Current Performance Characteristics of NASA Langley Research Center's Cockpit Motion Base and Standardized Test Procedure for Future Performance Characterization

NASA Technical Reports Server (NTRS)

Cowen, Brandon; Stringer, Mary T.; Hutchinson, Brian K.; Davidson, Paul C.; Gupton, Lawrence E.

2014-01-01

This report documents the updated performance characteristics of NASA Langley Research Center's (LaRC) Cockpit Motion Base (CMB) after recent revisions that were made to its inner-loop, feedback control law. The modifications to the control law will be briefly described. The performance of the Cockpit Motion Facility (CMF) will be presented. A short graphical comparison to the previous control law can be found in the appendix of this report. The revised controller will be shown to yield reduced parasitic accelerations with respect to the previous controller. Metrics based on the AGARD Advisory Report No. 144 are used to assess the overall system performance due to its recent control algorithm modification. This report also documents the standardized simulator test procedure which can be used in the future to evaluate potential updates to the control law.

Toilet Training, Cueing, Praise, and Self-Cleaning in the Treatment of Classroom Encopresis: A Case Study.

ERIC Educational Resources Information Center

Dixon, Joe W.; Saudargas, Richard A.

1980-01-01

Reports a successful method of teaching toileting procedures to a young elementary student. Implications discussed for school psychologists were: (1) handling intervention through a consultation model; (2) using the simplest approach before attempting more powerful procedures; and (3) attempting treatment despite previously unsuccessful…

Quality audit of colonoscopy reports amongst patients screened or surveilled for colorectal neoplasia.

PubMed

Beaulieu, Daphnée; Barkun, Alan; Martel, Myriam

2012-07-21

To complete a quality audit using recently published criteria from the Quality Assurance Task Group of the National Colorectal Cancer Roundtable. Consecutive colonoscopy reports of patients at average/high risk screening, or with a prior colorectal neoplasia (CRN) by endoscopists who perform 11 000 procedures yearly, using a commercial computerized endoscopic report generator. A separate institutional database providing pathological results. Required documentation included patient demographics, history, procedure indications, technical descriptions, colonoscopy findings, interventions, unplanned events, follow-up plans, and pathology results. Reports abstraction employed a standardized glossary with 10% independent data validation. Sample size calculations determined the number of reports needed. Two hundreds and fifty patients (63.2 ± 10.5 years, female: 42.8%, average risk: 38.5%, personal/family history of CRN: 43.3%/20.2%) were scoped in June 2009 by 8 gastroenterologists and 3 surgeons (mean practice: 17.1 ± 8.5 years). Procedural indication and informed consent were always documented. 14% provided a previous colonoscopy date (past polyp removal information in 25%, but insufficient in most to determine surveillance intervals appropriateness). Most procedural indicators were recorded (exam date: 98.4%, medications: 99.2%, difficulty level: 98.8%, prep quality: 99.6%). All reports noted extent of visualization (cecum: 94.4%, with landmarks noted in 78.8% - photodocumentation: 67.2%). No procedural times were recorded. One hundred and eleven had polyps (44.4%) with anatomic location noted in 99.1%, size in 65.8%, morphology in 62.2%; removal was by cold biopsy in 25.2% (cold snare: 18%, snare cautery: 31.5%, unrecorded: 20.7%), 84.7% were retrieved. Adenomas were noted in 24.8% (advanced adenomas: 7.6%, cancer: 0.4%) in this population with varying previous colonic investigations. This audit reveals lacking reported items, justifying additional research to optimize quality of reporting.

Quality audit of colonoscopy reports amongst patients screened or surveilled for colorectal neoplasia

PubMed Central

Beaulieu, Daphnée; Barkun, Alan; Martel, Myriam

2012-01-01

AIM: To complete a quality audit using recently published criteria from the Quality Assurance Task Group of the National Colorectal Cancer Roundtable. METHODS: Consecutive colonoscopy reports of patients at average/high risk screening, or with a prior colorectal neoplasia (CRN) by endoscopists who perform 11 000 procedures yearly, using a commercial computerized endoscopic report generator. A separate institutional database providing pathological results. Required documentation included patient demographics, history, procedure indications, technical descriptions, colonoscopy findings, interventions, unplanned events, follow-up plans, and pathology results. Reports abstraction employed a standardized glossary with 10% independent data validation. Sample size calculations determined the number of reports needed. RESULTS: Two hundreds and fifty patients (63.2 ± 10.5 years, female: 42.8%, average risk: 38.5%, personal/family history of CRN: 43.3%/20.2%) were scoped in June 2009 by 8 gastroenterologists and 3 surgeons (mean practice: 17.1 ± 8.5 years). Procedural indication and informed consent were always documented. 14% provided a previous colonoscopy date (past polyp removal information in 25%, but insufficient in most to determine surveillance intervals appropriateness). Most procedural indicators were recorded (exam date: 98.4%, medications: 99.2%, difficulty level: 98.8%, prep quality: 99.6%). All reports noted extent of visualization (cecum: 94.4%, with landmarks noted in 78.8% - photodocumentation: 67.2%). No procedural times were recorded. One hundred and eleven had polyps (44.4%) with anatomic location noted in 99.1%, size in 65.8%, morphology in 62.2%; removal was by cold biopsy in 25.2% (cold snare: 18%, snare cautery: 31.5%, unrecorded: 20.7%), 84.7% were retrieved. Adenomas were noted in 24.8% (advanced adenomas: 7.6%, cancer: 0.4%) in this population with varying previous colonic investigations. CONCLUSION: This audit reveals lacking reported items, justifying additional research to optimize quality of reporting. PMID:22826619

Factors Associated with Anxiety About Colonoscopy: The Preparation, the Procedure, and the Anticipated Findings.

PubMed

Shafer, L A; Walker, J R; Waldman, C; Yang, C; Michaud, V; Bernstein, C N; Hathout, L; Park, J; Sisler, J; Restall, G; Wittmeier, K; Singh, H

2018-03-01

Previous research has assessed anxiety around colonoscopy procedures, but has not considered anxiety related to different aspects related to the colonoscopy process. Before colonoscopy, we assessed anxiety about: bowel preparation, the procedure, and the anticipated results. We evaluated associations between patient characteristics and anxiety in each area. An anonymous survey was distributed to patients immediately prior to their outpatient colonoscopy in six hospitals and two ambulatory care centers in Winnipeg, Canada. Anxiety was assessed using a visual analog scale. For each aspect, logistic regression models were used to explore associations between patient characteristics and high anxiety. A total of 1316 respondents completed the questions about anxiety (52% female, median age 56 years). Anxiety scores > 70 (high anxiety) were reported by 18% about bowel preparation, 29% about the procedure, and 28% about the procedure results. High anxiety about bowel preparation was associated with female sex, perceived unclear instructions, unfinished laxative, and no previous colonoscopies. High anxiety about the procedure was associated with female sex, no previous colonoscopies, and confusing instructions. High anxiety about the results was associated with symptoms as an indication for colonoscopy and instructions perceived as confusing. Fewer people had high anxiety about preparation than about the procedure and findings of the procedure. There are unique predictors of anxiety about each colonoscopy aspect. Understanding the nuanced differences in aspects of anxiety may help to design strategies to reduce anxiety, leading to improved acceptance of the procedure, compliance with preparation instructions, and less discomfort with the procedure.

Reflection coefficients of permeant molecules in human red cell suspensions.

PubMed

Owen, J D; Eyring, E M

1975-08-01

The Staverman reflection coefficient, sigma for several permeant molecules was determined in human red cell suspensions with a Durrum stopped-flow spectrophotometer. This procedure was first used with dog, cat, and beef red cells and with human red cells. The stopped-flow technique used was similar to the rapid-flow method used by those who originally reported sigma measurements in human red cells for molecules which rapidly penetrate the red cell membrane. The sigma values we obtained agreed with those previously reported for most of the slow penetrants, except malonamide, but disagreed with all the sigma values previously reported for the rapid penetrants. We were unable to calculate an "equivalent pore radius" with our sigma data. The advantages of our equipment and our experimental procedure are discussed. Our sigma data suggest that sigma is indirectly proportional to the log of the nonelectrolyte permeability coefficient, omega. Since a similar trend has been previously shown for log omega and molar volume of the permeant molecules, a correlatioo was shown between sigma and molar volume suggesting the membrane acts as a sieve.

Salivary a-Amylase Reflects Change in Attentional Demands during Postural Control: Comparison with Probe Reaction Time

ERIC Educational Resources Information Center

Akizuki, Kazunori; Ohashi, Yukari

2014-01-01

Purpose: The influence of attention on postural control and the relationship between attention and falling has been reported in previous studies. Although a dual-task procedure is commonly used to measure attentional demand, such procedures are affected by allocation policy, which is a mental strategy to divide attention between simultaneous…

Annual Research Progress Report, FY 1980.

DTIC Science & Technology

1980-10-01

surgical procedure was documented on video tape for future reference. CONCLUSIONS A surgical procedure was developed to expose the dorsal spinal...cACicor M uW o , nbeloI *mpo,8 nnl PoRN 1AQQ PREVIOUS EDIOTIONS OF THIS FORM ARE ORSOLYTE DO FORMS 1498A. I NOV GO ABSTRACT PROJECT NO. 3S162772A814

An analysis of tire tread wear groove patterns and the effect of heteroscedasticity on tire tread wear statistics

DOT National Transportation Integrated Search

1985-09-01

This report examines the groove wear variability among tires subjected to the : Uniform Tire Quality Grading (UTQC) test procedure for determining tire tread wear. : The effects of heteroscedasticity (variable variance) on a previously reported : sta...

Intestinal volvulus following laparoscopic surgery: a literature review and case report.

PubMed

Ferguson, Louise; Higgs, Zoe; Brown, Sylvia; McCarter, Douglas; McKay, Colin

2008-06-01

Since its introduction in the early 1990s, the laparoscopic cholecystectomy has become the standard surgical intervention for cholelithiasis. The laparoscopic technique is being used in an increasing number of abdominal procedures. Intestinal volvulus is a rare complication of laparoscopic procedures, such as the laparoscopic cholecystectomy. A review of the literature revealed 12 reports of this complication occurring without a clear cause. Etiologic factors that have been postulated include congenital malrotation, previous surgery, and intraoperative factors, such as pneumoperitoneum, mobilization of the bowel, and patient position. In this paper, we review the literature for this rare complication and report on a case of cecal bascule (a type of cecal volvulus) occurring following the laparoscopic cholecystectomy. Of the 12 prior reports of intestinal volvulus following laparoscopic procedures, 8 of these followed the laparoscopic cholecystectomy, of which two were cecal volvulae. This is the first reported case of a cecal bascule occurring following the laparoscopic cholecystectomy.

Guidelines and standard procedures for continuous water-quality monitors: Station operation, record computation, and data reporting

USGS Publications Warehouse

Wagner, Richard J.; Boulger, Robert W.; Oblinger, Carolyn J.; Smith, Brett A.

2006-01-01

The U.S. Geological Survey uses continuous water-quality monitors to assess the quality of the Nation's surface water. A common monitoring-system configuration for water-quality data collection is the four-parameter monitoring system, which collects temperature, specific conductance, dissolved oxygen, and pH data. Such systems also can be configured to measure other properties, such as turbidity or fluorescence. Data from sensors can be used in conjunction with chemical analyses of samples to estimate chemical loads. The sensors that are used to measure water-quality field parameters require careful field observation, cleaning, and calibration procedures, as well as thorough procedures for the computation and publication of final records. This report provides guidelines for site- and monitor-selection considerations; sensor inspection and calibration methods; field procedures; data evaluation, correction, and computation; and record-review and data-reporting processes, which supersede the guidelines presented previously in U.S. Geological Survey Water-Resources Investigations Report WRIR 00-4252. These procedures have evolved over the past three decades, and the process continues to evolve with newer technologies.

Long Distance Enhancement of Nonlinear Optical Properties Using Low Concentration of Plasmonic Nanostructures in Dye Doped Monolithic SolGel Materials (Postprint)

DTIC Science & Technology

2016-05-31

www.MaterialsViews.com Synthesis of the Gold Nanoparticles : The Au nanospheres were prepared according to previously reported procedure using the...Au Nanoparticles Using Specifi c Silicone : The synthesis of the functional silicone was previously reported as well as the surface modifi cation of...types of gold nanoparticles (AuNPs) are prepared and polished to high optical quality. Their photophysical properties are investigated. The glass

Prospective Study of Combined Colon and Endometrial Cancer Screening in Women With Lynch Syndrome: A Patient-Centered Approach

PubMed Central

Huang, Marilyn; Sun, Charlotte; Boyd-Rogers, Stephanie; Burzawa, Jennifer; Milbourne, Andrea; Keeler, Elizabeth; Yzquierdo, Rebecca; Lynch, Patrick; Peterson, Susan K.; Lu, Karen

2011-01-01

Background: Endometrial and colorectal cancers are the most common cancers in Lynch syndrome. Consensus guidelines recommend annual endometrial biopsy (EMB) and regular colonoscopies. We assessed the feasibility of concurrently performing EMB and colonoscopy and evaluated women's perception of pain, satisfaction, and acceptability. Methods: From July 2002 to December 2009, women who had a gene mutation for Lynch syndrome, met the Amsterdam II criteria, or had a high-risk situation that required screening were prospectively enrolled. After conscious sedation, the procedures were sequentially performed. Patients completed pre- and postprocedure questionnaires assessing pain, level of satisfaction, and acceptability. The Wilcoxon rank test and Mann-Whitney test were used to compare pain scores. Results: Forty-two women completed the study. Median age was 37 years (range, 25 to 73). Nineteen had previously had an EMB in the office setting. Women reported significantly lower median levels of pain in the combined procedure compared with previous office setting biopsies (P < .001). Regardless of parity, women reported significantly less pain for an EMB as part of the combined screen compared with an office EMB (parous, P = .003; nulliparous, P = .026). Women also reported a high level of satisfaction and more convenience in the combined procedure. All participants preferred combined to separately scheduled procedures and would recommend the combined procedure to their relatives. Conclusion: Combined colon and endometrial cancer screening is a patient-centered approach that is feasible, acceptable, and may improve adherence to Lynch syndrome screening recommendations. PMID:21532810

Do procedural skills workshops during family practice residency work?

PubMed

MacKenzie, Mark S; Berkowitz, Jonathan

2010-08-01

To determine if participation in a procedural skills workshop during family practice residency affects future use of these skills in postgraduate clinical practice. Survey involving self-assessment of procedural skills experience and competence. British Columbia. Former University of British Columbia family practice residents who trained in Vancouver, BC, including residents who participated in a procedural skills workshop in 2001 or 2003 and residents graduating in 2000 and 2002 who did not participate in the procedural skills workshop. Self-assessed experience and competence in the 6 office-based procedural skills that were taught during the procedural skills workshops in 2001 and 2003. Participation in a procedural skills workshop had no positive effect on future use of these skills in clinical practice. Participation in the workshop was associated with less reported experience (P = .091) in injection of lateral epicondylitis. As with previous Canadian studies, more women than men reported experience and competence in gynecologic procedures. More women than men reported experience (P = .001) and competence (P = .004) in intrauterine device insertion and experience (P = .091) in endometrial aspiration biopsy. More men than women reported competence (P = .052) in injection of trochanteric bursae. A third year of emergency training was correlated with an increase in reported experience (P = .021) in shoulder injection. Participation in a procedural skills workshop during family practice residency did not produce a significant increase in the performance of these skills on the part of participants once they were in clinical practice. The benefit of a skills workshop might be lost when there is no opportunity to practise and perfect these skills. Sex bias in the case of some procedures might represent a needs-based acquisition of skills on the part of practising physicians. Short procedural skills workshops might be better suited to graduated physicians with more clinical experience.

Order of Processing and Attention Allotment between Comprehending and Using Text Ideas.

ERIC Educational Resources Information Center

Steinley, Gary L.

1990-01-01

Extends a previous study examining the relationship between reading comprehension and thinking skills by using an "on-line" reporting procedure in which undergraduate subjects reported on their reading during the process of reading. Reports that the extent of a reader's background knowledge affects the order of processing as well as the kinds of…

National Postsecondary Student Aid Study (NPSAS:2000) Methodology Report, 1999-2000. Technical Report.

ERIC Educational Resources Information Center

Riccobono, John A.; Cominole, Melissa B.; Siegel, Peter H.; Gabel, Tim J.; Link, Michael W.; Berkner, Lutz K.

This report describes the methods and procedures used for the 2000 National Postsecondary Student Aid Study (NPSAS:2000). NPSAS:2000 included notable changes from previous NPSAS surveys (conducted in 1987, 1990, 1993, and 1996) in its sample design and collection of data. For example, this study is the first to restrict institutional sampling to…

Washing with contaminated bar soap is unlikely to transfer bacteria.

PubMed Central

Heinze, J. E.; Yackovich, F.

1988-01-01

Recent reports of the isolation of microorganisms from used soap bars have raised the concern that bacteria may be transferred from contaminated soap bars during handwashing. Since only one study addressing this question has been published, we developed an additional procedure to test this concern. In our new method prewashed and softened commercial deodorant soap bars (0.8% triclocarban) not active against Gram-negative bacteria were inoculated with Escherichia coli and Pseudomonas aeruginosa to give mean total survival levels of 4.4 X 10(5) c.f.u. per bar which was 70-fold higher than those reported on used soap bars. Sixteen panelists were instructed to wash with the inoculated bars using their normal handwashing procedure. After washing, none of the 16 panelists had detectable levels of either test bacterium on their hands. Thus, the results obtained using our new method were in complete agreement with those obtained with the previously published method even though the two methods differ in a number of procedural aspects. These findings, along with other published reports, show that little hazard exists in routine handwashing with previously used soap bars and support the frequent use of soap and water for handwashing to prevent the spread of disease. PMID:3402545

Long-term durability of the distal urethral polypropylene sling for the treatment of stress urinary incontinence: minimum 11-year followup.

PubMed

Rogo-Gupta, Lisa; Baxter, Z Chad; Le, Ngoc-Bich; Raz, Shlomo; Rodríguez, Larissa V

2012-11-01

We report on the long-term outcomes of the distal urethral polypropylene sling for stress urinary incontinence in a patient cohort that was closely followed and whose outcomes were reported at 1 and 5 years after surgery. We performed a prospective study of all consecutive patients who underwent a distal urethral polypropylene sling procedure between November 1999 and April 2000. The 1 and 5-year outcomes for this particular patient cohort were previously reported. At the minimum 11-year followup, outcome was determined by patient self-assessment including validated questionnaires. A total of 69 patients were followed prospectively and followup was obtained for 30. Of those lost to followup 10 were deceased and 5 were cognitively impaired. Mean patient age at followup was 73 years (range 40 to 97). More than 11 years after surgery 48% of patients reported no stress urinary incontinence symptoms and 63% were never bothered by stress urinary incontinence. Patients reported a mean overall symptom improvement of 64% compared to 81% at 5 years. Overall 82% of patients met the criteria for treatment success by symptom scores and 80% met the criteria by bother scores. The distal urethral polypropylene sling procedure has excellent long-term durability in the treatment of stress urinary incontinence, in addition to low morbidity and low cost as previously described. Eleven years after the procedure the majority of patients report symptom improvement. Nevertheless, many older patients are unable to participate in followup. When choosing an anti-incontinence procedure, durability should be considered in light of patient age given that the theoretical advantages of long-term durability are limited by cognitive decline and mortality. Copyright © 2012 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

Multihandicapped Blind. Final Project Report.

ERIC Educational Resources Information Center

Jones, Lloyd

The final report of the Garden Grove unified school district project for 1969 through 1972 (funded through Title III) involving six multiply handicapped, legally blind children, 7- to 10-years-old, who were previously excluded from special education (SE) classes is presented. Described as the main procedural objective is development of a…

Reporting of the translation and cultural adaptation procedures of the Addenbrooke's Cognitive Examination version III (ACE-III) and its predecessors: a systematic review.

PubMed

Mirza, Nadine; Panagioti, Maria; Waheed, Muhammad Wali; Waheed, Waquas

2017-09-13

The ACE-III, a gold standard for screening cognitive impairment, is restricted by language and culture, with no uniform set of guidelines for its adaptation. To develop guidelines a compilation of all the adaptation procedures undertaken by adapters of the ACE-III and its predecessors is needed. We searched EMBASE, Medline and PsychINFO and screened publications from a previous review. We included publications on adapted versions of the ACE-III and its predecessors, extracting translation and cultural adaptation procedures and assessing their quality. We deemed 32 papers suitable for analysis. 7 translation steps were identified and we determined which items of the ACE-III are culturally dependent. This review lists all adaptations of the ACE, ACE-R and ACE-III, rates the reporting of their adaptation procedures and summarises adaptation procedures into steps that can be undertaken by adapters.

Delayed manifestation of bilateral scleral thinning after I-BRITE® procedure and review of literature for cosmetic eye-whitening procedures

PubMed Central

Moshirfar, Majid; McCaughey, Michael V; Fenzl, Carlton R; Santiago-Caban, Luis; Kramer, Gregory D; Mamalis, Nick

2015-01-01

Purpose To report a case of delayed-onset bilateral scleral thinning and calcium deposition following a cosmetic ocular-whitening procedure (I-BRITE®). Methods A 33-year-old male patient with a history of right-sided ptosis repair and left-sided anterior uveitis had previously undergone bilateral I-BRITE treatment for chronic conjunctival hyperemia. Four years after the procedure, the patient was referred to our institution with bilateral scleral thinning and overlying calcific depositions. A literature review was performed through PubMed from 1980 through 2014 using the search terms ‘cosmetic’, ‘ocular’, ‘conjunctivectomy’, ‘regional conjunctivectomy’, ‘I-BRITE’, ‘eye-whitening’, ‘scleritis’, ‘necrotizing scleritis’, ‘anterior uveitis’, ‘mitomycin C’, ‘5-fluorouracil’, and ‘bevacizumab’, along with associated cross-referencing from relevant articles. Results Examination of the patient revealed bilateral necrotizing scleritis within the nasal region of both eyes. Calcified plaques were also present within the areas of scleromalacia, along with epithelial defects demonstrated with fluorescein staining. Although evidence of previous intraocular inflammation was apparent within the left eye, there were no active signs of inflammation evident within either eye on initial presentation. Complication rates reported in the literature include: scleral thinning (1.8%), calcific plaque formation (2.9%), fibrovascular proliferation (13%), diplopia (1.2%), elevation of intraocular pressure (4.2%), and recurrence of conjunctival hyperemia (2.1%). Conclusion Cosmetic ocular whitening procedures have an attendant high complication rate, and have been associated with several adverse postoperative complications, which have in turn generated several reservations regarding the veritable benefit of the procedure. Many postsurgical complications may demonstrate delayed apparition, varying from several months to several years after primary surgical intervention as in the case reported here. PMID:25784790

Delayed manifestation of bilateral scleral thinning after I-BRITE(®) procedure and review of literature for cosmetic eye-whitening procedures.

PubMed

Moshirfar, Majid; McCaughey, Michael V; Fenzl, Carlton R; Santiago-Caban, Luis; Kramer, Gregory D; Mamalis, Nick

2015-01-01

To report a case of delayed-onset bilateral scleral thinning and calcium deposition following a cosmetic ocular-whitening procedure (I-BRITE(®)). A 33-year-old male patient with a history of right-sided ptosis repair and left-sided anterior uveitis had previously undergone bilateral I-BRITE treatment for chronic conjunctival hyperemia. Four years after the procedure, the patient was referred to our institution with bilateral scleral thinning and overlying calcific depositions. A literature review was performed through PubMed from 1980 through 2014 using the search terms 'cosmetic', 'ocular', 'conjunctivectomy', 'regional conjunctivectomy', 'I-BRITE', 'eye-whitening', 'scleritis', 'necrotizing scleritis', 'anterior uveitis', 'mitomycin C', '5-fluorouracil', and 'bevacizumab', along with associated cross-referencing from relevant articles. Examination of the patient revealed bilateral necrotizing scleritis within the nasal region of both eyes. Calcified plaques were also present within the areas of scleromalacia, along with epithelial defects demonstrated with fluorescein staining. Although evidence of previous intraocular inflammation was apparent within the left eye, there were no active signs of inflammation evident within either eye on initial presentation. Complication rates reported in the literature include: scleral thinning (1.8%), calcific plaque formation (2.9%), fibrovascular proliferation (13%), diplopia (1.2%), elevation of intraocular pressure (4.2%), and recurrence of conjunctival hyperemia (2.1%). Cosmetic ocular whitening procedures have an attendant high complication rate, and have been associated with several adverse postoperative complications, which have in turn generated several reservations regarding the veritable benefit of the procedure. Many postsurgical complications may demonstrate delayed apparition, varying from several months to several years after primary surgical intervention as in the case reported here.

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

Bahramipour, Phillip F.; Festa, Steven; Biswal, Rajiv

Though polycystic liver disease (PCLD) has historically been considered a contraindication to TIPS, we present a case where technically successful shunt creation was achieved without the need for modification of the standard TIPS procedure, as was required in a previous report.

"Supermarket Column Chromatography of Leaf Pigments" Revisited: Simple and Ecofriendly Separation of Plant Carotenoids, Chlorophylls, and Flavonoids from Green and Red Leaves

ERIC Educational Resources Information Center

Dias, Alice M.; Ferreira, Maria La Salete

2015-01-01

A simple and ecofriendly procedure was developed in order to prepare extracts from red and green leaves. This procedure enables the separation of yellow, green, and red band pigments and optimizes the previously reported baking soda "supermarket column". The same extract also led to a novel and colorful potato starch column, which can…

Quantification of hyaluronan (HA) using a simplified fluorophore-assisted carbohydrate electrophoresis (FACE) procedure.

PubMed

Midura, Ronald J; Cali, Valbona; Lauer, Mark E; Calabro, Anthony; Hascall, Vincent C

2018-01-01

Hyaluronan (HA) exhibits numerous important roles in physiology and pathologies, and these facts necessitate an ability to accurately and reproducibly measure its quantities in tissues and cell cultures. Our group previously reported a rigorous and analytical procedure to quantify HA (and chondroitin sulfate, CS) using a reductive amination chemistry and separation of the fluorophore-conjugated, unsaturated disaccharides unique to HA and CS on high concentration acrylamide gels. This procedure is known as fluorophore-assisted carbohydrate electrophoresis (FACE) and has been adapted for the detection and quantification of all glycosaminoglycan types. While this previous FACE procedure is relatively straightforward to implement by carbohydrate research investigators, many nonglycoscience laboratories now studying HA biology might have difficulties establishing this prior FACE procedure as a routine assay for HA. To address this need, we have greatly simplified our prior FACE procedure for accurate and reproducible assessment of HA in tissues and cell cultures. This chapter describes in detail this simplified FACE procedure and, because it uses an enzyme that degrades both HA and CS, investigators will also gain additional insight into the quantities of CS in the same samples dedicated for HA analysis. © 2018 Elsevier Inc. All rights reserved.

Standardized Test Results: KEEP and Control Students. 1975-1976, Technical Report #69.

ERIC Educational Resources Information Center

Antill, Ellen; Speidel, Gisela E.

This report presents the results of various standardized measures administered to Kamehameha Early Education Program (KEEP) students and control students in the school year 1975-1976. In contrast to previous comparisons, KEEP employed more rigorous procedures for the selection of the control students and for the conditions of test administration.…

Plastic surgeons’ self-reported operative infection rates at a Canadian academic hospital

PubMed Central

Ng, Wendy KY; Kaur, Manraj Nirmal; Thoma, Achilleas

2014-01-01

BACKGROUND: Surgical site infection rates are of great interest to patients, surgeons, hospitals and third-party payers. While previous studies have reported hospital-acquired infection rates that are nonspecific to all surgical services, there remain no overall reported infection rates focusing specifically on plastic surgery in the literature. OBJECTIVE: To estimate the reported surgical site infection rate in plastic surgery procedures over a 10-year period at an academic hospital in Canada. METHODS: A review was conducted on reported plastic surgery surgical site infection rates from 2003 to 2013, based on procedures performed in the main operating room. For comparison, prospective infection surveillance data over an eight-year period (2005 to 2013) for nonplastic surgery procedures were reviewed to estimate the overall operative surgical site infection rates. RESULTS: A total of 12,183 plastic surgery operations were performed from 2003 to 2013, with 96 surgical site infections reported, corresponding to a net operative infection rate of 0.79%. There was a 0.49% surgeon-reported infection rate for implant-based procedures. For non-plastic surgery procedures, surgical site infection rates ranged from 0.04% for cataract surgery to 13.36% for high-risk abdominal hysterectomies. DISCUSSION: The plastic surgery infection rate at the study institution was found to be <1%. This rate was equal to, or somewhat less than, surgical site infection rates. However, these results do not report patterns of infection rates germane to procedures, season, age groups or sex. To provide more in-depth knowledge of this topic, multicentre studies should be conducted. PMID:25535460

Endoscopic removal of laser-cut covered self-expandable metallic biliary stents: A report of six cases.

PubMed

Tanisaka, Yuki; Ryozawa, Shomei; Kobayashi, Masanori; Harada, Maiko; Kobatake, Tsutomu; Omiya, Kumiko; Iwano, Hirotoshi; Arai, Shin; Nonaka, Kouichi; Mashimo, Yumi

2018-02-01

Covered self-expandable metallic stents (CSEMS) may provide palliative drainage for unresectable distal malignant biliary strictures. Laser-cut CSEMS allows easy positioning due to its characteristic of minimal stent shortening. Endoscopic stent removal is sometimes recommended for recurrent biliary obstruction (RBO). However, there are no previous reports of endoscopic removal of laser-cut CSEMS. The current study presents data from 6 patients who were placed a laser-cut CSEMS for unresectable distal malignant biliary strictures, and later endoscopic stent removal was attempted for RBO at the present institute. The duration of stent placement, the procedural success rate, the procedural duration, and accidental complications were evaluated. The mean duration of stent placement was 156±37.9 days (range, 117-205). The procedural success rate was 100%. The mean procedural duration was 11.8±7.5 min (range, 5-24). No complications were reported. Laser-cut CSEMS were safely removed from all patients. The present case report is the first to demonstrate that Endoscopic stent removal of laser-cut CSEMS was safely performed.

Hemodynamic Parameters during Laryngoscopic Procedures in the Office and in the Operating Room.

PubMed

Tierney, William S; Chota, Rebecca L; Benninger, Michael S; Nowacki, Amy S; Bryson, Paul C

2016-09-01

Previous research has shown that office-based laryngoscopic procedures can induce hemodynamic changes, including tachycardia and severe hypertension, calling into question the safety of these procedures. However, comparison between office and operating room (OR) procedures has not been carried out. Therefore, we prospectively measured hemodynamic variables in both settings to compare hemodynamic changes between office and OR procedures. Prospective cohort study. Single academic center. Subjects undergoing office and OR laryngoscopic procedures were prospectively identified, and 92 OR and 70 office subjects were included. Heart rate and blood pressure were measured at established time points before, during, and after the procedures. Descriptive and comparative statistical analyses were conducted. Severe hemodynamic events, either tachycardia or severe hypertension (blood pressure >180 mm Hg systolic or >110 mm Hg diastolic), occurred significantly more frequently in OR than office procedures (41% vs 20%; P = .006). OR severe hemodynamic events occurred more commonly than previously reported rates in the office (41% vs 28%; P = .012). Regression analyses showed that the odds of having a severe hemodynamic event were 3.66 times higher in OR versus office procedures. Severe hemodynamic events are more likely to occur in the OR than in the office during laryngologic procedures. While larger studies will be required to establish rates of dangerous cardiovascular events in laryngoscopic procedures, hemodynamic parameters indicate that office-based procedures have a safety benefit for procedures that can be conducted in either setting. © American Academy of Otolaryngology—Head and Neck Surgery Foundation 2016.

Brief Report: Atypical Expression of Distress during the Separation Phase of the Strange Situation Procedure in Infant Siblings at High Risk for ASD

ERIC Educational Resources Information Center

Esposito, Gianluca; del Carmen Rostagno, Maria; Venuti, Paola; Haltigan, John D.; Messinger, Daniel S.

2014-01-01

Previous studies have provided preliminary evidence that disruptions in cry acoustics may be part of an atypical vocal signature of autism early in life. We examined the acoustic characteristics of cries extracted from the separation phase of the strange situation procedure in a sample of toddler of younger siblings of a child with autism spectrum…

Accidental displacement of a high-speed handpiece bur during mandibular third molar surgery: a case report.

PubMed

Yalcin, Serhat; Aktas, Irem; Emes, Yusuf; Atalay, Belir

2008-03-01

Removal of third molars is one of the most common surgical procedures performed in oral and maxillofacial surgery. This procedure may result in a number of major and minor complications. Accidental displacement of impacted third molars is a complication that occasionally occurs during these operations, but accidental displacement of a high-speed handpiece bur has never been reported in literature before. The aim of this article is to present a rare and previously unreported case of a foreign body in the submandibular space and to review the possible complications seen after third molar surgery.

Palladium nanoparticles formed on titanium silicate ETS-10.

PubMed

Lin, Christopher C H; Danaie, Mohsen; Mitlin, David; Kuznicki, Steven M

2011-03-01

We report that surface templated and supported palladium nanoparticles self assemble on ETS-10 type molecular sieve surfaces by simple exchange and activation procedures in the absence of a reductant. This procedure is similar to the one previously reported for silver nanoparticle self assembly on ETS-10. We observed a bimodal distribution with particle sizes ranging from 2-5 and 15-30 nm. This simple, economical method generates high concentrations (approximately 12 wt% of total composite) of uniform, metallic palladium nanoparticles that are multiply twinned and thermally stable making them potentially unique for advanced catalytic and electronic applications.

Do procedural skills workshops during family practice residency work?

PubMed Central

MacKenzie, Mark S.; Berkowitz, Jonathan

2010-01-01

ABSTRACT OBJECTIVE To determine if participation in a procedural skills workshop during family practice residency affects future use of these skills in postgraduate clinical practice. DESIGN Survey involving self-assessment of procedural skills experience and competence. SETTING British Columbia. PARTICIPANTS Former University of British Columbia family practice residents who trained in Vancouver, BC, including residents who participated in a procedural skills workshop in 2001 or 2003 and residents graduating in 2000 and 2002 who did not participate in the procedural skills workshop. MAIN OUTCOME MEASURES Self-assessed experience and competence in the 6 office-based procedural skills that were taught during the procedural skills workshops in 2001 and 2003. RESULTS Participation in a procedural skills workshop had no positive effect on future use of these skills in clinical practice. Participation in the workshop was associated with less reported experience (P = .091) in injection of lateral epicondylitis. As with previous Canadian studies, more women than men reported experience and competence in gynecologic procedures. More women than men reported experience (P = .001) and competence (P = .004) in intrauterine device insertion and experience (P = .091) in endometrial aspiration biopsy. More men than women reported competence (P = .052) in injection of trochanteric bursae. A third year of emergency training was correlated with an increase in reported experience (P = .021) in shoulder injection. CONCLUSION Participation in a procedural skills workshop during family practice residency did not produce a significant increase in the performance of these skills on the part of participants once they were in clinical practice. The benefit of a skills workshop might be lost when there is no opportunity to practise and perfect these skills. Sex bias in the case of some procedures might represent a needs-based acquisition of skills on the part of practising physicians. Short procedural skills workshops might be better suited to graduated physicians with more clinical experience. PMID:20705868

Risk Predictors for Postcontrast Acute Kidney Injury.

PubMed

Krause, Trudy Millard; Ukhanova, Maria; Lee Revere, Frances; Finkel, Kevin W

2018-05-22

To evaluate risk predictors of acute kidney injury (AKI) after contrast-media procedures in a broader cohort of patients than previously reported. Comprehensive medical and pharmacy commercial claims data from 2012 to 2014. Claims associated with contrast-media procedures for 2,737,020 persons between January 1, 2012 and November 30, 2014, were reviewed. The overall incidence of AKI after a contrast-media procedure was 0.85%. AKI occurred in 26% of cases that had two or more contrast procedures within 30 days, compared with 9% of non-AKI cases. Although the incidence of postcontrast AKI was low, 10% of patients who developed AKI had a recent previous episode of AKI. In cases when AKI had occurred within 180 days of contrast administration, the odds of subsequent kidney injury was 9.39. Overall, there is a low risk (0.85%) of developing an AKI after a procedure with contrast-media consistent with several recent studies. However, in adults with a recent history of AKI, physicians must consider this history as a risk factor for subsequent AKI. Copyright © 2018 American College of Radiology. Published by Elsevier Inc. All rights reserved.

Underdiagnosis of obstructive sleep apnoea syndrome in patients with type 2 diabetes in France: ENTRED 2007.

PubMed

Lecomte, P; Criniere, L; Fagot-Campagna, A; Druet, C; Fuhrman, C

2013-04-01

This study estimated the prevalence of symptoms evocative of obstructive sleep apneoa (OSA) in patients with type 2 diabetes and the proportion of those with evidence of a previous diagnosis or diagnostic procedure. In ENTRED 2007, 8926 people reimbursed for at least three antidiabetic agents within the last 12 months were randomly selected, and 3894 answered a self-administered questionnaire. Symptoms evocative of OSA were defined as frequent snoring with excessive daytime sleepiness and/or witnessed sleep apneoa. Patients were considered to have evidence of a previous diagnostic procedure if they reported an OSA diagnosis or had a sleep recording done, or if a sleep recording was found in the hospital discharge or medical claims database, or if they were currently being treated with nocturnal ventilation. The patients' mean age was 66 years. Around 8.5% reported being diagnosed with OSA, 4.2% were treated with nocturnal ventilation and 16% had symptoms evocative of OSA. Being male, obesity, high blood pressure, insulin treatment, living with a partner, lower educational level and financial difficulties were all associated with symptoms suggestive of OSA. Overall, 13% had evidence of a previous diagnostic procedure, and the rate was 35% among those with symptoms evocative of OSA. OSA is underdiagnosed in French diabetic patients, while the prevalence of symptoms is high. Only 13% of the study population and 35% of those with symptoms suggestive of OSA had benefited from a diagnostic procedure. It is of the utmost importance to better diagnose OSA in the diabetic population. Copyright © 2012 Elsevier Masson SAS. All rights reserved.

One-year retention of general and sequence-specific skills in a probabilistic, serial reaction time task.

PubMed

Romano, Jennifer C; Howard, James H; Howard, Darlene V

2010-05-01

Procedural skills such as riding a bicycle and playing a musical instrument play a central role in daily life. Such skills are learned gradually and are retained throughout life. The present study investigated 1-year retention of procedural skill in a version of the widely used serial reaction time task (SRTT) in young and older motor-skill experts and older controls in two experiments. The young experts were college-age piano and action video-game players, and the older experts were piano players. Previous studies have reported sequence-specific skill retention in the SRTT as long as 2 weeks but not at 1 year. Results indicated that both young and older experts and older non-experts revealed sequence-specific skill retention after 1 year with some evidence that general motor skill was retained as well. These findings are consistent with theoretical accounts of procedural skill learning such as the procedural reinstatement theory as well as with previous studies of retention of other motor skills.

Complications and results after stapled haemorrhoidopexy as a day surgical procedure.

PubMed

Mlakar, B; Kosorok, P

2003-10-01

The aim of this report is to describe our experience with stapled haemorrhoidopexy as a day surgery procedure. From January 2000 to January 2003, a total of 214 patients with third- and fourth-degree haemorrhoids underwent stapled haemorrhoidopexy under spinal anaesthesia. We analysed early postoperative complications and long-term results. Patients were followed for 4-36 months (mean, 22 months). Only 3 patients (1%) were hospitalised. The long-term complications were analysed by means of a mailed questionnaire. Minor bleeding at wiping after defecation was observed by 9% of patients and minor haemorrhoidal prolapse by 8% of patients. Pain after defecation was reported by 6% of patients and anal stenosis occurred in 2% of them. Faecal urgency was reported by 3% of patients with previously unknown incontinence problems. According to our experience, stapled haemorrhoidopexy can be safely performed as a day surgery procedure.

Digital enhancement of X-rays for NDT

NASA Technical Reports Server (NTRS)

Butterfield, R. L.

1980-01-01

Report is "cookbook" for digital processing of industrial X-rays. Computer techniques, previously used primarily in laboratory and developmental research, have been outlined and codified into step by step procedures for enhancing X-ray images. Those involved in nondestructive testing should find report valuable asset, particularly is visual inspection is method currently used to process X-ray images.

78 FR 13756 - Technical Report: Effectiveness of LED Stop Lamps for Reducing Rear-End Crashes: Analyses of...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-02-28

...) using real-world crash data. Previous work on this subject included laboratory experiments that suggest... pairs. Procedural Matters How can I influence NHTSA's thinking on this subject? NHTSA welcomes public...

Double-balloon endoscopy for retrograde cholangiography in patients with choledochojejunostomy and Roux-en-Y reconstruction.

PubMed

Pohl, J; May, A; Aschmoneit, I; Ell, C

2009-02-01

Choledochojejunal anastomoses with Roux-en-Y reconstruction excludes the biliary tract from conventional endoscopic retrograde cholangiography (ERC) with standard endoscopes due to the length of the interposed small bowel segment. Double-balloon enteroscopy (DBE) facilitates deep insertion into the small bowel and may be used to perform ERC in these patients. In the present case series we report our experience with diagnostic and therapeutic double-balloon ERC in patients with choledochojejunostomy to a long Roux-en-Y loop previously unavailable for standard length endoscopes. Between December 2004 and May 2008 15 patients (mean age: 60.2 years) with choledochojejunal anastomosis underwent a total of 25 DBE-ERC procedures. Cannulation of the bile ducts was achieved in 22 / 25 procedures (84 %). Twenty-one therapeutic interventions, including stone removal, biliary duct dilation, stent placement and removal of previously placed stents were performed during 16 procedures in 8 patients. The mean total duration time of the procedures was 74.6 +/- 25.0 minutes. Postinterventional self-limiting fever occurred after 4 procedures in 3 patients with cholangitis. After therapeutic interventions all patients had a significant drop of bilirubin levels and all except one patient were free of complaints (follow-up 10.4 +/- 8.6 months). The DBE system permits diagnostic and therapeutic ERC in surgically modified anatomy, previously unavailable for endoluminal access. In our experience this procedure is safe and has a high success rate with a favourable patient outcome.

Revision of loop colostomy under regional anaesthesia and sedation.

PubMed

Ng, Oriana; Thong, Sze Ying; Chia, Claramae Shulyn; Teo, Melissa Ching Ching

2015-05-01

Patients presenting for emergency abdominal procedures often have medical issues that cause both general anaesthesia and central neuraxial blockade to pose significant risks. Regional anaesthetic techniques are often used adjunctively for abdominal procedures under general anaesthesia, but there is limited published data on procedures done under peripheral nerve or plexus blocks. We herein report the case of a patient with recent pulmonary embolism and supraventricular tachycardia who required colostomy refashioning. Ultrasonography-guided regional anaesthesia was administered using a combination of ilioinguinal-iliohypogastric, rectus sheath and transversus abdominis plane blocks. This was supplemented with propofol and dexmedetomidine sedation as well as intermittent fentanyl and ketamine boluses to cover for visceral stimulation. We discuss the anatomical rationale for the choice of blocks and compare the anaesthetic conduct with similar cases that were previously reported.

Iatrogenic deep musculocutaneous radiation injury following percutaneous coronary intervention.

PubMed

Monaco, JoAn L; Bowen, Kanika; Tadros, Peter N; Witt, Peter D

2003-08-01

Radiation-induced skin injury has been reported for multiple fluoroscopic procedures. Previous studies have indicated that prolonged fluoroscopic exposure during even a single percutaneous coronary intervention (PCI) may lead to cutaneous radiation injury. We document a novel case of deep muscle damage requiring wide local debridement and muscle flap reconstruction in a 59-year-old man with a large radiation-induced wound to the lower thoracic region following 1 prolonged PCI procedure. The deep muscular iatrogenic injury described in this report may be the source of significant morbidity. Recommendations to reduce radiation-induced damage include careful examination of the skin site before each procedure, minimized fluoroscopy time, utilization of pulse fluoroscopy, employment of radiation filters, and collimator s and rotation of the location of the image intensifier.

MCSCF wave functions for excited states of polar molecules - Application to BeO. [Multi-Configuration Self-Consistent Field

NASA Technical Reports Server (NTRS)

Bauschlicher, C. W., Jr.; Yarkony, D. R.

1980-01-01

A previously reported multi-configuration self-consistent field (MCSCF) algorithm based on the generalized Brillouin theorem is extended in order to treat the excited states of polar molecules. In particular, the algorithm takes into account the proper treatment of nonorthogonality in the space of single excitations and invokes, when necessary, a constrained optimization procedure to prevent the variational collapse of excited states. In addition, a configuration selection scheme (suitable for use in conjunction with extended configuration interaction methods) is proposed for the MCSCF procedure. The algorithm is used to study the low-lying singlet states of BeO, a system which has not previously been studied using an MCSCF procedure. MCSCF wave functions are obtained for three 1 Sigma + and two 1 Pi states. The 1 Sigma + results are juxtaposed with comparable results for MgO in order to assess the generality of the description presented here.

Statistical evaluation of rainfall-simulator and erosion testing procedure : final report.

DOT National Transportation Integrated Search

1977-01-01

The specific aims of this study were (1) to supply documentation of statistical repeatability and precision of the rainfall-simulator and to document the statistical repeatabiity of the soil-loss data when using the previously recommended tentative l...

A simple and rapid microplate assay for glycoprotein-processing glycosidases

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

Kang, M.S.; Zwolshen, J.H.; Harry, B.S.

1989-08-15

A simple and convenient microplate assay for glycosidases involved in the glycoprotein-processing reactions is described. The assay is based on specific binding of high-mannose-type oligosaccharide substrates to concanavalin A-Sepharose, while monosaccharides liberated by enzymatic hydrolysis do not bind to concanavalin A-Sepharose. By the use of radiolabeled substrates (( 3H)glucose for glucosidases and (3H)mannose for mannosidases), the radioactivity in the liberated monosaccharides can be determined as a measure of the enzymatic activity. This principle was employed earlier for developing assays for glycosidases previously reported. These authors have reported the separation of substrate from the product by concanavalin A-Sepharose column chromatography. Thismore » procedure is handicapped by the fact that it cannot be used for a large number of samples and is time consuming. We have simplified this procedure and adapted it to the use of a microplate (96-well plate). This would help in processing a large number of samples in a short time. In this report we show that the assay is comparable to the column assay previously reported. It is linear with time and enzyme concentration and shows expected kinetics with castanospermine, a known inhibitor of alpha-glucosidase I.« less

Anodizing Aluminum with Frills.

ERIC Educational Resources Information Center

Doeltz, Anne E.; And Others

1983-01-01

"Anodizing Aluminum" (previously reported in this journal) describes a vivid/relevant laboratory experience for general chemistry students explaining the anodizing of aluminum in sulfuric acid and constrasting it to electroplating. Additions to this procedure and the experiment in which they are used are discussed. Reactions involved are…

The Efficacy of the Canter Background Interference Procedure in Identifying Children with Cerebral Dysfunction

ERIC Educational Resources Information Center

Adams, Jerry; Kenny, Thomas J.

1973-01-01

In this study, BIP records previously reported by Kenny (1971) were reused to determine the accuracy of identification of children with cerebral dysfunction and to update the results of using the revised BIP scoring system. (Author)

Functional outcomes after shoulder resection: the patient's perspective.

PubMed

Stevens, Nicole M; Kim, H Mike; Armstrong, April D

2015-09-01

Resection arthroplasty is a salvage procedure used for the treatment of deep-seated infections after total shoulder arthroplasty, hemiarthroplasty, and reverse total shoulder arthroplasty. Previous studies have reported a 50% to 66% rate of pain relief after resection arthroplasty but with significant functional limitations. Our study aimed to qualify the perspective of the patients on their limitations and satisfaction with resection arthroplasty. A retrospective record review of resection arthroplasties performed between September 2003 and December 2012 yielded 14 patients, and 7 completed the survey. The patients completed surveys with the focus on the "patient perspective." Functional scores, including American Shoulder and Elbow Surgeons, Simple Shoulder Test, Disabilities of the Arm, Shoulder, and Hand (DASH), DASH work, and DASH sports, were determined. Pain reduction and functional outcomes were similar to past reports of resection arthroplasty. Five of the 7 patients (71%) reported satisfaction with their resection arthroplasty, and 6 of the 7 patients (86%) would undergo the procedure again if given the choice. Five of the 7 patients (71%) were able to most of activities of daily living. Patients in our study were generally satisfied with their resection arthroplasty. Resection arthroplasty is a reasonable option for treatment of deep-seated periprosthetic infections or for patients with multiple previous failed procedures for total shoulder arthroplasty, hemiarthroplasty. and reverse shoulder arthroplasty. Copyright © 2015 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Evaluating Patient-Centered Outcomes in Clinical Trials of Procedural Sedation, Part 2 Safety: Sedation Consortium on Endpoints and Procedures for Treatment, Education, and Research Recommendations.

PubMed

Ward, Denham S; Williams, Mark R; Berkenbosch, John W; Bhatt, Maala; Carlson, Douglas; Chappell, Phillip; Clark, Randall M; Constant, Isabelle; Conway, Aaron; Cravero, Joseph; Dahan, Albert; Dexter, Franklin; Dionne, Raymond; Dworkin, Robert H; Gan, Tong J; Gozal, David; Green, Steven; Irwin, Michael G; Karan, Suzanne; Kochman, Michael; Lerman, Jerrold; Lightdale, Jenifer R; Litman, Ronald S; Mason, Keira P; Miner, James; O'Connor, Robert E; Pandharipande, Pratik; Riker, Richard R; Roback, Mark G; Sessler, Daniel I; Sexton, Anne; Tobin, Joseph R; Turk, Dennis C; Twersky, Rebecca S; Urman, Richard D; Weiss, Mark; Wunsch, Hannah; Zhao-Wong, Anna

2018-05-17

The Sedation Consortium on Endpoints and Procedures for Treatment, Education, and Research, established by the Analgesic, Anesthetic, and Addiction Clinical Trial Translations, Innovations, Opportunities, and Networks, a public-private partnership with the US Food and Drug Administration, convened a second meeting of sedation experts from a variety of clinical specialties and research backgrounds to develop recommendations for procedural sedation research. The previous meeting addressed efficacy and patient- and/or family-centered outcomes. This meeting addressed issues of safety, which was defined as "the avoidance of physical or psychological harm." A literature review identified 133 articles addressing safety measures in procedural sedation clinical trials. After basic reporting of vital signs, the most commonly measured safety parameter was oxygen saturation. Adverse events were inconsistently defined throughout the studies. Only 6 of the 133 studies used a previously validated measure of safety. The meeting identified methodological problems associated with measuring infrequent adverse events. With a consensus discussion, a set of core and supplemental measures were recommended to code for safety in future procedural clinical trials. When adopted, these measures should improve the integration of safety data across studies and facilitate comparisons in systematic reviews and meta-analyses.

International surgical telementoring: our initial experience.

PubMed

Lee, B R; Caddedu, J A; Janetschek, G; Schulam, P; Docimo, S G; Moore, R G; Partin, A W; Kavoussi, L R

1998-01-01

Telesurgical laparoscopic telementoring has successfully been implemented between the Johns Hopkins Bayview Medical Center and the Johns Hopkins Hospital in 27 prior operations. In this previously reported series, telerobotic mentoring was achieved between two institutions 3.5 miles away. We report our experience in performing two international surgical telementoring operations. To determine the clinical utility of international surgical telementoring during laparoscopic surgical procedures. A laparoscopic adrenalectomy was telementored between Innsbruck, Austria (5,083 miles) and Baltimore, MD. As well, a laparoscopic varicocelectomy was telementored between Bangkok, Thailand and Baltimore, MD (10,880 miles) both over three ISDN lines (384 kbps) with an approximate 1 sec delay. Both procedures were successfully accomplished with an uneventful postoperative course. International telementoring is a viable method of instructing less experienced laparoscopic surgeons through potentially complex laparoscopic procedures, as well as potentially improving patient access to specialty care.

Recovery patterns, histological observations and genetic integrity in Malus shoot tips cryopreserved using droplet-vitrification and encapsulation-dehydration procedures.

PubMed

Li, Bai-Quan; Feng, Chao-Hong; Wang, Min-Rui; Hu, Ling-Yun; Volk, Gayle; Wang, Qiao-Chun

2015-11-20

A droplet-vitrification procedure is described for cryopreservation of Malus shoot tips. Survival patterns, recovery types, histological observations, and genetic integrity were compared for Malus shoot tips cryopreserved using this droplet-vitrification procedure and an encapsulation-dehydration procedure that was previously reported by us. In both procedures, three types of shoot tip recovery were observed following cryopreservation: callus formation without shoot regrowth, leaf formation without shoot regrowth, and shoot regrowth. Three categories of histological observations were also identified in cross-sections of shoot tips recovered after cryopreservation using the two cryogenic procedures. In category 1, almost all of the cells (94-95%) in the apical dome (AD) were damaged or killed and only some cells (30-32%) in the leaf primordia (LPs) survived. In category 2, only a few cells (18-20%) in the AD and some cells (30-31%) in the LPs survived. In category 3, majority of the cells (60-62%) in the AD and some cells (30-33%) in the LPs survived. These data suggest that shoot regrowth is correlated to the presence of a majority of surviving cells in the AD after liquid nitrogen exposure. No polymorphic bands were detected by inter-simple sequence repeats or by random amplified polymorphic DNA assessments, and ploidy levels analyzed by flow cytometry were unchanged when plants recovered after cryoexposure were compared to controls. The droplet-vitrification procedure appears to be robust since seven genotypes representing four Malus species and one hybrid recovered shoots following cryopreservation. Mean shoot regrowth levels of these seven genotypes were 48% in the droplet-vitrification method, which were lower than those (61%) in the encapsulation-dehydration procedure reported in our previous study, suggesting the latter may be preferred for routine cryobanking applications for Malus shoot tips. Copyright © 2015 Elsevier B.V. All rights reserved.

23 CFR 230.409 - Contract compliance review procedures.

Code of Federal Regulations, 2013 CFR

2013-04-01

..., written corrective action plans, PR-1391 or Manpower Utilization Reports, training requirements, previous... result in increased utilization of minorities and women? (iv) Is there impartiality in treatment of...) Have the contractor's efforts produced results? (f) Exit conference (Action R-6). (1) During the exit...

23 CFR 230.409 - Contract compliance review procedures.

Code of Federal Regulations, 2014 CFR

2014-04-01

..., written corrective action plans, PR-1391 or Manpower Utilization Reports, training requirements, previous... result in increased utilization of minorities and women? (iv) Is there impartiality in treatment of...) Have the contractor's efforts produced results? (f) Exit conference (Action R-6). (1) During the exit...

23 CFR 230.409 - Contract compliance review procedures.

Code of Federal Regulations, 2011 CFR

2011-04-01

..., written corrective action plans, PR-1391 or Manpower Utilization Reports, training requirements, previous... result in increased utilization of minorities and women? (iv) Is there impartiality in treatment of...) Have the contractor's efforts produced results? (f) Exit conference (Action R-6). (1) During the exit...

23 CFR 230.409 - Contract compliance review procedures.

Code of Federal Regulations, 2012 CFR

2012-04-01

..., written corrective action plans, PR-1391 or Manpower Utilization Reports, training requirements, previous... result in increased utilization of minorities and women? (iv) Is there impartiality in treatment of...) Have the contractor's efforts produced results? (f) Exit conference (Action R-6). (1) During the exit...

14 CFR 91.1025 - Program operating manual contents.

Code of Federal Regulations, 2010 CFR

2010-01-01

... (CONTINUED) AIR TRAFFIC AND GENERAL OPERATING RULES GENERAL OPERATING AND FLIGHT RULES Fractional Ownership... flight; (f) Procedures to be followed by the pilot in command for determining that mechanical irregularities or defects reported for previous flights have been corrected or that correction of certain...

14 CFR 91.1025 - Program operating manual contents.

Code of Federal Regulations, 2013 CFR

2013-01-01

... (CONTINUED) AIR TRAFFIC AND GENERAL OPERATING RULES GENERAL OPERATING AND FLIGHT RULES Fractional Ownership... flight; (f) Procedures to be followed by the pilot in command for determining that mechanical irregularities or defects reported for previous flights have been corrected or that correction of certain...

14 CFR 91.1025 - Program operating manual contents.

Code of Federal Regulations, 2012 CFR

2012-01-01

... (CONTINUED) AIR TRAFFIC AND GENERAL OPERATING RULES GENERAL OPERATING AND FLIGHT RULES Fractional Ownership... flight; (f) Procedures to be followed by the pilot in command for determining that mechanical irregularities or defects reported for previous flights have been corrected or that correction of certain...

14 CFR 91.1025 - Program operating manual contents.

Code of Federal Regulations, 2014 CFR

2014-01-01

... (CONTINUED) AIR TRAFFIC AND GENERAL OPERATING RULES GENERAL OPERATING AND FLIGHT RULES Fractional Ownership... flight; (f) Procedures to be followed by the pilot in command for determining that mechanical irregularities or defects reported for previous flights have been corrected or that correction of certain...

14 CFR 91.1025 - Program operating manual contents.

Code of Federal Regulations, 2011 CFR

2011-01-01

... (CONTINUED) AIR TRAFFIC AND GENERAL OPERATING RULES GENERAL OPERATING AND FLIGHT RULES Fractional Ownership... flight; (f) Procedures to be followed by the pilot in command for determining that mechanical irregularities or defects reported for previous flights have been corrected or that correction of certain...

DNA ISOLATION FROM SMALL TISSUE SAMPLES USING SALT AND SPERMINE

EPA Science Inventory

Common DNA isolation methods rely upon protein denaturation by organic solvents such as phenol and chloroform. hese solvents pose some risk to the user and require special disposal procedures. e have previously reported a method for isolating DNA from peripheral blood lymphocytes...

Contemporary Surgical Trends in the Management of Symptomatic Meniscal Tears among United States Military Servicemembers from 2010 to 2015.

PubMed

Pekari, Timothy B; Wang, Kevin C; Cotter, Eric J; Kusnezov, Nicholas; Waterman, Brian R

2018-03-07

The purpose of this investigation is to report on trends over time in the treatment of meniscal pathology among military orthopaedic surgeons, as well as to evaluate the impact of patient demographics and concomitant procedure on the type of meniscal procedure performed. We performed a retrospective analysis of all active-duty United States military servicemembers who underwent a meniscal procedure from 2010 to 2015 within the Military Health System. Patient demographics and surgical variables were extracted from the electronic medical record. Treatments were categorized by location and by type of intervention (i.e., repair or debridement). Chi-square and linear regression analyses were performed to identify temporal trends in meniscal procedures and factors that were correlated with the type of meniscal procedure performed. Out of 29,571 meniscal procedures analyzed, partial meniscectomy was performed in 81.3% ( n  = 24,343) of cases, meniscal repair in 20.3% ( n  = 6,073), and meniscus allograft transplantation (MAT) in 0.7% ( n  = 206). The rates of debridement, repair, and concomitant surgeries did not demonstrate any significant temporal trends, whereas MAT demonstrated a significant decrease in overall utilization. Nearly two-thirds of all meniscal procedures were performed in the medial compartment. MAT occurred equally between the medial and lateral compartments. Lateral meniscal lesions demonstrated significantly higher rates of debridement. With each year of advancing age, there was a 3.7% increasing likelihood of meniscectomy and 6.5% decreasing likelihood of repair. Females were more likely to undergo meniscal repair than males. Patients in the military population were more likely to undergo meniscal repair compared with previously reported rates in the civilian population. In this physically active cohort of nearly 30,000 military patients, 1 in 5 meniscal tears were treated with meniscal repair. Meniscal repairs were performed at a higher rate for all age groups compared with previously reported rates in the civilian population. Further research is required to elucidate the causative factors behind these differences and the effect on postoperative outcomes. IV, cross-sectional study. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Cognitive and Linguistic Sources of Variance in 2-Year-Olds’ Speech-Sound Discrimination: A Preliminary Investigation

PubMed Central

Lalonde, Kaylah; Holt, Rachael Frush

2017-01-01

Purpose This preliminary investigation explored potential cognitive and linguistic sources of variance in 2-year-olds’ speech-sound discrimination by using the toddler change/no-change procedure and examined whether modifications would result in a procedure that can be used consistently with younger 2-year-olds. Method Twenty typically developing 2-year-olds completed the newly modified toddler change/no-change procedure. Behavioral tests and parent report questionnaires were used to measure several cognitive and linguistic constructs. Stepwise linear regression was used to relate discrimination sensitivity to the cognitive and linguistic measures. In addition, discrimination results from the current experiment were compared with those from 2-year-old children tested in a previous experiment. Results Receptive vocabulary and working memory explained 56.6% of variance in discrimination performance. Performance was not different on the modified toddler change/no-change procedure used in the current experiment from in a previous investigation, which used the original version of the procedure. Conclusions The relationship between speech discrimination and receptive vocabulary and working memory provides further evidence that the procedure is sensitive to the strength of perceptual representations. The role for working memory might also suggest that there are specific subject-related, nonsensory factors limiting the applicability of the procedure to children who have not reached the necessary levels of cognitive and linguistic development. PMID:24023371

Cognitive and linguistic sources of variance in 2-year-olds’ speech-sound discrimination: a preliminary investigation.

PubMed

Lalonde, Kaylah; Holt, Rachael Frush

2014-02-01

This preliminary investigation explored potential cognitive and linguistic sources of variance in 2-year-olds’ speech-sound discrimination by using the toddler change/ no-change procedure and examined whether modifications would result in a procedure that can be used consistently with younger 2-year-olds. Twenty typically developing 2-year-olds completed the newly modified toddler change/no-change procedure. Behavioral tests and parent report questionnaires were used to measure several cognitive and linguistic constructs. Stepwise linear regression was used to relate discrimination sensitivity to the cognitive and linguistic measures. In addition, discrimination results from the current experiment were compared with those from 2-year-old children tested in a previous experiment. Receptive vocabulary and working memory explained 56.6% of variance in discrimination performance. Performance was not different on the modified toddler change/no-change procedure used in the current experiment from in a previous investigation, which used the original version of the procedure. The relationship between speech discrimination and receptive vocabulary and working memory provides further evidence that the procedure is sensitive to the strength of perceptual representations. The role for working memory might also suggest that there are specific subject-related, nonsensory factors limiting the applicability of the procedure to children who have not reached the necessary levels of cognitive and linguistic development.

Predictors of self-reported negative mood following a depressive mood induction procedure across previously depressed, currently anxious, and control individuals.

PubMed

Scherrer, Martin C; Dobson, Keith S; Quigley, Leanne

2014-09-01

This study identified and examined a set of potential predictors of self-reported negative mood following a depressive mood induction procedure (MIP) in a sample of previously depressed, clinically anxious, and control participants. The examined predictor variables were selected on the basis of previous research and theories of depression, and included symptoms of depression and anxiety, negative and positive affect, negative and positive automatic thoughts, dysfunctional beliefs, rumination, self-concept, and occurrence and perceived unpleasantness of recent negative events. The sample consisted of 33 previously depressed, 22 currently anxious, and 26 non-clinical control participants, recruited from community sources. Participant group status was confirmed through structured diagnostic interviews. Participants completed the Velten negative self-statement MIP as well as self-report questionnaires of affective, cognitive, and psychosocial variables selected as potential predictors of mood change. Symptoms of anxiety were associated with increased self-reported negative mood shift following the MIP in previously depressed participants, but not clinically anxious or control participants. Increased occurrence of recent negative events was a marginally significant predictor of negative mood shift for the previously depressed participants only. None of the other examined variables was significant predictors of MIP response for any of the participant groups. These results identify factors that may increase susceptibility to negative mood states in previously depressed individuals, with implications for theory and prevention of relapse to depression. The findings also identify a number of affective, cognitive, and psychosocial variables that do not appear to influence mood change following a depressive MIP in previously depressed, currently anxious, and control individuals. Limitations of the study and directions for future research are discussed. Current anxiety symptomatology was a significant predictor and occurrence of recent negative events was a marginally significant predictor of greater negative mood shift following the depressive mood induction for previously depressed individuals. None of the examined variables predicted change in mood following the depressive mood induction for currently anxious or control individuals. These results suggest that anxiety symptoms and experience with negative events may increase risk for experiencing depressive mood states among individuals with a vulnerability to depression. The generalizability of the present results to individuals with comorbid depression and anxiety is limited. Future research employing appropriate statistical approaches for confirmatory research is needed to test and confirm the present results. © 2014 The British Psychological Society.

Remote discovery of an asymptomatic bowel perforation by a mid-urethral sling.

PubMed

Elliott, Jason E; Maslow, Ken D

2012-02-01

Bowel perforation is a rare complication of mid-urethral sling procedures and is usually reported shortly after the surgery. We report a remotely discovered asymptomatic bowel injury found at the time of subsequent surgery. The patient with a history of several prior pelvic surgeries underwent an uneventful retropubic mid-urethral sling placement. Five years later, during an abdominal sacrocolpopexy procedure, mesh from the mid-urethral sling was found perforating the wall of the cecum and fixating it to the right pelvic sidewall. Cecal wedge resection was performed to excise the sling mesh. Asymptomatic bowel perforation by mid-urethral sling mesh has not been previously reported. Pelvic and abdominal surgeons should be aware of the possibility of finding this injury in patients with prior sling surgeries.

DEVELOPING RELATIVE POTENCY FACTORS FOR PESTICIDE MIXTURES: BIOSTATISTICAL ANALYSES OF JOINT DOSE-RESPONSE

EPA Science Inventory

The 1996 Food Quality Protection Act (FQPA) and the 1996 Safe Drinking Water Act Amendments (SDWAA) reaffirm previous Acts that mandate the EPA to evaluate risks posed by environmental chemical mixtures. The current report develops biological concepts and statistical procedures f...

Determination of the thermal stability of fluids by tensimetry - Instrumentation and procedure

NASA Technical Reports Server (NTRS)

Helmick, Larry S.; Jones, William R., Jr.

1990-01-01

A computerized tensimeter and experimental procedure for determination of the thermal decomposition temperature (T sub d) of perfluoro alkylethers were developed and tested. Both the apparatus and the procedure are described in detail. Results of testing with bis(2-ethylhexyl) phthalate and trimethylolpropane triheptanoate demonstrate that the reciprocal of the decomposition temperature is a linear function of the logarithm of the gas volume/heated liquid volume ratio. The T sub d obtained for each compound at a gas volume/heated liquid volume ration of one was similar to the value previously reported using an isoteniscope technique. Results of testing with a polymer of hexafluoropropylene oxide demonstrate that this instrument and procedure can be used to determine the T sub d of perfluoro alkylethers.

Determination of the thermal stability of perfluoroalkylethers by tensimetry: Instrumentation and Procedure

NASA Technical Reports Server (NTRS)

Helmick, Larry S.; Jones, William R., Jr.

1989-01-01

A computerized tensimeter and experimental procedure for determination of the thermal decomposition temperature (T sub d) of perfluoro alkylethers were developed and tested. Both the apparatus and the procedure are described in detail. Results of testing with bis(2-ethylhexyl) phthalate and trimethylolpropane triheptanoate demonstrate that the reciprocal of the decomposition temperature is a linear function of the logarithm of the gas volume/heated liquid volume ratio. The T sub d obtained for each compound at a gas volume/heated liquid volume ration of one was similar to the value previously reported using an isoteniscope technique. Results of testing with a polymer of hexafluoropropylene oxide demonstrate that this instrument and procedure can be used to determine the T sub d of perfluoroalkylethers.

