Motorization of a surgical microscope for intra-operative navigation and intuitive control.

PubMed

Finke, M; Schweikard, A

2010-09-01

During surgical procedures, various medical systems, e.g. microscope or C-arm, are used. Their precise and repeatable manual positioning can be very cumbersome and interrupts the surgeon's work flow. Robotized systems can assist the surgeon but they require suitable kinematics and control. However, positioning must be fast, flexible and intuitive. We describe a fully motorized surgical microscope. Hardware components as well as implemented applications are specified. The kinematic equations are described and a novel control concept is proposed. Our microscope combines fast manual handling with accurate, automatic positioning. Intuitive control is provided by a small remote control mounted to one of the surgical instruments. Positioning accuracy and repeatability are < 1 mm and vibrations caused by automatic movements fade away in about 1 s. The robotic system assists the surgeon, so that he can position the microscope precisely and repeatedly without interrupting the clinical workflow. The combination of manual und automatic control guarantees fast and flexible positioning during surgical procedures. Copyright 2010 John Wiley & Sons, Ltd.

Comparison of extracorporeal shock wave lithotripsy for inferior caliceal calculus between children and adults: a retrospective analysis--why do results vary?

PubMed

Mandal, Swarnendu; Sankhwar, Satya N; Singh, Manish Kumar; Kathpalia, Rohit; Singh, Vishwajeet; Goel, Apul; Singh, Bhupendra P; Dalela, Divakar

2012-12-01

To retrospectively evaluate the effectiveness of extracorporeal shock wave lithotripsy (ESWL) for inferior caliceal calculi ≤ 20 mm in size and compare the results between children and adults. From January 2004 to January 2012, ESWL was performed for inferior caliceal calculi in 230 children and 1006 adults. The Dornier compact alpha-K1025163 (Dornier Med Tech) was used. The success rates, number of ESWL sessions required, and auxiliary procedures used were evaluated in a comparative manner. The overall stone-free rate (for both stone sizes) was 82.2% for children and 40% for the adults. Of the children, 17% had a residual stone compared with 47.8% of the adults. ESWL was unsuccessful in 0.8% of children and 12.2% of adults. The mean number of ESWL sessions required in children and adults was 1.43 (range 1-4) and 2.13 (range 1-4), respectively. Repeat treatment was required in 31% of the children and 65% of the adults. Auxiliary procedures were required in 5.2% of the children and 16.2% of the adults. Complications were seen in 5.6% of the children and 15% of the adults. The results of ESWL for inferior caliceal calculi ≤ 20 mm in adults remains poor but not so in children. Children can achieve high stone-free rates, require a fewer number of ESWL sessions than adults to be stone free, and have a lower need for repeat treatment and auxiliary procedures, and have fewer complications. Copyright © 2012 Elsevier Inc. All rights reserved.

The incidence of total hip arthroplasty after hip arthroscopy in osteoarthritic patients

PubMed Central

2010-01-01

Objective To assess the incidence of total hip arthroplasty (THA) in osteoarthritic patients who were treated by arthroscopic debridement and to evaluate factors that might influence the time interval from the first hip arthroscopy to THA. Design Retrospective clinical series Methods Follow-up data and surgical reports were retrieved from 564 records of osteoarthritic patients that have had hip arthroscopy between the years 2002 to 2009 with a mean follow-up time of 3.2 years (range, 1-6.4 years). The time interval between the first hip arthroscopy to THA was modelled as a function of patient age; level of cartilage damage; procedures performed and repeated arthroscopies with the use of multivariate regression analysis. Results Ninety (16%) of all participants eventually required THA. The awaiting time from the first arthroscopy to a hip replacement was found to be longer in patients younger than 55 years and in a milder osteoarthritic stage. Patients that experienced repeated hip scopes had a longer time to THA than those with only a single procedure. Procedures performed concomitant with debridement and lavage did not affect the time interval to THA. Conclusions In our series of arthroscopic treatment of hip osteoarthritis, 16% required THA over a period of 7 years. Factors that influence the time to arthroplasty were age, degree of osteoarthritis and recurrent procedures. PMID:20670440

Endoscopic management of traumatic posterior urethral stricture: early results and followup.

PubMed

Goel, M C; Kumar, M; Kapoor, R

1997-01-01

We assessed the outcome of core through internal urethrotomy for traumatic posterior urethral stricture, and reviewed the followup results of these patients. During the last 4 years 13 patients with a stricture up to 2 cm. long underwent core through internal urethrotomy with C-arm fluoroscopy guidance and an orientation in 2 planes. Retrograde urethrotomy was performed and an 18F Foley catheter was left indwelling for 4 weeks, after which urethrotomy was repeated. All patients were advised to perform clean intermittent self-catheterization for urethral calibration and dilation. Outcome was defined as class 1-3 patients who required 2 or fewer urethrotomies with clean intermittent self-catheterization discontinued after the primary procedure, class 2-5 who required 2 or fewer urethrotomies with clean intermittent self-catheterization and class 3-5 who required 3 or more urethrotomies. Of the 13 patients 8 (61%) did well after a mean followup of 17.7 months. The 3 patients with a class 1 outcome did well, while 2 of 5 with a class 2 outcome required repeat urethrotomy during followup. Of the 5 patients (39%) with a class 3 outcome in whom core through internal urethrotomy failed 3 required open surgery and 2 were lost to followup. Recurrence rate was 69% at 3 months and 25% at 12 months after the initial procedure. No patient was incontinent at last followup. Two patients had significant hematuria postoperatively, which resolved with conservative treatment. Endoscopic treatment should be considered the first line procedure for all post-traumatic posterior urethral strictures. The morbidity of open surgery can be avoided in 61% of patients. Hospital stay, loss of work, morbidity and related complications are also markedly decreased with endoscopic therapy.

Ureteric bupivicaine infusion for loin pain haematuria syndrome.

PubMed

Ahmed, M; Acher, P; Deane, A M

2010-03-01

Loin pain haematuria syndrome is a common problem with complications including opiate dependence. Morbidity treatments include intra-ureteric capsaicin infusion, nephrectomy, autotransplantation and nephrolysis. We explored the use of flexible cystoscopic infusion of intra-ureteric bupivicaine. Patients presenting with chronic loin pain underwent urological and nephrological evaluation. Bupivicaine (0.5%, 20 ml) was infused via an intra-ureteric catheter under flexible cystoscopic guidance. Repeat infusions were offered if indicated. Sixteen of 17 patients with 1-year follow-up responded and were satisfied. Twelve of these required repeat infusions (mean, 2.9 infusions). The procedures were well tolerated by all patients without adverse effects. Intra-ureteric bupivicaine infusion has a place in the management of patients with chronic renal pain. It offers a minimally invasive alternative to other treatments. This procedure warrants further investigation within a randomised, controlled trial setting.

Immediate Small Number Perception : Evidence from a New Numerical Carry-Over Procedure

ERIC Educational Resources Information Center

Demeyere, Nele; Humphreys, Glyn W.

2012-01-01

Evidence is presented for the immediate apprehension of exact small quantities. Participants performed a quantification task (are the number of items greater or smaller than?), and carry-over effects were examined between numbers requiring the same response. Carry-over effects between small numbers were strongly affected by repeats of pattern and…

40 CFR 90.316 - Hydrocarbon analyzer calibration.

Code of Federal Regulations, 2010 CFR

2010-07-01

...) Recheck the zero response. If it has changed by more than ±one percent of full scale, repeat the test. (6... operating adjustment using the appropriate fuel (see § 90.312) and purified synthetic air or zero-grade nitrogen. (2) Use of one of the following procedures is required for FID or HFID optimization: (i) The...

Washington State Juvenile Justice Code: An Experiment in Justice.

ERIC Educational Resources Information Center

Illinois Univ., Champaign. Community Research Center.

In the Washington State juvenile justice system, serious or repeat offenders receive the full panoply of due process rights and procedures, with the exception of jury trials; minor offenders are diverted to community boards that require community service or victim restitution; and status offenders are removed from the courts' jurisdiction and…

The natural history and management of patients with congenital deficits associated with lumbosacral lipomas.

PubMed

Tu, Albert; Hengel, Ross; Cochrane, D Douglas

2016-04-01

Many patients with lumbosacral lipoma are asymptomatic; however, a significant proportion will have neurological deficits present at birth. Implication of these deficits with respect to natural history and management are not well understood. A retrospective review of all infants with lumbosacral lipoma seen at BCCH between 1997 and 2013 was carried out. The study population was stratified on the presence of a congenital, non-progressive deficit and subdivided on treatment approach. The subsequent developments of deficits resulting in untethering procedures were recorded. Of the 44 infants in this study, 24 patients had no neurologic deficit while 20 patients had a fixed, non-progressive deficit evident at birth. Ten of 24 patients without a neurological deficit at birth underwent a prophylactic untethering with 3 eventually requiring repeat untethering after, on average, 62.7 months. Eleven of 14 asymptomatic, monitored patients required untethering for clinical deterioration. Two required a second untethering procedure after 48.7 months. Ten of 20 infants with congenital deficits present at birth underwent prophylactic untethering, and 4 required further surgery after 124 months. Ten patients underwent observation with 8 eventually requiring surgery. Two required repeat untethered after 154 months. The complication rates and operative burden for patients are similar whether prophylactic or delayed surgery is performed. The presence of congenital neurologic deficit does not affect the likelihood of deterioration in patients managed expectantly; prophylactic detethering of these patients did not prevent delayed neurologic deterioration. Comparing the need for repeat surgery in prophylactically untethered patients with initial untethering of patients operated upon at the time of deterioration, prophylactic untethering may confer a benefit with respect to subsequent symptomatic tethering if complication rates are low. However, in a setting with multidisciplinary follow-up, a period of observation for patients and intervention when patients become symptomatic is an acceptable approach for patients with or without congenital deficits.

What Is the Efficacy of Repeat Manipulations Under Anesthesia to Treat Stiffness Following Primary Total Knee Arthroplasty?

PubMed

Issa, Kimona; Pierce, Todd P; Brothers, Alexander; McInerney, Vincent K; Chughtai, Morad; Mistry, Jaydev B; Bryant, Wayne W; Delanois, Ronald E; Harwin, Steven F; Mont, Michael A

2016-04-01

Manipulation under anesthesia (MUA) can help post-total knee arthroplasty (TKA) patients who have knee stiffness regain range-of-motion. However, despite undergoing MUA, patients may have persistent knee stiffness. Often, this persistent knee stiffness is treated with a repeat MUA. Therefore, the purpose of this study was to evaluate repeat MUAs by assessing: (1) demographic characteristics, (2) range-of-motion, (3) clinical outcomes, and (4) rate of revision surgery in post-TKA patients with persistent knee stiffness who either underwent a single MUA or repeat MUAs. One-hundred-and-sixty-seven post-TKA who had undergone an MUA between 2005 and 2011 at two institutions were reviewed. Patients were stratified into those who had a single-MUA (138 knees) and those who had a repeat MUA (29 knees). The mean follow-up period was 63 months (range, 36 to 90 months). The incidence of repeat MUA within this cohort was determined. Demographics and ROM were compared using Student t-test and Chi-square as appropriate. Functional outcomes were assessed using Knee Society scores (KSS) and compared between the two cohorts. Among the 167 patients who underwent a MUA, 29 (17%) required repeat manipulations. The repeat MUA cohort was younger and more likely to have osteonecrosis as the underlying cause of knee disease. For the repeat MUA cohort, 17 patients (59%) had achieved satisfactory mean gains in ROM after their repeat MUAs. These patients had also achieved excellent mean Knee Society objective and functional scores. However, another seven knees (24%) had further persistent knee stiffness requiring arthrolysis of adhesions and five patients (17%) had undergone revision of the polyethylene spacer or patellar component to improve range-of-motion. In this study, the majority of patients who had undergone a repeat MUA were able to achieve improvements in flexion range-of-motion and functional outcomes. However, the remaining patients required more invasive procedure to treat persistent knee stiffness. In patients who have persistent knee stiffness after MUAs, a repeat MUA may be helpful to increase range-of-motion and function.

A bronchoscopic approach to benign subglottic stenosis.

PubMed

Raman, Tuhina; Chatterjee, Kshitij; Alzghoul, Bashar N; Innabi, Ayoub A; Tulunay, Ozlem; Bartter, Thaddeus; Meena, Nikhil K

2017-01-01

Subglottic stenosis is an abnormal narrowing of the tracheal lumen at the level of subglottis (the area in between the vocal cords and the cricoid cartilage). It can cause significant symptoms due to severe attenuation of airflow. We describe our experience in alleviating symptoms by addressing the stenosis using fibreoptic bronchoscopic methods. We report all concurrent cases performed between September 2015 and July 2016. We use a combination of balloon dilation, electro-surgery knife to dilate and incise stenotic segments followed by steroid injection to modulate healing. We treated 10 patients in the study period, 8 of which were women. A total of 39 procedures were performed on these patients during this period. Gastro-esophageal reflux was the most common comorbidity associated with stenosis. The majority of the patients required more than 2 therapeutic procedures, but none required more than 4 procedures. There were no complications. Tracheal stenosis and in particular subglottic stenosis is a recurrent process and its management requires extensive collaboration amongst treating specialties. Our technique of steroid injection after dilation of the stenosis was effective in symptom control and decreased the number of repeat procedures.

The effect of repeated laser stimuli to ink-marked skin on skin temperature-recommendations for a safe experimental protocol in humans.

PubMed

Madden, Victoria J; Catley, Mark J; Grabherr, Luzia; Mazzola, Francesca; Shohag, Mohammad; Moseley, G Lorimer

2016-01-01

Background. Nd:YAP laser is widely used to investigate the nociceptive and pain systems, generating perpetual and laser-evoked neurophysiological responses. A major procedural concern for the use of Nd:YAP laser stimuli in experimental research is the risk of skin damage. The absorption of Nd:YAP laser stimuli is greater in darker skin, or in pale skin that has been darkened with ink, prompting some ethics boards to refuse approval to experimenters wishing to track stimulus location by marking the skin with ink. Some research questions, however, require laser stimuli to be delivered at particular locations or within particular zones, a requirement that is very difficult to achieve if marking the skin is not possible. We thoroughly searched the literature for experimental evidence and protocol recommendations for safe delivery of Nd:YAP laser stimuli over marked skin, but found nothing. Methods. We designed an experimental protocol to define safe parameters for the use of Nd:YAP laser stimuli over skin that has been marked with black dots, and used thermal imaging to assess the safety of the procedure at the forearm and the back. Results. Using thermal imaging and repeated laser stimulation to ink-marked skin, we demonstrated that skin temperature did not increase progressively across the course of the experiment, and that the small change in temperature seen at the forearm was reversed during the rest periods between blocks. Furthermore, no participant experienced skin damage due to the procedure. Conclusion. This protocol offers parameters for safe, confident and effective experimentation using repeated Nd:YAP laser on skin marked with ink, thus paving the way for investigations that depend on it.

Developing and Trialling an independent, scalable and repeatable IT-benchmarking procedure for healthcare organisations.

PubMed

Liebe, J D; Hübner, U

2013-01-01

Continuous improvements of IT-performance in healthcare organisations require actionable performance indicators, regularly conducted, independent measurements and meaningful and scalable reference groups. Existing IT-benchmarking initiatives have focussed on the development of reliable and valid indicators, but less on the questions about how to implement an environment for conducting easily repeatable and scalable IT-benchmarks. This study aims at developing and trialling a procedure that meets the afore-mentioned requirements. We chose a well established, regularly conducted (inter-) national IT-survey of healthcare organisations (IT-Report Healthcare) as the environment and offered the participants of the 2011 survey (CIOs of hospitals) to enter a benchmark. The 61 structural and functional performance indicators covered among others the implementation status and integration of IT-systems and functions, global user satisfaction and the resources of the IT-department. Healthcare organisations were grouped by size and ownership. The benchmark results were made available electronically and feedback on the use of these results was requested after several months. Fifty-ninehospitals participated in the benchmarking. Reference groups consisted of up to 141 members depending on the number of beds (size) and the ownership (public vs. private). A total of 122 charts showing single indicator frequency views were sent to each participant. The evaluation showed that 94.1% of the CIOs who participated in the evaluation considered this benchmarking beneficial and reported that they would enter again. Based on the feedback of the participants we developed two additional views that provide a more consolidated picture. The results demonstrate that establishing an independent, easily repeatable and scalable IT-benchmarking procedure is possible and was deemed desirable. Based on these encouraging results a new benchmarking round which includes process indicators is currently conducted.

Design of a blood-freezing system for leukemia research

NASA Technical Reports Server (NTRS)

Williams, T. E.; Cygnarowicz, T. A.

1978-01-01

Leukemia research involves the use of cryogenic freezing and storage equipment. In a program being carried out at the National Cancer Institute (NCI), bone marrow (white blood cells) was frozen using a standard cryogenic biological freezer. With this system, it is difficult to maintain the desired rate of freezing and repeatability from sample to sample. A freezing system was developed that satisfies the requirements for a repeatable, constant freezing rate. The system was delivered to NIC and is now operational. This report describes the design of the major subsystems, the analyses, the operating procedure, and final system test results.

Endoluminal Intervention in the Salivary Duct: Clinical Outcomes at a District General Hospital

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

Nagra, I.; Jones, C.; Dyer, J., E-mail: Jules.Dyer@rwh-tr.nhs.u

Our aim was to assess the preliminary clinical outcomes of interventional radiology for salivary duct obstruction in relation to salivary duct strictures or calculi. A retrospective analysis of consecutive patients referred for endoluminal procedures by ENT surgeons during a 4-year period were identified. The procedure was performed by a single interventional radiologist under fluoroscopic guidance using wire baskets and angioplasty balloons. Between June 2004 and October 2008, 50 sialoplasties were performed in 43 patients (30 female and 13 male). Twenty-six patients were prepared for 32 procedures for extraction of calculi (13 submandibular and 13 parotid), and 17 patients had 18more » procedures for strictures (16 parotid and 1 submandibular). One patient in the group with calculi was judged unsuitable for intervention because the stone had migrated outside the salivary duct. Information was collected regarding the clinical indication; duration and type of symptoms; technical factors; follow-up; and success or failure of reintervention. Complete stone removal was achieved in 18 of the 26 patients (69%), with success on the first attempt in 14 patients (54%). Redo procedures were required in 4 patients (15%), with subsequent complete clearance of calculi. In this cohort, 20 patients were symptomatically improved (77%). Of the 6 patients (26%) with continuing symptoms, 2 patients had mild symptoms; two had moderate symptoms; and two patients opted to have surgery for unremitting symptoms. In the stricture group, 18 procedures were performed in 17 patients, with a successful outcome in 16 patients after the initial sialoplasty. Only 1 patient required repeat intervention (6%) and later opted to have surgery for continuing symptoms. In this group, 14 patients (82%) were symptomatically improved, and 3 remained symptomatic despite a good immediate result due to restenosis. Two patients experienced early complications: One had a transient facial nerve palsy, and the other had sialadenitis treated with antibiotics. Preliminary results suggest that symptom resolution at first intervention is higher in patients with acalculous strictures. Patients with calculi are more likely to require a repeat procedure for complete clearance.« less

Elbow Angle during a Simulated Task Requiring Fine Psychomotor Control.

ERIC Educational Resources Information Center

Colangelo, Gary A.; And Others

1991-01-01

This study examined elbow angle during a fine motor task (threading a needle), in the context of positions used in preclinical training exercises and assumed by practitioners performing dental procedures. The 101 subjects tended to choose an obtuse angle (mean of 125 degrees) and to vary this angle only slightly in repeated trials. (DB)

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…

Ureteric bupivicaine infusion for loin pain haematuria syndrome

PubMed Central

Ahmed, P; Acher, P; Deane, AM

2010-01-01

INTRODUCTION Loin pain haematuria syndrome is a common problem with complications including opiate dependence. Morbidity treatments include intra-ureteric capsaicin infusion, nephrectomy, autotransplantation and nephrolysis. We explored the use of flexible cystoscopic infusion of intra-ureteric bupivicaine. PATIENTS AND METHODS Patients presenting with chronic loin pain underwent urological and nephrological evaluation. Bupivicaine (0.5%, 20 ml) was infused via an intra-ureteric catheter under flexible cystoscopic guidance. Repeat infusions were offered if indicated. RESULTS Sixteen of 17 patients with 1-year follow-up responded and were satisfied. Twelve of these required repeat infusions (mean, 2.9 infusions). The procedures were well tolerated by all patients without adverse effects. CONCLUSIONS Intra-ureteric bupivicaine infusion has a place in the management of patients with chronic renal pain. It offers a minimally invasive alternative to other treatments. This procedure warrants further investigation within a randomised, controlled trial setting. PMID:20353642

Long-Term Safety of Repeated Blood-Brain Barrier Opening via Focused Ultrasound with Microbubbles in Non-Human Primates Performing a Cognitive Task.

PubMed

Downs, Matthew E; Buch, Amanda; Sierra, Carlos; Karakatsani, Maria Eleni; Teichert, Tobias; Chen, Shangshang; Konofagou, Elisa E; Ferrera, Vincent P

2015-01-01

Focused Ultrasound (FUS) coupled with intravenous administration of microbubbles (MB) is a non-invasive technique that has been shown to reliably open (increase the permeability of) the blood-brain barrier (BBB) in multiple in vivo models including non-human primates (NHP). This procedure has shown promise for clinical and basic science applications, yet the safety and potential neurological effects of long term application in NHP requires further investigation under parameters shown to be efficacious in that species (500 kHz, 200-400 kPa, 4-5 μm MB, 2 minute sonication). In this study, we repeatedly opened the BBB in the caudate and putamen regions of the basal ganglia of 4 NHP using FUS with systemically-administered MB over 4-20 months. We assessed the safety of the FUS with MB procedure using MRI to detect edema or hemorrhaging in the brain. Contrast enhanced T1-weighted MRI sequences showed a 98% success rate for openings in the targeted regions. T2-weighted and SWI sequences indicated a lack edema in the majority of the cases. We investigated potential neurological effects of the FUS with MB procedure through quantitative cognitive testing of' visual, cognitive, motivational, and motor function using a random dot motion task with reward magnitude bias presented on a touchpanel display. Reaction times during the task significantly increased on the day of the FUS with MB procedure. This increase returned to baseline within 4-5 days after the procedure. Visual motion discrimination thresholds were unaffected. Our results indicate FUS with MB can be a safe method for repeated opening of the BBB at the basal ganglia in NHP for up to 20 months without any long-term negative physiological or neurological effects with the parameters used.

