned readmission following pediatric neurosurgery, potentially helping to focus efforts at lowering readmission rates, minimizing patient risk, and lowering costs for health care systems.

Replica Analysis for Portfolio Optimization with Single-Factor Model

NASA Astrophysics Data System (ADS)

Shinzato, Takashi

2017-06-01

In this paper, we use replica analysis to investigate the influence of correlation among the return rates of assets on the solution of the portfolio optimization problem. We consider the behavior of an optimal solution for the case where the return rate is described with a single-factor model and compare the findings obtained from our proposed methods with correlated return rates with those obtained with independent return rates. We then analytically assess the increase in the investment risk when correlation is included. Furthermore, we also compare our approach with analytical procedures for minimizing the investment risk from operations research.

The Big-Five factor structure as an integrative framework: an analysis of Clarke's AVA model.

PubMed

Goldberg, L R; Sweeney, D; Merenda, P F; Hughes, J E

1996-06-01

Using a large (N = 3,629) sample of participants selected to be representative of U.S. working adults in the year 2,000, we provide links between the constructs in 2 personality models that have been derived from quite different rationales. We demonstrate the use of a novel procedure for providing orthogonal Big-Five factor scores and use those scores to analyze the scales of the Activity Vector Analysis (AVA). We discuss the implications of our many findings both for the science of personality assessment and for future research using the AVA model.

Solution of elliptic PDEs by fast Poisson solvers using a local relaxation factor

NASA Technical Reports Server (NTRS)

Chang, Sin-Chung

1986-01-01

A large class of two- and three-dimensional, nonseparable elliptic partial differential equations (PDEs) is presently solved by means of novel one-step (D'Yakanov-Gunn) and two-step (accelerated one-step) iterative procedures, using a local, discrete Fourier analysis. In addition to being easily implemented and applicable to a variety of boundary conditions, these procedures are found to be computationally efficient on the basis of the results of numerical comparison with other established methods, which lack the present one's: (1) insensitivity to grid cell size and aspect ratio, and (2) ease of convergence rate estimation by means of the coefficient of the PDE being solved. The two-step procedure is numerically demonstrated to outperform the one-step procedure in the case of PDEs with variable coefficients.

Statistical Analyses of Scatterplots to Identify Important Factors in Large-Scale Simulations

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

Kleijnen, J.P.C.; Helton, J.C.

1999-04-01

The robustness of procedures for identifying patterns in scatterplots generated in Monte Carlo sensitivity analyses is investigated. These procedures are based on attempts to detect increasingly complex patterns in the scatterplots under consideration and involve the identification of (1) linear relationships with correlation coefficients, (2) monotonic relationships with rank correlation coefficients, (3) trends in central tendency as defined by means, medians and the Kruskal-Wallis statistic, (4) trends in variability as defined by variances and interquartile ranges, and (5) deviations from randomness as defined by the chi-square statistic. The following two topics related to the robustness of these procedures are consideredmore » for a sequence of example analyses with a large model for two-phase fluid flow: the presence of Type I and Type II errors, and the stability of results obtained with independent Latin hypercube samples. Observations from analysis include: (1) Type I errors are unavoidable, (2) Type II errors can occur when inappropriate analysis procedures are used, (3) physical explanations should always be sought for why statistical procedures identify variables as being important, and (4) the identification of important variables tends to be stable for independent Latin hypercube samples.« less

The Effect of Endovascular Revascularization of Common Iliac Artery Occlusions on Erectile Function

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

Gur, Serkan, E-mail: mserkangur@yahoo.com; Ozkan, Ugur; Onder, Hakan

To determine the incidence of erectile dysfunction in patients with common iliac artery (CIA) occlusive disease and the effect of revascularization on erectile function using the sexual health inventory for males (SHIM) questionnaire. All patients (35 men; mean age 57 {+-} 5 years; range 42-67 years) were asked to recall their sexual function before and 1 month after iliac recanalization. Univariate and multivariate analyses were performed to determine variables effecting improvement of impotence. The incidence of impotence in patients with CIA occlusion was 74% (26 of 35) preoperatively. Overall 16 (46%) of 35 patients reported improved erectile function after iliacmore » recanalization. The rate of improvement of impotence was 61.5% (16 of 26 impotent patients). Sixteen patients (46%), including seven with normal erectile function before the procedure, had no change. Three patients (8%) reported deterioration of their sexual function, two of whom (6%) had normal erectile function before the procedure. The median SHIM score increased from 14 (range 4-25) before the procedure to 20 (range 1-25) after the procedure (P = 0.005). The type of recanalization, the age of the patients, and the length of occlusion were related to erectile function improvement in univariate analysis. However, these factors were not independent factors for improvement of erectile dysfunction in multivariate analysis (P > 0.05). Endovascular recanalization of CIA occlusions clearly improves sexual function. More than half of the patients with erectile dysfunction who underwent endovascular recanalization of the CIA experienced improvement.« less

Rate of revisions or conversion after bariatric surgery over 10 years in the state of New York.

PubMed

Altieri, Maria S; Yang, Jie; Nie, Lizhou; Blackstone, Robin; Spaniolas, Konstantinos; Pryor, Aurora

2018-04-01

A primary measure of the success of a procedure is the whether or not additional surgery may be necessary. Multi-institutional studies regarding the need for reoperation after bariatric surgery are scarce. The purpose of this study is to evaluate the rate of revisions/conversions (RC) after 3 common bariatric procedures over 10 years in the state of New York. University Hospital, involving a large database in New York State. The Statewide Planning and Research Cooperative System database was used to identify all patients undergoing laparoscopic adjustable gastric banding (LAGB), sleeve gastrectomy (SG), and Roux-en-Y gastric bypass (RYGB) between 2004 and 2010. Patients were followed for RC to other bariatric procedures for at least 4 years (up to 2014). Multivariable cox proportional hazard regression analysis was performed to identify risk factors for additional surgery after each common bariatric procedure. Multivariable logistic regression was used to check the factors associated with having ≥2 follow-up procedures. There were 40,994 bariatric procedures with 16,444 LAGB, 22,769 RYGB, and 1781 SG. Rate of RC was 26.0% for LAGB, 9.8% for SG, and 4.9% for RYGB. Multiple RC ( = />2) were more common for LAGB (5.7% for LAGB, .5% for RYGB, and .2% for LSG). Band revision/replacements required further procedures compared with patients who underwent conversion to RYGB/SG (939 compared with 48 procedures). Majority of RC were not performed at initial institution (68.2% of LAGB patients, 75.9% for RYGB, 63.7% of SG). Risk factors for multiple procedures included surgery type, as LAGB was more likely to have multiple RC. Reoperation was common for LAGB, but less common for RYGB (4.9%) and SG (9.8%). RC rate are almost twice after SG than after RYGB. LAGB had the highest rate (5.7%) of multiple reoperations. Conversion was the procedure of choice after a failed LAGB. Copyright © 2018 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

[Anesthesia-related cardiac arrest in children. Data from a tertiary referral hospital registry].

PubMed

Sanabria-Carretero, P; Ochoa-Osorio, C; Martín-Vega, A; Lahoz-Ramón, A; Rodríguez-Pérez, E; Reinoso-Barbero, F; Goldman-Tarlovsky, L

2013-10-01

The aim of this study is to analyze the cardiac arrests related to anesthesia in a tertiary children's hospital, in order to identify risk factors that would lead to opportunities for improvement. A 5-year retrospective study was conducted on anesthesia related cardiac arrest occurring in pediatric patients. All urgent and elective anesthetic procedures performed by anesthesiologists were included. Data collected included patient characteristics, the procedure, the probable cause, and outcome of the cardiac arrest. Odds ratio was calculated by univariate analysis to determine the clinical factors associated with cardiac arrest and mortality. There were a total of 15 cardiac arrests related to anesthesia in 43,391 anesthetic procedures (3.4 per 10,000), with an incidence in children with ASA I-II versus ASA≥III of 0.28 and 19.27 per 10,000, respectively. The main risk factors were children ASA≥III (P<.001), less than one month old (P<.001), less than one year old (P<.001), emergency procedures (P<.01), cardiac procedures (P<.001) and procedures performed in the catheterization laboratory (P<.05). The main causes of cardiac arrest were cardiovascular (53.3%), mainly due to hypovolemia, and cardiovascular depression associated with induction of anesthesia, followed by respiratory causes (20%), and medication causes (20%). The incidence of mortality and neurological injury within the first 24h after the cardiac arrest was 0.92 and 1.38 per 10,000, respectively. The mortality in the first 3 months was 1.6 per 10,000. The main causes of death were ASA≥III, age under one year, pulmonary arterial hypertension, cardiac arrest in areas remote from the surgery area, a duration of cardiopulmonary resuscitation over 20min, and when hypothermia was not applied after cardiac arrest. The main risk factors for cardiac arrest were ASA≥III, age under one year, emergency procedures, cardiology procedures and procedures performed in the catheterization laboratory. The main cause of the cardiac arrest was due mainly to cardiovascular hypovolemia. All patients who died or had neurological injury were ASA≥III. Pulmonary arterial hypertension is a risk of anesthesia-related mortality. Copyright © 2012 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Published by Elsevier España. All rights reserved.

Patient- and lesion-tailored algorithm of endovascular treatment for arterial occlusive disease of extracranial arteries supplying the brain: safety of the treatment at 30-day follow-up

PubMed Central

Simka, Marian; Brzegowy, Paweł; Janas, Piotr; Kazibudzki, Marek; Pieniążek, Piotr; Ochała, Andrzej; Popiela, Tadeusz; Mrowiecki, Tomasz

2017-01-01

Introduction Although surgical endarterectomy remains the treatment of choice for carotid artery stenosis, stenting plays an important role as an alternative treatment modality, especially in high-risk patients. The actual safety profile associated with stenting procedures is probably better than that reported by randomized controlled trials. Aim To assess the safety of stent implantations in extracranial arteries supplying the brain, and also to identify risk factors associated with this procedure. Material and methods This was a post hoc analysis, with 30-day follow-up. We analyzed the results of treatment of 372 patients who underwent 408 procedures, 197 such procedures in asymptomatic, and 211 in symptomatic individuals. Stenting procedures were performed using a technique and armamentarium which were tailored to the type and anatomy of lesions. Results There were 6 (1.5%) strokes, including 2 (0.5%) major strokes, 1 ipsi- and 1 contralateral, and 4 (1.0%) minor strokes. In asymptomatic patients there was 1 (0.3%) minor stroke. Transient ischemic attacks occurred in 5 (1.2%) patients. There were 2 (0.5%) non-STEMI myocardial infarctions and 2 (0.5%) non-stroke related fatalities. Risk factors of these adverse events were diabetes mellitus, lesions localized in a tortuous segment of the artery, embolic material in the filter and bilateral stenoses of carotid arteries. Additional risk factors in asymptomatic patients were renal impairment and advanced coronary artery disease; and in symptomatic patients, grade 3 arterial hypertension, dislipidemia, cigarette smoking and lesions requiring predilatation. Conclusions Stenting procedures of extracranial arteries supplying the brain, which are tailored to the type and anatomy of lesions, seem to be relatively safe. PMID:28344618

Patient- and lesion-tailored algorithm of endovascular treatment for arterial occlusive disease of extracranial arteries supplying the brain: safety of the treatment at 30-day follow-up.

PubMed

Latacz, Paweł; Simka, Marian; Brzegowy, Paweł; Janas, Piotr; Kazibudzki, Marek; Pieniążek, Piotr; Ochała, Andrzej; Popiela, Tadeusz; Mrowiecki, Tomasz

2017-01-01

Although surgical endarterectomy remains the treatment of choice for carotid artery stenosis, stenting plays an important role as an alternative treatment modality, especially in high-risk patients. The actual safety profile associated with stenting procedures is probably better than that reported by randomized controlled trials. To assess the safety of stent implantations in extracranial arteries supplying the brain, and also to identify risk factors associated with this procedure. This was a post hoc analysis, with 30-day follow-up. We analyzed the results of treatment of 372 patients who underwent 408 procedures, 197 such procedures in asymptomatic, and 211 in symptomatic individuals. Stenting procedures were performed using a technique and armamentarium which were tailored to the type and anatomy of lesions. There were 6 (1.5%) strokes, including 2 (0.5%) major strokes, 1 ipsi- and 1 contralateral, and 4 (1.0%) minor strokes. In asymptomatic patients there was 1 (0.3%) minor stroke. Transient ischemic attacks occurred in 5 (1.2%) patients. There were 2 (0.5%) non-STEMI myocardial infarctions and 2 (0.5%) non-stroke related fatalities. Risk factors of these adverse events were diabetes mellitus, lesions localized in a tortuous segment of the artery, embolic material in the filter and bilateral stenoses of carotid arteries. Additional risk factors in asymptomatic patients were renal impairment and advanced coronary artery disease; and in symptomatic patients, grade 3 arterial hypertension, dislipidemia, cigarette smoking and lesions requiring predilatation. Stenting procedures of extracranial arteries supplying the brain, which are tailored to the type and anatomy of lesions, seem to be relatively safe.

Staged surgical management of hypoplastic left heart syndrome: a single institution 12 year experience

PubMed Central

McGuirk, S P; Griselli, M; Stumper, O F; Rumball, E M; Miller, P; Dhillon, R; de Giovanni, J V; Wright, J G; Barron, D J; Brawn, W J

2006-01-01

Objective To describe a 12 year experience with staged surgical management of the hypoplastic left heart syndrome (HLHS) and to identify the factors that influenced outcome. Methods Between December 1992 and June 2004, 333 patients with HLHS underwent a Norwood procedure (median age 4 days, range 0–217 days). Subsequently 203 patients underwent a bidirectional Glenn procedure (stage II) and 81 patients underwent a modified Fontan procedure (stage III). Follow up was complete (median interval 3.7 years, range 32 days to 11.3 years). Results Early mortality after the Norwood procedure was 29% (n  =  95); this decreased from 46% (first year) to 16% (last year; p < 0.05). Between stages, 49 patients died, 27 before stage II and 22 between stages II and III. There were one early and three late deaths after stage III. Actuarial survival (SEM) was 58% (3%) at one year and 50% (3%) at five and 10 years. On multivariable analysis, five factors influenced early mortality after the Norwood procedure (p < 0.05). Pulmonary blood flow supplied by a right ventricle to pulmonary artery (RV‐PA) conduit, arch reconstruction with pulmonary homograft patch, and increased operative weight improved early mortality. Increased periods of cardiopulmonary bypass and deep hypothermic circulatory arrest increased early mortality. Similar factors also influenced actuarial survival after the Norwood procedure. Conclusion This study identified an improvement in outcome after staged surgical management of HLHS, which was primarily attributable to changes in surgical technique. The RV‐PA conduit, in particular, was associated with a notable and independent improvement in early and actuarial survival. PMID:15939721

Factors Associated with Increased Rates of Post-procedural Stroke or Death following Carotid Artery Stent Placement: A Systematic Review.

PubMed Central

Khan, Muhib; Qureshi, Adnan I

2014-01-01

Background and Purpose We provide an assessment of clinical, angiographic, and procedure related risk factors associated with stroke and/or death in patients undergoing carotid artery stent placement which will assist in patient stratification and identification of high-stent risk patients. Methods A comprehensive search of Medline from January 1st 1996 to December 31st 2011 was performed with key words “carotid artery stenosis”, “ carotid artery stenting”, “carotid artery stent placement”, “death” , ” mortality”, “stroke”, “outcome”, “clinical predictors”, “angiographic predictors”, was performed in various combinations. We independently abstracted data and assessed the quality of the studies. This analysis led to the selection of 71 articles for review. Results Clinical factors including age≥80 years, symptomatic status, procedure within 2 weeks of symptoms, chronic renal failure, diabetes mellitus, and hemispheric TIA were associated with stroke (ischemic or hemorrhagic) and death within 1 month after carotid artery stent placement. Angiographic factors including left carotid artery intervention, stenosis > 90%, ulcerated and calcified plaques, lesion length > 10mm, thrombus at the site, ostial involvement, predilation without EPD, ICA-CCA angulation > 60%, aortic arch type III, and aortic arch calcification were also associated with 1 month stroke and/or death. Intra-procedural platelet GP IIb/IIIa inhibitors, protamine use, multiple stents, predilatation prior to stent placement were associated with stroke (ischemic or hemorrhagic) and death after carotid artery stent placement. Intraprocedural use of embolic protection devices and stent design (open versus closed cell design) did not demonstrate a consistent relationship with 1 month stroke and/or death. Procedural statin use, and operator and center experience of more than 50 procedures per year were protective for 1 month stroke and/or death. Conclusions Our review identified risk factors for stroke, death, and MI within 1 month in patients undergoing carotid artery stent placement. Such information will result in better patient selection for carotid artery stent placement particularly in those who are also candidates for carotid endarterectomy. PMID:24920983

On Bi-Grid Local Mode Analysis of Solution Techniques for 3-D Euler and Navier-Stokes Equations

NASA Technical Reports Server (NTRS)

Ibraheem, S. O.; Demuren, A. O.

1994-01-01

A procedure is presented for utilizing a bi-grid stability analysis as a practical tool for predicting multigrid performance in a range of numerical methods for solving Euler and Navier-Stokes equations. Model problems based on the convection, diffusion and Burger's equation are used to illustrate the superiority of the bi-grid analysis as a predictive tool for multigrid performance in comparison to the smoothing factor derived from conventional von Neumann analysis. For the Euler equations, bi-grid analysis is presented for three upwind difference based factorizations, namely Spatial, Eigenvalue and Combination splits, and two central difference based factorizations, namely LU and ADI methods. In the former, both the Steger-Warming and van Leer flux-vector splitting methods are considered. For the Navier-Stokes equations, only the Beam-Warming (ADI) central difference scheme is considered. In each case, estimates of multigrid convergence rates from the bi-grid analysis are compared to smoothing factors obtained from single-grid stability analysis. Effects of grid aspect ratio and flow skewness are examined. Both predictions are compared with practical multigrid convergence rates for 2-D Euler and Navier-Stokes solutions based on the Beam-Warming central scheme.

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

Das, Raj, E-mail: rajdas@nhs.net, E-mail: raj.das@stgeorges.nhs.uk; Lucatelli, Pierleone, E-mail: pierleone.lucatelli@gmail.com; Wang, Haofan, E-mail: wwhhff123@gmail.com

AimA clear understanding of operator experience is important in improving technical success whilst minimising patient risk undergoing endovascular procedures, and there is the need to ensure that trainees have the appropriate skills as primary operators. The aim of the study is to retrospectively analyse uterine artery embolisation (UAE) procedures performed by interventional radiology (IR) trainees at an IR training unit analysing fluoroscopy times and radiation dose as surrogate markers of technical skill.MethodsTen IR fellows were primary operator in 200 UAE procedures over a 5-year period. We compared fluoroscopy times, radiation dose and complications, after having them categorised according to threemore » groups: Group 1, initial five, Group 2, >5 procedures and Group 3, penultimate five UAE procedures. We documented factors that may affect screening time (number of vials employed and use of microcatheters).ResultsMean fluoroscopy time was 18.4 (±8.1), 17.3 (±9.0), 16.3 (±8.4) min in Groups 1, 2 and 3, respectively. There was no statistically significant difference between these groups (p > 0.05) with respect to fluoroscopy time or radiation dose. Analysis after correction for confounding factors showed no statistical significance (p > 0.05). All procedures were technically successful, and total complication rate was 4 %.ConclusionUAE was chosen as a highly standardised procedure followed by IR practitioners. Although there is a non-significant trend for shorter screening times with experience, technical success and safety were not compromised with appropriate Consultant supervision, which illustrates a safe construct for IR training. This is important and reassuring information for patients undergoing a procedure in a training unit.« less

Global aesthetic surgery statistics: a closer look.

PubMed

Heidekrueger, Paul I; Juran, S; Ehrl, D; Aung, T; Tanna, N; Broer, P Niclas

2017-08-01

Obtaining quality global statistics about surgical procedures remains an important yet challenging task. The International Society of Aesthetic Plastic Surgery (ISAPS) reports the total number of surgical and non-surgical procedures performed worldwide on a yearly basis. While providing valuable insight, ISAPS' statistics leave two important factors unaccounted for: (1) the underlying base population, and (2) the number of surgeons performing the procedures. Statistics of the published ISAPS' 'International Survey on Aesthetic/Cosmetic Surgery' were analysed by country, taking into account the underlying national base population according to the official United Nations population estimates. Further, the number of surgeons per country was used to calculate the number of surgeries performed per surgeon. In 2014, based on ISAPS statistics, national surgical procedures ranked in the following order: 1st USA, 2nd Brazil, 3rd South Korea, 4th Mexico, 5th Japan, 6th Germany, 7th Colombia, and 8th France. When considering the size of the underlying national populations, the demand for surgical procedures per 100,000 people changes the overall ranking substantially. It was also found that the rate of surgical procedures per surgeon shows great variation between the responding countries. While the US and Brazil are often quoted as the countries with the highest demand for plastic surgery, according to the presented analysis, other countries surpass these countries in surgical procedures per capita. While data acquisition and quality should be improved in the future, valuable insight regarding the demand for surgical procedures can be gained by taking specific demographic and geographic factors into consideration.

Factor Structure and Item Level Psychometrics of the Social Problem Solving Inventory Revised-Short Form in Traumatic Brain Injury

PubMed Central

Li, Chih-Ying; Waid-Ebbs, Julia; Velozo, Craig A.; Heaton, Shelley C.

2016-01-01

Primary Objective Social problem solving deficits characterize individuals with traumatic brain injury (TBI). Poor social problem solving interferes with daily functioning and productive lifestyles. Therefore, it is of vital importance to use the appropriate instrument to identify deficits in social problem solving for individuals with TBI. This study investigates factor structure and item-level psychometrics of the Social Problem Solving Inventory-Revised Short Form (SPSI-R:S), for adults with moderate and severe TBI. Research Design Secondary analysis of 90 adults with moderate and severe TBI who completed the SPSI-R:S. Methods and Procedures An exploratory factor analysis (EFA), principal components analysis (PCA) and Rasch analysis examined the factor structure and item-level psychometrics of the SPSI-R:S. Main Outcomes and Results The EFA showed three dominant factors, with positively worded items represented as the most definite factor. The other two factors are negative problem solving orientation and skills; and negative problem solving emotion. Rasch analyses confirmed the three factors are each unidimensional constructs. Conclusions The total score interpretability of the SPSI-R:S may be challenging due to the multidimensional structure of the total measure. Instead, we propose using three separate SPSI-R:S subscores to measure social problem solving for the TBI population. PMID:26052731

Application of GIS-based Procedure on Slopeland Use Classification and Identification

NASA Astrophysics Data System (ADS)

KU, L. C.; LI, M. C.

2016-12-01

In Taiwan, the "Slopeland Conservation and Utilization Act" regulates the management of the slopelands. It categorizes the slopeland into land suitable for agricultural or animal husbandry, land suitable for forestry and land for enhanced conservation, according to the environmental factors of average slope, effective soil depth, soil erosion and parental rock. Traditionally, investigations of environmental factors require cost-effective field works. It has been confronted with many practical issues such as non-evaluated cadastral parcels, evaluation results depending on expert's opinion, difficulties in field measurement and judgment, and time consuming. This study aimed to develop a GIS-based procedure involved in the acceleration of slopeland use classification and quality improvement. First, the environmental factors of slopelands were analyzed by GIS and SPSS software. The analysis involved with the digital elevation model (DEM), soil depth map, land use map and satellite images. Second, 5% of the analyzed slopelands were selected to perform the site investigations and correct the results of classification. Finally, a 2nd examination was involved by randomly selected 2% of the analyzed slopelands to perform the accuracy evaluation. It was showed the developed procedure is effective in slopeland use classification and identification. Keywords: Slopeland Use Classification, GIS, Management

Spectral method for the correction of the Cerenkov light effect in plastic scintillation detectors: A comparison study of calibration procedures and validation in Cerenkov light-dominated situations

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

Guillot, Mathieu; Gingras, Luc; Archambault, Louis

2011-04-15

Purpose: The purposes of this work were: (1) To determine if a spectral method can accurately correct the Cerenkov light effect in plastic scintillation detectors (PSDs) for situations where the Cerenkov light is dominant over the scintillation light and (2) to develop a procedural guideline for accurately determining the calibration factors of PSDs. Methods: The authors demonstrate, by using the equations of the spectral method, that the condition for accurately correcting the effect of Cerenkov light is that the ratio of the two calibration factors must be equal to the ratio of the Cerenkov light measured within the two differentmore » spectral regions used for analysis. Based on this proof, the authors propose two new procedures to determine the calibration factors of PSDs, which were designed to respect this condition. A PSD that consists of a cylindrical polystyrene scintillating fiber (1.6 mm{sup 3}) coupled to a plastic optical fiber was calibrated by using these new procedures and the two reference procedures described in the literature. To validate the extracted calibration factors, relative dose profiles and output factors for a 6 MV photon beam from a medical linac were measured with the PSD and an ionization chamber. Emphasis was placed on situations where the Cerenkov light is dominant over the scintillation light and on situations dissimilar to the calibration conditions. Results: The authors found that the accuracy of the spectral method depends on the procedure used to determine the calibration factors of the PSD and on the attenuation properties of the optical fiber used. The results from the relative dose profile measurements showed that the spectral method can correct the Cerenkov light effect with an accuracy level of 1%. The results obtained also indicate that PSDs measure output factors that are lower than those measured with ionization chambers for square field sizes larger than 25x25 cm{sup 2}, in general agreement with previously published Monte Carlo results. Conclusions: The authors conclude that the spectral method can be used to accurately correct the Cerenkov light effect in PSDs. The authors confirmed the importance of maximizing the difference of Cerenkov light production between calibration measurements. The authors also found that the attenuation of the optical fiber, which is assumed to be constant in the original formulation of the spectral method, may cause a variation of the calibration factors in some experimental setups.« less

Analysis of Factors Associated With Rhytidectomy Malpractice Litigation Cases.

PubMed

Kandinov, Aron; Mutchnick, Sean; Nangia, Vaibhuv; Svider, Peter F; Zuliani, Giancarlo F; Shkoukani, Mahdi A; Carron, Michael A

2017-07-01

This study investigates the financial burden of medical malpractice litigation associated with rhytidectomies, as well as factors that contribute to litigation and poor defendant outcomes, which can help guide physician practices. To comprehensively evaluate rhytidectomy malpractice litigation. Jury verdict and settlement reports related to rhytidectomy malpractice litigations were obtained using the Westlaw Next database. Use of medical malpractice in conjunction with several terms for rhytidectomy, to account for the various procedure names associated with the procedure, yielded 155 court cases. Duplicate and nonrelevant cases were removed, and 89 cases were included in the analysis and reviewed for outcomes, defendant specialty, payments, and other allegations raised in proceedings. Data were collected from November 21, 2015, to December 25, 2015. Data analysis took place from December 25, 2015, to January 20, 2016. A total of 89 cases met our inclusion criteria. Most plaintiffs were female (81 of 88 with known sex [92%]), and patient age ranged from 40 to 76 years (median age, 56 years). Fifty-three (60%) were resolved in the defendant's favor, while the remaining 36 cases (40%) were resolved with either a settlement or a plaintiff verdict payment. The mean payment was $1.4 million. A greater proportion of cases involving plastic surgeon defendants were resolved with payment compared with cases involving defendants with ear, nose, and throat specialty (15 [36%] vs 4 [24%]). The most common allegations raised in litigation were intraoperative negligence (61 [69%]), poor cosmesis or disfigurement (57 [64%]), inadequate informed consent (30 [34%]), additional procedures required (14 [16%]), postoperative negligence (12 [14%]), and facial nerve injury (10 [11%]). Six cases (7%) involved alleged negligence surrounding a "lifestyle-lift" procedure, which tightens or oversews the superficial muscular aponeurosis system layer. In this study, although most cases of rhytidectomy malpractice litigation were resolved in the defendant's favor, cases resulting in payments created substantial financial burden for the defendants. Common factors cited by plaintiffs for pursuing litigation included dissatisfaction with cosmetic outcomes and perceived deficits in informed consent. These factors reinforce the importance of a comprehensive, preoperative informed consent process in which the specific potential risks and outcomes are presented by the surgeon to the patient to limit or avoid postsurgical allegations. Intraoperative negligence and facial nerve injury were significantly more likely to result in poor defendant outcomes. NA.

A Risk Analysis Methodology to Address Human and Organizational Factors in Offshore Drilling Safety: With an Emphasis on Negative Pressure Test

NASA Astrophysics Data System (ADS)

Tabibzadeh, Maryam

According to the final Presidential National Commission report on the BP Deepwater Horizon (DWH) blowout, there is need to "integrate more sophisticated risk assessment and risk management practices" in the oil industry. Reviewing the literature of the offshore drilling industry indicates that most of the developed risk analysis methodologies do not fully and more importantly, systematically address the contribution of Human and Organizational Factors (HOFs) in accident causation. This is while results of a comprehensive study, from 1988 to 2005, of more than 600 well-documented major failures in offshore structures show that approximately 80% of those failures were due to HOFs. In addition, lack of safety culture, as an issue related to HOFs, have been identified as a common contributing cause of many accidents in this industry. This dissertation introduces an integrated risk analysis methodology to systematically assess the critical role of human and organizational factors in offshore drilling safety. The proposed methodology in this research focuses on a specific procedure called Negative Pressure Test (NPT), as the primary method to ascertain well integrity during offshore drilling, and analyzes the contributing causes of misinterpreting such a critical test. In addition, the case study of the BP Deepwater Horizon accident and their conducted NPT is discussed. The risk analysis methodology in this dissertation consists of three different approaches and their integration constitutes the big picture of my whole methodology. The first approach is the comparative analysis of a "standard" NPT, which is proposed by the author, with the test conducted by the DWH crew. This analysis contributes to identifying the involved discrepancies between the two test procedures. The second approach is a conceptual risk assessment framework to analyze the causal factors of the identified mismatches in the previous step, as the main contributors of negative pressure test misinterpretation. Finally, a rational decision making model is introduced to quantify a section of the developed conceptual framework in the previous step and analyze the impact of different decision making biases on negative pressure test results. Along with the corroborating findings of previous studies, the analysis of the developed conceptual framework in this paper indicates that organizational factors are root causes of accumulated errors and questionable decisions made by personnel or management. Further analysis of this framework identifies procedural issues, economic pressure, and personnel management issues as the organizational factors with the highest influence on misinterpreting a negative pressure test. It is noteworthy that the captured organizational factors in the introduced conceptual framework are not only specific to the scope of the NPT. Most of these organizational factors have been identified as not only the common contributing causes of other offshore drilling accidents but also accidents in other oil and gas related operations as well as high-risk operations in other industries. In addition, the proposed rational decision making model in this research introduces a quantitative structure for analysis of the results of a conducted NPT. This model provides a structure and some parametric derived formulas to determine a cut-off point value, which assists personnel in accepting or rejecting an implemented negative pressure test. Moreover, it enables analysts to assess different decision making biases involved in the process of interpreting a conducted negative pressure test as well as the root organizational factors of those biases. In general, although the proposed integrated research methodology in this dissertation is developed for the risk assessment of human and organizational factors contributions in negative pressure test misinterpretation, it can be generalized and be potentially useful for other well control situations, both offshore and onshore; e.g. fracking. In addition, this methodology can be applied for the analysis of any high-risk operations, in not only the oil and gas industry but also in other industries such as nuclear power plants, aviation industry, and transportation sector.

Quantitative analysis of crystalline pharmaceuticals in tablets by pattern-fitting procedure using X-ray diffraction pattern.

PubMed

Takehira, Rieko; Momose, Yasunori; Yamamura, Shigeo

2010-10-15

A pattern-fitting procedure using an X-ray diffraction pattern was applied to the quantitative analysis of binary system of crystalline pharmaceuticals in tablets. Orthorhombic crystals of isoniazid (INH) and mannitol (MAN) were used for the analysis. Tablets were prepared under various compression pressures using a direct compression method with various compositions of INH and MAN. Assuming that X-ray diffraction pattern of INH-MAN system consists of diffraction intensities from respective crystals, observed diffraction intensities were fitted to analytic expression based on X-ray diffraction theory and separated into two intensities from INH and MAN crystals by a nonlinear least-squares procedure. After separation, the contents of INH were determined by using the optimized normalization constants for INH and MAN. The correction parameter including all the factors that are beyond experimental control was required for quantitative analysis without calibration curve. The pattern-fitting procedure made it possible to determine crystalline phases in the range of 10-90% (w/w) of the INH contents. Further, certain characteristics of the crystals in the tablets, such as the preferred orientation, size of crystallite, and lattice disorder were determined simultaneously. This method can be adopted to analyze compounds whose crystal structures are known. It is a potentially powerful tool for the quantitative phase analysis and characterization of crystals in tablets and powders using X-ray diffraction patterns. Copyright 2010 Elsevier B.V. All rights reserved.

Characteristics of dental fear among Arabic-speaking children: a descriptive study.

PubMed

El-Housseiny, Azza A; Alamoudi, Najlaa M; Farsi, Najat M; El Derwi, Douaa A

2014-09-22

Dental fear has not only been linked to poor dental health in children but also persists across the lifespan, if unaddressed, and can continue to affect oral, systemic, and psychological health. The aim of this study was to assess the factor structure of the Arabic version of the Children's Fear Survey Schedule-Dental Subscale (CFSS-DS), and to assess the difference in factor structure between boys and girls. Participants were 220 consecutive paediatric dental patients 6-12 years old seeking dental care at the Faculty of Dentistry, King Abdulaziz University, Saudi Arabia. Participants completed the 15-item Arabic version of the CFSS-DS questionnaire at the end of the visit. Internal consistency was assessed using Cronbach's alpha. Factor analysis (principal components, varimax rotation) was employed to assess the factor structure of the scale. The Cronbach's alpha was 0.86. Four factors with eigenvalues above 1.00 were identified, which collectively explained 64.45% of the variance. These factors were as follows: Factor 1, 'fear of usual dental procedures' consisted of 8 items such as 'drilling' and 'having to open the mouth', Factor 2, 'fear of health care personnel and injections' consisted of three items, Factor 3, 'fear of strangers', consisted of 2 items. Factor 4, 'fear of general medical aspects of treatment', consisted of 2 items. Notably, four factors of dental fear were found in girls, while five were found in boys. Four factors of different strength pertaining to dental fear were identified in Arabic-speaking children, indicating a simple structure. Most items loaded high on the factor related to fear of usual dental procedures. The fear-provoking aspects of dental procedures differed in boys and girls. Use of the scale may enable dentists to determine the item/s of dental treatment that a given child finds most fear-provoking and guide the child's behaviour accordingly.

Prospective Measurement of Patient Exposure to Radiation During Pediatric Ureteroscopy

PubMed Central

Kokorowski, Paul J.; Chow, Jeanne S.; Strauss, Keith; Pennison, Melanie; Routh, Jonathan C.; Nelson, Caleb P.

2013-01-01

Objective Little data have been reported regarding radiation exposure during pediatric endourologic procedures, including ureteroscopy (URS). We sought to measure radiation exposure during pediatric URS and identify opportunities for exposure reduction. Methods We prospectively observed URS procedures as part of a quality improvement initiative. Pre-operative patient characteristics, operative factors, fluoroscopy settings and radiation exposure were recorded. Our outcomes were entrance skin dose (ESD, in mGy) and midline dose (MLD, in mGy). Specific modifiable factors were identified as targets for potential quality improvement. Results Direct observation was performed on 56 consecutive URS procedures. Mean patient age was 14.8 ± 3.8 years (range 7.4 to 19.2); 9 children were under age 12 years. Mean ESD was 46.4 ± 48 mGy. Mean MLD was 6.2 ± 5.0 mGy. The most important major determinant of radiation dose was total fluoroscopy time (mean 2.68 ± 1.8 min) followed by dose rate setting, child anterior-posterior (AP) diameter, and source to skin distance (all p<0.01). The analysis of factors affecting exposure levels found that the use of ureteral access sheaths (p=0.01) and retrograde pyelography (p=0.04) were significantly associated with fluoroscopy time. We also found that dose rate settings were higher than recommended in up to 43% of cases and ideal C-arm positioning could have reduced exposure 14% (up to 49% in some cases). Conclusions Children receive biologically significant radiation doses during URS procedures. Several modifiable factors contribute to dose and could be targeted in efforts to implement dose reduction strategies. PMID:22341275

Psychometric Evaluation of the Eating Disorder Examination-Questionnaire for Bariatric Surgery Candidates

PubMed Central

Hrabosky, Joshua I.; White, Marney A.; Masheb, Robin M.; Rothschild, Bruce S.; Burke-Martindale, Carolyn H.; Grilo, Carlos M.

2013-01-01

Objective Despite increasing use of the Eating Disorder Examination-Questionnaire (EDE-Q) in bariatric surgery patients, little is known about the utility and psychometric performance of this self-report measure in this clinical group. The primary purpose of the current study was to evaluate the factor structure and construct validity of the EDE-Q in a large series of bariatric surgery candidates. Methods and Procedures Participants were 337 obese bariatric surgery candidates. Participants completed the EDE-Q and a battery of behavioral and psychological measures. Results Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) produced a 12-item, 4-factor structure of the EDE-Q. The four factors, interpreted as Dietary Restraint, Eating Disturbance, Appearance Concerns, and Shape/Weight Overvaluation, were found to be internally consistent and converged with other relevant measures of psychopathology. Discussion Factor analysis of the EDE-Q in bariatric surgery candidates did not replicate the original subscales but revealed an alternative factor structure. Future research must further evaluate the psychometric properties, including the factor structure, of the EDE-Q in this and other diverse populations and consider means of improving this measure's ability to best assess eating-related pathology in bariatric surgery patients. PMID:18379561

Landslide risk models for decision making.

PubMed

Bonachea, Jaime; Remondo, Juan; de Terán, José Ramón Díaz; González-Díez, Alberto; Cendrero, Antonio

2009-11-01

This contribution presents a quantitative procedure for landslide risk analysis and zoning considering hazard, exposure (or value of elements at risk), and vulnerability. The method provides the means to obtain landslide risk models (expressing expected damage due to landslides on material elements and economic activities in monetary terms, according to different scenarios and periods) useful to identify areas where mitigation efforts will be most cost effective. It allows identifying priority areas for the implementation of actions to reduce vulnerability (elements) or hazard (processes). The procedure proposed can also be used as a preventive tool, through its application to strategic environmental impact analysis (SEIA) of land-use plans. The underlying hypothesis is that reliable predictions about hazard and risk can be made using models based on a detailed analysis of past landslide occurrences in connection with conditioning factors and data on past damage. The results show that the approach proposed and the hypothesis formulated are essentially correct, providing estimates of the order of magnitude of expected losses for a given time period. Uncertainties, strengths, and shortcomings of the procedure and results obtained are discussed and potential lines of research to improve the models are indicated. Finally, comments and suggestions are provided to generalize this type of analysis.

Organizational factors related to low levels of sickness absence in a representative set of Swedish companies.

PubMed

Stoetzer, Ulrich; Bergman, Peter; Aborg, Carl; Johansson, Gun; Ahlberg, Gunnel; Parmsund, Marianne; Svartengren, Magnus

2014-01-01

The aim of this qualitative study was to identify manageable organizational factors that could explain why some companies have low levels of sickness absence. There may be factors at company level that can be managed to influence levels of sickness absence, and promote health and a prosperous organization. 38 representative Swedish companies. The study included a total of 204 semi-structured interviews at 38 representative Swedish companies. Qualitative thematic analysis was applied to the interviews, primarily with managers, to indicate the organizational factors that characterize companies with low levels of sickness absence. The factors that were found to characterize companies with low levels of sickness absence concerned strategies and procedures for managing leadership, employee development, communication, employee participation and involvement, corporate values and visions, and employee health. The results may be useful in finding strategies and procedures to reduce levels of sickness absence and promote health. There is research at individual level on the reasons for sickness absence. This study tries to elevate the issue to an organizational level. The findings suggest that explicit strategies for managing certain organizational factors can reduce sickness absence and help companies to develop more health-promoting strategies.

Analysis of damaging process and crack propagation

NASA Astrophysics Data System (ADS)

Semenski, D.; Wolf, H.; Božić, Ž.

2010-06-01

Supervising and health monitoring of structures can assess the actual state of existing structures after initial loading or in the state of operation. Structural life management requires the integration of design and analysis, materials behavior and structural testing, as given for several examples. Procedure of survey of structural elements and criteria for their selection must be strongly defined as it is for the offshore gas platforms. Numerical analysis of dynamic loading is shown for the Aeolian vibrations of overhead transmission line conductors. Since the damper’s efficiency strongly depends on its position, the procedure of determining the optimum position of the damper is described. The optical method of caustics is established in isotropic materials for determination of the stress intensity factors (SIFs) of the cracks in deformed structures and is advantageously improved for the application to fiberreinforced composites. A procedure for simulation of crack propagation for multiple cracks was introduced and SIFs have been calculated by using finite element method. Crack growth of a single crack or a periodical array of cracks initiated at the stiffeners in a stiffened panel has been investigated.