Special report on taxation. New IRS revenue procedure clarifies tax classification of limited liability companies.

PubMed

Schieble, M T

1995-05-01

Although its rules are complex, the publication of Revenue Procedure 95-10 will substantially facilitate the use of LLCs in those states with statutes that permit significant flexibility in the structuring of LLCs. Previously, the only way to assure that LLCs in those states would be classified as partnerships for income tax purposes was to obtain a private letter ruling from the IRS, often resulting in lengthy delays. The new revenue procedure should provide sufficient guidance in the vast majority of cases to allow tax counsel to determine the appropriate treatment for tax purposes without having to seek an IRS private letter ruling.

Simultaneous bilateral robotic partial nephrectomy: Case report and critical evaluation of the technique.

PubMed

Giberti, Claudio; Gallo, Fabrizio; Schenone, Maurizio; Cortese, Pierluigi

2014-06-16

We report our first simultaneous bilateral robot assisted partial nephrectomy (RAPN) in order to show and critically discuss the feasibility of this procedure. Materials and methods A 69-year-old male patient visited our department due to incidental finding of bilateral mesorenal small masses (2.5 cm on the right and 3.5 cm on the left) suspicious for malignancy. We started from the right side with patient in flank position. Port placement: 12-mm periumbilical camera port, two 8-mm robotic ports in wide ''V''configuration, additional 12 mm assistant port on the midline between the umbilicus and symphysis pubis. A right unclamping RAPN with sliding clip renorrhaphy was performed. The trocars were removed and the robot undocked. Without interrupting the anesthesiological procedures, the patient was reported in supine position and, after 180 degrees rotation of the surgical bed, was newly placed in contralateral flank position. Using both the previous periumbilical and midline ports, two other 8-mm robotic trocars were placed. The robot was then redocked and RAPN was also performed on the left side using the same previously reported technique. Results Total time: 285 min. Estimated blood losses: 150 cc. Postoperative period: uneventful. Pathological examination: bilateral renal cell carcinoma, negative surgical margins. Conclusions Our experience was encouraging and confirmed the feasibility and safety of this procedure. The planning of our technique was time and cost effective with cosmetic benefit for the patient. However, we think that an appropriate selection of the patients and a skill in robotic renal surgery are advisable before approaching this type of surgery.

Magnetic isolation of Plasmodium falciparum schizonts iRBCs to generate a high parasitaemia and synchronized in vitro culture.

PubMed

Mata-Cantero, Lydia; Lafuente, Maria J; Sanz, Laura; Rodriguez, Manuel S

2014-03-21

The establishment of methods for an in vitro continuous culture of Plasmodium falciparum is essential for gaining knowledge into its biology and for the development of new treatments. Previously, several techniques have been used to synchronize, enrich and concentrate P. falciparum, although obtaining cultures with high parasitaemia continues being a challenging process. Current methods produce high parasitaemia levels of synchronized P. falciparum cultures by frequent changes of culture medium or reducing the haematocrit. However, these methods are time consuming and sometimes lead to the loss of synchrony. A procedure that combines Percoll and sorbitol treatments, the use of magnetic columns, and the optimization of the in vitro culture conditions to reach high parasitaemia levels for synchronized Plasmodium falciparum cultures is described. A new procedure has been established using P. falciparum 3D7, combining previous reported methodologies to achieve in vitro parasite cultures that reach parasitaemia up to 40% at any intra-erythrocytic stage. High parasitaemia levels are obtained only one day after magnetic column purification without compromising the parasite viability and synchrony. The described procedure allows obtaining a large scale synchronized parasite culture at a high parasitaemia with less manipulations than other methods previously described.

A cubic extended interior penalty function for structural optimization

NASA Technical Reports Server (NTRS)

Prasad, B.; Haftka, R. T.

1979-01-01

This paper describes an optimization procedure for the minimum weight design of complex structures. The procedure is based on a new cubic extended interior penalty function (CEIPF) used with the sequence of unconstrained minimization technique (SUMT) and Newton's method. The Hessian matrix of the penalty function is approximated using only constraints and their derivatives. The CEIPF is designed to minimize the error in the approximation of the Hessian matrix, and as a result the number of structural analyses required is small and independent of the number of design variables. Three example problems are reported. The number of structural analyses is reduced by as much as 50 per cent below previously reported results.

Benchmarking surgical incident reports using a database and a triage system to reduce adverse outcomes.

PubMed

Antonacci, Anthony C; Lam, Steven; Lavarias, Valentina; Homel, Peter; Eavey, Roland D

2008-12-01

To study the profile of incidents affecting quality outcomes after surgery by developing a usable operating room and perioperative clinical incident report database and a functional electronic classification, triage, and reporting system. Previously, incident reports after surgery were handled on an individual, episodic basis, which limited the ability to perceive actuarial patterns and meaningfully improve outcomes. Clinical incident reports were experientially generated in the second largest health care system in New York City. Data were entered into a functional classification system organized into 16 categories, and weekly triage meetings were held to electronically review and report summaries on 40 to 60 incident reports per week. System development and deployment reviewed 1041 reports after 19,693 operative procedures. During the next 4 years, 3819 additional reports were generated from 83,988 operative procedures and were reported electronically to the appropriate departments. Number of incident reports generated annually. A significant decrease in volume-adjusted clinical incident reports occurred (from 53 to 39 reports per 1000 procedures) from 2001 to 2005 (P < .001). Reductions in incident reports were observed for ambulatory conversions (74% reduction), wasted implants (65%), skin breakdown (64%), complications in the operating room (42%), laparoscopic conversions (32%), and cancellations (23%) as a result of data-focused process and clinical interventions. Six of 16 categories of incident reports accounted for more than 88% of all incident reports. These data suggest that effective review, communication, and summary feedback of clinical incident reports can produce a statistically significant decrease in adverse outcomes.

Statistics of Scientific Procedures on Living Animals 2014: A new format, and hopefully a new era of diminishing animal experimentation?

PubMed

Hudson-Shore, Michelle

2016-03-01

The Annual Statistics of Scientific Procedures on Living Animals Great Britain 2014 reports a welcome decline in animal experimentation in the UK. However, caution has to be exercised when interpreting these most recent figures, due to the significant changes made to satisfy the requirements of Directive 2010/63/EU as to what information is reported and how it is reported. Comparisons to the figures and trends reported in previous years is difficult, so this paper focuses on the specifics of the current report, providing information on overall animal use and highlighting specific issues associated with genetically-altered animals, fish and primates. There is a detailed discussion of the extent of the changes, commenting on the benefits and disadvantages of the new format, in areas such as severity of procedures, legislation and techniques of special interest. It also considers the consequences of the changes on the effective monitoring of laboratory animal use, the openness and transparency regarding the impacts of animal use, and the implementation of Three Rs initiatives. In addition, suggestions for further improvements to the new format are made to the Home Office. 2016 FRAME.

Adults' strategies for simple addition and multiplication: verbal self-reports and the operand recognition paradigm.

PubMed

Metcalfe, Arron W S; Campbell, Jamie I D

2011-05-01

Accurate measurement of cognitive strategies is important in diverse areas of psychological research. Strategy self-reports are a common measure, but C. Thevenot, M. Fanget, and M. Fayol (2007) proposed a more objective method to distinguish different strategies in the context of mental arithmetic. In their operand recognition paradigm, speed of recognition memory for problem operands after solving a problem indexes strategy (e.g., direct memory retrieval vs. a procedural strategy). Here, in 2 experiments, operand recognition time was the same following simple addition or multiplication, but, consistent with a wide variety of previous research, strategy reports indicated much greater use of procedures (e.g., counting) for addition than multiplication. Operation, problem size (e.g., 2 + 3 vs. 8 + 9), and operand format (digits vs. words) had interactive effects on reported procedure use that were not reflected in recognition performance. Regression analyses suggested that recognition time was influenced at least as much by the relative difficulty of the preceding problem as by the strategy used. The findings indicate that the operand recognition paradigm is not a reliable substitute for strategy reports and highlight the potential impact of difficulty-related carryover effects in sequential cognitive tasks.

Development of a multiple-parameter nonlinear perturbation procedure for transonic turbomachinery flows: Preliminary application to design/optimization problems

NASA Technical Reports Server (NTRS)

Stahara, S. S.; Elliott, J. P.; Spreiter, J. R.

1983-01-01

An investigation was conducted to continue the development of perturbation procedures and associated computational codes for rapidly determining approximations to nonlinear flow solutions, with the purpose of establishing a method for minimizing computational requirements associated with parametric design studies of transonic flows in turbomachines. The results reported here concern the extension of the previously developed successful method for single parameter perturbations to simultaneous multiple-parameter perturbations, and the preliminary application of the multiple-parameter procedure in combination with an optimization method to blade design/optimization problem. In order to provide as severe a test as possible of the method, attention is focused in particular on transonic flows which are highly supercritical. Flows past both isolated blades and compressor cascades, involving simultaneous changes in both flow and geometric parameters, are considered. Comparisons with the corresponding exact nonlinear solutions display remarkable accuracy and range of validity, in direct correspondence with previous results for single-parameter perturbations.

A procedure for estimating the frequency distribution of CO levels in the micro-region of a highway.

DOT National Transportation Integrated Search

1979-01-01

This report demonstrates that the probability of violating a "not to be exceeded more than once per year", one-hour air quality standard can be bounded from above. This result represents a significant improvement over previous methods of ascertaining...

Flipping the Classroom: An Empirical Study Examining Student Learning

ERIC Educational Resources Information Center

Sparks, Roland J.

2013-01-01

Flipping the classroom is the latest reported teaching technique to improve student learning at all levels. Prior studies showed significant increases in learning by employing this technique. However, an examination of the previous studies indicates significant flaws in the testing procedure controls. Moreover, most studies were based on anecdotal…

46 CFR 162.018-8 - Procedure for approval.

Code of Federal Regulations, 2010 CFR

2010-10-01

... Center, for re-approval. (c) Pre-approval tests. (1) Prior to approval of safety relief valves by the...) Reports of conducted tests on designs of safety relief valves different from those previously approved... approval of a new design or type of safety relief valve shall submit in quadruplicate detail drawings...

46 CFR 162.018-8 - Procedure for approval.

Code of Federal Regulations, 2012 CFR

2012-10-01

... Center, for re-approval. (c) Pre-approval tests. (1) Prior to approval of safety relief valves by the...) Reports of conducted tests on designs of safety relief valves different from those previously approved... approval of a new design or type of safety relief valve shall submit in quadruplicate detail drawings...

46 CFR 162.018-8 - Procedure for approval.

Code of Federal Regulations, 2011 CFR

2011-10-01

... Center, for re-approval. (c) Pre-approval tests. (1) Prior to approval of safety relief valves by the...) Reports of conducted tests on designs of safety relief valves different from those previously approved... approval of a new design or type of safety relief valve shall submit in quadruplicate detail drawings...

46 CFR 162.018-8 - Procedure for approval.

Code of Federal Regulations, 2013 CFR

2013-10-01

... Center, for re-approval. (c) Pre-approval tests. (1) Prior to approval of safety relief valves by the...) Reports of conducted tests on designs of safety relief valves different from those previously approved... approval of a new design or type of safety relief valve shall submit in quadruplicate detail drawings...

46 CFR 162.018-8 - Procedure for approval.

Code of Federal Regulations, 2014 CFR

2014-10-01

... Center, for re-approval. (c) Pre-approval tests. (1) Prior to approval of safety relief valves by the...) Reports of conducted tests on designs of safety relief valves different from those previously approved... approval of a new design or type of safety relief valve shall submit in quadruplicate detail drawings...

20171130_Ind Ergo Report_631 DI Water Movement Process.

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

Rivera, Cynthia R.

Perform an industrial ergonomic assessment to evaluate the new procedures for filling, lifting, and delivering high purity de-ionized water to building 9925. The goal was to improve on the previous method by minimizing/eliminating as much lifting and bending as possible to reduce the potential for overexertion-related injuries.

Establishment of QC/QA procedures for open-graded mixes : final report.

DOT National Transportation Integrated Search

1998-09-01

The State of Oregon has employed the use of porous concrete surfaces (E- and F-mixes) since the 1970s. The use of porous mixes has increased substantially in the past five years. Previously, no work had been done to evaluate whether the quality contr...

Availability analysis of an HTGR fuel recycle facility. Summary report

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

Sharmahd, J.N.

1979-11-01

An availability analysis of reprocessing systems in a high-temperature gas-cooled reactor (HTGR) fuel recycle facility was completed. This report summarizes work done to date to define and determine reprocessing system availability for a previously planned HTGR recycle reference facility (HRRF). Schedules and procedures for further work during reprocessing development and for HRRF design and construction are proposed in this report. Probable failure rates, transfer times, and repair times are estimated for major system components. Unscheduled down times are summarized.

1995 Annual epidemiologic surveillance report for Pantex Plant

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

NONE

This report provides a summary of epidemiologic surveillance data collected from the Pantex Plant from January 1, 1995 through December 31,1995. The data were collected by a coordinator at Pantex and submitted to the Epidemiologic Surveillance Data Center,located at Oak Ridge Institute for Science and Education, where quality control procedures and data analyses were carried out. The data presented apply only to Pantex. The main sections of the report are the same as in previous years; the 1995 report provides additional information describing the work force by age and occupational groups.

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

Mendez, Jose C.; Gonzalez-Llanos, Francisco

We present a case of vertebral artery pseudoaneurysm after a posterior C1-C2 transarticular screw fixation procedure that was effectively treated with endovascular coil occlusion. Vertebral artery pseudoaneurysm complicating posterior C1-C2 transarticular fixation is extremely rare, with only one previous case having been reported previously. Endovascular occlusion is better achieved in the subacute phase of the pseudoaneurysm, when the wall of the pseudoaneurysm has matured and stabilized. Further follow-up angiographies are mandatory in order to confirm that there is no recurrence of the lesion.

Quantification of the Relationship between Surrogate Fuel Structure and Performance

DTIC Science & Technology

2012-07-31

order to account for know deficiencies [18]. The frequencies are then used to calculate the zero point energy ( ZPE ). In the G3 theory HF/6-31G* was used...for the ZPE and the new procedure is likely to be more reliable. Also in contrast to previous G series composite methods, the Hartree–Fock energy...The total energy is obtained by adding the previously calculated ZPE . Durant and Rohlfing [38] reported that B3LYP density functional methods provide

Combined surgical procedures using laparoendoscopic single-site surgery approach.

PubMed

Palanivelu, C; Ahluwalia, Jasmeet Singh; Palanivelu, Praveenraj; Palanisamy, Senthilnathan; Vij, Anirudh

2013-08-01

As our experience with laparoendoscopic single-site (LESS) surgeries increased, we considered how it might be employed if two or more surgeries were to be combined. LESS surgeries' cosmetic advantages, decreased parietal trauma and better patient satisfaction relative to standard multiport laparoscopy have been previously reported, but its special role in combined surgeries has never been stressed. In this series, we present the advantages of LESS procedure over multiport laparoscopy in combined surgical procedures. To the best of our knowledge, this has never been reported before. A retrospective analysis of 27 patients was performed. The patients underwent combined LESS procedures between February 2010 and January 2012 at GEM Hospital, Coimbatore, India. All patients were of ASA grade 1 or 2. Patients with previous surgery in the umbilical region were not offered single-incision surgery. We successfully performed 27 combined LESS procedures over a span of 2 years. Twenty patients were women and seven were men. Mean age was 35.94 years (range, 10-66 years). Mean BMI was 27.2. There were no major intraoperative complications. Mean blood loss was 45.7 mL (range, 0.0-120.0 mL). Mean postoperative hospital stay was 3.08 days (range, 1-5 days). When a suitable case of multiple pathologies is encountered and LESS surgery is feasible for all of them, performing LESS surgery not only has cosmetic advantages over standard laparoscopy, but it also avoids the need for additional ports to achieve adequate visualization and access. All quadrants of the abdomen remain under reach through umbilicus. © 2013 Japan Society for Endoscopic Surgery, Asia Endosurgery Task Force and Wiley Publishing Asia Pty Ltd.

Music Therapy as Procedural Support for Young Children Undergoing Immunizations: A Randomized Controlled Study.

PubMed

Yinger, Olivia Swedberg

2016-01-01

Children undergoing routine immunizations frequently experience severe distress, which may be improved through music therapy as procedural support. The purpose of this study was to examine effects of live, cognitive-behavioral music therapy during immunizations on (a) the behaviors of children, their parents, and their nurses; and (b) parental perceptions. Participants were children between the ages of 4 and 6 years (N = 58) who underwent immunizations, their parents (N = 62), and the nurses who administered the procedure (N = 19). Parent/child dyads were randomly assigned to receive music therapy (n = 29) or standard care (n = 29) during their immunization. Afterward, each parent rated their child's level of pain and the distress their child experienced compared to previous medical experiences. All procedures were videotaped and later viewed by trained observers, who classified child, parent, and nurse behaviors using the categories of the Child-Adult Medical Procedure Interaction Scale-Revised (CAMPIS-R). Significant differences between the music therapy and control groups were found in rates of child coping and distress behaviors and parent distress-promoting behaviors. Parents of children who received music therapy reported that their child's level of distress was less than during previous medical experiences, whereas parents of children in the control group reported that their child's level of distress was greater. No significant differences between groups were found in parents' ratings of children's pain or in rates of nurse behavior. Live, cognitive-behavioral music therapy has potential benefits for young children and their parents during immunizations. © the American Music Therapy Association 2016. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Surgical Management of Dural Arteriovenous Fistula After Craniotomy: Case Report and Review of Literature.

PubMed

Pabaney, Aqueel H; Robin, Adam M; Basheer, Azam; Malik, Ghaus

2016-05-01

Development of dural arteriovenous fistula (dAVF) with cortical venous drainage at the site of previous craniotomy is a rare manifestation of nontraumatic subarachnoid hemorrhage (SAH). The authors present a case of postcraniotomy dAVF formation and discuss plausible underlying mechanisms of fistula formation and treatment options as well as review the literature. A 62-year-old man, who had undergone craniotomy 2 decades previously, presented with SAH. Workup revealed a low-flow dAVF with leptomeningeal venous drainage at the posterior margin of the craniotomy. Surgical resection of fistula was undertaken that resulted in cure. Spontaneous SAH in patients with a previous history of an intracranial procedure (e.g., craniotomy, ventriculostomy) should prompt detailed imaging evaluation. In the absence of vascular disease, meticulous review of the angiogram must be undertaken to rule out dAVF at the procedure site and it should be treated definitively. Copyright © 2016 Elsevier Inc. All rights reserved.

Delayed Infective Endocarditis with Mycotic Aneurysm Rupture below the Mechanical Valved Conduit after the Bentall Procedure

PubMed Central

Chen, Mei-Ling; Chen, Michael Y.; Yin, Wei-Hsian; Wei, Jeng; Wang, Ji-Hung

2014-01-01

The Bentall procedure is the gold standard for treating aortic dissection complicated with valvular and ascending aorta disease. Recent results for this procedure have been excellent; nearly 100% of patients remain free of infective endocarditis in long-term follow-up. We report a case of delayed Streptococcus agalactiae infective endocarditis complicated by mycotic aneurysm in a man who had undergone the Bentall procedure with a mechanical valve conduit 15 years previously. The mycotic aneurysm was located in the remnant aortic root, below the mechanical valve conduit, and later ruptured into the right atrium. The patient was treated conservatively and survived the acute period. Later, the aortic root defect was repaired successfully by means of a hybrid technique using a Amplatzer duct occluder. PMID:27122809

Attention-deficit/hyperactivity disorder and phonological working memory: Methodological variability affects clinical and experimental performance metrics.

PubMed

Tarle, Stephanie J; Alderson, R Matt; Patros, Connor H G; Lea, Sarah E; Hudec, Kristen L; Arrington, Elaine F

2017-05-01

Despite promising findings in extant research that suggest impaired working memory (WM) serves as a central neurocognitive deficit or candidate endophenotype of attention-deficit/hyperactivity disorder (ADHD), findings from translational research have been relatively underwhelming. This study aimed to explicate previous equivocal findings by systematically examining the effect of methodological variability on WM performance estimates across experimental and clinical WM measures. Age-matched boys (ages 8-12 years) with (n = 20) and without (n = 20) ADHD completed 1 experimental (phonological) and 2 clinical (digit span, letter-number sequencing) WM measures. The use of partial scoring procedures, administration of greater trial numbers, and high central executive demands yielded moderate-to-large between-groups effect sizes. Moreover, the combination of these best-case procedures, compared to worst-case procedures (i.e., absolute scoring, administration of few trials, use of discontinue rules, and low central executive demands), resulted in a 12.5% increase in correct group classification. Collectively, these findings explain inconsistent ADHD-related WM deficits in previous reports, and highlight the need for revised clinical measures that utilize best-case procedures. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

Consulting report on the NASA technology utilization network system

NASA Technical Reports Server (NTRS)

Hlava, Marjorie M. K.

1992-01-01

The purposes of this consulting effort are: (1) to evaluate the existing management and production procedures and workflow as they each relate to the successful development, utilization, and implementation of the NASA Technology Utilization Network System (TUNS) database; (2) to identify, as requested by the NASA Project Monitor, the strengths, weaknesses, areas of bottlenecking, and previously unaddressed problem areas affecting TUNS; (3) to recommend changes or modifications of existing procedures as necessary in order to effect corrections for the overall benefit of NASA TUNS database production, implementation, and utilization; and (4) to recommend the addition of alternative procedures, routines, and activities that will consolidate and facilitate the production, implementation, and utilization of the NASA TUNS database.

Successful correction of tibial bone deformity through multiple surgical procedures, liquid nitrogen-pretreated bone tumor autograft, three-dimensional external fixation, and internal fixation in a patient with primary osteosarcoma: a case report.

PubMed

Takeuchi, Akihiko; Yamamoto, Norio; Shirai, Toshiharu; Nishida, Hideji; Hayashi, Katsuhiro; Watanabe, Koji; Miwa, Shinji; Tsuchiya, Hiroyuki

2015-12-07

In a previous report, we described a method of reconstruction using tumor-bearing autograft treated by liquid nitrogen for malignant bone tumor. Here we present the first case of bone deformity correction following a tumor-bearing frozen autograft via three-dimensional computerized reconstruction after multiple surgeries. A 16-year-old female student presented with pain in the left lower leg and was diagnosed with a low-grade central tibial osteosarcoma. Surgical bone reconstruction was performed using a tumor-bearing frozen autograft. Bone union was achieved at 7 months after the first surgical procedure. However, local tumor recurrence and lung metastases occurred 2 years later, at which time a second surgical procedure was performed. Five years later, the patient developed a 19° varus deformity and underwent a third surgical procedure, during which an osteotomy was performed using the Taylor Spatial Frame three-dimensional external fixation technique. A fourth corrective surgical procedure was performed in which internal fixation was achieved with a locking plate. Two years later, and 10 years after the initial diagnosis of tibial osteosarcoma, the bone deformity was completely corrected, and the patient's limb function was good. We present the first report in which a bone deformity due to a primary osteosarcoma was corrected using a tumor-bearing frozen autograft, followed by multiple corrective surgical procedures that included osteotomy, three-dimensional external fixation, and internal fixation.

Novel anatomic variation: heptafurcation of the celiac trunk.

PubMed

Rusu, M C; Manta, B A

2018-04-01

We report here anatomic variants which were found during a retrospective study of a male patient, 54 years old, evaluated in computed tomography: heptafurcation of the celiac trunk (CT) and bilateral double renal arteries. The seven branches of the heptafurcated CT were the (1) left and (2) right inferior phrenic arteries, the (3) splenic and (4) left gastric artery, the (5) common hepatic artery, further sending off the (a) proper, continued as left, hepatic artery and (b) the gastroduodenal artery, (6) a replaced right hepatic artery and (7) the dorsal pancreatic artery. To our knowledge, heptafurcation of the CT was not reported previously. The arterial variants have great importance during various surgical and interventional procedures and should be documented prior to respective procedures.

Paradoxical immune reconstitution inflammatory syndrome associated with previous Cryptococcus neoformans infection in an HIV-positive patient requiring neurosurgical intervention.

PubMed

Biagetti, Carlo; Nicola, Monica; Borderi, Marco; Pavoni, Michele; Tampellini, Livia; Verucchi, Gabriella; Chiodo, Francesco

2009-04-01

Immune reconstitution inflammatory syndrome (IRIS) in HIV-1-infected patients is associated with an exaggerated inflammatory response against an opportunistic infection during highly active antiretroviral therapy. The only review on IRIS associated with Criptococcus neoformans reported 21 episodes including lymphadenitis, necrotizing pneumonitis, breast and cutaneous abscess, and cryptococcomas. To our knowledge this is the first report of IRIS associated with previous meningeal criptococcal infection which required neurosurgical intervention with placement of a ventriculo-peritoneal shunt to drain a CSF cyst formed by exclusion of the temporal horn of the right lateral ventricle. We demonstrate that this procedure is possible without complications such as cryptococcal dissemination into the peritoneum.

40 CFR 80.131 - Agreed upon procedures for GTAB, certain conventional gasoline imported by truck, previously...

Code of Federal Regulations, 2010 CFR

2010-07-01

..., certain conventional gasoline imported by truck, previously certified gasoline used to produce gasoline... Agreed upon procedures for GTAB, certain conventional gasoline imported by truck, previously certified gasoline used to produce gasoline, and butane blenders. (a) Attest procedures for GTAB. The following are...

40 CFR 80.131 - Agreed upon procedures for GTAB, certain conventional gasoline imported by truck, previously...

Code of Federal Regulations, 2011 CFR

2011-07-01

..., certain conventional gasoline imported by truck, previously certified gasoline used to produce gasoline... Agreed upon procedures for GTAB, certain conventional gasoline imported by truck, previously certified gasoline used to produce gasoline, and butane blenders. (a) Attest procedures for GTAB. The following are...

40 CFR 80.131 - Agreed upon procedures for GTAB, certain conventional gasoline imported by truck, previously...

Code of Federal Regulations, 2013 CFR

2013-07-01

..., certain conventional gasoline imported by truck, previously certified gasoline used to produce gasoline... Agreed upon procedures for GTAB, certain conventional gasoline imported by truck, previously certified gasoline used to produce gasoline, and butane blenders. (a) Attest procedures for GTAB. The following are...

40 CFR 80.131 - Agreed upon procedures for GTAB, certain conventional gasoline imported by truck, previously...

Code of Federal Regulations, 2012 CFR

2012-07-01

..., certain conventional gasoline imported by truck, previously certified gasoline used to produce gasoline... Agreed upon procedures for GTAB, certain conventional gasoline imported by truck, previously certified gasoline used to produce gasoline, and butane blenders. (a) Attest procedures for GTAB. The following are...

40 CFR 80.131 - Agreed upon procedures for GTAB, certain conventional gasoline imported by truck, previously...

Code of Federal Regulations, 2014 CFR

2014-07-01

..., certain conventional gasoline imported by truck, previously certified gasoline used to produce gasoline... Agreed upon procedures for GTAB, certain conventional gasoline imported by truck, previously certified gasoline used to produce gasoline, and butane blenders. (a) Attest procedures for GTAB. The following are...

Computer Aided Phenomenography: The Role of Leximancer Computer Software in Phenomenographic Investigation

ERIC Educational Resources Information Center

Penn-Edwards, Sorrel

2010-01-01

The qualitative research methodology of phenomenography has traditionally required a manual sorting and analysis of interview data. In this paper I explore a potential means of streamlining this procedure by considering a computer aided process not previously reported upon. Two methods of lexicological analysis, manual and automatic, were examined…

Descriptive Analysis of Teachers' Responses to Problem Behavior Following Training

ERIC Educational Resources Information Center

Addison, Laura; Lerman, Dorothea C.

2009-01-01

The procedures described by Sloman et al. (2005) were extended to an analysis of teachers' responses to problem behavior after they had been taught to withhold potential sources of positive and negative reinforcement following instances of problem behavior. Results were consistent with those reported previously, suggesting that escape from child…

An optimized implementation of a fault-tolerant clock synchronization circuit

NASA Technical Reports Server (NTRS)

Torres-Pomales, Wilfredo

1995-01-01

A fault-tolerant clock synchronization circuit was designed and tested. A comparison to a previous design and the procedure followed to achieve the current optimization are included. The report also includes a description of the system and the results of tests performed to study the synchronization and fault-tolerant characteristics of the implementation.

A rapid and easy method for the DNA extraction from Cryptococcus neoformans

PubMed Central

2011-01-01

DNA isolation from C. neoformans is difficult due to a thick and resistant capsule. We have optimized a new and rapid DNA isolation method for Cryptococcus using a short urea treatment followed by a rapid method using a chelex resin suspension. This procedure is simpler than previously reported methods. PMID:21777412

Erythema after laser skin resurfacing.

PubMed

Ruiz-Esparza, J; Barba Gomez, J M; Gomez de la Torre, O L; David, L

1998-01-01

Erythema after laser skin resurfacing is seen by many as a necessary evil in order to get good results from the procedure. A critical review of widely accepted concepts may lead to diminishing the length of postoperative erythema in patients undergoing laser resurfacing. The authors report on two previously unrecognized factors in the causation of this problem.

A New Method for Obtaining Russell-Saunders Terms

ERIC Educational Resources Information Center

Liu, Ying; Liu, Yue; Liu, Bihui

2011-01-01

A new method for obtaining Russell-Saunders terms of atomic configurations is reported. This new method is significantly different from, while at the same time complementary to, previously published methods for obtaining atomic terms. This novel procedure is elicited by the method used to determine the splitting of S, P, D terms in weak ligand…

Synthesis of Aromatic Thiolate-Protected Gold Nanomolecules by Core Conversion: The Case of Au36(SPh-tBu)24.

PubMed

Theivendran, Shevanuja; Dass, Amala

2017-08-01

Ultrasmall nanomolecules (<2 nm) such as Au 25 (SCH 2 CH 2 Ph) 18 , Au 38 (SCH 2 CH 2 Ph) 24 , and Au 144 (SCH 2 CH 2 Ph) 60 are well studied and can be prepared using established synthetic procedures. No such synthetic protocols that result in high yield products from commercially available starting materials exist for Au 36 (SPh-X) 24 . Here, we report a synthetic procedure for the large-scale synthesis of highly stable Au 36 (SPh-X) 24 with a yield of ∼42%. Au 36 (SPh-X) 24 was conveniently synthesized by using tert-butylbenzenethiol (HSPh-tBu, TBBT) as the ligand, giving a more stable product with better shelf life and higher yield than previously reported for making Au 36 (SPh) 24 from thiophenol (PhSH). The choice of thiol, solvent, and reaction conditions were modified for the optimization of the synthetic procedure. The purposes of this work are to (1) optimize the existing procedure to obtain stable product with better yield, (2) develop a scalable synthetic procedure, (3) demonstrate the superior stability of Au 36 (SPh-tBu) 24 when compared to Au 36 (SPh) 24 , and (4) demonstrate the reproducibility and robustness of the optimized synthetic procedure.

Spectrum of use and effectiveness of endoscopic and surgical therapies for chronic pancreatitis in the United States.

PubMed

Glass, Lisa M; Whitcomb, David C; Yadav, Dhiraj; Romagnuolo, Joseph; Kennard, Elizabeth; Slivka, Adam A; Brand, Randall E; Anderson, Michelle A; Banks, Peter A; Lewis, Michele D; Baillie, John; Sherman, Stuart; Alkaade, Samer; Amann, Stephen T; Disario, James A; O'Connell, Michael; Gelrud, Andres; Forsmark, Christopher E; Gardner, Timothy B

2014-05-01

This study aims to describe the frequency of use and reported effectiveness of endoscopic and surgical therapies in patients with chronic pancreatitis treated at US referral centers. Five hundred fifteen patients were enrolled prospectively in the North American Pancreatitis Study 2, where patients and treating physicians reported previous therapeutic interventions and their perceived effectiveness. We evaluated the frequency and effectiveness of endoscopic (biliary or pancreatic sphincterotomy, biliary or pancreatic stent placement) and surgical (pancreatic cyst removal, pancreatic drainage procedure, pancreatic resection, surgical sphincterotomy) therapies. Biliary and/or pancreatic sphincterotomy (42%) were the most common endoscopic procedure (biliary stent, 14%; pancreatic stent, 36%; P < 0.001). Endoscopic procedures were equally effective (biliary sphincterotomy, 40.0%; biliary stent, 40.8%; pancreatic stent, 47.0%; P = 0.34). On multivariable analysis, the presence of abdominal pain (odds ratio, 1.82; 95% confidence interval, 1.15-2.88) predicted endoscopy, whereas exocrine insufficiency (odds ratio, 0.63; 95% confidence interval, 0.42-0.94) deterred endoscopy. Surgical therapies were attempted equally (cyst removal, 7%; drainage procedure, 10%; resection procedure, 12%) except for surgical sphincteroplasty (4%; P < 0.001). Surgical sphincteroplasty was the least effective (46%; P < 0.001) versus cyst removal (76% drainage [71%] and resection [73%]). Although surgical therapies were performed less frequently than endoscopic therapies, they were more often reported to be effective.

Self-motion perception: assessment by real-time computer-generated animations

NASA Technical Reports Server (NTRS)

Parker, D. E.; Phillips, J. O.

2001-01-01

We report a new procedure for assessing complex self-motion perception. In three experiments, subjects manipulated a 6 degree-of-freedom magnetic-field tracker which controlled the motion of a virtual avatar so that its motion corresponded to the subjects' perceived self-motion. The real-time animation created by this procedure was stored using a virtual video recorder for subsequent analysis. Combined real and illusory self-motion and vestibulo-ocular reflex eye movements were evoked by cross-coupled angular accelerations produced by roll and pitch head movements during passive yaw rotation in a chair. Contrary to previous reports, illusory self-motion did not correspond to expectations based on semicircular canal stimulation. Illusory pitch head-motion directions were as predicted for only 37% of trials; whereas, slow-phase eye movements were in the predicted direction for 98% of the trials. The real-time computer-generated animations procedure permits use of naive, untrained subjects who lack a vocabulary for reporting motion perception and is applicable to basic self-motion perception studies, evaluation of motion simulators, assessment of balance disorders and so on.

Spanish Heart Transplant Registry. 28th Official Report of the Spanish Society of Cardiology Working Group on Heart Failure (1984-2016).

PubMed

González-Vílchez, Francisco; Gómez-Bueno, Manuel; Almenar-Bonet, Luis; Crespo-Leiro, María G; Arizón Del Prado, José M; Delgado-Jiménez, Juan; Sousa-Casasnovas, Iago; Brossa-Loidi, Vicens; Sobrino-Márquez, José Manuel; González-Costelo, José

2017-12-01

The present article reports the characteristics and results of heart transplants in Spain since this therapeutic modality was first used in May 1984. We summarize the main features of recipients, donors, surgical procedures, and outcomes of all cardiac transplants performed in Spain up to December 31, 2016. A total of 281 cardiac transplants were performed in 2016. The whole historical series consisted of 7869 procedures. The main features of transplant procedures in 2016 were similar to those observed in recent years. A high percentage of procedures were urgent, particularly those with use of pretransplant continuous-flow left ventricular assist devices (19.1% of all transplants). Survival significantly improved in the last decade compared with previous periods. During the last few years, transplant activity in Spain has remained steady, with approximately 250-300 transplants/year. Despite a more complex clinical context, survival has improved in recent years. Copyright © 2017 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.

Evaluation of the localization auditory screening test in children 6-18 months of age.

PubMed

Tillis, C H; Grimm, W A

1978-01-01

The present paper is a report of a project to develop an automated auditory screening test for infants six to 18 months of age. The first year of the project was devoted to developing equipment and test procedures; the second year was concerned with testing the effectiveness of the equipment and procedures on an actual population of six to 18 month old infants. Two-hundred and fifty infants were screened auditorily as part of a county health department child development clinic. The pass/fail results of the screening test were evaluated in terms of physical and developmental examination following the screening and by means of a case review of the child's previous history. The results indicate that the procedure under investigation can be used to differentiate the normal hearing infant from the infant with possible hearing problems. It is shown by the test environment in which this study was conducted that the procedure reported can be successfully incorporated into a public health program, i.e., child development clinics or EPSDT programs.

The contributions of eye movements to the efficacy of brief exposure treatment for reducing fear of public speaking.

PubMed

Carrigan, M H; Levis, D J

1999-01-01

The present study was designed to isolate the effects of the eye-movement component of the Eye Movement Desensitization and Reprocessing (EMDR) procedure in the treatment of fear of public speaking. Seventy-one undergraduate psychology students who responded in a fearful manner on the Fear Survey Schedule II and on a standardized, self-report measure of public speaking anxiety (Personal Report of Confidence as a Speaker; PRCS) were randomly assigned to one of four groups in a 2x2 factorial design. The two independent variables assessed were treatment condition (imagery plus eye movements vs. imagery alone) and type of imagery (fear-relevant vs. relaxing). Dependent variables assessed were self-reported and physiological anxiety during exposure and behavioral indices of anxiety while giving a speech. Although process measures indicated exposure to fear-relevant imagery increased anxiety during the procedure, no significant differences among groups were found on any of the outcome measures, except that participants who received eye movements were less likely to give a speech posttreatment than participants who did not receive eye movements. Addition of the eye movements to the experimental procedure did not result in enhancement of fear reduction. It was concluded, consistent with the results of past research, that previously reported positive effects of the EMDR procedure may be largely due to exposure to conditioned stimuli.

RhBMP-7 for the treatment of nonunion of fractures of long bones.

PubMed

Papanagiotou, M; Dailiana, Z H; Karachalios, T; Varitimidis, S; Vlychou, M; Hantes, M; Malizos, K N

2015-07-01

We report the outcome of 84 nonunions involving long bones which were treated with rhBMP-7, in 84 patients (60 men: 24 women) with a mean age 46 years (18 to 81) between 2003 and 2011. The patients had undergone a mean of three previous operations (one to 11) for nonunion which had been present for a mean of 17 months (4 months to 20 years). The nonunions involved the lower limb in 71 patients and the remainder involved the upper limb. A total of 30 nonunions were septic. Treatment was considered successful when the nonunion healed without additional procedures. The relationship between successful union and the time to union was investigated and various factors including age and gender, the nature of the nonunion (location, size, type, chronicity, previous procedures, infection, the condition of the soft tissues) and type of index procedure (revision of fixation, type of graft, amount of rhBMP-7) were analysed. The improvement of the patients' quality of life was estimated using the Short Form (SF) 12 score. A total of 68 nonunions (80.9%) healed with no need for further procedures at a mean of 5.4 months (3 to 10) post-operatively. Multivariate logistic regression analysis of the factors affecting union suggested that only infection significantly affected the rate of union (p = 0.004).Time to union was only affected by the number of previous failed procedures (p = 0.006). An improvement of 79% and 32.2% in SF-12 physical and mental score, respectively, was noted within the first post-operative year. Rh-BMP-7 combined with bone grafts, enabled healing of the nonunion and improved quality of life in about 80% of patients. Aseptic nonunions were much more likely to unite than septic ones. The number of previous failed operations significantly delayed the time to union. ©2015 The British Editorial Society of Bone & Joint Surgery.

Aspiration and sclerotherapy: a nonsurgical treatment option for hydroceles.

PubMed

Francis, John J; Levine, Laurence A

2013-05-01

We demonstrated that hydrocele aspiration and sclerotherapy with doxycycline is an effective and safe nonsurgical treatment option for hydrocele correction. The medical records of patients who underwent hydrocele aspiration and sclerotherapy were analyzed in a retrospective cohort study for success rates as well as improvement in scrotal size and discomfort after a single hydrocele aspiration and sclerotherapy treatment. Patients who reported decreased scrotal size, improved physical symptoms and satisfaction with the procedure were considered as having success with hydrocele aspiration and sclerotherapy. A total of 29 patients (mean age 52.8 years) presenting with 32 nonseptated hydroceles underwent hydrocele aspiration and sclerotherapy with doxycycline between 2005 and 2012. Of the hydroceles 27 (84%) were successfully treated with a single aspiration and sclerotherapy procedure. Overall mean followup was 20.8 months. Three patients reported moderate pain which resolved in 2 to 3 days. Of those patients in whom hydrocele aspiration and sclerotherapy failed, 1 had hydrocele successfully resolved with a second aspiration and sclerotherapy treatment, 3 did not have success with a second procedure and underwent hydrocelectomy, and 1 wanted immediate surgical correction. Hydrocele aspiration and sclerotherapy was successful in correcting 84% of simple nonseptated hydroceles with a single treatment. This result is an increase from previously reported success rates involving a single hydrocele aspiration and sclerotherapy procedure with tetracycline (75%). The success rate of a single hydrocele aspiration and sclerotherapy procedure is similar to the reported success rates involving hydrocelectomy while avoiding the hospital expense and many other complications. We conclude that the hydrocele aspiration and sclerotherapy procedure is a reasonable, nonsurgical and underused treatment option for nonseptated simple hydroceles. Copyright © 2013 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

Statistics of Scientific Procedures on Living Animals Great Britain 2015 - highlighting an ongoing upward trend in animal use and missed opportunities.

PubMed

Hudson-Shore, Michelle

2016-12-01

The Annual Statistics of Scientific Procedures on Living Animals Great Britain 2015 indicate that the Home Office were correct in recommending that caution should be exercised when interpreting the 2014 data as an apparent decline in animal experiments. The 2015 report shows that, as the changes to the format of the annual statistics have become more familiar and less problematic, there has been a re-emergence of the upward trend in animal research and testing in Great Britain. The 2015 statistics report an increase in animal procedures (up to 4,142,631) and in the number of animals used (up to 4,069,349). This represents 1% more than the totals in 2013, and a 7% increase on the procedures reported in 2014. This paper details an analysis of these most recent statistics, providing information on overall animal use and highlighting specific issues associated with genetically-altered animals, dogs and primates. It also reflects on areas of the new format that have previously been highlighted as being problematic, and concludes with a discussion about the use of animals in regulatory research and testing, and how there are significant missed opportunities for replacing some of the animal-based tests in this area. 2016 FRAME.

Delayed Infective Endocarditis with Mycotic Aneurysm Rupture below the Mechanical Valved Conduit after the Bentall Procedure.

PubMed

Chen, Mei-Ling; Chen, Michael Y; Yin, Wei-Hsian; Wei, Jeng; Wang, Ji-Hung

2014-07-01

The Bentall procedure is the gold standard for treating aortic dissection complicated with valvular and ascending aorta disease. Recent results for this procedure have been excellent; nearly 100% of patients remain free of infective endocarditis in long-term follow-up. We report a case of delayed Streptococcus agalactiae infective endocarditis complicated by mycotic aneurysm in a man who had undergone the Bentall procedure with a mechanical valve conduit 15 years previously. The mycotic aneurysm was located in the remnant aortic root, below the mechanical valve conduit, and later ruptured into the right atrium. The patient was treated conservatively and survived the acute period. Later, the aortic root defect was repaired successfully by means of a hybrid technique using a Amplatzer duct occluder. Amplatzer duct occluder; Aortic dissection; Bentall technique; Infective endocarditis; Mycotic aneurysm.

24 CFR 200.213 - Applicability of procedure.

Code of Federal Regulations, 2010 CFR

2010-04-01

... Previous Participation Review and Clearance Procedure § 200.213 Applicability of procedure. The Previous Participation Review and Clearance procedure set forth in this part is administered by the Assistant Secretary... 887, which are tenant-based programs); (d) Sales of projects by the Secretary, including “all cash...

Aortic operation after previous coronary artery bypass grafting: management of patent grafts for myocardial protection.

PubMed

Nakajima, Masato; Tsuchiya, Koji; Fukuda, Shoji; Morimoto, Hironobu; Mitsumori, Yoshitaka; Kato, Kaori

2006-04-01

Aortic surgery for progressive aortic valve disease or aortic aneurysm after previous coronary artery bypass grafting (CABG) is a challenging procedure. We report the outcome of aortic reoperation after previous CABG and evaluate our management of patent grafts and our methods for obtaining myocardial protection. From February 2001 to July 2003, 6 patients with progressive aortic valve disease and aneurysm of the thoracic aorta were operated on. The group comprised 3 men and 3 women with a mean age of 67.6 years. There were 4 patients with an aneurysm of the aortic arch, 1 with chronic ascending aortic dissection, and 1 with progressive aortic valve stenosis. The interval between previous CABG and aortic surgery was 74.0 +/- 44.2 months. All reoperations were performed via median resternotomy. Myocardial protection was obtained by hypothermic perfusion of patent in-situ arterial grafts following cold-blood cardioplegia administration via the aortic root under aortic cross clamping. The operative procedure was aortic arch replacement in 4 patients, ascending aortic replacement with double CABG in 1, and aortic valve replacement in 1. All patients survived the reoperation. Postoperative maximum creatine kinase-MB was 49.2 +/- 29.8 and no new Q-waves occurred in the electrocardiogram nor were any new wall motion abnormalities recognized on echocardiography. There were no late deaths during a follow-up of 30.7 months. Reoperative aortic procedures after CABG can be performed safely with myocardial protection via hypothermic perfusion of a patent in-situ arterial graft.

Technical review of SRT-CMA-930058 revalidation studies of Mark 16 experiments: J70

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

Reed, R.L.

1993-10-25

This study is a reperformance of a set of MGBS-TGAL criticality safety code validation calculations previously reported by Clark. The reperformance was needed because the records of the previous calculations could not be located in current APG files and records. As noted by the author, preliminary attempts to reproduce the Clark results by direct modeling in MGBS and TGAL were unsuccessful. Consultation with Clark indicated that the MGBS-TGAL (EXPT) option within the KOKO system should be used to set up the MGBS and TGAL input data records. The results of the study indicate that the technique used by Clark hasmore » been established and that the technique is now documented for future use. File records of the calculations have also been established in APG files. The review was performed per QAP 11--14 of 1Q34. Since the reviewer was involved in developing the procedural technique used for this study, this review can not be considered a fully independent review, but should be considered a verification that the document contains adequate information to allow a new user to perform similar calculations, a verification of the procedure by performing several calculations independently with identical results to the reported results, and a verification of the readability of the report.« less

Greater physician involvement improves coding outcomes in endobronchial ultrasound-guided transbronchial needle aspiration procedures.

PubMed

Pillai, Anilkumar; Medford, Andrew R L

2013-01-01

Correct coding is essential for accurate reimbursement for clinical activity. Published data confirm that significant aberrations in coding occur, leading to considerable financial inaccuracies especially in interventional procedures such as endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA). Previous data reported a 15% coding error for EBUS-TBNA in a U.K. service. We hypothesised that greater physician involvement with coders would reduce EBUS-TBNA coding errors and financial disparity. The study was done as a prospective cohort study in the tertiary EBUS-TBNA service in Bristol. 165 consecutive patients between October 2009 and March 2012 underwent EBUS-TBNA for evaluation of unexplained mediastinal adenopathy on computed tomography. The chief coder was prospectively electronically informed of all procedures and cross-checked on a prospective database and by Trust Informatics. Cost and coding analysis was performed using the 2010-2011 tariffs. All 165 procedures (100%) were coded correctly as verified by Trust Informatics. This compares favourably with the 14.4% coding inaccuracy rate for EBUS-TBNA in a previous U.K. prospective cohort study [odds ratio 201.1 (1.1-357.5), p = 0.006]. Projected income loss was GBP 40,000 per year in the previous study, compared to a GBP 492,195 income here with no coding-attributable loss in revenue. Greater physician engagement with coders prevents coding errors and financial losses which can be significant especially in interventional specialties. The intervention can be as cheap, quick and simple as a prospective email to the coding team with cross-checks by Trust Informatics and against a procedural database. We suggest that all specialties should engage more with their coders using such a simple intervention to prevent revenue losses. Copyright © 2013 S. Karger AG, Basel.

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.

PHENYLKETONURIA, DETECTION IN THE NEWBORN INFANT AS A ROUTINE HOSPITAL PROCEDURE.

ERIC Educational Resources Information Center

GUTHRIE, ROBERT; WHITNEY, STEWART

A FIELD TRIAL OF AN INHIBITION ASSAY METHOD FOR SCREENING FOR PHENYLKETONURIA (PKU) TESTED MORE THAN 400,000 NEWBORN INFANTS PRIOR TO DISCHARGE FROM THE HOSPTIAL. IN ALL, 39 CASES WERE FOUND, A HIGHER INCIDENCE THAN HAD PREVIOUSLY BEEN EXPECTED. THE PRACTICALITY OF THE INHIBITION ASSAY METHOD WAS ALSO DEMONSTRATED. THE REPORT DETAILS THE TRIAL'S…

Methodological Considerations in On-Line Contingent Research and Implications for Learning. Technical Report.

ERIC Educational Resources Information Center

Whittington, Marna C.

Methods for the implementation of on-line contingent research are described in this study. In a contingent experimentation procedure, the content of successive experimental trials is a function of a subject's responses to a previous trial or trials (in contrast to traditional experimentation in which the subject is presented a previously…

Attachment between Infants and Mothers in China: Strange Situation Procedure Findings to Date and a New Sample

ERIC Educational Resources Information Center

Archer, Marc; Steele, Miriam; Lan, Jijun; Jin, Xiaochun; Herreros, Francisca; Steele, Howard

2015-01-01

The first distribution of Chinese infant-mother (n = 61) attachment classifications categorised by trained and reliability-tested coders is reported with statistical comparisons to US norms and previous Chinese distributions. Three-way distribution was 15% insecure-avoidant, 62% secure, 13% insecure-resistant, and 4-way distribution was 13%…

Herpes simplex encephalitis as a complication of neurosurgical procedures: report of 3 cases and review of the literature.

PubMed

Jaques, David A; Bagetakou, Spyridoula; L'Huillier, Arnaud G; Bartoli, Andrea; Vargas, Maria-Isabel; Fluss, Joel; Kaiser, Laurent

2016-05-23

Herpes simplex virus (HSV) is the most common identified cause of focal encephalitis worldwide. However, postoperative HSV encephalitis (HSVE) is a rare complication of neurosurgical procedures and a significant clinical challenge We describe 3 cases of postoperative HSVE and review all published reports. A total of 23 cases were identified. Clinical heterogeneity represents a diagnostic challenge in the postoperative setting. Cerebral magnetic resonance imaging showed typical findings in a minority of patients only, whereas HSV-specific polymerase chain reaction on the cerebrospinal fluid proved to be a valuable test. The postoperative viral pathophysiology remains a subject of debate. The rate of adverse outcome is high and early antiviral treatment seems to be a strong predictor of clinical outcome. We recommend early empirical treatment for any patient presenting with post-neurosurgical lymphocytic meningo-encephalitis, and prophylactic antiviral treatment for patients with a history of previous HSVE who will undergo a neurosurgical procedure.

Use of a powered shaver to remove multiple oral cavity papillomas.

PubMed

Miller, Robert Sean; Tami, Thomas A

2005-05-01

We report a previously undescribed method of removing multiple oral papillomas, which we performed on 5 men with human immunodeficiency virus (HIV) infection. Patients were brought to the operating room and placed under general anesthesia. In addition, 1% lidocaine with 1:100,000 epinephrine was injected under and around the lesions. We then removed the lesions with a Tricut laryngeal blade attached to a handheld powered shaver Postoperatively, patients were sent home on clindamycin, a pain medication, and Peridex. At the 1-week follow-up, patients reported only minimal pain, and their wounds were well healed. We observed no adverse events associated with the shaving procedure. Our method expedites the process of removing multiple oral cavity papillomas while reducing the morbidity generally associated with other procedures.

Selective Embolization of Systemic Collaterals for the Treatment of Recurrent Hemoptysis Secondary to the Unilateral Absence of a Pulmonary Artery in a Child

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

Zhou, Yin, E-mail: zhouyin502@163.com; Tsauo, Jiaywei, E-mail: 80732059@qq.com; Li, Yuan, E-mail: liyuanletters@163.com

The unilateral absence of the pulmonary artery (UAPA) is a rare anomaly. Hemoptysis due to systemic collaterals is one of the most common complications of UAPA. To the best of the authors’ knowledge, the utility of selective embolization for the treatment of this condition in children has not been reported previously. This report describes a 6-year-old girl with isolated UAPA (IUAPA) admitted for a 10-month history of recurrent hemoptysis that had worsened during the previous 2 months. Selective embolization of the bronchial systemic collaterals was performed. The patient remained asymptomatic with no recurrence of hemoptysis 8 months after the procedure.

Ipsilateral pedicled TRAM flaps: the safer alternative?

PubMed

Clugston, P A; Gingrass, M K; Azurin, D; Fisher, J; Maxwell, G P

2000-01-01

Transverse rectus abdominis myocutaneous (TRAM) flap breast reconstruction has become a commonly performed procedure in the 1990s. The original description of the procedure was that of an ipsilaterally based pedicle procedure. Concerns about potential folding of the pedicle with possible compromise of the vascular supply led many surgeons to prefer the contralateral pedicle. Subsequently, there have been several large clinical series of pedicled TRAM flaps showing a relatively high complication rate related to flap vascularity problems. Partial flap necrosis rates in pedicled TRAM series range from 5 to 44 percent. These findings resulted in many centers favoring free TRAM flap breast reconstruction, despite an increase in resource use and negligible differences in complication rates. Ipsilateral pedicle TRAM flap breast reconstruction is not a commonly reported procedure and is reserved for cases for which scars preclude use of the contralateral pedicle. Simplicity and versatility of flap shaping, improved maintenance of the inframammary fold, and lack of disruption of the natural xiphoid hollow give ipsilateral TRAM flaps further advantages. This study reports on a series of 252 consecutive ipsilateral TRAM flap reconstructions in 190 patients. The majority of patients underwent muscle-sparing procedures with preservation of a medial and a lateral strip of rectus muscle. Immediate reconstruction was done in 104 of the 190 patients. Skin-sparing (69 patients) or skin-reduction procedures (21 patients) were used in 90 of the 104 patients (87 percent) undergoing immediate reconstruction. Complication rates were comparable to those of series reported for contralateral TRAM flaps, except that partial flap necrosis (2.0 percent) was less in this series. Risk factors were analyzed with regard to the most common complications seen in this study. Ipsilateral TRAM flap breast reconstruction is our preferred method, if available, because we believe that it has several advantages over the contralateral pedicled TRAM and this report suggests a lower partial flap necrosis rate than previously reported.

Measurement of sub-parts-per-billion levels of carbonyl compounds in marine air by a simple cartridge trapping procedure followed by liquid chromatography

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

Xianliang, Zhou; Mopper, K.

1990-10-01

Carbonyl compounds in clean marine air were trapped onto 2,4-dinitrophenylhydrazine- (DNPH-) coated cartridges, and their hydrazone derivatives were separated by HPLC and detected by UV absorbance. More than 20 carbonyl compounds were isolated from marine air with >92% collection efficiency. The technique employs a highly effective reagent purification procedure, which results in much lower blanks compared to previously reported trapping techniques for carbonyl compounds. Blanks were routinely <0.07 ppb for formaldehyde and acetone and <0.02 ppb for the others. Humidity and reactive gases have no detectable effect on collection efficiencies. Carbonyl-DNPH derivatives eluted from the cartridges are stable in acetonitrilemore » for at least 2 weeks, which facilitates field studies. Several previously undetected unknown carbonyl compounds were found in marine air by this technique. Typical results for open ocean and coastal marine air are shown.« less

Comparison of 808, 980, and 1075nm lasers for noninvasive thermal coagulation of the canine vas deferens, ex vivo

NASA Astrophysics Data System (ADS)

Cilip, Christopher M.; Schweinsberger, Gino R.; Fried, Nathaniel M.

2011-03-01

Successful noninvasive laser coagulation of the canine vas deferens, in vivo, has been previously reported. However, the therapeutic window for treatment is relatively narrow. This study determines the dependence of vas thermal coagulation on laser wavelength for development of a noninvasive laser vasectomy procedure. Noninvasive laser coagulation of canine vas tissue, ex vivo, was performed using three commonly available near-infrared laser wavelengths: 808, 980, and 1075 nm. Each laser delivered an average power of 9.2 W, 500-ms pulse duration, pulse rate of 1.0-Hz, and 3.2-mm diameter laser spot, synchronized with cryogen spray cooling of the scrotal skin surface for a total treatment time of 60 s. Vas burst pressures were measured to determine strength of vas closure and compared to previously reported ejaculation pressures. Gross inspection of vas and scrotal skin was also performed immediately after the procedure as an indicator of thermal coagulation and skin burns. The 1075 nm laser produced the highest vas burst pressures (288 +/- 28 mmHg), significantly greater than previously reported ejaculation pressures (136 +/- 29 mmHg). The 808 nm wavelength produced insufficient vas burst pressures of 141 +/- 61 mmHg, and minor scrotal skin burns were observed in at least one case. The 980 nm wavelength was unable to produce thermal coagulation of the vas, with low burst pressures (89 +/- 58 mmHg) and severe scrotal skin burns. The 1075 nm wavelength was the only near-IR wavelength that consistently thermally coagulated the vas with a strong degree of closure and without any scrotal skin burns.

Primary telangiectatic osteosarcoma of occipital bone: a case report and review of literature.

PubMed

Patibandla, Mohana Rao; Uppin, Shantveer G; Thotakura, Amit Kumar; Panigrahi, Manas K; Challa, Sundaram

2011-01-01

Telangiectatic osteosarcoma (TOS), an uncommon variant of osteosarcoma, involving skull bones is extremely rare. We present clinico-pathological, imageological and treatment outcome of a primary TOS of occipital bone in a 30-year-old woman and review the previously reported skull bone TOS. We suggest that TOS should be included in the differential diagnosis of destructive lytic lesions involving the skull bones. As radical surgical procedures are not applicable to skull bones, the outcome is poor even with adjuvant chemotherapy.

A Procedure for the supercritical fluid extraction of coal samples, with subsequent analysis of extracted hydrocarbons

USGS Publications Warehouse

Kolak, Jonathan J.

2006-01-01

Introduction: This report provides a detailed, step-by-step procedure for conducting extractions with supercritical carbon dioxide (CO2) using the ISCO SFX220 supercritical fluid extraction system. Protocols for the subsequent separation and analysis of extracted hydrocarbons are also included in this report. These procedures were developed under the auspices of the project 'Assessment of Geologic Reservoirs for Carbon Dioxide Sequestration' (see http://pubs.usgs.gov/fs/fs026-03/fs026-03.pdf) to investigate possible environmental ramifications associated with CO2 storage (sequestration) in geologic reservoirs, such as deep (~1 km below land surface) coal beds. Supercritical CO2 has been used previously to extract contaminants from geologic matrices. Pressure-temperature conditions within deep coal beds may render CO2 supercritical. In this context, the ability of supercritical CO2 to extract contaminants from geologic materials may serve to mobilize noxious compounds from coal, possibly complicating storage efforts. There currently exists little information on the physicochemical interactions between supercritical CO2 and coal in this setting. The procedures described herein were developed to improve the understanding of these interactions and provide insight into the fate of CO2 and contaminants during simulated CO2 injections.

Preliminary experience with dexmedetomidine for monitored anesthesia care during ENT surgical procedures.

PubMed

Busick, Tamra; Kussman, Mary; Scheidt, Troy; Tobias, Joseph D

2008-01-01

Dexmedetomidine is an alpha2-adrenergic agonist that produces anxiolysis, amnesia, sedation, potentiation of opioid analgesia, and sympatholysis. It is currently approved by the U.S. Food & Drug Administration for the sedation of adults in the intensive care setting for up to 24 hours during mechanical ventilation. Given its beneficial sedative and anxiolytic properties and limited adverse effect profile, it has been used in several other clinical scenarios. The authors present their experience using dexmedetomidine for monitored anesthesia care (MAC) during "awake" ENT procedures such as thyroplasty, a procedure requiring a patient to verbalize when requested but to otherwise remain immobile to allow for completion of the procedure, and in a patient with post-polio syndrome with poor pulmonary reserve requiring esophagoscopy with dilation and botulinum toxin injection for cricopharyngeal dysfunction. Our preliminary experience suggests that dexmedetomidine provides effective sedation as the primary agent for MAC during such procedures in adult patients. The end-organ effects of dexmedetomidine and previous reports of its use during MAC are reviewed.

AM2 Brickwork Pattern Evaluation

DTIC Science & Technology

2016-12-01

pavement applications. Designation : D 6951. West Consho- hocken, PA: ASTM International. ASTM International. 2010a. Standard test method for in-place... design . This report provides test results for each evaluation and discussions comparing their perfor- mance to previous tests conducted under similar... designated by other authorized documents. DESTRUCTION NOTICE - For classified documents, follow the procedures in DOD5200.22-M, Industrial Security Manual

Analytical procedures for estimating structural response to acoustic fields generated by advanced launch systems, phase 2

NASA Technical Reports Server (NTRS)

Elishakoff, Isaac; Lin, Y. K.; Zhu, Li-Ping; Fang, Jian-Jie; Cai, G. Q.

1994-01-01

This report supplements a previous report of the same title submitted in June, 1992. It summarizes additional analytical techniques which have been developed for predicting the response of linear and nonlinear structures to noise excitations generated by large propulsion power plants. The report is divided into nine chapters. The first two deal with incomplete knowledge of boundary conditions of engineering structures. The incomplete knowledge is characterized by a convex set, and its diagnosis is formulated as a multi-hypothesis discrete decision-making algorithm with attendant criteria of adaptive termination.

Warthin tumor presenting as a fungal abscess in an immunocompetent host: case report and review of the literature.

PubMed

Leibowitz, Jason M; Montone, Kathleen T; Basu, Devraj

2010-01-01

Fungal abscesses of the parotid gland are rare, and cases arising within parotid neoplasms have not been described previously. This report conveys our experience managing such an entity, which is further distinguished by its occurrence in an immunocompetent host. A 59-year-old man experienced multiple recurrences of a parotid fungal abscess requiring repeated drainage procedures. Definitive excision ultimately demonstrated Candida glabrata infecting a Warthin tumor. This case is the first report of a parotid neoplasm presenting as a fungal abscess. It contributes to the scant literature on fungal abscesses of the parotid, which previously has only been described in debilitated hosts and without an associated neoplasm. The case also expands the spectrum of disease associated with C. glabrata. Warthin tumor may be an occult etiology for a parotid fungal abscess, and definitive diagnosis and therapy may require parotidectomy.

Accelerated Return to Sport After Osteochondral Autograft Plug Transfer

PubMed Central

Werner, Brian C.; Cosgrove, Chris T.; Gilmore, C. Jan; Lyons, Matthew L.; Miller, Mark D.; Brockmeier, Stephen F.; Diduch, David R.

2017-01-01

Background: Previous studies have reported varying return-to-sport protocols after knee cartilage restoration procedures. Purpose: To (1) evaluate the time for return to sport in athletes with an isolated chondral injury who underwent an accelerated return-to-sport protocol after osteochondral autograft plug transfer (OAT) and (2) evaluate clinical outcomes to assess for any consequences from the accelerated return to sport. Study Design: Case series; Level of evidence, 4. Methods: An institutional cohort of 152 OAT procedures was reviewed, of which 20 competitive athletes met inclusion and exclusion criteria. All patients underwent a physician-directed accelerated rehabilitation program after their procedure. Return to sport was determined for all athletes. Clinical outcomes were assessed using International Knee Documentation Committee (IKDC) and Tegner scores as well as assessment of level of participation on return to sport. Results: Return-to-sport data were available for all 20 athletes; 13 of 20 athletes (65%) were available for clinical evaluation at a mean 4.4-year follow-up. The mean time for return to sport for all 20 athletes was 82.9 ± 25 days (range, 38-134 days). All athletes were able to return to sport at their previous level and reported that they were satisfied or very satisfied with their surgical outcome and ability to return to sport. The mean postoperative IKDC score was 84.5 ± 9.5. The mean Tegner score prior to injury was 8.9 ± 1.7; it was 7.7 ± 1.9 at final follow-up. Conclusion: Competitive athletes with traumatic chondral defects treated with OAT managed using this protocol had reduced time to preinjury activity levels compared with what is currently reported, with excellent clinical outcomes and no serious long-term sequelae. PMID:28451623

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

PubMed

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

2015-01-01

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

Fat embolism syndrome following percutaneous vertebroplasty: a case report.

PubMed

Ahmadzai, Hasib; Campbell, Scott; Archis, Constantine; Clark, William A

2014-04-01

Vertebroplasty is commonly performed for management of pain associated with vertebral compression fractures. There have been two previous reports of fatal fat embolism following vertebroplasty. Here we describe a case of fat embolism syndrome following this procedure, and also provide fluoroscopic video evidence consistent with this occurrence. The purpose of this study was to review the literature and report a case of fat embolism syndrome in a patient who underwent percutaneous vertebroplasty for compression fracture. The study design for this manuscript was of a clinical case report. A 68-year-old woman who developed sudden back pain with minimal trauma was found to have a T6 vertebral compression fracture on radiographs and bone scans. Percutaneous vertebroplasty of T5 and T6 was performed. Fluoroscopic imaging during the procedure demonstrated compression and rarefaction of the fractured vertebra associated with changes in intrathoracic pressure. Immediately after the procedure, the patient's back pain resolved and she was discharged home. Two days later, she developed increasing respiratory distress, confusion, and chest pain. A petechial rash on her upper arms also appeared. No evidence of bone cement leakage or pulmonary filling defects were seen on computed tomography-pulmonary angiography. Brain magnetic resonance imaging demonstrated hyperintensities in the periventricular and subcortical white matter on T2/fluid-attenuated inversion recovery sequences. A diagnosis of fat embolism syndrome was made, and the patient recovered with conservative management. Percutaneous vertebroplasty is a relatively safe and simple procedure, reducing pain and improving functional limitations in patients with vertebral fractures. This case demonstrates an uncommon yet serious complication of fat embolism syndrome. Clinicians must be aware of this complication when explaining the procedure to patients and provide prompt supportive care when it does occur. Copyright © 2014 Elsevier Inc. All rights reserved.

The 2012 SAGE wait times program: Survey of Access to GastroEnterology in Canada

PubMed Central

Leddin, Desmond; Armstrong, David; Borgaonkar, Mark; Bridges, Ronald J; Fallone, Carlo A; Telford, Jennifer J; Chen, Ying; Colacino, Palma; Sinclair, Paul

2013-01-01

BACKGROUND: Periodically surveying wait times for specialist health services in Canada captures current data and enables comparisons with previous surveys to identify changes over time. METHODS: During one week in April 2012, Canadian gastroenterologists were asked to complete a questionnaire (online or by fax) recording demographics, reason for referral, and dates of referral and specialist visits for at least 10 consecutive new patients (five consultations and five procedures) who had not been seen previously for the same indication. Wait times were determined for 18 indications and compared with those from similar surveys conducted in 2008 and 2005. RESULTS: Data regarding adult patients were provided by 173 gastroenterologists for 1374 consultations, 540 procedures and 293 same-day consultations and procedures. Nationally, the median wait times were 92 days (95% CI 85 days to 100 days) from referral to consultation, 55 days (95% CI 50 days to 61 days) from consultation to procedure and 155 days (95% CI 142 days to 175 days) (total) from referral to procedure. Overall, wait times were longer in 2012 than in 2005 (P<0.05); the wait time to same-day consultation and procedure was shorter in 2012 than in 2008 (78 days versus 101 days; P<0.05), but continued to be longer than in 2005 (P<0.05). The total wait time remained longest for screening colonoscopy, increasing from 201 days in 2008 to 279 days in 2012 (P<0.05). DISCUSSION: Wait times for gastroenterology services continue to exceed recommended targets, remain unchanged since 2008 and exceed wait times reported in 2005. PMID:23472243

An improved glycerin-jelly mounting procedure for permanent preparations of helminth eggs.