[Safety of repeat median sternotomy in the palliative treatment of patients with a univentricular heart].

PubMed

Díliz-Nava, Héctor; Meléndez-Sagaón, Isis; Tamaríz-Cruz, Orlando; García-Benítez, Luis; Araujo-Martínez, Aric; Palacios-Macedo, Alexis

To establish the morbidity and mortality of patients with univentricular hearts who underwent a repeat median sternotomy at the Instituto Nacional de Pediatría. A retrospective review was performed on the clinical charts of all patients who underwent a repeat median sternotomy from 2001 to 2016. Sixty-five patients underwent 76 surgeries by repeat median sternotomy. Fifty-nine patients had a first repeat median sternotomy, with a mean age of 36 months (range: 4-176 months) and a mean weight of 12.2 kg (range: 3.2-21.5 kg). Forty patients had a Glenn procedure, and 19 patients had a Fontan procedure. There were 17 patients with a second repeat median sternotomy, with a mean age of 89 months (range 48-156 months), and a mean weight of 22.7 kg (14.4-41 kg). A Fontan procedure was performed on all these 17 patients. A section of the right coronary artery with electrocardiographic changes and a right atrium tear that caused hypotension occurred during first repeat sternotomy. An aortic tear occurred during a second repeat sternotomy with massive bleeding and subsequent death. This represents 3.9% of re-entry injuries. It is concluded that repeat median sternotomy is a safe procedure. Copyright © 2016 Instituto Nacional de Cardiología Ignacio Chávez. Publicado por Masson Doyma México S.A. All rights reserved.

Complex posterior urethral injury

PubMed Central

Kulkarni, Sanjay B.; Joshi, Pankaj M.; Hunter, Craig; Surana, Sandesh; Shahrour, Walid; Alhajeri, Faisal

2015-01-01

Objective To assess treatment strategies for seven different scenarios for treating complex pelvic fracture urethral injury (PFUI), categorised as repeat surgery for PFUI, ischaemic bulbar urethral necrosis (BUN), repair in boys and girls aged ⩽12 years, in patients with a recto-urethral fistula, or bladder neck incontinence, or with a double block at the bulbomembranous urethra and bladder neck/prostate region. Patients and methods We retrospectively reviewed the success rates and surgical procedures of these seven complex scenarios in the repair of PFUI at our institution from 2000 to 2013. Results In all, >550 PFUI procedures were performed at our centre, and 308 of these patients were classified as having a complex PFUI, with 225 patients available for follow-up. The overall success rates were 81% and 77% for primary and repeat procedures respectively. The overall success rate of those with BUN was 76%, using various methods of novel surgical techniques. Boys aged ⩽12 years with PFUI required a transpubic/abdominal approach 31% of the time, compared to 9% in adults. Young girls with PFUI also required a transpubic/abdominal urethroplasty, with a success rate of 66%. In patients with a recto-urethral fistula the success rate was 90% with attention to proper surgical principles, including a three-stage procedure and appropriate interposition. The treatment of bladder neck incontinence associated with the tear-drop deformity gave a continence rate of 66%. Children with a double block at the bulbomembranous urethra and at the bladder neck-prostate junction were all continent after a one-stage transpubic/abdominal procedure. Conclusion An understanding of complex pelvic fractures and their appropriate management can provide successful outcomes. PMID:26019978

Intra-articular glucocorticoid injections in patients with juvenile idiopathic arthritis in a Singapore hospital.

PubMed

Leow, Olivia Min Yi; Lim, Lee Kean; Ooi, Pei Ling; Shek, Lynette Pei Chi; Ang, Elizabeth You Ning; Son, Mary Beth

2014-05-01

This study aimed to evaluate the efficacy and safety of intra-articular glucocorticoid (IAG) injections in our institution in children with juvenile idiopathic arthritis (JIA). This is a retrospective assessment of IAG injections performed by the Department of Paediatrics, National University Hospital, Singapore, from October 2009 to October 2011. A total of 26 procedures were evaluated for efficacy, considering parameters such as clinical response, changes in systemic medication, length of time between repeat injections, safety, consent-taking, pre- and post-procedural advice, compliance with aseptic technique, and post-procedural complications. A total of 26 IAG injections of triamcinolone hexacetonide were administered over 17 occasions (i.e. patient encounters) to ten patients with JIA during the study period. After the injections, clinical scoring by a paediatric rheumatologist showed overall improvement by an average of 2.62 points out of 15. Besides six patient encounters that had an increase in systemic medication on the day of the injection, five required an increase within six months post injection, two required no adjustments, and one resulted in a decrease in medications. In all, 21 injections did not require subsequent injections. The mean interval between repeat injections was 7.8 months. Cutaneous side effects were noted in three anatomically difficult joints. Medical documentation with regard to patient progress was found to be lacking. As per the recommendations of the American College of Rheumatology, we safely used IAG injections as the first-line therapy in our group of patients with oligoarticular JIA, and/or as an adjunct to systemic therapy in our patients with JIA.

Intra-articular glucocorticoid injections in patients with juvenile idiopathic arthritis in a Singapore hospital

PubMed Central

Leow, Olivia Min Yi; Lim, Lee Kean; Ooi, Pei Ling; Shek, Lynette Pei Chi; Ang, Elizabeth You Ning; Son, Mary Beth

2014-01-01

INTRODUCTION This study aimed to evaluate the efficacy and safety of intra-articular glucocorticoid (IAG) injections in our institution in children with juvenile idiopathic arthritis (JIA). METHODS This is a retrospective assessment of IAG injections performed by the Department of Paediatrics, National University Hospital, Singapore, from October 2009 to October 2011. A total of 26 procedures were evaluated for efficacy, considering parameters such as clinical response, changes in systemic medication, length of time between repeat injections, safety, consent-taking, pre- and post-procedural advice, compliance with aseptic technique, and post-procedural complications. RESULTS A total of 26 IAG injections of triamcinolone hexacetonide were administered over 17 occasions (i.e. patient encounters) to ten patients with JIA during the study period. After the injections, clinical scoring by a paediatric rheumatologist showed overall improvement by an average of 2.62 points out of 15. Besides six patient encounters that had an increase in systemic medication on the day of the injection, five required an increase within six months post injection, two required no adjustments, and one resulted in a decrease in medications. In all, 21 injections did not require subsequent injections. The mean interval between repeat injections was 7.8 months. Cutaneous side effects were noted in three anatomically difficult joints. Medical documentation with regard to patient progress was found to be lacking. CONCLUSION As per the recommendations of the American College of Rheumatology, we safely used IAG injections as the first-line therapy in our group of patients with oligoarticular JIA, and/or as an adjunct to systemic therapy in our patients with JIA. PMID:24862747

Is top-down vs bottom-up radiological evaluation after febrile urinary tract infection really less stressful for the child and family? Challenging the dogma.

PubMed

Telli, Onur; Mermerkaya, Murat; Hajiyev, Perviz; Aydogdu, Ozgu; Afandiyev, Faraj; Suer, Evren; Soygur, Tarkan; Burgu, Berk

2015-03-01

We evaluated whether stress levels in children and parents during radiological evaluation after febrile urinary tract infection are really lower using the top-down approach, where (99m)technetium dimercaptosuccinic acid renal scintigraphy is used initially, than the bottom-up approach, where voiding cystourethrography is initially performed and repeated examinations are easier for all. We prospectively evaluated 120 children 3 to 8 years old. Pain ratings were obtained using the Faces Pain Scale-Revised, and conversation during the procedure was evaluated using the Child-Adult Medical Procedure Interaction Scale-Revised by 2 independent observers. To evaluate parental anxiety, the State-Trait Anxiety Inventory form was also completed. Following a documented febrile urinary tract infection children were randomized to the top-down or bottom-up group. A third group of 44 children undergoing repeat voiding cystourethrography and their parents were also evaluated. Child ratings of pain using the Faces Pain Scale-Revised were not significantly different between the top-down group following (99m)technetium dimercaptosuccinic acid renal scintigraphy (2.99 on a scale of 10) and the bottom-up group following voiding cystourethrography (3.21). Also the Faces Pain Scale-Revised was not significantly different in the repeat voiding cystourethrography group (3.35). On the Child-Adult Medical Procedure Interaction Scale-Revised there was negative correlation between child coping and child distress, as well as rate of child distress and adult coping promoting behavior. Parental state anxiety scores were significantly less in the top-down and repeat voiding cystourethrography groups than in the bottom-up group. Although the top-down approach and repeat voiding cystourethrography cause less anxiety for caregivers, these values do not correlate to pain scale in children. This finding might be due to lack of appropriate evaluation tools of pediatric pain and anxiety. However, the theory that the top-down approach is less invasive, and thus less stressful, requires further research. The Child-Adult Medical Procedure Interaction Scale-Revised data indicate that influences in adult-child interaction are bidirectional. Copyright © 2015 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

Outcomes of repeat catheter ablation using magnetic navigation or conventional ablation.

PubMed

Akca, Ferdi; Theuns, Dominic A M J; Abkenari, Lara Dabiri; de Groot, Natasja M S; Jordaens, Luc; Szili-Torok, Tamas

2013-10-01

After initial catheter ablation, repeat procedures could be necessary. This study evaluates the efficacy of the magnetic navigation system (MNS) in repeat catheter ablation as compared with manual conventional techniques (MANs). The results of 163 repeat ablation procedures were analysed. Ablations were performed either using MNS (n = 84) or conventional manual ablation (n = 79). Procedures were divided into four groups based on the technique used during the initial and repeat ablation procedure: MAN-MAN (n = 66), MAN-MNS (n = 31), MNS-MNS (n = 53), and MNS-MAN (n = 13). Three subgroups were analysed: supraventricular tachycardias (SVTs, n = 68), atrial fibrillation (AF, n = 67), and ventricular tachycardias (VT, n = 28). Recurrences were assessed during 19 ± 11 months follow-up. Overall, repeat procedures using MNS were successful in 89.0% as compared with 96.2% in the MAN group (P = ns). The overall recurrence rate was significantly lower using MNS (25.0 vs. 41.4%, P = 0.045). Acute success and recurrence rates for the MAN-MAN, MAN-MNS, MNS-MNS, and MNS-MAN groups were comparable. For the SVT subgroup a higher acute success rate was achieved using MAN (87.9 vs. 100.0%, P = 0.049). The use of MNS for SVT is associated with longer procedure times (205 ± 82 vs. 172 ± 69 min, P = 0.040). For AF procedure and fluoroscopy times were longer (257 ± 72 vs. 185 ± 64, P = 0.001; 59.5 ± 19.3 vs. 41.1 ± 18.3 min, P < 0.001). Less fluoroscopy was used for MNS-guided VT procedures (22.8 ± 14.7 vs. 41.2 ± 10.9, P = 0.011). Our data suggest that overall MNS is comparable with MAN in acute success after repeat catheter ablation. However, MNS is related to fewer recurrences as compared with MAN.

40 CFR 63.7142 - What are the requirements for claiming area source status?

Code of Federal Regulations, 2013 CFR

2013-07-01

... test must be repeated. (v) The post-test analyte spike procedure of section 11.2.7 of ASTM Method D6735... (3) ASTM Method D6735-01, Standard Test Method for Measurement of Gaseous Chlorides and Fluorides...)(3)(i) through (vi) of this section are followed. (i) A test must include three or more runs in which...

40 CFR 63.7142 - What are the requirements for claiming area source status?

Code of Federal Regulations, 2011 CFR

2011-07-01

... test must be repeated. (v) The post-test analyte spike procedure of section 11.2.7 of ASTM Method D6735... (3) ASTM Method D6735-01, Standard Test Method for Measurement of Gaseous Chlorides and Fluorides...)(3)(i) through (vi) of this section are followed. (i) A test must include three or more runs in which...

40 CFR 63.7142 - What are the requirements for claiming area source status?

Code of Federal Regulations, 2012 CFR

2012-07-01

... test must be repeated. (v) The post-test analyte spike procedure of section 11.2.7 of ASTM Method D6735... (3) ASTM Method D6735-01, Standard Test Method for Measurement of Gaseous Chlorides and Fluorides...)(3)(i) through (vi) of this section are followed. (i) A test must include three or more runs in which...

40 CFR 63.7142 - What are the requirements for claiming area source status?

Code of Federal Regulations, 2010 CFR

2010-07-01

... test must be repeated. (v) The post-test analyte spike procedure of section 11.2.7 of ASTM Method D6735... (3) ASTM Method D6735-01, Standard Test Method for Measurement of Gaseous Chlorides and Fluorides...)(3)(i) through (vi) of this section are followed. (i) A test must include three or more runs in which...

40 CFR 63.7142 - What are the requirements for claiming area source status?

Code of Federal Regulations, 2014 CFR

2014-07-01

... test must be repeated. (v) The post-test analyte spike procedure of section 11.2.7 of ASTM Method D6735... (3) ASTM Method D6735-01, Standard Test Method for Measurement of Gaseous Chlorides and Fluorides...)(3)(i) through (vi) of this section are followed. (i) A test must include three or more runs in which...

Insight, working through, and practice: the role of procedural knowledge.

PubMed

Rosenblatt, Allan

2004-01-01

A conception of insight is proposed, based on a systems and information-processing framework and using current neuroscience concepts, as an integration of information that results in a new symbolization of experience with a significant change in self-image and a transformation of non-declarative procedural knowledge into declarative knowledge. Since procedural memory and knowledge, seen to include emotional and relationship issues, is slow to change, durable emotional and behavioral change often requires repeated practice, a need not explicitly addressed in standard psychoanalytic technique. Working through is thus seen as also encompassing nondynamic factors. The application of these ideas to therapeutic technique suggests possible therapeutic interventions beyond interpretation. An illustrative clinical vignette is presented.

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.

Analysis of longitudinal "time series" data in toxicology.

PubMed

Cox, C; Cory-Slechta, D A

1987-02-01

Studies focusing on chronic toxicity or on the time course of toxicant effect often involve repeated measurements or longitudinal observations of endpoints of interest. Experimental design considerations frequently necessitate between-group comparisons of the resulting trends. Typically, procedures such as the repeated-measures analysis of variance have been used for statistical analysis, even though the required assumptions may not be satisfied in some circumstances. This paper describes an alternative analytical approach which summarizes curvilinear trends by fitting cubic orthogonal polynomials to individual profiles of effect. The resulting regression coefficients serve as quantitative descriptors which can be subjected to group significance testing. Randomization tests based on medians are proposed to provide a comparison of treatment and control groups. Examples from the behavioral toxicology literature are considered, and the results are compared to more traditional approaches, such as repeated-measures analysis of variance.

Endoscopic management of complications of self-expandable metal stents for treatment of malignant esophageal stenosis and tracheoesophageal fistulas.

PubMed

Bor, Renáta; Fábián, Anna; Bálint, Anita; Farkas, Klaudia; Szűcs, Mónika; Milassin, Ágnes; Czakó, László; Rutka, Mariann; Molnár, Tamás; Szepes, Zoltán

2017-08-01

Self-expandable metal stent (SEMS) implantation may rapidly improve the symptoms of malignant esophageal stenosis and tracheoesophageal fistulas (TEF). However, dysphagia often returns subsequently and repeated endoscopic intervention may be necessary. The aims of the study were to identify the risk factors of complications, and the frequency and efficacy of repeated endoscopic interventions; and to provide technical recommendations on appropriate stent selection. We analyzed retrospectively the clinical data of 212 patients with locally advanced esophageal cancer who underwent SEMS implantation. A total of 238 SEMS implantations were performed with 99.06% technical success and 1.26% procedure-related deaths in the enrolled 212 cases. Complications occurred in 84 patients (39.62%) and in 55 cases (25.94%) repeated endoscopic procedures were required. Early reintervention 24-48 h after the stent implantations was necessary due to stent migration (12 cases), arrhythmia (2 cases), intolerable retrosternal pain (1 case) and dyspnea (1 case). An average of 1.98 repeated gastroscopies (range 1-6; median 2), 13.58 weeks (range 1.5-48; median 11) after the stent implantation were performed during the follow-up period: 37 stent repositions, 23 restent implantations, 15 endoscopic esophageal dilations and 7 stent removals. In 48 cases (87.3%) oral feeding of patients was made possible by endoscopic interventions. In a quarter of SEMS implantations, complications occur that can be successfully managed by endoscopic interventions. Our experiences have shown that individualized stent choice may substantially reduce the complications rate and make repeated endoscopic interventions easier.

Asymptomatic Infection in Decompensated Full-Thickness Corneal Grafts Referred for Repeat Penetrating Keratoplasty.

PubMed

Nahum, Yoav; Leon, Pia; Ricci-Filipovic, Benedetta Azzurra; Camposampiero, Davide; Ponzin, Diego; Busin, Massimo

2017-04-01

We report a case series of asymptomatic infections affecting failed corneal grafts in patients referred for repeat penetrating keratoplasty (PK). In this retrospective, noncomparative, interventional case series, we reviewed the medical records of all repeat PK procedures performed at Villa Serena-Villa Igea private Hospitals (Forlì, Italy) between January 2011 and March 2016. Specifically, preoperative and postoperative slit-lamp examinations, and the results of histological and bacteriological examinations, were noted. Fifty-three repeat PKs were performed in the study period. All patients were referred because of long-standing graft decompensation with stromal scars or surface irregularities, thus unsuitable for endothelial keratoplasty. None was referred because of presumed infection. Histological examination of the explanted buttons showed the presence of microorganisms of various types in 7 eyes. Cultures were positive in 4 of these cases and in one additional case Staphylococcus aureus was grown in culture, but was not seen in the histology specimen. None of the patients presented with unusual pain, tearing, or discomfort. Preoperative abnormal clinical findings included epithelial defect (n = 6), focal whitening of corneal stroma (n = 5), crystalline keratopathy (n = 1), and an elevated pigmented lesion (n = 1). After repeat PK, recurrence of the infection was seen in 5 of 7 (71%) cases, 2 of which required a third PK procedure. Apparently quiet eyes with failed PK can harbor slow-growing asymptomatic infection. An epithelial defect in a failed PK graft should raise suspicion of infection. Routine cultures and histological examination of the excised corneal buttons are instrumental in the diagnosis of these infections and can guide further treatment.

Extremity Regeneration of Soft Tissue Injury Using Growth Factor-Impregnated Gels

DTIC Science & Technology

2017-10-01

required repeated refinements. Four swine surgeries were performed, modifying the procedure after the first two and now with a successful and...post-operative pain management. Under the modified protocol, two swine surgeries have been successfully performed. Ongoing studies to determine the...Significant changes in use or care of human subjects, vertebrate animals, biohazards, and/or select agents Following the initial surgeries on two

Effects of Covariance Heterogeneity on Three Procedures for Analyzing Multivariate Repeated Measures Designs.

ERIC Educational Resources Information Center

Vallejo, Guillermo; Fidalgo, Angel; Fernandez, Paula

2001-01-01

Estimated empirical Type I error rate and power rate for three procedures for analyzing multivariate repeated measures designs: (1) the doubly multivariate model; (2) the Welch-James multivariate solution (H. Keselman, M. Carriere, a nd L. Lix, 1993); and (3) the multivariate version of the modified Brown-Forsythe procedure (M. Brown and A.…

Repeatability of testing procedures for resilient modulus and fatigue : appendices.

DOT National Transportation Integrated Search

1989-04-01

The article is the appendices of "Repeatability of testing procedures for resilient modulus and fatigue". : Extensive use of diametral resilient modulus and fatigue testing is made by the Oregon State Highway Division to evaluate asphaltic concrete m...

An automatic identification procedure to promote the use of FES-cycling training for hemiparetic patients.

PubMed

Ambrosini, Emilia; Ferrante, Simona; Schauer, Thomas; Ferrigno, Giancarlo; Molteni, Franco; Pedrocchi, Alessandra

2014-01-01

Cycling induced by Functional Electrical Stimulation (FES) training currently requires a manual setting of different parameters, which is a time-consuming and scarcely repeatable procedure. We proposed an automatic procedure for setting session-specific parameters optimized for hemiparetic patients. This procedure consisted of the identification of the stimulation strategy as the angular ranges during which FES drove the motion, the comparison between the identified strategy and the physiological muscular activation strategy, and the setting of the pulse amplitude and duration of each stimulated muscle. Preliminary trials on 10 healthy volunteers helped define the procedure. Feasibility tests on 8 hemiparetic patients (5 stroke, 3 traumatic brain injury) were performed. The procedure maximized the motor output within the tolerance constraint, identified a biomimetic strategy in 6 patients, and always lasted less than 5 minutes. Its reasonable duration and automatic nature make the procedure usable at the beginning of every training session, potentially enhancing the performance of FES-cycling training.

Fixation-free assessment of the Hirschberg ratio.

