Are the results of multiple drilling and alendronate for osteonecrosis of the femoral head better than those of multiple drilling? A pilot study.

PubMed

Kang, Pengde; Pei, Fuxing; Shen, Bin; Zhou, Zongke; Yang, Jing

2012-01-01

The treatment of osteonecrosis of the femoral head (ONFH) remains controversial. A recently proposed treatment is multiple drilling core decompression combined with systemic alendronate as a femoral head-preserving procedure for ONFH. However, it is not known whether alendronate enhances the risk of collapse. We wondered whether the combined procedure could delay or prevent progression of ONFH compared to multiple drilling alone. Patients with early-stage ONFH were randomly assigned to be treated with either multiple drilling combined with alendronate (47 patients, 67 hips) or multiple drilling alone (46 patients, 60 hips). We defined failure as the need for THA or a Harris score less than 70. The minimum follow-up was 48 months for the 77 patients completing the protocol. After a minimum 4-year follow-up, 91% (40/44) of patients with Stage II disease and 62% (8/13) of patients with Stage III disease had not required THA in alendronate group, compared to 79% (31/39) of patients with Stage II disease and 46% (6/13) of patients with Stage III disease had not required THA in control group (P=0.12, P=0.047, respectively). Small or medium and central lesions had a better successful rate in both groups. Risk factors did not seem to affect the clinical successful rate of this procedure. Multiple small-diameter drilling core decompression combined with systemic alendronate administration can reduce pain and delay progression of early-stage ONFH. Even in Ficat IIA and III hips, some benefit was obtained from this approach at least delay in the need for THA. Copyright © 2011. Published by Elsevier SAS.

Step wise, multiple objective calibration of a hydrologic model for a snowmelt dominated basin

USGS Publications Warehouse

Hay, L.E.; Leavesley, G.H.; Clark, M.P.; Markstrom, S.L.; Viger, R.J.; Umemoto, M.

2006-01-01

The ability to apply a hydrologic model to large numbers of basins for forecasting purposes requires a quick and effective calibration strategy. This paper presents a step wise, multiple objective, automated procedure for hydrologic model calibration. This procedure includes the sequential calibration of a model's simulation of solar radiation (SR), potential evapotranspiration (PET), water balance, and daily runoff. The procedure uses the Shuffled Complex Evolution global search algorithm to calibrate the U.S. Geological Survey's Precipitation Runoff Modeling System in the Yampa River basin of Colorado. This process assures that intermediate states of the model (SR and PET on a monthly mean basis), as well as the water balance and components of the daily hydrograph are simulated, consistently with measured values.

Children's Understanding of the Inverse Relation between Multiplication and Division

ERIC Educational Resources Information Center

Robinson, Katherine M.; Dube, Adam K.

2009-01-01

Children's understanding of the inversion concept in multiplication and division problems (i.e., that on problems of the form "d multiplied by e/e" no calculations are required) was investigated. Children in Grades 6, 7, and 8 completed an inversion problem-solving task, an assessment of procedures task, and a factual knowledge task of simple…

Renoduodenal Fistula After Transcatheter Embolization of Renal Angiomyolipoma

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

Sheth, Rahul A.; Feldman, Adam S.; Walker, T. Gregory, E-mail: tgwalker@partners.org

Transcatheter embolization of renal angiomyolipomas is a routinely performed, nephron-sparing procedure with a favorable safety profile. Complications from this procedure are typically minor in severity, with postembolization syndrome the most common minor complication. Abscess formation is a recognized but uncommon major complication of this procedure and is presumably due to superinfection of the infarcted tissue after arterial embolization. In this case report, we describe the formation of a renoduodenal fistula after embolization of an angiomyolipoma, complicated by intracranial abscess formation and requiring multiple percutaneous drainage procedures and eventual partial nephrectomy.

Laser Speckle Photography: Some Simple Experiments for the Undergraduate Laboratory.

ERIC Educational Resources Information Center

Bates, B.; And Others

1986-01-01

Describes simple speckle photography experiments which are easy to set up and require only low cost standard laboratory equipment. Included are procedures for taking single, double, and multiple exposures. (JN)

Comparing the development of the multiplication of fractions in Turkish and American textbooks

NASA Astrophysics Data System (ADS)

Kar, Tuğrul; Güler, Gürsel; Şen, Ceylan; Özdemir, Ercan

2018-02-01

This study analyzed the methods used to teach the multiplication of fractions in Turkish and American textbooks. Two Turkish textbooks and two American textbooks, Everyday Mathematics (EM) and Connected Mathematics 3 (CM), were analyzed. The analyses focused on the content and the nature of the mathematical problems presented in the textbooks. The findings of the study showed that the American textbooks aimed at developing conceptual understanding first and then procedural fluency, whereas the Turkish textbooks aimed at developing both concurrently. The American textbooks provided more opportunities for different computational strategies. The solutions to most problems in all textbooks required a single computational step, a numerical answer, and procedural knowledge. Furthermore, compared with the Turkish textbooks, the American textbooks contained a greater number of problems that required high-level cognitive skills such as mathematical reasoning.

Finite-error metrological bounds on multiparameter Hamiltonian estimation

NASA Astrophysics Data System (ADS)

Kura, Naoto; Ueda, Masahito

2018-01-01

Estimation of multiple parameters in an unknown Hamiltonian is investigated. We present upper and lower bounds on the time required to complete the estimation within a prescribed error tolerance δ . The lower bound is given on the basis of the Cramér-Rao inequality, where the quantum Fisher information is bounded by the squared evolution time. The upper bound is obtained by an explicit construction of estimation procedures. By comparing the cases with different numbers of Hamiltonian channels, we also find that the few-channel procedure with adaptive feedback and the many-channel procedure with entanglement are equivalent in the sense that they require the same amount of time resource up to a constant factor.

Long‐term Outcomes of Catheter Ablation of Atrial Fibrillation: A Systematic Review and Meta‐analysis

PubMed Central

Ganesan, Anand N.; Shipp, Nicholas J.; Brooks, Anthony G.; Kuklik, Pawel; Lau, Dennis H.; Lim, Han S.; Sullivan, Thomas; Roberts‐Thomson, Kurt C.; Sanders, Prashanthan

2013-01-01

Background In the past decade, catheter ablation has become an established therapy for symptomatic atrial fibrillation (AF). Until very recently, few data have been available to guide the clinical community on the outcomes of AF ablation at ≥3 years of follow‐up. We aimed to systematically review the medical literature to evaluate the long‐term outcomes of AF ablation. Methods and Results A structured electronic database search (PubMed, Embase, Web of Science, Cochrane) of the scientific literature was performed for studies describing outcomes at ≥3 years after AF ablation, with a mean follow‐up of ≥24 months after the index procedure. The following data were extracted: (1) single‐procedure success, (2) multiple‐procedure success, and (3) requirement for repeat procedures. Data were extracted from 19 studies, including 6167 patients undergoing AF ablation. Single‐procedure freedom from atrial arrhythmia at long‐term follow‐up was 53.1% (95% CI 46.2% to 60.0%) overall, 54.1% (95% CI 44.4% to 63.4%) in paroxysmal AF, and 41.8% (95% CI 25.2% to 60.5%) in nonparoxysmal AF. Substantial heterogeneity (I2>50%) was noted for single‐procedure outcomes. With multiple procedures, the long‐term success rate was 79.8% (95% CI 75.0% to 83.8%) overall, with significant heterogeneity (I2>50%).The average number of procedures per patient was 1.51 (95% CI 1.36 to 1.67). Conclusions Catheter ablation is an effective and durable long‐term therapeutic strategy for some AF patients. Although significant heterogeneity is seen with single procedures, long‐term freedom from atrial arrhythmia can be achieved in some patients, but multiple procedures may be required. PMID:23537812

Investigation of Severe Craniomaxillofacial Battle Injuries Sustained by U.S. Service Members: A Case Series

PubMed Central

Brown Baer, Pamela R.; Wenke, Joseph C.; Thomas, Steven J.; Hale, Colonel Robert G.

2012-01-01

This case series describes craniomaxillofacial battle injuries, currently available surgical techniques, and the compromised outcomes of four service members who sustained severe craniomaxillofacial battle injuries in Iraq or Afghanistan. Demographic information, diagnostic evaluation, surgical procedures, and outcomes were collected and detailed with a follow-up of over 2 years. Reconstructive efforts with advanced, multidisciplinary, and multiple revision procedures were indicated; the full scope of conventional surgical options and resources were utilized. Patients experienced surgical complications, including postoperative wound dehiscence, infection, flap failure, inadequate mandibular healing, and failure of fixation. These complications required multiple revisions and salvage interventions. In addition, facial burns complicated reconstructive efforts by delaying treatment, decreasing surgical options, and increasing procedural numbers. All patients, despite multiple surgeries, continue to have functional and aesthetic deficits as a result of their injuries. Currently, no conventional treatments are available to satisfactorily reconstruct the face severely ravaged by explosive devices to an acceptable level, much less to natural form and function. PMID:24294409

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.

Improvement of structural models using covariance analysis and nonlinear generalized least squares

NASA Technical Reports Server (NTRS)

Glaser, R. J.; Kuo, C. P.; Wada, B. K.

1992-01-01

The next generation of large, flexible space structures will be too light to support their own weight, requiring a system of structural supports for ground testing. The authors have proposed multiple boundary-condition testing (MBCT), using more than one support condition to reduce uncertainties associated with the supports. MBCT would revise the mass and stiffness matrix, analytically qualifying the structure for operation in space. The same procedure is applicable to other common test conditions, such as empty/loaded tanks and subsystem/system level tests. This paper examines three techniques for constructing the covariance matrix required by nonlinear generalized least squares (NGLS) to update structural models based on modal test data. The methods range from a complicated approach used to generate the simulation data (i.e., the correct answer) to a diagonal matrix based on only two constants. The results show that NGLS is very insensitive to assumptions about the covariance matrix, suggesting that a workable NGLS procedure is possible. The examples also indicate that the multiple boundary condition procedure more accurately reduces errors than individual boundary condition tests alone.

Multiple IMU system test plan, volume 4. [subroutines for space shuttle requirements

NASA Technical Reports Server (NTRS)

Landey, M.; Vincent, K. T., Jr.; Whittredge, R. S.

1974-01-01

Operating procedures for this redundant system are described. A test plan is developed with two objectives. First, performance of the hardware and software delivered is demonstrated. Second, applicability of multiple IMU systems to the space shuttle mission is shown through detailed experiments with FDI algorithms and other multiple IMU software: gyrocompassing, calibration, and navigation. Gimbal flip is examined in light of its possible detrimental effects on FDI and navigation. For Vol. 3, see N74-10296.

Reconstruction after complex facial trauma: achieving optimal outcome through multiple contemporary surgeries.

PubMed

Jaiswal, Rohit; Pu, Lee L Q

2013-04-01

Major facial trauma injuries often require complex repair. Traditionally, the reconstruction of such injuries has primarily utilized only free tissue transfer. However, the advent of newer, contemporary procedures may lead to potential reconstructive improvement through the use of complementary procedures after free flap reconstruction. An 18-year-old male patient suffered a major left facial degloving injury resulting in soft-tissue defect with exposed zygoma, and parietal bone. Multiple operations were undertaken in a staged manner for reconstruction. A state-of-the-art free anterolateral thigh (ALT) perforator flap and Medpor implant reconstruction of the midface were initially performed, followed by flap debulking, lateral canthopexy, midface lift with redo canthopexy, scalp tissue expansion for hairline reconstruction, and epidermal skin grafting for optimal skin color matching. Over a follow-up period of 2 years, a good and impressive reconstructive result was achieved through the use of multiple contemporary reconstructive procedures following an excellent free ALT flap reconstruction. Multiple staged reconstructions are essential in producing an optimal outcome in this complex facial injury that would likely not have been produced through a 1-stage traditional free flap reconstruction. Utilizing multiple, sequential contemporary surgeries may substantially improve outcome through the enhancement and refinement of results based on possibly the best initial soft-tissue reconstruction.

Investigation of advanced counterrotation blade configuration concepts for high speed turboprop systems. Task 4: Advanced fan section aerodynamic analysis computer program user's manual

NASA Technical Reports Server (NTRS)

Crook, Andrew J.; Delaney, Robert A.

1992-01-01

The computer program user's manual for the ADPACAPES (Advanced Ducted Propfan Analysis Code-Average Passage Engine Simulation) program is included. The objective of the computer program is development of a three-dimensional Euler/Navier-Stokes flow analysis for fan section/engine geometries containing multiple blade rows and multiple spanwise flow splitters. An existing procedure developed by Dr. J. J. Adamczyk and associates at the NASA Lewis Research Center was modified to accept multiple spanwise splitter geometries and simulate engine core conditions. The numerical solution is based upon a finite volume technique with a four stage Runge-Kutta time marching procedure. Multiple blade row solutions are based upon the average-passage system of equations. The numerical solutions are performed on an H-type grid system, with meshes meeting the requirement of maintaining a common axisymmetric mesh for each blade row grid. The analysis was run on several geometry configurations ranging from one to five blade rows and from one to four radial flow splitters. The efficiency of the solution procedure was shown to be the same as the original analysis.

Further investigation on "A multiplicative regularization for force reconstruction"

NASA Astrophysics Data System (ADS)

Aucejo, M.; De Smet, O.

2018-05-01

We have recently proposed a multiplicative regularization to reconstruct mechanical forces acting on a structure from vibration measurements. This method does not require any selection procedure for choosing the regularization parameter, since the amount of regularization is automatically adjusted throughout an iterative resolution process. The proposed iterative algorithm has been developed with performance and efficiency in mind, but it is actually a simplified version of a full iterative procedure not described in the original paper. The present paper aims at introducing the full resolution algorithm and comparing it with its simplified version in terms of computational efficiency and solution accuracy. In particular, it is shown that both algorithms lead to very similar identified solutions.

APPLICATION OF SPATIAL INFORMATION TECHNOLOGY TO PETROLEUM RESOURCE ASSESSMENT ANALYSIS.

USGS Publications Warehouse

Miller, Betty M.; Domaratz, Michael A.

1984-01-01

Petroleum resource assessment procedures require the analysis of a large volume of spatial data. The US Geological Survey (USGS) has developed and applied spatial information handling procedures and digital cartographic techniques to a recent study involving the assessment of oil and gas resource potential for 74 million acres of designated and proposed wilderness lands in the western United States. The part of the study which dealt with the application of spatial information technology to petroleum resource assessment procedures is reviewed. A method was designed to expedite the gathering, integrating, managing, manipulating and plotting of spatial data from multiple data sources that are essential in modern resource assessment procedures.

Cross-Sectional Time Series Designs: A General Transformation Approach.

ERIC Educational Resources Information Center

Velicer, Wayne F.; McDonald, Roderick P.

1991-01-01

The general transformation approach to time series analysis is extended to the analysis of multiple unit data by the development of a patterned transformation matrix. The procedure includes alternatives for special cases and requires only minor revisions in existing computer software. (SLD)

Unpacking Referent Units in Fraction Operations

ERIC Educational Resources Information Center

Philipp, Randolph A.; Hawthorne, Casey

2015-01-01

Although fraction operations are procedurally straightforward, they are complex, because they require learners to conceptualize different units and view quantities in multiple ways. Prospective secondary school teachers sometimes provide an algebraic explanation for inverting and multiplying when dividing fractions. That authors of this article…

Specific arithmetic calculation deficits in children with Turner syndrome.

PubMed

Rovet, J; Szekely, C; Hockenberry, M N

1994-12-01

Study 1 compared arithmetic processing skills on the WRAT-R in 45 girls with Turner syndrome (TS) and 92 age-matched female controls. Results revealed significant underachievement by subjects with TS, which reflected their poorer performance on problems requiring the retrieval of addition and multiplication facts and procedural knowledge for addition and division operations. TS subjects did not differ qualitatively from controls in type of procedural error committed. Study 2, which compared the performance of 10 subjects with TS and 31 controls on the Keymath Diagnostic Arithmetic Test, showed that the TS group had less adequate knowledge of arithmetic, subtraction, and multiplication procedures but did not differ from controls on Fact items. Error analyses revealed that TS subjects were more likely to confuse component steps or fail to separate intermediate steps or to complete problems. TS subjects relied to a greater degree on verbal than visual-spatial abilities in arithmetic processing while their visual-spatial abilities were associated with retrieval of simple multidigit addition facts and knowledge of subtraction, multiplication, and division procedures. Differences between the TS and control groups increased with age for Keymath, but not WRAT-R, procedures. Discrepant findings are related to the different task constraints (timed vs. untimed, single vs. alternate versions, size of item pool) and the use of different strategies (counting vs. fact retrieval). It is concluded that arithmetic difficulties in females with TS are due to less adequate procedural skills, combined with poorer fact retrieval in timed testing situations, rather than to inadequate visual-spatial abilities.

Investigation of advanced counterrotation blade configuration concepts for high speed turboprop systems. Task 4: Advanced fan section aerodynamic analysis

NASA Technical Reports Server (NTRS)

Crook, Andrew J.; Delaney, Robert A.

1992-01-01

The purpose of this study is the development of a three-dimensional Euler/Navier-Stokes flow analysis for fan section/engine geometries containing multiple blade rows and multiple spanwise flow splitters. An existing procedure developed by Dr. J. J. Adamczyk and associates and the NASA Lewis Research Center was modified to accept multiple spanwise splitter geometries and simulate engine core conditions. The procedure was also modified to allow coarse parallelization of the solution algorithm. This document is a final report outlining the development and techniques used in the procedure. The numerical solution is based upon a finite volume technique with a four stage Runge-Kutta time marching procedure. Numerical dissipation is used to gain solution stability but is reduced in viscous dominated flow regions. Local time stepping and implicit residual smoothing are used to increase the rate of convergence. Multiple blade row solutions are based upon the average-passage system of equations. The numerical solutions are performed on an H-type grid system, with meshes being generated by the system (TIGG3D) developed earlier under this contract. The grid generation scheme meets the average-passage requirement of maintaining a common axisymmetric mesh for each blade row grid. The analysis was run on several geometry configurations ranging from one to five blade rows and from one to four radial flow splitters. Pure internal flow solutions were obtained as well as solutions with flow about the cowl/nacelle and various engine core flow conditions. The efficiency of the solution procedure was shown to be the same as the original analysis.

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

PubMed

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

2018-04-01

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

The concurrent multiplicative-additive approach for gauge-radar/satellite multisensor precipitation estimates

NASA Astrophysics Data System (ADS)

Garcia-Pintado, J.; Barberá, G. G.; Erena Arrabal, M.; Castillo, V. M.

2010-12-01

Objective analysis schemes (OAS), also called ``succesive correction methods'' or ``observation nudging'', have been proposed for multisensor precipitation estimation combining remote sensing data (meteorological radar or satellite) with data from ground-based raingauge networks. However, opposite to the more complex geostatistical approaches, the OAS techniques for this use are not optimized. On the other hand, geostatistical techniques ideally require, at the least, modelling the covariance from the rain gauge data at every time step evaluated, which commonly cannot be soundly done. Here, we propose a new procedure (concurrent multiplicative-additive objective analysis scheme [CMA-OAS]) for operational rainfall estimation using rain gauges and meteorological radar, which does not require explicit modelling of spatial covariances. On the basis of a concurrent multiplicative-additive (CMA) decomposition of the spatially nonuniform radar bias, within-storm variability of rainfall and fractional coverage of rainfall are taken into account. Thus both spatially nonuniform radar bias, given that rainfall is detected, and bias in radar detection of rainfall are handled. The interpolation procedure of CMA-OAS is built on the OAS, whose purpose is to estimate a filtered spatial field of the variable of interest through a successive correction of residuals resulting from a Gaussian kernel smoother applied on spatial samples. The CMA-OAS, first, poses an optimization problem at each gauge-radar support point to obtain both a local multiplicative-additive radar bias decomposition and a regionalization parameter. Second, local biases and regionalization parameters are integrated into an OAS to estimate the multisensor rainfall at the ground level. The approach considers radar estimates as background a priori information (first guess), so that nudging to observations (gauges) may be relaxed smoothly to the first guess, and the relaxation shape is obtained from the sequential optimization. The procedure is suited to relatively sparse rain gauge networks. To show the procedure, six storms are analyzed at hourly steps over 10,663 km2. Results generally indicated an improved quality with respect to other methods evaluated: a standard mean-field bias adjustment, an OAS spatially variable adjustment with multiplicative factors, ordinary cokriging, and kriging with external drift. In theory, it could be equally applicable to gauge-satellite estimates and other hydrometeorological variables.

Surgical treatment of Wolff-Parkinson-White syndrome: epicardial approach without the use of cardiopulmonary bypass.

PubMed

Graffigna, A; Pagani, F; Vigano, M

1993-03-01

Epicardial dissection without the use of cardiopulmonary bypass (CPB) was performed in 88 patients (56 males and 32 females, mean age 31.9 years). With intraoperative epicardial mapping, 101 accessory pathways were detected, with multiple pathways in 11 patients. CPB was avoided in all but one patient due to frequent onset of atrial fibrillation with rapid ventricular rate. Surgical ablation was successful in 86 patients (97.6%). Three patients required multiple surgical procedures because of persistence of conduction along a component of the original pathway. All but two patients were discharged without antiarrhythmic medication; these two patients were given quinidine therapy because of atrial fibrillation, but had normal early and late electrophysiological studies. Surgical ablation of Kent bundles by the epicardial approach for the treatment of Wolff-Parkinson-White syndrome can be achieved without the use of CPB. Optimal and steady exposure of the area are mandatory for the procedure, and dissection is eased by avoidance of heparin required for CPB.

Laparoendoscopic single site surgery in pediatric urology: does it require specialized tools?

PubMed Central

Patel, Nishant; Santomauro, Michael; Marietti, Sarah; Chiang, George

2016-01-01

ABSTRACT Purpose: To describe our experience utilizing Laparoendoscopic single site (LESS) surgery in pediatric urology. Materials and Methods: Retrospective chart review was performed on LESS urologic procedures from November 2009 through March 2013. A total of 44 patients underwent 54 procedures including: nephrectomy (23), orchiopexy (14), varicocelectomy (9), orchiectomy (2), urachal cyst excision (3), and antegrade continence enema (3) (ACE). Results: Median patient age was 6.9 years old. Estimated blood loss (EBL), ranged from less than 5cc to 47cc for a bilateral nephrectomy. Operative time varied from 56 mins for varicocelectomy to a median of 360 minutes for a bilateral nephroureterectomy. Incision length ranged between 2 and 2.5cm. In our initial experience we used a commercial port. However, as we progressed, we were able to perform the majority of our procedures via adjacent fascial punctures for instrumentation at the single incision site. One patient did require conversion to an open procedure as a result of bleeding. Three complications were noted (6.8%), with two Clavien Grade 3b complications. Two patients required additional procedures at 1-year follow-up. Conclusions: The use of LESS applies to many pediatric urologic procedures, ideally for ablative procedures or simple reconstructive efforts. The use of adjacent fascial puncture sites for instrumentation can obviate the need for a commercial port or multiple trocars. PMID:27256182

A multiplicative regularization for force reconstruction

NASA Astrophysics Data System (ADS)

Aucejo, M.; De Smet, O.

2017-02-01

Additive regularizations, such as Tikhonov-like approaches, are certainly the most popular methods for reconstructing forces acting on a structure. These approaches require, however, the knowledge of a regularization parameter, that can be numerically computed using specific procedures. Unfortunately, these procedures are generally computationally intensive. For this particular reason, it could be of primary interest to propose a method able to proceed without defining any regularization parameter beforehand. In this paper, a multiplicative regularization is introduced for this purpose. By construction, the regularized solution has to be calculated in an iterative manner. In doing so, the amount of regularization is automatically adjusted throughout the resolution process. Validations using synthetic and experimental data highlight the ability of the proposed approach in providing consistent reconstructions.

Simple and inexpensive microfluidic devices for the generation of monodisperse multiple emulsions

NASA Astrophysics Data System (ADS)

Li, Er Qiang; Zhang, Jia Ming; Thoroddsen, Sigurdur T.

2014-01-01

Droplet-based microfluidic devices have become a preferred versatile platform for various fields in physics, chemistry and biology. Polydimethylsiloxane soft lithography, the mainstay for fabricating microfluidic devices, usually requires the usage of expensive apparatus and a complex manufacturing procedure. Here, we report the design and fabrication of simple and inexpensive microfluidic devices based on microscope glass slides and pulled glass capillaries, for generating monodisperse multiple emulsions. The advantages of our method lie in a simple manufacturing procedure, inexpensive processing equipment and flexibility in the surface modification of the designed microfluidic devices. Different types of devices have been designed and tested and the experimental results demonstrated their robustness for preparing monodisperse single, double, triple and multi-component emulsions.

Demonstration of disinfection procedure for the development of accurate blood glucose meters in accordance with ISO 15197:2013

PubMed Central

Lin, Wen-Ye; Chang, Jung-Tzu; Chu, Chun-Feng

2017-01-01

Despite measures to reduce disease transmission, a risk can occur when blood glucose meters (BGMs) are used on multiple individuals or by caregivers assisting a patient. The laboratory and in-clinic performance of a BGM system before and after disinfection should be demonstrated to guarantee accurate readings and reliable control of blood glucose (BG) for patients. In this study, an effective disinfection procedure, conducting wiping 10 times to assure a one minute contact time of the disinfectant on contaminated surface, was first demonstrated using test samples of the meter housing materials, including acrylonitrile butadiene styrene (ABS), polymethyl methacrylate (PMMA), and polycarbonate (PC), in accordance with ISO 15197:2013. After bench studies comprising 10,000 disinfection cycles, the elemental compositions of the disinfected ABS, PMMA, and PC samples were almost the same as in the original samples, as indicated by electron spectroscopy for chemical analysis. Subsequently, the validated disinfection procedure was then directly applied to disinfect 5 commercial BGM systems composed of ABS, PMMA, or PC to observe the effect of the validated disinfection procedure on meter accuracy. The results of HBsAg values after treatment with HBV sera and disinfectant wipes for each material were less than the LoD of each material of 0.020 IU/mL. Before and after the multiple disinfection cycles, 900 of 900 samples (100%) were within the system accuracy requirements of ISO 15197:2013. All of the systems showed high performance before and after the series of disinfection cycles and met the ISO 15197:2013 requirements. In addition, our results demonstrated multiple cleaning and disinfection cycles that represented normal use over the lifetime of a meter of 3–5 years. Our validated cleaning and disinfection procedure can be directly applied to other registered disinfectants for cleaning commercial BGM products in the future. PMID:28683148

Demonstration of disinfection procedure for the development of accurate blood glucose meters in accordance with ISO 15197:2013.

PubMed

Lin, Shu-Ping; Lin, Wen-Ye; Chang, Jung-Tzu; Chu, Chun-Feng

2017-01-01

Despite measures to reduce disease transmission, a risk can occur when blood glucose meters (BGMs) are used on multiple individuals or by caregivers assisting a patient. The laboratory and in-clinic performance of a BGM system before and after disinfection should be demonstrated to guarantee accurate readings and reliable control of blood glucose (BG) for patients. In this study, an effective disinfection procedure, conducting wiping 10 times to assure a one minute contact time of the disinfectant on contaminated surface, was first demonstrated using test samples of the meter housing materials, including acrylonitrile butadiene styrene (ABS), polymethyl methacrylate (PMMA), and polycarbonate (PC), in accordance with ISO 15197:2013. After bench studies comprising 10,000 disinfection cycles, the elemental compositions of the disinfected ABS, PMMA, and PC samples were almost the same as in the original samples, as indicated by electron spectroscopy for chemical analysis. Subsequently, the validated disinfection procedure was then directly applied to disinfect 5 commercial BGM systems composed of ABS, PMMA, or PC to observe the effect of the validated disinfection procedure on meter accuracy. The results of HBsAg values after treatment with HBV sera and disinfectant wipes for each material were less than the LoD of each material of 0.020 IU/mL. Before and after the multiple disinfection cycles, 900 of 900 samples (100%) were within the system accuracy requirements of ISO 15197:2013. All of the systems showed high performance before and after the series of disinfection cycles and met the ISO 15197:2013 requirements. In addition, our results demonstrated multiple cleaning and disinfection cycles that represented normal use over the lifetime of a meter of 3-5 years. Our validated cleaning and disinfection procedure can be directly applied to other registered disinfectants for cleaning commercial BGM products in the future.

Could conscious sedation with midazolam for dental procedures be an alternative to general anesthesia?

PubMed

Silay, E; Candirli, C; Taskesen, F; Coskuner, I; Ceyhanli, K T; Yildiz, H

2013-01-01

The aim of our study was to evaluate the likelihood that conscious sedation (CS) with intravenous midazolam could become an alternative modality to general anesthesia (GA) for dental procedures. In our study, 58 and 47 American Society of Anesthesiologists (ASA)-1 pediatric patients, aged 2-12 (mean 6) years, underwent dental procedures and minor oral surgical procedures under GA and CS with intravenous midazolam, respectively. The two groups were evaluated in terms of vital signs, duration of the treatment procedure, patient behavior, and the treatment comfort experienced by the physicians. The oxygen saturation level was significantly lower (GA: 99.0 ± 0.30, CS: 98.4 ± 1.02; P < 0.001) and the duration of the treatment procedure was significantly shorter (P < 0.001) in the sedation group compared with the GA group. The physicians encountered various difficulties during implementation of the treatment strategy in cases where they used CS. Minor oral surgical procedures and tooth extraction processes requiring no saline irrigation, however, could be performed successfully under CS. In cases requiring multiple dental management issues, the sedation method was not found to be a useful alternative to GA.

Enhanced Multiobjective Optimization Technique for Comprehensive Aerospace Design. Part A

NASA Technical Reports Server (NTRS)

Chattopadhyay, Aditi; Rajadas, John N.

1997-01-01

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

Bon-EV: an improved multiple testing procedure for controlling false discovery rates.

PubMed

Li, Dongmei; Xie, Zidian; Zand, Martin; Fogg, Thomas; Dye, Timothy

2017-01-03

Stability of multiple testing procedures, defined as the standard deviation of total number of discoveries, can be used as an indicator of variability of multiple testing procedures. Improving stability of multiple testing procedures can help to increase the consistency of findings from replicated experiments. Benjamini-Hochberg's and Storey's q-value procedures are two commonly used multiple testing procedures for controlling false discoveries in genomic studies. Storey's q-value procedure has higher power and lower stability than Benjamini-Hochberg's procedure. To improve upon the stability of Storey's q-value procedure and maintain its high power in genomic data analysis, we propose a new multiple testing procedure, named Bon-EV, to control false discovery rate (FDR) based on Bonferroni's approach. Simulation studies show that our proposed Bon-EV procedure can maintain the high power of the Storey's q-value procedure and also result in better FDR control and higher stability than Storey's q-value procedure for samples of large size(30 in each group) and medium size (15 in each group) for either independent, somewhat correlated, or highly correlated test statistics. When sample size is small (5 in each group), our proposed Bon-EV procedure has performance between the Benjamini-Hochberg procedure and the Storey's q-value procedure. Examples using RNA-Seq data show that the Bon-EV procedure has higher stability than the Storey's q-value procedure while maintaining equivalent power, and higher power than the Benjamini-Hochberg's procedure. For medium or large sample sizes, the Bon-EV procedure has improved FDR control and stability compared with the Storey's q-value procedure and improved power compared with the Benjamini-Hochberg procedure. The Bon-EV multiple testing procedure is available as the BonEV package in R for download at https://CRAN.R-project.org/package=BonEV .

Viewpoint: observations on scaled average bioequivalence.

PubMed

Patterson, Scott D; Jones, Byron

2012-01-01

The two one-sided test procedure (TOST) has been used for average bioequivalence testing since 1992 and is required when marketing new formulations of an approved drug. TOST is known to require comparatively large numbers of subjects to demonstrate bioequivalence for highly variable drugs, defined as those drugs having intra-subject coefficients of variation greater than 30%. However, TOST has been shown to protect public health when multiple generic formulations enter the marketplace following patent expiration. Recently, scaled average bioequivalence (SABE) has been proposed as an alternative statistical analysis procedure for such products by multiple regulatory agencies. SABE testing requires that a three-period partial replicate cross-over or full replicate cross-over design be used. Following a brief summary of SABE analysis methods applied to existing data, we will consider three statistical ramifications of the proposed additional decision rules and the potential impact of implementation of scaled average bioequivalence in the marketplace using simulation. It is found that a constraint being applied is biased, that bias may also result from the common problem of missing data and that the SABE methods allow for much greater changes in exposure when generic-generic switching occurs in the marketplace. Copyright © 2011 John Wiley & Sons, Ltd.

Rapid diagnosis of tinea incognito using handheld reflectance confocal microscopy: a paradigm shift in dermatology?

PubMed

Navarrete-Dechent, Cristián; Bajaj, Shirin; Marghoob, Ashfaq A; Marchetti, Michael A

2015-06-01

Dermatophytoses are common skin infections. Traditional diagnostic tests such as skin scrapings for light microscopy examination, fungal cultures and biopsies remain imperfect due to false-negative test results, cost, time required to perform the procedure, time delays in test results and/or a requirement for an invasive procedure. Herein, we present a case of an 80-year-old female whose tinea incognito was non-invasively diagnosed within seconds using handheld reflectance confocal microscopy (RCM). As non-invasive skin imaging continues to improve, we expect light-based office microscopy to be replaced with technologies such as RCM, which has multiple and continually expanding diagnostic applications. © 2015 Blackwell Verlag GmbH.

Coexistence Analysis of Civil Unmanned Aircraft Systems at Low Altitudes

NASA Astrophysics Data System (ADS)

Zhou, Yuzhe

2016-11-01

The requirement of unmanned aircraft systems in civil areas is growing. However, provisioning of flight efficiency and safety of unmanned aircraft has critical requirements on wireless communication spectrum resources. Current researches mainly focus on spectrum availability. In this paper, the unmanned aircraft system communication models, including the coverage model and data rate model, and two coexistence analysis procedures, i. e. the interference and noise ratio criterion and frequency-distance-direction criterion, are proposed to analyze spectrum requirements and interference results of the civil unmanned aircraft systems at low altitudes. In addition, explicit explanations are provided. The proposed coexistence analysis criteria are applied to assess unmanned aircraft systems' uplink and downlink interference performances and to support corresponding spectrum planning. Numerical results demonstrate that the proposed assessments and analysis procedures satisfy requirements of flexible spectrum accessing and safe coexistence among multiple unmanned aircraft systems.

Electroacupuncture-Assisted Craniotomy on an Awake Patient.

PubMed

Sidhu, Amritpal; Murgahayah, Trushna; Narayanan, Vairavan; Chandran, Hari; Waran, Vicknes

2017-01-01

Although acupuncture has existed for over 2000 years, its application as an anesthetic aid began in the 1950s in China. The first surgical procedure performed under acupuncture anesthesia was a tonsillectomy. Soon thereafter, major and minor surgical procedures took place with electroacupuncture alone providing the anesthesia. The procedures performed were diverse, ranging from cardiothoracic surgery to dental extractions. Usage of acupuncture anesthesia, specifically in neurosurgery, has been well documented in hospitals across China, especially in Beijing, dating back to the 1970s. We present a case of a 65-year-old man who presented with right-sided body weakness. He had a past medical history of uncontrolled diabetes mellitus, hypertension, and obstructive sleep apnea requiring use of a nasal continuous positive airway pressure device during sleep. We performed a computed tomography brain scan, which revealed a left-sided acute on chronic subdural hemorrhage. Due to his multiple comorbidities, we decided to perform the surgical procedure under electroacupuncture anesthesia. The aim of this case report is to describe a craniotomy performed under electroacupuncture on an elderly patient with multiple comorbidities who was awake during the procedure and in whom this procedure, if it had been performed under general anesthesia, would have carried high risk. Copyright © 2016 Medical Association of Pharmacopuncture Institute. Published by Elsevier B.V. All rights reserved.

40 CFR 63.847 - Compliance provisions.

Code of Federal Regulations, 2013 CFR

2013-07-01

... authority; (4) Procedures for sampling single stacks associated with multiple anode bake furnaces; (5) For... system for potlines or for the anode bake furnace within the 12 months prior to the compliance date, the... potline (or potroom group) or anode bake furnace; (2) By the date determined according to the requirements...

40 CFR 63.847 - Compliance provisions.

Code of Federal Regulations, 2010 CFR

2010-07-01

... authority; (4) Procedures for sampling single stacks associated with multiple anode bake furnaces; (5) For... system for potlines or for the anode bake furnace within the 12 months prior to the compliance date, the... potline (or potroom group) or anode bake furnace; (2) By the date determined according to the requirements...

40 CFR 63.847 - Compliance provisions.

Code of Federal Regulations, 2011 CFR

2011-07-01

... authority; (4) Procedures for sampling single stacks associated with multiple anode bake furnaces; (5) For... system for potlines or for the anode bake furnace within the 12 months prior to the compliance date, the... potline (or potroom group) or anode bake furnace; (2) By the date determined according to the requirements...

40 CFR 63.847 - Compliance provisions.

Code of Federal Regulations, 2014 CFR

2014-07-01

... authority; (4) Procedures for sampling single stacks associated with multiple anode bake furnaces; (5) For... system for potlines or for the anode bake furnace within the 12 months prior to the compliance date, the... potline (or potroom group) or anode bake furnace; (2) By the date determined according to the requirements...

40 CFR 63.847 - Compliance provisions.

Code of Federal Regulations, 2012 CFR

2012-07-01

... authority; (4) Procedures for sampling single stacks associated with multiple anode bake furnaces; (5) For... system for potlines or for the anode bake furnace within the 12 months prior to the compliance date, the... potline (or potroom group) or anode bake furnace; (2) By the date determined according to the requirements...

INTERLABORATORY VALIDATION OF USEPA METHOD 1680: FECAL COLIFORMS IN BIOSOLIDS BY MULTIPLE-TUBE FERMENTATION PROCEDURES

EPA Science Inventory

In the US, the use and disposal of biosolids (including domestic septage) are regulated under 40 CFR Part 503. Subpart D of this regulation protects public health and the environment through requirements designed to reduce the potential for contact with pathogens in biosolids app...

INTERLABORATORY VALIDATION OF USEPA METHOD 1680: FECAL COLIFORMS IN BIOSOLIDS BY MULTIPLE-TUBE FERMENTATION PROCEDURES

EPA Science Inventory

In the United States, the use and disposal of biosolids (including domestic septage) are regulated under 40 CFR Part 503. Subpart D of this regulation protects public health and the environment through requirements designed to reduce the potential for contact with pathogens in bi...

Development and Pilot Testing of 24-Hour Multiple-Pass Recall to Assess Dietary Intake of Toddlers of Somali- and Iraqi-Born Mothers Living in Norway

PubMed Central

Grewal, Navnit Kaur; Mosdøl, Annhild; Aunan, Marte Bergsund; Monsen, Carina; Torheim, Liv Elin

2014-01-01

The aim of this study was to develop, test, and evaluate a 24-h recall procedure to assess the dietary intake of toddlers of Somali- and Iraqi-born mothers living in Norway. A protocol for a 24-h multiple-pass recall procedure, registration forms, and visual tools (a picture library for food identification and portion size estimation) was developed and tested in 12 mothers from Somalia and Iraq with children aged 10–21 months. Five female field workers were recruited and trained to conduct the interviews. Evaluation data for the 24-h recall procedure were collected from both the mothers and the field workers. Nutrient intake was calculated using a Norwegian dietary calculation system. Each child’s estimated energy intake was compared with its estimated energy requirement. Both the mothers and the field workers found the method feasible and the visual tools useful. The estimated energy intake corresponded well with the estimated energy requirement for most of the children (within mean ± 2 SD, except for three). The pilot study identified the need for additional foods in the picture library and some crucial aspects in training and supervising the field workers to reduce sources of error in the data collection. PMID:24949548

Two-dimensional imaging via a narrowband MIMO radar system with two perpendicular linear arrays.

PubMed

Wang, Dang-wei; Ma, Xiao-yan; Su, Yi

2010-05-01

This paper presents a system model and method for the 2-D imaging application via a narrowband multiple-input multiple-output (MIMO) radar system with two perpendicular linear arrays. Furthermore, the imaging formulation for our method is developed through a Fourier integral processing, and the parameters of antenna array including the cross-range resolution, required size, and sampling interval are also examined. Different from the spatial sequential procedure sampling the scattered echoes during multiple snapshot illuminations in inverse synthetic aperture radar (ISAR) imaging, the proposed method utilizes a spatial parallel procedure to sample the scattered echoes during a single snapshot illumination. Consequently, the complex motion compensation in ISAR imaging can be avoided. Moreover, in our array configuration, multiple narrowband spectrum-shared waveforms coded with orthogonal polyphase sequences are employed. The mainlobes of the compressed echoes from the different filter band could be located in the same range bin, and thus, the range alignment in classical ISAR imaging is not necessary. Numerical simulations based on synthetic data are provided for testing our proposed method.

Implied alignment: a synapomorphy-based multiple-sequence alignment method and its use in cladogram search

NASA Technical Reports Server (NTRS)

Wheeler, Ward C.

2003-01-01

A method to align sequence data based on parsimonious synapomorphy schemes generated by direct optimization (DO; earlier termed optimization alignment) is proposed. DO directly diagnoses sequence data on cladograms without an intervening multiple-alignment step, thereby creating topology-specific, dynamic homology statements. Hence, no multiple-alignment is required to generate cladograms. Unlike general and globally optimal multiple-alignment procedures, the method described here, implied alignment (IA), takes these dynamic homologies and traces them back through a single cladogram, linking the unaligned sequence positions in the terminal taxa via DO transformation series. These "lines of correspondence" link ancestor-descendent states and, when displayed as linearly arrayed columns without hypothetical ancestors, are largely indistinguishable from standard multiple alignment. Since this method is based on synapomorphy, the treatment of certain classes of insertion-deletion (indel) events may be different from that of other alignment procedures. As with all alignment methods, results are dependent on parameter assumptions such as indel cost and transversion:transition ratios. Such an IA could be used as a basis for phylogenetic search, but this would be questionable since the homologies derived from the implied alignment depend on its natal cladogram and any variance, between DO and IA + Search, due to heuristic approach. The utility of this procedure in heuristic cladogram searches using DO and the improvement of heuristic cladogram cost calculations are discussed. c2003 The Willi Hennig Society. Published by Elsevier Science (USA). All rights reserved.

Pediatric ureteroscopic management of intrarenal calculi.

PubMed

Tanaka, Stacy T; Makari, John H; Pope, John C; Adams, Mark C; Brock, John W; Thomas, John C

2008-11-01

Data addressing ureteroscopic management of intrarenal calculi in prepubertal children are limited. We reviewed our experience from January 2002 through December 2007. We retrospectively reviewed ureteroscopic procedures for intrarenal calculi in children younger than 14 years. Stone-free status was determined with postoperative imaging. Multiple logistic regression analysis was used to assess the influence of preoperative factors on initial stone-free status and the need for additional procedures. Intrarenal calculi were managed ureteroscopically in 52 kidneys in 50 children with a mean age of 7.9 years (range 1.2 to 13.6). Mean stone size was 8 mm (range 1 to 16). Stone-free rate after a single ureteroscopic procedure was 50% (25 of 50 patients) on initial postoperative imaging and 58% (29 of 50) with extended followup. Initial stone-free status was dependent on preoperative stone size (p = 0.005) but not stone location. Additional stone procedures were required in 18 upper tracts. Younger patient age (p = 0.04) and larger preoperative stone size (p = 0.002) were associated with the need for additional procedures. Additional procedures were required in more than half of the stones 6 mm or larger but in no stone smaller than 6 mm. Ureteroscopy is a safe method for the treatment of intrarenal calculi in the prepubertal population. Our ureteroscopic stone-free rate for intrarenal stones is lower than that reported for ureteral stones. Parents should be informed that additional procedures will likely be required, especially in younger patients and those with stones larger than 6 mm.

Hypnosis for Acute Procedural Pain: A Critical Review.

PubMed

Kendrick, Cassie; Sliwinski, Jim; Yu, Yimin; Johnson, Aimee; Fisher, William; Kekecs, Zoltán; Elkins, Gary

2016-01-01

Clinical evidence for the effectiveness of hypnosis in the treatment of acute procedural pain was critically evaluated based on reports from randomized controlled clinical trials (RCTs). Results from the 29 RCTs meeting inclusion criteria suggest that hypnosis decreases pain compared to standard care and attention control groups and that it is at least as effective as comparable adjunct psychological or behavioral therapies. In addition, applying hypnosis in multiple sessions prior to the day of the procedure produced the highest percentage of significant results. Hypnosis was most effective in minor surgical procedures. However, interpretations are limited by considerable risk of bias. Further studies using minimally effective control conditions and systematic control of intervention dose and timing are required to strengthen conclusions.

HYPNOSIS FOR ACUTE PROCEDURAL PAIN: A Critical Review

PubMed Central

Kendrick, Cassie; Sliwinski, Jim; Yu, Yimin; Johnson, Aimee; Fisher, William; Kekecs, Zoltán; Elkins, Gary

2015-01-01

Clinical evidence for the effectiveness of hypnosis in the treatment of acute, procedural pain was critically evaluated based on reports from randomized controlled clinical trials (RCTs). Results from the 29 RCTs meeting inclusion criteria suggest that hypnosis decreases pain compared to standard care and attention control groups and that it is at least as effective as comparable adjunct psychological or behavioral therapies. In addition, applying hypnosis in multiple sessions prior to the day of the procedure produced the highest percentage of significant results. Hypnosis was most effective in minor surgical procedures. However, interpretations are limited by considerable risk of bias. Further studies using minimally effective control conditions and systematic control of intervention dose and timing are required to strengthen conclusions. PMID:26599994

Two-port robotic hysterectomy: a novel approach.

PubMed

Moawad, Gaby N; Tyan, Paul; Khalil, Elias D Abi

2018-03-24

The objective of the study was to demonstrate a novel technique for two-port robotic hysterectomy with a particular focus on the challenging portions of the procedure. The study is designed as a technical video, showing step-by-step a two-port robotic hysterectomy approach (Canadian Task Force classification level III). IRB approval was not required for this study. The benefits of minimally invasive surgery for gynecological pathology have been clearly documented in multiple studies. Patients had fewer medical and surgical complications postoperatively, better cosmesis and quality of life. Most gynecological surgeons require 3-5 ports for the standard gynecological procedure. Even though the minimally invasive multiport system provides an excellent safety profile, multiple incisions are associated with a greater risk for morbidity including infection, pain, and hernia. In the past decade, various new methods have emerged to minimize the number of ports used in gynecological surgery. The interventions employed were a two-port robotic hysterectomy, using a camera port plus one robotic arm, with a focus on salpingectomy and cuff closure. We describe a transvaginal and a transabdominal approach for salpingectomy and a novel method for cuff closure. The transvaginal and transabdominal techniques for salpingectomy for two-port robotic-assisted hysterectomy provide excellent tension and exposure for a safe procedure without the need for an extra port. We also describe a transvaginal technique to place the vaginal cuff on tension during closure. With the necessary set of skills on a carefully chosen patient, two-port robotic-assisted total laparoscopic hysterectomy is a feasible procedure.

Multiple needle puncturing: balancing the varus knee.

PubMed

Bellemans, Johan

2011-09-09

The so-called "pie crusting" technique using multiple stab incisions is a well-established procedure for correcting tightness of the iliotibial band in the valgus knee. It is, however, not applicable for balancing the medial side in varus knees because of the risk for iatrogenic transsection of the medial collateral ligament (MCL). This article presents our experience with a safer alternative and minimally invasive technique for medial soft tissue balancing, where we make multiple punctures in the MCL using a 19-gauge needle to progressively stretch the MCL until a correct ligament balance is achieved. Our technique requires minimal to no additional soft tissue dissection and can even be performed percutaneously when necessary. This technique, therefore, does not impact the length of the skin or soft tissue incisions. We analyzed 61 cases with varus deformity that were intraoperatively treated using this technique. In 4 other cases, the technique was used as a percutaneous procedure to correct postoperative medial tightness that caused persistent pain on the medial side. The procedure was considered successful when a 2- to 4-mm mediolateral joint line opening was obtained in extension and 2 to 6 mm in flexion. In 62 cases (95%), a progressive correction of medial tightness was achieved according to the above-described criteria. Three cases were overreleased and required compensatory release of the lateral structures and use of a thicker insert. Based on these results, we consider needle puncturing an effective and safe technique for progressive correction of MCL tightness during minimally invasive total knee arthroplasty. Copyright 2011, SLACK Incorporated.

Needle aspiration of calcific deposits (NACD) for calcific tendinitis is safe and effective: Six months follow-up of clinical results and complications in a series of 431 patients.

PubMed

Oudelaar, Bart W; Schepers-Bok, Relinde; Ooms, Edwin M; Huis In 't Veld, Rianne; Vochteloo, Anne J H

2016-04-01

Although needle aspiration of calcific deposits (NACD) has proven to be an effective treatment for calcific tendinitis of the rotator cuff (CTRC) in patients who are resistant to conservative treatment, little is known about the effectiveness of NACD in terms of complete relief of symptoms and the effectiveness of repeated NACD procedures. Furthermore, analyses of complications of the procedure in large series are scarce. 431 consecutive patients with symptomatic CTRC treated by NACD were included in this retrospective cohort study. Short-term effects were assessed at two weeks post-treatment by using an 11-point numeric rating scale (NRS). The six months outcome was determined on a dichotomous symptom scale (symptom free or persistence of symptoms). NACD procedures performed within six months of a previous NACD procedure were considered repeated procedures. All complications that occurred within six months of the NACD procedure were registered. At two weeks post-treatment, a significant improvement of pain scores was noted (mean reduction of NRS: 4.4 points; p<0.001). 74% of patients had complete relief of symptoms at six months post-treatment. 143 (33.2%) patients required multiple treatments. These repeated procedures were equally effective as the primary procedure. Complications of the NACD procedure were seen in 31 (7.2%) patients: 21 patients (4.9%) developed a subacromial bursitis, seven patients (1.6%) a frozen shoulder and three patients (0.7%) developed a septic bursitis. Needle aspiration of calcific deposits (NACD) is an effective treatment for calcific tendinitis of the rotator cuff in the majority of patients. Approximately one third of the patients will require multiple treatments, which were equally effective as the primary procedure. Based on this, patients should not be withheld a second or even a third treatment in case of persistent symptoms. Furthermore, NACD has a low complication rate, the risk of infection should, however, always be accounted for. Retrospective study, level IV. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

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

PubMed

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

2016-04-01

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

Comparing two methods of thoracoscopic sympathectomy for palmar hyperhidrosis.

PubMed

Ibrahim, Magdi; Allam, Abdulla

2014-09-01

Hyperhidrosis can cause significant professional and social handicaps. Thoracic endoscopic sympathectomy has become the surgical technique of choice for treating intractable palmar hyperhidrosis and can be performed through multiple ports or a single port. This prospective study compares outcomes between the two methods. The study followed 71 consecutive patients who underwent video-assisted sympathectomy for palmar hyperhidrosis between January 2008 and June 2012. In all patients, the procedure was bilateral and performed in one stage. The multiple-port method was used in 35 patients (group A) and the single-port method in 36 patients (group B). Preoperative, intraoperative, and postoperative variables; morbidity, recurrence; and survival were compared in both groups. The procedure was successful in 100% of the patients; none experienced a recurrence of palmar hyperhidrosis, Horner syndrome (oculosympathetic palsy), or serious postoperative complications, and none died. No patients required conversion to an open procedure. Residual minimal pneumothorax occurred in two patients (5.7%) in group A and in one patient (2.8%) in group B. Minimal hemothorax occurred in one patient (2.9%) in group A and in three patients (8.3%) in group B. Compensatory hyperhidrosis occurred in seven patients (20%) in group A and in eight patients (22.2%) in group B. No difference was found between the multiple- and single-port methods. Both are effective, safe minimally invasive procedures that permanently improve quality of life in patients with palmar hyperhidrosis.

Management patterns of medicare patients undergoing treatment for upper urinary tract calculi.

PubMed

Matlaga, Brian R; Meckley, Lisa M; Kim, Micheline; Byrne, Thomas W

2014-06-01

We conducted this study to identify differences in the re-treatment rates and ancillary procedures for the two most commonly utilized stone treatment procedures in the Medicare population: ureteroscopy (URS) and shock wave lithotripsy (SWL). A retrospective claims analysis of the Medicare standard analytical file 5% sample was conducted to identify patients with a new diagnosis of urolithiasis undergoing treatment with URS or SWL from 2009-2010. Outcomes evaluated: (1) repeat stone removal procedures within 120 days post index procedure, (2) stent placement procedures on the index date, 30 days prior to and 120 days post index date, and (3) use of general anesthesia. We identified 3885 eligible patients, of which 2165 (56%) underwent SWL and 1720 (44%) underwent URS. Overall, SWL patients were 1.73 times more likely to undergo at least one repeat procedure than URS patients, and twice as likely to require multiple re-treatments compared to URS. Among those with ureteral stones, SWL patients were 2.27 times more likely to undergo repeat procedures. The difference was not statistically significant in renal stone patients. Overall, SWL patients were 1.41 times more likely than URS patients to have a stent placed prior to index procedure, and 1.33 times more likely to have a stent placed subsequent to the index procedure. The majority of URS patients (77.8%) had a stent placed at the time of index procedure. There was no significant difference in anesthetic approaches between SWL and URS. Patients undergoing SWL are significantly more likely to require re-treatments than URS patients. SWL patients are also significantly more likely to require ureteral stent placement as a separate event. SWL and URS patients have similar rates of general anesthesia.

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

PubMed

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

2016-05-10

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

Evidence for Preserved Novel Word Learning in Down Syndrome Suggests Multiple Routes to Vocabulary Acquisition

ERIC Educational Resources Information Center

Mosse, Emma K.; Jarrold, Christopher

2011-01-01

Purpose: Three studies investigated novel word learning, some requiring phonological production, each involving between 11 and 17 individuals with Down syndrome, and between 15 and 24 typically developing individuals matched for receptive vocabulary. The effect of stimuli wordlikeness and incidental procedure-based memory demands were examined to…

A Green Alternative to Aluminum Chloride Alkylation of Xylene

ERIC Educational Resources Information Center

Sereda, Grigoriy A.; Rajpara, Vikul B.

2007-01-01

An acutely less toxic 2-bromobutane is used to develop a simple graphite-promoted procedure of alkylation of p-xylene. It is further demonstrated that aluminum chloride is not required, the need for aqueous workup is eliminated, waste solutions are not produced and the multiple use of the catalyst is allowed.

The Multicultural Mathematics Classroom: Culturally Aware Teaching through Cooperative Learning & Multiple Representations

ERIC Educational Resources Information Center

Jao, Limin

2012-01-01

The National Council of Teachers of Mathematics (NCTM, 2000) has created a set of standards to reform mathematics teaching procedures to ensure that all students understand mathematics and learn to think mathematically. The standards also require teachers to use strategies that allow all students to reason and communicate mathematically and…

A numerical approach to controller design for the ACES facility

NASA Technical Reports Server (NTRS)

Frazier, W. Garth; Irwin, R. Dennis

1993-01-01

In recent years the employment of active control techniques for improving the performance of systems involving highly flexible structures has become a topic of considerable research interest. Most of these systems are quite complicated, using multiple actuators and sensors, and possessing high order models. The majority of analytical controller synthesis procedures capable of handling multivariable systems in a systematic way require considerable insight into the underlying mathematical theory to achieve a successful design. This insight is needed in selecting the proper weighting matrices or weighting functions to cast what is naturally a multiple constraint satisfaction problem into an unconstrained optimization problem. Although designers possessing considerable experience with these techniques have a feel for the proper choice of weights, others may spend a significant amount of time attempting to find an acceptable solution. Another disadvantage of such procedures is that the resulting controller has an order greater than or equal to that of the model used for the design. Of course, the order of these controllers can often be reduced, but again this requires a good understanding of the theory involved.

Computationally efficient stochastic optimization using multiple realizations

NASA Astrophysics Data System (ADS)

Bayer, P.; Bürger, C. M.; Finkel, M.

2008-02-01

The presented study is concerned with computationally efficient methods for solving stochastic optimization problems involving multiple equally probable realizations of uncertain parameters. A new and straightforward technique is introduced that is based on dynamically ordering the stack of realizations during the search procedure. The rationale is that a small number of critical realizations govern the output of a reliability-based objective function. By utilizing a problem, which is typical to designing a water supply well field, several variants of this "stack ordering" approach are tested. The results are statistically assessed, in terms of optimality and nominal reliability. This study demonstrates that the simple ordering of a given number of 500 realizations while applying an evolutionary search algorithm can save about half of the model runs without compromising the optimization procedure. More advanced variants of stack ordering can, if properly configured, save up to more than 97% of the computational effort that would be required if the entire number of realizations were considered. The findings herein are promising for similar problems of water management and reliability-based design in general, and particularly for non-convex problems that require heuristic search techniques.

Endoscopic duodenal perforation: surgical strategies in a regional centre

PubMed Central

2014-01-01

Background Duodenal perforation is an uncommon complication of endoscopic retrograde cholangio-pancreatography (ERCP) and a rare complication of upper gastrointestinal endoscopy. Most are minor perforations that settle with conservative management. A few perforations however result in life-threatening retroperitoneal necrosis and require surgical intervention. There is a relative paucity of references specifically describing the surgical interventions required for this eventuality. Methods Five cases of iatrogenic duodenal perforation were ascertained between 2002 and 2007 at Cairns Base Hospital. Clinical features were analyzed and compared, with reference to a review of ERCP at that institution for the years 2005/2006. Results One patient recovered with conservative management. Of the other four, one died after initial laparotomy. The other three survived, undergoing multiple procedures and long inpatient stays. Conclusions Iatrogenic duodenal perforation with retroperitoneal necrosis is an uncommon complication of endoscopy, but when it does occur it is potentially life-threatening. Early recognition may lead to a better outcome through earlier intervention, although a protracted course with multiple procedures should be anticipated. A number of surgical techniques may need to be employed according to the individual circumstances of the case. PMID:24461069

Near-Field Diffraction Imaging from Multiple Detection Planes

NASA Astrophysics Data System (ADS)

Loetgering, L.; Golembusch, M.; Hammoud, R.; Wilhein, T.

2017-06-01

We present diffraction imaging results obtained from multiple near-field diffraction constraints. An iterative phase retrieval algorithm was implemented that uses data redundancy achieved by measuring near-field diffraction intensities at various sample-detector distances. The procedure allows for reconstructing the exit surface wave of a sample within a multiple constraint satisfaction framework neither making use of a priori knowledge as enforced in coherent diffraction imaging (CDI) nor exact scanning grid knowledge as required in ptychography. We also investigate the potential of the presented technique to deal with polychromatic radiation as important for potential application in diffraction imaging by means of tabletop EUV and X-ray sources.

Towards Robust Designs Via Multiple-Objective Optimization Methods

NASA Technical Reports Server (NTRS)

Man Mohan, Rai

2006-01-01

Fabricating and operating complex systems involves dealing with uncertainty in the relevant variables. In the case of aircraft, flow conditions are subject to change during operation. Efficiency and engine noise may be different from the expected values because of manufacturing tolerances and normal wear and tear. Engine components may have a shorter life than expected because of manufacturing tolerances. In spite of the important effect of operating- and manufacturing-uncertainty on the performance and expected life of the component or system, traditional aerodynamic shape optimization has focused on obtaining the best design given a set of deterministic flow conditions. Clearly it is important to both maintain near-optimal performance levels at off-design operating conditions, and, ensure that performance does not degrade appreciably when the component shape differs from the optimal shape due to manufacturing tolerances and normal wear and tear. These requirements naturally lead to the idea of robust optimal design wherein the concept of robustness to various perturbations is built into the design optimization procedure. The basic ideas involved in robust optimal design will be included in this lecture. The imposition of the additional requirement of robustness results in a multiple-objective optimization problem requiring appropriate solution procedures. Typically the costs associated with multiple-objective optimization are substantial. Therefore efficient multiple-objective optimization procedures are crucial to the rapid deployment of the principles of robust design in industry. Hence the companion set of lecture notes (Single- and Multiple-Objective Optimization with Differential Evolution and Neural Networks ) deals with methodology for solving multiple-objective Optimization problems efficiently, reliably and with little user intervention. Applications of the methodologies presented in the companion lecture to robust design will be included here. The evolutionary method (DE) is first used to solve a relatively difficult problem in extended surface heat transfer wherein optimal fin geometries are obtained for different safe operating base temperatures. The objective of maximizing the safe operating base temperature range is in direct conflict with the objective of maximizing fin heat transfer. This problem is a good example of achieving robustness in the context of changing operating conditions. The evolutionary method is then used to design a turbine airfoil; the two objectives being reduced sensitivity of the pressure distribution to small changes in the airfoil shape and the maximization of the trailing edge wedge angle with the consequent increase in airfoil thickness and strength. This is a relevant example of achieving robustness to manufacturing tolerances and wear and tear in the presence of other objectives.