Relationship between affective determinants and achievement in science for seventeen-year-olds

NASA Astrophysics Data System (ADS)

Napier, John D.; Riley, Joseph P.

Data collected in the 1976-1977 NAEP survey of seventeen-year-olds was used to reanalyze the hypothesis that there are affective determinates of science achievement. Factor and item analysis procedures were used to examine affective and cognitive items from Booklet 4. Eight affective scales and one cognitive achievement scale were identified. Using stepwise multiple regression procedures, the four affective scales of Motivation, Anxiety, Student Choice, and Teacher Support were found to account for the majority of the correlation between the affective determinants and achievement.

Species-specific challenges in dog cloning.

PubMed

Kim, G A; Oh, H J; Park, J E; Kim, M J; Park, E J; Jo, Y K; Jang, G; Kim, M K; Kim, H J; Lee, B C

2012-12-01

Somatic cell nuclear transfer (SCNT) is now an established procedure used in cloning of several species. SCNT in dogs involves multiple steps including the removal of the nuclear material, injection of a donor cell, fusion, activation of the reconstructed oocytes and finally transfer to a synchronized female recipient. There are therefore many factors that contribute to cloning efficiency. By performing a retrospective analysis of 2005-2012 published papers regarding dog cloning, we define the optimum procedure and summarize the specific feature for dog cloning. © 2012 Blackwell Verlag GmbH.

[Criterion of dental treatment for the disabled].

PubMed

Huchun, Wan; Zheng, Yang; Hongkun, Wu; Jianguo, Liu; Jin, Zhao; Xiaoping, Ji; Lin, Zhu; Deqin, Yang; Xuedong, Zhou

2017-08-01

The number of disabled persons increases in the course of human life and in the aging population. The high prevalence, low treatment rate, long therapy period, and sophisticated procedures prevent most of disabled individuals from availing dental services. Moreover, special dental institutions for the disabled are insufficient, and a certain treatment standard is commonly not complied. This study performed analysis and evaluation, including treatment features, pretreatment procedures, patient communication, treatment factors, and treatment standards to provide a targeted solution for the special requirements of the oral therapy for disabled patients.

Factors associated with delayed bleeding after resection of large nonpedunculated colorectal polyps.

PubMed

Elliott, Timothy R; Tsiamoulos, Zacharias P; Thomas-Gibson, Siwan; Suzuki, Noriko; Bourikas, Leonidas A; Hart, Ailsa; Bassett, Paul; Saunders, Brian P

2018-04-06

 Delayed bleeding is the most common significant complication after piecemeal endoscopic mucosal resection (p-EMR) of large nonpedunculated colorectal polyps (NPCPs). Risk factors for delayed bleeding are incompletely defined. We aimed to determine risk factors for delayed bleeding following p-EMR.  Data were analyzed from a prospective tertiary center audit of patients with NPCPs ≥ 20 mm who underwent p-EMR between 2010 and 2012. Patient, polyp, and procedure-related data were collected. Four post p-EMR defect factors were evaluated for interobserver agreement and included in analysis. Delayed bleeding severity was reported in accordance with guidelines. Predictors of bleeding were identified.  Delayed bleeding requiring hospitalization occurred after 22 of 330 procedures (6.7 %). A total of 11 patients required blood transfusion; of these, 4 underwent urgent colonoscopy, 1 underwent radiological embolization, and 1 required surgery. Interobserver agreement for identification of the four post p-EMR defect factors was moderate (kappa range 0.52 - 0.57). Factors associated with delayed bleeding were visible muscle fibers ( P  = 0.03) and the presence of a "cherry red spot" ( P  = 0.05) in the post p-EMR defect. Factors not associated with delayed bleeding were American Association of Anesthesiologists class, aspirin use, polyp size, site, and use of argon plasma coagulation.  Visible muscle fibers and the presence of a "cherry red spot" in the resection defect were associated with delayed bleeding after p-EMR. These findings suggest evaluation and photodocumentation of the post p-EMR defect is important and, when considered alongside other patient and procedural factors, may help to reduce the incidence and severity of delayed bleeding. © Georg Thieme Verlag KG Stuttgart · New York.

IUS prerelease alignment

NASA Technical Reports Server (NTRS)

Evans, F. A.

1978-01-01

Space shuttle orbiter/IUS alignment transfer was evaluated. Although the orbiter alignment accuracy was originally believed to be the major contributor to the overall alignment transfer error, it was shown that orbiter alignment accuracy is not a factor affecting IUS alignment accuracy, if certain procedures are followed. Results are reported of alignment transfer accuracy analysis.

A Model of Objective Weighting for EIA.

ERIC Educational Resources Information Center

Ying, Long Gen; Liu, You Ci

1995-01-01

In the research of environmental impact assessment (EIA), the problem of weight distribution for a set of parameters has not yet been properly solved. Presents an approach of objective weighting by using a procedure of Pij principal component-factor analysis (Pij PCFA), which suits specifically those parameters measured directly by physical…

Restraint Procedures and Challenging Behaviours in Intellectual Disability: An Analysis of Causative Factors

ERIC Educational Resources Information Center

Matson, Johnny L.; Boisjoli, Jessica A.

2009-01-01

Background: Persons with intellectual disability often evince challenging behaviours. Efforts have been underway for some time to develop prosocial or positive skill acquisition treatments to address challenging behaviours. However, physical/mechanical and chemical restraint is still commonly used in many clinical and community settings. Such…

40 CFR 86.1823-08 - Durability demonstration procedures for exhaust emissions.

Code of Federal Regulations, 2012 CFR

2012-07-01

... delivers the appropriate exhaust flow, exhaust constituents, and exhaust temperature to the face of the... vehicles. (2) This data set must consist of randomly procured vehicles from actual customer use. The... equivalency factor. (C) The manufacturer must submit an analysis which evaluates whether the durability...

An Aggregate IRT Procedure for Exploratory Factor Analysis

ERIC Educational Resources Information Center

Camilli, Gregory; Fox, Jean-Paul

2015-01-01

An aggregation strategy is proposed to potentially address practical limitation related to computing resources for two-level multidimensional item response theory (MIRT) models with large data sets. The aggregate model is derived by integration of the normal ogive model, and an adaptation of the stochastic approximation expectation maximization…

A Typology of Students Based on Academic Entitlement

ERIC Educational Resources Information Center

Luckett, Michael; Trocchia, Philip J.; Noel, Noel Mark; Marlin, Dan

2017-01-01

Two hundred ninety-three university business students were surveyed using an academic entitlement (AE) scale updated to include new technologies. Using factor analysis, three components of AE were identified: grade entitlement, behavioral entitlement, and service entitlement. A k-means clustering procedure was then applied to identify four groups…

Dynamic Assessment: An Approach Toward Reducing Test Bias.

ERIC Educational Resources Information Center

Carlson, Jerry S.; Wiedl, Karl Heinz

Through dynamic testing (the notion that tailored testing can be extended to the use of a learning oriented approach to assessment), analysis were made of how motivational, personality, and cognitive style factors interact with assessment approaches to yield performance data. Testing procedures involving simple feedback, elaborated feedback, and…

Evaluating the appropriate level of service for Michigan rest areas and welcome centers considering safety and economic factors.

DOT National Transportation Integrated Search

2012-04-30

Research was performed to determine the value of public rest areas in Michigan, including welcome : centers. A benefit/cost (B/C) economic analysis procedure was utilized to assess rest areas both : individually and as a system. The benefits associat...

5 CFR 2610.107 - Allowable fees and expenses.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 5 Administrative Personnel 3 2010-01-01 2010-01-01 false Allowable fees and expenses. 2610.107 Section 2610.107 Administrative Personnel OFFICE OF GOVERNMENT ETHICS ORGANIZATION AND PROCEDURES... factors as may bear on the value of the services provided. (d) The reasonable cost of any study, analysis...

Student Satisfaction with Online Learning: Is It a Psychological Contract?

ERIC Educational Resources Information Center

Dziuban, Charles; Moskal, Patsy; Thompson, Jessica; Kramer, Lauren; DeCantis, Genevieve; Hermsdorfer, Andrea

2015-01-01

The authors explore the possible relationship between student satisfaction with online learning and the theory of psychological contracts. The study incorporates latent trait models using the image analysis procedure and computation of Anderson and Rubin factors scores with contrasts for students who are satisfied, ambivalent, or dissatisfied with…

Strainrange partitioning behavior of an automotive turbine alloy

NASA Technical Reports Server (NTRS)

Annis, C. G.; Vanwanderham, M. C.; Wallace, R. M.

1976-01-01

This report addresses Strainrange Partitioning, an advanced life prediction analysis procedure, as applied to CA-101 (cast IN 792 + Hf), an alloy proposed for turbine disks in automotive gas turbine engines. The methodology was successful in predicting specimen life under thermal-mechanical cycling, to within a factor of + or - 2.

Predictors of Youth Violence. Juvenile Justice Bulletin.

ERIC Educational Resources Information Center

Hawkins, J. David; Herrenkohl, Todd I.; Farrington, David P.; Brewer, Devon; Catalano, Richard F.; Harachi, Tracy W.; Cothern, Lynn

This Bulletin describes the strength and duration of changeable risk and protective factors for youth violence at points in youth development when they appear most salient. These predictors are potential targets for prevention and intervention. The quantitative results of a large number of studies were synthesized using meta-analysis procedures.…

Bayesian Adaptive Lasso for Ordinal Regression with Latent Variables

ERIC Educational Resources Information Center

Feng, Xiang-Nan; Wu, Hao-Tian; Song, Xin-Yuan

2017-01-01

We consider an ordinal regression model with latent variables to investigate the effects of observable and latent explanatory variables on the ordinal responses of interest. Each latent variable is characterized by correlated observed variables through a confirmatory factor analysis model. We develop a Bayesian adaptive lasso procedure to conduct…

Investigating Students' Mathematical Difficulties with Quadratic Equations

ERIC Educational Resources Information Center

O'Connor, Bronwyn Reid; Norton, Stephen

2016-01-01

This paper examines the factors that hinder students' success in working with and understanding the mathematics of quadratic equations using a case study analysis of student error patterns. Twenty-five Year 11 students were administered a written test to examine their understanding of concepts and procedures associated with this topic. The…

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

PubMed Central

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

2014-01-01

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

Evidence-based value of subcutaneous surgical wound drainage: the largest systematic review and meta-analysis.

PubMed

Kosins, Aaron M; Scholz, Thomas; Cetinkaya, Mine; Evans, Gregory R D

2013-08-01

The purpose of this study was to determine the evidenced-based value of prophylactic drainage of subcutaneous wounds in surgery. An electronic search was performed. Articles comparing subcutaneous prophylactic drainage with no drainage were identified and classified by level of evidence. If sufficient randomized controlled trials were included, a meta-analysis was performed using the random-effects model. Fifty-two randomized controlled trials were included in the meta-analysis, and subgroups were determined by specific surgical procedures or characteristics (cesarean delivery, abdominal wound, breast reduction, breast biopsy, femoral wound, axillary lymph node dissection, hip and knee arthroplasty, obesity, and clean-contaminated wound). Studies were compared for the following endpoints: hematoma, wound healing issues, seroma, abscess, and infection. Fifty-two studies with a total of 6930 operations were identified as suitable for this analysis. There were 3495 operations in the drain group and 3435 in the no-drain group. Prophylactic subcutaneous drainage offered a statistically significant advantage only for (1) prevention of hematomas in breast biopsy procedures and (2) prevention of seromas in axillary node dissections. In all other procedures studied, drainage did not offer an advantage. Many surgical operations can be performed safely without prophylactic drainage. Surgeons can consider omitting drains after cesarean section, breast reduction, abdominal wounds, femoral wounds, and hip and knee joint replacement. Furthermore, surgeons should consider not placing drains prophylactically in obese patients. However, drain placement following a surgical procedure is the surgeon's choice and can be based on multiple factors beyond the type of procedure being performed or the patient's body habitus. Therapeutic, II.

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

PubMed

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

2014-01-01

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

Prevention of bleeding after islet transplantation: lessons learned from a multivariate analysis of 132 cases at a single institution.

PubMed

Villiger, P; Ryan, E A; Owen, R; O'Kelly, K; Oberholzer, J; Al Saif, F; Kin, T; Wang, H; Larsen, I; Blitz, S L; Menon, V; Senior, P; Bigam, D L; Paty, B; Kneteman, N M; Lakey, J R T; Shapiro, A M James

2005-12-01

Islet transplantation is being offered increasingly for selected patients with unstable type 1 diabetes. Percutaneous transhepatic portal access avoids a need for surgery, but is associated with potential risk of bleeding. Between 1999 and 2005, we performed 132 percutaneous transhepatic islet transplants in 67 patients. We encountered bleeding in 18/132 cases (13.6%). In univariate analysis, the risk of bleeding in the absence of effective track ablation was associated with an increasing number of procedures (2nd and 3rd procedures with an odds ratio (OR) of 9.5 and 20.9, respectively), platelets count <150,000 (OR 4.4), elevated portal pressure (OR 1.1 per mm Hg rise), heparin dose > or =45 U/kg (OR 9.8) and pre-transplant aspirin (81 mg per day) (OR 2.6, p = 0.05). A multivariate analysis further confirmed the cumulative transplant procedure number (p < 0.001) and heparin dose > or =45 U/kg (p = 0.02) as independent risk factors for bleeding. Effective mechanical sealing of the intrahepatic portal catheter tract with thrombostatic coils and tissue fibrin glue completely prevented bleeding in all subsequent procedures (n = 26, p = 0.02). We conclude that bleeding after percutaneous islet implantation is an avoidable complication provided the intraparenchymal liver tract is sealed effectively.

Motives for cosmetic procedures in Saudi women.

PubMed

Al-Natour, Sahar H

2014-01-01

The media-fuelled obsession with beauty in modern society has led more women to seek elective cosmetic procedures to meet the portrayed ideals of beauty in different cultures. This study gives insights into incentives and desires to undergo cosmetic procedures in a conservative society with strict religious practices where women are veiled. Questionnaire data were obtained from 509 Saudi women who responded to a survey distributed randomly to a sample of Saudi women aged 17 to 72 years. At least 1 elective cosmetic procedure was performed in 42% of the women, of whom 77.8% wore a veil. Another 33% considered having a procedure. The motives for seeking a cosmetic procedure were to improve self-esteem in 83.7%, attract a husband in 63.3%, or prevent a husband from seeking another wife in 36.2%. The decision to seek a procedure was affected by the media, with high peer influence. Motivation for elective cosmetic procedures in Saudi women is influenced by a combination of emotional and cultural factors, level of education, marital status, and religious beliefs. The veil is not an impediment for seeking such procedures. The limitation of the study was missing data analysis as some items in the questionnaire were completed inaccurately or left unanswered.

Parallel-vector computation for linear structural analysis and non-linear unconstrained optimization problems

NASA Technical Reports Server (NTRS)

Nguyen, D. T.; Al-Nasra, M.; Zhang, Y.; Baddourah, M. A.; Agarwal, T. K.; Storaasli, O. O.; Carmona, E. A.

1991-01-01

Several parallel-vector computational improvements to the unconstrained optimization procedure are described which speed up the structural analysis-synthesis process. A fast parallel-vector Choleski-based equation solver, pvsolve, is incorporated into the well-known SAP-4 general-purpose finite-element code. The new code, denoted PV-SAP, is tested for static structural analysis. Initial results on a four processor CRAY 2 show that using pvsolve reduces the equation solution time by a factor of 14-16 over the original SAP-4 code. In addition, parallel-vector procedures for the Golden Block Search technique and the BFGS method are developed and tested for nonlinear unconstrained optimization. A parallel version of an iterative solver and the pvsolve direct solver are incorporated into the BFGS method. Preliminary results on nonlinear unconstrained optimization test problems, using pvsolve in the analysis, show excellent parallel-vector performance indicating that these parallel-vector algorithms can be used in a new generation of finite-element based structural design/analysis-synthesis codes.

On the performance of tests for the detection of signatures of selection: a case study with the Spanish autochthonous beef cattle populations.

PubMed

González-Rodríguez, Aldemar; Munilla, Sebastián; Mouresan, Elena F; Cañas-Álvarez, Jhon J; Díaz, Clara; Piedrafita, Jesús; Altarriba, Juan; Baro, Jesús Á; Molina, Antonio; Varona, Luis

2016-10-28

Procedures for the detection of signatures of selection can be classified according to the source of information they use to reject the null hypothesis of absence of selection. Three main groups of tests can be identified that are based on: (1) the analysis of the site frequency spectrum, (2) the study of the extension of the linkage disequilibrium across the length of the haplotypes that surround the polymorphism, and (3) the differentiation among populations. The aim of this study was to compare the performance of a subset of these procedures by using a dataset on seven Spanish autochthonous beef cattle populations. Analysis of the correlations between the logarithms of the statistics that were obtained by 11 tests for detecting signatures of selection at each single nucleotide polymorphism confirmed that they can be clustered into the three main groups mentioned above. A factor analysis summarized the results of the 11 tests into three canonical axes that were each associated with one of the three groups. Moreover, the signatures of selection identified with the first and second groups of tests were shared across populations, whereas those with the third group were more breed-specific. Nevertheless, an enrichment analysis identified the metabolic pathways that were associated with each group; they coincided with canonical axes and were related to immune response, muscle development, protein biosynthesis, skin and pigmentation, glucose metabolism, fat metabolism, embryogenesis and morphology, heart and uterine metabolism, regulation of the hypothalamic-pituitary-thyroid axis, hormonal, cellular cycle, cell signaling and extracellular receptors. We show that the results of the procedures used to identify signals of selection differed substantially between the three groups of tests. However, they can be classified using a factor analysis. Moreover, each canonical factor that coincided with a group of tests identified different signals of selection, which could be attributed to processes of selection that occurred at different evolutionary times. Nevertheless, the metabolic pathways that were associated with each group of tests were similar, which suggests that the selection events that occurred during the evolutionary history of the populations probably affected the same group of traits.

Selective Mutism Questionnaire: measurement structure and validity.

PubMed

Letamendi, Andrea M; Chavira, Denise A; Hitchcock, Carla A; Roesch, Scott C; Shipon-Blum, Elisa; Stein, Murray B

2008-10-01

To evaluate the factor structure, reliability, and validity of the 17-item Selective Mutism Questionnaire (SMQ). Diagnostic interviews were administered via telephone to 102 parents of children identified with selective mutism (SM) and 43 parents of children without SM from varying U.S. geographic regions. Children were between the ages of 3 and 11 inclusive and comprised 58% girls and 42% boys. SM diagnoses were determined using the Anxiety Disorders Interview Schedule for Children-Parent Version; SM severity was assessed using the 17-item SMQ; and behavioral and affective symptoms were assessed using the Child Behavior Checklist. An exploratory factor analysis was conducted to investigate the dimensionality of the SMQ and a modified parallel analysis procedure was used to confirm exploratory factor analysis results. Internal consistency, construct validity, and incremental validity were also examined. The exploratory factor analysis yielded a 13-item solution consisting of three factors: social situations outside of school, school situations, and home and family situations. Internal consistency of SMQ factors and total scale ranged from moderate to high. Convergent and incremental validity was also well supported. Measure structure findings are consistent with the three-factor solution found in a previous psychometric evaluation of the SMQ. Results also suggest that the SMQ provides useful and unique information in the prediction of SM phenomena beyond other child anxiety measures.

First Outbreak with MRSA in a Danish Neonatal Intensive Care Unit: Risk Factors and Control Procedures

PubMed Central

Ramsing, Benedicte Grenness Utke; Arpi, Magnus; Andersen, Erik Arthur; Knabe, Niels; Mogensen, Dorthe; Buhl, Dorte; Westh, Henrik; Østergaard, Christian

2013-01-01

Introduction The purpose of the study was to describe demographic and clinical characteristics and outbreak handling of a large methicillin-resistant Staphylococcus aureus (MRSA) outbreak in a neonatal intensive care unit (NICU) in Denmark June 25th–August 8th 2008, and to identify risk factors for MRSA transmission. Methods Data were collected retrospectively from medical records and the Danish Neobase database. All MRSA isolates obtained from neonates, relatives and NICU health care workers (HCW) as well as environmental cultures were typed. Results During the 46 day outbreak period, 102 neonates were admitted to the two neonatal wards. Ninety-nine neonates were subsequently sampled, and 32 neonates (32%) from 25 families were colonized with MRSA (spa-type t127, SCCmec V, PVL negative). Thirteen family members from 11 of those families (44%) and two of 161 HCWs (1%) were colonized with the same MRSA. No one was infected. Five environmental cultures were MRSA positive. In a multiple logistic regression analysis, nasal Continuous Positive Airway Pressure (nCPAP) treatment (p = 0.006) and Caesarean section (p = 0.016) were independent risk factors for MRSA acquisition, whereas days of exposure to MRSA was a risk factors in the unadjusted analysis (p = 0.04). Conclusions MRSA transmission occurs with high frequency in the NICU during hospitalization with unidentified MRSA neonates. Caesarean section and nCPAP treatment were identified as risk factors for MRSA colonization. The MRSA outbreak was controlled through infection control procedures. PMID:23825581

Organizational Justice and Physiological Coronary Heart Disease Risk Factors in Japanese Employees: a Cross-Sectional Study.

PubMed

Inoue, Akiomi; Kawakami, Norito; Eguchi, Hisashi; Miyaki, Koichi; Tsutsumi, Akizumi

2015-12-01

Growing evidence has shown that lack of organizational justice (i.e., procedural justice and interactional justice) is associated with coronary heart disease (CHD) while biological mechanisms underlying this association have not yet been fully clarified. The purpose of the present study was to investigate the cross-sectional association of organizational justice with physiological CHD risk factors (i.e., blood pressure, high-density lipoprotein [HDL] cholesterol, low-density lipoprotein [LDL] cholesterol, and triglyceride) in Japanese employees. Overall, 3598 male and 901 female employees from two manufacturing companies in Japan completed self-administered questionnaires measuring organizational justice, demographic characteristics, and lifestyle factors. They completed health checkup, which included blood pressure and serum lipid measurements. Multiple logistic regression analyses and trend tests were conducted. Among male employees, multiple logistic regression analyses and trend tests showed significant associations of low procedural justice and low interactional justice with high triglyceride (defined as 150 mg/dL or greater) after adjusting for demographic characteristics and lifestyle factors. Among female employees, trend tests showed significant dose-response relationship between low interactional justice and high LDL cholesterol (defined as 140 mg/dL or greater) while multiple logistic regression analysis showed only marginally significant or insignificant odds ratio of high LDL cholesterol among the low interactional justice group. Neither procedural justice nor interactional justice was associated with blood pressure or HDL cholesterol. Organizational justice may be an important psychosocial factor associated with increased triglyceride at least among Japanese male employees.

Proper muscle layer damage affects ulcer healing after gastric endoscopic submucosal dissection.

PubMed

Horikawa, Yohei; Mimori, Nobuya; Mizutamari, Hiroya; Kato, Yuhei; Shimazu, Kazuhiro; Sawaguchi, Masayuki; Tawaraya, Shin; Igarashi, Kimihiro; Okubo, Syunji

2015-11-01

Endoscopic submucosal dissection (ESD) is the established therapy for superficial gastrointestinal neoplasms. However, management of the artificial ulcers associated with ESD has become important and the relationship between ulcer healing factors and treatment is still unclear. We aimed to evaluate ESD-related artificial ulcer reduction ratio at 4 weeks to assess factors associating with ulcer healing after ESD that may lead to optimal treatment. Between January 2009 and December 2013, a total of 375 lesions fulfilled the expanded criteria for ESD. We defined ulcer reduction rate <90% as (A) poor-healing group; and rate ≥90% as (B) well-healing group. After exclusion, 328 lesions were divided into two groups and analyzed. These two groups were compared based on clinicopathological/endoscopic features, concomitant drugs, and treatment. Ulcer reduction rate was significantly correlated with factors related to the ESD procedure (i.e. procedure time, submucosal fibrosis, and injury of the proper muscle layer, in univariate analysis. Multivariate logistic regression analysis showed that submucosal fibrosis (F2) (P = 0.03; OR, 16.46; 95% CI, 1.31-206.73) and injury of the proper muscle layer (P = 0.01; OR, 4.27; 95% CI, 2.04-8.92) were statistically significant predictors of delayed healing. This single-center retrospective study indicated that ESD-induced artificial ulcer healing was affected by submucosal fibrosis and injury of the proper muscle layer, which induced damage to the muscle layer. Therefore, the preferable pharmacotherapy can be determined on completion of the ESD procedure. © 2015 The Authors Digestive Endoscopy © 2015 Japan Gastroenterological Endoscopy Society.

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

Ahmed, Osman, E-mail: osman1423@gmail.com; Patel, Mikin V.; Masrani, Abdulrahman

PurposeTo report hepatic arterial-related complications encountered during planning and treatment angiograms for radioembolization and understand any potential-associated risk factors.Materials and Methods518 mapping or treatment angiograms for 180 patients with primary or metastatic disease to the liver treated by Yttrium-90 radioembolization between 2/2010 and 12/2015 were retrospectively reviewed. Intra-procedural complications were recorded per SIR guidelines. Patient demographics, indication for treatment, prior exposure to chemotherapeutic agents, operator experience, and disease burden were reviewed. Technical variables including type of radioembolic (glass vs. resin microspheres), indication for angiography (mapping vs. treatment), variant anatomy, and attempts at coil embolization were also assessed.ResultsThirteen (13/518, 2.5%) arterial-relatedmore » complications occurred in 13 patients. All but two complications resulted during transcatheter coil embolization to prevent non-target embolization. Complications included coil migration (n = 6), arterial dissection (n = 2), focal vessel perforation (n = 2), arterial thrombus (n = 2), and vasospasm prohibiting further arterial sub-selection (n = 1). Transarterial coiling was identified as a significant risk factor of complications on both univariate and multivariate regression analysis (odds ratio 7.8, P = 0.004). Usage of resin microspheres was also a significant risk factor (odds ratio 9.5, P = 0.042). No other technical parameters or pre-procedural variables were significant after adjusting for confounding on multivariate analysis (P > 0.05).ConclusionIntra-procedural hepatic arterial complications encountered during radioembolization were infrequent but occurred mainly during coil embolization to prevent non-target delivery to extra-hepatic arteries.« less

Cultural adaptation in measuring common client characteristics with an urban Mainland Chinese sample.

PubMed

Song, Xiaoxia; Anderson, Timothy; Beutler, Larry E; Sun, Shijin; Wu, Guohong; Kimpara, Satoko

2015-01-01

This study aimed to develop a culturally adapted version of the Systematic Treatment Selection-Innerlife (STS) in China. A total of 300 nonclinical participants collected from Mainland China and 240 nonclinical US participants were drawn from archival data. A Chinese version of the STS was developed, using translation and back-translation procedures. After confirmatory factor analysis (CFA) of the original STS sub scales failed on both samples, exploratory factor analysis (EFA) was then used to access whether a simple structure would emerge on these STS treatment items. Parallel analysis and minimum average partial were used to determine the number of factor to retain. Three cross-cultural factors were found in this study, Internalized Distress, Externalized Distress and interpersonal relations. This supported that regardless of whether one is in presumably different cultural contexts of the USA or China, psychological distress is expressed in a few basic channels of internalized distress, externalized distress, and interpersonal relations, from which different manifestations in different culture were also discussed.

Component Selection for Sterile Compounding.

PubMed

Dilzer, Richard H

2017-01-01

This article describes the factors to consider, as well as the process of proper component selection, for use in preparing compounded sterile preparations. Special emphasis is placed on individual chemical factors that may impact a preparation's accuracy and potency. Values reported in a typical certificate of analysis are discussed, including methods of identifying any required adjustments to a master formulation or compounding record during the compounding of sterile preparations. Proper screening of the certificate of analysis, the Safety Data Sheet, procedural documentation, and the filing of all certificates of conformance are crucial to the operation of a sterile compounding facility. Copyright© by International Journal of Pharmaceutical Compounding, Inc.

Hybrid-finite-element analysis of some nonlinear and 3-dimensional problems of engineering fracture mechanics

NASA Technical Reports Server (NTRS)

Atluri, S. N.; Nakagaki, M.; Kathiresan, K.

1980-01-01

In this paper, efficient numerical methods for the analysis of crack-closure effects on fatigue-crack-growth-rates, in plane stress situations, and for the solution of stress-intensity factors for arbitrary shaped surface flaws in pressure vessels, are presented. For the former problem, an elastic-plastic finite element procedure valid for the case of finite deformation gradients is developed and crack growth is simulated by the translation of near-crack-tip elements with embedded plastic singularities. For the latter problem, an embedded-elastic-singularity hybrid finite element method, which leads to a direct evaluation of K-factors, is employed.

Impacts of biological and procedural factors on semiquantification uptake value of liver in fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography imaging.

PubMed

Mahmud, Mohd Hafizi; Nordin, Abdul Jalil; Ahmad Saad, Fathinul Fikri; Azman, Ahmad Zaid Fattah

2015-10-01

Increased metabolic activity of fluorodeoxyglucose (FDG) in tissue is not only resulting of pathological uptake, but due to physiological uptake as well. This study aimed to determine the impacts of biological and procedural factors on FDG uptake of liver in whole body positron emission tomography/computed tomography (PET/CT) imaging. Whole body fluorine-18 ((18)F) FDG PET/CT scans of 51 oncology patients have been reviewed. Maximum standardized uptake value (SUVmax) of lesion-free liver was quantified in each patient. Pearson correlation was performed to determine the association between the factors of age, body mass index (BMI), blood glucose level, FDG dose and incubation period and liver SUVmax. Multivariate regression analysis was established to determine the significant factors that best predicted the liver SUVmax. Then the subjects were dichotomised into four BMI groups. Analysis of variance (ANOVA) was established for mean difference of SUVmax of liver between those BMI groups. BMI and incubation period were significantly associated with liver SUVmax. These factors were accounted for 29.6% of the liver SUVmax variance. Statistically significant differences were observed in the mean SUVmax of liver among those BMI groups (P<0.05). BMI and incubation period are significant factors affecting physiological FDG uptake of liver. It would be recommended to employ different cut-off value for physiological liver SUVmax as a reference standard for different BMI of patients in PET/CT interpretation and use a standard protocol for incubation period of patient to reduce variation in physiological FDG uptake of liver in PET/CT study.

Factor analysis in optimization of formulation of high content uniformity tablets containing low dose active substance.

PubMed

Lukášová, Ivana; Muselík, Jan; Franc, Aleš; Goněc, Roman; Mika, Filip; Vetchý, David

2017-11-15

Warfarin is intensively discussed drug with narrow therapeutic range. There have been cases of bleeding attributed to varying content or altered quality of the active substance. Factor analysis is useful for finding suitable technological parameters leading to high content uniformity of tablets containing low amount of active substance. The composition of tabletting blend and technological procedure were set with respect to factor analysis of previously published results. The correctness of set parameters was checked by manufacturing and evaluation of tablets containing 1-10mg of warfarin sodium. The robustness of suggested technology was checked by using "worst case scenario" and statistical evaluation of European Pharmacopoeia (EP) content uniformity limits with respect to Bergum division and process capability index (Cpk). To evaluate the quality of active substance and tablets, dissolution method was developed (water; EP apparatus II; 25rpm), allowing for statistical comparison of dissolution profiles. Obtained results prove the suitability of factor analysis to optimize the composition with respect to batches manufactured previously and thus the use of metaanalysis under industrial conditions is feasible. Copyright © 2017 Elsevier B.V. All rights reserved.

Factors associated with no dental treatment in preschoolers with toothache: a cross-sectional study in outpatient public emergency services.

PubMed

Machado, Geovanna C M; Daher, Anelise; Costa, Luciane R

2014-08-08

Many parents rely on emergency services to deal with their children's dental problems, mostly pain and infection associated with dental caries. This cross-sectional study analyzed the factors associated with not doing an oral procedure in preschoolers with toothache attending public dental emergency services. Data were obtained from the clinical files of preschoolers treated at all nine dental emergency centers in Goiania, Brazil, in 2011. Data were children's age and sex, involved teeth, oral procedures, radiography request, medications prescribed and referrals. A total of 531 files of children under 6 years old with toothache out of 1,108 examined were selected. Children's mean age was 4.1 (SD 1.0) years (range 1-5 years) and 51.6% were girls. No oral procedures were performed in 49.2% of cases; in the other 50.8%, most of the oral procedures reported were endodontic intervention and temporary restorations. Primary molars were involved in 48.4% of cases. With the exception of "sex", the independent variables tested in the regression analysis significantly associated with non-performance of oral procedures: age (OR 0.7; 95% CI 0.5-0.8), radiography request (OR 3.8; 95% CI 1.7-8.2), medication prescribed (OR 7.5; 95% CI 4.9-11.5) and patient referred to another service (OR 5.7; 3.0-10.9). Many children with toothache received no oral procedure for pain relief.

What are the Rates, Reasons, and Risk Factors of 90-day Hospital Readmission After Lumbar Discectomy?: An Institutional Experience.

PubMed

Kohls, Morgan R; Jain, Nikhil; Khan, Safdar N

2018-06-07

This is a retrospective cohort study. To report the rate, reasons, and risk factors for 90-day readmissions after lumbar discectomy at an academic medical center. Several studies have reported complications and readmissions after spine surgery; however, only one previous study has focused specifically on lumbar discectomy. As the patient profile and morbidity of various spine procedures is different, focus on procedure-specific complications and readmissions will be beneficial. Patients who underwent lumbar discectomy for unrelieved symptoms of prolapsed intervertebral disk and had at least 90 days of follow-up at an academic institution (2013-2014) were included. Retrospective review of electronic medical record was performed to record demographic and clinical profile of patients. Details of lumbar discectomy, index hospital stay, discharge disposition, hospital readmission within 90 days, reason for readmission and treatment given have been reported. Risk factors for hospital readmission were analyzed by multivariate logistic regression analysis. A total of 356 patients with a mean age of 45.0±13.8 years were included. The 90-day readmission rate was 5.3% (19/360) of which two-third patients were admitted within 30 days giving a 30-day readmission rate of 3.7% (13/356). The top 2 primary reasons for readmission included back and/or leg pain, numbness, or tingling (42.9%), and persistent cerebrospinal fluid leak or seroma (25.0%). On adjusted analysis, risk factors associated with higher risk of readmission included incidental durotomy [odds ratio (OR), 26.2; 95% confidence interval (CI), 5.3-129.9] and discharge to skilled nursing facility/inpatient rehabilitation (OR, 25.2; 95% CI, 2.7-235.2). Increasing age was a negative predictor of readmission (OR, 0.95; 95% CI, 0.91-0.99). Incidental durotomy, younger age, and discharge to nursing facility were associated with higher risk of 90-day hospital readmission after lumbar discectomy. As compared with extensive spine procedures, patient comorbidity burden may not be as significant in predicting readmission after this relatively less invasive procedure.

Principal component regression analysis with SPSS.

PubMed

Liu, R X; Kuang, J; Gong, Q; Hou, X L

2003-06-01

The paper introduces all indices of multicollinearity diagnoses, the basic principle of principal component regression and determination of 'best' equation method. The paper uses an example to describe how to do principal component regression analysis with SPSS 10.0: including all calculating processes of the principal component regression and all operations of linear regression, factor analysis, descriptives, compute variable and bivariate correlations procedures in SPSS 10.0. The principal component regression analysis can be used to overcome disturbance of the multicollinearity. The simplified, speeded up and accurate statistical effect is reached through the principal component regression analysis with SPSS.

Electromagnetic Compatibility (EMC) in Microelectronics.

DTIC Science & Technology

1983-02-01

Fault Tree Analysis", System Saftey Symposium, June 8-9, 1965, Seattle: The Boeing Company . 12. Fussell, J.B., "Fault Tree Analysis-Concepts and...procedure for assessing EMC in microelectronics and for applying DD, 1473 EOiTO OP I, NOV6 IS OESOL.ETE UNCLASSIFIED SECURITY CLASSIFICATION OF THIS...CRITERIA 2.1 Background 2 2.2 The Probabilistic Nature of EMC 2 2.3 The Probabilistic Approach 5 2.4 The Compatibility Factor 6 3 APPLYING PROBABILISTIC

Guidelines for spaceborne microwave remote sensors

NASA Technical Reports Server (NTRS)

Litman, V.; Nicholas, J.

1982-01-01

A handbook was developed to provide information and support to the spaceborne remote sensing and frequency management communities: to guide sensor developers in the choice of frequencies; to advise regulators on sensor technology needs and sharing potential; to present sharing analysis models and, through example, methods for determining sensor sharing feasibility; to introduce developers to the regulatory process; to create awareness of proper assignment procedures; to present sensor allocations; and to provide guidelines on the use and limitations of allocated bands. Controlling physical factors and user requirements and the regulatory environment are discussed. Sensor frequency allocation achievable performance and usefulness are reviewed. Procedures for national and international registration, the use of non-allocated bands and steps for obtaining new frequency allocations, and procedures for reporting interference are also discussed.

Adverse cardiac events in children with Williams syndrome undergoing cardiovascular surgery: An analysis of the Society of Thoracic Surgeons Congenital Heart Surgery Database.

PubMed

Hornik, Christoph P; Collins, Ronnie Thomas; Jaquiss, Robert D B; Jacobs, Jeffrey P; Jacobs, Marshall L; Pasquali, Sara K; Wallace, Amelia S; Hill, Kevin D

2015-06-01

Patients with Williams syndrome (WS) undergoing cardiac surgery are at risk for major adverse cardiac events (MACE). Prevalence and risk factors for such events have not been well described. We sought to define frequency and risk of MACE in patients with WS using a multicenter clinical registry. We identified cardiac operations performed in patients with WS using the Society of Thoracic Surgeons Congenital Heart Surgery Database (2000-2012). Operations were divided into 4 groups: isolated supravalvular aortic stenosis, complex left ventricular outflow tract (LVOT), isolated right ventricular outflow tract (RVOT), and combined LVOT/RVOT procedures. The proportion of patients with MACE (in-hospital mortality, cardiac arrest, or postoperative mechanical circulatory support) was described and the association with preoperative factors was examined. Of 447 index operations (87 centers), median (interquartile range) age and weight at surgery were 2.4 years (0.6-7.4 years) and 10.6 kg (6.5-21.5 kg), respectively. Mortality occurred in 20 patients (5%). MACE occurred in 41 patients (9%), most commonly after combined LVOT/RVOT (18 out of 87; 21%) and complex LVOT (12 out of 131; 9%) procedures, but not after isolated RVOT procedures. Odds of MACE decreased with age (odds ratio [OR], 0.99; 95% confidence interval [CI], 0.98-0.99), weight (OR, 0.97; 95% CI, 0.93-0.99), but increased in the presence of any preoperative risk factor (OR, 2.08; 95% CI, 1.06-4.00), and in procedures involving coronary artery repair (OR, 5.37; 95% CI, 2.05-14.06). In this multicenter analysis, MACE occurred in 9% of patients with WS undergoing cardiac surgery. Demographic and operative characteristics were associated with risk. Further study is needed to elucidate mechanisms of MACE in this high-risk population. Copyright © 2015 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

Academic status does not affect outcome following complex hepato-pancreato-biliary procedures.

PubMed

Altieri, Maria S; Yang, Jie; Groves, Donald; Yin, Donglei; Cagino, Kristen; Talamini, Mark; Pryor, Aurora

2018-05-01

There is a growing debate regarding outcomes following complex hepato-pancreato-biliary (HPB) procedures. The purpose of our study is to examine if facility type has any impact on complications, readmission rates, emergency department (ED) visit rates, and length of stay (LOS) for patients undergoing HPB surgery. The SPARCS administrative database was used to identify patients undergoing complex HPB procedures between 2012 and 2014 in New York. Univariate generalized linear mixed models were fit to estimate the marginal association between outcomes such as overall/severe complication rates, 30-day and 1-year readmission rates, 30-day and 1-year ED-visit rates, and potential risk factors. Univariate linear mixed models were used to estimate the marginal association between possible risk factors and LOS. Facility type, as well as any variables found to be significant in our univariate analysis (p = 0.05), was further included in the multivariable regression models. There were 4122 complex HPB procedures performed. Academic facilities were more likely to have a higher hospital volume (p < 0001). Surgery at academic facilities were less likely to have coexisting comorbidities; however, they were more likely to have metastatic cancer and/or liver disease (p = 0.0114, < 0. 0001, and = 0.0299, respectively). Postoperatively, patients at non-academic facilities experienced higher overall complication rates, and higher severe complication rates, when compared to those at academic facilities (p < 0.0001 and = 0.0018, respectively). Further analysis via adjustment for possible confounding factors, however, revealed no significant difference in the risk of severe complications between the two facility types. Such adjustment also demonstrated higher 30-day readmission risk in patients who underwent their surgery at an academic facility. No significant difference was found when comparing the outcomes of academic and non-academic facilities, after adjusting for age, gender, race, region, insurance, and hospital volume. Patients from academic facilities were more likely to be readmitted within the first 30-days after surgery.