PubMed

Model, Dmitri; Eizenman, Moshe; Sturm, Veit

2010-08-01

To describe a novel methodology by which to measure the Hirschberg ratio (HR) in infants. The methodology does not require fixation on specific points, and measurements are made while infants look naturally at a display. The HR is calculated automatically from measurements of the direction of the optical axis, the position of the pupil center, and corneal reflexes in video images from an advanced two-camera eye-tracking system. The performance of the novel fixation-free procedure (FFP) was evaluated in 43 adults by measuring the average difference and the 95% limits of agreement with the standard fixation-based procedure (FBP). Repeatability of the HR measurements was evaluated by assessing the 95% limits of agreement between two independent measurements. Performance of the FFP was also evaluated in five infants. In adults, the average HR was 12.89 +/- 1.22 degrees/mm for FFP and 12.81 +/- 1.22 degrees/mm for FBP. FFP and FBP measurements were highly correlated (r = 0.95; P < 0.001). The 95% limits of agreement between FFP and FBP were +/-0.86 degrees/mm. The 95% limits of agreement of repeated measurements were +/-0.66 degrees/mm for FFP and +/-0.77 degrees/mm for FBP. In infants, the 95% limits of agreement of repeated measurements by FFP were +/-0.63 degrees/mm. In adults, the FFP provides accurate measurements of the HR that are in excellent agreement with measurements by FBP. In infants, measurements of HR by FFP show the same repeatability and consistency.

Non-terminal blood sampling techniques in guinea pigs.

PubMed

Birck, Malene M; Tveden-Nyborg, Pernille; Lindblad, Maiken M; Lykkesfeldt, Jens

2014-10-11

Guinea pigs possess several biological similarities to humans and are validated experimental animal models(1-3). However, the use of guinea pigs currently represents a relatively narrow area of research and descriptive data on specific methodology is correspondingly scarce. The anatomical features of guinea pigs are slightly different from other rodent models, hence modulation of sampling techniques to accommodate for species-specific differences, e.g., compared to mice and rats, are necessary to obtain sufficient and high quality samples. As both long and short term in vivo studies often require repeated blood sampling the choice of technique should be well considered in order to reduce stress and discomfort in the animals but also to ensure survival as well as compliance with requirements of sample size and accessibility. Venous blood samples can be obtained at a number of sites in guinea pigs e.g., the saphenous and jugular veins, each technique containing both advantages and disadvantages(4,5). Here, we present four different blood sampling techniques for either conscious or anaesthetized guinea pigs. The procedures are all non-terminal procedures provided that sample volumes and number of samples do not exceed guidelines for blood collection in laboratory animals(6). All the described methods have been thoroughly tested and applied for repeated in vivo blood sampling in studies within our research facility.

An Automated Inpatient Split-dose Bowel Preparation System Improves Colonoscopy Quality and Reduces Repeat Procedures.

PubMed

Yadlapati, Rena; Johnston, Elyse R; Gluskin, Adam B; Gregory, Dyanna L; Cyrus, Rachel; Werth, Lindsay; Ciolino, Jody D; Grande, David P; Keswani, Rajesh N

2017-07-19

Inpatient colonoscopy preparations are often inadequate, compromising patient safety and procedure quality, while resulting in greater hospital costs. The aims of this study were to: (1) design and implement an electronic inpatient split-dose bowel preparation order set; (2) assess the intervention's impact upon preparation adequacy, repeated colonoscopies, hospital days, and costs. We conducted a single center prospective pragmatic quasiexperimental study of hospitalized adults undergoing colonoscopy. The experimental intervention was designed using DMAIC (define, measure, analyze, improve, and control) methodology. Prospective data collected over 12 months were compared with data from a historical preintervention cohort. The primary outcome was bowel preparation quality and secondary outcomes included number of repeated procedures, hospital days, and costs. On the basis of a Delphi method and DMAIC process, we created an electronic inpatient bowel preparation order set inclusive of a split-dose bowel preparation algorithm, automated orders for rescue medications, and nursing bowel preparation checks. The analysis data set included 969 patients, 445 (46%) in the postintervention group. The adequacy of bowel preparation significantly increased following intervention (86% vs. 43%; P<0.01) and proportion of repeated procedures decreased (2.0% vs. 4.6%; P=0.03). Mean hospital days from bowel preparation initiation to discharge decreased from 8.0 to 6.9 days (P=0.02). The intervention resulted in an estimated 1-year cost-savings of $46,076 based on a reduction in excess hospital days associated with repeated and delayed procedures. Our interdisciplinary initiative targeting inpatient colonoscopy preparations significantly improved quality and reduced repeat procedures, and hospital days. Other institutions should consider utilizing this framework to improve inpatient colonoscopy value.

Results of a minimally invasive technique for treatment of unicameral bone cysts.

PubMed

Mik, Gökçe; Arkader, Alexandre; Manteghi, Alexander; Dormans, John P

2009-11-01

Unicameral bone cysts are benign bone lesions commonly seen in pediatric patients. Several treatment methods have been described with variable results and high recurrence rates. We previously reported short-term success of a minimally invasive technique that includes combining percutaneous decompression and grafting with medical-grade calcium sulfate pellets. The purpose of this study was to review the additional long-term results with a minimum followup of 24 months (average, 37 months; range, 24-70 months). We identified 55 patients with an average age of 10.8 years (range, 1.3-18 years). Forty-one of 55 lesions occurred in the humerus and femur. Forty-four of 55 (80%) patients had a partial or complete response after initial surgery; of these, seven obtained a partial or complete response after a repeat surgery (cumulative healing rate, 94%). Two patients underwent a third surgery (cumulative healing rate, 98%). One underwent a third repeat surgery (cumulative healing rate, 100%). There were no major complications associated with the procedure. Two patients had a superficial infection that resolved with oral antibiotics. Although some patients required a repeat procedure, complete or partial response at a minimum 24 months' followup was achieved in all patients. Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

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.

Endoscopic findings in patients presenting with dysphagia: analysis of a national endoscopy database.

PubMed

Krishnamurthy, Chaya; Hilden, Kristen; Peterson, Kathryn A; Mattek, Nora; Adler, Douglas G; Fang, John C

2012-03-01

Dysphagia is a common problem and an indication for upper endoscopy. There is no data on the frequency of the different endoscopic findings and whether they change according to demographics or by single versus repeat endoscopy. To determine the prevalence of endoscopic findings in patients with dysphagia and whether findings differ in regard to age, gender, ethnicity, and repeat procedure. This was a retrospective study using a national endoscopic database (CORI). A total of 30,377 patients underwent esophagogastroduodenoscopy (EGD) for dysphagia of which 4,202 patients were repeat endoscopies. Overall frequency of endoscopic findings was determined by gender, age, ethnicity, and single vs. repeat procedures. Esophageal stricture was the most common finding followed by normal, esophagitis/ulcer (EU), Schatzki ring (SR), esophageal food impaction (EFI), and suspected malignancy. Males were more likely to undergo repeat endoscopies and more likely to have stricture, EU, EFI, and suspected malignancy (P = 0.001). Patients 60 years or older had a higher prevalence of stricture, EU, SR, and suspected malignancy (P < 0.0001). Esophageal stricture was most common in white non-Hispanic patients compared to other ethnic groups. In patients undergoing repeat EGD, stricture, SR, EFI, and suspected malignancy were more common (P < 0.0001). The prevalence of endoscopic findings differs significantly by gender, age, and repeat procedure. The most common findings in descending order were stricture, normal, EU, SR, EFI, and suspected malignancy. For patients undergoing a repeat procedure, normal and EU were less common and all other abnormal findings were significantly more common.

Predicting recurrence after chronic subdural haematoma drainage.

PubMed

Jack, Andrew; O'Kelly, Cian; McDougall, Cameron; Findlay, J Max

2015-01-01

Recurrence of chronic subdural haematomas (CSDHs) after surgical drainage is a significant problem with rates up to 20%. This study focuses on determining factors predictive of haematoma recurrence and presents a scoring system stratifying recurrence risk for individual patients. Between the years 2005 and 2009, 331 consecutive patients with CSDHs treated with surgery were included in this study. Univariate and multivariate analyses were performed searching for risk factors of increased post-operative haematoma volume and haematoma recurrence requiring repeat drainage. We found a 12% reoperation rate. CSDH septation (seen on computed tomogram scan) was found to be an independent risk factor for recurrence requiring reoperation (p=0.04). Larger post-operative subdural haematoma volume was also significantly associated with requiring a second drainage procedure (p<0.001). Independent risk factors of larger post-operative haematoma volume included septations within a CSDH (p<0.01), increased pre-operative haematoma volume (p<0.01), and a greater amount of parenchymal atrophy (p=0.04). A simple scoring system for quantifying recurrence risk was created and validated based on patient age (< or ≥ 80 years), haematoma volume (< or ≥ 160 cc), and presence of septations within the subdural collection (yes or no). Septations within CSDHs are associated with larger post-operative residual haematoma collections requiring repeat drainage. When septations are clearly visible within a CSDH, craniotomy might be more suitable as a primary procedure as it allows greater access to a septated subdural collection. Our proposed scoring system combining haematoma volume, age, and presence of septations might be useful in identifying patients at higher risk for recurrence.

Solvent immersion imprint lithography: A high-performance, semi-automated procedure

PubMed Central

Liyu, D. A.; Canul, A. J.; Vasdekis, A. E.

2017-01-01

We expand upon our recent, fundamental report on solvent immersion imprint lithography (SIIL) and describe a semi-automated and high-performance procedure for prototyping polymer microfluidics and optofluidics. The SIIL procedure minimizes manual intervention through a cost-effective (∼$200) and easy-to-assemble apparatus. We analyze the procedure's performance specifically for Poly (methyl methacrylate) microsystems and report repeatable polymer imprinting, bonding, and 3D functionalization in less than 5 min, down to 8 μm resolutions and 1:1 aspect ratios. In comparison to commercial approaches, the modified SIIL procedure enables substantial cost reductions, a 100-fold reduction in imprinting force requirements, as well as a more than 10-fold increase in bonding strength. We attribute these advantages to the directed polymer dissolution that strictly localizes at the polymer-solvent interface, as uniquely offered by SIIL. The described procedure opens new desktop prototyping opportunities, particularly for non-expert users performing live-cell imaging, flow-through catalysis, and on-chip gas detection. PMID:28798847

Estimating prefledging survival: Allowing for brood mixing and dependence among brood mates

USGS Publications Warehouse

Flint, Paul L.; Pollock, Kenneth H.; Thomas, Dana; Sedinger, James S.

1995-01-01

Estimates of juvenile survival from hatch to fledging provide important information on waterfowl productivity. We develop a model for estimating survival of young waterfowl from hatch to fledging. Our model enables interchange of individuals among broods and relaxes the assumption that individuals within broods have independent survival probabilities. The model requires repeated observations of individually identifiable adults and their offspring that are not individually identifiable. A modified Kaplan-Meier procedure (Pollock et al. 1989a,b) and a modified Mayfield procedure (Mayfield 1961, 1975; Johnson 1979) can be used under this general modeling framework, and survival rates and corresponding variances of the point estimators can be determined.

The Pelleve procedure: an effective method for facial wrinkle reduction and skin tightening.

PubMed

Stampar, Michael

2011-05-01

Devices using radiofrequency (RF) energy and electrical energy to deliver a controlled thermal injury to heat skin have proliferated within the nonablative skin treatment market since the introduction of Thermage in 2002. By delivering continuous monopolar RF energy, rather than pulsed heating, and repeatedly bringing the skin to therapeutic temperatures until maximal contraction is obtained, the Pelleve Procedure can give obvious cosmetic results confluently over all treated areas painlessly and with no downtime. In this article, the technique, mechanism of continuous RF heating, and apparent treatment requirements to produce these results are presented. Some controversies are also addressed. Copyright © 2011 Elsevier Inc. All rights reserved.

An Efficient Method for Hair Containment During Head and Neck Surgery.

PubMed

Zingaretti, Nicola; De Biasio, Fabrizio; Riccio, Michele; Marchesi, Andrea; Parodi, Pier Camillo

2017-11-01

The authors present a simple technique for operations around hair-bearing areas such as during a rhytidectomy. Hair surrounding the surgical field is twisted into bundles and clipped with duckbill clips. The authors repeat the procedure for each strand of hair. Between 5 and 7 duckbill clips may be required per surgery.The clippers are faster, easily applicable, and well performing. They can be used with different hair lengths, and they do not require any additional trimming or shaving; clips also keep the hair firmly in place, and they do not loosen up in the process.This technical note explains a very simple, economical, and less time-consuming method to control hair located around the surgical site. It may be applied to all procedures within the field of the hair-bearing scalp, including craniofacial and maxillofacial surgery.

Power analysis for multivariate and repeated measures designs: a flexible approach using the SPSS MANOVA procedure.

PubMed

D'Amico, E J; Neilands, T B; Zambarano, R

2001-11-01

Although power analysis is an important component in the planning and implementation of research designs, it is often ignored. Computer programs for performing power analysis are available, but most have limitations, particularly for complex multivariate designs. An SPSS procedure is presented that can be used for calculating power for univariate, multivariate, and repeated measures models with and without time-varying and time-constant covariates. Three examples provide a framework for calculating power via this method: an ANCOVA, a MANOVA, and a repeated measures ANOVA with two or more groups. The benefits and limitations of this procedure are discussed.

Ethnicity influences pain after ultrasound-guided percutaneous liver biopsy.

PubMed

Mahadeva, Sanjiv; Mahfudz, Anis S; Vijayananthan, Anushya

2015-12-01

The influence of ethnicity on pain complicating ultrasound-guided percutaneous liver biopsy (US-guided PLB) and its clinical impact has not been reported to date. Consecutive adults from a multiethnic background, undergoing an US-guided PLB, were independently assessed for pain up to 6 h after the procedure. Clinical and demographic parameters were analysed to determine independent predictors of significant pain after PLB. Willingness to undergo a repeat procedure was assessed 1 week after PLB. Data from 203 patients (median age 50 years; 43.9% female; ethnicity: Malay 41.5%, Chinese 40%, Indian 18%; median BMI 27.7 kg/m; median waist circumference 92.0 cm) were analysed. Pain after US-guided PLB was experienced in 133 (61.1%) patients, with severity grades as follows: none, n=81 (39.9%); mild, n=56 (27.6%); moderate, n=51 (25.1%); and severe, n=15 (7.4%). Analgesia requirements correlated well with severity of pain. Independent predictors of significant pain after PLB (moderate and severe categories) in patients included age less than 50 years [odds ratio (OR) 3.0], female sex (OR 3.7), Indian ethnicity (OR 2.9) and Malay ethnicity (OR 2.7), but not number of needle passes, BMI and educational levels. Patients who experienced moderate/severe pain were less willing to undergo a repeat PLB compared with those who experienced mild/no pain (60.9 vs. 82.8%, P=0.001). Ethnicity has an important role in the development of pain after US-guided PLB. This has a significant impact on willingness to repeat the procedure.

Knee arthrodesis with a long intramedullary nail as limb salvage for complex periprosthetic infections.

PubMed

Razii, Nima; Abbas, Ammar M I; Kakar, Rahul; Agarwal, Sanjeev; Morgan-Jones, Rhidian

2016-12-01

Periprosthetic infection following total knee arthroplasty is a devastating complication, which is not always satisfactorily resolved by revision surgery. Arthrodesis is a salvage alternative to above-knee amputation or permanent resection arthroplasty. Fixation options include internal compression plating, external fixation, and intramedullary nails. We retrospectively reviewed twelve consecutive cases (9 males, 3 females; mean age, 67 years) of knee arthrodesis with a long intramedullary nail, performed at a single institution between 2003 and 2014. Desired outcomes were the ability to mobilize without pain, solid radiographic fusion, and the eradication of infection. Mean follow-up was 48.5 months (range, 9-120 months). Eleven patients (92 %) demonstrated stable fusion, ten patients (83 %) were ambulatory without pain, and ten patients (83 %) remained without infection at most recent follow-up. Eight patients (67 %) achieved union at an average of 12 months; three required repeat procedures, achieving union at an average of 9 months. There was a significant difference (P < 0.01) between the numbers of previous operations amongst the eight patients who initially achieved union (mean, 3.25) and three who subsequently required repeat procedures (mean, 8.33). In contrast to similar studies, we performed a single-stage exchange where possible, while comparable ambulatory and fusion rates were observed. Numerous previous attempts at revision arthroplasty, co-morbidities, and infections with highly resistant organisms have been associated with further complications. Although technically challenging, knee arthrodesis with a long intramedullary nail offers an acceptable limb salvage procedure for carefully selected patients with complex periprosthetic infections.

Comparative Robustness of Recent Methods for Analyzing Multivariate Repeated Measures Designs

ERIC Educational Resources Information Center

Seco, Guillermo Vallejo; Gras, Jaime Arnau; Garcia, Manuel Ato

2007-01-01

This study evaluated the robustness of two recent methods for analyzing multivariate repeated measures when the assumptions of covariance homogeneity and multivariate normality are violated. Specifically, the authors' work compares the performance of the modified Brown-Forsythe (MBF) procedure and the mixed-model procedure adjusted by the…

An efficient dynamic load balancing algorithm

NASA Astrophysics Data System (ADS)

Lagaros, Nikos D.

2014-01-01

In engineering problems, randomness and uncertainties are inherent. Robust design procedures, formulated in the framework of multi-objective optimization, have been proposed in order to take into account sources of randomness and uncertainty. These design procedures require orders of magnitude more computational effort than conventional analysis or optimum design processes since a very large number of finite element analyses is required to be dealt. It is therefore an imperative need to exploit the capabilities of computing resources in order to deal with this kind of problems. In particular, parallel computing can be implemented at the level of metaheuristic optimization, by exploiting the physical parallelization feature of the nondominated sorting evolution strategies method, as well as at the level of repeated structural analyses required for assessing the behavioural constraints and for calculating the objective functions. In this study an efficient dynamic load balancing algorithm for optimum exploitation of available computing resources is proposed and, without loss of generality, is applied for computing the desired Pareto front. In such problems the computation of the complete Pareto front with feasible designs only, constitutes a very challenging task. The proposed algorithm achieves linear speedup factors and almost 100% speedup factor values with reference to the sequential procedure.

Percutaneous Sclerotherapy of Congenital Slow-Flow Vascular Malformations of the Orbit

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

Chiramel, George Koshy, E-mail: gkchiramel@gmail.com; Keshava, Shyamkumar Nidugala, E-mail: aparna-shyam@yahoo.com; Moses, Vinu, E-mail: vinu@cmcvellore.ac.in

PurposeThis manuscript describes the clinical features, imaging findings, treatment details, and short-term outcomes of a series of congenital slow-flow vascular malformations.MethodsThis was a prospective study of congenital slow-flow vascular malformations involving the orbital region treated at a single institution with percutaneous sclerotherapy.ResultsTen patients presented during the study period, comprising eight venous malformations, one lymphatic malformation, and one veno-lymphatic malformation. Nine patients underwent percutaneous sclerotherapy under digital subtraction angiography guidance, of which three developed marked rise in intraocular pressure requiring lateral canthotomy. The treatments were performed in the presence of an ophthalmologist who measured the intraorbital pressure during and after the procedure. Onmore » follow-up, some of the patients required repeat sessions of sclerotherapy. All patients had improvement of symptoms on follow up after the procedure.ConclusionCongenital slow-flow vascular malformations of the orbital region are rare lesions that should be treated using a multidisciplinary approach. Monitoring of the intraorbital pressure is required both during and after the procedure to decide about the need for lateral canthotomy to reduce the transiently increased intraorbital pressure.« less

Stenting of aortic coarctation: acute, intermediate, and long-term results of a prospective multi-institutional registry--Congenital Cardiovascular Interventional Study Consortium (CCISC).

PubMed

Holzer, Ralf; Qureshi, Shakeel; Ghasemi, Abdolrahim; Vincent, Julie; Sievert, Horst; Gruenstein, Daniel; Weber, Howard; Alday, Luis; Peirone, Alejandro; Zellers, Thomas; Cheatham, John; Slack, Michael; Rome, Jonathan

2010-10-01

Since the 1980s, stent implantation has evolved as an important therapeutic strategy for coarctation of the aorta. However, available data is frequently flawed by short follow-up, lack of adequate follow-up imaging, and retrospective nature of data collection. Data was prospectively collected using a multicenter registry congenital cardiovascular interventional study consortium (CCISC). Between 2000 and 2009, 302 patients from 34 centers with a median weight of 58 kg underwent stent implantation for coarctation. Eligible patients (44%) completed intermediate follow-up (3-18 months) with integrated imaging (cath, CT, MRI), whereas 21% completed long-term follow-up (>18-60 months). Procedural success was defined as UL/LL systolic gradient of less than 20 mm Hg, lack of significant recurrent obstruction, and freedom from unplanned repeat intervention. Acute procedural success was 96%. Cumulative intermediate success was 86%, and cumulative long-term success was 77%. Unplanned repeat interventions were required in 4%, and aortic wall complications were seen in 1% of patients (dissection n = 1 and aneurysm n = 3). Other adverse events (n = 15) occurred mainly acutely and included technical complications such as stent malposition (n = 9). At long-term follow-up, 23% of patients continued to have systolic blood pressure above the 95th centile, 9% had an upper-to-lower limb blood pressure gradient in excess of 20 mm Hg, and 32% were taking antihypertensive medication. This study documented acute, intermediate, and long-term outcome data comparable or superior with other surgical or interventional series. However, even with successful initial stent therapy, patients continue to require long-term follow-up and have associated long-term morbidity, relating to aortic wall complications, systemic hypertension, recurrent obstruction as well as need for repeat intervention. © 2010 Wiley-Liss, Inc.

Evaluating the use of preoperative antibiotics in pediatric orthopaedic surgery.