PubMed

Kumagai, M; Inaba, T; Makioka, A; Ishiwata, K; Onishi, K; Watanabe, N

2010-04-01

Many attempts have been undertaken to make permanent preparations of helminth eggs. However, the resulting preparations either lacked durability or tended to deform thin-shelled eggs, such as those of the hookworm. To overcome these drawbacks, we have modified 2 aspects of the glycerin-jelly mounting procedure. First, we gradually changed the media in which the helminth eggs soaked, from 10% formalin via water to a 70% ethanol and 5% glycerin solution. It took 10 days, which is much longer than the time required for the processes previously reported. Second, we used a hole slide glass instead of a slide glass. Eggs of 11 species of helminths have been prepared with this procedure, and have kept their morphology without apparent change for more than 4 yr.

Percutaneous pulmonary and tricuspid valve implantations: An update

PubMed Central

Wagner, Robert; Daehnert, Ingo; Lurz, Philipp

2015-01-01

The field of percutaneous valvular interventions is one of the most exciting and rapidly developing within interventional cardiology. Percutaneous procedures focusing on aortic and mitral valve replacement or interventional treatment as well as techniques of percutaneous pulmonary valve implantation have already reached worldwide clinical acceptance and routine interventional procedure status. Although techniques of percutaneous pulmonary valve implantation have been described just a decade ago, two stent-mounted complementary devices were successfully introduced and more than 3000 of these procedures have been performed worldwide. In contrast, percutaneous treatment of tricuspid valve dysfunction is still evolving on a much earlier level and has so far not reached routine interventional procedure status. Taking into account that an “interdisciplinary challenging”, heterogeneous population of patients previously treated by corrective, semi-corrective or palliative surgical procedures is growing inexorably, there is a rapidly increasing need of treatment options besides redo-surgery. Therefore, the review intends to reflect on clinical expansion of percutaneous pulmonary and tricuspid valve procedures, to update on current devices, to discuss indications and patient selection criteria, to report on clinical results and finally to consider future directions. PMID:25914786

Feasibility and safety of general anesthesia for bronchial thermoplasty: a description of early 10 treatments.

PubMed

Aizawa, Mariko; Ishihara, Satoshi; Yokoyama, Takeshi; Katayama, Katsuyuki

2018-03-20

Bronchial thermoplasty (BT) is a recently introduced bronchoscopic treatment for patients with asthma refractory to pharmacotherapy. Intraprocedural sedation management is important for successful performance of BT. However, the results of general anesthesia in patients undergoing BT have not been well described. The aim of this study was to evaluate the feasibility and safety of general anesthesia in patients undergoing BT. We retrospectively reviewed the records of 10 consecutive BT treatments performed under general anesthesia in 4 patients. The feasibility outcomes were coughing and body movement during the procedure, procedure abandonment, and the relative frequency of thermal activation failure. The safety outcomes were bronchospasm and hypoxemia during the procedure, respiratory symptoms, and the need for oxygen after the procedure. Coughing occurred in two treatments. Neither body movement nor procedure abandonment occurred in any treatments. Neither intraprocedural bronchospasm nor hypoxemia occurred in any treatments. Respiratory symptoms occurred in 7 of 10 treatments within 1 day after the procedure and resolved within 4 days, which is comparable with a previous report. These results indicate that general anesthesia is feasible and safe for patients undergoing BT.

Robot-Assisted Medial Compartment Arthroplasty Following Remote Patellectomy: A Case Report

PubMed Central

Kouk, Shalen; Kalbian, Irene; Wolfe, Elizabeth; Strickland, Sabrina M

2018-01-01

Introduction: Total patellectomies are uncommon procedures that are reserved as salvage treatment for severely comminuted fractures of the patella. Due to the alteration of normal joint mechanics, these patients present later on in life with degenerative cartilage damage to the femorotibial joint and altered extensor mechanism. There are very few reports of unicondylar knee arthroplasties following previous patellectomy and none that specifically address robot-assisted unicompartmental knee arthroplasty. A recent case report by Pang et al. described the use of minimally invasive fixed-bearing unicondylar knee arthroplasty in a patellectomized patient with moderate medial compartment osteoarthritis. Our report details a case with more significant chondral loss along with patellar tendon subluxation. Case Report: This is a case report of a patient with severe medial compartment osteoarthritis after a patellectomy following a motor vehicle collision. After failing conservative treatment, the patient underwent a medial MAKOplasty with complete resolution of arthritic pain. Conclusion: Significant pain relief and improved knee function can be achieved with MAKOPlasty partial knee resurfacing system in a previously patellectomized patient with severe medial compartment osteoarthritis. PMID:29854684

Anaesthetic efficacy of articaine versus lidocaine in children's dentistry: a systematic review and meta-analysis.

PubMed

Tong, Huei Jinn; Alzahrani, Fatma Salem; Sim, Yu Fan; Tahmassebi, Jinous F; Duggal, Monty

2018-04-10

Over the last few years, numerous reviews and studies have awarded articaine hydrochloride local anaesthetic (LA) a superior reputation, with outcomes of different studies demonstrating a general tendency for articaine hydrochloride to outperform lidocaine hydrochloride for dental treatment. Nevertheless, there seems to be no clear agreement on which LA solution is more efficacious in dental treatment for children. There is no previous publication systematically reviewing and summarising the current best evidence with respect to the success rates of LA solutions in children. To evaluate the available evidence on the efficacy of lidocaine and articaine, used in paediatric dentistry. A systematic search was conducted on Cochrane CENTRAL Register of Controlled Trials, MEDLINE (OVID; 1950 to June 2017), Cumulative Index to Nursing and Allied Health Literature (CINAHL; EBSCOhost; 1982 to June 2017), EMBASE (OVID; 1980 to June 2017), SCI-EXPANDED (ISI Web of Knowledge; 1900 to June 2017), key journals, and previous review bibliographies through June 2017. Original research studies that compared articaine with lidocaine for dental treatment in children were included. Methodological quality assessment and assessment of risk of bias were carried out for each of the included studies. Electronic searching identified 525 publications. Following the primary and secondary assessment process, six randomised controlled trials (RCT) were included in the final analysis. There was no difference between patient self-reported pain between articaine and lidocaine during treatment procedures (SMD = 0.06, P-value = 0.614), and no difference in the occurrence of adverse events between articaine and lidocaine injections following treatment in paediatric patients (RR = 1.10, P-value = 0.863). Yet, patients reported significantly less pain post-procedure following articaine injections (SMD = 0.37, P-value = 0.013). Substantial heterogeneity was noted in the reporting of outcomes among studies, with the overall quality of majority of studies being at high risk of bias. There is low quality evidence suggesting that both articaine as infiltration and lidocaine IAD nerve blocks presented the same efficacy when used for routine dental treatments, with no difference between patient self-reported pain between articaine and lidocaine during treatment procedures. Yet, significantly less pain post-procedure was reported following articaine injections. There was no difference in the occurrence of adverse events between articaine and lidocaine injections following treatment in paediatric patients. © 2018 BSPD, IAPD and John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Prospective clinical observational study evaluating gender-associated differences of preoperative pain intensity.

PubMed

Tafelski, Sascha; Kerper, Léonie F; Salz, Anna-Lena; Spies, Claudia; Reuter, Eva; Nachtigall, Irit; Schäfer, Michael; Krannich, Alexander; Krampe, Henning

2016-07-01

Previous studies reported conflicting results concerning different pain perceptions of men and women. Recent research found higher pain levels in men after major surgery, contrasted by women after minor procedures. This trial investigates differences in self-reported preoperative pain intensity between genders before surgery.Patients were enrolled in 2011 and 2012 presenting for preoperative evaluation at the anesthesiological assessment clinic at Charité University hospital. Out of 5102 patients completing a computer-assisted self-assessment, 3042 surgical patients with any preoperative pain were included into this prospective observational clinical study. Preoperative pain intensity (0-100 VAS, visual analog scale) was evaluated integrating psychological cofactors into analysis.Women reported higher preoperative pain intensity than men with median VAS scores of 30 (25th-75th percentiles: 10-52) versus 21 (10-46) (P < 0.001). Adjusted multiple regression analysis showed that female gender remained statistically significantly associated with higher pain intensity (P < 0.001). Gender differences were consistent across several subgroups especially with varying patterns in elderly. Women scheduled for minor and moderate surgical procedures showed largest differences in overall pain compared to men.This large clinical study observed significantly higher preoperative pain intensity in female surgical patients. This gender difference was larger in the elderly potentially contradicting the current hypothesis of a primary sex-hormone derived effect. The observed variability in specific patient subgroups may help to explain heterogeneous findings of previous studies.

A review of ride comfort studies in the United Kingdom

NASA Technical Reports Server (NTRS)

Griffin, M. J.

1975-01-01

United Kingdom research which is relevant to the assessment of vehicle ride comfort was reviewed. The findings reported in approximately 80 research papers are outlined, and an index to the areas of application of these studies is provided. The data obtained by different research groups are compared, and it is concluded that, while there are some areas of general agreement, the findings obtained from previous United Kingdom research are insufficient to define a general purpose ride comfort evaluation procedure. The degree to which United Kingdom research supports the vibration evaluation procedure defined in the current International Standard on the evaluation of human exposure to whole-body vibration is discussed.

A neurological complication of inferior petrosal sinus sampling during investigation for Cushing's disease: a case report.

PubMed

Sturrock, N D; Jeffcoate, W J

1997-05-01

A 45 year old woman with hirsutism was found to have classic biochemical features of ACTH dependent Cushing's disease, with partial cortisol suppression in response to dexamethasone. As no pituitary adenoma could be visualised by CT or MRI, she proceeded to bilateral simultaneous inferior petrosal sinus sampling before possible surgery. During the course of this procedure she had a stroke affecting the brainstem at the level of the pontocerebellar junction. This complication of petrosal sinus sampling has been previously described but is not widely recognised; the procedure should only be undertaken when results of less invasive tests are equivocal.

Extending the limits of complex learning in organic amnesia: computer training in a vocational domain.

PubMed

Glisky, E L; Schacter, D L

1989-01-01

This study explored the limits of learning that could be achieved by an amnesic patient in a complex real-world domain. Using a cuing procedure known as the method of vanishing cues, a severely amnesic encephalitic patient was taught over 250 discrete pieces of new information concerning the rules and procedures for performing a task involving data entry into a computer. Subsequently, she was able to use this acquired knowledge to perform the task accurately and efficiently in the workplace. These results suggest that amnesic patients' preserved learning abilities can be extended well beyond what has been reported previously.

Cracking a tricuspid perimount bioprosthesis to optimize a second transcatheter sapien valve-in-valve placement.

PubMed

Brown, Stephen C; Cools, Bjorn; Gewillig, Marc

2016-09-01

Bioprosthetic valves degenerate over time. Transcatheter valve-in-valve procedures have become an attractive alternative to surgery. However, every valve increasingly diminishes the diameter of the valvar orifice. We report a 12-year-old female who had a previous transcatheter tricuspid valve-in-valve procedure; cracking the ring of a Carpentier Edwards Perimount valve by means of an ultrahigh pressure balloon allowed implantation of a further larger percutaneous valve. The advantage of this novel approach permits enlarging the inner valve diameter and may facilitate future interventions and prolong time to surgery. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

Limited experience, high body mass index and previous urethral surgery are risk factors for failure in open urethroplasty due to penile strictures.

PubMed

Ekerhult, Teresa O; Lindqvist, Klas; Peeker, Ralph; Grenabo, Lars

2015-01-01

The aim of this study was to evaluate outcomes and possible risk factors for failure of open urethroplasty due to penile urethral strictures. A retrospective chart review was undertaken of 90 patients with penile stricture undergoing 109 open urethroplasties between 2000 and 2011. In 80 urethroplasties, a one-stage procedure was performed: 68 of these had a pediculated penile skin flap, nine had a free buccal mucosal graft and three had a free skin graft. A two-stage procedure using buccal mucosa was performed in 29 urethroplasties. Failure was defined as when further urethral instrumentation was needed. The mean age in the one-stage and two-stage groups were 50 and 54 years, respectively. The success rates in the corresponding groups were 65% and 72%, with follow-up times of 63 and 40 months, respectively. Multivariable analyses disclosed body mass index (BMI) and previous urethral surgery to be significant risk factors for failure in the one-stage group. Failure over time significantly decreased during the study period. Both one- and two-stage penile urethroplasty demonstrated success rates in line with previous reports. Limited experience, high BMI and previous urethral surgery appear to be associated with less favourable outcome.

Local bone graft harvesting and volumes in posterolateral lumbar fusion: a technical report.

PubMed

Carragee, Eugene J; Comer, Garet C; Smith, Micah W

2011-06-01

In lumbar surgery, local bone graft is often harvested and used in posterolateral fusion procedures. The volume of local bone graft available for posterolateral fusion has not been determined in North American patients. Some authors have described this as minimal, but others have suggested the volume was sufficient to be reliably used as a stand-alone bone graft substitute for single-level fusion. To describe the technique used and determine the volume of local bone graft available in a cohort of patients undergoing single-level primary posterolateral fusion by the authors harvesting technique. Technical description and cohort report. Consecutive patients undergoing lumbar posterolateral fusion with or without instrumentation for degenerative processes. Local bone graft volume. Consecutive patients undergoing lumbar posterolateral fusion with or without instrumentation for degenerative processes of were studied. Local bone graft was harvested by a standard method in each patient and the volume measured by a standard procedure. Twenty-five patients were studied, and of these 11 (44%) had a previous decompression. The mean volume of local bone graft harvested was measured to be 25 cc (range, 12-36 cc). Local bone graft was augmented by iliac crest bone in six of 25 patients (24%) if the posterolateral fusion bed was not well packed with local bone alone. There was a trend to greater local bone graft volumes in men and in patients without previous decompression. Large volumes of local bone can be harvested during posterolateral lumbar fusion surgery. Even in patients with previous decompression the volume harvested is similar to that reported harvested from the posterior iliac crest for single-level fusion. Copyright © 2011 Elsevier Inc. All rights reserved.

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

Hagen, E.W.

This report reviews and evaluates the performance of the compressed-air and pressurized-nitrogen gas systems in commercial nuclear power units. The information was collected from readily available operating experiences, licensee event reports, system designs in safety analysis reports, and regulatory documents. The results are collated and analyzed for significance and impact on power plant safety performance. Under certain circumstances, the fail-safe philosophy for a piece of equipment or subsystem of the compressed-air systems initiated a series of actions culminating in reactor transient or unit scram. However, based on this study of prevailing operating experiences, reclassifying the compressed-gas systems to a highermore » safety level will neither prevent (nor mitigate) the reoccurrences of such happenings nor alleviate nuclear power plant problems caused by inadequate maintenance, operating procedures, and/or practices. Conversely, because most of the problems were derived from the sources listed previously, upgrading of both maintenance and operating procedures will not only result in substantial improvement in the performance and availability of the compressed-air (and backup nitrogen) systems but in improved overall plant performance.« less

Use of Cryoablation and Osteoplasty Reinforced with Kirschner Wires in the Treatment of Femoral Metastasis

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

Abdel-Aal, Ahmed Kamel, E-mail: akamel@uabmc.edu; Underwood, Edgar S.; Saddekni, Souheil

2012-10-15

Purpose: We report the case of a 43-year-old man with metastatic breast carcinoma to the proximal right femur resulting in severe painful pathological fracture. The patient experienced severe pain despite large doses of analgesia, resulting in impaired functionality and quality of life. The patient had significant comorbidities, making him a high surgical risk. Materials and Methods: The patient was treated with cryoablation and osteoplasty, followed by a novel technique consisting of osteoplasty reinforced with bone marrow Kirschner wires (K-wires) which will be described in details in this report. Results: The patient reported significant pain relief after the procedure, and gainedmore » right lower extremity functionality, as compared to total immobility before the procedure. Conclusion: Our technique offers an alternative feasible treatment for patients at high surgical risk with pathological fractures in weight-bearing bones, in which osteoplasty alone has a high risk of cement leakage, inadequate fracture reduction, and early refracture. To our knowledge, our technique has not been previously described.« less

Fibrosarcoma of the nose and the paranasal sinuses.

PubMed

Olekszyk, J; Siliunas, V; Mauer, T; Biondi, R

1989-07-01

We report a case of fibrosarcoma of the nose and paranasal sinuses and give a brief review of the literature. Fibrosarcoma of the nose and paranasal sinuses is uncommon, and few cases have been reported to date. Previously these tumors may have been overdiagnosed secondary to inadequate diagnostic procedures. Because histologic diagnosis is difficult, these tumors have been confused with other lesions of the head and neck. Thus, the improvement in diagnostic procedures has significantly reduced the reported incidence of fibrosarcoma. Because histologic diagnosis is difficult, this tumor has often been confused with other lesions of the head and neck. To ensure proper handling of the tissue, the pathologist should be informed if fibrosarcoma is suspected. It may be necessary to use electron microscopy or staining techniques such as immunoperoxidase stains to distinguish fibrosarcoma from other lesions. Unfortunately, the early signs and symptoms of the tumor are vague and sometimes misleading. Thus, at the patient's initial visit, it is important that the physician consider the possibility of fibrosarcoma.

Scaling of Two-Phase Flows to Partial-Earth Gravity

NASA Technical Reports Server (NTRS)

Hurlbert, Kathryn M.; Witte, Larry C.

2003-01-01

A report presents a method of scaling, to partial-Earth gravity, of parameters that describe pressure drops and other characteristics of two-phase (liquid/ vapor) flows. The development of the method was prompted by the need for a means of designing two-phase flow systems to operate on the Moon and on Mars, using fluid-properties and flow data from terrestrial two-phase-flow experiments, thus eliminating the need for partial-gravity testing. The report presents an explicit procedure for designing an Earth-based test bed that can provide hydrodynamic similarity with two-phase fluids flowing in partial-gravity systems. The procedure does not require prior knowledge of the flow regime (i.e., the spatial orientation of the phases). The method also provides for determination of pressure drops in two-phase partial-gravity flows by use of a generalization of the classical Moody chart (previously applicable to single-phase flow only). The report presents experimental data from Mars- and Moon-activity experiments that appear to demonstrate the validity of this method.

Department of Defense Systems Engineering FY 2012 Annual Report

DTIC Science & Technology

2013-03-01

by the Utility Helicopter PMO, is utilizing the latest Defense Acquisition Guidelines and previously approved PEO AVN SEP examples to develop all...efforts. As a whole, all of PEO AVN Program Management Offices understand the importance of systems engineering. They stress the continued use of...established SE guidelines, practices and procedures throughout our acquisition processes. PEO AVN , working with the AMRDEC SE Division, has

Unilateral cleft lip and palate: Simultaneous early repair of the nose, anterior palate and lip

PubMed Central

Laberge, Louise Caouette

2007-01-01

Unilateral cleft lip and palate is a defect involving the lip, nose and maxilla. These structures are inter-related, and simultaneous early correction of all the aspects of the defect is necessary to obtain a satisfactory result that will be maintained with growth. The surgical technique combining various procedures is presented and compared with previously published reports. PMID:19554125

Exchange and simple transfusion in sickle-cell diseases in pregnancy

PubMed Central

Buckle, A. E. R.; Price, T. M. L.; Whitmore, D. N.

1969-01-01

The management of sickle-cell crisis in a pregnant patient by exchange transfusion is described, the procedure leading to immediate and dramatic improvement in the condition. Partial exchange transfusion in three other patients with sickle-cell anaemia, judged by episodes of crisis in previous pregnancies to be at particular risk, is also reported and the value of this method of management discussed. PMID:5359314

Department of Defense Office of the Inspector General FY 2013 Audit Plan

DTIC Science & Technology

2012-11-01

oversight procedures to review KPMG LLPs work; and if applicable disclose instances where KPMG LLP does not comply, in all material respects, with U.S...decisions. Pervasive material internal control weaknesses impact the accuracy, reliability and timeliness of budgetary and accounting data and...reported the same 13 material internal control weaknesses as in the previous year. These pervasive and longstanding financial management challenges

THRESHOLD LOGIC.

DTIC Science & Technology

synthesis procedures; a ’best’ method is definitely established. (2) ’Symmetry Types for Threshold Logic’ is a tutorial expositon including a careful...development of the Goto-Takahasi self-dual type ideas. (3) ’Best Threshold Gate Decisions’ reports a comparison, on the 2470 7-argument threshold ...interpretation is shown best. (4) ’ Threshold Gate Networks’ reviews the previously discussed 2-algorithm in geometric terms, describes our FORTRAN

Rupture after Previous Endovascular Aneurysm Repair due to Type IA Endoleak: Complete Endograft Preservation Is Feasible with Proximal Suturing, Aortic Neck Banding, and Sac Plication.

PubMed

Karkos, Christos D; Mitka, Maria; Pliatsios, Ioannis; Xanthopoulou, Efthalia; Giagtzidis, Ioakeim T; Papadimitriou, Christina T; Papazoglou, Konstantinos O

2018-05-01

Rupture of an abdominal aortic aneurysm (AAA) after previous endovascular repair (EVAR) may require endograft explantation and replacement with a prosthetic surgical graft. Recent reports have suggested that total endograft removal during late surgical conversion in the nonruptured setting may not be necessary and that preserving functional parts of the endograft may improve results. Similar techniques may be used for ruptured cases diminishing the magnitude of an already difficult and complex procedure. We describe the successful treatment of a ruptured AAA after previous EVAR with complete endograft preservation by combining transmural endograft fixation with sutures, proximal aortic neck banding, and sac plication. Copyright © 2018 Elsevier Inc. All rights reserved.

Are all metal-on-metal hip revision operations contributing to the National Joint Registry implant survival curves? : a study comparing the London Implant Retrieval Centre and National Joint Registry datasets.

PubMed

Sabah, S A; Henckel, J; Koutsouris, S; Rajani, R; Hothi, H; Skinner, J A; Hart, A J

2016-01-01

The National Joint Registry for England, Wales and Northern Ireland (NJR) has extended its scope to report on hospital, surgeon and implant performance. Data linkage of the NJR to the London Implant Retrieval Centre (LIRC) has previously evaluated data quality for hip primary procedures, but did not assess revision records. We analysed metal-on-metal hip revision procedures performed between 2003 and 2013. A total of 69 929 revision procedures from the NJR and 929 revised pairs of components from the LIRC were included. We were able to link 716 (77.1%) revision procedures on the NJR to the LIRC. This meant that 213 (22.9%) revision procedures at the LIRC could not be identified on the NJR. We found that 349 (37.6%) explants at the LIRC completed the full linkage process to both NJR primary and revision databases. Data completion was excellent (> 99.9%) for revision procedures reported to the NJR. This study has shown that only approximately one third of retrieved components at the LIRC, contributed to survival curves on the NJR. We recommend prospective registry-retrieval linkage as a tool to feedback missing and erroneous data to the NJR and improve data quality. Prospective Registry - retrieval linkage is a simple tool to evaluate and improve data quality on the NJR. ©2016 Sabah et al.

A Review Over the Past 15 Years of the Management of the Internal Piriform Apex Sinus Tract of a Branchial Pouch Anomaly and Case Description.

PubMed

Josephson, Gary D; Black, Kaelan

2015-12-01

Literature review of treating the piriform apex sinus tract through microlaryngoscopy and a case description. Fourteen papers were identified in PubMed using the search criteria of piriform sinus fistula, microlaryngoscopic repair, and endoscopy. Institutional Review Board approval was obtained. One hundred forty-five cases including ours were available for review, with 182 procedures. Sixty-two cases were male, 73 female, and 10 genders were not reported. Multiple treatment options were used, including electrocautery, chemocautery, mass excision, fibrin glue, lasers, suture closure, or combination of stated modalities. Of the 182 procedures, 147 procedures were performed endoscopically. There were 37 recurrences (25%). These patients either underwent a repeat endoscopic procedure or an open excision. One hundred and ten (75%) endoscopic procedures were successful. Piriform sinus tract anomalies often present as a mass and recurrent neck infections. This review reveals that treating the internal piriform sinus opening alone can be successful. This procedure has low morbidity, short operative time, and high success. We advocate this approach first with a combined open/laryngoscopic approach for failed cases. To our knowledge, our technique of CO₂laser ablation of the tract followed by suture closure has not been previously described. We believe this to be the first comprehensive review of this topic and the largest series of cases included in a single report. © The Author(s) 2015.

Electromagnetic information transfer through aqueous system.

PubMed

Foletti, Alberto; Ledda, Mario; Lolli, Maria Grazia; Grimaldi, Settimio; Lisi, Antonella

2017-01-01

Several beneficial effects of the electromagnetic information transfer through aqueous system (EMITTAS) procedure have previously been reported in vitro. The clinical potential of this procedure has also started to be evaluated. Information flow in biological systems can be investigated through chemical and molecular approaches or by a biophysical approach focused on endogenous electrodynamic activities. Electromagnetic signals are endogenously generated at different levels of the biological organization and, likely, play an active role in synchronizing internal cell function or local/systemic adaptive response. Consequently, each adaptive response can be described by its specific electromagnetic pattern and, therefore, correlates with a unique and specific electromagnetic signature. A biophysical procedure synchronously integrating the EMITTAS procedure has already been applied for the treatment of articular pain, low-back pain, neck pain and mobility, fluctuating asymmetry, early-stage chronic kidney disease, refractory gynecological infections, minor anxiety and depression disorders. This clinical strategy involves a single treatment, since the EMITTAS procedure allows the patient to continue his/her own personal treatment at home by means of self-administration of the recorded aqueous system. A significant and long-lasting improvement has been reported, showing a potential beneficial use of this biophysical procedure in the management of common illnesses in an efficient, effective and personalized way. Data from recent studies suggest that aqueous systems may play a key role in providing the basis for recording, storing, transferring and retrieving clinically effective quanta of biological information. These features likely enable to trigger local and systemic self-regulation and self-regeneration potential of the organism.

Initial experience with hysteroscopic tubal occlusion (Essure®)

PubMed Central

Depes, Daniella De Batista; Pereira, Ana Maria Gomes; Lippi, Umberto Gazi; Martins, João Alfredo; Lopes, Reginaldo Guedes Coelho

2016-01-01

ABSTRACT Objective To evaluate results of early tubal occlusions performed by hysteroscopy (Essure®). Methods This prospective study included 38 patients, 73.7% of them were white, mean age 34.5 years, they have had on average 3 pregnancies and 2.7 of deliveries. A total of 86.8% of patients previously prepared the endometrium. All procedures were carried out at outpatient unit without anesthesia. Results Insertion rate of the device was 100% at a mean time of 4 minutes and 50 seconds. Based on the analogical visual scale, average pain reported was three, and 55.3% of women did not report pain after the procedure. After 3 months, 89.5% of patients were very satisfied with the method. Simple radiographs of the pelvis showed 92.1% of topical devices, and one case of unilateral expulsion had occurred. A four years follow-up did not show failure in the method. Conclusions Tubal occlusion through hysteroscopy at outpatient unit and without anesthesia was a quickly and well-tolerated procedure. No serious complications were seen, the success rate was high, and patients were satisfied. PMID:27462885

Coracoid bypass procedure: surgical technique for coracoclavicular reconstruction with coracoid insufficiency.

PubMed

Virk, Mandeep S; Lederman, Evan; Stevens, Christopher; Romeo, Anthony A

2017-04-01

Failed acromioclavicular (AC) joint reconstruction secondary to a coracoid fracture or insufficiency of the coracoid is an uncommon but challenging clinical situation. We describe a surgical technique of revision coracoclavicular (CC) reconstruction, the coracoid bypass procedure, and report short-term results with this technique in 3 patients. In the coracoid bypass procedure, reconstruction of the CC ligaments is performed by passing a tendon graft through a surgically created bone tunnel in the scapular body (inferior to the base of the coracoid) and then fixing the graft around the clavicle or through bone tunnels in the clavicle. Three patients treated with this technique were retrospectively reviewed. AC joint reconstruction performed for a traumatic AC joint separation failed in the 3 patients reported in this series. The previous procedures were an anatomic CC reconstruction in 2 patients and a modified Weaver-Dunn procedure in 1 patient. The coracoid fractures were detected postoperatively, and the mean interval from the index surgery to the coracoid bypass procedure was 8 months. The patients were a mean age of 44 years, and average follow-up was 21 months. At the last follow-up, all 3 patients were pain free, with full range of shoulder motion, preserved CC distance, and a stable AC joint. The coracoid bypass procedure is a treatment option for CC joint reconstruction during revision AC joint surgery in the setting of a coracoid fracture or coracoid insufficiency. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Endoscopic versus stereotactic procedure for pineal tumour biopsies: Comparative review of the literature and learning from a 25-year experience.

PubMed

Balossier, A; Blond, S; Touzet, G; Lefranc, M; de Saint-Denis, T; Maurage, C-A; Reyns, N

2015-01-01

Pineal tumours account for 1% to 4% of brain tumours in adults and for around 10% in children. Except in a few cases where germ cell markers are elevated, accurate histological samples are mandatory to initiate the treatment. Open surgery still has a high morbidity and is often needless. Biopsies can either be obtained by endoscopic or stereotactic procedures. Following an extensive review of the literature (PubMed 1970-2013; keywords pineal tumour, biopsy; English and French), 33 studies were analysed and relevant data compared regarding the type of procedure, diagnosis rate, cerebrospinal fluid diversion type and rate, perioperative mortality, morbidity. Endoscopic and stereotactic biopsies showed a diagnosis rate of 81.1% (20%-100%) and 93.7% (82%-100%), respectively. Endoscopic biopsies involved 21.0% of minor and 2.0% of major complications whereas stereotactic biopsies involved 6.4% of minor and 1.6% of major complications. The most frequently reported complication was haemorrhage for both endoscopic and stereotactic procedures, accounting for 4.8% and 4.3%, respectively. Mortality rate was low for both endoscopic and stereotactic procedures, equal to 0.4% and 1.3%, respectively. Local experience of stereotactic biopsies was also reported and corroborated the previous data. The difference between both procedures is not statistically significant (p>0.05) across large series (≥20patients). Nevertheless, tissue diagnosis appears less accurate with endoscopic procedures than with stereotactic procedures (81.1% versus 93.7%, weighted mean across all series). In our opinion, the neuroendoscopic approach is the best tool for managing hydrocephalus, whereas stereotactic biopsies remain the best way to obtain a tissue diagnosis with accuracy and low morbidity. Copyright © 2014. Published by Elsevier Masson SAS.

Inactivation of the Hutchinson strain of non-A, non-B hepatitis virus by combined use of beta-propiolactone and ultraviolet irradiation

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

Prince, A.M.; Stephan, W.; Dichtelmueller, H.B.

1985-06-01

A beta-propiolactone/ultraviolet irradiation procedure (beta PL/UV) has been evaluated for its ability to inactivate 30,000 chimpanzee infectious doses of the Hutchinson strain of non-A, non-B (NANB) virus. The chimpanzees were inoculated with plasma to which this dose of the titrated virus had been added prior to application of the beta PL/UV process in accordance with a procedure used for licensed blood derivatives in Germany. Neither animal developed hepatitis. When subsequently challenged with the same contaminated plasma, which had not been sterilized, both animals promptly developed typical NANB hepatitis. This study extends the high (approximately 10(7)-fold) process efficiency of the betamore » PL/UV procedure previously reported for hepatitis B virus to a blood-borne NANB virus.« less

Perioperative deaths: a further comparative review of coroner's autopsies with particular reference to the occurrence of fatal iatrogenic injury.

PubMed

Lau, G

2000-07-01

In previous triennial reviews of Coroner's perioperative autopsies conducted during the periods 1989 to 1991 and 1992 to 1994, it was observed that the necropsy incidence of such deaths rose from 2% to 2.6% (P < 0.05). Concurrently, the rate of iatrogenic deaths had nearly doubled from 15.2% to 28.8% (P < 0.02). These findings spurred a review of the subsequent triennium (1995 to 1997), in order to monitor the apparent rise in these trends and to study the frequency and occurrence of iatrogenic deaths in relation to the number of invasive procedures performed, as well as during emergency and elective procedures. A retrospective (descriptive and comparative) study, comprising a clinico-pathological review of a series of 270 perioperative deaths (defined as deaths occurring during or after invasive therapeutic or diagnostic procedures, up to a week after discharge, and excluding cases of major trauma from suicides, homicides, as well as road and industrial accidents) reported to the Coroner, for which autopsies were conducted at the Department of Forensic Medicine from 1995 to 1997. The necropsy incidence of 4.4% (270/6074) represented a significant rise over the previous triennia (P < 0.01). As in previous years, there was a predominance of males (M:F = 1.65:1) and middle-aged to elderly patients (range 0 to 92 years, mean 55.8 years, median 63 years), most of whom had died after a variable, but usually brief, postoperative interval [0 to 97, 4.2, 1 day(s)] and a more variable period of hospitalisation (< 1 to 289, 12.6, 7 days). A total of 408 invasive procedures were performed, amounting to an average of 1.5 per patient; 101 patients (37.4%) underwent multiple (> 1) interventions, which were initially classified as elective procedures in 27 cases. There were 66 (24.4%) iatrogenic deaths, of which 2 (0.7%) were due to anaesthetic mishaps; 18/64 iatrogenic deaths, unrelated to anaesthesia, occurred after the first postoperative day. The proportions of such deaths amongst patients subjected to multiple interventions, or initial elective procedures, were more than twice as high as amongst those undergoing single procedures, and those initially classified as emergencies (35.6% versus 16.6% and 33.3% versus 13.2%, respectively; P < 0.01). Only 51/66 (77.3%) iatrogenic deaths received Coroner's verdicts of misadventure; no verdict of criminal negligence was recorded during the period in question. There appears to have been a steady increase in the number of perioperative deaths reported to the Coroner over the previous triennia (1989 to 1997) for which autopsies were conducted. While this observation may not denote an increase in perioperative morality rates per se, it may be indicative of an increasingly "aggressive" or defensive approach to the clinical management of seriously ill patients, particularly over the past decade. Although the rate of iatrogenic deaths appears to have stabilised, it is too early to say whether this apparent trend will persist in the future. It is perhaps not surprising that the risk of iatrogenic injury appears to increase with the number of interventions performed; however, it is not clear why initial, supposedly elective, interventions should be associated with an apparently greater risk of iatrogenic injury than those classified as emergency procedures. The substantial divergence between the autopsy finding of an iatrogenic death and the corresponding Coroner's verdict of misadventure may be comforting to clinicians, but certainly warrants further examination.

Spectrophotometric determination of the tannin contents of various Turkish black tea, beer and wine samples.

PubMed

Tinkiliç, N; Uyanik, A

2001-05-01

This study reports tannin contents of various tea (19), beer (6) and wine (6) samples, produced or sold in Turkey under different brand names. Determinations were carried out by employing a previously reported UV-vis spectrophotometric method. The standard addition procedure was also compared to the direct determination procedure and found to be more reliable. The tannin contents of hot water extracts of tea, tea bag and herbal tea samples ranged between 6.20-8.33, 8.03-6.59 and 2.76-6.54 percent (w/w) respectively. Tannin contents of beer and wine samples determined without extraction were found ranging between 66.36-77.26 and 67.18-107.62 micrograms/mL respectively. Iron contents of analysed wine samples were also found ranging between 0.36 and 10.33 ppm by AAS and no relation is found between tannin and iron contents.

Systematic review of general thoracic surgery articles to identify predictors of operating room case durations.

PubMed

Dexter, Franklin; Dexter, Elisabeth U; Masursky, Danielle; Nussmeier, Nancy A

2008-04-01

Previous studies of operating room (OR) information systems data over the past two decades have shown how to predict case durations using the combination of scheduled procedure(s), individual surgeon and assistant(s), and type of anesthetic(s). We hypothesized that the accuracy of case duration prediction could be improved by the use of other electronic medical record data (e.g., patient weight or surgeon notes using standardized vocabularies). General thoracic surgery was used as a model specialty because much of its workload is elective (scheduled) and many of its cases are long. PubMed was searched for thoracic surgery papers reporting operative time, surgical time, etc. The systematic literature review identified 48 papers reporting statistically significant differences in perioperative times. There were multiple reports of differences in OR times based on the procedure(s), perioperative team including primary surgeon, and type of anesthetic, in that sequence of importance. All such detail may not be known when the case is originally scheduled and thus may require an updated duration the day before surgery. Although the use of these categorical data from OR systems can result in few historical data for estimating each case's duration, bias and imprecision of case duration estimates are unlikely to be affected. There was a report of a difference in case duration based on additional information. However, the incidence of the procedure for the diagnosis was so uncommon as to be unlikely to affect OR management. Matching findings of prior studies using OR information system data, multiple case series show that it is important to rely on the precise procedure(s), surgical team, and type of anesthetic when estimating case durations. OR information systems need to incorporate the statistical methods designed for small numbers of prior surgical cases. Future research should focus on the most effective methods to update the prediction of each case's duration as these data become available. The case series did not reveal additional data which could be cost-effectively integrated with OR information systems data to improve the accuracy of predicted durations for general thoracic surgery cases.

An Interlaboratory Validation of the Radiation Dose Response Relationship (DRR) for H-ARS in the Rhesus Macaque.

PubMed

Thrall, Karla D; Love, Ruschelle; OʼDonnell, Kyle C; Farese, Ann M; Manning, Ronald; MacVittie, Thomas J

2015-11-01

The Medical Countermeasures against Radiological Threats (MCART) consortium has established a dose response relationship for the hematopoietic acute radiation syndrome (HARS) in the rhesus macaque conducted under an individualized supportive care protocol, including blood transfusions. Application of this animal model as a platform for demonstrating efficacy of candidate medical countermeasures is significantly strengthened when the model is independently validated at multiple institutions. The study reported here describes implementation of standard operating procedures at an institute outside the consortium in order to evaluate the ability to establish an equivalent radiation dose response relationship in a selected species. Validation of the animal model is a significant component for consideration of the model protocol as an FDA-recommended drug development tool in the context of the "Animal Rule." In the current study, 48 male rhesus macaques (4-8 kg) were exposed to total-body irradiation (TBI) using 6 MV photon energy at a dose rate of approximately 0.8 Gy min. Results show that onset and duration of the hematological response, including anemia, neutropenia, and thrombocytopenia, following TBI ranging from 6.25 to 8.75 Gy correlate well with previously reported findings. The lethality values at 60 d following TBI were estimated to be 6.88 Gy (LD30/60), 7.43 Gy (LD50/60), and 7.98 Gy (LD70/60). These values are equivalent to those published previously of 7.06 Gy (LD30/60), 7.52 Gy (LD50/60), and 7.99 Gy (LD70/60); the DRR slope (p = 0.68) and y-intercepts show agreement along the complete dose range for HARS. The ability to replicate the previously established institutional lethality profile (PROBIT) and model outcomes through careful implementation of defined procedures is a testament to the robustness of the model and highlights the need for consistency in procedures.

Multiparameter optimization of mammography: an update

NASA Astrophysics Data System (ADS)

Jafroudi, Hamid; Muntz, E. P.; Jennings, Robert J.

1994-05-01

Previously in this forum we have reported the application of multiparameter optimization techniques to the design of a minimum dose mammography system. The approach used a reference system to define the physical imaging performance required and the dose to which the dose for the optimized system should be compared. During the course of implementing the resulting design in hardware suitable for laboratory testing, the state of the art in mammographic imaging changed, so that the original reference system, which did not have a grid, was no longer appropriate. A reference system with a grid was selected in response to this change, and at the same time the optimization procedure was modified, to make it more general and to facilitate study of the optimized design under a variety of conditions. We report the changes in the procedure, and the results obtained using the revised procedure and the up- to-date reference system. Our results, which are supported by laboratory measurements, indicate that the optimized design can image small objects as well as the reference system using only about 30% of the dose required by the reference system. Hardware meeting the specification produced by the optimization procedure and suitable for clinical use is currently under evaluation in the Diagnostic Radiology Department at the Clinical Center, NH.

Acquired left bundle branch block in an asymptomatic fighter pilot: a case report.

PubMed

Newman, D G

1999-12-01

This report describes a case of acquired left bundle branch block (LBBB) in an asymptomatic F/A-18 fighter pilot of the Royal Australian Air Force. The previously fit and healthy pilot was found to have LBBB on routine electrocardiographic screening prior to his annual aircrew medical. He was completely asymptomatic, and the only potential etiological factor was a short-lived acute gastrointestinal infectious illness some 4 mo previously. The pilot was extensively investigated with the full range of available diagnostic procedures, including coronary angiography and cardiac biopsy. No cause was determined for his LBBB pattern, and he was assessed as having normal cardiovascular function. The aeromedical disposition of this aviator and the issues involved in determining fitness to fly in such a case are discussed. The importance of thorough clinical investigation and appropriate follow-up are highlighted.

Geriatric screening in first opinion practice – results from 45 dogs

PubMed Central

Davies, M

2012-01-01

Objectives To evaluate and report the results of screening geriatric dogs in a first opinion practice. Methods A prospective health screen of dogs over nine-years-old involving history taking, physical examination and urinalysis. Results At least one previously unrecognised problem was identified in 80% of 45 dogs and 353 findings (mean 7·8 per dog) were recorded. Owners often failed to recognise and report serious signs of age-related disease. However, they most often reported increased sleeping (31%), loss of hearing (29%) or sight (20%), stiffness or lameness (22%) and “slowing down” (20%). Increased lens opacity (64%), increased thirst (58%), pain (24%), increased frequency of urination (24%), signs of osteoarthritis (24%) and dental disease (22%) were most frequently identified at the time of consultation. Potentially, life-threatening findings included respiratory distress, palpable abdominal masses and metastatic lung disease. Screening resulted in 29 further diagnostic procedures, including 10 dental procedures, seven medical treatments, two surgical procedures and euthanasia of two dogs. Clinical Significance Screening elderly dogs identified unrecognised and unreported health risk factors resulting in lifestyle modification and ongoing monitoring, as well as signs of age-related diseases resulting in diagnostic investigations, early diagnoses and surgical and medical interventions to improve quality of life. PMID:22835038

Geriatric screening in first opinion practice - results from 45 dogs.

PubMed

Davies, M

2012-09-01

To evaluate and report the results of screening geriatric dogs in a first opinion practice. A prospective health screen of dogs over nine-years-old involving history taking, physical examination and urinalysis. At least one previously unrecognised problem was identified in 80% of 45 dogs and 353 findings (mean 7·8 per dog) were recorded. Owners often failed to recognise and report serious signs of age-related disease. However, they most often reported increased sleeping (31%), loss of hearing (29%) or sight (20%), stiffness or lameness (22%) and "slowing down" (20%). Increased lens opacity (64%), increased thirst (58%), pain (24%), increased frequency of urination (24%), signs of osteoarthritis (24%) and dental disease (22%) were most frequently identified at the time of consultation. Potentially, life-threatening findings included respiratory distress, palpable abdominal masses and metastatic lung disease. Screening resulted in 29 further diagnostic procedures, including 10 dental procedures, seven medical treatments, two surgical procedures and euthanasia of two dogs. Screening elderly dogs identified unrecognised and unreported health risk factors resulting in lifestyle modification and ongoing monitoring, as well as signs of age-related diseases resulting in diagnostic investigations, early diagnoses and surgical and medical interventions to improve quality of life. © 2012 British Small Animal Veterinary Association.

Perceptual Reorganization of Lexical Tones: Effects of Age and Experimental Procedure

PubMed Central

Götz, Antonia; Yeung, H. Henny; Krasotkina, Anna; Schwarzer, Gudrun; Höhle, Barbara

2018-01-01

Findings on the perceptual reorganization of lexical tones are mixed. Some studies report good tone discrimination abilities for all tested age groups, others report decreased or enhanced discrimination with increasing age, and still others report U-shaped developmental curves. Since prior studies have used a wide range of contrasts and experimental procedures, it is unclear how specific task requirements interact with discrimination abilities at different ages. In the present work, we tested German and Cantonese adults on their discrimination of Cantonese lexical tones, as well as German-learning infants between 6 and 18 months of age on their discrimination of two specific Cantonese tones using two different types of experimental procedures. The adult experiment showed that German native speakers can discriminate between lexical tones, but native Cantonese speakers show significantly better performance. The results from German-learning infants suggest that 6- and 18-month-olds discriminate tones, while 9-month-olds do not, supporting a U-shaped developmental curve. Furthermore, our results revealed an effect of methodology, with good discrimination performance at 6 months after habituation but not after familiarization. These results support three main conclusions. First, habituation can be a more sensitive procedure for measuring infants' discrimination than familiarization. Second, the previous finding of a U-shaped curve in the discrimination of lexical tones is further supported. Third, discrimination abilities at 18 months appear to reflect mature perceptual sensitivity to lexical tones, since German adults also discriminated the lexical tones with high accuracy. PMID:29681877

Do patients have a say? A narrative review of the development of patient-reported outcome measures used in elective procedures for coronary revascularisation.

PubMed

Peeters, Geeske; Barker, Anna L; Talevski, Jason; Ackerman, Ilana; Ayton, Darshini R; Reid, Christopher; Evans, Sue M; Stoelwinder, Johannes U; McNeil, John J

2018-05-01

Patient-reported outcome measures (PROMs) capture health information from the patient's perspective that can be used when weighing up benefits, risks and costs of treatment. This is important for elective procedures such as those for coronary revascularisation. Patients should be involved in the development of PROMs to accurately capture outcomes that are important for the patient. The aims of this review are to identify if patients were involved in the development of cardiovascular-specific PROMs used for assessing outcomes from elective coronary revascularisation, and to explore what methods were used to capture patient perspectives. PROMs for evaluating outcomes from elective coronary revascularisation were identified from a previous review and an updated systematic search. The studies describing the development of the PROMs were reviewed for information on patient input in their conceptual and/or item development. 24 PROMs were identified from a previous review and three additional PROMs were identified from the updated search. Full texts were obtained for 26 of the 27 PROMs. The 26 studies (11 multidimensional, 15 unidimensional) were reviewed. Only nine studies reported developing PROMs using patient input. For eight PROMs, the inclusion of patient input could not be judged due to insufficient information in the full text. Only nine of the 26 reviewed PROMs used in elective coronary revascularisation reported involving patients in their conceptual and/or item development, while patient input was unclear for eight PROMs. These findings suggest that the patient's perspective is often overlooked or poorly described in the development of PROMs.

Salvage reconstruction of failed interposition arthroplasty at the base of the thumb.

PubMed

Braun, Richard M; Rechnic, Mark; Shah, Kalpit N

2012-12-01

We present an operative procedure designed to revise a failed arthroplasty at the base of the thumb. This report describes a reliable operation that corrects residual instability and malignment which results in thumbs that are weak and painful despite a previous procedure. The operation has also been used as a primary procedure for arthritis of the trapeziometacarpal joint where instability and subluxation was a major component of the problem requiring joint reconstruction. The unique features of this procedure include a reinforced double-thickness tendon graft, a unique tendon anchor, and a fascia lata allograft spacer. Significant functional improvement is anticipated when joint reconstruction provides increased proximal stability. Pinch and grip measurements improve. Pain scores also diminish after the operation. Hand function and patient satisfaction can be substantially improved with revision arthroplasty when the initial operation has failed to provide a thumb that is mobile, stable, and pain free. The technical features of the procedure address reduction of malignment, restoring of anatomic balance, and secure fixation of the proximal apex of the thumb metacarpal which restores thumb reduction position and digital balance.

Pseudoaneurysm with Arteriovenous Fistula after Arthroscopic Procedure: A Rare Complication of Arthroscopy

PubMed Central

Jin, Moran; Lee, Yang-Haeng; Yoon, Young Chul; Han, Il-Yong; Park, Kyung-Taek; Wi, Jin Hong

2015-01-01

Pseudoaneurysm with arteriovenous fistula is a rare complication of arthroscopy, and can be diagnosed by ultrasonography, computed tomography, magnetic resonance imaging, or angiography. This condition can be treated with open surgical repair or endovascular repair. We report our experience with the open surgical repair of a pseudoaneurysm with an arteriovenous fistula in a young male patient who underwent arthroscopy five months previously. PMID:26290846

Percutaneous treatment of transplant renal artery stenosis in children.

PubMed

Repetto, Horacio A; Rodríguez-Rilo, Laila; Mendaro, Esteban; Basso, Laura; Galvez, Hugo; Morrone, Gabriela; Vazquez, Luis A

2004-12-01

Percutaneous treatment of renal artery stenosis (RAS) is an accepted procedure and numerous reports have been published. However, experience with its use in RAS in the transplanted kidney in children is scarce. Since 1994 we have diagnosed RAS in seven children with the use of Doppler ultrasonography (US), confirming it with percutaneous angiography (PAG). In six of the seven patients percutaneous transluminal angioplasty (PTA) was performed. In one patient a metallic stent was placed due to the extension of the arterial lesion, and a second stent was placed in another child when a re-stenosis was diagnosed 1 month after the PTA. All patients presented with hypertension (de novo or 30% increase over previous values). After ruling out acute rejection, calcineurin inhibitor toxicity, and urinary obstruction, US was performed and, when an increase in arterial flux velocity was registered, PAG was also performed. Six children showed an increase in serum creatinine (Cr) and proteinuria. Blood pressure decreased after the procedure and Cr returned to previous levels in all children. One of the grafts was lost due to chronic transplant rejection 7 years later. The other children have a functioning kidney. Although this is a small group of patients, the consistently good results and the lack of reported experience prompted us to communicate our preliminary observation.

A preregistered, direct replication attempt of the retrieval-extinction effect in cued fear conditioning in rats.

PubMed

Luyten, Laura; Beckers, Tom

2017-10-01

In 2009, Monfils and colleagues proposed a behavioral procedure that was said to result in a permanent attenuation of a previously established fear memory, thereby precluding a possible return of fear after extinction (Monfils, Cowansage, Klann, & LeDoux, 2009). By presenting a single retrieval trial one hour before standard extinction training, they found an enduring reduction of fear. The retrieval-extinction procedure holds great clinical potential, particularly for anxiety patients, but the findings are not undisputed, and several conceptual replications have failed to reproduce the effect. These failures have largely been attributed to small procedural differences. This preregistered study is the first endeavor to exactly replicate three key experiments of the original report by Monfils et al. (2009), thereby gauging the robustness of their seminal findings. Despite adhering to the original procedures as closely as possible, we did not find any evidence for reduced return of fear with the retrieval-extinction procedure relative to regular extinction training, as assessed through spontaneous recovery, reinstatement and renewal. Behavior of animals in the control condition (extinction only) was comparable to that in the original studies and provided an adequate baseline to reveal differences with the retrieval-extinction condition. Our null findings indicate that the effect sizes in the original paper may have been inflated and question the legitimacy of previously proposed moderators of the retrieval-extinction effect. We argue that direct experimental evaluation of purported moderators of the retrieval-extinction effect will be key to shed more light on its nature and prerequisites. Copyright © 2017 Elsevier Inc. All rights reserved.

Aortic valve replacement for stenosis with or without coronary artery bypass grafting after 2 previous isolated coronary artery bypass grafting operations

PubMed Central

Lee Henry, Christopher; Ko, Jong Mi; Henry, Albert Carl; Matter, Gregory John

2011-01-01

Aortic valve replacement following an earlier coronary artery bypass grafting (CABG) procedure is fairly common. When this situation occurs, the type of valve dysfunction is usually stenosis (with or without regurgitation), and whether it was missed at the time of the earlier CABG or developed subsequently is usually unclear. We attempted to determine the survival in patients who had had aortic valve replacement after 2 previous CABG procedures. We describe 12 patients who had aortic valve replacement for aortic stenosis; rather than one previous CABG operation, all had had 2 previous CABG procedures. Only one patient died in the early postoperative period after aortic valve replacement, and the remaining 11 were improved substantially: all have lived at least 11 months, and one is still alive at over 101 months after aortic valve replacement. Aortic valve replacement remains beneficial for most patients even after 2 previous CABG procedures. PMID:21307968

Paying for quality not quantity: a wisconsin health maintenance organization proposes an incentive model for reimbursement of chiropractic services.

PubMed

Pursel, Kevin J; Jacobson, Martin; Stephenson, Kathy

2012-07-01

The purpose of this study is to describe a reimbursement model that was developed by one Health Maintenance Organization (HMO) to transition from fee-for-service to add a combination of pay for performance and reporting model of reimbursement for chiropractic care. The previous incentive program used by the HMO provided best-practice education and additional reimbursement incentives for achieving the National Committee for Quality Assurance Back Pain Recognition Program (NCQA-BPRP) recognition status. However, this model had not leveled costs between doctors of chiropractic (DCs). Therefore, the HMO management aimed to develop a reimbursement model to incentivize providers to embrace existing best-practice models and report existing quality metrics. The development goals included the following: it should (1) be as financially predictable as the previous system, (2) cost no more on a per-member basis, (3) meet the coverage needs of its members, and (4) be able to be operationalized. The model should also reward DCs who embraced best practices with compensation, not simply tied to providing more procedures, the new program needed to (1) cause little or no disruption in current billing, (2) be grounded achievable and defined expectations for improvement in quality, and (3) be voluntary, without being unduly punitive, should the DC choose not to participate in the program. The generated model was named the Comprehensive Chiropractic Quality Reimbursement Methodology (CCQRM; pronounced "Quorum"). In this hybrid model, additional reimbursement, beyond pay-for-procedures will be based on unique payment interpretations reporting selected, existing Physician Quality Reporting System (PQRS) codes, meaningful use of electronic health records, and achieving NCQA-BPRP recognition. This model aims to compensate providers using pay-for-performance, pay-for-quality reporting, pay-for-procedure methods. The CCQRM reimbursement model was developed to address the current needs of one HMO that aims to transition from fee-for-service to a pay-for-performance and quality reporting for reimbursement for chiropractic care. This model is theoretically based on the combination of a fee-for-service payment, pay for participation (NCQA Back Pain Recognition Program payment), meaningful use of electronic health record payment, and pay for reporting (PQRS-BPMG payment). Evaluation of this model needs to be implemented to determine if it will achieve its intended goals. Copyright © 2012 National University of Health Sciences. Published by Mosby, Inc. All rights reserved.

Remote Excavation System technology evaluation report: Buried Waste Robotics Program

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

Not Available

1993-09-01

This document describes the results from the Remote Excavation System demonstration and testing conducted at the Idaho National Engineering Laboratory during June and July 1993. The purpose of the demonstration was to ascertain the feasibility of the system for skimming soil and removing various types of buried waste in a safe manner and within all regulatory requirements, and to compare the performances of manual and remote operation of a backhoe. The procedures and goals of the demonstration were previously defined in The Remote Excavation System Test Plan, which served as a guideline for evaluating the various components of the systemmore » and discussed the procedures used to conduct the tests.« less

Abortion surveillance--United States, 2005.

PubMed

Gamble, Sonya B; Strauss, Lilo T; Parker, Wilda Y; Cook, Douglas A; Zane, Suzanne B; Hamdan, Saeed

2008-11-28

CDC began abortion surveillance in 1969 to document the number and characteristics of women obtaining legal induced abortions. This report summarizes and describes data voluntarily reported to CDC regarding legal induced abortions obtained in the United States in 2005. For each year since 1969, CDC has compiled abortion data by state or area of occurrence. Information is requested each year from all 50 states, New York City, and the District of Columbia. For 2005, data were received from 49 reporting areas: New York City, District of Columbia, and all states except California, Louisiana, and New Hampshire. For the purpose of trends analysis, data were evaluated from the 46 reporting areas that have been consistently reported since 1995. A total of 820,151 legal induced abortions were reported to CDC for 2005 from 49 reporting areas, the abortion ratio (number of abortions per 1,000 live births) was 233, and the abortion rate was 15 per 1,000 women aged 15--44 years. For the 46 reporting areas that have consistently reported since 1995, the abortion rate declined during 1995--2000 but has remained unchanged since 2000. For 2005, the highest percentages of reported abortions were for women who were known to be unmarried (81%), white (53%), and aged <25 years (50%). Of all abortions for which gestational age was reported, 62% were performed at 15 weeks' gestation (3.7% at 16--20 weeks and 1.3% at >/=21 weeks). A total of 35 reporting areas submitted data stating that they performed and enumerated medical (nonsurgical) procedures, making up 9.9% of all known reported procedures from the 45 areas with adequate reporting on type of procedure. In 2004 (the most recent years for which data are available), seven women died as a result of complications from known legal induced abortion. One death was associated with known illegal abortion. For the 46 reporting areas that have consistently reported since 1995, the number of abortions has steadily declined over the previous 10 years. The abortion rate declined from 1995 to 2000, but remained unchanged since 2000. In 2004, as in the previous years, deaths related to legal induced abortions occurred rarely. Abortion surveillance in the United States continues to provide the data necessary for examining trends in numbers and characteristics of women who obtain legal induced abortions and to increase understanding of this pregnancy outcome. Policymakers and program planners use these data to improve the health and well-being of women and evaluate efforts to prevent unintended pregnancies.

The application of moment methods to the analysis of fluid electrical conductivity logs in boreholes

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

Loew, S.; Tsang, Chin-Fu; Hale, F.V.

1990-08-01

This report is one of a series documenting the results of the Nagra-DOE Cooperative (NDC-I) research program in which the cooperating scientists explore the geological, geophysical, hydrological, geochemical, and structural effects anticipated from the use of a rock mass as a geologic repository for nuclear waste. Previous reports have presented a procedure for analyzing a time sequence of wellbore electric conductivity logs in order to obtain outflow parameters of fractures intercepted by the borehole, and a code, called BORE, used to simulate borehole fluid conductivity profiles given these parameters. The present report describes three new direct (not iterative) methods formore » analyzing a short time series of electric conductivity logs based on moment quantities of the individual outflow peaks and applies them to synthetic as well as to field data. The results of the methods discussed show promising results and are discussed in terms of their respective advantages and limitations. In particular it is shown that one of these methods, the so-called Partial Moment Method,'' is capable of reproducing packer test results from field experiments in the Leuggern deep well within a factor of three, which is below the range of what is recognized as the precision of packer tests themselves. Furthermore the new method is much quicker than the previously used iterative fitting procedure and is even capable of handling transient fracture outflow conditions. 20 refs., 11 figs., 10 tabs.« less

Internal carotid artery rupture caused by carotid shunt insertion

PubMed Central

Illuminati, Giulio; Caliò, Francesco G.; Pizzardi, Giulia; Vietri, Francesco

2015-01-01

Introduction Shunting is a well-accepted method of maintaining cerebral perfusion during carotid endarterectomy (CEA). Nonetheless, shunt insertion may lead to complications including arterial dissection, embolization, and thrombosis. We present a complication of shunt insertion consisting of arterial wall rupture, not reported previously. Presentation of case A 78-year-old woman underwent CEA combined with coronary artery bypass grafting (CABG). At the time of shunt insertion an arterial rupture at the distal tip of the shunt was detected and was repaired via a small saphenous vein patch. Eversion CEA and subsequent CABG completed the procedure whose postoperative course was uneventful. Discussion Shunting during combined CEA-CABG may be advisable to assure cerebral protection from possible hypoperfusion due to potential hemodynamic instability of patients with severe coronary artery disease. Awareness and prompt management of possible shunt-related complications, including the newly reported one, may contribute to limiting their harmful effect. Conclusion Arterial wall rupture is a possible, previously not reported, shunt-related complication to be aware of when performing CEA. PMID:26255001

The South Carolina bridge-scour envelope curves

USGS Publications Warehouse

Benedict, Stephen T.; Feaster, Toby D.; Caldwell, Andral W.

2016-09-30

The U.S. Geological Survey, in cooperation with the South Carolina Department of Transportation, conducted a series of three field investigations to evaluate historical, riverine bridge scour in the Piedmont and Coastal Plain regions of South Carolina. These investigations included data collected at 231 riverine bridges, which lead to the development of bridge-scour envelope curves for clear-water and live-bed components of scour. The application and limitations of the South Carolina bridge-scour envelope curves were documented in four reports, each report addressing selected components of bridge scour. The current investigation (2016) synthesizes the findings of these previous reports into a guidance manual providing an integrated procedure for applying the envelope curves. Additionally, the investigation provides limited verification for selected bridge-scour envelope curves by comparing them to field data collected outside of South Carolina from previously published sources. Although the bridge-scour envelope curves have limitations, they are useful supplementary tools for assessing the potential for scour at riverine bridges in South Carolina.

The use of prophylactic antibiotics in plastic surgery: update in 2010.

PubMed

Hauck, Randy M; Nogan, Stephen

2013-01-01

The indications for prophylactic antibiotics in plastic surgery remain controversial. No recent survey has been reported on the use of prophylactic antibiotics by plastic surgeons in clinical practice. This survey was designed to assess the current use of prophylactic antibiotics by plastic surgeons and to compare trends with previous studies. All members of the American Society of Plastic Surgeons with an e-mail address on the Society's website were contacted via an e-mail and sent a link to a SurveyMonkey questionnaire. To survey only in those subspecialty areas that they practice in, surgeons were queried only on the procedures that they perform. Within each section, a list of common representative procedures was included, with questions about the use of antibiotic prophylaxis. A total of 3824 American Society of Plastic Surgeons members were contacted. Of the 3613, 910 with working e-mail addresses responded to the survey for a response rate of 25%. And 833 or 91.5% completed the survey. Survey data cover the percentage of surgeons reporting their use of antibiotics in procedures that they currently perform. The percentage of plastic surgeons who use prophylactic antibiotics in almost all procedures studied has increased significantly when compared with earlier studies. The use of prophylactic antibiotics by plastic surgeons has increased considerably since the prior studies by Krizek et al (Plast Reconstr Surg. 1975;55:21-32 and 1985;76:953-963). Some of these uses are appropriate because of the use in procedures involving implants and longer operations. The elevated rates for clean procedures are not part of the evidence-based practice.

The child's perspective on discomfort during medical research procedures: a descriptive study.

PubMed

Staphorst, Mira S; Benninga, Marc A; Bisschoff, Margriet; Bon, Irma; Busschbach, Jan J V; Diederen, Kay; van Goudoever, Johannes B; Haarman, Eric G; Hunfeld, Joke A M; Jaddoe, Vincent V W; de Jong, Karin J M; de Jongste, Johan C; Kindermann, Angelika; Königs, Marsh; Oosterlaan, Jaap; Passchier, Jan; Pijnenburg, Mariëlle W; Reneman, Liesbeth; Ridder, Lissy de; Tamminga, Hyke G; Tiemeier, Henning W; Timman, Reinier; van de Vathorst, Suzanne

2017-08-01

The evaluation of discomfort in paediatric research is scarcely evidence-based. In this study, we make a start in describing children's self-reported discomfort during common medical research procedures and compare this with discomfort during dental check-ups which can be considered as a reference level of a 'minimal discomfort' medical procedure. We exploratory study whether there are associations between age, anxiety-proneness, gender, medical condition, previous experiences and discomfort. We also describe children's suggestions for reducing discomfort. Cross-sectional descriptive study. Paediatric research at three academic hospitals. 357 children with and without illnesses (8-18 years, mean=10.6 years) were enrolled: 307 from paediatric research studies and 50 from dental care. We measured various generic forms of discomfort (nervousness, annoyance, pain, fright, boredom, tiredness) due to six common research procedures: buccal swabs, MRI scans, pulmonary function tests, skin prick tests, ultrasound imaging and venepunctures. Most children reported limited discomfort during the research procedures (means: 1-2.6 on a scale from 1 to 5). Compared with dental check-ups, buccal swab tests, skin prick tests and ultrasound imaging were less discomforting, while MRI scans, venepunctures and pulmonary function tests caused a similar degree of discomfort. 60.3% of the children suggested providing distraction by showing movies to reduce discomfort. The exploratory analyses suggested a positive association between anxiety-proneness and discomfort. The findings of this study support the acceptability of participation of children in the studied research procedures, which stimulates evidence-based research practice. Furthermore, the present study can be considered as a first step in providing benchmarks for discomfort of procedures in paediatric research. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Transvesicular percutaneous cystolithotomy for the retrieval of cystic and urethral calculi in dogs and cats: 27 cases (2006-2008).

PubMed

Runge, Jeffrey J; Berent, Allyson C; Mayhew, Philipp D; Weisse, Chick

2011-08-01

To describe the use of transvesicular percutaneous cystolithotomy for the retrieval of cystic and urethral calculi and to report the outcome in dogs and cats. Retrospective case series. 23 dogs and 4 cats. Medical records were reviewed for signalment, procedure time, stone number, stone location, pre- and postoperative radiographs, procedure-associated complications, and short-term outcome. A ventral midline approach was made into the abdomen over the urinary bladder apex. A screw cannula was inserted at the bladder apex for normograde rigid and flexible cystourethroscopy. All uroliths were removed via a stone basket device and retrograde flushing and suction. Long-term follow-up (1 year after surgery) information was obtained by telephone or e-mail contact with owners. 27 animals with cystic and urethral calculi were included. Median patient weight was 8.3 kg (18.3 lb; range, 1.8 to 42.6 kg [4.0 to 93.7 lb]). Urolith number ranged from 1 to > 35 (median, 7). Urolith size ranged from < 1 to 30 mm (median, 4.5 mm). Fifteen of the 27 animals had a previous cystotomy (range, 1 to 5 procedures). Median procedure time was 66 minutes (range, 50 to 80 minutes). All patients were discharged within 24 hours. No postoperative complications were reported at the time of suture removal. At the time of long-term follow-up, the 22 clients that could be contacted were satisfied with the procedure. Transvesicular percutaneous cystolithotomy may decrease the need for urethrotomy, serial transurethral endoscopic procedures, and abdominal insufflation associated with other minimally invasive interventions currently available. This procedure also provided excellent visualization for bladder and urethral luminal inspection.

The child's perspective on discomfort during medical research procedures: a descriptive study

PubMed Central

Staphorst, Mira S; Benninga, Marc A; Bisschoff, Margriet; Bon, Irma; Busschbach, Jan J V; Diederen, Kay; van Goudoever, Johannes B; Haarman, Eric G; Hunfeld, Joke A M; Jaddoe, Vincent V W; de Jong, Karin J M; de Jongste, Johan C; Kindermann, Angelika; Königs, Marsh; Oosterlaan, Jaap; Passchier, Jan; Pijnenburg, Mariëlle W; Reneman, Liesbeth; de Ridder, Lissy; Tamminga, Hyke G; Tiemeier, Henning W; Timman, Reinier; van de Vathorst, Suzanne

2017-01-01

Objective The evaluation of discomfort in paediatric research is scarcely evidence-based. In this study, we make a start in describing children's self-reported discomfort during common medical research procedures and compare this with discomfort during dental check-ups which can be considered as a reference level of a ‘minimal discomfort’ medical procedure. We exploratory study whether there are associations between age, anxiety-proneness, gender, medical condition, previous experiences and discomfort. We also describe children's suggestions for reducing discomfort. Design Cross-sectional descriptive study. Setting Paediatric research at three academic hospitals. Patients 357 children with and without illnesses (8–18 years, mean=10.6 years) were enrolled: 307 from paediatric research studies and 50 from dental care. Main outcome measures We measured various generic forms of discomfort (nervousness, annoyance, pain, fright, boredom, tiredness) due to six common research procedures: buccal swabs, MRI scans, pulmonary function tests, skin prick tests, ultrasound imaging and venepunctures. Results Most children reported limited discomfort during the research procedures (means: 1–2.6 on a scale from 1 to 5). Compared with dental check-ups, buccal swab tests, skin prick tests and ultrasound imaging were less discomforting, while MRI scans, venepunctures and pulmonary function tests caused a similar degree of discomfort. 60.3% of the children suggested providing distraction by showing movies to reduce discomfort. The exploratory analyses suggested a positive association between anxiety-proneness and discomfort. Conclusions The findings of this study support the acceptability of participation of children in the studied research procedures, which stimulates evidence-based research practice. Furthermore, the present study can be considered as a first step in providing benchmarks for discomfort of procedures in paediatric research. PMID:28765130

Exploration of large, rare copy number variants associated with psychiatric and neurodevelopmental disorders in individuals with anorexia nervosa.