Kyphectomy improves sitting and skin problems in patients with myelomeningocele.

PubMed

Garg, Sumeet; Oetgen, Matthew; Rathjen, Karl; Richards, B Stephens

2011-05-01

Progressive kyphosis occurs in up to 20% of patients with myelomeningocele. Severely affected patients can develop recurrent skin breakdown, osteomyelitis, sitting imbalance, and poor cosmetic appearance. We (1) assessed the ability of kyphectomy to restore an intact skin envelope and allow comfortable seating in a wheelchair; (2) reviewed the complications of kyphectomy and spinal fusion in myelomeningocele; and (3) determined whether patients requiring unexpected reoperation had worse correction or more ulceration compared with those patients treated with a single surgery. We retrospectively reviewed the records of 23 children with thoracic-level myelomeningocele who were treated with kyphectomy and spinal fusion since 1980. Indications for surgery included recurrent skin breakdown (15 patients) and poor sitting balance or unacceptable cosmetic deformity (three patients). We evaluated operative technique, type of sacropelvic fixation, surgical complications, radiographic correction, and skin condition at followup. The minimum followup was 2 years (median, 4.1 years; range, 2.1-10 years); 18 of the 23 children had greater than 2 years followup and are reported here. Kyphectomy achieved a sitting balance and resolved in skin ulceration in 17 of 18 patients. Seven patients had complications requiring reoperation. Three patients had multiple reoperations for early deep infection and one patient each had reoperation for late infection, pseudarthrosis, implant-related sacral pressure sore, and planned extension of proximal fusion after growth. Patients requiring multiple operations had similar correction and relief of ulceration to those treated with a single procedure. Complications after kyphectomy are frequent and many children with myelomeningocele and severe hyperkyphosis require multiple procedures and lengthy hospital stays. Nonetheless, improved seating balance and resolution of skin problems was achieved in 17 of 18 patients.

Comparison of procedures for correction of matrix interferences in the analysis of soils by ICP-OES with CCD detection

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

Sadler, D.A.; Sun, F.; Littlejohn, D.

1995-12-31

ICP-OES is a useful technique for multi-element analysis of soils. However, as a number of elements are present in relatively high concentrations, matrix interferences can occur and examples have been widely reported. The availability of CCD detectors has increased the opportunities for rapid multi-element, multi-wave-length determination of elemental concentrations in soils and other environmental samples. As the composition of soils from industrial sites can vary considerably, especially when taken from different pit horizons, procedures are required to assess the extent of interferences and correct the effects, on a simultaneous multi-element basis. In single element analysis, plasma operating conditions can sometimesmore » be varied to minimize or even remove multiplicative interferences. In simultaneous multi-element analysis, the scope for this approach may be limited, depending on the spectrochemical characteristics of the emitting analyte species. Matrix matching, by addition of major sample components to the analyte calibrant solutions, can be used to minimize inaccuracies. However, there are also limitations to this procedure, when the sample composition varies significantly. Multiplicative interference effects can also be assessed by a {open_quotes}single standard addition{close_quotes} of each analyte to the sample solution and the information obtained may be used to correct the analyte concentrations determined directly. Each of these approaches has been evaluated to ascertain the best procedure for multi-element analysis of industrial soils by ICP-OES with CCD detection at multiple wavelengths. Standard reference materials and field samples have been analyzed to illustrate the efficacy of each procedure.« less

Frontal sinus revision rate after nasal polyposis surgery including frontal recess clearance and middle turbinectomy: A long-term analysis.

PubMed

Benkhatar, Hakim; Khettab, Idir; Sultanik, Philippe; Laccourreye, Ollivier; Bonfils, Pierre

2018-08-01

To determine the frontal sinus revision rate after nasal polyposis (NP) surgery including frontal recess clearance (FRC) and middle turbinectomy (MT), to search for predictive factors and to analyse surgical management. Longitudinal analysis of 153 patients who consecutively underwent bilateral sphenoethmoidectomy with FRC and MT for NP with a minimum follow-up of 7 years. Decision of revision surgery was made in case of medically refractory chronic frontal sinusitis or frontal mucocele. Univariate and multivariate analysis incorporating clinical and radiological variables were performed. The frontal sinus revision rate was 6.5% (10/153). The mean time between the initial procedure and revision surgery was 3 years, 10 months. Osteitis around the frontal sinus outflow tract (FSOT) was associated with a higher risk of frontal sinus revision surgery (p=0.01). Asthma and aspirin intolerance did not increase the risk, as well as frontal sinus ostium diameter or residual frontoethmoid cells. Among revised patients, 60% required multiple procedures and 70% required frontal sinus ostium enlargement. Our long-term study reports that NP surgery including FRC and MT is associated with a low frontal sinus revision rate (6.5%). Patients developing osteitis around the FSOT have a higher risk of frontal sinus revision surgery. As mucosal damage can lead to osteitis, FSOT mucosa should be preserved during initial NP surgery. However, as multiple procedures are common among NP patients requiring frontal sinus revision, frontal sinus ostium enlargement should be considered during first revision in the hope of reducing the need of further revisions. Copyright © 2018 Elsevier B.V. All rights reserved.

Synchronous occurrence of prostate carcinoma and multiple myeloma: a case report.

PubMed

Sehgal, Tushar; Sharma, Sudha; Naseem, Shano; Varma, Neelam; Das, Ashim; Sharma, S C

2014-09-01

We describe a rare case of metastatic prostate cancer to bone marrow and synchronous multiple myeloma as the second malignant disease. Various diagnostic procedures, including cytomorphology and immunohistochemistry analyses together contributed to the detection of metastasis of prostate cancer and synchronous plasma cell proliferation in the bone marrow. The association between these two disorders is poorly understood however, some studies show that bone marrow microenvironment may play a crucial role. The need for further research in this regard is required to unfold this fascinating association.

Optimization and validation of moving average quality control procedures using bias detection curves and moving average validation charts.

PubMed

van Rossum, Huub H; Kemperman, Hans

2017-02-01

To date, no practical tools are available to obtain optimal settings for moving average (MA) as a continuous analytical quality control instrument. Also, there is no knowledge of the true bias detection properties of applied MA. We describe the use of bias detection curves for MA optimization and MA validation charts for validation of MA. MA optimization was performed on a data set of previously obtained consecutive assay results. Bias introduction and MA bias detection were simulated for multiple MA procedures (combination of truncation limits, calculation algorithms and control limits) and performed for various biases. Bias detection curves were generated by plotting the median number of test results needed for bias detection against the simulated introduced bias. In MA validation charts the minimum, median, and maximum numbers of assay results required for MA bias detection are shown for various bias. Their use was demonstrated for sodium, potassium, and albumin. Bias detection curves allowed optimization of MA settings by graphical comparison of bias detection properties of multiple MA. The optimal MA was selected based on the bias detection characteristics obtained. MA validation charts were generated for selected optimal MA and provided insight into the range of results required for MA bias detection. Bias detection curves and MA validation charts are useful tools for optimization and validation of MA procedures.

The impact of multiple show-ups on eyewitness decision-making and innocence risk.

PubMed

Smith, Andrew M; Bertrand, Michelle; Lindsay, R C L; Kalmet, Natalie; Grossman, Deborah; Provenzano, Daniel

2014-09-01

If an eyewitness rejects a show-up, police may respond by finding a new suspect and conducting a second show-up with the same eyewitness. Police may continue finding suspects and conducting show-ups until the eyewitness makes an identification (Study 1). Relatively low criterion-setting eyewitnesses filter themselves out of the multiple show-ups procedure by choosing the first suspect with whom they are presented (Studies 2 and 3). Accordingly, response bias was more stringent on the second show-up when compared with the first, but became no more stringent with additional show-ups. Despite this stringent shift in response bias, innocence risk increased with additional show-ups, as false alarms cumulate (Studies 2 and 3). Although unbiased show-up instructions decreased innocent suspect identifications, the numbers were still discouraging (Study 4). Given the high number of innocent suspects who would be mistakenly identified through the use of multiple show-up procedures, using such identifications as evidence of guilt is questionable. Although evidence of guilt is limited to identifications from a single show-up, practical constraints might sometimes require police to use additional show-ups. Accordingly, we propose a stronger partition between evidentiary and investigative procedures. PsycINFO Database Record (c) 2014 APA, all rights reserved.

Anticipating Mathematics Performance: A Cross-Validation Comparison of AID3 and Regression. AIR 1988 Annual Forum Paper.

ERIC Educational Resources Information Center

Bloom, Allan M.; And Others

In response to the increasing importance of student performance in required classes, research was conducted to compare two prediction procedures, linear modeling using multiple regression and nonlinear modeling using AID3. Performance in the first college math course (College Mathematics, Calculus, or Business Calculus Matrices) was the dependent…

Multiple linear regression analysis

NASA Technical Reports Server (NTRS)

Edwards, T. R.

1980-01-01

Program rapidly selects best-suited set of coefficients. User supplies only vectors of independent and dependent data and specifies confidence level required. Program uses stepwise statistical procedure for relating minimal set of variables to set of observations; final regression contains only most statistically significant coefficients. Program is written in FORTRAN IV for batch execution and has been implemented on NOVA 1200.

Does a Repeated Guided-Instruction Approach with Multiple Assessments Increase Student Learning of Science?

ERIC Educational Resources Information Center

Smith, Robert; Peethambaran, Bela; Pontiggia, Laura; Blumberg, Phyllis

2013-01-01

Guided instruction is an approach that fully explains the concepts and procedures that students are required to learn. It seems intuitive that this approach should increase student learning; however, there is evidence in the literature that this may not always be the case. We wanted to assess the effectiveness of our own repeated…

75 FR 47203 - Airworthiness Directives; McDonnell Douglas Corporation Model MD-11 and MD-11F Airplanes Equipped...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-08-05

.... This AD requires revising the airplane flight manual to advise the flightcrew to use certain procedures during descent in certain icing conditions. This AD results from reports of several in-flight engine.... These certain icing conditions could cause a multiple engine flameout during flight with the potential...

Ultra-low mass drift chambers

NASA Astrophysics Data System (ADS)

Assiro, R.; Cappelli, L.; Cascella, M.; De Lorenzis, L.; Grancagnolo, F.; Ignatov, F.; L'Erario, A.; Maffezzoli, A.; Miccoli, A.; Onorato, G.; Perillo, M.; Piacentino, G.; Rella, S.; Rossetti, F.; Spedicato, M.; Tassielli, G.; Zavarise, G.

2013-08-01

We present a novel low mass drift chamber concept, developed in order to fulfill the stringent requirements imposed by the experiments for extremely rare processes, which require high resolutions (order of 100-200 keV/c) for particle momenta in a range (50-100 MeV/c) totally dominated by the multiple scattering contribution. We describe a geometry optimization procedure and a new wiring strategy with a feed-through-less wire anchoring system developed and tested on a drift chamber prototype under completion at INFN-Lecce .

Multiprocessing on supercomputers for computational aerodynamics

NASA Technical Reports Server (NTRS)

Yarrow, Maurice; Mehta, Unmeel B.

1991-01-01

Little use is made of multiple processors available on current supercomputers (computers with a theoretical peak performance capability equal to 100 MFLOPS or more) to improve turnaround time in computational aerodynamics. The productivity of a computer user is directly related to this turnaround time. In a time-sharing environment, such improvement in this speed is achieved when multiple processors are used efficiently to execute an algorithm. The concept of multiple instructions and multiple data (MIMD) is applied through multitasking via a strategy that requires relatively minor modifications to an existing code for a single processor. This approach maps the available memory to multiple processors, exploiting the C-Fortran-Unix interface. The existing code is mapped without the need for developing a new algorithm. The procedure for building a code utilizing this approach is automated with the Unix stream editor.

Endometrial ablation: normal appearance and complications.

PubMed

Drylewicz, Monica R; Robinson, Kathryn; Siegel, Cary Lynn

2018-03-14

Global endometrial ablation is a commonly performed, minimally invasive technique aimed at improving/resolving abnormal uterine bleeding and menorrhagia in women. As non-resectoscopic techniques have come into existence, endometrial ablation performance continues to increase due to accessibility and decreased requirements for operating room time and advanced technical training. The increased utilization of this method translates into increased imaging of patients who have undergone the procedure. An understanding of the expected imaging appearances of endometrial ablation using different modalities is important for the abdominal radiologist. In addition, the frequent usage of the technique naturally comes with complications requiring appropriate imaging work-up. We review the expected appearance of the post-endometrial ablated uterus on multiple imaging modalities and demonstrate the more common and rare complications seen in the immediate post-procedural time period and remotely.

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

Not Available

The Federal Oil and Gas Leasing Amendments Act of 1986 makes leasing competitive and establishes leasing procedures for onshore federal lands. The legislation is in response to evidence of mismanagement and abuse of the existing lottery system. There is also no evidence that oil and gas leasing decisions were integrated with other land-use decisions in the framework of multiple-use planning mandated by the Federal Land Policy Management Act, the Renewable Resources Planning Act, and the National Forest Management Act. The bill outlines procedures for competitive bidding, the nomination of areas to be offered for lease, quarterly lease sales, selection ofmore » the highest responsible qualified bidder, lease terms and extension, rentals and royalties, and reporting and notice requirements. Other sections establish environmental requirements and prohibit leasing on wilderness study lands.« less

A Rejection Principle for Sequential Tests of Multiple Hypotheses Controlling Familywise Error Rates

PubMed Central

BARTROFF, JAY; SONG, JINLIN

2015-01-01

We present a unifying approach to multiple testing procedures for sequential (or streaming) data by giving sufficient conditions for a sequential multiple testing procedure to control the familywise error rate (FWER). Together we call these conditions a “rejection principle for sequential tests,” which we then apply to some existing sequential multiple testing procedures to give simplified understanding of their FWER control. Next the principle is applied to derive two new sequential multiple testing procedures with provable FWER control, one for testing hypotheses in order and another for closed testing. Examples of these new procedures are given by applying them to a chromosome aberration data set and to finding the maximum safe dose of a treatment. PMID:26985125

Priority and Negotiation Based Dynamic Spectrum Allocation Scheme for Multiple Radio Access Network Operators

NASA Astrophysics Data System (ADS)

Kim, Hoon; Hyon, Taein; Lee, Yeonwoo

Most of previous works have presented the dynamic spectrum allocation (DSA) gain achieved by utilizing the time or regional variations in traffic demand between multi-network operators (NOs). In this paper, we introduce the functionalities required for the entities related with the spectrum sharing and allocation and propose a spectrum allocation algorithm while considering the long-term priority between NOs, the priority between multiple class services, and the urgent bandwidth request. To take into account the priorities among the NOs and the priorities of multiple class services, a spectrum sharing metric (SSM) is proposed, while a negotiation procedure is proposed to treat the urgent bandwidth request.

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.

Association between Exposure of Young Children to Procedures Requiring General Anesthesia and Learning and Behavioral Outcomes in a Population-based Birth Cohort.

PubMed

Hu, Danqing; Flick, Randall P; Zaccariello, Michael J; Colligan, Robert C; Katusic, Slavica K; Schroeder, Darrell R; Hanson, Andrew C; Buenvenida, Shonie L; Gleich, Stephen J; Wilder, Robert T; Sprung, Juraj; Warner, David O

2017-08-01

Exposure of young animals to general anesthesia causes neurodegeneration and lasting behavioral abnormalities; whether these findings translate to children remains unclear. This study used a population-based birth cohort to test the hypothesis that multiple, but not single, exposures to procedures requiring general anesthesia before age 3 yr are associated with adverse neurodevelopmental outcomes. A retrospective study cohort was assembled from children born in Olmsted County, Minnesota, from 1996 to 2000 (inclusive). Propensity matching selected children exposed and not exposed to general anesthesia before age 3 yr. Outcomes ascertained via medical and school records included learning disabilities, attention-deficit/hyperactivity disorder, and group-administered ability and achievement tests. Analysis methods included proportional hazard regression models and mixed linear models. For the 116 multiply exposed, 457 singly exposed, and 463 unexposed children analyzed, multiple, but not single, exposures were associated with an increased frequency of both learning disabilities and attention-deficit/hyperactivity disorder (hazard ratio for learning disabilities = 2.17 [95% CI, 1.32 to 3.59], unexposed as reference). Multiple exposures were associated with decreases in both cognitive ability and academic achievement. Single exposures were associated with modest decreases in reading and language achievement but not cognitive ability. These findings in children anesthetized with modern techniques largely confirm those found in an older birth cohort and provide additional evidence that children with multiple exposures are more likely to develop adverse outcomes related to learning and attention. Although a robust association was observed, these data do not determine whether anesthesia per se is causal.

Global Search Capabilities of Indirect Methods for Impulsive Transfers

NASA Astrophysics Data System (ADS)

Shen, Hong-Xin; Casalino, Lorenzo; Luo, Ya-Zhong

2015-09-01

An optimization method which combines an indirect method with homotopic approach is proposed and applied to impulsive trajectories. Minimum-fuel, multiple-impulse solutions, with either fixed or open time are obtained. The homotopic approach at hand is relatively straightforward to implement and does not require an initial guess of adjoints, unlike previous adjoints estimation methods. A multiple-revolution Lambert solver is used to find multiple starting solutions for the homotopic procedure; this approach can guarantee to obtain multiple local solutions without relying on the user's intuition, thus efficiently exploring the solution space to find the global optimum. The indirect/homotopic approach proves to be quite effective and efficient in finding optimal solutions, and outperforms the joint use of evolutionary algorithms and deterministic methods in the test cases.

A function-based approach to cockpit procedure aids

NASA Technical Reports Server (NTRS)

Phatak, Anil V.; Jain, Parveen; Palmer, Everett

1990-01-01

The objective of this research is to develop and test a cockpit procedural aid that can compose and present procedures that are appropriate for the given flight situation. The procedure would indicate the status of the aircraft engineering systems, and the environmental conditions. Prescribed procedures already exist for normal as well as for a number of non-normal and emergency situations, and can be presented to the crew using an interactive cockpit display. However, no procedures are prescribed or recommended for a host of plausible flight situations involving multiple malfunctions compounded by adverse environmental conditions. Under these circumstances, the cockpit procedural aid must review the prescribed procedures for the individual malfunction (when available), evaluate the alternatives or options, and present one or more composite procedures (prioritized or unprioritized) in response to the given situation. A top-down function-based conceptual approach towards composing and presenting cockpit procedures is being investigated. This approach is based upon the thought process that an operating crew must go through while attempting to meet the flight objectives given the current flight situation. In order to accomplish the flight objectives, certain critical functions must be maintained during each phase of the flight, using the appropriate procedures or success paths. The viability of these procedures depends upon the availability of required resources. If resources available are not sufficient to meet the requirements, alternative procedures (success paths) using the available resources must be constructed to maintain the critical functions and the corresponding objectives. If no success path exists that can satisfy the critical functions/objectives, then the next level of critical functions/objectives must be selected and the process repeated. Information is given in viewgraph form.

An International Perspective on Pharmacy Student Selection Policies and Processes

PubMed Central

Kennedy, Julia; Jensen, Maree; Sheridan, Janie

2015-01-01

Objective. To reflect on selection policies and procedures for programs at pharmacy schools that are members of an international alliance of universities (Universitas 21). Methods. A questionnaire on selection policies and procedures was distributed to admissions directors at participating schools. Results. Completed questionnaires were received from 7 schools in 6 countries. Although marked differences were noted in the programs in different countries, there were commonalities in the selection processes. There was an emphasis on previous academic performance, especially in science subjects. With one exception, all schools had some form of interview, with several having moved to multiple mini-interviews in recent years. Conclusion. The majority of pharmacy schools in this survey relied on traditional selection processes. While there was increasing use of multiple mini-interviews, the authors suggest that additional new approaches may be required in light of the changing nature of the profession. PMID:26689381

Derivation of a Performance Checklist for Ultrasound-Guided Arthrocentesis Using the Modified Delphi Method.

PubMed

Kunz, Derek; Pariyadath, Manoj; Wittler, Mary; Askew, Kim; Manthey, David; Hartman, Nicholas

2017-06-01

Arthrocentesis is an important skill for physicians in multiple specialties. Recent studies indicate a superior safety and performance profile for this procedure using ultrasound guidance for needle placement, and improving quality of care requires a valid measurement of competency using this modality. We endeavored to create a validated tool to assess the performance of this procedure using the modified Delphi technique and experts in multiple disciplines across the United States. We derived a 22-item checklist designed to assess competency for the completion of ultrasound-guided arthrocentesis, which demonstrated a Cronbach's alpha of 0.89, indicating an excellent degree of internal consistency. Although we were able to demonstrate content validity for this tool, further validity evidence should be acquired after the tool is used and studied in clinical and simulated contexts. © 2017 by the American Institute of Ultrasound in Medicine.

An International Perspective on Pharmacy Student Selection Policies and Processes.

PubMed

Shaw, John; Kennedy, Julia; Jensen, Maree; Sheridan, Janie

2015-10-25

Objective. To reflect on selection policies and procedures for programs at pharmacy schools that are members of an international alliance of universities (Universitas 21). Methods. A questionnaire on selection policies and procedures was distributed to admissions directors at participating schools. Results. Completed questionnaires were received from 7 schools in 6 countries. Although marked differences were noted in the programs in different countries, there were commonalities in the selection processes. There was an emphasis on previous academic performance, especially in science subjects. With one exception, all schools had some form of interview, with several having moved to multiple mini-interviews in recent years. Conclusion. The majority of pharmacy schools in this survey relied on traditional selection processes. While there was increasing use of multiple mini-interviews, the authors suggest that additional new approaches may be required in light of the changing nature of the profession.

Laparoscopic management of cystic disease of the liver.

PubMed

Albrink, M H; McAllister, E W; Rosemurgy, A S; Karl, R C; Carey, L C

1994-04-01

Laparoscopic surgical procedures are increasing in scope and in variety. The benefits of decreased wound morbidity and pain have been well documented for multiple procedures that have traditionally required laparotomy. Although there are few controlled studies to document them, these benefits may be evident from simple clinical observation. Cystic disease of the liver is a condition that is treated largely for symptomatic reasons. The so-called noninvasive or radiographic guided methods of treatment for cystic disease of the liver are fraught with high recurrence rates. We present four cases of cystic disease of the liver treated laparoscopically, followed with pertinent discussion.

Management of cystinuric patients: an observational, retrospective, single-centre analysis.

PubMed

Ahmed, Kamran; Khan, Mohammad Shamim; Thomas, Kay; Challacombe, Ben; Bultitude, Matthew; Glass, Jonathan; Tiptaft, Richard; Dasgupta, Prokar

2008-01-01

A critical appraisal of the management of patients with cystine stones treated in our unit in the past 6 years and to analyze the outcome of multimodality therapies. An observational, single-centre retrospective study. We reviewed the records of all patients with stones referred to our centre over a 6-year period from 1998 to 2005. Data recorded included demographic details, medical therapies received/prescribed, compliance with medical therapies, mode of treatment, stone clearance and any recurrence during this period of study. A total of 30 cystinuric patients were treated in our institution over the period of 6 years from 1998 to early 2005. Of these 16 were males and 14 females with an average age at last follow-up of 39 years (range 15-70). Two patients were successfully managed medically. The remaining patients (n = 28) underwent a total of 237 procedures (pre- and postreferral to our unit), with an average of 7.9 procedures per patient for 126 stone episodes (4.2 episodes/patient). The modes of treatment included extracorporeal shockwave lithotripsy (n = 143), ureterorenoscopy and intracorporeal lithotripsy (n = 50), percutaneous nephrolithotomy (n = 28) and open procedures (n = 16). Two patients needed open surgery at our unit. Prior to referral to our dedicated unit, patients had received treatment with extracorporeal shockwave lithotripsy (multiple sessions), ureteroscopy (n = 14), percutaneous nephrolithotomy (n = 4) and open stone removal (n = 14). Most of the stones at our unit were managed using minimally invasive therapies. Compliance of cystinuric patients with medical treatment is often poor and patients experience recurrent stone episodes requiring multiple interventions. Modern management of cystine calculi should be with staged minimally invasive procedures to avoid the complications of multiple open procedures wherever possible along with appropriate medical prophylaxis.

Learning procedures from interactive natural language instructions

NASA Technical Reports Server (NTRS)

Huffman, Scott B.; Laird, John E.

1994-01-01

Despite its ubiquity in human learning, very little work has been done in artificial intelligence on agents that learn from interactive natural language instructions. In this paper, the problem of learning procedures from interactive, situated instruction is examined in which the student is attempting to perform tasks within the instructional domain, and asks for instruction when it is needed. Presented is Instructo-Soar, a system that behaves and learns in response to interactive natural language instructions. Instructo-Soar learns completely new procedures from sequences of instruction, and also learns how to extend its knowledge of previously known procedures to new situations. These learning tasks require both inductive and analytic learning. Instructo-Soar exhibits a multiple execution learning process in which initial learning has a rote, episodic flavor, and later executions allow the initially learned knowledge to be generalized properly.

Grading Multiple Choice Exams with Low-Cost and Portable Computer-Vision Techniques

NASA Astrophysics Data System (ADS)

Fisteus, Jesus Arias; Pardo, Abelardo; García, Norberto Fernández

2013-08-01

Although technology for automatic grading of multiple choice exams has existed for several decades, it is not yet as widely available or affordable as it should be. The main reasons preventing this adoption are the cost and the complexity of the setup procedures. In this paper, Eyegrade, a system for automatic grading of multiple choice exams is presented. While most current solutions are based on expensive scanners, Eyegrade offers a truly low-cost solution requiring only a regular off-the-shelf webcam. Additionally, Eyegrade performs both mark recognition as well as optical character recognition of handwritten student identification numbers, which avoids the use of bubbles in the answer sheet. When compared with similar webcam-based systems, the user interface in Eyegrade has been designed to provide a more efficient and error-free data collection procedure. The tool has been validated with a set of experiments that show the ease of use (both setup and operation), the reduction in grading time, and an increase in the reliability of the results when compared with conventional, more expensive systems.

LMSS communication network design

NASA Technical Reports Server (NTRS)

1982-01-01

The architecture of the telecommunication network as the first step in the design of the LMSS system is described. A set of functional requirements including the total number of users to be served by the LMSS are hypothesized. The design parameters are then defined at length and are systematically selected such that the resultant system is capable of serving the hypothesized number of users. The design of the backhaul link is presented. The number of multiple backhaul beams required for communication to the base stations is determined. A conceptual procedure for call-routing and locating a mobile subscriber within the LMSS network is presented. The various steps in placing a call are explained, and the relationship between the two sets of UHF and S-band multiple beams is developed. A summary of the design parameters is presented.

Fabrication of Transition Edge Sensor Microcalorimeters for X-Ray Focal Planes

NASA Technical Reports Server (NTRS)

Chervenak, James A.; Adams, Joseph S.; Audley, Heather; Bandler, Simon R.; Betancourt-Martinez, Gabriele; Eckart, Megan E.; Finkbeiner, Fred M.; Kelley, Richard L.; Kilbourne, Caroline; Lee, Sang Jun;

Confidence Bounds and Power for the Reliability of Observational Measures on the Quality of a Social Setting

ERIC Educational Resources Information Center

Shin, Yongyun; Raudenbush, Stephen W.

2012-01-01

Social scientists are frequently interested in assessing the qualities of social settings such as classrooms, schools, neighborhoods, or day care centers. The most common procedure requires observers to rate social interactions within these settings on multiple items and then to combine the item responses to obtain a summary measure of setting…

Transformations in a Civil Discourse Public Speaking Class: Speakers' and Listeners' Attitude Change. Scholarship of Teaching and Learning

ERIC Educational Resources Information Center

Gayle, Barbara Mae

2004-01-01

Learning to engage in civil discourse requires students to maintain an openness to new points of view and attitude change. In a public speaking course based on principles of civil discourse, classroom procedures were designed to foster subjective reframing by engaging students in the disorienting exercise of supporting multiple perspectives on the…

FLIS Procedures Manual Multiple Application References/Instructions/Tables and Grids.

DTIC Science & Technology

1996-10-01

Agency OUSD ATIN: DCB/IIS Washington, DC 20505 62 Department of Health , Education, and Welfare Food and Drug Administration ATTN: Supply Requirements...Table 206 3 3 Table 209 1 thru 6 1 thru 6 Table 214 -- 1 thru 3 11. SIGNIFICANT CHANGES A. The page replacements are effective upon receipt. B... Effective Date (ED) Processing Conflict Conditions .......................................................................... 99 Effective Dated (ED

Efficient computation of the genomic relationship matrix and other matrices used in single-step evaluation.

PubMed

Aguilar, I; Misztal, I; Legarra, A; Tsuruta, S

2011-12-01

Genomic evaluations can be calculated using a unified procedure that combines phenotypic, pedigree and genomic information. Implementation of such a procedure requires the inverse of the relationship matrix based on pedigree and genomic relationships. The objective of this study was to investigate efficient computing options to create relationship matrices based on genomic markers and pedigree information as well as their inverses. SNP maker information was simulated for a panel of 40 K SNPs, with the number of genotyped animals up to 30 000. Matrix multiplication in the computation of the genomic relationship was by a simple 'do' loop, by two optimized versions of the loop, and by a specific matrix multiplication subroutine. Inversion was by a generalized inverse algorithm and by a LAPACK subroutine. With the most efficient choices and parallel processing, creation of matrices for 30 000 animals would take a few hours. Matrices required to implement a unified approach can be computed efficiently. Optimizations can be either by modifications of existing code or by the use of efficient automatic optimizations provided by open source or third-party libraries. © 2011 Blackwell Verlag GmbH.

A preliminary study of painless and effective transdermal botulinum toxin A delivery by jet nebulization for treatment of primary hyperhidrosis.

PubMed

Iannitti, Tommaso; Palmieri, Beniamino; Aspiro, Anna; Di Cerbo, Alessandro

2014-01-01

Hyperhidrosis is a chronic disease characterized by increased sweat production. Local injections of botulinum toxin A (BTX-A) have been extensively used for treatment of primary hyperhidrosis (idiopathic). The current treatment for this condition involves several intradermal injections, resulting in poor patient compliance due to injection-related pain. Therefore, new protocols, including an improved anesthetic regimen, are required. We designed the present study to determine whether JetPeel™-3, a medical device used for transdermal delivery of drugs by jet nebulization, could be used to deliver lidocaine prior to the standard multiple BTX-A injections or deliver lidocaine together with BTX-A in order to determine the protocol giving better results in terms of procedure-related pain, sweating, and patient satisfaction in subjects affected by primary axillary, palmar or plantar hyperhidrosis. Twenty patients with a visual analog scale (VAS) sweating score ≥ 8 cm were randomized to receive lidocaine 2% (5 mL) delivered by JetPeel™-3 followed by multiple injections of BTX-A (100 units) or lidocaine 2% (5 mL) and BTX-A (50 units) delivered together by JetPeel™-3. Effect of treatment on sweating was measured by VAS (0= minimum sweating; 10= maximum sweating) at 3-month follow-up. Pain induced by the procedure was assessed by VAS (0= minimum pain; 10= maximum pain) immediately after the procedure. Patient satisfaction was assessed at 3-month follow-up using a 5-point scale (1= not at all satisfied; 2= not satisfied; 3= partially satisfied; 4= satisfied; 5= highly satisfied). Both treatment modalities reduced sweating at 3-month follow-up, if compared with baseline (all P<0.001). Delivery of lidocaine and BTX-A by JetPeel™-3 resulted in lower procedure-related pain and reduced sweating, if compared with lidocaine delivered by JetPeel™-3 followed by multiple BTX-A injections (all P<0.001). Patient satisfaction with the procedure was higher in the group receiving lidocaine and BTX-A treatment by JetPeel™-3, if compared with lidocaine delivered by JetPeel™-3 followed by multiple BTX-A injections (P<0.001). No side effects were observed in both groups. Lidocaine and BTX-A can be safely delivered together by JetPeel™-3 to treat primary palmar, plantar and axillary hyperhidrosis, resulting in lower procedure-related pain, improved sweating and higher patient satisfaction, if compared with lidocaine delivered by JetPeel™-3 followed by standard BTX-A injection therapy. Our protocol delivering lidocaine and BTX-A together by JetPeel™-3 requires a reduced quantity of BTX-A, further supporting the use of the transdermal drug delivery by jet nebulization over standard injection therapy for treatment of primary hyperhidrosis.

[Actual medical care situation and therapeutic needs in multiple sclerosis: Impact of the Pharmaceutical Market Restructuring Act (AMNOG)].

PubMed

Bittner, S; Meuth, S G

2016-04-01

The treatment of patients with multiple sclerosis (MS) is associated with constantly rising costs for the healthcare system and pharmaceuticals constitute 60 % of the direct medical costs. The Pharmaceutical Market Restructuring Act (Arzneimittelmarkt-Neuordnungsgesetz, AMNOG) came into force on 1 January 2011 with the aim of limiting the costs of pharmaceuticals by obligating newly approved products to be subjected to an early evaluation of the additional benefits by the Federal Joint Committee (FJC, Gemeinsamer Bundesausschuss, G‑BA). The majority of products evaluated up to October 2015 in neurology (5 out of 8) were approved for treatment of MS. Has the AMNOG been able to fulfill the original aims? Analysis of available information on MS therapies evaluated by the FJC between December 2010 and October 2015. For various reasons an additional benefit could be shown in only 2 out of 5 assessment procedures for MS drugs. It is obvious that some methodological shortcomings of the process have to be improved. Additionally requirements for pivotal clinical trials have to be harmonized with AMNOG requirements taking the best available evidence and real-life data into consideration (e.g. non-interventional studies) and a closer collaboration between the FJC, healthcare providers and the neurological societies is necessary. The AMNOG procedure currently only partially fulfills the original aims, which could be the reason why guidelines play a more important role for therapy decision-making than FJC decisions. As the early evaluation procedure is an adaptive process methodological shortcomings might be overcome in the future; however, this requires a much closer collaboration between the FJC and neurological societies.

Production of knock-in mice in a single generation from embryonic stem cells.

PubMed

Ukai, Hideki; Kiyonari, Hiroshi; Ueda, Hiroki R

2017-12-01

The system-level identification and analysis of molecular networks in mammals can be accelerated by 'next-generation' genetics, defined as genetics that does not require crossing of multiple generations of animals in order to achieve the desired genetic makeup. We have established a highly efficient procedure for producing knock-in (KI) mice within a single generation, by optimizing the genome-editing protocol for KI embryonic stem (ES) cells and the protocol for the generation of fully ES-cell-derived mice (ES mice). Using this protocol, the production of chimeric mice is eliminated, and, therefore, there is no requirement for the crossing of chimeric mice to produce mice that carry the KI gene in all cells of the body. Our procedure thus shortens the time required to produce KI ES mice from about a year to ∼3 months. Various kinds of KI ES mice can be produced with a minimized amount of work, facilitating the elucidation of organism-level phenomena using a systems biology approach. In this report, we describe the basic technologies and protocols for this procedure, and discuss the current challenges for next-generation mammalian genetics in organism-level systems biology studies.

Quality control in diagnostic immunohistochemistry: integrated on-slide positive controls.

PubMed

Bragoni, A; Gambella, A; Pigozzi, S; Grigolini, M; Fiocca, R; Mastracci, L; Grillo, F

2017-11-01

Standardization in immunohistochemistry is a priority in modern pathology and requires strict quality control. Cost containment has also become fundamental and auditing of all procedures must take into account both these principles. Positive controls must be routinely performed so that their positivity guarantees the appropriateness of the immunohistochemical procedure. The aim of this study is to develop a low cost (utilizing a punch biopsy-PB-tool) procedure to construct positive controls which can be integrated in the patient's tissue slide. Sixteen frequently used control blocks were selected and multiple cylindrical samples were obtained using a 5-mm diameter punch biopsy tool, separately re-embedding them in single blocks. For each diagnostic immunoreaction requiring a positive control, an integrated PB-control section (cut from the appropriate PB-control block) was added to the top right corner of the diagnostic slide before immunostaining. This integrated control technique permitted a saving of 4.75% in total direct lab costs and proved to be technically feasible and reliable. Our proposal is easy to perform and within the reach of all pathology labs, requires easily available tools, its application costs is less than using external paired controls and ensures that a specific control for each slide is always available.

[Multiple colonic anastomoses in the surgical treatment of short bowel syndrome. A new technique].

PubMed

Robledo-Ogazón, Felipe; Becerril-Martínez, Guillermo; Hernández-Saldaña, Víctor; Zavala-Aznar, Marí Luisa; Bojalil-Durán, Luis

2008-01-01

Some surgical pathologies eventually require intestinal resection. This may lead to an extended procedure such as leaving 30 cm of proximal jejunum and left and sigmoid colon. One of the most important consequences of this type of resection is "intestinal failure" or short bowel syndrome. This complex syndrome leads to different metabolic and water and acid/base imbalances, as well as nutritional and immunological challenges along with the problem accompanying an abdomen subjected to many surgical procedures and high mortality. Many surgical techniques have been developed to improve quality of life of patients. We designed a non-transplant surgical approach and performed the procedure on two patients with postoperative short bowel syndrome with <40 cm of proximal jejunum and left colon. There are a variety of non-transplant surgical procedures that, due to their complex technique or high mortality rate, have not resolved this important problem. However, the technique we present in this work can be performed by a large number of surgeons. The procedure has a low morbimortality rate and offers the opportunity for better control of metabolic and acid/base balance, intestinal transit and proper nutrition. We consider that this technique offers a new alternative for the complex management required by patients with short bowel syndrome and facilitates their long-term nutritional control.

Systems Maintenance Automated Repair Tasks (SMART)

NASA Technical Reports Server (NTRS)

Schuh, Joseph; Mitchell, Brent; Locklear, Louis; Belson, Martin A.; Al-Shihabi, Mary Jo Y.; King, Nadean; Norena, Elkin; Hardin, Derek

2010-01-01

SMART is a uniform automated discrepancy analysis and repair-authoring platform that improves technical accuracy and timely delivery of repair procedures for a given discrepancy (see figure a). SMART will minimize data errors, create uniform repair processes, and enhance the existing knowledge base of engineering repair processes. This innovation is the first tool developed that links the hardware specification requirements with the actual repair methods, sequences, and required equipment. SMART is flexibly designed to be useable by multiple engineering groups requiring decision analysis, and by any work authorization and disposition platform (see figure b). The organizational logic creates the link between specification requirements of the hardware, and specific procedures required to repair discrepancies. The first segment in the SMART process uses a decision analysis tree to define all the permutations between component/ subcomponent/discrepancy/repair on the hardware. The second segment uses a repair matrix to define what the steps and sequences are for any repair defined in the decision tree. This segment also allows for the selection of specific steps from multivariable steps. SMART will also be able to interface with outside databases and to store information from them to be inserted into the repair-procedure document. Some of the steps will be identified as optional, and would only be used based on the location and the current configuration of the hardware. The output from this analysis would be sent to a work authoring system in the form of a predefined sequence of steps containing required actions, tools, parts, materials, certifications, and specific requirements controlling quality, functional requirements, and limitations.

Advanced 3-D analysis, client-server systems, and cloud computing-Integration of cardiovascular imaging data into clinical workflows of transcatheter aortic valve replacement.

PubMed

Schoenhagen, Paul; Zimmermann, Mathis; Falkner, Juergen

2013-06-01

Degenerative aortic stenosis is highly prevalent in the aging populations of industrialized countries and is associated with poor prognosis. Surgical valve replacement has been the only established treatment with documented improvement of long-term outcome. However, many of the older patients with aortic stenosis (AS) are high-risk or ineligible for surgery. For these patients, transcatheter aortic valve replacement (TAVR) has emerged as a treatment alternative. The TAVR procedure is characterized by a lack of visualization of the operative field. Therefore, pre- and intra-procedural imaging is critical for patient selection, pre-procedural planning, and intra-operative decision-making. Incremental to conventional angiography and 2-D echocardiography, multidetector computed tomography (CT) has assumed an important role before TAVR. The analysis of 3-D CT data requires extensive post-processing during direct interaction with the dataset, using advance analysis software. Organization and storage of the data according to complex clinical workflows and sharing of image information have become a critical part of these novel treatment approaches. Optimally, the data are integrated into a comprehensive image data file accessible to multiple groups of practitioners across the hospital. This creates new challenges for data management requiring a complex IT infrastructure, spanning across multiple locations, but is increasingly achieved with client-server solutions and private cloud technology. This article describes the challenges and opportunities created by the increased amount of patient-specific imaging data in the context of TAVR.

Multiple-digit resurfacing using a thin latissimus dorsi perforator flap.

PubMed

Kim, Sang Wha; Lee, Ho Jun; Kim, Jeong Tae; Kim, Youn Hwan

2014-01-01

Traumatic digit defects of high complexity and with inadequate local tissue represent challenging surgical problems. Recently, perforator flaps have been proposed for reconstructing large defects of the hand because of their thinness and pliability and minimal donor site morbidity. Here, we illustrate the use of thin latissimus dorsi perforator flaps for resurfacing multiple defects of distal digits. We describe the cases of seven patients with large defects, including digits, circumferential defects and multiple-digit defects, who underwent reconstruction with thin latissimus dorsi perforator flaps between January 2008 and March 2012. Single-digit resurfacing procedures were excluded. The mean age was 56.3 years and the mean flap size was 160.4 cm(2). All the flaps survived completely. Two patients had minor complications including partial flap loss and scar contracture. The mean follow-up period was 11.7 months. The ideal flap for digit resurfacing should be thin and amenable to moulding, have a long pedicle for microanastomosis and have minimal donor site morbidity. Thin flaps can be harvested by excluding the deep adipose layer, and their high pliability enables resurfacing without multiple debulking procedures. The latissimus dorsi perforator flap may be the best flap for reconstructing complex defects of the digits, such as large, multiple-digit or circumferential defects, which require complete wrapping of volar and dorsal surfaces. Copyright © 2013 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

Determination of primary energy in nucleus-nucleus collisions and the high P(sub)T tail of alpha-particles

NASA Technical Reports Server (NTRS)

Freier, P. S.; Atwater, T. W.

1985-01-01

A determination of primary energy is required in order to study the energy dependence of meson multiplicity in A-A collisions in cosmic rays. Various procedures which estimate the energy of a primary nucleus from its interaction were investigated. An average of two methods were used, one using the pions and wounded protons and the other using spectator protons and alpha particles. The high P sub T tail observed for Z = 2 fragments requires a modification of the latter method.

Utility and Safety of Combined Interventional Catheterization and Electrophysiology Procedures in a Children's Hospital.

PubMed

Asaki, S Yukiko; Orcutt, Jeffrey W; Miyake, Christina Y; Justino, Henri; de la Uz, Caridad M; Kim, Jeffrey J; Valdes, Santiago O; Qureshi, Athar M

2017-06-01

Interventional cardiac catheterization (cath) and electrophysiology (EP) procedures are not routinely performed together. There are several perceived barriers affecting this practice, though there are also advantages for both the patient and practitioner to a combined approach. This was a single-center retrospective study reviewing combined cath and EP procedures with a preprocedural intention to intervene at Texas Children's Hospital from 2001 to 2014. We excluded procedures in which the intended procedure was purely diagnostic in nature. A total of 121 patients requiring 125 procedures were identified, of which 61 patients underwent 62 procedures that met our inclusion criteria. Potential subgroups of interest included adult congenital heart disease patients (26% of cohort), single ventricle anatomy (34%), and heterotaxy (19%) and collectively 58% of procedures involved a patient in one of these groups. The combined nature of the procedure did not preclude a cath or EP intervention in any patient. There were no mortalities. There were three adverse events, affecting 4.8% of procedures. Combined interventional cardiac cath and EP procedures in pediatric patients and those with congenital heart disease can be performed safely in a high-volume center. These combined procedures save patients the risk and inconvenience of multiple procedures, and further investigation into cost savings is warranted. © 2017 Wiley Periodicals, Inc.

What Is Evidence-Based Behavior Analysis?

PubMed Central

Smith, Tristram

2013-01-01

Although applied behavior analysts often say they engage in evidence-based practice, they express differing views on what constitutes “evidence” and “practice.” This article describes a practice as a service offered by a provider to help solve a problem presented by a consumer. Solving most problems (e.g., increasing or decreasing a behavior and maintaining this change) requires multiple intervention procedures (i.e., a package). Single-subject studies are invaluable in investigating individual procedures, but researchers still need to integrate the procedures into a package. The package must be standardized enough for independent providers to replicate yet flexible enough to allow individualization; intervention manuals are the primary technology for achieving this balance. To test whether the package is effective in solving consumers' problems, researchers must evaluate outcomes of the package as a whole, usually in group studies such as randomized controlled trials. From this perspective, establishing an evidence-based practice involves more than analyzing the effects of discrete intervention procedures on behavior; it requires synthesizing information so as to offer thorough solutions to problems. Recognizing the need for synthesis offers behavior analysts many promising opportunities to build on their existing research to increase the quality and quantity of evidence-based practices. PMID:25729130

Rapid non-enzymatic extraction method for isolating PCR-quality camelpox virus DNA from skin.

PubMed

Yousif, A Ausama; Al-Naeem, A Abdelmohsen; Al-Ali, M Ahmad

2010-10-01

Molecular diagnostic investigations of orthopoxvirus (OPV) infections are performed using a variety of clinical samples including skin lesions, tissues from internal organs, blood and secretions. Skin samples are particularly convenient for rapid diagnosis and molecular epidemiological investigations of camelpox virus (CMLV). Classical extraction procedures and commercial spin-column-based kits are time consuming, relatively expensive, and require multiple extraction and purification steps in addition to proteinase K digestion. A rapid non-enzymatic procedure for extracting CMLV DNA from dried scabs or pox lesions was developed to overcome some of the limitations of the available DNA extraction techniques. The procedure requires as little as 10mg of tissue and produces highly purified DNA [OD(260)/OD(280) ratios between 1.47 and 1.79] with concentrations ranging from 6.5 to 16 microg/ml. The extracted CMLV DNA was proven suitable for virus-specific qualitative and, semi-quantitative PCR applications. Compared to spin-column and conventional viral DNA extraction techniques, the two-step extraction procedure saves money and time, and retains the potential for automation without compromising CMLV PCR sensitivity. Copyright (c) 2010 Elsevier B.V. All rights reserved.

Results of multiple drilling compared with those of conventional methods of core decompression.

PubMed

Song, Won Seok; Yoo, Jeong Joon; Kim, Young-Min; Kim, Hee Joong

2007-01-01

We performed multiple drilling as a femoral head-preserving procedure for osteonecrosis of the femoral head thinking the therapeutic effects of core decompression could be achieved by this simpler procedure than core decompression. We retrospectively reviewed 136 patients (163 hips) who had multiple drilling using 9/64-inch Steinmann pins for treatment of nontraumatic osteonecrosis of the femoral head. The mean followup for patients who did not require additional surgery (113 hips) was 87 months (range, 60-134 months). We defined failure as the need for additional surgery or a Harris hip score less than 75. After a minimum 5-year followup, 79% (31/39) of patients with Stage I disease and 77% (62/81) of patients with Stage II disease had no additional surgery. All (15/15) small lesions (<25% involvement) and 84% (37/44) of medium-sized lesions (25-50% involvement) were considered successful. Survival rates of patients with Ficat Stages I or II lesions were greater than survival rates for patients with Stage III lesions. Hips with a large necrotic area had poor results. We had one instance of subtrochanteric fracture through drill entry holes. Multiple drilling is straightforward with few complications and produces results comparable to results of other core decompression techniques.

29 CFR 1926.761 - Training.

Code of Federal Regulations, 2010 CFR

2010-07-01

... following activities. (1) Multiple lift rigging procedure. The employer shall ensure that each employee who performs multiple lift rigging has been provided training in the following areas: (i) The nature of the hazards associated with multiple lifts; and (ii) The proper procedures and equipment to perform multiple...

29 CFR 1926.761 - Training.

Code of Federal Regulations, 2011 CFR

2011-07-01

... following activities. (1) Multiple lift rigging procedure. The employer shall ensure that each employee who performs multiple lift rigging has been provided training in the following areas: (i) The nature of the hazards associated with multiple lifts; and (ii) The proper procedures and equipment to perform multiple...

Transonic flow solutions using a composite velocity procedure for potential, Euler and RNS equations

NASA Technical Reports Server (NTRS)

Gordnier, R. E.; Rubin, S. G.

1986-01-01

Solutions for transonic viscous and inviscid flows using a composite velocity procedure are presented. The velocity components of the compressible flow equations are written in terms of a multiplicative composite consisting of a viscous or rotational velocity and an inviscid, irrotational, potential-like function. This provides for an efficient solution procedure that is locally representative of both asymptotic inviscid and boundary layer theories. A modified conservative form of the axial momentum equation that is required to obtain rotational solutions in the inviscid region is presented and a combined conservation/nonconservation form is applied for evaluation of the reduced Navier-Stokes (RNS), Euler and potential equations. A variety of results is presented and the effects of the approximations on entropy production, shock capturing, and viscous interaction are discussed.

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.

Improvements to direct quantitative analysis of multiple microRNAs facilitating faster analysis.

PubMed

Ghasemi, Farhad; Wegman, David W; Kanoatov, Mirzo; Yang, Burton B; Liu, Stanley K; Yousef, George M; Krylov, Sergey N

2013-11-05

Studies suggest that patterns of deregulation in sets of microRNA (miRNA) can be used as cancer diagnostic and prognostic biomarkers. Establishing a "miRNA fingerprint"-based diagnostic technique requires a suitable miRNA quantitation method. The appropriate method must be direct, sensitive, capable of simultaneous analysis of multiple miRNAs, rapid, and robust. Direct quantitative analysis of multiple microRNAs (DQAMmiR) is a recently introduced capillary electrophoresis-based hybridization assay that satisfies most of these criteria. Previous implementations of the method suffered, however, from slow analysis time and required lengthy and stringent purification of hybridization probes. Here, we introduce a set of critical improvements to DQAMmiR that address these technical limitations. First, we have devised an efficient purification procedure that achieves the required purity of the hybridization probe in a fast and simple fashion. Second, we have optimized the concentrations of the DNA probe to decrease the hybridization time to 10 min. Lastly, we have demonstrated that the increased probe concentrations and decreased incubation time removed the need for masking DNA, further simplifying the method and increasing its robustness. The presented improvements bring DQAMmiR closer to use in a clinical setting.

The selection of adhesive systems for resin-based luting agents.

PubMed

Carville, Rebecca; Quinn, Frank

2008-01-01

The use of resin-based luting agents is ever expanding with the development of adhesive dentistry. A multitude of different adhesive systems are used with resin-based luting agents, and new products are introduced to the market frequently. Traditional adhesives generally required a multiple step bonding procedure prior to cementing with active resin-based luting materials; however, combined agents offer a simple application procedure. Self-etching 'all-in-one' systems claim that there is no need for the use of a separate adhesive process. The following review addresses the advantages and disadvantages of the available adhesive systems used with resin-based luting agents.

Progress in The Semantic Analysis of Scientific Code

NASA Technical Reports Server (NTRS)

Stewart, Mark

2000-01-01

This paper concerns a procedure that analyzes aspects of the meaning or semantics of scientific and engineering code. This procedure involves taking a user's existing code, adding semantic declarations for some primitive variables, and parsing this annotated code using multiple, independent expert parsers. These semantic parsers encode domain knowledge and recognize formulae in different disciplines including physics, numerical methods, mathematics, and geometry. The parsers will automatically recognize and document some static, semantic concepts and help locate some program semantic errors. These techniques may apply to a wider range of scientific codes. If so, the techniques could reduce the time, risk, and effort required to develop and modify scientific codes.

Effectiveness of percutaneous vertebroplasty in patients with multiple myeloma having vertebral pain

PubMed Central

Nas, Ömer Fatih; İnecikli, Mehmet Fatih; Hacıkurt, Kadir; Büyükkaya, Ramazan; Özkaya, Güven; Özkalemkaş, Fahir; Ali, Rıdvan; Erdoğan, Cüneyt; Hakyemez, Bahattin

2016-01-01

PURPOSE We aimed to assess the effectiveness, benefits, and reliability of percutaneous vertebroplasty (PV) in patients with vertebral involvement of multiple myeloma. METHODS PV procedures performed on 166 vertebrae of 41 patients with multiple myeloma were retrospectively evaluated. Most of our patients were using level 3 (moderate to severe pain) analgesics. Magnetic resonance imaging was performed before the procedure to assess vertebral involvement of multiple myeloma. The following variables were evaluated: affected vertebral levels, loss of vertebral body height, polymethylmethacrylate (PMMA) cement amount applied to the vertebral body during PV, PMMA cement leakages, and pain before and after PV as assessed by a visual analogue scale (VAS). RESULTS Median VAS scores of patients decreased from 9 one day before PV, to 6 one day after the procedure, to 3 one week after the procedure, and eventually to 1 three months after the procedure (P < 0.001). During the PV procedure, cement leakage was observed at 68 vertebral levels (41%). The median value of PMMA applied to the vertebral body was 6 mL. CONCLUSION Being a minimally invasive and easily performed procedure with low complication rates, PV should be preferred for serious back pain of multiple myeloma patients. PMID:26912107

Mass screening of multiple abdominal solid organs using mobile helical computed tomography scanner--a preliminary report.

PubMed

Ishikawa, Susumu; Aoki, Jun; Ohwada, Susumu; Takahashi, Toru; Morishita, Yasuo; Ueda, Keisuke

2007-04-01

The possibility of a new screening procedure for multiple abdominal solid organs using a mobile helical computed tomography (CT) scanner was evaluated. A total of 4,543 residents, who were 40 years of age or older, received CT scanning without contrast medium. The mean age of participants was 64 years including 2,022 males and 2,521 females. A total of 2,105 abnormal findings were uniquely detected in 1,594 participants. Liver and kidney diseases including ureter occupied around 30% of total abnormal findings, respectively. Besides frequent cystic or calcified lesions, solid tumours were suspected in 56 lesions, which received further examination by specialized physicians. Five (9%) of them were confirmed as being malignant tumours including pancreatic cancer in two patients, and liver, lung and ovary cancers in one patient each, respectively. All five patients with each malignant lesion received curative operations. Small-sized abdominal aortic aneurysms and heart valve diseases were uniquely found in 22 and two patients, respectively. Qualitative diagnoses of solid tumours were difficult using CT findings without contrast medium. CT screening procedures require further investigation in aspect of the selection of examinees, CT scanning procedure, sensitivity and specificity, and cost-effectiveness.

34 CFR 75.224 - What are the procedures for using a multiple tier review process to evaluate applications?

Code of Federal Regulations, 2010 CFR

2010-07-01

... 34 Education 1 2010-07-01 2010-07-01 false What are the procedures for using a multiple tier... applications received. (d) The Secretary may, in any tier— (1) Use more than one group of experts to gain... procedures for using a multiple tier review process to evaluate applications? (a) The Secretary may use a...

Functional Disorders: Slow-Transit Constipation

PubMed Central

Tillou, John; Poylin, Vitaliy

2017-01-01

Constipation is a very common complaint, with slow-transit constipation (STC) accounting for a significant proportion of cases. Old age, female gender, psychiatric illness, and history of sexual abuse are all associated with STC. The exact cause of STC remains elusive; however, multiple immune and cellular changes have been demonstrated. Diagnosis requires evidence of slowed colonic transit which may be achieved via numerous modalities. While a variety of medical therapies exist, these are often met with limited success and a minority of patients ultimately require operative intervention. When evaluating a patient with STC, it is important to determine the presence of concomitant obstructed defecation or other forms of enteric dysmotility, as this may affect treatment decisions. Although a variety of surgical procedures have been reported, subtotal colectomy with ileorectal anastomosis is the most commonly performed and well-studied procedure, with the best track record of success. PMID:28144215

Fumed silica nanoparticle mediated biomimicry for optimal cell-material interactions for artificial organ development.

PubMed

de Mel, Achala; Ramesh, Bala; Scurr, David J; Alexander, Morgan R; Hamilton, George; Birchall, Martin; Seifalian, Alexander M

2014-03-01

Replacement of irreversibly damaged organs due to chronic disease, with suitable tissue engineered implants is now a familiar area of interest to clinicians and multidisciplinary scientists. Ideal tissue engineering approaches require scaffolds to be tailor made to mimic physiological environments of interest with specific surface topographical and biological properties for optimal cell-material interactions. This study demonstrates a single-step procedure for inducing biomimicry in a novel nanocomposite base material scaffold, to re-create the extracellular matrix, which is required for stem cell integration and differentiation to mature cells. Fumed silica nanoparticle mediated procedure of scaffold functionalization, can be potentially adapted with multiple bioactive molecules to induce cellular biomimicry, in the development human organs. The proposed nanocomposite materials already in patients for number of implants, including world first synthetic trachea, tear ducts and vascular bypass graft. © 2014 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

Multiple curved descending approaches and the air traffic control problem

NASA Technical Reports Server (NTRS)

Hart, S. G.; Mcpherson, D.; Kreifeldt, J.; Wemple, T. E.

1977-01-01

A terminal area air traffic control simulation was designed to study ways of accommodating increased air traffic density. The concepts that were investigated assumed the availability of the microwave landing system and data link and included: (1) multiple curved descending final approaches; (2) parallel runways certified for independent and simultaneous operation under IFR conditions; (3) closer spacing between successive aircraft; and (4) a distributed management system between the air and ground. Three groups each consisting of three pilots and two air traffic controllers flew a combined total of 350 approaches. Piloted simulators were supplied with computer generated traffic situation displays and flight instruments. The controllers were supplied with a terminal area map and digital status information. Pilots and controllers also reported that the distributed management procedure was somewhat more safe and orderly than the centralized management procedure. Flying precision increased as the amount of turn required to intersect the outer mark decreased. Pilots reported that they preferred the alternative of multiple curved descending approaches with wider spacing between aircraft to closer spacing on single, straight in finals while controllers preferred the latter option. Both pilots and controllers felt that parallel runways are an acceptable way to accommodate increased traffic density safely and expeditiously.

Lipoinjection and Multiple Internal Cuts for Congenital Constriction Bands: A New Treatment Approach.

PubMed

Castro-Govea, Yanko; Vela-Martinez, Amin; Treviño-Garcia, Luis Alberto

2017-04-01

Traditional treatment for a congenital constriction band of the limb involves multiple Z-plasties and W-plasties. We propose an alternative surgical procedure for the treatment of congenital constriction bands that obviates the need for Z-plasties and eliminates the constriction band. We present the case of a 36-year-old woman with a congenital constriction band of the leg. Using a minimally invasive approach, the skin segment that included the band was dissected from the deep tissues. Afterwards, multiple slices were performed on the internal surface of the fibrous ring. This and lipoinjection were used to reverse the depression that characterizes the "hourglass sign" and homogenize the skin surface. Results have remained stable in a follow-up period of 18 months. This surgical alternative can be considered as an option for the treatment of congenital constriction bands. It is a safe, reproducible procedure that does not cause additional scars and has good functional and aesthetic results. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

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

Iguchi, Toshihiro, E-mail: iguchi@ba2.so-net.ne.jp; Hiraki, Takao, E-mail: takaoh@tc4.so-net.ne.jp; Gobara, Hideo, E-mail: gobara@cc.okayama-u.ac.jp

PurposeThe aim of the study was to retrospectively evaluate simultaneous multiple hook wire placement outcomes before video-assisted thoracoscopic surgery (VATS).Materials and MethodsThirty-eight procedures were performed on 35 patients (13 men and 22 women; mean age, 59.9 years) with 80 lung lesions (mean diameter 7.9 mm) who underwent simultaneous multiple hook wire placements for preoperative localizations. The primary endpoints were technical success, complications, procedure duration, and VATS outcome; secondary endpoints included comparisons between technical success rates, complication rates, and procedure durations of the 238 single-placement procedures performed. Complications were also evaluated.ResultsIn 35 procedures including 74 lesions, multiple hook wire placements were technically successful;more » in the remaining three procedures, the second target placement was aborted because of massive pneumothorax after the first placement. Although complications occurred in 34 procedures, no grade 3 or above adverse event was observed. The mean procedure duration was 36.4 ± 11.8 min. Three hook wires dislodged during patient transport to the surgical suite. Seventy-four successfully marked lesions were resected. Six lesions without hook wires were successfully resected after detection by palpation with an additional mini-thoracotomy or using subtle pleural changes as a guide. The complication rates and procedure durations of multiple-placement procedures were significantly higher (P = 0.04) and longer (P < 0.001) than those in the single-placement group, respectively, while the technical success rate was not significantly different (P = 0.051).ConclusionsSimultaneous multiple hook wire placements before VATS were clinically feasible, but increased the complication rate and lengthened the procedure time.« less

Compressed-air flow control system.

PubMed

Bong, Ki Wan; Chapin, Stephen C; Pregibon, Daniel C; Baah, David; Floyd-Smith, Tamara M; Doyle, Patrick S

2011-02-21

We present the construction and operation of a compressed-air driven flow system that can be used for a variety of microfluidic applications that require rapid dynamic response and precise control of multiple inlet streams. With the use of inexpensive and readily available parts, we describe how to assemble this versatile control system and further explore its utility in continuous- and pulsed-flow microfluidic procedures for the synthesis and analysis of microparticles.