PubMed

Formaini, Nathan; Jacob, Paul; Willis, Leisel; Kean, John R

2012-01-01

To evaluate the rate of infection after minimally invasive procedures on a consecutive series of pediatric orthopaedic patients. We hypothesized that the use of preoperative antibiotics for minimally invasive pediatric orthopaedic procedures does not significantly reduce the incidence of surgical site infection requiring surgical debridement within 30 days of the primary procedure. We retrospectively reviewed 2330 patients having undergone minimally invasive orthopaedic procedures at our institution between March 2008 and November 2010. Knee arthroscopy, closed reduction with percutaneous fixation, soft tissue releases, excision of bony or soft-tissue masses, and removal of hardware constituted the vast majority of included procedures. Two groups, based on whether prophylactic antibiotics were administered before surgery, were created and the incidence of a repeat procedure required for deep infection was recorded. Statistical analysis was performed to determine significance, if any, between the 2 groups. Chart review of the 2330 patients identified 1087 as having received preoperative antibiotics, whereas the remaining 1243 patients did not receive antibiotics before surgery. Only 1 patient out of the 1243 cases in which antibiotics were not given required additional surgery within 30 days of the primary procedure due to a complicated surgical site infection (an incidence of 0.0008%). No patients in the antibiotic group developed a postoperative infection within 30 days requiring a return to the operating room for management. Our data revealed no significant increase in the incidence of complicated infection requiring additional procedures when antibiotics were not administered before surgery. Though prophylactic antibiotics have been shown to confer numerous benefits for patients undergoing relatively major operations, their use in cases of minimally invasive and/or percutaneous orthopaedic surgery is not well defined. Our data suggest that the use of prophylactic antibiotics may not be indicated for many less invasive procedures when performed in a low-risk pediatric population. Future studies are warranted to help establish evidence-based guidelines regarding the routine use of prophylactic antibiotics in this specific population, hopefully resulting in improved cost-effectiveness and safety while slowing the emergence of new drug-resistant organisms. Level III, retrospective comparative.

Does Bootstrap Procedure Provide Biased Estimates? An Empirical Examination for a Case of Multiple Regression.

ERIC Educational Resources Information Center

Fan, Xitao

This paper empirically and systematically assessed the performance of bootstrap resampling procedure as it was applied to a regression model. Parameter estimates from Monte Carlo experiments (repeated sampling from population) and bootstrap experiments (repeated resampling from one original bootstrap sample) were generated and compared. Sample…

Omnibus Tests for Interactions in Repeated Measures Designs with Dichotomous Dependent Variables.

ERIC Educational Resources Information Center

Serlin, Ronald C.; Marascuilo, Leonard A.

When examining a repeated measures design with independent groups for a significant group by trial interaction, classical analysis of variance or multivariate procedures can be used if the assumptions underlying the tests are met. Neither procedure may be justified for designs with small sample sizes and dichotomous dependent variables. An omnibus…

Comparison of Two Procedures for Analyzing Small Sets of Repeated Measures Data

ERIC Educational Resources Information Center

Vallejo, Guillermo; Livacic-Rojas, Pablo

2005-01-01

This article compares two methods for analyzing small sets of repeated measures data under normal and non-normal heteroscedastic conditions: a mixed model approach with the Kenward-Roger correction and a multivariate extension of the modified Brown-Forsythe (BF) test. These procedures differ in their assumptions about the covariance structure of…

Analyzing Multivariate Repeated Measures Designs: A Comparison of Two Approximate Degrees of Freedom Procedures

ERIC Educational Resources Information Center

Lix, Lisa M.; Algina, James; Keselman, H. J.

2003-01-01

The approximate degrees of freedom Welch-James (WJ) and Brown-Forsythe (BF) procedures for testing within-subjects effects in multivariate groups by trials repeated measures designs were investigated under departures from covariance homogeneity and normality. Empirical Type I error and power rates were obtained for least-squares estimators and…

On the reproducibility of expert-operated and robotic ultrasound acquisitions.

PubMed

Kojcev, Risto; Khakzar, Ashkan; Fuerst, Bernhard; Zettinig, Oliver; Fahkry, Carole; DeJong, Robert; Richmon, Jeremy; Taylor, Russell; Sinibaldi, Edoardo; Navab, Nassir

2017-06-01

We present the evaluation of the reproducibility of measurements performed using robotic ultrasound imaging in comparison with expert-operated sonography. Robotic imaging for interventional procedures may be a valuable contribution, but requires reproducibility for its acceptance in clinical routine. We study this by comparing repeated measurements based on robotic and expert-operated ultrasound imaging. Robotic ultrasound acquisition is performed in three steps under user guidance: First, the patient is observed using a 3D camera on the robot end effector, and the user selects the region of interest. This allows for automatic planning of the robot trajectory. Next, the robot executes a sweeping motion following the planned trajectory, during which the ultrasound images and tracking data are recorded. As the robot is compliant, deviations from the path are possible, for instance due to patient motion. Finally, the ultrasound slices are compounded to create a volume. Repeated acquisitions can be performed automatically by comparing the previous and current patient surface. After repeated image acquisitions, the measurements based on acquisitions performed by the robotic system and expert are compared. Within our case series, the expert measured the anterior-posterior, longitudinal, transversal lengths of both of the left and right thyroid lobes on each of the 4 healthy volunteers 3 times, providing 72 measurements. Subsequently, the same procedure was performed using the robotic system resulting in a cumulative total of 144 clinically relevant measurements. Our results clearly indicated that robotic ultrasound enables more repeatable measurements. A robotic ultrasound platform leads to more reproducible data, which is of crucial importance for planning and executing interventions.

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.

Evidence-based severity assessment: Impact of repeated versus single open-field testing on welfare in C57BL/6J mice.

PubMed

Bodden, Carina; Siestrup, Sophie; Palme, Rupert; Kaiser, Sylvia; Sachser, Norbert; Richter, S Helene

2018-01-15

According to current guidelines on animal experiments, a prospective assessment of the severity of each procedure is mandatory. However, so far, the classification of procedures into different severity categories mainly relies on theoretic considerations, since it is not entirely clear which of the various procedures compromise the welfare of animals, or, to what extent. Against this background, a systematic empirical investigation of the impact of each procedure, including behavioral testing, seems essential. Therefore, the present study was designed to elucidate the effects of repeated versus single testing on mouse welfare, using one of the most commonly used paradigms for behavioral phenotyping in behavioral neuroscience, the open-field test. In an independent groups design, laboratory mice (Mus musculus f. domestica) experienced either repeated, single, or no open-field testing - procedures that are assigned to different severity categories. Interestingly, testing experiences did not affect fecal corticosterone metabolites, body weights, elevated plus-maze or home cage behavior differentially. Thus, with respect to the assessed endocrinological, physical, and behavioral outcome measures, no signs of compromised welfare could be detected in mice that were tested in the open-field repeatedly, once, or, not at all. These findings challenge current classification guidelines and may, furthermore, stimulate systematic research on the severity of single procedures involving living animals. Copyright © 2017 Elsevier B.V. All rights reserved.

Collection, quality control and delivery of ground-based magnetic data during ESA's Swarm mission

NASA Astrophysics Data System (ADS)

Macmillan, Susan; Humphries, Thomas; Flower, Simon; Swan, Anthony

2016-04-01

Ground-based magnetic data are used in a variety of ways when analysing satellite data. Selecting satellite data often involves the use of magnetic disturbance indices derived from ground-based stations and inverting satellite magnetic data for models of fields from various sources often requires ground-based data. Ground-based data can also be valuable independent data for validation purposes. We summarise data collection and quality control procedures in place at the British Geological Survey for global ground-based observatory and repeat station data. Whilst ongoing participation in the ICSU World Data System and INTERMAGNET facilitates this work, additional procedures have been specially developed for the Swarm mission. We describe these in detail.

Patient characteristics and service trends following abortion legalization in Mexico City, 2007-10.

PubMed

Mondragón y Kalb, Manuel; Ahued Ortega, Armando; Morales Velazquez, Jorge; Díaz Olavarrieta, Claudia; Valencia Rodríguez, Jorge; Becker, Davida; García, Sandra G

2011-09-01

Legal abortion services have been available in public and private health facilities in Mexico City since April 2007 for pregnancies of up to 12 weeks gestation. As of January 2011, more than 50,000 procedures have been performed by Ministry of Health hospitals and clinics. We researched trends in service users' characteristics, types of procedures performed, post-procedure complications, repeat abortions, and postabortion uptake of contraception in 15 designated hospitals from April 2007 to March 2010. The trend in procedures has been toward more medication and manual vacuum aspiration abortions and fewer done through dilation and curettage. Percentages of post-procedure complications and repeat abortions remain low (2.3 and 0.9 percent, respectively). Uptake of postabortion contraception has increased over time; 85 percent of women selected a method in 2009-10, compared with 73 percent in 2007-08. Our findings indicate that the Ministry of Health's program provides safe services that contribute to the prevention of repeat unintended pregnancies.

Long-term outcome of catheter ablation for left posterior fascicular ventricular tachycardia with the development of left posterior fascicular block and characteristics of repeat procedures.

PubMed

Luo, Bin; Zhou, Gongbu; Guo, Xiaogang; Liu, Xu; Yang, Jiandu; Sun, Qi; Ma, Jian; Zhang, Shu

2017-06-01

The present study aimed to retrospectively investigate long-term clinical outcomes of patients undergoing catheter ablation of left posterior fascicular ventricular tachycardia (LPF-VT) with the development of left posterior fascicular block (LPF block) and characteristics of repeat procedures. A total of 195 patients (mean age 29.76±1.03years, 16.4% females) who underwent catheter ablation for LPF-VT were consecutively enrolled. The earliest ventricular potential with a single fused Purkinje potential (PP) during VT and the PP located in the inferior-apical or mid-apical septum during SR were targeted for linear ablation. The endpoint of the procedure was noninducible VT and development of new-onset LPF block. Follow-up with clinic visits or telephonic interviews, electrocardiogram (ECG), or Holter monitoring was performed after the procedure. With a median follow-up of 85 (18,181) months, 20 patients were censored and 152 of 175 (86.86%) patients had long-term freedom from VT after a single procedure. No statistical difference in the outcome of catheter ablation of LPF-VT was found between inducible and non-inducible groups (P=0.89). Twenty-three patients exhibited recurrent LPF-VT. Seven of 23 patients developed new-onset left upper septal ventricular tachycardia that was successfully ablated. All the patients undergoing repeat procedures had freedom from VT. No procedural complications occurred. Ablation of LPF-VT using the development of LPF block as the endpoint is associated with a high procedural success rate. No difference in freedom from LPF-VT was found between inducible and non-inducible patients. New-onset LPF block recovery and non-early PP-QRS interval can be the predictors of LPF-VT repeat procedure. Copyright © 2017 Elsevier B.V. All rights reserved.

FLIS Procedures Manual. Document Identifier Code Input/Output Formats (Fixed Length). Volume 8.

DTIC Science & Technology

1997-04-01

DATA ELE- MENTS. SEGMENT R MAY BE REPEATED A MAXIMUM OF THREE (3) TIMES IN ORDER TO ACQUIRE THE REQUIRED MIX OF SEGMENTS OR INDIVIDUAL DATA ELEMENTS TO...preceding record. Marketing input DICs. QI Next DRN of appropriate segment will be QF The assigned NSN or PSCN being can- reflected in accordance with Table...Classified KFC Notification of Possible Duplicate (Sub- KRP Characteristics Data mitter) Follow-Up Interrogation LFU Notification of Return, SSR Transaction

Microbiological evaluation of the mobile biological isolator system

NASA Technical Reports Server (NTRS)

Taylor, D. M.; Morelli, F.; Neiderheiser, W.; Tratz, W. M.

1979-01-01

Evaluations on critical components of the mobile biological isolation system were performed. High efficiency particulate air filter efficiency and suit integrity were found to withstand repeated ethylene oxide (ETO) sterilizations. The minimum ETO sterilization time required to inactivate all contaminant organisms was established at four hours. Two days of aerating at 120 F was found to dissipate all harmful ETO residuals from the suit. Donning and doffing procedures were clarified and written specifically for isolation rooms.

[New possibilities in practical education of surgery].

PubMed

Kormos, Katalin; Sándor, József; Haidegger, Tamás; Ferencz, Andrea; Csukás, Domokos; Bráth, Endre; Szabó, Györgyi; Wéber, György

2013-10-01

The fast spread of laparoscopic surgery in the surgical community also required introduction of new methods of surgical education of these techniques. Training boxes applied for this reason meant a considerable help. The technique of the virtual reality introduced simulation, which is a new possibility in education. For the first time in the history of surgery we can measure medical students' or residents' dexterity and one can get acquainted with a surgical procedure in the form of "serious games". By application of the up-to-date imaging methods we can plan the movements of the surgeon's hand even before the planned operation, practice and repeating can contribute to the safety of the real procedure. Open surgical procedures can be practiced on plastic phantoms mimicking human anatomy and the use of interactive touch devices and e-learning can also contribute to practical education of surgery.

Challenging the in-vivo assessment of biomechanical properties of the uterine cervix: A critical analysis of ultrasound based quasi-static procedures.

PubMed

Maurer, M M; Badir, S; Pensalfini, M; Bajka, M; Abitabile, P; Zimmermann, R; Mazza, E

2015-06-25

Measuring the stiffness of the uterine cervix might be useful in the prediction of preterm delivery, a still unsolved health issue of global dimensions. Recently, a number of clinical studies have addressed this topic, proposing quantitative methods for the assessment of the mechanical properties of the cervix. Quasi-static elastography, maximum compressibility using ultrasound and aspiration tests have been applied for this purpose. The results obtained with the different methods seem to provide contradictory information about the physiologic development of cervical stiffness during pregnancy. Simulations and experiments were performed in order to rationalize the findings obtained with ultrasound based, quasi-static procedures. The experimental and computational results clearly illustrate that standardization of quasi-static elastography leads to repeatable strain values, but for different loading forces. Since force cannot be controlled, this current approach does not allow the distinction between a globally soft and stiff cervix. It is further shown that introducing a reference elastomer into the elastography measurement might overcome the problem of force standardization, but a careful mechanical analysis is required to obtain reliable stiffness values for cervical tissue. In contrast, the maximum compressibility procedure leads to a repeatable, semi-quantitative assessment of cervical consistency, due to the nonlinear nature of the mechanical behavior of cervical tissue. The evolution of cervical stiffness in pregnancy obtained with this procedure is in line with data from aspiration tests. Copyright © 2015 Elsevier Ltd. All rights reserved.

Recollection training and transfer effects in older adults: successful use of a repetition-lag procedure.

PubMed

Jennings, Janine M; Webster, Lauren M; Kleykamp, Bethea A; Dagenbach, Dale

2005-09-01

We examined an approach aimed at training consciously-controlled recollection, introduced by Jennings and Jacoby (2003) , for its ability to replicate and generalize. A continuous recognition task, requiring recollection to identify the occurrence of repeated items over gradually increasing lag intervals (number of intervening items between the first and second presentation of a repeated word), was given to a group of older adults twice a week for three weeks. Pre-and-post training performance was assessed on multiple measures and compared with a recognition practice and no contact control group. Recollection training proved successful; accurate identification of repeated items increased across a lag interval of 2 to 18 intervening items. Post-training gains following recollection training were found on n-back, self-ordered pointing, source discrimination and digit symbol substitution, but not with reading span or the CVLT-II. No changes were identified in the other groups. Gains from recollection training seem to transfer successfully in older adults.

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…

Taking the easy way out? Increasing implementation effort reduces probability maximizing under cognitive load.

PubMed

Schulze, Christin; Newell, Ben R

2016-07-01

Cognitive load has previously been found to have a positive effect on strategy selection in repeated risky choice. Specifically, whereas inferior probability matching often prevails under single-task conditions, optimal probability maximizing sometimes dominates when a concurrent task competes for cognitive resources. We examined the extent to which this seemingly beneficial effect of increased task demands hinges on the effort required to implement each of the choice strategies. Probability maximizing typically involves a simple repeated response to a single option, whereas probability matching requires choice proportions to be tracked carefully throughout a sequential choice task. Here, we flipped this pattern by introducing a manipulation that made the implementation of maximizing more taxing and, at the same time, allowed decision makers to probability match via a simple repeated response to a single option. The results from two experiments showed that increasing the implementation effort of probability maximizing resulted in decreased adoption rates of this strategy. This was the case both when decision makers simultaneously learned about the outcome probabilities and responded to a dual task (Exp. 1) and when these two aspects were procedurally separated in two distinct stages (Exp. 2). We conclude that the effort involved in implementing a choice strategy is a key factor in shaping repeated choice under uncertainty. Moreover, highlighting the importance of implementation effort casts new light on the sometimes surprising and inconsistent effects of cognitive load that have previously been reported in the literature.

Autologous plasma rich in growth factors in the prevention of severe bleeding after teeth extractions in patients with bleeding disorders: a controlled comparison with fibrin glue

PubMed Central

Cocero, Nadia; Pucci, Fabrizio; Messina, Maria; Pollio, Berardino; Mozzati, Marco; Bergamasco, Laura

2015-01-01

Background Dental extractions in haemophiliacs may cause secondary bleeding, requiring repeated surgical and haematological interventions. As a local haemostatic, fibrin glue has recognised efficacy but, as a plasma-derived product, it carries the risk of viral infections. We, therefore, compared fibrin glue with an autologous haemostatic, plasma rich in growth factors (PRGF), in a controlled trial. Material and methods One hundred and twenty patients with different blood disorders were randomised into two cohorts to undergo dental extraction procedures without hospitalisation. Prior to the extractions, patients underwent systemic haematological treatment. Complications were defined as secondary bleeding after the 7-day follow-up period or protracting after the repair procedure. Results There were 106 extractions (7 retained 3rd molars) in the group managed with fibrin glue: secondary bleeding affected 3/60 patients (5%) on the third day after extraction and necessitated additional surgery and systemic treatment (in one case the procedure had to be repeated on the 7th day). In the PRGF arm there were 98 extractions (23 retained 3rd molars): secondary bleeding affected two patients (3.3%) on the first day after extraction and was arrested with surgery without systemic treatment. Four out of the five secondary bleeds occurred in patients with haemophilia A. Concomitant diabetes or liver disease significantly increased the bleeding risk. Discussion The bleeding rates in the study and control arm prove that PRGF works as well as fibrin glue as a local haemostatic. Further assets are that PRGF has autologous origin, does not require additional systemic treatment in post-extraction repair surgery, is associated with an earlier onset of neo-angiogenesis and, overall, can reduce patients’ distress and costs to the health system. PMID:25369587

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

Friar, James Lewis; Goldman, Terrance J.; Pérez-Mercader, J.

In this paper, we apply the Law of Total Probability to the construction of scale-invariant probability distribution functions (pdf's), and require that probability measures be dimensionless and unitless under a continuous change of scales. If the scale-change distribution function is scale invariant then the constructed distribution will also be scale invariant. Repeated application of this construction on an arbitrary set of (normalizable) pdf's results again in scale-invariant distributions. The invariant function of this procedure is given uniquely by the reciprocal distribution, suggesting a kind of universality. Finally, we separately demonstrate that the reciprocal distribution results uniquely from requiring maximum entropymore » for size-class distributions with uniform bin sizes.« less

Remote Magnetic versus Manual Navigation for Radiofrequency Ablation of Paroxysmal Atrial Fibrillation: Long-Term, Controlled Data in a Large Cohort.

PubMed

Kataria, Vikas; Berte, Benjamin; Vandekerckhove, Yves; Tavernier, Rene; Duytschaever, Mattias

2017-01-01

Purpose. We aimed to study long-term outcome after pulmonary vein isolation (PVI) guided by remote magnetic navigation (RMN) and provided comparative data to outcome after manual navigation (MAN). Methods. Three hundred thirty-six patients with symptomatic paroxysmal AF underwent PVI by irrigated point-by-point radiofrequency (RF) ablation (RMN, n = 114 versus MAN, n = 222). Patients were followed up with symptom guided rhythm monitoring for a period up to 43 months. The end point of the study was freedom from repeat ablation after a single procedure and without antiarrhythmic drug treatment (ADT). Results. At the end of follow-up (median 26.3 months), freedom from repeat ablation was comparable between RMN and MAN (70.9% versus 69.5%, p = 0.61). At repeat, mean number of reconnected veins was 2.4 ± 1.2 in RMN versus 2.6 ± 1.0 in MAN ( p = 0.08). The majority of repeat procedures occurred during the first year (82.1% in RMN versus 78.5% in MAN; p = 0.74). Conclusion. On the long term (up to 3 years) and in a large cohort of patients with paroxysmal AF, RMN-guided PVI is as effective as MAN guided PVI. In both strategies the majority of repeat procedures occurred during the first year after index procedure.

Remote Magnetic versus Manual Navigation for Radiofrequency Ablation of Paroxysmal Atrial Fibrillation: Long-Term, Controlled Data in a Large Cohort

PubMed Central

Berte, Benjamin; Vandekerckhove, Yves; Tavernier, Rene

2017-01-01

Purpose. We aimed to study long-term outcome after pulmonary vein isolation (PVI) guided by remote magnetic navigation (RMN) and provided comparative data to outcome after manual navigation (MAN). Methods. Three hundred thirty-six patients with symptomatic paroxysmal AF underwent PVI by irrigated point-by-point radiofrequency (RF) ablation (RMN, n = 114 versus MAN, n = 222). Patients were followed up with symptom guided rhythm monitoring for a period up to 43 months. The end point of the study was freedom from repeat ablation after a single procedure and without antiarrhythmic drug treatment (ADT). Results. At the end of follow-up (median 26.3 months), freedom from repeat ablation was comparable between RMN and MAN (70.9% versus 69.5%, p = 0.61). At repeat, mean number of reconnected veins was 2.4 ± 1.2 in RMN versus 2.6 ± 1.0 in MAN (p = 0.08). The majority of repeat procedures occurred during the first year (82.1% in RMN versus 78.5% in MAN; p = 0.74). Conclusion. On the long term (up to 3 years) and in a large cohort of patients with paroxysmal AF, RMN-guided PVI is as effective as MAN guided PVI. In both strategies the majority of repeat procedures occurred during the first year after index procedure. PMID:28386560

Procedural learning and associative memory mechanisms contribute to contextual cueing: Evidence from fMRI and eye-tracking.