PubMed

Yilmaz, Zeynep; Szatkiewicz, Jin P; Crowley, James J; Ancalade, NaEshia; Brandys, Marek K; van Elburg, Annemarie; de Kovel, Carolien G F; Adan, Roger A H; Hinney, Anke; Hebebrand, Johannes; Gratacos, Monica; Fernandez-Aranda, Fernando; Escaramis, Georgia; Gonzalez, Juan R; Estivill, Xavier; Zeggini, Eleftheria; Sullivan, Patrick F; Bulik, Cynthia M

2017-08-01

Anorexia nervosa (AN) is a serious and heritable psychiatric disorder. To date, studies of copy number variants (CNVs) have been limited and inconclusive because of small sample sizes. We conducted a case-only genome-wide CNV survey in 1983 female AN cases included in the Genetic Consortium for Anorexia Nervosa. Following stringent quality control procedures, we investigated whether pathogenic CNVs in regions previously implicated in psychiatric and neurodevelopmental disorders were present in AN cases. We observed two instances of the well-established pathogenic CNVs in AN cases. In addition, one case had a deletion in the 13q12 region, overlapping with a deletion reported previously in two AN cases. As a secondary aim, we also examined our sample for CNVs over 1 Mbp in size. Out of the 40 instances of such large CNVs that were not implicated previously for AN or neuropsychiatric phenotypes, two of them contained genes with previous neuropsychiatric associations, and only five of them had no associated reports in public CNV databases. Although ours is the largest study of its kind in AN, larger datasets are needed to comprehensively assess the role of CNVs in the etiology of AN.

Symptomatic stent cast.

PubMed

Keohane, John; Moore, Michael; O'Mahony, Seamus; Crosbie, Orla

2008-02-01

Biliary stent occlusion is a major complication of endoscopic stent insertion and results in repeat procedures. Various theories as to the etiology have been proposed, the most frequently studied is the attachment of gram negative bacteria within the stent. Several studies have shown prolongation of stent patency with antibiotic prophylaxis. We report the case of stent occlusion from a cast of a previously inserted straight biliary stent; a "stent cast" in an 86-year-old woman with obstructive jaundice. This was retrieved with the lithotrypter and she made an uneventful recovery. This is the first reported case of a biliary stent cast.

Details of the 1998 Watt Balance Experiment Determining the Planck Constant

PubMed Central

Steiner, Richard; Newell, David; Williams, Edwin

2005-01-01

The National Institute of Standards and Technology (NIST) watt balance experiment completed a determination of Planck constant in 1998 with a relative standard uncertainty of 87 × 10−9 (k = 1), concurrently with an upper limit on the drift rate of the SI kilogram mass standard. A number of other fundamental physical constants with uncertainties dominated by this result are also calculated. This paper focuses on the details of the balance apparatus, the measurement and control procedures, and the reference calibrations. The alignment procedures are also described, as is a novel mutual inductance measurement procedure. The analysis summary discusses the data noise sources and estimates for the Type B uncertainty contributions to the uncertainty budget. Much of this detail, some historical progression, and a few recent findings have not been included in previous papers reporting the results of this experiment. PMID:27308100

On the reliability of the occlusion technique as a tool for the assessment of the HMI of in-vehicle information and communication systems.

PubMed

Gelau, Christhard; Henning, Matthias J; Krems, Josef F

2009-03-01

In recent years considerable efforts have been spent on the development of the occlusion technique as a procedure for the assessment of the human-machine interface of in-vehicle information and communication systems (IVIS) designed to be used by the driver while driving. The importance and significance of the findings resulting from the application of this procedure depends essentially on its reliability. Because there is a lack of evidence as to whether this basic criterion of measurement is met with this procedure, and because questionable reliability can lead to doubts about their validity, our project strove to clarify this issue. This paper reports on a statistical reanalysis of data obtained from previous experiments. To summarise, the characteristic values found for internal consistency were almost all in the range of .90 for the occlusion technique, which can be considered satisfactory.

[Irrigation in colostomies].

PubMed

Campo, Juana; Lecona, Ana; Caparrós, M Rosario; Barbero, M Antonia; Javier Cerdán, F

2002-01-01

The degree of acceptation of irrigation from a colostomy varies ostensibly from some cases to others, therefore, we study what occurs in our medium, separating those patients which have previously undergone other procedures (Group A) from those patients who have been informed and trained about the immediate postoperative period (Group B). 48 patients, 22 or 46% of these patients were considered not apt for irrigation. Of the 26 to whom this procedure was proposed, 14 or 54% accepted. Of these, 5 or 36% abandoned its use while 9 continued its use; this is 64% of those who accepted this procedure, 35% of those to whom it was proposed and 19% of the total study group. 189 patients. This procedure was not recommended to 95 patients, 50%. Of the 94 patients to whom this procedure was proposed, 65 or 69% accepted. Of these, 22 or 34% abandoned its use while 43 continued its use; this is 66% of those; who accepted this procedure, 46% of those to whom it was proposed and 23% of the total study group. In our medium, the practice of irrigation oscillates between 19 and 23% of patients who have undergone a colostomy, without any significant difference referring to the moment when a patient started this procedure. A first report on this study was submitted in the III National Congress for Nursing in Colostomies.

Karolinska prostatectomy: a robot-assisted laparoscopic radical prostatectomy technique.

PubMed

Nilsson, Andreas E; Carlsson, Stefan; Laven, Brett A; Wiklund, N Peter

2006-01-01

The last decade has witnessed an increasing trend towards minimally invasive management of prostate cancer, including laparoscopic and, more recently, robot-assisted laparoscopic prostatectomy. Several different laparoscopic approaches have been continuously developed during the last 5 years and it is still unclear which technique yields the best outcome. We present our current technique of robot-assisted laparoscopic radical prostatectomy. The technique described has evolved during the course of >400 robotic prostatectomies performed by the robotic team since the robot-assisted laparoscopic radical prostatectomy program was introduced at Karolinska University Hospital in January 2002. Our procedure comprises several modifications of previously reported ones, and we utilize fewer robotic instruments to reduce costs. An extended posterior dissection is performed to aid in the bladder neck-sparing dissection. In nerve-sparing procedures the vesicles are divided to avoid damage to the erectile nerves. In order to preserve the apical anatomy the dorsal venous complex is incised sharply and is first over-sewn after the apical dissection is completed. Our technique enables a more fluent dissection than previously described robotic techniques. Minimizing changes of instruments and the camera not only cuts costs but also reduces inefficient operating maneuvers, such as switching between 30 degrees and 0 degrees lenses during the procedure. We present a technique which in our hands has achieved excellent functional and oncological results.

MiDAS I (mild Decompression Alternative to Open Surgery): a preliminary report of a prospective, multi-center clinical study.

PubMed

Chopko, Bohdan; Caraway, David L

2010-01-01

Neurogenic claudication due to lumbar spinal stenosis is a common problem that can be caused by many factors including hypertrophic ligamentum flavum, facet hypertrophy, and disc protrusion. When standard medical therapies such as pain medication, epidural steroid injections, and physical therapy fail, or when the patient is unwilling, unable, or not severe enough to advance to more invasive surgical procedures, both physicians and patients are often left with a treatment dilemma. Patients in this study were treated with mild, an ultra-minimally invasive lumbar decompression procedure using a dorsal approach. The mild procedure is performed under fluoroscopic imaging to resect bone adjacent to, and achieve partial resection of, the hypertrophic ligamentum flavum with minimal disruption of surrounding muscular and skeletal structure. To assess the clinical application and patient safety and functional outcomes of the mild lumbar decompression procedure in the treatment of symptomatic central canal spinal stenosis. Multi-center, non-blinded, prospective clinical study. Fourteen US spine specialist practices. Between July 2008 and January 2010, 78 patients were enrolled in the MiDAS I Study and treated with the mild procedure for lumbar decompression. Of these patients, 6-week follow-up was available for 75 patients. Visual Analog Score (VAS), Oswestry Disability Index (ODI), Zurich Claudication Questionnaire (ZCQ), and SF-12v2 Health Survey. Outcomes were assessed at baseline and 6 weeks post-treatment. There were no major device or procedure-related complications reported in this patient cohort. At 6 weeks, the MiDAS I Study showed statistically and clinically significant reduction of pain as measured by VAS, ZCQ, and SF-12v2. In addition, improvement in physical function and mobility as measured by ODI, ZCQ, and SF-12v2 was statistically and clinically significant in this study. This is a preliminary report encompassing 6-week follow-up. There was no control group. In this 75-patient series, and in keeping with a previously published 90-patient safety cohort, the mild procedure proved to be safe. Further, based on near-term follow-up, the mild procedure demonstrated efficacy in improving mobility and reducing pain associated with lumbar spinal canal stenosis.

Strategy over operation: neural activation in subtraction and multiplication during fact retrieval and procedural strategy use in children.

PubMed

Polspoel, Brecht; Peters, Lien; Vandermosten, Maaike; De Smedt, Bert

2017-09-01

Arithmetic development is characterized by strategy shifts between procedural strategy use and fact retrieval. This study is the first to explicitly investigate children's neural activation associated with the use of these different strategies. Participants were 26 typically developing 4th graders (9- to 10-year-olds), who, in a behavioral session, were asked to verbally report on a trial-by-trial basis how they had solved 100 subtraction and multiplication items. These items were subsequently presented during functional magnetic resonance imaging. An event-related design allowed us to analyze the brain responses during retrieval and procedural trials, based on the children's verbal reports. During procedural strategy use, and more specifically for the decomposition of operands strategy, activation increases were observed in the inferior and superior parietal lobes (intraparietal sulci), inferior to superior frontal gyri, bilateral areas in the occipital lobe, and insular cortex. For retrieval, in comparison to procedural strategy use, we observed increased activity in the bilateral angular and supramarginal gyri, left middle to inferior temporal gyrus, right superior temporal gyrus, and superior medial frontal gyrus. No neural differences were found between the two operations under study. These results are the first in children to provide direct evidence for alternate neural activation when different arithmetic strategies are used and further unravel that previously found effects of operation on brain activity reflect differences in arithmetic strategy use. Hum Brain Mapp 38:4657-4670, 2017. © 2017 Wiley Periodicals, Inc. © 2017 Wiley Periodicals, Inc.

TVT-O for the treatment of pure urodynamic stress incontinence: efficacy, adverse effects, and prognostic factors at 5-year follow-up.

PubMed

Serati, Maurizio; Bauer, Ricarda; Cornu, Jean Nicolas; Cattoni, Elena; Braga, Andrea; Siesto, Gabriele; Lizée, Daphné; Haab, François; Torella, Marco; Salvatore, Stefano

2013-05-01

Inside-out tension-free vaginal transobturator tape (TVT-O) is currently one of the most effective and popular procedures for the surgical treatment of female stress urinary incontinence (SUI), but data reporting long-term outcomes are scarce. To evaluate the efficacy and safety of TVT-O 5-yr implantation for management of pure SUI in women. A prospective observational study was conducted in four tertiary reference centers. Consecutive women presenting with urodynamically proven, pure SUI treated by TVT-O were included. Patients with mixed incontinence and/or anatomic evidence of pelvic organ prolapse were excluded. TVT-O implantation without any associated procedure. Data regarding subjective outcomes (International Consultation on Incontinence-Short Form [ICIQ-SF], Patient Global Impression of Improvement, patient satisfaction scores), objective cure (stress test) rates, and adverse events were collected during follow-up. Multivariable analyses were performed to investigate outcomes. Of the 191 women included, 21 (11.0%) had previously undergone a failed anti-incontinence surgical procedure. Six (3.1%) patients were lost to follow-up. The 5-yr subjective and objective cure rates were 90.3% and 90.8%, respectively. De novo overactive bladder (OAB) was reported by 24.3% of patients at 5-yr follow-up. Median ICIQ-SF score significantly improved from 17 (interquartile range [IQR]:16-17) preoperatively to 0 (IQR: 0-2) (p<0.0001). Failure of a previous anti-incontinence procedure was the only independent predictor of subjective recurrence of SUI (hazard ratio [HR]: 4.4; p = 0.009) or objective (HR: 3.7; p = 0.02). No predictive factor of de novo OAB was identified. TVT-O implantation is a highly effective option for the treatment of women with pure SUI, showing a very high cure rate and a low incidence of complications after 5-yr follow-up. Copyright © 2012 European Association of Urology. Published by Elsevier B.V. All rights reserved.

The Differential Effects of Two Types of Task Repetition on the Complexity, Accuracy, and Fluency in Computer-Mediated L2 Written Production: A Focus on Computer Anxiety

ERIC Educational Resources Information Center

Amiryousefi, Mohammad

2016-01-01

Previous task repetition studies have primarily focused on how task repetition characteristics affect the complexity, accuracy, and fluency in L2 oral production with little attention to L2 written production. The main purpose of the study reported in this paper was to examine the effects of task repetition versus procedural repetition on the…

Department of Defense Financial Management Regulation. Volume 8. Civilian Pay Policy Procedures

DTIC Science & Technology

1999-08-01

servicing HRO perform a review of employee records to ensure that previously reported retirement plans are correct. Ensure that frozen CSRS accounts... meal periods) occur during the hours specified. See 53 Comp. Gen. 814 (1974) (reference (p)). Shift differential also is payable when an employee is: 1...Temporary Quarters Subsistence Allowance. The TQSA is an allowance granted to an employee for the reasonable cost of temporary quarters, meals and laundry

Repair of traumatic tricuspid insufficiency via minimally invasive port access.

PubMed

Kasahara, Hirofumi; Kudo, Mikihiko; Kawajiri, Hiroyuki; Yozu, Ryohei

2010-04-01

We report on a successful tricuspid valve plasty using port-access minimally invasive cardiac surgery (MICS) for severe traumatic tricuspid insufficiency caused by blunt chest trauma suffered 15 years previously. A combination repair procedure, consisting of cleft closures, plication of the anteroseptal commissure, and ring annuloplasty, was necessary to achieve valve competence and proved possible via port access without difficulty. Port-access MICS is an alternative approach for tricuspid valve surgery.

Synthesis of Large Quantities of Single-Walled Aluminogermanante Nanotube

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

Levard,C.; Rose, J.; Mision, A.

2008-01-01

A simple aqueous synthesis yielded about 100 times more structurally well-organized single-walled aluminogermanate nanotubes than previously reported 'standard' procedures. The structure analyses using XRD, IRTF, TEM, and XAS were greatly facilitated by the high concentrations available, and they ascertained the imogolite-like structure of the nanotubes. Simplicity and yield of the synthesis protocol are likely to favor commercial applications of theses materials as well as simplified syntheses of other nanophases.

Fungal Endocarditis Due to Aspergillus oryzae: The First Case Reported in the Literature.

PubMed

Mazza, Andrea; Luciani, Nicola; Luciani, Marco; Cammertoni, Federico; Giaquinto, Alessia; Pavone, Natalia; Bruno, Piergiorgio; Massetti, Massimo

2017-03-01

Infective endocarditis (IE) is a severe disease with high mortality and morbidity. Prosthetic valve endocarditis is a life-threatening complication which can occur in less than 10% of patients with valve prosthesis. A fungal etiology of IE is rare and accounts for only 2-4% of all case of endocarditis, but is associated with a higher mortality and morbidity. Herein is reported the first case of fungal endocarditis of aortic valve prosthesis due to Aspergillus oryzae in a 67-year-old caucasian man who nine years previously underwent mitral and aortic valve replacement with mechanical prostheses, and tricuspid annuloplasty for acute IE due to Enterococcus spp. Seven months previously, the patient also underwent a redo cardiac procedure to replace a mitral valve prosthesis with a new mechanical device due to a leakage. Aspergillus oryzae showed impressive growth with strong and unexpected virulence in both local and systemic settings.

Minimally invasive computer-assisted stereotactic fenestration of an aqueductal cyst: case report.

PubMed

Fonoff, E T; Gentil, A F; Padilha, P M; Teixeira, M J

2010-02-01

Current advances in frame modeling and computer software allow stereotactic procedures to be performed with great accuracy and minimal risk of neural tissue or vascular injury. In this report we associate a previously described minimally invasive stereotactic technique with state-of-the-art 3D computer guidance technology to successfully treat a 55-year-old patient with an arachnoidal cyst obstructing the aqueduct of Sylvius. We provide detailed technical information and discuss how this technique deals with previous limitations for stereotactic manipulation of the aqueductal region. We further discuss current advances in neuroendoscopy for treating obstructive hydrocephalus and make comparisons with our proposed technique. We advocate that this technique is not only capable of treating this pathology but it also has the advantages to enable reestablishment of physiological CSF flow thus preventing future brainstem compression by cyst enlargement. (c) Georg Thieme Verlag KG Stuttgart . New York.

Anterior ankle arthrodesis

PubMed Central

Slater, Gordon L; Sayres, Stephanie C; O’Malley, Martin J

2014-01-01

Ankle arthrodesis is a common procedure that resolves many conditions of the foot and ankle; however, complications following this procedure are often reported and vary depending on the fixation technique. Various techniques have been described in the attempt to achieve ankle arthrodesis and there is much debate as to the efficiency of each one. This study aims to evaluate the efficiency of anterior plating in ankle arthrodesis using customised and Synthes TomoFix plates. We present the outcomes of 28 ankle arthrodeses between 2005 and 2012, specifically examining rate of union, patient-reported outcomes scores, and complications. All 28 patients achieved radiographic union at an average of 36 wk; the majority of patients (92.86%) at or before 16 wk, the exceptions being two patients with Charcot joints who were noted to have bony union at a three year review. Patient-reported outcomes scores significantly increased (P < 0.05). Complications included two delayed unions as previously mentioned, infection, and extended postoperative pain. With multiple points for fixation and coaxial screw entry points, the contoured customised plate offers added compression and provides a rigid fixation for arthrodesis stabilization. PMID:24649408

Mining for Murder-Suicide: An Approach to Identifying Cases of Murder-Suicide in the National Violent Death Reporting System Restricted Access Database.

PubMed

McNally, Matthew R; Patton, Christina L; Fremouw, William J

2016-01-01

The National Violent Death Reporting System (NVDRS) is a United States Centers for Disease Control and Prevention (CDC) database of violent deaths from 2003 to the present. The NVDRS collects information from 32 states on several types of violent deaths, including suicides, homicides, homicides followed by suicides, and deaths resulting from child maltreatment or intimate partner violence, as well as legal intervention and accidental firearm deaths. Despite the availability of data from police narratives, medical examiner reports, and other sources, reliably finding the cases of murder-suicide in the NVDRS has proven problematic due to the lack of a unique code for murder-suicide incidents and outdated descriptions of case-finding procedures from previous researchers. By providing a description of the methods used to access to the NVDRS and coding procedures used to decipher these data, the authors seek to assist future researchers in correctly identifying cases of murder-suicide deaths while avoiding false positives. © 2015 American Academy of Forensic Sciences.

Eden-Hybinette and Pectoralis Major Transfer for Recurrent Shoulder Instability Due to Failed Latarjet and Chronic Subscapularis Rupture.

PubMed

Li, Xinning; Cusano, Antonio; Eichinger, Josef

2017-01-01

Shoulder dislocations are a common injury, with anterior shoulder dislocation among male patients being the most common presentation. A patient with recurrent shoulder instability, anterior-superior escape, and chronic subscapularis tendon rupture following multiple shoulder stabilization surgeries presents the surgeon with a complex and challenging case. This report describes a 40-year-old man with an extensive left shoulder history that included a failed Latarjet procedure, an irreparable, chronic subscapularis tear with grade 4 Goutallier fatty infiltration, and associated anterior-superior escape. Given his marked dysfunction, weakness, pain, and recurrent instability in the absence of glenohumeral arthritis, he underwent an open Eden-Hybinette procedure (iliac crest autograft), a pectoralis major transfer, and an anterior capsule repair. The patient returned to his previous work activities without limitations. To the authors' knowledge, this is the first report describing a combination of anterior glenoid bone grafting with a full pectoralis major muscle transfer for a patient with chronic subscapularis rupture and anterior-superior escape after a failed Latarjet procedure with minimum glenoid bone loss. Furthermore, the authors provide a biomechanical rationale for the reconstruction used for this problem. [Orthopedics. 2017; 40(1):e182-e187.]. Copyright 2016, SLACK Incorporated.

Reaching the limits of mandated self-reporting: clinical logbooks do not predict clerkship performance.

PubMed

Huang, Grace C; Almeida, Jacqueline M; Roberts, David H

2012-01-01

Logbooks are used by US medical schools to evaluate curricular objectives and meet accreditation requirements, but research supporting their utility is conflicting. The goal of our study was to examine the relationship between volume of clinical rotation experiences as reported in a logbook and clerkship grades within a longitudinal integrated clerkship. We conducted a retrospective cohort study of third-year (clinical) medical students during academic year 2008-2009. We tracked student entries in a pocket-sized logbook (number of clinical encounters per clerkship, total number of exams, and procedures over the academic year). We performed correlation analyses between logbook entries and clerkship grades. We enrolled 36 students, who reported a total of 2992 encounters, 2262 exams, and 2342 procedures. Correlation coefficients between volume of clinical experience and clerkship grades were less than 0.4, indicating low correlation. We found borderline statistical significance for the Neurology, OB/Gyn, and Surgery clerkships. Sensitivity analyses showed little correlation between low-reporting activity and clerkship grades. Even within an integrated longitudinal clerkship framework, our findings are consistent with previous studies showing a negligible relationship between logbooks as an educational process measure and how they relate to educational outcomes.

Carbon dioxide laser ablation of dermatosis papulosa nigra: high satisfaction and few complications in patients with pigmented skin.

PubMed

Ali, Faisal R; Bakkour, Waseem; Ferguson, Janice E; Madan, Vishal

2016-04-01

Dermatosis papulosa nigra (DPN) is a common condition of pigmented skin. Whilst lesions are benign, they may be symptomatic or cosmetically disfiguring. Ablative lasers have previously been reported as a useful therapeutic modality in DPN. We report the largest case series to date of patients with DPN ablated with the carbon dioxide (CO2) laser. A retrospective case note review was conducted of all patients with DPN treated in our laser clinic in the last five years, and a post-treatment telephone survey was undertaken to assess patient satisfaction. Forty-five patients were identified, with a median age of 41 years (range 25-74 years), of whom 37 (82%) were female. The median number of treatments undertaken was three (range 1-10). Of the 18 respondents to the telephone survey, when asked to grade their satisfaction with the procedure out of 10, median response was 9.5 (range 6-10) with nine patients citing the maximum score of 10. All patients replied that their confidence had improved following the procedure and that they would recommend the treatment to other patients. Five respondents (28%) reported recurrence of a few lesions following CO2 laser ablation; the remaining 13 respondents (72%) reported no recurrence of DPN. No respondents reported any other post-procedural complications (including scarring, hypopigmentation and hyperpigmentation). We advocate use of the CO2 laser as a safe, convenient means of treating DPN, with a high degree of patient satisfaction, low recurrence rate and few complications.

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

PubMed

Sauer, James; Hope, Lorraine

2016-09-01

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

Pediatric endocanalicular diode laser dacryocystorhinostomy: results of a minimally invasive surgical technique.

PubMed

Uysal, Ismail Onder; Ozçimen, Muammer; Yener, Halil Ibrahim; Kal, Ali

2011-09-01

The purpose of this study was to evaluate the effectiveness of endocanalicular diode laser dacryocystorhinostomy (DCR), which is a minimally invasive surgical technique, in pediatric patients with congenital nasolacrimal duct obstruction (NLDO). A retrospective study was carried out on patients treated between October 2008 and August 2009 for nasolacrimal duct obstruction with an endocanalicular diode laser procedure. Patients diagnosed as having nasolacrimal duct obstruction were included in this study and an endocanalicular diode laser procedure was performed. The main outcome measures were patients' previous treatments, clinical presentation, operative and postoperative complications, postoperative follow-up and resolution of epiphora. Eighteen children (10 girls, 8 boys) with a mean age of 6.11 ± 2.08 years (range, 4-10) underwent 20 endocanalicular laser DCR operations for congenital NLDO. In all eyes (100%), there was a history of epiphora and chronic dacryocystitis; two (10%) presented with acute dacryocystitis. Previous procedures included probing and irrigation of all eyes (100%) and silicone tube intubation in nine eyes (45%). None of the patients underwent any previous DCR operations. During a mean postoperative follow-up period of 20.50 ± 3.24 months (range, 14-24 months), the anatomical success rate (patency of ostium on nasal endoscopy) was 100%, and the clinical success rate (resolution of epiphora) was 85%. Endocanalicular diode laser DCR is an effective treatment modality for pediatric patients with congenital NLDO that compares favorably with the reported success rates of external and endoscopic endonasal DCR. Moreover, it has an added advantage of shorter operative time, less morbidity and avoidance of overnight admission.

Coagulation syndrome: Delayed perforation after colorectal endoscopic treatments

PubMed Central

Hirasawa, Kingo; Sato, Chiko; Makazu, Makomo; Kaneko, Hiroaki; Kobayashi, Ryosuke; Kokawa, Atsushi; Maeda, Shin

2015-01-01

Various procedure-related adverse events related to colonoscopic treatment have been reported. Previous studies on the complications of colonoscopic treatment have focused primarily on perforation or bleeding. Coagulation syndrome (CS), which is synonymous with transmural burn syndrome following endoscopic treatment, is another typical adverse event. CS is the result of electrocoagulation injury to the bowel wall that induces a transmural burn and localized peritonitis resulting in serosal inflammation. CS occurs after polypectomy, endoscopic mucosal resection (EMR), and even endoscopic submucosal dissection (ESD). The occurrence of CS after polypectomy or EMR varies according previous reports; most report an occurrence rate around 1%. However, artificial ulcers after ESD are largely theoretical, and CS following ESD was reported in about 9% of cases, which is higher than that for CS after polypectomy or EMR. Most cases of post-polypectomy syndrome (PPS) have an excellent prognosis, and they are managed conservatively with medical therapy. PPS rarely develops into delayed perforation. Delayed perforation is a severe adverse event that often requires emergency surgery. Since few studies have reported on CS and delayed perforation associated with CS, we focused on CS after colonoscopic treatments in this review. Clinicians should consider delayed perforation in CS patients. PMID:26380051

The Relationship between Feelings-of-Knowing and Partial Knowledge for General Knowledge Questions

PubMed Central

Norman, Elisabeth; Blakstad, Oskar; Johnsen, Øivind; Martinsen, Stig K.; Price, Mark C.

2016-01-01

Feelings of knowing (FoK) are introspective self-report ratings of the felt likelihood that one will be able to recognize a currently unrecallable memory target. Previous studies have shown that FoKs are influenced by retrieved fragment knowledge related to the target, which is compatible with the accessibility hypothesis that FoK is partly based on currently activated partial knowledge about the memory target. However, previous results have been inconsistent as to whether or not FoKs are influenced by the accuracy of such information. In our study (N = 26), we used a recall-judge-recognize procedure where stimuli were general knowledge questions. The measure of partial knowledge was wider than those applied previously, and FoK was measured before rather than after partial knowledge. The accuracy of reported partial knowledge was positively related to subsequent recognition accuracy, and FoK only predicted recognition on trials where there was correct partial knowledge. Importantly, FoK was positively related to the amount of correct partial knowledge, but did not show a similar incremental relation with incorrect knowledge. PMID:27445950

Vertical canaliculotomy with retrograde expression of concretions for the treatment of canaliculitis.

PubMed

Perumal, Balaji; Meyer, Dale R

2015-01-01

To evaluate the efficacy and safety of the technique of vertical canaliculotomy with retrograde expression of concretions for the treatment of canaliculitis. This is a retrospective, interventional case series. Patients who underwent vertical canaliculotomy by 1 surgeon (D.R.M.) from August 2011 to December 2013 were identified. On initial diagnosis of canaliculitis, all patients were treated with a combination antibiotic/steroid eyedrop and an oral antibiotic. The procedure was performed 1 month later and consisted of a 2-mm vertical canaliculotomy with sharp-tipped scissors followed by retrograde expression of the canalicular contents by compressing the canaliculus medial to lateral with 2 cotton-tipped applicators. All concretion specimens were sent for pathologic examination. Pre- and postoperative subjective complaints and objective findings on examination, including eyelid thickening and probing/irrigation results, were recorded. Canalicular contents were readily expressed from all 8 patients who underwent the procedure. Pathologic analysis revealed Actinomyces species in 5 of 8 specimens and other Gram-negative and Gram-positive bacteria in the remaining specimens. All patients reported significant improvement in their symptoms and were patent to irrigation. Many reported surgical procedures for the treatment of canaliculitis involve the use of a curette, an instrument with sharp edges, that could potentially damage the lining of the canaliculus. Previous studies examining these procedures have reported canalicular stricture and dysfunction postoperatively. The current technique of vertical canaliculotomy with retrograde expression of canalicular contents described herein has been effective, limits iatrogenic trauma, and had a low incidence of postoperative complications in this series.

Recurrent neuroma formation after lateral arm free flap coverage with neurorraphy to the posteroantebrachial nerve.

PubMed

Peterson, Steven L; Gordon, Michael J

2004-09-01

We report a patient with previous wrist trauma and development of a symptomatic neuroma of the palmar cutaneous branch of the median nerve. The patient had previously been successfully treated with lateral arm free flap coverage with neurorrhaphy to a segment of the posteroantebrachial cutaneous nerve carried with the flap. Two years following this procedure the patient experienced re-onset of symptoms prompting surgical exploration of the area. At the time of operation a recurrent neuroma was found at the free distal terminus of the transferred posteroantebrachial cutaneous nerve. The neuroma was repositioned into the distal radius via a burr hole with relief of symptoms.

Estimating proportions of objects from multispectral scanner data

NASA Technical Reports Server (NTRS)

Horwitz, H. M.; Lewis, J. T.; Pentland, A. P.

1975-01-01

Progress is reported in developing and testing methods of estimating, from multispectral scanner data, proportions of target classes in a scene when there are a significiant number of boundary pixels. Procedures were developed to exploit: (1) prior information concerning the number of object classes normally occurring in a pixel, and (2) spectral information extracted from signals of adjoining pixels. Two algorithms, LIMMIX and nine-point mixtures, are described along with supporting processing techniques. An important by-product of the procedures, in contrast to the previous method, is that they are often appropriate when the number of spectral bands is small. Preliminary tests on LANDSAT data sets, where target classes were (1) lakes and ponds, and (2) agricultural crops were encouraging.

Interest in cosmetic improvement as a marker for tanning behavior: a survey of 1602 respondents

PubMed Central

Cathcart, Shelley; DeCoster, Jamie; Northington, Marian; Cantrell, Wendy; Elmets, Craig A.; Elewski, Boni E.

2011-01-01

Dermatologists see many patients interested in improving their physical appearance through cosmetic procedures or medical means. Dermatologists frequently counsel patients on sun protection as well, particularly those with a personal or family history of skin cancer, sun-sensitive dermatoses or those with obvious sun damage. Our objective in this study was to identify novel markers of skin cancer risk which may aid dermatologists in targeting extra sun protection counseling for certain groups. A sixteen-question survey was distributed to subjects nineteen years of age and older in public areas of downtown Birmingham, Alabama in August and September of 2008. Overall, about 40% of both genders reported that they were highly concerned that current sun exposure could cause skin cancer. Participants interested in at least one appearance-related questionnaire item were significantly more likely than those not interested to rate tanned skin as highly important (31.6% vs 17.5%, p<0.001), and to report regret for previous sun exposure (12.5% vs 3.6%, p<0.001). Subjects who thought tanned skin was important were significantly more likely to report interest in improving their appearance through cosmetic procedures and medical means. We conclude that individuals with an interest in improving their physical appearance through cosmetic procedures or medical means may be especially in need of sun protection counseling. PMID:21332909

Interest in cosmetic improvement as a marker for tanning behavior: a survey of 1602 respondents.

PubMed

Cathcart, Shelley; DeCoster, Jamie; Northington, Marian; Cantrell, Wendy; Elmets, Craig A; Elewski, Boni E

2011-03-01

Dermatologists see many patients interested in improving their physical appearance through cosmetic procedures or medical means. Dermatologists frequently counsel patients on sun protection as well, particularly those with a personal or family history of skin cancer, sun-sensitive dermatoses or those with obvious sun damage. Our objective in this study was to identify novel markers of skin cancer risk, which may aid dermatologists in targeting extra sun protection counseling for certain groups. A 16-question survey was distributed to subjects 19 years of age and older in public areas of downtown Birmingham, Alabama in August and September of 2008. Overall, about 40% of both genders reported that they were highly concerned that current sun exposure could cause skin cancer. Participants interested in at least one appearance-related questionnaire item were significantly more likely than those not interested to rate tanned skin as highly important (31.6%vs. 17.5%, P<0.001), and to report regret for previous sun exposure (12.5%vs. 3.6%, P<0.001). Subjects who thought tanned skin was important were significantly more likely to report interest in improving their appearance through cosmetic procedures and medical means. We conclude that individuals with an interest in improving their physical appearance through cosmetic procedures or medical means may be especially in need of sun protection counseling. © 2011 Wiley Periodicals, Inc.

Examining Recall Memory in Infancy and Early Childhood Using the Elicited Imitation Paradigm.

PubMed

Lukowski, Angela F; Milojevich, Helen M

2016-04-28

The ability to recall the past allows us to report on details of previous experiences, from the everyday to the significant. Because recall memory is commonly assessed using verbal report paradigms in adults, studying the development of this ability in preverbal infants and children proved challenging. Over the past 30 years, researchers have developed a non-verbal means of assessing recall memory known as the elicited or deferred imitation paradigm. In one variant of the procedure, participants are presented with novel three-dimensional stimuli for a brief baseline period before a researcher demonstrates a series of actions that culminate in an end- or goal-state. The participant is allowed to imitate the demonstrated actions immediately, after a delay, or both. Recall performance is then compared to baseline or to performance on novel control sequences presented at the same session; memory can be assessed for the individual target actions and the order in which they were completed. This procedure is an accepted analogue to the verbal report techniques used with adults, and it has served to establish a solid foundation of the nature of recall memory in infancy and early childhood. In addition, the elicited or deferred imitation procedure has been modified and adapted to answer questions relevant to other aspects of cognitive functioning. The broad utility and application of imitation paradigms is discussed, along with limitations of the approach and directions for future research.

B-1 Systems Approach to Training. Simulation Technology Assessment Report (STAR)

DTIC Science & Technology

1975-07-01

Psychology in the Air Force, 1974. Creelman , J.A., Evaluation of Approach Training Procedures, U.S. Naval School of Aviation Med., Proj. No. NM001-109-107...training. 3.2 PHYSICAL VERSUS PSYCHOLOGICAL SIMULATION In the previous section, the term "physical simulation" was used to represent the case where... psychology that there is no "step function" threshold. Rather, detection capability plotted against phys- ical parameter strength results in an ogival

Laparoscopic completion cholecystectomy and common bile duct exploration for retained gallbladder after single-incision cholecystectomy.

PubMed

Kroh, Matthew; Chalikonda, Sricharan; Chand, Bipan; Walsh, R Matthew

2013-01-01

Recent enthusiasm in the surgical community for less invasive surgical approaches has resulted in widespread application of single-incision techniques. This has been most commonly applied in laparoscopic cholecystectomy in general surgery. Cosmesis appears to be improved, but other advantages remain to be seen. Feasibility has been demonstrated, but there is little description in the current literature regarding complications. We report the case of a patient who previously underwent single-incision laparoscopic cholecystectomy for symptomatic gallstone disease. After a brief symptom-free interval, she developed acute pancreatitis. At evaluation, imaging results of ultrasonography and magnetic resonance cholangiopancreatography demonstrated a retained gallbladder with cholelithiasis. The patient was subsequently referred to our hospital, where she underwent further evaluation and surgical intervention. Our patient underwent 4-port laparoscopic remnant cholecystectomy with transcystic common bile duct exploration. Operative exploration demonstrated a large remnant gallbladder and a partially obstructed cystic duct with many stones. Transcystic exploration with balloon extraction resulted in duct clearance. The procedure took 75 minutes, with minimal blood loss. The patient's postoperative course was uneventful. Final pathology results demonstrated a remnant gallbladder with cholelithiasis and cholecystitis. This report is the first in the literature to describe successful laparoscopic remnant cholecystectomy and transcystic common bile duct exploration after previous single-port cholecystectomy. Although inadvertent partial cholecystectomy is not unique to this technique, single-port laparoscopic procedures may result in different and significant complications.

Using simulators to teach pediatric airway procedures in an international setting.

PubMed

Schwartz, Marissa A; Kavanagh, Katherine R; Frampton, Steven J; Bruce, Iain A; Valdez, Tulio A

2018-01-01

There has been a growing shift towards endoscopic management of laryngeal procedures in pediatric otolaryngology. There still appears to be a shortage of pediatric otolaryngology programs and children's hospitals worldwide where physicians can learn and practice these skills. Laryngeal simulation models have the potential to be part of the educational training of physicians who lack exposure to relatively uncommon pediatric otolaryngologic pathology. The objective of this study was to assess the utility of pediatric laryngeal models to teach laryngeal pathology to physicians at an international meeting. Pediatric laryngeal models were assessed by participants at an international pediatric otolaryngology meeting. Participants provided demographic information and previous experience with pediatric airways. Participants then performed simulated surgery on these models and evaluated them using both a previously validated Tissue Likeness Scale and a pre-simulation to post-simulation confidence scale. Participants reported significant subjective improvement in confidence level after use of the simulation models (p < 0.05). Participants reported realistic representations of human anatomy and pathology. The models' tissue mechanics were adequate to practice operative technique including the ability to incise, suture, and suspend models. The pediatric laryngeal models demonstrate high quality anatomy, which is easy manipulated with surgical instruments. These models allow both trainees and surgeons to practice time-sensitive airway surgeries in a safe and controlled environment. Copyright © 2017 Elsevier B.V. All rights reserved.

REHABILITATION FOLLOWING KNEE DISLOCATION WITH LATERAL SIDE INJURY: IMPLEMENTATION OF THE KNEE SYMMETRY MODEL

PubMed Central

Jenkins, Walter; Urch, Scott E.; Shelbourne, K. Donald

2010-01-01

Rehabilitation following lateral side knee ligament repair or reconstruction has traditionally utilized a conservative approach. An article outlining a new concept in rehabilitation following ACL reconstruction called the Knee Symmetry Model was recently published13. The Knee Symmetry Model can also be applied to rehabilitation of other knee pathologies including a knee dislocation with a lateral side injury. This Clinical Commentary describes the rehabilitation procedures used with patients who underwent surgery to repair lateral side ligaments, based upon the Knee Symmetry Model. These procedures were used previously to rehabilitate a group of patients with lateral side ligament repair as reported by Shelbourne et al10. Outcome data and subjective knee scores for these patients were recorded via the International Knee Documentation Committee (IKDC) guidelines and modified Noyes survey scores and are summarized in this paper, as previously published. Rehabilitation following lateral side knee ligament repair using guidelines based upon the Knee Symmetry Model appears to provide patients with excellent long-term stability, normal ROM and strength, and a high level of function. PMID:21589671

Reducing bias and analyzing variability in the time-left procedure.

PubMed

Trujano, R Emmanuel; Orduña, Vladimir

2015-04-01

The time-left procedure was designed to evaluate the psychophysical function for time. Although previous results indicated a linear relationship, it is not clear what role the observed bias toward the time-left option plays in this procedure and there are no reports of how variability changes with predicted indifference. The purposes of this experiment were to reduce bias experimentally, and to contrast the difference limen (a measure of variability around indifference) with predictions from scalar expectancy theory (linear timing) and behavioral economic model (logarithmic timing). A control group of 6 rats performed the original time-left procedure with C=60 s and S=5, 10,…, 50, 55 s, whereas a no-bias group of 6 rats performed the same conditions in a modified time-left procedure in which only a single response per choice trial was allowed. Results showed that bias was reduced for the no-bias group, observed indifference grew linearly with predicted indifference for both groups, and difference limen and Weber ratios decreased as expected indifference increased for the control group, which is consistent with linear timing, whereas for the no-bias group they remained constant, consistent with logarithmic timing. Therefore, the time-left procedure generates results consistent with logarithmic perceived time once bias is experimentally reduced. Copyright © 2015 Elsevier B.V. All rights reserved.

Report to Congress on abnormal occurrences, October--December 1994. Volume 17, No. 4

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

NONE

Section 208 of the Energy Reorganization Act of 1974 identifies an abnormal occurrence (AO) as an unscheduled incident or event that the Nuclear Regulatory Commission determines to be significant from the standpoint of public health or safety and requires a quarterly report of such occurrences to be made to Congress. This report provides a description of those incidents and events that have been determined to be AOs during the period of October 1 through December 31, 1994. This report addresses four AOs at NRC-licensed facilities. These occurrences involved the following: a generic concern relating to core shroud cracking in boilingmore » water reactors; recurring incidents of administering higher doses than procedurally allowed for diagnostic imaging at a single facility; one medical teletherapy misadministration; and one medical brachytherapy misadministration. Agreement States submitted four AO reports. These four occurrences involved the following: one major contamination at a commercial facility; two medical brachytherapy misadministrations; and one medical teletherapy misadministration. The report also contains updates of seven AOs previously reported by NRC licensees and four AOs previously reported by the Agreement States. Two ``Other Events of Interest`` are also being reported. These occurrences involved the operability of safety relief valves at a nuclear power plant, and an error in the installation process of a Leksell Gamma KnifeR teletherapy unit that resulted in an operational failure.« less

Vaginal prolapse surgery with transvaginal mesh: results of the Austrian registry.

PubMed

Bjelic-Radisic, V; Aigmueller, T; Preyer, O; Ralph, G; Geiss, I; Müller, G; Riss, P; Klug, P; Konrad, M; Wagner, G; Medl, M; Umek, W; Lozano, P; Tamussino, K; Tammaa, A

2014-08-01

Several mesh repair systems for pelvic organ prolapse (POP) were introduced into clinical practice with limited data on safety, complications or success rates, and impact on sexual function. The Austrian Urogynecology Working Group initiated a registry to assess the use of transvaginal mesh devices for POP repair. We looked at perioperative data, as well as outcomes at 3 and 12 months. Between 2006 and 2010 a total of 20 gynecology departments in Austria participated in the Transvaginal Mesh Registry. Case report forms were completed to gather data on operations, the postoperative course, and results at 3 and 12 months. A total of 726 transvaginal procedures with 10 different transvaginal kits were registered. Intra- and perioperative complications were reported in 6.8%. The most common complication was increased intraoperative bleeding (2.2%). Bladder and bowel perforation occurred in 6 (0.8%) and 2 (0.3%) cases. Mesh exposure was seen in 11% at 3 and in 12% at 12 months. 24 (10%) previously asymptomatic patients developed bowel symptoms by 1 year. De novo bladder symptoms were reported in 39 (10%) at 3 and in 26 (11%) at 12 months. Dyspareunia was reported by 7% and 10% of 265 and 181 sexually active patients at 3 and 12 months postoperatively respectively. The 6.8% rate of intra- and perioperative complications is in line with previous reports. Visceral injury was rare. The 12% rate of mesh exposure is consistent with previous series.

Training Japanese listeners to identify English /r/ and /l/: A first report

PubMed Central

Logan, John S.; Lively, Scott E.; Pisoni, David B.

2012-01-01

Native speakers of Japanese learning English generally have difficulty differentiating the phonemes /r/ and /l/, even after years of experience with English. Previous research that attempted to train Japanese listeners to distinguish this contrast using synthetic stimuli reported little success, especially when transfer to natural tokens containing /r/ and /l/ was tested. In the present study, a different training procedure that emphasized variability among stimulus tokens was used. Japanese subjects were trained in a minimal pair identification paradigm using multiple natural exemplars contrasting /r/ and /l/ from a variety of phonetic environments as stimuli. A pretest–posttest design containing natural tokens was used to assess the effects of training. Results from six subjects showed that the new procedure was more robust than earlier training techniques. Small but reliable differences in performance were obtained between pretest and posttest scores. The results demonstrate the importance of stimulus variability and task-related factors in training nonnative speakers to perceive novel phonetic contrasts that are not distinctive in their native language. PMID:2016438

Visual search for emotional expressions: Effect of stimulus set on anger and happiness superiority.

PubMed

Savage, Ruth A; Becker, Stefanie I; Lipp, Ottmar V

2016-01-01

Prior reports of preferential detection of emotional expressions in visual search have yielded inconsistent results, even for face stimuli that avoid obvious expression-related perceptual confounds. The current study investigated inconsistent reports of anger and happiness superiority effects using face stimuli drawn from the same database. Experiment 1 excluded procedural differences as a potential factor, replicating a happiness superiority effect in a procedure that previously yielded an anger superiority effect. Experiments 2a and 2b confirmed that image colour or poser gender did not account for prior inconsistent findings. Experiments 3a and 3b identified stimulus set as the critical variable, revealing happiness or anger superiority effects for two partially overlapping sets of face stimuli. The current results highlight the critical role of stimulus selection for the observation of happiness or anger superiority effects in visual search even for face stimuli that avoid obvious expression related perceptual confounds and are drawn from a single database.

Altered Passive Eruption Complicating Optimal Orthodontic Bracket Placement: A Case Report and Review of Literature.

PubMed

Pulgaonkar, Rohan; Chitra, Prasad

2015-11-01

An unusual case of altered passive eruption with gingival hyperpigmentation and a Class I malocclusion in a 12-year-old girl having no previous history of medication is presented. The patient reported with spacing in the upper arch, moderate crowding in the lower arch, anterior crossbite and excessive gingival tissue on the labial surfaces of teeth in both the arches. The inadequate crown lengths made placement of the orthodontic brackets difficult. Preadjusted orthodontic brackets have a very precise placement protocol which can affect tooth movement in all 3 planes of space if violated. The periodontal condition was diagnosed as altered passive eruption Type IA. Interdisciplinary treatment protocols including periodontal surgical and orthodontic procedures were used. The periodontal surgical procedures were carried out prior to orthodontic therapy and the results obtained were satisfactory. It is suggested that orthodontists should be aware of conditions like altered passive eruption and modalities of management. In most instances, orthodontic therapy is not hindered.

A late unusual complication after an open cholecystectomy: Amputation neuroma of the CBD causing obstructive jaundice.

PubMed

Sleiman, Youssef A; Hassoun, Ziad A; Nasser, Haydar A; Abs, Leila; Allouch, Mustafa

2017-01-01

Cholecystectomy is one of the most frequently done procedures in general surgery. There are few reports of amputation neuromas following this procedure. This presentation describes a case of obstructive jaundice due to amputation neuroma in a patient with a history of cholecystectomy. We report about a 53 y o lady who presented with obstructive jaundice, 8 years following open cholecystectomy. Paraclinical investigations were in favor of cholangicarcinoma, however the final pathology revealed an amputation neuroma of the CBD. Amputation neuromas are rarely seen in the era of laparoscopic cholecystectomy. They are benign reparative lesions of the CBD following surgery or manipulation of the extra hepatic biliary tree. It is very difficult to diagnose them pre-operatively. Surgical resection is the first choice of treatment. Traumatic neuromas should always be among the differential diagnosis, when assessing a CBD mass in patients with a previous history of open cholecystectomy or surgery to the gastrointestinal tract. Copyright © 2017 The Author(s). Published by Elsevier Ltd.. All rights reserved.

Pulmonary embolism after arterial chemoembolization for hepatocellular carcinoma: an autopsy case report.

PubMed

Hatamaru, Keiichi; Azuma, Shunjiro; Akamatsu, Takuji; Seta, Takeshi; Urai, Shunji; Uenoyama, Yoshito; Yamashita, Yukitaka; Ono, Kazuo

2015-01-28

We report an extremely rare case of pulmonary lipiodol embolism with acute respiratory distress syndrome (ARDS) after transcatheter arterial chemoembolization (TACE) for hepatocellular carcinoma (HCC). A 77-year-old man who was diagnosed with a huge HCC was admitted for TACE. Immediately after the procedure, this patient experienced severe dyspnea. We suspected that his symptoms were associated with a pulmonary lipiodol embolism after TACE, and we began intensive treatment. However, his condition did not improve, and he died on the following day. A subsequent autopsy revealed that the cause of death was ARDS due to pulmonary lipiodol embolism. No cases have been previously reported for which an autopsy was performed to explain the most probable mechanism of pulmonary lipiodol embolism; thus, ours is the first report for such a rare case.

Automatic picker of P & S first arrivals and robust event locator

NASA Astrophysics Data System (ADS)

Pinsky, V.; Polozov, A.; Hofstetter, A.

2003-12-01

We report on further development of automatic all distances location procedure designed for a regional network. The procedure generalizes the previous "loca l" (R < 500 km) and "regional" (500 < R < 2000 km) routines and comprises: a) preliminary data processing (filtering and de-spiking), b) phase identificatio n, c) P, S first arrival picking, d) preliminary location and e) robust grid-search optimization procedure. Innovations concern phase identification, automa tic picking and teleseismic location. A platform free flexible Java interface was recently created, allowing easy parameter tuning and on/off switching to t he full-scale manual picking mode. Identification of the regional P and S phase is provided by choosing between the two largest peaks in the envelope curve. For automatic on-time estimation we utilize now ratio of two STAs, calculated in two consecutive and equal time windows (instead of previously used Akike Information Criterion). "Teleseismic " location is split in two stages: preliminary and final one. The preliminary part estimates azimuth and apparent velocity by fitting a plane wave to the P automatic pickings. The apparent velocity criterion is used to decide about strategy of the following computations: teleseismic or regional. The preliminary estimates of azimuth and apparent velocity provide starting value for the final teleseismic and regional location. Apparent velocity is used to get first a pproximation distance to the source on the basis of the P, Pn, Pg travel-timetables. The distance estimate together with the preliminary azimuth estimate provides first approximations of the source latitude and longitude via sine and cosine theorems formulated for the spherical triangle. Final location is based on robust grid-search optimization procedure, weighting the number of pickings that simultaneously fit the model travel times. The grid covers initial location and becomes finer while approaching true hypocenter. The target function is a sum of the bell-shaped characteristic functions, used to emphasize true pickings and eliminate outliers. The final solution is a grid point that provides maximum to the target function. The procedure was applied to a list of ML > 4 earthquakes recorded by the Israel Seismic Network (ISN) in the 1999-2002 time period. Most of them are badly constrained relative the network. However, the results of location with average normalized error relative bulletin solutions e=dr/R of 5% were obtained, in each of the distance ranges. The first version of the procedure was incorporated in the national Early Warning System in 2001. Recently, we started to send automatic Early Warn ing reports, to the EMSC Real Time Bulletin. Initially reported some teleseismic location discrepancies have been eliminated by introduction of station corrections.

Outcome of the use of tension-free vaginal tape in women with mixed urinary incontinence, previous failed surgery, or low valsalva pressure.

PubMed

Abdel-Hady, El-Said; Constantine, Glyn

2005-02-01

To assess the safety and efficacy of the use of tension-free vaginal tape (TVT) for the treatment of stress urinary incontinence (SUI) in women with mixed incontinence, previous failed incontinence surgery or low valsalva leak point pressure (VLPP). Six hundred and fifty-eight women with SUI underwent the TVT procedure. These included women with mixed stress and urge incontinence (n=128), previous surgery for SUI (n=118), low VLPP (n=80), and those over 70 years old (n=68). The procedure was carried out under spinal anesthetic and operative and immediate postoperative data was collected for all women. Six-month follow-up data was available on 454 women, with the first 300 women completing a quality of life (QOL) questionnaire before and after surgery. The overall subjective cure rate at 6 months was 91%, with 8% of women reporting significant (>50%) improvement in their symptoms. Subgroups with a body mass index > 30, age > 70 years, coexisting instability, previous failed surgery, and low VLPP showed cure rates of 81-89%. QOL improvements for all groups were highly significant. Significant complications included voiding difficulties in 29 women (4.4%), retropubic hematomas in four (0.6%), and thromboembolic episodes in three (0.5%). The simplicity and high efficacy of the TVT makes it the first choice for the treatment of women with SUI, including those with more complex problems or coexisting risk factors.

Rescue associating liver partition and portal vein ligation for staged hepatectomy after portal embolization: Our experience and literature review.

PubMed

Maulat, Charlotte; Philis, Antoine; Charriere, Bérénice; Mokrane, Fatima-Zohra; Guimbaud, Rosine; Otal, Philippe; Suc, Bertrand; Muscari, Fabrice

2017-08-10

To report a single-center experience in rescue associating liver partition and portal vein ligation for staged hepatectomy (ALPPS), after failure of previous portal embolization. We also performed a literature review. Between January 2014 and December 2015, every patient who underwent a rescue ALPPS procedure in Toulouse Rangueil University Hospital, France, was included. Every patient included had a project of major hepatectomy and a previous portal vein embolization (PVE) with insufficient future liver remnant to body weight ratio after the procedure. The ALPPS procedure was performed in two steps (ALPPS-1 and ALPPS-2), separated by an interval phase. ALPPS-2 was done within 7 to 9 d after ALPPS-1. To estimate the FLR, a computed tomography scan examination was performed 3 to 6 wk after the PVE procedure and 6 to 8 d after ALPPS-1. A transcystic stent was placed during ALPPS-1 and remained opened during the interval phase, in order to avoid biliary complications. Postoperative liver failure was defined using the 50-50 criteria. Postoperative complications were assessed according to the Dindo-Clavien Classification. From January 2014 to December 2015, 7 patients underwent a rescue ALPPS procedure. Median FLR before PVE, ALPPS-1 and ALPPS-2 were respectively 263 cc (221-380), 450 cc (372-506), and 660 cc (575-776). Median FLR/BWR before PVE, ALPPS-1 and ALPPS-2 were respectively 0.4% (0.3-0.5), 0.6% (0.5-0.8), and 1% (0.8-1.2). Median volume growth of FLR was 69% (18-92) after PVE, and 45% (36-82) after ALPPS-1. The combination of PVE and ALPPS induced a growth of median initial FLR of +408 cc (254-513), leading to an increase of +149% (68-199). After ALPPS-2, 4 patients had stage I-II complications. Three patients had more severe complications (one stage III, one stage IV and one death due to bowel perforation). Two patients suffered from postoperative liver failure according to the 50/50 criteria. None of our patients developed any biliary complication during the ALPPS procedure. Rescue ALPPS may be an alternative after unsuccessful PVE and could allow previously unresectable patients to reach surgery. Biliary drainage seems to reduce biliary complications.

Experiential learning not enough for organ procurement surgery: implications for perioperative nursing education.

PubMed

Smith, Zaneta; Leslie, Gavin; Wynaden, Dianne

2015-12-01

Perioperative nurses play a vital role in assisting in surgical procedures for multiorgan procurement, receiving little education apart from on-the-job experiential learning when they are asked to participate in these procedures. Within an Australian context and as part of a larger study, this article describes issues that hindered perioperative nurses' participatory experiences as a result of lacking education, previous exposure, and preparation for assisting in surgical procedures for organ procurement. The grounded theory method was used to develop a substantive theory of perioperative nurses' experiences of participating in surgical procedures for multiorgan procurement. Thirty-five perioperative nurses who had experience in surgical procedures for organ procurement from regional, rural, and metropolitan hospitals of 2 Australian states, New South Wales and Western Australia, participated in the research. Levels of knowledge and experience emerged from the data as an influencing condition and was reported to affect the perioperative nurses' participatory experiences when assisting in procurement surgical procedures. Six components of levels of knowledge and experience were identified and are described. The findings from this study provide a unique contribution to the existing literature by providing an in-depth understanding of the educational needs of perioperative nurses in order to assist successfully in multiorgan procurement procedures. These findings could guide further research with implications for clinical initiatives or education programs specifically targeting the perioperative nursing profession both locally and internationally.

Delayed hypersensitivity reaction of the knee after injection of arthroscopy portals with bupivacaine (marcaine)

PubMed

Craft, D V; Good, R P

1994-06-01

The number of arthroscopic procedures performed annually for the management of intraarticular injuries has grown at an exponential rate. Whether done with the patient under general anesthesia or local anesthesia supplemented with intravenous sedation, it is common practice to postoperatively inject each portal as well as the joint with a local anesthetic to provide pain relief in the transition to the recovery room and discharge after outpatient surgery. To our knowledge, no previous reports of localized urticaria and delayed hypersensitivity reaction have been reported in the postarthroscopy setting. We are reporting a case of delayed hypersensitivity reaction and urticaria of the knee that presented after bupivacaine (Marcaine) injection of arthroscopic portals after routine meniscectomy.

Umbilical endometriosis associated with large umbilical hernia. Case report.

PubMed

Stojanovic, M; Radojkovic, M; Jeremic, L; Zlatic, A; Stanojevic, G; Janjic, D; Mihajlovic, S; Dimov, I; Kostov, M; Zdravkovic, M; Stojanovic, M

2014-01-01

Umbilical endometriosis is a rare condition, usually following laparoscopic and surgical procedures involving the umbilicus.Spontaneous umbilical endometriosis occurring without any previous abdominal or uterine surgery is extremely rare. The maximal depth of penetration of the umbilical endometriosis described is up to fascial level. There have been only two cases of endometriosis reported arising within umbilical hernia. The authors report a case of a patient with spontaneous umbilical endometriosis associated with a large umbilical hernia, treated by surgical excision and mesh repair of the abdominal wall. To the best of our knowledge, this is the first described case of the association of umbilical endometriosis with a large umbilical hernia that requires prosthetic mesh repair of the abdominal wall defect. Celsius.

Chronic idiopathic constipation: a psychological enquiry.

PubMed

Dykes, S; Smilgin-Humphreys, S; Bass, C

2001-01-01

Intractable idiopathic constipation in women is often associated with psychosocial problems. To determine the past and current psychological factors associated with slow and normal transit constipation. Twenty-eight consecutive patients referred for biofeedback treatment were interviewed before the procedure. All were women. Transit studies revealed that 12 had slow transit constipation (STC) and 16 had normal transit constipation (NTC). Patients were assessed for evidence of previous and current psychiatric diagnoses using a standardized diagnostic interview schedule. A full family and social history was noted. Self-rating scales were used to measure psychological distress, abnormal attitudes to eating and current psychosocial functioning. The mean age of the 28 patients was 38.2 years (SD = 10.8) with a mean duration of symptoms of 17.5 years (SD = 16.9). Seventeen (61%) had a current psychiatric disorder and 18 (64%) a previous episode of psychiatric illness. The mean age of the 16 NTC patients was 38.4 years (SD = 10.1) with a mean duration of symptoms of 12.4 years (SD = 15.9). By contrast, the 12 STC patients had a much longer mean duration of constipation (24.3 years; SD = 16.4), a mean age of 37.9 years (SD = 12.1), with half having an onset in childhood. The STC patients reported more psychosocial distress on the rating scales than those with NTC, and only one did not experience some form of adverse life event or gynaecological procedure in the 6 months before the onset of constipation. Eleven (39%) of the 28 women had had a hysterectomy at a mean age of 36 years, but only four (14%) reported a history of sexual abuse. Of the nine (32%) patients who reported markedly distorted attitudes to food, six had NTC and three had STC. Of consecutive patients undergoing psychological assessment for intractable constipation, three fifths had evidence of current, and two thirds a previous, affective disorder. One third reported distorted attitudes to food. Although STC is a chronic disorder accompanied by high rates of psychological distress, it does not appear to be associated with gross functional impairment. We suggest that patients who present to surgical departments with chronic intractable constipation should routinely have a psychological assessment.

Internal carotid artery rupture caused by carotid shunt insertion.

PubMed

Illuminati, Giulio; Caliò, Francesco G; Pizzardi, Giulia; Vietri, Francesco

2015-01-01

Shunting is a well-accepted method of maintaining cerebral perfusion during carotid endarterectomy (CEA). Nonetheless, shunt insertion may lead to complications including arterial dissection, embolization, and thrombosis. We present a complication of shunt insertion consisting of arterial wall rupture, not reported previously. A 78-year-old woman underwent CEA combined with coronary artery bypass grafting (CABG). At the time of shunt insertion an arterial rupture at the distal tip of the shunt was detected and was repaired via a small saphenous vein patch. Eversion CEA and subsequent CABG completed the procedure whose postoperative course was uneventful. Shunting during combined CEA-CABG may be advisable to assure cerebral protection from possible hypoperfusion due to potential hemodynamic instability of patients with severe coronary artery disease. Awareness and prompt management of possible shunt-related complications, including the newly reported one, may contribute to limiting their harmful effect. Arterial wall rupture is a possible, previously not reported, shunt-related complication to be aware of when performing CEA. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.

Correlation, evaluation, and extension of linearized theories for tire motion and wheel shimmy

NASA Technical Reports Server (NTRS)

Smiley, Robert F

1957-01-01

An evaluation is made of the existing theories of a linearized tire motion and wheel shimmy. It is demonstrated that most of the previously published theories represent varying degrees of approximation to a summary theory developed in this report which is a minor modification of the basic theory of Von Schlippe and Dietrich. In most cases where strong differences exist between the previously published theories and summary theory, the previously published theories are shown to possess certain deficiencies. A series of systematic approximations to the summary theory is developed for the treatment of problems too simple to merit the use of the complete summary theory, and procedures are discussed for applying the summary theory and its systematic approximations to the shimmy of more complex landing-gear structures than have previously been considered. Comparisons of the existing experimental data with the predictions of the summary theory and the systematic approximations provide a fair substantiation of the more detailed approximate theories.

Bariatric Surgery and Endoluminal Procedures: IFSO Worldwide Survey 2014.

PubMed

Angrisani, L; Santonicola, A; Iovino, P; Vitiello, A; Zundel, N; Buchwald, H; Scopinaro, N

2017-09-01

Several bariatric surgery worldwide surveys have been previously published to illustrate the evolution of bariatric surgery in the last decades. The aim of this survey is to report an updated overview of all bariatric procedures performed in 2014.For the first time, a special section on endoluminal techniques was added. The 2014 International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) survey form evaluating the number and the type of surgical and endoluminal bariatric procedures was emailed to all IFSO societies. Trend analyses from 2011 to 2014 were also performed. There were 56/60 (93.3%) responders. The total number of bariatric/metabolic procedures performed in 2014 consisted of 579,517 (97.6%) surgical operations and 14,725 (2.4%) endoluminal procedures. The most commonly performed procedure in the world was sleeve gastrectomy (SG) that reached 45.9%, followed by Roux-en-Y gastric bypass (RYGB) (39.6%), and adjustable gastric banding (AGB) (7.4%). The annual percentage changes from 2013 revealed the increase of SG and decrease of RYGB in all the IFSO regions (USA/Canada, Europe, and Asia/Pacific) with the exception of Latin/South America, where SG decreased and RYGB represented the most frequent procedure. There was a further increase in the total number of bariatric/metabolic procedures in 2014 and SG is currently the most frequent surgical procedure in the world. This is the first survey that describes the endoluminal procedures, but the accuracy of provided data should be hopefully improved in the next future. We encourage the creation of further national registries and their continuous updates taking into account all new bariatric procedures including the endoscopic procedures that will obtain increasing importance in the near future.

Proposal for a new classification of variations in the iliac venous system based on internal iliac veins: a case series and a review of double and left inferior vena cava.

PubMed

Hayashi, Shogo; Naito, Munekazu; Hirai, Shuichi; Terayama, Hayato; Miyaki, Takayoshi; Itoh, Masahiro; Fukuzawa, Yoshitaka; Nakano, Takashi

2013-09-01

There are many reports on variations in the inferior vena cava (IVC), particularly double IVC (DIVC) and left IVC (LIVC). However, no systematic report has recorded iliac vein (IV) flow patterns in the DIVC and LIVC. In this study, we examined IV flow patterns in both DIVC and LIVC observed during gross anatomy courses conducted for medical students and in previously reported cases. During the gross anatomy courses, three cases of DIVC and one case of LIVC were found in 618 cadavers. The IV flow pattern from these four cases and all other previously reported cases can be classified into one of the following three types according to the vein into which the internal iliac vein drained: the ipsilateral external IV; confluence of the ipsilateral external IV and IVC; and the communicating vein, which connects the IVC and the contralateral IVC or its iliac branch. This classification, which is based on the internal IV course, is considered to be useful because IV variations have the potential to cause clinical problems during related retroperitoneal surgery, venous interventional radiology, and diagnostic procedures for pelvic cancer.

Hospital utilization by health maintenance organizations. Separating apples from oranges.

PubMed

Mott, P D

1986-05-01

The hospitalization rate of HMOs is reported to be 444 bed days per 1,000 enrollees per year. It is often forgotten that there is also out-of-plan utilization. A review of previous studies and a survey of reporting practices by three HMOs illustrate many problems with HMO utilization data. HMO rates, like those of other insurers, reflect only the hospital admissions that the plans know about and pay for, not the total hospital experience of their enrollees. While only a thorough tracking of subscriber utilization of all insurers and institutions will provide estimates of the magnitude of unreported admissions and their impact on utilization rates, this report enumerates the ways in which patients may receive inpatient care without the HMO having a record of the admissions and/or having to pay for them. It was found that admissions can be unreported when another insurer or institution pays (e.g., Medicare, No Fault, Workmen's Compensation, duplicate coverage, school health and liability insurance or VA, military, municipal, and state hospitals); when the HMO does not cover benefits (e.g., cosmetic and oral surgery, experimental procedures, long-term psychiatric, chronic, or rehabilitation stays); and when HMO coverage is denied for procedural reasons (e.g., catastrophic stays covered by reinsurance, newborns, voluntary "leakage," or improper following of HMO procedures). True HMO rates are unknown but are estimated by some authors to be 7-37% higher than the reported figure, depending on which types of unreported use are estimated. There is a need for future analyses to quantify true hospitalization rates of enrollees of HMOs and other insurers.

Case report: Osteonecrosis of the femoral head after hip arthroscopy.

PubMed

Scher, Danielle L; Belmont, Philip J; Owens, Brett D

2010-11-01

Hip arthroscopy is a common orthopaedic procedure used as a diagnostic and therapeutic tool with a multitude of surgical indications. The complication rate is reportedly between 1.3% and 23.3%. Major complications are related to traction, fluid extravasation, and iatrogenic chondral injury. Although osteonecrosis is a concern with any surgical procedure about the hip, this complication has been primarily a theoretical concern with hip arthroscopy. We report the case of a 24-year-old man who presented with a 2-year history of left hip pain. He underwent hip arthroscopy to include débridement of a torn labrum and removal of a prominent pincer lesion for femoroacetabular impingement. Traction was initiated by applying manual traction to the traction bar until 10 mm of joint distraction was obtained. Traction was removed at 90 minutes. At the 3-month followup, MRI showed osteonecrosis in the subcapital region of the left femoral head. It generally is agreed the magnitude and duration of traction during hip arthroscopy increase the risk of traction-related injuries. Only one previous case of femoral head osteonecrosis associated with hip arthroscopy has been reported, and this may have resulted from the initial traumatic event. Based on anatomic studies, the use of standard arthroscopic portals would not put at risk any dominant normal vascular structures supplying the femoral head. In contrast, the literature shows that femoral head osteonecrosis may develop secondary to a combination of increased intraarticular pressure and traction. We suspect this case of femoral head osteonecrosis after hip arthroscopy was caused by traction used in the procedure.