Simplified multiple scattering model for radiative transfer in turbid water

NASA Technical Reports Server (NTRS)

Ghovanlou, A. H.; Gupta, G. N.

1978-01-01

Quantitative analytical procedures for relating selected water quality parameters to the characteristics of the backscattered signals, measured by remote sensors, require the solution of the radiative transport equation in turbid media. Presented is an approximate closed form solution of this equation and based on this solution, the remote sensing of sediments is discussed. The results are compared with other standard closed form solutions such as quasi-single scattering approximations.

Increasing Efficiency of Fecal Coliform Testing Through EPA-Approved Alternate Method Colilert*-18

NASA Technical Reports Server (NTRS)

Cornwell, Brian

2017-01-01

The 21 SM 9221 E multiple-tube fermentation method for fecal coliform analysis requires a large time and reagent investment for the performing laboratory. In late 2010, the EPA approved an alternative procedure for the determination of fecal coliforms designated as Colilert*-18. However, as of late 2016, only two VELAP-certified laboratories in the Commonwealth of Virginia have been certified in this method.

The relational database model and multiple multicenter clinical trials.

PubMed

Blumenstein, B A

1989-12-01

The Southwest Oncology Group (SWOG) chose to use a relational database management system (RDBMS) for the management of data from multiple clinical trials because of the underlying relational model's inherent flexibility and the natural way multiple entity types (patients, studies, and participants) can be accommodated. The tradeoffs to using the relational model as compared to using the hierarchical model include added computing cycles due to deferred data linkages and added procedural complexity due to the necessity of implementing protections against referential integrity violations. The SWOG uses its RDBMS as a platform on which to build data operations software. This data operations software, which is written in a compiled computer language, allows multiple users to simultaneously update the database and is interactive with respect to the detection of conditions requiring action and the presentation of options for dealing with those conditions. The relational model facilitates the development and maintenance of data operations software.

Influence of Temporal Context on Value in the Multiple-Chains and Successive-Encounters Procedures

ERIC Educational Resources Information Center

O'Daly, Matthew; Angulo, Samuel; Gipson, Cassandra; Fantino, Edmund

2006-01-01

This set of studies explored the influence of temporal context across multiple-chain and multiple-successive-encounters procedures. Following training with different temporal contexts, the value of stimuli sharing similar reinforcement schedules was assessed by presenting these stimuli in concurrent probes. The results for the multiple-chain…

Multiple-grid convergence acceleration of viscous and inviscid flow computations

NASA Technical Reports Server (NTRS)

Johnson, G. M.

1983-01-01

A multiple-grid algorithm for use in efficiently obtaining steady solution to the Euler and Navier-Stokes equations is presented. The convergence of a simple, explicit fine-grid solution procedure is accelerated on a sequence of successively coarser grids by a coarse-grid information propagation method which rapidly eliminates transients from the computational domain. This use of multiple-gridding to increase the convergence rate results in substantially reduced work requirements for the numerical solution of a wide range of flow problems. Computational results are presented for subsonic and transonic inviscid flows and for laminar and turbulent, attached and separated, subsonic viscous flows. Work reduction factors as large as eight, in comparison to the basic fine-grid algorithm, were obtained. Possibilities for further performance improvement are discussed.

A preliminary study of painless and effective transdermal botulinum toxin A delivery by jet nebulization for treatment of primary hyperhidrosis

PubMed Central

Iannitti, Tommaso; Palmieri, Beniamino; Aspiro, Anna; Di Cerbo, Alessandro

2014-01-01

Background Hyperhidrosis is a chronic disease characterized by increased sweat production. Local injections of botulinum toxin A (BTX-A) have been extensively used for treatment of primary hyperhidrosis (idiopathic). The current treatment for this condition involves several intradermal injections, resulting in poor patient compliance due to injection-related pain. Therefore, new protocols, including an improved anesthetic regimen, are required. Aim We designed the present study to determine whether JetPeel™-3, a medical device used for transdermal delivery of drugs by jet nebulization, could be used to deliver lidocaine prior to the standard multiple BTX-A injections or deliver lidocaine together with BTX-A in order to determine the protocol giving better results in terms of procedure-related pain, sweating, and patient satisfaction in subjects affected by primary axillary, palmar or plantar hyperhidrosis. Materials and methods Twenty patients with a visual analog scale (VAS) sweating score ≥ 8 cm were randomized to receive lidocaine 2% (5 mL) delivered by JetPeel™-3 followed by multiple injections of BTX-A (100 units) or lidocaine 2% (5 mL) and BTX-A (50 units) delivered together by JetPeel™-3. Effect of treatment on sweating was measured by VAS (0= minimum sweating; 10= maximum sweating) at 3-month follow-up. Pain induced by the procedure was assessed by VAS (0= minimum pain; 10= maximum pain) immediately after the procedure. Patient satisfaction was assessed at 3-month follow-up using a 5-point scale (1= not at all satisfied; 2= not satisfied; 3= partially satisfied; 4= satisfied; 5= highly satisfied). Results Both treatment modalities reduced sweating at 3-month follow-up, if compared with baseline (all P<0.001). Delivery of lidocaine and BTX-A by JetPeel™-3 resulted in lower procedure-related pain and reduced sweating, if compared with lidocaine delivered by JetPeel™-3 followed by multiple BTX-A injections (all P<0.001). Patient satisfaction with the procedure was higher in the group receiving lidocaine and BTX-A treatment by JetPeel™-3, if compared with lidocaine delivered by JetPeel™-3 followed by multiple BTX-A injections (P<0.001). No side effects were observed in both groups. Conclusion Lidocaine and BTX-A can be safely delivered together by JetPeel™-3 to treat primary palmar, plantar and axillary hyperhidrosis, resulting in lower procedure-related pain, improved sweating and higher patient satisfaction, if compared with lidocaine delivered by JetPeel™-3 followed by standard BTX-A injection therapy. Our protocol delivering lidocaine and BTX-A together by JetPeel™-3 requires a reduced quantity of BTX-A, further supporting the use of the transdermal drug delivery by jet nebulization over standard injection therapy for treatment of primary hyperhidrosis. PMID:25075176

Advising patients seeking stem cell interventions for multiple sclerosis.

PubMed

von Wunster, Beatrice; Bailey, Steven; Wilkins, Alastair; Marks, David I; Scolding, Neil J; Rice, Claire M

2018-05-30

Given the intuitive potential of stem cell therapy and limitations of current treatment options for progressive multiple sclerosis (MS), it is not surprising that patients consider undertaking significant clinical and financial risks to access stem cell transplantation. However, while increasing evidence supports autologous haematopoietic stem cell transplantation (AHSCT) in aggressive relapsing-remitting MS, interventions employing haematopoietic or other stem cells should otherwise be considered experimental and recommended only in the context of a properly regulated clinical study. Understandably, most neurologists are unfamiliar with AHSCT procedures and the specific requirements for quality assurance and safety standards, as well as post-procedure precautions and follow-up. Consequently they may feel ill-equipped to advise patients. Here, we highlight important points for discussion in consultations with patients considering stem cell 'tourism' for MS. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Evaluation of intranuclear BrdU detection procedures for use in multicolor flow cytometry*

PubMed Central

Rothaeusler, Kristina; Baumgarth, Nicole

2010-01-01

Background Measurement of cell proliferation via BrdU incorporation in combination with multicolor cell surface staining would facilitate studies on cell subsets that require multiple markers for their identification. However, the extent to which the often harsh cell preparation procedures required affect the staining quality of more recently developed fluorescent dyes has not been assessed. Methods Three cell preparation protocols for BrdU measurement were compared for their ability to maintain fluorescent surface staining and scatter parameters of in vivo BrdU-labeled cells by flow cytometry. A 10-color fluorescent panel was developed to test the quality of surface staining following cell treatment and the ability to perform BrdU measurements on even small B lymphocyte subsets. Results All cell preparation procedures affected the quality of fluorescent and/or scatter parameters to varying degrees. Paraformaldehyde / saponin-based procedures preserved sufficient fluorescent surface staining to determine BrdU incorporation rates among all splenic B cell subsets, including B-1a cells, which constitute roughly 0.5% of cells. Turnover rates of B-1a cells were similar to immature B cells and higher than those of the other mature B cell subsets. Conclusion Paraformaldehyde / saponin-based cell preparation procedures facilitate detailed cell turnover studies on small cell subsets in vivo, revealing new functional information on rare cell populations. PMID:16538653

Measuring the effect of multiple eye fixations on memory for visual attributes.

PubMed

Palmer, J; Ames, C T

1992-09-01

Because of limited peripheral vision, many visual tasks depend on multiple eye fixations. Good performance in such tasks demonstrates that some memory must survive from one fixation to the next. One factor that must influence performance is the degree to which multiple eye fixations interfere with the critical memories. In the present study, the amount of interference was measured by comparing visual discriminations based on multiple fixations to visual discriminations based on a single fixation. The procedure resembled partial report, but used a discrimination measure. In the prototype study, two lines were presented, followed by a single line and a cue. The cue pointed toward one of the positions of the first two lines. Observers were required to judge if the single line in the second display was longer or shorter than the cued line of the first display. These judgments were used to estimate a length threshold. The critical manipulation was to instruct observers either to maintain fixation between the lines of the first display or to fixate each line in sequence. The results showed an advantage for multiple fixations despite the intervening eye movements. In fact, thresholds for the multiple-fixation condition were nearly as good as those in a control condition where the lines were foveally viewed without eye movements. Thus, eye movements had little or no interfering effect in this task. Additional studies generalized the procedure and the stimuli. In conclusion, information about a variety of size and shape attributes was remembered with essentially no interference across eye fixations.

Procedures and equipment for staining large numbers of plant root samples for endomycorrhizal assay.

PubMed

Kormanik, P P; Bryan, W C; Schultz, R C

1980-04-01

A simplified method of clearing and staining large numbers of plant roots for vesicular-arbuscular (VA) mycorrhizal assay is presented. Equipment needed for handling multiple samples is described, and two formulations for the different chemical solutions are presented. Because one formulation contains phenol, its use should be limited to basic studies for which adequate laboratory exhaust hoods are available and great clarity of fungal structures is required. The second staining formulation, utilizing lactic acid instead of phenol, is less toxic, requires less elaborate laboratory facilities, and has proven to be completely satisfactory for VA assays.

A Case of Traumatic Retrograde Type A Aortic Dissection Accompanied by Multiorgan Injuries.

PubMed

Tsukioka, Katsuaki; Kono, Tetsuya; Takahashi, Kohei; Kehara, Hiromu; Urashita, Shuichi; Komatsu, Kazunori

2018-03-25

A 75-year-old woman was involved in a traffic accident and suffered retrograde type A aortic dissection, multiple rib fractures, and grade II hepatic injury accompanied by intraperitoneal bleeding. We performed total arch replacement using an open stent graft with cardiopulmonary bypass and circulatory arrest. This procedure requires anticoagulation and hypothermia, which are principally contraindicated in severe trauma patients. However, this situation was resolved by managing the patient non-operatively for 7 days, confirming the stabilization of other injured organs, and then performing the surgery. She required prolonged postoperative rehabilitation; however, she recovered steadily.

Environmental Control Subsystem Development

NASA Technical Reports Server (NTRS)

Laidlaw, Jacob; Zelik, Jonathan

2017-01-01

Kennedy Space Center's Launch Pad 39B, part of Launch Complex 39, is currently undergoing construction to prepare it for NASA's Space Launch System missions. The Environmental Control Subsystem, which provides the vehicle with an air or nitrogen gas environment, required development of its local and remote display screens. The remote displays, developed by NASA contractors and previous interns, were developed without complete functionality; the remote displays were revised, adding functionality to over 90 displays. For the local displays, multiple test procedures were developed to assess the functionality of the screens, as well as verify requirements. One local display screen was also developed.

Decentralized operating procedures for orchestrating data and behavior across distributed military systems and assets

NASA Astrophysics Data System (ADS)

Peach, Nicholas

2011-06-01

In this paper, we present a method for a highly decentralized yet structured and flexible approach to achieve systems interoperability by orchestrating data and behavior across distributed military systems and assets with security considerations addressed from the beginning. We describe an architecture of a tool-based design of business processes called Decentralized Operating Procedures (DOP) and the deployment of DOPs onto run time nodes, supporting the parallel execution of each DOP at multiple implementation nodes (fixed locations, vehicles, sensors and soldiers) throughout a battlefield to achieve flexible and reliable interoperability. The described method allows the architecture to; a) provide fine grain control of the collection and delivery of data between systems; b) allow the definition of a DOP at a strategic (or doctrine) level by defining required system behavior through process syntax at an abstract level, agnostic of implementation details; c) deploy a DOP into heterogeneous environments by the nomination of actual system interfaces and roles at a tactical level; d) rapidly deploy new DOPs in support of new tactics and systems; e) support multiple instances of a DOP in support of multiple missions; f) dynamically add or remove run-time nodes from a specific DOP instance as missions requirements change; g) model the passage of, and business reasons for the transmission of each data message to a specific DOP instance to support accreditation; h) run on low powered computers with lightweight tactical messaging. This approach is designed to extend the capabilities of existing standards, such as the Generic Vehicle Architecture (GVA).

U.S. Department of Defense Multiple-Parameter Biodosimetry Network.

PubMed

Blakely, William F; Romanyukha, Alexander; Hayes, Selena M; Reyes, Ricardo A; Stewart, H Michael; Hoefer, Matthew H; Williams, Anthony; Sharp, Thad; Huff, L Andrew

2016-12-01

The U.S. Department of Defense (USDOD) service members are at risk of exposure to ionizing radiation due to radiation accidents, terrorist attacks and national defense activities. The use of biodosimetry is a standard of care for the triage and treatment of radiation injuries. Resources and procedures need to be established to implement a multiple-parameter biodosimetry system coupled with expert medial guidance to provide an integrated radiation diagnostic system to meet USDOD requirements. Current USDOD biodosimetry capabilities were identified and recommendations to fill the identified gaps are provided. A USDOD Multi-parametric Biodosimetry Network, based on the expertise that resides at the Armed Forces Radiobiology Research Institute and the Naval Dosimetry Center, was designed. This network based on the use of multiple biodosimetry modalities would provide diagnostic and triage capabilities needed to meet USDOD requirements. These are not available with sufficient capacity elsewhere but could be needed urgently after a major radiological/nuclear event. Published by Oxford University Press 2016. This work is written by (a) US Government employee(s) and is in the public domain in the US.

Multiple hypotheses testing based on ordered p values--a historical survey with applications to medical research.

PubMed

Hommel, Gerhard; Bretz, Frank; Maurer, Willi

2011-07-01

Global tests and multiple test procedures are often based on ordered p values. Such procedures are available for arbitrary dependence structures as well as for specific dependence assumptions of the test statistics. Most of these procedures have been considered as global tests. Multiple test procedures can be obtained by applying the closure principle in order to control the familywise error rate, or by using the false discovery rate as a criterion for type I error rate control. We provide an overview and present examples showing the importance of these procedures in medical research. Finally, we discuss modifications when different weights for the hypotheses of interest are chosen.

The economic burden of gallstone lithotripsy. Will cost determine its fate?

PubMed Central

Nealon, W H; Urrutia, F; Fleming, D; Thompson, J C

1991-01-01

Gallstone lithotripsy (LITHO) was performed on 52 patients who underwent 107 procedures. Two hundred sixty-seven gallstone patients were screened and 215 (81%) were excluded. Excessive stone burden and nonvisualization by oral cholecystogram (OCG) were the most common reasons for exclusion. The hospital course of 100 excluded patients who later underwent elective cholecystectomy was evaluated for length of hospital stay (2.3 days) and total cost of treatment ($3685.00). Successful fragmentation to less than 5 mm was achieved in 43 LITHO patients (83%). Five LITHO patients (10%) required conversion to operative management. Complications of LITHO included acute cholecystitis (1 of 52 patients) and biliary colic (17 of 52 patients, or 33%). Multiple procedures in one patient were common. Costs for LITHO were calculated in two ways: first the individual cost for each of the 52 candidates; second the cost for successful LITHO was calculated by excluding five patients who required operation as well as five patients (10%) who are predicted failures of LITHO. Including the preoperative evaluation, treatment, recovery room, and follow-up, the individual LITHO cost for 52 patients was $8275.00. If the same total expenditure is calculated after excluding patients who required operation and those predicted to fail, the cost per 'successful' LITHO procedure was $10,245. The cost of 1 year of bile acid therapy is $1949.00 or $2413.00 per 'successful' procedure. Follow-up costs were $1232.00 per patient or $1525.00 per 'successful' procedure. The added LITHO cost incurred by screening eventual noncandidates was $904.00 per successful procedure. The sum of these individual costs was $15,087.00 per success, as compared to $3685.00 for cholecystectomy. No allowance was made for cost of stone recurrence. Lithotripsy costs appear to be sufficiently high to render the procedure unlikely to emerge as the treatment of choice. PMID:2039296

The economic burden of gallstone lithotripsy. Will cost determine its fate?

PubMed

Nealon, W H; Urrutia, F; Fleming, D; Thompson, J C

1991-06-01

Gallstone lithotripsy (LITHO) was performed on 52 patients who underwent 107 procedures. Two hundred sixty-seven gallstone patients were screened and 215 (81%) were excluded. Excessive stone burden and nonvisualization by oral cholecystogram (OCG) were the most common reasons for exclusion. The hospital course of 100 excluded patients who later underwent elective cholecystectomy was evaluated for length of hospital stay (2.3 days) and total cost of treatment ($3685.00). Successful fragmentation to less than 5 mm was achieved in 43 LITHO patients (83%). Five LITHO patients (10%) required conversion to operative management. Complications of LITHO included acute cholecystitis (1 of 52 patients) and biliary colic (17 of 52 patients, or 33%). Multiple procedures in one patient were common. Costs for LITHO were calculated in two ways: first the individual cost for each of the 52 candidates; second the cost for successful LITHO was calculated by excluding five patients who required operation as well as five patients (10%) who are predicted failures of LITHO. Including the preoperative evaluation, treatment, recovery room, and follow-up, the individual LITHO cost for 52 patients was $8275.00. If the same total expenditure is calculated after excluding patients who required operation and those predicted to fail, the cost per 'successful' LITHO procedure was $10,245. The cost of 1 year of bile acid therapy is $1949.00 or $2413.00 per 'successful' procedure. Follow-up costs were $1232.00 per patient or $1525.00 per 'successful' procedure. The added LITHO cost incurred by screening eventual noncandidates was $904.00 per successful procedure. The sum of these individual costs was $15,087.00 per success, as compared to $3685.00 for cholecystectomy. No allowance was made for cost of stone recurrence. Lithotripsy costs appear to be sufficiently high to render the procedure unlikely to emerge as the treatment of choice.

Resampling probability values for weighted kappa with multiple raters.

PubMed

Mielke, Paul W; Berry, Kenneth J; Johnston, Janis E

2008-04-01

A new procedure to compute weighted kappa with multiple raters is described. A resampling procedure to compute approximate probability values for weighted kappa with multiple raters is presented. Applications of weighted kappa are illustrated with an example analysis of classifications by three independent raters.

Delphi Method Validation of a Procedural Performance Checklist for Insertion of an Ultrasound-Guided Internal Jugular Central Line.

PubMed

Hartman, Nicholas; Wittler, Mary; Askew, Kim; Manthey, David

2016-01-01

Placement of ultrasound-guided central lines is a critical skill for physicians in several specialties. Improving the quality of care delivered surrounding this procedure demands rigorous measurement of competency, and validated tools to assess performance are essential. Using the iterative, modified Delphi technique and experts in multiple disciplines across the United States, the study team created a 30-item checklist designed to assess competency in the placement of ultrasound-guided internal jugular central lines. Cronbach α was .94, indicating an excellent degree of internal consistency. Further validation of this checklist will require its implementation in simulated and clinical environments. © The Author(s) 2014.

BEHAVIORAL COACHING TO IMPROVE OFFENSIVE LINE PASS-BLOCKING SKILLS OF HIGH SCHOOL FOOTBALL ATHLETES

PubMed Central

Stokes, John V; Luiselli, James K; Reed, Derek D; Fleming, Richard K

2010-01-01

We evaluated several behavioral coaching procedures for improving offensive line pass-blocking skills with 5 high school varsity football players. Pass blocking was measured during practice drills and games, and our intervention included descriptive feedback with and without video feedback and teaching with acoustical guidance (TAG). Intervention components and pass blocking were evaluated in a multiple baseline design, which showed that video feedback and TAG were the most effective procedures. For all players, improved pass blocking matched a standard derived by observing more experienced linemen and was evident in games. Additional intervention was required to maintain pass-blocking proficiency. Issues pertinent to behavioral coaching and sport psychology research are discussed. PMID:21358905

The evolution of the midface lift in aesthetic plastic surgery.

PubMed

Paul, Malcolm D; Calvert, Jay W; Evans, Gregory R D

2006-05-01

The midface lift has recently gained significant popularity with many surgeons. It allows the surgeon an opportunity to achieve greater facial harmony with facial rejuvenation procedures by correcting midfacial atrophy, addressing the tear trough deformity, and correcting the perceived malposition of the malar fat pad. This article examines the history of midfacial procedures. Surgical attempts at improving the aging face have evolved from minimal excisions and skin closure to aggressive dissections at multiple planes. The midface target area is peripheral to classic approaches, and its correction has required further anterior dissection from a distance or direct access centrally. Ultimately, conquering the stigmata of midface aging is entirely related to vectors and volume.

TH-C-19A-01: Analytic Design Method to Make a 2D Planar, Segmented Ion Chamber Water-Equivalent for Proton Dose Measurements

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

Harris, W; Hollebeek, R; Teo, B

2014-06-15

Purpose: Quality Assurance (QA) measurements of proton therapy fields must accurately measure steep longitudinal dose gradients as well as characterize the dose distribution laterally. Currently, available devices for two-dimensional field measurements perturb the dose distribution such that routine QA measurements performed at multiple depths require multiple field deliveries and are time consuming. Methods: A design procedure for a two-dimensional detector array is introduced whereby the proton energy loss and scatter are adjusted so that the downstream dose distribution is maintained to be equivalent to that which would occur in uniform water. Starting with the design for an existing, functional two-dimensionalmore » segmented ion chamber prototype, a compensating material is introduced downstream of the detector to simultaneously equate the energy loss and lateral scatter in the detector assembly to the values in water. An analytic formalism and procedure is demonstrated to calculate the properties of the compensating material in the general case of multiple layers of arbitrary material. The resulting design is validated with Monte Carlo simulations. Results: With respect to the specific prototype design considered, the results indicate that a graphite compensating layer of the proper dimensions can yield proton beam range perturbation less than 0.1mm and beam sigma perturbation less than 2% across the energy range of therapeutic proton beams. Conclusion: We have shown that, for a 2D gas-filled detector array, a graphite-compensating layer can balance the energy loss and multiple Coulomb scattering relative to uniform water. We have demonstrated an analytic formalism and procedure to determine a compensating material in the general case of multiple layers of arbitrary material. This work was supported by the US Army Medical Research and Materiel Command under Contract Agreement No. DAMD17-W81XWH-04-2-0022. Opinions, interpretations, conclusions and recommendations are those of the author and are not necessarily endorsed by the US Army.« less

Semantics of Procedures: A Cognitive Basis for Maintenance Training Competency

DTIC Science & Technology

1988-04-01

provided by presenting these multiple, interacting views. These 0 conclusions are similar to the views of George Polya , who proposed the use of... exercises . It is also clear that at least some understanding of machine structure and function is required to interpret much of the information in the...check of the problem lists provides the names of all the usual subpects. This accessibility permits the technician to modify the sequence according to

Congenital malformations of the skull and meninges.

PubMed

Kanev, Paul M

2007-02-01

The surgery and management of children who have congenital malformations of the skull and meninges require multidisciplinary care and long-term follow-up by multiple specialists in birth defects. The high definition of three-dimensional CT and MRI allows precise surgery planning of reconstruction and management of associated malformations. The reconstruction of meningoencephaloceles and craniosynostosis are challenging procedures that transform the child's appearance. The embryology, clinical presentation, and surgical management of these malformations are reviewed.

Sex differences in mortality in children undergoing congenital heart disease surgery: a United States population-based study.

PubMed

Marelli, Ariane; Gauvreau, Kimberlee; Landzberg, Mike; Jenkins, Kathy

2010-09-14

The changing demographics of the adult congenital heart disease (CHD) population requires an understanding of the factors that impact patient survival to adulthood. We sought to investigate sex differences in CHD surgical mortality in children. Children <18 years old hospitalized for CHD surgery were identified using the Kids' Inpatient Database in 2000, 2003, and 2006. Demographic, diagnostic, and procedural variables were grouped according to RACHS-1 (Risk Adjustment for Congenital Heart Surgery) method. Logistic regression was used to determine the odds ratio of death in females versus males adjusting for RACHS-1 risk category, age, prematurity, major noncardiac anomalies, and multiple procedures. Analyses were stratified by RACHS-1 risk categories and age. Of 33 848 hospitalizations for CHD surgery, 54.7% were in males. Males were more likely than females to have CHD surgery in infancy, high-risk CHD surgery, and multiple CHD procedures. Females had more major noncardiac structural anomalies and more low-risk procedures. However, the adjusted risk of in-hospital death was higher in females (odds ratio, 1.21; 95% confidence interval, 1.08 to 1.36) on account of the subgroup with high-risk surgeries who were <1 year of age (odds ratio, 1.39; 95% confidence interval, 1.16 to 1.67). In this large US population study, more male children underwent CHD surgery and had high-risk procedures. Female infants who had high-risk procedures were at higher risk for death, but this accounted for a small proportion of females and is therefore unlikely to have a major impact on the changing demographics in adults in CHD.

The Multiple Doppler Radar Workshop, November 1979.

NASA Astrophysics Data System (ADS)

Carbone, R. E.; Harris, F. I.; Hildebrand, P. H.; Kropfli, R. A.; Miller, L. J.; Moninger, W.; Strauch, R. G.; Doviak, R. J.; Johnson, K. W.; Nelson, S. P.; Ray, P. S.; Gilet, M.

1980-10-01

The findings of the Multiple Doppler Radar Workshop are summarized by a series of six papers. Part I of this series briefly reviews the history of multiple Doppler experimentation, fundamental concepts of Doppler signal theory, and organization and objectives of the Workshop. Invited presentations by dynamicists and cloud physicists are also summarized.Experimental design and procedures (Part II) are shown to be of critical importance. Well-defined and limited experimental objectives are necessary in view of technological limitations. Specified radar scanning procedures that balance temporal and spatial resolution considerations are discussed in detail. Improved siting for suppression of ground clutter as well as scanning procedures to minimize errors at echo boundaries are discussed. The need for accelerated research using numerically simulated proxy data sets is emphasized.New technology to eliminate various sampling limitations is cited as an eventual solution to many current problems in Part III. Ground clutter contamination may be curtailed by means of full spectral processing, digital filters in real time, and/or variable pulse repetition frequency. Range and velocity ambiguities also may be minimized by various pulsing options as well as random phase transmission. Sidelobe contamination can be reduced through improvements in radomes, illumination patterns, and antenna feed types. Radar volume-scan time can be sharply reduced by means of wideband transmission, phased array antennas, multiple beam antennas, and frequency agility.Part IV deals with synthesis of data from several radars in the context of scientific requirements in cumulus clouds, widespread precipitation, and severe convective storms. The important temporal and spatial scales are examined together with the accuracy required for vertical air motion in each phenomenon. Factors that introduce errors in the vertical velocity field are identified and synthesis techniques are discussed separately for the dual Doppler and multiple Doppler cases. Various filters and techniques, including statistical and variational approaches, are mentioned. Emphasis is placed on the importance of experiment design and procedures, technological improvements, incorporation of all information from supporting sensors, and analysis priority for physically simple cases. Integrated reliability is proposed as an objective tool for radar siting.Verification of multiple Doppler-derived vertical velocity is discussed in Part V. Three categories of verification are defined as direct, deductive, and theoretical/numerical. Direct verification consists of zenith-pointing radar measurements (from either airborne or ground-based systems), air motion sensing aircraft, instrumented towers, and tracking of radar chaff. Deductive sources include mesonetworks, aircraft (thermodynamic and microphysical) measurements, satellite observations, radar reflectivity, multiple Doppler consistency, and atmospheric soundings. Theoretical/numerical sources of verification include proxy data simulation, momentum checking, and numerical cloud models. New technology, principally in the form of wide bandwidth radars, is seen as a development that may reduce the need for extensive verification of multiple Doppler-derived vertical air motions. Airborne Doppler radar is perceived as the single most important source of verification within the bounds of existing technology.Nine stages of data processing and display are identified in Part VI. The stages are identified as field checks, archival, selection, editing, coordinate transformation, synthesis of Cartesian fields, filtering, display, and physical analysis. Display of data is considered to be a problem critical to assimilation of data at all stages. Interactive computing systems and software are concluded to be very important, particularly for the editing stage. Three- and 4-dimensional displays are considered essential for data assimilation, particularly at the physical analysis stage. The concept of common data tape formats is approved both for data in radar spherical space as well as for synthesized Cartesian output.1169

Concurrent orthopedic and neurosurgical procedures in pediatric patients with spinal deformity.

PubMed

Mooney, James F; Glazier, Stephen S; Barfield, William R

2012-11-01

The management of pediatric patients with complex spinal deformity often requires both an orthopedic and a neurosurgical intervention. The reasons for multiple subspecialty involvement include, but are not limited to, the presence of a tethered cord requiring release or a syrinx requiring decompression. It has been common practice to perform these procedures in a staged manner, although there is little evidence in the literature to support separate interventions. We reviewed a series of consecutive patients who underwent spinal deformity correction and a neurosurgical intervention concurrently in an attempt to assess the safety, efficacy, and possible complications associated with such an approach. Eleven patients were reviewed who underwent concurrent orthopedic and neurosurgical procedures. Data were collected for patient demographics, preoperative diagnosis, procedures performed, intraoperative and perioperative complications, as well as any unexpected return to the operating room for any reason. Operative notes and anesthesia records were reviewed to determine estimated blood loss, surgical time, and the use of intraoperative neurological monitoring. Patient diagnoses included myelodysplasia (N=6), congenital scoliosis and/or kyphosis (N=4), and scoliosis associated with Noonan syndrome (N=1). Age at the time of surgery averaged 9 years 2 months (range=14 months to 17 years 2 months). Estimated blood loss averaged 605 ml (range=50-3000 ml). The operative time averaged 313 min (range=157-477 min). There were no intraoperative complications, including incidental dural tears or deterioration in preoperative neurological status. One patient developed a sore associated with postoperative cast immobilization that led to a deep wound infection. It appears that concurrent orthopedic and neurosurgical procedures in pediatric patients with significant spinal deformities can be performed safely and with minimal intraoperative and postoperative complications when utilizing modern surgical and neuromonitoring techniques. Level of evidence=Level IV. © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins.

Infrared needle mapping to assist biopsy procedures and training.

PubMed

Shar, Bruce; Leis, John; Coucher, John

2018-04-01

A computed tomography (CT) biopsy is a radiological procedure which involves using a needle to withdraw tissue or a fluid specimen from a lesion of interest inside a patient's body. The needle is progressively advanced into the patient's body, guided by the most recent CT scan. CT guided biopsies invariably expose patients to high dosages of radiation, due to the number of scans required whilst the needle is advanced. This study details the design of a novel method to aid biopsy procedures using infrared cameras. Two cameras are used to image the biopsy needle area, from which the proposed algorithm computes an estimate of the needle endpoint, which is projected onto the CT image space. This estimated position may be used to guide the needle between scans, and results in a reduction in the number of CT scans that need to be performed during the biopsy procedure. The authors formulate a 2D augmentation system which compensates for camera pose, and show that multiple low-cost infrared imaging devices provide a promising approach.

Laparoscopic Choledochoduodenostomy.

PubMed

Cuendis-Velázquez, Adolfo; E Trejo-Ávila, Mario; Rosales-Castañeda, Enrique; Cárdenas-Lailson, Eduardo; E Rojano-Rodríguez, Martin; Romero-Loera, Sujey; A Sanjuan-Martínez, Carlos; Moreno-Portillo, Mucio

Today's options for biliary bypass procedures, for difficult choledocholithiasis, range from open surgery to laparo-endoscopic hybrid procedures. The aim of this study was to analyze the outcomes of patients with difficult choledocholithiasis treated with laparoscopic choledochoduodenostomy. We performed a prospective observational study from March 2011 to June 2016. We included patients with difficult common bile duct stones (recurrent or unresolved by ERCP) in which a biliary bypass procedure was required. We performed a laparoscopic bile duct exploration with choledochoduodenostomy and intraoperative cholangioscopy. A total of 19 patients were included. We found female predominance (78.9%), advanced mean age (72.4±12 years) and multiple comorbidities. Most patients with previous episodes of choledocholitiasis or cholangitis, mode 1 (min-max: 1-7). Mean common bile duct diameter 24.9±7mm. Mean operative time 218.5±74min, estimated blood loss 150 (30-600)mL, resume of oral intake 3.2±1 days, postoperative length of stay 4.9±2 days. We found a median of 18 (12-32) months of follow-up. All patients with normalization of liver enzymes during follow-up. One patient presented with sump syndrome and one patient died due to nosocomial pneumonia. Laparoscopic choledochoduodenostomy with intraoperative cholangioscopy seems to be safe and effective treatment for patients with difficult common bile duct stones no resolved by endoscopic procedures. This procedure is a good option for patients with advanced age and multiple comorbidities. We offer all the advantages of minimally invasive surgery to these patients. Copyright © 2017 AEC. Publicado por Elsevier España, S.L.U. All rights reserved.

Sequential Tests of Multiple Hypotheses Controlling Type I and II Familywise Error Rates

PubMed Central

Bartroff, Jay; Song, Jinlin

2014-01-01

This paper addresses the following general scenario: A scientist wishes to perform a battery of experiments, each generating a sequential stream of data, to investigate some phenomenon. The scientist would like to control the overall error rate in order to draw statistically-valid conclusions from each experiment, while being as efficient as possible. The between-stream data may differ in distribution and dimension but also may be highly correlated, even duplicated exactly in some cases. Treating each experiment as a hypothesis test and adopting the familywise error rate (FWER) metric, we give a procedure that sequentially tests each hypothesis while controlling both the type I and II FWERs regardless of the between-stream correlation, and only requires arbitrary sequential test statistics that control the error rates for a given stream in isolation. The proposed procedure, which we call the sequential Holm procedure because of its inspiration from Holm’s (1979) seminal fixed-sample procedure, shows simultaneous savings in expected sample size and less conservative error control relative to fixed sample, sequential Bonferroni, and other recently proposed sequential procedures in a simulation study. PMID:25092948

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

ERIC Educational Resources Information Center

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

2010-01-01

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

EnRICH: Extraction and Ranking using Integration and Criteria Heuristics.

PubMed

Zhang, Xia; Greenlee, M Heather West; Serb, Jeanne M

2013-01-15

High throughput screening technologies enable biologists to generate candidate genes at a rate that, due to time and cost constraints, cannot be studied by experimental approaches in the laboratory. Thus, it has become increasingly important to prioritize candidate genes for experiments. To accomplish this, researchers need to apply selection requirements based on their knowledge, which necessitates qualitative integration of heterogeneous data sources and filtration using multiple criteria. A similar approach can also be applied to putative candidate gene relationships. While automation can assist in this routine and imperative procedure, flexibility of data sources and criteria must not be sacrificed. A tool that can optimize the trade-off between automation and flexibility to simultaneously filter and qualitatively integrate data is needed to prioritize candidate genes and generate composite networks from heterogeneous data sources. We developed the java application, EnRICH (Extraction and Ranking using Integration and Criteria Heuristics), in order to alleviate this need. Here we present a case study in which we used EnRICH to integrate and filter multiple candidate gene lists in order to identify potential retinal disease genes. As a result of this procedure, a candidate pool of several hundred genes was narrowed down to five candidate genes, of which four are confirmed retinal disease genes and one is associated with a retinal disease state. We developed a platform-independent tool that is able to qualitatively integrate multiple heterogeneous datasets and use different selection criteria to filter each of them, provided the datasets are tables that have distinct identifiers (required) and attributes (optional). With the flexibility to specify data sources and filtering criteria, EnRICH automatically prioritizes candidate genes or gene relationships for biologists based on their specific requirements. Here, we also demonstrate that this tool can be effectively and easily used to apply highly specific user-defined criteria and can efficiently identify high quality candidate genes from relatively sparse datasets.

Reconstruction of bilateral tibial aplasia and split hand-foot syndrome in a father and daughter.

PubMed

Al Kaissi, Ali; Ganger, Rudolf; Klaushofer, Klaus; Grill, Franz

2014-01-01

Tibial aplasia is of heterogeneous aetiology, the majority of reports are sporadic. We describe the reconstruction procedures in two subjects - a daughter and father manifested autosomal dominant (AD) inheritance of the bilateral tibial aplasia and split hand-foot syndrome. Reconstruction of these patients required multiple surgical procedures and orthoprosthesis was mandatory. The main goal of treatment was to achieve walking. Stabilization of the ankle joint by fibular-talar-chondrodesis on both sides, followed by bilateral Brown-procedure at the knee joint level has been applied accordingly. The outcome was with improved function of the deformed limbs and walking was achieved with simultaneous designation of orthotic fitting. This is the first study encompassing the diagnosis and management of a father and daughter with bilateral tibial aplasia associated with variable split hand/foot deformity without foot ablation. Our patients showed the typical AD pattern of inheritance of split-hand/foot and tibial aplasia.

A simple Lagrangian forecast system with aviation forecast potential

NASA Technical Reports Server (NTRS)

Petersen, R. A.; Homan, J. H.

1983-01-01

A trajectory forecast procedure is developed which uses geopotential tendency fields obtained from a simple, multiple layer, potential vorticity conservative isentropic model. This model can objectively account for short-term advective changes in the mass field when combined with fine-scale initial analyses. This procedure for producing short-term, upper-tropospheric trajectory forecasts employs a combination of a detailed objective analysis technique, an efficient mass advection model, and a diagnostically proven trajectory algorithm, none of which require extensive computer resources. Results of initial tests are presented, which indicate an exceptionally good agreement for trajectory paths entering the jet stream and passing through an intensifying trough. It is concluded that this technique not only has potential for aiding in route determination, fuel use estimation, and clear air turbulence detection, but also provides an example of the types of short range forecasting procedures which can be applied at local forecast centers using simple algorithms and a minimum of computer resources.

Reiki therapy for postoperative oral pain in pediatric patients: pilot data from a double-blind, randomized clinical trial.

PubMed

Kundu, Anjana; Lin, Yuting; Oron, Assaf P; Doorenbos, Ardith Z

2014-02-01

To examine the effects of Reiki as an adjuvant therapy to opioid therapy for postoperative pain control in pediatric patients. This was a double-blind, randomized controlled study of children undergoing dental procedures. Participants were randomly assigned to receive either Reiki therapy or the control therapy (sham Reiki) preoperatively. Postoperative pain scores, opioid requirements, and side effects were assessed. Family members were also asked about perioperative care satisfaction. Multiple linear regressions were used for analysis. Thirty-eight children participated. The blinding procedure was successful. No statistically significant difference was observed between groups on all outcome measures. Our study provides a successful example of a blinding procedure for Reiki therapy among children in the perioperative period. This study does not support the effectiveness of Reiki as an adjuvant therapy to opioid therapy for postoperative pain control in pediatric patients. Copyright © 2013 Elsevier Ltd. All rights reserved.

Reiki therapy for postoperative oral pain in pediatric patients: Pilot data from a double-blind, randomized clinical trial

PubMed Central

Kundu, Anjana; Lin, Yuting; Oron, Assaf P.; Doorenbos, Ardith Z.

2014-01-01

Purpose To examine the effects of Reiki as an adjuvant therapy to opioid therapy for postoperative pain control in pediatric patients. Methods This was a double-blind, randomized controlled study of children undergoing dental procedures. Participants were randomly assigned to receive either Reiki therapy or the control therapy (sham Reiki) preoperatively. Postoperative pain scores, opioid requirements, and side effects were assessed. Family members were also asked about perioperative care satisfaction. Multiple linear regressions were used for analysis. Results Thirty-eight children participated. The blinding procedure was successful. No statistically significant difference was observed between groups on all outcome measures. Implications Our study provides a successful example of a blinding procedure for Reiki therapy among children in the perioperative period. This study does not support the effectiveness of Reiki as an adjuvant therapy to opioid therapy for postoperative pain control in pediatric patients. PMID:24439640

Carpal valgus in llamas and alpacas: Retrospective evaluation of patient characteristics, radiographic features and outcomes following surgical treatment

PubMed Central

Hunter, Barbara; Duesterdieck-Zellmer, Katja F.; Huber, Michael J.; Parker, Jill E.; Semevolos, Stacy A.

2014-01-01

This study evaluated outcomes of surgical treatment for carpal valgus in New World camelids and correlated successful outcome (absence of carpal valgus determined by a veterinarian) with patient characteristics and radiographic features. Univariable and multivariable analyses of retrospective case data in 19 camelids (33 limbs) treated for carpal valgus between 1987 and 2010 revealed that procedures incorporating a distal radial transphyseal bridge were more likely (P = 0.03) to result in success after a single surgical procedure. A greater degree of angulation (> 19°, P = 0.02) and younger age at surgery (< 4 months, P = 0.03) were associated with unsuccessful outcome. Overall, 74% of limbs straightened, 15% overcorrected, and 11% had persistent valgus following surgical intervention. To straighten, 22% of limbs required multiple procedures, not including implant removal. According to owners, valgus returned following implant removal in 4 limbs that had straightened after surgery. PMID:25477542

Parry-Romberg reconstruction: optimal timing for hard and soft tissue procedures.

PubMed

Slack, Ginger C; Tabit, Christina J; Allam, Karam A; Kawamoto, Henry K; Bradley, James P

2012-11-01

For the treatment of Parry-Romberg syndrome or progressive hemifacial atrophy, we studied 3 controversial issues: (1) optimal timing, (2) need for skeletal reconstruction, and (3) need for soft tissue (medial canthus/lacrimal duct) reconstruction. Patients with Parry-Romberg syndrome (>5 y follow-up) were divided into 2 groups: (1) younger than 14 years and (2) 14 years or older (n = 43). Sex, age, severity of deformity, number of procedures, operative times, and augmentation fat volumes were recorded. Physician and patient satisfaction surveys (5-point scale) were obtained, preoperative and postoperative three-dimensional computed tomographic scans were reviewed, and a digital three-dimensional photogrammetry system was used to determine volume retention. Our results indicate that the younger patient group required more procedures compared with the older patient group (4.3 versus 2.8); however, the younger group had higher patient/family satisfaction scores (3.8 versus 3.0). Skeletal and soft tissue reconstruction resulted in improved symmetry score (60% preoperatively to 93% final) and satisfaction scores (3.4 preoperatively to 3.8 final). Patients with Parry-Romberg syndrome required multiple corrective surgeries but showed improvements even when beginning before puberty. Soft and hard tissue reconstruction was beneficial.

A procedural skills OSCE: assessing technical and non-technical skills of internal medicine residents.

PubMed

Pugh, Debra; Hamstra, Stanley J; Wood, Timothy J; Humphrey-Murto, Susan; Touchie, Claire; Yudkowsky, Rachel; Bordage, Georges

2015-03-01

Internists are required to perform a number of procedures that require mastery of technical and non-technical skills, however, formal assessment of these skills is often lacking. The purpose of this study was to develop, implement, and gather validity evidence for a procedural skills objective structured clinical examination (PS-OSCE) for internal medicine (IM) residents to assess their technical and non-technical skills when performing procedures. Thirty-five first to third-year IM residents participated in a 5-station PS-OSCE, which combined partial task models, standardized patients, and allied health professionals. Formal blueprinting was performed and content experts were used to develop the cases and rating instruments. Examiners underwent a frame-of-reference training session to prepare them for their rater role. Scores were compared by levels of training, experience, and to evaluation data from a non-procedural OSCE (IM-OSCE). Reliability was calculated using Generalizability analyses. Reliabilities for the technical and non-technical scores were 0.68 and 0.76, respectively. Third-year residents scored significantly higher than first-year residents on the technical (73.5 vs. 62.2%) and non-technical (83.2 vs. 75.1%) components of the PS-OSCE (p < 0.05). Residents who had performed the procedures more frequently scored higher on three of the five stations (p < 0.05). There was a moderate disattenuated correlation (r = 0.77) between the IM-OSCE and the technical component of the PS-OSCE scores. The PS-OSCE is a feasible method for assessing multiple competencies related to performing procedures and this study provides validity evidence to support its use as an in-training examination.

29 CFR 1926.753 - Hoisting and rigging.

Code of Federal Regulations, 2010 CFR

2010-07-01

... lift rigging procedure. (1) A multiple lift shall only be performed if the following criteria are met: (i) A multiple lift rigging assembly is used; (ii) A maximum of five members are hoisted per lift... multiple lift have been trained in these procedures in accordance with § 1926.761(c)(1). (v) No crane is...

Extremes in Otolaryngology Resident Surgical Case Numbers: An Update.

PubMed

Baugh, Tiffany P; Franzese, Christine B

2017-06-01

Objectives The purpose of this study is to examine the effect of minimum case numbers on otolaryngology resident case log data and understand differences in minimum, mean, and maximum among certain procedures as a follow-up to a prior study. Study Design Cross-sectional survey using a national database. Setting Academic otolaryngology residency programs. Subjects and Methods Review of otolaryngology resident national data reports from the Accreditation Council for Graduate Medical Education (ACGME) resident case log system performed from 2004 to 2015. Minimum, mean, standard deviation, and maximum values for total number of supervisor and resident surgeon cases and for specific surgical procedures were compared. Results The mean total number of resident surgeon cases for residents graduating from 2011 to 2015 ranged from 1833.3 ± 484 in 2011 to 2072.3 ± 548 in 2014. The minimum total number of cases ranged from 826 in 2014 to 1004 in 2015. The maximum total number of cases increased from 3545 in 2011 to 4580 in 2015. Multiple key indicator procedures had less than the required minimum reported in 2015. Conclusion Despite the ACGME instituting required minimum numbers for key indicator procedures, residents have graduated without meeting these minimums. Furthermore, there continues to be large variations in the minimum, mean, and maximum numbers for many procedures. Variation among resident case numbers is likely multifactorial. Ensuring proper instruction on coding and case role as well as emphasizing frequent logging by residents will ensure programs have the most accurate data to evaluate their case volume.

Second-site prosthetic joint infection in patients with multiple prosthetic joints.

PubMed

Clesham, Kevin; Hughes, Andrew J; O' hEireamhoin, Sven; Fleming, Catherine; Murphy, Colin G

2018-04-10

Prosthetic joint infections (PJIs) are among the most serious complications in arthroplasty. A second-site PJI in patients with multiple prosthetic joints increases morbidity, with many requiring further revision procedures. We aimed to establish why some patients with multiple joints develop second-site infections. Our institution's arthroplasty database was reviewed from 2004 to 2017. All PJIs were identified, and all patients with more than one prosthetic joint in situ were included. We recorded risk factors, causative organisms, number of procedures and length of stay. Forty-four patients meeting the criteria were identified. Four patients (9.1%) developed second-site infection. Eight patients (18.2%) developed re-infection of the primary PJI. Positive MRSA carrier status and PJI of a total knee replacement were associated with an increased risk of a second episode of infection. Patients who developed further infection had more frequent admission and longer lengths of stay than isolated PJIs. Higher morbidity and use of hospital resources are associated with this cohort of patients. PJIs in total knee replacements and positive MRSA status are associated with higher rates of second infection. Identifying this vulnerable cohort of patients at an early stage is critical to ensure measures are taken to reduce the risks of further infection.

Hematopoietic Stem Cell Transplantation From Unrelated Donors in 2 Cases of Interleukin-10 Receptor Deficiency: Is Surgery Not a Requirement?

PubMed

Kocacik Uygun, Dilara F; Uygun, Vedat; Daloğlu, Hayriye; Öztürkmen, Seda; Karasu, Gülsün; Reisli, İsmail; Sayar, Ersin; Yüksekkaya, Hasan A; Glocker, Erik-Oliver; Boztuğ, Kaan; Yeşilipek, Akif

2018-04-20

Mutations in interleukin-10 and its receptors cause infantile inflammatory bowel disease (IBD), a hyperinflammatory disorder characterized by severe, treatment-refractory colitis, multiple abscesses, and enterocutaneous fistulas. Patients with infantile IBD often require several surgical interventions, including complete colectomy, and hematopoietic stem cell transplantation is currently the only known medical therapy. Traditionally, operative management has been preferred before stem cell transplantation because of the latter's increased susceptibility to procedural complications; however, surgical intervention could be delayed, and possibly reconsidered, because our 2 patients with infantile IBD demonstrated a rapid response to treatment via engraftment.

A comparison of multiprocessor scheduling methods for iterative data flow architectures

NASA Technical Reports Server (NTRS)

Storch, Matthew

1993-01-01

A comparative study is made between the Algorithm to Architecture Mapping Model (ATAMM) and three other related multiprocessing models from the published literature. The primary focus of all four models is the non-preemptive scheduling of large-grain iterative data flow graphs as required in real-time systems, control applications, signal processing, and pipelined computations. Important characteristics of the models such as injection control, dynamic assignment, multiple node instantiations, static optimum unfolding, range-chart guided scheduling, and mathematical optimization are identified. The models from the literature are compared with the ATAMM for performance, scheduling methods, memory requirements, and complexity of scheduling and design procedures.

A Knowledge-Modeling Approach to Integrate Multiple Clinical Practice Guidelines to Provide Evidence-Based Clinical Decision Support for Managing Comorbid Conditions.

PubMed

Abidi, Samina

2017-10-26

Clinical management of comorbidities is a challenge, especially in a clinical decision support setting, as it requires the safe and efficient reconciliation of multiple disease-specific clinical procedures to formulate a comorbid therapeutic plan that is both effective and safe for the patient. In this paper we pursue the integration of multiple disease-specific Clinical Practice Guidelines (CPG) in order to manage co-morbidities within a computerized Clinical Decision Support System (CDSS). We present a CPG integration framework-termed as COMET (Comorbidity Ontological Modeling & ExecuTion) that manifests a knowledge management approach to model, computerize and integrate multiple CPG to yield a comorbid CPG knowledge model that upon execution can provide evidence-based recommendations for handling comorbid patients. COMET exploits semantic web technologies to achieve (a) CPG knowledge synthesis to translate a paper-based CPG to disease-specific clinical pathways (CP) that include specialized co-morbidity management procedures based on input from domain experts; (b) CPG knowledge modeling to computerize the disease-specific CP using a Comorbidity CPG ontology; (c) CPG knowledge integration by aligning multiple ontologically-modeled CP to develop a unified comorbid CPG knowledge model; and (e) CPG knowledge execution using reasoning engines to derive CPG-mediated recommendations for managing patients with comorbidities. We present a web-accessible COMET CDSS that provides family physicians with CPG-mediated comorbidity decision support to manage Atrial Fibrillation and Chronic Heart Failure. We present our qualitative and quantitative analysis of the knowledge content and usability of COMET CDSS.

Postinflammatory hyperpigmentation in patients with skin of color.

PubMed

Shokeen, Divya

2016-01-01

Postinflammatory hyperpigmentation (PIH) has posed a substantial challenge for patients with higher Fitzpatrick skin types, specifically types III to VI. Treatment modalities pose a number of limitations due to the number of treatments required, potential side effects, and overall efficacy. Fortunately, multiple therapies have been delineated that can be moderately to highly efficacious in treating PIH in patients with skin of color. This article will review some of these modalities and procedures for this common patient concern.

Concepts for a global resources information system

NASA Technical Reports Server (NTRS)

Billingsley, F. C.; Urena, J. L.

1984-01-01

The objective of the Global Resources Information System (GRIS) is to establish an effective and efficient information management system to meet the data access requirements of NASA and NASA-related scientists conducting large-scale, multi-disciplinary, multi-mission scientific investigations. Using standard interfaces and operating guidelines, diverse data systems can be integrated to provide the capabilities to access and process multiple geographically dispersed data sets and to develop the necessary procedures and algorithms to derive global resource information.

Duodenal perforation following esophagogastroduodenoscopy (EGD) with cautery and epinephrine injection for peptic ulcer disease: An interesting case of nonoperative management in the medical intensive care unit (MICU).

PubMed

Chertoff, Jason; Khullar, Vikas; Burke, Lucas

2015-01-01

The utilization of esophagogastroduodenoscopy (EGD) and related procedures continues to rise. Due to this increase in utilization is an inevitable rise in serious complications such as hemorrhage and perforation. One understudied and dreaded complication of EGD causing significant morbidity and mortality is duodenal perforation. We present the case of a 63-year-old male who presented to our institution's emergency room with dyspepsia, melanic stools, tachycardia, and hypotension. Initial laboratory evaluation was significant for severe anemia, lactic acidosis, and acute kidney injury, while CT scan of the abdomen pelvis did not suggest retroperitoneal hematoma or bowel perforation. An emergent EGD was performed which showed multiple bleeding duodenal ulcers that were cauterized and injected with epinephrine. Post-procedure the patient developed worsening abdominal pain, distension, diaphoresis, and tachypnea, requiring emergent intubation. A CT scan of the abdomen and pelvis with oral contrast confirmed pneumoperitoneum and duodenal perforation. Due to the patient's hemodynamic instability and multiple comorbidities, he was treated non-operatively with strict bowel rest and intravenous antibiotics. The patient ultimately had a 19-day hospital course complicated by renal failure requiring hemodialysis and an ischemic limb necessitating above knee amputation. This case describes an unsuccessful attempt at nonoperative management of duodenal perforation following EGD. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.

Goals and Objectives to Optimize the Value of an Acute Pain Service in Perioperative Pain Management.

PubMed

Le-Wendling, Linda; Glick, Wesley; Tighe, Patrick

2017-12-01

As newer pharmacologic and procedural interventions, technology, and data on outcomes in pain management are becoming available, effective acute pain management will require a dedicated Acute Pain Service (APS) to help determine the most optimal pain management plan for the patients. Goals for pain management must take into consideration the side effect profile of drugs and potential complications of procedural interventions. Multiple objective optimization is the combination of multiple different objectives for acute pain management. Simple use of opioids, for example, can reduce all pain to minimal levels, but at what cost to the patient, the medical system, and to public health as a whole? Many models for APS exist based on personnel's skills, knowledge and experience, but effective use of an APS will also require allocation of time, space, financial, and personnel resources with clear objectives and a feedback mechanism to guide changes to acute pain medicine practices to meet the constantly evolving medical field. Physician-based practices have the advantage of developing protocols for the management of low-variability, high-occurrence scenarios in addition to tailoring care to individual patients with high-variability, low-occurrence scenarios. Frequent feedback and data collection/assessment on patient outcomes is essential in evaluating the efficacy of the Acute Pain Service's intervention in improving patient outcomes in the acute and perioperative setting.

Development of a Searchable Database of Cryoablation Simulations for Use in Treatment Planning.

PubMed

Boas, F Edward; Srimathveeravalli, Govindarajan; Durack, Jeremy C; Kaye, Elena A; Erinjeri, Joseph P; Ziv, Etay; Maybody, Majid; Yarmohammadi, Hooman; Solomon, Stephen B

2017-05-01

To create and validate a planning tool for multiple-probe cryoablation, using simulations of ice ball size and shape for various ablation probe configurations, ablation times, and types of tissue ablated. Ice ball size and shape was simulated using the Pennes bioheat equation. Five thousand six hundred and seventy different cryoablation procedures were simulated, using 1-6 cryoablation probes and 1-2 cm spacing between probes. The resulting ice ball was measured along three perpendicular axes and recorded in a database. Simulated ice ball sizes were compared to gel experiments (26 measurements) and clinical cryoablation cases (42 measurements). The clinical cryoablation measurements were obtained from a HIPAA-compliant retrospective review of kidney and liver cryoablation procedures between January 2015 and February 2016. Finally, we created a web-based cryoablation planning tool, which uses the cryoablation simulation database to look up the probe spacing and ablation time that produces the desired ice ball shape and dimensions. Average absolute error between the simulated and experimentally measured ice balls was 1 mm in gel experiments and 4 mm in clinical cryoablation cases. The simulations accurately predicted the degree of synergy in multiple-probe ablations. The cryoablation simulation database covers a wide range of ice ball sizes and shapes up to 9.8 cm. Cryoablation simulations accurately predict the ice ball size in multiple-probe ablations. The cryoablation database can be used to plan ablation procedures: given the desired ice ball size and shape, it will find the number and type of probes, probe configuration and spacing, and ablation time required.

Is retrograde intrarenal surgery the game changer in the management of upper tract calculi? A single-center single-surgeon experience of 131 cases.

PubMed

Parikh, Kandarp Priyakant; Jain, Ravi Jineshkumar; Kandarp, Aditya Parikh

2018-01-01

Success of any modality for stone disease needs to be evaluated in terms of Stone Free Rates (SFR), auxiliary procedures needed; complications and follow up. SFR in RIRS is subject to parameters like stone burden, location, number, hardness, composition; calyceal and ureter anatomy; use of ureteric access sheath (UAS); surgeon experience etc. The aim of this study is to evaluate the efficacy and safety of RIRS for managing upper tract stones. The objectives include evaluating SFR in RIRS in relation to stone burden, location and number. Other objectives include evaluating SFR after re RIRS in relation to stone burden, necessity of pre DJ stenting, use of UAS and post operative complication rate. 131 patients operated by single surgeon for single/multiple renal and/or upper ureteric stones were evaluated. Stone size > 3 mm on follow up CT KUB was considered as residual. Re RIRS was required for residual stones. The overall SFR was 76%. SFR were statistically lower with stone burden > 1.5 cm, lower calyceal stones and single stones with stone burden > 1.5 cm. SFR was 90% after 2 nd RIRS and 98.5% after 3 rd RIRS procedure. No significant difference in SFR was noted between single v/s multiple stones, single calyx v/s multiple calyx stones and renal v/s upper ureteric stones. No major complication was noted. Larger stone burden and lower calyceal location are important factors deciding SFR in RIRS. With auxiliary procedure, RIRS is safe and effective compared to PCNL.

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

PubMed

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

2009-01-01

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

The Small Aircraft Transportation System (SATS), Higher Volume Operations (HVO) Concept and Research

NASA Technical Reports Server (NTRS)

Baxley, B.; Williams, D.; Consiglio, M.; Adams, C.; Abbott, T.

2005-01-01

The ability to conduct concurrent, multiple aircraft operations in poor weather at virtually any airport offers an important opportunity for a significant increase in the rate of flight operations, a major improvement in passenger convenience, and the potential to foster growth of operations at small airports. The Small Aircraft Transportation System, (SATS) Higher Volume Operations (HVO) concept is designed to increase capacity at the 3400 non-radar, non-towered airports in the United States where operations are currently restricted to one-in/one-out procedural separation during low visibility or ceilings. The concept s key feature is that pilots maintain their own separation from other aircraft using air-to-air datalink and on-board software within the Self-Controlled Area (SCA), an area of flight operations established during poor visibility and low ceilings around an airport without Air Traffic Control (ATC) services. While pilots self-separate within the SCA, an Airport Management Module (AMM) located at the airport assigns arriving pilots their sequence based on aircraft performance, position, winds, missed approach requirements, and ATC intent. The HVO design uses distributed decision-making, safe procedures, attempts to minimize pilot and controller workload, and integrates with today's ATC environment. The HVO procedures have pilots make their own flight path decisions when flying in Instrument Metrological Conditions (IMC) while meeting these requirements. This paper summarizes the HVO concept and procedures, presents a summary of the research conducted and results, and outlines areas where future HVO research is required. More information about SATS HVO can be found at http://ntrs.nasa.gov.

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

Okada, Takuya, E-mail: okabone@gmail.com; Frank, Michael, E-mail: michael.frank@egp.aphp.fr; Pellerin, Olivier, E-mail: olivier@pellerin.as

PurposeTo evaluate the safety and efficacy of transarterial embolization of life-threatening arterial rupture in patients with vascular Ehlers–Danlos syndrome (vEDS) in a single tertiary referral center.MethodsWe retrospectively analyzed transarterial embolization for vEDS performed at our institution from 2000 to 2012. The indication of embolization was spontaneous arterial rupture or pseudoaneurysm with acute bleeding. All interventions used a percutaneous approach through a 5F or less introducer sheath. Embolic agents were microcoils and glue in 3 procedures, glue alone in 2, and microcoils alone in 2.ResultsFive consecutive vEDS patients were treated by 7 embolization procedures (4 women, mean age 29.8 years). All proceduresmore » were successfully performed. Two patients required a second procedure for newly arterial lesions at a different site from the first procedure. Four of the five patients were still alive after a mean follow-up of 19.4 (range 1–74.7) months. One patient died of multiple organ failure 2 days after procedure. Minor procedural complications were observed in 3 procedures (43 %), all directly managed during the same session. Remote arterial lesions occurred after 3 procedures (43 %); one underwent a second embolization, and the other 2 were observed conservatively. Puncture site complication was observed in only one procedure (14 %).ConclusionEmbolization for vEDS is a safe and effective method to manage life-threatening arterial rupture.« less

A non-linear regression analysis program for describing electrophysiological data with multiple functions using Microsoft Excel.