PubMed

Manelis, Anna; Reder, Lynne M

2012-10-16

Using a combination of eye tracking and fMRI in a contextual cueing task, we explored the mechanisms underlying the facilitation of visual search for repeated spatial configurations. When configurations of distractors were repeated, greater activation in the right hippocampus corresponded to greater reductions in the number of saccades to locate the target. A psychophysiological interactions analysis for repeated configurations revealed that a strong functional connectivity between this area in the right hippocampus and the left superior parietal lobule early in learning was significantly reduced toward the end of the task. Practice related changes (which we call "procedural learning") in activation in temporo-occipital and parietal brain regions depended on whether or not spatial context was repeated. We conclude that context repetition facilitates visual search through chunk formation that reduces the number of effective distractors that have to be processed during the search. Context repetition influences procedural learning in a way that allows for continuous and effective chunk updating.

Procedural learning and associative memory mechanisms contribute to contextual cueing: Evidence from fMRI and eye-tracking

PubMed Central

Manelis, Anna; Reder, Lynne M.

2012-01-01

Using a combination of eye tracking and fMRI in a contextual cueing task, we explored the mechanisms underlying the facilitation of visual search for repeated spatial configurations. When configurations of distractors were repeated, greater activation in the right hippocampus corresponded to greater reductions in the number of saccades to locate the target. A psychophysiological interactions analysis for repeated configurations revealed that a strong functional connectivity between this area in the right hippocampus and the left superior parietal lobule early in learning was significantly reduced toward the end of the task. Practice related changes (which we call “procedural learning”) in activation in temporo-occipital and parietal brain regions depended on whether or not spatial context was repeated. We conclude that context repetition facilitates visual search through chunk formation that reduces the number of effective distractors that have to be processed during the search. Context repetition influences procedural learning in a way that allows for continuous and effective chunk updating. PMID:23073642

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

Maintaining confidentiality in prospective studies: anonymous repeated measurements via email (ARME) procedure.

PubMed

Carli, Vladimir; Hadlaczky, Gergö; Wasserman, Camilla; Stingelin-Giles, Nicola; Reiter-Theil, Stella; Wasserman, Danuta

2012-02-01

Respecting and protecting the confidentiality of data and the privacy of individuals regarding the information that they have given as participants in a research project is a cornerstone of complying with accepted research standards. However, in longitudinal studies, establishing and maintaining privacy is often challenging because of the necessity of repeated contact with participants. A novel internet-based solution is introduced here, which maintains privacy while at the same time ensures linkage of data to individual participants in a repeated measures design. With the use of the anonymous repeated measurements via email (ARME) procedure, two separate one-way communication systems are established through ad hoc email accounts and a secure study website. Strengths and limitations of the approach are discussed.

Anatomical frame identification and reconstruction for repeatable lower limb joint kinematics estimates.

PubMed

Donati, Marco; Camomilla, Valentina; Vannozzi, Giuseppe; Cappozzo, Aurelio

2008-07-19

The quantitative description of joint mechanics during movement requires the reconstruction of the position and orientation of selected anatomical axes with respect to a laboratory reference frame. These anatomical axes are identified through an ad hoc anatomical calibration procedure and their position and orientation are reconstructed relative to bone-embedded frames normally derived from photogrammetric marker positions and used to describe movement. The repeatability of anatomical calibration, both within and between subjects, is crucial for kinematic and kinetic end results. This paper illustrates an anatomical calibration approach, which does not require anatomical landmark manual palpation, described in the literature to be prone to great indeterminacy. This approach allows for the estimate of subject-specific bone morphology and automatic anatomical frame identification. The experimental procedure consists of digitization through photogrammetry of superficial points selected over the areas of the bone covered with a thin layer of soft tissue. Information concerning the location of internal anatomical landmarks, such as a joint center obtained using a functional approach, may also be added. The data thus acquired are matched with the digital model of a deformable template bone. Consequently, the repeatability of pelvis, knee and hip joint angles is determined. Five volunteers, each of whom performed five walking trials, and six operators, with no specific knowledge of anatomy, participated in the study. Descriptive statistics analysis was performed during upright posture, showing a limited dispersion of all angles (less than 3 deg) except for hip and knee internal-external rotation (6 deg and 9 deg, respectively). During level walking, the ratio of inter-operator and inter-trial error and an absolute subject-specific repeatability were assessed. For pelvic and hip angles, and knee flexion-extension the inter-operator error was equal to the inter-trial error-the absolute error ranging from 0.1 deg to 0.9 deg. Knee internal-external rotation and ab-adduction showed, on average, inter-operator errors, which were 8% and 28% greater than the relevant inter-trial errors, respectively. The absolute error was in the range 0.9-2.9 deg.

Road Asphalt Pavements Analyzed by Airborne Thermal Remote Sensing: Preliminary Results of the Venice Highway.

PubMed

Pascucci, Simone; Bassani, Cristiana; Palombo, Angelo; Poscolieri, Maurizio; Cavalli, Rosa

2008-02-22

This paper describes a fast procedure for evaluating asphalt pavement surface defects using airborne emissivity data. To develop this procedure, we used airborne multispectral emissivity data covering an urban test area close to Venice (Italy).For this study, we first identify and select the roads' asphalt pavements on Multispectral Infrared Visible Imaging Spectrometer (MIVIS) imagery using a segmentation procedure. Next, since in asphalt pavements the surface defects are strictly related to the decrease of oily components that cause an increase of the abundance of surfacing limestone, the diagnostic absorption emissivity peak at 11.2μm of the limestone was used for retrieving from MIVIS emissivity data the areas exhibiting defects on asphalt pavements surface.The results showed that MIVIS emissivity allows establishing a threshold that points out those asphalt road sites on which a check for a maintenance intervention is required. Therefore, this technique can supply local government authorities an efficient, rapid and repeatable road mapping procedure providing the location of the asphalt pavements to be checked.

Laser sclerectomy and 5-FU controlled-drug-release biodegradable implant for glaucoma therapy

NASA Astrophysics Data System (ADS)

Villain, Franck L.; Parel, Jean-Marie A.; Kiss, Katalin; Parrish, Richard K.; Kuhne, Francois; Takesue, Yoshiko; Hostyn, Patrick

1993-06-01

Laser sclerectomy, a simple filtering procedure performed to alleviate high intraocular pressure in glaucoma patients, was taught to offer longer lasting effect and therefore improve the patient's outcome when compared with the standard trabeculectomy procedure. Recent clinical trials have shown that this was not the case and pharmacologic wound healing modulation is also required with this new procedure. Five-Fluorouracil (5-FU) is useful as an adjunct treatment for glaucoma filtering surgery. However, efficacy depends upon maintaining sustained drug levels, currently achieved by repeated daily injection of the drug for several weeks. To overcome this limitation, we designed a biodegradable implant for the sustained release of 5-FU. After laser sclerectomy, the implant is inserted through the same 1 mm wide conjunctival snip incision and positioned below the open channel. Implantation takes less than a minute. The implant releases the drug for over 15 days and totally biodegrades in less than 100 days. The combined laser surgery and implantation procedure show great potentials for the treatment of glaucoma.

Percutaneous coronary intervention using a combination of robotics and telecommunications by an operator in a separate physical location from the patient: an early exploration into the feasibility of telestenting (the REMOTE-PCI study).

PubMed

Madder, Ryan D; VanOosterhout, Stacie M; Jacoby, Mark E; Collins, J Stewart; Borgman, Andrew S; Mulder, Abbey N; Elmore, Matthew A; Campbell, Jessica L; McNamara, Richard F; Wohns, David H

2017-01-20

The present study explores the feasibility of telestenting, wherein a physician operator performs stenting on a patient in a separate physical location using a combination of robotics and telecommunications. Patients undergoing robotic stenting were eligible for inclusion. All manipulations of guidewires, balloons, and stents were performed robotically by a physician operator located in an isolated separate room outside the procedure room housing the patient. Communication between the operating physician and laboratory personnel was via telecommunication devices providing real-time audio and video connectivity. Among 20 patients who consented to participate, technical success, defined as successful advancement and retraction of guidewires, balloons, and stents by the robotic system without conversion to manual operation, was achieved in 19 of 22 lesions (86.4%). Procedural success, defined as <30% residual stenosis upon completion of the procedure in the absence of death or repeat revascularisation prior to hospital discharge, was achieved in 19 of 20 patients (95.0%). There were no deaths or repeat revascularisations prior to hospital discharge. To the best of our knowledge, the present study is the first to explore the feasibility of telestenting. Additional studies are required to determine if future advancements in robotics will facilitate telestenting over greater geographic distances.

SPRT Calibration Uncertainties and Internal Quality Control at a Commercial SPRT Calibration Facility

NASA Astrophysics Data System (ADS)

Wiandt, T. J.

2008-06-01

The Hart Scientific Division of the Fluke Corporation operates two accredited standard platinum resistance thermometer (SPRT) calibration facilities, one at the Hart Scientific factory in Utah, USA, and the other at a service facility in Norwich, UK. The US facility is accredited through National Voluntary Laboratory Accreditation Program (NVLAP), and the UK facility is accredited through UKAS. Both provide SPRT calibrations using similar equipment and procedures, and at similar levels of uncertainty. These uncertainties are among the lowest available commercially. To achieve and maintain low uncertainties, it is required that the calibration procedures be thorough and optimized. However, to minimize customer downtime, it is also important that the instruments be calibrated in a timely manner and returned to the customer. Consequently, subjecting the instrument to repeated calibrations or extensive repeated measurements is not a viable approach. Additionally, these laboratories provide SPRT calibration services involving a wide variety of SPRT designs. These designs behave differently, yet predictably, when subjected to calibration measurements. To this end, an evaluation strategy involving both statistical process control and internal consistency measures is utilized to provide confidence in both the instrument calibration and the calibration process. This article describes the calibration facilities, procedure, uncertainty analysis, and internal quality assurance measures employed in the calibration of SPRTs. Data will be reviewed and generalities will be presented. Finally, challenges and considerations for future improvements will be discussed.

Interatrial septum thickness and difficulty with transseptal puncture during redo catheter ablation of atrial fibrillation.

PubMed

Tomlinson, David R; Sabharwal, Nikant; Bashir, Yaver; Betts, Timothy R

2008-12-01

Patients undergoing catheter ablation for atrial fibrillation (AF) frequently require redo procedures, but there are no data reporting interatrial septum thickness (IAS) and difficulty during repeat transseptal puncture (TSP). Patients undergoing two separate AF ablation procedures had preprocedural fossa ovalis (FO) thickness measured using transesophageal echocardiography (TEE). "Difficult" TSP was defined by two observers as requiring excessive force, or conversion to TEE guidance. The study comprised 42 patients (37 male) with mean+/-SD age 55+/-9 years. Mean FO thickness was significantly greater at the time of redo TSP (2.2+/-1.6 mm vs 2.6+/-1.5 mm at redo, P=0.03); however, this finding was limited to those who underwent initial dual transseptal sheath procedures, FO thickness 2.0+/-1.5 mm and 2.5+/-1.4 mm for TEE 1 and 2, respectively (P=0.048). There was a trend for more frequent difficult redo TSP procedures, 7/42 (17%; 95% confidence interval [CI] 8-31) redo, versus 4/42 (10%; 95% CI 3-23) first TSP. On univariate analysis, FO thickness was not predictive of TSP difficulty; the only predictor of difficult redo TSP was diabetes. IAS thickness at the FO increased following catheter ablation of AF, yet on subgroup analysis this was limited to initial procedures utilizing dual transseptal sheaths. There was a trend toward more frequent difficulty during redo TSP, yet this was not associated with FO thickening. Diabetes may predispose to difficulty during redo TSP; this finding requires confirmation in a larger study population.

Specific NIST projects in support of the NIJ Concealed Weapon Detection and Imaging Program

NASA Astrophysics Data System (ADS)

Paulter, Nicholas G.

1998-12-01

The Electricity Division of the National Institute of Standards and Technology is developing revised performance standards for hand-held (HH) and walk-through (WT) metal weapon detectors, test procedures and systems for these detectors, and a detection/imaging system for finding concealed weapons. The revised standards will replace the existing National Institute of Justice (NIJ) standards for HH and WT devices and will include detection performance specifications as well as system specifications (environmental conditions, mechanical strength and safety, response reproducibility and repeatability, quality assurance, test reporting, etc.). These system requirements were obtained from the Law Enforcement and corrections Technology Advisory Council, an advisory council for the NIJ. Reproducible and repeatable test procedures and appropriate measurement systems will be developed for evaluating HH and WT detection performance. A guide to the technology and application of non- eddy-current-based detection/imaging methods (such as acoustic, passive millimeter-wave and microwave, active millimeter-wave and terahertz-wave, x-ray, etc.) Will be developed. The Electricity Division is also researching the development of a high- frequency/high-speed (300 GH to 1 THz) pulse-illuminated, stand- off, video-rate, concealed weapons/contraband imaging system.

Direct measurement of a patient's entrance skin dose during pediatric cardiac catheterization

PubMed Central

Sun, Lue; Mizuno, Yusuke; Iwamoto, Mari; Goto, Takahisa; Koguchi, Yasuhiro; Miyamoto, Yuka; Tsuboi, Koji; Chida, Koichi; Moritake, Takashi

2014-01-01

Children with complex congenital heart diseases often require repeated cardiac catheterization; however, children are more radiosensitive than adults. Therefore, radiation-induced carcinogenesis is an important consideration for children who undergo those procedures. We measured entrance skin doses (ESDs) using radio-photoluminescence dosimeter (RPLD) chips during cardiac catheterization for 15 pediatric patients (median age, 1.92 years; males, n = 9; females, n = 6) with cardiac diseases. Four RPLD chips were placed on the patient's posterior and right side of the chest. Correlations between maximum ESD and dose–area products (DAP), total number of frames, total fluoroscopic time, number of cine runs, cumulative dose at the interventional reference point (IRP), body weight, chest thickness, and height were analyzed. The maximum ESD was 80 ± 59 (mean ± standard deviation) mGy. Maximum ESD closely correlated with both DAP (r = 0.78) and cumulative dose at the IRP (r = 0.82). Maximum ESD for coiling and ballooning tended to be higher than that for ablation, balloon atrial septostomy, and diagnostic procedures. In conclusion, we directly measured ESD using RPLD chips and found that maximum ESD could be estimated in real-time using angiographic parameters, such as DAP and cumulative dose at the IRP. Children requiring repeated catheterizations would be exposed to high radiation levels throughout their lives, although treatment influences radiation dose. Therefore, the radiation dose associated with individual cardiac catheterizations should be analyzed, and the effects of radiation throughout the lives of such patients should be followed. PMID:24968708

Biodegradable airway stents in infants - Potential life-threatening pitfalls.

PubMed

Sztanó, B; Kiss, G; Márai, K; Rácz, G; Szegesdi, I; Rácz, K; Katona, G; Rovó, L

2016-12-01

The solution of severe tracheobronchial obstructions in early childhood means a great challenge. Biodegradable stents were intended to be a minimally invasive temporary solution which may decrease the number of interventions and limit the possible complications of stenting procedures. However, our first experiences have brought out a new, - especially in childhood - potentially life-threatening complication of this concept. Five SX-ELLA biodegradable polydioxanone stents was applied in three patients because of severe tracheobronchial obstruction: congenital tracheomalacia (7 day-old), acquired tracheomalacia (10 month-old), and congenital trachea-bronchomalacia (10 month-old). The breathing of all children improved right after the procedure. We observed degradation of the stent from the 5th postoperative week which resulted in large intraluminar fragments causing significant airway obstruction: one patient died of severe pneumonia, the other baby required urgent bronchoscopy to remove the obstructing 'foreign body' from the trachea. In the third case repeated stent placements successfully maintained the tracheal lumen. Polydioxanone stents may offer an alternative to metallic or silastic stents for collapse or external compression of the trachea in children; however, large decaying fragments mean a potential risk especially in the small size pediatric airway. The fragmentation of the stent, which generally starts in the 4-6 postoperative weeks, may create large sharp pieces. These may be anchored to the mucosa and covered by crust leading to obstruction. As repeated interventions are required, we do not consider the application of biodegradable stents unambiguously advantageous. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Epidermal Growth Factor (EGF) Receptor Intron 1 CA Repeat Polymorphisms in African-American and Caucasian Males: Influence on Prostate Cancer Risk or Disease Progression and Interaction with Androgen Receptor CAG Repeat Polymorphisms

DTIC Science & Technology

2003-09-01

Adipose Stromal Cells from Tumescent Liposuction Procedures. American Society for Dermatologic Surgery, $15,000 direct, 11/01/01 -10/31/02. 1999...stromal cells from tumescent liposuction procedures" ASDS Annual Meeting, Chicago, IL, November 1,2002."Adult Multipotent Stem Cells", Coriell

Endoscopic Cold Incision, Balloon Dilation, Mitomycin C Application, and Steroid Injection for Adult Laryngotracheal Stenosis

PubMed Central

Parker, Noah P.; Bandyopadhyay, Dipankar; Misono, Stephanie; Goding, George S.

2017-01-01

Objectives/Hypothesis To describe the presentation, stenosis characteristics, etiological differences, and outcomes of adult laryngotracheal stenosis treated with endoscopic cold incision, balloon dilation, topical mitomycin C application, and steroid injection. Study Design Retrospective chart review. Methods Demographic and clinical data were extracted for patients treated between March 2000 and December 2010. Prolonged intubation and idiopathic patient data were utilized for comparative analysis. Results Eighty patients (65 females; 15 males; 220 procedures; 2.9 years mean follow-up) presented with dyspnea (81%) and/or exercise intolerance (40%). Most commonly, etiologies were idiopathic (53 of 80; 66%) or prolonged intubation (14 of 80; 18%). Mean procedures per patient and interval between procedures were 2.8 procedures and 405 days, respectively. Mean stenosis length and distance from the caudal phonating edge of the true vocal folds were 9 mm and 19 mm. Complication, tracheotomy, and open-procedure rates were 1.8%, 1.4%, and 10.0%, respectively. Patients with more than two procedures demonstrated a mean 4-mm reduction in stenosis length and a 2-mm cephalad progression of stenosis over time. More caudal stenoses required more frequent procedures. Procedures were less frequent as more procedures were performed. Stenosis characteristics, interval between procedures, and total procedures were similar between idiopathic patients with or without intubation histories, but different between idiopathic and prolonged intubation patients. Conclusions This procedure was shown to be a viable option in adult laryngotracheal stenosis. Repeat dilation was likely, but was performed without adversely affecting stenosis characteristics. Stenoses farther from the vocal folds required procedures more frequently. Idiopathic patients with a history of brief, elective intubation had stenosis characteristics and responses to therapy similar to idiopathic patients without an intubation history. Both idiopathic groups together demonstrated stenosis characteristics and responses to therapy dissimilar to patients with a history of prolonged intubation. PMID:23086662

Measuring complete quantum states with a single observable

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

Peng Xinhua; Suter, Dieter; Du Jiangfeng

2007-10-15

Experimental determination of an unknown quantum state usually requires several incompatible measurements. However, it is also possible to determine the full quantum state from a single, repeated measurement. For this purpose, the quantum system whose state is to be determined is first coupled to a second quantum system (the 'assistant') in such a way that part of the information in the quantum state is transferred to the assistant. The actual measurement is then performed on the enlarged system including the original system and the assistant. We discuss in detail the requirements of this procedure and experimentally implement it on amore » simple quantum system consisting of nuclear spins.« less

Ubiquity of Benford's law and emergence of the reciprocal distribution

DOE PAGES

Friar, James Lewis; Goldman, Terrance J.; Pérez-Mercader, J.

2016-04-07

In this paper, we apply the Law of Total Probability to the construction of scale-invariant probability distribution functions (pdf's), and require that probability measures be dimensionless and unitless under a continuous change of scales. If the scale-change distribution function is scale invariant then the constructed distribution will also be scale invariant. Repeated application of this construction on an arbitrary set of (normalizable) pdf's results again in scale-invariant distributions. The invariant function of this procedure is given uniquely by the reciprocal distribution, suggesting a kind of universality. Finally, we separately demonstrate that the reciprocal distribution results uniquely from requiring maximum entropymore » for size-class distributions with uniform bin sizes.« less

76 FR 47178 - Energy Efficiency Program: Test Procedure for Lighting Systems (Luminaires)

Federal Register 2010, 2011, 2012, 2013, 2014

2011-08-04

...: Test Procedure for Lighting Systems (Luminaires) AGENCY: Office of Energy Efficiency and Renewable... (``DOE'' or the ``Department'') is currently evaluating energy efficiency test procedures for luminaires... products. DOE recognizes that well-designed test procedures are important to produce reliable, repeatable...

Distributed parameter modeling of repeated truss structures

NASA Technical Reports Server (NTRS)

Wang, Han-Ching

1994-01-01

A new approach to find homogeneous models for beam-like repeated flexible structures is proposed which conceptually involves two steps. The first step involves the approximation of 3-D non-homogeneous model by a 1-D periodic beam model. The structure is modeled as a 3-D non-homogeneous continuum. The displacement field is approximated by Taylor series expansion. Then, the cross sectional mass and stiffness matrices are obtained by energy equivalence using their additive properties. Due to the repeated nature of the flexible bodies, the mass, and stiffness matrices are also periodic. This procedure is systematic and requires less dynamics detail. The first step involves the homogenization from a 1-D periodic beam model to a 1-D homogeneous beam model. The periodic beam model is homogenized into an equivalent homogeneous beam model using the additive property of compliance along the generic axis. The major departure from previous approaches in literature is using compliance instead of stiffness in homogenization. An obvious justification is that the stiffness is additive at each cross section but not along the generic axis. The homogenized model preserves many properties of the original periodic model.