Emergency right hepatectomy after laparoscopic tru-cut liver biopsy

PubMed Central

Quezada, Nicolás; León, Felipe; Martínez, Jorge; Jarufe, Nicolás; Guerra, Juan Francisco

2015-01-01

Background Liver biopsy is a common procedure usually required for final pathologic diagnosis of different liver diseases. Morbidity following tru-cut biopsy is uncommon, with bleeding complications generally self-limited. Few cases of major hemorrhage after liver biopsies have been reported, but to our knowledge, no cases of emergency hepatectomy following a tru-cut liver biopsy have been reported previously. Presentation of case We report the case of a 38 years-old woman who presented with an intrahepatic arterial bleeding after a tru-cut liver biopsy under direct laparoscopic visualization, initially controlled by ligation of the right hepatic artery and temporary liver packing. On tenth postoperative day, she developed a pseudo-aneurysm of the anterior branch of the right hepatic artery, evolving with massive bleeding that was not amenable to control by endovascular therapy. Therefore, an emergency right hepatectomy had to be performed in order to stop the bleeding. The patient achieved hemodynamic stabilization, but developed a biliary fistula from the liver surface, refractory to non-operative treatment. In consequence, a Roux-Y hepatico-jejunostomy was performed at third month, with no further complications. Discussion Bleeding following tru-cut biopsy is a rare event. To our knowledge, this is the first report of an emergency hepatectomy due to hemorrhage following liver biopsy. Risks and complications of liver biopsy are revised. Conclusion Care must be taken when performing this kind of procedures and a high level of suspicion regarding this complication should be taken in count when clinical/hemodynamic deterioration occurs after these procedures. PMID:25618399

Descending genicular artery injury following transient lateral patellar dislocation.

PubMed

Silvestri, Andrea; Regis, Dario; Trivellin, Giacomo; Piccoli, Marco; Spina, Mauro; Magnan, Bruno; Sandri, Andrea

2018-06-01

Transient lateral patellar dislocation (TLPD) is a common lesion in young adults. Vascular injury as a complication of TLPD has not been previously described. We report a case of descending genicular artery (DGA) injury after TLPD. Immediate angiography demonstrated rupture of DGA. Embolization was performed with sudden interruption of bleeding. DGA injury should be considered as a complication after TLPD and prompt diagnosis and intervention are required. We propose selective embolization as a safe and effective procedure to stop bleeding.

Application of imaging to the atmospheric Cherenkov technique

NASA Technical Reports Server (NTRS)

Cawley, M. F.; Fegan, D. J.; Gibbs, K.; Gorham, P. W.; Hillas, A. M.; Lamb, R. C.; Liebing, D. F.; Mackeown, P. K.; Porter, N. A.; Stenger, V. J.

1985-01-01

Turver and Weekes proposed using a system of phototubes in the focal plane of a large reflector to give an air Cherenkov camera for gamma ray astronomy. Preliminary results with a 19 element camera have been reported previously. In 1983 the camera was increased to 37 pixels; it has now been routinely operated for two years. A brief physical description of the camera, its mode of operation, and the data reduction procedures are presented. The Monte Carlo simultations on which these are based on also reviewed.

Improving the throughput of batch photochemical reactions using flow: Dual photoredox and nickel catalysis in flow for C(sp2)C(sp3) cross-coupling.

PubMed

Abdiaj, Irini; Alcázar, Jesús

2017-12-01

We report herein the transfer of dual photoredox and nickel catalysis for C(sp 2 )C(sp 3 ) cross coupling form batch to flow. This new procedure clearly improves the scalability of the previous batch reaction by the reactor's size and operating time reduction, and allows the preparation of interesting compounds for drug discovery in multigram amounts. Copyright © 2016 Elsevier Ltd. All rights reserved.

"Anti-Michael addition" of Grignard reagents to sulfonylacetylenes: synthesis of alkynes.

PubMed

Esteban, Francisco; Boughani, Lazhar; García Ruano, José L; Fraile, Alberto; Alemán, José

2017-05-10

In this work, the addition of Grignard reagents to arylsulfonylacetylenes, which undergoes an "anti-Michael addition", resulting in their alkynylation under very mild conditions is described. The simplicity of the experimental procedure and the functional group tolerance are the main features of this methodology. This is an important advantage over the use of organolithium at -78 °C that we previously reported. Moreover, the synthesis of diynes and other examples showing functional group tolerance in this anti-Michael reaction is also presented.

Virtually Instantaneous, Room-temperature [11C]-Cyanation Using Biaryl Phosphine Pd(0) Complexes

PubMed Central

Lee, Hong Geun; Milner, Phillip J.; Placzek, Michael S.; Buchwald, Stephen L.; Hooker, Jacob M.

2015-01-01

A new radiosynthetic protocol for the preparation of [11C]aryl nitriles has been developed. This process is based on the direct reaction of in situ prepared L•Pd(Ar)X complexes (L=biaryl phosphine) with [11C]HCN. The strategy is operationally simple, exhibits a remarkably wide substrate scope with short reaction times, and demonstrates superior reactivity compared to previously reported systems. With this procedure, a variety of [11C]nitrile-containing pharmaceuticals were prepared with high radiochemical efficiency. PMID:25565277

Cerebral Lipiodol Embolism: A Complication of Transcatheter Arterial Chemoembolization for Hepatocellular Carcinoma

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

Matsumoto, Koichi, E-mail: matsumk2@cc.saga-u.ac.jp; Nojiri, Junichi; Takase, Yukinori

2007-06-15

We report a case of cerebral lipiodol embolism following transcatheter chemoembolization (TACE) for hepatocellular carcinoma. A 70-year-old woman with a large unresectable hepatocellular carcinoma underwent TACE. Her level of consciousness deteriorated after the procedure, and magnetic resonance imaging and non-contrast computed tomography revealed a cerebral lipiodol embolism. Despite intensive care, the patient died 2 weeks later. The complication might have been due to systemic-pulmonary shunts caused by previous surgeries and/or direct invasion of the recurrent tumor.

Multiple intensity distributions from a single optical element

NASA Astrophysics Data System (ADS)

Berens, Michael; Bruneton, Adrien; Bäuerle, Axel; Traub, Martin; Wester, Rolf; Stollenwerk, Jochen; Loosen, Peter

2013-09-01

We report on an extension of the previously published two-step freeform optics tailoring algorithm using a Monge-Kantorovich mass transportation framework. The algorithm's ability to design multiple freeform surfaces allows for the inclusion of multiple distinct light paths and hence the implementation of multiple lighting functions in a single optical element. We demonstrate the procedure in the context of automotive lighting, in which a fog lamp and a daytime running lamp are integrated in a single optical element illuminated by two distinct groups of LEDs.

Electropyroelectric technique: A methodology free of fitting procedures for thermal effusivity determination in liquids.

PubMed

Ivanov, R; Marin, E; Villa, J; Gonzalez, E; Rodríguez, C I; Olvera, J E

2015-06-01

This paper describes an alternative methodology to determine the thermal effusivity of a liquid sample using the recently proposed electropyroelectric technique, without fitting the experimental data with a theoretical model and without having to know the pyroelectric sensor related parameters, as in most previous reported approaches. The method is not absolute, because a reference liquid with known thermal properties is needed. Experiments have been performed that demonstrate the high reliability and accuracy of the method with measurement uncertainties smaller than 3%.

Rapid method to extract DNA from Cryptococcus neoformans.

PubMed Central

Varma, A; Kwon-Chung, K J

1991-01-01

A rapid and easy method for the extraction of total cellular DNA from Cryptococcus neoformans is described. This procedure modifies and considerably simplifies previously reported methods. Numerous steps were either eliminated or replaced, including preincubations with cell wall permeability agents such as beta-mercaptoethanol and dithiothreitol. The commercially available enzyme preparation Novozyme 234 was found to contain a potent concentration of DNases which actively degrade DNA. Degradation and loss of DNA was prevented by maintaining a high concentration of EDTA in the lysing solution. This procedure resulted in high yields (150 to 200 micrograms of DNA from 100 ml of culture) of good-quality (undegraded), high-molecular-weight DNA which was readily digested by restriction endonucleases, making it suitable for use in various molecular applications. Images PMID:1909713

The impact of outcome orientation and justice concerns on tax compliance: the role of taxpayers' identity.

PubMed

Wenzel, Michael

2002-08-01

Previous research has yielded inconsistent evidence for the impact of justice perceptions on tax compliance. This article suggests a more differentiated view on the basis of 2 congenial theories of procedural and distributive justice. The group-value model and a categorization approach argue that taxpayers are more concerned about justice and less about personal outcomes when they identify strongly with the inclusive category within which procedures and distributions apply. Regression analyses of survey data from 2,040 Australian citizens showed that 2 forms of tax compliance (pay-income reporting and tax minimization) were determined by self-interest variables. For 2 other forms (nonpay income and deductions), inclusive identification had an additional effect and moderated the effects of self-interest and justice variables as predicted.

Dose and elasticity of demand for self-administered cocaine in rats.

PubMed

Kearns, David N; Silberberg, Alan

2016-04-01

The present experiment tested whether the elasticity of demand for self-administered cocaine in rats is dose-dependent. Subjects lever pressed for three different doses of intravenous cocaine - 0.11, 0.33, and 1.0 mg/kg/infusion - on a demand procedure where the number of lever presses required per infusion increased within a session. The main finding was that demand for the 0.11 mg/kg dose was more elastic than it was for the two larger doses. There was no difference in demand elasticity between the 0.33 and 1.0 mg/kg doses. These results parallel findings previously reported in monkeys. The present study also demonstrated that a within-session procedure can be used to generate reliable demand curves.

Chronic vaginal discharge and left leg edema after a transobturator tape procedure.

PubMed

Kim, Tae-Hee; Lee, Hae-Hyeog; Kim, Jun-Mo

2014-05-01

We report on a patient who underwent total vaginal hysterectomy for urinary incontinence 8 years previously with a sling operation using transobturator tape (TOT). She was admitted to our hospital after complaints of vaginal discharge, foul odor, and bleeding, left thigh pain, and edema. Magnetic resonance imaging (MRI) and computed tomography (CT) revealed a fistula tract from the vagina or urethra with remnant sling tape. We removed the remnant tape using intraoperative ultrasonography. This case exemplifies the rare occurrence of a vaginal fistula extending to the obturator, adductor, and pectineus muscles combined with myositis after TOT placement. It is important that urogynecologists recognize that TOT procedures may result in complications accompanied by common recurrent vaginal symptoms, such as vaginal odor and spotting, which can be identified by MRI or CT.

Lumbar puncture simulation in pediatric residency training: improving procedural competence and decreasing anxiety.

PubMed

McMillan, Hugh J; Writer, Hilary; Moreau, Katherine A; Eady, Kaylee; Sell, Erick; Lobos, Anna-Theresa; Grabowski, Jenny; Doja, Asif

2016-08-08

Pediatric residents must become proficient with performing a lumbar puncture (LP) during training. Residents have traditionally acquired LP skills by observing the procedure performed by a more senior resident or staff physician and then attempting the procedure themselves. This process can result in variable procedural skill acquisition and trainee discomfort. This study assessed changes in resident procedural skill and self-reported anxiety when residents were provided with an opportunity to participate in an interactive training session and practice LPs using a simulator. All pediatric residents at our institution were invited to participate. Residents were asked to report their post-graduate year (PGY), prior LP attempts and self-reported anxiety scores as measured by the standardized State-Trait Anxiety Inventory - State Anxiety Scale (STAI-S) prior to completing an observed pre-test using an infant-sized LP simulator. Staff physicians observed and scored each resident's procedural skill using a previously published 21-point scoring system. Residents then participated in an interactive lecture on LP technique and were given an opportunity for staff-supervised, small group simulator-based practice within 1 month of the pre-test. Repeat post-test was performed within 4 months. Of the pediatric residents who completed the pre-test (N = 20), 16/20 (80 %) completed both the training session and post-test. Their PGY training level was: PGY1 (38 %), PGY2 (25 %), PGY3 (25 %) or PGY4 (12 %). Procedural skill improved in 15/16 residents (paired t-test; p < 0.001), driven by a significant improvement in skill for residents in PGY1 (P = 0.015) and PGY2 (p = 0.003) but not PGY3 or PGY4. Overall anxiety scores were higher at baseline than at post testing (mean ± SD; 44.8 ± 12.1 vs 39.7 ± 9.4; NS) however only PGY1 residents experienced a significant reduction in anxiety (paired t-test, p = 0.04). LP simulation training combined with an interactive training session may be a useful tool for improving procedural competence and decreasing anxiety levels, particularly among those at an earlier stage of residency training.

[Multiple stones in atypical heterotopic reservoir in a patient with renal transplant: endourologic resolution].

PubMed

Pietro, Granelli; Antonio, Frattini; Stefania, Ferretti; Paolo, Salsi; Davide, Campobasso; Matteo, Moretti; Enzo, Capocasale; Patrizia, Mazzoni; Pietro, Cortellini; Granelli, Pietro; Frattini, Antonio; Ferretti, Stefania; Salsi, Paolo; Campobasso, Davide; Moretti, Matteo; Capocasale, Enzo; Mazzoni, Patrizia; Cortellini, Pietro

2011-10-01

Urolithiasis is a frequent complication in a heterotopic reservoir and the surgical management could be a difficult problem. Open surgery is not recommended in patients with multiple previous surgeries. A less invasive technique, such as the endourologic procedures, would allow high stone-free rate and low surgical morbidity. Stone formation in the reservoir is a well-known complication of urinary diversion. The incidence of lithiasis in patients with continent urinary diversion is reported as 12-52.5%. Most patients will have multiple physical factors, such as immobility, need for self-catheterization and poor urine drainage, so that it is not certain that an intestinal reservoir is the cause of stones on its own. The management of urolithiasis in continent urinary diversion can be challenging and could be a difficult problem to solve. A less invasive technique, such as the endourologic procedures, is desiderable, especially in patients with kidney transplant and low immune defence. We present the case of a 59-year-old woman with previous history of spina bifida and with neurogenic bladder. At a pediatric age, she underwent incontinent urinary diversion using a sigmo-colic conduit. For several years she had been suffering from kidney stones and recurrent urinary infections, which led to a left nephrectomy for pyonephrosis, subsequent deterioration of renal function and dialysis. In 2004, we performed an atypical continent and self-catheterizable reservoir using the previous colic conduit detubularized and ileum-cecal tract with Mitrofanoff system conduit of 14 Fr size. Finally, kidney transplant was carried out as last surgical procedure. Recently she has come to our attention for multiple and large reservoir stones. preliminary exploration of the continent pouch with flexible cystoscope. Percutaneous access with Endovision° direct control through the afferent conduit with 8 Fr flexible ureteroscope. Dilation of percutaneous tract with pneumatic balloon and positioning 30 Fr Amplats sheet. Lithotripsy, with ultrasound and ballistic sources, was performed and the residual fragments were removed with grasping. At the end of the procedure, after controlling the complete clearance with flexible nephroscope and X-ray, a percutanous 12 Fr catheter and a 12 Fr Foley in the Mitrofanoff conduit were inserted. No fever or increase serum creatinine were observed in the post-operative time. On day 3, we removed the percutaneous foley and after 7 days we performed a cystography with a normal pouch configuration; no leakage or residual fragments were observed. The woman was discarge and returned to usual self-catheterization. The first 3-month post-operative control was regular; no infections or pain were reported. In special cases, like this one, the percutaneous procedure is preferred to open surgery for a best control of the pouch and a simple complete clearence of the fragments.

[Low transverse laparotomy with rectus abdominus section in gynecology and obstetrics. Apropos of 1,000 cases].

PubMed

Querleu, D; Delahousse, G; Turpin, D; Leblanc, P; Debodinance, P; Boutteville, C; Meurette, J; Laurent, J C; Crépin, G

1987-11-01

The authors report 1,000 cases (357 cesarean sections, 230 hysterectomies for benign lesions, 157 conservative utero-adnexal procedures, 128 tubal plasties, 58 prolapse or incontinence procedures, 70 cancers) ,of laparotomies performed according to the technique described by Mouchel in 1980, i.e. strictly supra-pubic and transverse, from skin to peritoneum, including section of the rectus abdominis. This incision enables to perform in ideal technical conditions, with a minimal complication rate (3 hematomas, 2 incisional hernias for 1,000), and satisfactory esthetic results, almost all of the gynecological and obstetrical surgical procedures (90% of two among the authors' practice). The only contra-indications are, except for cases of previous median laparotomy, ovarian tumors. Neither the high risk of infection, nor obesity, extended hysterectomy, nor fetal distress, represent contra-indications, which is a definite advantage over the Pfannenstiel incision. As compared with the median incision which at some time offered similar results, the esthetics and mainly the strength of the abdominal wall are markedly superior.

Newborn screening healthcare information system based on service-oriented architecture.

PubMed

Hsieh, Sung-Huai; Hsieh, Sheau-Ling; Chien, Yin-Hsiu; Weng, Yung-Ching; Hsu, Kai-Ping; Chen, Chi-Huang; Tu, Chien-Ming; Wang, Zhenyu; Lai, Feipei

2010-08-01

In this paper, we established a newborn screening system under the HL7/Web Services frameworks. We rebuilt the NTUH Newborn Screening Laboratory's original standalone architecture, having various heterogeneous systems operating individually, and restructured it into a Service-Oriented Architecture (SOA), distributed platform for further integrity and enhancements of sample collections, testing, diagnoses, evaluations, treatments or follow-up services, screening database management, as well as collaboration, communication among hospitals; decision supports and improving screening accuracy over the Taiwan neonatal systems are also addressed. In addition, the new system not only integrates the newborn screening procedures among phlebotomy clinics, referral hospitals, as well as the newborn screening center in Taiwan, but also introduces new models of screening procedures for the associated, medical practitioners. Furthermore, it reduces the burden of manual operations, especially the reporting services, those were heavily dependent upon previously. The new system can accelerate the whole procedures effectively and efficiently. It improves the accuracy and the reliability of the screening by ensuring the quality control during the processing as well.

Vertebroplasty and delayed subdural cauda equina hematoma: Review of literature and case report.

PubMed

Tropeano, Maria Pia; La Pira, Biagia; Pescatori, Lorenzo; Piccirilli, Manolo

2017-08-16

Vertebroplasy is considered an alternative and effective treatment of painful oncologic spine disease. Major complications are very rare, but with high morbidity and occur in less than 1% of patients who undergo vertebroplasty. Spinal subdural hematoma (SDH) is an extremely rare complication, usual developing within 12 h to 24 h after the procedure. We report the case of a tardive SDH in an oncologic patient who underwent VP for Myxoid Liposarcoma metastasis. Trying to explain the pathogenesis, we support the hypothesis that both venous congestion of the vertebral venous plexus of the vertebral body and venous congestion due to a traumatic injury can provoke SDH. To our best knowledge, only 4 cases of spinal subdural hematoma following a transpedicular vertebroplasty have been previously described in International literature and only one of them occurred two weeks after that surgical procedures. Percutaneous verteboplasty is a well-known treatment of pain oncologic spine disease, used to provide pain relief and improvement of quality life and is considered a simple surgical procedure, involving a low risk of complications, but related to high morbidity, such as SDH. Therefore it has to be performed by experienced and skilled surgeons, that should also recognize possible risk factors, making SDH more risky.

Vertebroplasty and delayed subdural cauda equina hematoma: Review of literature and case report

PubMed Central

Tropeano, Maria Pia; La Pira, Biagia; Pescatori, Lorenzo; Piccirilli, Manolo

2017-01-01

Vertebroplasy is considered an alternative and effective treatment of painful oncologic spine disease. Major complications are very rare, but with high morbidity and occur in less than 1% of patients who undergo vertebroplasty. Spinal subdural hematoma (SDH) is an extremely rare complication, usual developing within 12 h to 24 h after the procedure. We report the case of a tardive SDH in an oncologic patient who underwent VP for Myxoid Liposarcoma metastasis. Trying to explain the pathogenesis, we support the hypothesis that both venous congestion of the vertebral venous plexus of the vertebral body and venous congestion due to a traumatic injury can provoke SDH. To our best knowledge, only 4 cases of spinal subdural hematoma following a transpedicular vertebroplasty have been previously described in International literature and only one of them occurred two weeks after that surgical procedures. Percutaneous verteboplasty is a well-known treatment of pain oncologic spine disease, used to provide pain relief and improvement of quality life and is considered a simple surgical procedure, involving a low risk of complications, but related to high morbidity, such as SDH. Therefore it has to be performed by experienced and skilled surgeons, that should also recognize possible risk factors, making SDH more risky. PMID:28868305

Predictors and perception of pain in women undergoing first trimester surgical abortion.

PubMed

Singh, Rameet H; Ghanem, Khalil G; Burke, Anne E; Nichols, Mark D; Rogers, Kathy; Blumenthal, Paul D

2008-08-01

The aim of the study was to evaluate pain and predictors of pain in women undergoing electric (EVA) or manual vacuum aspiration (MVA) for first trimester surgical abortions and to examine how perceptions of pain differ among participants, advocates (participant support person) and physicians. In this randomized controlled study, women presenting for first trimester abortion underwent standardized EVA or MVA. Participants completed questionnaires, visual analog scales (VAS) and Likert scales for pain. Logistic and linear regression models were used to analyze the data. Nonwhite women and women who preoperatively expected more pain reported higher procedure-related pain scores. Vacuum source, previous history of abortion, comfort with decision to have an abortion and partner involvement did not affect participant pain scores. In the multivariable analyses, no single factor predicted procedure-associated pain. The advocates perceived that more educated women had less pain. Physicians felt longer procedures and a woman's fear of pelvic examinations caused more pain. Physicians believed women had less pain than the participants reported themselves (p<.001). Only physicians thought that EVA was less painful than MVA (p<.01). Distinct factors other than vacuum source affect the perception of abortion-related pain. Understanding these factors may help inform counseling strategies aimed at ameliorating pain perception during first trimester abortions.

Effects of Reusing Gel Electrophoresis and Electrotransfer Buffers on Western Blotting.

PubMed

Heda, Ghanshyam D; Omotola, Oluwabukola B; Heda, Rajiv P; Avery, Jamie

2016-09-01

SDS-PAGE and Western blotting are 2 of the most commonly used biochemical methods for protein analysis. Proteins are electrophoretically separated based on their MWs by SDS-PAGE and then electrotransferred to a solid membrane surface for subsequent protein-specific analysis by immunoblotting, a procedure commonly known as Western blotting. Both of these procedures use a salt-based buffer, with the latter procedure consisting of methanol as an additive known for its toxicity. Previous reports present a contradictory view in favor or against reusing electrotransfer buffer, also known as Towbin's transfer buffer (TTB), with an aim to reduce the toxic waste. In this report, we present a detailed analysis of not only reusing TTB but also gel electrophoresis buffer (EB) on proteins of low to high MW range. Our results suggest that EB can be reused for at least 5 times without compromising the electrophoretic separation of mixture of proteins in an MW standard, BSA, and crude cell lysates. Additionally, reuse of EB did not affect the quality of subsequent Western blots. Successive reuse of TTB, on the other hand, diminished the signal of proteins of different MWs in a protein standard and a high MW membrane protein cystic fibrosis transmembrane-conductance regulator (CFTR) in Western blotting.

All in: expansion of the acquisition of data for outcomes and procedure transfer (ADOPT) program to an entire SAGES annual meeting hands-on hernia course.

PubMed

Dort, Jonathan; Trickey, Amber; Paige, John; Schwarz, Erin; Cecil, Tom; Coleman, Mark; Dunkin, Brian

2018-05-01

Continuing professional development (CPD) for the surgeon has been challenging because of a lack of standardized approaches of hands-on courses, resulting in poor post-course outcomes. To remedy this situation, SAGES has introduced the ADOPT program, implementing a standardized, long-term mentoring program as part of its hernia hands-on course. Previous work evaluating the pilot program showed increased adoption of learned procedures as well as increased confidence of the mentored surgeons. This manuscript describes the impact of such a program when it is instituted across an entire hands-on course. Following collection of pre-course benchmark data, all participants in the 2016 SAGES hands-on hernia course underwent structured, learner-focused instruction during the cadaveric lab. All faculty had completed a standardized teaching course in the Lapco TT format. Subsequently, course participants were enrolled in a year-long program involving longitudinal mentorship, webinars, conference calls, and coaching. Information about participant demographics, training, experience, self-reported case volumes, and confidence levels related to procedures were collected via survey 3 months prior to 9 months after the course. Twenty surgeons participated in the SAGES ADOPT 2016 hands-on hernia program. Of these, seventeen completed pre-course questionnaires (85%), ten completed the 3-month questionnaire (50%), and four completed the 9-month questionnaire (20%). Nine of ten respondents of the 3-month survey (90%) reported changes in their practice. In the 9-month survey, significant increases in the annualized procedural volumes were reported for open primary ventral hernia repair, open components separation, and mesh insertion for ventral hernia repair (p < 0.001). The expansion of the ADOPT program to an entire hands-on hernia course is both feasible and beneficial, with evidence of Kirkpatrick Levels 1-4a training effectiveness. This expanded success suggests that it is a useful blueprint for the CPD of surgeons wishing to learn new techniques and procedures for their patients.

Da Vinci robot error and failure rates: single institution experience on a single three-arm robot unit of more than 700 consecutive robot-assisted laparoscopic radical prostatectomies.

PubMed

Zorn, Kevin C; Gofrit, Ofer N; Orvieto, Marcelo A; Mikhail, Albert A; Galocy, R Matthew; Shalhav, Arieh L; Zagaja, Gregory P

2007-11-01

Previous reports have suggested that a 2% to 5% device failure rate (FR) be quoted when counseling patients about robot-assisted laparoscopic radical prostatectomy (RLRP). We sought to evaluate our FR on the da Vinci system. Since February 2003, more than 800 RLRPs have been performed at our institution using a single three-armed robotic unit. A prospective database was analyzed to determine the device FR and whether it resulted in case abortion or open conversion. Intuitive Surgical Systems provided data concerning the system's performance, including its fault rate. Error messages were classified as recoverable and non-recoverable faults. Between February 2003 and November 2006, 725 RLRP cases were available for evaluation. There were no intraoperative device failures that resulted in a case conversion. Technical errors resulting in surgeon handicap occurred in 3 cases (0.4%). Four patients (0.5%) had their procedures aborted secondary to system failure at initial set-up prior to patient entrance to the operating room. Data analysis retrieved from the da Vinci console reported on a total of 807 procedures since 2003. Only 4 cases (0.4%) were reported from the Intuitive Surgical database to result in either an aborted or a converted case, which compares favorably with our results. Since the last computer system upgrade (September 2005), the mean recoverable and non-recoverable fault rates per procedure were 0.21 and 0.05, respectively. For all the advanced features the da Vinci system offers, it is surprisingly reliable. Throughout our RLRP experience, device failure resulted in case conversion, procedure abortion, and surgeon handicap in 0, 0.5%, and 0.4% of procedures, respectively. As such, a lowered device FR of 0.5% should be used when counseling patients undergoing RLRP. To avoid futile general anesthesia, a policy should be enforced to ensure that the da Vinci system is completely set up before the patient enters the operating room.

Drawbar Pull (DP) Procedures for Off-Road Vehicle Testing

NASA Technical Reports Server (NTRS)

Creager, Colin; Asnani, Vivake; Oravec, Heather; Woodward, Adam

2017-01-01

As NASA strives to explore the surface of the Moon and Mars, there is a continued need for improved tire and vehicle development. When tires or vehicles are being designed for off-road conditions where significant thrust generation is required, such as climbing out of craters on the Moon, it is important to use a standard test method for evaluating their tractive performance. The drawbar pull (DP) test is a way of measuring the net thrust generated by tires or a vehicle with respect to performance metrics such as travel reduction, sinkage, or power efficiency. DP testing may be done using a single tire on a traction rig, or with a set of tires on a vehicle; this report focuses on vehicle DP tests. Though vehicle DP tests have been used for decades, there are no standard procedures that apply to exploration vehicles. This report summarizes previous methods employed, shows the sensitivity of certain test parameters, and provides a body of knowledge for developing standard testing procedures. The focus of this work is on lunar applications, but these test methods can be applied to terrestrial and planetary conditions as well. Section 1.0 of this report discusses the utility of DP testing for off-road vehicle evaluation and the metrics used. Section 2.0 focuses on test-terrain preparation, using the example case of lunar terrain. There is a review of lunar terrain analogs implemented in the past and a discussion on the lunar terrain conditions created at the NASA Glenn Research Center, including methods of evaluating the terrain strength variation and consistency from test to test. Section 3.0 provides details of the vehicle test procedures. These consist of a review of past methods, a comprehensive study on the sensitivity of test parameters, and a summary of the procedures used for DP testing at Glenn.

Abortion surveillance--United States, 1999.

PubMed

Elam-Evans, Laurie D; Strauss, Lilo T; Herndon, Joy; Parker, Wilda Y; Whitehead, Sara; Berg, Cynthia J

2002-11-29

CDC began abortion surveillance in 1969 to document the number and characteristics of women obtaining legal induced abortions and to monitor unintended pregnancy. This report summarizes and describes data reported to CDC regarding legal induced abortions obtained in the United States in 1999. For each year since 1969, CDC has compiled abortion data by state or area of occurrence. From 1973 through 1997, data were received from or estimated for 52 reporting areas in the United States: 50 states, the District of Columbia, and New York City. Beginning in 1998, CDC compiled abortion data from 48 reporting areas. Alaska, California, New Hampshire, and Oklahoma did not report, and data for these areas were not estimated. The availability of data regarding the characteristics of women who obtained an abortion in 1999 varied by state and by the number of states reporting each characteristic. The total number of legal induced abortions is reported by state of residence and also by state of occurrence for most areas; characteristics of women obtaining abortions in 1999 are reported by state of occurrence. A total of 861,789 legal induced abortions were reported to CDC for 1999, representing a 2.5% decrease from the 884,273 legal induced abortions reported by the same 48 reporting areas for 1998. The abortion ratio, defined as the number of abortions per 1,000 live births, was 256 in 1999, compared with 264 reported for 1998; the abortion rate for these 48 reporting areas was 17 per 1,000 women aged 15-44 years for 1999, the same as in 1997 and 1998. The highest percentages of abortions were reported for women aged < 25 years, women who were white, and unmarried women; slightly more than half were obtaining an abortion for the first time. Fifty-eight percent of all abortions for which gestational age was reported were performed at < or = 8 weeks of gestation, and 88% were performed before 13 weeks. From 1992 (when these data were first collected) through 1999, increases have occurred in the percentage of abortions performed at < or = 6 weeks of gestation. Few abortions were provided after 15 weeks of gestation; 4.3% were obtained at 16-20 weeks and 1.5% were obtained at > or = 21 weeks. A total of 27 reporting areas submitted data stating that they performed medical (nonsurgical) procedures (two of these areas categorized medical abortions with "other" procedures), making up < 1.0% of all procedures reported from all reporting areas. In 1998 (for which data have not been published previously and the most recent year for which such data are available), nine women died as a result of complications from known legal induced abortion; no deaths were associated with known illegal abortion. From 1990 through 1997, the number of legal induced abortions gradually declined. In 1998 and in 1999, the number of abortions continued to decrease when comparing the same 48 reporting areas. In 1998, as in previous years, deaths related to legal induced abortions occurred rarely. Abortion surveillance in the United States should continue so that trends and characteristics of women who obtain legal induced abortions can be examined and efforts to prevent unintended pregnancy can be enhanced.

Per-oral endoscopic myotomy (POEM): a new endoscopic treatment for achalasia.

PubMed

Miranda García, Pablo; Casals Seoane, Fernando; Gonzalez, Jean-Michel; Barthet, Marc; Santander Vaquero, Cecilio

2017-10-01

Per-oral endoscopic myotomy (POEM) is a new minimally invasive technique to treat achalasia. We performed a review of the literature of POEM with a special focus on technical details and the results obtained with this technique in patients with achalasia and other esophageal motility disorders. Thousands of POEM procedures have been performed worldwide since its introduction in 2008. The procedure is based on the creation of a mucosal entry point in the proximal esophagus to reach the cardia through a submucosal tunnel and then perform a myotomy of the muscular layers of the cardia, esophagogastric junction and distal esophagus, as performed in a Heller myotomy. The clinical remission rate ranges from 82 to 100%. Although no randomized studies exist and available data are from single-center studies, no differences have been found between laparoscopic Heller myotomy (LHM) and POEM in terms of perioperative outcomes, short-term outcomes (12 months) and long-term outcomes (up to three years). Procedure time and length of hospital stay were lower for POEM. Post-POEM reflux is a concern, and controversial data have been reported compared to LHM. The technique is safe, with no reported deaths related to the procedure and an adverse event rate comparable to surgery. Potential complications include bleeding, perforation, aspiration and insufflation-related adverse events. Thus, this is a complex technique that needs specific training even in expert hands. The indication for this procedure is widening and other motor hypercontractil esophageal disorders have been treated by POEM with promising results. POEM can be performed in complicated situations such as in pediatric patients, sigmoid achalasia or after failure of previous treatments. POEM is an effective treatment for achalasia and is a promising tool for other motor esophageal disorders. It is a safe procedure but, due to its technical difficulty and possible associated complications, the procedure should be performed in referral centers by trained endoscopists.

Hip Arthroscopic Synovectomy and Labral Repair in a Patient With Rheumatoid Arthritis With a 2-Year Follow-up

PubMed Central

Watanabe, Nobuyuki; Iguchi, Hirotaka; Mitsui, Hiroto; Tawada, Kaneaki; Murakami, Satona; Otsuka, Takanobu

2014-01-01

The arthroscopic surgical procedures reported previously for a rheumatic hip joint have been primarily performed as diagnostic procedures. Only a few studies have reported the success of arthroscopic surgery in hip joint preservation. We encountered a special case in which joint remodeling was seen in a patient with rheumatoid arthritis treated with biological drugs after hip arthroscopic synovectomy and labral repair. We report the case of a 39-year-old woman with rheumatism, which was controlled with tocilizumab, prednisolone, and tacrolimus. The hip joint showed Larsen grade 3 destruction, and the Harris Hip Score was 55 points. Because of the patient's strong desire to undergo a hip preservation operation, we performed hip arthroscopic synovectomy and repair of a longitudinal labral tear. After 2.5 years, the joint space had undergone rebuilding with improvement to Larsen grade 2, and the Harris Hip Score had improved to 78 points; the patient was able to return to work with the use of 1 crutch. It is possible to perform hip arthroscopic surgery for rheumatoid arthritis with a hip preservation operation with biological drugs. PMID:25276611

Learning curves for urological procedures: a systematic review.

PubMed

Abboudi, Hamid; Khan, Mohammed Shamim; Guru, Khurshid A; Froghi, Saied; de Win, Gunter; Van Poppel, Hendrik; Dasgupta, Prokar; Ahmed, Kamran

2014-10-01

To determine the number of cases a urological surgeon must complete to achieve proficiency for various urological procedures. The MEDLINE, EMBASE and PsycINFO databases were systematically searched for studies published up to December 2011. Studies pertaining to learning curves of urological procedures were included. Two reviewers independently identified potentially relevant articles. Procedure name, statistical analysis, procedure setting, number of participants, outcomes and learning curves were analysed. Forty-four studies described the learning curve for different urological procedures. The learning curve for open radical prostatectomy ranged from 250 to 1000 cases and for laparoscopic radical prostatectomy from 200 to 750 cases. The learning curve for robot-assisted laparoscopic prostatectomy (RALP) has been reported to be 40 procedures as a minimum number. Robot-assisted radical cystectomy has a documented learning curve of 16-30 cases, depending on which outcome variable is measured. Irrespective of previous laparoscopic experience, there is a significant reduction in operating time (P = 0.008), estimated blood loss (P = 0.008) and complication rates (P = 0.042) after 100 RALPs. The available literature can act as a guide to the learning curves of trainee urologists. Although the learning curve may vary among individual surgeons, a consensus should exist for the minimum number of cases to achieve proficiency. The complexities associated with defining procedural competence are vast. The majority of learning curve trials have focused on the latest surgical techniques and there is a paucity of data pertaining to basic urological procedures. © 2013 The Authors. BJU International © 2013 BJU International.

Pulmonary embolism after arterial chemoembolization for hepatocellular carcinoma: An autopsy case report

PubMed Central

Hatamaru, Keiichi; Azuma, Shunjiro; Akamatsu, Takuji; Seta, Takeshi; Urai, Shunji; Uenoyama, Yoshito; Yamashita, Yukitaka; Ono, Kazuo

2015-01-01

We report an extremely rare case of pulmonary lipiodol embolism with acute respiratory distress syndrome (ARDS) after transcatheter arterial chemoembolization (TACE) for hepatocellular carcinoma (HCC). A 77-year-old man who was diagnosed with a huge HCC was admitted for TACE. Immediately after the procedure, this patient experienced severe dyspnea. We suspected that his symptoms were associated with a pulmonary lipiodol embolism after TACE, and we began intensive treatment. However, his condition did not improve, and he died on the following day. A subsequent autopsy revealed that the cause of death was ARDS due to pulmonary lipiodol embolism. No cases have been previously reported for which an autopsy was performed to explain the most probable mechanism of pulmonary lipiodol embolism; thus, ours is the first report for such a rare case. PMID:25632211

Examining Recall Memory in Infancy and Early Childhood Using the Elicited Imitation Paradigm

PubMed Central

Lukowski, Angela F.; Milojevich, Helen M.

2016-01-01

The ability to recall the past allows us to report on details of previous experiences, from the everyday to the significant. Because recall memory is commonly assessed using verbal report paradigms in adults, studying the development of this ability in preverbal infants and children proved challenging. Over the past 30 years, researchers have developed a non-verbal means of assessing recall memory known as the elicited or deferred imitation paradigm. In one variant of the procedure, participants are presented with novel three-dimensional stimuli for a brief baseline period before a researcher demonstrates a series of actions that culminate in an end- or goal-state. The participant is allowed to imitate the demonstrated actions immediately, after a delay, or both. Recall performance is then compared to baseline or to performance on novel control sequences presented at the same session; memory can be assessed for the individual target actions and the order in which they were completed. This procedure is an accepted analogue to the verbal report techniques used with adults, and it has served to establish a solid foundation of the nature of recall memory in infancy and early childhood. In addition, the elicited or deferred imitation procedure has been modified and adapted to answer questions relevant to other aspects of cognitive functioning. The broad utility and application of imitation paradigms is discussed, along with limitations of the approach and directions for future research. PMID:27167994

Acute cooling of the feet and the onset of common cold symptoms.

PubMed

Johnson, Claire; Eccles, Ronald

2005-12-01

There is a common folklore that chilling of the body surface causes the development of common cold symptoms, but previous clinical research has failed to demonstrate any effect of cold exposure on susceptibility to infection with common cold viruses. This study will test the hypothesis that acute cooling of the feet causes the onset of common cold symptoms. 180 healthy subjects were randomized to receive either a foot chill or control procedure. All subjects were asked to score common cold symptoms, before and immediately after the procedures, and twice a day for 4/5 days. 13/90 subjects who were chilled reported they were suffering from a cold in the 4/5 days after the procedure compared to 5/90 control subjects (P=0.047). There was no evidence that chilling caused any acute change in symptom scores (P=0.62). Mean total symptom score for days 1-4 following chilling was 5.16 (+/-5.63 s.d. n=87) compared to a score of 2.89 (+/-3.39 s.d. n=88) in the control group (P=0.013). The subjects who reported that they developed a cold (n=18) reported that they suffered from significantly more colds each year (P=0.007) compared to those subjects who did not develop a cold (n=162). Acute chilling of the feet causes the onset of common cold symptoms in around 10% of subjects who are chilled. Further studies are needed to determine the relationship of symptom generation to any respiratory infection.

KSC 50-MHz Doppler Radar Wind Profiler (DRWP) Operational Acceptance Test (OAT) Report

NASA Technical Reports Server (NTRS)

Barbre, Robert E.

2015-01-01

This report documents analysis results of the Kennedy Space Center updated 50-MHz Doppler Radar Wind Profiler (DRWP) Operational Acceptance Test (OAT). This test was designed to demonstrate that the new DRWP operates in a similar manner to the previous DRWP for use as a situational awareness asset for mission operations at the Eastern Range to identify rapid changes in the wind environment that weather balloons cannot depict. Data examination and two analyses showed that the updated DRWP meets the specifications in the OAT test plan and performs at least as well as the previous DRWP. Data examination verified that the DRWP provides complete profiles every five minutes from 1.8-19.5 km in vertical increments of 150 m. Analysis of 5,426 wind component reports from 49 concurrent DRWP and balloon profiles presented root mean square (RMS) wind component differences around 2.0 m/s. The DRWP's effective vertical resolution (EVR) was found to be 300 m for both the westerly and southerly wind component, which the best EVR possible given the DRWP's vertical sampling interval. A third analysis quantified the sensitivity to rejecting data that do not have adequate signal by assessing the number of first-guess propagations at each altitude. This report documents the data, quality control procedures, methodology, and results of each analysis. It also shows that analysis of the updated DRWP produced results that were at least as good as the previous DRWP with proper rationale. The report recommends acceptance of the updated DRWP for situational awareness usage as per the OAT's intent.

The dopamine D1 receptor agonist SKF81297 has dose-related effects on locomotor activity but is without effect in a CER trace conditioning procedure conducted with two versus four trials.

PubMed

Pezze, M A; Marshall, H J; Cassaday, H J

2016-08-01

In an appetitively motivated procedure, we have previously reported that systemic treatment with the dopamine (DA) D1 receptor agonist SKF81297 (0.4 and 0.8 mg/kg) depressed acquisition at a 2 s inter-stimulus-interval (ISI), suitable to detect trace conditioning impairment. However since DA is involved in reinforcement processes, the generality of effects across appetitively- and aversively-motivated trace conditioning procedures cannot be assumed. The present study tested the effects of SKF81297 (0.4 and 0.8 mg/kg) in an established conditioned emotional response (CER) procedure. Trace-dependent conditioning was clearly shown in two experiments: while conditioning was relatively strong at a 3-s ISI, it was attenuated at a 30-s ISI. This was shown after two (Experiment 1) or four (Experiment 2) conditioning trials conducted in - as far as possible - the same CER procedure. Contrary to prediction, in neither experiment was there any indication that trace conditioning was attenuated by treatment with 0.4 or 0.8 mg/kg SKF81297. In the same rats, locomotor activity was significantly enhanced at the 0.8 mg/kg dose of SKF81297. These results suggest that procedural details of the trace conditioning variant in use are an important determinant of the profile of dopaminergic modulation.

Long-term follow-up of a randomized clinical trial comparing Beger with pylorus-preserving Whipple procedure for chronic pancreatitis.

PubMed

Müller, M W; Friess, H; Martin, D J; Hinz, U; Dahmen, R; Büchler, M W

2008-03-01

Duodenum-preserving pancreatic head resection according to Beger and the pylorus-preserving Whipple (ppWhipple) procedure were compared in patients with chronic pancreatitis (CP) in a randomized clinical trial. Perioperative data and short-term outcome have been reported previously. The present study evaluated long-term follow-up. Forty patients were enrolled originally, 20 in each group. Long-term follow-up included mortality, morbidity, pain status, occupational rehabilitation, quality of life (QoL), and endocrine and exocrine function at median follow-up of 7 and 14 years. One patient who had a ppWhipple procedure was lost to follow-up. There were five late deaths in each group. No differences were noted in pain status and exocrine pancreatic function. Loss of appetite was significantly worse in the ppWhipple group at 14 years' follow-up, but there were no other differences in QoL parameters examined. After 14 years, diabetes mellitus was present in seven of 15 patients who had the Beger procedure and 11 of 14 patients after ppWhipple resection (P = 0.128). After long-term follow-up of up to 14 years early advantages of the Beger procedure were no longer present. 2007 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.

Current food chain information provides insufficient information for modern meat inspection of pigs.

PubMed

Felin, Elina; Jukola, Elias; Raulo, Saara; Heinonen, Jaakko; Fredriksson-Ahomaa, Maria

2016-05-01

Meat inspection now incorporates a more risk-based approach for protecting human health against meat-borne biological hazards. Official post-mortem meat inspection of pigs has shifted to visual meat inspection. The official veterinarian decides on additional post-mortem inspection procedures, such as incisions and palpations. The decision is based on declarations in the food chain information (FCI), ante-mortem inspection and post-mortem inspection. However, a smooth slaughter and inspection process is essential. Therefore, one should be able to assess prior to slaughter which pigs are suitable for visual meat inspection only, and which need more profound inspection procedures. This study evaluates the usability of the FCI provided by pig producers and considered the possibility for risk ranking of incoming slaughter batches according to the previous meat inspection data and the current FCI. Eighty-five slaughter batches comprising 8954 fattening pigs were randomly selected at a slaughterhouse that receives animals from across Finland. The mortality rate, the FCI and the meat inspection results for each batch were obtained. The current FCI alone provided insufficient and inaccurate information for risk ranking purposes for meat inspection. The partial condemnation rate for a batch was best predicted by the partial condemnation rate calculated for all the pigs sent for slaughter from the same holding in the previous year (p<0.001) and by prior information on cough declared in the current FCI (p=0.02) statement. Training and information to producers are needed to make the FCI reporting procedures more accurate. Historical meat inspection data on pigs slaughtered from the same holdings and well-chosen symptoms/signs for reporting, should be included in the FCI to facilitate the allocation of pigs for visual inspection. The introduced simple scoring system can be easily used for additional information for directing batches to appropriate meat inspection procedures. To control the main biological public health hazards related to pork, serological surveillance should be done and the information obtained from analyses should be used as part of the FCI. Copyright © 2016 Elsevier B.V. All rights reserved.

Laryngospasm With Apparent Aspiration During Sedation With Nitrous Oxide.

PubMed

Babl, Franz E; Grindlay, Joanne; Barrett, Michael Joseph

2015-11-01

Nitrous oxide and oxygen mixture has become increasingly popular for the procedural sedation and analgesia of children in the emergency department. In general, nitrous oxide is regarded as a very safe agent according to large case series. We report a case of single-agent nitrous oxide sedation of a child, complicated by laryngospasm and radiographically confirmed bilateral upper lobe pulmonary opacities. Although rarely reported with parenteral sedative agents, laryngospasm and apparent aspiration has not been previously reported in isolated nitrous oxide sedation. This case highlights that, similar to other sedative agents, nitrous oxide administration also needs to be conducted by staff and in settings in which airway emergencies can be appropriately managed. Copyright © 2015 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

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

PubMed Central

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

2014-01-01

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

Derived Relational Responding: A Comparison of Match-to-Sample and the Relational Completion Procedure

ERIC Educational Resources Information Center

Dymond, Simon; Whelan, Robert

2010-01-01

Previous research suggests that the Relational Completion Procedure may be an effective alternative procedure for studying derived relational responding. However, the parameters that make it effective, relative to traditional match-to-sample, remain to be determined. The present experiment compared the Relational Completion Procedure and…

40 CFR 444.12 - Monitoring Requirements

Code of Federal Regulations, 2011 CFR

2011-07-01

... requirements to monitor, according to EPA-approved test procedures, each pollutant limited in the permit, the... test procedures listed in the table to this paragraph. Most of these test procedures have previously been incorporated by reference at 40 CFR 136.3(a), Table IB. The test procedures for the regulated...

40 CFR 444.12 - Monitoring Requirements

Code of Federal Regulations, 2012 CFR

2012-07-01

... requirements to monitor, according to EPA-approved test procedures, each pollutant limited in the permit, the... test procedures listed in the table to this paragraph. Most of these test procedures have previously been incorporated by reference at 40 CFR 136.3(a), Table IB. The test procedures for the regulated...

40 CFR 444.12 - Monitoring Requirements

Code of Federal Regulations, 2010 CFR

2010-07-01

... requirements to monitor, according to EPA-approved test procedures, each pollutant limited in the permit, the... test procedures listed in the table to this paragraph. Most of these test procedures have previously been incorporated by reference at 40 CFR 136.3(a), Table IB. The test procedures for the regulated...

Complications of botulinum toxin injections for treatment of esophageal motility disorders†.

PubMed

van Hoeij, Froukje B; Tack, Jan F; Pandolfino, John E; Sternbach, Joel M; Roman, Sabine; Smout, André J P M; Bredenoord, Albert J

2017-02-01

In achalasia and spastic esophageal motility disorders, botulinum toxin (botox) injection is considered an effective and low-risk procedure for short-term symptom relief. It is mainly offered to medically high-risk patients. However, no analysis of risks of botox injections has been performed. To determine the incidence and risk factors of procedure-related complications after esophageal botox injections, we analyzed the records of all patients undergoing botox injection therapy for esophageal motility disorders at four university hospitals in Europe and North America between 2008 and 2014. Complications were assigned grades according to the Clavien-Dindo classification. In 386 patients, 661 botox treatments were performed. Main indications were achalasia (51%) and distal esophageal spasm (DES) (30%). In total, 52 (7.9%) mild complications (Clavien-Dindo grade I) were reported by 48 patients, the majority consisting of chest pain or heartburn (29 procedures) or epigastric pain (5 procedures). No ulceration, perforation, pneumothorax, or abscess were reported. One patient died after developing acute mediastinitis (Clavien-Dindo grade V) following injections in the body of the esophagus. In univariate logistic regression, younger age was associated with an increased risk of complications (OR 1.43, 95%CI 1.03-1.96). Treatment for DES, injections into the esophageal body, more injections per procedure, more previous treatments and larger amount of injected botulinum toxin were no risk factors for complications. Esophageal botox injection seems particularly appropriate for high-risk patients due to low complication rate. However, it should not be considered completely safe, as it is associated with rare side effects that cannot be predicted. © 2016 International Society for Diseases of the Esophagus.

Outcomes of a novel minimalist approach for the treatment of cubital tunnel syndrome.

PubMed

Lan, Zheng D; Tatsui, Claudio E; Jalali, Ali; Humphries, William E; Rilea, Katheryn; Patel, Akash; Ehni, Bruce L

2015-06-01

We describe a minimalist approach to perform in situ decompression of the ulnar nerve. Our technique employs a unique small skin incision strategically placed to minimize postoperative scarring over the ulnar nerve and potentially decrease the risk of iatrogenic injury to the medial antebrachial cutaneous nerve. We retrospectively report the outcome of patients who have undergone this procedure at our institution, the Michael E. DeBakey Veterans Affairs Medical Center, from January 1 2007 through November 29 2010. All individuals underwent in situ decompression via the previously described minimalist approach. Outcome variables were Louisiana State University Medical Center (LSU) ulnar neuropathy grade, patient satisfaction, subjective improvement, complications and re-operation rate. A total of 44 procedures were performed in this cohort of 41 patients. Overall, patients' postoperative LSU grades showed a statistically significant improvement (p=0.0019) compared to preoperative grades. Improvement of at least one grade in the LSU scale was observed in 50% of the procedures with a preoperative grade of four or less. Overall procedure satisfaction rate was 88% (39 of 44) with 70% (31 of 44) of the procedures resulting in improvement of symptoms. There were no intraoperative or postoperative complications. One patient required re-operation due to failure of neurological improvement. Our minimalistic approach to perform in situ decompression of the ulnar nerve at the cubital tunnel is both safe and effective. We observed a statistically significant improvement in LSU ulnar neuropathy grades and a success rate comparable to those reported for other more extensive surgical techniques while providing the benefit of a smaller incision, less scarring, decreased risk of iatrogenic nerve injury and minimal complications. Copyright © 2015 Elsevier Ltd. All rights reserved.

Assessment of pediatric Malone antegrade continence enema (MACE) complications: Effects of variations in technique.

PubMed

Saikaly, Sami K; Rich, Mark A; Swana, Hubert S

2016-08-01

The Malone antegrade continence enema (MACE) procedure is performed for patients with fecal incontinence and constipation who do not respond to medical therapy. The MACE procedure provides antegrade catheter access to the right colon and allows administration of enemas to help evacuate the bowel regularly. The objective of this study was to identify risk factors for surgical complications in children who undergo the MACE procedure. Records from 97 pediatric patients who underwent MACE procedure were reviewed retrospectively. Data collected included age, sex, weight (obese/not obese), stomal location, presence of a permanent button/catheter in the stoma, open vs. laparoscopic surgery, and etiology of fecal incontinence/constipation. The complications reviewed included stomal stenosis, leakage, and stomal site infection. The relationships between the independent variables and complications were assessed using chi-square tests and Fisher's exact test. Statistical significance was set at p < 0.05. Overall, 66 (68%) patients had at least one complication. Twenty-three (23.7%) patients developed stomal stenosis, and 27 (27.8%) patients had significant stomal leakage. Insertion of a stomal button/catheter device was associated with an increased risk of developing stomal leakage and stomal infection. The presence of a stomal button/catheter was also associated with a decreased risk of stomal stenosis (Figure). The non-intubated, imbricated sub-population, preteen patients (<12 years old) experienced more stomal leakage than teenage patients. In this subgroup, patients with umbilical stomas also experienced more leakage than patients with right lower quadrant (RLQ) stomas. The prevalence rates of stomal complications in our study were consistent with previously reported series. In our study, however, stomal leakage had a higher prevalence in comparison with stomal stenosis. This seems to be related to the heterogeneity of the study group, which contained two variants of the MACE procedure; non-imbricated, intubated MACE and imbricated, non-intubated MACE. The use of stomal buttons in conjunction with MACE has previously been reported without changes in complication rates. We found the use of stomal buttons/catheters to be associated with changes in the prevalence of stomal complications. Stomal complications are common in the MACE procedure. The use of a permanent stomal button/catheter is associated with changes in the rates of stomal complications. While many find an umbilical stomal site is more cosmetically appealing, there is an increased risk of leakage with imbricated, non-intubated stomas. In the non-intubated, imbricated sub-population, the MACE procedure results in a higher risk of stomal leakage in preteen patients in comparison with teenage patients. Copyright © 2016 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.

Rolled Tendon Allograft Interposition Arthroplasty for Salvage Surgery of the Hallux Metatarsophalangeal Joint.

PubMed

Thomas, Danielle; Thordarson, David

2018-04-01

Hallux rigidus is a common osteoarthritic disease of the first metatarsophalangeal joint (MTPJ). Few salvage treatment options exist that preserve motion for patients who have failed an initial procedure and who are not amenable to fusion, typically patients who are active or who would like to wear high heels. Allograft tendon interpositional arthroplasty is an unconventional salvage treatment option that may preserve motion and prevent bone loss. A retrospective chart review is reported of 19 patients who failed previous procedures and refused fusion who underwent allograft tendon interpositional arthroplasty of the hallux MTPJ by a single surgeon between 2012 and 2015. Outcomes included the American Orthopaedic Foot & Ankle Society (AOFAS) hallux metatarsophalangeal-interphalangeal scale assessment as well as measurement of apparent joint space on anterior to posterior and lateral views. The cumulative average AOFAS score for all patients was 68.5 preoperatively and 74.1 postoperatively. The average AOFAS pain subscore was 24.7 preoperatively and 26.8 postoperatively (SD = 7.7 and 13.8, respectively). Radiographically, patients had an increase in apparent joint space from pre- to postoperatively, most notable on the lateral view (0.6 to 4.7 mm; SD = 0.7 and 3.2 mm). Five patients required a second operative procedure, for an overall 26% reoperation rate. One patient underwent hallux MTPJ fusion after the interpositional arthroplasty. An additional 4 patients (21%) had symptoms requiring a steroid injection, and another 3 patients (16%) were recommended to undergo a revision procedure based on their symptoms. Rolled allograft tendon interposition arthroplasty performed poorly as a salvage strategy for failed previous hallux MTPJ surgery for hallux rigidus because of a high rate of complication and minimal benefits. The senior author has abandoned the technique. Level IV, retrospective case series.

Epidemiology and management of painful procedures in children in Canadian hospitals

PubMed Central

Stevens, Bonnie J.; Abbott, Laura K.; Yamada, Janet; Harrison, Denise; Stinson, Jennifer; Taddio, Anna; Barwick, Melanie; Latimer, Margot; Scott, Shannon D.; Rashotte, Judith; Campbell, Fiona; Finley, G. Allen

2011-01-01

Background Children being cared for in hospital undergo multiple painful procedures daily. However, little is known about the frequency of these procedures and associated interventions to manage the pain. We undertook this study to determine, for children in Canadian hospitals, the frequency of painful procedures, the types of pain management interventions associated with painful procedures and the influence of the type of hospital unit on procedural pain management. Methods We reviewed medical charts for infants and children up to 18 years of age who had been admitted to 32 inpatient units at eight Canadian pediatric hospitals between October 2007 and April 2008. We recorded all of the painful procedures performed and the pain management interventions that had been implemented in the 24-hour period preceding data collection. We performed descriptive and comparative (analysis of variance, χ2) analyses. Results Of the 3822 children included in the study, 2987 (78.2%) had undergone at least one painful procedure in the 24-hour period preceding data collection, for a total of 18 929 painful procedures (mean 6.3 per child who had any painful procedure). For 2334 (78.1%) of the 2987 children who had a painful procedure, a pain management intervention in the previous 24 hours was documented in the chart: 1980 (84.8%) had a pharmacologic intervention, 609 (26.1%) a physical intervention, 584 (25.0%) a psychologic intervention and 753 (32.3%) a combination of interventions. However, for only 844 (28.3%) of the 2987 children was one or more pain management interventions administered and documented specifically for a painful procedure. Pediatric intensive care units reported the highest proportion of painful procedures and analgesics administered. Interpretation For less than one-third of painful procedures was there documentation of one or more specific pain management interventions. Strategies for implementing changes in pain management must be tailored to the type of hospital unit. PMID:21464171

An improved procedure for El Nino forecasting: Implications for predictability

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

Chen, D.; Zebiak, S.E.; Cane, M.A.

A coupled ocean-atmosphere data assimilation procedure yields improved forecasts of El Nino for the 1980s compared with previous forecasting procedures. As in earlier forecasts with the same model, no oceanic data were used, and only wind information was assimilated. The improvement is attributed to the explicit consideration of air-sea interaction in the initialization. These results suggest that El Nino is more predictable than previously estimated, but that predictability may vary on decadal or longer time scales. This procedure also eliminates the well-known spring barrier to El Nino prediction, which implies that it may not be intrinsic to the real climatemore » system. 24 refs., 5 figs., 1 tab.« less

Bilateral corneal perforations and autoproptosis as self-induced manifestations of ocular Munchausen's syndrome.

PubMed

Lin, Joseph L; Servat, J Javier; Bernardino, Carlo R; Goldberg, Robert A; Levin, Flora

2012-08-01

To report a patient with bilateral corneal perforations and autoproptosis in a case of ocular Munchausen's syndrome. Case report. A 26-year-old white male referred to the oculoplastics service with one month history of decreased vision bilaterally and painful right eye. Multiple eyelid scars and right corneal opacity were noted. The patient was previously seen at another institution for rapid loss of vision in both eyes. An orbit decompression among many procedures failed to controlled extreme pain and proptosis. Resolution of proptosis, stabilization of vision, pain resolution. Three weeks after enucleation of the right eye was offered, patient presented with spontaneous left ruptured globe. After multiple episodes of self-mutilation and infections, both eyes were exenterated. Munchausen syndrome can be seen with ophthalmic manifestations and should be considered in the differential diagnosis when ocular abnormalities cannot be explained after a thorough evaluation. Recognition of this psychiatric disease is not only important for correct medical diagnosis and treatment, but also essential in protecting the patients from unnecessary invasive and aggressive medical procedures.

Breaking bad news and personality assessment.

PubMed

Rudnick, A; Ezra, Y; Melamed, E

2000-09-01

Breaking bad news to seriously ill patients is an especially difficult and important part of patient education and counseling. Guidelines for breaking bad news have been previously presented, but this is the first report to address the personality of the patient in deciding how to break had news. A case study of a patient diagnosed with amyotrophic lateral sclerosis is presented. A psychiatric consultation assisted in assessing the patient's personality and thus preparing the medical staff for breaking the bad news to him. The patient was assessed as having an obsessive-compulsive personality, and consequently the staff was instructed to concentrate on facts and not on feelings when breaking the bad news to him. The patient coped adaptively with this procedure, as did the staff. This case report illustrates that personality assessment may be of benefit in breaking bad news to seriously ill patients. It remains to be seen whether this procedure can be successfully generalized to other patients and settings as well as to other domains of patient education and counseling, and if so--whether this will also prove to be cost-effective.

Polyoma virus JC DNA detection by polymerase chain reaction in CSF of HIV infected patients with suspected progressive multifocal leukoencephalopathy.

PubMed

Giri, J A; Gregoresky, J; Silguero, P; García Messina, O; Planes, N

2001-01-01

Several studies had previously demonstrated the high sensitivity and specificity of JCV DNA detection in CSF by PCR. This paper reported the implementation of a simple PCR procedure to detect JCV in the CSF in a cohort of HIV-1 infected patients from Argentina. Years ago, the confirmatory diagnosis of this disease was made by in-situ hybridization or immunohistochemistry techniques on brain biopsies. The PCR procedure described here improves the diagnosis of PML because it is simple and noninvasive, and allows the differential diagnosis of PML from other neurological syndromes associated with AIDS. Many recent studies report a significant benefit of combined antiretroviral therapy on the survival of HIV patients without clear neurological improvements. A negative correlation has been described between the concentration of JCV in the CSF and survival time in HIV-1 infected patients, and the level of immune depression may influence JCV replication. This suggests that a single CSF JCV viral load determination during the course of PML disease progression may be of prognostic value for managing HIV patients.

Preliminary analysis of force-torque measurements for robot-assisted fracture surgery.

PubMed

Georgilas, Ioannis; Dagnino, Giulio; Tarassoli, Payam; Atkins, Roger; Dogramadzi, Sanja

2015-08-01

Our group at Bristol Robotics Laboratory has been working on a new robotic system for fracture surgery that has been previously reported [1]. The robotic system is being developed for distal femur fractures and features a robot that manipulates the small fracture fragments through small percutaneous incisions and a robot that re-aligns the long bones. The robots controller design relies on accurate and bounded force and position parameters for which we require real surgical data. This paper reports preliminary findings of forces and torques applied during bone and soft tissue manipulation in typical orthopaedic surgery procedures. Using customised orthopaedic surgical tools we have collected data from a range of orthopaedic surgical procedures at Bristol Royal Infirmary, UK. Maximum forces and torques encountered during fracture manipulation which involved proximal femur and soft tissue distraction around it and reduction of neck of femur fractures have been recorded and further analysed in conjunction with accompanying image recordings. Using this data we are establishing a set of technical requirements for creating safe and dynamically stable minimally invasive robot-assisted fracture surgery (RAFS) systems.

Rumination as a Marker of Psychological Improvement in Transsexual Women Postoperative

PubMed Central

Mueller, Andressa; Quadros, Cláudia; Schwarz, Karine; Brandelli Costa, Angelo; Vaitses Fontanari, Anna Martha; Machado Borba Soll, Bianca; Cardoso da Silva, Dhiordan; Abel Schneider, Maiko; de Moura Silveira, Érico; Kauer-Sant'Anna, Marcia; Rodrigues Lobato, Maria Inês

2016-01-01

Abstract Purpose: This study aimed to analyze rumination levels of transsexual women before and after gender affirmation surgery (GAS). Rumination scores may represent a broader measure of GAS success and an alternative to patient-reported satisfaction, quality of life, well-being, or the presence of “caseness” for anxiety or depression as previously established in the literature. Methods: Thirty-nine transsexual women were recruited. The participants completed the rumination scale of the Response Styles Questionnaire (RSQ) and were divided into three subsets according to the treatment time. Results: The rumination scores were lower in the transsexual women who had undergone surgical procedures on primary sexual characteristics and gradually decreased with each additional procedure completed with respect to secondary sexual characteristics. Conclusion: Rumination appears to comprise an important marker of improvement in post-GAS transsexual women. PMID:28861541

Endovascular therapy of acute ischemic stroke: report of the Standards of Practice Committee of the Society of NeuroInterventional Surgery.

PubMed

Blackham, K A; Meyers, P M; Abruzzo, T A; Albuquerque, F C; Alberquerque, F C; Fiorella, D; Fraser, J; Frei, D; Gandhi, C D; Heck, D V; Hirsch, J A; Hsu, D P; Hussain, M Shazam; Jayaraman, M; Narayanan, S; Prestigiacomo, C; Sunshine, J L

2012-03-01

To summarize and classify the evidence for the use of endovascular techniques in the treatment of patients with acute ischemic stroke. Recommendations previously published by the American Heart Association (AHA) (Guidelines for the early management of adults with ischemic stroke (Circulation 2007) and Scientific statement indications for the performance of intracranial endovascular neurointerventional procedures (Circulation 2009)) were vetted and used as a foundation for the current process. Building on this foundation, a critical review of the literature was performed to evaluate evidence supporting the endovascular treatment of acute ischemic stroke. The assessment was based on guidelines for evidence based medicine proposed by the Stroke Council of the AHA and the University of Oxford, Centre for Evidence Based Medicine (CEBM). Procedural safety, technical efficacy and impact on patient outcomes were specifically examined.

Ad hoc cost analysis of the new gastrointestinal bleeding algorithm in patients with ventricular assist device.

PubMed

Hirose, Hitoshi; Sarosiek, Konrad; Cavarocchi, Nicholas C

2014-01-01

Gastrointestinal bleed (GIB) is a known complication in patients receiving nonpulsatile ventricular assist devices (VAD). Previously, we reported a new algorithm for the workup of GIB in VAD patients using deep bowel enteroscopy. In this new algorithm, patients underwent fewer procedures, received less transfusions, and took less time to make the diagnosis than the traditional GIB algorithm group. Concurrently, we reviewed the cost-effectiveness of this new algorithm compared with the traditional workup. The procedure charges for the diagnosis and treatment of each episode of GIB was ~ $2,902 in the new algorithm group versus ~ $9,013 in the traditional algorithm group (p < 0.0001). Following the new algorithm in VAD patients with GIB resulted in fewer transfusions and diagnostic tests while attaining a substantial cost savings per episode of bleeding.

Effects of dietary choline availability on latent inhibition of flavor aversion learning.

PubMed

Gámiz, Fernando; Recio, Sergio Andrés; Iliescu, Adela Florentina; Gallo, Milagros; de Brugada, Isabel

2015-08-01

It has been previously reported that dietary choline supplementation might affect latent inhibition (LI) using a conditioned suppression procedure in rats. We have assessed the effect of dietary choline on LI of flavor aversion learning. Adult male Wistar rats received a choline supplemented (5 g/kg), deficient (0 g/kg), or standard (1.1 g/kg) diet for 3 months. After this supplementation period, all rats went through a conditioned taste aversion (CTA) procedure, half of them being pre-exposed to the conditioned stimulus before the conditioning. The results indicated that choline deficiency prevents LI of conditioned flavor aversion to cider vinegar (3%) induced by a LiCl (0.15 M; 2% body weight) intraperitoneal injection, while choline supplementation enhances CTA leading to slower extinction. The role of the brain systems modulating attentional processes is discussed.