Factors affecting healing and survival after finger amputations in patients with digital artery occlusive disease.

PubMed

Landry, Gregory J; McClary, Ashley; Liem, Timothy K; Mitchell, Erica L; Azarbal, Amir F; Moneta, Gregory L

2013-05-01

Finger amputations are typically performed as distal as possible to preserve maximum finger length. Failure of primary amputation leads to additional procedures, which could potentially be avoided if a more proximal amputation was initially performed. The effect of single versus multiple procedures on morbidity and mortality is not known. We evaluated factors that predicted primary healing and the effects of secondary procedures on survival. Patients undergoing finger amputations from 1995 to 2011 were evaluated for survival with uni- and multivariate analysis of demographic data and preoperative vascular laboratory studies to assess factors influencing primary healing. Seventy-six patients underwent 175 finger amputations (range 1 to 6 fingers per patient). Forty-one percent had diabetes, 33% had nonatherosclerotic digital artery disease, and 29% were on dialysis. Sex distribution was equal. Primary healing occurred in 78.9%, with the remainder requiring revisions. By logistic regression analysis, nonatherosclerotic digital artery disease was associated with failure of primary healing (odds ratio = 7.5; 95% confidence interval, 1.03 to 54; P = .047). Digital photoplethysmography did not predict primary healing. The overall healing of primary and secondary finger amputations was 96.0%. The mean survival after the initial finger amputation was 34.3 months and did not differ between patients undergoing single (35.6 months) versus multiple procedures (33.6 months). Dialysis dependence was associated with decreased survival (hazard ratio = 2.9; 95% confidence interval, 1.13 to 7.25; P = .026). Failure of primary healing is associated with the presence of nonatherosclerotic digital artery disease and is not predicted by digital photoplethysmographic studies. Dialysis dependence is associated with decreased survival in patients with finger amputations, but failure of primary healing does not adversely affect survival. A strategy of aggressive preservation of finger length is appropriate for most patients. Copyright © 2013. Published by Elsevier Inc.

Risk factors for recurrent symptomatic pigmented biliary stones after percutaneous transhepatic biliary extraction.

PubMed

Kim, Dong Won; Lee, Sang Yun; Cho, Jin-Han; Kang, Myong Jin; Noh, Myung Hwan; Park, Byeong-Ho

2010-07-01

To evaluate risk factors for the recurrence of biliary stones after a percutaneous transhepatic biliary stone extraction. The procedures were performed on 339 patients between July 2004 and December 2008 (54 months). Medical records and images were retrospectively reviewed for 135 patients (mean age, 66.4 years; 83 men and 52 women) who had undergone follow-up for a mean of 13.2 months (range, 3-37 months). To evaluate risk factors for the recurrence of biliary stones, variables were evaluated with univariate and multivariate analyses. Variables included sex, age, stone location, number of stones, stone size, presence of a peripapillary diverticulum, application of antegrade sphincteroplasty, presence of a biliary stricture, largest biliary diameter before the procedure, and gallbladder status. Thirty-three of the 135 patients (24%) had recurrent symptomatic biliary stones and underwent an additional extraction. The mean time to recurrence was 17.2 months +/- 8.7. Univariate analysis of risk factors for recurrence of biliary stones demonstrated that location, number of stones, stone size, application of antegrade sphincteroplasty, presence of a biliary stricture, and biliary diameter were significant factors (P < .05). With use of multivariate analysis, the number of stones (> or =6; relative risk, 64.8; 95% confidence interval: 5.8, 717.6) and stone size (> or =14 mm; relative risk, 3.8; 95% confidence interval: 1.138, 13.231) were determined to be significant risk factors. The independent risk factors for recurrence of symptomatic biliary stones after percutaneous transhepatic biliary stone extraction were a stone size of at least 14 mm and the presence of at least six stones. Copyright 2010 SIR. Published by Elsevier Inc. All rights reserved.

Risk Factors for Proximal Junctional Kyphosis Associated With Dual-rod Growing-rod Surgery for Early-onset Scoliosis.

PubMed

Watanabe, Kota; Uno, Koki; Suzuki, Teppei; Kawakami, Noriaki; Tsuji, Taichi; Yanagida, Haruhisa; Ito, Manabu; Hirano, Toru; Yamazaki, Ken; Minami, Shohei; Taneichi, Hiroshi; Imagama, Shiro; Takeshita, Katsushi; Yamamoto, Takuya; Matsumoto, Morio

2016-10-01

A retrospective, multicenter study. To identify risk factors for proximal junctional kyphosis (PJK) when treating early-onset scoliosis (EOS) with dual-rod growing-rod (GR) procedure. The risk factors for PJK associated with GR treatment for EOS have not been adequately studied. We evaluated clinical and radiographic results from 88 patients with EOS who underwent dual-rod GR surgery in 12 spine centers in Japan. The mean age at the time of the initial surgery was 6.5±2.2 years (range, 1.5-9.8 y), and the mean follow-up period was 3.9±2.6 years (range, 2.0-12.0 y). Risk factors for PJK were analyzed by binomial multiple logistic regression analysis. The potential factors analyzed were sex, etiology, age, the number of rod-lengthening procedures, coronal and sagittal parameters on radiographs, the type of foundation (pedicle screws or hooks), the uppermost level of the proximal foundation, and the lowermost level of the distal foundation. PJK developed in 23 patients (26%); in 19 of these, the proximal foundation became dislodged following PJK. Binomial multiple logistic regression analysis identified the following significant independent risk factors for PJK: a lower instrumented vertebra at or cranial to L3 [odds ratio (OR), 3.32], a proximal thoracic scoliosis of ≥40 degrees (OR, 2.95), and a main thoracic kyphosis of ≥60 degrees (OR, 5.08). The significant independent risk factors for PJK during dual-rod GR treatment for EOS were a lower instrumented vertebra at or cranial to L3, a proximal thoracic scoliosis of ≥40 degrees, and a main thoracic kyphosis of ≥60 degrees.

Follow-Up of 58 Traumatic Carotid-Cavernous Fistulas after Endovascular Detachable-Balloon Embolization at a Single Center

PubMed Central

Xu, Xiao-Quan; Liu, Sheng; Zu, Qing-Quan; Zhao, Lin-Bo; Xia, Jin-Guo; Zhou, Chun-Gao; Zhou, Wei-Zhong

2013-01-01

Background and Purpose This study evaluated the clinical value of detachable-balloon embolization for traumatic carotid-cavernous fistula (TCCF), focusing on the frequency, risk factors, and retreatment of recurrence. Methods Fifty-eight patients with TCCF underwent transarterial detachable-balloon embolization between October 2004 and March 2011. The clinical follow-up was performed every 3 months until up to 3 years postprocedure. Each patient was placed in either the recurrence group or the nonrecurrence group according to whether a recurrence developed after the first procedure. The relevant factors including gender, fistula location, interval between trauma and the interventional procedure, blood flow in the carotid-cavernous fistula, number of balloons, and whether the internal carotid artery (ICA) was sacrificed were evaluated. Results All 58 TCCFs were successfully treated with transarterial balloon embolization, including 7 patients with ICA sacrifice. Recurrent fistulas occurred in seven patients during the follow-up period. Univariate analysis indicated that the interval between trauma and the interventional procedure (p=0.006) might be the main factor related to the recurrence of TCCF. The second treatments involved ICA sacrifice in two patients, fistula embolization with balloons in four patients, and placement of a covered stent in one patient. Conclusions Detachable balloons can still serve as the first-line treatment for TCCFs and recurrent TCCFs despite having a nonnegligible recurrence rate. Shortening the interval between trauma and the interventional procedure may reduce the risk of recurrence. PMID:23626645

Analysis of eccentric annular incompressible seals. II - Effects of eccentricity on rotordynamic coefficients

NASA Technical Reports Server (NTRS)

Nelson, C. C.; Nguyen, D. T.

1987-01-01

A new analysis procedure has been presented which solves for the flow variables of an annular pressure seal in which the rotor has a large static displacement (eccentricity) from the centered position. The present paper incorporates the solutions to investigate the effect of eccentricity on the rotordynamic coefficients. The analysis begins with a set of governing equations based on a turbulent bulk-flow model and Moody's friction factor equation. Perturbations of the flow variables yields a set of zeroth- and first-order equations. After integration of the zeroth-order equations, the resulting zeroth-order flow variables are used as input in the solution of the first-order equations. Further integration of the first order pressures yields the eccentric rotordynamic coefficients. The results from this procedure compare well with available experimental and theoretical data, with accuracy just as good or slightly better than the predictions based on a finite-element model.

Hierarchical Bayes approach for subgroup analysis.

PubMed

Hsu, Yu-Yi; Zalkikar, Jyoti; Tiwari, Ram C

2017-01-01

In clinical data analysis, both treatment effect estimation and consistency assessment are important for a better understanding of the drug efficacy for the benefit of subjects in individual subgroups. The linear mixed-effects model has been used for subgroup analysis to describe treatment differences among subgroups with great flexibility. The hierarchical Bayes approach has been applied to linear mixed-effects model to derive the posterior distributions of overall and subgroup treatment effects. In this article, we discuss the prior selection for variance components in hierarchical Bayes, estimation and decision making of the overall treatment effect, as well as consistency assessment of the treatment effects across the subgroups based on the posterior predictive p-value. Decision procedures are suggested using either the posterior probability or the Bayes factor. These decision procedures and their properties are illustrated using a simulated example with normally distributed response and repeated measurements.

The Regular Education Initiative: What Do Three Groups of Education Professionals Think?

ERIC Educational Resources Information Center

Davis, Jane C.; Maheady, Larry

1991-01-01

A survey of general education teachers, special education teachers, and building principals in Michigan assessed their agreement with the Regular Education Initiative (REI) goals and methods. Analysis of the 605 responses indicated general agreement with REI goals and procedures. Most educators believed that pragmatic factors posed the greatest…

7 CFR 201.51a - Special procedures for purity analysis.

Code of Federal Regulations, 2014 CFR

2014-01-01

..., Pensacola variety of bahiagrass, orchardgrass, blue grama, and side-oats grama. (1) When kinds listed in... calibration sample for Kentucky bluegrass shall be used for Canada bluegrass, rough bluegrass, blue grama, and... General-type seed blower. (iii) The blowing point for blue grama shall be a factor of 1.157 of the blowing...

7 CFR 201.51a - Special procedures for purity analysis.

Code of Federal Regulations, 2012 CFR

2012-01-01

..., Pensacola variety of bahiagrass, orchardgrass, blue grama, and side-oats grama. (1) When kinds listed in... calibration sample for Kentucky bluegrass shall be used for Canada bluegrass, rough bluegrass, blue grama, and... General-type seed blower. (iii) The blowing point for blue grama shall be a factor of 1.157 of the blowing...

7 CFR 201.51a - Special procedures for purity analysis.

Code of Federal Regulations, 2013 CFR

2013-01-01

..., Pensacola variety of bahiagrass, orchardgrass, blue grama, and side-oats grama. (1) When kinds listed in... calibration sample for Kentucky bluegrass shall be used for Canada bluegrass, rough bluegrass, blue grama, and... General-type seed blower. (iii) The blowing point for blue grama shall be a factor of 1.157 of the blowing...

A Critical Practice Analysis of Response to Intervention Appropriation in an Urban School

ERIC Educational Resources Information Center

King Thorius, Kathleen A.; Maxcy, Brendan D.; Macey, Erin; Cox, Adrienne

2014-01-01

This qualitative case study focuses on factors mediating an urban school's enactment of Response to Intervention (RTI). Over one school year, we (a) observed weekly RTI meetings, (b) debriefed observations weekly, (c) interviewed RTI team members, and (d) examined procedural documents. Analyses included post-observation debriefing and coding…

Generating Nonnormal Multivariate Data Using Copulas: Applications to SEM

ERIC Educational Resources Information Center

Mair, Patrick; Satorra, Albert; Bentler, Peter M.

2012-01-01

This article develops a procedure based on copulas to simulate multivariate nonnormal data that satisfy a prespecified variance-covariance matrix. The covariance matrix used can comply with a specific moment structure form (e.g., a factor analysis or a general structural equation model). Thus, the method is particularly useful for Monte Carlo…

Equivalency for Father and Mother Ratings of the ADHD Symptoms

ERIC Educational Resources Information Center

Gomez, Rapson

2010-01-01

The study used multiple-group confirmatory factor analysis (CFA) and multiple indicators multiple causes (MIMIC) procedures to examine the measurement and construct equivalencies for father and mother ratings of ADHD symptoms, recoded as binary scores. Fathers (N = 387) and mothers (N = 411) rated their primary school-aged children on the…

Modelling Student Satisfaction and Motivation in the Integrated Educational Environment: An Empirical study

ERIC Educational Resources Information Center

Stukalina, Yulia

2016-01-01

Purpose: The purpose of this paper is to explore some issues related to enhancing the quality of educational services provided by a university in the agenda of integrating quality assurance activities and strategic management procedures. Design/methodology/approach: Employing multiple regression analysis the author has examined some factors that…

7 CFR 800.85 - Inspection of grain in combined lots.

Code of Federal Regulations, 2010 CFR

2010-01-01

... REGULATIONS Inspection Methods and Procedures § 800.85 Inspection of grain in combined lots. (a) General. The...) Weighted or mathematical average. Official factor and official criteria information shown on a certificate... section, be based on the weighted or mathematical averages of the analysis of the sublots in the lot and...

A Construct Validation of the Mental Models Learning Outcome Using Exploratory Factor Analysis.

ERIC Educational Resources Information Center

Sheehan, Joseph; Tessmer, Martin

A mental model is a knowledge structure composed of concepts and the relations between them. Mental models are distinct from declarative and procedural knowledge--they go beyond semantic relationships and skills acquisition and contain varied intellectual skills and knowledge. This study describes an initial investigation into the construct…

Conditional Covariance-Based Subtest Selection for DIMTEST

ERIC Educational Resources Information Center

Froelich, Amy G.; Habing, Brian

2008-01-01

DIMTEST is a nonparametric hypothesis-testing procedure designed to test the assumptions of a unidimensional and locally independent item response theory model. Several previous Monte Carlo studies have found that using linear factor analysis to select the assessment subtest for DIMTEST results in a moderate to severe loss of power when the exam…

Deciphering Sources of Variability in Clinical Pathology.

PubMed

Tripathi, Niraj K; Everds, Nancy E; Schultze, A Eric; Irizarry, Armando R; Hall, Robert L; Provencher, Anne; Aulbach, Adam

2017-01-01

The objectives of this session were to explore causes of variability in clinical pathology data due to preanalytical and analytical variables as well as study design and other procedures that occur in toxicity testing studies. The presenters highlighted challenges associated with such variability in differentiating test article-related effects from the effects of experimental procedures and its impact on overall data interpretation. These presentations focused on preanalytical and analytical variables and study design-related factors and their influence on clinical pathology data, and the importance of various factors that influence data interpretation including statistical analysis and reference intervals. Overall, these presentations touched upon potential effect of many variables on clinical pathology parameters, including animal physiology, sample collection process, specimen handling and analysis, study design, and some discussion points on how to manage those variables to ensure accurate interpretation of clinical pathology data in toxicity studies. This article is a brief synopsis of presentations given in a session entitled "Deciphering Sources of Variability in Clinical Pathology-It's Not Just about the Numbers" that occurred at the 35th Annual Symposium of the Society of Toxicologic Pathology in San Diego, California.

Combination of COFRADIC and high temperature-extended column length conventional liquid chromatography: a very efficient way to tackle complex protein samples, such as serum.

PubMed

Sandra, Koen; Verleysen, Katleen; Labeur, Christine; Vanneste, Lies; D'Hondt, Filip; Thomas, Grégoire; Kas, Koen; Gevaert, Kris; Vandekerckhove, Joël; Sandra, Pat

2007-03-01

The previously reported COmbined FRActional DIagonal Chromatography (COFRA-DIC) methodology, in which a subset of peptides representative for their parent proteins are sorted, is particularly powerful for whole proteome analysis. This peptide-centric technology is built around diagonal chromatography, where peptide separations are crucial. This paper presents high efficiency peptide separations, in which four 250 x 2.1 mm, 5 microm Zorbax 300SB-C18 columns (total length 1 m) were coupled at operating temperatures of 60'C using a dedicated LC oven and conventional LC equipment. The high efficiency separations were combined with the COFRADIC procedure. This extremely powerful combination resulted, for the analysis of serum, in an increase in the uniquely identified peptide sequences by a factor of 2.6, compared to the COFRADIC procedure on a 25 cm column. This is a reflection of the increased peak capacity obtained on the 1 m column, which was calculated to be a factor 2.7 higher than on the 25 cm column. Besides more efficient sorting, less ion suppression was noticed.

Factors predictive of survival after stapler hepatectomy of hepatocellular carcinoma: a multivariate, single-center analysis.

PubMed

Hoffmann, Katrin; Müller-Bütow, Verena; Franz, Clemens; Hinz, Ulf; Longerich, Thomas; Büchler, Markus W; Schemmer, Peter

2014-02-01

New technical devices for hepatic parenchymal transection have improved perioperative safety and patient survival. The aim of the present study was to determine the oncological outcome after stapler hepatectomy in patients with HCC. Data of 95 patients who underwent stapler hepatectomy for HCC between 2001 and 2011 were analyzed retrospectively regarding clinical safety of the procedure and predictive factors for survial. Thirty-nine minor (≤2 segments) and 56 major (≥3 segments) hepatic resections were performed. The median survival was 47.5 months, after 36 months follow-up. Low grading, tumors ≥5 cm, multiple nodules and liver cirrhosis were predictors of decreased overall survival using multivariate analysis with hazard ratio(HR)=2.62, 2.41, 2.05, and 1.92 respectively. An estimated intra-operative blood loss of ≥1.2l was inversely correlated to disease free survival (HR=1.96). Stapler hepatectomy is a safe procedure in patients with HCC. Substantial intraoperative blood loss and the presence of cirrhosis independently predict the overall probability of patient survival. Intraoperative blood loss directly impacts HCC recurrence.

Reliability considerations for the total strain range version of strainrange partitioning

NASA Technical Reports Server (NTRS)

Wirsching, P. H.; Wu, Y. T.

1984-01-01

A proposed total strainrange version of strainrange partitioning (SRP) to enhance the manner in which SRP is applied to life prediction is considered with emphasis on how advanced reliability technology can be applied to perform risk analysis and to derive safety check expressions. Uncertainties existing in the design factors associated with life prediction of a component which experiences the combined effects of creep and fatigue can be identified. Examples illustrate how reliability analyses of such a component can be performed when all design factors in the SRP model are random variables reflecting these uncertainties. The Rackwitz-Fiessler and Wu algorithms are used and estimates of the safety index and the probablity of failure are demonstrated for a SRP problem. Methods of analysis of creep-fatigue data with emphasis on procedures for producing synoptic statistics are presented. An attempt to demonstrate the importance of the contribution of the uncertainties associated with small sample sizes (fatique data) to risk estimates is discussed. The procedure for deriving a safety check expression for possible use in a design criteria document is presented.

[Retrospective statistical analysis of clinical factors of recurrence in chronic subdural hematoma: correlation between univariate and multivariate analysis].

PubMed

Takayama, Motoharu; Terui, Keita; Oiwa, Yoshitsugu

2012-10-01

Chronic subdural hematoma is common in elderly individuals and surgical procedures are simple. The recurrence rate of chronic subdural hematoma, however, varies from 9.2 to 26.5% after surgery. The authors studied factors of the recurrence using univariate and multivariate analyses in patients with chronic subdural hematoma We retrospectively reviewed 239 consecutive cases of chronic subdural hematoma who received burr-hole surgery with irrigation and closed-system drainage. We analyzed the relationships between recurrence of chronic subdural hematoma and factors such as sex, age, laterality, bleeding tendency, other complicated diseases, density on CT, volume of the hematoma, residual air in the hematoma cavity, use of artificial cerebrospinal fluid. Twenty-one patients (8.8%) experienced a recurrence of chronic subdural hematoma. Multiple logistic regression found that the recurrence rate was higher in patients with a large volume of the residual air, and was lower in patients using artificial cerebrospinal fluid. No statistical differences were found in bleeding tendency. Techniques to reduce the air in the hematoma cavity are important for good outcome in surgery of chronic subdural hematoma. Also, the use of artificial cerebrospinal fluid reduces recurrence of chronic subdural hematoma. The surgical procedures can be the same for patients with bleeding tendencies.

Risk factors for an additional port in single-incision laparoscopic cholecystectomy in patients with cholecystitis.

PubMed

Araki, Kenichiro; Shirabe, Ken; Watanabe, Akira; Kubo, Norio; Sasaki, Shigeru; Suzuki, Hideki; Asao, Takayuki; Kuwano, Hiroyuki

2017-01-01

Although single-incision laparoscopic cholecystectomy is now widely performed in patients with cholecystitis, some cases require an additional port to complete the procedure. In this study, we focused on risk factor of additional port in this surgery. We performed single-incision cholecystectomy in 75 patients with acute cholecystitis or after cholecystitis between 2010 and 2014 at Gunma University Hospital. Surgical indications followed the TG13 guidelines. Our standard procedure for single-incision cholecystectomy routinely uses two needlescopic devices. We used logistic regression analysis to identify the risk factors associated with use of an additional full-size port (5 or 10 mm). Surgical outcome was acceptable without biliary injury. Nine patients (12.0%) required an additional port, and one patient (1.3%) required conversion to open cholecystectomy because of severe adhesions around the cystic duct and common bile duct. In multivariate analysis, high C-reactive protein (CRP) values (>7.0 mg/dl) during cholecystitis attacks were significantly correlated with the need for an additional port (P = 0.009), with a sensitivity of 55.6%, specificity of 98.5%, and accuracy of 93.3%. This study indicated that the severe inflammation indicated by high CRP values during cholecystitis attacks predicts the need for an additional port. J. Med. Invest. 64: 245-249, August, 2017.

Systematic Review: Predisposing, Precipitating, Perpetuating, and Present Factors Predicting Anticipatory Distress to Painful Medical Procedures in Children

PubMed Central

Pillai Riddell, Rebecca R.; Khan, Maria; Calic, Masa; Taddio, Anna; Tablon, Paula

2016-01-01

Objective To conduct a systematic review of the factors predicting anticipatory distress to painful medical procedures in children. Methods A systematic search was conducted to identify studies with factors related to anticipatory distress to painful medical procedures in children aged 0–18 years. The search retrieved 7,088 articles to review against inclusion criteria. A total of 77 studies were included in the review. Results 31 factors were found to predict anticipatory distress to painful medical procedures in children. A narrative synthesis of the evidence was conducted, and a summary figure is presented. Conclusions Many factors were elucidated that contribute to the occurrence of anticipatory distress to painful medical procedures. The factors that appear to increase anticipatory distress are child psychopathology, difficult child temperament, parent distress promoting behaviors, parent situational distress, previous pain events, parent anticipation of distress, and parent anxious predisposition. Longitudinal and experimental research is needed to further elucidate these factors. PMID:26338981

Efficacy and safety of recombinant activated factor vii in major surgical procedures: systematic review and meta-analysis of randomized clinical trials.

PubMed

Ranucci, Marco; Isgrò, Giuseppe; Soro, Giorgio; Conti, Daniela; De Toffol, Barbara

2008-03-01

To investigate the efficacy and safety of recombinant activated factor VII (rFVIIa) treatment in patients undergoing major surgical procedures. Relevant studies were searched in BioMedCentral, CENTRAL, PubMed, and PubMed Central. Only randomized controlled trials on humans undergoing major surgery were included. Efficacy was determined as the rate of patients receiving allogeneic packed red blood cells; safety was assessed in terms of thromboembolic complications and mortality rate. We followed the Cochrane Collaboration method for data extraction and internal validity procedures, as well as the Quality of Reporting of Meta-analyses statement. Seven randomized controlled trials met the inclusion criteria. Treatment with rFVIIa is associated with a reduced risk of receiving allogeneic packed red blood cells (odds ratio, 0.29; 95% confidence interval, 0.10-0.80). In a subgroup analysis, only patients receiving at least 50 mug/kg of rFVIIa had a significant benefit (odds ratio, 0.43; 95% confidence interval, 0.23-0.78). No differences in thromboembolic complications and mortality rates were observed. Treatment with rFVIIa is effective in reducing the rate of patients undergoing transfusion with allogeneic packed red blood cells. However, the cost-benefit ratio is favorable only in patients who need a huge number of packed red blood cell units. No safety concerns arise from the present study.

Virtual reality laparoscopy: which potential trainee starts with a higher proficiency level?

PubMed

Paschold, M; Schröder, M; Kauff, D W; Gorbauch, T; Herzer, M; Lang, H; Kneist, W

2011-09-01

Minimally invasive surgery requires technical skills distinct from those used in conventional surgery. The aim of this prospective study was to identify personal characteristics that may predict the attainable proficiency level of first-time virtual reality laparoscopy (VRL) trainees. Two hundred and seventy-nine consecutive undergraduate medical students without experience attended a standardized VRL training. Performance data of an abstract and a procedural task were correlated with possible predictive factors providing potential competence in VRL. Median global score requirement status was 86.7% (interquartile range (IQR) 75-93) for the abstract task and 74.4% (IQR 67-88) for the procedural task. Unadjusted analysis showed significant increase in the global score in both tasks for trainees who had a gaming console at home and frequently used it as well as for trainees who felt self-confident to assist in a laparoscopic operation. Multiple logistic regression analysis identified frequency of video gaming (often/frequently vs. rarely/not at all, odds ratio: abstract model 2.1 (95% confidence interval 1.2; 3.6), P = 0.009; virtual reality operation procedure 2.4 (95% confidence interval 1.3; 4.2), P = 0.003) as a predictive factor for VRL performance. Frequency of video gaming is associated with quality of first-time VRL performance. Video game experience may be used as trainee selection criteria for tailored concepts of VRL training programs.

Thermal Adaptation Methods of Urban Plaza Users in Asia’s Hot-Humid Regions: A Taiwan Case Study

PubMed Central

Wu, Chen-Fa; Hsieh, Yen-Fen; Ou, Sheng-Jung

2015-01-01

Thermal adaptation studies provide researchers great insight to help understand how people respond to thermal discomfort. This research aims to assess outdoor urban plaza conditions in hot and humid regions of Asia by conducting an evaluation of thermal adaptation. We also propose that questionnaire items are appropriate for determining thermal adaptation strategies adopted by urban plaza users. A literature review was conducted and first hand data collected by field observations and interviews used to collect information on thermal adaptation strategies. Item analysis—Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA)—were applied to refine the questionnaire items and determine the reliability of the questionnaire evaluation procedure. The reliability and validity of items and constructing process were also analyzed. Then, researchers facilitated an evaluation procedure for assessing the thermal adaptation strategies of urban plaza users in hot and humid regions of Asia and formulated a questionnaire survey that was distributed in Taichung’s Municipal Plaza in Taiwan. Results showed that most users responded with behavioral adaptation when experiencing thermal discomfort. However, if the thermal discomfort could not be alleviated, they then adopted psychological strategies. In conclusion, the evaluation procedure for assessing thermal adaptation strategies and the questionnaire developed in this study can be applied to future research on thermal adaptation strategies adopted by urban plaza users in hot and humid regions of Asia. PMID:26516881

Higher plasma level of STIM1, OPG are correlated with stent restenosis after PCI.

PubMed

Li, Haibin; Jiang, Zhian; Liu, Xiangdong; Yang, Zhihui

2015-01-01

Percutaneous Coronary Intervention (PCI) is one of the most effective treatments for Coronary Heart Disease (CHD), but the high rate of In Stent Restenosis (ISR) has plagued clinicians after PCI. We aim to investigate the correlation of plasma Stromal Interaction Molecular 1 (STIM1) and Osteoprotegerin (OPG) level with stent restenosis after PCI. A total of 100 consecutive patients with Coronary Heart Disease (CHD) received PCI procedure were recruited. Coronary angiography was performed 8 months after their PCI. Then patients were divided into 2 groups: observation group was composed by patients who existing postoperative stenosis after intervention; Control group was composed by patients with no postoperative stenosis. The plasma levels of STIM, OPG in all patients were tested before and after intervention. Pearson correlation and multiple linear regression analysis were performed to analysis the correlation between STIM, OPG level and postoperative stenosis. 35 cases were divided into observation group and other 65 were divided into control group. The plasma levels of STIM, OPG have no statistical difference before their PCI procedure, but we observed higher level of High-sensitivity C-reactive protein (Hs-CRP) existed in observation group. We observed higher level of plasma STIM, OPG in observation group when compared with control group after PCI procedure (P < 0.05). Regression analysis demonstrated that Hs-CRP, STIM1, OPG are independent risk factors for ISR. Elevated levels of plasma STIM1, OPG are independent risk factors for ISR in patients received PCI, which could provide useful information for the restenosis control after PCI.

Are there risk factors that increase the rate of staple line leakage in patients undergoing primary sleeve gastrectomy for morbid obesity?

PubMed

Benedix, Frank; Benedix, Diana D; Knoll, Christian; Weiner, Rudolf; Bruns, Christiane; Manger, Thomas; Stroh, Christine

2014-10-01

Laparoscopic sleeve gastrectomy (LSG) is currently being performed with increasing frequency worldwide. It offers an excellent weight loss and resolution of comorbidities in the short term with a very low incidence of complications. However, the ever present risk of a staple line leak is still a major concern. Since 2005, data from obese patients that undergo bariatric procedures in Germany are prospectively registered in an online database and analyzed at the Institute of Quality Assurance in Surgical Medicine. For the current analysis, all patients that had undergone primary sleeve gastrectomy for morbid obesity within a 7-year period were considered. Using the GBSR, data from 5.400 LSGs were considered for analysis. Staple line leak rate decreased during the study period from 6.5 to 1.4 %. Male gender, higher BMI, concomitant sleep apnea, conversion to laparotomy, longer operation time, use of both buttresses and oversewing, and the occurrence of intraoperative complications were associated with a significantly higher leakage rate. On multivariate analysis, operation time and year of procedure only had a significant impact on staple line leak rate. The results of the current study demonstrated that there are factors that increase the risk of a leakage which would enable surgeons to define risk groups, to more carefully select patients, and to offer a closer follow-up during the postoperative course with early recognition and adequate treatment. All future efforts should be focused on a further reduction of serious complications to make the LSG a widely accepted and safer procedure.

Application of Information-Theoretic Data Mining Techniques in a National Ambulatory Practice Outcomes Research Network

PubMed Central

Wright, Adam; Ricciardi, Thomas N.; Zwick, Martin

2005-01-01

The Medical Quality Improvement Consortium data warehouse contains de-identified data on more than 3.6 million patients including their problem lists, test results, procedures and medication lists. This study uses reconstructability analysis, an information-theoretic data mining technique, on the MQIC data warehouse to empirically identify risk factors for various complications of diabetes including myocardial infarction and microalbuminuria. The risk factors identified match those risk factors identified in the literature, demonstrating the utility of the MQIC data warehouse for outcomes research, and RA as a technique for mining clinical data warehouses. PMID:16779156

Supplemental Conceptual Design Study of an Integrated Voice/Data Switching and Multiplexing Technique for an Access Area Exchange

DTIC Science & Technology

1976-11-11

exchange. The basis for this choice was derived from several factors . One was a timing analysis that was made for certain basic time-critical software...randidate 6jrstem designs were developed and _*xamined with respect to L their capability to demonstrate the workability of the basic concept and for factors ...algorithm recuires a bit time completion, while SOF production allows byte timing and the involved = SOF correlation procedure may be perfor-med during

Contemporary militant extremism: a linguistic approach to scale development.

PubMed

Stankov, Lazar; Higgins, Derrick; Saucier, Gerard; Knežević, Goran

2010-06-01

In this article, the authors describe procedures used in the development of a new scale of militant extremist mindset. A 2-step approach consisted of (a) linguistic analysis of the texts produced by known terrorist organizations and selection of statements from these texts that reflect the mindset of those belonging to these organizations and (b) analyses of the structural properties of the scales based on 132 selected statements. Factor analysis of militant extremist statements with participants (N = 452) from Australia, Serbia, and the United States produced 3 dimensions: (a) justification and advocacy of violence (War factor), (b) violence in the name of God (God factor), and (c) blaming Western nations for the problems in the world today (West factor). We also report the distributions of scores for the 3 subscales, mean differences among the 3 national samples, and correlations with a measure of dogmatism (M. Rokeach, 1956).

Evaluation of liquefaction potential for building code

NASA Astrophysics Data System (ADS)

Nunziata, C.; De Nisco, G.; Panza, G. F.

2008-07-01

The standard approach for the evaluation of the liquefaction susceptibility is based on the estimation of a safety factor between the cyclic shear resistance to liquefaction and the earthquake induced shear stress. Recently, an updated procedure based on shear-wave velocities (Vs) has been proposed which could be more easily applied. These methods have been applied at La Plaja beach of Catania, that experienced liquefaction because of the 1693 earthquake. The detailed geotechnical and Vs information and the realistic ground motion computed for the 1693 event let us compare the two approaches. The successful application of the Vs procedure, slightly modified to fit historical and safety factor information, even if additional field performances are needed, encourages the development of a guide for liquefaction potential analysis, based on well defined Vs profiles to be included in the italian seismic code.

Limiting excessive postoperative blood transfusion after cardiac procedures. A review.

PubMed Central

Ferraris, V A; Ferraris, S P

1995-01-01

Analysis of blood product use after cardiac operations reveals that a few patients (< or = 20%) consume the majority of blood products (> 80%). The risk factors that predispose a minority of patients to excessive blood use include patient-related factors, transfusion practices, drug-related causes, and procedure-related factors. Multivariate studies suggest that patient age and red blood cell volume are independent patient-related variables that predict excessive blood product transfusion after cardiac procedures. Other factors include preoperative aspirin ingestion, type of operation, over- or underutilization of heparin during cardiopulmonary bypass, failure to correct hypothermia after cardiopulmonary bypass, and physician overtransfusion. A survey of the currently available blood conservation techniques reveals 5 that stand out as reliable methods: 1) high-dose aprotinin therapy, 2) preoperative erythropoietin therapy when time permits adequate dosage before operation, 3) hemodilution by harvest of whole blood immediately before cardiopulmonary bypass, 4) autologous predonation of blood, and 5) salvage of oxygenator blood after cardiopulmonary bypass. Other methods, such as the use of epsilon-aminocaproic acid or desmopressin, cell saving devices, reinfusion of shed mediastinal blood, and hemofiltration have been reported to be less reliable and may even be harmful in some high-risk patients. Consideration of the available data allows formulation of a 4-pronged plan for limiting excessive blood transfusion after surgery: 1) recognize the causes of excessive transfusion, including the importance of red blood cell volume, type of procedure being performed, preoperative aspirin ingestion, etc.; 2) establish a quality management program, including a survey of transfusion practices that emphasizes physician education and availability of real-time laboratory testing to guide transfusion therapy; 3) adopt a multimodal approach using institution-proven techniques; and 4) continually reassess blood product use and analyze the cost-benefits of blood conservation interventions. PMID:7580359

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

PubMed

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

2018-02-01

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

Safety compliance and safety climate: A repeated cross-sectional study in the oil and gas industry.

PubMed

Kvalheim, Sverre A; Dahl, Øyvind

2016-12-01

Violations of safety rules and procedures are commonly identified as a causal factor in accidents in the oil and gas industry. Extensive knowledge on effective management practices related to improved compliance with safety procedures is therefore needed. Previous studies of the causal relationship between safety climate and safety compliance demonstrate that the propensity to act in accordance with prevailing rules and procedures is influenced to a large degree by workers' safety climate. Commonly, the climate measures employed differ from one study to another and identical measures of safety climate are seldom tested repeatedly over extended periods of time. This research gap is addressed in the present study. The study is based on a survey conducted four times among sharp-end workers of the Norwegian oil and gas industry (N=31,350). This is done by performing multiple tests (regression analysis) over a period of 7years of the causal relationship between safety climate and safety compliance. The safety climate measure employed is identical across the 7-year period. Taking all periods together, the employed safety climate model explained roughly 27% of the variance in safety compliance. The causal relationship was found to be stable across the period, thereby increasing the reliability and the predictive validity of the factor structure. The safety climate factor that had the most powerful effect on safety compliance was work pressure. The factor structure employed shows high predictive validity and should therefore be relevant to organizations seeking to improve safety in the petroleum sector. The findings should also be relevant to other high-hazard industries where safety rules and procedures constitute a central part of the approach to managing safety. Copyright © 2016 Elsevier Ltd and National Safety Council. All rights reserved.

A qualitative analysis of the determinants in the choice of a French journal reviewing procedures

NASA Astrophysics Data System (ADS)

Morge, Ludovic

2015-12-01

Between 1993 and 2010, two French journals (Aster and Didaskalia) coming from different backgrounds but belonging to the same institution used to publish papers on research in science and technology education. The merging of these journals made it necessary for them to compare the different reviewing procedures used by each. This merging occurred at a time when research is becoming increasingly international which partly determines some of the reviewing procedure choices. In order for a francophone international journal to survive, it needs to take this internationalization into account in a reasoned manner. The author of this article, as a chief editor of RDST (Recherches en Didactique des Sciences et des Technologies)—the journal resulting from the merging- taking part in this merger, analyses the social, cultural and pragmatic determinants which impacted the choices made in reviewing procedures. This paper describes how these diversity of factors leads us to drop the idea of a standard reviewing procedure which would be valid for all journals.

Scoring correction for MMPI-2 Hs scale with patients experiencing a traumatic brain injury: a test of measurement invariance.

PubMed

Alkemade, Nathan; Bowden, Stephen C; Salzman, Louis

2015-02-01

It has been suggested that MMPI-2 scoring requires removal of some items when assessing patients after a traumatic brain injury (TBI). Gass (1991. MMPI-2 interpretation and closed head injury: A correction factor. Psychological assessment, 3, 27-31) proposed a correction procedure in line with the hypothesis that MMPI-2 endorsement may be affected by symptoms of TBI. This study assessed the validity of the Gass correction procedure. A sample of patients with a TBI (n = 242), and a random subset of the MMPI-2 normative sample (n = 1,786). The correction procedure implies a failure of measurement invariance across populations. This study examined measurement invariance of one of the MMPI-2 scales (Hs) that includes TBI correction items. A four-factor model of the MMPI-2 Hs items was defined. The factor model was found to meet the criteria for partial measurement invariance. Analysis of the change in sensitivity and specificity values implied by partial measurement invariance failed to indicate significant practical impact of partial invariance. Overall, the results support continued use of all Hs items to assess psychological well-being in patients with TBI. © The Author 2014. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Three Factors Are Critical in Order to Synthesize Intelligible Noise-Vocoded Japanese Speech

PubMed Central

Kishida, Takuya; Nakajima, Yoshitaka; Ueda, Kazuo; Remijn, Gerard B.

2016-01-01

Factor analysis (principal component analysis followed by varimax rotation) had shown that 3 common factors appear across 20 critical-band power fluctuations derived from spoken sentences of eight different languages [Ueda et al. (2010). Fechner Day 2010, Padua]. The present study investigated the contributions of such power-fluctuation factors to speech intelligibility. The method of factor analysis was modified to obtain factors suitable for resynthesizing speech sounds as 20-critical-band noise-vocoded speech. The resynthesized speech sounds were used for an intelligibility test. The modification of factor analysis ensured that the resynthesized speech sounds were not accompanied by a steady background noise caused by the data reduction procedure. Spoken sentences of British English, Japanese, and Mandarin Chinese were subjected to this modified analysis. Confirming the earlier analysis, indeed 3–4 factors were common to these languages. The number of power-fluctuation factors needed to make noise-vocoded speech intelligible was then examined. Critical-band power fluctuations of the Japanese spoken sentences were resynthesized from the obtained factors, resulting in noise-vocoded-speech stimuli, and the intelligibility of these speech stimuli was tested by 12 native Japanese speakers. Japanese mora (syllable-like phonological unit) identification performances were measured when the number of factors was 1–9. Statistically significant improvement in intelligibility was observed when the number of factors was increased stepwise up to 6. The 12 listeners identified 92.1% of the morae correctly on average in the 6-factor condition. The intelligibility improved sharply when the number of factors changed from 2 to 3. In this step, the cumulative contribution ratio of factors improved only by 10.6%, from 37.3 to 47.9%, but the average mora identification leaped from 6.9 to 69.2%. The results indicated that, if the number of factors is 3 or more, elementary linguistic information is preserved in such noise-vocoded speech. PMID:27199790

Initial Data Analysis Results for ATD-2 ISAS HITL Simulation

NASA Technical Reports Server (NTRS)

Lee, Hanbong

2017-01-01

To evaluate the operational procedures and information requirements for the core functional capabilities of the ATD-2 project, such as tactical surface metering tool, APREQ-CFR procedure, and data element exchanges between ramp and tower, human-in-the-loop (HITL) simulations were performed in March, 2017. This presentation shows the initial data analysis results from the HITL simulations. With respect to the different runway configurations and metering values in tactical surface scheduler, various airport performance metrics were analyzed and compared. These metrics include gate holding time, taxi-out in time, runway throughput, queue size and wait time in queue, and TMI flight compliance. In addition to the metering value, other factors affecting the airport performance in the HITL simulation, including run duration, runway changes, and TMI constraints, are also discussed.