PubMed

Brown, Angus M

2006-04-01

The objective of this present study was to demonstrate a method for fitting complex electrophysiological data with multiple functions using the SOLVER add-in of the ubiquitous spreadsheet Microsoft Excel. SOLVER minimizes the difference between the sum of the squares of the data to be fit and the function(s) describing the data using an iterative generalized reduced gradient method. While it is a straightforward procedure to fit data with linear functions, and we have previously demonstrated a method of non-linear regression analysis of experimental data based upon a single function, it is more complex to fit data with multiple functions, usually requiring specialized expensive computer software. In this paper we describe an easily understood program for fitting experimentally acquired data, in this case the stimulus-evoked compound action potential from the mouse optic nerve, with multiple Gaussian functions. The program is flexible and can be applied to describe data with a wide variety of user-input functions.

Next generation industrial biotechnology based on extremophilic bacteria.

PubMed

Chen, Guo-Qiang; Jiang, Xiao-Ran

2018-04-01

Industrial biotechnology aims to produce bulk chemicals including polymeric materials and biofuels based on bioprocessing sustainable agriculture products such as starch, fatty acids and/or cellulose. However, traditional bioprocesses require bioreactors made of stainless steel, complicated sterilization, difficult and expensive separation procedures as well as well-trained engineers that are able to conduct bioprocessing under sterile conditions, reducing the competitiveness of the bio-products. Amid the continuous low petroleum price, next generation industrial biotechnology (NGIB) allows bioprocessing to be conducted under unsterile (open) conditions using ceramic, cement or plastic bioreactors in a continuous way, it should be an energy, water and substrate saving technology with convenient operation procedure. NGIB also requires less capital investment and reduces demand on highly trained engineers. The foundation for the simplified NGIB is microorganisms that resist contaminations by other microbes, one of the examples is rapid growing halophilic bacteria inoculated under high salt concentration and alkali pH. They have been engineered to produce multiple products in various scales. Copyright © 2017 Elsevier Ltd. All rights reserved.

Model of Procedure Usage – Results from a Qualitative Study to Inform Design of Computer-Based Procedures

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

Johanna H Oxstrand; Katya L Le Blanc

The nuclear industry is constantly trying to find ways to decrease the human error rate, especially the human errors associated with procedure use. As a step toward the goal of improving procedure use performance, researchers, together with the nuclear industry, have been looking at replacing the current paper-based procedures with computer-based procedure systems. The concept of computer-based procedures is not new by any means; however most research has focused on procedures used in the main control room. Procedures reviewed in these efforts are mainly emergency operating procedures and normal operating procedures. Based on lessons learned for these previous efforts wemore » are now exploring a more unknown application for computer based procedures - field procedures, i.e. procedures used by nuclear equipment operators and maintenance technicians. The Idaho National Laboratory, the Institute for Energy Technology, and participants from the U.S. commercial nuclear industry are collaborating in an applied research effort with the objective of developing requirements and specifications for a computer-based procedure system to be used by field operators. The goal is to identify the types of human errors that can be mitigated by using computer-based procedures and how to best design the computer-based procedures to do this. The underlying philosophy in the research effort is “Stop – Start – Continue”, i.e. what features from the use of paper-based procedures should we not incorporate (Stop), what should we keep (Continue), and what new features or work processes should be added (Start). One step in identifying the Stop – Start – Continue was to conduct a baseline study where affordances related to the current usage of paper-based procedures were identified. The purpose of the study was to develop a model of paper based procedure use which will help to identify desirable features for computer based procedure prototypes. Affordances such as note taking, markups, sharing procedures between fellow coworkers, the use of multiple procedures at once, etc. were considered. The model describes which affordances associated with paper based procedures should be transferred to computer-based procedures as well as what features should not be incorporated. The model also provides a means to identify what new features not present in paper based procedures need to be added to the computer-based procedures to further enhance performance. The next step is to use the requirements and specifications to develop concepts and prototypes of computer-based procedures. User tests and other data collection efforts will be conducted to ensure that the real issues with field procedures and their usage are being addressed and solved in the best manner possible. This paper describes the baseline study, the construction of the model of procedure use, and the requirements and specifications for computer-based procedures that were developed based on the model. It also addresses how the model and the insights gained from it were used to develop concepts and prototypes for computer based procedures.« less

The DRIL procedure for arteriovenous access ischemic steal: a controversial approach.

PubMed

Davidson, Ingemar; Beathard, Gerald; Gallieni, Maurizio; Ross, John

2017-01-18

The DRIL procedure first described in 1988 has long been considered the preferred treatment for arteriovenous access ischemic steal (AVAIS). At the time it was a brilliant concept and breakthrough. In the last decade, the DRIL procedure has become less used. With the increasing age of the dialysis population, patients developing AVAIS are more likely to be elderly with advanced peripheral arterial disease, making the distal revascularization anastomosis difficult and risky if not impossible to perform. In addition, the distal ligation of the main artery to the arm is something most surgeons are reluctant to do. The occlusion of the arterial bypass over time is not uncommon with recurrence of hand ischemia. The multistep DRIL procedure requires general anesthesia and the need to harvest the saphenous vein for the bypass, add to the surgical risk in patients with multiple co-morbidities. For these reasons, some surgeons prefer to do only the DR (distal re-vascularization) portion of the procedure omitting the IL (interval ligation). Increasing the bypass distance from the original anastomosis, makes this modification similar to the less invasive proximal arterial inflow (PAI) procedure. Because of changes in the patient population clinical presentation, most notably forearm atherosclerosis and with new technologies, this editorial addresses the current validity of the DRIL procedure as a safe option in treating AVAIS.

Step by Step: Biology Undergraduates' Problem-Solving Procedures during Multiple-Choice Assessment

ERIC Educational Resources Information Center

Prevost, Luanna B.; Lemons, Paula P.

2016-01-01

This study uses the theoretical framework of domain-specific problem solving to explore the procedures students use to solve multiple-choice problems about biology concepts. We designed several multiple-choice problems and administered them on four exams. We trained students to produce written descriptions of how they solved the problem, and this…

Examining Measurement Invariance and Differential Item Functioning with Discrete Latent Construct Indicators: A Note on a Multiple Testing Procedure

ERIC Educational Resources Information Center

Raykov, Tenko; Dimitrov, Dimiter M.; Marcoulides, George A.; Li, Tatyana; Menold, Natalja

2018-01-01

A latent variable modeling method for studying measurement invariance when evaluating latent constructs with multiple binary or binary scored items with no guessing is outlined. The approach extends the continuous indicator procedure described by Raykov and colleagues, utilizes similarly the false discovery rate approach to multiple testing, and…

Quality specifications for articles of botanical origin from the United States Pharmacopeia.

PubMed

Ma, Cuiying; Oketch-Rabah, Hellen; Kim, Nam-Cheol; Monagas, Maria; Bzhelyansky, Anton; Sarma, Nandakumara; Giancaspro, Gabriel

2018-06-01

In order to define appropriate quality of botanical dietary supplements, botanical drugs, and herbal medicines, the United States Pharmacopeia (USP) and the Herbal Medicines Compendium (HMC) contain science-based quality standards that include multiple interrelated tests to provide a full quality characterization for each article in terms of its identity, purity, and content. To provide a comprehensive description of the pharmacopeial tests and requirements for articles of botanical origin in the aforementioned compendia. Selective chromatographic procedures, such as high-performance liquid chromatography (HPLC) and high-performance thin-layer chromatography (HPTLC), are used as Identification tests in pharmacopeial monographs to detect species substitution or other confounders. HPLC quantitative tests are typically used to determine the content of key constituents, i.e., the total or individual amount of plant secondary metabolites that are considered bioactive constituents or analytical marker compounds. Purity specifications are typically set to limit the content of contaminants such as toxic elements, pesticides, and fungal toxins. Additional requirements highlight the importance of naming, definition, use of reference materials, and packaging/storage conditions. Technical requirements for each section of the monographs were illustrated with specific examples. Tests were performed on authentic samples using pharmacopeial reference standards. The chromatographic analytical procedures were validated to provide characteristic profiles for the identity and/or accurate determination of the content of quality markers. The multiple tests included in each monograph complement each other to provide an appropriate pharmacopeial quality characterization for the botanicals used as herbal medicines and dietary supplements. The monographs provide detailed specifications for identity, content of bioactive constituents or quality markers, and limits of contaminants, adulterants, and potentially toxic substances. Additional requirements such as labeling and packaging further contribute to preserve the quality of these products. Compliance with pharmacopeial specifications should be required to ensure the reliability of botanical articles used for health care purposes. Copyright © 2018. Published by Elsevier GmbH.

Multiple huge epiphrenic esophageal diverticula with motility disease treated with video-assisted thoracoscopic and hand-assisted laparoscopic esophagectomy: a case report.

PubMed

Taniguchi, Yoshiki; Takahashi, Tsuyoshi; Nakajima, Kiyokazu; Higashi, Shigeyoshi; Tanaka, Koji; Miyazaki, Yasuhiro; Makino, Tomoki; Kurokawa, Yukinori; Yamasaki, Makoto; Takiguchi, Shuji; Mori, Masaki; Doki, Yuichiro

2017-12-01

Epiphrenic esophageal diverticulum is a rare condition that is often associated with a concomitant esophageal motor disorder. Some patients have the chief complaints of swallowing difficulty and gastroesophageal reflux; traditionally, such diverticula have been resected via right thoracotomy. Here, we describe a case with huge multiple epiphrenic diverticula with motility disorder, which were successfully resected using a video-assisted thoracic and laparoscopic procedure. A 63-year-old man was admitted due to dysphagia, heartburn, and vomiting. An esophagogram demonstrated an S-shaped lower esophagus with multiple epiphrenic diverticula (75 × 55 mm and 30 × 30 mm) and obstruction by the lower esophageal sphincter (LES). Esophageal manometry showed normal peristaltic contractions in the esophageal body, whereas the LES pressure was high (98.6 mmHg). The pressure vector volume of LES was 23,972 mmHg 2  cm. Based on these findings, we diagnosed huge multiple epiphrenic diverticula with a hypertensive lower esophageal sphincter and judged that resection might be required. We performed lower esophagectomy with gastric conduit reconstruction using a video-assisted thoracic and hand-assisted laparoscopic procedure. The postoperative course was uneventful, and the esophagogram demonstrated good passage, with no leakage, stenosis, or diverticula. The most common causes of mid-esophageal and epiphrenic diverticula are motility disorders of the esophageal body; appropriate treatment should be considered based on the morphological and motility findings.

Comparison of the phenolic composition of fruit juices by single step gradient HPLC analysis of multiple components versus multiple chromatographic runs optimised for individual families.

PubMed

Bremner, P D; Blacklock, C J; Paganga, G; Mullen, W; Rice-Evans, C A; Crozier, A

2000-06-01

After minimal sample preparation, two different HPLC methodologies, one based on a single gradient reversed-phase HPLC step, the other on multiple HPLC runs each optimised for specific components, were used to investigate the composition of flavonoids and phenolic acids in apple and tomato juices. The principal components in apple juice were identified as chlorogenic acid, phloridzin, caffeic acid and p-coumaric acid. Tomato juice was found to contain chlorogenic acid, caffeic acid, p-coumaric acid, naringenin and rutin. The quantitative estimates of the levels of these compounds, obtained with the two HPLC procedures, were very similar, demonstrating that either method can be used to analyse accurately the phenolic components of apple and tomato juices. Chlorogenic acid in tomato juice was the only component not fully resolved in the single run study and the multiple run analysis prior to enzyme treatment. The single run system of analysis is recommended for the initial investigation of plant phenolics and the multiple run approach for analyses where chromatographic resolution requires improvement.

Documentation and tagging of casualties in multiple casualty incidents.

PubMed

Garner, Alan

2003-01-01

The use of triage tags is widely advocated as a tool to improve the management of multiple casualty incident scenes. However, there are no published reports to suggest that triage tags have improved the management of incidents involving more than 24 persons, and a number of reports have detailed problems associated with triage tag use. Alternative systems of scene management such as geographical triage have been successfully used in very large incidents, and are recommended as an alternative to triage tags. Documentation cards attached to casualties may be of use in situations where casualties will pass through an extended evacuation chain, and clear labels for deceased casualties are of benefit as they discourage repeat assessments. Adoption of an evidence-based approach to multiple casualty incident scene management will require a paradigm shift in the thinking of ambulance services. A broad-based educational approach that encourages critical reappraisal of existing procedures is recommended.

Toward a standard line for use in multibeam echo sounder calibration

NASA Astrophysics Data System (ADS)

Weber, Thomas C.; Rice, Glen; Smith, Michael

2018-06-01

A procedure is suggested in which a relative calibration for the intensity output of a multibeam echo sounder (MBES) can be performed. This procedure identifies a common survey line (i.e., a standard line), over which acoustic backscatter from the seafloor is collected with multiple MBES systems or by the same system multiple times. A location on the standard line which exhibits temporal stability in its seafloor backscatter response is used to bring the intensity output of the multiple MBES systems to a common reference. This relative calibration procedure has utility for MBES users wishing to generate an aggregate seafloor backscatter mosaic using multiple systems, revisiting an area to detect changes in substrate type, and comparing substrate types in the same general area but with different systems or different system settings. The calibration procedure is demonstrated using three different MBES systems over 3 different years in New Castle, NH, USA.

Feasibility and safety of bilateral same-session flexible ureteroscopy (FURS) for renal and ureteral stone disease

PubMed Central

Drake, Tamsin; Ali, Ahmed

2015-01-01

Introduction With rising incidence of urolithiasis, treatment of stones (both symptomatic and asymptomatic) in multiple locations including bilateral stones can be controversial and challenging. We report our experience and treatment outcomes in patients undergoing bilateral, same-session ureterorenoscopy (BS-URS) for bilateral ureteric and/or renal calculi, and discuss the advantages and disadvantages of such procedures. Material and methods Between May 2012 and October 2013, 251 patients underwent ureteroscopic surgery for stone disease at our institution. Of these, 21 patients underwent 25 bilateral same-session ureterorenoscopy (BS-URS) procedures during this period. Stone-free status was defined as endoscopically stone-free or radiological fragments <2 mm. Results The mean bilateral stone size was 21mm (range: 4-63 mm) with a mean operating time of 70 minutes (range 35-129 minutes). Fifteen procedures (60%) were done as day case procedures with a mean stay of 0.9 days (range 0-7 days). Of the 42 renal units treated, 80% (34/42) were stone-free after a single bilateral ureteroscopy session. A further 12% (5/42) were cleared after a re-look procedure making the overall stone free rate 92.8% (39/42). There were no major complications and 3 minor complications (2 early stent removals due to stent symptoms and 1 pyelonephritis requiring intravenous antibiotics). Conclusions Bilateral same-session ureteroscopy is a safe and effective treatment option for patients with bilateral ureteric and/or renal calculi, even with stones in multiple locations and increasing stone loads. However, as with all surgery, proper patient and equipment selection is crucial in terms of reducing complication rates and improving treatment outcomes. PMID:26251740

Rendezvous Integration Complexities of NASA Human Flight Vehicles

NASA Technical Reports Server (NTRS)

Brazzel, Jack P.; Goodman, John L.

2009-01-01

Propellant-optimal trajectories, relative sensors and navigation, and docking/capture mechanisms are rendezvous disciplines that receive much attention in the technical literature. However, other areas must be considered. These include absolute navigation, maneuver targeting, attitude control, power generation, software development and verification, redundancy management, thermal control, avionics integration, robotics, communications, lighting, human factors, crew timeline, procedure development, orbital debris risk mitigation, structures, plume impingement, logistics, and in some cases extravehicular activity. While current and future spaceflight programs will introduce new technologies and operations concepts, the complexity of integrating multiple systems on multiple spacecraft will remain. The systems integration task may become more difficult as increasingly complex software is used to meet current and future automation, autonomy, and robotic operation requirements.

Self-expandable CoreValve implantation without contrast media.

PubMed

Bruschi, Giuseppe; Colombo, Paola; De Marco, Federico; Barosi, Alberto; Mauri, Silvia; Klugmann, Silvio

2016-09-01

Transcatheter aortic valve implantation has been designed to treat high-risk surgical patients affected by severe aortic stenosis, many of whom are affected by chronic kidney disease. To perform transcatheter self-expandable valve implantation, multiple contrast injections are required to monitor the procedure, so these patients are at increased risk of acute kidney injury. We described self-expandable transcatheter aortic valve implantation without contrast media in an 80-year-old man affected by severe aortic stenosis and endstage chronic kidney disease. © The Author(s) 2015.

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

PubMed

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

2017-09-01

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

[A consensual therapeutic recommendation for type 2 diabetes mellitus by the Slovak Diabetes Society (2018)].

PubMed

Martinka, Emil; Uličiansky, Vladimír; Mokáň, Marián; Tkáč, Ivan; Galajda, Peter; Dókušová, Silvia; Schroner, Zbynek

2018-01-01

Type 2 diabetes mellitus is a heterogeneous medical condition involving multiple pathophysiological mechanisms. Its successful treatment requires an individualized approach and frequently combined therapy with utilizing its effect on multiple levels. Current possibilities enable the employment of such procedures to an incomparably greater extent than before. The effects of different classes of oral antidiabetic drugs on the reduction of glycemia and HbA1c is mutually comparable. However differences are observed in the proportions of patients who met the required criteria, regarding the increase in weight, incidence of hypoglycemia as well as the effect on cardiovascular, renal or oncologic morbidity and mortality, and severity of specific adverse effects, potential risks and contraindications. The presented text provides the reader with the information about the Consensual therapeutic algorithm for the treatment of type 2 diabetes mellitus in compliance with SPC, the ADA/EASD amended indicative limitations and recommendations, formulated by the Committee of the Slovak Diabetes Society.Key words: biguanides - gliflozins - gliptins - glitazones - GLP-1-receptor agonists - insulin - sulfonylurea.

Epidemiologic programs for computers and calculators. A microcomputer program for multiple logistic regression by unconditional and conditional maximum likelihood methods.

PubMed

Campos-Filho, N; Franco, E L

1989-02-01

A frequent procedure in matched case-control studies is to report results from the multivariate unmatched analyses if they do not differ substantially from the ones obtained after conditioning on the matching variables. Although conceptually simple, this rule requires that an extensive series of logistic regression models be evaluated by both the conditional and unconditional maximum likelihood methods. Most computer programs for logistic regression employ only one maximum likelihood method, which requires that the analyses be performed in separate steps. This paper describes a Pascal microcomputer (IBM PC) program that performs multiple logistic regression by both maximum likelihood estimation methods, which obviates the need for switching between programs to obtain relative risk estimates from both matched and unmatched analyses. The program calculates most standard statistics and allows factoring of categorical or continuous variables by two distinct methods of contrast. A built-in, descriptive statistics option allows the user to inspect the distribution of cases and controls across categories of any given variable.

Airway reconstruction: review of an approach to the advanced-stage laryngotracheal stenosis.

PubMed

Bitar, Mohamad Ahmad; Al Barazi, Randa; Barakeh, Rana

The management of laryngotracheal stenosis is complex and is influenced by multiple factors that can affect the ultimate outcome. Advanced lesions represent a special challenge to the treating surgeon to find the best remedying technique. To review the efficacy of our surgical reconstructive approach in managing advanced-stage laryngotracheal stenosis treated at a tertiary medical center. A retrospective review of all patients that underwent open laryngotracheal repair/reconstruction by the senior author between 2002 and 2014. Patients with mild/moderate stenosis (e.g. stage 1 or 2), or those who had an open reconstructive procedure prior to referral, were excluded. Patients who had only endoscopic treatment (e.g. laser, balloon dilatation) and were not subjected to an open reconstructive procedure at our institution, were not included in this study. Variables studied included patient demographics, clinical presentation, etiology of the laryngotracheal pathology, the location of stenosis, the stage of stenosis, the type of corrective or reconstructive procedure performed with the type of graft used (where applicable), the type and duration of stent used, the post-reconstruction complications, and the duration of follow-up. Outcome measures included decannulation rate, total number of reconstructive surgeries needed to achieve decannulation, and the number of post-operative endoscopies needed to reach a safe patent airway. Twenty five patients were included, aged 0.5 months to 45 years (mean 13.5 years, median 15 years) with 16 males and 9 females. Seventeen patients (68%) were younger than 18 years. Most patients presented with stridor, failure of decannulation, or respiratory distress. Majority had acquired etiology for their stenosis with only 24% having a congenital pathology. Thirty-two reconstructive procedures were performed resulting in decannulating 24 patients (96%), with 15/17 (88%) pediatric patients and 5/8 (62.5%) adult patients requiring only a single reconstructive procedure. Cartilage grafts were mostly used in children (84% vs. 38%) and stents were mostly silicone made, followed by endotracheal tubes. The number of endoscopies required ranged from 1 to 7 (mean 3). More co-morbidities existed in young children, resulting in failure to decannulate one patient. Adult patients had more complex pathologies requiring multiple procedures to achieve decannulation, with grafting less efficacious than in younger patients. The pediatric patients had double the incidence of granulation tissue compared to adults. The decannulated patients remained asymptomatic at a mean follow-up of 50.5 months. The review of our approach to open airway repair/reconstruction showed its efficacy in advanced-stage laryngotracheal stenosis. Good knowledge of a variety of reconstructive techniques is important to achieve good results in a variety of age groups. Copyright © 2016 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Published by Elsevier Editora Ltda. All rights reserved.

Extended Pausing by Humans on Multiple Fixed-Ratio Schedules with Varied Reinforcer Magnitude and Response Requirements

PubMed Central

Williams, Dean C; Saunders, Kathryn J; Perone, Michael

2011-01-01

We conducted three experiments to reproduce and extend Perone and Courtney's (1992) study of pausing at the beginning of fixed-ratio schedules. In a multiple schedule with unequal amounts of food across two components, they found that pigeons paused longest in the component associated with the smaller amount of food (the lean component), but only when it was preceded by the rich component. In our studies, adults with mild intellectual disabilities responded on a touch-sensitive computer monitor to produce money. In Experiment 1, the multiple-schedule components differed in both response requirement and reinforcer magnitude (i.e., the rich component required fewer responses and produced more money than the lean component). Effects shown with pigeons were reproduced in all 7 participants. In Experiment 2, we removed the stimuli that signaled the two schedule components, and participants' extended pausing was eliminated. In Experiment 3, to assess sensitivity to reinforcer magnitude versus fixed-ratio size, we presented conditions with equal ratio sizes but disparate magnitudes and conditions with equal magnitudes but disparate ratio sizes. Sensitivity to these manipulations was idiosyncratic. The present experiments obtained schedule control in verbally competent human participants and, despite procedural differences, we reproduced findings with animal participants. We showed that pausing is jointly determined by past conditions of reinforcement and stimuli correlated with upcoming conditions. PMID:21541121

16 CFR 1702.2 - Procedural requirements and recommendations.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 16 Commercial Practices 2 2010-01-01 2010-01-01 false Procedural requirements and recommendations...; PETITION PROCEDURES AND REQUIREMENTS § 1702.2 Procedural requirements and recommendations. (a) Requirements... recommendations. The following are procedural recommendations to help the Commission in its consideration of...

16 CFR 1702.2 - Procedural requirements and recommendations.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 16 Commercial Practices 2 2011-01-01 2011-01-01 false Procedural requirements and recommendations...; PETITION PROCEDURES AND REQUIREMENTS § 1702.2 Procedural requirements and recommendations. (a) Requirements... recommendations. The following are procedural recommendations to help the Commission in its consideration of...

APD in the developing world: is there a future?

PubMed

Correa-Rotter, Ricardo

2002-01-01

Automated peritoneal dialysis (APD) has experienced significant growth in highly developed nations in the last few years, while in developing countries with important social, educational, and financial constraints this treatment modality is, at best, trying to emerge. APD offers advantages that make it popular. Some of these advantages include increased adequacy for some patient groups, enhanced patient well-being and positive changes in lifestyle, as well as a reduction in peritonitis rates attributed to fewer connect-disconnect procedures. The development of APD in developing nations has been very poor mainly due to educational and financial constraints. APD growth as a treatment modality in the developing world requires multiple approaches, some of them general and others related to the specific needs of each nation. There is a need to develop APD research projects and pilot programs to demonstrate the benefits for specific subpopulations. In addition, the development of research and industry-market strategies directed at reducing costs related to this form of treatment are required. The relatively low use of APD in developing nations is primarily influenced by nonmedical factors. Given the financial and educational constraints, APD programs may need to be directed toward specific subpopulations such as young working adults, individuals who require assistance to perform procedures, or patients who require an increased dialysis dose in order to reach adequate clearances.

A two-step hierarchical hypothesis set testing framework, with applications to gene expression data on ordered categories

PubMed Central

2014-01-01

Background In complex large-scale experiments, in addition to simultaneously considering a large number of features, multiple hypotheses are often being tested for each feature. This leads to a problem of multi-dimensional multiple testing. For example, in gene expression studies over ordered categories (such as time-course or dose-response experiments), interest is often in testing differential expression across several categories for each gene. In this paper, we consider a framework for testing multiple sets of hypothesis, which can be applied to a wide range of problems. Results We adopt the concept of the overall false discovery rate (OFDR) for controlling false discoveries on the hypothesis set level. Based on an existing procedure for identifying differentially expressed gene sets, we discuss a general two-step hierarchical hypothesis set testing procedure, which controls the overall false discovery rate under independence across hypothesis sets. In addition, we discuss the concept of the mixed-directional false discovery rate (mdFDR), and extend the general procedure to enable directional decisions for two-sided alternatives. We applied the framework to the case of microarray time-course/dose-response experiments, and proposed three procedures for testing differential expression and making multiple directional decisions for each gene. Simulation studies confirm the control of the OFDR and mdFDR by the proposed procedures under independence and positive correlations across genes. Simulation results also show that two of our new procedures achieve higher power than previous methods. Finally, the proposed methodology is applied to a microarray dose-response study, to identify 17 β-estradiol sensitive genes in breast cancer cells that are induced at low concentrations. Conclusions The framework we discuss provides a platform for multiple testing procedures covering situations involving two (or potentially more) sources of multiplicity. The framework is easy to use and adaptable to various practical settings that frequently occur in large-scale experiments. Procedures generated from the framework are shown to maintain control of the OFDR and mdFDR, quantities that are especially relevant in the case of multiple hypothesis set testing. The procedures work well in both simulations and real datasets, and are shown to have better power than existing methods. PMID:24731138

Analysis of in vitro fertilization data with multiple outcomes using discrete time-to-event analysis

PubMed Central

Maity, Arnab; Williams, Paige; Ryan, Louise; Missmer, Stacey; Coull, Brent; Hauser, Russ

2014-01-01

In vitro fertilization (IVF) is an increasingly common method of assisted reproductive technology. Because of the careful observation and followup required as part of the procedure, IVF studies provide an ideal opportunity to identify and assess clinical and demographic factors along with environmental exposures that may impact successful reproduction. A major challenge in analyzing data from IVF studies is handling the complexity and multiplicity of outcome, resulting from both multiple opportunities for pregnancy loss within a single IVF cycle in addition to multiple IVF cycles. To date, most evaluations of IVF studies do not make use of full data due to its complex structure. In this paper, we develop statistical methodology for analysis of IVF data with multiple cycles and possibly multiple failure types observed for each individual. We develop a general analysis framework based on a generalized linear modeling formulation that allows implementation of various types of models including shared frailty models, failure specific frailty models, and transitional models, using standard software. We apply our methodology to data from an IVF study conducted at the Brigham and Women’s Hospital, Massachusetts. We also summarize the performance of our proposed methods based on a simulation study. PMID:24317880

Proceedings of the Conference on the Design of Experiments in Army Research Development and Testing (26th) Held at New Mexico State University, Las Cruces, New Mexico on 22-24 October 1980.

DTIC Science & Technology

1981-06-01

normality and several types of nonnormality. Overall the rank transformation procedure seems to be the best. The Fisher’s LSD multiple comparisons procedure...the rank transformation procedure appears to maintain power better than Fisher’s LSD or the randomization proce- dures. The conclusion of this study...best. The Fisher’s LSD multiple comparisons procedure in the one way and two way layouts iv compared with a randomization procedure and with the same

Step by Step: Biology Undergraduates’ Problem-Solving Procedures during Multiple-Choice Assessment

PubMed Central

Prevost, Luanna B.; Lemons, Paula P.

2016-01-01

This study uses the theoretical framework of domain-specific problem solving to explore the procedures students use to solve multiple-choice problems about biology concepts. We designed several multiple-choice problems and administered them on four exams. We trained students to produce written descriptions of how they solved the problem, and this allowed us to systematically investigate their problem-solving procedures. We identified a range of procedures and organized them as domain general, domain specific, or hybrid. We also identified domain-general and domain-specific errors made by students during problem solving. We found that students use domain-general and hybrid procedures more frequently when solving lower-order problems than higher-order problems, while they use domain-specific procedures more frequently when solving higher-order problems. Additionally, the more domain-specific procedures students used, the higher the likelihood that they would answer the problem correctly, up to five procedures. However, if students used just one domain-general procedure, they were as likely to answer the problem correctly as if they had used two to five domain-general procedures. Our findings provide a categorization scheme and framework for additional research on biology problem solving and suggest several important implications for researchers and instructors. PMID:27909021

Hair transplantation in burn scar alopecia

PubMed Central

Farjo, Bessam; Farjo, Nilofer; Williams, Greg

2015-01-01

Treating patients with burn alopecia or hair loss can often be a challenge to both the surgeon and the patient. As with other reconstructive procedures that are required in the post-burn phase, this is usually a multiple stage process often requiring surgery over several years. This is because graft take is not as reliable as in healthy non-scarred skin and may need repeating to achieve adequate density. Also, different areas of hair loss may need to be addressed in separate procedures. There are several limiting factors that will determine whether or not a patient is a candidate for hair restoration which includes but is not limited to the amount of hair loss and the availability of suitable donor hair. Here we discuss how the current surgical technique of hair transplant surgery by follicular unit extraction (FUE) or strip follicular unit transplant (FUT) has become the treatment of choice for alopecic areas that require a more refined aesthetic result. Eyebrow, eyelash, beard and scalp hair loss can all have a negative impact on a burn survivor’s self-esteem and even if surgery is not a possibility, there are non-surgical options available for hair restoration and these are also discussed. PMID:29799573

Facilitating relational framing in children and individuals with developmental delay using the relational completion procedure.

PubMed

Walsh, Sinead; Horgan, Jennifer; May, Richard J; Dymond, Simon; Whelan, Robert

2014-01-01

The Relational Completion Procedure is effective for establishing same, opposite and comparative derived relations in verbally able adults, but to date it has not been used to establish relational frames in young children or those with developmental delay. In Experiment 1, the Relational Completion Procedure was used with the goal of establishing two 3-member sameness networks in nine individuals with Autism Spectrum Disorder (eight with language delay). A multiple exemplar intervention was employed to facilitate derived relational responding when required. Seven of nine participants in Experiment 1 passed tests for derived relations. In Experiment 2, eight participants (all of whom, except one, had a verbal repertoire) were given training with the aim of establishing two 4-member sameness networks. Three of these participants were typically developing young children aged between 5 and 6 years old, all of whom demonstrated derived relations, as did four of the five participants with developmental delay. These data demonstrate that it is possible to reliably establish derived relations in young children and those with developmental delay using an automated procedure. © Society for the Experimental Analysis of Behavior.

Automated riverine landscape characterization: GIS-based tools for watershed-scale research, assessment, and management.

PubMed

Williams, Bradley S; D'Amico, Ellen; Kastens, Jude H; Thorp, James H; Flotemersch, Joseph E; Thoms, Martin C

2013-09-01

River systems consist of hydrogeomorphic patches (HPs) that emerge at multiple spatiotemporal scales. Functional process zones (FPZs) are HPs that exist at the river valley scale and are important strata for framing whole-watershed research questions and management plans. Hierarchical classification procedures aid in HP identification by grouping sections of river based on their hydrogeomorphic character; however, collecting data required for such procedures with field-based methods is often impractical. We developed a set of GIS-based tools that facilitate rapid, low cost riverine landscape characterization and FPZ classification. Our tools, termed RESonate, consist of a custom toolbox designed for ESRI ArcGIS®. RESonate automatically extracts 13 hydrogeomorphic variables from readily available geospatial datasets and datasets derived from modeling procedures. An advanced 2D flood model, FLDPLN, designed for MATLAB® is used to determine valley morphology by systematically flooding river networks. When used in conjunction with other modeling procedures, RESonate and FLDPLN can assess the character of large river networks quickly and at very low costs. Here we describe tool and model functions in addition to their benefits, limitations, and applications.

Transumbilical single port laparoscopic surgery for the treatment of concomitant disease.

PubMed

Lee, Jun Suh; Hong, Tae Ho; Park, Byung Joon; Kim, Jin Jo

2013-06-01

We report our experience of transumbilical single port laparoscopic surgery (TUSPLS) for multiple concomitant intraabdominal pathologies, and assess the feasibility of this technique with several technical tips. Various combined procedures using TUSPLS were performed since April, 2008. All records of concomitant laparoscopic procedures using TUSPLS were searched at three hospitals. Forty-one patients underwent 82 combined procedures using TUSPLS in a single session. The perioperative outcomes of simultaneously performed cholecystectomy and ovarian cystectomy using TUSPLS (n = 14) are compared with those of using CLS (n = 11). The operating time was significantly longer with the TUSPLS method than with the CLS method. However, postoperative convalescent outcomes such as postoperative hospital stay, VAS pain score, and required analgesics showed no differences between the two methods. Also, there were no significant operative complications associated with the two methods. Fewer trocars were used with the TUSPLS method. Combined laparoscopic procedures for various concomitant pathologies in the abdomen can be performed using transumbilical single port laparoscopic surgery without increasing morbidity or hospital stay in patients with acceptable risk.

POWER-ENHANCED MULTIPLE DECISION FUNCTIONS CONTROLLING FAMILY-WISE ERROR AND FALSE DISCOVERY RATES.

PubMed

Peña, Edsel A; Habiger, Joshua D; Wu, Wensong

2011-02-01

Improved procedures, in terms of smaller missed discovery rates (MDR), for performing multiple hypotheses testing with weak and strong control of the family-wise error rate (FWER) or the false discovery rate (FDR) are developed and studied. The improvement over existing procedures such as the Šidák procedure for FWER control and the Benjamini-Hochberg (BH) procedure for FDR control is achieved by exploiting possible differences in the powers of the individual tests. Results signal the need to take into account the powers of the individual tests and to have multiple hypotheses decision functions which are not limited to simply using the individual p -values, as is the case, for example, with the Šidák, Bonferroni, or BH procedures. They also enhance understanding of the role of the powers of individual tests, or more precisely the receiver operating characteristic (ROC) functions of decision processes, in the search for better multiple hypotheses testing procedures. A decision-theoretic framework is utilized, and through auxiliary randomizers the procedures could be used with discrete or mixed-type data or with rank-based nonparametric tests. This is in contrast to existing p -value based procedures whose theoretical validity is contingent on each of these p -value statistics being stochastically equal to or greater than a standard uniform variable under the null hypothesis. Proposed procedures are relevant in the analysis of high-dimensional "large M , small n " data sets arising in the natural, physical, medical, economic and social sciences, whose generation and creation is accelerated by advances in high-throughput technology, notably, but not limited to, microarray technology.

Natural Resource Information System. Volume 1: Overall description

NASA Technical Reports Server (NTRS)

1972-01-01

A prototype computer-based Natural Resource Information System was designed which could store, process, and display data of maximum usefulness to land management decision making. The system includes graphic input and display, the use of remote sensing as a data source, and it is useful at multiple management levels. A survey established current decision making processes and functions, information requirements, and data collection and processing procedures. The applications of remote sensing data and processing requirements were established. Processing software was constructed and a data base established using high-altitude imagery and map coverage of selected areas of SE Arizona. Finally a demonstration of system processing functions was conducted utilizing material from the data base.

Combining states without scale hierarchies with ordered parton showers

DOE PAGES

Fischer, Nadine; Prestel, Stefan

2017-09-12

Here, we present a parameter-free scheme to combine fixed-order multi-jet results with parton-shower evolution. The scheme produces jet cross sections with leading-order accuracy in the complete phase space of multiple emissions, resumming large logarithms when appropriate, while not arbitrarily enforcing ordering on momentum configurations beyond the reach of the parton-shower evolution equation. This then requires the development of a matrix-element correction scheme for complex phase-spaces including ordering conditions as well as a systematic scale-setting procedure for unordered phase-space points. Our algorithm does not require a merging-scale parameter. We implement the new method in the Vincia framework and compare to LHCmore » data.« less

North Carolina Medicaid recipient management lock-in program: the pharmacist's perspective.

PubMed

Werth, S Rose; Sachdeva, Nidhi; Roberts, Andrew W; Garrettson, Mariana; Ringwalt, Chris; Moss, Leslie A; Pikoulas, Theodore; Skinner, Asheley Cockrell

2014-11-01

The misuse and abuse of prescription opioids have become an urgent health issue in North Carolina (NC), particularly among Medicaid patients who suffer high rates of morbidity and mortality due to abuse and overdose. The NC Division of Medical Assistance (DMA) implemented a recipient management lock-in program, which limits identified patients for a 12-month period to 1 prescriber and 1 pharmacy for benzodiazepine, opiate, and certain anxiolytic prescriptions in order to prevent misuse and reduce overutilization of Medicaid benefits.  To (a) evaluate pharmacists' perceptions of the implementation of the NC recipient management lock-in program (MLIP) and (b) determine how the beliefs and attitudes of pharmacists could promote or inhibit its success.  We conducted 12 structured phone interviews with NC pharmacists serving lock-in patients. Interview responses were analyzed through construct analysis, which identified themes organized into 3 domains: organization and implementation, perceived effectiveness, and acceptability.  Most respondents reported a positive experience with the program but expressed doubt concerning its impact on prescription drug abuse. The program successfully utilized the pharmacist role as a gatekeeper of controlled substances, and the procedures of the program required no active effort on pharmacists' part. However, respondents suggested that the DMA improve communication and outreach to address pharmacists' lack of knowledge about the program's purpose and confusion over remediating problems that arise with lock-in patients. The DMA should also address the ways in which the program can interfere with access to health care and treatment, allow patients to see multiple physicians within the same clinic, and clarify procedures for patients whose complex health issues require multiple specialists.  Although possible improvements were identified, the NC MLIP has strong potential for success as it utilizes pharmacists' medication gate-keeping role, while minimizing the effort required for successful implementation.

Development of a Searchable Database of Cryoablation Simulations for Use in Treatment Planning

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

Boas, F. Edward, E-mail: boasf@mskcc.org; Srimathveeravalli, Govindarajan, E-mail: srimaths@mskcc.org; Durack, Jeremy C., E-mail: durackj@mskcc.org

PurposeTo create and validate a planning tool for multiple-probe cryoablation, using simulations of ice ball size and shape for various ablation probe configurations, ablation times, and types of tissue ablated.Materials and MethodsIce ball size and shape was simulated using the Pennes bioheat equation. Five thousand six hundred and seventy different cryoablation procedures were simulated, using 1–6 cryoablation probes and 1–2 cm spacing between probes. The resulting ice ball was measured along three perpendicular axes and recorded in a database. Simulated ice ball sizes were compared to gel experiments (26 measurements) and clinical cryoablation cases (42 measurements). The clinical cryoablation measurements weremore » obtained from a HIPAA-compliant retrospective review of kidney and liver cryoablation procedures between January 2015 and February 2016. Finally, we created a web-based cryoablation planning tool, which uses the cryoablation simulation database to look up the probe spacing and ablation time that produces the desired ice ball shape and dimensions.ResultsAverage absolute error between the simulated and experimentally measured ice balls was 1 mm in gel experiments and 4 mm in clinical cryoablation cases. The simulations accurately predicted the degree of synergy in multiple-probe ablations. The cryoablation simulation database covers a wide range of ice ball sizes and shapes up to 9.8 cm.ConclusionCryoablation simulations accurately predict the ice ball size in multiple-probe ablations. The cryoablation database can be used to plan ablation procedures: given the desired ice ball size and shape, it will find the number and type of probes, probe configuration and spacing, and ablation time required.« less

An Experiment in Scientific Program Understanding

NASA Technical Reports Server (NTRS)

Stewart, Mark E. M.; Owen, Karl (Technical Monitor)

2000-01-01

This paper concerns a procedure that analyzes aspects of the meaning or semantics of scientific and engineering code. This procedure involves taking a user's existing code, adding semantic declarations for some primitive variables, and parsing this annotated code using multiple, independent expert parsers. These semantic parsers encode domain knowledge and recognize formulae in different disciplines including physics, numerical methods, mathematics, and geometry. The parsers will automatically recognize and document some static, semantic concepts and help locate some program semantic errors. Results are shown for three intensively studied codes and seven blind test cases; all test cases are state of the art scientific codes. These techniques may apply to a wider range of scientific codes. If so, the techniques could reduce the time, risk, and effort required to develop and modify scientific codes.

Processing techniques for software based SAR processors

NASA Technical Reports Server (NTRS)

Leung, K.; Wu, C.

1983-01-01

Software SAR processing techniques defined to treat Shuttle Imaging Radar-B (SIR-B) data are reviewed. The algorithms are devised for the data processing procedure selection, SAR correlation function implementation, multiple array processors utilization, cornerturning, variable reference length azimuth processing, and range migration handling. The Interim Digital Processor (IDP) originally implemented for handling Seasat SAR data has been adapted for the SIR-B, and offers a resolution of 100 km using a processing procedure based on the Fast Fourier Transformation fast correlation approach. Peculiarities of the Seasat SAR data processing requirements are reviewed, along with modifications introduced for the SIR-B. An Advanced Digital SAR Processor (ADSP) is under development for use with the SIR-B in the 1986 time frame as an upgrade for the IDP, which will be in service in 1984-5.

Effectiveness of a five-step method for teaching clinical skills to students in a dental college in India.

PubMed

Virdi, Mandeep S; Sood, Meenakshi

2011-11-01

This study conducted at the PDM Dental College and Research Institute, Haryana, India, had the purpose of developing a teaching method based upon a five-step method for teaching clinical skills to students proposed by the American College of Surgeons. This five-step teaching method was used to place fissure sealants as an initial procedure by dental students in clinics. The sealant retention was used as an objective evaluation of the skill learnt by the students. The sealant retention was 92 percent at six- and twelve-month evaluations and 90 percent at the eighteen-month evaluation. These results indicate that simple methods can be devised for teaching clinical skills and achieve high success rates in clinical procedures requiring multiple steps.

Amnesia Associated with Bilateral Hippocampal and Bilateral Basal Ganglia Lesions in Anoxia with Stimulant Use

PubMed Central

Haut, Marc W.; Hogg, Jeffery P.; Marshalek, Patrick J.; Suter, Blair C.; Miller, Liv E.

2017-01-01

We report a case of a 55-year-old man with ischemic lesions of the bilateral hippocampus and bilateral basal ganglia following a myocardial infarction during an episode of multiple drug use with subsequent anoxia requiring resuscitation. He presented for a neuropsychological evaluation with an anterograde amnesia for both explicit and procedural memory. There are two main points to this case, the unique aspects of the bilateral multifocal lesions and the functional, cognitive impact of these lesions. We hypothesize that his rare focal bilateral lesions of both the hippocampus and basal ganglia are a result of anoxia acting in synergy with his stimulant drug use (cocaine and/or 3,4-methylenedioxy-methamphetamine). Second, his unique lesions produced an explicit and implicit/procedural anterograde amnesia. PMID:28228745

Amnesia Associated with Bilateral Hippocampal and Bilateral Basal Ganglia Lesions in Anoxia with Stimulant Use.

PubMed

Haut, Marc W; Hogg, Jeffery P; Marshalek, Patrick J; Suter, Blair C; Miller, Liv E

2017-01-01

We report a case of a 55-year-old man with ischemic lesions of the bilateral hippocampus and bilateral basal ganglia following a myocardial infarction during an episode of multiple drug use with subsequent anoxia requiring resuscitation. He presented for a neuropsychological evaluation with an anterograde amnesia for both explicit and procedural memory. There are two main points to this case, the unique aspects of the bilateral multifocal lesions and the functional, cognitive impact of these lesions. We hypothesize that his rare focal bilateral lesions of both the hippocampus and basal ganglia are a result of anoxia acting in synergy with his stimulant drug use (cocaine and/or 3,4-methylenedioxy-methamphetamine). Second, his unique lesions produced an explicit and implicit/procedural anterograde amnesia.

A Study of Platelet Inhibition, Using a 'Point of Care' Platelet Function Test, following Primary Percutaneous Coronary Intervention for ST-Elevation Myocardial Infarction [PINPOINT-PPCI].

PubMed

Johnson, Thomas W; Mumford, Andrew D; Scott, Lauren J; Mundell, Stuart; Butler, Mark; Strange, Julian W; Rogers, Chris A; Reeves, Barnaby C; Baumbach, Andreas

2015-01-01

Rapid coronary recanalization following ST-elevation myocardial infarction (STEMI) requires effective anti-platelet and anti-thrombotic therapies. This study tested the impact of door to end of procedure ('door-to-end') time and baseline platelet activity on platelet inhibition within 24hours post-STEMI. 108 patients, treated with prasugrel and procedural bivalirudin, underwent Multiplate® platelet function testing at baseline, 0, 1, 2 and 24hours post-procedure. Major adverse cardiac events (MACE), bleeding and stent thrombosis (ST) were recorded. Baseline ADP activity was high (88.3U [71.8-109.0]), procedural time and consequently bivalirudin infusion duration were short (median door-to-end time 55minutes [40-70] and infusion duration 30minutes [20-42]). Baseline ADP was observed to influence all subsequent measurements of ADP activity, whereas door-to-end time only influenced ADP immediately post-procedure. High residual platelet reactivity (HRPR ADP>46.8U) was observed in 75% of patients immediately post-procedure and persisted in 24% of patients at 2hours. Five patients suffered in-hospital MACE (4.6%). Acute ST occurred in 4 patients, all were <120mins post-procedure and had HRPR. No significant bleeding was observed. In a post-hoc analysis, pre-procedural morphine use was associated with significantly higher ADP activity following intervention. Baseline platelet function, time to STEMI treatment and opiate use all significantly influence immediate post-procedural platelet activity.

Identification of treatment responders based on multiple longitudinal outcomes with applications to multiple sclerosis patients.

PubMed

Kondo, Yumi; Zhao, Yinshan; Petkau, John

2017-05-30

Identification of treatment responders is a challenge in comparative studies where treatment efficacy is measured by multiple longitudinally collected continuous and count outcomes. Existing procedures often identify responders on the basis of only a single outcome. We propose a novel multiple longitudinal outcome mixture model that assumes that, conditionally on a cluster label, each longitudinal outcome is from a generalized linear mixed effect model. We utilize a Monte Carlo expectation-maximization algorithm to obtain the maximum likelihood estimates of our high-dimensional model and classify patients according to their estimated posterior probability of being a responder. We demonstrate the flexibility of our novel procedure on two multiple sclerosis clinical trial datasets with distinct data structures. Our simulation study shows that incorporating multiple outcomes improves the responder identification performance; this can occur even if some of the outcomes are ineffective. Our general procedure facilitates the identification of responders who are comprehensively defined by multiple outcomes from various distributions. Copyright © 2017 John Wiley & Sons, Ltd. Copyright © 2017 John Wiley & Sons, Ltd.

False Discovery Control in Large-Scale Spatial Multiple Testing

PubMed Central

Sun, Wenguang; Reich, Brian J.; Cai, T. Tony; Guindani, Michele; Schwartzman, Armin

2014-01-01

Summary This article develops a unified theoretical and computational framework for false discovery control in multiple testing of spatial signals. We consider both point-wise and cluster-wise spatial analyses, and derive oracle procedures which optimally control the false discovery rate, false discovery exceedance and false cluster rate, respectively. A data-driven finite approximation strategy is developed to mimic the oracle procedures on a continuous spatial domain. Our multiple testing procedures are asymptotically valid and can be effectively implemented using Bayesian computational algorithms for analysis of large spatial data sets. Numerical results show that the proposed procedures lead to more accurate error control and better power performance than conventional methods. We demonstrate our methods for analyzing the time trends in tropospheric ozone in eastern US. PMID:25642138

Construction of a 3-arcsecond digital elevation model for the Gulf of Maine

USGS Publications Warehouse

Twomey, Erin R.; Signell, Richard P.

2013-01-01

A system-wide description of the seafloor topography is a basic requirement for most coastal oceanographic studies. The necessary detail of the topography obviously varies with application, but for many uses, a nominal resolution of roughly 100 m is sufficient. Creating a digital bathymetric grid with this level of resolution can be a complex procedure due to a multiplicity of data sources, data coverages, datums and interpolation procedures. This report documents the procedures used to construct a 3-arcsecond (approximately 90-meter grid cell size) digital elevation model for the Gulf of Maine (71°30' to 63° W, 39°30' to 46° N). We obtained elevation and bathymetric data from a variety of American and Canadian sources, converted all data to the North American Datum of 1983 for horizontal coordinates and the North American Vertical Datum of 1988 for vertical coordinates, used a combination of automatic and manual techniques for quality control, and interpolated gaps using a surface-fitting routine.

Identifying and exploiting trait-relevant tissues with multiple functional annotations in genome-wide association studies

PubMed Central

Zhang, Shujun

2018-01-01

Genome-wide association studies (GWASs) have identified many disease associated loci, the majority of which have unknown biological functions. Understanding the mechanism underlying trait associations requires identifying trait-relevant tissues and investigating associations in a trait-specific fashion. Here, we extend the widely used linear mixed model to incorporate multiple SNP functional annotations from omics studies with GWAS summary statistics to facilitate the identification of trait-relevant tissues, with which to further construct powerful association tests. Specifically, we rely on a generalized estimating equation based algorithm for parameter inference, a mixture modeling framework for trait-tissue relevance classification, and a weighted sequence kernel association test constructed based on the identified trait-relevant tissues for powerful association analysis. We refer to our analytic procedure as the Scalable Multiple Annotation integration for trait-Relevant Tissue identification and usage (SMART). With extensive simulations, we show how our method can make use of multiple complementary annotations to improve the accuracy for identifying trait-relevant tissues. In addition, our procedure allows us to make use of the inferred trait-relevant tissues, for the first time, to construct more powerful SNP set tests. We apply our method for an in-depth analysis of 43 traits from 28 GWASs using tissue-specific annotations in 105 tissues derived from ENCODE and Roadmap. Our results reveal new trait-tissue relevance, pinpoint important annotations that are informative of trait-tissue relationship, and illustrate how we can use the inferred trait-relevant tissues to construct more powerful association tests in the Wellcome trust case control consortium study. PMID:29377896

Long-term complications of JJ stent and its management: A 5 years review.

PubMed

Ray, Rajendra Prasad; Mahapatra, Rajkumar Singha; Mondal, Partha Pratim; Pal, Dilip Kumar

2015-01-01

To assess the long term complications of JJ stent, the management of complications and the role of endoscopic approach to manage these complications. Nineteen patients with indwelling JJ stent for a duration of more than 6 months were included in this study. Patients were assessed with X-ray KUB, USG KUB, blood urea, creatinine and DTPA renogram. Data were analyzed by Microsoft excel 2007. Out of 19 patients 12 (63.16%) were male and 7 (36.84%) were female. The mean age was 39.78 ± 13.69 years., Mean duration for which the stent was in situ was 29.56 months. The most common complication was broken stent, in 11 cases (57.89%). Other complications were migration in 5 (26.32%), encrustation in 2 (10.52%) and 1 case of (5.26%) stone formation. Eighteen cases were managed by endoscopic approaches. A total of 22 procedures were performed to treat the complications. Eleven cases were managed by a single procedure and 8 patients required multiple procedures. All were managed successfully with no death reported. Post-operative complications were seen in eight cases (42.11%). JJ stent related long-term complications are not uncommon and are usually seen after 6 months of indwelling time. Endourological procedure should be the initial approach with a high success rate. Coordinated use multimodality and technology helps in management of difficult cases. Open surgery is rarely required. Prevention of the complication by judicious use and early removal is the cornerstone.

40 CFR 1066.410 - Dynamometer test procedure.

Code of Federal Regulations, 2014 CFR

2014-07-01

... drive mode. (For purposes of this paragraph (g), the term four-wheel drive includes other multiple drive... Dynamometer test procedure. (a) Dynamometer testing may consist of multiple drive cycles with both cold-start...-setting part identifies the driving schedules and the associated sample intervals, soak periods, engine...

Multiple testing with discrete data: Proportion of true null hypotheses and two adaptive FDR procedures.

PubMed

Chen, Xiongzhi; Doerge, Rebecca W; Heyse, Joseph F

2018-05-11

We consider multiple testing with false discovery rate (FDR) control when p values have discrete and heterogeneous null distributions. We propose a new estimator of the proportion of true null hypotheses and demonstrate that it is less upwardly biased than Storey's estimator and two other estimators. The new estimator induces two adaptive procedures, that is, an adaptive Benjamini-Hochberg (BH) procedure and an adaptive Benjamini-Hochberg-Heyse (BHH) procedure. We prove that the adaptive BH (aBH) procedure is conservative nonasymptotically. Through simulation studies, we show that these procedures are usually more powerful than their nonadaptive counterparts and that the adaptive BHH procedure is usually more powerful than the aBH procedure and a procedure based on randomized p-value. The adaptive procedures are applied to a study of HIV vaccine efficacy, where they identify more differentially polymorphic positions than the BH procedure at the same FDR level. © 2018 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

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

PubMed

Schneider, Simon; Schmidli, Heinz; Friede, Tim

2013-07-01

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

Obtaining eigensolutions for multiple frequency ranges in a single NASTRAN execution

NASA Technical Reports Server (NTRS)

Pamidi, P. R.; Brown, W. K.

1990-01-01

A novel and general procedure for obtaining eigenvalues and eigenvectors for multiple frequency ranges in a single NASTRAN execution is presented. The scheme is applicable to normal modes analyzes employing the FEER and Inverse Power methods of eigenvalue extraction. The procedure is illustrated by examples.

Timing of intra-aortic balloon pump support and 1-year survival.

PubMed

Ramnarine, Ian R; Grayson, Antony D; Dihmis, Walid C; Mediratta, Neeraj K; Fabri, Brian M; Chalmers, John A C

2005-05-01

The relationship between the timing of intra-aortic balloon pump (IABP) support and surgical outcome remains a subject of debate. Peri-operative mechanical circulatory support is commenced either prophylactically or after increasing inotropic support has proved inadequate. This study evaluates the effect timing of IABP support on the 1-year survival of patients undergoing cardiac surgery. From April 1997 to September 2002, 7698 consecutive cardiac surgical procedures were performed. This included 5678 isolated coronary artery bypasses (CABGs), 1245 isolated valve procedures and 775 simultaneous CABG and valve procedures. IABP support was required in 237 patients (3.1%). Twenty-seven patients (0.35%) were classed as high-risk and received preoperative IABP support, 25 patients (0.32%) were haemodynamically compromised and required preoperative IABP support, 120 patients (1.56%) required intra-operative IABP support, and 65 patients (0.84%) required post-operative IABP support. Multiple variables were offered to a Cox proportional hazards model and significant predictors of 1-year survival were identified. These were used to risk adjust Kaplan-Meier survival curves. 1-year follow-up was complete and 450 deaths (5.8%) were recorded. The significant independent predictors of increased mortality at 1-year (P<0.05, HR=hazard ratio) were post-operative renal failure (HR=3.5), increasing EuroSCORE (HR=1.2), post-operative myocardial infarction (HR=3.7), post-operative IABP (HR=4.1) intra-operative IABP (HR=2.8), post-operative stroke (HR=2.5), increasing number of valves (HR=1.6), ejection fraction <30% (HR=1.3) and triple-vessel disease (HR=1.3). After risk-adjustment, 1-year survival for patients who required intra-operative IABP support was significantly greater than for those patients who required IABP support in the post-operative period. Patients who warrant IABP support in the post-operative setting have a significantly increased mortality at 1-year when compared to any other group. Therefore, earlier IABP support as part of surgical strategy may help to improve the outcome.

Reliability, Maintainability, and Availability: Consideration During the Design Phase in Ground Systems to Ensure Successful Launch Support

NASA Technical Reports Server (NTRS)

Gillespie, Amanda M.

2012-01-01

The future of Space Exploration includes missions to the moon, asteroids, Mars, and beyond. To get there, the mission concept is to launch multiple launch vehicles months, even years apart. In order to achieve this, launch vehicles, payloads (satellites and crew capsules), and ground systems must be highly reliable and/or available, to include maintenance concepts and procedures in the event of a launch scrub. In order to achieve this high probability of mission success, Ground Systems Development and Operations (GSDO) has allocated Reliability, Maintainability, and Availability (RMA) requirements to all hardware and software required for both launch operations and, in the event of a launch scrub, required to support a repair of the ground systems, launch vehicle, or payload. This is done concurrently with the design process (30/60/90 reviews).

Mixture-based gatekeeping procedures in adaptive clinical trials.

PubMed

Kordzakhia, George; Dmitrienko, Alex; Ishida, Eiji

2018-01-01

Clinical trials with data-driven decision rules often pursue multiple clinical objectives such as the evaluation of several endpoints or several doses of an experimental treatment. These complex analysis strategies give rise to "multivariate" multiplicity problems with several components or sources of multiplicity. A general framework for defining gatekeeping procedures in clinical trials with adaptive multistage designs is proposed in this paper. The mixture method is applied to build a gatekeeping procedure at each stage and inferences at each decision point (interim or final analysis) are performed using the combination function approach. An advantage of utilizing the mixture method is that it enables powerful gatekeeping procedures applicable to a broad class of settings with complex logical relationships among the hypotheses of interest. Further, the combination function approach supports flexible data-driven decisions such as a decision to increase the sample size or remove a treatment arm. The paper concludes with a clinical trial example that illustrates the methodology by applying it to develop an adaptive two-stage design with a mixture-based gatekeeping procedure.

Reconstructive procedures for segmental resection of bone in giant cell tumors around the knee.

PubMed

Aggarwal, Aditya N; Jain, Anil K; Kumar, Sudhir; Dhammi, Ish K; Prashad, Bhagwat

2007-04-01

Segmental resection of bone in Giant Cell Tumor (GCT) around the knee, in indicated cases, leaves a gap which requires a complex reconstructive procedure. The present study analyzes various reconstructive procedures in terms of morbidity and various complications encountered. Thirteen cases (M-six and F-seven; lower end femur-six and upper end tibia -seven) of GCT around the knee, radiologically either Campanacci Grade II, Grade II with pathological fracture or Grade III were included. Mean age was 25.6 years (range 19-30 years). Resection arthrodesis with telescoping (shortening) over intramedullary nail (n=5), resection arthrodesis with an intercalary allograft threaded over a long intramedullary nail (n=3) and resection arthrodesis with intercalary fibular autograft and simultaneous limb lengthening (n=5) were the procedure performed. Shortening was the major problem following resection arthrodesis with telescoping (shortening) over intramedullary nail. Only two patients agreed for subsequent limb lengthening. The rest continued to walk with shortening. Infection was the major problem in all cases of resection arthrodesis with an intercalary allograft threaded over a long intramedullary nail and required multiple drainage procedures. Fusion was achieved after two years in two patients. In the third patient the allograft sequestrated. The patient underwent sequestrectomy, telescoping of fragments and ilizarov fixator application with subsequent limb lengthening. The patient was finally given an ischial weight relieving orthosis, 54 months after the index procedure. After resection arthrodesis with intercalary autograft and simultaneous lengthening the resultant gap (∼15cm) was partially bridged by intercalary nonvascularized dual fibular strut graft (6-7cm) and additional corticocancellous bone graft from ipsilateral patella. Simultaneous limb lengthening with a distal tibial corticotomy was performed on an ilizarov fixator. The complications were superficial infection (n=5), stress fracture of fibula (n=2). The stress fracture fibula required DCP fixation and bone grafting. The usual time taken for union and limb length equalization was approximately one year. Resection arthrodesis with intercalary dual fibular autograft and cortico-cancellous bone grafting with simultaneous limb lengthening achieved limb length equalization with relatively short morbidity.

The multi-criteria optimization for the formation of the multiple-valued logic model of a robotic agent

NASA Astrophysics Data System (ADS)

Bykovsky, A. Yu; Sherbakov, A. A.