Low acceptability of medical male circumcision as an HIV/AIDS prevention intervention within a South African community that practises traditional circumcision.

PubMed

Mark, Daniella; Middelkoop, Keren; Black, Samantha; Roux, Surita; Fleurs, Llewellyn; Wood, Robin; Bekker, Linda-Gail

2012-05-23

Traditional circumcision is practised among some indigenous tribes in South Africa (SA) such as the Xhosa. Recent experimental evidence has demonstrated the benefits of male circumcision for the prevention of HIV infection in heterosexual men. The acceptability of circumcision as a biomedical intervention mirroring an ingrained cultural practice, as well as the age and extent of the procedure, are poorly understood. Men aged 15 - 42 years were recruited in a peri-urban settlement near Cape Town. Participants completed an interviewer-administered questionnaire assessing self-reported circumcision status, context and reasons for previous or planned circumcision, and willingness to undergo medical circumcision for themselves or their sons. Results were confirmed by clinical examination. The most recent HIV test result was compared with circumcision status. Of the 199 men enrolled, 148 (74%) reported being traditionally circumcised; of the 51 not circumcised, 50 were planning the traditional procedure. Among men self-reporting circumcision, 40 (27%) had some or all of the foreskin remaining. The median age at traditional circumcision was 21 years (interquartile range 19 - 22 years). While knowledge of the preventive benefit of circumcision was reported by 128 men (66%), most were unwilling to undergo medical circumcision or allow their sons to do so, because of religion/culture, notions of manhood, and social disapproval. Almost all men in this study had undergone or were planning to undergo traditional circumcision and were largely opposed to the medically performed procedure. In the majority, traditional circumcision had occurred after the mean age of sexual debut and almost a quarter were found to have only partial foreskin removal. To ensure optimal HIV prevention benefits, strategies to facilitate complete foreskin removal prior to sexual debut within traditional circumcision practices require further attention.

Ureteroscopic treatment of larger renal calculi (>2 cm).

PubMed

Bagley, Demetrius H; Healy, Kelly A; Kleinmann, Nir

2012-09-01

To evaluate the current status of ureteroscopic lithotripsy (UL) for treating renal calculi of >2 cm, as advances in flexible ureteroscope design, accessory instrumentation and lithotrites have revolutionised the treatment of urinary calculi. While previously reserved for ureteric and small renal calculi, UL has gained an increasing role in the selective management of larger renal stone burdens. We searched the available databases, including PubMed, Google Scholar, and Scopus, for relevant reports in English, and the article bibliographies to identify additional relevant articles. Keywords included ureteroscopy, lithotripsy, renal calculi, and calculi >2 cm. Retrieved articles were reviewed to consider the number of patients, mean stone size, success rates, indications and complications. In all, nine studies (417 patients) were eligible for inclusion. After one, two or three procedures the mean (range) success rates were 68.2 (23-84)%, 87.1 (79-91)% and 94.4 (90.1-96.7)%, respectively. Overall, the success rate was >90% with a mean of 1.2-2.3 procedures per patient. The overall complication rate was 10.3%, including six (1.4%) intraoperative and 37 (8.9%) postoperative complications, most of which were minor. The most common indications for UL were a failed previous treatment (46%), comorbidities (18.2%), and technical and anatomical factors (12.3%). UL is safe and effective for treating large renal calculi. While several procedures might be required for total stone clearance, UL should be considered a standard approach in the urologist's options treating renal calculi of >2 cm.

[Gender-sensitive epidemiological data analysis: methodological aspects and empirical outcomes. Illustrated by a health reporting example].

PubMed

Jahn, I; Foraita, R

2008-01-01

In Germany gender-sensitive approaches are part of guidelines for good epidemiological practice as well as health reporting. They are increasingly claimed to realize the gender mainstreaming strategy in research funding by the federation and federal states. This paper focuses on methodological aspects of data analysis, as an empirical data example of which serves the health report of Bremen, a population-based cross-sectional study. Health reporting requires analysis and reporting methods that are able to discover sex/gender issues of questions, on the one hand, and consider how results can adequately be communicated, on the other hand. The core question is: Which consequences do a different inclusion of the category sex in different statistical analyses for identification of potential target groups have on the results? As evaluation methods logistic regressions as well as a two-stage procedure were exploratively conducted. This procedure combines graphical models with CHAID decision trees and allows for visualising complex results. Both methods are analysed by stratification as well as adjusted by sex/gender and compared with each other. As a result, only stratified analyses are able to detect differences between the sexes and within the sex/gender groups as long as one cannot resort to previous knowledge. Adjusted analyses can detect sex/gender differences only if interaction terms have been included in the model. Results are discussed from a statistical-epidemiological perspective as well as in the context of health reporting. As a conclusion, the question, if a statistical method is gender-sensitive, can only be answered by having concrete research questions and known conditions. Often, an appropriate statistic procedure can be chosen after conducting a separate analysis for women and men. Future gender studies deserve innovative study designs as well as conceptual distinctiveness with regard to the biological and the sociocultural elements of the category sex/gender.

Classification of healthcare-associated infection: a systematic review 10 years after the first proposal

PubMed Central

2014-01-01

Background Ten years after the first proposal, a consensus definition of healthcare-associated infection (HCAI) has not been reached, preventing the development of specific treatment recommendations. A systematic review of all definitions of HCAI used in clinical studies is made. Methods The search strategy focused on an HCAI definition. MEDLINE, SCOPUS and ISI Web of Knowledge were searched for articles published from earliest achievable data until November 2012. Abstracts from scientific meetings were searched for relevant abstracts along with a manual search of references from reports, earlier reviews and retrieved studies. Results The search retrieved 49,405 references: 15,311 were duplicates and 33,828 were excluded based on title and abstract. Of the remaining 266, 43 met the inclusion criteria. The definition more frequently used was the initial proposed in 2002 - an infection present at hospital admission or within 48 hours of admission in patients that fulfilled any of the following criteria: received intravenous therapy at home, wound care or specialized nursing care in the previous 30 days; attended a hospital or hemodialysis clinic or received intravenous chemotherapy in the previous 30 days; were hospitalized in an acute care hospital for ≥2 days in the previous 90 days, resided in a nursing home or long-term care facility. Additional criteria founded in other studies were: immunosuppression, active or metastatic cancer, previous radiation therapy, transfer from another care facility, elderly or physically disabled persons who need healthcare, previous submission to invasive procedures, surgery performed in the last 180 days, family member with a multi-drug resistant microorganism and recent treatment with antibiotics. Conclusions Based on the evidence gathered we conclude that the definition initially proposed is widely accepted. In a future revision, recent invasive procedures, hospitalization in the last year or previous antibiotic treatment should be considered for inclusion in the definition. The role of immunosuppression in the definition of HCAI still requires ongoing discussion. PMID:24597462

Bio-Thiersch as an Adjunct to Perineal Proctectomy Reduces Rates of Recurrent Rectal Prolapse.

PubMed

Eftaiha, Saleh M; Calata, Jed F; Sugrue, Jeremy J; Marecik, Slawomir J; Prasad, Leela M; Mellgren, Anders; Nordenstam, Johan; Park, John J

2017-02-01

The rates of recurrent prolapse after perineal proctectomy vary widely in the literature, with incidences ranging between 0% and 50%. The Thiersch procedure, first described in 1891 for the treatment of rectal prolapse, involves encircling the anus with a foreign material with the goal of confining the prolapsing rectum above the anus. The Bio-Thiersch procedure uses biological mesh for anal encirclement and can be used as an adjunct to perineal proctectomy for rectal prolapse to reduce recurrence. The aim of this study was to evaluate the Bio-Thiersch procedure as an adjunct to perineal proctectomy and its impact on recurrence compared with perineal proctectomy alone. A retrospective review of consecutive patients undergoing perineal proctectomy with and without Bio-Thiersch was performed. Procedures took place in the Division of Colon and Rectal Surgery at a tertiary academic teaching hospital. Patients who had undergone perineal proctectomy and those who received perineal proctectomy with Bio-Thiersch were evaluated and compared. All of the patients with rectal prolapse received perineal proctectomy with levatorplasty, and a proportion of those patients had a Bio-Thiersch placed as an adjunct. The incidence of recurrent rectal prolapse after perineal proctectomy alone or perineal proctectomy with Bio-Thiersch was documented. Sixty-two patients underwent perineal proctectomy (8 had a previous prolapse procedure), and 25 patients underwent perineal proctectomy with Bio-Thiersch (12 had a previous prolapse procedure). Patients who received perineal proctectomy with Bio-Thiersch had a lower rate of recurrent rectal prolapse (p < 0.05) despite a higher proportion of them having had a previous prolapse procedure (p < 0.01). Perineal proctectomy with Bio-Thiersch had a lower recurrence over time versus perineal proctectomy alone (p < 0.05). This study was limited by nature of being a retrospective review. Bio-Thiersch as an adjunct to perineal proctectomy may reduce the risk for recurrent rectal prolapse and can be particularly effective in patients with a history of previous failed prolapse procedures.

Practices for the disbudding and dehorning of dairy calves by veterinarians and dairy producers in Ontario, Canada.

PubMed

Winder, Charlotte B; LeBlanc, Stephen J; Haley, Derek B; Lissemore, Kerry D; Godkin, M Ann; Duffield, Todd F

2016-12-01

Disbudding and dehorning dairy calves is very common, despite the introduction of polled genetics to most dairy breeds. Appropriate pain-control practices for these procedures affect both calf welfare and public perception of the dairy industry. Previously published work has shown that North American dairy producers have not widely adopted use of these medications for disbudding or dehorning. However, since the last published work examining these practices in Canada, changes regarding awareness, availability, and future requirements for pain control have occurred in the industry. With this in mind, online and telephone surveys of both veterinarians (n=238) and dairy producers (n=603) in Ontario, Canada, were conducted in the fall of 2014 with a goal of describing current disbudding and dehorning practices and examining factors associated with the adoption of pain control use. Approximately three-quarters of dairy producers reported performing disbudding or dehorning themselves, whereas the remainder used a veterinarian or technician. Almost all (97%) of the veterinarians surveyed reported using local anesthetic, 62% used sedation, and 48% used a nonsteroidal anti-inflammatory drug. Producer use of local anesthetic was 62%, 38% used sedation and 24% used a nonsteroidal anti-inflammatory drug. Seventy-eight percent of veterinarian disbudding or dehorning was done before 8wk of age, whereas 64% of dairy producers performed this procedure before 8wk of age. Seventy-two percent of veterinarians and 63% of producers reported changing their disbudding or dehorning practices over the past 10 yr; of producers that changed their practices, 73% cited their herd veterinarian as influential. The use of pain control described in these surveys is higher than previously reported in Ontario. Identification of factors associated with best practices, or the lack of adoption of these practices, may help veterinarians target appropriate educational opportunities for their dairy clients. Copyright © 2016 American Dairy Science Association. Published by Elsevier Inc. All rights reserved.

Massive Pulmonary Calculi Embolism: A Novel Complication of Pneumatic Lithotripsy: A Case Report.

PubMed

Zhang, Lin; Zhou, Yiwu

2015-07-01

Pneumatic lithotripsy is a minimally invasive technique mainly for the treatment of urinary staghorn stones. Previous literatures have reported some therapeutic complications during or after this procedure, but calculi embolism has not been mentioned before.We report here a fatal case of calculi-induced pulmonary embolism in an adult woman who underwent pneumatic lithotripsy. An autopsy did not reveal any evidence of pulmonary embolism. However, light microscopy revealed noticeable presence of calculi in pulmonary arterioles and capillaries, as evidenced by environmental scanning electron microscope and energy dispersive X-ray analysis. The primary determinants of calculi embolism include intrarenal pressure, and volume and viscosity of the calculi fragments formation. Vascular intravasation of smashed calculi might increase pulmonary vascular resistance and hypoxemia and decrease cardiac output.This case report intends to provide information for clinicians to consider the probability of intraoperative calculi embolism during lithotripsies when patients develop typical symptoms of acute pulmonary embolism.

An improved synthesis of pyran-3,5-dione: application to the synthesis of ABT-598, a potassium channel opener, via Hantzsch reaction.

PubMed

Li, Wenke; Wayne, Gregory S; Lallaman, John E; Chang, Sou-Jen; Wittenberger, Steven J

2006-02-17

Ketoester 1 is cyclized to give pyran-3,5-dione 2 in 78% yield using a parallel addition of ketoester 1 and base NaO(t)Bu in refluxing THF. Compared to the previously reported procedures, these optimized conditions have significantly increased the yield of this transformation and the quality of pyran 2 and prove to be suitable for large-scale preparation. An application of 2 to the synthesis of ABT-598, a potassium channel opener, is demonstrated.

Estimation of the Operating Characteristics when the Test Information of the Old Test is not Constant II: Simple Sum Procedure of the Conditional P.D.F. Approach/Normal Approach Method Using Three Subtests of the Old Test. Research Report 80-4.

ERIC Educational Resources Information Center

Samejima, Fumiko

The rationale behind the method of estimating the operating characteristics of discrete item responses when the test information of the Old Test is not constant was presented previously. In the present study, two subtests of the Old Test, i.e. Subtests 1, and 2, each of which has a different non-constant test information function, are used in…

Recent Developments on Microencapsulation for Autonomous Corrosion Protection

NASA Technical Reports Server (NTRS)

Calle, Luz M.; Li, Wenyan; Buhrow, Jerry W.; Fitzpatrick, Lilliana; Jolley, Scott T.; Surma, Jan M.; Pearman, Benjamin P.; Zhang, Xuejun

2014-01-01

This work concerns recent progress in the development of a multifunctional smart coating based on microencapsulation for the autonomous control of corrosion. Microencapsulation allows the incorporation of desired corrosion control functionalities, such as early corrosion detection and inhibition through corrosion controlled release of corrosion indicators and inhibitors, as well as self-healing agent release when mechanical damage occurs.While proof-of-concept results have been reported previously, more recent efforts have been concentrated in technical developments to improve coating compatibility, synthesis procedure scalability, as well as fine tuning the release property of encapsulated active agents.

Resolution of a life-threatening complication after lung radiofrequency ablation.

PubMed

Andreetti, Claudio; Maurizi, Giulio; Cassiano, Francesco; Rendina, Erino Angelo

2014-10-01

Lung radiofrequency ablation (RFA) is an option for the treatment of unresectable lung cancer. Clinical investigators have previously warned against severe complications associated with this procedure. We report a case of life-threatening complication after lung RFA for non-operable non-small-cell lung cancer consisting of pulmonary abscess evolving into a bronchopleural fistula, severe pneumothorax and septic pleuritis, which was successfully treated with a multimodal conservative approach. © The Author 2014. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

Symptomatic retention of the Agile® patency capsule.

PubMed

Egea Valenzuela, Juan; Estrella Díez, Esther; Alberca de Las Parras, Fernando

2017-06-01

The Agile® capsule has shown to be useful when evaluating the patency of the small bowel in patients prior to capsule endoscopy studies. It is a safe tool and a low rate of complications have been reported, highlighting symptomatic retention, although references in literature are scarce and it is only observed in 1.2% of the procedures. We present the case of a symptomatic retention of this device in a patient with previously known colonic Crohn's disease in who a small bowel study was indicated and was sent for prior patency test.

Cost-consequence analysis of different active flowable hemostatic matrices in cardiac surgical procedures.

PubMed

Makhija, D; Rock, M; Xiong, Y; Epstein, J D; Arnold, M R; Lattouf, O M; Calcaterra, D

2017-06-01

A recent retrospective comparative effectiveness study found that use of the FLOSEAL Hemostatic Matrix in cardiac surgery was associated with significantly lower risks of complications, blood transfusions, surgical revisions, and shorter length of surgery than use of SURGIFLO Hemostatic Matrix. These outcome improvements in cardiac surgery procedures may translate to economic savings for hospitals and payers. The objective of this study was to estimate the cost-consequence of two flowable hemostatic matrices (FLOSEAL or SURGIFLO) in cardiac surgeries for US hospitals. A cost-consequence model was constructed using clinical outcomes from a previously published retrospective comparative effectiveness study of FLOSEAL vs SURGIFLO in adult cardiac surgeries. The model accounted for the reported differences between these products in length of surgery, rates of major and minor complications, surgical revisions, and blood product transfusions. Costs were derived from Healthcare Cost and Utilization Project's National Inpatient Sample (NIS) 2012 database and converted to 2015 US dollars. Savings were modeled for a hospital performing 245 cardiac surgeries annually, as identified as the average for hospitals in the NIS dataset. One-way sensitivity analysis and probabilistic sensitivity analysis were performed to test model robustness. The results suggest that if FLOSEAL is utilized in a hospital that performs 245 mixed cardiac surgery procedures annually, 11 major complications, 31 minor complications, nine surgical revisions, 79 blood product transfusions, and 260.3 h of cumulative operating time could be avoided. These improved outcomes correspond to a net annualized saving of $1,532,896. Cost savings remained consistent between $1.3m and $1.8m and between $911k and $2.4m, even after accounting for the uncertainty around clinical and cost inputs, in a one-way and probabilistic sensitivity analysis, respectively. Outcome differences associated with FLOSEAL vs SURGIFLO that were previously reported in a comparative effectiveness study may result in substantial cost savings for US hospitals.

A competitive immunoassay for sensitive detection of small molecules chloramphenicol based on luminol functionalized silver nanoprobe.

PubMed

Yu, Xiuxia; He, Yi; Jiang, Jie; Cui, Hua

2014-02-17

Chloramphenicol (CHL) as a broad-spectrum antibiotic has a broad action spectrum against Gram-positive and Gram-negative bacteria, as well as anaerobes. The use of CHL is strictly restricted in poultry because of its toxic effect. However, CHL is still illegally used in animal farming because of its accessibility and low cost. Therefore, sensitive methods are highly desired for the determination of CHL in foodstuffs. The immunoassays based on labeling as an important tool have been reported for the detection of CHL residues in food-producing animals. However, most of the labeling procedures require multi-step reactions and purifications and thus they are complicated and time-consuming. Recently, in our previous work, luminol functionalized silver nanoparticles have been successfully synthesized, which exhibits higher CL efficiency than luminol functionalized gold nanoparticles. In this work, the new luminol functionalized silver nanoparticles have been used for the labeling of small molecules CHL for the first time and a competitive chemiluminescent immunoassay has been developed for the detection of CHL. Owing to the amplification of silver nanoparticles, high sensitivity for CHL could be achieved with a low detection limit of 7.6×10(-9) g mL(-1) and a wide linear dynamic range of 1.0×10(-8)-1.0×10(-6) g mL(-1). This method has also been successfully applied to determine CHL in milk and honey samples with a good recoveries (92% and 102%, 99% and 107% respectively), indicating that the method is feasible for the determination of CHL in real milk and honey samples. The labeling procedure is simple, convenient and fast, superior to previously reported labeling procedures. The immunoassay is also simple, fast, sensitive and selective. It is of application potential for the determination of CHL in foodstuffs. Copyright © 2014 Elsevier B.V. All rights reserved.

Child sexual abuse and mandatory reporting intervention preservice content preferred by student teachers.

PubMed

Goldman, Juliette D G; Grimbeek, Peter

2014-01-01

The importance of preservice university teacher training about child sexual abuse and its mandatory reporting intervention is addressed in educational literature, although very little is known about student teachers' learning interests and preferences in this area. In this article, student teachers refer to students in university who are training to become teachers whose training includes teaching experiences in schools. This study examines the content about child sexual abuse and its intervention that student teachers believe they should learn. Results based on quantitative analyses show the relative importance of gender in determining responses to questions about university training and, to a lesser extent, the importance of a previous acquaintance with victims of sexual abuse, previous employment, and the length of the university course. Results based on qualitative data show that content knowledge preferred by elementary/primary and secondary school student teachers includes the teacher's role in mandatory reporting of child sexual abuse and signs, experiences, and responses to student disclosure. Student teachers prefer content examples of school professionals' responses and procedures after disclosure and prefer direct learning content from intervening school professionals. These outcomes could usefully guide teachers and educators who design intervention curricula on child sexual abuse for preservice teachers.

Subaru HDS transmission spectroscopy of the transiting extrasolar planet HD209458b

NASA Astrophysics Data System (ADS)

Narita, N.; Suto, Y.; Winn, J. N.; Turner, E. L.; Aoki, W.; Leigh, C. J.; Sato, B.; Tamura, M.; Yamada, T.

2006-02-01

We have searched for absorption in several common atomic species due to the atmosphere or exosphere of the transiting extrasolar planet HD 209458b, using high precision optical spectra obtained with the Subaru High Dispersion Spectrograph (HDS). Previously we reported an upper limit on Hα absorption of 0.1% (3σ) within a 5.1Å band. Using the same procedure, we now report upper limits on absorption due to the optical transitions of Na D, Li, Hα, Hβ, Hγ, Fe, and Ca. The 3σ upper limit for each transition is approximately 1% within a 0.3Å band (the core of the line), and a few tenths of a per cent within a 2Å band (the full line width). The wide-band results are close to the expected limit due to photon-counting (Poisson) statistics, although in the narrow-band case we have encountered unexplained systematic errors at a few times the Poisson level. These results are consistent with all previously reported detections (Charbonneau et al. 2002, ApJ, 568, 377) and upper limits (Bundy & Marcy 2000, PASP, 112, 1421; Moutou et al. 2001, A&A, 371, 260), but are significantly more sensitive yet achieved from ground based observations.

Retention of blinding at follow-up in a randomized clinical study using a sham-control cervical manipulation procedure for neck pain: secondary analyses from a randomized clinical study.

PubMed

Vernon, Howard; Triano, John T; Soave, David; Dinulos, Maricelle; Ross, Kim; Tran, Steven

2013-10-01

Participants in clinical trials of spinal manipulation have not been rigorously blinded to group assignment. This study reports on secondary analyses of the retention of participant blinding beyond the immediate posttreatment time frame following a single-session, randomized clinical study. A novel control cervical manipulation procedure that has previously been shown to be therapeutically inert was contrasted with a typical manipulation procedure. A randomized clinical study of a single session of typical vs sham-control manipulation in patients with chronic neck pain was conducted. Findings of self-reported group registration at 24 to 48 hours posttreatment were computed. The Blinding Index (BI) of Bang et al was then applied to both the immediate and post-24- to 48-hour results. Twenty-four to 48 hours after treatment, 94% and 22% of participants in the typical and control groups, respectively, correctly identified their group assignment. When analyzed with the BI of Bang et al, the immediate posttreatment BI for the group receiving a typical manipulation was 0.22 (95% confidence interval [CI], -0.03 to 0.47); for the group receiving a control manipulation, it was 0.19 (95% CI, -0.06 to 0.43). The BI at post-24 hours was as follows: typical = 0.75 (95% CI, 0.59-0.91) and control = -0.34 (95% CI, -0.58 to -0.11). This study found that the novel sham-control cervical manipulation procedure may be effective in blinding sham group allocation up to 48 hours posttreatment. It appears that, at 48 hours posttreatment, the modified form of the typical cervical manipulation was not. The sham-control procedure appears to be a promising procedure for future clinical trials. © 2013. Published by National University of Health Sciences All rights reserved.

Clinical skills assessment of procedural and advanced communication skills: performance expectations of residency program directors.

PubMed

Langenau, Erik E; Zhang, Xiuyuan; Roberts, William L; DeChamplain, Andre F; Boulet, John R

2012-01-01

High stakes medical licensing programs are planning to augment and adapt current examinations to be relevant for a two-decision point model for licensure: entry into supervised practice and entry into unsupervised practice. Therefore, identifying which skills should be assessed at each decision point is critical for informing examination development, and gathering input from residency program directors is important. Using data from previously developed surveys and expert panels, a web-delivered survey was distributed to 3,443 residency program directors. For each of the 28 procedural and 18 advanced communication skills, program directors were asked which clinical skills should be assessed, by whom, when, and how. Descriptive statistics were collected, and Intraclass Correlations (ICC) were conducted to determine consistency across different specialties. Among 347 respondents, program directors reported that all advanced communication and some procedural tasks are important to assess. The following procedures were considered 'important' or 'extremely important' to assess: sterile technique (93.8%), advanced cardiovascular life support (ACLS) (91.1%), basic life support (BLS) (90.0%), interpretation of electrocardiogram (89.4%) and blood gas (88.7%). Program directors reported that most clinical skills should be assessed at the end of the first year of residency (or later) and not before graduation from medical school. A minority were considered important to assess prior to the start of residency training: demonstration of respectfulness (64%), sterile technique (67.2%), BLS (68.9%), ACLS (65.9%) and phlebotomy (63.5%). Results from this study support that assessing procedural skills such as cardiac resuscitation, sterile technique, and phlebotomy would be amenable to assessment at the end of medical school, but most procedural and advanced communications skills would be amenable to assessment at the end of the first year of residency training or later. Gathering data from residency program directors provides support for developing new assessment tools in high-stakes licensing examinations.

Clinical skills assessment of procedural and advanced communication skills: performance expectations of residency program directors

PubMed Central

Langenau, Erik E.; Zhang, Xiuyuan; Roberts, William L.; DeChamplain, Andre F.; Boulet, John R.

2012-01-01

Background High stakes medical licensing programs are planning to augment and adapt current examinations to be relevant for a two-decision point model for licensure: entry into supervised practice and entry into unsupervised practice. Therefore, identifying which skills should be assessed at each decision point is critical for informing examination development, and gathering input from residency program directors is important. Methods Using data from previously developed surveys and expert panels, a web-delivered survey was distributed to 3,443 residency program directors. For each of the 28 procedural and 18 advanced communication skills, program directors were asked which clinical skills should be assessed, by whom, when, and how. Descriptive statistics were collected, and Intraclass Correlations (ICC) were conducted to determine consistency across different specialties. Results Among 347 respondents, program directors reported that all advanced communication and some procedural tasks are important to assess. The following procedures were considered ‘important’ or ‘extremely important’ to assess: sterile technique (93.8%), advanced cardiovascular life support (ACLS) (91.1%), basic life support (BLS) (90.0%), interpretation of electrocardiogram (89.4%) and blood gas (88.7%). Program directors reported that most clinical skills should be assessed at the end of the first year of residency (or later) and not before graduation from medical school. A minority were considered important to assess prior to the start of residency training: demonstration of respectfulness (64%), sterile technique (67.2%), BLS (68.9%), ACLS (65.9%) and phlebotomy (63.5%). Discussion Results from this study support that assessing procedural skills such as cardiac resuscitation, sterile technique, and phlebotomy would be amenable to assessment at the end of medical school, but most procedural and advanced communications skills would be amenable to assessment at the end of the first year of residency training or later. Conclusions Gathering data from residency program directors provides support for developing new assessment tools in high-stakes licensing examinations. PMID:22833698

Use of a national continuing medical education meeting to provide simulation-based training in temporary hemodialysis catheter insertion skills: a pre-test post-test study.

PubMed

Clark, Edward G; Paparello, James J; Wayne, Diane B; Edwards, Cedric; Hoar, Stephanie; McQuillan, Rory; Schachter, Michael E; Barsuk, Jeffrey H

2014-01-01

Simulation-based-mastery-learning (SBML) is an effective method to train nephrology fellows to competently insert temporary, non-tunneled hemodialysis catheters (NTHCs). Previous studies of SBML for NTHC-insertion have been conducted at a local level. Determine if SBML for NTHC-insertion can be effective when provided at a national continuing medical education (CME) meeting. Describe the correlation of demographic factors, prior experience with NTHC-insertion and procedural self-confidence with simulated performance of the procedure. Pre-test - post-test study. 2014 Canadian Society of Nephrology annual meeting. Nephrology fellows, internal medicine residents and medical students. Participants were surveyed regarding demographics, prior NTHC-insertion experience, procedural self-confidence and attitudes regarding the training they received. NTHC-insertion skills were assessed using a 28-item checklist. Participants underwent a pre-test of their NTHC-insertion skills at the internal jugular site using a realistic patient simulator and ultrasound machine. Participants then had a training session that included a didactic presentation and 2 hours of deliberate practice using the simulator. On the following day, trainees completed a post-test of their NTHC-insertion skills. All participants were required to meet or exceed a minimum passing score (MPS) previously set at 79%. Trainees who did not reach the MPS were required to perform more deliberate practice until the MPS was achieved. Twenty-two individuals participated in SBML training. None met or exceeded the MPS at baseline with a median checklist score of 20 (IQR, 7.25 to 21). Seventeen of 22 participants (77%) completed post-testing and improved their scores to a median of 27 (IQR, 26 to 28; p < 0.001). All met or exceeded the MPS on their first attempt. There were no significant correlations between demographics, prior experience or procedural self-confidence with pre-test performance. Small sample-size and self-selection of participants. Costs could limit the long-term feasibility of providing this type of training at a CME conference. Despite most participants reporting having previously inserted NTHCs in clinical practice, none met the MPS at baseline; this suggests their prior training may have been inadequate.

Direct-location versus verbal report methods for measuring auditory distance perception in the far field.

PubMed

Etchemendy, Pablo E; Spiousas, Ignacio; Calcagno, Esteban R; Abregú, Ezequiel; Eguia, Manuel C; Vergara, Ramiro O

2018-06-01

In this study we evaluated whether a method of direct location is an appropriate response method for measuring auditory distance perception of far-field sound sources. We designed an experimental set-up that allows participants to indicate the distance at which they perceive the sound source by moving a visual marker. We termed this method Cross-Modal Direct Location (CMDL) since the response procedure involves the visual modality while the stimulus is presented through the auditory modality. Three experiments were conducted with sound sources located from 1 to 6 m. The first one compared the perceived distances obtained using either the CMDL device or verbal report (VR), which is the response method more frequently used for reporting auditory distance in the far field, and found differences on response compression and bias. In Experiment 2, participants reported visual distance estimates to the visual marker that were found highly accurate. Then, we asked the same group of participants to report VR estimates of auditory distance and found that the spatial visual information, obtained from the previous task, did not influence their reports. Finally, Experiment 3 compared the same responses that Experiment 1 but interleaving the methods, showing a weak, but complex, mutual influence. However, the estimates obtained with each method remained statistically different. Our results show that the auditory distance psychophysical functions obtained with the CMDL method are less susceptible to previously reported underestimation for distances over 2 m.

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

PubMed

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

2015-05-01

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

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.

A sustainable on-line CapLC method for quantifying antifouling agents like irgarol-1051 and diuron in water samples: Estimation of the carbon footprint.

PubMed

Pla-Tolós, J; Serra-Mora, P; Hakobyan, L; Molins-Legua, C; Moliner-Martinez, Y; Campins-Falcó, P

2016-11-01

In this work, in-tube solid phase microextraction (in-tube SPME) coupled to capillary LC (CapLC) with diode array detection has been reported, for on-line extraction and enrichment of booster biocides (irgarol-1051 and diuron) included in Water Frame Directive 2013/39/UE (WFD). The analytical performance has been successfully demonstrated. Furthermore, in the present work, the environmental friendliness of the procedure has been quantified by means of the implementation of the carbon footprint calculation of the analytical procedure and the comparison with other methodologies previously reported. Under the optimum conditions, the method presents good linearity over the range assayed, 0.05-10μg/L for irgarol-1051 and 0.7-10μg/L for diuron. The LODs were 0.015μg/L and 0.2μg/L for irgarol-1051 and diuron, respectively. Precision was also satisfactory (relative standard deviation, RSD<3.5%). The proposed methodology was applied to monitor water samples, taking into account the EQS standards for these compounds. The carbon footprint values for the proposed procedure consolidate the operational efficiency (analytical and environmental performance) of in-tube SPME-CapLC-DAD, in general, and in particular for determining irgarol-1051 and diuron in water samples. Copyright © 2016 Elsevier B.V. All rights reserved.

New insights on the baker's yeast-mediated hydration of oleic acid: the bacterial contaminants of yeast are responsible for the stereoselective formation of (R)-10-hydroxystearic acid.

PubMed

Serra, S; De Simeis, D

2018-03-01

The preparation of the high-value flavour γ-dodecalactone is based on the biotransformation of natural 10-HSA, which is in turn obtained by microbial hydration of oleic acid. We want to establish a reliable baker's yeast-mediated procedure for 10-HSA preparation. The previously reported yeast-mediated hydration procedures are unreliable because bacteria-free baker's yeast is not able to hydrate oleic acid. The actual responsible for performing this reaction are the bacterial contaminants present in baker's yeast. Moreover, we demonstrated that the enantioselectivity in the production of (R)-10-HSA is affected mainly by the temperature used in the biotransformation. We demonstrated that Saccharomyces cerevisiae is not able to hydrate oleic acid, whereas different bacterial strains present in baker's yeast transform oleic acid into (R)-10-HSA. We reported a general procedure for the preparation of (R)-10-HSA starting from oleic acid and using commercially available baker's yeast. This study holds both scientific and industrial interest. It unambiguously establishes that the eukaryote micro-organisms present in baker's yeast are not able to hydrate oleic acid. The isolation of oleic acid hydrating bacterial strains from commercial baker's yeast points to their prospective use for the industrial synthesis of 10-HSA. © 2017 The Society for Applied Microbiology.

Sub-barrier radioactive ion beam investigations using a new methodology and analysis for the stacked target technique

NASA Astrophysics Data System (ADS)

Fisichella, M.; Shotter, A. C.; Di Pietro, A.; Figuera, P.; Lattuada, M.; Marchetta, C.; Privitera, V.; Romano, L.; Ruiz, C.; Zadro, M.

2015-12-01

For low energy reaction studies involving radioactive ion beams, the experimental reaction yields are generally small due to the low intensity of the beams. For this reason, the stacked target technique has been often used to measure excitation functions. This technique offers considerable advantages since the reaction cross-section at several energies can be simultaneously measured. In a further effort to increase yields, thick targets are also employed. The main disadvantage of the method is the degradation of the beam quality as it passes through the stack due to the statistical nature of energy loss processes and any nonuniformity of the stacked targets. This degradation can lead to ambiguities of associating effective beam energies to reaction product yields for the targets within the stack and, as a consequence, to an error in the determination of the excitation function for the reaction under study. A thorough investigation of these ambiguities is reported, and a best practice procedure of analyzing data obtained using the stacked target technique with radioactive ion beams is recommended. Using this procedure a re-evaluation is reported of some previously published sub-barrier fusion data in order to demonstrate the possibility of misinterpretations of derived excitation functions. In addition, this best practice procedure has been used to evaluate, from a new data set, the sub-barrier fusion excitation function for the reaction 6Li+120Sn .

Constant and Progressive Time Delay Procedures for Teaching Children with Autism: A Literature Review

ERIC Educational Resources Information Center

Walker, Gabriela

2008-01-01

A review of 22 empirical studies examining the use of constant (CTD) and progressive (PTD) time delay procedures employed with children with autism frames an indirect analysis of the demographic, procedural, methodological, and outcome parameters of existing research. None of the previous manuscripts compared the two response prompting procedures.…

Using comprehension strategies with authentic text in a college chemistry course

NASA Astrophysics Data System (ADS)

Cain, Stephen Daniel

College science students learn important topics by reading textbooks, which contain dense technical prose. Comprehension strategies are known to increase learning from reading. One class of comprehension strategies, called elaboration strategies, is intended to link new information with prior knowledge. Elaboration strategies have an appeal in science courses where new information frequently depends on previously learned information. The purpose of this study was to determine the effectiveness of an elaboration strategy in an authentic college environment. General chemistry students read text about Lewis structures, figures drawn by chemists to depict molecules, while assigned to use either an elaboration strategy, namely elaborative interrogation, or another strategy, rereading, which served as a placebo control. Two texts of equal length were employed in this pretest-posttest experimental design. One was composed by the researcher. The other was an excerpt from a college textbook and contained a procedure for constructing Lewis structures. Students (N = 252) attending a large community college were randomly assigned to one of the two texts and assigned one of the two strategies. The elaborative interrogation strategy was implemented with instructions to answer why-questions posed throughout the reading. Answering why-questions has been hypothesized to activate prior knowledge of a topic, and thus to aid in cognitively connecting new material with prior knowledge. The rereading strategy was implemented with instructions to read text twice. The use of authentic text was one of only a few instances of applying elaborative interrogation with a textbook. In addition, previous studies have generally focused on the learning of facts contained in prose. The application of elaborative interrogation to procedural text has not been previously reported. Results indicated that the more effective strategy was undetermined when reading authentic text in this setting. However, prior knowledge level was identified as a statistically significant factor for learning from authentic text. That is, students with high prior knowledge learned more, regardless of assigned strategy. Another descriptive study was conducted with a separate student sample (N = 34). Previously reported Lewis structure research was replicated. The trend of difficulty for 50 structures in the earlier work was supported.

Redo Heller Myotomy for Achalasia in a Patient with Down Syndrome: a Case Report.

PubMed

Sosa-Stanley, Jessica; Vandendool, KellyAnn; Kiev, Jonathan

2015-01-01

Up to 77% of Down syndrome (DS) patients have associated structural or functional gastrointestinal abnormalities. Functional disturbances, such as processes affecting the enteric nervous system, can often affect the outcome of corrective surgical procedures. Recently, an association between DS and achalasia has been reported. In this report we present a 28-year-old male patient with a history of Down syndrome and achalasia, who presented with recurrent dysphagia, gastroesophageal reflux, and recurrent aspirations. The patient had previously undergone a laparoscopic Heller myotomy with Dor fundoplication. Unfortunately, despite this surgery, he continued to require multiple esophageal dilations, and intraesophageal administration of Botox therapy. Additionally, there were numerous subsequent hospital admissions for recurrent aspiration pneumonia. Evaluation revealed an incomplete myotomy and a revision long Heller myotomy was successfully performed intraabdominally and he is now symptom and aspiration free.

Oscillating-flow regenerator test rig

NASA Technical Reports Server (NTRS)

Wood, J. G.; Gedeon, D. R.

1994-01-01

This report summarizes work performed in setting up and performing tests on a regenerator test rig. An earlier status report presented test results, together with heat transfer correlations, for four regenerator samples (two woven screen samples and two felt metal samples). Lessons learned from this testing led to improvements to the experimental setup, mainly instrumentation as well as to the test procedure. Given funding and time constraints for this project it was decided to complete as much testing as possible while the rig was set up and operational, and to forego final data reduction and analysis until later. Additional testing was performed on several of the previously tested samples as well an on five newly fabricated samples. The following report is a summary of the work performed at OU, with many of the final test results included in raw data form.

Radiological pitfalls of age estimation in adopted children: a case report.

PubMed

Gibelli, D; De Angelis, D; Cattaneo, C

2015-04-01

Age estimation has a relevant importance in assessing adopted children, also in cases where the age of the minor seems unquestioned, since pathological conditions may radically alter bodily growth. This may lead to an incorrect age evaluation, with consequent social and psychological problems linked to an inadequate collocation in public school. This study aims at exposing a case report concerning age estimation for a newly adopted child from Cambodia; previous clinical documentation reported information suggesting possible malnutrition, which was verified by the observation of a general disalignment of bone and dental structures. This example shows the importance of a thorough forensic evaluation of adopted children from other countries in order to verify the possible environmental modification of physiological growth even where it seems not to be needed, and represents a caveat for clinical and social personnel dealing with adoption procedures.

An Unusual Complication of Ventriculoperitoneal Shunt: Urinary Bladder Stone Case Report and Literature Review.

PubMed

Xu, Songtao; Sheng, Weixin; Qiu, Yufa; Wang, Jianguo

2016-01-01

Ventriculoperitoneal (V-P) shunt surgery is the most common technique used for the treatment of hydrocephalus. The migration of ventriculoperitoneal shunt to the bladder is rare. Only two cases have been previously reported in the literature. We report on a 38-year-old male who had hydrocephalus and V-P shunt for 12 years. Two years ago, he found himself with recurrent urinary tract infections, haematuria and urges incontinence, and then he was diagnosed with bladder perforation and merge stones. The patient had an abdominal operation to cut off and take out the shunt catheter, as well as a transurethral holmium laser lithotripsy. Bladder perforation and stones are rare examples of complications in V-P surgical procedures. Controlling the effective length of the terminal V-P shunt and modifying it appropriately can effectively reduce these complications.

Efferent limb of gastrojejunostomy obstruction by a whole okra phytobezoar: Case report and brief review

PubMed Central

Zin, Thant; Maw, Myat; Pai, Dinker Ramananda; Paijan, Rosaini Binti; Kyi, Myo

2012-01-01

A phytobezoar is one of the intraluminal causes of gastric outlet obstruction, especially in patients with previous gastric surgery and/or gastric motility disorders. Before the proton pump inhibitor era, vagotomy, pyloroplasty, gastrectomy and gastrojejunostomy were commonly performed procedures in peptic ulcer patients. One of the sequelae of gastrojejunostomy is phytobezoar formation. However, a bezoar causing gastric outlet obstruction is rare even with giant gastric bezoars. We report a rare case of gastric outlet obstruction due to a phytobezoar obstructing the efferent limb of the gastrojejunostomy site. This phytobezoar which consisted of a whole piece of okra (lady finger vegetable) was successfully removed by endoscopic snare. To the best of our knowledge, this is the first case of okra bezoar-related gastrojejunostomy efferent limb obstruction reported in the literature. PMID:22624073

Assessment of Psychophysiological Responses During Motion Sickness Testing

NASA Technical Reports Server (NTRS)

Stoud, Cynthia S.; Toscano, William B.; Cowings, Patricia; Freidman, Gary

1994-01-01

The purpose of this investigation is to evaluate a methodology designed to accurately trace the temporal progression of motion sickness and space motion sickness symptoms. With this method, subjects continuously monitor their own motion sickness symptoms during exposure to a provocative stimulus as symptoms occur, in contrast to previous methods during which subjects report symptoms verbally at discrete time intervals. This method not only is comparable to previous methods in the type of symptoms that subjects report, but subjects report symptoms more frequently. Frequent reporting of motion sickness symptoms allows researchers to detail the waxing and waning of motion sickness symptoms for each individual. Previous research has shown that physiological responses to motion sickness stimuli are characterized by unique individual differences in response patterns. By improving our assessment of motion sickness symptoms with continuous monitoring of symptoms, the relationship between specific physiological responses and sickness levels can be more accurately determined for each individual. Results from this study show significant positive relationships between skin conductance levels and symptom levels for ten individuals; a significant positive relationship between temperature and symptom levels for 5 of 10 individuals; and both positive and negative relationships between respiration, heart rate, blood volume pulse and symptom levels. Continuous monitoring of motion sickness symptoms can be used to more accurately assess motion sickness to aid in the evaluation of countermeasures. In addition, recognition of the onset of symptoms that are strongly related to specific physiological responses could be used as cues to initiate procedures (e.g., Autogenic Feedback Training) to prevent the development of severe motion sickness symptoms.

34 CFR 30.35 - What procedures does the Secretary follow to report debts to consumer reporting agencies?

Code of Federal Regulations, 2010 CFR

2010-07-01

... Debts to Consumer Reporting Agencies § 30.35 What procedures does the Secretary follow to report debts to consumer reporting agencies? (a)(1) The Secretary reports information regarding debts arising... 34 Education 1 2010-07-01 2010-07-01 false What procedures does the Secretary follow to report...

[Local approval procedures act as a brake on RCTs].

PubMed

van der Stok, E P; Huiskens, J; Hemmes, B; Grünhagen, D J; van Gulik, T M; Verhoef, C; Punt, C J A

2016-01-01

Large multicentre randomised controlled trials (RCTs) in the Netherlands are increasingly being impeded by major differences between local approval procedures. However, no national agenda exists as yet to improve this situation. The existence of major local differences in processing time and documentation required has been reported previously but little is known about the costs incurred and whether or not specific certifications and research contracts are mandatory. The current study evaluated these aspects of local procedures for obtaining approval of two oncological multicentre RCTs. Retrospective, descriptive. All local procedures for obtaining approval of two randomised clinical trials were evaluated: the CAIRO5 and CHARISMA trials initiated by the Dutch Colorectal Cancer Group (DCCG). We objectified time between approval by the Medical Ethics Review Committee (METC) and final approval by the Board of Directors (RvB), the type and number of documents needed, and costs charged. The median time interval between the approval by the Medical Ethics Review Committee and the approval by the Board of Directors was 90 days (range 4-312). The number of documents required per centre ranged from 6-20. The costs charged ranged from € 0-€ 1750, and amounted to € 8575 for all procedures combined. No costs were charged by the majority of the centres. The approval procedures for multicentre clinical trials in the Netherlands demonstrate major differences. Processing times, documentation required and costs are unpredictable; greater uniformity is highly desirable in this context.

Successful outcome of modified quad surgical procedure in preteen and teen patients with brachial plexus birth palsy.

PubMed

Nath, Rahul K; Somasundaram, Chandra

2012-01-01

To evaluate the outcome of modified Quad procedure in preteen and teen patients with brachial plexus birth palsy. We have previously demonstrated a significant improvement in shoulder abduction, resulting from the modified Quad procedure in children (mean age 2.5 years; range, 0.5-9 years) with obstetric brachial plexus injury. We describe in this report the outcome of 16 patients (6 girls and 10 boys; 7 preteen and 9 teen) who have undergone the modified Quad procedure for the correction of the shoulder function, specifically abduction. The patients underwent transfer of the latissimus dorsi and teres major muscles, release of contractures of subscapularis pectoralis major and minor, and axillary nerve decompression and neurolysis (the modified Quad procedure). Mean age of these patients at surgery was 13.5 years (range, 10.1-17.9 years). The mean preoperative total Mallet score was 14.8 (range, 10-20), and active abduction was 84° (range, 20°-140°). At a mean follow-up of 1.5 years, the mean postoperative total Mallet score increased to 19.7 (range, 13-25, P < .0001), and the mean active abduction improved to 132° (range, 40°-180°, P < .0003). The modified Quad procedure greatly improves not only the active abduction but also other shoulder functions in preteen and teen patients, as this outcome is the combined result of decompression and neurolysis of the axillary nerve and the release of the contracted internal rotators of the shoulder.

Teaching Palatoplasty Using a High-Fidelity Cleft Palate Simulator.

PubMed

Cheng, Homan; Podolsky, Dale J; Fisher, David M; Wong, Karen W; Lorenz, H Peter; Khosla, Rohit K; Drake, James M; Forrest, Christopher R

2018-01-01

Cleft palate repair is a challenging procedure for cleft surgeons to teach. A novel high-fidelity cleft palate simulator has been described for surgeon training. This study evaluates the simulator's effect on surgeon procedural confidence and palatoplasty knowledge among learners. Plastic surgery trainees attended a palatoplasty workshop consisting of a didactic session on cleft palate anatomy and repair followed by a simulation session. Participants completed a procedural confidence questionnaire and palatoplasty knowledge test immediately before and after the workshop. All participants reported significantly higher procedural confidence following the workshop (p < 0.05). Those with cleft palate surgery experience had higher procedural confidence before (p < 0.001) and after (p < 0.001) the session. Palatoplasty knowledge test scores increased in 90 percent of participants. The mean baseline test score was 28 ± 10.89 percent and 43 ± 18.86 percent following the workshop. Those with prior cleft palate experience did not have higher mean baseline test scores than those with no experience (30 percent versus 28 percent; p > 0.05), but did have significantly higher scores after the workshop (61 percent versus 35 percent; p < 0.05). All trainees strongly agreed or agreed that the simulator should be integrated into training and they would use it again. This study demonstrates the effective use of a novel cleft palate simulator as a training tool to teach palatoplasty. Improved procedural confidence and knowledge were observed after a single session, with benefits seen among trainees both with and without previous cleft experience.

Double checking medicines: defence against error or contributory factor?

PubMed

Armitage, Gerry

2008-08-01

The double checking of medicines in health care is a contestable procedure. It occupies an obvious position in health care practice and is understood to be an effective defence against medication error but the process is variable and the outcomes have not been exposed to testing. This paper presents an appraisal of the process using data from part of a larger study on the contributory factors in medication errors and their reporting. Previous research studies are reviewed; data are analysed from a review of 991 drug error reports and a subsequent series of 40 in-depth interviews with health professionals in an acute hospital in northern England. The incident reports showed that errors occurred despite double checking but that action taken did not appear to investigate the checking process. Most interview participants (34) talked extensively about double checking but believed the process to be inconsistent. Four key categories were apparent: deference to authority, reduction of responsibility, automatic processing and lack of time. Solutions to the problems were also offered, which are discussed with several recommendations. Double checking medicines should be a selective and systematic procedure informed by key principles and encompassing certain behaviours. Psychological research may be instructive in reducing checking errors but the aviation industry may also have a part to play in increasing error wisdom and reducing risk.

Complications of wrist arthroscopy.

PubMed

Ahsan, Zahab S; Yao, Jeffrey

2012-06-01

The purpose of this systematic review was to address the incidence of complications associated with wrist arthroscopy. Given the paucity of information published on this topic, an all-inclusive review of published wrist arthroscopy complications was sought. Two independent reviewers performed a literature search using PubMed, Google Scholar, EBSCO, and Academic Megasearch using the terms "wrist arthroscopy complications," "complications of wrist arthroscopy," "wrist arthroscopy injury," and "wrist arthroscopy." Inclusion criteria were (1) Levels I to V evidence, (2) "complication" defined as an adverse outcome directly related to the operative procedure, and (3) explicit description of operative complications in the study. Eleven multiple-patient studies addressing complications of wrist arthroscopy from 1994 to 2010 were identified, with 42 complications reported from 895 wrist arthroscopy procedures, a 4.7% complication rate. Four case reports were also found, identifying injury to the dorsal sensory branch of the ulnar nerve, injury to the posterior interosseous nerve, and extensor tendon sheath fistula formation. This systematic review suggests that the previously documented rate of wrist arthroscopy complications may be underestimating the true incidence. The report of various complications provides insight to surgeons for improving future surgical techniques. Level IV, systematic review of Levels I-V studies. Copyright © 2012 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

Characterizing pediatric surgical capacity in the Eastern Democratic Republic of Congo: results of a pilot study.

PubMed

Cairo, Sarah B; Kalisya, Luc Malemo; Bigabwa, Richard; Rothstein, David H

2018-03-01

Characterize pediatric surgical capacity in the eastern Democratic Republic of Congo (DRC) to identify areas of potential improvement. The Pediatric Personnel, Infrastructure, Procedures, Equipment, and Supplies (PediPIPES) survey was used in two representative eastern DRC provinces to assess existing surgical infrastructure and capacity. We compared our results to previously published reports from other sub-Saharan African countries. Fourteen hospitals in the eastern DRC and 37 in 19 sub-Saharan African (SSA) countries were compared. The average PediPIPES index for the DRC was 7.7 compared to 13.5 for SSAs. The greatest disparities existed in the areas of personnel and infrastructure. Running water was reportedly available to 57.1% of the hospitals in the DRC, and the majority of hospitals (78.6%) were dependent on generators and solar panels for electricity. Only two hospitals in the DRC (14.3%) reported a pediatric surgeon equivalent on staff, compared to 86.5% of facilities sampled in SSA reporting ≥ 1 pediatric surgeon. Significant barriers in personnel, infrastructure, procedures, equipment, and supplies impede the provision of adequate surgical care to children. Further work is needed to assess allocation and utilization of existing resources, and to enhance training of personnel with specific attention to pediatric surgery.

Conversion to Stoppa Procedure in Laparoscopic Totally Extraperitoneal Inguinal Hernia Repair

PubMed Central

Dirican, Abuzer; Ozgor, Dincer; Gonultas, Fatih; Isik, Burak

2012-01-01

Background and Objectives: Conversion to open surgery is an important problem, especially during the learning curve of laparoscopic totally extraperitoneal (TEP) inguinal hernia repair. Methods: Here, we discuss conversion to the Stoppa procedure during laparoscopic TEP inguinal hernia repair. Outcomes of patients who underwent conversion to an open approach during laparoscopic TEP inguinal hernia repair between September 2004 and May 2010 were evaluated. Results: In total, 259 consecutive patients with 281 inguinal hernias underwent laparoscopic TEP inguinal hernia repair. Thirty-one hernia repairs (11%) were converted to open conventional surgical procedures. Twenty-eight of 31 laparoscopic TEP hernia repairs were converted to modified Stoppa procedures, because of technical difficulties. Three of these patients underwent Lichtenstein hernia repairs, because they had undergone previous surgeries. Conclusion: Stoppa is an easy and successful procedure used to solve problems during TEP hernia repair. The Lichtenstein procedure may be a suitable option in patients who have undergone previous operations, such as a radical prostatectomy. PMID:23477173

An optimized protocol for DNA extraction in plants with a high content of secondary metabolites, based on leaves of Mimosa tenuiflora (Willd.) Poir. (Leguminosae).

PubMed

Arruda, S R; Pereira, D G; Silva-Castro, M M; Brito, M G; Waldschmidt, A M

2017-07-06

Some species are characterized by a high content of tannins, alkaloids, and phenols in their leaves. These secondary metabolites are released during DNA extraction and might hinder molecular studies based on PCR (polymerase chain reaction). To provide an efficient method to extract DNA, Mimosa tenuiflora, an important leguminous plant from Brazilian semiarid region used in popular medicine and as a source of fuelwood or forage, was used. Eight procedures previously reported for plants were tested and adapted from leaf tissues of M. tenuiflora stored at -20°C. The optimized procedure in this study encompassed the utilization of phenol during deproteinization, increased concentrations of cetyltrimethylammonium bromide and sodium chloride, and a shorter period and lower temperature of incubation concerning other methods. The extracted DNA did not present degradation, and amplification via PCR was successful using ISSR, trnL, ITS, and ETS primers. Besides M. tenuiflora, this procedure was also tested and proved to be efficient in genetic studies of other plant species.

A videoscope for use in minimally invasive periodontal surgery.

PubMed

Harrel, Stephen K; Wilson, Thomas G; Rivera-Hidalgo, Francisco

2013-09-01

Minimally invasive periodontal procedures have been reported to produce excellent clinical results. Visualization during minimally invasive procedures has traditionally been obtained by the use of surgical telescopes, surgical microscopes, glass fibre endoscopes or a combination of these devices. All of these methods for visualization are less than fully satisfactory due to problems with access, magnification and blurred imaging. A videoscope for use with minimally invasive periodontal procedures has been developed to overcome some of the difficulties that exist with current visualization approaches. This videoscope incorporates a gas shielding technology that eliminates the problems of fogging and fouling of the optics of the videoscope that has previously prevented the successful application of endoscopic visualization to periodontal surgery. In addition, as part of the gas shielding technology the videoscope also includes a moveable retractor specifically adapted for minimally invasive surgery. The clinical use of the videoscope during minimally invasive periodontal surgery is demonstrated and discussed. The videoscope with gas shielding alleviates many of the difficulties associated with visualization during minimally invasive periodontal surgery. © 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Translating the simulation of procedural drilling techniques for interactive neurosurgical training.

PubMed

Stredney, Don; Rezai, Ali R; Prevedello, Daniel M; Elder, J Bradley; Kerwin, Thomas; Hittle, Bradley; Wiet, Gregory J

2013-10-01

Through previous efforts we have developed a fully virtual environment to provide procedural training of otologic surgical technique. The virtual environment is based on high-resolution volumetric data of the regional anatomy. These volumetric data help drive an interactive multisensory, ie, visual (stereo), aural (stereo), and tactile, simulation environment. Subsequently, we have extended our efforts to support the training of neurosurgical procedural technique as part of the Congress of Neurological Surgeons simulation initiative. To deliberately study the integration of simulation technologies into the neurosurgical curriculum and to determine their efficacy in teaching minimally invasive cranial and skull base approaches. We discuss issues of biofidelity and our methods to provide objective, quantitative and automated assessment for the residents. We conclude with a discussion of our experiences by reporting preliminary formative pilot studies and proposed approaches to take the simulation to the next level through additional validation studies. We have presented our efforts to translate an otologic simulation environment for use in the neurosurgical curriculum. We have demonstrated the initial proof of principles and define the steps to integrate and validate the system as an adjuvant to the neurosurgical curriculum.

Numerical 3+1 General Relativistic Magnetohydrodynamics: A Local Characteristic Approach

NASA Astrophysics Data System (ADS)

Antón, Luis; Zanotti, Olindo; Miralles, Juan A.; Martí, José M.; Ibáñez, José M.; Font, José A.; Pons, José A.

2006-01-01

We present a general procedure to solve numerically the general relativistic magnetohydrodynamics (GRMHD) equations within the framework of the 3+1 formalism. The work reported here extends our previous investigation in general relativistic hydrodynamics (Banyuls et al. 1997) where magnetic fields were not considered. The GRMHD equations are written in conservative form to exploit their hyperbolic character in the solution procedure. All theoretical ingredients necessary to build up high-resolution shock-capturing schemes based on the solution of local Riemann problems (i.e., Godunov-type schemes) are described. In particular, we use a renormalized set of regular eigenvectors of the flux Jacobians of the relativistic MHD equations. In addition, the paper describes a procedure based on the equivalence principle of general relativity that allows the use of Riemann solvers designed for special relativistic MHD in GRMHD. Our formulation and numerical methodology are assessed by performing various test simulations recently considered by different authors. These include magnetized shock tubes, spherical accretion onto a Schwarzschild black hole, equatorial accretion onto a Kerr black hole, and magnetized thick disks accreting onto a black hole and subject to the magnetorotational instability.

Direct synthesis of BiCuChO-type oxychalcogenides by mechanical alloying

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

Pele, Vincent; Barreteau, Celine; CNRS, Orsay F-91405

2013-07-15

We report on the direct synthesis of BiCuChO based materials by mechanical alloying (Ch=Se, Te). We show that contrary to the synthesis paths used in the previous reports dealing with this family of materials, which use costly annealings in closed silica tubes under controlled atmosphere, this new synthesis route enables the synthesis of pure phase materials at room temperature under air, with reasonable milling time. This synthesis procedure is easily scalable for large scale applications. - Highlights: • Phase pure BiCuSeO doped and undoped prepared by mechanical alloying. • Synthesis performed under air at room temperature. • Electrical properties similarmore » to that of samples synthesized by a classical path.« less

Recovery of Third Nerve Palsy after Endovascular Packing of Internal Carotid-Posterior Communicating Artery Aneurysms

PubMed Central

Mavilio, N.; Pisani, R.; Rivano, C.; Testa, V.; Spaziante, R.; Rosa, M.

2000-01-01

Summary Endovascular packing of intracranial aneurysm with preservation of the parent vessel has become in many cases a valid alternative to surgical clipping. Regression of oculomotor disorders after clipping of internal carotid-posterior communicating artery (ICA-PCoA) aneurysms has been well assessed. This report focuses on the reversal of third nerve palsy after endovascular packing of ICA-PCoA aneurysms. To this end, clinical appearances, neuroradiological features, and endovascular interventional procedures of six treated patient are reported and discussed in the light of the very few previous case observations found in the literature. Results indicate that endovascular packing of ICA-PCoA aneurysms may produce effective recovery of correlated third nerve dysfunction. PMID:20667199

Severe hematuria after transurethral electrocoagulation in a patient with an arteriovesical fistula

PubMed Central

2013-01-01

Background Arteriovesical fistulas are extremely rare. Only eleven cases were previously reported in the literature. They can occur iatrogenically, traumatically or spontaneously. Case presentation We report an unusual case of a 62-year-old woman with arteriovesical fistula that developed fatal hematuria after transurethral electrocoagulation. Computed tomography (CT) and selective angiography revealed a pseudoaneurysm of the right superior vesical artery with arteriovesical fistula formation, which was managed by transarterial embolization. Conclusions Contrast enhanced CT or CT angiography should be performed when a pulsatile hemorrhage is revealed during cystoscopy. Therapeutic vesical arterial embolization should be considered as a safe and effective procedure for arteriovesical fistulas. Transurethral electrocoagulation may cause severe hematuria for pulsatile bladder bleeding in patients with pelvic vascular malformation. PMID:24289138

Severe hematuria after transurethral electrocoagulation in a patient with an arteriovesical fistula.

PubMed

Zheng, Xiangyi; Lin, Yiwei; Chen, Bin; Zhou, Xianyong; Zhou, Xiaofeng; Shen, Yuehong; Xie, Liping

2013-12-01

Arteriovesical fistulas are extremely rare. Only eleven cases were previously reported in the literature. They can occur iatrogenically, traumatically or spontaneously. We report an unusual case of a 62-year-old woman with arteriovesical fistula that developed fatal hematuria after transurethral electrocoagulation. Computed tomography (CT) and selective angiography revealed a pseudoaneurysm of the right superior vesical artery with arteriovesical fistula formation, which was managed by transarterial embolization. Contrast enhanced CT or CT angiography should be performed when a pulsatile hemorrhage is revealed during cystoscopy. Therapeutic vesical arterial embolization should be considered as a safe and effective procedure for arteriovesical fistulas. Transurethral electrocoagulation may cause severe hematuria for pulsatile bladder bleeding in patients with pelvic vascular malformation.

10 CFR 205.353 - Special investigation and reports.

Code of Federal Regulations, 2010 CFR

2010-01-01

... Energy DEPARTMENT OF ENERGY OIL ADMINISTRATIVE PROCEDURES AND SANCTIONS Electric Power System Permits and Reports; Applications; Administrative Procedures and Sanctions Report of Major Electric Utility System... surrounding a specific power system disturbance, including the restoration procedures utilized. The report...

Lens of the eye dose calculation for neuro-interventional procedures and CBCT scans of the head

NASA Astrophysics Data System (ADS)

Xiong, Zhenyu; Vijayan, Sarath; Rana, Vijay; Jain, Amit; Rudin, Stephen; Bednarek, Daniel R.

2016-03-01

The aim of this work is to develop a method to calculate lens dose for fluoroscopically-guided neuro-interventional procedures and for CBCT scans of the head. EGSnrc Monte Carlo software is used to determine the dose to the lens of the eye for the projection geometry and exposure parameters used in these procedures. This information is provided by a digital CAN bus on the Toshiba Infinix C-Arm system which is saved in a log file by the real-time skin-dose tracking system (DTS) we previously developed. The x-ray beam spectra on this machine were simulated using BEAMnrc. These spectra were compared to those determined by SpekCalc and validated through measured percent-depth-dose (PDD) curves and half-value-layer (HVL) measurements. We simulated CBCT procedures in DOSXYZnrc for a CTDI head phantom and compared the surface dose distribution with that measured with Gafchromic film, and also for an SK150 head phantom and compared the lens dose with that measured with an ionization chamber. Both methods demonstrated good agreement. Organ dose calculated for a simulated neuro-interventional-procedure using DOSXYZnrc with the Zubal CT voxel phantom agreed within 10% with that calculated by PCXMC code for most organs. To calculate the lens dose in a neuro-interventional procedure, we developed a library of normalized lens dose values for different projection angles and kVp's. The total lens dose is then calculated by summing the values over all beam projections and can be included on the DTS report at the end of the procedure.

Selective Heart, Brain and Body Perfusion in Open Aortic Arch Replacement.

PubMed

Maier, Sven; Kari, Fabian; Rylski, Bartosz; Siepe, Matthias; Benk, Christoph; Beyersdorf, Friedhelm

2016-09-01

Open aortic arch replacement is a complex and challenging procedure, especially in post dissection aneurysms and in redo procedures after previous surgery of the ascending aorta or aortic root. We report our experience with the simultaneous selective perfusion of heart, brain, and remaining body to ensure optimal perfusion and to minimize perfusion-related risks during these procedures. We used a specially configured heart-lung machine with a centrifugal pump as arterial pump and an additional roller pump for the selective cerebral perfusion. Initial arterial cannulation is achieved via femoral artery or right axillary artery. After lower body circulatory arrest and selective antegrade cerebral perfusion for the distal arch anastomosis, we started selective lower body perfusion simultaneously to the selective antegrade cerebral perfusion and heart perfusion. Eighteen patients were successfully treated with this perfusion strategy from October 2012 to November 2015. No complications related to the heart-lung machine and the cannulation occurred during the procedures. Mean cardiopulmonary bypass time was 239 ± 33 minutes, the simultaneous selective perfusion of brain, heart, and remaining body lasted 55 ± 23 minutes. One patient suffered temporary neurological deficit that resolved completely during intensive care unit stay. No patient experienced a permanent neurological deficit or end-organ dysfunction. These high-risk procedures require a concept with a special setup of the heart-lung machine. Our perfusion strategy for aortic arch replacement ensures a selective perfusion of heart, brain, and lower body during this complex procedure and we observed excellent outcomes in this small series. This perfusion strategy is also applicable for redo procedures.

Restoring tactile and erogenous penile sensation in low-spinal-lesion patients: procedural and technical aspects following 43 TOMAX nerve transfer procedures.

PubMed

Overgoor, Max L E; de Jong, Tom P V M; Kon, Moshe

2014-08-01

The "TOMAX" (TO MAX-imize sensation, sexuality, and quality of life) procedure restores genital sensation in men with low spinal lesions, improving sexual health, as shown previously. It connects the dorsal nerve of the penis to the intact ipsilateral ilioinguinal nerve, unilaterally or bilaterally. This study reports on the technical aspects based on 43 TOMAX nerve transfers. In 40 patients with no penile but intact groin sensation, 43 nerve transfers were performed. Data on patient selection, surgical history, anatomy of the ilioinguinal nerve and dorsal nerve of the penis, unilateral or bilateral surgery, surgical technique, complications, and patient information were collected prospectively. Regardless of origin, all patients with no penile but good groin sensation are eligible for the procedure, provided the ilioinguinal nerve is not damaged because of former inguinal surgery or absent because of anatomical variations. Selection of a unilateral or bilateral procedure depends on the presence or absence of reflex erections and bulbocavernosus reflex. Preliminary experience with the first three bilateral cases shows that it is technically feasible, with encouraging results. The surgical technique has evolved (described in detail, including video) to enhance outcome and reduce complications. Patients are better informed, resulting in realistic expectations. This article synthesizes the procedural and technical experience of 43 TOMAX nerve transfers. Anyone skilled in peripheral nerve surgery and microsurgery can adopt this concept and further develop it. The TOMAX procedure can then be used to restore erogenous penile sensation and improve the quality of sexual health in patients with absent penile but good groin sensation.

[Design of an HACCP program for a cocoa processing facility].

PubMed

López D'Sola, Patrizia; Sandia, María Gabriela; Bou Rached, Lizet; Hernández Serrano, Pilar

2012-12-01

The HACCP plan is a food safety management tool used to control physical, chemical and biological hazards associated to food processing through all the processing chain. The aim of this work is to design a HACCP Plan for a Venezuelan cocoa processing facility.The production of safe food products requires that the HACCP system be built upon a solid foundation of prerequisite programs such as Good Manufacturing Practices (GMP) and Sanitation Standard Operating Procedures (SSOP). The existence and effectiveness of these prerequisite programs were previously assessed.Good Agriculture Practices (GAP) audit to cocoa nibs suppliers were performed. To develop the HACCP plan, the five preliminary tasks and the seven HACCP principles were accomplished according to Codex Alimentarius procedures. Three Critical Control Points (CCP) were identified using a decision tree: winnowing (control of ochratoxin A), roasting (Salmonella control) and metallic particles detection. For each CCP, Critical limits were established, the Monitoring procedures, Corrective actions, Procedures for Verification and Documentation concerning all procedures and records appropriate to these principles and their application was established. To implement and maintain a HACCP plan for this processing plant is suggested. Recently OchratoxinA (OTA) has been related to cocoa beans. Although the shell separation from the nib has been reported as an effective measure to control this chemical hazard, ochratoxin prevalence study in cocoa beans produced in the country is recommended, and validate the winnowing step as well

Perineal anastomotic urethroplasty for posttraumatic urethral stricture with or without previous urethral manipulations: a review of 61 cases with long-term followup.