Different approaches in Partial Least Squares and Artificial Neural Network models applied for the analysis of a ternary mixture of Amlodipine, Valsartan and Hydrochlorothiazide

NASA Astrophysics Data System (ADS)

Darwish, Hany W.; Hassan, Said A.; Salem, Maissa Y.; El-Zeany, Badr A.

2014-03-01

Different chemometric models were applied for the quantitative analysis of Amlodipine (AML), Valsartan (VAL) and Hydrochlorothiazide (HCT) in ternary mixture, namely, Partial Least Squares (PLS) as traditional chemometric model and Artificial Neural Networks (ANN) as advanced model. PLS and ANN were applied with and without variable selection procedure (Genetic Algorithm GA) and data compression procedure (Principal Component Analysis PCA). The chemometric methods applied are PLS-1, GA-PLS, ANN, GA-ANN and PCA-ANN. The methods were used for the quantitative analysis of the drugs in raw materials and pharmaceutical dosage form via handling the UV spectral data. A 3-factor 5-level experimental design was established resulting in 25 mixtures containing different ratios of the drugs. Fifteen mixtures were used as a calibration set and the other ten mixtures were used as validation set to validate the prediction ability of the suggested methods. The validity of the proposed methods was assessed using the standard addition technique.

Chemical factor analysis of skin cancer FTIR-FEW spectroscopic data

NASA Astrophysics Data System (ADS)

Bruch, Reinhard F.; Sukuta, Sydney

2002-03-01

Chemical Factor Analysis (CFA) algorithms were applied to transform complex Fourier transform infrared fiberoptical evanescent wave (FTIR-FEW) normal and malignant skin tissue spectra into factor spaces for analysis and classification. The factor space approach classified melanoma beyond prior pathological classifications related to specific biochemical alterations to health states in cluster diagrams allowing diagnosis with more biochemical specificity, resolving biochemical component spectra and employing health state eigenvector angular configurations as disease state sensors. This study demonstrated a wealth of new information from in vivo FTIR-FEW spectral tissue data, without extensive a priori information or clinically invasive procedures. In particular, we employed a variety of methods used in CFA to select the rank of spectroscopic data sets of normal benign and cancerous skin tissue. We used the Malinowski indicator function (IND), significance level and F-Tests to rank our data matrices. Normal skin tissue, melanoma and benign tumors were modeled by four, two and seven principal abstract factors, respectively. We also showed that the spectrum of the first eigenvalue was equivalent to the mean spectrum. The graphical depiction of angular disparities between the first abstract factors can be adopted as a new way to characterize and diagnose melanoma cancer.

NASA Johnson Space Center Usability Testing and Analysis facility (UTAF) Overview

NASA Technical Reports Server (NTRS)

Whitmore, Mihriban; Holden, Kritina L.

2005-01-01

The Usability Testing and Analysis Facility (UTAF) is part of the Space Human Factors Laboratory at the NASA Johnson Space Center in Houston, Texas. The facility performs research for NASA's HumanSystems Integration Program, under the HumanSystems Research and Technology Division. Specifically, the UTAF provides human factors support for space vehicles, including the International Space Station, the Space Shuttle, and the forthcoming Crew Exploration Vehicle. In addition, there are ongoing collaborative research efforts with external corporations and universities. The UTAF provides human factors analysis, evaluation, and usability testing of crew interfaces for space applications. This includes computer displays and controls, workstation systems, and work environments. The UTAF has a unique mix of capabilities, with a staff experienced in both cognitive human factors and ergonomics. The current areas of focus are: human factors applications in emergency medical care and informatics; control and display technologies for electronic procedures and instructions; voice recognition in noisy environments; crew restraint design for unique microgravity workstations; and refinement of human factors processes and requirements. This presentation will provide an overview of ongoing activities, and will address how the UTAF projects will evolve to meet new space initiatives.

Accelerated stress testing of terrestrial solar cells

NASA Technical Reports Server (NTRS)

Prince, J. L.; Lathrop, J. W.

1979-01-01

A program to investigate the reliability characteristics of unencapsulated low-cost terrestrial solar cells using accelerated stress testing is described. Reliability (or parametric degradation) factors appropriate to the cell technologies and use conditions were studied and a series of accelerated stress tests was synthesized. An electrical measurement procedure and a data analysis and management system was derived, and stress test fixturing and material flow procedures were set up after consideration was given to the number of cells to be stress tested and measured and the nature of the information to be obtained from the process. Selected results and conclusions are presented.

Cleared for the visual approach: Human factor problems in air carrier operations

NASA Technical Reports Server (NTRS)

Monan, W. P.

1983-01-01

The study described herein, a set of 353 ASRS reports of unique aviation occurrences significantly involving visual approaches was examined to identify hazards and pitfalls embedded in the visual approach procedure and to consider operational practices that might help avoid future mishaps. Analysis of the report set identified nine aspects of the visual approach procedure that appeared to be predisposing conditions for inducing or exacerbating the effects of operational errors by flight crew members or controllers. Predisposing conditions, errors, and operational consequences of the errors are discussed. In a summary, operational policies that might mitigate the problems are examined.

Determination of Actual Friction Factors in Metal Forming under Heavy Loaded Regimes Combining Experimental and Numerical Analysis.

PubMed

Camacho, Ana María; Veganzones, Mariano; Claver, Juan; Martín, Francisco; Sevilla, Lorenzo; Sebastián, Miguel Ángel

2016-09-01

Tribological conditions can change drastically during heavy loaded regimes as experienced in metal forming; this is especially critical when lubrication can only be applied at the early stage of the process because the homogeneous lubricant layer can break along the die-workpiece interface. In these cases, adopting a constant friction factor for the lubricant-surface pair may not be a valid assumption. This paper presents a procedure based on the use of dual friction factor maps to determine friction factors employed in heavy loaded regimes. A finite element (FE) simulation is used to obtain the friction factor map for the alloy UNS A96082. Experiments were conducted using four lubricants (aluminum anti-size, MoS₂ grease, silicone oil, and copper paste) to determine the actual friction curves. The experimental procedure is based on the application of lubricant only at the beginning of the first stage of ring compression, and not at intermediate stages as is usual in typical ring compression tests (RCTs). The results show that for small reductions ( r h < 20%), the conventional RCT can be applied because the tribological conditions remain similar. For large reductions ( r h > 20%), it is recommended to obtain an average value of the friction factor for every lubricant-surface pair in the range of deformation considered.

Determination of Actual Friction Factors in Metal Forming under Heavy Loaded Regimes Combining Experimental and Numerical Analysis

PubMed Central

Camacho, Ana María; Veganzones, Mariano; Claver, Juan; Martín, Francisco; Sevilla, Lorenzo; Sebastián, Miguel Ángel

2016-01-01

Tribological conditions can change drastically during heavy loaded regimes as experienced in metal forming; this is especially critical when lubrication can only be applied at the early stage of the process because the homogeneous lubricant layer can break along the die-workpiece interface. In these cases, adopting a constant friction factor for the lubricant-surface pair may not be a valid assumption. This paper presents a procedure based on the use of dual friction factor maps to determine friction factors employed in heavy loaded regimes. A finite element (FE) simulation is used to obtain the friction factor map for the alloy UNS A96082. Experiments were conducted using four lubricants (aluminum anti-size, MoS2 grease, silicone oil, and copper paste) to determine the actual friction curves. The experimental procedure is based on the application of lubricant only at the beginning of the first stage of ring compression, and not at intermediate stages as is usual in typical ring compression tests (RCTs). The results show that for small reductions (rh < 20%), the conventional RCT can be applied because the tribological conditions remain similar. For large reductions (rh > 20%), it is recommended to obtain an average value of the friction factor for every lubricant-surface pair in the range of deformation considered. PMID:28773868

Upper extremity palsy following cervical decompression surgery results from a transient spinal cord lesion.

PubMed

Hasegawa, Kazuhiro; Homma, Takao; Chiba, Yoshikazu

2007-03-15

Retrospective analysis. To test the hypothesis that spinal cord lesions cause postoperative upper extremity palsy. Postoperative paresis, so-called C5 palsy, of the upper extremities is a common complication of cervical surgery. Although there are several hypotheses regarding the etiology of C5 palsy, convincing evidence with a sufficient study population, statistical analysis, and clear radiographic images illustrating the nerve root impediment has not been presented. We hypothesized that the palsy is caused by spinal cord damage following the surgical decompression performed for chronic compressive cervical disorders. The study population comprised 857 patients with chronic cervical cord compressive lesions who underwent decompression surgery. Anterior decompression and fusion was performed in 424 cases, laminoplasty in 345 cases, and laminectomy in 88 cases. Neurologic characteristics of patients with postoperative upper extremity palsy were investigated. Relationships between the palsy, and patient sex, age, diagnosis, procedure, area of decompression, and preoperative Japanese Orthopaedic Association score were evaluated with a risk factor analysis. Radiographic examinations were performed for all palsy cases. Postoperative upper extremity palsy occurred in 49 cases (5.7%). The common features of the palsy cases were solely chronic compressive spinal cord disorders and decompression surgery to the cord. There was no difference in the incidence of palsy among the procedures. Cervical segments beyond C5 were often disturbed with frequent multiple segment involvement. There was a tendency for spontaneous improvement of the palsy. Age, decompression area (anterior procedure), and diagnosis (ossification of the posterior longitudinal ligament) are the highest risk factors of the palsy. The results of the present study support our hypothesis that the etiology of the palsy is a transient disturbance of the spinal cord following a decompression procedure. It appears to be caused by reperfusion after decompression of a chronic compressive lesion of the cervical cord. We recommend that physicians inform patients and surgeons of the potential risk of a spinal cord deficit after cervical decompression surgery.

Vibroacoustic optimization using a statistical energy analysis model

NASA Astrophysics Data System (ADS)

Culla, Antonio; D`Ambrogio, Walter; Fregolent, Annalisa; Milana, Silvia

2016-08-01

In this paper, an optimization technique for medium-high frequency dynamic problems based on Statistical Energy Analysis (SEA) method is presented. Using a SEA model, the subsystem energies are controlled by internal loss factors (ILF) and coupling loss factors (CLF), which in turn depend on the physical parameters of the subsystems. A preliminary sensitivity analysis of subsystem energy to CLF's is performed to select CLF's that are most effective on subsystem energies. Since the injected power depends not only on the external loads but on the physical parameters of the subsystems as well, it must be taken into account under certain conditions. This is accomplished in the optimization procedure, where approximate relationships between CLF's, injected power and physical parameters are derived. The approach is applied on a typical aeronautical structure: the cabin of a helicopter.

Analysis of nuclear export using photoactivatable GFP fusion proteins and interspecies heterokaryons.

PubMed

Nakrieko, Kerry-Ann; Ivanova, Iordanka A; Dagnino, Lina

2010-01-01

In this chapter, we review protocols for the analysis of nucleocytoplasmic shuttling of transcription factors and nuclear proteins, using two different approaches. The first involves the use of photoactivatable forms of the protein of interest by fusion to photoactivatable green fluorescent protein to follow its movement out of the nucleus by live-cell confocal microscopy. This methodology allows for the kinetic characterization of protein movements as well as measurement of steady-state levels. In a second procedure to assess the ability of a nuclear protein to move into and out of the nucleus, we describe the use of interspecies heterokaryon assays, which provide a measurement of steady-state distribution. These technologies are directly applicable to the analysis of nucleocytoplasmic movements not only of transcription factors, but also other nuclear proteins.

An analysis of life expectancy of airplane wings in normal cruising flight

NASA Technical Reports Server (NTRS)

Putnam, Abbott A

1945-01-01

In order to provide a basis for judging the relative importance of wing failure by fatigue and by single intense gusts, an analysis of wing life for normal cruising flight was made based on data on the frequency of atmospheric gusts. The independent variables considered in the analysis included stress-concentration factor, stress-load relation, wing loading, design and cruising speeds, design gust velocity, and airplane size. Several methods for estimating fatigue life from gust frequencies are discussed. The procedure selected for the analysis is believed to be simple and reasonably accurate, though slightly conservative.

Monitoring the use and outcomes of new devices and procedures: how does coding affect what Hospital Episode Statistics contribute? Lessons from 12 emerging procedures 2006-10.

PubMed

Patrick, Hannah; Sims, Andrew; Burn, Julie; Bousfield, Derek; Colechin, Elaine; Reay, Christopher; Alderson, Neil; Goode, Stephen; Cunningham, David; Campbell, Bruce

2013-03-01

New devices and procedures are often introduced into health services when the evidence base for their efficacy and safety is limited. The authors sought to assess the availability and accuracy of routinely collected Hospital Episodes Statistics (HES) data in the UK and their potential contribution to the monitoring of new procedures. Four years of HES data (April 2006-March 2010) were analysed to identify episodes of hospital care involving a sample of 12 new interventional procedures. HES data were cross checked against other relevant sources including national or local registers and manufacturers' information. HES records were available for all 12 procedures during the entire study period. Comparative data sources were available from national (5), local (2) and manufacturer (2) registers. Factors found to affect comparisons were miscoding, alternative coding and inconsistent use of subsidiary codes. The analysis of provider coverage showed that HES is sensitive at detecting centres which carry out procedures, but specificity is poor in some cases. Routinely collected HES data have the potential to support quality improvements and evidence-based commissioning of devices and procedures in health services but achievement of this potential depends upon the accurate coding of procedures.

The impact of obesity on 30-day complications in pediatric surgery.

PubMed

Train, A T; Cairo, S B; Meyers, H A; Harmon, C M; Rothstein, D H

2017-11-01

To examine the effects of obesity on specialty-specific surgical outcomes in children. Retrospective cohort study using the National Surgical Quality Improvement Program, Pediatric, 2012-2014. Patients included those aged 2-17 years who underwent a surgical procedure in one of six specialties. Obesity was the primary patient variable of interest. Outcomes of interest were postoperative complications and operative times. Odds ratios for development of postoperative complications were calculated using stepwise multivariate regression analysis. Obesity was associated with a significantly greater risk of wound complications (OR 1.24, 95% CI 1.13-1.36), but decreased risk of non-wound complications (OR 0.68, 95% CI 0.63-0.73) and morbidity (OR 0.79, 95% CI 0.75-0.84). Obesity was not a significant factor in predicting postoperative complications in patients undergoing otolaryngology or plastic surgery procedures. Anesthesia times and operative times were significantly longer for obese patients undergoing most types of pediatric surgical procedures. Obesity confers an increased risk of wound complications in some pediatric surgical specialties and is associated with overall decreased non-wound complications and morbidity. These findings suggest that the relationship between obesity and postoperative complications is complex and may be more dependent on underlying procedure- or specialty-related factors than previously suspected.

Comparative analysis of dosimetry parameters for nuclear medicine

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

Toohey, R.E.; Stabin, M.G.

For years many have employed the concept of ``total-body dose`` or ``whole-body dose,`` i.e., the total energy deposited in the body divided by the mass of the body, when evaluating the risks of different nuclear medicine procedures. The effective dose equivalent (H{sub E}), first described in ICRP Publication 26, has been accepted by some as a better quantity to use in evaluating the total risk of a procedure, but its use has been criticized by others primarily because the tissue weighting factors were intended for use in the radiation worker, rather than the nuclear medicine patient population. Nevertheless, in ICRPmore » Publication 52, the ICRP has suggested that the H{sub E} may be used in nuclear medicine. The ICRP also has published a compendium of dose estimates, including H{sub E} values, for various nuclear medicine procedures at various ages in ICRP Publication 53. The effective dose (E) of ICRP Publication 60 is perhaps more suitable for use in nuclear medicine, with tissue weighting factors based on the entire population. Other comparisons of H{sub E} and E have been published. The authors have used the program MIRDOSE 3.1 to compute total-body dose, H{sub E}, and E for 62 radiopharmaceutical procedures, based on the best current biokinetic data available.« less

Comparison of mixed-mode stress-intensity factors obtained through displacement correlation, J-integral formulation, and modified crack-closure integral

NASA Astrophysics Data System (ADS)

Bittencourt, Tulio N.; Barry, Ahmabou; Ingraffea, Anthony R.

This paper presents a comparison among stress-intensity factors for mixed-mode two-dimensional problems obtained through three different approaches: displacement correlation, J-integral, and modified crack-closure integral. All mentioned procedures involve only one analysis step and are incorporated in the post-processor page of a finite element computer code for fracture mechanics analysis (FRANC). Results are presented for a closed-form solution problem under mixed-mode conditions. The accuracy of these described methods then is discussed and analyzed in the framework of their numerical results. The influence of the differences among the three methods on the predicted crack trajectory of general problems is also discussed.

Access site-related complications after transradial catheterization can be reduced with smaller sheath size and statins.

PubMed

Honda, Tsuyoshi; Fujimoto, Kazuteru; Miyao, Yuji; Koga, Hidenobu; Hirata, Yoshihiro

2012-09-01

The aim of this study was to investigate the risk factors for access site-related complications after transradial coronary angiography (CAG) or percutaneous coronary intervention (PCI). Transradial PCI has been shown to reduce access site-related bleeding complications compared with procedures performed through a femoral approach. Although previous studies focused on risk factors for access site-related complications after a transfemoral approach or transfemoral and transradial approaches, it is uncertain which factors affect vascular complications after transradial catheterization. We enrolled 500 consecutive patients who underwent transradial CAG or PCI. We determined the incidence and risk factors for access site-related complications such as radial artery occlusion and bleeding complications. Age, sheath size, the dose of heparin and the frequency of PCI (vs. CAG) were significantly greater in patients with than without bleeding complications. However, body mass index (BMI) was significantly lower in patients with than without bleeding complications. Sheath size was significantly higher and the frequency of statin use was significantly lower in patients with than without radial artery occlusion. Multiple logistic analysis revealed that sheath size [odds ratio (OR) 5.5; P < 0.05] and BMI (OR 0.86; P < 0.01) were risk factors for bleeding complications; and sheath size (OR 5.2; P < 0.05) and the lack of statin pretreatment (OR 0.50; P < 0.05) were risk factors for occlusive complications. In conclusion, these findings indicate that down-sizing of the devices used in transradial procedures might attenuate access site-related complications after transradial CAG or PCI. Statin pretreatment might also be a strategy that could prevent radial artery occlusion after transradial procedures.

[Non operative treatment for perforated peptic ulcer: results of a prospective study].

PubMed

Songne, B; Jean, F; Foulatier, O; Khalil, H; Scotté, M

2004-12-01

The conservative management of perforated peptic ulcer has not gained widespread acceptance despite introduction of proton-pomp inhibitors because surgical procedures can achieve immediate closure by eventually using a laparoscopic approach. The aim of this prospective study was to evaluate the results of Taylor's method and to identify predictive factors of failure of medical treatment in patients presenting with perforated peptic ulcer. Between 1990 and 2000, 82 consecutive patients, with diagnosis of perforated peptic ulcer were prospectively included in this study. They were initially treated with non-operative procedure (nasogastric suction and intravenous administration of H2-blockers or proton-pomp inhibitors). No clinical improvement after 24 hours required a surgical treatment. Predictive factors of failure of non-operative treatment were tested in univariate or multivariate analysis. Clinical improvement was obtained with non-operative treatment in 54% of the patients (44/82). The overall mortality rate was 1%. In univariate analysis, significant predictive factors of failure of non-operative treatment were: size of pneumoperitoneum, heart beat >94 bpm, abdominal meteorism, pain at digital rectal exam, and age >59 years. In multivariate analysis, the significant factors were the size of pneumoperitoneum, heart beat, and abdominal meteorism. The association of these criteria: size of pneumoperitoneum >size of the first lumbar vertebra, heart beat >94 bpm, pain at digital rectal exam and age > 59 years , led to surgical treatment in all cases. These results suggest that more than 50% of patients with perforated peptic ulcer respond to conservative treatment without surgery and that the association of few criteria (size of pneumoperitoneum, heart beat, pain at digital rectal exam and age) require emergency surgery.

Measuring leader perceptions of school readiness for reforms: use of an iterative model combining classical and Rasch methods.

PubMed

Chatterji, Madhabi

2002-01-01

This study examines validity of data generated by the School Readiness for Reforms: Leader Questionnaire (SRR-LQ) using an iterative procedure that combines classical and Rasch rating scale analysis. Following content-validation and pilot-testing, principal axis factor extraction and promax rotation of factors yielded a five factor structure consistent with the content-validated subscales of the original instrument. Factors were identified based on inspection of pattern and structure coefficients. The rotated factor pattern, inter-factor correlations, convergent validity coefficients, and Cronbach's alpha reliability estimates supported the hypothesized construct properties. To further examine unidimensionality and efficacy of the rating scale structures, item-level data from each factor-defined subscale were subjected to analysis with the Rasch rating scale model. Data-to-model fit statistics and separation reliability for items and persons met acceptable criteria. Rating scale results suggested consistency of expected and observed step difficulties in rating categories, and correspondence of step calibrations with increases in the underlying variables. The combined approach yielded more comprehensive diagnostic information on the quality of the five SRR-LQ subscales; further research is continuing.

The influence of scale structure and sex on parental reports of children’s social (pragmatic) communication symptoms

PubMed Central

Ash, Andrea C.; Redmond, Sean M.; Timler, Geralyn R.; Kean, Jacob

2017-01-01

The addition of social (pragmatic) communication disorder [S(P)CD] to the DSM-5 taxonomy has left clinicians and researchers searching for appropriate diagnostic measures. Factor analysis procedures examined the extent to which S(P)CD symptoms presented within the Children’s Communication Checklist-Second Edition (CCC-2) represented a unique construct and whether these factors were influenced by children’s sex. Parents of 208 children (males = 125 and females = 83) from a community-based sample completed the CCC-2. Two pragmatic scores from the CCC-2 were analysed as follows: the social interaction difference index (SIDI) and a pragmatic composite from the original CCC (PC-5). Factor analysis failed to find a unique factor structure for either pragmatic composite. Analyses uncovered different factor structures for the CCC-2 SIDI and PC-5 composites and for boys and girls. S(P)CD represents a complex combination of symptoms that are poorly differentiated from other language and socioemotional behavioural difficulties. PMID:27936954

The revelation effect: A meta-analytic test of hypotheses.

PubMed

Aßfalg, André; Bernstein, Daniel M; Hockley, William

2017-12-01

Judgments can depend on the activity directly preceding them. An example is the revelation effect whereby participants are more likely to claim that a stimulus is familiar after a preceding task, such as solving an anagram, than without a preceding task. We test conflicting predictions of four revelation-effect hypotheses in a meta-analysis of 26 years of revelation-effect research. The hypotheses' predictions refer to three subject areas: (1) the basis of judgments that are subject to the revelation effect (recollection vs. familiarity vs. fluency), (2) the degree of similarity between the task and test item, and (3) the difficulty of the preceding task. We use a hierarchical multivariate meta-analysis to account for dependent effect sizes and variance in experimental procedures. We test the revelation-effect hypotheses with a model selection procedure, where each model corresponds to a prediction of a revelation-effect hypothesis. We further quantify the amount of evidence for one model compared to another with Bayes factors. The results of this analysis suggest that none of the extant revelation-effect hypotheses can fully account for the data. The general vagueness of revelation-effect hypotheses and the scarcity of data were the major limiting factors in our analyses, emphasizing the need for formalized theories and further research into the puzzling revelation effect.

Tactical metrics that discriminate winning, drawing and losing teams in UEFA Euro 2012®.

PubMed

Winter, Christian; Pfeiffer, Mark

2016-01-01

The objectives of this article are twofold: first, an innovative approach to notational analysis in football is outlined. By considering the important theoretical requirements for the analysis of sports games (like the interaction between two parties, the procedural sequence of action or the significance of tactical behaviour) the meaning of the introduced parameters, called tactical metrics, is illustrated. In a second step, the validity of this approach is tested using matches of the Union of European Football Associations (UEFA) Euro 2012® to investigate a connection between these metrics and success. The results show that 11 tactical metrics model tactical behaviour in 4 different dimensions (game speed, transition play after ball recovery, transition play after ball loss and offence efficiency (OE)). Discriminant analysis based on the factor values leads to a correct classification of 64.8% identifying winners, losers and drawers. This successful discrimination reveals a connection between match success and the presented metrics. Especially, the transition play after losing the ball and the OE seem to be factors connected directly with the result of a match, since those were important values for a successful discrimination. Furthermore, the procedural description of tactical behaviour provides the opportunity to conduct meaningful recommendations for the training and coaching process.

Body contouring surgery following bariatric surgery and dietetically induced massive weight reduction: a risk analysis.

PubMed

de Kerviler, S; Hüsler, R; Banic, A; Constantinescu, M A

2009-05-01

This study analyzed the impact of weight reduction method, preoperative, and intraoperative variables on the outcome of reconstructive body contouring surgery following massive weight reduction. All patients presenting with a maximal BMI >/=35 kg/m(2) before weight reduction who underwent body contouring surgery of the trunk following massive weight loss (excess body mass index loss (EBMIL) >/= 30%) between January 2002 and June 2007 were retrospectively analyzed. Incomplete records or follow-up led to exclusion. Statistical analysis focused on weight reduction method and pre-, intra-, and postoperative risk factors. The outcome was compared to current literature results. A total of 104 patients were included (87 female and 17 male; mean age 47.9 years). Massive weight reduction was achieved through bariatric surgery in 62 patients (59.6%) and dietetically in 42 patients (40.4%). Dietetically achieved excess body mass index loss (EBMIL) was 94.20% and in this cohort higher than surgically induced reduction EBMIL 80.80% (p < 0.01). Bariatric surgery did not present increased risks for complications for the secondary body contouring procedures. The observed complications (26.9%) were analyzed for risk factors. Total tissue resection weight was a significant risk factor (p < 0.05). Preoperative BMI had an impact on infections (p < 0.05). No impact on the postoperative outcome was detected in EBMIL, maximal BMI, smoking, hemoglobin, blood loss, body contouring technique or operation time. Corrective procedures were performed in 11 patients (10.6%). The results were compared to recent data. Bariatric surgery does not increase risks for complications in subsequent body contouring procedures when compared to massive dietetic weight reduction.

Baastrup's Disease Is Associated with Recurrent of Sciatica after Posterior Lumbar Spinal Decompressions Utilizing Floating Spinous Process Procedures

PubMed Central

Mannoji, Chikato; Murakami, Masazumi; Kinoshita, Tomoaki; Hirayama, Jiro; Miyashita, Tomohiro; Eguchi, Yawara; Yamazaki, Masashi; Suzuki, Takane; Aramomi, Masaaki; Ota, Mitsutoshi; Maki, Satoshi; Takahashi, Kazuhisa; Furuya, Takeo

2016-01-01

Study Design Retrospective case-control study. Purpose To determine whether kissing spine is a risk factor for recurrence of sciatica after lumbar posterior decompression using a spinous process floating approach. Overview of Literature Kissing spine is defined by apposition and sclerotic change of the facing spinous processes as shown in X-ray images, and is often accompanied by marked disc degeneration and decrement of disc height. If kissing spine significantly contributes to weight bearing and the stability of the lumbar spine, trauma to the spinous process might induce a breakdown of lumbar spine stability after posterior decompression surgery in cases of kissing spine. Methods The present study included 161 patients who had undergone posterior decompression surgery for lumbar canal stenosis using a spinous process floating approaches. We defined recurrence of sciatica as that resolved after initial surgery and then recurred. Kissing spine was defined as sclerotic change and the apposition of the spinous process in a plain radiogram. Preoperative foraminal stenosis was determined by the decrease of perineural fat intensity detected by parasagittal T1-weighted magnetic resonance imaging. Preoperative percentage slip, segmental range of motion, and segmental scoliosis were analyzed in preoperative radiographs. Univariate analysis followed by stepwise logistic regression analysis determined factors independently associated with recurrence of sciatica. Results Stepwise logistic regression revealed kissing spine (p=0.024; odds ratio, 3.80) and foraminal stenosis (p<0.01; odds ratio, 17.89) as independent risk factors for the recurrence of sciatica after posterior lumbar spinal decompression with spinous process floating procedures for lumbar spinal canal stenosis. Conclusions When a patient shows kissing spine and concomitant subclinical foraminal stenosis at the affected level, we should sufficiently discuss the selection of an appropriate surgical procedure. PMID:27994785

Baastrup's Disease Is Associated with Recurrent of Sciatica after Posterior Lumbar Spinal Decompressions Utilizing Floating Spinous Process Procedures.

PubMed

Koda, Masao; Mannoji, Chikato; Murakami, Masazumi; Kinoshita, Tomoaki; Hirayama, Jiro; Miyashita, Tomohiro; Eguchi, Yawara; Yamazaki, Masashi; Suzuki, Takane; Aramomi, Masaaki; Ota, Mitsutoshi; Maki, Satoshi; Takahashi, Kazuhisa; Furuya, Takeo

2016-12-01

Retrospective case-control study. To determine whether kissing spine is a risk factor for recurrence of sciatica after lumbar posterior decompression using a spinous process floating approach. Kissing spine is defined by apposition and sclerotic change of the facing spinous processes as shown in X-ray images, and is often accompanied by marked disc degeneration and decrement of disc height. If kissing spine significantly contributes to weight bearing and the stability of the lumbar spine, trauma to the spinous process might induce a breakdown of lumbar spine stability after posterior decompression surgery in cases of kissing spine. The present study included 161 patients who had undergone posterior decompression surgery for lumbar canal stenosis using a spinous process floating approaches. We defined recurrence of sciatica as that resolved after initial surgery and then recurred. Kissing spine was defined as sclerotic change and the apposition of the spinous process in a plain radiogram. Preoperative foraminal stenosis was determined by the decrease of perineural fat intensity detected by parasagittal T1-weighted magnetic resonance imaging. Preoperative percentage slip, segmental range of motion, and segmental scoliosis were analyzed in preoperative radiographs. Univariate analysis followed by stepwise logistic regression analysis determined factors independently associated with recurrence of sciatica. Stepwise logistic regression revealed kissing spine ( p =0.024; odds ratio, 3.80) and foraminal stenosis ( p <0.01; odds ratio, 17.89) as independent risk factors for the recurrence of sciatica after posterior lumbar spinal decompression with spinous process floating procedures for lumbar spinal canal stenosis. When a patient shows kissing spine and concomitant subclinical foraminal stenosis at the affected level, we should sufficiently discuss the selection of an appropriate surgical procedure.

The ADOPT-LC score: a novel predictive index of in-hospital mortality of cirrhotic patients following surgical procedures, based on a national survey.

PubMed

Sato, Masaya; Tateishi, Ryosuke; Yasunaga, Hideo; Horiguchi, Hiromasa; Matsui, Hiroki; Yoshida, Haruhiko; Fushimi, Kiyohide; Koike, Kazuhiko

2017-03-01

We aimed to develop a model for predicting in-hospital mortality of cirrhotic patients following major surgical procedures using a large sample of patients derived from a Japanese nationwide administrative database. We enrolled 2197 cirrhotic patients who underwent elective (n = 1973) or emergency (n = 224) surgery. We analyzed the risk factors for postoperative mortality and established a scoring system for predicting postoperative mortality in cirrhotic patients using a split-sample method. In-hospital mortality rates following elective or emergency surgery were 4.7% and 20.5%, respectively. In multivariate analysis, patient age, Child-Pugh (CP) class, Charlson Comorbidity Index (CCI), and duration of anesthesia in elective surgery were significantly associated with in-hospital mortality. In emergency surgery, CP class and duration of anesthesia were significant factors. Based on multivariate analysis in the training set (n = 987), the Adequate Operative Treatment for Liver Cirrhosis (ADOPT-LC) score that used patient age, CP class, CCI, and duration of anesthesia to predict in-hospital mortality following elective surgery was developed. This scoring system was validated in the testing set (n = 986) and produced an area under the curve of 0.881. We also developed iOS/Android apps to calculate ADOPT-LC scores to allow easy access to the current evidence in daily clinical practice. Patient age, CP class, CCI, and duration of anesthesia were identified as important risk factors for predicting postoperative mortality in cirrhotic patients. The ADOPT-LC score effectively predicts in-hospital mortality following elective surgery and may assist decisions regarding surgical procedures in cirrhotic patients based on a quantitative risk assessment. © 2016 The Authors Hepatology Research published by John Wiley & Sons Australia, Ltd on behalf of Japan Society of Hepatology.

How useful is determination of anti-factor Xa activity to guide bridging therapy with enoxaparin? A pilot study.

PubMed

Hammerstingl, Christoph; Omran, Heyder; Tripp, Christian; Poetzsch, Bernd

2009-02-01

Low-molecular-weight heparins (LMWH) are commonly used as peri-procedural bridging anticoagulants. The usefulness of measurement of anti-factor Xa activity (anti-Xa) to guide bridging therapy with LMWH is unknown. It was the objective of this study to determine levels of anti-Xa during standard bridging therapy with enoxaparin, and to examine predictors for residual anti-Xa. Consecutive patients receiving enoxaparin at a dosage of 1 mg/kg body weight/12 hours for temporary interruption of phenprocoumon were prospectively enrolled to the study. Blood-samples were obtained 14 hours after LMWH-application immediately pre- procedurally. Procedural details, clinical and demographic data were collected and subsequently analyzed. Seventy patients were included (age 75.2 +/- 10.8 years, Cr Cl 55.7 +/- 21.7ml/min, body mass index [BMI] 27.1 +/- 4.9). LMWH- therapy was for a mean of 4.2 +/- 1.6 days; overall anti-Xa was 0.58 +/- 0.32 U/ml. In 37 (52.8%) of patients anti-Xa was > or U/ml, including 10 (14.3%) patients with anti-Xa > 1U/ml. Linear regression analysis of single variables and logistic multivariable regression analysis failed to prove a correlation between anti-Xa and single or combined factors. No major bleeding, no thromboembolism and four (5.7%) minor haemorrhages were observed. When bridging OAC with therapeutic doses of enoxaparin a high percentage of patients undergo interventions with high residual anti-Xa. The levels of anti-Xa vary largely and are independent of single or combined clinical variables. Since the anti-Xa-related outcome of patients receiving bridging therapy with LMWH is not investigated, no firm recommendation on the usefulness of monitoring of anti-Xa can be given at this stage.

An outcomes analysis of patients undergoing body contouring surgery after massive weight loss.

PubMed

Shermak, Michele A; Chang, David; Magnuson, Thomas H; Schweitzer, Michael A

2006-09-15

Although published reports about technical management of massive weight loss patients are beginning to appear, risk factors for complications following body contouring operations are not known. A retrospective analysis of massive weight loss patients who had body contouring operations between March of 1998 and October of 2004 was performed. Demographic and surgical factors were analyzed. Outcome measures included seroma, wound dehiscence, thromboembolic complications, blood transfusion after surgery, and extended lengths of stay (>2 days). A total of 139 patients were analyzed; 82.7 percent of them were female; mean age was 41 years. On multiple logistic regression, male gender was associated with significant risks for wound dehiscence (odds ratio, 6.4; p = 0.01). There were also trends toward increased risk for wound dehiscence with hypothyroidism (odds ratio, 4.3; p = 0.06) and Ehlers-Danlos syndrome (odds ratio, 18.7; p = 0.05). In terms of risk of blood transfusion, asthma and having three or more procedures were the two variables that emerged with significant association (odds ratio, 16.8 and 13.7, respectively; both p < 0.01). Increased length of stay to greater than 2 days was also significantly associated with having three or more procedures (odds ratio, 4.72; p < 0.01). Male gender, hypothyroidism, and Ehlers-Danlos syndrome may be risk factors for wound dehiscence following body contour operations for massive weight loss. Asthma may be a marker of poor general health status, and asthmatic patients are at increased risk for requiring blood transfusions. Having three or more procedures is associated with an increased risk of blood transfusion and increased length of stay.

Patient complaints in healthcare services in Vietnam’s health system

PubMed Central

Thi Thu Ha, Bui; Mirzoev, Tolib; Morgan, Rosemary

2015-01-01

Background: There is growing recognition of patient rights in health sectors around the world. Patients’ right to complain in hospitals, often visible in legislative and regulatory protocols, can be an important information source for service quality improvement and achievement of better health outcomes. However, empirical evidence on complaint processes is scarce, particularly in the developing countries. To contribute in addressing this gap, we investigated patients’ complaint handling processes and the main influences on their implementation in public hospitals in Vietnam. Methods: The study was conducted in two provinces of Vietnam. We focused specifically on the implementation of the Law on Complaints and Denunciations and the Ministry of Health regulation on resolving complaints in the health sector. The data were collected using document review and in-depth interviews with key respondents. Framework approach was used for data analysis, guided by a conceptual framework and aided by qualitative data analysis software. Results: Five steps of complaint handling were implemented, which varied in practice between the provinces. Four groups of factors influenced the procedures: (1) insufficient investment in complaint handling procedures; (2) limited monitoring of complaint processes; (3) patients’ low awareness of, and perceived lack of power to change, complaint procedures and (4) autonomization pressures on local health facilities. While the existence of complaint handling processes is evident in the health system in Vietnam, their utilization was often limited. Different factors which constrained the implementation and use of complaint regulations included health system–related issues as well as social and cultural influences. Conclusion: The study aimed to contribute to improved understanding of complaint handling processes and the key factors influencing these processes in public hospitals in Vietnam. Specific policy implications for improving these processes were proposed, which include improving accountability of service providers and better utilization of information on complaints. PMID:26770804

Theoretical and experimental study of a new algorithm for factoring numbers

NASA Astrophysics Data System (ADS)

Tamma, Vincenzo

The security of codes, for example in credit card and government information, relies on the fact that the factorization of a large integer N is a rather costly process on a classical digital computer. Such a security is endangered by Shor's algorithm which employs entangled quantum systems to find, with a polynomial number of resources, the period of a function which is connected with the factors of N. We can surely expect a possible future realization of such a method for large numbers, but so far the period of Shor's function has been only computed for the number 15. Inspired by Shor's idea, our work aims to methods of factorization based on the periodicity measurement of a given continuous periodic "factoring function" which is physically implementable using an analogue computer. In particular, we have focused on both the theoretical and the experimental analysis of Gauss sums with continuous arguments leading to a new factorization algorithm. The procedure allows, for the first time, to factor several numbers by measuring the periodicity of Gauss sums performing first-order "factoring" interfer ence processes. We experimentally implemented this idea by exploiting polychromatic optical interference in the visible range with a multi-path interferometer, and achieved the factorization of seven digit numbers. The physical principle behind this "factoring" interference procedure can be potentially exploited also on entangled systems, as multi-photon entangled states, in order to achieve a polynomial scaling in the number of resources.

Selecting the "Best" Factor Structure and Moving Measurement Validation Forward: An Illustration.

PubMed

Schmitt, Thomas A; Sass, Daniel A; Chappelle, Wayne; Thompson, William

2018-04-09

Despite the broad literature base on factor analysis best practices, research seeking to evaluate a measure's psychometric properties frequently fails to consider or follow these recommendations. This leads to incorrect factor structures, numerous and often overly complex competing factor models and, perhaps most harmful, biased model results. Our goal is to demonstrate a practical and actionable process for factor analysis through (a) an overview of six statistical and psychometric issues and approaches to be aware of, investigate, and report when engaging in factor structure validation, along with a flowchart for recommended procedures to understand latent factor structures; (b) demonstrating these issues to provide a summary of the updated Posttraumatic Stress Disorder Checklist (PCL-5) factor models and a rationale for validation; and (c) conducting a comprehensive statistical and psychometric validation of the PCL-5 factor structure to demonstrate all the issues we described earlier. Considering previous research, the PCL-5 was evaluated using a sample of 1,403 U.S. Air Force remotely piloted aircraft operators with high levels of battlefield exposure. Previously proposed PCL-5 factor structures were not supported by the data, but instead a bifactor model is arguably more statistically appropriate.

Predictive factors for cosmetic surgery: a hospital-based investigation.