2016-08-01

The C-valued Allen-Givone algebra is the attractive tool for modeling of a robotic agent, but it requires the consensus method of minimization for the simplification of logic expressions. This procedure substitutes some undefined states of the function for the maximal truth value, thus extending the initially given truth table. This further creates the problem of different formal representations for the same initially given function. The multi-criteria optimization is proposed for the deliberate choice of undefined states and model formation.

Program CONTRAST--A general program for the analysis of several survival or recovery rate estimates

USGS Publications Warehouse

Hines, J.E.; Sauer, J.R.

1989-01-01

This manual describes the use of program CONTRAST, which implements a generalized procedure for the comparison of several rate estimates. This method can be used to test both simple and composite hypotheses about rate estimates, and we discuss its application to multiple comparisons of survival rate estimates. Several examples of the use of program CONTRAST are presented. Program CONTRAST will run on IBM-cimpatible computers, and requires estimates of the rates to be tested, along with associated variance and covariance estimates.

Using a modification of the Clavien-Dindo system accounting for readmissions and multiple interventions: defining quality for pancreaticoduodenectomy.

PubMed

Baker, Marshall S; Sherman, Karen L; Stocker, Susan J; Hayman, Amanda V; Bentrem, David J; Prinz, Richard A; Talamonti, Mark S

2014-09-01

The Clavien-Dindo system (CD) does not change the grade assigned a complication when multiple readmissions or interventions are required to manage a complication. We apply a modification of CD accounting for readmissions and interventions to pancreaticoduodenectomy (PD). PDs done between 1999 and 2009 were reviewed. CD grade IIIa complications requiring more than one intervention and II and IIIa complications requiring significantly prolonged lengths of stay including all 90-day readmissions were classified severe-adverse-postoperative-outcomes (SAPO). CD IIIb, IV, and V complications were also classified SAPOs. All other complications were considered minor-adverse-postoperative-outcomes (MAPO). Four-hundred forty three of 490 PD patients (90.4%) had either no complication or a complication of low to moderate CD grade (I, II, IIIa). When reclassified by the new metric, 92 patient-outcomes (19%) were upgraded from CD II or IIIa to SAPO. One-hundred thirty nine patients (28.4%) had a SAPO. Multivariable regression identified age >75 years, pylorus preservation and operative blood loss >1,500 ml as predictors of SAPO. Age was not associated with poor outcome using the unmodified CD system. Established systems may under-grade the severity of some complications following PD. We define a procedure-specific modification of CD accounting for readmissions and multiple interventions. Using this modification, advanced age, pylorus preservation, and significant blood loss are associated with poor outcome. © 2014 Wiley Periodicals, Inc.

Allocation and management issues in multiple-transaction open access transmission networks

NASA Astrophysics Data System (ADS)

Tao, Shu

This thesis focuses on some key issues related to allocation and management by the independent grid operator (IGO) of unbundled services in multiple-transaction open access transmission networks. The three unbundled services addressed in the thesis are transmission real power losses, reactive power support requirements from generation sources, and transmission congestion management. We develop the general framework that explicitly represents multiple transactions undertaken simultaneously in the transmission grid. This framework serves as the basis for formulating various problems treated in the thesis. We use this comprehensive framework to develop a physical-flow-based mechanism to allocate the total transmission losses to each transaction using the system. An important property of the allocation scheme is its capability to effectively deal with counter flows that result in the presence of specific transactions. Using the loss allocation results as the basis, we construct the equivalent loss compensation concept and apply it to develop flexible and effective procedures for compensating losses in multiple-transaction networks. We present a new physical-flow-based mechanism for allocating the reactive power support requirements provided by generators in multiple-transaction networks. The allocatable reactive support requirements are formulated as the sum of two specific components---the voltage magnitude variation component and the voltage angle variation component. The formulation utilizes the multiple-transaction framework and makes use of certain simplifying approximations. The formulation leads to a natural allocation as a function of the amount of each transaction. The physical interpretation of each allocation as a sensitivity of the reactive output of a generator is discussed. We propose a congestion management allocation scheme for multiple-transaction networks. The proposed scheme determines the allocation of congestion among the transactions on a physical-flow basis. It also proposes a congestion relief scheme that removes the congestion attributed to each transaction on the network in a least-cost manner to the IGO and determines the appropriate transmission charges to each transaction for its transmission usage. The thesis provides a compendium of problems that are natural extensions of the research results reported here and appear to be good candidates for future work.

Radiofrequency Ablation Using a Multiple-Electrode Switching System for Lung Tumors with 2.0-5.0-cm Maximum Diameter: Phase II Clinical Study.

PubMed

Kodama, Hiroshi; Yamakado, Koichiro; Hasegawa, Takaaki; Fujimori, Masashi; Yamanaka, Takashi; Takaki, Haruyuki; Uraki, Junji; Nakatsuka, Atsuhiro; Sakuma, Hajime

2015-12-01

To prospectively evaluate the safety and effectiveness of radiofrequency ablation (RFA) by using a multiple-electrode switching system to treat 2.0-5.0-cm lung tumors. The institutional review board approved this prospective phase II study. Written informed consent was obtained from all patients. Between September 2009 and July 2011, RFA using two or three radiofrequency (RF) electrodes and a multiple-electrode switching system was performed for malignant lung tumors with a maximum tumor diameter of 2.0-5.0 cm in nonsurgical candidates. The primary endpoint was safety, as evaluated using the Common Terminology Criteria for Adverse Events. Patients were observed for at least 1 year. Local tumor progression and overall survival were analyzed with the Kaplan-Meier method. Thirty-three patients (26 men, seven women; mean age, 70.5 years ± 10.0; age range, 46-87 years) with 35 lung tumors with a mean maximum diameter of 3.0 cm ± 0.7 (standard deviation; range, 2.0-4.4 cm) underwent treatment in 35 sessions. No procedure-related death or grade 4 adverse events (AEs) occurred. Grade 3 AEs occurred in four patients (12%), with pleural effusion requiring chest tube placement in two patients, pneumothorax requiring pleural adhesion in one patient, and pulmonary hemorrhage requiring pulmonary artery coil embolization in one patient. Grade 2 AEs were detected in 13 patients (39%). The 1-year local tumor progression and overall survival rates were 12.7% (95% confidence interval [CI]: 1.0, 25.5) and 81.2% (95% CI: 67.6, 94.8). RFA with a multiple-electrode switching system may be a safe therapeutic option with which to treat 2.0-5.0-cm lung cancer tumors.

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.

Complimentary use of epicardial echo imaging and Doppler in quantification of coronary artery stenoses

NASA Astrophysics Data System (ADS)

Richards, Kent L.; Cannon, Scott R.

1990-08-01

As more advanced therapeutic procedures are performed on coronary arteries during open chest surgery more advanced diagnostic procedures will be required to define the location and severity of coronary artery disease. This manuscript describes our preliminary experiences in identifying human coronary artery stenoses using epicardial two-dimensional color flow Doppler. Once the lesions were identified we used standard echo Doppler and imaging techniques to define their severity. The accuracy of stenotic cross sectional area calculated using the continuity equation and pressure gradient calculated using the Bernoulli equation were defined using a pulsatile flow model of the coronary circulation. Suggestions about further hardware development required to allow easy clinical application of this technique are described. 1 - CLINICAL NEED FOR INTRA-OPERATIVE EVAUJATION OFCORONARY ARTERIES The severity of coronary artery disease in adults who require coronary bypass surgery has changed significantly in the last ten years. More effective medications used to control angina pectoris and the wide use of percutaneous y artery angioplasty have delayed the timing of surgery until atherosclerotic involvement is more extensive. In addition patients who have had initial coronary bypass operations are now reaching ages at which atherosclerotic involvement of their bypass grafts and native vessels has progressed and reoperation is required. To meet the challenge of coronary arteries with multiple lesions or diffuse disease intraoperative angioplasty devices are being developed. Whether bypass surgery for advanced lesions or reoperation of

Outlook with conservative treatment of peptic oesophageal stricture.

PubMed Central

Ogilvie, A L; Ferguson, R; Atkinson, M

1980-01-01

In order to assess the outlook for patients with peptic oesophageal strictures treated by Eder Puestow dilatation at fibreoptic endoscopy, 50 patients were followed up for periods ranging from nine months to four years. Twenty patients (40%) required only a single dilatation, and the remaining 30 (60%) required multiple dilatations. The frequency of dilatation tended to decrease with time. There was one death attributable to the procedure. Two patients developed an adenocarcinoma at the site of the stricture. We conclude that conservative management of peptic oesophageal stricture combining the use of dilatation at fibreoptic endoscopy with medical measures to control gastro-oesophageal reflux offers a relatively safe means of providing symptomatic relief, maintaining nutrition, and allowing the patient an acceptable quality of life. PMID:7364314

Digital sun sensor multi-spot operation.

PubMed

Rufino, Giancarlo; Grassi, Michele

2012-11-28

The operation and test of a multi-spot digital sun sensor for precise sun-line determination is described. The image forming system consists of an opaque mask with multiple pinhole apertures producing multiple, simultaneous, spot-like images of the sun on the focal plane. The sun-line precision can be improved by averaging multiple simultaneous measures. Nevertheless, the sensor operation on a wide field of view requires acquiring and processing images in which the number of sun spots and the related intensity level are largely variable. To this end, a reliable and robust image acquisition procedure based on a variable shutter time has been considered as well as a calibration function exploiting also the knowledge of the sun-spot array size. Main focus of the present paper is the experimental validation of the wide field of view operation of the sensor by using a sensor prototype and a laboratory test facility. Results demonstrate that it is possible to keep high measurement precision also for large off-boresight angles.

Turbomachinery Airfoil Design Optimization Using Differential Evolution

NASA Technical Reports Server (NTRS)

Madavan, Nateri K.; Biegel, Bryan A. (Technical Monitor)

2002-01-01

An aerodynamic design optimization procedure that is based on a evolutionary algorithm known at Differential Evolution is described. Differential Evolution is a simple, fast, and robust evolutionary strategy that has been proven effective in determining the global optimum for several difficult optimization problems, including highly nonlinear systems with discontinuities and multiple local optima. The method is combined with a Navier-Stokes solver that evaluates the various intermediate designs and provides inputs to the optimization procedure. An efficient constraint handling mechanism is also incorporated. Results are presented for the inverse design of a turbine airfoil from a modern jet engine. The capability of the method to search large design spaces and obtain the optimal airfoils in an automatic fashion is demonstrated. Substantial reductions in the overall computing time requirements are achieved by using the algorithm in conjunction with neural networks.

Operating room integration and telehealth.

PubMed

Bucholz, Richard D; Laycock, Keith A; McDurmont, Leslie

2011-01-01

The increasing use of advanced automated and computer-controlled systems and devices in surgical procedures has resulted in problems arising from the crowding of the operating room with equipment and the incompatible control and communication standards associated with each system. This lack of compatibility between systems and centralized control means that the surgeon is frequently required to interact with multiple computer interfaces in order to obtain updates and exert control over the various devices at his disposal. To reduce this complexity and provide the surgeon with more complete and precise control of the operating room systems, a unified interface and communication network has been developed. In addition to improving efficiency, this network also allows the surgeon to grant remote access to consultants and observers at other institutions, enabling experts to participate in the procedure without having to travel to the site.

Cross-informant and cross-national equivalence using item-response theory (IRT) linking: A case study using the behavioral assessment for children of African heritage in the United States and Jamaica.

PubMed

Lambert, Michael Canute; Ferguson, Gail M; Rowan, George T

2016-03-01

Cross-national study of adolescents' psychological adjustment requires measures that permit reliable and valid assessment across informants and nations, but such measures are virtually nonexistent. Item-response-theory-based linking is a promising yet underutilized methodological procedure that permits more accurate assessment across informants and nations. To demonstrate this procedure, the Resilience Scale of the Behavioral Assessment for Children of African Heritage (Lambert et al., 2005) was administered to 250 African American and 294 Jamaican nonreferred adolescents and their caregivers. Multiple items without significant differential item functioning emerged, allowing scale linking across informants and nations. Calibrating item parameters via item response theory linking can permit cross-informant cross-national assessment of youth. (c) 2016 APA, all rights reserved).

Lawn-mower injuries in children.

PubMed

Love, S M; Grogan, D P; Ogden, J A

1988-01-01

The power lawn mower is capable of inflicting serious injury, particularly to the pediatric population. A total of 27 patients who had sustained lawn-mower injuries were reviewed to identify those factors responsible for power-mower accidents and to determine an effective treatment regimen for these patients. The injuries included amputations in 19, major lacerations in 34, and fractures in 23 extremities. Aggressive treatment of both the soft tissue and bony injuries was necessary. Fractures were treated with either open reduction and internal fixation or external fixation, as appropriate, and early soft tissue coverage. The results were satisfactory in the majority of patients, but often required multiple surgical procedures over a number of years. The incidence of these injuries can be reduced by educating the public about the potential dangers of these machines, and by encouraging the use of proper safety procedures.

Using the Multiple Choice Procedure to Measure College Student Gambling

ERIC Educational Resources Information Center

Butler, Leon Harvey

2010-01-01

Research suggests that gambling is similar to addictive behaviors such as substance use. In the current study, gambling was investigated from a behavioral economics perspective. The Multiple Choice Procedure (MCP) with gambling as the target behavior was used to assess for relative reinforcing value, the effect of alternative reinforcers, and…

A New Zero-Inflated Negative Binomial Methodology for Latent Category Identification

ERIC Educational Resources Information Center

Blanchard, Simon J.; DeSarbo, Wayne S.

2013-01-01

We introduce a new statistical procedure for the identification of unobserved categories that vary between individuals and in which objects may span multiple categories. This procedure can be used to analyze data from a proposed sorting task in which individuals may simultaneously assign objects to multiple piles. The results of a synthetic…

Effects of Estimation Bias on Multiple-Category Classification with an IRT-Based Adaptive Classification Procedure

ERIC Educational Resources Information Center

Yang, Xiangdong; Poggio, John C.; Glasnapp, Douglas R.

2006-01-01

The effects of five ability estimators, that is, maximum likelihood estimator, weighted likelihood estimator, maximum a posteriori, expected a posteriori, and Owen's sequential estimator, on the performances of the item response theory-based adaptive classification procedure on multiple categories were studied via simulations. The following…

An Optimal Bahadur-Efficient Method in Detection of Sparse Signals with Applications to Pathway Analysis in Sequencing Association Studies.

PubMed

Dai, Hongying; Wu, Guodong; Wu, Michael; Zhi, Degui

2016-01-01

Next-generation sequencing data pose a severe curse of dimensionality, complicating traditional "single marker-single trait" analysis. We propose a two-stage combined p-value method for pathway analysis. The first stage is at the gene level, where we integrate effects within a gene using the Sequence Kernel Association Test (SKAT). The second stage is at the pathway level, where we perform a correlated Lancaster procedure to detect joint effects from multiple genes within a pathway. We show that the Lancaster procedure is optimal in Bahadur efficiency among all combined p-value methods. The Bahadur efficiency,[Formula: see text], compares sample sizes among different statistical tests when signals become sparse in sequencing data, i.e. ε →0. The optimal Bahadur efficiency ensures that the Lancaster procedure asymptotically requires a minimal sample size to detect sparse signals ([Formula: see text]). The Lancaster procedure can also be applied to meta-analysis. Extensive empirical assessments of exome sequencing data show that the proposed method outperforms Gene Set Enrichment Analysis (GSEA). We applied the competitive Lancaster procedure to meta-analysis data generated by the Global Lipids Genetics Consortium to identify pathways significantly associated with high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, triglycerides, and total cholesterol.

Experimental Assessment and Enhancement of Planar Laser-Induced Fluorescence Measurements of Nitric Oxide in an Inverse Diffusion Flame

NASA Technical Reports Server (NTRS)

Partridge, William P.; Laurendeau, Normand M.

1997-01-01

We have experimentally assessed the quantitative nature of planar laser-induced fluorescence (PLIF) measurements of NO concentration in a unique atmospheric pressure, laminar, axial inverse diffusion flame (IDF). The PLIF measurements were assessed relative to a two-dimensional array of separate laser saturated fluorescence (LSF) measurements. We demonstrated and evaluated several experimentally-based procedures for enhancing the quantitative nature of PLIF concentration images. Because these experimentally-based PLIF correction schemes require only the ability to make PLIF and LSF measurements, they produce a more broadly applicable PLIF diagnostic compared to numerically-based correction schemes. We experimentally assessed the influence of interferences on both narrow-band and broad-band fluorescence measurements at atmospheric and high pressures. Optimum excitation and detection schemes were determined for the LSF and PLIF measurements. Single-input and multiple-input, experimentally-based PLIF enhancement procedures were developed for application in test environments with both negligible and significant quench-dependent error gradients. Each experimentally-based procedure provides an enhancement of approximately 50% in the quantitative nature of the PLIF measurements, and results in concentration images nominally as quantitative as LSF point measurements. These correction procedures can be applied to other species, including radicals, for which no experimental data are available from which to implement numerically-based PLIF enhancement procedures.

3D Printed Abdominal Aortic Aneurysm Phantom for Image Guided Surgical Planning with a Patient Specific Fenestrated Endovascular Graft System

PubMed Central

Meess, Karen M.; Izzo, Richard L.; Dryjski, Maciej L.; Curl, Richard E.; Harris, Linda M.; Springer, Michael; Siddiqui, Adnan H.; Rudin, Stephen; Ionita, Ciprian N.

2017-01-01

Following new trends in precision medicine, Juxatarenal Abdominal Aortic Aneurysm (JAAA) treatment has been enabled by using patient-specific fenestrated endovascular grafts. The X-ray guided procedure requires precise orientation of multiple modular endografts within the arteries confirmed via radiopaque markers. Patient-specific 3D printed phantoms could familiarize physicians with complex procedures and new devices in a risk-free simulation environment to avoid periprocedural complications and improve training. Using the Vascular Modeling Toolkit (VMTK), 3D Data from a CTA imaging of a patient scheduled for Fenestrated EndoVascular Aortic Repair (FEVAR) was segmented to isolate the aortic lumen, thrombus, and calcifications. A stereolithographic mesh (STL) was generated and then modified in Autodesk MeshMixer for fabrication via a Stratasys Eden 260 printer in a flexible photopolymer to simulate arterial compliance. Fluoroscopic guided simulation of the patient-specific FEVAR procedure was performed by interventionists using all demonstration endografts and accessory devices. Analysis compared treatment strategy between the planned procedure, the simulation procedure, and the patient procedure using a derived scoring scheme. Results With training on the patient-specific 3D printed AAA phantom, the clinical team optimized their procedural strategy. Anatomical landmarks and all devices were visible under x-ray during the simulation mimicking the clinical environment. The actual patient procedure went without complications. Conclusions With advances in 3D printing, fabrication of patient specific AAA phantoms is possible. Simulation with 3D printed phantoms shows potential to inform clinical interventional procedures in addition to CTA diagnostic imaging. PMID:28638171

3D Printed Abdominal Aortic Aneurysm Phantom for Image Guided Surgical Planning with a Patient Specific Fenestrated Endovascular Graft System.

PubMed

Meess, Karen M; Izzo, Richard L; Dryjski, Maciej L; Curl, Richard E; Harris, Linda M; Springer, Michael; Siddiqui, Adnan H; Rudin, Stephen; Ionita, Ciprian N

2017-02-11

Following new trends in precision medicine, Juxatarenal Abdominal Aortic Aneurysm (JAAA) treatment has been enabled by using patient-specific fenestrated endovascular grafts. The X-ray guided procedure requires precise orientation of multiple modular endografts within the arteries confirmed via radiopaque markers. Patient-specific 3D printed phantoms could familiarize physicians with complex procedures and new devices in a risk-free simulation environment to avoid periprocedural complications and improve training. Using the Vascular Modeling Toolkit (VMTK), 3D Data from a CTA imaging of a patient scheduled for Fenestrated EndoVascular Aortic Repair (FEVAR) was segmented to isolate the aortic lumen, thrombus, and calcifications. A stereolithographic mesh (STL) was generated and then modified in Autodesk MeshMixer for fabrication via a Stratasys Eden 260 printer in a flexible photopolymer to simulate arterial compliance. Fluoroscopic guided simulation of the patient-specific FEVAR procedure was performed by interventionists using all demonstration endografts and accessory devices. Analysis compared treatment strategy between the planned procedure, the simulation procedure, and the patient procedure using a derived scoring scheme. With training on the patient-specific 3D printed AAA phantom, the clinical team optimized their procedural strategy. Anatomical landmarks and all devices were visible under x-ray during the simulation mimicking the clinical environment. The actual patient procedure went without complications. With advances in 3D printing, fabrication of patient specific AAA phantoms is possible. Simulation with 3D printed phantoms shows potential to inform clinical interventional procedures in addition to CTA diagnostic imaging.

Amniotic Constriction Bands: Secondary Deformities and Their Treatments.

PubMed

Drury, Benjamin T; Rayan, Ghazi M

2018-01-01

The purpose of this study was to report the surgical treatment experience of patients with amniotic constriction bands (ACB) over a 35-year interval and detail consequential limb deformities with emphasis on hands and upper extremities, along with the nature and frequency of their surgical treatment methods. Fifty-one patients were identified; 26 were males and 25 females. The total number of deformities was listed. The total number of operations, individual procedures, and operations plus procedures that were done for each patient and their frequency were recorded. The total number of operations was 117, and total number of procedures was 341. More procedures were performed on the upper extremity (85%) than the lower extremity (15%). Including the primary deformity ACB, 16 different hand deformities secondary to ACB were encountered. Sixteen different surgical methods for the upper extremity were utilized; a primary procedure for ACB and secondary reconstructions for all secondary deformities. Average age at the time of the first procedure was 9.3 months. The most common procedures performed, in order of frequency, were excision of ACB plus Z-plasty, release of partial syndactyly, release of fenestrated syndactyly, full-thickness skin grafts, resection of digital bony overgrowth from amputation stumps, and deepening of first and other digital web spaces. Many hand and upper extremity deformities secondary to ACB are encountered. Children with ACB may require more than one operation including multiple procedures. Numerous surgical methods of reconstruction for these children's secondary deformities are necessary in addition to the customary primary procedure of excision of ACB and Z-plasty.

3D printed abdominal aortic aneurysm phantom for image guided surgical planning with a patient specific fenestrated endovascular graft system

NASA Astrophysics Data System (ADS)

Meess, Karen M.; Izzo, Richard L.; Dryjski, Maciej L.; Curl, Richard E.; Harris, Linda M.; Springer, Michael; Siddiqui, Adnan H.; Rudin, Stephen; Ionita, Ciprian N.

2017-03-01

Following new trends in precision medicine, Juxatarenal Abdominal Aortic Aneurysm (JAAA) treatment has been enabled by using patient-specific fenestrated endovascular grafts. The X-ray guided procedure requires precise orientation of multiple modular endografts within the arteries confirmed via radiopaque markers. Patient-specific 3D printed phantoms could familiarize physicians with complex procedures and new devices in a risk-free simulation environment to avoid periprocedural complications and improve training. Using the Vascular Modeling Toolkit (VMTK), 3D Data from a CTA imaging of a patient scheduled for Fenestrated EndoVascular Aortic Repair (FEVAR) was segmented to isolate the aortic lumen, thrombus, and calcifications. A stereolithographic mesh (STL) was generated and then modified in Autodesk MeshMixer for fabrication via a Stratasys Eden 260 printer in a flexible photopolymer to simulate arterial compliance. Fluoroscopic guided simulation of the patient-specific FEVAR procedure was performed by interventionists using all demonstration endografts and accessory devices. Analysis compared treatment strategy between the planned procedure, the simulation procedure, and the patient procedure using a derived scoring scheme. Results: With training on the patient-specific 3D printed AAA phantom, the clinical team optimized their procedural strategy. Anatomical landmarks and all devices were visible under x-ray during the simulation mimicking the clinical environment. The actual patient procedure went without complications. Conclusions: With advances in 3D printing, fabrication of patient specific AAA phantoms is possible. Simulation with 3D printed phantoms shows potential to inform clinical interventional procedures in addition to CTA diagnostic imaging.

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

Impacts of Intelligent Automated Quality Control on a Small Animal APD-Based Digital PET Scanner

NASA Astrophysics Data System (ADS)

Charest, Jonathan; Beaudoin, Jean-François; Bergeron, Mélanie; Cadorette, Jules; Arpin, Louis; Lecomte, Roger; Brunet, Charles-Antoine; Fontaine, Réjean

2016-10-01

Stable system performance is mandatory to warrant the accuracy and reliability of biological results relying on small animal positron emission tomography (PET) imaging studies. This simple requirement sets the ground for imposing routine quality control (QC) procedures to keep PET scanners at a reliable optimal performance level. However, such procedures can become burdensome to implement for scanner operators, especially taking into account the increasing number of data acquisition channels in newer generation PET scanners. In systems using pixel detectors to achieve enhanced spatial resolution and contrast-to-noise ratio (CNR), the QC workload rapidly increases to unmanageable levels due to the number of independent channels involved. An artificial intelligence based QC system, referred to as Scanner Intelligent Diagnosis for Optimal Performance (SIDOP), was proposed to help reducing the QC workload by performing automatic channel fault detection and diagnosis. SIDOP consists of four high-level modules that employ machine learning methods to perform their tasks: Parameter Extraction, Channel Fault Detection, Fault Prioritization, and Fault Diagnosis. Ultimately, SIDOP submits a prioritized faulty channel list to the operator and proposes actions to correct them. To validate that SIDOP can perform QC procedures adequately, it was deployed on a LabPET™ scanner and multiple performance metrics were extracted. After multiple corrections on sub-optimal scanner settings, a 8.5% (with a 95% confidence interval (CI) of [7.6, 9.3]) improvement in the CNR, a 17.0% (CI: [15.3, 18.7]) decrease of the uniformity percentage standard deviation, and a 6.8% gain in global sensitivity were observed. These results confirm that SIDOP can indeed be of assistance in performing QC procedures and restore performance to optimal figures.

Multiple-Objective Stepwise Calibration Using Luca

USGS Publications Warehouse

Hay, Lauren E.; Umemoto, Makiko

2007-01-01

This report documents Luca (Let us calibrate), a multiple-objective, stepwise, automated procedure for hydrologic model calibration and the associated graphical user interface (GUI). Luca is a wizard-style user-friendly GUI that provides an easy systematic way of building and executing a calibration procedure. The calibration procedure uses the Shuffled Complex Evolution global search algorithm to calibrate any model compiled with the U.S. Geological Survey's Modular Modeling System. This process assures that intermediate and final states of the model are simulated consistently with measured values.

Single- and Multiple-Objective Optimization with Differential Evolution and Neural Networks

NASA Technical Reports Server (NTRS)

Rai, Man Mohan

2006-01-01

Genetic and evolutionary algorithms have been applied to solve numerous problems in engineering design where they have been used primarily as optimization procedures. These methods have an advantage over conventional gradient-based search procedures became they are capable of finding global optima of multi-modal functions and searching design spaces with disjoint feasible regions. They are also robust in the presence of noisy data. Another desirable feature of these methods is that they can efficiently use distributed and parallel computing resources since multiple function evaluations (flow simulations in aerodynamics design) can be performed simultaneously and independently on ultiple processors. For these reasons genetic and evolutionary algorithms are being used more frequently in design optimization. Examples include airfoil and wing design and compressor and turbine airfoil design. They are also finding increasing use in multiple-objective and multidisciplinary optimization. This lecture will focus on an evolutionary method that is a relatively new member to the general class of evolutionary methods called differential evolution (DE). This method is easy to use and program and it requires relatively few user-specified constants. These constants are easily determined for a wide class of problems. Fine-tuning the constants will off course yield the solution to the optimization problem at hand more rapidly. DE can be efficiently implemented on parallel computers and can be used for continuous, discrete and mixed discrete/continuous optimization problems. It does not require the objective function to be continuous and is noise tolerant. DE and applications to single and multiple-objective optimization will be included in the presentation and lecture notes. A method for aerodynamic design optimization that is based on neural networks will also be included as a part of this lecture. The method offers advantages over traditional optimization methods. It is more flexible than other methods in dealing with design in the context of both steady and unsteady flows, partial and complete data sets, combined experimental and numerical data, inclusion of various constraints and rules of thumb, and other issues that characterize the aerodynamic design process. Neural networks provide a natural framework within which a succession of numerical solutions of increasing fidelity, incorporating more realistic flow physics, can be represented and utilized for optimization. Neural networks also offer an excellent framework for multiple-objective and multi-disciplinary design optimization. Simulation tools from various disciplines can be integrated within this framework and rapid trade-off studies involving one or many disciplines can be performed. The prospect of combining neural network based optimization methods and evolutionary algorithms to obtain a hybrid method with the best properties of both methods will be included in this presentation. Achieving solution diversity and accurate convergence to the exact Pareto front in multiple objective optimization usually requires a significant computational effort with evolutionary algorithms. In this lecture we will also explore the possibility of using neural networks to obtain estimates of the Pareto optimal front using non-dominated solutions generated by DE as training data. Neural network estimators have the potential advantage of reducing the number of function evaluations required to obtain solution accuracy and diversity, thus reducing cost to design.

A neurocomputational theory of how explicit learning bootstraps early procedural learning.

PubMed

Paul, Erick J; Ashby, F Gregory

2013-01-01

It is widely accepted that human learning and memory is mediated by multiple memory systems that are each best suited to different requirements and demands. Within the domain of categorization, at least two systems are thought to facilitate learning: an explicit (declarative) system depending largely on the prefrontal cortex, and a procedural (non-declarative) system depending on the basal ganglia. Substantial evidence suggests that each system is optimally suited to learn particular categorization tasks. However, it remains unknown precisely how these systems interact to produce optimal learning and behavior. In order to investigate this issue, the present research evaluated the progression of learning through simulation of categorization tasks using COVIS, a well-known model of human category learning that includes both explicit and procedural learning systems. Specifically, the model's parameter space was thoroughly explored in procedurally learned categorization tasks across a variety of conditions and architectures to identify plausible interaction architectures. The simulation results support the hypothesis that one-way interaction between the systems occurs such that the explicit system "bootstraps" learning early on in the procedural system. Thus, the procedural system initially learns a suboptimal strategy employed by the explicit system and later refines its strategy. This bootstrapping could be from cortical-striatal projections that originate in premotor or motor regions of cortex, or possibly by the explicit system's control of motor responses through basal ganglia-mediated loops.

Multiagent Work Practice Simulation: Progress and Challenges

NASA Technical Reports Server (NTRS)

Clancey, William J.; Sierhuis, Maarten; Shaffe, Michael G. (Technical Monitor)

2001-01-01

Modeling and simulating complex human-system interactions requires going beyond formal procedures and information flows to analyze how people interact with each other. Such work practices include conversations, modes of communication, informal assistance, impromptu meetings, workarounds, and so on. To make these social processes visible, we have developed a multiagent simulation tool, called Brahms, for modeling the activities of people belonging to multiple groups, situated in a physical environment (geographic regions, buildings, transport vehicles, etc.) consisting of tools, documents, and a computer system. We are finding many useful applications of Brahms for system requirements analysis, instruction, implementing software agents, and as a workbench for relating cognitive and social theories of human behavior. Many challenges remain for representing work practices, including modeling: memory over multiple days, scheduled activities combining physical objects, groups, and locations on a timeline (such as a Space Shuttle mission), habitat vehicles with trajectories (such as the Shuttle), agent movement in 3D space (e.g., inside the International Space Station), agent posture and line of sight, coupled movements (such as carrying objects), and learning (mimicry, forming habits, detecting repetition, etc.).

Multiagent Work Practice Simulation: Progress and Challenges

NASA Technical Reports Server (NTRS)

Clancey, William J.; Sierhuis, Maarten

2002-01-01

Modeling and simulating complex human-system interactions requires going beyond formal procedures and information flows to analyze how people interact with each other. Such work practices include conversations, modes of communication, informal assistance, impromptu meetings, workarounds, and so on. To make these social processes visible, we have developed a multiagent simulation tool, called Brahms, for modeling the activities of people belonging to multiple groups, situated in a physical environment (geographic regions, buildings, transport vehicles, etc.) consisting of tools, documents, and computer systems. We are finding many useful applications of Brahms for system requirements analysis, instruction, implementing software agents, and as a workbench for relating cognitive and social theories of human behavior. Many challenges remain for representing work practices, including modeling: memory over multiple days, scheduled activities combining physical objects, groups, and locations on a timeline (such as a Space Shuttle mission), habitat vehicles with trajectories (such as the Shuttle), agent movement in 3d space (e.g., inside the International Space Station), agent posture and line of sight, coupled movements (such as carrying objects), and learning (mimicry, forming habits, detecting repetition, etc.).

A procedure of multiple period searching in unequally spaced time-series with the Lomb-Scargle method

NASA Technical Reports Server (NTRS)

Van Dongen, H. P.; Olofsen, E.; VanHartevelt, J. H.; Kruyt, E. W.; Dinges, D. F. (Principal Investigator)

1999-01-01

Periodogram analysis of unequally spaced time-series, as part of many biological rhythm investigations, is complicated. The mathematical framework is scattered over the literature, and the interpretation of results is often debatable. In this paper, we show that the Lomb-Scargle method is the appropriate tool for periodogram analysis of unequally spaced data. A unique procedure of multiple period searching is derived, facilitating the assessment of the various rhythms that may be present in a time-series. All relevant mathematical and statistical aspects are considered in detail, and much attention is given to the correct interpretation of results. The use of the procedure is illustrated by examples, and problems that may be encountered are discussed. It is argued that, when following the procedure of multiple period searching, we can even benefit from the unequal spacing of a time-series in biological rhythm research.

Cost-effective treatment for the couple with infertility.

PubMed

Van Voorhis, B J; Syrop, C H

2000-12-01

Although the evaluation of cost-effective approaches to infertility treatment remains in its infancy, several important principles have emerged from the initial studies in this field. Currently, in treating couples with infertility without tubal disease or severe male-factor infertility, the most cost-effective approach is to start with IUI or superovulation-IUI treatments before resorting to IVF procedures. The woman's age and number of sperm present for insemination are significant factors influencing cost-effectiveness. The influence of certain diagnoses on the cost-effectiveness of infertility treatments requires further study. Even when accounting for the costs associated with multiple gestations and premature deliveries, the cost of IVF decreases within the range of other cost-effective medical procedures and decreases to less than the willingness to pay for these procedures. Indeed, for patients with severe tubal disease, IVF has been found to be more cost-effective than surgical repair. The cost-effectiveness of IVF will likely improve as success rates show continued improvements over the course of time. In addition, usefulness of embryo selection and practices to reduce the likelihood of high-order multiple pregnancies, without reductions in pregnancy rates, will significantly impact cost-effectiveness. The exclusion of infertility treatments from insurance plans is unfortunate and accentuates the importance of physicians understanding the economics of infertility treatment with costs that are often passed directly to the patient. The erroneous economic policies and judgments that have led to inequities in access to infertility health care should not be tolerated.

Statistical Power in Evaluations That Investigate Effects on Multiple Outcomes: A Guide for Researchers

ERIC Educational Resources Information Center

Porter, Kristin E.

2018-01-01

Researchers are often interested in testing the effectiveness of an intervention on multiple outcomes, for multiple subgroups, at multiple points in time, or across multiple treatment groups. The resulting multiplicity of statistical hypothesis tests can lead to spurious findings of effects. Multiple testing procedures (MTPs) are statistical…

Localization of small arms fire using acoustic measurements of muzzle blast and/or ballistic shock wave arrivals.

PubMed

Lo, Kam W; Ferguson, Brian G

2012-11-01

The accurate localization of small arms fire using fixed acoustic sensors is considered. First, the conventional wavefront-curvature passive ranging method, which requires only differential time-of-arrival (DTOA) measurements of the muzzle blast wave to estimate the source position, is modified to account for sensor positions that are not strictly collinear (bowed array). Second, an existing single-sensor-node ballistic model-based localization method, which requires both DTOA and differential angle-of-arrival (DAOA) measurements of the muzzle blast wave and ballistic shock wave, is improved by replacing the basic external ballistics model (which describes the bullet's deceleration along its trajectory) with a more rigorous model and replacing the look-up table ranging procedure with a nonlinear (or polynomial) equation-based ranging procedure. Third, a new multiple-sensor-node ballistic model-based localization method, which requires only DTOA measurements of the ballistic shock wave to localize the point of fire, is formulated. The first method is applicable to situations when only the muzzle blast wave is received, whereas the third method applies when only the ballistic shock wave is received. The effectiveness of each of these methods is verified using an extensive set of real data recorded during a 7 day field experiment.

Defining quality for distal pancreatectomy: does the laparoscopic approach protect patients from poor quality outcomes?

PubMed

Baker, Marshall S; Sherman, Karen L; Stocker, Susan; Hayman, Amanda V; Bentrem, David J; Prinz, Richard A; Talamonti, Mark S

2013-02-01

Established systems for grading postoperative complications do not change the assigned grade when multiple interventions or readmissions are required to manage a complication. Studies using these systems may misrepresent outcomes for the surgical procedures being evaluated. We define a quality outcome for distal pancreatectomy (DP) and use this metric to compare laparoscopic distal pancreatectomy (LDP) to open distal pancreatectomy (ODP). Records for patients undergoing DP between January 2006 and December 2009 were reviewed. Clavien-Dindo grade IIIb, IV, and V complications were classified as severe adverse--poor quality--postoperative outcomes (SAPOs). II and IIIa complications requiring either significantly prolonged overall lengths of stay including readmissions within 90 days or more than one invasive intervention were also classified as SAPOs. By Clavien-Dindo system alone, 91 % of DP patients had either no complication or a low/moderate grade (I, II, IIIa) complication. Using our reclassification, however, 25 % had a SAPO. Patients undergoing LDP demonstrated a Clavien-Dindo complication profile identical to that for SDP but demonstrated significantly shorter overall lengths of stay, were less likely to require perioperative transfusion, and less likely to have a SAPO. Established systems undergrade the severity of some complications following DP. Using a procedure-specific metric for quality, we demonstrate that LDP affords a higher quality postoperative outcome than ODP.

Nonparametric relevance-shifted multiple testing procedures for the analysis of high-dimensional multivariate data with small sample sizes.

PubMed

Frömke, Cornelia; Hothorn, Ludwig A; Kropf, Siegfried

2008-01-27

In many research areas it is necessary to find differences between treatment groups with several variables. For example, studies of microarray data seek to find a significant difference in location parameters from zero or one for ratios thereof for each variable. However, in some studies a significant deviation of the difference in locations from zero (or 1 in terms of the ratio) is biologically meaningless. A relevant difference or ratio is sought in such cases. This article addresses the use of relevance-shifted tests on ratios for a multivariate parallel two-sample group design. Two empirical procedures are proposed which embed the relevance-shifted test on ratios. As both procedures test a hypothesis for each variable, the resulting multiple testing problem has to be considered. Hence, the procedures include a multiplicity correction. Both procedures are extensions of available procedures for point null hypotheses achieving exact control of the familywise error rate. Whereas the shift of the null hypothesis alone would give straight-forward solutions, the problems that are the reason for the empirical considerations discussed here arise by the fact that the shift is considered in both directions and the whole parameter space in between these two limits has to be accepted as null hypothesis. The first algorithm to be discussed uses a permutation algorithm, and is appropriate for designs with a moderately large number of observations. However, many experiments have limited sample sizes. Then the second procedure might be more appropriate, where multiplicity is corrected according to a concept of data-driven order of hypotheses.

Multiple window spatial registration error of a gamma camera: 133Ba point source as a replacement of the NEMA procedure.

PubMed

Bergmann, Helmar; Minear, Gregory; Raith, Maria; Schaffarich, Peter M

2008-12-09

The accuracy of multiple window spatial resolution characterises the performance of a gamma camera for dual isotope imaging. In the present study we investigate an alternative method to the standard NEMA procedure for measuring this performance parameter. A long-lived 133Ba point source with gamma energies close to 67Ga and a single bore lead collimator were used to measure the multiple window spatial registration error. Calculation of the positions of the point source in the images used the NEMA algorithm. The results were validated against the values obtained by the standard NEMA procedure which uses a liquid 67Ga source with collimation. Of the source-collimator configurations under investigation an optimum collimator geometry, consisting of a 5 mm thick lead disk with a diameter of 46 mm and a 5 mm central bore, was selected. The multiple window spatial registration errors obtained by the 133Ba method showed excellent reproducibility (standard deviation < 0.07 mm). The values were compared with the results from the NEMA procedure obtained at the same locations and showed small differences with a correlation coefficient of 0.51 (p < 0.05). In addition, the 133Ba point source method proved to be much easier to use. A Bland-Altman analysis showed that the 133Ba and the 67Ga Method can be used interchangeably. The 133Ba point source method measures the multiple window spatial registration error with essentially the same accuracy as the NEMA-recommended procedure, but is easier and safer to use and has the potential to replace the current standard procedure.

40 CFR 63.1549 - Recordkeeping and reporting requirements.

Code of Federal Regulations, 2014 CFR

2014-07-01

... recordkeeping required as part of the practices described in the standard operating procedures manual for... as part of the practices described in the standard operating procedures manual for baghouses required... procedures outlined in the standard operating procedures manual required by § 63.1544(a) were not followed...

40 CFR 63.1549 - Recordkeeping and reporting requirements.

Code of Federal Regulations, 2012 CFR

2012-07-01

... recordkeeping required as part of the practices described in the standard operating procedures manual for... as part of the practices described in the standard operating procedures manual for baghouses required... procedures outlined in the standard operating procedures manual required by § 63.1544(a) were not followed...

40 CFR 63.1549 - Recordkeeping and reporting requirements.

Code of Federal Regulations, 2013 CFR

2013-07-01

... recordkeeping required as part of the practices described in the standard operating procedures manual for... as part of the practices described in the standard operating procedures manual for baghouses required... procedures outlined in the standard operating procedures manual required by § 63.1544(a) were not followed...

Behavior analytic approaches to problem behavior in intellectual disabilities.

PubMed

Hagopian, Louis P; Gregory, Meagan K

2016-03-01

The purpose of the current review is to summarize recent behavior analytic research on problem behavior in individuals with intellectual disabilities. We have focused our review on studies published from 2013 to 2015, but also included earlier studies that were relevant. Behavior analytic research on problem behavior continues to focus on the use and refinement of functional behavioral assessment procedures and function-based interventions. During the review period, a number of studies reported on procedures aimed at making functional analysis procedures more time efficient. Behavioral interventions continue to evolve, and there were several larger scale clinical studies reporting on multiple individuals. There was increased attention on the part of behavioral researchers to develop statistical methods for analysis of within subject data and continued efforts to aggregate findings across studies through evaluative reviews and meta-analyses. Findings support continued utility of functional analysis for guiding individualized interventions and for classifying problem behavior. Modifications designed to make functional analysis more efficient relative to the standard method of functional analysis were reported; however, these require further validation. Larger scale studies on behavioral assessment and treatment procedures provided additional empirical support for effectiveness of these approaches and their sustainability outside controlled clinical settings.

76 FR 302 - Pesticides; Satisfaction of Data Requirements; Procedures To Ensure Protection of Data Submitters...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-01-04

... Pesticides; Satisfaction of Data Requirements; Procedures To Ensure Protection of Data Submitters' Rights..., concerning the revision of its regulations which govern procedures for the satisfaction of data requirements... regulations which govern procedures for the satisfaction of data requirements under the Federal Insecticide...

Single-specialty management and reconstruction of necrotizing fasciitis of the upper extremities: clinical and economic benefits from a case series.

PubMed

Mattison, Gennaya; Leis, Amber R; Gupta, Subhas C

2014-05-01

Patients with necrotizing fasciitis are managed with multiple prompt, radical surgical debridements and critical care support. Debridement and reconstruction are often provided by different surgical teams. Anecdotally, single-specialty management seemed to be a more efficient management strategy. This study aimed to investigate and compare the outcomes of management by plastic surgery versus multiple disciplines through a retrospective economic and clinical analysis of patients with necrotizing fasciitis treated over 8 years. We also present 3 index cases for which our service functioned as the primary management team. Necrotizing fasciitis cases evaluated and treated by our department, covering both Level I and Level II Trauma Centers, were reviewed for total charges, length of hospital stay, length of intensive care unit (ICU) stay, and number of procedures. The admission Acute Physiology and Chronic Health Evaluation II score was calculated for each patient. Three comparative index cases of upper extremity necrotizing fasciitis managed primarily by the plastic surgery team are presented in greater detail. Patients managed primarily by the plastic surgery service had equivalent Acute Physiology and Chronic Health Evaluation II scores to patients managed by multiple services for their necrotizing fasciitis, with the average score higher for patients managed by plastic surgery alone. In a case-matched series of upper extremity necrotizing fasciitis, the patients admitted directly to plastic surgery had shorter average lengths of hospital and ICU stays as well as decreased total number of procedures, resulting in decreased average total hospital charges. There were no amputations among the cases treated primarily by the plastic surgery. The patients also required smaller areas of reconstruction with skin grafting despite large initial areas of debridement compared to those whose reconstructive teams differed from the team performing the debridement. Improved economic and clinical outcomes-as indicated by the reduced lengths of overall and ICU stay, the reduced number of procedures, none of the cases requiring amputation, and the reduced need for skin grafting-may be attainable when the surgeon eventually performing the reconstruction is involved early in management. We propose that, in the interest of improving patient care, a closer collaboration should be established between the reconstructive and primary managing teams.

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

PubMed

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

2006-10-01

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

Multiple memory systems, multiple time points: how science can inform treatment to control the expression of unwanted emotional memories

PubMed Central

Lau-Zhu, Alex; Henson, Richard N.; Holmes, Emily A.

2018-01-01

Memories that have strong emotions associated with them are particularly resilient to forgetting. This is not necessarily problematic, however some aspects of memory can be. In particular, the involuntary expression of those memories, e.g. intrusive memories after trauma, are core to certain psychological disorders. Since the beginning of this century, research using animal models shows that it is possible to change the underlying memory, for example by interfering with its consolidation or reconsolidation. While the idea of targeting maladaptive memories is promising for the treatment of stress and anxiety disorders, a direct application of the procedures used in non-human animals to humans in clinical settings is not straightforward. In translational research, more attention needs to be paid to specifying what aspect of memory (i) can be modified and (ii) should be modified. This requires a clear conceptualization of what aspect of memory is being targeted, and how different memory expressions may map onto clinical symptoms. Furthermore, memory processes are dynamic, so procedural details concerning timing are crucial when implementing a treatment and when assessing its effectiveness. To target emotional memory in its full complexity, including its malleability, science cannot rely on a single method, species or paradigm. Rather, a constructive dialogue is needed between multiple levels of research, all the way ‘from mice to mental health’. This article is part of a discussion meeting issue ‘Of mice and mental health: facilitating dialogue between basic and clinical neuroscientists'. PMID:29352036

Superior mesenteric vein thrombosis - unusual management of unusual complication of Whipple procedure.

PubMed

Huťan, Martin; Bartko, Christian; Slyško, Roman; Sekáč, Jaroslav; Prochotský, Augustín; Majeský, Ivan; Skultéty, Ján

2014-01-01

Pancreatoduodenectomy is an extensive procedure carrying risk of a number of postoperative complications. Of these the most common are surgical site infections (SSI), bleeding, delayed gastric emptying, and anastomotic leakage. However, the most serious complications are ones, that are rare, clinically hardly diagnosed, and if untreated, leading to the death of a patient. Among the latter complications is thrombosis of superior mesenteric vein. Its clinical signs are unspecific and diagnostics complicated. Treatment requires aggressive approach. If this is absent, intestinal necrosis with septic state, Multiple Organ Dysfunction Syndrome (MODS) and Multiple Organ Failure (MOF) lead to a death of a patient. Authors present a case of a patient after pancreatoduodenectomy, complicated by the thrombosis of superior mesenteric vein. Patient was managed by resection of the necrotic bowel, venous decompression by venous bypass from superior mesenteric vein to the right ovarian vein, and open abdomen with negative pressure wound therapy (NPWT). Patient suffered severe abdominal sepsis with need for intensive organ support. Abdomen was definitely closed on fourth NPWT redress. Patient healed without any further complications, is well and was released to the ambulatory setting. Superior mesenteric vein (VMS) thrombosis is a rare complication. It diagnosis requires high level of vigilance and once diagnosed, aggressive therapy is essential. Two goals of surgical treatment exist: resection of the necrotic bowel and facilitation of the blood outflow. Mesenteroovarian anastomosis is one of the options in treatment of thrombosis of VMS if thrombectomy is not feasible. Copyright © 2014 The Authors. Published by Elsevier Ltd.. All rights reserved.

Including persistency of impairment in mild cognitive impairment classification enhances prediction of 5-year decline.

PubMed

Vandermorris, Susan; Hultsch, David F; Hunter, Michael A; MacDonald, Stuart W S; Strauss, Esther

2011-02-01

Although older adults with Mild Cognitive Impairment (MCI) show elevated rates of conversion to dementia as a group, heterogeneity of outcomes is common at the individual level. Using data from a prospective 5-year longitudinal investigation of cognitive change in healthy older adults (N = 262, aged 64-92 years), this study addressed limitations in contemporary MCI identification procedures which rely on single occasion assessment ("Single-Assessment [SA] MCI") by evaluating an alternate operational definition of MCI requiring evidence of persistent cognitive impairment over multiple-testing sessions ("Multiple-Assessment [MA] MCI"). As hypothesized, prevalence of SA-MCI exceeded that of MA-MCI. Further, the MA-MCI groups showed lower baseline cognitive and functional performance and steeper cognitive decline compared with Control and SA-MCI group. Results are discussed with reference to retest effects and clinical implications.

Retrieving the Height of Smoke and Dust Aerosols by Synergistic Use of Multiple Satellite Sensors

NASA Technical Reports Server (NTRS)

Lee, Jaehwa; Hsu, N. Christina; Bettenhausen, Corey; Sayer, Andrew M.; Seftor, Colin J.; Jeong, Myeong-Jae

2016-01-01

The Aerosol Single scattering albedo and Height Estimation (ASHE) algorithm was first introduced in Jeong and Hsu (2008) to provide aerosol layer height and single scattering albedo (SSA) for biomass burning smoke aerosols. By using multiple satellite sensors synergistically, ASHE can provide the height information over much broader areas than lidar observations alone. The complete ASHE algorithm uses aerosol data from MODIS or VIIRS, OMI or OMPS, and CALIOP. A simplified algorithm also exists that does not require CALIOP data as long as the SSA of the aerosol layer is provided by another source. Several updates have recently been made: inclusion of dust layers in the retrieval process, better determination of the input aerosol layer height from CALIOP, improvement in aerosol optical depth (AOD) for nonspherical dust, development of quality assurance (QA) procedure, etc.

Facilitating enrollment in a Cancer Registry through modified consent procedures: a pilot study.

PubMed

Mazanec, Susan; Daly, Barbara; Meropol, Neal J; Step, Mary

2012-12-01

Research registries are increasingly important in medical research and are essential to the mission of cancer centers. However, designing enrollment and data collection procedures that are consistent with ethical norms and regulatory requirements yet are efficient and cost effective is a major challenge. Current standard consent forms can be a barrier to enrollment because of their length, multiple components, and technical language. We pilot tested an IRB-approved registry booklet and simplified one-page, tiered consent form, allowing for choice of extent of participation. The booklet was mailed to patients with breast cancer as part of their routine information packet prior to the first clinic appointment. A research nurse met with 27 patients at initial treatment to review the booklet, answer questions, obtain informed consent, and collect quality of life data. The consent rate was 78% with 21 patients enrolling in the study. Twelve of the 21 patients (57%) did not read the booklet prior to the visit. The 9 patients (43%) who had read the booklet prior to arrival found it easy to understand. The multi-stage, simplified consent process and data collection were acceptable to these patients and readily integrated into clinical operations. An easy-to-read registry booklet may be an effective guide for discussion, but in-person consent procedures and further testing of the approach are required.

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

PubMed

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

2011-09-01

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

Project START: Using a Multiple Intelligences Model in Identifying and Promoting Talent in High-Risk Students. Research Monograph 95136.

ERIC Educational Resources Information Center

Callahan, Carolyn M.; Tomlinson, Carol A.; Moon, Tonya R.; Tomchin, Ellen M.; Plucker, Jonathan A.

This monograph describes Project START (Support To Affirm Rising Talent), a three-year collaborative research effort to develop and apply gifted identification procedures based on Howard Gardner's (1983) theory of multiple intelligences. Specifically, the study attempted to: (1) develop identification procedures; (2) identify high-potential…

Constructing Standards: A Study of Nurses Negotiating with Multiple Modes of Knowledge

ERIC Educational Resources Information Center

Nes, Sturle; Moen, Anne

2010-01-01

Purpose: The aim of the paper is to explore how multiple modes of knowledge play out in the consolidation of nursing procedures in construction of "local universality". The paper seeks to explore processes where nurses negotiate universal procedures that are to become local standards in a hospital. Design/methodology/approach: The paper…

Pairwise Multiple Comparisons in Single Group Repeated Measures Analysis.

ERIC Educational Resources Information Center

Barcikowski, Robert S.; Elliott, Ronald S.

Research was conducted to provide educational researchers with a choice of pairwise multiple comparison procedures (P-MCPs) to use with single group repeated measures designs. The following were studied through two Monte Carlo (MC) simulations: (1) The T procedure of J. W. Tukey (1953); (2) a modification of Tukey's T (G. Keppel, 1973); (3) the…

The Effect of a Multiple Treatment Program and Maintenance Procedures on Smoking Cessation.

ERIC Educational Resources Information Center

Powell, Don R.

The efficacy of a multiple treatment smoking cessation program and three maintenance strategies was evaluated. Phases I and II of the study involved 51 subjects who participated in a five-day smoking cessation project consisting of lectures, demonstrations, practice exercises, negative smoking, and the teaching of self-control procedures. At the…

The Inverse Relation between Multiplication and Division: Concepts, Procedures, and a Cognitive Framework

ERIC Educational Resources Information Center

Robinson, Katherine M.; LeFevre, Jo-Anne

2012-01-01

Researchers have speculated that children find it more difficult to acquire conceptual understanding of the inverse relation between multiplication and division than that between addition and subtraction. We reviewed research on children and adults' use of shortcut procedures that make use of the inverse relation on two kinds of problems:…

A SAS(®) macro implementation of a multiple comparison post hoc test for a Kruskal-Wallis analysis.

PubMed

Elliott, Alan C; Hynan, Linda S

2011-04-01

The Kruskal-Wallis (KW) nonparametric analysis of variance is often used instead of a standard one-way ANOVA when data are from a suspected non-normal population. The KW omnibus procedure tests for some differences between groups, but provides no specific post hoc pair wise comparisons. This paper provides a SAS(®) macro implementation of a multiple comparison test based on significant Kruskal-Wallis results from the SAS NPAR1WAY procedure. The implementation is designed for up to 20 groups at a user-specified alpha significance level. A Monte-Carlo simulation compared this nonparametric procedure to commonly used parametric multiple comparison tests. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

Clinical efficacy of periodontal plastic surgery procedures: consensus report of Group 2 of the 10th European Workshop on Periodontology.

PubMed

Tonetti, Maurizio S; Jepsen, Søren

2014-04-01

The scope of the discussions of this consensus report was to assess the strength of the scientific evidence and make clinical and research recommendations for surgical interventions to cover exposed root surfaces and enhance soft tissues at implants. Discussions were informed by three systematic reviews covering single recessions, multiple recessions and soft-tissue deficiencies at implants. The strength of the evidence was assessed using a modification in GRADE. The group also emphasized the need to report the experience of the surgeon and the performance of the control intervention (CONSORT guidelines for non-pharmacological treatment). A moderate strength of evidence supported the following statements for single (moderately deep, mostly maxillary) recessions without inter-dental attachment loss: (i) The addition of a connective tissue graft (CTG) improved outcomes of coronally advanced flaps (CAF). (ii) The addition of enamel matrix derivative (EMD) improved the outcomes of CAF. For multiple recessions, preliminary data indicate that flaps specifically designed to treat this condition are worthy of additional attention. Emerging data indicate that it is possible to obtain complete root coverage at sites with some inter-dental attachment loss. With regards to soft-tissue deficiencies at implants, several procedures are available, but great heterogeneity among studies does not allow drawing conclusions at this time. The group highlighted that periodontal plastic procedures are complex, technique-sensitive interventions that require advanced skills and expertise. At single recessions, the addition of autologous CTG or EMD under CAF improves complete root coverage and may be considered the procedure of choice at maxillary anterior and premolar teeth. The adjunctive benefit needs to be put in the context of increased morbidity of the donor area or increased cost. Additional research is needed to: (i) assess the role of alternatives to autologous soft-tissue grafting in combination with CAF; (ii) identify the optimal surgical design and the need for additional soft-tissue grafting (or alternatives) at multiple recessions, recessions with inter-dental attachment loss and soft-tissue deficiencies at implants. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Factors influencing the commercialisation of cloning in the pork industry.

PubMed

Pratt, S L; Sherrer, E S; Reeves, D E; Stice, S L

2006-01-01

Production of cloned pigs using somatic cell nuclear transfer (SCNT) is a repeatable and predictable procedure and multiple labs around the world have generated cloned pigs and genetically modified cloned pigs. Due to the integrated nature of the pork production industry, pork producers are the most likely to benefit and are in the best position to introduce cloning in to production systems. Cloning can be used to amplify superior genetics or be used in conjunction with genetic modifications to produce animals with superior economic traits. Though unproven, cloning could add value by reducing pig-to-pig variability in economically significant traits such as growth rate, feed efficiency, and carcass characteristics. However, cloning efficiencies using SCNT are low, but predictable. The inefficiencies are due to the intrusive nature of the procedure, the quality of oocytes and/or the somatic cells used in the procedure, the quality of the nuclear transfer embryos transferred into recipients, pregnancy rates of the recipients, and neonatal survival of the clones. Furthermore, in commercial animal agriculture, clones produced must be able to grow and thrive under normal management conditions, which include attainment of puberty and subsequent capability to reproduce. To integrate SCNT into the pork industry, inefficiencies at each step of the procedure must be overcome. In addition, it is likely that non-surgical embryo transfer will be required to deliver cloned embryos, and/or additional methods to generate high health clones will need to be developed. This review will focus on the state-of-the-art for SCNT in pigs and the steps required for practical implementation of pig cloning in animal agriculture.

Long-term complications of JJ stent and its management: A 5 years review

PubMed Central

Ray, Rajendra Prasad; Mahapatra, Rajkumar Singha; Mondal, Partha Pratim; Pal, Dilip Kumar

2015-01-01

Objectives: To assess the long term complications of JJ stent, the management of complications and the role of endoscopic approach to manage these complications. Materials and Methods: Nineteen patients with indwelling JJ stent for a duration of more than 6 months were included in this study. Patients were assessed with X-ray KUB, USG KUB, blood urea, creatinine and DTPA renogram. Data were analyzed by Microsoft excel 2007. Results: Out of 19 patients 12 (63.16%) were male and 7 (36.84%) were female. The mean age was 39.78 ± 13.69 years., Mean duration for which the stent was in situ was 29.56 months. The most common complication was broken stent, in 11 cases (57.89%). Other complications were migration in 5 (26.32%), encrustation in 2 (10.52%) and 1 case of (5.26%) stone formation. Eighteen cases were managed by endoscopic approaches. A total of 22 procedures were performed to treat the complications. Eleven cases were managed by a single procedure and 8 patients required multiple procedures. All were managed successfully with no death reported. Post-operative complications were seen in eight cases (42.11%). Conclusions: JJ stent related long-term complications are not uncommon and are usually seen after 6 months of indwelling time. Endourological procedure should be the initial approach with a high success rate. Coordinated use multimodality and technology helps in management of difficult cases. Open surgery is rarely required. Prevention of the complication by judicious use and early removal is the cornerstone. PMID:25657542

Alternative fuels for multiple-hearth furnaces

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

Bracken, B.D.; Lawson, T.U.

1980-04-01

A study of alternative procedures for reducing the consumption of No. 2 fuel oil at the Lower Molonglo Water Quality Control Centre near Canberra, Aust., indicated that in comparison with the present system of incineration with heat supplied by burning fuel oil, the installation of a sludge drying operation, consisting of a rotary dryer heated by furnace exhaust gases with the dried sludge used to fuel the furnace, would become economically desirable by 1985 if afterburning is not required, and would be justified immediately if afterburning is required to meet air pollution control regulations. The substitution of any of fourmore » waste fuels (refuse-derived fuel, waste paper, wood waste, or waste oil) or of coal for the No. 2 fuel oil would not be cost-effective through 1989. The furnace system, including afterburning and fuel oil requirements, the envisioned alternative fuel use systems, sludge processing alternatives, heat balance results, and economics are discussed.« less

Step by Step: Biology Undergraduates' Problem-Solving Procedures during Multiple-Choice Assessment.