PubMed

Lumen, Nicolaas; Hoebeke, Piet; Troyer, Bart De; Ysebaert, Barbara; Oosterlinck, Willem

2009-03-01

We retrospectively analyzed cases of anastomotic urethroplasty for posttraumatic urethral strictures that were done at our center. Surgical and functional outcomes were evaluated. The impact of previous urethral manipulations was assessed. Between 1993 and 2006, 61 males were treated with anastomotic urethroplasty because of urethral trauma after pelvic fracture. Mean followup was 67 months (range 19 to 173). In 21 of the 61 cases (34.4%) urethral manipulation had been performed previously (secondary cases) but had failed. All patients were treated via the perineal approach. In 9 patients (14.8%) recurrence was reported. The recurrence rate was higher in patients who underwent former treatment than in primary patients (19% vs 12.5%). Posttraumatic impotence was reported by 20 patients (32.8%) but in 2 erectile function was restored after treatment. One patient had minor stress incontinence. In 2 secondary cases the rectum was injured during the procedure but could be repaired. Anastomotic urethroplasty via the perineal approach is an excellent treatment for posttraumatic urethral stricture. Results are good at long-term followup. Although statistical significance has not been attained, failures and complications seem to be higher in patients who have already undergone failed urethroplasty.

33 CFR 277.5 - General.

Code of Federal Regulations, 2010 CFR

2010-07-01

... has established implementing procedures based on those previously adopted and utilized by the Chief of Engineers prior to 15 October 1966. This regulation adapts these cost apportionment procedures, found in...

33 CFR 277.5 - General.

Code of Federal Regulations, 2011 CFR

2011-07-01

... has established implementing procedures based on those previously adopted and utilized by the Chief of Engineers prior to 15 October 1966. This regulation adapts these cost apportionment procedures, found in...

Potential media influence on the high incidence of medical disputes from the perspective of plastic surgeons.

PubMed

Chen, Chiehfeng; Lin, Ching-Feng; Chen, Cha-Chun; Chiu, Shih-Feng; Shih, Fuh-Yuan; Lyu, Shu-Yu; Lee, Ming-Been

2017-08-01

The main purpose of this study is to investigate the prevalence of medical disputes among plastic surgeons in Taiwan and to elucidate their perspectives regarding the influence of medical litigation media coverage on the physician-patient relationship. A self-administered questionnaire was distributed among plastic surgeons attending a series of continuing education training lectures organized by the Taiwan Society of Plastic Surgery in 2015. Of the 109 respondents, over a third (36.4%) had previously experienced a medical dispute. The vast majority of both physicians who had medical disputes (77.1%) and those who did not (72.1%) felt that the media tends to be supportive of patients in their reporting, and 37.1% of all plastic surgeons felt that the media always portrays the patient as a victim. Respondents who experienced medical disputes in this study felt that the top five leading causes of the high incidence of medical disputes were patient disappointment with procedure results (81.1%), insufficient patient psychological preparation or emotional instability (61.7%), inadequate risk communication on the part of the physician (64.9%), patient uneasiness with the procedure or perception of carelessness (60.6%), and insufficient physician training or incorrect medical evaluation (57.4%). Over a third of the respondents had previously experienced a medical dispute. This study highlights the perception among plastic surgeons that the media reporting of medical disputes and medical litigation is biased in favor of the patients, with 37.1% of the plastic surgeons surveyed opining that patients are always cast as victims. Copyright © 2017. Published by Elsevier B.V.

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

PubMed

Gerson, Lauren; Stouch, Bruce; Lobonţiu, Adrian

2018-01-01

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

Historical patterns in the types of procedures performed and radiation safety practices used in nuclear medicine from 1945–2009

PubMed Central

Van Dyke, Miriam E.; Drozdovitch, Vladimir; Doody, Michele M.; Lim, Hyeyeun; Bolus, Norman E.; Simon, Steven L.; Alexander, Bruce H.; Kitahara, Cari M.

2016-01-01

We evaluated historical patterns in the types of procedures performed in diagnostic and therapeutic nuclear medicine and the associated radiation safety practices used from 1945–2009 in a sample of U.S. radiologic technologists. In 2013–2014, 4,406 participants from the U.S. Radiologic Technologists (USRT) Study who previously reported working with medical radionuclides completed a detailed survey inquiring about the performance of 23 diagnostic and therapeutic radionuclide procedures and the use of radiation safety practices when performing radionuclide procedure-related tasks during five time periods: 1945–1964, 1965–1979, 1980–1989, 1990–1999, and 2000–2009. We observed an overall increase in the proportion of technologists who performed specific diagnostic or therapeutic procedures across the five time periods. Between 1945–1964 and 2000–2009, the median frequency of diagnostic procedures performed substantially increased (5 per week to 30 per week), attributable mainly to an increasing frequency of cardiac and non-brain PET scans, while the median frequency of therapeutic procedures performed modestly decreased (from 4 per month to 3 per month). We also observed a notable increase in the use of most radiation safety practices from 1945–1964 to 2000–2009 (e.g., use of lead-shielded vials during diagnostic radiopharmaceutical preparation increased from 56 to 96%), although lead apron use dramatically decreased (e.g., during diagnostic imaging procedures, from 81 to 7%). These data describe historical practices in nuclear medicine and can be used to support studies of health risks in nuclear medicine technologists. PMID:27218293

40 CFR 444.12 - Monitoring requirements.

Code of Federal Regulations, 2014 CFR

2014-07-01

... must include requirements to monitor, according to EPA-approved test procedures, each pollutant limited... be accomplished using approved test procedures listed in the table to this paragraph. Most of these test procedures have previously been incorporated by reference at 40 CFR 136.3(a), Table IB. The test...

40 CFR 444.12 - Monitoring requirements.

Code of Federal Regulations, 2013 CFR

2013-07-01

... must include requirements to monitor, according to EPA-approved test procedures, each pollutant limited... be accomplished using approved test procedures listed in the table to this paragraph. Most of these test procedures have previously been incorporated by reference at 40 CFR 136.3(a), Table IB. The test...

Life threatening bleeding from duodenal ulcer after Roux-en-Y gastric bypass: Case report and review of the literature.

PubMed

Ivanecz, Arpad; Sremec, Marko; Ceranić, Davorin; Potrč, Stojan; Skok, Pavel

2014-12-16

Acute upper gastrointestinal bleeding is a rare, but serious complication of gastric bypass surgery. The inaccessibility of the excluded stomach restrains postoperative examination and treatment of the gastric remnant and duodenum, and represents a major challenge, especially in the emergency setting. A 59-year-old patient with previous history of peptic ulcer disease had an upper gastrointestinal bleeding from a duodenal ulcer two years after having a gastric bypass procedure for morbid obesity. After negative upper endoscopy finding, he was urgently evaluated for gastrointestinal bleeding. At emergency laparotomy, the bleeding duodenal ulcer was identified by intraoperative endoscopy through gastrotomy. The patient recovered well after surgical hemostasis, excision of the duodenal ulcer and completion of the remnant gastrectomy. Every general practitioner, gastroenterologist and general surgeon should be aware of growing incidence of bariatric operations and coherently possible complications after such procedures, which modify patient's anatomy and physiology.

Feasibility studies of time-like proton electromagnetic form factors at $$\\overline{\\rm P}$$ANDA at FAIR

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

Singh, B.; Erni, W.; Krusche, B.

Simulation results for future measurements of electromagnetic proton form factors atmore » $$\\overline{\\rm P}$$ANDA (FAIR) within the PandaRoot software framework are reported. The statistical precision with which the proton form factors can be determined is estimated. The signal channel p¯p → e +e – is studied on the basis of two different but consistent procedures. The suppression of the main background channel, i.e. p¯p → π +π –, is studied. Furthermore, the background versus signal efficiency, statistical and systematical uncertainties on the extracted proton form factors are evaluated using two different procedures. The results are consistent with those of a previous simulation study using an older, simplified framework. Furthermore, a slightly better precision is achieved in the PandaRoot study in a large range of momentum transfer, assuming the nominal beam conditions and detector performance.« less

Determination of element affinities by density fractionation of bulk coal samples

USGS Publications Warehouse

Querol, X.; Klika, Z.; Weiss, Z.; Finkelman, R.B.; Alastuey, A.; Juan, R.; Lopez-Soler, A.; Plana, F.; Kolker, A.; Chenery, S.R.N.

2001-01-01

A review has been made of the various methods of determining major and trace element affinities for different phases, both mineral and organic in coals, citing their various strengths and weaknesses. These include mathematical deconvolution of chemical analyses, direct microanalysis, sequential extraction procedures and density fractionation. A new methodology combining density fractionation with mathematical deconvolution of chemical analyses of whole coals and their density fractions has been evaluated. These coals formed part of the IEA-Coal Research project on the Modes of Occurrence of Trace Elements in Coal. Results were compared to a previously reported sequential extraction methodology and showed good agreement for most elements. For particular elements (Be, Mo, Cu, Se and REEs) in specific coals where disagreement was found, it was concluded that the occurrence of rare trace element bearing phases may account for the discrepancy, and modifications to the general procedure must be made to account for these.

Feasibility studies of time-like proton electromagnetic form factors at $$\\overline{\\rm P}$$ANDA at FAIR

DOE PAGES

Singh, B.; Erni, W.; Krusche, B.; ...

2016-10-28

Simulation results for future measurements of electromagnetic proton form factors atmore » $$\\overline{\\rm P}$$ANDA (FAIR) within the PandaRoot software framework are reported. The statistical precision with which the proton form factors can be determined is estimated. The signal channel p¯p → e +e – is studied on the basis of two different but consistent procedures. The suppression of the main background channel, i.e. p¯p → π +π –, is studied. Furthermore, the background versus signal efficiency, statistical and systematical uncertainties on the extracted proton form factors are evaluated using two different procedures. The results are consistent with those of a previous simulation study using an older, simplified framework. Furthermore, a slightly better precision is achieved in the PandaRoot study in a large range of momentum transfer, assuming the nominal beam conditions and detector performance.« less

A variationally coupled FE-BE method for elasticity and fracture mechanics

NASA Technical Reports Server (NTRS)

Lu, Y. Y.; Belytschko, T.; Liu, W. K.

1991-01-01

A new method for coupling finite element and boundary element subdomains in elasticity and fracture mechanics problems is described. The essential feature of this new method is that a single variational statement is obtained for the entire domain, and in this process the terms associated with tractions on the interfaces between the subdomains are eliminated. This provides the additional advantage that the ambiguities associated with the matching of discontinuous tractions are circumvented. The method leads to a direct procedure for obtaining the discrete equations for the coupled problem without any intermediate steps. In order to evaluate this method and compare it with previous methods, a patch test for coupled procedures has been devised. Evaluation of this variationally coupled method and other methods, such as stiffness coupling and constraint traction matching coupling, shows that this method is substantially superior. Solutions for a series of fracture mechanics problems are also reported to illustrate the effectiveness of this method.

Transbronchial cryobiopsy for diffuse parenchymal lung disease: a state-of-the-art review of procedural techniques, current evidence, and future challenges.

PubMed

Lentz, Robert J; Argento, A Christine; Colby, Thomas V; Rickman, Otis B; Maldonado, Fabien

2017-07-01

Transbronchial lung biopsy with a cryoprobe, or cryobiopsy, is a promising new bronchoscopic biopsy technique capable of obtaining larger and better-preserved samples than previously possible using traditional biopsy forceps. Over two dozen case series and several small randomized trials are now available describing experiences with this technique, largely for the diagnosis of diffuse parenchymal lung disease (DPLD), in which the reported diagnostic yield is typically 70% to 80%. Cryobiopsy technique varies widely between centers and this predominantly single center-based retrospective literature heterogeneously defines diagnostic yield and complications, limiting the degree to which this technique can be compared between centers or to surgical lung biopsy (SLB). This review explores the broad range of cryobiopsy techniques currently in use, their rationale, the current state of the literature, and suggestions for the direction of future study into this promising but unproven procedure.

Colonoscopy-associated pneumothorax: a case of tension pneumothorax and review of the literature.

PubMed

Zeno, Brian R; Sahn, Steven A

2006-09-01

A 64-year-old woman presented with severe abdominal pain and was found to have a large fecolith in the sigmoid colon with resulting bowel obstruction. During a therapeutic colonoscopy, she developed severe shortness of breath and hypoxia, and was found to have a tension pneumothorax. We review the potential mechanisms by which pneumothorax may occur following colonoscopy. In addition, the eight previously published cases are reviewed. Pneumothorax, with or without pneumomediastinum, can occur through a variety of mechanisms following colonoscopy. Although rarely reported, this may represent an underappreciated complication and should be fully investigated in the appropriate setting. Colonoscopy, an exceedingly common procedure, will continue to increase with the aging population. As a result, tension pneumothorax can have a profound effect on the patient outcome and therefore physicians, both gastroenterologists and pulmonologists, should be aware of all the potential problems with this procedure.

Performance evaluation of a LYSO-based PET scanner for monitoring of dose delivery in hadrontherapy

NASA Astrophysics Data System (ADS)

Fabbiani, E.; Belcari, N.; Camarlinghi, N.; Del Guerra, A.; Ferretti, S.; Kraan, A.; Panetta, D.; Sportelli, G.; Rosso, V.

2015-12-01

The DoPET scanner is a compact positron emission tomography (PET) device. It has been developed for monitoring the range of charged particles during therapy with hadron beams. Previous works have focused on the development and upgrade of the device and on data analysis. In this paper, a full performance characterization of the DoPET system in terms of the energy resolution, spatial resolution, sensitivity, uniformity, and noise equivalent count rate is reported. All measurements refer to an adapted version of the National Electrical Manufacturers Association (NEMA) NU 4 - 2008 protocol, which was written originally for small animal PET systems. Since DoPET is a dual head planar system, it requires a modified characterisation procedure with respect to those described for ring geometries as in the NEMA NU 4 - 2008 protocol. The presented procedure may be of interest for any other PET system with a similar geometry as DoPET.

Study of design and control of remote manipulators. Part 2: Vibration considerations in manipulator design

NASA Technical Reports Server (NTRS)

Book, W. J.

1973-01-01

An investigation is reported involving a mathematical procedure using 4 x 4 transformation matrices for analyzing the vibrations of flexible manipulators. Previous studies with the procedure are summarized and the method is extended to include flexible joints as well as links, and to account for the effects of various power transmission schemes. A systematic study of the allocation of structural material and the placement of components such as motors and gearboxes was undertaken using the analytical tools developed. As one step in this direction the variables which relate the vibration parameters of the arm to the task and environment of the arm were isolated and nondimensionalized. The 4 x 4 transformation matrices were also used to develop analytical expressions for the terms of the complete 6 x 6 compliance matrix for the case of two flexible links joined by a rotating joint, flexible about its axis of rotation.

Abortion surveillance--United States, 1998.

PubMed

Herndon, Joy; Strauss, Lilo T; Whitehead, Sara; Parker, Wilda Y; Bartlett, Linda; Zane, Suzanne

2002-06-07

In 1969, CDC began abortion surveillance to document the number and characteristics of women obtaining legal induced abortions, to monitor unintended pregnancy, and to assist efforts to identify and reduce preventable causes of morbidity and mortality associated with abortions. This report summarizes and reviews information reported to CDC regarding legal induced abortions obtained in the United States in 1998. For each year since 1969, CDC has compiled abortion data by occurrence. From 1973 to 1997, data were received from or estimated for 52 reporting areas in the United States: 50 states, the District of Columbia, and New York City. In 1998, CDC compiled abortion data from only 48 reporting areas; Alaska, California, New Hampshire, and Oklahoma did not report. In 1998, 884,273 legal induced abortions were reported to CDC, representing a 2% decrease from the 900,171 legal induced abortions reported by the same 48 reporting areas for 1997. The abortion ratio, defined as the number of abortions per 1,000 live births, was 264, compared with 274 in 1997 (for the same 48 areas); the abortion rate for these 48 areas was 17 per 1,000 women aged 15-44 years for both 1997 and 1998. The availability of information about characteristics of women who obtained an abortion in 1998 varied by state and by the number of states reporting each characteristic. The total number of legal induced abortions by state is reported by state of residence and state of occurrence; characteristics of women obtaining abortions in 1998 are reported by state of occurrence. Women undergoing an abortion were likely to be young (i.e., age < 25 years), white, and unmarried; slightly more than one half were obtaining an abortion for the first time. Of all abortions for which gestational age was reported, 56% were performed at < or = 8 weeks of gestation, and 88% were performed before 13 weeks. Overall, 19% of abortions were performed at the earliest weeks of gestation (< or = 6 weeks), 18% at 7 weeks, and 19% at 8 weeks. From 1992 (when this information was first collected) through 1998, an increasing percentage of abortions were performed at the very early weeks of gestation. Few abortions were provided after 15 weeks of gestation; 4% were obtained at 16-20 weeks, and 1.4% were obtained at > or = 21 weeks. A total of 24 reporting areas submitted information stating that they performed medical (nonsurgical) procedures (two of these areas categorized medical abortions with "other" procedures), making up < 1% of all procedures reported from all states. From 1993 through 1997 (years for which data have not been published previously and the most recent years for which such data are available), 36 women died as a result of complications from known legal induced abortion, and three deaths were associated with known illegal abortion. The annual case-fatality rate of legal induced abortion ranged from 0.3 to 0.8 abortion-related deaths per 100,000 reported legal induced abortions. From 1990 through 1995, the number of abortions declined each year; in 1996, the number increased slightly, but in 1997, it declined to its lowest level since 1978. In 1998, the number of abortions continued to decrease when comparing the 48 reporting areas. In 1997, as in previous years, deaths related to legal induced abortions occurred rarely. PUBLIC HEALTH ACTIONS TAKEN: The number and characteristics of women who obtain abortions in the United States should continue to be monitored so that trends in induced abortion can be assessed and efforts to prevent unintended pregnancy can be evaluated.

Sentinel lymph node navigation surgery for gastric cancer: Does it really benefit the patient?

PubMed

Tani, Tohru; Sonoda, Hiromichi; Tani, Masaji

2016-03-14

Sentinel lymph node (SLN) navigation surgery is accepted as a standard treatment procedure for malignant melanoma and breast cancer. However, the benefit of reduced lymphadenectomy based on SLN examination remains unclear in cases of gastric cancer. Here, we review previous studies to determine whether SLN navigation surgery is beneficial for gastric cancer patients. Recently, a large-scale prospective study from the Japanese Society of Sentinel Node Navigation Surgery reported that the endoscopic dual tracer method, using a dye and radioisotope for SLN biopsy, was safe and effective when applied to cases of superficial and relatively small gastric cancers. SLN mapping with SLN basin dissection was preferred for early gastric cancer since it is minimally invasive. However, previous studies reported that limited gastrectomy and lymphadenectomy may not improve the patient's postoperative quality of life (QOL). As a result, the benefit of SLN navigation surgery for gastric cancer patients, in terms of their QOL, is limited. Thus, endoscopic and laparoscopic limited gastrectomy combined with SLN navigation surgery has the potential to become the standard minimally invasive surgery in early gastric cancer.

Simple and rapid quantification of brominated vegetable oil in commercial soft drinks by LC–MS

PubMed Central

Chitranshi, Priyanka; da Costa, Gonçalo Gamboa

2016-01-01

We report here a simple and rapid method for the quantification of brominated vegetable oil (BVO) in soft drinks based upon liquid chromatography–electrospray ionization mass spectrometry. Unlike previously reported methods, this novel method does not require hydrolysis, extraction or derivatization steps, but rather a simple “dilute and shoot” sample preparation. The quantification is conducted by mass spectrometry in selected ion recording mode and a single point standard addition procedure. The method was validated in the range of 5–25 μg/mL BVO, encompassing the legal limit of 15 μg/mL established by the US FDA for fruit-flavored beverages in the US market. The method was characterized by excellent intra- and inter-assay accuracy (97.3–103.4%) and very low imprecision [0.5–3.6% (RSD)]. The direct nature of the quantification, simplicity, and excellent statistical performance of this methodology constitute clear advantages in relation to previously published methods for the analysis of BVO in soft drinks. PMID:27451219

The 25 percent-efficient GaAs Cassegrainian concentrator cell

NASA Technical Reports Server (NTRS)

Hamaker, H. C.; Grounner, M.; Kaminar, N. R.; Kuryla, M. S.; Ladle, M. J.; Liu, D. D.; Macmillan, H. F.; Partain, L. D.; Virshup, G. F.; Werthen, J. G.

1989-01-01

Very high-efficiency GaAs Cassegrainian solar cells have been fabricated in both the n-p and p-n configurations. The n-p configuration exhibits the highest efficiency at concentration, the best cells having an efficiency eta of 24.5 percent (100X, AM0, temperature T = 28 C). Although the cells are designed for operation at this concentration, peak efficiency is observed near 300 suns (eta = 25.1 percent). To our knowledge, this is the highest reported solar cell efficiency for space applications. The improvement in efficiency over that reported at the previous SPRAT conference is attributed primarily to lower series resistance and improved grid-line plating procedures. Using previously measured temperature coefficients, researchers estimate that the n-p GaAs cells should deliver approximately 22.5 percent efficiency at the operating conditions of 100 suns and T = 80 C. This performance exceeds the NASA program goal of 22 percent for the Cassegrainian cell. One hundred Cassegrainian cells have been sent to NASA as deliverables, sixty-eight in the n-p configuration and thirty-two in the p-n configuration.

Medical school admission test: advantages for students whose parents are medical doctors?

PubMed

Simmenroth-Nayda, Anne; Görlich, Yvonne

2015-04-23

Admission candidates especially in medicine do not represent the socio-demographic proportions of the average population: children of parents with an academic background are highly overrepresented, and those with parents who are medical doctors represent quite a large and special group. At Göttingen University Medicine, a new admission procedure was established with the intention to broaden the base of applicants towards including candidates with previous medical training or lower final school grades. With a view to family background, we wished to know whether candidates differ in the test scores in our admission procedure. In February 2014 we asked all admission candidates of Göttingen University Medicine by questionnaire (nine closed, four open questions) about the academic background in their families, specifically, the medical background, school exam grades, and previous medical training as well as about how they prepared for the admission test. We also analysed data from admission scores of this group (semi-structured interview and four multiple mini-interviews). In addition to descriptive statistics, we used a Pearson correlation, means comparisons (t-test, analysis of variance), ANOVA, and a Scheffé test. In February 2014 nearly half of the applicants (44%) at Göttingen University Medicine had a medical background, most frequently, their parents were physicians. This rate is much higher than reported in the literature. Other socio-demographic baseline data did not differ from the percentages given in the literature. Of all applicants, 20% had previous medical training. The group of applicants with parents who were medical doctors did not show any advantage in either test-scoring (MMI and interview), their individual preparation for the admission test, or in receiving or accepting a place at medical school. Candidates with parents who were medical doctors had scored slightly lower in school exam grades. Our results suggest that there is a self-selection bias as well as a pre-selection for this particular group of applicants. This effect has to be observed during future admission procedures.

30 CFR 402.15 - Reporting procedures.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 30 Mineral Resources 2 2013-07-01 2013-07-01 false Reporting procedures. 402.15 Section 402.15 Mineral Resources GEOLOGICAL SURVEY, DEPARTMENT OF THE INTERIOR WATER-RESOURCES RESEARCH PROGRAM AND THE WATER-RESOURCES TECHNOLOGY DEVELOPMENT PROGRAM Reporting § 402.15 Reporting procedures. (a) Grantees or...

30 CFR 402.15 - Reporting procedures.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 30 Mineral Resources 2 2014-07-01 2014-07-01 false Reporting procedures. 402.15 Section 402.15 Mineral Resources GEOLOGICAL SURVEY, DEPARTMENT OF THE INTERIOR WATER-RESOURCES RESEARCH PROGRAM AND THE WATER-RESOURCES TECHNOLOGY DEVELOPMENT PROGRAM Reporting § 402.15 Reporting procedures. (a) Grantees or...

30 CFR 402.15 - Reporting procedures.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 30 Mineral Resources 2 2012-07-01 2012-07-01 false Reporting procedures. 402.15 Section 402.15 Mineral Resources GEOLOGICAL SURVEY, DEPARTMENT OF THE INTERIOR WATER-RESOURCES RESEARCH PROGRAM AND THE WATER-RESOURCES TECHNOLOGY DEVELOPMENT PROGRAM Reporting § 402.15 Reporting procedures. (a) Grantees or...

30 CFR 402.15 - Reporting procedures.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 30 Mineral Resources 2 2010-07-01 2010-07-01 false Reporting procedures. 402.15 Section 402.15 Mineral Resources GEOLOGICAL SURVEY, DEPARTMENT OF THE INTERIOR WATER-RESOURCES RESEARCH PROGRAM AND THE WATER-RESOURCES TECHNOLOGY DEVELOPMENT PROGRAM Reporting § 402.15 Reporting procedures. (a) Grantees or...

30 CFR 402.15 - Reporting procedures.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 30 Mineral Resources 2 2011-07-01 2011-07-01 false Reporting procedures. 402.15 Section 402.15 Mineral Resources GEOLOGICAL SURVEY, DEPARTMENT OF THE INTERIOR WATER-RESOURCES RESEARCH PROGRAM AND THE WATER-RESOURCES TECHNOLOGY DEVELOPMENT PROGRAM Reporting § 402.15 Reporting procedures. (a) Grantees or...

Monitoring Items in Real Time to Enhance CAT Security

ERIC Educational Resources Information Center

Zhang, Jinming; Li, Jie

2016-01-01

An IRT-based sequential procedure is developed to monitor items for enhancing test security. The procedure uses a series of statistical hypothesis tests to examine whether the statistical characteristics of each item under inspection have changed significantly during CAT administration. This procedure is compared with a previously developed…

The Psychophysics of Contingency Assessment

ERIC Educational Resources Information Center

Allan, Lorraine G.; Hannah, Samuel D.; Crump, Matthew J. C.; Siegel, Shepard

2008-01-01

The authors previously described a procedure that permits rapid, multiple within-participant evaluations of contingency assessment (the "streamed-trial" procedure, M. J. C. Crump, S. D. Hannah, L. G. Allan, & L. K. Hord, 2007). In the present experiments, they used the streamed-trial procedure, combined with the method of constant stimuli and a…

Is the frozen elephant trunk procedure superior to the conventional elephant trunk procedure for completion of the second stage?

PubMed

Rustum, Saad; Beckmann, Erik; Wilhelmi, Mathias; Krueger, Heike; Kaufeld, Tim; Umminger, Julia; Haverich, Axel; Martens, Andreas; Shrestha, Malakh

2017-10-01

Our goal was to compare the results and outcomes of second-stage completion in patients who had previously undergone the elephant trunk (ET) or the frozen elephant trunk (FET) procedure for the treatment of complex aortic arch and descending aortic disease. Between August 2001 and December 2014, 53 patients [mean age 61 ± 13 years, 64% (n = 34) male] underwent a second-stage completion procedure. Of these patients, 32% (n = 17) had a previous ET procedure and 68% (n = 36) a previous FET procedure as a first-stage procedure. The median times to the second-stage procedure were 7 (0-78) months in the ET group and 8 (0-66) months in the FET group. The second-stage procedure included thoracic endovascular aortic repair in 53% (n = 28) of patients and open surgical repair in 47% (n = 25). More endovascular interventions were performed in FET patients (61%, n = 22) than in the ET group (35%, n = 6, P = 0.117). The in-hospital mortality rate was significantly lower in the FET (8%, n = 3) group compared with the ET group (29%, n = 5, P = 0.045). The median follow-up time after the second-stage operation for the entire cohort was 4.6 (0.4-10.4) years. The 5-year survival rate was 76% in the ET patients versus 89% in the FET patients (log-rank: P = 0.11). We observed a significantly lower in-hospital mortality rate in the FET group compared to the ET group. This result might be explained by the higher rate of endovascular completion in the FET group. We assume that the FET procedure offers the benefit of a more ideal landing zone, thus facilitating endovascular completion. © The Author 2017. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

INCIDENCE AND RISK FACTORS FOR CHRONIC PELVIC PAIN AFTER HYSTEROSCOPIC STERILIZATION

PubMed Central

YUNKER, Amanda C.; RITCH, Jessica M. B.; ROBINSON, Erica F.; GOLISH, Cara T.

2014-01-01

Objective To investigate the incidence and pre-operative risk factors for developing pelvic pain after hysteroscopic sterilization using the Essure™ micro-inserts Design Retrospective cohort study (Canadian Task Force classification II-2). Setting University Medical Center Patients A total of 458 patients who underwent hysteroscopic sterilization with Essure™ between January 1, 2005 and June 30, 2012. Results The incidence of acute pelvic pain after hysteroscopic sterilization was 8.1%, and the incidence of persistent pain after 3 months post-procedure was 4.2%. The range of presentation with pain was 1 to 469 days, with a mean time of 56 days. Of the patients that developed chronic pelvic pain after the procedure, 75% presented within 130 days of the procedure. Patients with previous diagnoses of any chronic pain (chronic pelvic pain, chronic low back pain, chronic headache, and fibromyalgia) were more likely to report both acute pain (OR 6.81, 95% CI 2.95,15.73) and chronic pain (OR 6.15, 95% CI 2.10,18.10) after hysteroscopic sterilization. Conclusions Pelvic pain may develop after hysteroscopic sterilization. Patients with preexisting chronic pain diagnoses may be at increased risk of developing pelvic pain after the procedure. Fifty percent of new pelvic pain after Essure™ placement will resolve by 3 months. PMID:24952343

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.

Loop-mediated isothermal amplification with the Procedure for Ultra Rapid Extraction kit for the diagnosis of pneumocystis pneumonia.

PubMed

Kawano, Shuichi; Maeda, Takuya; Suzuki, Takefumi; Abe, Tatsuhiro; Mikita, Kei; Hamakawa, Yusuke; Ono, Takeshi; Sonehara, Wataru; Miyahira, Yasushi; Kawana, Akihiko

2015-03-01

Loop-mediated isothermal amplification (LAMP) is an innovative molecular technique requiring only a heating device and isothermal conditions to amplify a specific target gene. The results of current microscopic diagnostic tools for pneumocystis pneumonia are not sufficiently consistent for detecting infection with a low-density of Pneumocystis jirovecii. Although polymerase chain reaction (PCR) is highly sensitive, it is not suitable for resource-limited facilities. LAMP is a potential diagnostic replacement for PCR in such settings but a critical disadvantage of DNA extraction was still remained. Therefore, we employed the Procedure for Ultra Rapid Extraction (PURE) kit, which uses a porous material, to isolate the DNA from clinical samples in a simple way in combination with previously reported LAMP procedure for diagnosing PCP. The detection limit of the PURE-LAMP method applied to artificial bronchoalveolar lavage fluid samples was 100 copies/tube, even with the use of massive blood-contaminated solutions. In addition, we concluded the diagnostic procedure within 1 h without the need for additional equipment. PURE-LAMP coupled with suitable primers for specific pathogens has good potential for diagnosing various infectious diseases. Copyright © 2014 Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

A Bone Marrow Aspirate and Trephine Simulator.

PubMed

Yap, Eng Soo; Koh, Pei Lin; Ng, Chin Hin; de Mel, Sanjay; Chee, Yen Lin

2015-08-01

Bone marrow aspirate and trephine (BMAT) biopsy is a commonly performed procedure in hematology-oncology practice. Although complications are uncommon, they can cause significant morbidity and mortality. Simulation models are an excellent tool to teach novice doctors basic procedural skills before performing the actual procedure on patients to improve patient safety and well-being. There are no commercial BMAT simulators, and this technical report describes the rationale, technical specifications, and construction of a low-cost, easily constructed, reusable BMAT simulator that reproduced the tactile properties of tissue layers for use as a teaching tool in our resident BMAT simulation course. Preliminary data of learner responses to the simulator were also collected. From April 2013 to November 2013, 32 internal medicine residents underwent the BMAT simulation course. Eighteen (56%) completed the online survey, 11 residents with previous experience doing BMAT and 7 without experience. Despite the difference in operative experience, both experienced and novice residents all agreed or strongly agreed that the model aided their understanding of the BMAT procedure. All agreed or strongly agreed that this enhanced their knowledge of anatomy and 16 residents (89%) agreed or strongly agreed that this model was a realistic simulator. We present a novel, low-cost, easily constructed, realistic BMAT simulator for training novice doctors to perform BMAT.

Dietary assessment of British police force employees: a description of diet record coding procedures and cross-sectional evaluation of dietary energy intake reporting (The Airwave Health Monitoring Study)

PubMed Central

Gibson, Rachel; Eriksen, Rebeca; Lamb, Kathryn; McMeel, Yvonne; Vergnaud, Anne-Claire; Spear, Jeanette; Aresu, Maria; Chan, Queenie; Elliott, Paul; Frost, Gary

2017-01-01

Objectives Dietary intake is a key aspect of occupational health. To capture the characteristics of dietary behaviour that is affected by occupational environment that may affect disease risk, a collection of prospective multiday dietary records is required. The aims of this paper are to: (1) collect multiday dietary data in the Airwave Health Monitoring Study, (2) describe the dietary coding procedures applied and (3) investigate the plausibility of dietary reporting in this occupational cohort. Design A dietary coding protocol for this large-scale study was developed to minimise coding error rate. Participants (n 4412) who completed 7-day food records were included for cross-sectional analyses. Energy intake (EI) misreporting was estimated using the Goldberg method. Multivariate logistic regression models were applied to determine participant characteristics associated with EI misreporting. Setting British police force employees enrolled (2007–2012) into the Airwave Health Monitoring Study. Results The mean code error rate per food diary was 3.7% (SD 3.2%). The strongest predictors of EI under-reporting were body mass index (BMI) and physical activity. Compared with participants with BMI<25 kg/m2, those with BMI>30 kg/m2 had increased odds of being classified as under-reporting EI (men OR 5.20 95% CI 3.92 to 6.89; women OR 2.66 95% CI 1.85 to 3.83). Men and women in the highest physical activity category compared with the lowest were also more likely to be classified as under-reporting (men OR 3.33 95% CI 2.46 to 4.50; women OR 4.34 95% CI 2.91 to 6.55). Conclusions A reproducible dietary record coding procedure has been developed to minimise coding error in complex 7-day diet diaries. The prevalence of EI under-reporting is comparable with existing national UK cohorts and, in agreement with previous studies, classification of under-reporting was biased towards specific subgroups of participants. PMID:28377391

Use of the QR Reader to Provide Real-Time Evaluation of Residents' Skills Following Surgical Procedures.

PubMed

Reynolds, Kellin; Barnhill, Danny; Sias, Jamie; Young, Amy; Polite, Florencia Greer

2014-12-01

A portable electronic method of providing instructional feedback and recording an evaluation of resident competency immediately following surgical procedures has not previously been documented in obstetrics and gynecology. This report presents a unique electronic format that documents resident competency and encourages verbal communication between faculty and residents immediately following operative procedures. The Microsoft Tag system and SurveyMonkey platform were linked by a 2-D QR code using Microsoft QR code generator. Each resident was given a unique code (TAG) embedded onto an ID card. An evaluation form was attached to each resident's file in SurveyMonkey. Postoperatively, supervising faculty scanned the resident's TAG with a smartphone and completed the brief evaluation using the phone's screen. The evaluation was reviewed with the resident and automatically submitted to the resident's educational file. The evaluation system was quickly accepted by residents and faculty. Of 43 residents and faculty in the study, 38 (88%) responded to a survey 8 weeks after institution of the electronic evaluation system. Thirty (79%) of the 38 indicated it was superior to the previously used handwritten format. The electronic system demonstrated improved utilization compared with paper evaluations, with a mean of 23 electronic evaluations submitted per resident during a 6-month period versus 14 paper assessments per resident during an earlier period of 6 months. This streamlined portable electronic evaluation is an effective tool for direct, formative feedback for residents, and it creates a longitudinal record of resident progress. Satisfaction with, and use of, this evaluation system was high.

Use of the QR Reader to Provide Real-Time Evaluation of Residents' Skills Following Surgical Procedures

PubMed Central

Reynolds, Kellin; Barnhill, Danny; Sias, Jamie; Young, Amy; Polite, Florencia Greer

2014-01-01

Background A portable electronic method of providing instructional feedback and recording an evaluation of resident competency immediately following surgical procedures has not previously been documented in obstetrics and gynecology. Objective This report presents a unique electronic format that documents resident competency and encourages verbal communication between faculty and residents immediately following operative procedures. Methods The Microsoft Tag system and SurveyMonkey platform were linked by a 2-D QR code using Microsoft QR code generator. Each resident was given a unique code (TAG) embedded onto an ID card. An evaluation form was attached to each resident's file in SurveyMonkey. Postoperatively, supervising faculty scanned the resident's TAG with a smartphone and completed the brief evaluation using the phone's screen. The evaluation was reviewed with the resident and automatically submitted to the resident's educational file. Results The evaluation system was quickly accepted by residents and faculty. Of 43 residents and faculty in the study, 38 (88%) responded to a survey 8 weeks after institution of the electronic evaluation system. Thirty (79%) of the 38 indicated it was superior to the previously used handwritten format. The electronic system demonstrated improved utilization compared with paper evaluations, with a mean of 23 electronic evaluations submitted per resident during a 6-month period versus 14 paper assessments per resident during an earlier period of 6 months. Conclusions This streamlined portable electronic evaluation is an effective tool for direct, formative feedback for residents, and it creates a longitudinal record of resident progress. Satisfaction with, and use of, this evaluation system was high. PMID:26140128

Selective lateral laser thyroarytenoid myotomy for adductor spasmodic dysphonia.

PubMed

Hussain, A; Shakeel, M

2010-08-01

Selective lateral laser thyroarytenoid myotomy is a conceptually sound, simple, minimally invasive, repeatable and predictable new surgical procedure for treating adductor spasmodic dysphonia. This paper aims to introduce and describe the surgical technique, and to present a clinical case series and its outcomes. A prospective, clinical case series treated with selective lateral laser thyroarytenoid myotomy, with follow up of 2.5 years. Pre- and post-operative data were collected prospectively for patients undergoing selective lateral laser thyroarytenoid myotomy. These data included patient demographics, previous interventions for adductor spasmodic dysphonia, technical aspects of surgery and clinical outcome. Outcome data included clinical assessment, voice handicap index, need for further intervention, and patient satisfaction assessed by subjective improvement (detailed subjectively by the patients themselves and objectively using the Glasgow benefit inventory). Four patients (two men and two women; mean age 65 years; age range 41-80 years) were included. The mean duration of adductor spasmodic dysphonia was 11 years. All patients had previously been treated with botulinum toxin A. All patients reported improvement in voice quality, fluency, sustainability and elimination of voice breaks over 2.5 years' follow up. Clinical assessment revealed no alteration in mucosal wave, and complete relief of hyperadduction was observed on phonation. No patients required supplementary botulinum toxin treatment during follow up. Selective lateral laser thyroarytenoid myotomy seems to represent a curative procedure for adductor spasmodic dysphonia, a chronic, debilitating condition. This procedure is conceptually simple, minimally invasive and repeatable. It also seems to offer a safe and lasting alternative to botulinum toxin therapy.

Ureteroscopic treatment of larger renal calculi (>2 cm)

PubMed Central

Bagley, Demetrius H.; Healy, Kelly A.; Kleinmann, Nir

2012-01-01

Objectives To evaluate the current status of ureteroscopic lithotripsy (UL) for treating renal calculi of >2 cm, as advances in flexible ureteroscope design, accessory instrumentation and lithotrites have revolutionised the treatment of urinary calculi. While previously reserved for ureteric and small renal calculi, UL has gained an increasing role in the selective management of larger renal stone burdens. Methods We searched the available databases, including PubMed, Google Scholar, and Scopus, for relevant reports in English, and the article bibliographies to identify additional relevant articles. Keywords included ureteroscopy, lithotripsy, renal calculi, and calculi >2 cm. Retrieved articles were reviewed to consider the number of patients, mean stone size, success rates, indications and complications. Results In all, nine studies (417 patients) were eligible for inclusion. After one, two or three procedures the mean (range) success rates were 68.2 (23–84)%, 87.1 (79–91)% and 94.4 (90.1–96.7)%, respectively. Overall, the success rate was >90% with a mean of 1.2–2.3 procedures per patient. The overall complication rate was 10.3%, including six (1.4%) intraoperative and 37 (8.9%) postoperative complications, most of which were minor. The most common indications for UL were a failed previous treatment (46%), comorbidities (18.2%), and technical and anatomical factors (12.3%). Conclusions UL is safe and effective for treating large renal calculi. While several procedures might be required for total stone clearance, UL should be considered a standard approach in the urologist’s options treating renal calculi of >2 cm. PMID:26558040

Ultrasound-guided lumbar puncture in pediatric patients: technical success and safety.

PubMed

Pierce, David B; Shivaram, Giri; Koo, Kevin S H; Shaw, Dennis W W; Meyer, Kirby F; Monroe, Eric J

2018-06-01

Disadvantages of fluoroscopically guided lumbar puncture include delivery of ionizing radiation and limited resolution of incompletely ossified posterior elements. Ultrasound (US) allows visualization of critical soft tissues and the cerebrospinal fluid (CSF) space without ionizing radiation. To determine the technical success and safety of US-guided lumbar puncture in pediatric patients. A retrospective review identified all patients referred to interventional radiology for lumbar puncture between June 2010 and June 2017. Patients who underwent lumbar puncture with fluoroscopic guidance alone were excluded. For the remaining procedures, technical success and procedural complications were assessed. Two hundred and one image-guided lumbar punctures in 161 patients were included. Eighty patients (43%) had previously failed landmark-based attempts. One hundred ninety-six (97.5%) patients underwent lumbar puncture. Five procedures (2.5%) were not attempted after US assessment, either due to a paucity of CSF or unsafe window for needle placement. Technical success was achieved in 187 (95.4%) of lumbar punctures attempted with US guidance. One hundred seventy-seven (90.3%) were technically successful with US alone (age range: 2 days-15 years, weight range: 1.9-53.1 kg) and an additional 10 (5.1%) were successful with US-guided thecal access and subsequent fluoroscopic confirmation. Three (1.5%) cases were unsuccessful with US guidance but were subsequently successful with fluoroscopic guidance. Of the 80 previously failed landmark-based lumbar punctures, 77 (96.3%) were successful with US guidance alone. There were no reported complications. US guidance is safe and effective for lumbar punctures and has specific advantages over fluoroscopy in pediatric patients.

Stabilizing and destabilizing effects of damping in non-conservative systems: Some new results

NASA Astrophysics Data System (ADS)

Abdullatif, Mahmoud; Mukherjee, Ranjan; Hellum, Aren

2018-01-01

Previous work has amply demonstrated that non-conservative systems can be made unstable by the application of damping. Systems with two neutrally-stable damping levels, whereby the system initially gains stability but later loses stability as the level of damping is increased, have also been observed. The phenomenon of three damping-induced stability transitions has not been reported in the literature. Here we show that the addition of damping can cause non-conservative systems to become stable, then unstable, then stable again at the same value of the non-conservative forcing variable. This combination of stability transitions is found to exist for several example systems, including linkages with follower end forces and fluid-conveying pipes. Another interesting observation is that a given system can exhibit different forms of stability transitions in different regions of its parameter space. In a particular example, the neutral stability curves corresponding to two different modes are observed to intersect, such that the boundary separating the stable and unstable regions is piecewise continuous. This observation requires that the accepted definitions of "stabilizing" and "destabilizing" roles of damping be revised. All of these stability transition behaviors were found by applying the Routh-Hurwitz procedure, whereby the traditional procedure is first applied to the characteristic polynomial of the system, and then again to guarantee the existence of a second-order auxiliary polynomial in the Routh array. This procedure is developed in the context of examples, each of which concerns a classical apparatus who dynamics are more interesting than previously believed.

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 questionnaire-based study on patients' experiences with rechargeable implanted programmable generators for spinal cord stimulation to treat chronic lumbar spondylosis pain.

PubMed

McAuley, John; Farah, Nima; van Gröningen, Richard; Green, Christopher

2013-01-01

The latest generation of rechargeable implantable programmable generators (IPGs) for spinal cord stimulation may greatly extend IPG lifespan compared with previous nonrechargeable devices. This study explores patients' experiences with these devices. Twenty-five patients attending the Department of Neurostimulation, Royal London Hospital, who were implanted with a rechargeable IPG (SC-1110; Boston Scientific, Minneapolis, MN, USA) to provide pain relief from post-surgical lumbosacral spondylosis were surveyed using a questionnaire. Patients reported a mean (SD) benefit from stimulation of 43.7% (32.6%). On a 1 (worst) to 5 (best) scale, the median score was 5 for ease of recharging. Eight patients who had previously had nonrechargeable IPGs felt the rechargeable system was better (p= 0.0143). A particular issue with nonrechargeable batteries was that, while patients considered 5 years an acceptable interval for battery replacements and the procedure itself not too inconvenient, they felt an acceptable wait for replacement after failure to be only 1 week, much shorter than actual waiting times. Patients found the rechargeable IPG easy to recharge and those who had had previous experience with nonrechargeable devices preferred using the rechargeable device. Its benefits in terms of pain relief fell within the range expected from previous studies using nonrechargeable batteries. The main disadvantage of nonrechargeable devices as reported by the patients in this study was concern over the length of time they would have to wait without pain relief between battery replacements. © 2012 International Neuromodulation Society.

Altered fronto-striatal functions in the Gdi1-null mouse model of X-linked Intellectual Disability.

PubMed

Morè, Lorenzo; Künnecke, Basil; Yekhlef, Latefa; Bruns, Andreas; Marte, Antonella; Fedele, Ernesto; Bianchi, Veronica; Taverna, Stefano; Gatti, Silvia; D'Adamo, Patrizia

2017-03-06

RAB-GDP dissociation inhibitor 1 (GDI1) loss-of-function mutations are responsible for a form of non-specific X-linked Intellectual Disability (XLID) where the only clinical feature is cognitive impairment. GDI1 patients are impaired in specific aspects of executive functions and conditioned response, which are controlled by fronto-striatal circuitries. Previous molecular and behavioral characterization of the Gdi1-null mouse revealed alterations in the total number/distribution of hippocampal and cortical synaptic vesicles as well as hippocampal short-term synaptic plasticity, and memory deficits. In this study, we employed cognitive protocols with high translational validity to human condition that target the functionality of cortico-striatal circuitry such as attention and stimulus selection ability with progressive degree of complexity. We previously showed that Gdi1-null mice are impaired in some hippocampus-dependent forms of associative learning assessed by aversive procedures. Here, using appetitive-conditioning procedures we further investigated associative learning deficits sustained by the fronto-striatal system. We report that Gdi1-null mice are impaired in attention and associative learning processes, which are a key part of the cognitive impairment observed in XLID patients. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

A unique complication of radiofrequency therapy to the tongue base

PubMed Central

Tornari, Chrysostomos; Wong, Gentle; Arora, Asit; Kotecha, Bhik

2015-01-01

Introduction Radiofrequency ablation treatment of the tongue base can be used either alone or as part of a multilevel approach in the treatment of snoring. This involves the generation of thermal energy around the circumvallate papillae of the tongue. Potential complications include ulceration, dysphagia, haematoma and abscess formation. Presentation of case We present the case of a 50-year-old patient who developed an anterior neck swelling following a second application of radiofrequency ablation therapy to the tongue base for snoring. This was secondary to an infection of a previously undiagnosed thyroglossal cyst. The patient made a full recovery following intravenous antibiotic therapy and ultrasound-guided needle aspiration. Discussion Thyroglossal tract remnants are thought to be present in seven percent of the adult population. An infection in a thyroglossal tract cyst has not previously been reported following radiofrequency ablation of the tongue base. Given the relatively high complication rate of tongue base radiofrequency ablation in some series, this complication may be under-recognised. Conclusion An infected thyroglossal tract cyst should be suspected in patients with anterior neck swellings following radiofrequency ablation therapy to the tongue base. We advise caution when performing this procedure on patients with known thyroglossal tract remnants though there is insufficient evidence to suggest that this procedure is contraindicated. PMID:25603484

Effect of local endometrial injury on pregnancy outcomes in ovum donation cycles.

PubMed

Dain, Lena; Ojha, Kamal; Bider, David; Levron, Jacob; Zinchenko, Viktor; Walster, Sharon; Dirnfeld, Martha

2014-10-01

To evaluate the effect of local endometrial injury (LEI) on clinical outcomes in ovum donation recipients. Retrospective cohort analysis of ovum donation cycles conducted from 2005 to 2012. Two private IVF centers. Total 737 ovum donation cycles. LEI by endometrial "scratch" with the use of a Pipelle catheter. Clinical pregnancy and live birth rates. No statistically significant differences were found in clinical pregnancy rates and live birth rates in cycles subjected to LEI compared with those without. Combination of LEI with fibroid uterus resulted with significantly higher clinical pregnancy rates compared with LEI in normal uterine anatomy. This is the first study done in ovum recipients who underwent LEI by a "scratch" procedure after failed implantation. Unlike most previous reports, which found improved pregnancy rates with the use of "scratch effect" or "minor endometrial injury" after repeated implantation failures in standard IVF with own eggs, we did not find any changes in implantation rates in a population of egg recipients following this procedure. In view of a possible positive effect of LEI in cycles with a previous four or more failures, prospective randomized controlled studies are warranted to better define the target population who may benefit from this intervention. Copyright © 2014 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

Factors associated with participant and provider pain rating during office-based first-trimester vacuum aspiration.

PubMed

Oviedo, Johana D; Ohly, N Tanya; Guerrero, Jacqueline M; Castaño, Paula M

2018-06-01

The objective was to describe factors associated with reported pain and assess correlations between participant and provider pain assessments during first-trimester vacuum aspiration. Participants and providers in a trial evaluating music for pain reduction reported procedure-related pain using a 100-mm visual analog scale. The mean participant-reported maximum pain was 65.9±23.0 compared to 41.3±22.0 by provider assessment. Provider-reported scores correlated poorly with participant maximum pain (r=0.28) and participant maximum pain adjusted for baseline (r=0.27). Previous abortion (60.5 versus 71.4, p=.02) and immediate intrauterine device insertion (46.1 versus 68.6, p=.03) were associated with lower participant-reported pain. Providers underestimate pain reported during vacuum aspiration; provider estimates correlate poorly with participant self-report. To improve management of pain during first-trimester vacuum aspiration, we need to better understand factors that influence patient and provider pain rating. When assessing patient pain in this setting, providers should not assume a baseline of zero pain. Copyright © 2018 Elsevier Inc. All rights reserved.

Hybrid procedure in living donor liver transplantation.

PubMed

Soyama, A; Takatsuki, M; Hidaka, M; Adachi, T; Kitasato, A; Kinoshita, A; Natsuda, K; Baimakhanov, Z; Kuroki, T; Eguchi, S

2015-04-01

We have previously reported a hybrid procedure that uses a combination of laparoscopic mobilization of the liver and subsequent hepatectomy under direct vision in living donor liver transplantation (LDLT). We present the details of this hybrid procedure and the outcomes of the procedure. Between January 1997 and August 2014, 204 LDLTs were performed at Nagasaki University Hospital. Among them, 67 recent donors underwent hybrid donor hepatectomy. Forty-one donors underwent left hemihepatectomy, 25 underwent right hemihepatectomy, and 1 underwent posterior sectionectomy. First, an 8-cm subxiphoid midline incision was made; laparoscopic mobilization of the liver was then achieved with a hand-assist through the midline incision under the pneumoperitoneum. Thereafter, the incision was extended up to 12 cm for the right lobe and posterior sector graft and 10 cm left lobe graft procurement. Under direct vision, parenchymal transection was performed by means of the liver-hanging maneuver. The hybrid procedure for LDLT recipients was indicated only for selected cases with atrophic liver cirrhosis without a history of upper abdominal surgery, significant retroperitoneal collateral vessels, or hypertrophic change of the liver (n = 29). For total hepatectomy and splenectomy, the midline incision was sufficiently extended. All of the hybrid donor hepatectomies were completed without an extra subcostal incision. No significant differences were observed in the blood loss or length of the operation compared with conventional open procedures. All of the donors have returned to their preoperative activity level, with fewer wound-related complaints compared with those treated with the use of the conventional open procedure. In recipients treated with the hybrid procedure, no clinically relevant drawbacks were observed compared with the recipients treated with a regular Mercedes-Benz-type incision. Our hybrid procedure was safely conducted with the same quality as the conventional open procedure in both LDLT donors and recipients. Copyright © 2015 Elsevier Inc. All rights reserved.

Brief Report: Effects of Video-Based Group Instruction on Spontaneous Social Interaction of Adolescents with Autism Spectrum Disorders.

PubMed

Plavnick, Joshua B; Dueñas, Ana D

2018-06-01

Four adolescents with autism spectrum disorder (ASD) were taught to interact with peers by asking social questions or commenting about others during game play or group activities. Participants were shown a video model and then given an opportunity to perform the social behavior depicted in the model when playing a game with one another. All participants demonstrated an increase in both social interaction skills, replicating previous research on video-based group instruction for adolescents with ASD. The results suggest the procedure may be useful for teaching social skills that occur under natural conditions.

Molecular Toxicology of Chromatin: The Role of Poly(ADP-Ribose) in Gene Control.

DTIC Science & Technology

1985-02-01

04 4 0V 0 r4. $) 4 0n U) Ln 𔃺 V W 0 Ř (u %D -T -a Ai j4 W0 .. 04 04 0 04rd 412% I cb 01 41 410 41 .j A . . to 2.4 Ř -A 411 0 2 0 -r 0. 04 0A CAt e4...reported previously (1). The selection procedures used for NNSF * were compared with fibrosarcoma . Ieionmyosarcoui and synovial sarcoma cells. V...tumor incidence of human fibrosarcoma , lelomyosarcoma and synovial sarcoma cells in nude mice was identical with that of UV-transformed human

Transtracheal aspiration in the diagnosis of pulmonary blastomycosis (17 cases: 2000–2005)

PubMed Central

McMillan, Chantal J.; Taylor, Susan M.

2008-01-01

Blastomyces dermatitidis is a common etiologic agent of fungal pneumonia in dogs. Definitive diagnosis is based on cytologic demonstration of the organism in affected tissues. Fluid obtained through transtracheal aspiration has previously been reported to have a low diagnostic yield for B. dermatitidis organisms. This retrospective study identified B. dermatitidis organisms in 76% of samples when transtracheal aspiration was performed in 17 nonsedated dogs with pulmonary blastomycosis. Transtracheal aspiration is a noninvasive and simple procedure that should be considered as an early diagnostic test whenever blastomycosis is a differential diagnosis in dogs with pulmonary disease. PMID:18320978

Correction for intravascular activity in the oxygen-15 steady-state technique is independent of the regional hematocrit

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

Lammertsma, A.A.; Baron, J.C.; Jones, T.

1987-06-01

The oxygen-15 steady-state technique to measure the regional cerebral metabolic rate for oxygen requires a correction for the nonextracted intravascular molecular oxygen-15. To perform this correction, an additional procedure is carried out using RBCs labeled with /sup 11/CO or C/sup 15/O. The previously reported correction method, however, required knowledge of the regional cerebral to large vessel hematocrit ratio. A closer examination of the underlying model eliminated this ratio. Both molecular oxygen and carbon monoxide are carried by RBCs and are therefore similarly affected by a change in hematocrit.

Synthesis of racemic β-chamigrene, a spiro[5.5]undecane sequiterpene.

PubMed

Antonsen, Simen; Skattebøl, Lars; Stenstrøm, Yngve

2014-12-10

The present paper describes a total synthesis of racemic β-chamigrene, a sesquiterpene with a spiro[5.5]undecane carbon framework. Compared with previously reported β-chamigrene syntheses, we were able to reduce the total number of reaction steps, which also resulted in a significant improvement of the overall yield. The commercially available ketone 6-methylhept-5-en-2-one was transformed by known simple procedures into 3,3-dimethyl-2-methylenecyclohexanone. This reacted with isoprene by a Diels-Alder reaction to give a spiro ketone. An olefination reaction on this compound gave the target molecule.

Knee and Ankle Arthroplasty in Hemophilia

PubMed Central

Solimeno, Luigi Piero; Pasta, Gianluigi

2017-01-01

Today, major surgical procedures can be safely performed in hemophilic patients with chronic arthropathy, using available factor concentrates. In this setting, total knee replacement is considered the “gold standard”, while the use of total ankle replacement is still debated. Indeed, the unsatisfactory results obtained with the previous available design of implants did not raise enthusiasm as knee or hip replacement. Recently, the introduction of new implant designs and better reported outcomes have renewed the interest in total ankle replacement in people with hemophilia. In this review, the role of replacement surgery in the treatment of chronic hemophilic arthropathy will be described. PMID:29165342

Fatal ovarian hyperstimulation syndrome in an anonymous egg donor.

PubMed

Pooniya, Shashank; Behera, C; Mridha, A R; Bhardwaj, D N; Millo, Tabin

2016-12-01

Ovarian hyperstimulation syndrome is a rare, but potentially life-threatening iatrogenic disorder arising from ovulation induction or ovarian hyperstimulation for assisted reproduction techniques. We report a case of a 26-year-old multiparous woman, an anonymous egg donor, who died a few hours after undergoing a procedure to donate eggs at an in vitro fertilization clinic. Her husband alleged that medical negligence had led to her death. The autopsy confirmed death due to ovarian hyperstimulation syndrome. We know of no previous descriptions of fatal ovarian hyperstimulation syndrome in an anonymous egg donor in medico-legal literature. © The Author(s) 2016.

Advanced computer architecture specification for automated weld systems

NASA Technical Reports Server (NTRS)

Katsinis, Constantine

1994-01-01

This report describes the requirements for an advanced automated weld system and the associated computer architecture, and defines the overall system specification from a broad perspective. According to the requirements of welding procedures as they relate to an integrated multiaxis motion control and sensor architecture, the computer system requirements are developed based on a proven multiple-processor architecture with an expandable, distributed-memory, single global bus architecture, containing individual processors which are assigned to specific tasks that support sensor or control processes. The specified architecture is sufficiently flexible to integrate previously developed equipment, be upgradable and allow on-site modifications.

77 FR 6862 - Proposed Collection; Comment Request for Revenue Procedure 99-50

Federal Register 2010, 2011, 2012, 2013, 2014

2012-02-09

... Revenue Procedure 99-50 AGENCY: Internal Revenue Service (IRS), Treasury. ACTION: Notice and request for... Revenue Procedure 99-50, Combined Information Reporting. DATES: Written comments should be received on or... Number: Revenue Procedure 99-50. Abstract: Revenue Procedure 99-50 permits combined information reporting...

The protective effects of acute cardiovascular exercise on the interference of procedural memory.

PubMed

Jo, J S; Chen, J; Riechman, S; Roig, M; Wright, D L

2018-04-10

Numerous studies have reported a positive impact of acute exercise for procedural skill memory. Previous work has revealed this effect, but these findings are confounded by a potential contribution of a night of sleep to the reported exercise-mediated reduction in interference. Thus, it remains unclear if exposure to a brief bout of exercise can provide protection to a newly acquired motor memory. The primary objective of the present study was to examine if a single bout of moderate-intensity cardiovascular exercise after practice of a novel motor sequence reduces the susceptibility to retroactive interference. To address this shortcoming, 17 individuals in a control condition practiced a novel motor sequence that was followed by test after a 6-h wake-filled interval. A separate group of 17 individuals experienced practice with an interfering motor sequence 45 min after practice with the original sequence and were then administered test trials 6 h later. One additional group of 12 participants was exposed to an acute bout of exercise immediately after practice with the original motor sequence but prior to practice with the interfering motor sequence and the subsequent test. In comparison with the control condition, increased response times were revealed during the 6-h test for the individuals that were exposed to interference. The introduction of an acute bout of exercise between the practice of the two motor sequences produced a reduction in interference from practice with the second task at the time of test, however, this effect was not statistically significant. These data reinforce the hypothesis that while there may be a contribution from exercise to post-practice consolidation of procedural skills which is independent of sleep, sleep may interact with exercise to strengthen the effects of the latter on procedural memory.

EMS providers' perceptions of safety climate and adherence to safe work practices.

PubMed

Eliseo, Laura J; Murray, Kate A; White, Laura F; Dyer, Sophia; Mitchell, Patricia A; Fernandez, William G

2012-01-01

Occupational injuries are an important source of morbidity for emergency medical services (EMS) providers. Previous work has shown that employee perceptions of an organization's commitment to safety (i.e., safety climate) correlate with adherence to safe practices. To assess the association between perceived safety climate and compliance with safety procedures in an urban EMS system with >100,000 calls/year. EMS providers were issued a self-administered survey that included questions on demographics, years of experience, perceived safety climate, and adherence to safety procedures. Safety climate was assessed with a 20-item validated instrument. Adherence to safety procedures was assessed with a nine-item list of safety behaviors. Strict adherence to safety procedures was defined as endorsing "agree" or "strongly agree" on 80% of items. The effect of safety climate on compliance with safe practices was estimated using multiple logistic regression. One hundred ninety-six of 221 providers (89%) completed surveys; 74% were male; the median age was 36-40 years; and the median amount of experience was 8 years. One hundred twenty-seven of 196 respondents (65%) reported strict adherence to safe work practice. Factor analysis confirmed the original six-factor grouping of questions; frequent safety-related feedback/training was significantly associated with safe practices (odds ratio [OR] = 2.14, 95% confidence interval [CI] = 1.01-4.51). EMS workers perceiving a high degree of perceived safety climate was associated with twofold greater odds of self-reported level of strict adherence to safe work practices. Frequent safety-related feedback/training was the one dimension of safety climate that had the strongest association with adherence to safe workplace behaviors.

Atrial fibrillation ablation using remote magnetic navigation and the risk of atrial-esophageal fistula: international multicenter experience.

PubMed

Danon, Asaf; Shurrab, Mohammed; Nair, Krishnakumar Mohanan; Latcu, Decebal Gabriel; Arruda, Mauricio S; Chen, Xu; Szili-Torok, Tamas; Rossvol, Ole; Wissner, Eric E; Lashevsky, Ilan; Crystal, Eugene

2015-08-01

Remote magnetic navigation (RMN) has been used in various electrophysiological procedures, including atrial fibrillation (AF) ablation. Atrial-esophageal fistula (AEF) is one of most disastrous complications of AF ablation. We aimed to evaluate the incidence of AEF during AF ablation using RMN in comparison to manual ablation. We conducted the first international survey among RMN operators for assessment of the prevalence of AEF and procedural parameters affecting the risk. Data from parallel survey of AEF among Canadian interventional electrophysiologists (CIE) using only manual catheters served as control. Fifteen RMN operators (who performed 3637 procedures) and 25 manual CIE operators (7016 procedures) responded to the survey. RMN operators were more experienced than CIE operators (16.3 ± 8.3 vs. 9.2 ± 5.4 practice years in electrophysiology, p = 0.007). The maximal energy output in the posterior wall was higher in the operator using RMN (33 ± 5 vs. 28.6 ± 4.9 W; p = 0.02). Other parameters including use of preprocedural images, irrigated catheter, pump flow rate, esophageal temperature monitoring, intracardiac echocardiography (ICE), and general anesthesia were similar. CIE operators administered proton-pump inhibitors postoperatively significantly more than RMN operators (76 vs. 35%, p = 0.01). AEF was reported in 5 of the 7016 patients in the control group (0.07%) but in none of the RMN group (p = 0.11). AEF is a rare complication and its evaluation necessitates large-scale studies. Although no AEF case with RMN was reported in this large study or previously on the literature, the rarity of this complication prevents firm conclusion about the risk.

A Case of Tranexamic Acid as Adjunctive Treatment for Chronic Subdural Hematoma with Multiple Recurrences

PubMed Central

Mikkelsen, Ronni; Anker-Møller, Thorkil; Hvas, Anne-Mette; Sunde, Niels

2017-01-01

Patient: Male, 64 Final Diagnosis: Chronic subdural hematoma Symptoms: Aphasia • headache • paresis Medication: — Clinical Procedure: Burr hole evacuation • Tranexamic acid Specialty: Neurosurgery Objective: Unusual clinical course Background: Chronic subdural hematoma (CSDH) is a common neurosurgical condition that is treated using a cranial burr hole evacuation procedure, but recurrence is common. The use of anticoagulant therapy can increase the risk of developing a recurrent subdural hematoma. We present a challenging case of a patient on long-term anticoagulant therapy following previous aortic and aortic valve surgery who had CSDH with multiple recurrences and was ultimately treated with tranexamic acid as an adjunct to surgery. Case Report: A male patient in his mid-sixties presented with a headache and bilateral CSDH. Apart from a mechanical heart valve, he was otherwise healthy. A standard burr hole evacuation was performed, but the left hematoma and symptoms recurred after three months, and he presented with additional symptoms of aphasia and right-hand weakness. He had an additional three procedures followed by recurrences over a period of six weeks. Following his fifth and final surgical procedure, he was given postoperative intravenous tranexamic acid 10 mg/kg four times during the first 24 hours with dalteparin sodium 9,500 international units (IU) twice daily. His symptoms resolved, and after nine months he had no residual hematoma, and no thromboembolic complications occurred. Conclusions: This case has demonstrated that tranexamic acid can be used as an adjunctive treatment to surgery when dealing with recurring CSDH, even in patients who require concomitant anticoagulant therapy. Although clinical trials are underway to evaluate tranexamic acid as a medical treatment for CSDH, this case report may support further studies that include patients with risk factors for thromboembolic disease. PMID:28912416

Spanish Heart Transplantation Registry. 27th Official Report of the Spanish Society of Cardiology Working Group on Heart Failure and Heart Transplantation (1984-2015).

PubMed

González-Vílchez, Francisco; Segovia Cubero, Javier; Almenar, Luis; Crespo-Leiro, María G; Arizón, José M; Sousa, Iago; Delgado, Juan; Roig, Eulalia; Sobrino, José Manuel; González-Costello, José

2016-11-01

The present article reports the characteristics and results of heart transplants in Spain since this therapeutic modality was first used in May 1984. We describe the main features of recipients, donors, surgical procedures, and results of all heart transplants performed in Spain until December 31, 2015. A total of 299 cardiac transplants were performed in 2015, with the whole series comprising 7588 procedures. The main transplant features in 2015 were similar to those observed in recent years. A remarkably high percentage of transplants were performed under emergency conditions and there was widespread use of circulatory assist devices, particularly continuous-flow left ventricular assist devices prior to transplant (16% of all transplants). Survival has significantly improved in the last decade compared with previous time periods. During the last few years, between 250 and 300 heart transplants have consistently been performed each year in Spain. Despite a more complex clinical context, survival has increased in recent years. Copyright © 2016 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.

[Bouveret's syndrome: A rare presentation of gallstone ileus].

PubMed

Franco-Avilés, Luis; Arce-Guridi, Héctor Tonalli; Mercado, Ulises

2016-01-01

Bouveret's syndrome is defined as gastric outlet obstruction caused by duodenal impaction of a gallstone which passes into the duodenal bulb through a cholecystoduodenal fistula. We reported the case of a 46-year-old woman who presented intermittent epigastric pain, nausea, vomiting, and weight loss of 2-months duration. The patient admitted alcohol and methamphetamine abuse. She had not fever, dehydration or jaundice. Amylase, electrolytes, enzymes, and creatinine level were within normal limits. Seven months previously she was seen in the emergency department for acute cholecystitis. In that occasion, an abdominal ultrasound was reported with cholelithiasis without dilatation of the intra/extra-hepatic bile duct. Abdominal plain radiographs showed no relevant findings. A laparoscopic surgery was performed. During the procedure a sub-hepatic plastron with firm adhesions was found. The gallbladder was found attached to the duodenal bulb and an impacted calculus in the duodenum. The procedure was converted to surgery. Surgeon decided to perform a Bilroth 1 as the best choice. Seven days later, she was discharged. The clinical manifestations of the Bouveret's syndrome are nonspecific. Preoperative diagnosis is a challenge for clinicians because of the rarity of this condition. Treatment must be individualized.