PubMed

Li, Jun; Li, Qian; Zhou, Bei; Gao, Yanli; Ma, Jiehua; Li, Jingyun

2016-01-01

Cosmetic surgery is becoming increasingly popular in China. However, reports on the predictive factors for cosmetic surgery in Chinese individuals are scarce in the literature. We retrospectively analyzed 4550 cosmetic surgeries performed from January 2010 to December 2014 at a single center in China. Data collection included patient demographics and type of cosmetic surgery. Predictive factors were age, sex, marital status, occupational status, educational degree, and having had children. Predictive factors for the three major cosmetic surgeries were determined using a logistic regression analysis. Patients aged 19-34 years accounted for the most popular surgical procedures (76.9 %). The most commonly requested procedures were eye surgery, Botox injection, and nevus removal. Logistic regression analysis showed that higher education level (college, P = 0.01, OR 1.21) was predictive for eye surgery. Age (19-34 years, P = 0.00, OR 33.39; 35-50, P = 0.00, OR 31.34; ≥51, P = 0.00, OR 16.42), female sex (P = 0.00, OR 9.19), employment (service occupations, P = 0.00, OR 2.31; non-service occupations, P = 0.00, OR 1.76), and higher education level (college, P = 0.00, OR 1.39) were independent predictive factors for Botox injection. Married status (P = 0.00, OR 1.57), employment (non-service occupations, P = 0.00, OR 1.50), higher education level (masters, P = 0.00, OR 6.61), and having children (P = 0.00, OR 1.45) were independent predictive factors for nevus removal. The principal three cosmetic surgeries (eye surgery, Botox injection, and nevus removal) were associated with multiple variables. Patients employed in non-service occupations were more inclined to undergo Botox injection and nevus removal. Cohort study, Level III.

Incidence and risk factors of early arterial blood flow stasis during first radioembolization of primary and secondary liver malignancy using resin microspheres: an initial single-center analysis.

PubMed

Pieper, Claus Christian; Willinek, Winfried A; Thomas, Daniel; Ahmadzadehfar, Hojjat; Essler, Markus; Nadal, Jennifer; Wilhelm, Kai E; Schild, Hans Heinz; Meyer, Carsten

2016-08-01

To retrospectively determine incidence of early arterial blood flow stasis and its influencing factors during resin-based radioembolization (RE) of liver tumours. Data of patients undergoing resin-based RE from 06/2006-12/2013 were reviewed. Second RE procedures of the same liver lobe were excluded. 90-yttrium dose was calculated according to the body surface area method. Data were categorized according to RE without full dose application because of early stasis and with full dose application. Clinical/procedural characteristics were recorded. Logistic regression was performed to identify associations between clinical/procedural characteristics and early stasis. 362 patients [220 male; mean age 62 years (range 26-90)] underwent 416 RE sessions with early stasis occurring in 103 REs (24.8 %). Highest incidence and degree of stasis were observed in breast cancer metastases [42.6 % (20/47); 55.8 % of mean intended dose administered]. Independent risk factors were: metastasized breast cancer (odds ratio [OR] 2.18, p = 0.02), liver tumour-burden <25 % and 25-50 % (ORs 5.33, 15.64; p < 0.0001), tumour hypovascularity (OR 2.70, p = 0.04), previous bevacizumab therapy (OR 2.79, p = 0.0009) and concurrent chemotherapy (OR 8.69, p < 0.0001). Early stasis was observed in 24.8 % of resin-based REs. In the presence of the identified risk factors, extra care should be taken during microsphere administration. • Early arterial blood flow stasis is a known problem of resin-based RE. • The study showed that early stasis occurs in 25 % of REs. • Several clinical and procedural factors are associated with early stasis. • In patients at risk extra care should be taken during RE.

[Factors Affecting Long-Term Cosmetic Results after Minimally Invasive Video-Assisted Thyroidectomy and Conventional Thyroid Surgery].

PubMed

Sahm, Maik; Otto, Ronny; Pross, Matthias; Mantke, Rene

2018-06-25

Approximately 90,000 thyroid operations are performed in Germany each year. Minimally invasive video-assisted thyroidectomy (MIVAT) accounts for 5 - 10% of these operations. There are few data that compare long-term cosmetic results after MIVAT to those after conventional surgery. Current systematic reviews show no advantage for MIVAT. The goal of this study was to analyse the long-term postoperative results in both procedures and the evaluation of relevant factors. The analysis of the long-term results is based on follow-up examinations using a validated method for scar appraisal (POSAS). Cohort analysis was performed on MIVAT operations in our hospital between 2004 and 2011 and conventional thyroid operations in 2011. Follow-up examination data were analysed from 117 patients from the MIVAT group and 102 patients from the conventional group. The follow-up examination was performed with a mean of 23.1 vs. 23.6 months postoperatively (MIVAT vs. conventional). The Friedman Test showed that scar pigmentation (mean rank 4.79) and scar surface structure (mean rank 3.62) were the deciding factors influencing the long-term cosmetic results. Both MIVAT and conventional surgery gave very good long-term cosmetic results. From the patient's perspective, there is no significant advantage with conventional surgery. The evaluation of the long-term results largely depends on factors such as scar pigmentation and surface structure that can only be influenced to a limited extent by the surgical procedure. Georg Thieme Verlag KG Stuttgart · New York.

Structural design/margin assessment

NASA Technical Reports Server (NTRS)

Ryan, R. S.

1993-01-01

Determining structural design inputs and the structural margins following design completion is one of the major activities in space exploration. The end result is a statement of these margins as stability, safety factors on ultimate and yield stresses, fracture limits (fracture control), fatigue lifetime, reuse criteria, operational criteria and procedures, stability factors, deflections, clearance, handling criteria, etc. The process is normally called a load cycle and is time consuming, very complex, and involves much more than structures. The key to successful structural design is the proper implementation of the process. It depends on many factors: leadership and management of the process, adequate analysis and testing tools, data basing, communications, people skills, and training. This process and the various factors involved are discussed.

An investigation of constructions of justice and injustice in chronic pain: a Q-methodology approach.

PubMed

McParland, Joanna; Hezseltine, Louisa; Serpell, Michael; Eccleston, Christopher; Stenner, Paul

2011-09-01

This study used Q-methodology to explore justice-related accounts of chronic pain. Eighty participants completed the Q-sorting procedure (33 chronic pain sufferers and 47 non-pain sufferers). Analysis revealed five main factors. Three factors blame: society for poor medical and interpersonal treatment; the chronic pain sufferer for indulging in self-pity and unempathic healthcare workers for ignoring patients. A fourth factor acknowledges the unfairness of pain and encourages self-reliance. The fifth factor rejects injustice in the chronic pain discourse. Overall, there is a shared view that chronic pain brings unfair treatment, disrespect and a de-legitimization of pain. Future research ideas are suggested.

Systematic Review: Predisposing, Precipitating, Perpetuating, and Present Factors Predicting Anticipatory Distress to Painful Medical Procedures in Children.

PubMed

Racine, Nicole M; Riddell, Rebecca R Pillai; Khan, Maria; Calic, Masa; Taddio, Anna; Tablon, Paula

2016-03-01

To conduct a systematic review of the factors predicting anticipatory distress to painful medical procedures in children. A systematic search was conducted to identify studies with factors related to anticipatory distress to painful medical procedures in children aged 0-18 years. The search retrieved 7,088 articles to review against inclusion criteria. A total of 77 studies were included in the review. 31 factors were found to predict anticipatory distress to painful medical procedures in children. A narrative synthesis of the evidence was conducted, and a summary figure is presented. Many factors were elucidated that contribute to the occurrence of anticipatory distress to painful medical procedures. The factors that appear to increase anticipatory distress are child psychopathology, difficult child temperament, parent distress promoting behaviors, parent situational distress, previous pain events, parent anticipation of distress, and parent anxious predisposition. Longitudinal and experimental research is needed to further elucidate these factors. © The Author 2015. Published by Oxford University Press on behalf of the Society of Pediatric Psychology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Empirical likelihood based detection procedure for change point in mean residual life functions under random censorship.

PubMed

Chen, Ying-Ju; Ning, Wei; Gupta, Arjun K

2016-05-01

The mean residual life (MRL) function is one of the basic parameters of interest in survival analysis that describes the expected remaining time of an individual after a certain age. The study of changes in the MRL function is practical and interesting because it may help us to identify some factors such as age and gender that may influence the remaining lifetimes of patients after receiving a certain surgery. In this paper, we propose a detection procedure based on the empirical likelihood for the changes in MRL functions with right censored data. Two real examples are also given: Veterans' administration lung cancer study and Stanford heart transplant to illustrate the detecting procedure. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

Job Satisfaction, Organizational Commitment, and Religious Commitment of Full-Time University Employees

ERIC Educational Resources Information Center

Brown, Donna; Sargeant, Marcel A.

2007-01-01

This study investigated the relationship of job satisfaction and organizational and religious commitment among full time workers at Akra University (a pseudonym) based on a number of demographic factors. Analysis of variance using the Games-Howell procedure revealed that workers who were older than age 46 years had higher job satisfaction and…

Using Recursive Regression to Explore Nonlinear Relationships and Interactions: A Tutorial Applied to a Multicultural Education Study

ERIC Educational Resources Information Center

Strang, Kenneth David

2009-01-01

This paper discusses how a seldom-used statistical procedure, recursive regression (RR), can numerically and graphically illustrate data-driven nonlinear relationships and interaction of variables. This routine falls into the family of exploratory techniques, yet a few interesting features make it a valuable compliment to factor analysis and…

Development of LRFD design procedures for bridge piles in Iowa : field testing of steel H-piles in clay, sand, and mixed soils and data analysis (volume II).

DOT National Transportation Integrated Search

2011-09-01

In response to the mandate on Load and Resistance Factor Design (LRFD) implementations by the Federal Highway Administration : (FHWA) on all new bridge projects initiated after October 1, 2007, the Iowa Highway Research Board (IHRB) sponsored these r...

An Experimental Analysis of Procedures for Increasing Specific Vocalizations of Children Who Do Not Develop Functional Speech. Progress Report.

ERIC Educational Resources Information Center

LeBlanc, Judith M.

To gain some insight into the problem of deviant speech development in low income populations, this study investigated the environmental factors that encourage the development of normal speech. Two specific questions were examined in this study: (1) If specific vocalized environmental sounds are presented contiguously with reinforcement, will…

[The economic culture of medical institution as the factor of innovative development].

PubMed

Poliakov, B A; Kizeev, M V; Mushnikov, D L

2010-01-01

The article presents the results of study of economic culture of sanatorium type medical institution based on the analysis of its components sorted out with specially developed procedures. The medical organizational pattern of enhancing the economic culture of sanatorium type medical institution was proposed. It's effectiveness was checked in the medical organizational experiment.

Validation of the Chinese Version of the Epistemic Beliefs Inventory Using Confirmatory Factor Analysis

ERIC Educational Resources Information Center

Wang, Xihui; Zhang, Zhidong; Zhang, Xiuying; Hou, Dadong

2013-01-01

The Epistemic Beliefs Inventory (EBI), as a theory-based and empirically validated instrument, was originally developed and widely used in the North American context. Through a strict translation procedure the authors translated the EBI into Chinese, and then administered it to 451 students in 7 universities in mainland China. The construct…

How Does One Assess the Accuracy of Academic Success Predictors? ROC Analysis Applied to University Entrance Factors

ERIC Educational Resources Information Center

Vivo, Juana-Maria; Franco, Manuel

2008-01-01

This article attempts to present a novel application of a method of measuring accuracy for academic success predictors that could be used as a standard. This procedure is known as the receiver operating characteristic (ROC) curve, which comes from statistical decision techniques. The statistical prediction techniques provide predictor models and…

Use of Item Parceling in Structural Equation Modeling with Missing Data

ERIC Educational Resources Information Center

Orcan, Fatih

2013-01-01

Parceling is referred to as a procedure for computing sums or average scores across multiple items. Parcels instead of individual items are then used as indicators of latent factors in the structural equation modeling analysis (Bandalos 2002, 2008; Little et al., 2002; Yang, Nay, & Hoyle, 2010). Item parceling may be applied to alleviate some…

Performance Factors Analysis -- A New Alternative to Knowledge Tracing

ERIC Educational Resources Information Center

Pavlik, Philip I., Jr.; Cen, Hao; Koedinger, Kenneth R.

2009-01-01

Knowledge tracing (KT)[1] has been used in various forms for adaptive computerized instruction for more than 40 years. However, despite its long history of application, it is difficult to use in domain model search procedures, has not been used to capture learning where multiple skills are needed to perform a single action, and has not been used…

Critical Uses of College Resources. Part II: Utilization of Space Facilities.

ERIC Educational Resources Information Center

Carter, Edith H.

Space utilization analysis is required as building programs are slowing in community colleges. State planning procedures fail to provide adequate information, since they tell little about the actual use of space. The formula derived by Bareither and Schillinger can evolve a space factor, using square feet per student station, hours per week the…

An Eco-Behavioral Approach to Research in Special Education. The Juniper Gardens Children's Project. [Volume 1].

ERIC Educational Resources Information Center

Greenwood, Charles R., Ed.; And Others

This monograph contains five papers that discuss an eco-behavioral approach to psychology, special education, and applied behavior analysis. The papers point out the advantages of assessing ecological factors (such as natural stimuli and special education procedures) in a quantitative fashion and in a temporal relationship with student behavior.…

Impact of Aneurysm Projection on Intraoperative Complications During Surgical Clipping of Ruptured Posterior Communicating Artery Aneurysms.

PubMed

Fukuda, Hitoshi; Hayashi, Kosuke; Yoshino, Kumiko; Koyama, Takashi; Lo, Benjamin; Kurosaki, Yoshitaka; Yamagata, Sen

2016-03-01

Surgical clipping of ruptured posterior communicating artery (PCoA) aneurysms is a well-established procedure to date. However, preoperative factors associated with procedure-related risk require further elucidation. To investigate the impact of the direction of aneurysm projection on the incidence of procedure-related complications during surgical clipping of ruptured PCoA aneurysms. A total of 65 patients with ruptured PCoA aneurysms who underwent surgical clipping were retrospectively analyzed from a single-center, prospective, observational cohort database in this study. The aneurysms were categorized into lateral and posterior projection groups, depending on direction of the dome. Characteristics and operative findings of each projection group were identified. We also evaluated any correlation of aneurysm projection with the incidence of procedure-related complications. Patients with ruptured PCoA aneurysms with posterior projection more likely presented with good-admission-grade subarachnoid hemorrhage (P = .01, χ test) and were less to also have intracerebral hematoma (P = .01). These aneurysms were found to be associated with higher incidence of intraoperative rupture (P = .02), complex clipping with fenestrated clips (P = .02), and dense adherence to PCoA or its perforators (P = .04) by univariate analysis. Aneurysms with posterior projection were also correlated with procedure-related complications, including postoperative cerebral infarction or hematoma formation (odds ratio, 5.87; 95% confidence interval, 1.11-31.1; P = .04) by multivariable analysis. Ruptured PCoA aneurysms with posterior projection carried a higher risk of procedure-related complications of surgical clipping than those with lateral projection.

WE-E-18A-03: How Accurately Can the Peak Skin Dose in Fluoroscopy Be Determined Using Indirect Dose Metrics?

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

Jones, A; Pasciak, A

Purpose: Skin dosimetry is important for fluoroscopically-guided interventions, as peak skin doses (PSD) that Result in skin reactions can be reached during these procedures. The purpose of this study was to assess the accuracy of different indirect dose estimates and to determine if PSD can be calculated within ±50% for embolization procedures. Methods: PSD were measured directly using radiochromic film for 41 consecutive embolization procedures. Indirect dose metrics from procedures were collected, including reference air kerma (RAK). Four different estimates of PSD were calculated and compared along with RAK to the measured PSD. The indirect estimates included a standard method,more » use of detailed information from the RDSR, and two simplified calculation methods. Indirect dosimetry was compared with direct measurements, including an analysis of uncertainty associated with film dosimetry. Factors affecting the accuracy of the indirect estimates were examined. Results: PSD calculated with the standard calculation method were within ±50% for all 41 procedures. This was also true for a simplified method using a single source-to-patient distance (SPD) for all calculations. RAK was within ±50% for all but one procedure. Cases for which RAK or calculated PSD exhibited large differences from the measured PSD were analyzed, and two causative factors were identified: ‘extreme’ SPD and large contributions to RAK from rotational angiography or runs acquired at large gantry angles. When calculated uncertainty limits [−12.8%, 10%] were applied to directly measured PSD, most indirect PSD estimates remained within ±50% of the measured PSD. Conclusions: Using indirect dose metrics, PSD can be determined within ±50% for embolization procedures, and usually to within ±35%. RAK can be used without modification to set notification limits and substantial radiation dose levels. These results can be extended to similar procedures, including vascular and interventional oncology. Film dosimetry is likely an unnecessary effort for these types of procedures.« less

Hysteroscopic sterilization success in outpatient vs office setting is not affected by patient or procedural characteristics.

PubMed

Anderson, Ted L; Yunker, Amanda C; Scheib, Stacey A; Callahan, Tamara L

2013-01-01

To determine factors associated with hysteroscopic sterilization success and whether it differs between the operating room and office settings. Retrospective cohort analysis (Canadian Task Force classification II-2). Major university medical center. Six hundred thirty-eight women who underwent hysteroscopic sterilization between July 1, 2005, and June 30, 2011. Data collected included age, body mass index, previous office procedures, previous cesarean section, and presence of myomas or retroverted uterus. Place of surgery, experience of surgeon, insurance type, bilateral device placement, compliance with hysterosalpingography, and confirmation of occlusion were also recorded. Bivariate analysis of patient characteristics between groups was performed using χ(2) and independent t tests, and identified confounders and associated variables. Multivariate analysis was performed using logistic regression to assess for association and to adjust for confounders. Procedures were performed in the operating room (57%) or in the office (43%). There was no association between success in bilateral device placement or occlusion and any patient characteristic, regardless of surgery setting. Private insurance, patient age, and performance of procedures in the office setting were positively associated with likelihood of compliance with hysterosalpingography. Successful device placement and tubal occlusion are independent of patient age, body mass index, or setting of the procedure. Association between insurance type and completing hysterosalpingography illustrates an important public health problem. Patients who fail to undergo hysterosalpingography to confirm tubal occlusion may unknowingly be at risk of pregnancy and increased risk of ectopic pregnancy. Copyright © 2013 AAGL. Published by Elsevier Inc. All rights reserved.

Laparoscopic versus robotic-assisted Roux-en-Y gastric bypass: a retrospective, single-center study of early perioperative outcomes at a community hospital.

PubMed

Ahmad, Arif; Carleton, Jared D; Ahmad, Zoha F; Agarwala, Ashish

2016-09-01

The purpose of this study was to compare the operative and early perioperative outcomes of laparoscopic versus robotic-assisted Roux-en-Y gastric bypass procedures performed in a community hospital setting. The study was a chart review and analysis of the early perioperative outcomes of a total of 345 Roux-en-Y gastric bypass procedures performed by a single surgeon in a community hospital setting from January 2011 to October 2014. Of these, 173 procedures were performed laparoscopically and 172 were performed with robotic assistance utilizing the daVinci(®) surgical platform. Factors such as baseline patient characteristics, operative time, estimated blood loss (EBL), conversions to open procedure, complication rates, adverse events, length of stay (LOS), and return to the operating room for the two groups were retrospectively analyzed from a prospectively maintained database. Student's t test with unequal variances was used for statistical analysis, and a p value <0.05 was used for significance. There were no statistically significant differences in complication rates, EBL, or LOS between the two groups. There was a significant difference between the total operative times (135.30 ± 37.60 min for the laparoscopic procedure versus 154.84 ± 38.44 min for the robotic procedure, p < 0.05). There were no adverse intraoperative events, conversions to open procedures, leaks, strictures, returns to the operating room within 30 days, or mortalities in either group. Our study, which is the first of its kind to analyze the operative and early perioperative outcomes between laparoscopic and robotic-assisted Roux-en-Y gastric bypass procedures in the US community hospital setting, indicates that both are comparable in terms of safety, efficacy, and operative and early perioperative outcomes.

Independent predictors of retrograde failure in CTO-PCI after successful collateral channel crossing.

PubMed

Suzuki, Yoriyasu; Muto, Makoto; Yamane, Masahisa; Muramatsu, Toshiya; Okamura, Atsunori; Igarashi, Yasumi; Fujita, Tsutomu; Nakamura, Shigeru; Oida, Akitsugu; Tsuchikane, Etsuo

2017-07-01

To evaluate factors for predicting retrograde CTO-PCI failure after successful collateral channel crossing. Successful guidewire/catheter collateral channel crossing is important for the retrograde approach in percutaneous coronary intervention (PCI) for chronic total occlusion (CTO). A total of 5984 CTO-PCI procedures performed in 45 centers in Japan from 2009 to 2012 were studied. The retrograde approach was used in 1656 CTO-PCIs (27.7%). We investigated these retrograde procedures to evaluate factors for predicting retrograde CTO-PCI failure even after successful collateral channel crossing. Successful guidewire/catheter collateral crossing was achieved in 77.1% (n = 1,276) of 1656 retrograde CTO-PCI procedures. Retrograde procedural success after successful collateral crossing was achieved in 89.4% (n = 1,141). Univariate analysis showed that the predictors for retrograde CTO-PCI failure were in-stent occlusion (OR = 1.9829, 95%CI = 1.1783 - 3.3370 P = 0.0088), calcified lesions (OR = 1.9233, 95%CI = 1.2463 - 2.9679, P = 0.0027), and lesion tortuosity (OR = 1.5244, 95%CI = 1.0618 - 2.1883, P = 0.0216). On multivariate analysis, lesion calcification was an independent predictor of retrograde CTO-PCI failure after successful collateral channel crossing (OR = 1.3472, 95%CI = 1.0614 - 1.7169, P = 0.0141). The success rate of retrograde CTO-PCI following successful guidewire/catheter collateral channel crossing was high in this registry. Lesion calcification was an independent predictor of retrograde CTO-PCI failure after successful collateral channel crossing. Devices and techniques to overcome complex CTO lesion morphology, such as lesion calcification, are required to further improve the retrograde CTO-PCI success rate. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

Risk factors for acquisition of OXA-48-producing Klebsiella pneumonia among contact patients: a multicentre study.

PubMed

Hilliquin, D; Le Guern, R; Thepot Seegers, V; Neulier, C; Lomont, A; Marie, V; Legeay, C; Merrer, J; Lepelletier, D; Rogues, A M; Grandbastien, B; Lucet, J C; Zahar, J R

2018-03-01

Cohorting carbapenemase-producing Enterobacteriaceae (CPE) carriers during hospitalization limits in-hospital spreading. To identify risk factors for CPE acquisition among contacts of an index patient in non-cohorted populations. A multicentre retrospective matched case-control study was conducted in five hospitals. Each contact patient (case) who acquired Klebsiella pneumoniae (KP)-OXA-48 from an index patient was compared to three contact (controls) with the same index patients matched with hospitalization in the same unit and similar exposure times. Fifty-one secondary cases and 131 controls were included. By univariate analysis, exposure time (odds ratio: 1.06; 95% confidence interval: 1.02-1.1; P = 0.006), concomitant infection at admission (3.23; 1.42-7.35; P = 0.005), antimicrobial therapy within the last month before hospitalization (2.88; 1.34-6.2; P = 0.007), antimicrobial therapy during the exposure time (5.36; 2.28-12.6; P < 0.001), use of at least one invasive procedure (2.99; 1.25-7.15; P = 0.014), number of invasive procedures (1.52; 1.05-2.19; P = 0.025), and geographical proximity (2.84; 1.15-7.00; P = 0.023) were associated with CPE acquisition. By multivariate analysis, antimicrobial therapy during the exposure time (odds ratio: 6.36; 95% confidence interval: 2.46-16.44; P < 0.001), at least one invasive procedure (2.92; 1.04-8.17; P = 0.041), and geographical proximity (3.69; 1.15-11.86; P = 0.028) were associated with acquisition. In this study, geographical proximity, invasive procedure, and antimicrobial therapy during exposure time were significantly associated with KP-OXA-48 acquisition. Copyright © 2017 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

Association of code status discussion with invasive procedures among advanced-stage cancer and noncancer patients.

PubMed

Sasaki, Akinori; Hiraoka, Eiji; Homma, Yosuke; Takahashi, Osamu; Norisue, Yasuhiro; Kawai, Koji; Fujitani, Shigeki

2017-01-01

Code status discussion is associated with a decrease in invasive procedures among terminally ill cancer patients. We investigated the association between code status discussion on admission and incidence of invasive procedures, cardiopulmonary resuscitation (CPR), and opioid use among inpatients with advanced stages of cancer and noncancer diseases. We performed a retrospective cohort study in a single center, Ito Municipal Hospital, Japan. Participants were patients who were admitted to the Department of Internal Medicine between October 1, 2013 and August 30, 2015, with advanced-stage cancer and noncancer. We collected demographic data and inquired the presence or absence of code status discussion within 24 hours of admission and whether invasive procedures, including central venous catheter placement, intubation with mechanical ventilation, and CPR for cardiac arrest, and opioid treatment were performed. We investigated the factors associated with CPR events by using multivariate logistic regression analysis. Among the total 232 patients, code status was discussed with 115 patients on admission, of which 114 (99.1%) patients had do-not-resuscitate (DNR) orders. The code status was not discussed with the remaining 117 patients on admission, of which 69 (59%) patients had subsequent code status discussion with resultant DNR orders. Code status discussion on admission decreased the incidence of central venous catheter placement, intubation with mechanical ventilation, and CPR in both cancer and noncancer patients. It tended to increase the rate of opioid use. Code status discussion on admission was the only factor associated with the decreased use of CPR ( P <0.001, odds ratio =0.03, 95% CI =0.004-0.21), which was found by using multivariate logistic regression analysis. Code status discussion on admission is associated with a decrease in invasive procedures and CPR in cancer and noncancer patients. Physicians should be educated about code status discussion to improve end-of-life care.

Risk factors for baclofen pump infection in children: a multivariate analysis.

PubMed

Spader, Heather S; Bollo, Robert J; Bowers, Christian A; Riva-Cambrin, Jay

2016-06-01

OBJECTIVE Intrathecal baclofen infusion systems to manage severe spasticity and dystonia are associated with higher infection rates in children than in adults. Factors unique to this population, such as poor nutrition and physical limitations for pump placement, have been hypothesized as the reasons for this disparity. The authors assessed potential risk factors for infection in a multivariate analysis. METHODS Patients who underwent implantation of a programmable pump and intrathecal catheter for baclofen infusion at a single center between January 1, 2000, and March 1, 2012, were identified in this retrospective cohort study. The primary end point was infection. Potential risk factors investigated included preoperative (i.e., demographics, body mass index [BMI], gastrostomy tube, tracheostomy, previous spinal fusion), intraoperative (i.e., surgeon, antibiotics, pump size, catheter location), and postoperative (i.e., wound dehiscence, CSF leak, and number of revisions) factors. Univariate analysis was performed, and a multivariate logistic regression model was created to identify independent risk factors for infection. RESULTS A total of 254 patients were evaluated. The overall infection rate was 9.8%. Univariate analysis identified young age, shorter height, lower weight, dehiscence, CSF leak, and number of revisions within 6 months of pump placement as significantly associated with infection. Multivariate analysis identified young age, dehiscence, and number of revisions as independent risk factors for infection. CONCLUSIONS Young age, wound dehiscence, and number of revisions were independent risk factors for infection in this pediatric cohort. A low BMI and the presence of either a gastrostomy or tracheostomy were not associated with infection and may not be contraindications for this procedure.

Development of quantitative security optimization approach for the picture archives and carrying system between a clinic and a rehabilitation center

NASA Astrophysics Data System (ADS)

Haneda, Kiyofumi; Kajima, Toshio; Koyama, Tadashi; Muranaka, Hiroyuki; Dojo, Hirofumi; Aratani, Yasuhiko

2002-05-01

The target of our study is to analyze the level of necessary security requirements, to search for suitable security measures and to optimize security distribution to every portion of the medical practice. Quantitative expression must be introduced to our study, if possible, to enable simplified follow-up security procedures and easy evaluation of security outcomes or results. Using fault tree analysis (FTA), system analysis showed that system elements subdivided into groups by details result in a much more accurate analysis. Such subdivided composition factors greatly depend on behavior of staff, interactive terminal devices, kinds of services provided, and network routes. Security measures were then implemented based on the analysis results. In conclusion, we identified the methods needed to determine the required level of security and proposed security measures for each medical information system, and the basic events and combinations of events that comprise the threat composition factors. Methods for identifying suitable security measures were found and implemented. Risk factors for each basic event, a number of elements for each composition factor, and potential security measures were found. Methods to optimize the security measures for each medical information system were proposed, developing the most efficient distribution of risk factors for basic events.

Leadership: validation of a self-report scale.

PubMed

Dussault, Marc; Frenette, Eric; Fernet, Claude

2013-04-01

The aim of this paper was to propose and test the factor structure of a new self-report questionnaire on leadership. A sample of 373 school principals in the Province of Quebec, Canada completed the initial 46-item version of the questionnaire. In order to obtain a questionnaire of minimal length, a four-step procedure was retained. First, items analysis was performed using Classical Test Theory. Second, Rasch analysis was used to identify non-fitting or overlapping items. Third, a confirmatory factor analysis (CFA) using structural equation modelling was performed on the 21 remaining items to verify the factor structure of the scale. Results show that the model with a single third-order dimension (leadership), two second-order dimensions (transactional and transformational leadership), and one first-order dimension (laissez-faire leadership) provides a good fit to the data. Finally, invariance of factor structure was assessed with a second sample of 222 vice-principals in the Province of Quebec, Canada. This model is in agreement with the theoretical model developed by Bass (1985), upon which the questionnaire is based.

The Incidence of Complications in Single-stage Endoscopic Stone Removal for Patients with Common Bile Duct Stones: A Propensity Score Analysis.

PubMed

Saito, Hirokazu; Kadono, Yoshihiro; Kamikawa, Kentaro; Urata, Atsushi; Imamura, Haruo; Matsushita, Ikuo; Kakuma, Tatsuyuki; Tada, Shuji

2018-02-15

Objective Single-stage endoscopic stone removal for choledocholithiasis is an advantageous approach because it is associated with a shorter hospital stay; however, few studies have reported the incidence of complications related to this procedure in detail. The aim of this study was to examine the incidence of complications and efficacy of this procedure. Methods This retrospective study investigated the incidence of complications in 345 patients with naive papilla who underwent therapeutic endoscopic retrograde cholangiopancreatography (ERCP) for choledocholithiasis at three institutions between April 2014 and March 2016 by a propensity score analysis. The efficacy of single-stage endoscopic stone removal was assessed based on a hospital stay of within 7 days and the number of ERCP attempts. Results Among 114 patients who underwent single-stage endoscopic stone removal, 15 patients (13.2%) experienced complications. Among the remaining 231 patients in the two-stage endoscopic stone removal group, complications were observed in 17 patients (7.4%). The propensity score analysis, which was adjusted for confounding factors, revealed that single-stage endoscopic stone removal was not a significant risk factor for complications (p=0.52). In patients in whom >10 min was required for deep cannulation, single-stage endoscopic stone removal was not a significant risk factor for complications in the propensity score analysis (p=0.37). In the single-stage group, the proportion of patients with a hospital stay of within 7 days was significantly higher and the number of ERCP attempts was significantly lower in comparison to the two-stage group (p <0.0001 and <0.0001, respectively). Conclusion Single-stage endoscopic stone removal did not increase the incidence of complications associated with ERCP and was effective for reducing the hospital stay and the number of ERCP attempts.

The Incidence of Complications in Single-stage Endoscopic Stone Removal for Patients with Common Bile Duct Stones: A Propensity Score Analysis

PubMed Central

Saito, Hirokazu; Kadono, Yoshihiro; Kamikawa, Kentaro; Urata, Atsushi; Imamura, Haruo; Matsushita, Ikuo; Kakuma, Tatsuyuki; Tada, Shuji

2017-01-01

Objective Single-stage endoscopic stone removal for choledocholithiasis is an advantageous approach because it is associated with a shorter hospital stay; however, few studies have reported the incidence of complications related to this procedure in detail. The aim of this study was to examine the incidence of complications and efficacy of this procedure. Methods This retrospective study investigated the incidence of complications in 345 patients with naive papilla who underwent therapeutic endoscopic retrograde cholangiopancreatography (ERCP) for choledocholithiasis at three institutions between April 2014 and March 2016 by a propensity score analysis. The efficacy of single-stage endoscopic stone removal was assessed based on a hospital stay of within 7 days and the number of ERCP attempts. Results Among 114 patients who underwent single-stage endoscopic stone removal, 15 patients (13.2%) experienced complications. Among the remaining 231 patients in the two-stage endoscopic stone removal group, complications were observed in 17 patients (7.4%). The propensity score analysis, which was adjusted for confounding factors, revealed that single-stage endoscopic stone removal was not a significant risk factor for complications (p=0.52). In patients in whom >10 min was required for deep cannulation, single-stage endoscopic stone removal was not a significant risk factor for complications in the propensity score analysis (p=0.37). In the single-stage group, the proportion of patients with a hospital stay of within 7 days was significantly higher and the number of ERCP attempts was significantly lower in comparison to the two-stage group (p <0.0001 and <0.0001, respectively). Conclusion Single-stage endoscopic stone removal did not increase the incidence of complications associated with ERCP and was effective for reducing the hospital stay and the number of ERCP attempts. PMID:29151506

From direct-space discrepancy functions to crystallographic least squares.

PubMed

Giacovazzo, Carmelo

2015-01-01

Crystallographic least squares are a fundamental tool for crystal structure analysis. In this paper their properties are derived from functions estimating the degree of similarity between two electron-density maps. The new approach leads also to modifications of the standard least-squares procedures, potentially able to improve their efficiency. The role of the scaling factor between observed and model amplitudes is analysed: the concept of unlocated model is discussed and its scattering contribution is combined with that arising from the located model. Also, the possible use of an ancillary parameter, to be associated with the classical weight related to the variance of the observed amplitudes, is studied. The crystallographic discrepancy factors, basic tools often combined with least-squares procedures in phasing approaches, are analysed. The mathematical approach here described includes, as a special case, the so-called vector refinement, used when accurate estimates of the target phases are available.

Parents' and Adolescents' Attitudes about Parental Involvement in Clinical Research.

PubMed

Rosenthal, Susan L; de Roche, Ariel M; Catallozzi, Marina; Breitkopf, Carmen Radecki; Ipp, Lisa S; Chang, Jane; Francis, Jenny K R; Hu, Mei-Chen

2016-08-01

To understand parent and adolescent attitudes toward parental involvement during clinical trials and factors related to those attitudes. As part of a study on willingness to participate in a hypothetical microbicide study, adolescents and their parents were interviewed separately. Adolescent medicine clinics in New York City. There were 301 dyads of adolescents (ages 14-17 years; 62% female; 72% Hispanic) and their parents. None. The interview included questions on demographic characteristics, sexual history, and family environment (subscales of the Family Environment Scale) that were associated with attitudes about parental involvement. Factor analysis of the parental involvement scale yielded 2 factors: LEARN, reflecting gaining knowledge about study test results and behaviors (4 items) and PROCEDURE, reflecting enrollment and permissions (4 items). Adolescents endorsed significantly fewer items on the LEARN scale and the PROCEDURE scale indicating that adolescents believed in less parental involvement. There was no significant concordance between adolescents and their own parents on the LEARN scale and the PROCEDURE scale. In final multivariate models predicting attitudes, adolescents who were female and had sexual contact beyond kissing, and non-Hispanic parents had lower LEARN scores. Adolescents who were older, had previous research experience, and reported less moral or religious emphasis in their family had lower PROCEDURE scores; there were no significant predictors for parents in the multivariate analyses. Parents wanted greater involvement in the research process than adolescents. Recruitment and retention might be enhanced by managing these differing expectations. Copyright © 2016 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.

The transcatheter aortic valve implementation (TAVI)--a qualitative approach to the implementation and diffusion of a minimally invasive surgical procedure.

PubMed

Merkel, Sebastian; Eikermann, Michaela; Neugebauer, Edmund A; von Bandemer, Stephan

2015-10-06

The transcatheter aortic valve implantation (TAVI), a minimally invasive surgical procedure to treat patients with severe symptomatic aortic stenosis, showed a rapid diffusion in Germany compared to the international level. The aim of this study is to identify and analyze factors affecting the implementation and diffusion of the procedure in hospitals using a qualitative application of the diffusion of innovations theory. We conducted problem-centered interviews with cardiologists and cardiac surgeons working in German hospitals. The multi-level model "diffusion of innovations in health services organizations" developed by Greenhalgh et al. was used to guide the research. Data was analyzed using content and a thematic analysis. Among the ten participants who were interviewed, we found both barriers and facilitators related to the innovation itself, system readiness and antecedents, communication and influence, and the outer context. Key issues were the collaboration between cardiologists and cardiac surgeons, reimbursement policies, requirements needed to conduct the procedure, and medical advantages of the method. The findings show that there are multiple factors influencing the diffusion of TAVI that go beyond the reimbursement and cost issues. The diffusion of innovations model proved to be helpful in understanding the different aspects of the uptake of the procedure. A central theme that affected the implementation of TAVI was the collaboration and competition between involved medical departments: cardiology and cardiac surgery. Against this background, it seems especially important to moderate and coordinate the cooperation of the different medical disciplines.

SURROGATE MODEL DEVELOPMENT AND VALIDATION FOR RELIABILITY ANALYSIS OF REACTOR PRESSURE VESSELS

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

Hoffman, William M.; Riley, Matthew E.; Spencer, Benjamin W.

In nuclear light water reactors (LWRs), the reactor coolant, core and shroud are contained within a massive, thick walled steel vessel known as a reactor pressure vessel (RPV). Given the tremendous size of these structures, RPVs typically contain a large population of pre-existing flaws introduced in the manufacturing process. After many years of operation, irradiation-induced embrittlement makes these vessels increasingly susceptible to fracture initiation at the locations of the pre-existing flaws. Because of the uncertainty in the loading conditions, flaw characteristics and material properties, probabilistic methods are widely accepted and used in assessing RPV integrity. The Fracture Analysis of Vesselsmore » – Oak Ridge (FAVOR) computer program developed by researchers at Oak Ridge National Laboratory is widely used for this purpose. This program can be used in order to perform deterministic and probabilistic risk-informed analyses of the structural integrity of an RPV subjected to a range of thermal-hydraulic events. FAVOR uses a one-dimensional representation of the global response of the RPV, which is appropriate for the beltline region, which experiences the most embrittlement, and employs an influence coefficient technique to rapidly compute stress intensity factors for axis-aligned surface-breaking flaws. The Grizzly code is currently under development at Idaho National Laboratory (INL) to be used as a general multiphysics simulation tool to study a variety of degradation mechanisms in nuclear power plant components. The first application of Grizzly has been to study fracture in embrittled RPVs. Grizzly can be used to model the thermo-mechanical response of an RPV under transient conditions observed in a pressurized thermal shock (PTS) scenario. The global response of the vessel provides boundary conditions for local 3D models of the material in the vicinity of a flaw. Fracture domain integrals are computed to obtain stress intensity factors, which can in turn be used to assess whether a fracture would initiate at a pre-existing flaw. To use Grizzly for probabilistic analysis, it is necessary to have a way to rapidly evaluate stress intensity factors. To accomplish this goal, a reduced order model (ROM) has been developed to efficiently represent the behavior of a detailed 3D Grizzly model used to calculate fracture parameters. This approach uses the stress intensity factor influence coefficient method that has been used with great success in FAVOR. Instead of interpolating between tabulated solutions, as FAVOR does, the ROM approach uses a response surface methodology to compute fracture solutions based on a sampled set of results used to train the ROM. The main advantages of this approach are that the process of generating the training data can be fully automated, and the procedure can be readily used to consider more general flaw configurations. This paper demonstrates the procedure used to generate a ROM to rapidly compute stress intensity factors for axis-aligned flaws. The results from this procedure are in good agreement with those produced using the traditional influence coefficient interpolation procedure, which gives confidence in this method. This paves the way for applying this procedure for more general flaw configurations.« less

Predictive capacity of sperm quality parameters and sperm subpopulations on field fertility after artificial insemination in sheep.