PubMed

Prevost, Luanna B; Lemons, Paula P

2016-01-01

This study uses the theoretical framework of domain-specific problem solving to explore the procedures students use to solve multiple-choice problems about biology concepts. We designed several multiple-choice problems and administered them on four exams. We trained students to produce written descriptions of how they solved the problem, and this allowed us to systematically investigate their problem-solving procedures. We identified a range of procedures and organized them as domain general, domain specific, or hybrid. We also identified domain-general and domain-specific errors made by students during problem solving. We found that students use domain-general and hybrid procedures more frequently when solving lower-order problems than higher-order problems, while they use domain-specific procedures more frequently when solving higher-order problems. Additionally, the more domain-specific procedures students used, the higher the likelihood that they would answer the problem correctly, up to five procedures. However, if students used just one domain-general procedure, they were as likely to answer the problem correctly as if they had used two to five domain-general procedures. Our findings provide a categorization scheme and framework for additional research on biology problem solving and suggest several important implications for researchers and instructors. © 2016 L. B. Prevost and P. P. Lemons. CBE—Life Sciences Education © 2016 The American Society for Cell Biology. This article is distributed by The American Society for Cell Biology under license from the author(s). It is available to the public under an Attribution–Noncommercial–Share Alike 3.0 Unported Creative Commons License (http://creativecommons.org/licenses/by-nc-sa/3.0).

Predictors of perioperative major bleeding in patients who interrupt warfarin for an elective surgery or procedure: Analysis of the BRIDGE trial.

PubMed

Clark, Nathan P; Douketis, James D; Hasselblad, Vic; Schulman, Sam; Kindzelski, Andrei L; Ortel, Thomas L

2018-01-01

The use of low-molecular weight heparin bridge therapy during warfarin interruption for elective surgery/procedures increases bleeding. Other predictors of bleeding in this setting are not well described. BRIDGE was a randomized, double-blind, placebo-controlled trial of bridge therapy with dalteparin 100 IU/kg twice daily in patients with atrial fibrillation requiring warfarin interruption. Bleeding outcomes were documented from the time of warfarin interruption until up to 37 days postprocedure. Multiple logistic regression and time-dependent hazard models were used to identify major bleeding predictors. We analyzed 1,813 patients of whom 895 received bridging and 918 received placebo. Median patient age was 72.6 years, and 73.3% were male. Forty-one major bleeding events occurred at a median time of 7.0 days (interquartile range, 4.0-18.0 days) postprocedure. Bridge therapy was a baseline predictor of major bleeding (odds ratio [OR]=2.4, 95% CI: 1.2-4.8), as were a history of renal disease (OR=2.9, 95% CI: 1.4-6.0), and high-bleeding risk procedures (vs low-bleeding risk procedures) (OR=2.9, 95% CI: 1.4-5.9). Perioperative aspirin use (OR=3.6, 95% CI: 1.1-11.9) and postprocedure international normalized ratio >3.0 (OR=2.1, 95% CI: 1.5-3.1) were time-dependent predictors of major bleeding. Major bleeding was most common in the first 10 days compared with 11-37 days postprocedure (OR=3.5, 95% CI: 1.8-6.9). In addition to bridge therapy, perioperative aspirin use, postprocedure international normalized ratio >3.0, a history of renal failure, and having a high-bleeding risk procedure increase the risk of major bleeding around the time of an elective surgery/procedure requiring warfarin interruption. Copyright © 2017 Elsevier Inc. All rights reserved.

Defining unnecessary disinfection procedures for single-dose and multiple-dose vials.

PubMed

Buckley, T; Dudley, S M; Donowitz, L G

1994-11-01

Recommendations in the literature conflict on the necessity of disinfecting single-use vials prior to aspiration of fluid. Interventions to disinfect the stopper surface on multiple-dose vials vary considerably. To determine the necessity of alcohol disinfection of the stopper on single-dose vials and to compare povidone-iodine and alcohol versus alcohol-only disinfection of the stopper prior to each needle penetration on multiple-dose vials. The rubber stopper surfaces of 100 single-dose vials were cultured for the presence of bacteria. To determine the efficacy of two procedures for disinfection of multiple-dose vials, 87 stopper surfaces routinely disinfected with both povidone-iodine and alcohol were cultured for bacteria. After a change in practice, 100 multiple-dose vials routinely disinfected with alcohol only were cultured for the presence of bacteria. Of the cultures done on single-dose vial stoppers, 99% were sterile. A comparison of the two disinfection techniques for multiple-dose vials revealed that 83 (95%) of the 87 vials prepped with both povidone-iodine and alcohol were sterile, compared with all stoppers disinfected with alcohol only. This study shows the lack of necessity of any disinfection procedure on the rubber stopper of single-dose vials and the efficacy of alcohol only for disinfecting the stopper of multiple-dose vials.

Analysing the impact of multiple stressors in aquatic biomonitoring data: A 'cookbook' with applications in R.

PubMed

Feld, Christian K; Segurado, Pedro; Gutiérrez-Cánovas, Cayetano

2016-12-15

Multiple stressors threaten biodiversity and ecosystem integrity, imposing new challenges to ecosystem management and restoration. Ecosystem managers are required to address and mitigate the impact of multiple stressors, yet the knowledge required to disentangle multiple-stressor effects is still incomplete. Experimental studies have advanced the understanding of single and combined stressor effects, but there is a lack of a robust analytical framework, to address the impact of multiple stressors based on monitoring data. Since 2000, the monitoring of Europe's waters has resulted in a vast amount of biological and environmental (stressor) data of about 120,000 water bodies. For many reasons, this data is rarely exploited in the multiple-stressor context, probably because of its rather heterogeneous nature: stressors vary and are mixed with broad-scale proxies of environmental stress (e.g. land cover), missing values and zero-inflated data limit the application of statistical methods and biological indicators are often aggregated (e.g. taxon richness) and do not respond stressor-specific. Here, we present a 'cookbook' to analyse the biological response to multiple stressors using data from biomonitoring schemes. Our 'cookbook' includes guidance for the analytical process and the interpretation of results. The 'cookbook' is accompanied by scripts, which allow the user to run a stepwise analysis based on his/her own data in R, an open-source language and environment for statistical computing and graphics. Using simulated and real data, we show that the recommended procedure is capable of identifying stressor hierarchy (importance) and interaction in large datasets. We recommend a minimum number of 150 independent observations and a minimum stressor gradient length of 75% (of the most relevant stressor's gradient in nature), to be able to reliably rank the stressor's importance, detect relevant interactions and estimate their standardised effect size. We conclude with a brief discussion of the advantages and limitations of this protocol. Copyright © 2016 Elsevier B.V. All rights reserved.

Unscaled Bayes factors for multiple hypothesis testing in microarray experiments.

PubMed

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

2015-12-01

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

Laparoscopic Myomectomy for a Plethora of Submucous Myomas.

PubMed

Paul, P G; Paul, George; Radhika, K T; Bulusu, Saumya; Shintre, Hemant

To demonstrate a laparoscopic myomectomy technique for the removal of multiple submucous myomas. A step-by-step demonstration of the surgical procedure (Canadian Task Force classification III-C). In cases of multiple submucous myomas, hysteroscopic resection of myomas might not be a viable option, especially in cases requiring fertility preservation. It may cause significant damage to the endometrial surface, leading to the formation of endometrial synechiae [1]. The procedure is technically challenging and requires prolonged operating time owing to impaired visibility and the need for repeated specimen removal. This can lead to complications, such as fluid overload and, rarely, air embolism [2]. Thus, laparoscopic myomectomy may be a better option in such cases [1]. A 30-year-old nulligravida presented with a 3-year history of heavy menstrual bleeding and dysmenorrhea. She had received no symptom relief with hormonal medications and magnetic resonance-guided focused ultrasound. On examination, she was anemic, and her uterus was enlarged to 16-weeks gravid size. Ultrasonography revealed an intramural fundal myoma of 6 × 4.2 cm and numerous submucous myomas of 1 to 3.2 cm. During hysteroscopy, multiple submucous myomas of varying sizes ranging from type 0 to type 1 were seen. On laparoscopy, an incision was made on the uterine fundus with an ultrasonic device after injecting vasopressin (20 U in 200 mL dilution), and the fundal myoma was enucleated. The incision was then extended to open the endometrial cavity for the removal of the submucous myomas. Most of the myomas were removed with mechanical force, along with the minimal use of ultrasonic energy. A total of 46 myomas were removed, and the myometrium was closed in 2 layers. The duration of the surgery was 210 minutes, and estimated blood loss was 850 mL. The patient did not require blood transfusion, but was advised to take hematinics. At a 6-month follow-up, the patient reported significant improvement in her symptoms. A repeat hysteroscopy revealed moderate synechiae in the midline and 2 small submucous myomas near the internal os. The synechiae were incised with hysteroscopic scissors, and the submucous myomas were resected with a bipolar resectoscope. The patient was advised to attempt conception after 2 months. Laparoscopic myomectomy is an alternative to hysteroscopic resection for multiple submucous myomas. A repeat hysteroscopy is useful for identifying any residual myomas and synechiae. Copyright © 2017 AAGL. Published by Elsevier Inc. All rights reserved.

Analysis of damaging process and crack propagation

NASA Astrophysics Data System (ADS)

Semenski, D.; Wolf, H.; Božić, Ž.

2010-06-01

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

MultipleColposcopyJCO

Cancer.gov

Performing multiple biopsies during a procedure known as colposcopy—visual inspection of the cervix—is more effective than performing only a single biopsy of the worst-appearing area for detecting cervical cancer precursors. This multiple biopsy approach

Lipreading in the prelingually deaf: what makes a skilled speechreader?

PubMed

Rodríguez Ortiz, Isabel de los Reyes

2008-11-01

Lipreading proficiency was investigated in a group of hearing-impaired people, all of them knowing Spanish Sign Language (SSL). The aim of this study was to establish the relationships between lipreading and some other variables (gender, intelligence, audiological variables, participants' education, parents' education, communication practices, intelligibility, use of SSL). The 32 participants were between 14 and 47 years of age. They all had sensorineural hearing losses (from severe to profound). The lipreading procedures comprised identification of words in isolation. The words selected for presentation in isolation were spoken by the same talker. Identification of words required participants to select their responses from set of four pictures appropriately labelled. Lipreading was significantly correlated with intelligence and intelligibility. Multiple regression analyses were used to obtain a prediction equation for the lipreading measures. As a result of this procedure, it is concluded that proficient deaf lipreaders are more intelligent and their oral speech was more comprehensible for others.

Provenance studies by fission-track dating of zircon-etching and counting procedures

USGS Publications Warehouse

Naeser, N.D.; Zeitler, P.K.; Naeser, C.W.; Cerveny, P.F.

1987-01-01

In sedimentary rocks that have not been heated to high enough temperatures to anneal fission tracks in zircon (greater than ≈ 160°C), fission-track ages of individual detrital zircon grains provide valuable information about the source rocks eroded to form the sediments. The success of such studies depends, however, on the degree to which the ages determined from the detrital suite accurately portray the range of grain ages that are present in the suite. This in turn depends to a large extent on using counting and, in particular, etching procedures that permit proper sampling of grains with a wide range of age and uranium concentrations. Results are reported here of an experimental study of a ‘detrital’ zircon suite manufactured from several zircon populations of known age. This study suggests that multiple etches are required when a complete spectrum of ages in a zircon suite is desired.

Provenance studies by fission-track dating of zircon-etching and counting procedures

USGS Publications Warehouse

Naeser, Nancy D.; Zeitler, Peter K.; Naeser, Charles W.; Cerveny, Philip F.

1987-01-01

In sedimentary rocks that have not been heated to high enough temperatures to anneal fission tracks in zircon (greater than approximately equals 160 degree C), fission-track ages of individual detrital zircon grains provide valuable information about the source rocks eroded to form the sediments. The success of such studies depends, however, on the degree to which the ages determined from the detrital suite accurately portray the range of grain ages that are present in the suite. This in turn depends to a large extent on using counting and, in particular, etching procedures that permit proper sampling of grains with a wide range of age and uranium concentrations. Results are reported here of an experimental study of a 'detrital' zircon suite manufactured from several zircon populations of known age. This study suggests that multiple etches are required when a complete spectrum of ages in a zircon suite is desired.

A universal procedure for evaluation and application of surge-protective devices

NASA Technical Reports Server (NTRS)

1980-01-01

The source, nature, and frequency of occurrence of transients must be identified and a representative standard test wave chosen for proof testing. The performance of candidate suppressor devices then can be evaluated against the withstand goals set for the equipment. The various suppressors divide into two classes of generic behavior. The key to a universal procedure for evaluating both classes lies in representing transients as quasi-current sources of defined current impulse duration. The available surge current is established by the Thevenin equivalent transient voltage and source impedance. A load line drawn on the V-I characteristic graph of the suppressor quickly determines the clamping voltage and peak current. These values then can be compared to the requirement. The deposited energy and average power dissipation for multiple transients also can be calculated. The method is illustrated with a design example for motor vehicle alternator load dump suppression.

Residual Gases in Crystal Growth Systems: Their Origin, Magnitude, and Dependence on the Processing Conditions

NASA Technical Reports Server (NTRS)

Palosz, W.

2003-01-01

Residual gases present in closed ampoules may affect different crystal growth processes. Their presence may affect techniques requiring low pressures and affect the crystal quality in different ways. For that reason a good understanding and control of formation of residual gases may be important for an optimum design and meaningful interpretation of crystal growth experiments. Our extensive experimental and theoretical study includes degassing of silica glass and generation of gases from various source materials. Different materials processing conditions, like outgassing under vacuum, annealing in hydrogen, resublimation, different material preparation procedures, multiple annealings, different processing times, and others were applied and their effect on the amount and composition of gas were analyzed. The experimental results were interpreted based on theoretical calculations on diffusion in silica glass and source materials and thermochemistry of the system. Procedures for a reduction of the amount of gas are also discussed.

[Reconstruction of the ear in the burns patient].

PubMed

Carrillo-Córdova, Jorge Raúl; Jiménez Murat, Yusef; Apellaniz-Campo, Armando; Bracho-Olvera, Hazel; Carrillo Esper, Raúl

Face burns are a singular pathology with great functional and psychological impact in the patients suffering them. The ears play a fundamental role in personal interactions and damage to this organ results in physical and emotional distress. The reconstructive treatment of the burned ear is a challenge. Multiple procedures have been described to achieve success in the reconstruction of the burned ear; immediate reconstruction with autologous rib cartilage, secondary reconstruction, alloplastic material reconstruction, tissue expansion, skin grafts and also microvascular flaps are some of the most common procedures used in this patients. All these techniques focus on giving a natural appearance to the patient. Burns to the ears affect 30% of the patients with facial burns, they require an excellent treatment given by a multidisciplinary team. Copyright © 2017 Academia Mexicana de Cirugía A.C. Publicado por Masson Doyma México S.A. All rights reserved.

[Effect of non-pharmacological methods for alleviation of pain in newborns].

PubMed

Chromá, Jana; Sikorová, Lucie

2012-01-01

The aim of the paper is to analyze currently most used non-pharmacological methods for pain alleviation in newborns for the best evidence-based practice. Source of the required data for the period 2000-2011 were electronic licensed and freely accessible databases. Evaluation found evidence (30 studies) was carried out according to the table-level evidence (Fineout-Overholt, Johnston 2005). The selection was included in the evidence level I, II, III. Nutritive sucking is currently considered the most effective method for alleviating pain in newborns. Analysis of studies shows that non-pharmacological methods used to control pain in neonates are much more effective when used in combination with other non-pharmacological methods, such as music therapy, swaddling, facilitated tucking, multiple-stimulation, kangaroo care and non-nutritive suction. Non-pharmacological procedures are effective and lead to pain relief especially in procedural performance as heel lancet and venipuncture for blood sampling, etc.

Boundary layer simulator improvement

NASA Technical Reports Server (NTRS)

Praharaj, Sarat C.; Schmitz, Craig P.; Nouri, Joseph A.

1989-01-01

Boundary Layer Integral Matrix Procedure (BLIMPJ) has been identified by the propulsion community as the rigorous boundary layer program in connection with the existing JANNAF reference programs. The improvements made to BLIMPJ and described herein have potential applications in the design of the future Orbit Transfer Vehicle engines. The turbulence model is validated to include the effects of wall roughness and a way is devised to treat multiple smooth-rough surfaces. A prediction of relaminarization regions is examined as is the combined effects of wall cooling and surface roughness on relaminarization. A turbulence model to represent the effects of constant condensed phase loading is given. A procedure is described for thrust decrement calculation in thick boundary layers by coupling the T-D Kinetics Program and BLIMPJ and a way is provided for thrust loss optimization. Potential experimental studies in rocket nozzles are identified along with the required instrumentation to provide accurate measurements in support of the presented new analytical models.

Nanofibers implant functionalized by neural growth factor as a strategy to innervate a bioengineered tooth.

PubMed

Eap, Sandy; Bécavin, Thibault; Keller, Laetitia; Kökten, Tunay; Fioretti, Florence; Weickert, Jean-Luc; Deveaux, Etienne; Benkirane-Jessel, Nadia; Kuchler-Bopp, Sabine

2014-03-01

Current strategies for jaw reconstruction require multiple procedures, to repair the bone defect, to offer sufficient support, and to place the tooth implant. The entire procedure can be painful and time-consuming, and the desired functional repair can be achieved only when both steps are successful. The ability to engineer combined tooth and bone constructs, which would grow in a coordinated fashion with the surrounding tissues, could potentially improve the clinical outcomes and also reduce patient suffering. A unique nanofibrous and active implant for bone-tooth unit regeneration and also the innervation of this bioengineered tooth are demonstrated. A nanofibrous polycaprolactone membrane is functionalized with neural growth factor, along with dental germ, and tooth innervation follows. Such innervation allows complete functionality and tissue homeostasis of the tooth, such as dentinal sensitivity, odontoblast function, masticatory forces, and blood flow. © 2013 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

Noninvasive imaging systems for gametes and embryo selection in IVF programs: a review.

PubMed

Omidi, Marjan; Faramarzi, Azita; Agharahimi, Azam; Khalili, Mohammad Ali

2017-09-01

Optimizing the efficiency of the in vitro fertilization procedure by improving pregnancy rates and reducing the risks of multiple pregnancies simultaneously are the primary goals of the current assisted reproductive technology program. With the move to single embryo transfers, the need for more cost-effective and noninvasive methods for embryo selection prior to transfer is paramount. These aims require advancement in a more acquire gametes/embryo testing and selection procedures using high-tech devices. Therefore, the aim of the present review is to evaluate the efficacy of noninvasive imaging systems in the current literatures, focusing on the potential clinical application in infertile patients undergoing assisted reproductive technology treatments. In this regards, three advanced imaging systems of motile sperm organelle morphology examination, polarization microscopy and time-lapse monitoring for the best selection of the gametes and preimplantation embryos are introduced in full. © 2017 The Authors Journal of Microscopy © 2017 Royal Microscopical Society.

Reporter-Based Isolation of Developmental Myogenic Progenitors

PubMed Central

Kheir, Eyemen; Cusella, Gabriella; Messina, Graziella; Cossu, Giulio; Biressi, Stefano

2018-01-01

The formation and activity of mammalian tissues entail finely regulated processes, involving the concerted organization and interaction of multiple cell types. In recent years the prospective isolation of distinct progenitor and stem cell populations has become a powerful tool in the hands of developmental biologists and has rendered the investigation of their intrinsic properties possible. In this protocol, we describe how to purify progenitors with different lineage history and degree of differentiation from embryonic and fetal skeletal muscle by fluorescence-activated cell sorting (FACS). The approach takes advantage of a panel of murine strains expressing fluorescent reporter genes specifically in the myogenic progenitors. We provide a detailed description of the dissection procedures and of the enzymatic dissociation required to maximize the yield of mononucleated cells for subsequent FACS-based purification. The procedure takes ~6–7 h to complete and allows for the isolation and the subsequent molecular and phenotypic characterization of developmental myogenic progenitors. PMID:29674978

Management of a high risk epileptic patient under conscious sedation: A multidisciplinary approach

PubMed Central

Chellathurai, Burnice Nalina Kumari; Thiagarajan, Ramakrishnan; Jayakumaran, SelvaKumar; Devadoss, Pradeep; Elavazhagan

2016-01-01

Epilepsy, characterized by the risk of recurrent seizures, is a chronic disease that afflicts about 5% of the world's population. The main dental problems associated with epileptic patients include gingival hyperplasia, minor oral injuries, tooth trauma, and prosthodontic problems, which require the dental treatment. Stress and fear are the most common triggering factors for the epilepsy in dental chair. Therefore, a more appropriate method of treating such epileptic patients may be warranted. Conscious sedation is a technique of providing good anesthesia and analgesia to patients, the main advantage of which is the patient's rapid return to presentation levels. Midazolam used as a sedative agent has anticonvulsant properties. This case report highlights a case requiring multiple dental procedures carried out in a high risk epileptic patient under conscious sedation. PMID:27041847

No longer waiting for an accident to happen: Simulation in emergency medicine.

PubMed

Ellison, Stefanie; Sullivan, Christine; McCullough, Robert

2013-01-01

The practice of emergency medicine (EM) requires proficient and expert skills in multiple high risk procedures. The emergency physician in-training needs a safe and realistic environment in which to practice and perfect the skills necessary to care for patients ranging from the critically ill to the patient with difficult intravenous access. Undergraduate medical, education overall has a need for training that enables students to develop the knowledge, skills and attitudes to practice in a variety of specialties. This article provides an overview of simulation in a three-year emergency medicine residency at Truman Medical Center, in a required final year clerkship for all medical students at the University of Missouri-Kansas City, and discusses national trends for the use of simulation in emergency medicine.

Interdisciplinary Development of an Improved Emergency Department Procedural Work Surface Through Iterative Design and Use Testing in Simulated and Clinical Environments.

PubMed

Zhang, Xiao C; Bermudez, Ana M; Reddy, Pranav M; Sarpatwari, Ravi R; Chheng, Darin B; Mezoian, Taylor J; Schwartz, Victoria R; Simmons, Quinneil J; Jay, Gregory D; Kobayashi, Leo

2017-03-01

A stable and readily accessible work surface for bedside medical procedures represents a valuable tool for acute care providers. In emergency department (ED) settings, the design and implementation of traditional Mayo stands and related surface devices often limit their availability, portability, and usability, which can lead to suboptimal clinical practice conditions that may affect the safe and effective performance of medical procedures and delivery of patient care. We designed and built a novel, open-source, portable, bedside procedural surface through an iterative development process with use testing in simulated and live clinical environments. The procedural surface development project was conducted between October 2014 and June 2016 at an academic referral hospital and its affiliated simulation facility. An interdisciplinary team of emergency physicians, mechanical engineers, medical students, and design students sought to construct a prototype bedside procedural surface out of off-the-shelf hardware during a collaborative university course on health care design. After determination of end-user needs and core design requirements, multiple prototypes were fabricated and iteratively modified, with early variants featuring undermattress stabilizing supports or ratcheting clamp mechanisms. Versions 1 through 4 underwent 2 hands-on usability-testing simulation sessions; version 5 was presented at a design critique held jointly by a panel of clinical and industrial design faculty for expert feedback. Responding to select feedback elements over several surface versions, investigators arrived at a near-final prototype design for fabrication and use testing in a live clinical setting. This experimental procedural surface (version 8) was constructed and then deployed for controlled usability testing against the standard Mayo stands in use at the study site ED. Clinical providers working in the ED who opted to participate in the study were provided with the prototype surface and just-in-time training on its use when performing bedside procedures. Subjects completed the validated 10-point System Usability Scale postshift for the surface that they had used. The study protocol was approved by the institutional review board. Multiple prototypes and recursive design revisions resulted in a fully functional, portable, and durable bedside procedural surface that featured a stainless steel tray and intuitive hook-and-lock mechanisms for attachment to ED stretcher bed rails. Forty-two control and 40 experimental group subjects participated and completed questionnaires. The median System Usability Scale score (out of 100; higher scores associated with better usability) was 72.5 (interquartile range [IQR] 51.3 to 86.3) for the Mayo stand; the experimental surface was scored at 93.8 (IQR 84.4 to 97.5 for a difference in medians of 17.5 (95% confidence interval 10 to 27.5). Subjects reported several usability challenges with the Mayo stand; the experimental surface was reviewed as easy to use, simple, and functional. In accordance with experimental live environment deployment, questionnaire responses, and end-user suggestions, the project team finalized the design specification for the experimental procedural surface for open dissemination. An iterative, interdisciplinary approach was used to generate, evaluate, revise, and finalize the design specification for a new procedural surface that met all core end-user requirements. The final surface design was evaluated favorably on a validated usability tool against Mayo stands when use tested in simulated and live clinical settings. Copyright © 2016 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

Generating Models of Surgical Procedures using UMLS Concepts and Multiple Sequence Alignment

PubMed Central

Meng, Frank; D’Avolio, Leonard W.; Chen, Andrew A.; Taira, Ricky K.; Kangarloo, Hooshang

2005-01-01

Surgical procedures can be viewed as a process composed of a sequence of steps performed on, by, or with the patient’s anatomy. This sequence is typically the pattern followed by surgeons when generating surgical report narratives for documenting surgical procedures. This paper describes a methodology for semi-automatically deriving a model of conducted surgeries, utilizing a sequence of derived Unified Medical Language System (UMLS) concepts for representing surgical procedures. A multiple sequence alignment was computed from a collection of such sequences and was used for generating the model. These models have the potential of being useful in a variety of informatics applications such as information retrieval and automatic document generation. PMID:16779094

Digital robust active control law synthesis for large order flexible structure using parameter optimization

NASA Technical Reports Server (NTRS)

Mukhopadhyay, V.

1988-01-01

A generic procedure for the parameter optimization of a digital control law for a large-order flexible flight vehicle or large space structure modeled as a sampled data system is presented. A linear quadratic Guassian type cost function was minimized, while satisfying a set of constraints on the steady-state rms values of selected design responses, using a constrained optimization technique to meet multiple design requirements. Analytical expressions for the gradients of the cost function and the design constraints on mean square responses with respect to the control law design variables are presented.

Multiphoton Scattering Tomography with Coherent States.

PubMed

Ramos, Tomás; García-Ripoll, Juan José

2017-10-13

In this work we develop an experimental procedure to interrogate the single- and multiphoton scattering matrices of an unknown quantum system interacting with propagating photons. Our proposal requires coherent state laser or microwave inputs and homodyne detection at the scatterer's output, and provides simultaneous information about multiple-elastic and inelastic-segments of the scattering matrix. The method is resilient to detector noise and its errors can be made arbitrarily small by combining experiments at various laser powers. Finally, we show that the tomography of scattering has to be performed using pulsed lasers to efficiently gather information about the nonlinear processes in the scatterer.

49 CFR 218.97 - Good faith challenge procedures.

Code of Federal Regulations, 2011 CFR

2011-10-01

... the railroad's operating rules implementing the requirements of this subpart. (b) General procedures... requirements of this subpart. (1) Each railroad or employer shall adopt and implement written procedures which... fulfill the requirements of this subpart. Each railroad or employer's written procedures shall provide for...

49 CFR 218.97 - Good faith challenge procedures.

Code of Federal Regulations, 2014 CFR

2014-10-01

... the railroad's operating rules implementing the requirements of this subpart. (b) General procedures... requirements of this subpart. (1) Each railroad or employer shall adopt and implement written procedures which... fulfill the requirements of this subpart. Each railroad or employer's written procedures shall provide for...

49 CFR 218.97 - Good faith challenge procedures.

Code of Federal Regulations, 2013 CFR

2013-10-01

... the railroad's operating rules implementing the requirements of this subpart. (b) General procedures... requirements of this subpart. (1) Each railroad or employer shall adopt and implement written procedures which... fulfill the requirements of this subpart. Each railroad or employer's written procedures shall provide for...

49 CFR 218.97 - Good faith challenge procedures.

Code of Federal Regulations, 2010 CFR

2010-10-01

... the railroad's operating rules implementing the requirements of this subpart. (b) General procedures... requirements of this subpart. (1) Each railroad or employer shall adopt and implement written procedures which... fulfill the requirements of this subpart. Each railroad or employer's written procedures shall provide for...

49 CFR 218.97 - Good faith challenge procedures.

Code of Federal Regulations, 2012 CFR

2012-10-01

... the railroad's operating rules implementing the requirements of this subpart. (b) General procedures... requirements of this subpart. (1) Each railroad or employer shall adopt and implement written procedures which... fulfill the requirements of this subpart. Each railroad or employer's written procedures shall provide for...

Using audio script fading and multiple-exemplar training to increase vocal interactions in children with autism.

PubMed

Garcia-Albea, Elena; Reeve, Sharon A; Brothers, Kevin J; Reeve, Kenneth F

2014-01-01

Script-fading procedures have been shown to be effective for teaching children with autism to initiate and participate in social interactions without vocal prompts from adults. In previous script and script-fading research, however, there has been no demonstration of a generalized repertoire of vocal interactions under the control of naturally occurring relevant stimuli. In this study, 4 boys with autism were taught to initiate a conversation in the presence of toys through the use of a script and script-fading procedure. Training with multiple categories and exemplars of toys was used to increase the likelihood of generalization of vocal interactions across novel toys. A multiple-probe design across participants was used to assess the effects of these procedures. The intervention successfully brought interactions by children with autism under the control of relevant stimuli in the environment. Future research pertaining to the specific implementation of these procedures (e.g., fading, script placement, participant characteristics) is discussed. © Society for the Experimental Analysis of Behavior.

A stone extraction facilitation device to achieve an improved technique for performing LCBDE.

PubMed

Wenner, D E; Whitwam, P; Rosser, J; Hashmi, S; Wenner, D E

2005-01-01

Laparoscopic common bile duct exploration (LCBDE) has proved to be a safe, cost-effective way to treat common bile duct (CBD) stones. Despite this, LCBDE has not gained widespread adoption by surgeons. The technique has proved difficult to master, and damage to the fragile choledochoscope by grasping forceps and passage through the port valves has been problematic. Cases involving large, impacted, or multiple stones have required conversion to open exploration of CBD. The Multichannel Instrument Guide (MIG) is introduced as a solution for these problems. The MIG is a J-shaped plastic extrusion with three lumens. It is flexible and can be straightened for insertion through a 10-mm port. The MIG facilitates insertion of a flexible 2.8- to 3.2-mm choledochoscope into the CBD. At the same time, additional tools such as balloon or irrigation catheters and lithotripters can be introduced into the CBD. These can be manipulated under video guidance via the choledochoscope. This procedural multitasking allows for a more efficient LCBDE. The authors describe their initial experience using the MIG for 23 patients. Of the 23 patients who underwent LCBDE procedures, 20 had stones in the CBD. Multiple stones were present in 48% of the patients; impacted stones were present in 26% of the patients; and stones larger than 1 cm were present in 26% of the patients. A 95% stone clearance rate was achieved. Difficult cases with large, impacted or multiple stones were resolved using the MIG. Two choledochoscopes were damaged; one during surgery and one during cleaning and storage. The MIG has demonstrated significant advantages over previously described techniques. The device secures biliary tract access and allows procedural multitasking while protecting the delicate and expensive equipment. Subsequently, a simplified technique algorithm can be followed that may encourage more surgeons to adopt the routine performance of LCBDE.

Evaluation of Oral and Maxillofacial Surgery Residents' Operative Skills: Feasibility and Engagement Study Using SIMPL Software for a Mobile Phone.

PubMed

Kaban, Leonard B; Cappetta, Alyssa; George, Brian C; Lahey, Edward T; Bohnen, Jordan D; Troulis, Maria J

2017-10-01

There are no universally accepted tools to evaluate operative skills of surgical residents in a timely fashion. The purpose of this study was to determine the feasibility of using a smartphone application, SIMPL (System for Improving and Measuring Procedural Learning), developed by a multi-institutional research collaborative, to achieve a high rate of timely operative evaluations and resident communication and to collect performance data. The authors hypothesized that these goals would be achieved because the process is convenient and efficient. This was a prospective feasibility and engagement study using SIMPL to evaluate residents' operative skills. SIMPL requires the attending surgeon to answer 3 multiple-choice questions: 1) What level of help (Zwisch Scale) was required by the trainee? 2) What was the level of performance? 3) How complex was the case? The evaluator also can dictate a narrative. The sample was composed of 3 faculty members and 3 volunteer senior residents. Predictor variables were the surgeons, trainees, and procedures performed. Outcome variables included number and percentage of procedures performed by faculty-and-resident pairs assessed, time required to complete assessments, time lapsed to submission, percentage of assessments with narratives, and residents' response rates. From March through June 2016, 151 procedures were performed in the operating room by the faculty-and-resident teams. There were 107 assessments submitted (71%). Resident response (self-assessment) to faculty evaluations was 81%. Recorded time to complete assessments (n = 75 of 107) was shorter than 2 minutes. The time lapsed to submission was shorter than 72 hours (100%). Dictations were submitted for 35 evaluations (33%). Data for the type of help, performance, and complexity of cases were collected for each resident. SIMPL facilitates timely intraoperative evaluations of surgical skills, engagement by faculty and residents, and collection of detailed procedural data. Additional prospective trials to assess this tool further are planned. Copyright © 2017 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

[Implementation of a rational standard of hygiene for preparation of operating rooms].

PubMed

Bauer, M; Scheithauer, S; Moerer, O; Pütz, H; Sliwa, B; Schmidt, C E; Russo, S G; Waeschle, R M

2015-10-01

The assurance of high standards of care is a major requirement in German hospitals while cost reduction and efficient use of resources are mandatory. These requirements are particularly evident in the high-risk and cost-intensive operating theatre field with multiple process steps. The cleaning of operating rooms (OR) between surgical procedures is of major relevance for patient safety and requires time and human resources. The hygiene procedure plan for OR cleaning between operations at the university hospital in Göttingen was revised and optimized according to the plan-do-check-act principle due to not clearly defined specifications of responsibilities, use of resources, prolonged process times and increased staff engagement. The current status was evaluated in 2012 as part of the first step "plan". The subsequent step "do" included an expert symposium with external consultants, interdisciplinary consensus conferences with an actualization of the former hygiene procedure plan and the implementation process. All staff members involved were integrated into this management change process. The penetration rate of the training and information measures as well as the acceptance and compliance with the new hygiene procedure plan were reviewed within step "check". The rates of positive swabs and air sampling as well as of postoperative wound infections were analyzed for quality control and no evidence for a reduced effectiveness of the new hygiene plan was found. After the successful implementation of these measures the next improvement cycle ("act") was performed in 2014 which led to a simplification of the hygiene plan by reduction of the number of defined cleaning and disinfection programs for preparation of the OR. The reorganization measures described led to a comprehensive commitment of the hygiene procedure plan by distinct specifications for responsibilities, for the course of action and for the use of resources. Furthermore, a simplification of the plan, a rational staff assignment and reduced process times were accomplished. Finally, potential conflicts due to an insufficient evidence-based knowledge of personnel was reduced. This present project description can be used by other hospitals as a guideline for similar changes in management processes.

Linezolid desensitization for a patient with multiple medication hypersensitivity reactions.

PubMed

Bagwell, Autumn D; Stollings, Joanna L; White, Katie D; Fadugba, Olajumoke O; Choi, Jane J

2013-01-01

To describe a case in which a linezolid desensitization protocol was successfully used for a polymicrobial surgical wound infection in a patient with multiple drug hypersensitivity reactions. A 24-year-old woman with vocal cord dysfunction requiring tracheostomy was admitted for a surgical wound infection following a tracheostomy fistula closure procedure. The patient reported multiple antibiotic allergies including penicillins (rash), sulfonamides (rash), vancomycin (anaphylaxis), azithromycin (rash), cephalosporins (anaphylaxis), levofloxacin (unspecified), clindamycin (unspecified), and carbapenems (unspecified). Gram stain of the purulent wound drainage demonstrated mixed gram-negative and gram-positive flora, and bacterial cultures were overgrown with Proteus mirabilis, which precluded identification of other pathogens. Following failed test doses of linezolid, tigecycline, and daptomycin, all of which resulted in hypersensitivity reactions, a 16-step linezolid desensitization protocol was developed and successfully implemented without adverse reactions. The patient completed a 2-week course of antibiotic therapy that included linezolid upon finishing the desensitization protocol. Linezolid is useful in treating complicated and uncomplicated skin and soft tissue infections caused by gram-positive bacteria. With precautions, including premedication, a monitored nursing unit, and immediate availability of an emergency anaphylaxis kit, drug desensitization allows patients the ability to safely use medications to which they may have an immediate hypersensitivity reaction. Minimal data exist on linezolid desensitization protocols. Linezolid desensitization can be a viable option in patients requiring antimicrobial therapy for complicated gram-positive skin infections.

Prediction of lethal/effective concentration/dose in the presence of multiple auxiliary covariates and components of variance

USGS Publications Warehouse

Gutreuter, S.; Boogaard, M.A.

2007-01-01

Predictors of the percentile lethal/effective concentration/dose are commonly used measures of efficacy and toxicity. Typically such quantal-response predictors (e.g., the exposure required to kill 50% of some population) are estimated from simple bioassays wherein organisms are exposed to a gradient of several concentrations of a single agent. The toxicity of an agent may be influenced by auxiliary covariates, however, and more complicated experimental designs may introduce multiple variance components. Prediction methods lag examples of those cases. A conventional two-stage approach consists of multiple bivariate predictions of, say, medial lethal concentration followed by regression of those predictions on the auxiliary covariates. We propose a more effective and parsimonious class of generalized nonlinear mixed-effects models for prediction of lethal/effective dose/concentration from auxiliary covariates. We demonstrate examples using data from a study regarding the effects of pH and additions of variable quantities 2???,5???-dichloro-4???- nitrosalicylanilide (niclosamide) on the toxicity of 3-trifluoromethyl-4- nitrophenol to larval sea lamprey (Petromyzon marinus). The new models yielded unbiased predictions and root-mean-squared errors (RMSEs) of prediction for the exposure required to kill 50 and 99.9% of some population that were 29 to 82% smaller, respectively, than those from the conventional two-stage procedure. The model class is flexible and easily implemented using commonly available software. ?? 2007 SETAC.

Memory and other properties of multiple test procedures generated by entangled graphs.

PubMed

Maurer, Willi; Bretz, Frank

2013-05-10

Methods for addressing multiplicity in clinical trials have attracted much attention during the past 20 years. They include the investigation of new classes of multiple test procedures, such as fixed sequence, fallback and gatekeeping procedures. More recently, sequentially rejective graphical test procedures have been introduced to construct and visualize complex multiple test strategies. These methods propagate the local significance level of a rejected null hypothesis to not-yet rejected hypotheses. In the graph defining the test procedure, hypotheses together with their local significance levels are represented by weighted vertices and the propagation rule by weighted directed edges. An algorithm provides the rules for updating the local significance levels and the transition weights after rejecting an individual hypothesis. These graphical procedures have no memory in the sense that the origin of the propagated significance level is ignored in subsequent iterations. However, in some clinical trial applications, memory is desirable to reflect the underlying dependence structure of the study objectives. In such cases, it would allow the further propagation of significance levels to be dependent on their origin and thus reflect the grouped parent-descendant structures of the hypotheses. We will give examples of such situations and show how to induce memory and other properties by convex combination of several individual graphs. The resulting entangled graphs provide an intuitive way to represent the underlying relative importance relationships between the hypotheses, are as easy to perform as the original individual graphs, remain sequentially rejective and control the familywise error rate in the strong sense. Copyright © 2012 John Wiley & Sons, Ltd.

Covered self-expandable metal stents for benign biliary tract diseases.

PubMed

Baron, Todd H

2011-05-01

Benign biliary diseases are often managed endoscopically using plastic stents. Benign biliary strictures (BBS) respond to placement of multiple large-bore plastic stents, though requiring multiple procedures to place stents, and to exchange stents to prevent and/or treat stent occlusion. Bile leaks close using plastic stents, which divert bile away from the leak into the duodenum. Covered self-expandable metal stents (CSEMS), intended for palliation of malignant biliary obstruction, have been used to treat benign biliary diseases. Advantages include small predeployment and large postexpansion diameters. Lack of imbedding of the metal into the bile duct wall enables removability. For strictures, one CSEMS is inserted without need for dilation and remains in place for up to 6 months. Successful removal has been reported in all cases. Long-term stricture resolution is achieved in up to 92%. Adverse events include migration and new stricture formation. For treatment of complex bile leaks, the covering and large diameter allow successful closure in nearly all cases. Other uses of CSEMS include treatment of postsphincterotomy bleeding and closure of perforations. CSEMS show promise for treatment of BBS and complex biliary leaks. Successful resolution can be achieved in the majority of patients with the advantage of fewer procedures, which offsets their higher cost.

Measurement accuracy of a stressed contact lens during its relaxation period

NASA Astrophysics Data System (ADS)

Compertore, David C.; Ignatovich, Filipp V.

2018-02-01

We examine the dioptric power and transmitted wavefront of a contact lens as it releases its handling stresses. Handling stresses are introduced as part of the contact lens loading process and are common across all contact lens measurement procedures and systems. The latest advances in vision correction require tighter quality control during the manufacturing of the contact lenses. The optical power of contact lenses is one of the critical characteristics for users. Power measurements are conducted in the hydrated state, where the lens is resting inside a solution-filled glass cuvette. In a typical approach, the contact lens must be subject to long settling times prior to any measurements. Alternatively, multiple measurements must be averaged. Apart from potential operator dependency of such approach, it is extremely time-consuming, and therefore it precludes higher rates of testing. Comprehensive knowledge about the settling process can be obtained by monitoring multiple parameters of the lens simultaneously. We have developed a system that combines co-aligned a Shack-Hartmann transmitted wavefront sensor and a time-domain low coherence interferometer to measure several optical and physical parameters (power, cylinder power, aberrations, center thickness, sagittal depth, and diameter) simultaneously. We monitor these parameters during the stress relaxation period and show correlations that can be used by manufacturers to devise methods for improved quality control procedures.

Factitious panniculitis induced by cupping therapy.

PubMed

Moon, Suk-Ho; Han, Hyun-Ho; Rhie, Jong-Won

2011-11-01

Cupping therapy is an alternative medical procedure that has been widely performed in Asian countries to relieve pain. It is known that there is no complication to this therapy, so many non-health care professionals have performed this procedure. However, there have been few reports on complications, such as iron deficiency anemia, hemorrhagic bullae, kelloids, vasovagal syncope, and foreign body reactions. Masses associated with panniculitis induced by cupping are extremely rare, and they require a unique approach.A 56-year-old woman presented with a 10-month history of multiple masses in the posterior neck and right shoulder areas. The patient repeatedly attempted cupping therapy by herself, and multiple palpable masses developed in the posterior neck and right shoulder area where cupping therapy had been performed. The masses were enlarged by repeated cupping, and they decreased in size when cupping was stopped. Among all lesions, the 2 masses with tenderness were surgically excised. The remaining masses resolved after cupping therapy was ceased. When a patient with subcutaneous mass has a history of cupping or trace of cupping marks, panniculitis induced by cupping should be suspected. The lesion seems to spontaneously resolve unless they are repeatedly stimulated. However, surgical resection is considered in patients with infections or severe tenderness as a complication.

Measures of Agreement Between Many Raters for Ordinal Classifications

PubMed Central

Nelson, Kerrie P.; Edwards, Don

2015-01-01

Screening and diagnostic procedures often require a physician's subjective interpretation of a patient's test result using an ordered categorical scale to define the patient's disease severity. Due to wide variability observed between physicians’ ratings, many large-scale studies have been conducted to quantify agreement between multiple experts’ ordinal classifications in common diagnostic procedures such as mammography. However, very few statistical approaches are available to assess agreement in these large-scale settings. Existing summary measures of agreement rely on extensions of Cohen's kappa [1 - 5]. These are prone to prevalence and marginal distribution issues, become increasingly complex for more than three experts or are not easily implemented. Here we propose a model-based approach to assess agreement in large-scale studies based upon a framework of ordinal generalized linear mixed models. A summary measure of agreement is proposed for multiple experts assessing the same sample of patients’ test results according to an ordered categorical scale. This measure avoids some of the key flaws associated with Cohen's kappa and its extensions. Simulation studies are conducted to demonstrate the validity of the approach with comparison to commonly used agreement measures. The proposed methods are easily implemented using the software package R and are applied to two large-scale cancer agreement studies. PMID:26095449

Effectiveness of CO2 laser with subcision in patients with acne scars.

PubMed

Anupama, Y G; Wahab, Afthab Jameela

2016-11-01

Post-acne facial scarring has always been a challenge to treat. It requires multiple therapeutic modalities as single modality is not hundred percent effective. Therefore, we have combined CO 2 laser resurfacing with subcision in patients with acne scars for better results. The aim is to study the effectiveness and side effects of CO 2 laser with subcision in patients with atrophic acne scars. Fifty patients were selected for the study. Baseline grading was done with Goodman and Baron grading system. Twenty-five patients were randomly selected for subcision followed by CO 2 laser and the remaining patients were selected for CO 2 laser alone. The treatment was done for four sessions at 4-week interval. Clinical photographs were obtained for evaluation. CO 2 laser with subcision showed excellent response in grade-2 and -3 acne scars. Statistically there is a significant difference between CO 2 laser following subcision and CO 2 laser alone at 5% level (p < 0.05). Both procedures were well tolerated with minimal side effects. The highly versatile CO 2 laser is useful for treating acne scars. Subcision prior to the CO 2 laser procedure showed better improvement when compared to CO 2 laser alone. Thus, in acne scars, multiple therapeutic modalities achieve better results.

Foramen magnum decompression for Chiari I malformation: a procedure not to be underestimated.

PubMed

Duddy, John Charles; Allcutt, David; Crimmins, Darach; O'Brien, David; O'Brien, Donncha Finbarr; Rawluk, Daniel; Sattar, Mohammed Taufiq; Young, Steven; Caird, John

2014-06-01

Chiari I malformation may be treated with foramen magnum decompression (FMD). We aim to describe the symptoms with which patients initially present, and to determine the number and type of complications occurring after FMD for Chiari I malformation. Retrospective review of medical records for patients who had FMD performed for Chiari I malformation between January 2009 and December 2011. Post-operative outcomes were recorded and analysed. Patient demographic details and other relevant medical conditions were also noted. Between January 2009 and December 2011, 54 FMDs were performed for Chiari I malformation. Among them, 40(74%) patients were female and 14 patients (26%) were male. The majority of patients (42.6%) were aged 16-39 years and 24.07% of patients were children aged < 16 years. A total of 30(55.6%) patients had documented evidence of a syrinx pre-operatively. 18(33.3%) patients developed complications. Nine of these developed multiple complications while nine had a single problem. One mortality was reported. Ten (18.5%) patients developed hydrocephalus requiring shunting. Two patients developed subdural collections requiring evacuation associated with hydrocephalus. Six (11.1%) patients developed post-operative infections: two CNS infections; one wound infection; and three other infections. FMD for Chiari I malformation is a procedure which carries risk. In particular, the risk of developing post-operative hydrocephalus requiring permanent shunting is relatively high. ICP monitoring prior to FMD may be required to definitively rule out raised intracranial pressure.

Multiple Testing of Gene Sets from Gene Ontology: Possibilities and Pitfalls.

PubMed

Meijer, Rosa J; Goeman, Jelle J

2016-09-01

The use of multiple testing procedures in the context of gene-set testing is an important but relatively underexposed topic. If a multiple testing method is used, this is usually a standard familywise error rate (FWER) or false discovery rate (FDR) controlling procedure in which the logical relationships that exist between the different (self-contained) hypotheses are not taken into account. Taking those relationships into account, however, can lead to more powerful variants of existing multiple testing procedures and can make summarizing and interpreting the final results easier. We will show that, from the perspective of interpretation as well as from the perspective of power improvement, FWER controlling methods are more suitable than FDR controlling methods. As an example of a possible power improvement, we suggest a modified version of the popular method by Holm, which we also implemented in the R package cherry. © The Author 2015. Published by Oxford University Press. For Permissions, please email: journals.permissions@oup.com.

Multiple personality disorder among female inpatients in a state hospital.

PubMed

Latz, T T; Kramer, S I; Hughes, D L

1995-09-01

Professional skepticism and concerns regarding diagnostic reliability hinder research in dissociative disorders and multiple personality disorder. The reported frequency of multiple personality disorder in different psychiatric settings ranges from 2.4% to 35%. The authors conducted a replication study of multiple personality disorder ascertainment in women admitted to a state hospital over a 5.5-month period. Responses to the Dissociative Experiences Scale and to the Dissociative Disorders Interview Schedule were obtained, along with data on length of stay, county of admission referral, admission commitment status, and discharge diagnoses, for 176 female inpatients in a state hospital. Of 421 women representing 483 consecutive admissions, 121 were discharged before they could be assessed for study, 64 were excluded, 60 declined to participate, 176 enrolled in the study, and 175 completed the research procedures. Twenty-one women (12%) met criteria for multiple personality disorder based on the Dissociative Disorders Interview Schedule; these women were significantly younger than the women without multiple personality disorder. Scores on the Dissociative Experiences Scale of the women with multiple personality disorder (mean = 59.5, SD = 19.6) were significantly higher than the scores of women without multiple personality disorder (mean = 22.5, SD = 20.1), but considerable overlap occurred. There was no significant difference between groups in length of stay or admission status. The authors conclude that 1) the wide variability in multiple personality disorder detection is partially due to site-specific ascertainment biases and 2) despite its apparent usefulness for screening purposes, the Dissociative Experiences Scale requires more comprehensive evaluation before it can be applied broadly.

Basics of kidney biopsy: A nephrologist's perspective

PubMed Central

Agarwal, S. K.; Sethi, S.; Dinda, A. K.

2013-01-01

The introduction of the kidney biopsy is one of the major events in the history of nephrology. Primary indications of kidney biopsy are glomerular hematuria/proteinuria with or without renal dysfunction and unexplained renal failure. Kidney biopsy is usually performed in prone position but in certain situations, supine and lateral positions may be required. Biopsy needles have changed with times from Vim–Silverman needle to Tru-cut needle to spring-loaded automatic gun. The procedure has also changed from blind bedside kidney biopsy to ultrasound marking to real-time ultrasound guidance to rarely computerized tomography guidance and laparoscopic and open biopsy. In very specific situations, transjugular kidney biopsy may be required. Most of the centers do kidney biopsy on short 1-day admission, whereas some take it as an outdoor procedure. For critical interpretation of kidney biopsy, adequate sample and clinical information are mandatory. Tissue needs to be stained with multiple stains for delineation of various components of kidney tissue. Many consider that electron microscopy (EM) is a must for all kidney biopsies, but facilities for EM are limited even in big centers. Sophisticated tests such as immunohistochemistry and in-situ hybridization are useful adjuncts for definitive diagnosis in certain situations. PMID:23960337

Safety and efficacy of office-based surgery with monitored anesthesia care/sedation in 4778 consecutive plastic surgery procedures.

PubMed

Bitar, George; Mullis, William; Jacobs, William; Matthews, David; Beasley, Michael; Smith, Kevin; Watterson, Paul; Getz, Stanley; Capizzi, Peter; Eaves, Felmont

2003-01-01

Office-based surgery has several potential benefits over hospital-based surgery, including cost containment, ease of scheduling, and convenience to both patients and surgeons. Scrutiny of office-based surgery by regulators and state-licensing agencies has increased and must be addressed by improved documentation of safety and efficacy. To evaluate the safety and efficacy of the authors' office-based plastic surgery, a review was undertaken of 3615 consecutive patients undergoing 4778 outpatient plastic surgery procedures under monitored anesthesia care/sedation in a single office. The charts of 3615 consecutive patients who had undergone office-based surgery with monitored anesthesia care/sedation between May of 1995 and May of 2000 were reviewed. In all cases, the anesthesia protocol used included sedation with midazolam, propofol, and a narcotic administered by a board-certified registered nurse anesthetist with local anesthesia provided by the surgeon. Charts were reviewed for patient profile, types of procedures, multiple procedures, duration of anesthesia, American Society of Anesthesiologists class, and complications related to anesthesia. Outcomes measured included death, airway compromise, dyspnea, hypotension, venous thrombosis, pulmonary emboli, protracted nausea and vomiting lasting more than 24 hours, and unplanned hospital admissions. Statistical analyses were performed using the Microsoft Excel program and the SAS package. Results were as follows: 92.3 percent of the patients were female and 7.7 percent were male, with a mean age of 42.7 years (range, 3 to 83 years). Patients underwent aesthetic (95.6 percent) and reconstructive (4.4 percent) plastic surgery procedures. Same-session multiple procedures occurred in 24.8 percent of patients. The vast majority of patients were healthy: 84.3 percent of patients were American Society of Anesthesiologists class I, 15.6 percent were class II, and 0.1 percent were class III. The operations required a mean of 111 minutes. There were no deaths, ventilator requirements, deep venous thromboses, or pulmonary emboli. Complications were as follows: 0.05 percent (n = 2) of patients had dyspnea that resolved, 0.2 percent (n = 6) of patients had protracted nausea and vomiting, and 0.05 percent (n = 2) of patients had unplanned hospital admissions (<24 hours). One patient had an emergent intubation. No prolonged adverse effects were noted. There was a 30-day follow-up minimum. Outpatient surgery is an important aspect of plastic surgery. It was shown that office-based surgery with intravenous sedation, performed by board-certified plastic surgeons and nurse anesthetists, is safe. Appropriate accreditation, safe anesthesia protocols, and proper patient selection constitute the basis for safe and efficacious office-based outpatient plastic surgery.

Endodontic flare-ups: comparison of incidence between single and multiple visit procedures in patients attending a Nigerian teaching hospital.

PubMed

Oginni, Adeleke O; Udoye, Christopher I

2004-11-26

BACKGROUND: Until recently the most accepted technique of doing root canal treatment stresses multiple visit procedure. Most schools also concentrated upon teaching the multi-visit concept. However, it has now been reported that the procedure of single visit treatment is advocated by at least 70% of schools in all geographical areas. It was therefore the aims of the present study to find the incidence of post-obturation flare-ups following single and multiple visit endodontic treatment procedures, and to establish the relationship between pre-operative and post-obturation pain in patients referred for endodontic therapy in a Nigerian teaching Hospital. METHODS: Data collected included pulp vitality status, the presence or absence of pre-operative, inter-appointment and post-obturation pain. Pain was recorded as none, slight, or moderate/severe. Flare-ups were defined as either patient's report of pain not controlled with over the counter medication or as increasing swelling. The patients were recalled at three specific post-obturation periods, 1st, 7th and 30th day. The presence or absence of pain, or the appropriate degree of pain was recorded for each recall visits and the interval between visits. The compiled data were analysed using chi-square where applicable. P level

Disruptive effects of prefeeding and haloperidol administration on multiple measures of food-maintained behavior in rats

PubMed Central

Hayashi, Yusuke; Wirth, Oliver

2015-01-01

Four rats responded under a choice reaction-time procedure. At the beginning of each trial, the rats were required to hold down a center lever for a variable duration, release it following a high- or low-pitched tone, and press either a left or right lever, conditionally on the tone. Correct choices were reinforced with a probability of .95 or .05 under blinking or static houselights, respectively. After performance stabilized, disruptive effects of free access to food pellets prior to sessions (prefeeding) and intraperitoneal injection of haloperidol were examined on multiple behavioral measures (i.e., the number of trials completed, percent of correct responses, and reaction time). Resistance to prefeeding depended on the probability of food delivery for the number of trials completed and reaction time. Resistance to haloperidol, on the other hand, was not systematically affected by the probability of food delivery for all dependent measures. PMID:22209910

The FORE-SCE model: a practical approach for projecting land cover change using scenario-based modeling

USGS Publications Warehouse

Sohl, Terry L.; Sayler, Kristi L.; Drummond, Mark A.; Loveland, Thomas R.

2007-01-01

A wide variety of ecological applications require spatially explicit, historic, current, and projected land use and land cover data. The U.S. Land Cover Trends project is analyzing contemporary (1973–2000) land-cover change in the conterminous United States. The newly developed FORE-SCE model used Land Cover Trends data and theoretical, statistical, and deterministic modeling techniques to project future land cover change through 2020 for multiple plausible scenarios. Projected proportions of future land use were initially developed, and then sited on the lands with the highest potential for supporting that land use and land cover using a statistically based stochastic allocation procedure. Three scenarios of 2020 land cover were mapped for the western Great Plains in the US. The model provided realistic, high-resolution, scenario-based land-cover products suitable for multiple applications, including studies of climate and weather variability, carbon dynamics, and regional hydrology.

Using a Cray Y-MP as an array processor for a RISC Workstation

NASA Technical Reports Server (NTRS)

Lamaster, Hugh; Rogallo, Sarah J.

1992-01-01

As microprocessors increase in power, the economics of centralized computing has changed dramatically. At the beginning of the 1980's, mainframes and super computers were often considered to be cost-effective machines for scalar computing. Today, microprocessor-based RISC (reduced-instruction-set computer) systems have displaced many uses of mainframes and supercomputers. Supercomputers are still cost competitive when processing jobs that require both large memory size and high memory bandwidth. One such application is array processing. Certain numerical operations are appropriate to use in a Remote Procedure Call (RPC)-based environment. Matrix multiplication is an example of an operation that can have a sufficient number of arithmetic operations to amortize the cost of an RPC call. An experiment which demonstrates that matrix multiplication can be executed remotely on a large system to speed the execution over that experienced on a workstation is described.

Software-defined networking control plane for seamless integration of multiple silicon photonic switches in Datacom networks.

PubMed

Shen, Yiwen; Hattink, Maarten H N; Samadi, Payman; Cheng, Qixiang; Hu, Ziyiz; Gazman, Alexander; Bergman, Keren

2018-04-16

Silicon photonics based switches offer an effective option for the delivery of dynamic bandwidth for future large-scale Datacom systems while maintaining scalable energy efficiency. The integration of a silicon photonics-based optical switching fabric within electronic Datacom architectures requires novel network topologies and arbitration strategies to effectively manage the active elements in the network. We present a scalable software-defined networking control plane to integrate silicon photonic based switches with conventional Ethernet or InfiniBand networks. Our software-defined control plane manages both electronic packet switches and multiple silicon photonic switches for simultaneous packet and circuit switching. We built an experimental Dragonfly network testbed with 16 electronic packet switches and 2 silicon photonic switches to evaluate our control plane. Observed latencies occupied by each step of the switching procedure demonstrate a total of 344 µs control plane latency for data-center and high performance computing platforms.

Development of an Immunochromatography Assay (QuickNavi-Ebola) to Detect Multiple Species of Ebolaviruses

PubMed Central

Yoshida, Reiko; Muramatsu, Shino; Akita, Hiroshi; Saito, Yuji; Kuwahara, Miwa; Kato, Daisuke; Changula, Katendi; Miyamoto, Hiroko; Kajihara, Masahiro; Manzoor, Rashid; Furuyama, Wakako; Marzi, Andrea; Feldmann, Heinz; Mweene, Aaron; Masumu, Justin; Kapeteshi, Jimmy; Muyembe-Tamfum, Jean-Jacques; Takada, Ayato

2016-01-01

The latest outbreak of Ebola virus disease (EVD) in West Africa has highlighted the urgent need for the development of rapid and reliable diagnostic assays. We used monoclonal antibodies specific to the ebolavirus nucleoprotein to develop an immunochromatography (IC) assay (QuickNavi-Ebola) for rapid diagnosis of EVD. The IC assay was first evaluated with tissue culture supernatants of infected Vero E6 cells and found to be capable of detecting 103–104 focus-forming units/mL of ebolaviruses. Using serum samples from experimentally infected nonhuman primates, we confirmed that the assay could detect the viral antigen shortly after disease onset. It was also noted that multiple species of ebolaviruses could be detected by the IC assay. Owing to the simplicity of the assay procedure and absence of requirements for special equipment and training, QuickNavi-Ebola is expected to be a useful tool for rapid diagnosis of EVD. PMID:27462094

Multiplicative Thinking: Much More than Knowing Multiplication Facts and Procedures

ERIC Educational Resources Information Center

Hurst, Chris; Hurrell, Derek

2016-01-01

Multiplicative thinking is accepted as a "big idea" of mathematics that underpins important mathematical concepts such as fraction understanding, proportional reasoning, and algebraic thinking. It is characterised by understandings such as the multiplicative relationship between places in the number system, basic and extended number…

Developing Procedural Flexibility: Are Novices Prepared to Learn from Comparing Procedures?

ERIC Educational Resources Information Center

Rittle-Johnson, Bethany; Star, Jon R.; Durkin, Kelley

2012-01-01

Background: A key learning outcome in problem-solving domains is the development of procedural flexibility, where learners know multiple procedures and use them appropriately to solve a range of problems (e.g., Verschaffel, Luwel, Torbeyns, & Van Dooren, 2009). However, students often fail to become flexible problem solvers in mathematics. To…

Complications of endoscopic dilation for esophageal stenosis after endoscopic submucosal dissection of superficial esophageal cancer.