Duct Leakage Repeatability Testing

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

Walker, Iain; Sherman, Max

2014-08-01

The purpose of this report is to evaluate the repeatability of the three most significant measurement techniques for duct leakage using data from the literature and recently obtained field data. We will also briefly discuss the first two factors. The main question to be answered by this study is to determine if differences in the repeatability of these tests methods is sufficient to indicate that any of these methods is so poor that it should be excluded from consideration as an allowed procedure in codes and standards. The three duct leak measurement methods assessed in this report are the twomore » duct pressurization methods that are commonly used by many practitioners and the DeltaQ technique. These are methods B, C and A, respectively of the ASTM E1554 standard. Although it would be useful to evaluate other duct leak test methods, this study focused on those test methods that are commonly used and are required in various test standards, such as BPI (2010), RESNET (2014), ASHRAE 62.2 (2013), California Title 24 (CEC 2012), DOE Weatherization and many other energy efficiency programs.« less

Can repeat injection provide clinical benefit in patients with cervical disc herniation and stenosis when the first epidural injection results only in partial response?

PubMed

Lee, Jung Hwan; Lee, Sang-Ho

2016-07-01

Epidural steroid injection (ESI) is known to be an effective treatment for neck or radicular pain due to herniated intervertebral disc (HIVD) and spinal stenosis (SS). Although repeat ESI has generally been indicated to provide more pain relief in partial responders after single ESI, there has been little evidence supporting the usefulness of this procedure. The purpose of this study, therefore, was to determine whether repeat ESI at a prescribed interval of 2 to 3 weeks after the first injection would provide greater clinical benefit in patients with partial pain reduction than intermittent ESI performed only when pain was aggravated. One hundred eighty-four patients who underwent transforaminal ESI (TFESI) for treatment of axial neck and radicular arm pain due to HIVD or SS and could be followed up for 1 year were enrolled. We divided the patients into 2 groups. Group A (N = 108) comprised partial responders (numeric rating scale (NRS) ≥ 3 after the first injection) who underwent repeat injection at a prescribed interval of 2 to 3 weeks after the first injection. Group B (N = 76) comprised partial responders who did not receive repeat injection at the prescribed interval, but received intermittent injections only for aggravation of pain. Various clinical data were assessed, including total number of injections during 1 year, NRS duration of <3 during 1 year (NRS < 3 duration), and time interval until pain was increased to require additional injections after repeat injection in Group A, or after first injection in Group B (time to reinjection). Groups A and B were compared in terms of total population, HIVD, and SS. In the whole population, HIVD subgroup, and SS subgroup, patients in Group A required significantly fewer injections to obtain satisfactory pain relief during the 1-year follow-up period. Group A showed a significantly longer time to reinjection and longer NRS < 3 than Group B did. Repeat TFESI conducted at 2- to 3-week intervals after the first injection in partial responders contributed to greater clinical benefit compared with intermittent TFESI performed only upon pain aggravation, with fewer TFESI sessions.

Using Peer-Mediated Repeated Readings as a Fluency-Building Activity for Urban Learners

ERIC Educational Resources Information Center

Yurick, Amanda L.; Robinson, Porsha D.; Cartledge, Gwendolyn; Lo, Ya-yu; Evans, Trisha L.

2006-01-01

We conducted three experiments examining the effects of peer-mediated repeated readings on students' oral reading fluency and comprehension. Each repeated reading session consisted of students reading in pairs, alternating paragraphs, for 10 minutes. Students used a scripted correction procedure when errors occurred. Students then participated in…

Endoscope-guided pneumatic dilation for treatment of esophageal achalasia

PubMed Central

Chuah, Seng-Kee; Wu, Keng-Liang; Hu, Tsung-Hui; Tai, Wei-Chen; Changchien, Chi-Sin

2010-01-01

Pneumatic dilation (PD) is considered to be the first line nonsurgical therapy for achalasia. The principle of the procedure is to weaken the lower esophageal sphincter by tearing its muscle fibers by generating radial force. The endoscope-guided procedure is done without fluoroscopic control. Clinicians usually use a low-compliance balloon such as Rigiflex dilator to perform endoscope-guided PD for the treatment of esophageal achalasia. It has the advantage of determining mucosal injury during the dilation process, so that a repeat endoscopy is not needed to assess the mucosal tearing. Previous studies have shown that endoscope-guided PD is an efficient and safe nonsurgical therapy with results that compare well with other treatment modalities. Although the results may be promising, long-term follow-up is required in the near future. PMID:20101764

Laser vaporization in treatment of superficial endometriosis of the uterine cervix

NASA Astrophysics Data System (ADS)

Wozniak, Jakub; Wilczak, Maciej; Opala, Tomasz; Pisarska-Krawczyk, Magdalena; Cwojdzinski, Marek; Pisarski, Tadeusz

1996-03-01

The study shows the treatment of superficial endometriosis of the uterine cervix in 79 patients. After first vaporization 74 patients were cured successfully. In two cases the laser procedure should be repeated and in 3 women the operation should be performed for the third time. All patients are still under control in our department and there is no recurrence observed. Carbon- dioxide laser vaporization under colposcopic control is an efficient method of treatment of superficial endometriosis of the uterine cervix that requires no anaesthesia. The healing process after laser procedures is fast and without complications. The number of recurrences is low. Use of carbon-dioxide laser under colposcopic control because of precise destruction of lesions, fast healing and a low number of recurrences seems to be the method of choice.

Cognitive load in distributed and massed practice in virtual reality mastoidectomy simulation.

PubMed

Andersen, Steven Arild Wuyts; Mikkelsen, Peter Trier; Konge, Lars; Cayé-Thomasen, Per; Sørensen, Mads Sølvsten

2016-02-01

Cognitive load theory states that working memory is limited. This has implications for learning and suggests that reducing cognitive load (CL) could promote learning and skills acquisition. This study aims to explore the effect of repeated practice and simulator-integrated tutoring on CL in virtual reality (VR) mastoidectomy simulation. Prospective trial. Forty novice medical students performed 12 repeated virtual mastoidectomy procedures in the Visible Ear Simulator: 21 completed distributed practice with practice blocks spaced in time and 19 participants completed massed practice (all practices performed in 1 day). Participants were randomized for tutoring with the simulator-integrated tutor function. Cognitive load was estimated by measuring reaction time in a secondary task. Data were analyzed using linear mixed models for repeated measurements. The mean reaction time increased by 37% during the procedure compared with baseline, demonstrating that the procedure placed substantial cognitive demands. Repeated practice significantly lowered CL in the distributed practice group but not in massed practice group. In addition, CL was found to be further increased by 10.3% in the later and more complex stages of the procedure. The simulator-integrated tutor function did not have an impact on CL. Distributed practice decreased CL in repeated VR mastoidectomy training more consistently than was seen in massed practice. This suggests a possible effect of skills and memory consolidation occurring over time. To optimize technical skills learning, training should be organized as time-distributed practice rather than as a massed block of practice, which is common in skills-training courses. N/A. © 2015 The American Laryngological, Rhinological and Otological Society, Inc.

Pediatric ureteroscopic stone management.

PubMed

Thomas, John C; DeMarco, Romano T; Donohoe, Jeffrey M; Adams, Mark C; Brock, John W; Pope, John C

2005-09-01

We reviewed our experience of 5 years using ureteroscopy with laser lithotripsy to treat stone disease in prepubertal children. A retrospective review was performed of all ureteroscopic procedures performed in prepubertal children. A total of 33 ureteroscopic procedures were performed in 29 prepubertal children (15 males and 14 females) 5 to 144 months old (mean age 94 months, including 3 patients 24 months or younger). Stones were located in the renal pelvis in 1 case (3%), proximal ureter in 3 (9%), mid ureter in 5 (15%) and distal ureter in 24 (73%). Stone size ranged from 3 to 14 mm (mean 6). Eight patients required balloon dilation of the ureteral orifice. Followup ranged from 1 to 66 months (mean 11). Stone-free rate after initial ureteroscopy and laser lithotripsy was 88%, with all distal and mid ureteral stones (3 to 9 mm, mean 5) successfully treated. Three patients with proximal ureteral stones 7 to 14 mm in diameter (mean 10.3) required a secondary procedure (repeat ureteroscopy in 2 and shock wave lithotripsy in 1) to become stone-free. One patient with cystinuria and a renal pelvic stone measuring 14 mm required shock wave lithotripsy and percutaneous nephrostolithotomy. There were no major complications of ureteroscopy but there was 1 case of extravasation at the ureterovesical junction after balloon dilation that was managed with stent placement. Although more patients and longer followup are needed, ureteroscopy with laser lithotripsy is an excellent first line treatment for children with stones in whom conservative therapy fails, especially those with distal and mid ureteral stones. Patients with a stone burden of 10 mm or greater, especially in the proximal ureter, likely will require a secondary procedure to become stone-free.

Behavioral and physiological adaptation to repeated chair restraint in rhesus macaques.

PubMed

Ruys, J D; Mendoza, S P; Capitanio, J P; Mason, W A

2004-09-15

Physical restraint is a commonly used procedure when working closely with nonhuman primates. Nonhuman primates show rapid behavioral changes when learning the restraint procedure, and these changes have been taken to reflect behavioral and physiological habituation to the procedure. This study examined the behavioral and adrenocortical responses to repeated physical restraint in a large sample of adult male rhesus monkeys. Subjects showed a decline in behavioral agitation and cortisol concentrations across seven consecutive days of restraint. The changes in adrenocortical responsiveness were also coincident with an increased sensitivity to dexamethasone and a change in early morning basal cortisol secretion. The subjects were restrained for a single session 6 months later, and while the reduction in behavioral agitation was still present, the majority of changes in adrenocortical responsiveness were no longer present. These data show that behavior is not necessarily an indicator of underlying physiological processes and that the reduction of hypothalamic-pituitary-adrenal (HPA) activity with repeated restraint is due to physiological adaptation to high glucocorticoid concentrations and not to psychological habituation to the restraint procedures.

A synergetic combination of small and large neighborhood schemes in developing an effective procedure for solving the job shop scheduling problem.

PubMed

Amirghasemi, Mehrdad; Zamani, Reza

2014-01-01

This paper presents an effective procedure for solving the job shop problem. Synergistically combining small and large neighborhood schemes, the procedure consists of four components, namely (i) a construction method for generating semi-active schedules by a forward-backward mechanism, (ii) a local search for manipulating a small neighborhood structure guided by a tabu list, (iii) a feedback-based mechanism for perturbing the solutions generated, and (iv) a very large-neighborhood local search guided by a forward-backward shifting bottleneck method. The combination of shifting bottleneck mechanism and tabu list is used as a means of the manipulation of neighborhood structures, and the perturbation mechanism employed diversifies the search. A feedback mechanism, called repeat-check, detects consequent repeats and ignites a perturbation when the total number of consecutive repeats for two identical makespan values reaches a given threshold. The results of extensive computational experiments on the benchmark instances indicate that the combination of these four components is synergetic, in the sense that they collectively make the procedure fast and robust.

Efficacy of adrenal venous sampling is increased by point of care cortisol analysis

PubMed Central

Viste, Kristin; Grytaas, Marianne A; Jørstad, Melissa D; Jøssang, Dag E; Høyden, Eivind N; Fotland, Solveig S; Jensen, Dag K; Løvås, Kristian; Thordarson, Hrafnkell; Almås, Bjørg; Mellgren, Gunnar

2013-01-01

Primary aldosteronism (PA) is a common cause of secondary hypertension and is caused by unilateral or bilateral adrenal disease. Treatment options depend on whether the disease is lateralized or not, which is preferably evaluated with selective adrenal venous sampling (AVS). This procedure is technically challenging, and obtaining representative samples from the adrenal veins can prove difficult. Unsuccessful AVS procedures often require reexamination. Analysis of cortisol during the procedure may enhance the success rate. We invited 21 consecutive patients to participate in a study with intra-procedural point of care cortisol analysis. When this assay showed nonrepresentative sampling, new samples were drawn after redirection of the catheter. The study patients were compared using the 21 previous procedures. The intra-procedural cortisol assay increased the success rate from 10/21 patients in the historical cohort to 17/21 patients in the study group. In four of the 17 successful procedures, repeated samples needed to be drawn. Successful sampling at first attempt improved from the first seven to the last seven study patients. Point of care cortisol analysis during AVS improves success rate and reduces the need for reexaminations, in accordance with previous studies. Successful AVS is crucial when deciding which patients with PA will benefit from surgical treatment. PMID:24169597

One-Step Extraction and Hydrolysis of Flavonoid Glycosides in Rape Bee Pollen Based on Soxhlet-Assisted Matrix Solid Phase Dispersion.

PubMed

Tu, Xijuan; Ma, Shuangqin; Gao, Zhaosheng; Wang, Jing; Huang, Shaokang; Chen, Wenbin

2017-11-01

Flavonoids are frequently found as glycosylated derivatives in plant materials. To determine contents of flavonoid aglycones in these matrices, procedures for the extraction and hydrolysis of flavonoid glycosides are required. The current sample preparation method is both labour and time consuming. Develop a modified matrix solid phase dispersion (MSPD) procedure as an alternative methodology for the one-step extraction and hydrolysis of flavonoid glycosides. HPLC-DAD was applied for demonstrating the one-step extraction and hydrolysis of flavonoids in rape bee pollen. The obtained contents of flavonoid aglycones (quercetin, kaempferol, isorhamnetin) were used for the optimisation and validation of the method. The extraction and hydrolysis were accomplished in one step. The procedure completes in 2 h with silica gel as dispersant, a 1:2 ratio of sample to dispersant, and 60% aqueous ethanol with 0.3 M hydrochloric acid as the extraction solution. The relative standard deviations (RSDs) of repeatability were less than 5%, and the recoveries at two fortified levels were between 88.3 and 104.8%. The proposed methodology is simple and highly efficient, with good repeatability and recovery. Compared with currently available methods, the present work has advantages of using less time and labour, higher extraction efficiency, and less consumption of the acid catalyst. This method may have applications for the one-step extraction and hydrolysis of bioactive compounds from plant materials. Copyright © 2017 John Wiley & Sons, Ltd. Copyright © 2017 John Wiley & Sons, Ltd.

A simple and highly repeatable viral plaque assay for enterovirus 71.

PubMed

Yin, Yingxian; Xu, Yi; Ou, Zhiying; Su, Ling; Xia, Huimin

2015-04-01

The classic plaque assay is a method for counting infectious viral particles, however its complexity limits its use in a variety of virological experiments. To simplify the operation and to improve the repeatability, we employed an improved plaque assay procedure based on Avicel to make the whole experiment easier and optimize the results on a model of Vero cells infection with Enterovirus 71(EV71). Clear plaques visible to the naked eyes can be formed on a 24-well plate or a 96-well plate without immunostaining. Following further improvement, this plaque assay procedure could be applied to other viruses, being both simple and repeatable. © 2014 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

A preliminary study into performing routine tube output and automatic exposure control quality assurance using radiology information system data.

PubMed

Charnock, P; Jones, R; Fazakerley, J; Wilde, R; Dunn, A F

2011-09-01

Data are currently being collected from hospital radiology information systems in the North West of the UK for the purposes of both clinical audit and patient dose audit. Could these data also be used to satisfy quality assurance (QA) requirements according to UK guidance? From 2008 to 2009, 731 653 records were submitted from 8 hospitals from the North West England. For automatic exposure control QA, the protocol from Institute of Physics and Engineering in Medicine (IPEM) report 91 recommends that milliamperes per second can be monitored for repeatability and reproducibility using a suitable phantom, at 70-81 kV. Abdomen AP and chest PA examinations were analysed to find the most common kilovoltage used with these records then used to plot average monthly milliamperes per second with time. IPEM report 91 also recommends that a range of commonly used clinical settings is used to check output reproducibility and repeatability. For each tube, the dose area product values were plotted over time for two most common exposure factor sets. Results show that it is possible to do performance checks of AEC systems; however more work is required to be able to monitor tube output performance. Procedurally, the management system requires work and the benefits to the workflow would need to be demonstrated.

40 CFR 141.858 - Repeat monitoring and E. coli requirements.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 40 Protection of Environment 24 2013-07-01 2013-07-01 false Repeat monitoring and E. coli....858 Repeat monitoring and E. coli requirements. (a) Repeat monitoring. (1) If a sample taken under... exceeded. (b) Escherichia coli (E. coli) testing. (1) If any routine or repeat sample is total coliform...

40 CFR 141.858 - Repeat monitoring and E. coli requirements.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 40 Protection of Environment 23 2014-07-01 2014-07-01 false Repeat monitoring and E. coli....858 Repeat monitoring and E. coli requirements. (a) Repeat monitoring. (1) If a sample taken under... volume repeat sample(s) in one or more sample containers of any size, as long as the total volume...

Road Asphalt Pavements Analyzed by Airborne Thermal Remote Sensing: Preliminary Results of the Venice Highway

PubMed Central

Pascucci, Simone; Bassani, Cristiana; Palombo, Angelo; Poscolieri, Maurizio; Cavalli, Rosa

2008-01-01

This paper describes a fast procedure for evaluating asphalt pavement surface defects using airborne emissivity data. To develop this procedure, we used airborne multispectral emissivity data covering an urban test area close to Venice (Italy).For this study, we first identify and select the roads' asphalt pavements on Multispectral Infrared Visible Imaging Spectrometer (MIVIS) imagery using a segmentation procedure. Next, since in asphalt pavements the surface defects are strictly related to the decrease of oily components that cause an increase of the abundance of surfacing limestone, the diagnostic absorption emissivity peak at 11.2μm of the limestone was used for retrieving from MIVIS emissivity data the areas exhibiting defects on asphalt pavements surface.The results showed that MIVIS emissivity allows establishing a threshold that points out those asphalt road sites on which a check for a maintenance intervention is required. Therefore, this technique can supply local government authorities an efficient, rapid and repeatable road mapping procedure providing the location of the asphalt pavements to be checked. PMID:27879765

Serial office-based steroid injections for treatment of idiopathic subglottic stenosis.

PubMed

Hoffman, Matthew R; Coughlin, Adam R; Dailey, Seth H

2017-11-01

Current treatment options for idiopathic subglottic stenosis include endoscopic interventions, resection, and tracheotomy. Recently, serial office-based steroid injections were proposed as an alternative that may stabilize or induce regression of airway stenosis without the need for repeated operations. Procedure completion rate, pain, complications, effect on stenosis, time since the last operation, and limitations have not been described. Retrospective case series. Retrospective series of 19 patients undergoing serial office-based steroid injection for idiopathic subglottic stenosis. Outcome measures included completion rate, procedure-related pain scores, complications, percentage of airway stenosis, and time since the last operative intervention. Procedure completion rate was 98.8%. Average pain score during the procedure was 2.3 ± 1.7 on a 10-point scale. There were no immediate complications. One patient underwent awake tracheotomy 8 days after her second injection and was later decannulated. Average stenosis decreased from 35% ± 15% to 25% ± 15% (n = 16; P = .086) over the first of three injections and 40% ± 15% to 25% ± 10% to 20% ± 10% (n = 8; P = .002) for those patients completing two sets of three injections. Fourteen of 17 patients undergoing at least three injections have not returned to the operating room since the first injection. Office-based steroid injection represents a promising new treatment pathway for a disease that requires long-term management, offering a purely pharmacologic approach to a disorder that has traditionally been approached from a mechanical perspective. It is safe, well tolerated, and effective. Furthermore, it may help patients and physicians avoid repeated trips to the operating room and the associated risks. 4. Laryngoscope, 127:2475-2481, 2017. © 2017 The American Laryngological, Rhinological and Otological Society, Inc.

Effect of heterophoria measurement technique on the clinical accommodative convergence to accommodation ratio.

PubMed

Escalante, Jaime Bernal; Rosenfield, Mark

2006-05-01

Measurement of the stimulus accommodative convergence to accommodation (AC/A) ratio is a standard procedure in clinical optometric practice. Typically, heterophoria is assessed at several accommodative stimulus levels, and the gradient of the vergence to accommodation function computed. A number of procedures are available for the subjective measurement of heterophoria, but it is unclear whether the use of different vergence measurement techniques will alter the obtained AC/A value. Accordingly, the current study compared AC/A ratios measured using 3 clinical subjective heterophoria tests, namely the von Graefe (VG), Maddox Rod (MR), and Modified Thorington (MT) procedures. The AC/A ratio was measured in 60 visually normal subjects between 20 and 25 years of age using each of the 3 procedures listed above. The accommodative stimulus was varied by the introduction of +/-1.00 diopter (D) spherical lenses over the distance refractive correction while subjects viewed a target at a viewing distance of 40 cm. To examine the repeatability of each procedure, the AC/A ratio was measured on 2 separate occasions for each measurement technique, with the 2 sessions being separated by at least 24 hours. Mean values of stimulus AC/A ratio measured using the VG, MR, and MT procedures were 3.47, 2.99, and 2.46Delta/D, respectively. These differences were significant (p=0.0001). In addition, the coefficient of repeatability for the 3 techniques was 2.22, 1.99, and 1.20 Delta/D, respectively. Ratios obtained using the Modified Thorington technique with +/-1.00 D lenses showed the best repeatability, whereas the poorest repeatability was found with the von Graefe technique when only +1.00 D lenses were used to vary the accommodative stimulus. Accordingly, we recommend that that Modified Thorington procedure with +/-1.00 D lenses be used to quantify heterophoria during clinical measurement of the stimulus AC/A ratio.

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

PubMed

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

2016-06-01

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

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

A new method for noninvasive measurement of pulmonary gas exchange using expired gas.