PubMed

Santolaria, P; Vicente-Fiel, S; Palacín, I; Fantova, E; Blasco, M E; Silvestre, M A; Yániz, J L

2015-12-01

This study was designed to evaluate the relevance of several sperm quality parameters and sperm population structure on the reproductive performance after cervical artificial insemination (AI) in sheep. One hundred and thirty-nine ejaculates from 56 adult rams were collected using an artificial vagina, processed for sperm quality assessment and used to perform 1319 AI. Analyses of sperm motility by computer-assisted sperm analysis (CASA), sperm nuclear morphometry by computer-assisted sperm morphometry analysis (CASMA), membrane integrity by acridine orange-propidium iodide combination and sperm DNA fragmentation using the sperm chromatin dispersion test (SCD) were performed. Clustering procedures using the sperm kinematic and morphometric data resulted in the classification of spermatozoa into three kinematic and three morphometric sperm subpopulations. Logistic regression procedures were used, including fertility at AI as the dependent variable (measured by lambing, 0 or 1) and farm, year, month of AI, female parity, female lambing-treatment interval, ram, AI technician and sperm quality parameters (including sperm subpopulations) as independent factors. Sperm quality variables remaining in the logistic regression model were viability and VCL. Fertility increased for each one-unit increase in viability (by a factor of 1.01) and in VCL (by a factor of 1.02). Multiple linear regression analyses were also performed to analyze the factors possibly influencing ejaculate fertility (N=139). The analysis yielded a significant (P<0.05) relationship between sperm viability and ejaculate fertility. The discriminant ability of the different semen variables to predict field fertility was analyzed using receiver operating characteristic (ROC) curve analysis. Sperm viability and VCL showed significant, albeit limited, predictive capacity on field fertility (0.57 and 0.54 Area Under Curve, respectively). The distribution of spermatozoa in the different subpopulations was not related to fertility. Copyright © 2015 Elsevier B.V. All rights reserved.

NECAP 4.1: NASA's energy-cost analysis program user's manual

NASA Technical Reports Server (NTRS)

Jensen, R. N.; Henninger, R. H.; Miner, D. L.

1983-01-01

The Enery Cost Analysis Program (NECAP) is a powerful computerized method to determine and to minimize building energy consumption. The program calculates hourly heat gain or losses taking into account the building thermal resistance and mass, using hourly weather and a "response factor' method. Internal temperatures are allowed to vary in accordance with thermostat settings and equipment capacity. A simplified input procedure and numerous other technical improvements are presented. This Users Manual describes the program and provides examples.

Numerical Modeling of Unsteady Thermofluid Dynamics in Cryogenic Systems

NASA Technical Reports Server (NTRS)

Majumdar, Alok

2003-01-01

A finite volume based network analysis procedure has been applied to model unsteady flow without and with heat transfer. Liquid has been modeled as compressible fluid where the compressibility factor is computed from the equation of state for a real fluid. The modeling approach recognizes that the pressure oscillation is linked with the variation of the compressibility factor; therefore, the speed of sound does not explicitly appear in the governing equations. The numerical results of chilldown process also suggest that the flow and heat transfer are strongly coupled. This is evident by observing that the mass flow rate during 90-second chilldown process increases by factor of ten.

Psychometric properties of the Tuckman Procrastination Scale in a Turkish sample.

PubMed

Ozer, Bilge Uzun; Saçkes, Mesut; Tuckman, Bruce W

2013-12-01

A stepwise validation procedure was carried out to translate and develop a Turkish version of the Tuckman Procrastination Scale. A total of 858 college students completed the Tuckman Procrastination Scale, the Academic Self-efficacy Scale, and the Rosenberg Self-esteem Scale. Two items in the original scale loaded on a different factor and were removed from the measure. The 14-item scale had a one-factor solution as supported by subsequent confirmatory factor analysis. The Turkish version of the Tuckman Procrastination Scale scores correlated negatively with academic self-efficacy and self-esteem scores. Overall results provided evidence for the validity and the reliability of the scale scores.

Boolean Minimization and Algebraic Factorization Procedures for Fully Testable Sequential Machines

DTIC Science & Technology

1989-09-01

Boolean Minimization and Algebraic Factorization Procedures for Fully Testable Sequential Machines Srinivas Devadas and Kurt Keutzer F ( Abstract In this...Projects Agency under contract number N00014-87-K-0825. Author Information Devadas : Department of Electrical Engineering and Computer Science, Room 36...MA 02139; (617) 253-0292. 0 * Boolean Minimization and Algebraic Factorization Procedures for Fully Testable Sequential Machines Siivas Devadas

[Arthrodesis following revision of a knee endoprosthesis. Literature review 1984-1994].

PubMed

Kohn, D; Schmolke, S

1996-04-01

Two percent of primary and 8% of revision total knee replacements are followed by arthrodesis. Today knee arthrodesis is the most important salvage procedure after failed total knee arthroplasty, resection arthroplasty and above-the-knee amputation being the only alternatives. Analysis of the literature between 1984 and 1994 revealed 533 cases treated with arthrodesis of the knee; 403 were done after failed total knee arthroplasty. The fusion rate was 74%. External fixation, intramedullary nail, plates and combinations of these are currently used for fixation. The literature and an analysis of our own patients from 1988 to 1994 showed that arthrodesis after failed arthroplasty is a difficult procedure, and complications often occur. Bone loss of the distal femur and proximal tibia is the one most important prognostic factor. A new classification system for bone loss is presented.

Function Allocation in Complex Socio-Technical Systems: Procedure usage in nuclear power and the Context Analysis Method for Identifying Design Solutions (CAMIDS) Model

NASA Astrophysics Data System (ADS)

Schmitt, Kara Anne

This research aims to prove that strict adherence to procedures and rigid compliance to process in the US Nuclear Industry may not prevent incidents or increase safety. According to the Institute of Nuclear Power Operations, the nuclear power industry has seen a recent rise in events, and this research claims that a contributing factor to this rise is organizational, cultural, and based on peoples overreliance on procedures and policy. Understanding the proper balance of function allocation, automation and human decision-making is imperative to creating a nuclear power plant that is safe, efficient, and reliable. This research claims that new generations of operators are less engaged and thinking because they have been instructed to follow procedures to a fault. According to operators, they were once to know the plant and its interrelations, but organizationally more importance is now put on following procedure and policy. Literature reviews were performed, experts were questioned, and a model for context analysis was developed. The Context Analysis Method for Identifying Design Solutions (CAMIDS) Model was created, verified and validated through both peer review and application in real world scenarios in active nuclear power plant simulators. These experiments supported the claim that strict adherence and rigid compliance to procedures may not increase safety by studying the industry's propensity for following incorrect procedures, and when it directly affects the outcome of safety or security of the plant. The findings of this research indicate that the younger generations of operators rely highly on procedures, and the organizational pressures of required compliance to procedures may lead to incidents within the plant because operators feel pressured into following the rules and policy above performing the correct actions in a timely manner. The findings support computer based procedures, efficient alarm systems, and skill of the craft matrices. The solution to the problems facing the industry include in-depth, multiple fault failure training which tests the operator's knowledge of the situation. This builds operator collaboration, competence and confidence to know what to do, and when to do it in response to an emergency situation. Strict adherence to procedures and rigid compliance to process may not prevent incidents or increase safety; building operators' fundamental skills of collaboration, competence and confidence will.

Sulbutiamine counteracts trophic factor deprivation induced apoptotic cell death in transformed retinal ganglion cells.

PubMed

Kang, Kui Dong; Majid, Aman Shah Abdul; Kim, Kyung-A; Kang, Kyungsu; Ahn, Hong Ryul; Nho, Chu Won; Jung, Sang Hoon

2010-11-01

Sulbutiamine is a highly lipid soluble synthetic analogue of vitamin B(1) and is used clinically for the treatment of asthenia. The aim of our study was to demonstrate whether sulbutiamine is able to attenuate trophic factor deprivation induced cell death to transformed retinal ganglion cells (RGC-5). Cells were subjected to serum deprivation for defined periods and sulbutiamine at different concentrations was added to the cultures. Various procedures (e.g. cell viability assays, apoptosis assay, reactive oxygen species analysis, Western blot analysis, flow cytometric analysis, glutathione (GSH) and glutathione-S-transferase (GST) measurement) were used to demonstrate the effect of sulbutiamine. Sulbutiamine dose-dependently attenuated apoptotic cell death induced by serum deprivation and stimulated GSH and GST activity. Moreover, sulbutiamine decreased the expression of cleaved caspase-3 and AIF. This study demonstrates for the first time that sulbutiamine is able to attenuate trophic factor deprivation induced apoptotic cell death in neuronal cells in culture.

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

PubMed

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

2017-01-01

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

Can Rheumatologists Predict Eventual Need for Orthopaedic Intervention in Patients with Rheumatoid Arthritis? Results of a Systematic Review and Analysis of Two UK Inception Cohorts.

PubMed

Nikiphorou, Elena; Carpenter, Lewis; Norton, Sam; Morris, Stephen; MacGregor, Alex; Dixey, Josh; Williams, Peter; Kiely, Patrick; Walsh, David Andrew; Young, Adam

2017-03-01

The structural damage caused by rheumatoid arthritis (RA) can often be mitigated by orthopaedic surgery in late disease. This study evaluates the value of predictive factors for orthopaedic intervention. A systematic review of literature was undertaken to identify papers describing predictive factors for orthopaedic surgery in RA. Manuscripts were selected if they met inclusion criteria of cohort study design, diagnosis of RA, follow-up duration/disease duration ≥3 years, any orthopaedic surgical interventions recorded, and then summarised for predictive factors. A separate predictive analysis was performed on two consecutive UK Early RA cohorts, linked to national datasets. The literature search identified 15 reports examining predictive factors for orthopaedic intervention, 4 inception, 5 prospective and 6 retrospective. Despite considerable variation, acute phase, x-ray scores, women and genotyping were the most commonly reported prognostic markers. The current predictive analysis included 1602 procedures performed in 711 patients (25-year cumulative incidence 26%). Earlier recruitment year, erosions and lower haemoglobin predicted both intermediate and major surgery (P<0.05). Studies report variations in type of and predictive power of clinical and laboratory parameters for different surgical interventions suggesting specific contributions from different pathological and/or patient-level factors. Our current analysis suggests that attention to non-inflammatory factors in addition to suppression of inflammation is needed to minimise the burden of orthopaedic surgery.

Pediatric reduction mammaplasty: A retrospective analysis of the Kids' Inpatient Database (KID).

PubMed

Soleimani, Tahereh; Evans, Tyler A; Sood, Rajiv; Hadad, Ivan; Socas, Juan; Flores, Roberto L; Tholpady, Sunil S

2015-09-01

Pediatric breast reduction mammaplasty is a procedure commonly performed in children suffering from excess breast tissue, back pain, and social anxiety. Minimal information exists regarding demographics, epidemiology, and complications in adolescents. As health care reform progresses, investigating the socioeconomic and patient-related factors affecting cost and operative outcomes is essential. The Kids' Inpatient Database (KID) was used from 2000 to 2009. Patients with an International Classification of Diseases, 9th Revision code of macromastia and procedure code of reduction mammaplasty 20 and less were included. Demographic data, including age, sex, payer mix, and location, were collected. Significant independent variables associated with complications and duration of stay were identified with bivariate and multiple regression analysis. A total of 1,345 patients between the ages 12 and 20 were evaluated. The majority of patients were white (64%), from a zip code with greatest income (36%), and had private insurance (75%). Overall comorbidity and complication rates were 30% and 3.2%, respectively. Duration of stay was associated with race, income quartile, insurance type, having complications, and hospital type. African-American race, Medicaid, lower income, and private-investor owned hospitals were predictive of greater hospital charges. In this large retrospective database analysis, pediatric reduction mammaplasty had a relatively low early complication rate and short duration of stay. Complications, total charges, and duration of stay discrepancies were associated with race, location, and socioeconomic status. Although demonstrably safe, this is the first study demonstrating the negative effect of race and socioeconomic status on a completely elective procedure involving children. These results demonstrate the intricate association between socioeconomic and patient-related factors influencing overall outcomes in the pediatric population. Copyright © 2015 Elsevier Inc. All rights reserved.

National Variation in Urethroplasty Cost and Predictors of Extreme Cost: A Cost Analysis With Policy Implications.

PubMed

Harris, Catherine R; Osterberg, E Charles; Sanford, Thomas; Alwaal, Amjad; Gaither, Thomas W; McAninch, Jack W; McCulloch, Charles E; Breyer, Benjamin N

2016-08-01

To determine which factors are associated with higher costs of urethroplasty procedure and whether these factors have been increasing over time. Identification of determinants of extreme costs may help reduce cost while maintaining quality. We conducted a retrospective analysis using the 2001-2010 Healthcare Cost and Utilization Project-Nationwide Inpatient Sample (HCUP-NIS). The HCUP-NIS captures hospital charges which we converted to cost using the HCUP cost-to-charge ratio. Log cost linear regression with sensitivity analysis was used to determine variables associated with increased costs. Extreme cost was defined as the top 20th percentile of expenditure, analyzed with logistic regression, and expressed as odds ratios (OR). A total of 2298 urethroplasties were recorded in NIS over the study period. The median (interquartile range) calculated cost was $7321 ($5677-$10,000). Patients with multiple comorbid conditions were associated with extreme costs [OR 1.56, 95% confidence interval (CI) 1.19-2.04, P = .02] compared with patients with no comorbid disease. Inpatient complications raised the odds of extreme costs (OR 3.2, CI 2.14-4.75, P <.001). Graft urethroplasties were associated with extreme costs (OR 1.78, 95% CI 1.2-2.64, P = .005). Variations in patient age, race, hospital region, bed size, teaching status, payor type, and volume of urethroplasty cases were not associated with extremes of cost. Cost variation for perioperative inpatient urethroplasty procedures is dependent on preoperative patient comorbidities, postoperative complications, and surgical complexity related to graft usage. Procedural cost and cost variation are critical for understanding which aspects of care have the greatest impact on cost. Copyright © 2016 Elsevier Inc. All rights reserved.

Human Factors Considerations for Area Navigation Departure and Arrival Procedures

NASA Technical Reports Server (NTRS)

Barhydt, Richard; Adams, Catherine A.

2006-01-01

Area navigation (RNAV) procedures are being implemented in the United States and around the world as part of a transition to a performance-based navigation system. These procedures are providing significant benefits and have also caused some human factors issues to emerge. Under sponsorship from the Federal Aviation Administration (FAA), the National Aeronautics and Space Administration (NASA) has undertaken a project to document RNAV-related human factors issues and propose areas for further consideration. The component focusing on RNAV Departure and Arrival Procedures involved discussions with expert users, a literature review, and a focused review of the NASA Aviation Safety Reporting System (ASRS) database. Issues were found to include aspects of air traffic control and airline procedures, aircraft systems, and procedure design. Major findings suggest the need for specific instrument procedure design guidelines that consider the effects of human performance. Ongoing industry and government activities to address air-ground communication terminology, design improvements, and chart-database commonality are strongly encouraged. A review of factors contributing to RNAV in-service errors would likely lead to improved system design and operational performance.

Simple criteria to predict margin involvement after chemoradiotherapy and sphincter-sparing for low rectal cancer.

PubMed

Dumont, F; Tilly, C; Dartigues, P; Goéré, D; Honoré, C; Elias, D

2015-09-01

Low rectal cancers carry a high risk of circumferential margin involvement (CRM+). The anatomy of the lower part of the rectum and a long course of chemoradiotherapy (CRT) limit the accuracy of imaging to predict the CRM+. Additional criteria are required. Eighty six patients undergoing rectal resection with a sphincter-sparing procedure after CRT for low rectal cancer between 2000 and 2013 were retrospectively reviewed. Risk factors of CRM+ and the cut-off number of risk factors required to accurately predict the CRM+ were analyzed. The CRM+ rate was 9.3% and in the multivariate analysis, the significant risk factors were a tumor size exceeding 3 cm, poor response to CRT and a fixed tumor. The best cut-off to predict CRM+ was the presence of 2 risk factors. Patients with 0-1 and 2-3 risk factors had a CRM+ respectively in 1.3% and 50% of cases and a 3-year recurrence rate of 7% and 35% after a median follow-up of 50 months. Poor response, a residual tumor greater than 3 cm and a fixed tumor are predictive of CRM+. Sphincter sparing is an oncological safety procedure for patients with 0-1 criteria but not for patients with 2-3 criteria. Copyright © 2015 Elsevier Ltd. All rights reserved.

Human factors evaluation of remote afterloading brachytherapy. Volume 2, Function and task analysis

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

Callan, J.R.; Gwynne, J.W. III; Kelly, T.T.

1995-05-01

A human factors project on the use of nuclear by-product material to treat cancer using remotely operated afterloaders was undertaken by the Nuclear Regulatory Commission. The purpose of the project was to identify factors that contribute to human error in the system for remote afterloading brachytherapy (RAB). This report documents the findings from the first phase of the project, which involved an extensive function and task analysis of RAB. This analysis identified the functions and tasks in RAB, made preliminary estimates of the likelihood of human error in each task, and determined the skills needed to perform each RAB task.more » The findings of the function and task analysis served as the foundation for the remainder of the project, which evaluated four major aspects of the RAB system linked to human error: human-system interfaces; procedures and practices; training and qualifications of RAB staff; and organizational practices and policies. At its completion, the project identified and prioritized areas for recommended NRC and industry attention based on all of the evaluations and analyses.« less

Analysis of Pre-Analytic Factors Affecting the Success of Clinical Next-Generation Sequencing of Solid Organ Malignancies.

PubMed

Chen, Hui; Luthra, Rajyalakshmi; Goswami, Rashmi S; Singh, Rajesh R; Roy-Chowdhuri, Sinchita

2015-08-28

Application of next-generation sequencing (NGS) technology to routine clinical practice has enabled characterization of personalized cancer genomes to identify patients likely to have a response to targeted therapy. The proper selection of tumor sample for downstream NGS based mutational analysis is critical to generate accurate results and to guide therapeutic intervention. However, multiple pre-analytic factors come into play in determining the success of NGS testing. In this review, we discuss pre-analytic requirements for AmpliSeq PCR-based sequencing using Ion Torrent Personal Genome Machine (PGM) (Life Technologies), a NGS sequencing platform that is often used by clinical laboratories for sequencing solid tumors because of its low input DNA requirement from formalin fixed and paraffin embedded tissue. The success of NGS mutational analysis is affected not only by the input DNA quantity but also by several other factors, including the specimen type, the DNA quality, and the tumor cellularity. Here, we review tissue requirements for solid tumor NGS based mutational analysis, including procedure types, tissue types, tumor volume and fraction, decalcification, and treatment effects.

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

PubMed

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

2013-01-01

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

Six Sigma methods applied to cryogenic coolers assembly line

NASA Astrophysics Data System (ADS)

Ventre, Jean-Marc; Germain-Lacour, Michel; Martin, Jean-Yves; Cauquil, Jean-Marc; Benschop, Tonny; Griot, René

2009-05-01

Six Sigma method have been applied to manufacturing process of a rotary Stirling cooler: RM2. Name of the project is NoVa as main goal of the Six Sigma approach is to reduce variability (No Variability). Project has been based on the DMAIC guideline following five stages: Define, Measure, Analyse, Improve, Control. Objective has been set on the rate of coolers succeeding performance at first attempt with a goal value of 95%. A team has been gathered involving people and skills acting on the RM2 manufacturing line. Measurement System Analysis (MSA) has been applied to test bench and results after R&R gage show that measurement is one of the root cause for variability in RM2 process. Two more root causes have been identified by the team after process mapping analysis: regenerator filling factor and cleaning procedure. Causes for measurement variability have been identified and eradicated as shown by new results from R&R gage. Experimental results show that regenerator filling factor impacts process variability and affects yield. Improved process haven been set after new calibration process for test bench, new filling procedure for regenerator and an additional cleaning stage have been implemented. The objective for 95% coolers succeeding performance test at first attempt has been reached and kept for a significant period. RM2 manufacturing process is now managed according to Statistical Process Control based on control charts. Improvement in process capability have enabled introduction of sample testing procedure before delivery.

Analysis of In Vivo Chromatin and Protein Interactions of Arabidopsis Transcript Elongation Factors.

PubMed

Pfab, Alexander; Antosz, Wojciech; Holzinger, Philipp; Bruckmann, Astrid; Griesenbeck, Joachim; Grasser, Klaus D

2017-01-01

A central step to elucidate the function of proteins commonly comprises the analysis of their molecular interactions in vivo. For nuclear regulatory proteins this involves determining protein-protein interactions as well as mapping of chromatin binding sites. Here, we present two protocols to identify protein-protein and chromatin interactions of transcript elongation factors (TEFs) in Arabidopsis. The first protocol (Subheading 3.1) describes protein affinity-purification coupled to mass spectrometry (AP-MS) that utilizes suspension cultured cells as experimental system. This approach provides an unbiased view of proteins interacting with epitope-tagged TEFs. The second protocol (Subheading 3.2) depicts details about a chromatin immunoprecipitation (ChIP) procedure to characterize genomic binding sites of TEFs. These methods should be valuable tools for the analysis of a broad variety of nuclear proteins.

A new procedure for investigating three-dimensional stress fields in a thin plate with a through-the-thickness crack

NASA Astrophysics Data System (ADS)

Yi, Dake; Wang, TzuChiang

2018-06-01

In the paper, a new procedure is proposed to investigate three-dimensional fracture problems of a thin elastic plate with a long through-the-thickness crack under remote uniform tensile loading. The new procedure includes a new analytical method and high accurate finite element simulations. In the part of theoretical analysis, three-dimensional Maxwell stress functions are employed in order to derive three-dimensional crack tip fields. Based on the theoretical analysis, an equation which can describe the relationship among the three-dimensional J-integral J( z), the stress intensity factor K( z) and the tri-axial stress constraint level T z ( z) is derived first. In the part of finite element simulations, a fine mesh including 153360 elements is constructed to compute the stress field near the crack front, J( z) and T z ( z). Numerical results show that in the plane very close to the free surface, the K field solution is still valid for in-plane stresses. Comparison with the numerical results shows that the analytical results are valid.

New method to incorporate Type B uncertainty into least-squares procedures in radionuclide metrology.

PubMed

Han, Jubong; Lee, K B; Lee, Jong-Man; Park, Tae Soon; Oh, J S; Oh, Pil-Jei

2016-03-01

We discuss a new method to incorporate Type B uncertainty into least-squares procedures. The new method is based on an extension of the likelihood function from which a conventional least-squares function is derived. The extended likelihood function is the product of the original likelihood function with additional PDFs (Probability Density Functions) that characterize the Type B uncertainties. The PDFs are considered to describe one's incomplete knowledge on correction factors being called nuisance parameters. We use the extended likelihood function to make point and interval estimations of parameters in the basically same way as the least-squares function used in the conventional least-squares method is derived. Since the nuisance parameters are not of interest and should be prevented from appearing in the final result, we eliminate such nuisance parameters by using the profile likelihood. As an example, we present a case study for a linear regression analysis with a common component of Type B uncertainty. In this example we compare the analysis results obtained from using our procedure with those from conventional methods. Copyright © 2015. Published by Elsevier Ltd.

The PX-EM algorithm for fast stable fitting of Henderson's mixed model

PubMed Central

Foulley, Jean-Louis; Van Dyk, David A

2000-01-01

This paper presents procedures for implementing the PX-EM algorithm of Liu, Rubin and Wu to compute REML estimates of variance covariance components in Henderson's linear mixed models. The class of models considered encompasses several correlated random factors having the same vector length e.g., as in random regression models for longitudinal data analysis and in sire-maternal grandsire models for genetic evaluation. Numerical examples are presented to illustrate the procedures. Much better results in terms of convergence characteristics (number of iterations and time required for convergence) are obtained for PX-EM relative to the basic EM algorithm in the random regression. PMID:14736399

Characterization of bonded stationary phase performance as a function of qualitative and quantitative chromatographic factors in chaotropic chromatography with risperidone and its impurities as model substances.

PubMed

Čolović, Jelena; Rmandić, Milena; Malenović, Anđelija

2018-05-17

Numerous stationary phases have been developed with the aim to provide desired performances during chromatographic analysis of the basic solutes in their protonated form. In this work, the procedure for the characterization of bonded stationary phase performance, when both qualitative and quantitative chromatographic factors were varied in chaotropic chromatography, was proposed. Risperidone and its three impurities were selected as model substances, while acetonitrile content in the mobile phase (20-30%), the pH of the aqueous phase (3.00-5.00), the content of chaotropic agents in the aqueous phase (10-100 mM), type of chaotropic agent (NaClO 4 , CF 3 COONa), and stationary phase type (Zorbax Eclipse XDB, Zorbax Extend) were studied as chromatographic factors. The proposed procedure implies the combination of D-optimal experimental design, indirect modeling, and polynomial-modified Gaussian model, while grid point search method was selected for the final choice of the experimental conditions which lead to the best possible stationary phase performance for basic solutes. Good agreement between experimentally obtained chromatogram and simulated chromatogram for chosen experimental conditions (25% acetonitrile, 75 mM of NaClO 4 , pH 4.00 on Zorbax Eclipse XDB column) confirmed the applicability of the proposed procedure. The additional point was selected for the verification of proposed procedure ability to distinguish changes in solutes' elution order. Simulated chromatogram for 21.5% acetonitrile, 85 mM of NaClO 4 , pH 5.00 on Zorbax Eclipse XDB column was in line with experimental data. Furthermore, the values of left and right peak half-widths obtained from indirect modeling were used in order to evaluate performances of differently modified stationary phases applying a half-width plots approach. The results from half-width plot approach as well as from the proposed procedure indicate higher efficiency and better separation performance of the stationary phase extra densely bonded and double end-capped with trimethylsilyl group than the stationary phase with the combination of end-capping and bidentate silane bonding for chromatographic analysis of basic solutes in RP-HPLC systems with chaotropic agents. Graphical abstract ᅟ.

National Trends of Simple Prostatectomy for Benign Prostatic Hyperplasia With an Analysis of Risk Factors for Adverse Perioperative Outcomes.

PubMed

Pariser, Joseph J; Pearce, Shane M; Patel, Sanjay G; Bales, Gregory T

2015-10-01

To examine the national trends of simple prostatectomy (SP) for benign prostatic hyperplasia (BPH) focusing on perioperative outcomes and risk factors for complications. The National Inpatient Sample (2002-2012) was utilized to identify patients with BPH undergoing SP. Analysis included demographics, hospital details, associated procedures, and operative approach (open, robotic, or laparoscopic). Outcomes included complications, length of stay, charges, and mortality. Multivariate logistic regression was used to determine the risk factors for perioperative complications. Linear regression was used to assess the trends in the national annual utilization of SP. The study population included 35,171 patients. Median length of stay was 4 days (interquartile range 3-6). Cystolithotomy was performed concurrently in 6041 patients (17%). The overall complication rate was 28%, with bleeding occurring most commonly. In total, 148 (0.4%) patients experienced in-hospital mortality. On multivariate analysis, older age, black race, and overall comorbidity were associated with greater risk of complications while the use of a minimally invasive approach and concurrent cystolithotomy had a decreased risk. Over the study period, the national use of simple prostatectomy decreased, on average, by 145 cases per year (P = .002). By 2012, 135/2580 procedures (5%) were performed using a minimally invasive approach. The nationwide utilization of SP for BPH has decreased. Bleeding complications are common, but perioperative mortality is low. Patients who are older, black race, or have multiple comorbidities are at higher risk of complications. Minimally invasive approaches, which are becoming increasingly utilized, may reduce perioperative morbidity. Copyright © 2015 Elsevier Inc. All rights reserved.

Proposed method for hazard mapping of landslide propagation zone

NASA Astrophysics Data System (ADS)

Serbulea, Manole-Stelian; Gogu, Radu; Manoli, Daniel-Marcel; Gaitanaru, Dragos Stefan; Priceputu, Adrian; Andronic, Adrian; Anghel, Alexandra; Liviu Bugea, Adrian; Ungureanu, Constantin; Niculescu, Alexandru

2013-04-01

Sustainable development of communities situated in areas with landslide potential requires a fully understanding of the mechanisms that govern the triggering of the phenomenon as well as the propagation of the sliding mass, with catastrophic consequences on the nearby inhabitants and environment. Modern analysis methods for areas affected by the movement of the soil bodies are presented in this work, as well as a new procedure to assess the landslide hazard. Classical soil mechanics offer sufficient numeric models to assess the landslide triggering zone, such as Limit Equilibrium Methods (Fellenius, Janbu, Morgenstern-Price, Bishop, Spencer etc.), blocks model or progressive mobilization models, Lagrange-based finite element method etc. The computation methods for assessing the propagation zones are quite recent and have high computational requirements, thus not being sufficiently used in practice to confirm their feasibility. The proposed procedure aims to assess not only the landslide hazard factor, but also the affected areas, by means of simple mathematical operations. The method can easily be employed in GIS software, without requiring engineering training. The result is obtained by computing the first and second derivative of the digital terrain model (slope and curvature maps). Using the curvature maps, it is shown that one can assess the areas most likely to be affected by the propagation of the sliding masses. The procedure is first applied on a simple theoretical model and then used on a representative section of a high exposure area in Romania. The method is described by comparison with Romanian legislation for risk and vulnerability assessment, which specifies that the landslide hazard is to be assessed, using an average hazard factor Km, obtained from various other factors. Following the employed example, it is observed that using the Km factor there is an inconsistent distribution of the polygonal surfaces corresponding to different landslide potential. For small values of Km (0.00..0.10) the polygonal surfaces have reduced dimensions along the slopes belonging to main rivers. This can be corrected by including in the analysis the potential areas to be affected by soil instability. Finally, it is shown that the proposed procedure can be used to better assess these areas and to produce more reliable landslide hazard maps. This work was supported by a grant of the Romanian National Authority for Scientific Research, Program for research - Space Technology and Advanced Research - STAR, project number 30/2012.

Programmed Multiphasic Health Testing

NASA Technical Reports Server (NTRS)

Hershberg, P. I.

1970-01-01

Multiphase health screening procedures are advocated for detection and prevention of disease at an early stage through risk factor analysis. The use of an automated medical history questionnaire together with scheduled physical examination data provides a scanning input for computer printout. This system makes it possible to process laboratory results from 1,000 to 2,000 patients for biochemical determinations on an economically feasible base.

Laying down the Family Burden: A Cross-Cultural Analysis of Resilience in the Midst of Family Violence

ERIC Educational Resources Information Center

Kassis, Wassilis; Artz, Sibylle; Moldenhauer, Stephanie

2013-01-01

Questionnaire data from a cross-sectional study of a randomly selected sample of 5,149 middle-school students from four EU countries (Austria, Germany, Slovenia, and Spain) were used to explore the effects of family violence burden level, structural and procedural risk and protective factors, and personal characteristics on adolescents who are…

Physiological responses to environmental factors related to space flight

NASA Technical Reports Server (NTRS)

Pace, N.; Grunbaum, B. W.; Kodama, A. M.; Mains, R. C.; Rahlmann, D. F.

1975-01-01

Physiological procedures and instrumentation developed for the measurement of hemodynamic and metabolic parameters during prolonged periods of weightlessness are described along with the physiological response of monkeys to weightlessness. Specific areas examined include: cardiovascular studies; thyroid function; blood oxygen transport; growth and reproduction; excreta analysis for metabolic balance studies; and electrophoretic separation of creatine phosphokinase isoenzymes in human blood.

Validation of Student and Parent Reported Data on the Basic Grant Application Form: Corrections Analysis Study. Final Report, Volume 4.

ERIC Educational Resources Information Center

Vogel, Ronald J.

A study was conducted in 1976 of applicants who submitted corrections or amendments to their Student Eligibility Reports (SERs) for the Basic Educational Opportunity Grant (BEOG) Program. The objective was to review the applications corrections process and to determine factors linked to applicants' use of correction procedures. Attention was…

Alternatives to Three-Mode Factor Analysis: A Case Study with Data Evaluating Perceived Barriers to Medical School Training.

ERIC Educational Resources Information Center

Thomson, William A.; And Others

While educational researchers frequently collect data from a sample of individuals on a sample of variables, they sometimes collect data involving samples of: (1) subjects; (2) variables; and (3) occasions of measurement. A multistage procedure for analyzing such three-mode data is presented, focusing on effect sizes and graphic confidence…

Identification of physical habitats limiting the production of coho salmon in western Oregon and Washington.

Treesearch

G.H. Reeves; F.H. Everest; T.E. Nickelson

1989-01-01

Fishery managers are currently spending millions of dollars per year on habitat enhancement for anadromous salmonids but often do not have the tools needed to ensure success. An analysis of factors limiting production of salmonids in streams must be completed before any habitat-enhancement program is begun. This paper outlines the first formal procedure for identifying...

Economic rationality and health and lifestyle choices for people with diabetes.

PubMed

Baker, Rachel Mairi

2006-11-01

Economic rationality is traditionally represented by goal-oriented, maximising behaviour, or 'instrumental rationality'. Such a consequentialist, instrumental model of choice is often implicit in a biomedical approach to health promotion and education. The research reported here assesses the relevance of a broader conceptual framework of rationality, which includes 'procedural' and 'expressive' rationality as complements to an instrumental model of rationality, in a health context. Q methodology was used to derive 'factors' underlying health and lifestyle choices, based on a factor analysis of the results of a card sorting procedure undertaken by 27 adult respondents with type 2 diabetes in Newcastle upon Tyne, UK. These factors were then compared with the rationality framework and the appropriateness of an extended model of economic rationality as a means of better understanding health and lifestyle choices was assessed. Taking a wider rational choice perspective, choices which are rendered irrational within a narrow-biomedical or strictly instrumental model, can be understood in terms of a coherent rationale, grounded in the accounts of respondents. The implications of these findings are discussed in terms of rational choice theory and diabetes management and research.

Does the Type of Metal Instrumentation Affect the Risk of Surgical Site Infection in Pediatric Scoliosis Surgery?

PubMed

Wright, Margaret L; Skaggs, David L; Matsumoto, Hiroko; Woon, Regina P; Trocle, Ashley; Flynn, John M; Vitale, Michael G

2016-05-01

Retrospective cohort study. To determine the association of implant metal composition with the risk of surgical site infection (SSI) following pediatric spine surgery. SSI is a well-described complication following pediatric spine surgery. Many risk factors have been identified in the literature, but controversy remains regarding metal composition as a risk factor. This was a retrospective study of patients who underwent posterior spinal instrumentation procedures between January 1, 2006, and December 31, 2008, at three large children's hospitals for any etiology of scoliosis and had at least 1 year of postoperative follow-up. Procedures included posterior spinal fusion, growth-friendly instrumentation, and revision of spinal instrumentation. The Centers for Disease Control and Prevention definition of SSI was used. A chi-squared test was performed to determine the relationship between type of metal instrumentation and development of an SSI. The study included 874 patients who underwent 1,156 total procedures. Overall, 752 (65%) procedures used stainless steel instrumentation, 238 (21%) procedures used titanium instrumentation, and the remaining 166 (14%) procedures used cobalt chrome and titanium hybrid instrumentation. The overall risk of infection was 6.1% (70/1,156) per procedure, with 5.9% (44/752) for stainless steel, 6.7% (12/238) for titanium, and 6.0% (10/166) for cobalt chrome. The multiple regression analysis found no significant differences in the metal type used between patients with and without infection (p = .886) adjusting for etiology, instrumentation to pelvis, and type of procedures. When stratified based on etiology, the multiple regression analyses also found no significant difference in SSI between two metal type groups. This study found no difference in risk of infection with stainless steel, titanium, or cobalt chrome/titanium instrumentation and is adequately powered to detect a true difference in risk of SSI. Level II, prognostic. Copyright © 2016 Scoliosis Research Society. Published by Elsevier Inc. All rights reserved.

90-day Readmission After Lumbar Spinal Fusion Surgery in New York State Between 2005 and 2014: A 10-year Analysis of a Statewide Cohort.

PubMed

Baaj, Ali A; Lang, Gernot; Hsu, Wei-Chun; Avila, Mauricio J; Mao, Jialin; Sedrakyan, Art

2017-11-15

MINI: We assessed 90-day readmission and evaluated risk factors associated with readmission after lumbar spinal fusion surgery in New York State. The overall 90-day readmission rate was 24.8%. Age, sex, race, insurance, procedure, number of operated spinal levels, health service area, and comorbidities are major risk factors for 90-day readmission. Retrospective cohort study. The aim of this study was to assess 90-day readmission and evaluate risk factors associated with readmission after lumbar fusion in New York State. Readmission is becoming an important metric for quality and efficiency of health care. Readmission and its predictors following spine surgery are overall poorly understood and limited evidence is available specifically in lumbar fusion. The New York Statewide Planning and Research Cooperative System (SPARCS) was utilized to capture patients undergoing lumbar fusion from 2005 to 2014. Temporal trend of 90-day readmission was assessed using Cochran-Armitage test. Logistic regression was used to examine predictors associated with 90-day readmission. There were 86,869 patients included in this cohort study. The overall 90-day readmission rate was 24.8%. On a multivariable analysis model, age (odds ratio [OR] comparing ≥75 versus <35 years: 1.24, 95% confidence interval [CI]: 1.13-1.35), sex (OR female to male: 1.19, 95% CI: 1.15-1.23), race (OR African-American to white: 1.60, 95% CI: 1.52-1.69), insurance (OR Medicaid to Medicare: 1.42, 95% CI: 1.33-1.53), procedure (OR comparing thoracolumbar fusion, combined [International Classification of Disease, Ninth Revision, ICD-9: 81.04] to posterior lumbar interbody fusion/transforaminal lumbar spinal fusion [ICD-9: 81.08]: 2.10, 95% CI: 1.49-2.97), number of operated spinal levels (OR comparing four to eight vertebrae to two to three vertebrae: 2.39, 95% CI: 2.07-2.77), health service area ([HSA]; OR comparing Finger Lakes to New York-Pennsylvania border: 0.67, 95% CI: 0.61-0.73), and comorbidity, i.e., coronary artery disease (OR: 1.26, 95% CI: 1.19-1.33) were significantly associated with 90-day readmission. Directions of the odds ratios for these factors were consistent after stratification by procedure type. Age, sex, race, insurance, procedure, number of operated spinal levels, HSA, and comorbidities are major risk factors for 90-day readmission. Our study allows risk calculation to determine high-risk patients before undergoing spinal fusion surgery to prevent early readmission, improve quality of care, and reduce health care expenditures. 3.

Analysis of routine pilot-controller communication

NASA Technical Reports Server (NTRS)

Morrow, Daniel G.; Lee, Alfred; Rodvold, Michelle

1990-01-01

Although pilot-controller communication is central to aviation safety, this area of aviation human factors has not been extensively researched. Most research has focused on what kinds of communication problems occur. A more complete picture of communication problems requires understanding how communication usually works in routine operations. A sample of routine pilot-controller communication in the TRACON environment is described. After describing several dimensions of routine communication, three kinds of communication problems are treated: inaccuracies such as incorrect readbacks, procedural deviations such as missing callsigns and readbacks, and nonroutine transactions where pilot and controller must deal with misunderstandings or other communication problems. Preliminary results suggest these problems are not frequent events in daily operations. However, analysis of the problems that do occur suggest some factors that may cause them.

Factor analysis of social skills inventory responses of Italians and Americans.

PubMed

Galeazzi, Aldo; Franceschina, Emilio; Holmes, George R

2002-06-01

The Social Skills Inventory is a 90-item self-report procedure designed to measure social and communication skills. The inventory measures six dimensions, namely, Emotional Expressivity, Emotional Sensitivity, Emotional Control, Social Expressivity, Social Sensitivity, and Social Control. The Italian version was administered in several cities in Northern Italy to 500 Italian participants ranging in age from 15 to 59 years. Factor analysis appears to confirm the adequacy of the inventory for the Italian adult population. Results indicate strong similarities between the Italian and American populations with respect to the measure of social skills. Indexes of internal reliability and test-retest reliability are good for almost all subscales of the inventory, which should encourage the use of this inventory with Italian samples.

Risk factors for donor endothelial loss in eye bank-prepared posterior lamellar corneal tissue for descemet stripping automated endothelial keratoplasty.

PubMed

Liu, Yu-Chi; Alvarez Paraz, Carisa M; Cajucom-Uy, Howard Yu; Agahari, Djoni; Sethuraman, Selvam; Tan, Donald T-H; Mehta, Jodhbir S

2014-07-01

The aim of this study was to investigate donor, tissue, and precut procedure risk factors for endothelial cell density (ECD) loss in posterior lamellar corneal tissue preparation by an eye bank for Descemet stripping automated endothelial keratoplasty. A total of 259 corneoscleral rims precut by the Singapore Eye Bank from October 2011 to August 2013 were evaluated. Donor characteristics, tissue characteristics, and precut procedure parameters were analyzed. The mean donor age was 57.18 ± 11.35 years, and the mean cutting transition time was 4.16 ± 0.75 seconds. The mean ECD was 2826 ± 225 and 2787 ± 224 cells per square millimeter before and after precutting, respectively, with an average ECD change of -1.38% ± 3.28%. The precutting procedure failure rate was 1.2%. Mutivariate regression analysis showed that an older donor age, a higher ECD before cutting, and a slower cutting transition speed were significant factors. Corneas with an ECD >2800 cells per square millimeter before precutting, cutting transition time >5.5 seconds, and corneas with donor age >65 years were significantly more likely to have greater than 5% ECD loss after precutting (odds ratio, 6.42, 1.66, and 1.62; 95% confidence interval, 1.44-29.43, 1.45-2.72, and 1.66-5.82, respectively). Donor source, death-to-preservation time (range, 0.67-10.88 hours), death-to-precutting time (range, 0-7 days), and graft thickness (range, 43-232 μm) were not statistically significant factors. The ECD loss in the precut tissue prepared by the eye bank was very low. The risk factors identified provide better understanding of how to improve the quality and safety profiles when preparing graft tissue for Descemet stripping automated endothelial keratoplasty.