PubMed

Kishida, Yoshihiro; Kakushima, Naomi; Kawata, Noboru; Tanaka, Masaki; Takizawa, Kohei; Imai, Kenichiro; Hotta, Kinichi; Matsubayashi, Hiroyuki; Ono, Hiroyuki

2015-10-01

Endoscopic dilation (ED) is used for the treatment of benign strictures caused by reflux esophagitis or anastomotic stenosis after esophagectomy. Esophageal stenosis is a major complication after endoscopic submucosal dissection (ESD) of large superficial esophageal cancer, but little is known regarding the incidence of complications of ED for stenosis caused by esophageal ESD. This was a retrospective study conducted at a single institution. From September 2002 to December 2012, a total of 1,337 ED procedures were performed for stenosis after esophageal ESD in 121 patients. The incidence of complications of ED and related clinical characteristics were analyzed. The incidence of bleeding was 0.8 % (1/121) per patient and 0.07 % (1/1,337) per procedure. The incidence of perforation was 4.1 % (5/121) per patient and 0.37 % (5/1,337) per procedure. Perforation occurred at a median of third time of ED procedures (range 2-9 procedures) and at a median of 18 days (range 8-29 days) after ESD. There were no significant characteristics correlated to perforation, such as location, circumferential extent, or diameter of mucosal defect after ESD. The total number of ED procedures was significantly larger among perforation cases (37, range 6-57) compared with those without perforation (7, range 1-70) (p = 0.01), and the treatment duration tended to be longer (190 vs. 69 days, respectively). The incidence of bleeding caused by ED for esophageal stenosis after ESD was very low. Relevant risk of perforation should be considered for patients requiring multiple ED procedures.

Statistical procedures for determination and verification of minimum reporting levels for drinking water methods.

PubMed

Winslow, Stephen D; Pepich, Barry V; Martin, John J; Hallberg, George R; Munch, David J; Frebis, Christopher P; Hedrick, Elizabeth J; Krop, Richard A

2006-01-01

The United States Environmental Protection Agency's Office of Ground Water and Drinking Water has developed a single-laboratory quantitation procedure: the lowest concentration minimum reporting level (LCMRL). The LCMRL is the lowest true concentration for which future recovery is predicted to fall, with high confidence (99%), between 50% and 150%. The procedure takes into account precision and accuracy. Multiple concentration replicates are processed through the entire analytical method and the data are plotted as measured sample concentration (y-axis) versus true concentration (x-axis). If the data support an assumption of constant variance over the concentration range, an ordinary least-squares regression line is drawn; otherwise, a variance-weighted least-squares regression is used. Prediction interval lines of 99% confidence are drawn about the regression. At the points where the prediction interval lines intersect with data quality objective lines of 50% and 150% recovery, lines are dropped to the x-axis. The higher of the two values is the LCMRL. The LCMRL procedure is flexible because the data quality objectives (50-150%) and the prediction interval confidence (99%) can be varied to suit program needs. The LCMRL determination is performed during method development only. A simpler procedure for verification of data quality objectives at a given minimum reporting level (MRL) is also presented. The verification procedure requires a single set of seven samples taken through the entire method procedure. If the calculated prediction interval is contained within data quality recovery limits (50-150%), the laboratory performance at the MRL is verified.

Multiprocessing on supercomputers for computational aerodynamics

NASA Technical Reports Server (NTRS)

Yarrow, Maurice; Mehta, Unmeel B.

1990-01-01

Very little use is made of multiple processors available on current supercomputers (computers with a theoretical peak performance capability equal to 100 MFLOPs or more) in computational aerodynamics to significantly improve turnaround time. The productivity of a computer user is directly related to this turnaround time. In a time-sharing environment, the improvement in this speed is achieved when multiple processors are used efficiently to execute an algorithm. The concept of multiple instructions and multiple data (MIMD) through multi-tasking is applied via a strategy which requires relatively minor modifications to an existing code for a single processor. Essentially, this approach maps the available memory to multiple processors, exploiting the C-FORTRAN-Unix interface. The existing single processor code is mapped without the need for developing a new algorithm. The procedure for building a code utilizing this approach is automated with the Unix stream editor. As a demonstration of this approach, a Multiple Processor Multiple Grid (MPMG) code is developed. It is capable of using nine processors, and can be easily extended to a larger number of processors. This code solves the three-dimensional, Reynolds averaged, thin-layer and slender-layer Navier-Stokes equations with an implicit, approximately factored and diagonalized method. The solver is applied to generic oblique-wing aircraft problem on a four processor Cray-2 computer. A tricubic interpolation scheme is developed to increase the accuracy of coupling of overlapped grids. For the oblique-wing aircraft problem, a speedup of two in elapsed (turnaround) time is observed in a saturated time-sharing environment.

Closed bore XMR (CBXMR) systems for aortic valve replacement: Active magnetic shielding of x-ray tubes

PubMed Central

Bracken, John A.; DeCrescenzo, Giovanni; Komljenovic, Philip; Lillaney, Prasheel V.; Fahrig, Rebecca; Rowlands, J. A.

2009-01-01

Hybrid closed bore x-ray∕MRI systems are being developed to improve the safety and efficacy of percutaneous aortic valve replacement procedures by harnessing the complementary strengths of the x-ray and MRI modalities in a single interventional suite without requiring patient transfer between two rooms. These systems are composed of an x-ray C-arm in close proximity (≈1 m) to an MRI scanner. The MRI magnetic fringe field can cause the electron beam in the x-ray tube to deflect. The deflection causes the x-ray field of view to shift position on the detector receptacle. This could result in unnecessary radiation exposure to the patient and the staff in the cardiac catheterization laboratory. Therefore, the electron beam deflection must be corrected. The authors developed an active magnetic shielding system that can correct for electron beam deflection to within an accuracy of 5% without truncating the field of view or increasing exposure to the patient. This system was able to automatically adjust to different field strengths as the external magnetic field acting on the x-ray tube was changed. Although a small torque was observed on the shielding coils of the active shielding system when they were placed in a magnetic field, this torque will not impact their performance if they are securely mounted on the x-ray tube and the C-arm. The heating of the coils of the shielding system for use in the clinic caused by electric current was found to be slow enough not to require a dedicated cooling system for one percutaneous aortic valve replacement procedure. However, a cooling system will be required if multiple procedures are performed in one session. PMID:19544789

Closed bore XMR (CBXMR) systems for aortic valve replacement: active magnetic shielding of x-ray tubes.

PubMed

Bracken, John A; DeCrescenzo, Giovanni; Komljenovic, Philip; Lillaney, Prasheel V; Fahrig, Rebecca; Rowlands, J A

2009-05-01

Hybrid closed bore x-ray/MRI systems are being developed to improve the safety and efficacy of percutaneous aortic valve replacement procedures by harnessing the complementary strengths of the x-ray and MRI modalities in a single interventional suite without requiring patient transfer between two rooms. These systems are composed of an x-ray C-arm in close proximity (approximately 1 m) to an MRI scanner. The MRI magnetic fringe field can cause the electron beam in the x-ray tube to deflect. The deflection causes the x-ray field of view to shift position on the detector receptacle. This could result in unnecessary radiation exposure to the patient and the staff in the cardiac catheterization laboratory. Therefore, the electron beam deflection must be corrected. The authors developed an active magnetic shielding system that can correct for electron beam deflection to within an accuracy of 5% without truncating the field of view or increasing exposure to the patient. This system was able to automatically adjust to different field strengths as the external magnetic field acting on the x-ray tube was changed. Although a small torque was observed on the shielding coils of the active shielding system when they were placed in a magnetic field, this torque will not impact their performance if they are securely mounted on the x-ray tube and the C-arm. The heating of the coils of the shielding system for use in the clinic caused by electric current was found to be slow enough not to require a dedicated cooling system for one percutaneous aortic valve replacement procedure. However, a cooling system will be required if multiple procedures are performed in one session.

Multiple objective optimization in reliability demonstration test

DOE PAGES

Lu, Lu; Anderson-Cook, Christine Michaela; Li, Mingyang

2016-10-01

Reliability demonstration tests are usually performed in product design or validation processes to demonstrate whether a product meets specified requirements on reliability. For binomial demonstration tests, the zero-failure test has been most commonly used due to its simplicity and use of minimum sample size to achieve an acceptable consumer’s risk level. However, this test can often result in unacceptably high risk for producers as well as a low probability of passing the test even when the product has good reliability. This paper explicitly explores the interrelationship between multiple objectives that are commonly of interest when planning a demonstration test andmore » proposes structured decision-making procedures using a Pareto front approach for selecting an optimal test plan based on simultaneously balancing multiple criteria. Different strategies are suggested for scenarios with different user priorities and graphical tools are developed to help quantify the trade-offs between choices and to facilitate informed decision making. As a result, potential impacts of some subjective user inputs on the final decision are studied to offer insights and useful guidance for general applications.« less

An urban observatory for quantifying phosphorus and suspended solid loads in combined natural and stormwater conveyances.

PubMed

Melcher, Anthony A; Horsburgh, Jeffery S

2017-06-01

Water quality in urban streams and stormwater systems is highly dynamic, both spatially and temporally, and can change drastically during storm events. Infrequent grab samples commonly collected for estimating pollutant loadings are insufficient to characterize water quality in many urban water systems. In situ water quality measurements are being used as surrogates for continuous pollutant load estimates; however, relatively few studies have tested the validity of surrogate indicators in urban stormwater conveyances. In this paper, we describe an observatory aimed at demonstrating the infrastructure required for surrogate monitoring in urban water systems and for capturing the dynamic behavior of stormwater-driven pollutant loads. We describe the instrumentation of multiple, autonomous water quality and quantity monitoring sites within an urban observatory. We also describe smart and adaptive sampling procedures implemented to improve data collection for developing surrogate relationships and for capturing the temporal and spatial variability of pollutant loading events in urban watersheds. Results show that the observatory is able to capture short-duration storm events within multiple catchments and, through inter-site communication, sampling efforts can be synchronized across multiple monitoring sites.

Comparative Microbial Modules Resource: Generation and Visualization of Multi-species Biclusters

PubMed Central

Bate, Ashley; Eichenberger, Patrick; Bonneau, Richard

2011-01-01

The increasing abundance of large-scale, high-throughput datasets for many closely related organisms provides opportunities for comparative analysis via the simultaneous biclustering of datasets from multiple species. These analyses require a reformulation of how to organize multi-species datasets and visualize comparative genomics data analyses results. Recently, we developed a method, multi-species cMonkey, which integrates heterogeneous high-throughput datatypes from multiple species to identify conserved regulatory modules. Here we present an integrated data visualization system, built upon the Gaggle, enabling exploration of our method's results (available at http://meatwad.bio.nyu.edu/cmmr.html). The system can also be used to explore other comparative genomics datasets and outputs from other data analysis procedures – results from other multiple-species clustering programs or from independent clustering of different single-species datasets. We provide an example use of our system for two bacteria, Escherichia coli and Salmonella Typhimurium. We illustrate the use of our system by exploring conserved biclusters involved in nitrogen metabolism, uncovering a putative function for yjjI, a currently uncharacterized gene that we predict to be involved in nitrogen assimilation. PMID:22144874

Comparative microbial modules resource: generation and visualization of multi-species biclusters.

PubMed

Kacmarczyk, Thadeous; Waltman, Peter; Bate, Ashley; Eichenberger, Patrick; Bonneau, Richard

2011-12-01

The increasing abundance of large-scale, high-throughput datasets for many closely related organisms provides opportunities for comparative analysis via the simultaneous biclustering of datasets from multiple species. These analyses require a reformulation of how to organize multi-species datasets and visualize comparative genomics data analyses results. Recently, we developed a method, multi-species cMonkey, which integrates heterogeneous high-throughput datatypes from multiple species to identify conserved regulatory modules. Here we present an integrated data visualization system, built upon the Gaggle, enabling exploration of our method's results (available at http://meatwad.bio.nyu.edu/cmmr.html). The system can also be used to explore other comparative genomics datasets and outputs from other data analysis procedures - results from other multiple-species clustering programs or from independent clustering of different single-species datasets. We provide an example use of our system for two bacteria, Escherichia coli and Salmonella Typhimurium. We illustrate the use of our system by exploring conserved biclusters involved in nitrogen metabolism, uncovering a putative function for yjjI, a currently uncharacterized gene that we predict to be involved in nitrogen assimilation. © 2011 Kacmarczyk et al.

Contact laser prostatectomy in a patient on chronic anticoagulation

NASA Astrophysics Data System (ADS)

Mueller, Edward J.

1995-05-01

The `gold standard' therapy for patients with symptomatic bladder outlet obstruction secondary to benign prostatic hyperplasia has always been electrocautery TURP. However, in patients with medical problems requiring chronic anticoagulation, this procedure is contraindicated due to the extreme risk of hemorrhage, both during the procedure and the immediate post operative period. With the recent development of contact laser prostatectomy the patient on chronic anticoagulation can safely undergo the procedure. Herein, I present a case of a 60 year old with significant bladder outlet obstruction yielding an AUA symptom score of 18. The patient had a history of multiple episodes of deep venous thrombosis of the left leg with three prior pulmonary emboli. He was maintained on chronic anticoagulation with alternating days of 3.5 mg. and 5.0 mg. of warfarin sodium (coumadin). Preoperative cystoscopy showed a 4 cm prostatic fossa obstructed by tri-lobar hypertrophy, with large kissing lateral lobes and visual obstruction from the verumontanum. The patient underwent a contact laser prostatectomy with the SLT Nd:YAG laser at 50 watts. There was minimal bleeding both during the procedure and in the immediate postoperative period. At three months post-op the AUA symptom score had decreased to 2. This case demonstrated that contact laser prostatectomy can be safely and effectively performed in patients on chronic anticoagulation.

Inducing mental set constrains procedural flexibility and conceptual understanding in mathematics.

PubMed

DeCaro, Marci S

2016-10-01

An important goal in mathematics is to flexibly use and apply multiple, efficient procedures to solve problems and to understand why these procedures work. One factor that may limit individuals' ability to notice and flexibly apply strategies is the mental set induced by the problem context. Undergraduate (N = 41, Experiment 1) and fifth- and sixth-grade students (N = 87, Experiment 2) solved mathematical equivalence problems in one of two set-inducing conditions. Participants in the complex-first condition solved problems without a repeated addend on both sides of the equal sign (e.g., 7 + 5 + 9 = 3 + _), which required multistep strategies. Then these students solved problems with a repeated addend (e.g., 7 + 5 + 9 = 7 + _), for which a shortcut strategy could be readily used (i.e., adding 5 + 9). Participants in the shortcut-first condition solved the same problem set but began with the shortcut problems. Consistent with laboratory studies of mental set, participants in the complex-first condition were less likely to use the more efficient shortcut strategy when possible. In addition, these participants were less likely to demonstrate procedural flexibility and conceptual understanding on a subsequent assessment of mathematical equivalence knowledge. These findings suggest that certain problem-solving contexts can help or hinder both flexibility in strategy use and deeper conceptual thinking about the problems.

Using Simultaneous Prompting Procedure to Promote Recall of Multiplication Facts by Middle School Students with Cognitive Impairment

ERIC Educational Resources Information Center

Rao, Shaila; Mallow, Lynette

2009-01-01

This study examined effectiveness of simultaneous prompting system in teaching students with cognitive impairment to automate recall of multiplication facts. A multiple probes design with multiple sets of math facts and replicated across multiple subjects was used to assess effectiveness of simultaneous prompting on recall of basic multiplication…

Effects of Mathematics Computer Games on Special Education Students' Multiplicative Reasoning Ability

ERIC Educational Resources Information Center

Bakker, Marjoke; van den Heuvel-Panhuizen, Marja; Robitzsch, Alexander

2016-01-01

This study examined the effects of a teacher-delivered intervention with online mathematics mini-games on special education students' multiplicative reasoning ability (multiplication and division). The games involved declarative, procedural, as well as conceptual knowledge of multiplicative relations, and were accompanied with teacher-led lessons…

The role of response force on the persistence and structure of behavior during extinction.

PubMed

Pinkston, Jonathan W; Foss, Erica K

2018-01-01

Behavior Momentum Theory has emerged as a prominent account of resistance to change in both basic and applied research. Although laboratory studies often define precise, repeatable responses, application research often deals with response classes that may vary widely along a number of dimensions. In general, Behavior Momentum Theory has not addressed how response dimensions impact resistance to change, providing an opportunity to expand the model in new directions. Four rats pressed a force transducer under a multiple variable interval (VI) 60-s VI 60-s schedule of reinforcement. In one component, responses satisfied the schedule only if the response force fell within a "low" force band requirement; responses in the other schedule were required to satisfy a "high" force band. Once responding stabilized, extinction was programmed for three sessions. Then, the procedures were replicated. The results showed that response force came under discriminative control, but force requirements had no impact on resistance to extinction. In a follow-up condition, the schedule was changed to a multiple VI 30-s VI 120-s schedule and the low-force band operated in both components. The results showed that behavior maintained by the VI 30-s schedule was generally more resistant to extinction. A secondary analysis showed that force distributions created under baseline maintained during extinction. Overall, the results suggest that differential response force requirements prevailing in steady state do not affect the course of extinction. © 2018 Society for the Experimental Analysis of Behavior.

Multiple Replica Repulsion Technique for Efficient Conformational Sampling of Biological Systems

PubMed Central

Malevanets, Anatoly; Wodak, Shoshana J.

2011-01-01

Here, we propose a technique for sampling complex molecular systems with many degrees of freedom. The technique, termed “multiple replica repulsion” (MRR), does not suffer from poor scaling with the number of degrees of freedom associated with common replica exchange procedures and does not require sampling at high temperatures. The algorithm involves creation of multiple copies (replicas) of the system, which interact with one another through a repulsive potential that can be applied to the system as a whole or to portions of it. The proposed scheme prevents oversampling of the most populated states and provides accurate descriptions of conformational perturbations typically associated with sampling ground-state energy wells. The performance of MRR is illustrated for three systems of increasing complexity. A two-dimensional toy potential surface is used to probe the sampling efficiency as a function of key parameters of the procedure. MRR simulations of the Met-enkephalin pentapeptide, and the 76-residue protein ubiquitin, performed in presence of explicit water molecules and totaling 32 ns each, investigate the ability of MRR to characterize the conformational landscape of the peptide, and the protein native basin, respectively. Results obtained for the enkephalin peptide reflect more closely the extensive conformational flexibility of this peptide than previously reported simulations. Those obtained for ubiquitin show that conformational ensembles sampled by MRR largely encompass structural fluctuations relevant to biological recognition, which occur on the microsecond timescale, or are observed in crystal structures of ubiquitin complexes with other proteins. MRR thus emerges as a very promising simple and versatile technique for modeling the structural plasticity of complex biological systems. PMID:21843487

Remotely-supervised transcranial direct current stimulation (tDCS) for clinical trials: guidelines for technology and protocols.

PubMed

Charvet, Leigh E; Kasschau, Margaret; Datta, Abhishek; Knotkova, Helena; Stevens, Michael C; Alonzo, Angelo; Loo, Colleen; Krull, Kevin R; Bikson, Marom

2015-01-01

The effect of transcranial direct current stimulation (tDCS) is cumulative. Treatment protocols typically require multiple consecutive sessions spanning weeks or months. However, traveling to clinic for a tDCS session can present an obstacle to subjects and their caregivers. With modified devices and headgear, tDCS treatment can be administered remotely under clinical supervision, potentially enhancing recruitment, throughput, and convenience. Here we propose standards and protocols for clinical trials utilizing remotely-supervised tDCS with the goal of providing safe, reproducible and well-tolerated stimulation therapy outside of the clinic. The recommendations include: (1) training of staff in tDCS treatment and supervision; (2) assessment of the user's capability to participate in tDCS remotely; (3) ongoing training procedures and materials including assessments of the user and/or caregiver; (4) simple and fail-safe electrode preparation techniques and tDCS headgear; (5) strict dose control for each session; (6) ongoing monitoring to quantify compliance (device preparation, electrode saturation/placement, stimulation protocol), with corresponding corrective steps as required; (7) monitoring for treatment-emergent adverse effects; (8) guidelines for discontinuation of a session and/or study participation including emergency failsafe procedures tailored to the treatment population's level of need. These guidelines are intended to provide a minimal level of methodological rigor for clinical trials seeking to apply tDCS outside a specialized treatment center. We outline indication-specific applications (Attention Deficit Hyperactivity Disorder, Depression, Multiple Sclerosis, Palliative Care) following these recommendations that support a standardized framework for evaluating the tolerability and reproducibility of remote-supervised tDCS that, once established, will allow for translation of tDCS clinical trials to a greater size and range of patient populations.

Open total gastrectomy with Roux-en-Y reconstruction for a chronic fistula after sleeve gastrectomy.

PubMed

Bruzzi, Matthieu; Douard, Richard; Voron, Thibault; Berger, Anne; Zinzindohoue, Franck; Chevallier, Jean-Marc

2016-12-01

Surgery appears to be the best treatment option for a chronic fistula after laparoscopic sleeve gastrectomy (LSG). Conservative procedures (conversion into a Roux-en-Y gastric bypass, Roux-limb placement) have proven their feasibility and efficacy, but an open total gastrectomy (TG) is sometimes required in challenging situations. To assess outcomes from 12 consecutive patients who underwent surgery for a post-sleeve gastrectomy chronic fistula (PSGCF) between January 2004 and February 2012. University public hospital, France. Patients with a PSGCF who underwent surgery were included in this retrospective study. Mortality, morbidity (i.e., Clavien-Dindo score), weight loss, and nutritional status were assessed. Twelve of 57 patients (21%) with a post-LSG leak developed a PSGCF. There were 3 men (25%). Mean age was 39±9 years and mean preoperative body mass index was 35±5 kg/m 2 . All 12 patients underwent an open total gastrectomy with an esojejunostomy (TG). Conservative procedures were considered but not possible. The mean follow-up period was 38±11 months. The mean delay between LSG and TG was 12±6 months. Intraoperative discovery of multiple (>2) gastric fistulas was reported in 9 patients (75%). There were no deaths, but morbidity rate was 50%. Early postoperative fistula occurred in 3 patients (anastomosis n = 1, duodenal stump n = 2). None of these patients required further surgery. The median healing time of the fistula was 37 days (range 24-53). Promising results from weight loss and nutritional status were found at the end of the follow-up. A salvage open TG is a well-tolerated and reproducible salvage procedure for cases of a PSGCF, when conservative procedures are not possible. Copyright © 2016 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

Generalized Cartographic and Simultaneous Representation of Utility Networks for Decision-Support Systems and Crisis Management in Urban Environments

NASA Astrophysics Data System (ADS)

Becker, T.; König, G.

2015-10-01

Cartographic visualizations of crises are used to create a Common Operational Picture (COP) and enforce Situational Awareness by presenting relevant information to the involved actors. As nearly all crises affect geospatial entities, geo-data representations have to support location-specific analysis throughout the decision-making process. Meaningful cartographic presentation is needed for coordinating the activities of crisis manager in a highly dynamic situation, since operators' attention span and their spatial memories are limiting factors during the perception and interpretation process. Situational Awareness of operators in conjunction with a COP are key aspects in decision-making process and essential for making well thought-out and appropriate decisions. Considering utility networks as one of the most complex and particularly frequent required systems in urban environment, meaningful cartographic presentation of multiple utility networks with respect to disaster management do not exist. Therefore, an optimized visualization of utility infrastructure for emergency response procedures is proposed. The article will describe a conceptual approach on how to simplify, aggregate, and visualize multiple utility networks and their components to meet the requirements of the decision-making process and to support Situational Awareness.

Integrated aerodynamic/dynamic optimization of helicopter rotor blades

NASA Technical Reports Server (NTRS)

Chattopadhyay, Aditi; Walsh, Joanne L.; Riley, Michael F.

1989-01-01

An integrated aerodynamic/dynamic optimization procedure is used to minimize blade weight and 4 per rev vertical hub shear for a rotor blade in forward flight. The coupling of aerodynamics and dynamics is accomplished through the inclusion of airloads which vary with the design variables during the optimization process. Both single and multiple objective functions are used in the optimization formulation. The Global Criteria Approach is used to formulate the multiple objective optimization and results are compared with those obtained by using single objective function formulations. Constraints are imposed on natural frequencies, autorotational inertia, and centrifugal stress. The program CAMRAD is used for the blade aerodynamic and dynamic analyses, and the program CONMIN is used for the optimization. Since the spanwise and the azimuthal variations of loading are responsible for most rotor vibration and noise, the vertical airload distributions on the blade, before and after optimization, are compared. The total power required by the rotor to produce the same amount of thrust for a given area is also calculated before and after optimization. Results indicate that integrated optimization can significantly reduce the blade weight, the hub shear and the amplitude of the vertical airload distributions on the blade and the total power required by the rotor.

An Authentication Protocol for Future Sensor Networks.

PubMed

Bilal, Muhammad; Kang, Shin-Gak

2017-04-28

Authentication is one of the essential security services in Wireless Sensor Networks (WSNs) for ensuring secure data sessions. Sensor node authentication ensures the confidentiality and validity of data collected by the sensor node, whereas user authentication guarantees that only legitimate users can access the sensor data. In a mobile WSN, sensor and user nodes move across the network and exchange data with multiple nodes, thus experiencing the authentication process multiple times. The integration of WSNs with Internet of Things (IoT) brings forth a new kind of WSN architecture along with stricter security requirements; for instance, a sensor node or a user node may need to establish multiple concurrent secure data sessions. With concurrent data sessions, the frequency of the re-authentication process increases in proportion to the number of concurrent connections. Moreover, to establish multiple data sessions, it is essential that a protocol participant have the capability of running multiple instances of the protocol run, which makes the security issue even more challenging. The currently available authentication protocols were designed for the autonomous WSN and do not account for the above requirements. Hence, ensuring a lightweight and efficient authentication protocol has become more crucial. In this paper, we present a novel, lightweight and efficient key exchange and authentication protocol suite called the Secure Mobile Sensor Network (SMSN) Authentication Protocol. In the SMSN a mobile node goes through an initial authentication procedure and receives a re-authentication ticket from the base station. Later a mobile node can use this re-authentication ticket when establishing multiple data exchange sessions and/or when moving across the network. This scheme reduces the communication and computational complexity of the authentication process. We proved the strength of our protocol with rigorous security analysis (including formal analysis using the BAN-logic) and simulated the SMSN and previously proposed schemes in an automated protocol verifier tool. Finally, we compared the computational complexity and communication cost against well-known authentication protocols.

An Authentication Protocol for Future Sensor Networks

PubMed Central

Bilal, Muhammad; Kang, Shin-Gak

2017-01-01

Authentication is one of the essential security services in Wireless Sensor Networks (WSNs) for ensuring secure data sessions. Sensor node authentication ensures the confidentiality and validity of data collected by the sensor node, whereas user authentication guarantees that only legitimate users can access the sensor data. In a mobile WSN, sensor and user nodes move across the network and exchange data with multiple nodes, thus experiencing the authentication process multiple times. The integration of WSNs with Internet of Things (IoT) brings forth a new kind of WSN architecture along with stricter security requirements; for instance, a sensor node or a user node may need to establish multiple concurrent secure data sessions. With concurrent data sessions, the frequency of the re-authentication process increases in proportion to the number of concurrent connections. Moreover, to establish multiple data sessions, it is essential that a protocol participant have the capability of running multiple instances of the protocol run, which makes the security issue even more challenging. The currently available authentication protocols were designed for the autonomous WSN and do not account for the above requirements. Hence, ensuring a lightweight and efficient authentication protocol has become more crucial. In this paper, we present a novel, lightweight and efficient key exchange and authentication protocol suite called the Secure Mobile Sensor Network (SMSN) Authentication Protocol. In the SMSN a mobile node goes through an initial authentication procedure and receives a re-authentication ticket from the base station. Later a mobile node can use this re-authentication ticket when establishing multiple data exchange sessions and/or when moving across the network. This scheme reduces the communication and computational complexity of the authentication process. We proved the strength of our protocol with rigorous security analysis (including formal analysis using the BAN-logic) and simulated the SMSN and previously proposed schemes in an automated protocol verifier tool. Finally, we compared the computational complexity and communication cost against well-known authentication protocols. PMID:28452937

Influence of temporal context on value in the multiple-chains and successive-encounters procedures.

PubMed

O'Daly, Matthew; Angulo, Samuel; Gipson, Cassandra; Fantino, Edmund

2006-05-01

This set of studies explored the influence of temporal context across multiple-chain and multiple-successive-encounters procedures. Following training with different temporal contexts, the value of stimuli sharing similar reinforcement schedules was assessed by presenting these stimuli in concurrent probes. The results for the multiple-chain schedule indicate that temporal context does impact the value of a conditioned reinforcer consistent with delay-reduction theory, such that a stimulus signaling a greater reduction in delay until reinforcement has greater value. Further, nonreinforced stimuli that are concurrently presented with the preferred terminal link also have greater value, consistent with value transfer. The effects of context on value for conditions with the multiple-successive-encounters procedure, however, appear to depend on whether the search schedule or alternate handling schedule was manipulated, as well as on whether the tested stimuli were the rich or lean schedules in their components. Overall, the results help delineate the conditions under which temporal context affects conditioned-reinforcement value (acting as a learning variable) and the conditions under which it does not (acting as a performance variable), an issue of relevance to theories of choice.

Developmental dissociation in the neural responses to simple multiplication and subtraction problems

PubMed Central

Prado, Jérôme; Mutreja, Rachna; Booth, James R.

2014-01-01

Mastering single-digit arithmetic during school years is commonly thought to depend upon an increasing reliance on verbally memorized facts. An alternative model, however, posits that fluency in single-digit arithmetic might also be achieved via the increasing use of efficient calculation procedures. To test between these hypotheses, we used a cross-sectional design to measure the neural activity associated with single-digit subtraction and multiplication in 34 children from 2nd to 7th grade. The neural correlates of language and numerical processing were also identified in each child via localizer scans. Although multiplication and subtraction were undistinguishable in terms of behavior, we found a striking developmental dissociation in their neural correlates. First, we observed grade-related increases of activity for multiplication, but not for subtraction, in a language-related region of the left temporal cortex. Second, we found grade-related increases of activity for subtraction, but not for multiplication, in a region of the right parietal cortex involved in the procedural manipulation of numerical quantities. The present results suggest that fluency in simple arithmetic in children may be achieved by both increasing reliance on verbal retrieval and by greater use of efficient quantity-based procedures, depending on the operation. PMID:25089323

40 CFR 63.1549 - Recordkeeping and reporting requirements.

Code of Federal Regulations, 2011 CFR

2011-07-01

... the practices described in the standard operating procedures manual required under § 63.1544(a) for... described in the standard operating procedures manual for baghouses required under § 63.1547(a). (6) If an... in the standard operating procedures manual for baghouses required under § 63.1547(a), including an...

40 CFR 63.1549 - Recordkeeping and reporting requirements.

Code of Federal Regulations, 2010 CFR

2010-07-01

... the practices described in the standard operating procedures manual required under § 63.1544(a) for... described in the standard operating procedures manual for baghouses required under § 63.1547(a). (6) If an... in the standard operating procedures manual for baghouses required under § 63.1547(a), including an...

40 CFR 63.550 - Recordkeeping and reporting requirements.

Code of Federal Regulations, 2013 CFR

2013-07-01

..., corrective action, report, or record, according to § 63.10(b)(1). (b) The standard operating procedures... standard operating procedures manual for baghouses required under § 63.548(a). (4) Electronic records of... required as part of the practices described in the standard operating procedures manual required under § 63...

40 CFR 63.550 - Recordkeeping and reporting requirements.

Code of Federal Regulations, 2012 CFR

2012-07-01

..., corrective action, report, or record, according to § 63.10(b)(1). (b) The standard operating procedures... standard operating procedures manual for baghouses required under § 63.548(a). (4) Electronic records of... required as part of the practices described in the standard operating procedures manual required under § 63...

40 CFR 63.550 - Recordkeeping and reporting requirements.

Code of Federal Regulations, 2014 CFR

2014-07-01

..., corrective action, report, or record, according to § 63.10(b)(1). (b) The standard operating procedures... standard operating procedures manual for baghouses required under § 63.548(a). (4) Electronic records of... required as part of the practices described in the standard operating procedures manual required under § 63...

75 FR 68297 - Pesticides; Satisfaction of Data Requirements; Procedures To Ensure Protection of Data Submitters...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-11-05

... Pesticides; Satisfaction of Data Requirements; Procedures To Ensure Protection of Data Submitters' Rights... regulations governing procedures for the satisfaction of data requirements under the Federal Insecticide... ground water. C. Satisfaction of Data Requirements EPA regulations in 40 CFR part 152, subpart E...

The Effects of Direct Instruction Flashcard and Math Racetrack Procedures on Mastery of Basic Multiplication Facts by Three Elementary School Students

ERIC Educational Resources Information Center

Skarr, Adam; Zielinski, Katie; Ruwe, Kellen; Sharp, Hannah; Williams, Randy L.; McLaughlin, T. F.

2014-01-01

The purpose of this study was to determine if a typical third-grade boy and fifth-grade girl and a boy with learning disabilities could benefit from the combined use of Direct Instruction (DI) flashcard and math racetrack procedures in an after-school program. The dependent variable was accuracy and fluency of saying basic multiplication facts. A…

Choice in situations of time-based diminishing returns: immediate versus delayed consequences of action.

PubMed Central

Hackenberg, T D; Hineline, P N

1992-01-01

Pigeons chose between two schedules of food presentation, a fixed-interval schedule and a progressive-interval schedule that began at 0 s and increased by 20 s with each food delivery provided by that schedule. Choosing one schedule disabled the alternate schedule and stimuli until the requirements of the chosen schedule were satisfied, at which point both schedules were again made available. Fixed-interval duration remained constant within individual sessions but varied across conditions. Under reset conditions, completing the fixed-interval schedule not only produced food but also reset the progressive interval to its minimum. Blocks of sessions under the reset procedure were interspersed with sessions under a no-reset procedure, in which the progressive schedule value increased independent of fixed-interval choices. Median points of switching from the progressive to the fixed schedule varied systematically with fixed-interval value, and were consistently lower during reset than during no-reset conditions. Under the latter, each subject's choices of the progressive-interval schedule persisted beyond the point at which its requirements equaled those of the fixed-interval schedule at all but the highest fixed-interval value. Under the reset procedure, switching occurred at or prior to that equality point. These results qualitatively confirm molar analyses of schedule preference and some versions of optimality theory, but they are more adequately characterized by a model of schedule preference based on the cumulated values of multiple reinforcers, weighted in inverse proportion to the delay between the choice and each successive reinforcer. PMID:1548449

Otolaryngology Service Usage in Children With Cleft Palate.

PubMed

Whittemore, Kenneth R; Dargie, Jenna M; Dornan, Briana K; Boudreau, Brian

2018-05-01

To determine the usage of otolaryngology services by children with cleft palate at a pediatric tertiary care facility. Retrospective case series. Specialty clinic at a pediatric tertiary care hospital. Children born between January 1, 1999, and December 31, 2002, with the diagnosis of cleft palate or cleft lip and palate. A total of 41 female and 48 male patients were included. Total number of otolaryngology clinic visits and total number of otolaryngologic surgeries (tympanostomy tube placements and other otologic or upper airway procedures). In the first 5 years of life, these children utilized an average of 8.2 otolaryngology clinic visits (SD = 5.0; range: 1-22) and underwent 3.3 tympanostomy tube surgeries (SD = 2.0; range: 0-10). Seventy-three had their first tube placed at the time of palate repair, and 4 at the time of lip repair. Fifty-one (57.3%) required other otologic or upper airway procedures, including tonsillectomy and/or adenoidectomy (27 children), removal of tympanostomy tubes (24 children), tympanomastoidectomy (3 children), and tympanoplasty (14 children). Of the children who underwent other procedures, they underwent a mean of 1.67 (SD = 0.84; range: 1-4) surgeries. Children with cleft palate are at increased risk for eustachian tube dysfunction, frequently utilize otolaryngology care, and typically receive multiple sets of tympanostomy tubes. This study found that children with cleft palate receive on average of approximately 3 sets of tympanostomy tubes, and the majority required another otologic or upper airway surgery.

39 CFR 230.26 - Do these rules affect the service of process requirements of the Federal Rules of Civil Procedure...

Code of Federal Regulations, 2011 CFR

2011-07-01

... requirements of the Federal Rules of Civil Procedure (28 U.S.C. Appendix)? 230.26 Section 230.26 Postal Service....26 Do these rules affect the service of process requirements of the Federal Rules of Civil Procedure... Rules of Civil Procedure regarding service of process. ...

48 CFR 6.102 - Use of competitive procedures.

Code of Federal Regulations, 2011 CFR

2011-10-01

... ACQUISITION PLANNING COMPETITION REQUIREMENTS Full and Open Competition 6.102 Use of competitive procedures. The competitive procedures available for use in fulfilling the requirement for full and open... procedures (e.g., two-step sealed bidding). (d) Other competitive procedures. (1) Selection of sources for...

Detecting active pelvic arterial haemorrhage on admission following serious pelvic fracture in multiple trauma patients.

PubMed

Brun, Julien; Guillot, Stéphanie; Bouzat, Pierre; Broux, Christophe; Thony, Frédéric; Genty, Céline; Heylbroeck, Christophe; Albaladejo, Pierre; Arvieux, Catherine; Tonetti, Jérôme; Payen, Jean-Francois

2014-01-01

The early diagnosis of pelvic arterial haemorrhage is challenging for initiating treatment by transcatheter arterial embolization (TAE) in multiple trauma patients. We use an institutional algorithm focusing on haemodynamic status on admission and on a whole-body CT scan in stabilized patients to screen patients requiring TAE. This study aimed to assess the effectiveness of this approach. This retrospective cohort study included 106 multiple trauma patients admitted to the emergency room with serious pelvic fracture [pelvic abbreviated injury scale (AIS) score of 3 or more]. Of the 106 patients, 27 (25%) underwent pelvic angiography leading to TAE for active arterial haemorrhage in 24. The TAE procedure was successful within 3h of arrival in 18 patients. In accordance with the algorithm, 10 patients were directly admitted to the angiography unit (n=8) and/or operating room (n=2) for uncontrolled haemorrhagic shock on admission. Of the remaining 96 stabilized patients, 20 had contrast media extravasation on pelvic CT scan that prompted pelvic angiography in 16 patients leading to TAE in 14. One patient underwent a pelvic angiography despite showing no contrast media extravasation on pelvic CT scan. All 17 stabilized patients who underwent pelvic angiography presented a more severely compromised haemodynamic status on admission, and they required more blood products during their initial management than the 79 patients who did not undergo pelvic angiography. The incidence of unstable pelvic fractures was however comparable between the two groups. Overall, haemodynamic instability and contrast media extravasation on the CT-scan identified 26 out of the 27 patients who required subsequent pelvic angiography leading to TAE in 24. An algorithm focusing on haemodynamic status on arrival and on the whole-body CT scan in stabilized patients may be effective at triaging multiple trauma patients with serious pelvic fractures. Copyright © 2013 Elsevier Ltd. All rights reserved.

Approximate solution of the multiple watchman routes problem with restricted visibility range.

PubMed

Faigl, Jan

2010-10-01

In this paper, a new self-organizing map (SOM) based adaptation procedure is proposed to address the multiple watchman route problem with the restricted visibility range in the polygonal domain W. A watchman route is represented by a ring of connected neuron weights that evolves in W, while obstacles are considered by approximation of the shortest path. The adaptation procedure considers a coverage of W by the ring in order to attract nodes toward uncovered parts of W. The proposed procedure is experimentally verified in a set of environments and several visibility ranges. Performance of the procedure is compared with the decoupled approach based on solutions of the art gallery problem and the consecutive traveling salesman problem. The experimental results show the suitability of the proposed procedure based on relatively simple supporting geometrical structures, enabling application of the SOM principles to watchman route problems in W.

LHCb migration from Subversion to Git

NASA Astrophysics Data System (ADS)

Clemencic, M.; Couturier, B.; Closier, J.; Cattaneo, M.

2017-10-01

Due to user demand and to support new development workflows based on code review and multiple development streams, LHCb decided to port the source code management from Subversion to Git, using the CERN GitLab hosting service. Although tools exist for this kind of migration, LHCb specificities and development models required careful planning of the migration, development of migration tools, changes to the development model, and redefinition of the release procedures. Moreover we had to support a hybrid situation with some software projects hosted in Git and others still in Subversion, or even branches of one projects hosted in different systems. We present the way we addressed the special LHCb requirements, the technical details of migrating large non standard Subversion repositories, and how we managed to smoothly migrate the software projects following the schedule of each project manager.

Iron Containing Metal-Organic Frameworks: Structure, Synthesis, and Applications in Environmental Remediation.

PubMed

Liu, Xiaocheng; Zhou, Yaoyu; Zhang, Jiachao; Tang, Lin; Luo, Lin; Zeng, Guangming

2017-06-21

Metal-organic frameworks (MOFs) with Fe content are gradually developing into an independent branch in environmental remediation, requiring economical, effective, low-toxicity strategies to the complete procedure. In this review, recent advancements in the structure, synthesis, and environmental application focusing on the mechanism are presented. The unique structure of novel design proposed specific characteristics of different iron-containing MOFs with potential innovation. Synthesis of typical MILs, NH 2 -MILs and MILs based materials reveal the basis and defect of the current method, indicating the optimal means for the actual requirements. The adsorption of various contamination with multiple interaction as well as the catalytic degradation over radicals or electron-hole pairs are reviewed. This review implied considerable prospects of iron-containing MOFs in the field of environment and a more comprehensive cognition into the challenges and potential improvement.

Tail regeneration affects the digestive performance of a Mediterranean lizard

NASA Astrophysics Data System (ADS)

Sagonas, Kostas; Karambotsi, Niki; Bletsa, Aristoula; Reppa, Aikaterini; Pafilis, Panayiotis; Valakos, Efstratios D.

2017-04-01

In caudal autotomy, lizards shed their tail to escape from an attacking predator. Since the tail serves multiple functions, caudal regeneration is of pivotal importance. However, it is a demanding procedure that requires substantial energy and nutrients. Therefore, lizards have to increase energy income to fuel the extraordinary requirements of the regenerating tail. We presumed that autotomized lizards would adjust their digestion to acquire this additional energy. To clarify the effects of tail regeneration on digestion, we compared the digestive performance before autotomy, during regeneration, and after its completion. Tail regeneration indeed increased gut passage time but did not affect digestive performance in a uniform pattern: though protein income was maximized, lipid and sugar acquisition remained stable. This divergence in proteins may be attributed to their particular role in tail reconstruction, as they are the main building blocks for tissue formation.

21 CFR 111.553 - What are the requirements under this subpart O for written procedures?

Code of Federal Regulations, 2010 CFR

2010-04-01

... 21 Food and Drugs 2 2010-04-01 2010-04-01 false What are the requirements under this subpart O for... What are the requirements under this subpart O for written procedures? You must establish and follow written procedures to fulfill the requirements of this subpart O. ...

Incidence of complications associated with tibial tuberosity advancement in Boxer dogs.

PubMed

de Lima Dantas, Brigite; Sul, Rui; Parkin, Tim; Calvo, Ignacio

2016-01-01

To retrospectively review and describe the incidence of complications associated with tibial tuberosity advancement (TTA) surgical procedures in a group of Boxer dogs (n = 36 stifles) and compare the data with a non-Boxer control population (n = 271 stifles). Retrospective analysis of medical records to identify all dogs that underwent TTA surgery due to cranial cruciate ligament disease. These records were categorized into two groups: Boxer dogs and non-Boxer dogs (controls - all other breeds). Of the 307 stifles included, 69 complications were reported in 58 joints. The complication rate differed significantly for Boxer dogs (16/36 stifles) and non-Boxer dogs (42/271 stifles), corresponding to an odds ratio of 5.8 (confidence interval: 1.96-17.02; p-value <0.001). Boxer dogs were more likely to undergo revision surgery and to develop multiple complications. The incidence of tibial tuberosity fractures requiring surgical repair (2/36 versus 1/271) and incisional infections requiring antibiotic treatment (three in each group) was significantly higher in the Boxer group. Boxer dogs had more major and multiple complications after TTA surgery than the control non-Boxer group; these complications included higher rates of revision surgery, tibial tuberosity fractures requiring stabilization, and infection related complications. The pertinence and value of breed-specific recommendations for cranial cruciate ligament disease appears to be a subject worthy of further investigation.

Endodontic flare-ups: comparison of incidence between single and multiple visits procedures in patients attending a Nigerian teaching hospital.

PubMed

Oginni, Ao; Udoye, C I

2004-12-01

The present study was performed to compare the incidence of endodontic flare ups in single with multiple visits treatment procedures, to establish the relationship between pre-operative and post obturation pain in patients attending for endodontic therapy in a Nigerian teaching Hospital. Patients were randomly assigned to either single visit or multiple visits group. Data collected at root canal treatment appointment and recall visits (1st, 7th and 30th day post obturation) include pulp vitality status, the presence or absence of pre-operative pain, presence and degree of post obturation pain. Presence of endodontic flare-ups (defined as either patient's report of pain not controlled with over the counter medication and or increasing swelling). The compiled data were analyzed using chi-square where applicable. P level < 0.05 was taken as significant. Ten endodontic flare-ups (8.1 %) were recorded in the multiple visits group compared to 19 (18,3%) flare-ups for the single visit group, P = 0.02. For both single and multiple visits procedures, there were statistically significant correlations between pre operative and post obturation pain (P = 0.002 and P = 0.0004 respectively). Teeth with vital pulps reported the lowest frequency of post obturation pain (48.8%), while those with non vital pulps were found to have the highest frequency oh post obturation pain (50,3%), P = 0.9. Although the present study reported higher incidences for post obturation pain and flare-ups following the single visit procedures, single visit endodontic therapy has been shown to be a safe and effective alternative to multiple visits treatment.

A comparison of vowel normalization procedures for language variation research

NASA Astrophysics Data System (ADS)

Adank, Patti; Smits, Roel; van Hout, Roeland

2004-11-01

An evaluation of vowel normalization procedures for the purpose of studying language variation is presented. The procedures were compared on how effectively they (a) preserve phonemic information, (b) preserve information about the talker's regional background (or sociolinguistic information), and (c) minimize anatomical/physiological variation in acoustic representations of vowels. Recordings were made for 80 female talkers and 80 male talkers of Dutch. These talkers were stratified according to their gender and regional background. The normalization procedures were applied to measurements of the fundamental frequency and the first three formant frequencies for a large set of vowel tokens. The normalization procedures were evaluated through statistical pattern analysis. The results show that normalization procedures that use information across multiple vowels (``vowel-extrinsic'' information) to normalize a single vowel token performed better than those that include only information contained in the vowel token itself (``vowel-intrinsic'' information). Furthermore, the results show that normalization procedures that operate on individual formants performed better than those that use information across multiple formants (e.g., ``formant-extrinsic'' F2-F1). .

A comparison of vowel normalization procedures for language variation research.

PubMed

Adank, Patti; Smits, Roel; van Hout, Roeland

2004-11-01

An evaluation of vowel normalization procedures for the purpose of studying language variation is presented. The procedures were compared on how effectively they (a) preserve phonemic information, (b) preserve information about the talker's regional background (or sociolinguistic information), and (c) minimize anatomical/physiological variation in acoustic representations of vowels. Recordings were made for 80 female talkers and 80 male talkers of Dutch. These talkers were stratified according to their gender and regional background. The normalization procedures were applied to measurements of the fundamental frequency and the first three formant frequencies for a large set of vowel tokens. The normalization procedures were evaluated through statistical pattern analysis. The results show that normalization procedures that use information across multiple vowels ("vowel-extrinsic" information) to normalize a single vowel token performed better than those that include only information contained in the vowel token itself ("vowel-intrinsic" information). Furthermore, the results show that normalization procedures that operate on individual formants performed better than those that use information across multiple formants (e.g., "formant-extrinsic" F2-F1).

Iterative pass optimization of sequence data

NASA Technical Reports Server (NTRS)

Wheeler, Ward C.

2003-01-01

The problem of determining the minimum-cost hypothetical ancestral sequences for a given cladogram is known to be NP-complete. This "tree alignment" problem has motivated the considerable effort placed in multiple sequence alignment procedures. Wheeler in 1996 proposed a heuristic method, direct optimization, to calculate cladogram costs without the intervention of multiple sequence alignment. This method, though more efficient in time and more effective in cladogram length than many alignment-based procedures, greedily optimizes nodes based on descendent information only. In their proposal of an exact multiple alignment solution, Sankoff et al. in 1976 described a heuristic procedure--the iterative improvement method--to create alignments at internal nodes by solving a series of median problems. The combination of a three-sequence direct optimization with iterative improvement and a branch-length-based cladogram cost procedure, provides an algorithm that frequently results in superior (i.e., lower) cladogram costs. This iterative pass optimization is both computation and memory intensive, but economies can be made to reduce this burden. An example in arthropod systematics is discussed. c2003 The Willi Hennig Society. Published by Elsevier Science (USA). All rights reserved.

Smoking and morphology of calcific deposits affect the outcome of needle aspiration of calcific deposits (NACD) for calcific tendinitis of the rotator cuff.

PubMed

Oudelaar, Bart W; Ooms, Edwin M; Huis In 't Veld, Rianne M H A; Schepers-Bok, Relinde; Vochteloo, Anne J

2015-11-01

Although NACD has proven to be an effective minimal invasive treatment for calcific tendinitis of the rotator cuff, little is known about the factors associated with treatment failure or the need for multiple procedures. Patients with symptomatic calcific tendinitis who were treated by NACD were evaluated in a retrospective cohort study. Demographic details, medical history, sonographic and radiographic findings were collected from patient files. Failure of NACD was defined as the persistence of symptoms after a follow-up of at least six months. NACD procedures performed within six months after a previous NACD procedure were considered repeated procedures. Multivariate logistic regression analysis was used to determine factors associated with treatment failure and multiple procedures. 431 patients (277 female; mean age 51.4±9.9 years) were included. Smoking (adjusted odds ratio (AOR): 1.7, 95% CI 1.0-2.7, p=0.04) was significantly associated with failure of NACD. Patients with Gärtner and Heyer (GH) type I calcific deposits were more likely to need multiple NACD procedures (AOR: 3.4, 95% CI 1.6-7.5, p<0.01) compared to patients with type III calcific deposits. Partial thickness rotator cuff tears were of no influence on the outcome of NACD or the number of treatments necessary. Smoking almost doubled the chance of failure of NACD and the presence of GH type I calcific deposits significantly increased the chance of multiple procedures. Partial thickness rotator cuff tears did not seem to affect the outcome of NACD. Based on the findings in this study, the importance of quitting smoking should be emphasized prior to NACD and partial thickness rotator cuff tears should not be a reason to withhold patients NACD. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

UV-LIGA microfabrication process for sub-terahertz waveguides utilizing multiple layered SU-8 photoresist

NASA Astrophysics Data System (ADS)

Malekabadi, Ali; Paoloni, Claudio

2016-09-01

A microfabrication process based on UV LIGA (German acronym of lithography, electroplating and molding) is proposed for the fabrication of relatively high aspect ratio sub-terahertz (100-1000 GHz) metal waveguides, to be used as a slow wave structure in sub-THz vacuum electron devices. The high accuracy and tight tolerances required to properly support frequencies in the sub-THz range can be only achieved by a stable process with full parameter control. The proposed process, based on SU-8 photoresist, has been developed to satisfy high planar surface requirements for metal sub-THz waveguides. It will be demonstrated that, for a given thickness, it is more effective to stack a number of layers of SU-8 with lower thickness rather than using a single thick layer obtained at lower spin rate. The multiple layer approach provides the planarity and the surface quality required for electroforming of ground planes or assembly surfaces and for assuring low ohmic losses of waveguides. A systematic procedure is provided to calculate soft and post-bake times to produce high homogeneity SU-8 multiple layer coating as a mold for very high quality metal waveguides. A double corrugated waveguide designed for 0.3 THz operating frequency, to be used in vacuum electronic devices, was fabricated as test structure. The proposed process based on UV LIGA will enable low cost production of high accuracy sub-THz 3D waveguides. This is fundamental for producing a new generation of affordable sub-THz vacuum electron devices, to fill the technological gap that still prevents a wide diffusion of numerous applications based on THz radiation.

Solving the problem of comparing whole bacterial genomes across different sequencing platforms.

PubMed

Kaas, Rolf S; Leekitcharoenphon, Pimlapas; Aarestrup, Frank M; Lund, Ole

2014-01-01

Whole genome sequencing (WGS) shows great potential for real-time monitoring and identification of infectious disease outbreaks. However, rapid and reliable comparison of data generated in multiple laboratories and using multiple technologies is essential. So far studies have focused on using one technology because each technology has a systematic bias making integration of data generated from different platforms difficult. We developed two different procedures for identifying variable sites and inferring phylogenies in WGS data across multiple platforms. The methods were evaluated on three bacterial data sets and sequenced on three different platforms (Illumina, 454, Ion Torrent). We show that the methods are able to overcome the systematic biases caused by the sequencers and infer the expected phylogenies. It is concluded that the cause of the success of these new procedures is due to a validation of all informative sites that are included in the analysis. The procedures are available as web tools.

Using time-delay to improve social play skills with peers for children with autism.

PubMed

Liber, Daniella B; Frea, William D; Symon, Jennifer B G

2008-02-01

Interventions that teach social communication and play skills are crucial for the development of children with autism. The time delay procedure is effective in teaching language acquisition, social use of language, discrete behaviors, and chained activities to individuals with autism and developmental delays. In this study, three boys with autism, attending a non-public school, were taught play activities that combined a play sequence with requesting peer assistance, using a graduated time delay procedure. A multiple-baseline across subjects design demonstrated the success of this procedure to teach multiple-step social play sequences. Results indicated an additional gain of an increase in pretend play by one of the participants. Two also demonstrated a generalization of the skills learned through the time delay procedure.

21 CFR 821.25 - Device tracking system and content requirements: manufacturer requirements.

Code of Federal Regulations, 2014 CFR

2014-04-01

... accordance with its standard operating procedure of the information identified in paragraphs (a)(1), (a)(2... shall establish a written standard operating procedure for the collection, maintenance, and auditing of... standard operating procedure: (1) Data collection and recording procedures, which shall include a procedure...

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

PubMed

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

2013-05-01

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

Fast realization of nonrecursive digital filters with limits on signal delay

NASA Astrophysics Data System (ADS)

Titov, M. A.; Bondarenko, N. N.

1983-07-01

Attention is given to the problem of achieving a fast realization of nonrecursive digital filters with the aim of reducing signal delay. It is shown that a realization wherein the impulse characteristic of the filter is divided into blocks satisfies the delay requirements and is almost as economical in terms of the number of multiplications as conventional fast convolution. In addition, the block method leads to a reduction in the needed size of the memory and in the number of additions; the short-convolution procedure is substantially simplified. Finally, the block method facilitates the paralleling of computations owing to the simple transfers between subfilters.

Central Data Processing System (CDPS) user's manual: Solar heating and cooling program

NASA Technical Reports Server (NTRS)

1976-01-01

The software and data base management system required to assess the performance of solar heating and cooling systems installed at multiple sites is presented. The instrumentation data associated with these systems is collected, processed, and presented in a form which supported continuity of performance evaluation across all applications. The CDPS consisted of three major elements: communication interface computer, central data processing computer, and performance evaluation data base. Users of the performance data base were identified, and procedures for operation, and guidelines for software maintenance were outlined. The manual also defined the output capabilities of the CDPS in support of external users of the system.

Pad Safety Personnel Launch Support For STS-200

NASA Technical Reports Server (NTRS)

Guarino, Jennifer

2007-01-01

The launch of a space shuttle is a complex and lengthy procedure. There are many places and components to look at and prepare. The components are the orbiter, solid rocket boosters, external tank, and ground equipment. Some of the places are the launch pad, fuel locations, and surrounding structures. Preparations for a launch include equipment checks, system checks, sniff checks for hazardous commodities, and countless walkdowns. Throughout these preparations, pad safety personnel must always be on call. This requires three shifts of multiple people to be ready when needed. Also, the pad safety personnel must be available for the non-launch tasks that are always present for both launch pads

10 CFR 1021.300 - General requirements.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 10 Energy 4 2013-01-01 2013-01-01 false General requirements. 1021.300 Section 1021.300 Energy DEPARTMENT OF ENERGY (GENERAL PROVISIONS) NATIONAL ENVIRONMENTAL POLICY ACT IMPLEMENTING PROCEDURES Implementing Procedures § 1021.300 General requirements. (a) DOE shall determine, under the procedures in the...

A Normalized Direct Approach for Estimating the Parameters of the Normal Ogive Three-Parameter Model for Ability Tests.

ERIC Educational Resources Information Center

Gugel, John F.

A new method for estimating the parameters of the normal ogive three-parameter model for multiple-choice test items--the normalized direct (NDIR) procedure--is examined. The procedure is compared to a more commonly used estimation procedure, Lord's LOGIST, using computer simulations. The NDIR procedure uses the normalized (mid-percentile)…

Using a Constant Time Delay Procedure to Teach Support Personnel to Use a Simultaneous Prompting Procedure

ERIC Educational Resources Information Center

Britton, Nicole Scott; Collins, Belva C.; Ault, Melinda Jones; Bausch, Margaret E.

2017-01-01

Within the context of a multiple baseline design, the researchers in this investigation used a constant time delay (CTD) procedure to teach two classroom support personnel (i.e., paraprofessional, peer tutor) to use a simultaneous prompting (SP) procedure when teaching a high school student with a moderate intellectual disability to (a) identify…

Professional charges not reimbursed to dentists in the U.S.: evidence from Medical Expenditure Panel Survey, 1996.

PubMed

Chattopadhyay, A; Slade, G D; Caplan, D J

2009-12-01

This cross-sectional study examined professional charges not paid to dentists. This analysis used logistic regression in SUDAAN examining the 1996 MEPS data from 12,931 adults. Among people incurring dental care charges, 13.6% had more than $50 of unpaid charge (UC). The percapita UC was $53.30. Total UC was higher for highest income group [45.4% of total] compared to lowest income group [26.0%]. The percapita UC of $76.70 for low income group was significantly greater than for high income group ($47.80, P < 0.01). More Medicaid recipients (52% vs. non-recipients: 12%) incurred at least $50 in UC (P < 0.01). Adjusted odds of incurring UC were greater for those employed (OR = 1.3, 95% CI: 1.0-1.7), and for those with private insurance (OR: 1.5, CI: 1.3-1.9). Number of dental procedure types modified the association between Medicaid recipient and UC (OR = 13.6 for Medicaid recipients undergoing multiple procedure types; OR: 2.3 for Medicaid non-recipients with multiple procedure types; OR: 1.9 for Medicaid recipients receiving single dental procedure. Having private insurance, being unemployed and being Medicaid insured undergoing multiple procedure were strongest predictors of UC.

Retrograde intrarenal surgery for the treatment of renal stones in children: factors influencing stone clearance and complications.

PubMed

Azili, Mujdem Nur; Ozcan, Fatma; Tiryaki, Tugrul

2014-07-01

Retrograde intrarenal surgery (RIRS) is a known option for the treatment of upper tract calculi with an excellent success. However, the reports of RIRS in prepubertal children are limited. In this study, we evaluated the factors which affected the success rate and the complications of RIRS at renal stone treatment in childhood. We retrospectively reviewed the records of children under 14 years old who underwent RIRS for renal stone disease between January 2009 and December 2012. Patients' age, gender, body mass index (BMI), stone size, stone location, stone number, intraoperative complications, stone free status, postoperative complications were recorded. There were 80 ureterorenoscopic procedures performed in 58 renal units of 47 children (23 males and 24 females). The patients' ages ranged from 8 months to 14 years (mean age 4.7 ± 3.4 years). There was a difference in the distribution of symptoms in age groups. UTI was higher in the 1-4 years age group, abdominal pain was seen mostly in children aged 5-14 years. Multiple stones (included staghorn stone) were noted in 60.4% of patients. In 27.6% of patients, ureteral stones were accompanied by renal stones in our series. In the infancy group, cystine and staghorn stones were more frequently seen, mostly bilateral. After a single ureteroscopic procedure for intrarenal stones in children, we achieved stone free status in 50.9% of the ureters (n=26). After the repeated sessions, the stone clearance rate reached to 85.1%. Retrograde intrarenal surgery can be used as a first line therapy to treat renal stones in children. This is especially important if an associated ureteral stone is present that requires treatment; or in patients with cystinuria, which is not favorably treated with ESWL. Complications were seen more frequently in patients with cystine stones. Extravasation was noted more frequently in patients admitted with UTIs. There was a significant relationship between the conversion to open procedures and the age groups, with most procedures occurring in infancy. The parents should be informed about the probability of multiple procedures to achieve stone free status. Copyright © 2014 Elsevier Inc. All rights reserved.

Double trouble: prolapsing epiglottis and unexpected dual pathology in an infant.