PubMed

West, John B; Prisk, G Kim

2018-01-01

Measurement of the gas exchange efficiency of the lung is often required in the practice of pulmonary medicine and in other settings. The traditional standard is the values of the PO2, PCO2, and pH of arterial blood. However arterial puncture requires technical expertise, is invasive, uncomfortable for the patient, and expensive. Here we describe how the composition of expired gas can be used in conjunction with pulse oximetry to obtain useful measures of gas exchange efficiency. The new procedure is noninvasive, well tolerated by the patient, and takes only a few minutes. It could be particularly useful when repeated measurements of pulmonary gas exchange are required. One product of the procedure is the difference between the PO2 of end-tidal alveolar gas and the calculated PO2 of arterial blood. This measurement is related to the classical alveolar-arterial PO2 difference based on ideal alveolar gas. However that traditional index is heavily influenced by lung units with low ventilation-perfusion ratios, whereas the new index has a broader physiological basis because it includes contributions from the whole lung. Copyright © 2017 Elsevier B.V. All rights reserved.

Mapping High Dimensional Sparse Customer Requirements into Product Configurations

NASA Astrophysics Data System (ADS)

Jiao, Yao; Yang, Yu; Zhang, Hongshan

2017-10-01

Mapping customer requirements into product configurations is a crucial step for product design, while, customers express their needs ambiguously and locally due to the lack of domain knowledge. Thus the data mining process of customer requirements might result in fragmental information with high dimensional sparsity, leading the mapping procedure risk uncertainty and complexity. The Expert Judgment is widely applied against that background since there is no formal requirements for systematic or structural data. However, there are concerns on the repeatability and bias for Expert Judgment. In this study, an integrated method by adjusted Local Linear Embedding (LLE) and Naïve Bayes (NB) classifier is proposed to map high dimensional sparse customer requirements to product configurations. The integrated method adjusts classical LLE to preprocess high dimensional sparse dataset to satisfy the prerequisite of NB for classifying different customer requirements to corresponding product configurations. Compared with Expert Judgment, the adjusted LLE with NB performs much better in a real-world Tablet PC design case both in accuracy and robustness.

Bottom-up laboratory testing of the DKIST Visible Broadband Imager (VBI)

NASA Astrophysics Data System (ADS)

Ferayorni, Andrew; Beard, Andrew; Cole, Wes; Gregory, Scott; Wöeger, Friedrich

2016-08-01

The Daniel K. Inouye Solar Telescope (DKIST) is a 4-meter solar observatory under construction at Haleakala, Hawaii [1]. The Visible Broadband Imager (VBI) is a first light instrument that will record images at the highest possible spatial and temporal resolution of the DKIST at a number of scientifically important wavelengths [2]. The VBI is a pathfinder for DKIST instrumentation and a test bed for developing processes and procedures in the areas of unit, systems integration, and user acceptance testing. These test procedures have been developed and repeatedly executed during VBI construction in the lab as part of a "test early and test often" philosophy aimed at identifying and resolving issues early thus saving cost during integration test and commissioning on summit. The VBI team recently completed a bottom up end-to-end system test of the instrument in the lab that allowed the instrument's functionality, performance, and usability to be validated against documented system requirements. The bottom up testing approach includes four levels of testing, each introducing another layer in the control hierarchy that is tested before moving to the next level. First the instrument mechanisms are tested for positioning accuracy and repeatability using a laboratory position-sensing detector (PSD). Second the real-time motion controls are used to drive the mechanisms to verify speed and timing synchronization requirements are being met. Next the high-level software is introduced and the instrument is driven through a series of end-to-end tests that exercise the mechanisms, cameras, and simulated data processing. Finally, user acceptance testing is performed on operational and engineering use cases through the use of the instrument engineering graphical user interface (GUI). In this paper we present the VBI bottom up test plan, procedures, example test cases and tools used, as well as results from test execution in the laboratory. We will also discuss the benefits realized through completion of this testing, and share lessons learned from the bottoms up testing process.

Procedures for estimating confidence intervals for selected method performance parameters.

PubMed

McClure, F D; Lee, J K

2001-01-01

Procedures for estimating confidence intervals (CIs) for the repeatability variance (sigmar2), reproducibility variance (sigmaR2 = sigmaL2 + sigmar2), laboratory component (sigmaL2), and their corresponding standard deviations sigmar, sigmaR, and sigmaL, respectively, are presented. In addition, CIs for the ratio of the repeatability component to the reproducibility variance (sigmar2/sigmaR2) and the ratio of the laboratory component to the reproducibility variance (sigmaL2/sigmaR2) are also presented.

A break-even price calculation for the use of sirolimus-eluting stents in angioplasty.

PubMed

Galanaud, Jean-Philippe; Delavennat, Juliette; Durand-Zaleski, Isabelle

2003-03-01

One of the major complications of angioplasty is the early occurrence of restenosis requiring a repeat procedure. When bare-metal stents are used, clinical restenosis results in a repeat procedure in 10% to 15% of cases. Based on the results of an international, randomized clinical trial, the use of sirolimus-eluting stents reduces this risk. The aims of this study were to calculate the theoretical break-even price for sirolimus-eluting stents in France, the Netherlands, and the United States, and to determine the additional health care cost per patient. The break-even price was calculated by adding the savings resulting from a 15% decrease in the rate of clinical restenosis to the price of bare-metal stents. Costs were computed from the viewpoint of the health care system, exclusive of other societal costs. The break-even prices were 1291 Euro to 1489 Euro in France, 2028 Euro in the Netherlands, and 2708 Euroin the United States (1.00 Euro = 1.00 US dollar in purchasing power parity). These results indicate that the commercial price of sirolimuseluting stents will increase hospital spending for patients undergoing angioplasty by 17% to 55% per patient. This additional cost to the health care system should be discussed in view of possible productivity savings and improved quality of life for patients.

Repeat analysis of intraoral digital imaging performed by undergraduate students using a complementary metal oxide semiconductor sensor: An institutional case study.

PubMed

Yusof, Mohd Yusmiaidil Putera Mohd; Rahman, Nur Liyana Abdul; Asri, Amiza Aqiela Ahmad; Othman, Noor Ilyani; Wan Mokhtar, Ilham

2017-12-01

This study was performed to quantify the repeat rate of imaging acquisitions based on different clinical examinations, and to assess the prevalence of error types in intraoral bitewing and periapical imaging using a digital complementary metal-oxide-semiconductor (CMOS) intraoral sensor. A total of 8,030 intraoral images were retrospectively collected from 3 groups of undergraduate clinical dental students. The type of examination, stage of the procedure, and reasons for repetition were analysed and recorded. The repeat rate was calculated as the total number of repeated images divided by the total number of examinations. The weighted Cohen's kappa for inter- and intra-observer agreement was used after calibration and prior to image analysis. The overall repeat rate on intraoral periapical images was 34.4%. A total of 1,978 repeated periapical images were from endodontic assessment, which included working length estimation (WLE), trial gutta-percha (tGP), obturation, and removal of gutta-percha (rGP). In the endodontic imaging, the highest repeat rate was from WLE (51.9%) followed by tGP (48.5%), obturation (42.2%), and rGP (35.6%). In bitewing images, the repeat rate was 15.1% and poor angulation was identified as the most common cause of error. A substantial level of intra- and interobserver agreement was achieved. The repeat rates in this study were relatively high, especially for certain clinical procedures, warranting training in optimization techniques and radiation protection. Repeat analysis should be performed from time to time to enhance quality assurance and hence deliver high-quality health services to patients.

Effect of formative evaluation using direct observation of procedural skills in assessment of postgraduate students of obstetrics and gynecology: Prospective study.

PubMed

Kumar, Naina; Singh, Namit Kant; Rudra, Samar; Pathak, Swanand

2017-01-01

Direct Observation of Procedural Skills (DOPS) is a way of evaluating procedural skills through observation in the workplace. The purpose of this study was to assess the role of DOPS in teaching and assessment of postgraduate students and to know the effect of repeated DOPS on improvement of the skills and confidence of the students. In both phases, significant difference was observed between the two groups on first DOPS comparison (1st phase: p=0.000; 2nd phase: p=0.002), with simulation group performing better. Comparison of sixth DOPS in the two groups revealed no difference in both phases, but significant difference on first and sixth DOPS comparison in each group (p=0.000). Repeated DOPS results in improved skills and confidence of students in managing real life obstetric emergencies irrespective of the teaching modality. Repeated DOPS results in improved skills and confidence of students in managing real life obstetric emergencies irrespective of the teaching modality.

Holmium:YAG Laser Ablation for the Management of Lower Urinary Tract Foreign Bodies Following Incontinence Surgery: A Case Series and Systematic Review.

PubMed

Chan, Garson; Mamut, Adiel; Martin, Paul; Welk, Blayne

2016-11-01

The objective of this study was to determine the outcomes associated with the endoscopic removal of foreign bodies (such as mesh or permanent suture) in the lower urinary tract after female stress incontinence surgery with the Holmium:YAG (Ho:YAG) laser, and to systematically review the literature on this topic. A retrospective chart review of 18 consecutive women found to have mesh or suture exposure was performed. All patients underwent Ho:YAG laser ablation. A systematic review was performed to identify literature addressing the endoscopic management of mesh/suture exposure after stress incontinence surgery. Between November 2011 and February 2016, 18 women underwent Ho:YAG laser ablation of exposed mesh or suture. Presenting symptoms included lower urinary tract symptoms, pelvic pain, incontinence, or recurrent urinary tract infections. Thirteen women had a previous synthetic midurethral sling and five had a prior retropubic suspension. The median age was 58 years (interquartile range [IQR] 50-60) and median follow-up was 2 years (IQR 1-2). Four patients (22%) had residual mesh after the first procedure, requiring a repeat endoscopic procedure. Only one patient had a small amount of asymptomatic residual mesh on cystoscopy after the final procedure. Only minor postoperative complications were observed. Eight patients had stress incontinence and four underwent operative treatment for this. In our systematic review, we identified 16 case series, which described a total of 158 patients. Women most commonly presented with voiding symptoms or incontinence. Based on the synthesis of these data, repeat procedures were necessary in 16% and vesicovaginal fistula occurred in 2%. Recurrent/persistent stress incontinence was present in 20%, and of these patients, 3/4 underwent a new stress incontinence procedure. Both our case series and the systematic review of the literature demonstrated that endoscopic treatment of lower urinary tract foreign bodies after stress incontinence surgery has good success rates and minimal morbidity.

Power analysis for multivariate and repeated measurements designs via SPSS: correction and extension of D'Amico, Neilands, and Zambarano (2001).

PubMed

Osborne, Jason W

2006-05-01

D'Amico, Neilands, and Zambarano (2001) published SPSS syntax to perform power analyses for three complex procedures: ANCOVA, MANOVA, and repeated measures ANOVA. Unfortunately, the published SPSS syntax for performing the repeated measures analysis needed some minor revision in order to perform the analysis correctly. This article presents the corrected syntax that will successfully perform the repeated measures analysis and provides some guidance on modifying the syntax to customize the analysis.

[Digital electroencephalography in brain death diagnostics : Technical requirements and results of a survey on the compatibility with medical guidelines of digital EEG systems from providers in Germany].

PubMed

Walter, U; Noachtar, S; Hinrichs, H

2018-02-01

The guidelines of the German Medical Association and the German Society for Clinical Neurophysiology and Functional Imaging (DGKN) require a high procedural and technical standard for electroencephalography (EEG) as an ancillary method for diagnosing the irreversible cessation of brain function (brain death). Nowadays, digital EEG systems are increasingly being applied in hospitals. So far it is unclear to what extent the digital EEG systems currently marketed in Germany meet the guidelines for diagnosing brain death. In the present article, the technical und safety-related requirements for digital EEG systems and the EEG documentation for diagnosing brain death are described in detail. On behalf of the DGKN, the authors sent out a questionnaire to all identified distributors of digital EEG systems in Germany with respect to the following technical demands: repeated recording of the calibration signals during an ongoing EEG recording, repeated recording of all electrode impedances during an ongoing EEG recording, assessability of intrasystem noise and galvanic isolation of measurement earthing from earthing conductor (floating input). For 15 of the identified 20 different digital EEG systems the specifications were provided by the distributors (among them all distributors based in Germany). All of these EEG systems are provided with a galvanic isolation (floating input). The internal noise can be tested with all systems; however, some systems do not allow repeated recording of the calibration signals and/or the electrode impedances during an ongoing EEG recording. The majority but not all of the currently available digital EEG systems offered for clinical use are eligible for use in brain death diagnostics as per German guidelines.

Use of a spiral rectal diaphragm technique to control anal sphincter incontinence in a cat.

PubMed

Pavletic, Michael; Mahn, Matt; Duddy, Jean

2012-09-15

A 10-year-old castrated male domestic shorthair cat was examined for a mass involving the right anal sac region. The mass was diagnosed as a fibrosarcoma, and resulted in progressive tenesmus, requiring repeated resection. Surgical removal of the fibrosarcoma was performed on 4 occasions, including complete resection of the anal sphincter muscles and portions of the rectum. A perineal urethrostomy was required during the third surgical procedure secondary to tumor invasion of the preputial tissues. To reduce involuntary loss of feces, the remaining rectal wall was rotated approximately 225° prior to surgical closure during the second, third, and fourth surgical procedures. This procedure created a natural spiral diaphragm within the rectal lumen. The elastic spiral barrier reduced inadvertent fecal loss and facilitated fecal distention of the terminal portion of the colon, allowing the patient to anticipate the impending passage of feces and to use the litter tray on a daily basis. With complete loss of the terminal portion of the rectum and anal sphincter muscles, spiraling the rectum created a deformable threshold barrier to reduce excessive loss of stool secondary to fecal incontinence. On the basis of the positive outcome in this patient, this novel technique may be a useful option to consider for the treatment of cats with loss of anal sphincter function.

The Method of Repeated Readings.

ERIC Educational Resources Information Center

Samuels, S. Jay

1997-01-01

Reprints a reading classic, originally published in this journal in 1979. Describes the method of repeated readings, discussing the procedure, comprehension, and theoretical rationale. Compares it with music and sports and notes how versions of this method were used in early schooling. (SR)

Performance testing and results of the first Etec CORE-2564

NASA Astrophysics Data System (ADS)

Franks, C. Edward; Shikata, Asao; Baker, Catherine A.

1993-03-01

In order to be able to write 64 megabit DRAM reticles, to prepare to write 256 megabit DRAM reticles and in general to meet the current and next generation mask and reticle quality requirements, Hoya Micro Mask (HMM) installed in 1991 the first CORE-2564 Laser Reticle Writer from Etec Systems, Inc. The system was delivered as a CORE-2500XP and was subsequently upgraded to a 2564. The CORE (Custom Optical Reticle Engraver) system produces photomasks with an exposure strategy similar to that employed by an electron beam system, but it uses a laser beam to deliver the photoresist exposure energy. Since then the 2564 has been tested by Etec's standard Acceptance Test Procedure and by several supplementary HMM techniques to insure performance to all the Etec advertised specifications and certain additional HMM requirements that were more demanding and/or more thorough than the advertised specifications. The primary purpose of the HMM tests was to more closely duplicate mask usage. The performance aspects covered by the tests include registration accuracy and repeatability; linewidth accuracy, uniformity and linearity; stripe butting; stripe and scan linearity; edge quality; system cleanliness; minimum geometry resolution; minimum address size and plate loading accuracy and repeatability.

Clostridium difficile Infection

MedlinePlus

... These drugs can make your infection worse. Certain probiotics, or “good bacteria,” may help prevent repeat C. ... Your Doctor Drugs, Procedures & Devices Over-the-counter Products Procedures & Devices Prescription Medicines Health Tools Dictionary Symptom ...

Speeds of film-screen combinations for radiography.

PubMed

Holloway, A F; Cheng, C N; Paix, D

1983-12-01

Values of Ex, the exposure required to yield a net optical density of 1.0, were determined for 12 blue- and nine green-sensitive film types used with 11 blue- and eight green-emitting screen types respectively. The measurements were made using x-rays generated at 80 kVp and 200 mA, under conditions simulating clinical procedures. To examine reciprocity law failure many of the determinations were repeated under similar conditions but at 15 mA. The values of Ex obtained at 15 mA were 6% to 93% greater than those at 200 mA.

Anesthetic-Related Neurotoxicity and Neuroimaging in Children: A Call for Conversation.

PubMed

Bjur, Kara A; Payne, Eric T; Nemergut, Michael E; Hu, Danqing; Flick, Randall P

2017-05-01

Each year millions of young children undergo procedures requiring sedation or general anesthesia. An increasing proportion of the anesthetics used are provided to optimize diagnostic imaging studies such as magnetic resonance imaging. Concern regarding the neurotoxicity of sedatives and anesthetics has prompted the US Food and Drug Administration to change labeling of anesthetics and sedative agents warning against repeated or prolonged exposure in young children. This review aims to summarize the risk of anesthesia in children with an emphasis on anesthetic-related neurotoxicity, acknowledge the value of pediatric neuroimaging, and address this call for conversation.

Development of two surgical approaches to the pituitary gland in the Horse.

PubMed

Carmalt, James L; Scansen, Brian A

2018-12-01

Current treatment of equine pituitary pars intermedia dysfunction (PPID) requires daily oral medication. Minimally invasive surgical palliation of this condition is appealing as a single treatment to alleviate the clinical signs of disease, dramatically improving the welfare of the horse. To develop a surgical approach to the equine pituitary gland, for subsequent treatment of PPID. A cadaver study to develop methodology and a terminal procedure under anaesthesia in the most promising techniques. Four surgical approaches to the pituitary gland were investigated in cadaver animals. A ventral trans-basispheniodal osteotomy and a minimally invasive intravenous approach via the ventral cavernous sinus progressed to live horse trials. Technical complications prevented the myeloscopic and trans-sphenopalatine sinus techniques from being successful. The ventral basisphenoidal osteotomy was repeatable and has potential if an intra-operative imaging guidance system could be employed. The minimally invasive approach was repeatable, atraumatic and relatively inexpensive. A minimally invasive surgical approach to the equine pituitary gland is possible and allows for needle placement within the target tissue. More work is necessary to determine what that treatment might be, but repeatable access to the gland has been obtained, which is a promising step.

Selective lateral laser thyroarytenoid myotomy for adductor spasmodic dysphonia.

PubMed

Hussain, A; Shakeel, M

2010-08-01

Selective lateral laser thyroarytenoid myotomy is a conceptually sound, simple, minimally invasive, repeatable and predictable new surgical procedure for treating adductor spasmodic dysphonia. This paper aims to introduce and describe the surgical technique, and to present a clinical case series and its outcomes. A prospective, clinical case series treated with selective lateral laser thyroarytenoid myotomy, with follow up of 2.5 years. Pre- and post-operative data were collected prospectively for patients undergoing selective lateral laser thyroarytenoid myotomy. These data included patient demographics, previous interventions for adductor spasmodic dysphonia, technical aspects of surgery and clinical outcome. Outcome data included clinical assessment, voice handicap index, need for further intervention, and patient satisfaction assessed by subjective improvement (detailed subjectively by the patients themselves and objectively using the Glasgow benefit inventory). Four patients (two men and two women; mean age 65 years; age range 41-80 years) were included. The mean duration of adductor spasmodic dysphonia was 11 years. All patients had previously been treated with botulinum toxin A. All patients reported improvement in voice quality, fluency, sustainability and elimination of voice breaks over 2.5 years' follow up. Clinical assessment revealed no alteration in mucosal wave, and complete relief of hyperadduction was observed on phonation. No patients required supplementary botulinum toxin treatment during follow up. Selective lateral laser thyroarytenoid myotomy seems to represent a curative procedure for adductor spasmodic dysphonia, a chronic, debilitating condition. This procedure is conceptually simple, minimally invasive and repeatable. It also seems to offer a safe and lasting alternative to botulinum toxin therapy.

Repeat analysis of intraoral digital imaging performed by undergraduate students using a complementary metal oxide semiconductor sensor: An institutional case study

PubMed Central

Rahman, Nur Liyana Abdul; Asri, Amiza Aqiela Ahmad; Othman, Noor Ilyani; Wan Mokhtar, Ilham

2017-01-01

Purpose This study was performed to quantify the repeat rate of imaging acquisitions based on different clinical examinations, and to assess the prevalence of error types in intraoral bitewing and periapical imaging using a digital complementary metal-oxide-semiconductor (CMOS) intraoral sensor. Materials and Methods A total of 8,030 intraoral images were retrospectively collected from 3 groups of undergraduate clinical dental students. The type of examination, stage of the procedure, and reasons for repetition were analysed and recorded. The repeat rate was calculated as the total number of repeated images divided by the total number of examinations. The weighted Cohen's kappa for inter- and intra-observer agreement was used after calibration and prior to image analysis. Results The overall repeat rate on intraoral periapical images was 34.4%. A total of 1,978 repeated periapical images were from endodontic assessment, which included working length estimation (WLE), trial gutta-percha (tGP), obturation, and removal of gutta-percha (rGP). In the endodontic imaging, the highest repeat rate was from WLE (51.9%) followed by tGP (48.5%), obturation (42.2%), and rGP (35.6%). In bitewing images, the repeat rate was 15.1% and poor angulation was identified as the most common cause of error. A substantial level of intra- and interobserver agreement was achieved. Conclusion The repeat rates in this study were relatively high, especially for certain clinical procedures, warranting training in optimization techniques and radiation protection. Repeat analysis should be performed from time to time to enhance quality assurance and hence deliver high-quality health services to patients. PMID:29279822

CONSUMER PREFERENCES FOR SCANNING MODALITY TO DIAGNOSE FOCAL LIVER LESIONS.