Risk Factors for 30-Day Readmission Following Shoulder Arthroscopy.

PubMed

Hill, J Ryan; McKnight, Braden; Pannell, William C; Heckmann, Nathanael; Sivasundaram, Lakshmanan; Mostofi, Amir; Omid, Reza; Rick Hatch, George F

2017-01-01

The purpose of this study was to evaluate a large population of shoulder arthroscopy cases in order to provide insight into the risk factors associated with readmission following this common orthopaedic procedure. The American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) database was queried using current procedural terminology (CPT) billing codes to identify all patients older than 18 years of age who underwent shoulder arthroscopy between 2011 and 2013. Univariate and multivariate analyses were conducted to identify factors associated with 30-day readmission. We identified 15,015 patients who had undergone shoulder arthroscopy, with a 30-day readmission rate of 0.98%. The most common reason for readmission was pulmonary embolism (0.09%). On multivariate analysis, operative time > 1.5 hours (odds ratio [OR], 1.80; 95% confidence interval [CI], 1.29 to 2.50), age 40 to 65 years (OR, 3.80; 95% CI, 1.37 to 10.59), age > 65 years (OR, 3.91; 95% CI, 1.35 to 11.35), American Society of Anesthesiologists (ASA) class 3 (OR, 4.53; 95% CI, 1.90 to 10.78), ASA class 4 (OR, 7.73; 95% CI, 2.91 to 27.25), chronic obstructive pulmonary disease (COPD; OR, 2.65; 95% CI, 1.54 to 4.55), and chronic steroid use (OR, 2.96; 95% CI, 1.46 to 6.01) were identified as independent risk factors for readmission. Operative time > 1.5 hours, age > 40 years, ASA classes 3 or 4, COPD, and chronic steroid use are independent risk factors for readmission following elective arthroscopic shoulder surgery, although the readmission rate following these procedures is low. Level III, retrospective comparative study. Copyright © 2016 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

Identification of modifiable factors for reducing readmission after colectomy: a national analysis.

PubMed

Lawson, Elise H; Hall, Bruce Lee; Louie, Rachel; Zingmond, David S; Ko, Clifford Y

2014-05-01

Rates of hospital readmission are currently used for public reporting and pay for performance. Colectomy procedures account for a large number of readmissions among operative procedures. Our objective was to compare the importance of 3 groups of clinical variables (demographics, preoperative risk factors, and postoperative complications) in predicting readmission after colectomy procedures. Patient records (2005-2008) from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) were linked to Medicare inpatient claims. Patient demographics (n = 2), preoperative risk factors (n = 23), and 30-day postoperative complications (n = 17) were identified from ACS-NSQIP, whereas 30-day postoperative readmissions and costs were determined from Medicare. Multivariable logistic regression models were used to examine risk-adjusted predictors of colectomy readmission. Among 12,981 colectomy patients, the 30-day postoperative readmission rate was 13.5%. Readmitted patients had slightly greater rates of comorbidities and indicators of clinical severity and substantially greater rates of complications than non-readmitted patients. After risk adjustment, patients with a complication were 3.3 times as likely to be readmitted as patients without a complication. Among individual complications, progressive renal failure and organ-space surgical site infection had the highest risk-adjusted relative risks of readmission (4.6 and 4.0, respectively). Demographic, preoperative risk factor, and postoperative complication variables increased the ability to discriminate readmissions (reflected by the c-statistic) by 5.3%, 23.3%, and 35.4%, respectively. Postoperative complications after colectomy are more predictive of readmission than traditional risk factors. Focusing quality improvement efforts on preventing and managing postoperative complications may be the most important step toward reducing readmission rates. Copyright © 2014 Mosby, Inc. All rights reserved.

Scientific literacy: Factor structure and gender differences

NASA Astrophysics Data System (ADS)

Manhart, James Joseph

The purpose of this study was to investigate the factor structure of scientific literacy and to document any gender differences with respect to each factor. Participants included 1139 students (574 females, 565 males) in grades 9 through 12 who were taking a science class at one of four Midwestern high schools. Based on National Science Education Standards, a 100 item multiple-choice test was constructed to assess scientific literacy. Confirmatory factor analysis of item parcels suggested a three factor model was the best way to explain the data resulting from the administration of this test. The factors were labeled constructs of science, abilities necessary to do scientific inquiry, and social aspects of science. Gender differences with respect to these factors were examined using analysis of variance procedures. Because differential enrollment in science classes could cause gender differences in grades 11 and 12, parallel analyses were conducted on the grades 9 and 10 subsample and the grades 11 and 12 subsample. However, the results of the two analyses were similar. The most consistent gender difference observed was that females performed better than males on the social aspects of science factor. Males tended to perform better than females on the constructs of science factor, although no consistent gender difference was noted for items dealing with life science. With respect to the abilities necessary to do scientific inquiry factor, females tended to perform better than males in grades 9 and 10, while no consistent gender difference was observed in grades 11 and 12. Gender differences were also examined using the Mantel-Haenszel procedure to flag individual items that functioned differently for females and males of the same ability. Twelve items were flagged for grades 9 and 10 (8 in favor of females, 4 in favor of males). Fourteen items were flagged for grades 11 and 12 (7 in favor of females, 7 in favor of males). All of the flagged items exhibited only small to moderate differential item functioning (DIF). Only three items were similarly flagged in both subsamples, one item from each factor.

A risk-factor analysis of medical litigation judgments related to fall injuries in Korea.

PubMed

Kim, Insook; Won, Seonae; Lee, Mijin; Lee, Won

2018-01-01

The aim of this study was to find out the risk factors through analysis of seven medical malpractice judgments related to fall injuries. The risk factors were analysed by using the framework that approaches falls from a systems perspective and comprised people, organisational or environmental factors, with each factor being comprised of subfactors. The risk factors found in each of the seven judgments were aggregated into one framework. The risk factors related to patients (i.e. the people factor) were age, pain, related disease, activities and functional status, urination state, cognitive function impairment, past history of fall, blood transfusion, sleep endoscopy state and uncooperative attitude. The risk factors related to the medical staff and caregivers (i.e. people factor) were observation negligence, no fall prevention activities and negligence in managing high-risk group for fall. Organisational risk factors were a lack of workforce, a lack of training, neglecting the management of the high-risk group, neglecting the management of caregivers and the absence of a fall prevention procedure. Regarding the environment, the risk factors were found to be the emergency room, chairs without a backrest and the examination table. Identifying risk factors is essential for preventing fall accidents, since falls are preventable patient-safety incidents. Falls do not happen as a result of a single risk factor. Therefore, a systems approach is effective to identify risk factors, especially organisational and environmental factors.

Structured smoking cessation training for health professionals on cardiology wards: a prospective study.

PubMed

Raupach, Tobias; Falk, Jan; Vangeli, Eleni; Schiekirka, Sarah; Rustler, Christa; Grassi, Maria Caterina; Pipe, Andrew; West, Robert

2014-07-01

Smoking is a major cardiovascular risk factor, and smoking cessation is imperative for patients hospitalized with a cardiovascular event. This study aimed to evaluate a systems-based approach to helping hospitalized smokers quit and to identify implementation barriers. Prospective intervention study followed by qualitative analysis of staff interviews. The prospective intervention study assessed the effects of implementing standard operating procedures (SOPs) for the provision of counselling and pharmacotherapy to smokers admitted to cardiology wards on counselling frequency. In addition, a qualitative analysis of staff interviews was undertaken to examine determinants of physician and nurse behaviour; this sought to understand barriers in terms of motivation, capability, and/or opportunity. A total of 150 smoking patients were included in the study (75 before and 75 after SOP implementation). Before the implementation of SOPs, the proportion of patients reporting to have received cessation counselling from physicians and nurses was 6.7% and 1.3%, respectively. Following SOP implementation, these proportions increased to 38.7% (p < 0.001) and 2.7% (p = 0.56), respectively. Qualitative analysis revealed that lack of motivation, e.g. role incongruence, appeared to be a major barrier. Introduction of a set of standard operating procedures for smoking cessation advice was effective with physicians but not nurses. Analysis of barriers to implementation highlighted lack of motivation rather than capability or opportunity as a major factor that would need to be addressed. © The European Society of Cardiology 2012.

Emergent Writing in Preschoolers: Preliminary Evidence for a Theoretical Framework

PubMed Central

Puranik, Cynthia S.; Lonigan, Christopher J.

2014-01-01

Researchers and educators use the term emergent literacy to refer to a broad set of skills and attitudes that serve as foundational skills for acquiring success in later reading and writing; however, models of emergent literacy have generally focused on reading and reading-related behaviors. Hence, the primary aim of this study was to articulate and evaluate a theoretical model of the components of emergent writing. Alternative models of the structure of individual and developmental differences of emergent writing and writing-related skills were examined in 372 preschool children who ranged in age from 3- to 5-years using confirmatory factor analysis. Results from a confirmatory factor analysis provide evidence that these emergent writing skills are best described by three correlated but distinct factors, (a) Conceptual Knowledge, (b) Procedural Knowledge, and (c) Generative Knowledge. Evidence that these three emergent writing factors show different patterns of relations to emergent literacy constructs is presented. Implications for understanding the development of writing and assessment of early writing skills are discussed. PMID:25316955

Optimization conditions of samples saponification for tocopherol analysis.

PubMed

Souza, Aloisio Henrique Pereira; Gohara, Aline Kirie; Rodrigues, Ângela Claudia; Ströher, Gisely Luzia; Silva, Danielle Cristina; Visentainer, Jesuí Vergílio; Souza, Nilson Evelázio; Matsushita, Makoto

2014-09-01

A full factorial design 2(2) (two factors at two levels) with duplicates was performed to investigate the influence of the factors agitation time (2 and 4 h) and the percentage of KOH (60% and 80% w/v) in the saponification of samples for the determination of α, β and γ+δ-tocopherols. The study used samples of peanuts (cultivar armadillo), produced and marketed in Maringá, PR. The factors % KOH and agitation time were significant, and an increase in their values contributed negatively to the responses. The interaction effect was not significant for the response δ-tocopherol, and the contribution of this effect to the other responses was positive, but less than 10%. The ANOVA and response surfaces analysis showed that the most efficient saponification procedure was obtained using a 60% (w/v) solution of KOH and with an agitation time of 2 h. Copyright © 2014 Elsevier Ltd. All rights reserved.

Surgical swab counting: a qualitative analysis from the perspective of the scrub nurse.

PubMed

D'Lima, D; Sacks, M; Blackman, W; Benn, J

2014-05-01

The aim of the study was to conduct a qualitative exploration of the sociotechnical processes underlying retained surgical swabs, and to explore the fundamental reasons why the swab count procedure and related protocols fail in practice. Data was collected through a set of 27 semistructured qualitative interviews with scrub nurses from a large, multi-site teaching hospital. Interview transcripts were analysed using established constant comparative methods, moving between inductive and deductive reasoning. Key findings were associated with interprofessional perspectives, team processes and climate and responsibility for the swab count. The analysis of risk factors revealed that perceived social and interprofessional issues played a significant role in the reliability of measures to prevent retained swabs. This work highlights the human, psychological and organisational factors that impact upon the reliability of the process and gives rise to recommendations to address contextual factors and improve perioperative practice and training.

Attribution of Observed Streamflow Changes in Key British Columbia Drainage Basins

NASA Astrophysics Data System (ADS)

Najafi, Mohammad Reza; Zwiers, Francis W.; Gillett, Nathan P.

2017-11-01

We study the observed decline in summer streamflow in four key river basins in British Columbia (BC), Canada, using a formal detection and attribution (D&A) analysis procedure. Reconstructed and simulated streamflow is generated using the semidistributed variable infiltration capacity hydrologic model, which is driven by 1/16° gridded observations and downscaled climate model data from the Coupled Model Intercomparison Project phase 5 (CMIP5), respectively. The internal variability of the regional hydrologic components using 5100 years of streamflow was simulated using CMIP5 preindustrial control runs. Results show that the observed changes in summer streamflow are inconsistent with simulations representing the responses to natural forcing factors alone, while the response to anthropogenic and natural forcing factors combined is detected in these changes. A two-signal D&A analysis indicates that the effects of anthropogenic (ANT) forcing factors are discernable from natural forcing in BC, albeit with large uncertainties.

Increased anaesthesia duration increases venous thromboembolism risk in plastic surgery: A 6-year analysis of over 19,000 cases using the NSQIP dataset.

PubMed

Mlodinow, Alexei S; Khavanin, Nima; Ver Halen, Jon P; Rambachan, Aksharananda; Gutowski, Karol A; Kim, John Y S

2015-01-01

Venous thromboembolism (VTE) is a significant cause of morbidity and mortality, particularly in the postoperative setting. Various risk stratification schema exist in the plastic surgery literature, but do not take into account variations in procedure length. The putative risk of VTE conferred by increased length of time under anaesthesia has never been rigorously explored. The goal of this study is to assess this relationship and to benchmark VTE rates in plastic surgery. A large, multi-institutional quality-improvement database was queried for plastic and reconstructive surgery procedures performed under general anaesthesia between 2005-2011. In total, 19,276 cases were abstracted from the database. Z-scores were calculated based on procedure-specific mean surgical durations, to assess each case's length in comparison to the mean for that procedure. A total of 70 patients (0.36%) experienced a post-operative VTE. Patients with and without post-operative VTE were compared with respect to a variety of demographics, comorbidities, and intraoperative characteristics. Potential confounders for VTE were included in a regression model, along with the Z-scores. VTE occurred in both cosmetic and reconstructive procedures. Longer surgery time, relative to procedural means, was associated with increased VTE rates. Further, regression analysis showed increase in Z-score to be an independent risk factor for post-operative VTE (Odds Ratio of 1.772 per unit, p-value < 0.001). Subgroup analyses corroborated these findings. This study validates the long-held view that increased surgical duration confers risk of VTE, as well as benchmarks VTE rates in plastic surgery procedures. While this in itself does not suggest an intervention, surgical time under general anaesthesia would be a useful addition to existing risk models in plastic surgery.

Robotic hepatobiliary and pancreatic surgery: lessons learned and predictors for conversion.

PubMed

Hanna, Erin M; Rozario, Nigel; Rupp, Christopher; Sindram, David; Iannitti, David A; Martinie, John B

2013-06-01

The use of surgical robots has slowly gained an increasing presence in the realm of hepatobiliary and pancreatic (HPB) surgery. With additional experience, anecdotal evidence has been useful in guiding patient selection for complex robotic procedures. In the following analysis, we reviewed our case series and looked for predictors of conversion in robotic HPB surgery. We retrospectively reviewed all patients who underwent robotic HPB procedures by a single surgeon at two institutions during March 2006-June 2012. Patient demographics, operative data, procedure type and conversion information were recorded. Trends were analysed for indications for conversion. A subset analysis of robotic-assisted laparoscopic distal pancreatomy was performed and compared with laparoscopic and open distal pancreatectomy during the same time period by the same surgeon. During this time period, 77 patients underwent robotic hepatobiliary and pancreatic procedures. All procedures were performed by a single surgeon (J.M.) and included 38 males (49%) and 39 females (51%). Median age was 59 and the majority of patients were ASA class III. There were 24 conversions, which decreased in frequency from 2009 (7) to 2011 (3). Reasons for conversion included significant obesity and technical difficulty. Patients with conversions had more intraoperative blood loss (966 vs 176 ml), more frequently received transfusion (29% vs 2%) and were more likely to have postoperative intensive care. Overall length of stay was longer following conversion (8.3 vs 5.6 days). Robotic-assisted hepatobiliary and pancreatic procedures are often extremely complex, with a significant learning curve. Recognizing factors that prohibit successful completion of a robotic-assisted surgical procedure is key for patient safety. Careful patient selection in the appropriate settings facilitates the maximal benefit of robotic-assisted complex HPB surgery. Copyright © 2013 John Wiley & Sons, Ltd.

Comparison of Battery-Powered and Manual Bone Biopsy Systems for Core Needle Biopsy of Sclerotic Bone Lesions.

PubMed

Cohen, Micah G; McMahon, Colm J; Kung, Justin W; Wu, Jim S

2016-05-01

The purpose of this study was to compare manual and battery-powered bone biopsy systems for diagnostic yield and procedural factors during core needle biopsy of sclerotic bone lesions. A total of 155 consecutive CT-guided core needle biopsies of sclerotic bone lesions were performed at one institution from January 2006 to November 2014. Before March 2012, lesions were biopsied with manual bone drill systems. After March 2012, most biopsies were performed with a battery-powered system and either noncoaxial or coaxial biopsy needles. Diagnostic yield, crush artifact, CT procedure time, procedure radiation dose, conscious sedation dose, and complications were compared between the manual and battery-powered core needle biopsy systems by Fisher exact test and t test. One-way ANOVA was used for subgroup analysis of the two battery-powered systems for procedure time and radiation dose. The diagnostic yield for all sclerotic lesions was 60.0% (93/155) and was significantly higher with the battery-powered system (73.0% [27/37]) than with the manual systems (55.9% [66/118]) (p = 0.047). There was no significant difference between the two systems in terms of crush artifact, procedure time, radiation dose, conscious sedation administered, or complications. In subgroup analysis, the coaxial battery-powered biopsies had shorter procedure times (p = 0.01) and lower radiation doses (p = 0.002) than the coaxial manual systems, but the noncoaxial battery-powered biopsies had longer average procedure times and higher radiation doses than the coaxial manual systems. In biopsy of sclerotic bone lesions, use of a battery-powered bone drill system improves diagnostic yield over use of a manual system.

Bio-Oil Analysis Laboratory Procedures | Bioenergy | NREL

Science.gov Websites

Bio-Oil Analysis Laboratory Procedures Bio-Oil Analysis Laboratory Procedures NREL develops standard procedures have been validated and allow for reliable bio-oil analysis. Procedures Determination different hydroxyl groups (-OH) in pyrolysis bio-oil: aliphatic-OH, phenolic-OH, and carboxylic-OH. Download

An efficient dynamic load balancing algorithm

NASA Astrophysics Data System (ADS)

Lagaros, Nikos D.

2014-01-01

In engineering problems, randomness and uncertainties are inherent. Robust design procedures, formulated in the framework of multi-objective optimization, have been proposed in order to take into account sources of randomness and uncertainty. These design procedures require orders of magnitude more computational effort than conventional analysis or optimum design processes since a very large number of finite element analyses is required to be dealt. It is therefore an imperative need to exploit the capabilities of computing resources in order to deal with this kind of problems. In particular, parallel computing can be implemented at the level of metaheuristic optimization, by exploiting the physical parallelization feature of the nondominated sorting evolution strategies method, as well as at the level of repeated structural analyses required for assessing the behavioural constraints and for calculating the objective functions. In this study an efficient dynamic load balancing algorithm for optimum exploitation of available computing resources is proposed and, without loss of generality, is applied for computing the desired Pareto front. In such problems the computation of the complete Pareto front with feasible designs only, constitutes a very challenging task. The proposed algorithm achieves linear speedup factors and almost 100% speedup factor values with reference to the sequential procedure.

Analysis of national representative opinion surveys concerning gestational surrogacy in Japan.

PubMed

Suzuki, Kohta; Hoshi, Kazuhiko; Minai, Junko; Yanaihara, Takumi; Takeda, Yasuhisa; Yamagata, Zentaro

2006-05-01

Although gestational surrogacy offers several advantages, this procedure has given rise to some ethical and legal issues. We aimed to clarify the factors affecting the attitude of the Japanese toward gestational surrogacy. Cross-sectional study. Nationwide opinion surveys concerning assisted reproductive technologies (ART) were carried out in 1999 and 2003. Participants included 2568 and 3647 people from the general public surveyed in 1999 and 2003, respectively (1564 people received only the questionnaire, and 2083 people received a questionnaire and brochure about ART). Multivariate-adjusted odds ratio and 95% confidence interval from logistic regression models for factors affecting the attitude toward gestational surrogacy. In both surveys, approximately half of respondents approved of gestational surrogacy; 20-30% disapproved of the procedure. People with high socioeconomic status clearly expressed their opinion on this issue. A liberal attitude toward gender role promoted approval of gestational surrogacy; a liberal attitude toward family had the opposite effect. Our findings suggest that socioeconomic status affects people's expression of their opinion regarding this issue, while attitudes toward this procedure were influenced by individual belief. Considering socioeconomic status and diversity of individual belief is required for further discussion on this topic.

Ergonomic evaluation of a wheelchair transportation securement system.

PubMed

Ahmed, Madiha; Campbell-Kyureghyan, Naira; Frost, Karen; Bertocci, Gina

2012-01-01

The Americans with Disabilities Act (ADA) specifies guidelines covering the securement system and environment for wheeled mobility device (WhMD) passengers on the public bus system in the United States, referred to as the wheelchair tiedown and occupant restraint system (WTORS). The misuse or disuse of the WTORS system can be a source of injury for WhMD passengers riding the buses. The purpose of this study was to quantify the risks posed to the bus driver while performing the WTORS procedure using traditional ergonomic analysis methods. Four bus drivers completed the WTORS procedure for a representative passenger seated in three different WhMDs: manual wheelchair (MWC), scooter (SCTR), and power wheelchair (PWC). Potential work-related risks were identified using the four most applicable ergonomic assessment tools: PLIBEL, RULA, REBA, and iLMM. Task evaluation results revealed high levels of risk to be present to drivers during the WTORS procedure. The securement station space design and equipment layout were identified as contributing factors forcing drivers to adopt awkward postures while performing the WTORS task. These risk factors are known contributors to injury and the drivers could opt to improperly secure the passengers to avoid that risk.

Trainee participation is associated with adverse outcomes in emergency general surgery: an analysis of the National Surgical Quality Improvement Program database.

PubMed

Kasotakis, George; Lakha, Aliya; Sarkar, Beda; Kunitake, Hiroko; Kissane-Lee, Nicole; Dechert, Tracey; McAneny, David; Burke, Peter; Doherty, Gerard

2014-09-01

To identify whether resident involvement affects clinically relevant outcomes in emergency general surgery. Previous research has demonstrated a significant impact of trainee participation on outcomes in a broad surgical patient population. We identified 141,010 patients who underwent emergency general surgery procedures in the 2005-2010 Surgeons National Surgical Quality Improvement Program database. Because of the nonrandom assignment of complex cases to resident participation, patients were matched (1:1) on known risk factors [age, sex, inpatient status, preexisting comorbidities (obesity, diabetes, smoking, alcohol, steroid use, coronary artery disease, chronic renal failure, pulmonary disease)] and preoperatively calculated probability for morbidity and mortality. Clinically relevant outcomes were compared with a t or χ test. The impact of resident participation on outcomes was assessed with multivariable regression modeling, adjusting for risk factors and operative time. The most common procedures in the matched cohort (n = 83,790) were appendectomy (39.9%), exploratory laparotomy (8.8%), and adhesiolysis (6.6%). Trainee participation is independently associated with intra- and postoperative events, wound, pulmonary, and venous thromboembolic complications, and urinary tract infections. Trainee participation is associated with adverse outcomes in emergency general surgery procedures.

The incidence of total hip arthroplasty after hip arthroscopy in osteoarthritic patients

PubMed Central

2010-01-01

Objective To assess the incidence of total hip arthroplasty (THA) in osteoarthritic patients who were treated by arthroscopic debridement and to evaluate factors that might influence the time interval from the first hip arthroscopy to THA. Design Retrospective clinical series Methods Follow-up data and surgical reports were retrieved from 564 records of osteoarthritic patients that have had hip arthroscopy between the years 2002 to 2009 with a mean follow-up time of 3.2 years (range, 1-6.4 years). The time interval between the first hip arthroscopy to THA was modelled as a function of patient age; level of cartilage damage; procedures performed and repeated arthroscopies with the use of multivariate regression analysis. Results Ninety (16%) of all participants eventually required THA. The awaiting time from the first arthroscopy to a hip replacement was found to be longer in patients younger than 55 years and in a milder osteoarthritic stage. Patients that experienced repeated hip scopes had a longer time to THA than those with only a single procedure. Procedures performed concomitant with debridement and lavage did not affect the time interval to THA. Conclusions In our series of arthroscopic treatment of hip osteoarthritis, 16% required THA over a period of 7 years. Factors that influence the time to arthroplasty were age, degree of osteoarthritis and recurrent procedures. PMID:20670440

Is this the right normalization? A diagnostic tool for ChIP-seq normalization.

PubMed

Angelini, Claudia; Heller, Ruth; Volkinshtein, Rita; Yekutieli, Daniel

2015-05-09

Chip-seq experiments are becoming a standard approach for genome-wide profiling protein-DNA interactions, such as detecting transcription factor binding sites, histone modification marks and RNA Polymerase II occupancy. However, when comparing a ChIP sample versus a control sample, such as Input DNA, normalization procedures have to be applied in order to remove experimental source of biases. Despite the substantial impact that the choice of the normalization method can have on the results of a ChIP-seq data analysis, their assessment is not fully explored in the literature. In particular, there are no diagnostic tools that show whether the applied normalization is indeed appropriate for the data being analyzed. In this work we propose a novel diagnostic tool to examine the appropriateness of the estimated normalization procedure. By plotting the empirical densities of log relative risks in bins of equal read count, along with the estimated normalization constant, after logarithmic transformation, the researcher is able to assess the appropriateness of the estimated normalization constant. We use the diagnostic plot to evaluate the appropriateness of the estimates obtained by CisGenome, NCIS and CCAT on several real data examples. Moreover, we show the impact that the choice of the normalization constant can have on standard tools for peak calling such as MACS or SICER. Finally, we propose a novel procedure for controlling the FDR using sample swapping. This procedure makes use of the estimated normalization constant in order to gain power over the naive choice of constant (used in MACS and SICER), which is the ratio of the total number of reads in the ChIP and Input samples. Linear normalization approaches aim to estimate a scale factor, r, to adjust for different sequencing depths when comparing ChIP versus Input samples. The estimated scaling factor can easily be incorporated in many peak caller algorithms to improve the accuracy of the peak identification. The diagnostic plot proposed in this paper can be used to assess how adequate ChIP/Input normalization constants are, and thus it allows the user to choose the most adequate estimate for the analysis.

Defining Rates and Risk Factors for Readmissions Following Emergency General Surgery.

PubMed

Havens, Joaquim M; Olufajo, Olubode A; Cooper, Zara R; Haider, Adil H; Shah, Adil A; Salim, Ali

2016-04-01

Hospital readmission rates following surgery are increasingly being used as a marker of quality of care and are used in pay-for-performance metrics. To our knowledge, comprehensive data on readmissions to the initial hospital or a different hospital after emergency general surgery (EGS) procedures do not exist. To define readmission rates and identify risk factors for readmission after common EGS procedures. Patients undergoing EGS, as defined by the American Association for the Surgery of Trauma, were identified in the California State Inpatient Database (2007-2011) on January 15, 2015. Patients were 18 years and older. We identified the 5 most commonly performed EGS procedures in each of 11 EGS diagnosis groups. Patient demographics (sex, age, race/ethnicity, and insurance type) as well as Charlson Comorbidity Index score, length of stay, complications, and discharge disposition were collected. Factors associated with readmission were determined using multivariate logistic regression models analysis. Thirty-day hospital readmission. Among 177,511 patients meeting inclusion criteria, 57.1% were white, 48.8% were privately insured, and most were 45 years and older (51.3%). Laparoscopic appendectomy (35.2%) and laparoscopic cholecystectomy (19.3%) were the most common procedures. The overall 30-day readmission rate was 5.91%. Readmission rates ranged from 4.1% (upper gastrointestinal) to 16.8% (cardiothoracic). Of readmitted patients, 16.8% were readmitted at a different hospital. Predictors of readmission included Charlson Comorbidity Index score of 2 or greater (adjusted odds ratio: 2.26 [95% CI, 2.14-2.39]), leaving against medical advice (adjusted odds ratio: 2.24 [95% CI, 1.89-2.66]), and public insurance (adjusted odds ratio: 1.55 [95% CI, 1.47-1.64]). The most common reasons for readmission were surgical site infections (16.9%), gastrointestinal complications (11.3%), and pulmonary complications (3.6%). Readmission after EGS procedures is common and varies widely depending on patient factors and diagnosis categories. One in 5 readmitted patients will go to a different hospital, causing fragmentation of care and potentially obscuring the utility of readmission as a quality metric. Assisting socially vulnerable patients and reducing postoperative complications, including infections, are targets to reduce readmissions.

Risk Factors for Revision Surgery After Superior Labral Anterior-Posterior Repair: A National Perspective.

PubMed

Taylor, Samuel A; Degen, Ryan M; White, Alexander E; McCarthy, Moira M; Gulotta, Lawrence V; O'Brien, Stephen J; Werner, Brian C

2017-06-01

Data regarding risk factors for revision surgery after superior labral anterior-posterior (SLAP) repair are limited to institutional series. To define risk factors for revision surgery after SLAP repair among patients in a large national database. Case-control study; Level of evidence, 3. A national insurance database was queried for patients undergoing arthroscopic SLAP repair (Current Procedural Terminology [CPT] code 29807) for the diagnosis of a SLAP tear. Patients without a CPT modifier for laterality were excluded. Revision surgery was defined as (1) subsequent ipsilateral SLAP repair (CPT 29807), (2) ipsilateral arthroscopic debridement for the diagnosis of a SLAP tear (CPT 29822 or 29823, with diagnosis code 840.7), (3) subsequent ipsilateral arthroscopic biceps tenodesis (CPT 29828), (4) subsequent ipsilateral open biceps tenodesis (CPT 23430), and (5) subsequent biceps tenotomy (CPT 23405). Multivariable binomial logistic regression analysis was performed to identify risk factors for revision surgery after SLAP repair, including patient demographics/comorbidities, concomitant diagnoses, and concomitant procedures performed. Odds ratios (ORs), 95% CIs, and P values were calculated. The estimated financial impact of revision surgery was also calculated. There were 4751 patients who met inclusion and exclusion criteria. Overall, 121 patients (2.5%) required revision surgery after SLAP repair. Regression analysis identified numerous risk factors for revision surgery, including age >40 years (OR, 1.5; 95% CI, 1.2-1.8; P = .045), female sex (OR, 1.5; 95% CI, 1.3-1.8; P = .010), obesity (OR, 1.8; 95% CI, 1.5-2.2; P = .001), smoking (OR, 2.0; 95% CI, 1.6-2.4; P < .0001), and diagnosis of biceps tendinitis (OR, 3.5; 95% CI, 3.0-4.2; P < .0001) or long head of the biceps tearing (OR, 5.1; 95% CI, 4.1-6.3; P < .0001) at or before the time of surgery. Concomitant rotator cuff repair and distal clavicle excision were not significant risk factors for revision surgery. The cost of revision surgery averaged almost $9000. Risk factors for revision surgery after SLAP repair include age >40 years, female sex, obesity, smoking, and diagnosis of biceps tendinitis or long head of the biceps tearing. The diagnosis of biceps tendinitis (OR, 3.5) or long head of the biceps tearing (OR, 5.1) at or before the time of surgery was an especially significant risk factor for revision surgery. The high cost of revision surgery highlights the importance of appropriate indications to avoid the need for subsequent procedures.

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

PubMed

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

2016-02-01

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

Image-derived input function with factor analysis and a-priori information.

PubMed

Simončič, Urban; Zanotti-Fregonara, Paolo

2015-02-01

Quantitative PET studies often require the cumbersome and invasive procedure of arterial cannulation to measure the input function. This study sought to minimize the number of necessary blood samples by developing a factor-analysis-based image-derived input function (IDIF) methodology for dynamic PET brain studies. IDIF estimation was performed as follows: (a) carotid and background regions were segmented manually on an early PET time frame; (b) blood-weighted and tissue-weighted time-activity curves (TACs) were extracted with factor analysis; (c) factor analysis results were denoised and scaled using the voxels with the highest blood signal; (d) using population data and one blood sample at 40 min, whole-blood TAC was estimated from postprocessed factor analysis results; and (e) the parent concentration was finally estimated by correcting the whole-blood curve with measured radiometabolite concentrations. The methodology was tested using data from 10 healthy individuals imaged with [(11)C](R)-rolipram. The accuracy of IDIFs was assessed against full arterial sampling by comparing the area under the curve of the input functions and by calculating the total distribution volume (VT). The shape of the image-derived whole-blood TAC matched the reference arterial curves well, and the whole-blood area under the curves were accurately estimated (mean error 1.0±4.3%). The relative Logan-V(T) error was -4.1±6.4%. Compartmental modeling and spectral analysis gave less accurate V(T) results compared with Logan. A factor-analysis-based IDIF for [(11)C](R)-rolipram brain PET studies that relies on a single blood sample and population data can be used for accurate quantification of Logan-V(T) values.

Laparoscopic Heller Myotomy vs Per Oral Endoscopic Myotomy: Patient-Reported Outcomes at a Single Institution.

PubMed

Hanna, Andrew N; Datta, Jashodeep; Ginzberg, Sara; Dasher, Kevin; Ginsberg, Gregory G; Dempsey, Daniel T

2018-04-01

Although laparoscopic Heller myotomy (LHM) has been the standard of care for achalasia, per oral endoscopic myotomy (POEM) has gained popularity as a viable alternative. This retrospective study aimed to compare patient-reported outcomes between LHM and POEM in a consecutive series of achalasia patients with more than 1 year of follow-up. We reviewed demographic and procedure-related data for patients who underwent either LHM or POEM for achalasia between January 2011 and May 2016. Phone interviews were conducted assessing post-procedure achalasia symptoms via the Eckardt score and achalasia severity questionnaire (ASQ). Demographics, disease factors, and survey results were compared between LHM and POEM patients using univariate analysis. Significant predictors of procedure failure were analyzed using univariate and multivariate analysis. There were no serious complications in 110 consecutive patients who underwent LHM or POEM during the study period, and 96 (87%) patients completed phone surveys. There was a nonsignificant trend toward better patient-reported outcomes with POEM. There were significant differences in patient characteristics including sex, achalasia type, mean residual lower esophageal pressure (rLESP), and follow-up time. The only univariate predictors of an unsatisfactory Eckardt score or ASQ were longer follow-up and lower rLESP, with follow-up length being the only predictor on multivariate analysis. There were significant demographic and clinical differences in patient selection for POEM vs LHM in our group. Although the 2 procedures have similar patient-reported effectiveness, subjective outcomes seem to decline as a result of time rather than procedure type. Copyright © 2018 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

Cost analysis of single-use (Ambu® aScope™) and reusable bronchoscopes in the ICU.

PubMed

Perbet, S; Blanquet, M; Mourgues, C; Delmas, J; Bertran, S; Longère, B; Boïko-Alaux, V; Chennell, P; Bazin, J-E; Constantin, J-M

2017-12-01

Flexible optical bronchoscopes are essential for management of airways in ICU, but the conventional reusable flexible scopes have three major drawbacks: high cost of repairs, need for decontamination, and possible transmission of infectious agents. The main objective of this study was to measure the cost of bronchoalveolar lavage (BAL) and percutaneous tracheostomy (PT) using reusable bronchoscopes and single-use bronchoscopes in an ICU of an university hospital. The secondary objective was to compare the satisfaction of healthcare professionals with reusable and single-use bronchoscopes. The study was performed between August 2009 and July 2014 in a 16-bed ICU. All BAL and PT procedures were performed by experienced healthcare professionals. Cost analysis was performed considering ICU and hospital organization. Healthcare professional satisfaction with single-use and reusable scopes was determined based on eight factors. Sensitivity analysis was performed by applying discount rates (0, 3, and 5%) and by simulation of six situations based on different assumptions. At a discount rate of 3%, the costs per BAL for the two reusable scopes were 188.86€ (scope 1) and 185.94€ (scope 2), and the costs per PT for the reusable scope 1 and scope 2 and single-use scopes were 1613.84€, 410.24€, and 204.49€, respectively. The cost per procedure for the reusable scopes depended on the number of procedures performed, maintenance costs, and decontamination costs. Healthcare professionals were more satisfied with the third-generation single-use Ambu ® aScope™. The cost per procedure for the single-use scope was not superior to that for reusable scopes. The choice of single-use or reusable bronchoscopes in an ICU should consider the frequency of procedures and the number of bronchoscopes needed.

Development of an instrument to measure medical students' perceptions of the assessment environment: initial validation.

PubMed

Sim, Joong Hiong; Tong, Wen Ting; Hong, Wei-Han; Vadivelu, Jamuna; Hassan, Hamimah

2015-01-01

Assessment environment, synonymous with climate or atmosphere, is multifaceted. Although there are valid and reliable instruments for measuring the educational environment, there is no validated instrument for measuring the assessment environment in medical programs. This study aimed to develop an instrument for measuring students' perceptions of the assessment environment in an undergraduate medical program and to examine the psychometric properties of the new instrument. The Assessment Environment Questionnaire (AEQ), a 40-item, four-point (1=Strongly Disagree to 4=Strongly Agree) Likert scale instrument designed by the authors, was administered to medical undergraduates from the authors' institution. The response rate was 626/794 (78.84%). To establish construct validity, exploratory factor analysis (EFA) with principal component analysis and varimax rotation was conducted. To examine the internal consistency reliability of the instrument, Cronbach's α was computed. Mean scores for the entire AEQ and for each factor/subscale were calculated. Mean AEQ scores of students from different academic years and sex were examined. Six hundred and eleven completed questionnaires were analysed. EFA extracted four factors: feedback mechanism (seven items), learning and performance (five items), information on assessment (five items), and assessment system/procedure (three items), which together explained 56.72% of the variance. Based on the four extracted factors/subscales, the AEQ was reduced to 20 items. Cronbach's α for the 20-item AEQ was 0.89, whereas Cronbach's α for the four factors/subscales ranged from 0.71 to 0.87. Mean score for the AEQ was 2.68/4.00. The factor/subscale of 'feedback mechanism' recorded the lowest mean (2.39/4.00), whereas the factor/subscale of 'assessment system/procedure' scored the highest mean (2.92/4.00). Significant differences were found among the AEQ scores of students from different academic years. The AEQ is a valid and reliable instrument. Initial validation supports its use to measure students' perceptions of the assessment environment in an undergraduate medical program.

Analysis of malondialdehyde in human plasma samples through derivatization with 2,4-dinitrophenylhydrazine by ultrasound-assisted dispersive liquid-liquid microextraction-GC-FID approach.

PubMed

Malaei, Reyhane; Ramezani, Amir M; Absalan, Ghodratollah

2018-05-04

A sensitive and reliable ultrasound-assisted dispersive liquid-liquid microextraction (UA-DLLME) procedure was developed and validated for extraction and analysis of malondialdehyde (MDA) as an important lipids-peroxidation biomarker in human plasma. In this methodology, to achieve an applicable extraction procedure, the whole optimization processes were performed in human plasma. To convert MDA into readily extractable species, it was derivatized to hydrazone structure-base by 2,4-dinitrophenylhydrazine (DNPH) at 40 °C within 60 min. Influences of experimental variables on the extraction process including type and volume of extraction and disperser solvents, amount of derivatization agent, temperature, pH, ionic strength, sonication and centrifugation times were evaluated. Under the optimal experimental conditions, the enhancement factor and extraction recovery were 79.8 and 95.8%, respectively. The analytical signal linearly (R 2  = 0.9988) responded over a concentration range of 5.00-4000 ng mL -1 with a limit of detection of 0.75 ng mL -1 (S/N = 3) in the plasma sample. To validate the developed procedure, the recommend guidelines of Food and Drug Administration for bioanalytical analysis have been employed. Copyright © 2018. Published by Elsevier B.V.

Predictive factors that influence treatment outcomes of innovative single incision sling: comparing TVT-Secur to an established transobturator sling for female stress urinary incontinence.