Augmented reality in the surgery of cerebral aneurysms: a technical report.

PubMed

Cabrilo, Ivan; Bijlenga, Philippe; Schaller, Karl

2014-06-01

Augmented reality is the overlay of computer-generated images on real-world structures. It has previously been used for image guidance during surgical procedures, but it has never been used in the surgery of cerebral aneurysms. To report our experience of cerebral aneurysm surgery aided by augmented reality. Twenty-eight patients with 39 unruptured aneurysms were operated on in a prospective manner with augmented reality. Preoperative 3-dimensional image data sets (angio-magnetic resonance imaging, angio-computed tomography, and 3-dimensional digital subtraction angiography) were used to create virtual segmentations of patients' vessels, aneurysms, aneurysm necks, skulls, and heads. These images were injected intraoperatively into the eyepiece of the operating microscope. An example case of an unruptured posterior communicating artery aneurysm clipping is illustrated in a video. The described operating procedure allowed continuous monitoring of the accuracy of patient registration with neuronavigation data and assisted in the performance of tailored surgical approaches and optimal clipping with minimized exposition. Augmented reality may add to the performance of a minimally invasive approach, although further studies need to be performed to evaluate whether certain groups of aneurysms are more likely to benefit from it. Further technological development is required to improve its user friendliness.

Emergency medicine tools to manage smallpox (vaccinia) vaccination complications: clinical practice guideline and policies and procedures.

PubMed

Thorne, Craig D; Hirshon, Jon Mark; Himes, Carrie D; McDiarmid, Melissa A

2003-11-01

In December 2002, the federal government began a program to immunize approximately 500000 civilian public health and health care workers with smallpox (vaccinia) vaccine as a part of our pre-event defense against bioterrorism. First responders will likely follow, and the general US population might be offered vaccination in the next 1 to 2 years. Recent reports that suggest the possible association of the vaccine to adverse cardiac events (including deaths), liability concerns for hospitals, and the availability of compensation for workers with vaccine complications have significantly reduced voluntary participation. Vaccinees might experience robust primary takes or serious adverse events, including viral or even bacterial cellulitides, encephalitis, progressive skin destruction, and other life-threatening complications. With the increasing prevalence of immune suppression from both diseases and immunosuppressive medications, complications might be seen in higher frequency than previously reported. Emergency medicine providers and staff must become familiar with clinical presentations and management of vaccine complications. In addition, policies and procedures must be developed to prevent unimmunized providers from inadvertently contacting the active vaccination sites of their patients and, if the providers themselves have active vaccination sites, to protect their patients and their own families.

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

ERIC Educational Resources Information Center

Chapman, Dane M.; And Others

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

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

ERIC Educational Resources Information Center

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

2015-01-01

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

Chimpanzees' (Pan troglodytes) use of gaze cues in object-choice tasks: different methods yield different results.

PubMed

Barth, Jochen; Reaux, James E; Povinelli, Daniel J

2005-04-01

To assess the influence of different procedures on chimpanzees' performance in object-choice tasks, five adult chimpanzees were tested using three experimenter-given cues to food location: gazing, glancing, and pointing. These cues were delivered to the subjects in an identical fashion but were deployed within the context of two distinct meta-procedures that have been previously employed with this species with conflicting results. In one procedure, the subjects entered the test unit and approached the experimenter (who had already established the cue) on each trial. In the other procedure, the subjects stayed in the test unit throughout a session, witnessed the hiding procedure, and waited for a delay of 10 s during which the cue was provided. The subjects scored at high levels far exceeding chance in response to the gaze cue only when they approached the experimenter for each trial. They performed at chance levels when they stayed inside the test unit throughout the session. They scored at chance levels on all other cues irrespective of the procedure. These findings imply that (a) chimpanzees can immediately exploit social gaze cues, and (b) previous conflicting findings were likely due to the different meta-procedures that were used.

Medical tourism services available to residents of the United States.

PubMed

Alleman, Brandon W; Luger, Tana; Reisinger, Heather Schacht; Martin, Rene; Horowitz, Michael D; Cram, Peter

2011-05-01

There are growing reports of United States (US) residents traveling overseas for medical care, but empirical data about medical tourism are limited. To characterize the businesses and business practices of entities promoting medical tourism and the types and costs of procedures being offered. DESIGN, PARTICIPANTS, AND OUTCOMES: Between June and August 2008, we conducted a telephone survey of all businesses engaged in facilitating overseas medical travel for US residents. We collected information from each company including: the number of employees; number of patients referred overseas; medical records security processes; destinations to which patients were referred; treatments offered; treatment costs; and whether patient outcomes were collected. We identified 63 medical tourism companies and 45 completed our survey (71%). Companies had a mean of 9.8 employees and had referred an average of 285 patients overseas (a total of approximately 13,500 patients). 35 (79%) companies reported requiring accreditation of foreign providers, 22 (50%) collected patient outcome data, but only 17 (39%) described formal medical records security policies. The most common destinations were India (23 companies, 55%), Costa Rica (14, 33%), and Thailand (12, 29%). The most common types of care included orthopedics (32 companies, 73%), cardiac care (23, 52%), and cosmetic surgery (29, 66%). 20 companies (44%) offered treatments not approved for use in the US--most commonly stem cell therapy. Average costs for common procedures, CABG ($18,600) and knee arthroplasty ($10,800), were similar to previous reports. The number of Americans traveling overseas for medical care with assistance from medical tourism companies is relatively small. Attention to medical records security and patient outcomes is variable and cost-savings are dependent on US prices. That said, overseas medical care can be a reasonable alternative for price sensitive patients in need of relatively common, elective medical procedures.

Retrosternal abscess after trigger point injections in a pregnant woman: a case report.

PubMed

Usman, Faisal; Bajwa, Abubakr; Shujaat, Adil; Cury, James

2011-08-23

Although retrosternal abscess is a well known complication of sternotomy and intravenous drug abuse, to date it has not been described as a consequence of trigger point injections. There are reported cases of serious complications as a result of this procedure including epidural abscess, necrotizing fasciitis, osteomyelitis and gas gangrene. A 37-year-old African-American woman, who was 20 weeks pregnant, presented to our emergency room with complaints of progressively worsening chest pain and shortness of breath over the course of the last two months. She was undergoing trigger point injections at multiple different sites including the sternoclavicular joint for chest pain and dystonia. Two years previously she had developed a left-sided pneumothorax as a result of this procedure, requiring chest tube placement and subsequent pleurodesis. Her vital signs in our emergency room were normal except for resting tachycardia, with a pulse of 100 beats per minute. A physical examination revealed swelling and tenderness of the sternal notch with tenderness to palpation over the left sternoclavicular joint. Laboratory data was significant for a white blood count of 13.3 × 109/L with 82% granulocytes. A chest radiograph revealed left basilar scarring with blunting of the left costophrenic angle. A computed tomography angiogram showed a 4.7 cm abscess in the retrosternal region behind the manubrium with associated sclerosis and cortical irregularity of the manubrium and left clavicle. Trigger point injection is generally considered very safe. However, there are reported cases of serious complications as a result of this procedure. A computed tomography scan of the chest should strongly be considered in the evaluation of chest pain and shortness of breath of unclear etiology in patients with even a remote history of trigger point injections.

Setting priorities for space research: An experiment in methodology

NASA Technical Reports Server (NTRS)

1995-01-01

In 1989, the Space Studies Board created the Task Group on Priorities in Space Research to determine whether scientists should take a role in recommending priorities for long-term space research initiatives and, if so, to analyze the priority-setting problem in this context and develop a method by which such priorities could be established. After answering the first question in the affirmative in a previous report, the task group set out to accomplish the second task. The basic assumption in developing a priority-setting process is that a reasoned and structured approach for ordering competing initiatives will yield better results than other ways of proceeding. The task group proceeded from the principle that the central criterion for evaluating a research initiative must be its scientific merit -- the value of the initiative to the proposing discipline and to science generally. The group developed a two-stage methodology for priority setting and constructed a procedure and format to support the methodology. The first of two instruments developed was a standard format for structuring proposals for space research initiatives. The second instrument was a formal, semiquantitative appraisal procedure for evaluating competing proposals. This report makes available complete templates for the methodology, including the advocacy statement and evaluation forms, as well as an 11-step schema for a priority-setting process. From the beginning of its work, the task group was mindful that the issue of priority setting increasingly pervades all of federally supported science and that its work would have implications extending beyond space research. Thus, although the present report makes no recommendations for action by NASA or other government agencies, it provides the results of the task group's work for the use of others who may study priority-setting procedures or take up the challenge of implementing them in the future.

Isolation of carbohydrate-metabolizing, extremely halophilic bacteria.

NASA Technical Reports Server (NTRS)

Tomlinson, G. A.; Hochstein, L. I.

1972-01-01

Four previously unrecognized strains of extremely halophilic bacteria that utilize carbohydrates have been isolated. Gas production proved an unreliable index of carbohydrate metabolism; therefore, carbohydrate utilization was measured by determining acid formation and sugar disappearance during growth. By these procedures, carbohydrate utilization was readily detected. The results suggest that carbohydrate dissimilation by extremely halophilic bacteria may be more common than previously thought and that the apparent rarity of carbohydrate-metabolizing halophiles may be an artifact of the isolation procedures used.

1995 annual epidemiologic surveillance report for Sandia National Laboratory-Albuquerque

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

NONE

1995-12-31

The US Department of Energy`s (DOE`s) conduct of epidemiologic surveillance provides an early warning system for health problems among workers. This program monitors illnesses and injuries that result in an absence of five or more consecutive workdays, occupational injuries and illnesses, and disabilities and deaths among current workers. This report provides a summary of epidemiologic surveillance data collected from the Sandia National Laboratory-Albuquerque (SNL-AL) from January 1, 1995 through December 31, 1995. The data were collected by a coordinator at SNL-AL and submitted to the Epidemiologic Surveillance Data Center, located at Oak Ridge Institute for Science and Education, where qualitymore » control procedures and data analyses were carried out. The annual report for 1995 has been redesigned from reports for previous years. Most of the information in the previous reports is also in this report, but some material now appears in the appendices instead of the main body of the report. The information presented in the main body of the report provides a descriptive analysis of the data collected from the site and the appendices provide more detail. A new section of the report presents trends in health over time. The Glossary and an Explanation of Diagnostic Categories have been expanded with more examples of diagnoses to illustrate the content of each category. The data presented here apply only to SNL-AL. The DOE sites are varied, so comparisons of SNL-AL with other DOE sites should be made with caution. It is important to keep in mind that many factors can affect the completeness and accuracy of health information collected at the sites as well as affect patterns of illness and injury observed.« less

7 CFR 1794.53 - Environmental report.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 7 Agriculture 12 2010-01-01 2010-01-01 false Environmental report. 1794.53 Section 1794.53... AGRICULTURE (CONTINUED) ENVIRONMENTAL POLICIES AND PROCEDURES Procedure for Environmental Assessments With Scoping § 1794.53 Environmental report. (a) After scoping procedures have been completed, RUS shall...

7 CFR 1794.53 - Environmental report.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 7 Agriculture 12 2011-01-01 2011-01-01 false Environmental report. 1794.53 Section 1794.53... AGRICULTURE (CONTINUED) ENVIRONMENTAL POLICIES AND PROCEDURES Procedure for Environmental Assessments With Scoping § 1794.53 Environmental report. (a) After scoping procedures have been completed, RUS shall...

Completeness of breast cancer operative reports in a community care setting.

PubMed

Eng, Jordan Lang; Baliski, Christopher Ronald; McGahan, Colleen; Cai, Eric

2017-10-01

The narrative operative report represents the traditional means by which breast cancer surgery has been documented. Previous work has established that omissions occur in narrative operative reports produced in an academic setting. The goal of this study was to determine the completeness of breast cancer narrative operative reports produced in a community care setting and to explore the effect of a surgeon's case volume and years in practice on the completeness of these reports. A standardized retrospective review of operative reports produced over a consecutive 2 year period was performed using a set of procedure-specific elements identified through a review of the relevant literature and work done locally. 772 operative reports were reviewed. 45% of all elements were completely documented. A small positive trend was observed between case volume and completeness while a small negative trend was observed between years in practice and completeness. The dictated narrative report inadequately documents breast cancer surgery irrespective of the recording surgeon's volume or experience. An intervention, such as the implementation of synoptic reporting, should be considered in an effort to maximize the utility of the breast cancer operative report. Copyright © 2017. Published by Elsevier Ltd.

Lawrence Livermore National Laboratory Environmental Report 2016

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

Rosene, Crystal

The purposes of the Environmental Report 2016 are to record LLNL’s compliance with environmental standards and requirements, describe LLNL’s environmental protection and remediation programs, and present the results of environmental monitoring. Specifically, the report discusses LLNL’s EMS; describes significant accomplishments in pollution prevention; presents the results of air, water, vegetation, and foodstuff monitoring; reports radiological doses from LLNL operations; summarizes LLNL’s activities involving special status wildlife, plants, and habitats; and describes the progress LLNL has made in remediating groundwater contamination. Environmental monitoring at LLNL, including analysis of samples and data, is conducted according to documented standard operating procedures. Duplicate samplesmore » are collected and analytical results are reviewed and compared to internal acceptance standards. This report is prepared for DOE by LLNL’s Environmental Functional Area (EFA). Submittal of the report satisfies requirements under DOE Order 231.1B, “Environment, Safety and Health Reporting,” and DOE Order 458.1, “Radiation Protection of the Public and Environment.” The report is distributed in electronic form and is available to the public at https://saer.llnl.gov/, the website for the LLNL annual environmental report. Previous LLNL annual environmental reports beginning with 1994 are also on the website.« less

Patient doses from fluoroscopically guided cardiac procedures in pediatrics

NASA Astrophysics Data System (ADS)

Martinez, L. C.; Vano, E.; Gutierrez, F.; Rodriguez, C.; Gilarranz, R.; Manzanas, M. J.

2007-08-01

Infants and children are a higher risk population for radiation cancer induction compared to adults. Although some values on pediatric patient doses for cardiac procedures have been reported, data to determine reference levels are scarce, especially when compared to those available for adults in diagnostic and therapeutic procedures. The aim of this study is to make a new contribution to the scarce published data in pediatric cardiac procedures and help in the determination of future dose reference levels. This paper presents a set of patient dose values, in terms of air kerma area product (KAP) and entrance surface air kerma (ESAK), measured in a pediatric cardiac catheterization laboratory equipped with a biplane x-ray system with dynamic flat panel detectors. Cardiologists were properly trained in radiation protection. The study includes 137 patients aged between 10 days and 16 years who underwent diagnostic catheterizations or therapeutic procedures. Demographic data and technical details of the procedures were also gathered. The x-ray system was submitted to a quality control programme, including the calibration of the transmission ionization chamber. The age distribution of the patients was 47 for <1 year; 52 for 1-<5 years; 25 for 5-<10 years and 13 for 10-<16 years. Median values of KAP were 1.9, 2.9, 4.5 and 15.4 Gy cm2 respectively for the four age bands. These KAP values increase by a factor of 8 when moving through the four age bands. The probability of a fatal cancer per fluoroscopically guided cardiac procedure is about 0.07%. Median values of ESAK for the four age bands were 46, 50, 56 and 163 mGy, which lie far below the threshold for deterministic effects on the skin. These dose values are lower than those published in previous papers.

Application of the Refined Integral Method in the mathematical modeling of drug delivery from one-layer torus-shaped devices.

PubMed

Helbling, Ignacio M; Ibarra, Juan C D; Luna, Julio A

2012-02-28

A mathematical modeling of controlled release of drug from one-layer torus-shaped devices is presented. Analytical solutions based on Refined Integral Method (RIM) are derived. The validity and utility of the model are ascertained by comparison of the simulation results with matrix-type vaginal rings experimental release data reported in the literature. For the comparisons, the pair-wise procedure is used to measure quantitatively the fit of the theoretical predictions to the experimental data. A good agreement between the model prediction and the experimental data is observed. A comparison with a previously reported model is also presented. More accurate results are achieved for small A/C(s) ratios. Copyright © 2011 Elsevier B.V. All rights reserved.

Gonioscopy-assisted Transluminal Trabeculotomy (GATT): Thermal Suture Modification With a Dye-stained Rounded Tip.

PubMed

Grover, Davinder S; Fellman, Ronald L

2016-06-01

To describe a novel technique for thermally marking the tip of a suture, in preparation for a gonioscopy-assisted transluminal trabeculotomy. One patient was used as an example for this technique. Technique report. The authors introduce a modification of a novel surgical procedure (GATT) in which a suture is marked and thermally blunted allowing a proper visualization while performing an ab interno, minimally invasive, circumferential 360-degree suture trabeculotomy. The authors have previously reported on the GATT surgery with the use of an illuminated microcatheter, which allowed for visualization of the tip of the catheter as it circumnavigated Schlemm canal. This modification allows for similar visualization of the tip of the suture, however, is much more cost-effective while still maintaining similar safety.

The removal of a malpositioned implant in the anterior mandible using piezosurgery.

PubMed

Marini, Ettore; Cisterna, Veronica; Messina, Antonello Maria

2013-05-01

In oral, cranio, and maxillofacial surgery, a close relationship among the bone, nerves, and blood vessels can be regularly observed. Surgical procedures for the removal of dental implants have the potential to cause vascular injury and bleeding in the floor of the mouth and internal anterior region of the mandible. Furthermore, conventional osteotomy techniques always require extensive protection of adjacent soft tissue because cutting is not limited to bone and could easily affect other tissues when applied improperly. We report the removal by means of piezosurgery of a malpositioned osseointegrated implant that had previously caused a sublingual hematoma during its insertion. The postoperative course was uneventful, no bleeding, infection, or hematoma formation was noted and the patient reported 100% resolution of all symptoms. Copyright © 2013 Elsevier Inc. All rights reserved.

Successful Outcome of Modified Quad Surgical Procedure in Preteen and Teen Patients with Brachial Plexus Birth Palsy

PubMed Central

Nath, Rahul K.; Somasundaram, Chandra

2012-01-01

Objective: To evaluate the outcome of modified Quad procedure in preteen and teen patients with brachial plexus birth palsy. Background: We have previously demonstrated a significant improvement in shoulder abduction, resulting from the modified Quad procedure in children (mean age 2.5 years; range, 0.5–9 years) with obstetric brachial plexus injury. Methods: We describe in this report the outcome of 16 patients (6 girls and 10 boys; 7 preteen and 9 teen) who have undergone the modified Quad procedure for the correction of the shoulder function, specifically abduction. The patients underwent transfer of the latissimus dorsi and teres major muscles, release of contractures of subscapularis pectoralis major and minor, and axillary nerve decompression and neurolysis (the modified Quad procedure). Mean age of these patients at surgery was 13.5 years (range, 10.1–17.9 years). Results: The mean preoperative total Mallet score was 14.8 (range, 10–20), and active abduction was 84° (range, 20°–140°). At a mean follow-up of 1.5 years, the mean postoperative total Mallet score increased to 19.7 (range, 13–25, P < .0001), and the mean active abduction improved to 132° (range, 40°–180°, P < .0003). Conclusion: The modified Quad procedure greatly improves not only the active abduction but also other shoulder functions in preteen and teen patients, as this outcome is the combined result of decompression and neurolysis of the axillary nerve and the release of the contracted internal rotators of the shoulder. PMID:23308301

Single-operator cholangioscopy in patients requiring evaluation of bile duct disease or therapy of biliary stones (with videos).

PubMed

Chen, Yang K; Parsi, Mansour A; Binmoeller, Kenneth F; Hawes, Robert H; Pleskow, Douglas K; Slivka, Adam; Haluszka, Oleh; Petersen, Bret T; Sherman, Stuart; Devière, Jacques; Meisner, Søren; Stevens, Peter D; Costamagna, Guido; Ponchon, Thierry; Peetermans, Joyce A; Neuhaus, Horst

2011-10-01

The feasibility of single-operator cholangioscopy (SOC) for biliary diagnostic and therapeutic procedures was previously reported. To confirm the utility of SOC in more widespread clinical use. Prospective clinical cohort study. Fifteen endoscopy referral centers in the United States and Europe. Two hundred ninety-seven patients requiring evaluation of bile duct disease or biliary stone therapy. SOC examination and, as indicated, SOC-directed stone therapy or forceps biopsy. Procedural success defined as ability to (1) visualize target lesions and, if indicated, collect biopsy specimens adequate for histological evaluation or (2) visualize biliary stones and initiate fragmentation and removal. The overall procedure success rate was 89% (95% CI, 84%-92%). Adequate tissue for histological examination was secured in 88% of 140 patients who underwent biopsy. Overall sensitivity in diagnosing malignancy was 78% for SOC visual impression and 49% for SOC-directed biopsy. Sensitivity was higher (84% and 66%, respectively) for intrinsic bile duct malignancies. Diagnostic SOC procedures altered clinical management in 64% of patients. Procedure success was achieved in 92% of 66 patients with stones and complete stone clearance during the study SOC session in 71%. The incidence of serious procedure-related adverse events was 7.5% for diagnostic SOC and 6.1% for SOC-directed stone therapy. The study was observational in design with no control group. Evaluation of bile duct disease and biliary stone therapy can be safely performed with a high success rate by using the SOC system. Copyright © 2011 American Society for Gastrointestinal Endoscopy. Published by Mosby, Inc. All rights reserved.

Per-Oral Endoscopic Myotomy (POEM) After Previous Laparoscopic Heller Myotomy Is Feasible and Safe in a Porcine Model.

PubMed

Miles, Luke F; Frelich, Matthew J; Gould, Jon C; Dua, Kulwinder S; Jensen, Eric S; Kastenmeier, Andrew S

2015-10-01

We sought to evaluate the feasibility, safety, and difficulty of performing the per-oral endoscopic myotomy (POEM) procedure in the setting of a prior Heller myotomy using a survival porcine model. Four pigs underwent laparoscopic Heller myotomy with Dor partial anterior fundoplication followed by the POEM performed 4 weeks later. Two additional pigs served as controls, undergoing only the POEM. All procedures were completed without complications. The revisional POEM was not significantly more difficult than POEM controls based on procedure time, POEM procedure components, or procedure difficulty scores. Revisional POEM had a longer mean operative time when compared with Heller myotomy (126.0 vs. 83.8 min; P<0.01) but had a lower total difficulty score (28.6 vs. 52.1; P≪0.01). A POEM after previous Heller myotomy is safe and feasible in the porcine model and has potential as an option for patients suffering from recurrent or persistent symptoms after failed surgical myotomy.

Lymphedema of the Transplanted Kidney and Abdominal Wall with Ipsilateral Pleural Effusion Following Kidney Biopsy in a Patient Treated with Sirolimus: A Case Report and Review of the Literature

PubMed Central

Rashid-Farokhi, Farin; Afshar, Hale

2017-01-01

Patient: Female, 32 Final Diagnosis: Sirolimus induced congestion of kidney and overlying abdominal wall Symptoms: Abdominal pain • abdominal swelling • dyspnea Medication: — Clinical Procedure: Improvement of symptoms with drug withdrawal Specialty: Nephrology Objective: Adverse events of drug therapy Background: Sirolimus is a mammalian target of rapamycin (mTOR) inhibitor, which is used in immunosuppressive treatment regimens in organ transplant recipients. Although mTOR inhibitors are well tolerated, their adverse effects have been reported. Sirolimus treatment in transplant recipients has been reported to be associated with lymphedema of the skin and subcutaneous tissues, and with pleural effusion, but edema of internal organs and organomegaly have not been previously reported. A case is presented lymphedema of the transplanted kidney and abdominal wall with ipsilateral pleural effusion following kidney biopsy in a patient treated with sirolimus. Case Report: A 32-year-old woman with a history of end-stage renal disease of unknown etiology had undergone right renal transplantation from an unrelated living donor, eight years previously. She was referred to our hospital with dyspnea, localized abdominal pain, and swelling of the transplanted kidney. The symptoms appeared following a kidney biopsy and the replacement of cyclosporin with sirolimus four months previously. On examination, she had localized swelling of the abdominal wall overlying the transplanted kidney, and a right pleural effusion. Hydronephrosis and nephrotic syndrome were excluded as causes of kidney enlargement. Following the withdrawal of sirolimus therapy her symptoms resolved within three months. Conclusions: A case is described of lymphedema of the transplanted kidney and abdominal wall with ipsilateral pleural effusion following kidney biopsy attributed to her change in anti-rejection therapy to sirolimus. This case report should raise awareness of this unusual complication of sirolimus anti-rejection therapy and its possible effects on the lymphatic system. PMID:29269724

Oral clefting in china over the last decade: 205,679 patients.

PubMed

Kling, Rochelle R; Taub, Peter J; Ye, Xiaoqian; Jabs, Ethylin Wang

2014-10-01

China is the most populated country and has one of the highest prevalences of oral clefting. The present study reports the epidemiology and surgical procedures performed on the largest reported cohort of individuals with clefting in China. A retrospective review of patients who received cleft repair through Smile Train in China from 2000 to 2011 was conducted. Data on demographics, cleft characteristics, associated malformations, pregnancy and family history, and surgical technique were analyzed using SPSS (IBM, Chicago, Ill.). A total of 205,679 patients underwent 209,169 cleft procedures. Cleft lip and palate (42.7%) was most common followed by isolated cleft palate (32.4%) and isolated cleft lip (24.9%). Males accounted for 63.5% of cases. The average age at initial surgery was 6.12 years. By 2011, this decreased to 1.8 years of age for lip repair and to 5.9 years of age for palate repair. The preferred techniques were rotation-advancement (55%) for unilateral lip repair and Von-Langenbeck (38%) and pushback (39%) for palate repair. The percentages of cases with associated anomalies and surgical complications were 12.8% and 0.36%, respectively. This study provides insight into cleft care in China as it reports the largest cohort of cleft patients treated by surgeons to date. Our results generally follow trends previously reported in China and developed countries. The male:female ratio for cleft palate patients was higher than expected. The average age at primary repair is higher than recommended, but seems to be decreasing.

Cosmetic Professionals' Awareness of Body Dysmorphic Disorder.

PubMed

Bouman, Theo K; Mulkens, Sandra; van der Lei, Berend

2017-02-01

Preoccupation with a perceived appearance flaw is the main feature of body dysmorphic disorder. The majority of these patients seek and often receive some sort of cosmetic procedure, although this condition is considered to be a contraindication. This study evaluates cosmetic professionals' recognition of body dysmorphic disorder and the way they act on this. Members of Dutch professional associations for aesthetic plastic surgery, dermatology, and cosmetic medicine received an online survey by means of their association's digital mailing lists; the survey was completed by 173 respondents. Most participants indicated being more or less familiar with the diagnostic criteria and clinical picture of body dysmorphic disorder. Approximately two-thirds of the participants reported that they had encountered between one and five of these patients in their practice over the past year, a percentage that is significantly lower than the estimated prevalence of body dysmorphic disorder. The majority of professionals sometimes or often address body image problems during consultation, most of them collaborate with psychologists or psychiatrists when encountering a patient with body dysmorphic disorder, and approximately 70 percent had refused to perform a procedure in such a patient. Our results converge with those of previous studies, showing that most cosmetic professionals have some degree of awareness of body dysmorphic disorder, although the number they report encountering in clinical practice departs from prevalence figures. When a patient is identified as having body dysmorphic disorder, the professionals use this knowledge to guide their decision to perform a cosmetic procedure.

Voice outcomes following the gray minithyrotomy.

PubMed

Mallur, Pavan S; Gartner-Schmidt, Jacqueline; Rosen, Clark A

2012-07-01

Most practitioners have limited treatment options for vocal fold scar and sulcus vocalis. The Gray minithyrotomy (GMT) is a surgical procedure for the treatment of these conditions, although limited objective data exist regarding voice outcomes. This study compares the quantified subjective and visual perceptual outcomes following GMT for the treatment of vocal fold scar and sulcus vocalis. We performed a retrospective review of patients who underwent GMT in a single institution. Patient-reported satisfaction, Voice Handicap Index-10 scores, results of video perceptual analysis, and complications were recorded. Sixteen patients underwent GMT for phonotraumatic or postoperative scar (11), radiation-induced scar (3), or sulcus vocalis (2). Seven underwent bilateral operations. Follow-up data were available for 12 patients. Eight patients had 2 or more failed surgical interventions before GMT. Seven of the 13 procedures resulted in a self-reported improvement. Although the mean preoperative Voice Handicap Index-10 score (30.6) across all patients did not decrease after the operation, 6 of the 13 GMT procedures resulted in improvement (mean decrease, 7.5). Complications, encountered in 5 patients, included ecchymosis, neck abscess, tongue numbness, wound dehiscence, and aspiration pneumonia. The GMT is a viable treatment for severe vocal fold scar and sulcus vocalis. Our results show improvement in half of a cohort that was marked by previous failures at improving voice. These results point to the recalcitrant nature of voice difficulties in treating vocal fold scar and sulcus, and may properly guide clinicians and patients in their expectations following this infrequently used technique.

Human infertility: is medical treatment enough? A cross-sectional study of a sample of Italian couples.

PubMed

Sina, Manuela; Ter Meulen, Ruud; Carrasco de Paula, Ignacio

2010-09-01

To explore infertile couples' well-being, needs and drop-out rates considering their previous gynaecological history, treatments and support received. Self-reported questionnaires and a telephone follow-up were used to gather data from a sample of 57 Italian couples undergoing first-step procedures for infertility treatment. The questions concerned socio-demographic and personality factors, global perspective on generation, childbearing motivation, intra-psychic and relational dimensions. The study found a strong need for psychological and ethical counselling and showed that drop-out rates were related to psychological discontent. Among couples who had a longer history of infertility, those who had no previous treatments presented higher dyadic adjustment than those who had an history of previous treatments. Moreover, the study provides evidences of the stronger need for personal support for couples who had undergone previous treatments, and for psychological and ethical support for couples with previous generative failures. It also showed that there were beneficial effects to attending to couples' religious and ethical needs. Professional care for those who are undergoing or have undergone fertility treatment should (i) embrace a broader and more comprehensive perspective to understand infertile couples' experience and should (ii) provide appropriate therapy to cope with these experiences.

Classification and reporting of severity experienced by animals used in scientific procedures: FELASA/ECLAM/ESLAV Working Group report.

PubMed

Smith, David; Anderson, David; Degryse, Anne-Dominique; Bol, Carla; Criado, Ana; Ferrara, Alessia; Franco, Nuno Henrique; Gyertyan, Istvan; Orellana, Jose M; Ostergaard, Grete; Varga, Orsolya; Voipio, Hanna-Marja

2018-02-01

Directive 2010/63/EU introduced requirements for the classification of the severity of procedures to be applied during the project authorisation process to use animals in scientific procedures and also to report actual severity experienced by each animal used in such procedures. These requirements offer opportunities during the design, conduct and reporting of procedures to consider the adverse effects of procedures and how these can be reduced to minimize the welfare consequences for the animals. Better recording and reporting of adverse effects should also help in highlighting priorities for refinement of future similar procedures and benchmarking good practice. Reporting of actual severity should help inform the public of the relative severity of different areas of scientific research and, over time, may show trends regarding refinement. Consistency of assignment of severity categories across Member States is a key requirement, particularly if re-use is considered, or the safeguard clause is to be invoked. The examples of severity classification given in Annex VIII are limited in number, and have little descriptive power to aid assignment. Additionally, the examples given often relate to the procedure and do not attempt to assess the outcome, such as adverse effects that may occur. The aim of this report is to deliver guidance on the assignment of severity, both prospectively and at the end of a procedure. A number of animal models, in current use, have been used to illustrate the severity assessment process from inception of the project, through monitoring during the course of the procedure to the final assessment of actual severity at the end of the procedure (Appendix 1).

Classification and reporting of severity experienced by animals used in scientific procedures: FELASA/ECLAM/ESLAV Working Group report

PubMed Central

Smith, David; Anderson, David; Degryse, Anne-Dominique; Bol, Carla; Criado, Ana; Ferrara, Alessia; Gyertyan, Istvan; Orellana, Jose M; Ostergaard, Grete; Varga, Orsolya; Voipio, Hanna-Marja

2018-01-01

Directive 2010/63/EU introduced requirements for the classification of the severity of procedures to be applied during the project authorisation process to use animals in scientific procedures and also to report actual severity experienced by each animal used in such procedures. These requirements offer opportunities during the design, conduct and reporting of procedures to consider the adverse effects of procedures and how these can be reduced to minimize the welfare consequences for the animals. Better recording and reporting of adverse effects should also help in highlighting priorities for refinement of future similar procedures and benchmarking good practice. Reporting of actual severity should help inform the public of the relative severity of different areas of scientific research and, over time, may show trends regarding refinement. Consistency of assignment of severity categories across Member States is a key requirement, particularly if re-use is considered, or the safeguard clause is to be invoked. The examples of severity classification given in Annex VIII are limited in number, and have little descriptive power to aid assignment. Additionally, the examples given often relate to the procedure and do not attempt to assess the outcome, such as adverse effects that may occur. The aim of this report is to deliver guidance on the assignment of severity, both prospectively and at the end of a procedure. A number of animal models, in current use, have been used to illustrate the severity assessment process from inception of the project, through monitoring during the course of the procedure to the final assessment of actual severity at the end of the procedure (Appendix 1). PMID:29359995

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

Corcillo, Antonella, E-mail: antonella.corcillo@chuv.ch; Aellen, Steve, E-mail: steve.aellen@hopitalvs.ch; Zingg, Tobias

Purpose: Colonoscopy is reported to be a safe procedure that is routinely performed for the diagnosis and treatment of colorectal diseases. Splenic rupture is considered to be a rare complication with high mortality and morbidity that requires immediate diagnosis and management. Nonoperative management (NOM), surgical treatment (ST), and, more recently, proximal splenic artery embolization (PSAE) have been proposed as treatment options. The goal of this study was to assess whether PSAE is safe even in high-grade ruptures. Methods: We report two rare cases of post colonoscopy splenic rupture. A systematic review of the literature from 2002 to 2010 (first reportedmore » case of PSAE) was performed and the three types of treatment compared. Results: All patients reviewed (77 of 77) presented with intraperitoneal hemorrhage due to isolated splenic trauma. Splenic rupture was high-grade in most patients when grading was possible. Six of 77 patients (7.8 %) were treated with PSAE, including the 2 cases reported herein. Fifty-seven patients (74 %) underwent ST. NOM was attempted first in 25 patients with a high failure rate (11 of 25 [44 %]) and requiring a salvage procedure, such as PSAE or ST. Previous surgery (31 of 59 patients), adhesions (10 of 13), diagnostic colonoscopies (49 of 71), previous biopsies or polypectomies (31 of 57) and female sex (56 of 77) were identified as risk factors. In contrast, splenomegaly (0 of 77 patients), medications that increase the risk of bleeding (13 of 30) and difficult colonoscopies (16 of 51) were not identified as risk factors. PSAE was safe and effective even in elderly patients with comorbidities and those taking medications that increase the risk of bleeding, and the length of the hospital stay was similar to that after ST. Conclusion: We propose a treatment algorithm based on clinical and radiological criteria. Because of the high failure rate after NOM, PSAE should be the treatment of choice to manage grade I through IV splenic ruptures after colonoscopy in hemodynamically stabilized patients.« less

Do surgeons and patients discuss what they document on consent forms?

PubMed

Hall, Daniel E; Hanusa, Barbara H; Fine, Michael J; Arnold, Robert M

2015-07-01

Previous studies of surgeon behavior report that surgeons rarely meet basic standards of informed consent, raising concerns that current practice requires urgent remediation. We wondered if the Veterans Affairs Healthcare System's recent implementation of standardized, procedure-specific consent forms might produce a better practice of informed consent than has been reported previously. Our goal was to determine how the discussions shared between surgeons and patients correspond to the VA's standardized consent forms. We enrolled a prospective cohort of patients presenting for possible cholecystectomy or inguinal herniorrhaphy and the surgical providers for those patients. Audio recordings captured the clinical encounter(s) culminating in a decision to have surgery. Each patient's informed consent was documented using a standardized, computer-generated form. We abstracted and compared the information documented with the information discussed. Of 75 consecutively enrolled patients, 37 eventually decided to have surgery and signed the standardized consent form. Patients and providers discussed 37% (95% confidence interval, 0.07-0.67) and 33% (95% confidence interval, 0.21-0.43) of the information found on the cholecystectomy and herniorrhaphy consent forms, respectively. However, the patient-provider discussions frequently included relevant details nowhere documented on the standardized forms, culminating in discussions that included a median 27.5 information items for cholecystectomy and 20 items for herniorrhaphy. Fully, 80% of cholecystectomy discussions and 76% of herniorrhaphy discussions mentioned at least one risk, benefit or alternative, indication for, and description of the procedure. The patients and providers observed here collaborated in a detailed process of informed consent that challenges the initial reports suggesting the need to remediate surgeon's practice of informed consent. However, because the discrepancy between the information documented and discussed exposes legal and ethical liability, there is an opportunity to improve the iMed system so that it better reflects what surgeons discuss and more frequently includes all the information patients need. Published by Elsevier Inc.

On making laboratory report work more meaningful through criterion-based evaluation.

PubMed

Naeraa, N

1987-05-01

The purpose of this work was to encourage students to base their laboratory report work on guidelines reflecting a quality criterion set, previously derived from the functional role of the various sections in scientific papers. The materials were developed by a trial-and-error approach and comprise learning objectives, a parallel structure of manual and reports, general and specific report guidelines and a new common starting experiment. The principal contents are presented, followed by an account of the author's experience with them. Most of the author's students now follow the guidelines. Their conclusions are affected by difficulties in adjusting expected results with due regard to the specific conditions of the experimental subject or to their own deviations from the experimental or analytical procedures prescribed in the manual. Also, problems in interpreting data unbiased by explicit expectations are evident, although a clear distinction between expected and actual results has been helpful for them in seeing the relationship between experiments and textbook contents more clearly, and thus in understanding the hypothetico-deductive approach.

Mixed anhydrides (phosphoric-carboxyl) are also formed in the esterification of 5'-amp with n-acetylaminoacyl imidazolides - Implications regarding the origin of protein synthesis

NASA Technical Reports Server (NTRS)

Wickramasinghe, Nalinie S. M. D.; Lacey, James C., Jr.

1992-01-01

Procedure for the formation of aminoacyl esters of monoribonucleotides with aminoacyl imidazolides were first reported by Gottikh et al. (1970) and summarized in 1970. This reaction has been widely used by us and numbers of other workers as a convenient means of preparing aminoacyl esters of nucleotides. We have previously reported that, under conditions of excess imidazolide, large amounts of bis 2', 3' esters are formed in addition to the monoesters. However, to our knowledge, no one has reported that in addition to the esters, relatively large amounts of the mixed anhydride, with the amino acid carboxyl attached to the phosphate, are also formed at short reaction times. We report here on the relative amounts of anhydride and esters formed in this reaction of racemic mixtures of eleven N-acetyl amino acid imidazolides with 5'-AMP and discuss the relevance of the findings to the origin of protein synthesis.

Laser-ultraviolet-A-induced ultraweak photon emission in mammalian cells.

PubMed

Niggli, Hugo J; Tudisco, Salvatore; Privitera, Giuseppe; Applegate, Lee Ann; Scordino, Agata; Musumeci, Franco

2005-01-01

Photobiological research in the last 30 yr has shown the existence of ultraweak photon emission in biological tissue, which can be detected with sophisticated photomultiplier systems. Although the emission of this ultraweak radiation, often termed biophotons, is extremely low in mammalian cells, it can be efficiently increased by ultraviolet light. Most recently it was shown that UV-A (330 to 380 nm) releases such very weak cell radiation in differentiated human skin fibroblasts. Based on these findings, a new and powerful tool in the form of UV-A-laser-induced biophotonic emission of cultured cells was developed with the intention to detect biophysical changes between carcinogenic and normal cells. With suspension densities ranging from 1 to 8 x 10(6) cells/mL, it was evident that an increase of the UV-A-laser-light induced photon emission intensity could be observed in normal as well as melanoma cells. Using this new detection procedure of ultraweak light emission, photons in cell suspensions as low as 100 microL could be determined, which is a factor of 100 lower compared to previous procedures. Moreover, the detection procedure has been further refined by turning off the photomultiplier system electronically during irradiation leading to the first measurements of induced light emission in the cells after less than 10 micros instead of 150 ms, as reported in previous procedures. This improvement leads to measurements of light bursts up 10(7) photons/s instead of several hundred as found with classical designs. Overall, we find decreasing induction ratings between normal and melanoma cells as well as cancer-prone and melanoma cells. Therefore, it turns out that this highly sensitive and noninvasive device enables us to detect high levels of ultraweak photon emission following UV-A-laser-induced light stimulation within the cells, which enables future development of new biophysical strategies in cell research. Copyright 2005 Society of Photo-Optical Instrumentation Engineers.

Statistics in the pharmacy literature.

PubMed

Lee, Charlene M; Soin, Herpreet K; Einarson, Thomas R

2004-09-01

Research in statistical methods is essential for maintenance of high quality of the published literature. To update previous reports of the types and frequencies of statistical terms and procedures in research studies of selected professional pharmacy journals. We obtained all research articles published in 2001 in 6 journals: American Journal of Health-System Pharmacy, The Annals of Pharmacotherapy, Canadian Journal of Hospital Pharmacy, Formulary, Hospital Pharmacy, and Journal of the American Pharmaceutical Association. Two independent reviewers identified and recorded descriptive and inferential statistical terms/procedures found in the methods, results, and discussion sections of each article. Results were determined by tallying the total number of times, as well as the percentage, that each statistical term or procedure appeared in the articles. One hundred forty-four articles were included. Ninety-eight percent employed descriptive statistics; of these, 28% used only descriptive statistics. The most common descriptive statistical terms were percentage (90%), mean (74%), standard deviation (58%), and range (46%). Sixty-nine percent of the articles used inferential statistics, the most frequent being chi(2) (33%), Student's t-test (26%), Pearson's correlation coefficient r (18%), ANOVA (14%), and logistic regression (11%). Statistical terms and procedures were found in nearly all of the research articles published in pharmacy journals. Thus, pharmacy education should aim to provide current and future pharmacists with an understanding of the common statistical terms and procedures identified to facilitate the appropriate appraisal and consequential utilization of the information available in research articles.

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

PubMed

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

2016-06-21

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

Automation and Optimization of Multipulse Laser Zona Drilling of Mouse Embryos During Embryo Biopsy.

PubMed

Wong, Christopher Yee; Mills, James K

2017-03-01

Laser zona drilling (LZD) is a required step in many embryonic surgical procedures, for example, assisted hatching and preimplantation genetic diagnosis. LZD involves the ablation of the zona pellucida (ZP) using a laser while minimizing potentially harmful thermal effects on critical internal cell structures. Develop a method for the automation and optimization of multipulse LZD, applied to cleavage-stage embryos. A two-stage optimization is used. The first stage uses computer vision algorithms to identify embryonic structures and determines the optimal ablation zone farthest away from critical structures such as blastomeres. The second stage combines a genetic algorithm with a previously reported thermal analysis of LZD to optimize the combination of laser pulse locations and pulse durations. The goal is to minimize the peak temperature experienced by the blastomeres while creating the desired opening in the ZP. A proof of concept of the proposed LZD automation and optimization method is demonstrated through experiments on mouse embryos with positive results, as adequately sized openings are created. Automation of LZD is feasible and is a viable step toward the automation of embryo biopsy procedures. LZD is a common but delicate procedure performed by human operators using subjective methods to gauge proper LZD procedure. Automation of LZD removes human error to increase the success rate of LZD. Although the proposed methods are developed for cleavage-stage embryos, the same methods may be applied to most types LZD procedures, embryos at different developmental stages, or nonembryonic cells.

Infrainguinal arterial reconstructions in patients with aortoiliac occlusive disease: the influence of iliac stenting.

PubMed

Timaran, C H; Stevens, S L; Freeman, M B; Goldman, M H

2001-12-01

Iliac artery angioplasty (IAA) is an effective adjunct when combined with infrainguinal arterial reconstructions (IARs) in appropriate patients with multilevel occlusive disease. However, the effect of iliac artery stenting (IAS) on the outcome of patients undergoing distal bypass procedures is not defined. The purpose of this study was to estimate the influence of previous IAS for iliac occlusive disease on the outcome of IARs, compared with those after IAA alone or aortofemoral bypass grafting procedures (AFBs). During a 5-year period (1995-2000), 105 patients with previous intervention for iliac occlusive disease underwent 120 IARs. The criteria prepared by the Ad Hoc Committee on Reporting Standards (Society for Vascular Surgery/International Society for Cardiovascular Surgery) were followed to define the variables. The TransAtlantic Inter-Society Consensus classification was used to characterize the type of iliac lesions. Univariate (Kaplan-Meier) and multivariate analyses (Cox proportional hazards model) were used to determine the association between preoperative variables and cumulative primary patency. Forty-five IARs were performed in patients with an earlier IAS repair, 33 in patients with an earlier IAA repair, and 42 in patients with an earlier AFB repair. There were not significant differences between patients in the IAS and IAA groups, except for a more frequent use of polytetrafluoroethylene grafts for IARs in the IAS group (40% vs 15%; chi(2) test, P = .03). The 5-year primary patency rate for IARs was 68% in the IAS group, 46% in the IAA group, and 61% in the AFB group. Univariate analyses revealed that primary patency rates for IARs in patients with previous IAS were significantly higher than those in the IAA group (Kaplan-Meier, log-rank test, P = .02). Previous IAA repair was associated with a two-fold increased risk of IAR graft failure (relative risk, 2.2; 95% CI, 1.1-4.8; P = .04). IARs in patients with previous IAS have significantly improved graft patency, compared with those in patients with previous IAA alone. Such graft patency for IAR after IAS is similar to that obtained after AFB repair.

Hypnotism as a Function of Trance State Effects, Expectancy, and Suggestibility: An Italian Replication.

PubMed

Pekala, Ronald J; Baglio, Francesca; Cabinio, Monia; Lipari, Susanna; Baglio, Gisella; Mendozzi, Laura; Cecconi, Pietro; Pugnetti, Luigi; Sciaky, Riccardo

2017-01-01

Previous research using stepwise regression analyses found self-reported hypnotic depth (srHD) to be a function of suggestibility, trance state effects, and expectancy. This study sought to replicate and expand that research using a general state measure of hypnotic responsivity, the Phenomenology of Consciousness Inventory: Hypnotic Assessment Procedure (PCI-HAP). Ninety-five participants completed an Italian translation of the PCI-HAP, with srHD scores predicted from the PCI-HAP assessment items. The regression analysis replicated the previous research results. Additionally, stepwise regression analyses were able to predict the srHD score equally well using only the PCI dimension scores. These results not only replicated prior research but suggest how this methodology to assess hypnotic responsivity, when combined with more traditional neurophysiological and cognitive-behavioral methodologies, may allow for a more comprehensive understanding of that enigma called hypnosis.

Purification and characterization of charantin, a napin-like ribosome-inactivating peptide from bitter gourd (Momordica charantia) seeds.

PubMed

Parkash, A; Ng, T B; Tso, W W

2002-05-01

A peptide designated charantin, with a molecular mass of 9.7 kDa, was isolated from bitter gourd seeds. The procedure comprised affinity chromatography on Affi-gel blue gel, ion-exchange chromatography on Mono S and gel filtration on Superdex 75. The N-terminal sequence of charantin exhibited marked similarity to that of the 7.8-kDa napin-like peptide previously isolated from bitter gourd seeds. Charantin inhibited cell-free translation in a rabbit reticulocyte lysate system with an IC50 of 400 nm, a potency lower than that of the previously reported small ribosome-inactivating protein gamma-momorcharin (IC50 = 55 nm) which also exhibited an abundance of arginine and glutamate/glutamine residues. Charantin reacted positively in the N-glycosidase assay, yielding a band similar to that formed by the small ribosome-inactivating proteins gamma-momorcharin and luffin S.

Delaying Shoulder Motion and Strengthening and Increasing Achilles Allograft Thickness for Glenoid Resurfacing Did Not Improve the Outcome for a 30-Year-Old Patient with Postarthroscopic Glenohumeral Chondrolysis

PubMed Central

Skedros, John G.; Henrie, Tanner R.; Mears, Chad S.

2014-01-01

Although interposition soft-tissue (biologic) resurfacing of the glenoid with humeral hemiarthroplasty has been considered an option for end-stage glenohumeral arthritis, the results of this procedure are highly unsatisfactory in patients less than 40 years old. Achilles tendon allograft is popular for glenoid resurfacing because it can be made robust by folding it. But one reason that the procedure might fail in younger patients is that the graft is not initially thick enough for the young active patient. Most authors report folding the graft only once to achieve two-layer thickness. We report the case of a 30-year-old male who had postarthroscopic glenohumeral chondrolysis that was treated with Achilles tendon allograft resurfacing of the glenoid and humeral hemiarthroplasty. An important aspect of our case is that the tendon was folded so that it was 50–100% thicker than most allograft constructs reported previously. We also used additional measures to enhance allograft resiliency and bone incorporation: (1) multiple nonresorbable sutures to attach the adjacent graft layers, (2) additional resorbable suture anchors and nonresorbable sutures in order to more robustly secure the graft to the glenoid, and (3) delaying postoperative motion and strengthening. However, despite these additional measures, our patient did not have an improved outcome. PMID:25580331

Lumbar lateral shift in a patient with interspinous device implantation: a case report.

PubMed

Peterson, Seth; Hodges, Cheri

2016-09-01

Lumbar lateral shift (LLS) is a common clinical observation but has rarely been described in a patient with a history of lumbar surgery. The purpose of the current case report was to describe the use of the McKenzie Method of Mechanical Diagnosis and Therapy (MDT) in the multi-modal treatment of a patient with an LLS and a history of multiple surgical procedures in the lumbar spine, including interspinous process device (IPD) implantation. A 72-year-old female with chronic low back pain (LBP) and a surgical history in the lumbar spine was referred to physical therapy for radiating leg pain and presented with a right LLS. Her chief complaints included sitting for long periods, vacuuming and ascending stairs into her home. The patient was treated during eight visits over 30 days. Treatment interventions included manual shift correction, self-correction and management, joint mobilisation below the level of IPD implantation ,neurophysiology education, and development of a home exercise programme. At discharge, her leg pain was resolved and all goals had been met. The patient reported maintenance of gains at 6-month follow-up. Utilisation of the MDT approach, including LLS correction, produced positive outcomes in a complex patient with previous IPD implantation. Future research should investigate treatment and outcomes after invasive spinal procedures in similar patient populations to better inform clinical management. 4.

Partial report and other sampling procedures overestimate the duration of iconic memory.

PubMed

Appelman, I B

1980-03-01

In three experiments, subjects estimated the duration of a brief visual image (iconic memory) either directly by adjusting onset of a click to offset of the visual image, or indirectly with a Sperling partial report (sampling) procedure. The results indicated that partial report and other sampling procedures may reflect other brief phenomena along with iconic memory. First, the partial report procedure yields a greater estimate of the duration of iconic memory than the more direct click method. Second, the partial report estimate of the duration of iconic memory is affected if the subject is required to simultaneously retain a list of distractor items (memory load), while the click method estimate of the duration of iconic memory is not affected by a memory load. Finally, another sampling procedure based on visual cuing yields different estimates of the duration of iconic memory depending on how many items are cued. It was concluded that partial report and other sampling procedures overestimate the duration of iconic memory.

Diagnostic reference level: an important tool for reducing radiation doses in adult and pediatric nuclear medicine procedures in Brazil.

PubMed

Willegaignon, José; Braga, Luis F E F; Sapienza, Marcelo T; Coura-Filho, George B; Cardona, Marissa A R; Alves, Carlos E R; Gutterres, Ricardo F; Buchpiguel, Carlos A

2016-05-01

This study aimed to establish a concise method for determining a diagnostic reference level (DRL) for adult and pediatric nuclear medicine patients on the basis of diagnostic procedures and administered radioisotope as a means of controlling medical exposure. A screening was carried out in all Brazilian Nuclear Medicine Service (NMS) establishments to support this study by collecting the average activities administered during adult diagnostic procedures and the rules applied to adjust these according to the patient's age and body mass. Percentile 75 was used in all the activities administered as a means of establishing DRL for adult patients, with additional correction factors for pediatric patients. Radiation doses from nuclear medicine procedures on the basis of average administered activity were calculated for all diagnostic exams. A total of 107 NMSs in Brazil agreed to participate in the project. From the 64 nuclear medicine procedures studied, bone, kidney, and parathyroid scans were found to be used in more than 85% of all the NMSs analyzed. There was a large disparity among the activities administered, when applying the same procedures, this reaching, in some cases, more than 20 times between the lowest and the highest. Diagnostic exams based on Ga, Tl, and I radioisotopes proved to be the major exams administering radiation doses to patients. On introducing the DRL concept into clinical routine, the minimum reduction in radiation doses received by patients was about 15%, the maximum was 95%, and the average was 50% compared with the previously reported administered activities. Variability in the available diagnostic procedures as well as in the amount of activities administered within the same procedure was appreciable not only in Brazil, but worldwide. Global efforts are needed to establish a concise DRL that can be applied in adult and pediatric nuclear medicine procedures as the application of DRL in clinical routine has been proven to be an important tool for controlling and reducing radiation doses received by patients in medical exposure.

Establishing Arbitrarily Applicable Relations of Same and Opposite with the Relational Completion Procedure: Selection-Based Feedback

ERIC Educational Resources Information Center

Dymond, Simon; Ng, Tsz Ching; Whelan, Robert

2013-01-01

Research suggests that the relational completion procedure (RCP) is effective for studying derived relations of same and opposite. Previously, procedural parameters, such as the presence or absence of a confirmatory response requirement, were found to have a facilitative effect on the number of training trials to criterion and overall arbitrary…

Exploring the Efficacy of Behavioral Skills Training to Teach Basic Behavior Analytic Techniques to Oral Care Providers

ERIC Educational Resources Information Center

Graudins, Maija M.; Rehfeldt, Ruth Anne; DeMattei, Ronda; Baker, Jonathan C.; Scaglia, Fiorella

2012-01-01

Performing oral care procedures with children with autism who exhibit noncompliance can be challenging for oral care professionals. Previous research has elucidated a number of effective behavior analytic procedures for increasing compliance, but some procedures are likely to be too time consuming and expensive for community-based oral care…

Training with Differential Outcomes Enhances Discriminative Learning and Visuospatial Recognition Memory in Children Born Prematurely

ERIC Educational Resources Information Center

Martinez, Lourdes; Mari-Beffa, Paloma; Roldan-Tapia, Dolores; Ramos-Lizana, Julio; Fuentes, Luis J.; Estevez, Angeles F.

2012-01-01

Previous studies have demonstrated that discriminative learning is facilitated when a particular outcome is associated with each relation to be learned. When this training procedure is applied (the differential outcome procedure; DOP), learning is faster and more accurate than when the more common non-differential outcome procedure is used. This…

The Effects of Rationales, Differential Reinforcement, and a Guided Compliance Procedure to Increase Compliance among Preschool Children

ERIC Educational Resources Information Center

Wilder, David A.; Myers, Kristin; Nicholson, Katie; Allison, Janelle; Fischetti, Anthony T.

2012-01-01

Previous research suggests that rationales, or statements describing why a child should comply with a caregiver-delivered instruction, are ineffective at increasing compliance. In the current study, we compared the effects of rationales to a differential reinforcement procedure and a guided compliance procedure. The results indicated that…

Preparedness of Entering Pediatric Dentistry Residents: Advanced Pediatric Program Directors' and First-Year Residents' Perspectives.

PubMed

Rutkauskas, John; Seale, N Sue; Casamassimo, Paul; Rutkauskas, John S

2015-11-01

For children to receive needed oral health care, adequate training at both the predoctoral and postdoctoral levels of dental education is required, but previous studies have found inadequacies in predoctoral education that lead to general dentists' unwillingness to treat certain young populations. As another way of assessing predoctoral preparation, the aim of this study was to determine the perspectives of first-year residents and pediatric program directors about residents' preparedness to enter advanced education programs in pediatric dentistry. Surveys were sent to all 74 U.S. program directors and 360 first-year residents. The survey focused on procedures related to prevention, behavior management, restorative procedures, pulp therapy, sedation, and surgery, as well as treating patients funded by Medicaid and with special health care needs. Among the first-year residents, 173 surveys were returned for a 48% response rate; 61 directors returned surveys for an 82% response rate. Only half of the residents (55%) reported feeling adequately prepared for their first year in residency; less than half cited adequate preparation to place stainless steel crowns (SSCs) (42%) and perform pulpotomies (45%). Far fewer felt adequately prepared to provide treatment for children six months to three years of age, including examinations (29%), infant oral exams (27%), and children with severe caries (37%). The program directors were even less positive about the adequacy of residents' preparation. Only 17% deemed them adequately prepared to place SSCs and 13% to perform pulpotomies. Approximately half reported their first-year residents were inadequately prepared to treat very young children and children with severe caries (55% each). This study found that the perceived inadequacy of predoctoral education in pediatric dentistry was consistent at both the learner and educator levels, supporting previous studies identifying inadequacies in this area.

Updates to watershed modeling in the Potholes Reservoir basin, Washington-a supplement to Scientific Investigation Report 2009-5081

USGS Publications Warehouse

Mastin, Mark

2012-01-01

A previous collaborative effort between the U.S. Geological Survey and the Bureau of Reclamation resulted in a watershed model for four watersheds that discharge into Potholes Reservoir, Washington. Since the model was constructed, two new meteorological sites have been established that provide more reliable real-time information. The Bureau of Reclamation was interested in incorporating this new information into the existing watershed model developed in 2009, and adding measured snowpack information to update simulated results and to improve forecasts of runoff. This report includes descriptions of procedures to aid a user in making model runs, including a description of the Object User Interface for the watershed model with details on specific keystrokes to generate model runs for the contributing basins. A new real-time, data-gathering computer program automates the creation of the model input files and includes the new meteorological sites. The 2009 watershed model was updated with the new sites and validated by comparing simulated results to measured data. As in the previous study, the updated model (2012 model) does a poor job of simulating individual storms, but a reasonably good job of simulating seasonal runoff volumes. At three streamflow-gaging stations, the January 1 to June 30 retrospective forecasts of runoff volume for years 2010 and 2011 were within 40 percent of the measured runoff volume for five of the six comparisons, ranging from -39.4 to 60.3 percent difference. A procedure for collecting measured snowpack data and using the data in the watershed model for forecast model runs, based on the Ensemble Streamflow Prediction method, is described, with an example that uses 2004 snow-survey data.

A research program in empirical computer science

NASA Technical Reports Server (NTRS)

Knight, J. C.

1991-01-01

During the grant reporting period our primary activities have been to begin preparation for the establishment of a research program in experimental computer science. The focus of research in this program will be safety-critical systems. Many questions that arise in the effort to improve software dependability can only be addressed empirically. For example, there is no way to predict the performance of the various proposed approaches to building fault-tolerant software. Performance models, though valuable, are parameterized and cannot be used to make quantitative predictions without experimental determination of underlying distributions. In the past, experimentation has been able to shed some light on the practical benefits and limitations of software fault tolerance. It is common, also, for experimentation to reveal new questions or new aspects of problems that were previously unknown. A good example is the Consistent Comparison Problem that was revealed by experimentation and subsequently studied in depth. The result was a clear understanding of a previously unknown problem with software fault tolerance. The purpose of a research program in empirical computer science is to perform controlled experiments in the area of real-time, embedded control systems. The goal of the various experiments will be to determine better approaches to the construction of the software for computing systems that have to be relied upon. As such it will validate research concepts from other sources, provide new research results, and facilitate the transition of research results from concepts to practical procedures that can be applied with low risk to NASA flight projects. The target of experimentation will be the production software development activities undertaken by any organization prepared to contribute to the research program. Experimental goals, procedures, data analysis and result reporting will be performed for the most part by the University of Virginia.

Local repair of stoma prolapse: Case report of an in vivo application of linear stapler devices.

PubMed

Monette, Margaret M; Harney, Rodney T; Morris, Melanie S; Chu, Daniel I

2016-11-01

One of the most common late complications following stoma construction is prolapse. Although the majority of prolapse can be managed conservatively, surgical revision is required with incarceration/strangulation and in certain cases laparotomy and/or stoma reversal are not appropriate. This report will inform surgeons on safe and effective approaches to revising prolapsed stomas using local techniques. A 58 year old female with an obstructing rectal cancer previously received a diverting transverse loop colostomy. On completion of neoadjuvant treatment, re-staging found new lung metastases. She was scheduled for further chemotherapy but incarcerated a prolapsed segment of her loop colostomy. As there was no plan to resect her primary rectal tumor at the time, a local revision was preferred. Linear staplers were applied to the prolapsed stoma in step-wise fashion to locally revise the incarcerated prolapse. Post-operative recovery was satisfactory with no complications or recurrence of prolapse. We detail in step-wise fashion a technique using linear stapler devices that can be used to locally revise prolapsed stoma segments and therefore avoid a laparotomy. The procedure is technically easy to perform with satisfactory post-operative outcomes. We additionally review all previous reports of local repairs and show the evolution of local prolapse repair to the currently reported technique. This report offers surgeons an alternative, efficient and effective option for addressing the complications of stoma prolapse. While future studies are needed to assess long-term outcomes, in the short-term, our report confirms the safety and effectiveness of this local technique.

Self-reported pain after orthodontic treatments: a randomized controlled study on the effects of two follow-up procedures

PubMed Central

Cozzani, Mauro; Delucchi, Alessia; Barreca, Carlo; Rinchuse, Daniel J.; Servetto, Roberto; Calevo, Maria Grazia; Piras, Vincenzo

2016-01-01

Summary Objectives: To assess the effects of a follow-up text message and a telephone call after bonding on participants’ self-reported level of pain. Materials and methods: Eighty-four participants were randomly assigned to one of three trial arms. Randomization was performed by the Department of Epidemiology and Biostatistics of IRCCS G.Gaslini. Participants were enrolled from patients with a permanent dentition who were beginning fixed no extraction treatment at the Orthodontic Department, Gaslini Hospital. Participants completed baseline questionnaires to assess their levels of pain prior to treatment. After the initial appointment, participants were completed a pain questionnaire at the same time, daily, for 7 days. The first group, served as control, did not receive any post-procedure communication; the second group received a structured text message; and the third group received a structured telephone call. Participants were blinded to group assignment. Limitations: A larger sample size should have been considered in order to increase the ability to generalize this study’s results. Results: Participants in both the telephone call group and the text message group reported lower level of pain than participants in the control group with a larger and more consistent effect for the telephone call group. Most participants reported a higher level of pain during the first 48 hours post-bonding. The analgesic’s consumption significantly correlated with the level of pain during the previous 24 hours. Female participants appeared to be more sensitive to pain than male participants. Conclusions: A telephone follow-up after orthodontic treatment may be an effective procedure to reduce participants’ level of pain. Protocol: The research protocol was approved by the Italian Comitato Etico Regionale della Liguria-sezione 3^ c/o IRCCS- Istituto G.Gaslini 845/2014. Registration: 182 Reg 2014, 16/09/2014 Comitato Etico Regione Liguria, Sez.3. PMID:26070922

Self-reported pain after orthodontic treatments: a randomized controlled study on the effects of two follow-up procedures.

PubMed

Cozzani, Mauro; Ragazzini, Giulia; Delucchi, Alessia; Barreca, Carlo; Rinchuse, Daniel J; Servetto, Roberto; Calevo, Maria Grazia; Piras, Vincenzo

2016-06-01

To assess the effects of a follow-up text message and a telephone call after bonding on participants' self-reported level of pain. Eighty-four participants were randomly assigned to one of three trial arms. Randomization was performed by the Department of Epidemiology and Biostatistics of IRCCS G.Gaslini. Participants were enrolled from patients with a permanent dentition who were beginning fixed no extraction treatment at the Orthodontic Department, Gaslini Hospital. Participants completed baseline questionnaires to assess their levels of pain prior to treatment. After the initial appointment, participants were completed a pain questionnaire at the same time, daily, for 7 days. The first group, served as control, did not receive any post-procedure communication; the second group received a structured text message; and the third group received a structured telephone call. Participants were blinded to group assignment. A larger sample size should have been considered in order to increase the ability to generalize this study's results. Participants in both the telephone call group and the text message group reported lower level of pain than participants in the control group with a larger and more consistent effect for the telephone call group. Most participants reported a higher level of pain during the first 48 hours post-bonding. The analgesic's consumption significantly correlated with the level of pain during the previous 24 hours. Female participants appeared to be more sensitive to pain than male participants. A telephone follow-up after orthodontic treatment may be an effective procedure to reduce participants' level of pain. The research protocol was approved by the Italian Comitato Etico Regionale della Liguria-sezione 3^ c/o IRCCS- Istituto G.Gaslini 845/2014. 182 Reg 2014, 16/09/2014 Comitato Etico Regione Liguria, Sez.3. © The Author 2015. Published by Oxford University Press on behalf of the European Orthodontic Society. All rights reserved. For permissions, please email: journals.permissions@oup.com.

A novel implantable device for the treatment of obstructive sleep apnea: clinical safety and feasibility.

PubMed

Pavelec, Vaclav; Rotenberg, Brian W; Maurer, Joachim T; Gillis, Edward; Verse, Thomas

2016-01-01

Many cases of obstructive sleep apnea (OSA) involve collapse of the tongue base and soft palate during sleep, causing occlusion of the upper airway and leading to oxygen desaturation. Existing therapies can be effective, but they are plagued by patient adherence issues and the invasiveness of surgical approaches. A new, minimally invasive implant for OSA has been developed, which is elastic and contracts a few weeks after deployment, stabilizing the surrounding soft tissue. The device has had good outcomes in preclinical testing; this report describes the preliminary feasibility and safety of its implementation in humans. A prospective, multicenter, single-arm feasibility study was conducted. Subjects were adults with moderate-to-severe OSA who had previously failed or refused conventional continuous positive airway pressure treatment. Intraoperative feasibility data, postoperative pain, and safety information were collected for a 30-day postoperative period. Forty subjects participated (37 men, three women; average age of 46.1 years); each received two tongue-base implants and two soft-palate implants. Surgical procedure time averaged 43 minutes. Postsurgical pain resolved readily in most cases; at 30 days post implantation, <20% of subjects reported pain, which averaged less than two out of ten. Adverse events were generally the mild and expected sequelae of a surgical procedure with general anesthesia and intraoral manipulation. The device was well tolerated. Implant extrusions were reported with soft-palate implants (n=12), while tongue-base implants required few revisions (n=2). Quantitative and qualitative sleep effectiveness outcomes (including full-night polysomnographic and quality-of-life measures) will be presented in a subsequent report. Implantation of the device was feasible. Although a relatively high rate of extrusions occurred in the now-discontinued palate implants, tongue-base implants were largely stable and well tolerated. The minimally invasive and maintenance-free implant may provide a new alternative to higher morbidity surgical procedures.