PubMed

De Beer, David; Chambers, Neil

2003-06-01

A 3-week-old full-term female neonate was admitted with a 4-day history of episodic stridor, desaturations and difficult feeding. Initial assessment using fluoroscopy suggested distal tracheomalacia. Inhalational induction for examination under anaesthesia of the upper airway at 4 weeks of age caused almost complete airway obstruction due to severe anterior, or epiglottic, laryngomalacia. This airway obstruction was unresponsive to continuous positive airway pressure, the use of an oropharyngeal airway and hand ventilation and required urgent tracheal intubation using suxamethonium. Epiglottopexy, a relatively unknown procedure, was performed uneventfully 2 days later, with complete relief of the respiratory compromise. However, the infant remained desaturated postoperatively. A ventilation perfusion scan subsequently revealed multiple pulmonary arteriovenous malformations, unsuitable for embolization and requiring nocturnal home oxygen therapy. Review at 3 months of age found a thriving infant with no airway obstruction and good epiglottic positioning on examination under anaesthesia. Although the patient's oxygen requirements had diminished, the long-term outcome remains uncertain.

Flexible Modeling of Survival Data with Covariates Subject to Detection Limits via Multiple Imputation.

PubMed

Bernhardt, Paul W; Wang, Huixia Judy; Zhang, Daowen

2014-01-01

Models for survival data generally assume that covariates are fully observed. However, in medical studies it is not uncommon for biomarkers to be censored at known detection limits. A computationally-efficient multiple imputation procedure for modeling survival data with covariates subject to detection limits is proposed. This procedure is developed in the context of an accelerated failure time model with a flexible seminonparametric error distribution. The consistency and asymptotic normality of the multiple imputation estimator are established and a consistent variance estimator is provided. An iterative version of the proposed multiple imputation algorithm that approximates the EM algorithm for maximum likelihood is also suggested. Simulation studies demonstrate that the proposed multiple imputation methods work well while alternative methods lead to estimates that are either biased or more variable. The proposed methods are applied to analyze the dataset from a recently-conducted GenIMS study.

Staging resection of multiple primary esophageal cancer by endoscopic submucosal dissection and esophagectomy: A case report.

PubMed

Yao, Yufeng; Wu, Yimin; Chai, Ying

2018-05-01

Multiple primary esophageal cancer pose great risks to patients and are always challenging to resect surgically. In order to reduce the risk of postoperative complication and meet the needs of minimally invasive and precision medicine, new treatment plans have been always developed for patients with multiple primary esophageal cancer. A 75-year-old man was admitted to our hospital for aggravated dysphagia. No significant abnormalities were identified on physical examination. Endoscopic examination detected 3 masses in the esophagus and biopsy confirmed multiple primary esophageal cancer. The patient received a new staging treatment procedure firstly and an innovative single-position, minimally invasive Ivor Lewis esophagectomy in our hospital. This patient discharged one week after the surgery and enjoyed a good health during our follow up for 30 month. We believe our procedure provides a beneficial new alternative approach for patients with multiple primary esophageal cancer.

A new zero-inflated negative binomial methodology for latent category identification.

PubMed

Blanchard, Simon J; DeSarbo, Wayne S

2013-04-01

We introduce a new statistical procedure for the identification of unobserved categories that vary between individuals and in which objects may span multiple categories. This procedure can be used to analyze data from a proposed sorting task in which individuals may simultaneously assign objects to multiple piles. The results of a synthetic example and a consumer psychology study involving categories of restaurant brands illustrate how the application of the proposed methodology to the new sorting task can account for a variety of categorization phenomena including multiple category memberships and for heterogeneity through individual differences in the saliency of latent category structures.

40 CFR 63.550 - Recordkeeping and reporting requirements.

Code of Federal Regulations, 2010 CFR

2010-07-01

... recordkeeping required as part of the practices described in the standard operating procedures manual for... part of the practices described in the standard operating procedures manual for baghouses required... period, including an explanation of the periods when the procedures outlined in the standard operating...

40 CFR 63.550 - Recordkeeping and reporting requirements.

Code of Federal Regulations, 2011 CFR

2011-07-01

... recordkeeping required as part of the practices described in the standard operating procedures manual for... part of the practices described in the standard operating procedures manual for baghouses required... period, including an explanation of the periods when the procedures outlined in the standard operating...

75 FR 16957 - Energy Conservation Program: Test Procedures for Battery Chargers and External Power Supplies

Federal Register 2010, 2011, 2012, 2013, 2014

2010-04-02

... Procedures C. Review of Single-Voltage External Power Supply Test Procedure D. Multiple-Voltage External...) Deletions of Existing Definitions (b) Revisions to Existing Definitions (c) Additions of New Definitions 4. Test Apparatus and General Instructions (a) Confidence Intervals (b) Temperature (c) AC Input Voltage...

49 CFR 1141.1 - Procedures to calculate interest rates.

Code of Federal Regulations, 2010 CFR

2010-10-01

... the portion of the year covered by the interest rate. A simple multiplication of the nominal rate by... 49 Transportation 8 2010-10-01 2010-10-01 false Procedures to calculate interest rates. 1141.1... TRANSPORTATION BOARD, DEPARTMENT OF TRANSPORTATION RULES OF PRACTICE PROCEDURES TO CALCULATE INTEREST RATES...

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…

Analysis of Cosmetic Topics on the Plastic Surgery In-Service Training Exam.

PubMed

Silvestre, Jason; Taglienti, Anthony J; Serletti, Joseph M; Chang, Benjamin

2015-08-01

The Plastic Surgery In-Service Training Exam (PSITE) is a multiple-choice examination taken by plastic surgery trainees to provide an assessment of plastic surgery knowledge. The purpose of this study was to evaluate cosmetic questions and determine overlap with national procedural data. Digital syllabi of six consecutive PSITE administrations (2008-2013) were analyzed for cosmetic surgery topics. Questions were classified by taxonomy, focus, anatomy, and procedure. Answer references were tabulated by source. Relationships between tested material and national procedural volume were assessed via Pearson correlation. 301 questions addressed cosmetic topics (26% of all questions) and 20 required image interpretations (7%). Question-stem taxonomy favored decision-making (40%) and recall (37%) skills over interpretation (23%, P < .001). Answers focused on treatments/outcomes (67%) over pathology/anatomy (20%) and diagnoses (13%, P < .001). Tested procedures were largely surgical (85%) and focused on the breast (25%), body (18%), nose (13%), and eye (10%). The most common surgeries were breast augmentation (12%), rhinoplasty (11%), blepharoplasty (10%), and body contouring (6%). Minimally invasive procedures were lasers (5%), neuromodulators (4%), and fillers (3%). Plastic and Reconstructive Surgery (58%), Clinics in Plastic Surgery (7%), and Aesthetic Surgery Journal (6%) were the most cited journals, with a median 5-year publication lag. There was poor correlation between PSITE content and procedural volume data (r(2) = 0.138, P = .539). Plastic surgeons receive routine evaluation of cosmetic surgery knowledge. These data may help optimize clinical and didactic experiences for training in cosmetic surgery. © 2015 The American Society for Aesthetic Plastic Surgery, Inc. Reprints and permission: journals.permissions@oup.com.

A Rapid Segmentation-Insensitive "Digital Biopsy" Method for Radiomic Feature Extraction: Method and Pilot Study Using CT Images of Non-Small Cell Lung Cancer.

PubMed

Echegaray, Sebastian; Nair, Viswam; Kadoch, Michael; Leung, Ann; Rubin, Daniel; Gevaert, Olivier; Napel, Sandy

2016-12-01

Quantitative imaging approaches compute features within images' regions of interest. Segmentation is rarely completely automatic, requiring time-consuming editing by experts. We propose a new paradigm, called "digital biopsy," that allows for the collection of intensity- and texture-based features from these regions at least 1 order of magnitude faster than the current manual or semiautomated methods. A radiologist reviewed automated segmentations of lung nodules from 100 preoperative volume computed tomography scans of patients with non-small cell lung cancer, and manually adjusted the nodule boundaries in each section, to be used as a reference standard, requiring up to 45 minutes per nodule. We also asked a different expert to generate a digital biopsy for each patient using a paintbrush tool to paint a contiguous region of each tumor over multiple cross-sections, a procedure that required an average of <3 minutes per nodule. We simulated additional digital biopsies using morphological procedures. Finally, we compared the features extracted from these digital biopsies with our reference standard using intraclass correlation coefficient (ICC) to characterize robustness. Comparing the reference standard segmentations to our digital biopsies, we found that 84/94 features had an ICC >0.7; comparing erosions and dilations, using a sphere of 1.5-mm radius, of our digital biopsies to the reference standard segmentations resulted in 41/94 and 53/94 features, respectively, with ICCs >0.7. We conclude that many intensity- and texture-based features remain consistent between the reference standard and our method while substantially reducing the amount of operator time required.

40 CFR 63.1547 - Monitoring requirements.

Code of Federal Regulations, 2010 CFR

2010-07-01

... standard operating procedures manual that describes in detail the procedures for inspection, maintenance...) The standard operating procedures manual for baghouses required by paragraph (a) of this section shall... specified in the standard operating procedures manual for inspections and routine maintenance shall, at a...

40 CFR 63.1547 - Monitoring requirements.

Code of Federal Regulations, 2011 CFR

2011-07-01

... standard operating procedures manual that describes in detail the procedures for inspection, maintenance...) The standard operating procedures manual for baghouses required by paragraph (a) of this section shall... specified in the standard operating procedures manual for inspections and routine maintenance shall, at a...

Multi-gel casting apparatus for vertical polyacrylamide gels with in-built solution flow system and liquid level detectors.

PubMed

Maurye, Praveen; Basu, Arpita; Bandyopadhyay, Tapas Kumar; Biswas, Jayanta Kumar; Mohanty, Bimal Prasana

2017-08-01

PAGE is the most widely used technique for the separation and biochemical analysis of biomolecules. The ever growing field of proteomics and genomics necessitates the analysis of many proteins and nucleic acid samples to understand further about the structure and function of cells. Simultaneous analysis of multiple protein samples often requires casting of many PAGE gels. Several variants of multi-gel casting/electrophoresis apparatuses are frequently used in research laboratories. Requirement of supplementary gels to match the growing demand for analyzing additional protein samples sometimes become a cause of concern. Available apparatuses are not amenable to and therefore, not recommended for any modification to accommodate additional gel casting units other than what is prescribed by the manufacturer. A novel apparatus is described here for casting multiple PAGE gels comprising four detachable components that provide enhanced practicability and performance of the apparatus. This newly modified apparatus promises to be a reliable source for making multiple gels in less time without hassle. Synchronized functioning of unique components broaden the possibilities of developing inexpensive, safe, and time-saving multi-gel casting apparatus. This apparatus can be easily fabricated and modified to accommodate desired number of gel casting units. The estimated cost (∼$300) for fabrication of the main apparatus is very competitive and effortless assembly procedure can be completed within ∼30 min. © 2017 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

A new perspective on life-saving procedures in a battlefield setting: Emergency cricothyroidotomy, needle thoracostomy, and chest tube thoracostomy with night vision goggles.

PubMed

Bilge, Sedat; Aydın, Attila; Bilge, Meltem; Aydın, Cemile; Çevik, Erdem; Eryılmaz, Mehmet

2017-11-01

In the patients with multiple and serious trauma, early applications of life-saving procedures are related to improved survival. We tried to experimentally determine the feasibility of life-saving interventions that are performed with the aid of night vision goggles (NVG) in nighttime combat scenario. Chest tube thoracostomy (CTT), emergency cricothyroidotomy (EC), and needle thoracostomy (NT) interventions were performed by 10 combatant medical staff. The success and duration of interventions were explored in the study. Procedures were performed on the formerly prepared manikins/models in a bright room and in a dark room with the aid of NVG. Operators graded the ease of interventions. All interventions were found successful. Operators stated that both CTT and EC interventions were more difficult in dark than in daytime (p<0.05). No significant difference was observed in the difficulty in the NT interventions. No significant difference was observed in terms of completion times of interventions between in daytime and in dark scenario. The operators who use NVGs have to be aware of that they can perform their tactic and medical activities without taking off the NVGs and without the requirement of an extra light source.

Plastic surgery after weight loss: current concepts in massive weight loss surgery.

PubMed

Gusenoff, Jeffrey A; Rubin, J Peter

2008-01-01

The authors begin their discussion of current concepts in massive weight loss (MWL) surgery by offering terminological guidelines that help define reconstructive and aesthetic concepts and procedures for the post-MWL patient. Measures for effective preoperative nutritional and metabolic screening include assessment of weight fluctuations over time, constitutional symptoms, and medications and nutritional supplements. Although there is no established body-mass index (BMI) threshold above which surgery should be refused, higher BMIs have been associated with increased complications. Residual medical problems and psychosocial issues require assessment before surgery, with appropriate specialist consultation as necessary. Consultation with patients concerning the different expectations for functional versus aesthetic procedures and issues such as postoperative scarring and the common incidence of wound healing problems is essential. Patient safety is paramount in decisions to combine multiple procedures and plan stages. The authors often recommend combining abdominoplasty and mastopexy. Surgeon experience, operative setting, and a patient's medical status are factors which influence how much surgery should be performed in the same operative setting. Centers of Excellence in body contouring that provide a team approach combining comprehensive patient evaluation, outcomes research, and surgical training may be the optimal approach for treating the massive weight loss patient.

Aspirin challenge and desensitization: how, when and why.

PubMed

Cortellini, Gabriele; Caruso, Cristiano; Romano, Antonino

2017-08-01

To investigate the current approach to aspirin challenge (drug provocation) and/or desensitization in patients with histories of hypersensitivity reactions to it, particularly in those with cardiovascular diseases. The literature indicates that patients with coronary artery disease (CAD), including those with an acute coronary syndrome, may safely undergo low-dose aspirin challenge and/or desensitization. Recently, flowcharts regarding challenge/desensitization procedures with aspirin in patients with CAD and histories of aspirin hypersensitivity reactions have become available. Aspirin desensitization and continuous aspirin therapy constitute an effective option in patients with nonsteroidal anti-inflammatory drug-exacerbated respiratory diseases (NERD) who have suboptimally controlled asthma or rhinosinusitis, or require multiple revision polypectomies. The use of aspirin has proven to reduce morbidity and mortality associated with CAD. There is a general consensus on aspirin's effectiveness in secondary prevention of CAD. Therefore, aspirin desensitization is necessary in patients with CAD and histories of hypersensitivity reactions to it. The effectiveness of aspirin desensitization and continuous therapy in patients with NERD has been shown in numerous studies. However, shared selection criteria of candidates for aspirin challenge/desensitization procedures, and simple and homogeneous protocols are necessary. Moreover, preventive safety measures are still needed in order to reduce the potential risks of these procedures.

Interventional procedures and future drug therapy for hypertension

PubMed Central

Lobo, Melvin D.; Sobotka, Paul A.; Pathak, Atul

2017-01-01

Hypertension management poses a major challenge to clinicians globally once non-drug (lifestyle) measures have failed to control blood pressure (BP). Although drug treatment strategies to lower BP are well described, poor control rates of hypertension, even in the first world, suggest that more needs to be done to surmount the problem. A major issue is non-adherence to antihypertensive drugs, which is caused in part by drug intolerance due to side effects. More effective antihypertensive drugs are therefore required which have excellent tolerability and safety profiles in addition to being efficacious. For those patients who either do not tolerate or wish to take medication for hypertension or in whom BP control is not attained despite multiple antihypertensives, a novel class of interventional procedures to manage hypertension has emerged. While most of these target various aspects of the sympathetic nervous system regulation of BP, an additional procedure is now available, which addresses mechanical aspects of the circulation. Most of these new devices are supported by early and encouraging evidence for both safety and efficacy, although it is clear that more rigorous randomized controlled trial data will be essential before any of the technologies can be adopted as a standard of care. PMID:27406184

Statistically Comparing the Performance of Multiple Automated Raters across Multiple Items

ERIC Educational Resources Information Center

Kieftenbeld, Vincent; Boyer, Michelle

2017-01-01

Automated scoring systems are typically evaluated by comparing the performance of a single automated rater item-by-item to human raters. This presents a challenge when the performance of multiple raters needs to be compared across multiple items. Rankings could depend on specifics of the ranking procedure; observed differences could be due to…

Comparison of Deep Brain Stimulation Lead Targeting Accuracy and Procedure Duration between 1.5- and 3-Tesla Interventional Magnetic Resonance Imaging Systems: An Initial 12-Month Experience.

PubMed

Southwell, Derek G; Narvid, Jared A; Martin, Alastair J; Qasim, Salman E; Starr, Philip A; Larson, Paul S

2016-01-01

Interventional magnetic resonance imaging (iMRI) allows deep brain stimulator lead placement under general anesthesia. While the accuracy of lead targeting has been described for iMRI systems utilizing 1.5-tesla magnets, a similar assessment of 3-tesla iMRI procedures has not been performed. To compare targeting accuracy, the number of lead targeting attempts, and surgical duration between procedures performed on 1.5- and 3-tesla iMRI systems. Radial targeting error, the number of targeting attempts, and procedure duration were compared between surgeries performed on 1.5- and 3-tesla iMRI systems (SmartFrame and ClearPoint systems). During the first year of operation of each system, 26 consecutive leads were implanted using the 1.5-tesla system, and 23 consecutive leads were implanted using the 3-tesla system. There was no significant difference in radial error (Mann-Whitney test, p = 0.26), number of lead placements that required multiple targeting attempts (Fisher's exact test, p = 0.59), or bilateral procedure durations between surgeries performed with the two systems (p = 0.15). Accurate DBS lead targeting can be achieved with iMRI systems utilizing either 1.5- or 3-tesla magnets. The use of a 3-tesla magnet, however, offers improved visualization of the target structures and allows comparable accuracy and efficiency of placement at the selected targets. © 2016 S. Karger AG, Basel.

The transcatheter aortic valve implementation (TAVI)--a qualitative approach to the implementation and diffusion of a minimally invasive surgical procedure.

PubMed

Merkel, Sebastian; Eikermann, Michaela; Neugebauer, Edmund A; von Bandemer, Stephan

2015-10-06

The transcatheter aortic valve implantation (TAVI), a minimally invasive surgical procedure to treat patients with severe symptomatic aortic stenosis, showed a rapid diffusion in Germany compared to the international level. The aim of this study is to identify and analyze factors affecting the implementation and diffusion of the procedure in hospitals using a qualitative application of the diffusion of innovations theory. We conducted problem-centered interviews with cardiologists and cardiac surgeons working in German hospitals. The multi-level model "diffusion of innovations in health services organizations" developed by Greenhalgh et al. was used to guide the research. Data was analyzed using content and a thematic analysis. Among the ten participants who were interviewed, we found both barriers and facilitators related to the innovation itself, system readiness and antecedents, communication and influence, and the outer context. Key issues were the collaboration between cardiologists and cardiac surgeons, reimbursement policies, requirements needed to conduct the procedure, and medical advantages of the method. The findings show that there are multiple factors influencing the diffusion of TAVI that go beyond the reimbursement and cost issues. The diffusion of innovations model proved to be helpful in understanding the different aspects of the uptake of the procedure. A central theme that affected the implementation of TAVI was the collaboration and competition between involved medical departments: cardiology and cardiac surgery. Against this background, it seems especially important to moderate and coordinate the cooperation of the different medical disciplines.

Guide for mass prophylaxis of hospital employees in preparation for a bioterrorist attack.

PubMed

Lee, Jeremy John; Johnson, Shannon John; Sohmer, Michael J

2009-03-15

The key elements required for the health-system pharmacist to prepare and implement a hospital-based mass prophylaxis distribution effort for hospital employees are described. A bioterrorist attack may involve multiple jurisdictions which would necessitate a regional response. Pharmacists should collaborate not only with colleagues in their immediate areas, but also with pharmacists and emergency-management planners in neighboring counties and jurisdictions. Pharmacists must also develop antibiotic drug selection protocols and define the quantity needed to maintain hospital operations after a bioterrorist attack. Once the desired antibiotics have been selected and the number of employees has been determined, along with the length of prophylaxis therapy, it should be determined how much money will be needed to purchase and store enough medications to meet the need. Next, provisions must be made to acquire and store the antibiotic cache, with attention paid to cache rotation and packaging and repackaging recommendations. A detailed procedure for the deployment of an antibiotic cache must be developed. This procedure should include job descriptions and job action sheets for deployment team members and plans for receiving and dispensing antibiotics from the Strategic National Stockpile. Once the employee prophylaxis procedure is developed, staff must be educated about it, and exercises should be conducted to identify possible weaknesses in the procedure. Health-system pharmacists should play an active role in designing and implementing an antibiotic prophylaxis plan for employees for a potential bioterrorist attack. Understanding and following procedures provided in the tool kit are critical to their successful readiness.

AMO EXPRESS: A Command and Control Experiment for Crew Autonomy

NASA Technical Reports Server (NTRS)

Stetson, Howard K.; Frank, Jeremy; Cornelius, Randy; Haddock, Angie; Wang, Lui; Garner, Larry

2015-01-01

NASA is investigating a range of future human spaceflight missions, including both Mars-distance and Near Earth Object (NEO) targets. Of significant importance for these missions is the balance between crew autonomy and vehicle automation. As distance from Earth results in increasing communication delays, future crews need both the capability and authority to independently make decisions. However, small crews cannot take on all functions performed by ground today, and so vehicles must be more automated to reduce the crew workload for such missions. NASA's Advanced Exploration Systems Program funded Autonomous Mission Operations (AMO) project conducted an autonomous command and control demonstration of intelligent procedures to automatically initialize a rack onboard the International Space Station (ISS) with power and thermal interfaces, and involving core and payload command and telemetry processing, without support from ground controllers. This autonomous operations capability is enabling in scenarios such as a crew medical emergency, and representative of other spacecraft autonomy challenges. The experiment was conducted using the Expedite the Processing of Experiments for Space Station (EXPRESS) rack 7, which was located in the Port 2 location within the U.S Laboratory onboard the International Space Station (ISS). Activation and deactivation of this facility is time consuming and operationally intensive, requiring coordination of three flight control positions, 47 nominal steps, 57 commands, 276 telemetry checks, and coordination of multiple ISS systems (both core and payload). The autonomous operations concept includes a reduction of the amount of data a crew operator is required to verify during activation or de-activation, as well as integration of procedure execution status and relevant data in a single integrated display. During execution, the auto-procedures provide a step-by-step messaging paradigm and a high level status upon termination. This messaging and high level status is the only data generated for operator display. To enhance situational awareness of the operator, the Web-based Procedure Display (WebPD) provides a novel approach to the issues of procedure display and execution tracking. For this demonstration, the procedure was initiated and monitored from the ground. As the Timeliner sequences executed, their high level execution status was transmitted to ground, for WebPD consumption.

Three-dimensional rotational angiography fused with multimodal imaging modalities for targeted endomyocardial injections in the ischaemic heart.

PubMed

Dauwe, Dieter Frans; Nuyens, Dieter; De Buck, Stijn; Claus, Piet; Gheysens, Olivier; Koole, Michel; Coudyzer, Walter; Vanden Driessche, Nina; Janssens, Laurens; Ector, Joris; Dymarkowski, Steven; Bogaert, Jan; Heidbuchel, Hein; Janssens, Stefan

2014-08-01

Biological therapies for ischaemic heart disease require efficient, safe, and affordable intramyocardial delivery. Integration of multiple imaging modalities within the fluoroscopy framework can provide valuable information to guide these procedures. We compared an anatomo-electric method (LARCA) with a non-fluoroscopic electromechanical mapping system (NOGA(®)). LARCA integrates selective three-dimensional-rotational angiograms with biplane fluoroscopy. To identify the infarct region, we studied LARCA-fusion with pre-procedural magnetic resonance imaging (MRI), dedicated CT, or (18)F-FDG-PET/CT. We induced myocardial infarction in 20 pigs by 90-min LAD occlusion. Six weeks later, we compared peri-infarct delivery accuracy of coloured fluospheres using sequential NOGA(®)- and LARCA-MRI-guided vs. LARCA-CT- and LARCA-(18)F-FDG-PET/CT-guided intramyocardial injections. MRI after 6 weeks revealed significant left ventricular (LV) functional impairment and remodelling (LVEF 31 ± 3%, LVEDV 178 ± 15 mL, infarct size 17 ± 2% LV mass). During NOGA(®)-procedures, three of five animals required DC-shock for major ventricular arrhythmias vs. one of ten during LARCA-procedures. Online procedure time was shorter for LARCA than NOGA(®) (77 ± 6 vs. 130 ± 3 min, P < 0.0001). Absolute distance of injection spots to the infarct border was similar for LARCA-MRI (4.8 ± 0.5 mm) and NOGA(®) (5.4 ± 0.5 mm). LARCA-CT-integration allowed closer approximation of the targeted border zone than LARCA-PET (4.0 ± 0.5 mm vs. 6.2 ± 0.6 mm, P < 0.05). Three-dimensional -rotational angiography fused with multimodal imaging offers a new, cost-effective, and safe strategy to guide intramyocardial injections. Endoventricular procedure times and arrhythmias compare favourably to NOGA(®), without compromising injection accuracy. LARCA-based fusion imaging is a promising enabling technology for cardiac biological therapies. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2014. For permissions please email: journals.permissions@oup.com.

9 CFR 2.25 - Requirements and procedures.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 9 Animals and Animal Products 1 2010-01-01 2010-01-01 false Requirements and procedures. 2.25 Section 2.25 Animals and Animal Products ANIMAL AND PLANT HEALTH INSPECTION SERVICE, DEPARTMENT OF AGRICULTURE ANIMAL WELFARE REGULATIONS Registration § 2.25 Requirements and procedures. (a) Each carrier and...

9 CFR 2.25 - Requirements and procedures.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 9 Animals and Animal Products 1 2013-01-01 2013-01-01 false Requirements and procedures. 2.25 Section 2.25 Animals and Animal Products ANIMAL AND PLANT HEALTH INSPECTION SERVICE, DEPARTMENT OF AGRICULTURE ANIMAL WELFARE REGULATIONS Registration § 2.25 Requirements and procedures. (a) Each carrier and...

9 CFR 2.25 - Requirements and procedures.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 9 Animals and Animal Products 1 2011-01-01 2011-01-01 false Requirements and procedures. 2.25 Section 2.25 Animals and Animal Products ANIMAL AND PLANT HEALTH INSPECTION SERVICE, DEPARTMENT OF AGRICULTURE ANIMAL WELFARE REGULATIONS Registration § 2.25 Requirements and procedures. (a) Each carrier and...

9 CFR 2.25 - Requirements and procedures.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 9 Animals and Animal Products 1 2012-01-01 2012-01-01 false Requirements and procedures. 2.25 Section 2.25 Animals and Animal Products ANIMAL AND PLANT HEALTH INSPECTION SERVICE, DEPARTMENT OF AGRICULTURE ANIMAL WELFARE REGULATIONS Registration § 2.25 Requirements and procedures. (a) Each carrier and...

9 CFR 2.25 - Requirements and procedures.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 9 Animals and Animal Products 1 2014-01-01 2014-01-01 false Requirements and procedures. 2.25 Section 2.25 Animals and Animal Products ANIMAL AND PLANT HEALTH INSPECTION SERVICE, DEPARTMENT OF AGRICULTURE ANIMAL WELFARE REGULATIONS Registration § 2.25 Requirements and procedures. (a) Each carrier and...

42 CFR 493.47 - Requirements for a certificate for provider-performed microscopy (PPM) procedures.

Code of Federal Regulations, 2010 CFR

2010-10-01

...-performed microscopy (PPM) procedures. 493.47 Section 493.47 Public Health CENTERS FOR MEDICARE & MEDICAID... REQUIREMENTS Registration Certificate, Certificate for Provider-performed Microscopy Procedures, and Certificate of Compliance § 493.47 Requirements for a certificate for provider-performed microscopy (PPM...

42 CFR 493.47 - Requirements for a certificate for provider-performed microscopy (PPM) procedures.

Code of Federal Regulations, 2013 CFR

2013-10-01

...-performed microscopy (PPM) procedures. 493.47 Section 493.47 Public Health CENTERS FOR MEDICARE & MEDICAID... REQUIREMENTS Registration Certificate, Certificate for Provider-performed Microscopy Procedures, and Certificate of Compliance § 493.47 Requirements for a certificate for provider-performed microscopy (PPM...

42 CFR 493.47 - Requirements for a certificate for provider-performed microscopy (PPM) procedures.

Code of Federal Regulations, 2012 CFR

2012-10-01

...-performed microscopy (PPM) procedures. 493.47 Section 493.47 Public Health CENTERS FOR MEDICARE & MEDICAID... REQUIREMENTS Registration Certificate, Certificate for Provider-performed Microscopy Procedures, and Certificate of Compliance § 493.47 Requirements for a certificate for provider-performed microscopy (PPM...

42 CFR 493.47 - Requirements for a certificate for provider-performed microscopy (PPM) procedures.

Code of Federal Regulations, 2011 CFR

2011-10-01

...-performed microscopy (PPM) procedures. 493.47 Section 493.47 Public Health CENTERS FOR MEDICARE & MEDICAID... REQUIREMENTS Registration Certificate, Certificate for Provider-performed Microscopy Procedures, and Certificate of Compliance § 493.47 Requirements for a certificate for provider-performed microscopy (PPM...

42 CFR 493.47 - Requirements for a certificate for provider-performed microscopy (PPM) procedures.

Code of Federal Regulations, 2014 CFR

2014-10-01

...-performed microscopy (PPM) procedures. 493.47 Section 493.47 Public Health CENTERS FOR MEDICARE & MEDICAID... REQUIREMENTS Registration Certificate, Certificate for Provider-performed Microscopy Procedures, and Certificate of Compliance § 493.47 Requirements for a certificate for provider-performed microscopy (PPM...

Dynamic vehicle routing with time windows in theory and practice.

PubMed

Yang, Zhiwei; van Osta, Jan-Paul; van Veen, Barry; van Krevelen, Rick; van Klaveren, Richard; Stam, Andries; Kok, Joost; Bäck, Thomas; Emmerich, Michael

2017-01-01

The vehicle routing problem is a classical combinatorial optimization problem. This work is about a variant of the vehicle routing problem with dynamically changing orders and time windows. In real-world applications often the demands change during operation time. New orders occur and others are canceled. In this case new schedules need to be generated on-the-fly. Online optimization algorithms for dynamical vehicle routing address this problem but so far they do not consider time windows. Moreover, to match the scenarios found in real-world problems adaptations of benchmarks are required. In this paper, a practical problem is modeled based on the procedure of daily routing of a delivery company. New orders by customers are introduced dynamically during the working day and need to be integrated into the schedule. A multiple ant colony algorithm combined with powerful local search procedures is proposed to solve the dynamic vehicle routing problem with time windows. The performance is tested on a new benchmark based on simulations of a working day. The problems are taken from Solomon's benchmarks but a certain percentage of the orders are only revealed to the algorithm during operation time. Different versions of the MACS algorithm are tested and a high performing variant is identified. Finally, the algorithm is tested in situ: In a field study, the algorithm schedules a fleet of cars for a surveillance company. We compare the performance of the algorithm to that of the procedure used by the company and we summarize insights gained from the implementation of the real-world study. The results show that the multiple ant colony algorithm can get a much better solution on the academic benchmark problem and also can be integrated in a real-world environment.

Objective assessment of operator performance during ultrasound-guided procedures.

PubMed

Tabriz, David M; Street, Mandie; Pilgram, Thomas K; Duncan, James R

2011-09-01

Simulation permits objective assessment of operator performance in a controlled and safe environment. Image-guided procedures often require accurate needle placement, and we designed a system to monitor how ultrasound guidance is used to monitor needle advancement toward a target. The results were correlated with other estimates of operator skill. The simulator consisted of a tissue phantom, ultrasound unit, and electromagnetic tracking system. Operators were asked to guide a needle toward a visible point target. Performance was video-recorded and synchronized with the electromagnetic tracking data. A series of algorithms based on motor control theory and human information processing were used to convert raw tracking data into different performance indices. Scoring algorithms converted the tracking data into efficiency, quality, task difficulty, and targeting scores that were aggregated to create performance indices. After initial feasibility testing, a standardized assessment was developed. Operators (N = 12) with a broad spectrum of skill and experience were enrolled and tested. Overall scores were based on performance during ten simulated procedures. Prior clinical experience was used to independently estimate operator skill. When summed, the performance indices correlated well with estimated skill. Operators with minimal or no prior experience scored markedly lower than experienced operators. The overall score tended to increase according to operator's clinical experience. Operator experience was linked to decreased variation in multiple aspects of performance. The aggregated results of multiple trials provided the best correlation between estimated skill and performance. A metric for the operator's ability to maintain the needle aimed at the target discriminated between operators with different levels of experience. This study used a highly focused task model, standardized assessment, and objective data analysis to assess performance during simulated ultrasound-guided needle placement. The performance indices were closely related to operator experience.

40 CFR 63.1547 - Monitoring requirements.

Code of Federal Regulations, 2012 CFR

2012-07-01

... according to, a standard operating procedures manual that describes in detail the procedures for inspection...) The standard operating procedures manual for baghouses required by paragraph (a) of this section must... specified in the standard operating procedures manual for inspections and routine maintenance must, at a...

40 CFR 63.1547 - Monitoring requirements.

Code of Federal Regulations, 2013 CFR

2013-07-01

... according to, a standard operating procedures manual that describes in detail the procedures for inspection...) The standard operating procedures manual for baghouses required by paragraph (a) of this section must... specified in the standard operating procedures manual for inspections and routine maintenance must, at a...

40 CFR 63.1547 - Monitoring requirements.

Code of Federal Regulations, 2014 CFR

2014-07-01

... according to, a standard operating procedures manual that describes in detail the procedures for inspection...) The standard operating procedures manual for baghouses required by paragraph (a) of this section must... specified in the standard operating procedures manual for inspections and routine maintenance must, at a...

Application of stroboscopic and pulsed-laser electronic speckle pattern interferometry (ESPI) to modal analysis problems

NASA Astrophysics Data System (ADS)

Van der Auweraer, H.; Steinbichler, H.; Vanlanduit, S.; Haberstok, C.; Freymann, R.; Storer, D.; Linet, V.

2002-04-01

Accurate structural models are key to the optimization of the vibro-acoustic behaviour of panel-like structures. However, at the frequencies of relevance to the acoustic problem, the structural modes are very complex, requiring high-spatial-resolution measurements. The present paper discusses a vibration testing system based on pulsed-laser holographic electronic speckle pattern interferometry (ESPI) measurements. It is a characteristic of the method that time-triggered (and not time-averaged) vibration images are obtained. Its integration into a practicable modal testing and analysis procedure is reviewed. The accumulation of results at multiple excitation frequencies allows one to build up frequency response functions. A novel parameter extraction approach using spline-based data reduction and maximum-likelihood parameter estimation was developed. Specific extensions have been added in view of the industrial application of the approach. These include the integration of geometry and response information, the integration of multiple views into one single model, the integration with finite-element model data and the prior identification of the critical panels and critical modes. A global procedure was hence established. The approach has been applied to several industrial case studies, including car panels, the firewall of a monovolume car, a full vehicle, panels of a light truck and a household product. The research was conducted in the context of the EUREKA project HOLOMODAL and the Brite-Euram project SALOME.

Flexible Mediation Analysis With Multiple Mediators.

PubMed

Steen, Johan; Loeys, Tom; Moerkerke, Beatrijs; Vansteelandt, Stijn

2017-07-15

The advent of counterfactual-based mediation analysis has triggered enormous progress on how, and under what assumptions, one may disentangle path-specific effects upon combining arbitrary (possibly nonlinear) models for mediator and outcome. However, current developments have largely focused on single mediators because required identification assumptions prohibit simple extensions to settings with multiple mediators that may depend on one another. In this article, we propose a procedure for obtaining fine-grained decompositions that may still be recovered from observed data in such complex settings. We first show that existing analytical approaches target specific instances of a more general set of decompositions and may therefore fail to provide a comprehensive assessment of the processes that underpin cause-effect relationships between exposure and outcome. We then outline conditions for obtaining the remaining set of decompositions. Because the number of targeted decompositions increases rapidly with the number of mediators, we introduce natural effects models along with estimation methods that allow for flexible and parsimonious modeling. Our procedure can easily be implemented using off-the-shelf software and is illustrated using a reanalysis of the World Health Organization's Large Analysis and Review of European Housing and Health Status (WHO-LARES) study on the effect of mold exposure on mental health (2002-2003). © The Author(s) 2017. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

40 CFR Appendix B to Subpart S of... - Test Procedures

Code of Federal Regulations, 2010 CFR

2010-07-01

... percent or the vehicle's engine stalls at any time during the test sequence. (4) Multiple exhaust pipes. Exhaust gas concentrations from vehicle engines equipped with multiple exhaust pipes shall be sampled... pipes. Exhaust gas concentrations from vehicle engines equipped with multiple exhaust pipes shall be...

15 CFR 970.514 - Scale requiring application procedures.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 15 Commerce and Foreign Trade 3 2010-01-01 2010-01-01 false Scale requiring application procedures. 970.514 Section 970.514 Commerce and Foreign Trade Regulations Relating to Commerce and Foreign Trade... § 970.514 Scale requiring application procedures. (a) A proposal by the Administrator to modify a term...

Light duty utility arm phase 2 qualification test procedure

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

Barnes, G.A.

1997-01-16

This Acceptance Test Procedure (ATP) will test and verify that the Exhauster meets the specified functional requirements, safety requirements, operating requirements, and provide a record of the functional test results. The system/functions that will be tested are listed in the scope section of the Acceptance Test Procedure.

19 CFR 101.9 - Test programs or procedures; alternate requirements.

Code of Federal Regulations, 2010 CFR

2010-04-01

... requirements. (a) General testing. For purposes of conducting a test program or procedure designed to evaluate... test and the basis for selecting participants; and, (2) Post publication requirement. Within a... 19 Customs Duties 1 2010-04-01 2010-04-01 false Test programs or procedures; alternate...

19 CFR 101.9 - Test programs or procedures; alternate requirements.

Code of Federal Regulations, 2013 CFR

2013-04-01

... requirements. (a) General testing. For purposes of conducting a test program or procedure designed to evaluate... test and the basis for selecting participants; and, (2) Post publication requirement. Within a... 19 Customs Duties 1 2013-04-01 2013-04-01 false Test programs or procedures; alternate...

19 CFR 101.9 - Test programs or procedures; alternate requirements.

Code of Federal Regulations, 2011 CFR

2011-04-01

... requirements. (a) General testing. For purposes of conducting a test program or procedure designed to evaluate... test and the basis for selecting participants; and, (2) Post publication requirement. Within a... 19 Customs Duties 1 2011-04-01 2011-04-01 false Test programs or procedures; alternate...

19 CFR 101.9 - Test programs or procedures; alternate requirements.

Code of Federal Regulations, 2012 CFR

2012-04-01

... requirements. (a) General testing. For purposes of conducting a test program or procedure designed to evaluate... test and the basis for selecting participants; and, (2) Post publication requirement. Within a... 19 Customs Duties 1 2012-04-01 2012-04-01 false Test programs or procedures; alternate...

A comparative study of serial and parallel aeroelastic computations of wings

NASA Technical Reports Server (NTRS)

Byun, Chansup; Guruswamy, Guru P.

1994-01-01

A procedure for computing the aeroelasticity of wings on parallel multiple-instruction, multiple-data (MIMD) computers is presented. In this procedure, fluids are modeled using Euler equations, and structures are modeled using modal or finite element equations. The procedure is designed in such a way that each discipline can be developed and maintained independently by using a domain decomposition approach. In the present parallel procedure, each computational domain is scalable. A parallel integration scheme is used to compute aeroelastic responses by solving fluid and structural equations concurrently. The computational efficiency issues of parallel integration of both fluid and structural equations are investigated in detail. This approach, which reduces the total computational time by a factor of almost 2, is demonstrated for a typical aeroelastic wing by using various numbers of processors on the Intel iPSC/860.

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.

14 CFR 91.1069 - Flight crew: Instrument proficiency check requirements.

Code of Federal Regulations, 2010 CFR

2010-01-01

... procedures. The instrument approach procedure or procedures must include at least one straight-in approach... conducted to published minimums for that procedure. (d) The instrument proficiency checks required by... emergencies, and standard instrument approaches involving navigational facilities which that pilot is to be...

14 CFR 91.1069 - Flight crew: Instrument proficiency check requirements.

Code of Federal Regulations, 2011 CFR

2011-01-01

... procedures. The instrument approach procedure or procedures must include at least one straight-in approach... conducted to published minimums for that procedure. (d) The instrument proficiency checks required by... emergencies, and standard instrument approaches involving navigational facilities which that pilot is to be...

29 CFR 1926.1406 - Assembly/Disassembly-employer procedures-general requirements.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 29 Labor 8 2012-07-01 2012-07-01 false Assembly/Disassembly-employer procedures-general... CONSTRUCTION Cranes and Derricks in Construction § 1926.1406 Assembly/Disassembly—employer procedures—general requirements. (a) When using employer procedures instead of manufacturer procedures for assembly/disassembly...

29 CFR 1926.1406 - Assembly/Disassembly-employer procedures-general requirements.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 29 Labor 8 2014-07-01 2014-07-01 false Assembly/Disassembly-employer procedures-general... CONSTRUCTION Cranes and Derricks in Construction § 1926.1406 Assembly/Disassembly—employer procedures—general requirements. (a) When using employer procedures instead of manufacturer procedures for assembly/disassembly...

29 CFR 1926.1406 - Assembly/Disassembly-employer procedures-general requirements.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 29 Labor 8 2013-07-01 2013-07-01 false Assembly/Disassembly-employer procedures-general... CONSTRUCTION Cranes and Derricks in Construction § 1926.1406 Assembly/Disassembly—employer procedures—general requirements. (a) When using employer procedures instead of manufacturer procedures for assembly/disassembly...

29 CFR 1926.1406 - Assembly/Disassembly-employer procedures-general requirements.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 29 Labor 8 2011-07-01 2011-07-01 false Assembly/Disassembly-employer procedures-general... CONSTRUCTION Cranes and Derricks in Construction § 1926.1406 Assembly/Disassembly—employer procedures—general requirements. (a) When using employer procedures instead of manufacturer procedures for assembly/disassembly...

45 CFR 164.316 - Policies and procedures and documentation requirements.

Code of Federal Regulations, 2010 CFR

2010-10-01

... Electronic Protected Health Information § 164.316 Policies and procedures and documentation requirements. A... reasonable and appropriate policies and procedures to comply with the standards, implementation... 45 Public Welfare 1 2010-10-01 2010-10-01 false Policies and procedures and documentation...

45 CFR 164.316 - Policies and procedures and documentation requirements.

Code of Federal Regulations, 2011 CFR

2011-10-01

... Electronic Protected Health Information § 164.316 Policies and procedures and documentation requirements. A... reasonable and appropriate policies and procedures to comply with the standards, implementation... 45 Public Welfare 1 2011-10-01 2011-10-01 false Policies and procedures and documentation...

Analysis of direct costs of decompressive craniectomy in victims of traumatic brain injury.

PubMed

Badke, Guilherme Lellis; Araujo, João Luiz Vitorino; Miura, Flávio Key; Guirado, Vinicius Monteiro de Paula; Saade, Nelson; Paiva, Aline Lariessy Campos; Avelar, Tiago Marques; Pedrozo, Charles Alfred Grander; Veiga, José Carlos Esteves

2018-04-01

Decompressive craniectomy is a procedure required in some cases of traumatic brain injury (TBI). This manuscript evaluates the direct costs and outcomes of decompressive craniectomy for TBI in a developing country and describes the epidemiological profile. A retrospective study was performed using a five-year neurosurgical database, taking a sample of patients with TBI who underwent decompressive craniectomy. Several variables were considered and a formula was developed for calculating the total cost. Most patients had multiple brain lesions and the majority (69.0%) developed an infectious complication. The general mortality index was 68.8%. The total cost was R$ 2,116,960.22 (US$ 661,550.06) and the mean patient cost was R$ 66,155.00 (US$ 20,673.44). Decompressive craniectomy for TBI is an expensive procedure that is also associated with high morbidity and mortality. This was the first study performed in a developing country that aimed to evaluate the direct costs. Prevention measures should be a priority.

Cervical amyloidoma of C2. Case report and review of the literature.

PubMed

Porchet, F; Sonntag, V K; Vrodos, N

1998-01-01

Second published report of a patient with amyloidoma of the upper cervical spine. To describe a patient with rare radiculopathy to alert other physicians to consider amyloid tumor as a differential diagnosis of locally destructive spine lesions. Localized amyloid tumor of the bone is a rare disease. Only seven cases of spine involvement have been reported. Appropriate tissue sampling is required to establish the diagnosis. Histopathologic examination shows pathognomonic apple-green birefringence under polarized light. When bone is involved with amyloid, it is most commonly associated with multiple myeloma or other plasma cell-dyscrasias. This case was described, and pertinent literature was reviewed. The patient showed persistent neurologic improvement after transoral complete tumor removal, followed by a secondary posterior stabilization procedure using transarticular C1-C2 screws. Amyloidomas are benign lesions with no associated documented risk for the development of plasmocytoma-related diseases. The clinical and radiographic manifestations of this lesion are nonspecific. A cure is possible with complete resection of the tumor and no adjuvant management procedures.

Pollicization for thumb reconstruction in severe pediatric hand burns.

PubMed

Ward, J W; Pensler, J M; Parry, S W

1985-12-01

Our experience in pollicization of the index ray for severely burned hands in children is reviewed with attention to severity of burn, functional impairment, age at pollicization, procedure used, operative time, length of hospital stay, and long-term functional results. Fifteen pollicizations were performed in 11 patients with an average follow-up of over 5 years. Indication for pollicization was lack of prehension due to total loss of the thumb with the presence of a transposable index ray. The bipedicle flap method was used in two cases and the neurovascular pedicle technique was employed in all others. Skin grafts were necessary in all cases. Results were graded according to presence or absence of tip pinch, key pinch, grasp, and opposition. Significant functional improvement was seen in 14 of 15 cases (94 percent). Four patients (27 percent) developed complications requiring secondary procedures. In our experience, pollicization provides the most rapid and effective means of restoration of thumb function in the severe pediatric hand burn with multiple digit loss.

Group B streptococcal arthritis in adults.

PubMed

Small, C B; Slater, L N; Lowy, F D; Small, R D; Salvati, E A; Casey, J I

1984-03-01

Group B streptococcal arthritis in adults is uncommon. This report describes seven cases seen at these institutions over the past five years and reviews the previous 17 documented cases. Of seven adults, three were diabetics, three had prosthetic hips, and one had undergone splenectomy. Six had undergone no prior dental, genitourinary, or gastrointestinal procedures. The most common clinical presentation was fever and acute joint pain. Five patients had monoarticular arthritis; two had multiple joint involvement. Underlying joint abnormalities included osteoarthritis (two), prosthetic hip (three), and neuropathic joint (one). Bacteremia was documented in three and suspected in the remaining four patients, often without a primary source. Therapy included parenteral antibiotics, usually penicillin G, and drainage of the involved joint. Two of three patients with prosthetic implants required Girdlestone procedures; the third was apparently cured. The three diabetic patients died, one with resolution of group B streptococcal arthritis. The seventh patient was cured. Group B streptococcal arthritis is a serious infection in adults with diabetes and late prosthetic hip infections.

Asymptotic Analysis Of The Total Least Squares ESPRIT Algorithm'

NASA Astrophysics Data System (ADS)

Ottersten, B. E.; Viberg, M.; Kailath, T.

1989-11-01

This paper considers the problem of estimating the parameters of multiple narrowband signals arriving at an array of sensors. Modern approaches to this problem often involve costly procedures for calculating the estimates. The ESPRIT (Estimation of Signal Parameters via Rotational Invariance Techniques) algorithm was recently proposed as a means for obtaining accurate estimates without requiring a costly search of the parameter space. This method utilizes an array invariance to arrive at a computationally efficient multidimensional estimation procedure. Herein, the asymptotic distribution of the estimation error is derived for the Total Least Squares (TLS) version of ESPRIT. The Cramer-Rao Bound (CRB) for the ESPRIT problem formulation is also derived and found to coincide with the variance of the asymptotic distribution through numerical examples. The method is also compared to least squares ESPRIT and MUSIC as well as to the CRB for a calibrated array. Simulations indicate that the theoretic expressions can be used to accurately predict the performance of the algorithm.

[Clinical experience on the use of total parenteral nutrition in patients subjected to radical cystectomy intervention for infiltrating neoplasms of the bladder].

PubMed

Del Boca, C; Furiosi, D; Bolis, C; Ferrari, C

1989-03-01

The Authors report their 7 year follow-up on the use of T.P.N. in 28 patients treated surgically for infiltrating cancer of the bladder. They consider the pathogenetic mechanisms that influence the organism's adaptation to surgical stress with particular reference to the multiple neuroendocrinal and biochemical interconnections. The procedures to define the nutritional/metabolic levels, of the patients undergoing operation are exposed. The T.P.N. is given according to the personal requirements of each patient and is a function of the "performance status", caloric need and to the presence of sepsis. Problems concerning the radical cistectomy such as: time of surgery, extention of exeresis, uroentheroanastomosis, metabolic variations, sepsis, etc., are evaluated. Considering the positive results obtained with this nutritional procedure, the Authors underline the importance of a systematic use of T.P.N. wich should be included, in their opinion, in a multidisciplinar treatment of advanced bladder neoplasms.

Male urethral strictures and their management

PubMed Central

Hampson, Lindsay A.; McAninch, Jack W.; Breyer, Benjamin N.

2014-01-01

Male urethral stricture disease is prevalent and has a substantial impact on quality of life and health-care costs. Management of urethral strictures is complex and depends on the characteristics of the stricture. Data show that there is no difference between urethral dilation and internal urethrotomy in terms of long-term outcomes; success rates range widely from 8–80%, with long-term success rates of 20–30%. For both of these procedures, the risk of recurrence is greater for men with longer strictures, penile urethral strictures, multiple strictures, presence of infection, or history of prior procedures. Analysis has shown that repeated use of urethrotomy is not clinically effective or cost-effective in these patients. Long-term success rates are higher for surgical reconstruction with urethroplasty, with most studies showing success rates of 85–90%. Many techniques have been utilized for urethroplasty, depending on the location, length, and character of the stricture. Successful management of urethral strictures requires detailed knowledge of anatomy, pathophysiology, proper patient selection, and reconstructive techniques. PMID:24346008

Multiple congenital brachymetatarsia. A one-stage combined shortening and lengthening procedure without iliac bone graft.

PubMed

Kim, J S; Baek, G H; Chung, M S; Yoon, P W

2004-09-01

We performed nine metatarsal and three proximal phalangeal lengthenings in five patients with congenital brachymetatarsia of the first and one or two other metatarsal bones, by a one-stage combined shortening and lengthening procedure using intercalcary autogenous bone grafts from adjacent shortened metatarsal bones. Instead of the isolated lengthening of the first and the other metatarsal bones, we shortened the adjacent normal metatarsal and used the excised bone to lengthen the short toes, except for the great toe, to restore the normal parabola. One skin incision was used. All the operations were performed bilaterally and the patients were followed up for a mean period of 69.5 months (29 to 107). They all regained a nearly normal parabola and were satisfied with the cosmetic results. Our technique is straightforward and produces good cosmetic results. Satisfactory, bony union is achieved, morbidity is low, and no additional surgery is required for the removal of metal implants.

Multi-Tasking Non-Destructive Laser Technology in Conservation Diagnostic Procedures

NASA Astrophysics Data System (ADS)

Tornari, V.; Tsiranidou, E.; Orphanos, Y.; Falldorf, C.; Klattenhof, R.; Esposito, E.; Agnani, A.; Dabu, R.; Stratan, A.; Anastassopoulos, A.; Schipper, D.; Hasperhoven, J.; Stefanaggi, M.; Bonnici, H.; Ursu, D.

Laser metrology provides techniques that have been successfully applied in industrial structural diagnostic fields but have not yet been refined and optimised for the special investigative requirements found in cultural heritage applications. A major impediment is the partial applicability of various optical coherent techniques, each one narrowing its use down to a specific application. This characteristic is not well suited for a field that encounters a great variety of diagnostic problems ranging from movable, multiple-composition museum objects, to immovable multi-layered wall paintings, statues and wood carvings, to monumental constructions and outdoor cultural heritage sites. Various diagnostic techniques have been suggested and are uniquely suited for each of the mentioned problems but it is this fragmented suitability that obstructs the technology transfer. Since optical coherent techniques for metrology are based on fundamental principles and take advantage of similar procedures for generation of informative signals for data collection, then the imposed limits elevate our aim to identify complementary capabilities to accomplish the needed functionality.

An efficient parallel-processing method for transposing large matrices in place.

PubMed

Portnoff, M R

1999-01-01

We have developed an efficient algorithm for transposing large matrices in place. The algorithm is efficient because data are accessed either sequentially in blocks or randomly within blocks small enough to fit in cache, and because the same indexing calculations are shared among identical procedures operating on independent subsets of the data. This inherent parallelism makes the method well suited for a multiprocessor computing environment. The algorithm is easy to implement because the same two procedures are applied to the data in various groupings to carry out the complete transpose operation. Using only a single processor, we have demonstrated nearly an order of magnitude increase in speed over the previously published algorithm by Gate and Twigg for transposing a large rectangular matrix in place. With multiple processors operating in parallel, the processing speed increases almost linearly with the number of processors. A simplified version of the algorithm for square matrices is presented as well as an extension for matrices large enough to require virtual memory.

[Retrospective study of 50 ileostomies at the Salvador Zubirán National Institute of Nutrition].

PubMed

Granados-García, J; Takahashi, T; Tapia, M; Hoyos, C; Villalobos, J J

1996-01-01

To establish the diseases that motivated an ileostomy and the short and long-term morbi-mortality of the procedure. Retrospective analysis of 50 consecutive cases of ileostomies performed from 1989-1993 at a referral center in Mexico City. Most ileostomies were temporary (92%); the most frequent diagnoses were multiple familial polyposis, inflammatory bowel disease, and diverse intra-abdominal inflammatory complications. Operative mortality was 22%, caused mainly by the severity of the disease that motivated the ileostomy. A reoperation was required in 14% of the cases because of stomal complications (stricture, prolapse); 6% presented peristomal dermatitis, 4% high output, and 4% associated depression. With a mean time interval of three months, 32 patients were subjected to intestinal reconnection with a morbidity of 19% but no mortality. Ileostomy remains a necessary procedure mainly on a temporary basis. It is convenient to prevent complications by means of adequate surgical techniques, and a better rehabilitation by a multidisciplinary team.

An insect-tapeworm model as a proxy for anthelminthic effects in the mammalian host.

PubMed

Woolsey, Ian David; Fredensborg, Brian L; Jensen, Per M; Kapel, Christian M O; Meyling, Nicolai V

2015-07-01

Invertebrate models provide several important advantages over their vertebrate counterparts including fewer legislative stipulations and faster, more cost-effective experimental procedures. Furthermore, various similarities between insect and mammalian systems have been highlighted. To obtain maximum use of invertebrate models in pharmacology, their fidelity as analogues of vertebrate systems requires verification. We utilised a flour beetle (Tenebrio molitor)-tapeworm (Hymenolepis diminuta) model to evaluate the efficacy of known anthelmintic compounds, praziquantel, mebendazole and levamisole against H. diminuta cysticercoid larvae in vitro. Inhibition of cysticercoid activity during the excystation procedure was used as a proxy for worm removal. The effects of the three compounds mirrored their relative efficacy in treatment against adult worms in mammalian systems; however, further study is required to determine the fidelity of this model in relation to dose administered. The model precludes comparison of consecutive daily administration of pharmaceuticals in mammals due to cysticercoids not surviving outside of the host for multiple days. Treatment of beetles in vivo, followed by excystation of cysticercoids postdissection could potentially allow for such comparisons. Further model validation will include analysis of pharmaceutical efficacy in varying H. diminuta isolates and pharmaceutical dilution in solvents other than water. Notwithstanding, our results demonstrate that this model holds promise as a method to efficiently identify promising new cestocidal candidates.

Progression from on-site to point-of-care fine needle aspiration service: Opportunities and challenges

PubMed Central

Gupta, Prabodh K

2010-01-01

Background Standard-of-care requires the availability of an efficient, economical and accurate on-site fine needle aspiration (FNA) service. Presence of a trained individual during the procedure ensures an improved patient care. Appropriate selection of the equipment, interaction with the clinicians and compliance with the various regulations during the procedure is essential. This is often done by an on-site FNA service. Organization and implementation of such a system in a large academic center is challenging. Method we reviewed the ambulatory care needs in the new Perelman Center for Advanced Medicine (PeCAM). Multiple (9) FNA sites have been established keeping in view the patient's convenience, clinic demands, various regulatory requirements and laboratory staff. Each location has dedicated FNA station with microscopes and supplies. In addition, state- ofthe -art technologies including a mobile FNA cart (Penn-A- Cart), remote specimen evaluation (TeleCyP) have been incorporated. Results The new set up is extremely efficient and much valued by the patients and the clinicians. It has improved patient care. Conclusion With necessary investments and resources a point-of-care FNA service has been created which has improved patient care. This, albeit with certain modifications may serve as a model for FNA service. PMID:20607093

Teaching key use to persons with severe disabilities in congregate living settings.

PubMed

Ivancic, M T; Schepis, M M

1995-01-01

Key use remains overlooked for increasing independent material use by persons with severe mental retardation. In Experiment 1, a procedure to train key locating was evaluated in a multiple-probe withdrawal design across three groups of participants. Most participants located their keys when reinforced for doing so; however, key locating decreased when the reinforcement procedure was withdrawn. In Experiment 2, a multiple probe design across four participant groups was used to evaluate a training procedure to teach key use. Twenty of 25 participants used a key to open and lock their personal lockers as a result of training. However, only 36% of the participants were able to use their keys without prompts from experimenters.

Protein alignment algorithms with an efficient backtracking routine on multiple GPUs.

PubMed

Blazewicz, Jacek; Frohmberg, Wojciech; Kierzynka, Michal; Pesch, Erwin; Wojciechowski, Pawel

2011-05-20

Pairwise sequence alignment methods are widely used in biological research. The increasing number of sequences is perceived as one of the upcoming challenges for sequence alignment methods in the nearest future. To overcome this challenge several GPU (Graphics Processing Unit) computing approaches have been proposed lately. These solutions show a great potential of a GPU platform but in most cases address the problem of sequence database scanning and computing only the alignment score whereas the alignment itself is omitted. Thus, the need arose to implement the global and semiglobal Needleman-Wunsch, and Smith-Waterman algorithms with a backtracking procedure which is needed to construct the alignment. In this paper we present the solution that performs the alignment of every given sequence pair, which is a required step for progressive multiple sequence alignment methods, as well as for DNA recognition at the DNA assembly stage. Performed tests show that the implementation, with performance up to 6.3 GCUPS on a single GPU for affine gap penalties, is very efficient in comparison to other CPU and GPU-based solutions. Moreover, multiple GPUs support with load balancing makes the application very scalable. The article shows that the backtracking procedure of the sequence alignment algorithms may be designed to fit in with the GPU architecture. Therefore, our algorithm, apart from scores, is able to compute pairwise alignments. This opens a wide range of new possibilities, allowing other methods from the area of molecular biology to take advantage of the new computational architecture. Performed tests show that the efficiency of the implementation is excellent. Moreover, the speed of our GPU-based algorithms can be almost linearly increased when using more than one graphics card.

Bronchoscopy with endobronchial ultrasound guided transbronchial needle aspiration vs. transthoracic needle aspiration in lung cancer diagnosis and staging.

PubMed

Munoz, Mark L; Lechtzin, Noah; Li, Qing Kay; Wang, KoPen; Yarmus, Lonny B; Lee, Hans J; Feller-Kopman, David J

2017-07-01

In evaluating patients with suspected lung cancer, it is important to not only obtain a tissue diagnosis, but also to obtain enough tissue for both histologic and molecular analysis in order to appropriately stage the patient with a safe and efficient strategy. The diagnostic approach may often be dependent on local resources and practice patterns rather than current guidelines. We Describe lung cancer staging at two large academic medical centers to identify the impact different procedural approaches have on patient outcomes. We conducted a retrospective cohort study of all patients undergoing a lung cancer diagnostic evaluation at two multidisciplinary centers during a 1-year period. Identifying complication rates and the need for multiple biopsies as our primary outcomes, we developed a multivariate regression model to determine features associated with complications and need for multiple biopsies. Of 830 patients, 285 patients were diagnosed with lung cancers during the study period. Those staged at the institution without an endobronchial ultrasound (EBUS) program were more likely to require multiple biopsies (OR 3.62, 95% CI: 1.71-7.67, P=0.001) and suffer complications associated with the diagnostic procedure (OR 10.2, 95% CI: 3.08-33.58, P<0.001). Initial staging with transthoracic needle aspiration (TTNA) and conventional bronchoscopy were associated with greater need for subsequent biopsies (OR 8.05 and 14.00, 95% CI: 3.43-18.87 and 5.17-37.86, respectively) and higher complication rates (OR 37.75 and 7.20, 95% CI: 10.33-137.96 and 1.36-37.98, respectively). Lung cancer evaluation at centers with a dedicated EBUS program results in fewer biopsies and complications than at multidisciplinary counterparts without an EBUS program.