PubMed

Hwang, Eugene; Shin, Ju Hyun; Lim, Jae Sung; Song, Ki Hak; Sul, Chong Koo; Na, Yong Gil

2012-07-01

This study aims to identify independent risk factors for treatment failure of tension-free vaginal tape TVT-Secur (TVT-S) compared to that of the well-established transobturator tape. Of a total of 175 consecutive patients with urodynamically confirmed stress urinary incontinence (SUI) identified between July 2007 and March 2010, 89 patients underwent TVT-S, and 86 underwent TOT. Cure was defined using the Urogenital Distress Inventory as no urinary leakage during physical activity, coughing, or sneezing as reported by patients during a telephone survey. To identify predictors of treatment failure, multivariable logistic regression models were used, and odds ratios (ORs) were calculated using variables identified during univariate analysis. There were more patients with cystocele ≥ grade 2 in the TVT-S group (p = 0.031); otherwise the groups were well matched. After a median follow-up of 32 months (range, 12-44 months), the overall cure rate was 80.6%; it was 70.8% for those treated with TVT-S and 90.7% for those treated with TOT (p = 0.001). In a multivariate model, previous incontinence surgery (OR 27.1, p = 0.005) and a cystocele ≥ grade 2 (OR 3.0, p = 0.020) were independent risk factors influencing the outcome of TVT-S procedures. For the TOT procedures, detrusor overactivity was an independent risk factor in a multivariate model (OR 8.6, p = 0.033). TVT-S could be performed for selected patients, but conventional TOT procedures are still superior to the novel TVT-S device.

Interpreting outcome following foot surgery in people with rheumatoid arthritis.

PubMed

Backhouse, Michael R; Vinall-Collier, Karen A; Redmond, Anthony C; Helliwell, Philip S; Keenan, Anne-Maree

2016-01-01

Foot surgery is common in RA but the current lack of understanding of how patients interpret outcomes inhibits evaluation of procedures in clinical and research settings. This study aimed to explore which factors are important to people with RA when they evaluate the outcome of foot and ankle surgery. Semi structured interviews with 11 RA participants who had mixed experiences of foot surgery were conducted and analysed using thematic analysis. Responses showed that while participants interpreted surgical outcome in respect to a multitude of factors, five major themes emerged: functional ability, participation, appearance of feet and footwear, surgeons' opinion, and pain. Participants interpreted levels of physical function in light of other aspects of their disease, reflecting on relative change from their preoperative state more than absolute levels of ability. Appearance was important to almost all participants: physical appearance, foot shape, and footwear were closely interlinked, yet participants saw these as distinct concepts and frequently entered into a defensive repertoire, feeling the need to justify that their perception of outcome was not about cosmesis. Surgeons' post-operative evaluation of the procedure was highly influential and made a lasting impression, irrespective of how the outcome compared to the participants' initial goals. Whilst pain was important to almost all participants, it had the greatest impact upon them when it interfered with their ability to undertake valued activities. People with RA interpret the outcome of foot surgery using multiple interrelated factors, particularly functional ability, appearance and surgeons' appraisal of the procedure. While pain was often noted, this appeared less important than anticipated. These factors can help clinicians in discussing surgical options in patients.

Analysis of spatio-temporal variability of C-factor derived from remote sensing data

NASA Astrophysics Data System (ADS)

Pechanec, Vilem; Benc, Antonin; Purkyt, Jan; Cudlin, Pavel

2016-04-01

In some risk areas water erosion as the present task has got the strong influence on agriculture and can threaten inhabitants. In our country combination of USLE and RUSLE models has been used for water erosion assessment (Krása et al., 2013). Role of vegetation cover is characterized by the help of vegetation protection factor, so-called C- factor. Value of C-factor is given by the ratio of washing-off on a plot with arable crops to standard plot which is kept as fallow regularly spud after any rain (Janeček et al., 2012). Under conditions we cannot identify crop structure and its turn, determination of C-factor can be problem in large areas. In such case we only determine C-factor according to the average crop representation. New technologies open possibilities for acceleration and specification of the approach. Present-day approach for the C-factor determination is based on the analysis of multispectral image data. Red and infrared spectrum is extracted and these parts of image are used for computation of vegetation index series (NDVI, TSAVI). Acquired values for fractional time sections (during vegetation period) are averaged out. At the same time values of vegetation indices for a forest and cleared area are determined. Also regressive coefficients are computed. Final calculation is done by the help of regressive equations expressing relation between values of NDVI and C-factor (De Jong, 1994; Van der Knijff, 1999; Karaburun, 2010). Up-to-date land use layer is used for the determination of erosion threatened areas on the base of selection of individual landscape segments of erosion susceptible categories of land use. By means of Landsat 7 data C-factor has been determined for the whole area of the Czech Republic in every month of the year of 2014. At the model area in a small watershed C-factor has been determined by the conventional (tabular) procedure. Analysis was focused on: i) variability assessment of C-factor values while using the conventional procedure and remote sensing, ii) variability assessment of values in different months for selected crops - time variability, growth dynamics and vegetation cover have been taken into account; iii) evaluation of space variability of C-factor values for selected crops - variability of natural conditions, markedly influencing vegetation fitness, has been taken into account. Described methods can be used for the planning of agricultural activities and for the proposing of full-scale land replotting. Presently these activities have been financially supported by the European Structural and Investment Funds.

Hepatitis C virus acquisition among Egyptians: analysis of a 10-year surveillance of acute hepatitis C.

PubMed

Mohsen, Amira; Bernier, Adeline; LeFouler, Lenaig; Delarocque-Astagneau, Elisabeth; El-Daly, Mai; El-Kafrawy, Sherif; El-Mango, Salwa; Abdel-Hamid, Mohamed; Gadallah, Mohsen; Esmat, Gamal; Mohamed, Mostafa K; Fontanet, Arnaud

2015-01-01

To identify current risk factors for hepatitis C virus (HCV) acquisition among Egyptians. Patients with acute HCV were identified through a surveillance system of acute hepatitis in four fever hospitals in Egypt between 2002 and 2012. Case-control analysis was conducted, cases being incident acute symptomatic HCV and controls being acute hepatitis A identified at the same hospitals. The questionnaire covered iatrogenic, community and household exposures to HCV in the 1-6 months prior to onset of symptoms. Multivariate models were built to identify risk factors associated with HCV acquisition among non-drug users and drug users separately. Among non-drug users, hospital admission was independently associated with acute HCV infection (OR = 4.2, 95% CI = 1.7-10.5). Several iatrogenic procedures, for example admission in a surgery unit, sutures, IV injections and IV infusions, highly correlated with hospital admission, were also associated with acute HCV infection and could have been used in the final model instead of hospital admission. Among drug users, identified risk factors were multiple sexual relations (OR = 4.0, 95% CI = 1.1-14.7), intravenous drug use (OR = 3.9, 95% CI = 1.2-13.0) and shaving at the barbershops (OR = 8.7, 95% CI = 2.4-31.4). Illiteracy and marriage were significant risk factors in both groups. Invasive medical procedures are still a major risk for acquiring new HCV infections in Egypt, as is illicit drug use in spreading HCV infection. © 2014 John Wiley & Sons Ltd.

Loss Factor Estimation Using the Impulse Response Decay Method on a Stiffened Structure

NASA Technical Reports Server (NTRS)

Cabell, Randolph; Schiller, Noah; Allen, Albert; Moeller, Mark

2009-01-01

High-frequency vibroacoustic modeling is typically performed using energy-based techniques such as Statistical Energy Analysis (SEA). Energy models require an estimate of the internal damping loss factor. Unfortunately, the loss factor is difficult to estimate analytically, and experimental methods such as the power injection method can require extensive measurements over the structure of interest. This paper discusses the implications of estimating damping loss factors using the impulse response decay method (IRDM) from a limited set of response measurements. An automated procedure for implementing IRDM is described and then evaluated using data from a finite element model of a stiffened, curved panel. Estimated loss factors are compared with loss factors computed using a power injection method and a manual curve fit. The paper discusses the sensitivity of the IRDM loss factor estimates to damping of connected subsystems and the number and location of points in the measurement ensemble.

Decision-making in rectal and colorectal cancer: systematic review and qualitative analysis of surgeons' preferences.

PubMed

Broc, Guillaume; Gana, Kamel; Denost, Quentin; Quintard, Bruno

2017-04-01

Surgeons are experiencing difficulties implementing recommendations not only owing to incomplete, confusing or conflicting information but also to the increasing involvement of patients in decisions relating to their health. This study sought to establish which common factors including heuristic factors guide surgeons' decision-making in colon and rectal cancers. We conducted a systematic literature review of surgeons' decision-making factors related to colon and rectal cancer treatment. Eleven of 349 identified publications were eligible for data analyses. Using the IRaMuTeQ (Interface of R for the Multidimensional Analyses of Texts and Questionnaire), we carried out a qualitative analysis of the significant factors collected in the studies reviewed. Several validation procedures were applied to control the robustness of the findings. Five categories of factors (i.e. patient, surgeon, treatment, tumor and organizational cues) were found to influence surgeons' decision-making. Specifically, all decision criteria including biomedical (e.g. tumor information) and heuristic (e.g. surgeons' dispositional factors) criteria converged towards the factor 'age of patient' in the similarity analysis. In the light of the results, we propose an explanatory model showing the impact of heuristic criteria on medical issues (i.e. diagnosis, prognosis, treatment features, etc.) and thus on decision-making. Finally, the psychosocial complexity involved in decision-making is discussed and a medico-psycho-social grid for use in multidisciplinary meetings is proposed.

Addressing the Hard Factors for Command File Errors by Probabilistic Reasoning

NASA Technical Reports Server (NTRS)

Meshkat, Leila; Bryant, Larry

2014-01-01

Command File Errors (CFE) are managed using standard risk management approaches at the Jet Propulsion Laboratory. Over the last few years, more emphasis has been made on the collection, organization, and analysis of these errors for the purpose of reducing the CFE rates. More recently, probabilistic modeling techniques have been used for more in depth analysis of the perceived error rates of the DAWN mission and for managing the soft factors in the upcoming phases of the mission. We broadly classify the factors that can lead to CFE's as soft factors, which relate to the cognition of the operators and hard factors which relate to the Mission System which is composed of the hardware, software and procedures used for the generation, verification & validation and execution of commands. The focus of this paper is to use probabilistic models that represent multiple missions at JPL to determine the root cause and sensitivities of the various components of the mission system and develop recommendations and techniques for addressing them. The customization of these multi-mission models to a sample interplanetary spacecraft is done for this purpose.

Analysis of administrative barriers in the industry of the high-rise construction in Russian Federation

NASA Astrophysics Data System (ADS)

Zaychenko, Irina; Borremans, Alexandra; Gutman, Svetlana

2018-03-01

The article describes the concept and types of administrative barriers encountered in various areas of the enterprise. The particularities of the Russian high-rise construction industry are described and a comparative analysis of administrative barriers in this sector is performed. The main stages and administrative procedures when the developers implement investment and construction projects in the field of high-rise construction are determined. The regulatory and legal framework for the implementation of investment and project activities in the high-rise construction industry has been studied and conclusions have been drawn on its low level of precision in the issue of the formation of competitive and efficient high-rise construction markets. The average number of administrative procedures for the implementation of the investment and construction project in the field of high-rise construction is determined. The factors preventing the reduction of administrative barriers in the high-rise construction industry are revealed.

Spectral analysis based on fast Fourier transformation (FFT) of surveillance data: the case of scarlet fever in China.

PubMed

Zhang, T; Yang, M; Xiao, X; Feng, Z; Li, C; Zhou, Z; Ren, Q; Li, X

2014-03-01

Many infectious diseases exhibit repetitive or regular behaviour over time. Time-domain approaches, such as the seasonal autoregressive integrated moving average model, are often utilized to examine the cyclical behaviour of such diseases. The limitations for time-domain approaches include over-differencing and over-fitting; furthermore, the use of these approaches is inappropriate when the assumption of linearity may not hold. In this study, we implemented a simple and efficient procedure based on the fast Fourier transformation (FFT) approach to evaluate the epidemic dynamic of scarlet fever incidence (2004-2010) in China. This method demonstrated good internal and external validities and overcame some shortcomings of time-domain approaches. The procedure also elucidated the cycling behaviour in terms of environmental factors. We concluded that, under appropriate circumstances of data structure, spectral analysis based on the FFT approach may be applicable for the study of oscillating diseases.

The Importance of Experimental Design, Quality Assurance, and Control in Plant Metabolomics Experiments.

PubMed

Martins, Marina C M; Caldana, Camila; Wolf, Lucia Daniela; de Abreu, Luis Guilherme Furlan

2018-01-01

The output of metabolomics relies to a great extent upon the methods and instrumentation to identify, quantify, and access spatial information on as many metabolites as possible. However, the most modern machines and sophisticated tools for data analysis cannot compensate for inappropriate harvesting and/or sample preparation procedures that modify metabolic composition and can lead to erroneous interpretation of results. In addition, plant metabolism has a remarkable degree of complexity, and the number of identified compounds easily surpasses the number of samples in metabolomics analyses, increasing false discovery risk. These aspects pose a large challenge when carrying out plant metabolomics experiments. In this chapter, we address the importance of a proper experimental design taking into consideration preventable complications and unavoidable factors to achieve success in metabolomics analysis. We also focus on quality control and standardized procedures during the metabolomics workflow.

Headspace screening: A novel approach for fast quality assessment of the essential oil from culinary sage.

PubMed

Cvetkovikj, Ivana; Stefkov, Gjoshe; Acevska, Jelena; Karapandzova, Marija; Dimitrovska, Aneta; Kulevanova, Svetlana

2016-07-01

Quality assessment of essential oil (EO) from culinary sage (Salvia officinalis L., Lamiaceae) is limited by the long pharmacopoeial procedure. The aim of this study was to employ headspace (HS) sampling in the quality assessment of sage EO. Different populations (30) of culinary sage were assessed using GC/FID/MS analysis of the hydrodistilled EO (pharmacopoeial method) and HS sampling directly from leaves. Compound profiles from both procedures were evaluated according to ISO 9909 and GDC standards for sage EO quality, revealing compliance for only 10 populations. Factors to convert HS values, for the target ISO and GDC components, into theoretical EO values were calculated. Statistical analysis revealed a significant relationship between HS and EO values for seven target components. Consequently, HS sampling could be used as a complementary extraction technique for rapid screening in quality assessment of sage EOs. Copyright © 2016 Elsevier Ltd. All rights reserved.

Continuation of TNF blockade in patients with inflammatory rheumatic disease. An observational study on surgical site infections in 1,596 elective orthopedic and hand surgery procedures.

PubMed

Berthold, Elisabet; Geborek, Pierre; Gülfe, Anders

2013-10-01

Increased infection risk in inflammatory rheumatic diseases may be due to inflammation or immunosuppressive treatment. The influence of tumor necrosis factor (TNF) inhibitors on the risk of developing surgical site infections (SSIs) is not fully known. We compared the incidence of SSI after elective orthopedic surgery or hand surgery in patients with a rheumatic disease when TNF inhibitors were continued or discontinued perioperatively. We included 1,551 patients admitted for elective orthopedic surgery or hand surgery between January 1, 2003 and September 30, 2009. Patient demographic data, previous and current treatment, and factors related to disease severity were collected. Surgical procedures were grouped as hand surgery, foot surgery, implant-related surgery, and other surgery. Infections were recorded and defined according to the 1992 Centers for Disease Control definitions for SSI. In 2003-2005, TNF inhibitors were discontinued perioperatively (group A) but not during 2006-2009 (group B). In group A, there were 28 cases of infection in 870 procedures (3.2%) and in group B, there were 35 infections in 681 procedures (5.1%) (p = < 0.05). Only foot surgery had significantly more SSIs in group B, with very low rates in group A. In multivariable analysis with groups A and B merged, only age was predictive of SSI in a statistically significant manner. Overall, the SSI rates were higher after abolishing the discontinuation of anti-TNF perioperatively, possibly due to unusually low rates in the comparator group. None of the medical treatments analyzed, e.g. methotrexate or TNF inhibitors, were significant risk factors for SSI. Continuation of TNF blockade perioperatively remains a routine at our center.

Preliminary results of an attempt to predict over apron occupational exposure of cardiologists from cardiac fluoroscopy procedures based on DAP (dose area product) values.

PubMed

Toossi, Mohammad Taghi Bahreyni; Mehrpouyan, Mohammad; Nademi, Hossein; Fardid, Reza

2015-03-01

This study is an effort to propose a mathematical relation between the occupational exposure measured by a dosimeter worn on a lead apron in the chest region of a cardiologist and the dose area product (DAP) recorded by a meter attached to the X-ray tube. We aimed to determine factors by which DAP values attributed to patient exposure could be converted to the over-apron entrance surface air kerma incurred by cardiologists during an angiographic procedure. A Rando phantom representing a patient was exposed by an X-ray tube from 77 pre-defined directions. DAP value for each exposure angle was recorded. Cardiologist exposure was measured by a Radcal ionization chamber 10X5-180 positioned on a second phantom representing the physician. The exposure conversion factor was determined as the quotient of over apron exposure by DAP value. To verify the validity of this method, the over-apron exposure of a cardiologist was measured using the ionization chamber while performing coronary angiography procedures on 45 patients weighing on average 75 ± 5 kg. DAP values for the corresponding procedures were also obtained. Conversion factors obtained from phantom exposure were applied to the patient DAP values to calculate physician exposure. Mathematical analysis of our results leads us to conclude that a linear relationship exists between two sets of data: (a) cardiologist exposure measured directly by Radcal & DAP values recorded by the X-ray machine system (R (2) = 0.88), (b) specialist measured and estimated exposure derived from DAP values (R (2) = 0.91). The results demonstrate that cardiologist occupational exposure can be derived from patient data accurately.

Predictors of Good Outcome After Endovascular Therapy for Vertebrobasilar Occlusion Stroke.

PubMed

Bouslama, Mehdi; Haussen, Diogo C; Aghaebrahim, Amin; Grossberg, Jonathan A; Walker, Gregory; Rangaraju, Srikant; Horev, Anat; Frankel, Michael R; Nogueira, Raul G; Jovin, Tudor G; Jadhav, Ashutosh P

2017-12-01

Endovascular therapy is increasingly used in acute ischemic stroke treatment and is now considered the gold standard approach for selected patient populations. Prior studies have demonstrated that eventual patient outcomes depend on both patient-specific factors and procedural considerations. However, these factors remain unclear for acute basilar artery occlusion stroke. We sought to determine prognostic factors of good outcome in acute posterior circulation large vessel occlusion strokes treated with endovascular therapy. We reviewed our prospectively collected endovascular databases at 2 US tertiary care academic institutions for patients with acute posterior circulation strokes from September 2005 to September 2015 who had 3-month modified Rankin Scale documented. Baseline characteristics, procedural data, and outcomes were evaluated. A good outcome was defined as a 90-day modified Rankin Scale score of 0 to 2. The association between clinical and procedural parameters and functional outcome was assessed. A total of 214 patients qualified for the study. Smoking status, creatinine levels, baseline National Institutes of Health Stroke Scale score, anesthesia modality (conscious sedation versus general anesthesia), procedural length, and reperfusion status were significantly associated with good outcomes in the univariate analysis. Multivariate logistic regression indicated that only smoking (odds ratio=2.61; 95% confidence interval, 1.23-5.56; P =0.013), low baseline National Institutes of Health Stroke Scale score (odds ratio=1.09; 95% confidence interval, 1.04-1.13; P <0.0001), and successful reperfusion status (odds ratio=10.80; 95% confidence interval, 1.36-85.96; P =0.025) were associated with good outcome. In our retrospective case series, only smoking, low baseline National Institutes of Health Stroke Scale score, and successful reperfusion status were associated with good outcome in patients with posterior circulation stroke treated with endovascular therapy. © 2017 American Heart Association, Inc.

Readmission After Abdominal Surgery for Crohn's Disease: Identification of High-Risk Patients.

PubMed

Mege, Diane; Michelassi, Fabrizio

2018-05-16

Although many predictive factors for postoperative morbidity are known, few data are available about readmission after abdominal surgery for Crohn's disease (CD). The objective of this study is to identify predictive factors and high-risk patients for readmission after abdominal CD surgery. All patients who underwent abdominal surgery for CD in one tertiary referral center between January 2004 and December 2016 were included. Patients who required readmission and those without were compared. Perineal procedures, elective readmissions, and abdominal procedures for non-Crohn's indications were not included. Nine hundred eight abdominal procedures were performed in 712 patients. Readmission rates were 8, 8.5, 8.6, 8.8, and 8.9% at 30, 60, and 90 days and 12 and 60 months, respectively. The main reasons were wound infection (14%), deep abscess (13%), small-bowel obstruction (13%), and dehydration (11%). Eight (11%) patients required percutaneous drainage and 19 (27%) underwent an unplanned surgery. After multivariate analysis, three independent predictive factors for readmission were identified: older age (OR 1.02, 95%CI 1.005-1.04; p < 0.006), a history of previous proctectomy (OR 3, 95%CI 1.2-9, p < 0.02), and higher blood loss volume during surgery (OR 1.0001, 95%CI 1-1.002, p < 0.05). Readmission occurred in 8-9% of abdominal procedures for CD within 1-3 months after surgery and it required unplanned reoperation in a quarter of them. Identification of high-risk groups and knowledge of the more common postoperative complications requiring readmission help in increasing postoperative vigilance to select patients who may benefit from early interventions.

Operational NDT simulator, towards human factors integration in simulated probability of detection

NASA Astrophysics Data System (ADS)

Rodat, Damien; Guibert, Frank; Dominguez, Nicolas; Calmon, Pierre

2017-02-01

In the aeronautic industry, the performance demonstration of Non-Destructive Testing (NDT) procedures relies on Probability Of Detection (POD) analyses. This statistical approach measures the ability of the procedure to detect a flaw with regard to one of its characteristic dimensions. The inspection chain is evaluated as a whole, including equipment configuration, probe effciency but also operator manipulations. Traditionally, a POD study requires an expensive campaign during which several operators apply the procedure on a large set of representative samples. Recently, new perspectives for the POD estimation have been introduced using NDT simulation to generate data. However, these approaches do not offer straightforward solutions to take the operator into account. The simulation of human factors, including cognitive aspects, often raises questions. To address these diffculties, we propose a concept of operational NDT simulator [1]. This work presents the first steps in the implementation of such simulator for ultrasound phased array inspection of composite parts containing Flat Bottom Holes (FBHs). The final system will look like a classical ultrasound testing equipment with a single exception: the displayed signals will be synthesized. Our hardware (ultrasound acquisition card, 3D position tracker) and software (position analysis, inspection scenario, synchronization, simulations) environments are developed as a bench to test the meta-modeling techniques able to provide fast-simulated realistic ultra-sound signals. The results presented here are obtained by on-the-fly merging of real and simulated signals. They confirm the feasibility of our approach: the replacement of real signals by purely simulated ones has been unnoticed by operators. We believe this simulator is a great prospect for POD evaluation including human factors, and may also find applications for training or procedure set-up.

Modified Maze Procedure for Atrial Fibrillation as an Adjunct to Elective Cardiac Surgery: Predictors of Mid-Term Recurrence and Echocardiographic Follow-Up

PubMed Central

Alamanni, Francesco; Veglia, Fabrizio; Galli, Claudia; Parolari, Alessandro; Zanobini, Marco

2015-01-01

The radiofrequency maze procedure achieves sinus rhythm in 45%–95% of patients treated for atrial fibrillation. This retrospective study evaluates mid-term results of the radiofrequency maze—performed concomitant to elective cardiac surgery—to determine sinus-rhythm predictive factors, and describes the evolution of patients' echocardiographic variables. From 2003 through 2011, 247 patients (mean age, 64 ± 9.5 yr) with structural heart disease (79.3% mitral disease) and atrial fibrillation underwent a concomitant radiofrequency modified maze procedure. Patients were monitored by 24-hour Holter at 3, 6, 12, and 24 months, then annually. Eighty-four mitral-valve patients underwent regular echocardiographic follow-up. Univariate and multivariate analysis for risk factors of maze failure were identified. The in-hospital mortality rate was 1.2%. During a median follow-up of 39.4 months, the late mortality rate was 3.6%, and pacemaker insertion was necessary in 26 patients (9.4%). Sinus rhythm was present in 63% of patients at the latest follow-up. Predictive factors for atrial fibrillation recurrence were arrhythmia duration (hazard ratio [HR]=1.296, P=0.045) and atrial fibrillation at hospital discharge (HR=2.03, P=0.019). The monopolar device favored maze success (HR=0.191, P <0.0001). Left atrial area and indexed left ventricular end-diastolic volume showed significant decrease both in sinus rhythm and atrial fibrillation patients. Early sinus rhythm conversion was associated with improved left ventricular ejection fraction. Concomitant radiofrequency maze procedure provided remarkable outcomes. Shorter preoperative atrial fibrillation duration, monopolar device use, and prompt treatment of arrhythmia recurrences increase the midterm success rate. Early sinus rhythm restoration seems to result in better left ventricular ejection fraction recovery. PMID:26413016

Review of Ophthalmology Medical Professional Liability Claims in the United States from 2006 through 2015.

PubMed

Thompson, Atalie C; Parikh, P Divya; Lad, Eleonora M

2018-05-01

To describe characteristics of closed medical professional liability (MPL) claims against ophthalmologists in the United States. Retrospective analysis of MPL claims from 2006-2015. Data were obtained from the Physician Insurers Association of America (PIAA) Data Sharing Project (DSP). Comparison was made between ophthalmology and all healthcare specialties for physician demographics, prevalence and costs associated with closed claims, and resolution of claims. The most prevalent chief medical factor, presenting medical condition, operative procedure, outcomes, and resolution of ophthalmology claims were compared between the 2006-2010 and 2011-2015 periods. From 2006-2015, 90 743 MPL claims were closed: 2.6% (2325/90 743) of closed claims and 2.2% (564/24 670) of all paid claims were against ophthalmologists. Retrospective analysis of MPL claims captured by the PIAA DSP over a 10-year period. Subspecialty pertaining to the claim, number of claims closed and paid, indemnity paid, allocated loss adjustment expenses, chief medical factor, presenting medical condition, operative procedure, outcome, and resolution. Only 24% of closed claims against ophthalmologists resulted in payment. Two-thirds were dropped, withdrawn, or dismissed. Ninety percent of claims that received a verdict were favorable toward the ophthalmologist. Cataract and cornea surgeries were the most prevalent and most costly operative procedures, accounting for 50% of all claims and $47 641 376 and $32 570 148 in total paid indemnity, respectively. Average indemnity was higher for corneal procedures ($304 476) than vitreoretinal procedures ($270 141) or oculoplastic procedures on the eyelid ($222 471) or orbit and eyeball ($183 467). The prevalence and cost of claims related to endophthalmitis declined from 2006-2010 (n = 38/1160 [3.3%]; average indemnity, $516 875) period to the 2011-2015 (n = 26/1165 [2.2%]; average indemnity, $247 083) period. Average indemnity paid ($280 227 vs. $335 578) and amount spent on legal defense ($41 450 vs. $46 391) was slightly lower among ophthalmologists compared with all healthcare specialties, respectively. Ophthalmology has a relatively low number of malpractice claims reported compared with other healthcare specialties and shows less spending on average indemnity and defense. Further studies are needed to investigate the reasons for the higher prevalence of claims related to cataract and corneal surgeries and the higher average indemnity paid for corneal procedures relative to vitreoretinal or oculoplastic procedures. Copyright © 2018 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.

Lipids and bariatric procedures Part 2 of 2: scientific statement from the American Society for Metabolic and Bariatric Surgery (ASMBS), the National Lipid Association (NLA), and Obesity Medicine Association (OMA).

PubMed

Bays, Harold; Kothari, Shanu N; Azagury, Dan E; Morton, John M; Nguyen, Ninh T; Jones, Peter H; Jacobson, Terry A; Cohen, David E; Orringer, Carl; Westman, Eric C; Horn, Deborah B; Scinta, Wendy; Primack, Craig

2016-01-01

Bariatric procedures generally improve dyslipidemia, sometimes substantially so. Bariatric procedures also improve other major cardiovascular risk factors. This 2-part Scientific Statement examines the lipid effects of bariatric procedures and reflects contributions from authors representing the American Society for Metabolic and Bariatric Surgery (ASMBS), the National Lipid Association (NLA), and the Obesity Medicine Association (OMA). Part 1 was published in the Journal of Clinical Lipidology, and reviewed the impact of bariatric procedures upon adipose tissue endocrine and immune factors, adipose tissue lipid metabolism, as well as the lipid effects of bariatric procedures relative to bile acids and intestinal microbiota. This Part 2 reviews: (1) the importance of nutrients (fats, carbohydrates, and proteins) and their absorption on lipid levels; (2) the effects of bariatric procedures on gut hormones and lipid levels; (3) the effects of bariatric procedures on nonlipid cardiovascular disease (CVD) risk factors; (4) the effects of bariatric procedures on lipid levels; (5) effects of bariatric procedures on CVD; and finally, (6) the potential lipid effects of vitamin, mineral, and trace element deficiencies, that may occur after bariatric procedures. Copyright © 2016 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

Identification of factors associated with sedation tolerance in 5000 patients undergoing outpatient colonoscopy: Canadian tertiary center experience.

PubMed

Shingina, Alexandra; Ou, George; Takach, Oliver; Svarta, Sigrid; Kwok, Ricky; Tong, Jessica; Donaldson, Kieran; Lam, Eric; Enns, Robert

2016-12-16

To develop a prediction model aimed at identifying patients that may require higher than usual sedation doses during colonoscopy. A retrospective chart review on 5000 patients who underwent an outpatient colonoscopy at St. Paul's Hospital from 2009 to 2010 was conducted in order to develop a model for identifying patients who will require increased doses of sedatives. Potential predictor variables including age, gender, endoscopy indication, high sedation requirements during previous endoscopies, difficulty of the procedure, bowel preparation quality, interventions, findings as well as current use of benzodiazepines, opioids and alcohol were analyzed. The outcome of study was the use of high dose of sedation agents for the procedure. In particular, the high dose of sedation was defined as fentanyl greater than 50 mcg and midazolam greater than 3 mg. Analysis of 5282 patients (mean age 57 ± 12, 49% female) was performed. Most common indication for the procedure was screening colonoscopy (57%). Almost half of our patients received doses exceeding Fentanyl 50 mcg and Midazolam 3 mg. Logistic regression models identified the following variables associated with high sedation: Younger age (OR = 0.95 95%CI: 0.94-0.95; P < 0.0001); abdominal pain (OR = 1.45, 95%CI: 1.08-1.96); P = 0.01) and Inflammatory Bowel Disease (OR = 1.45, 95%CI: 1.04-2.03; P = 0.02) as indications for the procedure; difficult procedure as defined by gastroenterologist (OR = 1.73, 95%CI: 1.48-2.03; P < 0.0001); past history of abdominal surgery (OR = 1.33, 95%CI: 1.17-1.52; P <0.0001) and previous colonoscopy (OR = 1.39, 95%CI: 1.21-1.60; P = 0.0001) and alcohol use (OR = 1.26, 95%CI: 1.03-1.54; P = 0.02). Age and gender adjusted analysis yielded inflammatory bowel disease as an indication (OR = 3.17, 95%CI: 1.58-6.37; P = 0.002); difficult procedure as defined by an endoscopist (OR = 5.13 95%CI: 2.97-8.85; P = 0.0001) and current use of opioids, benzodiazepines or antidepressants (OR = 2.88, 95%CI: 1.74-4.77; P = 0.001) having the highest predictive value of high sedation requirements. Our prediction model using the following pre-procedural variables including age, gender, indication for the procedure, medication/substance use, previous surgeries, previous high sedation requirements for colonoscopy yielded an area under the curve of 0.76 for Fentanyl ≥ 100 mcg and Midazolam ≥ 3 mg. Pre-procedural planning is the key in conducting successful, efficient colonoscopy. Logistic regression analysis of 5000 patients who underwent out-patient colonoscopy revealed the following factors associated with increased sedation requirement: Younger age, female gender, difficult endoscopy, specific indications as well as cardiopulmonary complications and current use of opioids/benzodiazepines. Age and gender adjusted analysis yielded similar results. These patients are more likely to need a longer recovery periods post-endoscopy, which could result in additional time and personnel requirements. The final predictive model has good predictive ability for Fentanyl ≥ 100 mcg and Midazolam ≥ 3 mg and fair predictive ability for Fentanyl ≥ 50 mcg and Midazolam ≥ 2 mg. The external validity of this model is planned to be tested in another center.

Development and validation of a virtual reality simulator: human factors input to interventional radiology training.

PubMed

Johnson, Sheena Joanne; Guediri, Sara M; Kilkenny, Caroline; Clough, Peter J

2011-12-01

This study developed and validated a virtual reality (VR) simulator for use by interventional radiologists. Research in the area of skill acquisition reports practice as essential to become a task expert. Studies on simulation show skills learned in VR can be successfully transferred to a real-world task. Recently, with improvements in technology, VR simulators have been developed to allow complex medical procedures to be practiced without risking the patient. Three studies are reported. In Study I, 35 consultant interventional radiologists took part in a cognitive task analysis to empirically establish the key competencies of the Seldinger procedure. In Study 2, 62 participants performed one simulated procedure, and their performance was compared by expertise. In Study 3, the transferability of simulator training to a real-world procedure was assessed with 14 trainees. Study I produced 23 key competencies that were implemented as performance measures in the simulator. Study 2 showed the simulator had both face and construct validity, although some issues were identified. Study 3 showed the group that had undergone simulator training received significantly higher mean performance ratings on a subsequent patient procedure. The findings of this study support the centrality of validation in the successful design of simulators and show the utility of simulators as a training device. The studies show the key elements of a validation program for a simulator. In addition to task analysis and face and construct validities, the authors highlight the importance of transfer of training in validation studies.

The Fibroid Registry for outcomes data (FIBROID) for uterine embolization: short-term outcomes.

PubMed

Worthington-Kirsch, Robert; Spies, James B; Myers, Evan R; Mulgund, Jyotsna; Mauro, Matthew; Pron, Gaylene; Peterson, Eric D; Goodwin, Scott

2005-07-01

To investigate the short-term safety of uterine embolization for leiomyomata in a large cohort of patients treated in a variety of clinical settings. Examining the FIBROID Registry, a multicenter prospective voluntary registry of patients undergoing uterine embolization for leiomyomata, we studied the frequency of adverse events and predictors of adverse events within 30 days of the procedure. We also report on the technical aspects of the procedure, including details of periprocedural care, technique, and short-term recovery. All adverse events were recorded and classified using standard definitions, both in terms of type and severity. Summary statistics were used to describe the data set, and univariate and multivariate analyses were used to determine which factors might influence the incidence of adverse events. Of the 3,160 patients enrolled at 72 contributing sites, major in-hospital complications occurred in 0.66%, and postdischarge major events occurred in 4.8% within the first 30 days. The most common adverse event after discharge was inadequate pain relief requiring additional hospital treatment (2.4%). Thirty-one patients required additional surgical intervention within 30 days after treatment, 3 of whom required hysterectomy (0.1%). There were no deaths. Multivariate analysis showed modest increased odds for an adverse event for African Americans, smokers, and those with prior leiomyoma procedures. There were no differences in outcome based on the practice site experience, practice type, or any procedure-related factors. Uterine embolization for leiomyomata is a low-risk procedure with little variability in short-term outcome based on either patient demographics or practice setting. II-3.

32 CFR 989.37 - Procedures for analysis abroad.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 32 National Defense 6 2011-07-01 2011-07-01 false Procedures for analysis abroad. 989.37 Section... PROTECTION ENVIRONMENTAL IMPACT ANALYSIS PROCESS (EIAP) § 989.37 Procedures for analysis abroad. Procedures for analysis of environmental actions abroad are contained in 32 CFR part 187. That directive provides...

Photoelastic Analysis of Cracked Thick Walled Cylinders

NASA Astrophysics Data System (ADS)

Pastramă, Ştefan Dan

2017-12-01

In this paper, the experimental determination of the stress intensity factor in thick walled cylinders subject to uniform internal pressure and having longitudinal non-penetrating cracks is presented. Photoelastic measurements were used together with the expressions of the stress field near the crack tip for Mode I crack extension and a specific methodology for stress intensity factor determination. Two types of longitudinal cracks - internal and external - were considered. Four plane models were manufactured and analyzed in a plane polariscope at different values of the applied internal pressure. The values of the normalized stress intensity factor were calculated and the results were compared to those reported by other authors. A good accuracy was noticed, showing the reliability of the experimental procedure.

A Social Evaluation of Perception on Body Contouring Surgery by Turkish Male Aesthetic Surgery Patients.

PubMed

Ozel, Bora; Sezgin, Billur; Guney, Kirdar; Latifoglu, Osman; Celebi, Cemallettin

2015-02-01

Although aesthetic procedures are known to have a higher impact on women, men are becoming more inclined toward such procedures since the last decade. To determine the reason behind the increase in demand for male aesthetic procedures and to learn about the expectations and inquietude related to body contouring surgery, a prospective questionnaire study was conducted on 200 Turkish males from January 1, 2011-May 31, 2012. Demographic information, previous aesthetic procedures and thoughts on body contouring procedures with given reasons were questioned. The results of the study showed that 53 % of all participants considered undergoing body contouring surgery with the given reason that they believed their current body structure required it. For those who did not consider contouring operations, 92.5 % said they felt that they did not need such a procedure. The results of the statistical analysis showed that BMI was a significant factor in the decision making process for wanting to undergo body contouring procedures. The results of the study showed that men's consideration for aesthetic operations depends mainly on necessity and that the most considered region was the abdominal zone in regard to contouring. We can conclude that men are becoming more interested in body contouring operations and therefore different surgical procedures should be refined and re-defined according to the expectations of this new patient group.

Human Factors Considerations for Performance-Based Navigation

NASA Technical Reports Server (NTRS)

Barhydt, Richard; Adams, Catherine A.

2006-01-01

A transition toward a performance-based navigation system is currently underway in both the United States and around the world. Performance-based navigation incorporates Area Navigation (RNAV) and Required Navigation Performance (RNP) procedures that do not rely on the location of ground-based navigation aids. These procedures offer significant benefits to both operators and air traffic managers. Under sponsorship from the Federal Aviation Administration (FAA), the National Aeronautics and Space Administration (NASA) has undertaken a project to document human factors issues that have emerged during RNAV and RNP operations and propose areas for further consideration. Issues were found to include aspects of air traffic control and airline procedures, aircraft systems, and procedure design. Major findings suggest the need for human factors-specific instrument procedure design guidelines. Ongoing industry and government activities to address air-ground communication terminology, procedure design improvements, and chart-database commonality are strongly encouraged.

Columbia River System Operation Review : Final Environmental Impact Statement, Appendix J: Recreation.

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

Columbia River System Operation Review

1995-11-01

This Appendix J of the Final Environmental Impact Statement for the Columbia River System discusses impacts on the recreational activities in the region. Major sections include the following: scope and processes; recreation in the Columbia River Basin today - by type, location, participation, user characteristics, factors which affect usage, and managing agencies; recreation analysis procedures and methodology; and alternatives and their impacts.

Occupational stress in a rural hospital.

PubMed

McKenna, J F

1985-01-01

A rural hospital served as the research setting for this study. Respondents completed occupational stress questionnaires which incorporated five sources of work-related stress factors. Specifically, knowledge, patient care, conflict, environmental, and managerial sources of stress were assessed. The results of an analysis of variance procedure indicated that certain forms of occupational stress were clearly more associated with certain departmental groupings within the hospital than others.

Aggregating Indices of Governance Quality: An Exploratory Factor Analysis

DTIC Science & Technology

2011-03-01

these important decisions. Financial assistance programs like the Millennium Challenge Account (MCA), have been criticized for their overreliance on...is the civil society, and relates to the system of values and beliefs necessary for social behaviour to happen and public decisions to be made...difference between two successive solutions is negligible. The whole procedure is then repeated multiple times, with the analyst systematically varying

Skin prick tests and allergy diagnosis.

PubMed

Antunes, João; Borrego, Luís; Romeira, Ana; Pinto, Paula

2009-01-01

Skin testing remains an essential diagnostic tool in modern allergy practice. A significant variability has been reported regarding technical procedures, interpretation of results and documentation. This review has the aim of consolidating methodological recommendations through a critical analysis on past and recent data. This will allow a better understanding on skin prick test (SPT) history; technique; (contra-) indications; interpretation of results; diagnostic pitfalls; adverse reactions; and variability factors.

An Evaluation of the Precision of Measurement of Ryff's Psychological Well-Being Scales in a Population Sample

ERIC Educational Resources Information Center

Abbott, Rosemary A.; Ploubidis, George B.; Huppert, Felicia A.; Kuh, Diana; Croudace, Tim J.

2010-01-01

The aim of this study is to assess the effective measurement range of Ryff's Psychological Well-being scales (PWB). It applies normal ogive item response theory (IRT) methodology using factor analysis procedures for ordinal data based on a limited information estimation approach. The data come from a sample of 1,179 women participating in a…