PubMed

Whitty, Jennifer; Filby, Alexandra; Smith, Adam B; Carr, Louise M

2015-01-01

Differences in the process of using liver imaging technologies might be important to patients. This study aimed to investigate preferences for scanning modalities used in diagnosing focal liver lesions. A discrete choice experiment was administered to 504 adults aged 25 ≥years. Respondents made repeated choices between two hypothetical scans, described according to waiting time for scan and results, procedure type, the chance of minor side-effects, and whether further scanning procedures were likely to be required. Choice data were analyzed using mixed-logit models with respondent characteristics used to explain preference heterogeneity. Respondents preferred shorter waiting times, the procedure to be undertaken with a handheld scanner on a couch instead of within a body scanner, no side-effects, and no follow–up scans (p≤.01). The average respondent was willing to wait an additional 2 weeks for the scan if it resulted in avoiding side-effects, 1.5 weeks to avoid further procedures or to be told the results immediately, and 1 week to have the scan performed on a couch with a handheld scanner. However, substantial heterogeneity was observed in the strength of preference for desirable imaging characteristics. An average individual belonging to a general population sub–group most likely to require imaging to characterize focal liver lesions in the United Kingdom would prefer contrast–enhanced ultrasound over magnetic resonance imaging or computed tomography. Insights into the patient perspective around differential characteristics of imaging modalities have the potential to be used to guide recommendations around the use of these technologie

Repeated superovulation increases the risk of osteoporosis and cardiovascular diseases by accelerating ovarian aging in mice.

PubMed

Zhang, Jinjin; Lai, Zhiwen; Shi, Liangyan; Tian, Yong; Luo, Aiyue; Xu, Zheyuan; Ma, Xiangyi; Wang, Shixuan

2018-05-22

Superovulation procedures and assisted reproductive technologies have been widely used to treat couples who have infertility problems. Although generally safe, the superovulation procedures are associated with a series of complications, such as ovarian hyper-stimulation syndrome, thromboembolism, and adnexal torsion. The role of long-term repeated superovulation in ovarian aging and especially in associated disorders such as osteoporosis and cardiovascular diseases is still unclear. In this study, we sought to determine if repeated superovulation by ten cycles of treatment with pregnant mare serum gonadotropin/human chorionic gonadotropin could affect ovarian reserve, ovarian function, bone density and heart function. Ovarian reserve and function were reflected by the size of the primordial follicle pool, anti-Mullerian hormone expressions, hormone levels and fertility status. Furthermore, we examined bone density and heart function by microCT and cardiovascular ultrasonography, respectively. After repeated superovulation, the size of the primordial follicle pool and the expression of anti-mullerian hormone decreased, along with the concentrations of estrogen and progesterone. Mice exposed to repeated superovulation showed an obvious decrease in fertility and fecundity. Furthermore, both bone density and heart ejection fraction significantly decreased. These results suggest that repeated superovulation may increase the risk of osteoporosis and cardiovascular diseases by accelerating ovarian aging.

Comparison of cast materials for the treatment of congenital idiopathic clubfoot using the Ponseti method: a prospective randomized controlled trial

PubMed Central

Hui, Catherine; Joughin, Elaine; Nettel-Aguirre, Alberto; Goldstein, Simon; Harder, James; Kiefer, Gerhard; Parsons, David; Brauer, Carmen; Howard, Jason

2014-01-01

Background The Ponseti method of congenital idiopathic clubfoot correction has traditionally specified plaster of Paris (POP) as the cast material of choice; however, there are negative aspects to using POP. We sought to determine the influence of cast material (POP v. semirigid fibreglass [SRF]) on clubfoot correction using the Ponseti method. Methods Patients were randomized to POP or SRF before undergoing the Ponseti method. The primary outcome measure was the number of casts required for clubfoot correction. Secondary outcome measures included the number of casts by severity, ease of cast removal, need for Achilles tenotomy, brace compliance, deformity relapse, need for repeat casting and need for ancillary surgical procedures. Results We enrolled 30 patients: 12 randomized to POP and 18 to SRF. There was no difference in the number of casts required for clubfoot correction between the groups (p = 0.13). According to parents, removal of POP was more difficult (p < 0.001), more time consuming (p < 0.001) and required more than 1 method (p < 0.001). At a final follow-up of 30.8 months, the mean times to deformity relapse requiring repeat casting, surgery or both were 18.7 and 16.4 months for the SRF and POP groups, respectively. Conclusion There was no significant difference in the number of casts required for correction of clubfoot between the 2 materials, but SRF resulted in a more favourable parental experience, which cannot be ignored as it may have a positive impact on psychological well-being despite the increased cost associated. PMID:25078929

Automatic Nanodesign Using Evolutionary Techniques

NASA Technical Reports Server (NTRS)

Globus, Al; Saini, Subhash (Technical Monitor)

1998-01-01

Many problems associated with the development of nanotechnology require custom designed molecules. We use genetic graph software, a new development, to automatically evolve molecules of interest when only the requirements are known. Genetic graph software designs molecules, and potentially nanoelectronic circuits, given a fitness function that determines which of two molecules is better. A set of molecules, the first generation, is generated at random then tested with the fitness function, Subsequent generations are created by randomly choosing two parent molecules with a bias towards high scoring molecules, tearing each molecules in two at random, and mating parts from the mother and father to create two children. This procedure is repeated until a satisfactory molecule is found. An atom pair similarity test is currently used as the fitness function to evolve molecules similar to existing pharmaceuticals.

Standardizing evaluation of pQCT image quality in the presence of subject movement: qualitative versus quantitative assessment.

PubMed

Blew, Robert M; Lee, Vinson R; Farr, Joshua N; Schiferl, Daniel J; Going, Scott B

2014-02-01

Peripheral quantitative computed tomography (pQCT) is an essential tool for assessing bone parameters of the limbs, but subject movement and its impact on image quality remains a challenge to manage. The current approach to determine image viability is by visual inspection, but pQCT lacks a quantitative evaluation. Therefore, the aims of this study were to (1) examine the reliability of a qualitative visual inspection scale and (2) establish a quantitative motion assessment methodology. Scans were performed on 506 healthy girls (9-13 years) at diaphyseal regions of the femur and tibia. Scans were rated for movement independently by three technicians using a linear, nominal scale. Quantitatively, a ratio of movement to limb size (%Move) provided a measure of movement artifact. A repeat-scan subsample (n = 46) was examined to determine %Move's impact on bone parameters. Agreement between measurers was strong (intraclass correlation coefficient = 0.732 for tibia, 0.812 for femur), but greater variability was observed in scans rated 3 or 4, the delineation between repeat and no repeat. The quantitative approach found ≥95% of subjects had %Move <25 %. Comparison of initial and repeat scans by groups above and below 25% initial movement showed significant differences in the >25 % grouping. A pQCT visual inspection scale can be a reliable metric of image quality, but technicians may periodically mischaracterize subject motion. The presented quantitative methodology yields more consistent movement assessment and could unify procedure across laboratories. Data suggest a delineation of 25% movement for determining whether a diaphyseal scan is viable or requires repeat.

Standardizing Evaluation of pQCT Image Quality in the Presence of Subject Movement: Qualitative vs. Quantitative Assessment

PubMed Central

Blew, Robert M.; Lee, Vinson R.; Farr, Joshua N.; Schiferl, Daniel J.; Going, Scott B.

2013-01-01

Purpose Peripheral quantitative computed tomography (pQCT) is an essential tool for assessing bone parameters of the limbs, but subject movement and its impact on image quality remains a challenge to manage. The current approach to determine image viability is by visual inspection, but pQCT lacks a quantitative evaluation. Therefore, the aims of this study were to (1) examine the reliability of a qualitative visual inspection scale, and (2) establish a quantitative motion assessment methodology. Methods Scans were performed on 506 healthy girls (9–13yr) at diaphyseal regions of the femur and tibia. Scans were rated for movement independently by three technicians using a linear, nominal scale. Quantitatively, a ratio of movement to limb size (%Move) provided a measure of movement artifact. A repeat-scan subsample (n=46) was examined to determine %Move’s impact on bone parameters. Results Agreement between measurers was strong (ICC = .732 for tibia, .812 for femur), but greater variability was observed in scans rated 3 or 4, the delineation between repeat or no repeat. The quantitative approach found ≥95% of subjects had %Move <25%. Comparison of initial and repeat scans by groups above and below 25% initial movement, showed significant differences in the >25% grouping. Conclusions A pQCT visual inspection scale can be a reliable metric of image quality but technicians may periodically mischaracterize subject motion. The presented quantitative methodology yields more consistent movement assessment and could unify procedure across laboratories. Data suggest a delineation of 25% movement for determining whether a diaphyseal scan is viable or requires repeat. PMID:24077875

Evaluation of routine depopulation, cleaning, and disinfection procedures in the live bird markets, New York.

PubMed

Trock, Susan C; Gaeta, Michelle; Gonzalez, Annette; Pederson, Janice C; Senne, Dennis A

2008-03-01

During the past years surveillance for avian influenza has been conducted in the live bird markets (LBMs) in New York as well as other states along the east coast. Repeated attempts to eradicate H5 and H7 influenza from the New York markets have focused efforts on the LBMs themselves. Despite repeated mandatory market closures accompanied by cleaning and disinfecting (C/D) procedures, avian influenza virus continued to be isolated. In an effort to assess the adequacy of the C/D procedure, samples were collected in temporal proximity to the depopulation and C/D. Comparison of the pre-C/D (83% virus positive), at C/D approval (1.6% positive) and post-C/D testing (33% positive) indicate that the current procedures of C/D can be effective at eliminating these influenza viruses. However, reinfection via introduction of influenza-virus-positive birds can occur shortly after the market reopens.

Hydrophilic chromatographic determination of carnosine, anserine, balenine, creatine, and creatinine.

PubMed

Mora, Leticia; Sentandreu, Miguel Angel; Toldrá, Fidel

2007-06-13

A new HPLC procedure based on hydrophilic interaction chromatography (HILIC) has been developed for the simultaneous determination of carnosine, anserine, balenine, creatine, and creatinine in meat. This is the first time that HILIC has been directly applied to the study of meat components, having the advantage of not requiring complex cleanup and/or sample derivatization procedures. The chromatographic separation has been developed using a silica column (4.6 x 150 mm, 3 microm), and the proposed methodology is simple, reliable, and fast (<13 min per sample). The method has been validated in terms of linearity, repeatability, reproducibility, and recovery and represents an interesting alternative to methods currently in use for determining the mentioned compounds and other polar substances. The detection limits are 5.64, 8.23, 3.66, 3.99, and 0.06 microg/mL for carnosine, anserine, balenine, creatine, and creatinine, respectively.

PV systems photoelectric parameters determining for field conditions and real operation conditions

NASA Astrophysics Data System (ADS)

Shepovalova, Olga V.

2018-05-01

In this work, research experience and reference documentation have been generalized related to PV systems photoelectric parameters (PV array output parameters) determining. The basic method has been presented that makes it possible to determine photoelectric parameters with the state-of-the-art reliability and repeatability. This method provides an effective tool for PV systems comparison and evaluation of PV system parameters that the end-user will have in the course of its real operation for compliance with those stipulated in reference documentation. The method takes in consideration all parameters that may possibly affect photoelectric performance and that are supported by sufficiently valid procedures for their values testing. Test conditions, requirements for equipment subject to tests and test preparations have been established and the test procedure for fully equipped PV system in field tests and in real operation conditions has been described.

Performance analysis of a generalized upset detection procedure

NASA Technical Reports Server (NTRS)

Blough, Douglas M.; Masson, Gerald M.

1987-01-01

A general procedure for upset detection in complex systems, called the data block capture and analysis upset monitoring process is described and analyzed. The process consists of repeatedly recording a fixed amount of data from a set of predetermined observation lines of the system being monitored (i.e., capturing a block of data), and then analyzing the captured block in an attempt to determine whether the system is functioning correctly. The algorithm which analyzes the data blocks can be characterized in terms of the amount of time it requires to examine a given length data block to ascertain the existence of features/conditions that have been predetermined to characterize the upset-free behavior of the system. The performance of linear, quadratic, and logarithmic data analysis algorithms is rigorously characterized in terms of three performance measures: (1) the probability of correctly detecting an upset; (2) the expected number of false alarms; and (3) the expected latency in detecting upsets.

Neutron and gamma (density) logging in welded tuff

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

Lin, W

This Technical Implementation Procedure (TIP) describes the field operation, and the management of data records pertaining to neutron logging and density logging in welded tuff. This procedure applies to all borehole surveys performed in support of Engineered Barrier System Field Tests (EBSFT), including the Earge Block Tests (LBT) and Initial Engineered Barrier System Field Tests (IEBSFT) - WBS 1.2.3.12.4. The purpose of this TIP is to provide guidelines so that other equally trained and qualified personnel can understand how the work is performed or how to repeat the work if needed. The work will be documented by the use ofmore » Scientific Notebooks (SNs) as discussed in 033-YMP-QP 3.4. The TIP will provide a set of guidelines which the scientists will take into account in conducting the mea- surements. The use of this TIP does not imply that this is repetitive work that does not require profes- sional judgment.« less

Determination of somatropin charged variants by capillary zone electrophoresis - optimisation, verification and implementation of the European pharmacopoeia method.

PubMed

Storms, S M; Feltus, A; Barker, A R; Joly, M-A; Girard, M

2009-03-01

Measurement of somatropin charged variants by isoelectric focusing was replaced with capillary zone electrophoresis in the January 2006 European Pharmacopoeia Supplement 5.3, based on results from an interlaboratory collaborative study. Due to incompatibilities and method-robustness issues encountered prior to verification, a number of method parameters required optimisation. As the use of a diode array detector at 195 nm or 200 nm led to a loss of resolution, a variable wavelength detector using a 200 nm filter was employed. Improved injection repeatability was obtained by increasing the injection time and pressure, and changing the sample diluent from water to running buffer. Finally, definition of capillary pre-treatment and rinse procedures resulted in more consistent separations over time. Method verification data are presented demonstrating linearity, specificity, repeatability, intermediate precision, limit of quantitation, sample stability, solution stability, and robustness. Based on these experiments, several modifications to the current method have been recommended and incorporated into the European Pharmacopoeia to help improve method performance across laboratories globally.

Design ATE systems for complex assemblies

NASA Astrophysics Data System (ADS)

Napier, R. S.; Flammer, G. H.; Moser, S. A.

1983-06-01

The use of ATE systems in radio specification testing can reduce the test time by approximately 90 to 95 percent. What is more, the test station does not require a highly trained operator. Since the system controller has full power over all the measurements, human errors are not introduced into the readings. The controller is immune to any need to increase output by allowing marginal units to pass through the system. In addition, the software compensates for predictable, repeatable system errors, for example, cabling losses, which are an inherent part of the test setup. With no variation in test procedures from unit to unit, there is a constant repeatability factor. Preparing the software, however, usually entails considerable expense. It is pointed out that many of the problems associated with ATE system software can be avoided with the use of a software-intensive, or computer-intensive, system organization. Its goal is to minimize the user's need for software development, thereby saving time and money.

Verification of a Remaining Flying Time Prediction System for Small Electric Aircraft

NASA Technical Reports Server (NTRS)

Hogge, Edward F.; Bole, Brian M.; Vazquez, Sixto L.; Celaya, Jose R.; Strom, Thomas H.; Hill, Boyd L.; Smalling, Kyle M.; Quach, Cuong C.

2015-01-01

This paper addresses the problem of building trust in online predictions of a battery powered aircraft's remaining available flying time. A set of ground tests is described that make use of a small unmanned aerial vehicle to verify the performance of remaining flying time predictions. The algorithm verification procedure described here uses a fully functional vehicle that is restrained to a platform for repeated run-to-functional-failure experiments. The vehicle under test is commanded to follow a predefined propeller RPM profile in order to create battery demand profiles similar to those expected in flight. The fully integrated aircraft is repeatedly operated until the charge stored in powertrain batteries falls below a specified lower-limit. The time at which the lower-limit on battery charge is crossed is then used to measure the accuracy of remaining flying time predictions. Accuracy requirements are considered in this paper for an alarm that warns operators when remaining flying time is estimated to fall below a specified threshold.

A Rapid Approach to Modeling Species-Habitat Relationships

NASA Technical Reports Server (NTRS)

Carter, Geoffrey M.; Breinger, David R.; Stolen, Eric D.

2005-01-01

A growing number of species require conservation or management efforts. Success of these activities requires knowledge of the species' occurrence pattern. Species-habitat models developed from GIS data sources are commonly used to predict species occurrence but commonly used data sources are often developed for purposes other than predicting species occurrence and are of inappropriate scale and the techniques used to extract predictor variables are often time consuming and cannot be repeated easily and thus cannot efficiently reflect changing conditions. We used digital orthophotographs and a grid cell classification scheme to develop an efficient technique to extract predictor variables. We combined our classification scheme with a priori hypothesis development using expert knowledge and a previously published habitat suitability index and used an objective model selection procedure to choose candidate models. We were able to classify a large area (57,000 ha) in a fraction of the time that would be required to map vegetation and were able to test models at varying scales using a windowing process. Interpretation of the selected models confirmed existing knowledge of factors important to Florida scrub-jay habitat occupancy. The potential uses and advantages of using a grid cell classification scheme in conjunction with expert knowledge or an habitat suitability index (HSI) and an objective model selection procedure are discussed.

An overview of safety assessment, regulation, and control of hazardous material use at NREL

NASA Astrophysics Data System (ADS)

Nelson, B. P.; Crandall, R. S.; Moskowitz, P. D.; Fthenakis, V. M.

1992-12-01

This paper summarizes the methodology we use to ensure the safe use of hazardous materials at the National Renewable Energy Laboratory (NREL). First, we analyze the processes and the materials used in those processes to identify the hazards presented. Then we study federal, state, and local regulations and apply the relevant requirements to our operations. When necessary, we generate internal safety documents to consolidate this information. We design research operations and support systems to conform to these requirements. Before we construct the systems, we perform a semiquantitative risk analysis on likely accident scenarios. All scenarios presenting an unacceptable risk require system or procedural modifications to reduce the risk. Following these modifications, we repeat the risk analysis to ensure that the respective accident scenarios present an acceptable risk. Once all risks are acceptable, we conduct an operational readiness review (ORR). A management-appointed panel performs the ORR ensuring compliance with all relevant requirements. After successful completion of the ORR, operations can begin.

38 CFR 17.606 - Award procedures.

Code of Federal Regulations, 2011 CFR

2011-07-01

... satisfactorily completed the repeated course work and is proceeding as a full-time student in the course of study... that the number of credit hours carried by such participant bears to the number of credit hours..., repeated course work. The Secretary may suspend scholarship payments to or on behalf of a participant if...

Testing Multiple Outcomes in Repeated Measures Designs

ERIC Educational Resources Information Center

Lix, Lisa M.; Sajobi, Tolulope

2010-01-01

This study investigates procedures for controlling the familywise error rate (FWR) when testing hypotheses about multiple, correlated outcome variables in repeated measures (RM) designs. A content analysis of RM research articles published in 4 psychology journals revealed that 3 quarters of studies tested hypotheses about 2 or more outcome…

An Examination of Disciplinary Procedures with Children

ERIC Educational Resources Information Center

Forehand, Rex; And Others

1976-01-01

Experiment 1 examined the effect of negative attention and repeated demands on the noncompliant behavior of children. Experiment 2 studied the relative effectiveness of negative attention, isolation, ignoring, and a combination of procedures in reducing noncompliance in children. (GO)

Autoclave use in dental practice in the Republic of Ireland.

PubMed

Healy, C M; Kearns, H P O; Coulter, W A; Stevenson, M; Burke, F J T

2004-08-01

To assess by postal questionnaire, cross-infection control methods, especially sterilisation procedures, of 700 general dental practitioners in the Republic of Ireland, and to biologically monitor steam pressure sterilisers or autoclaves in their practices. Methods of instrument cleaning and sterilisation, autoclave efficacy. A response rate of 40% with all, except one practitioner, using steam sterilisation. 49% also reported the use of chemical sterilisation with a quarter of these using glutaraldehyde. However, instrument soaking time varied greatly from 2.5 minutes to 74 hours. Methods of instrument cleaning prior to autoclaving were as follows: scrubbing by hand 41.5%, ultrasonic cleaning 7.0%, combination of both 50%. 52.9% of the respondents did not autoclave their dental handpieces and only 44.7% disinfected impressions before sending them to the laboratory. The autoclaves of thirty practitioners (11.3%) did not pass the initial biological test. Following counselling about possible causes of failure, four autoclaves (1.5%) failed a repeat biological test. However, seven practitioners did not return the repeat biological test. Some aspects of recommended cross-infection control procedures are well adhered to, e.g. instrument cleaning, but further education is required in certain key areas, in particular the use of chemical sterilisation, dental handpiece autoclaving and impression disinfection. There is also a need to increase awareness of the importance of routine autoclave servicing and calibration, along with validation and monitoring.

Is it useful to repeat an adrenal venous sampling in patients with primary hyperaldosteronism?

PubMed

Bouhanick, B; Delchier, M-C; Fauvel, J; Rousseau, H; Amar, J; Chamontin, B

2014-02-01

Adrenal venous sampling (AVS) is a challenging technical procedure and few patients had AVS procedure twice. To evaluate the reproducibility of the AVS, why AVS were repeated and the conclusions drawn from them. From 1997-2012, 12 patients underwent two AVS. A cortisol level in the adrenal vein greater than or equal to 1.1 to inferior vena cava defined a successful catheterization and a lateralization of secretion corresponded to an aldosterone-to-cortisol vein ratio greater than or equal to 2 between the one side to another. The same side of lateralization of secretion was found in 75% of them. The second AVS were due to technical failure (n=4), unproven lateralization (n=2), a lateralization opposite to the main nodule and ipsilateral to hyperplasia (n=4) on first AVS. For two patients, as the CT was normal, AVS was required again. The second AVS was successful in all patients, including those with an initial technical failure but only patient with technical failure underwent surgery, as BP and kaliemia were controlled. Lateralization on the side of hyperplasia or opposite to the biggest nodule was confirmed in two of four cases. When AVS is unsuccessful for technical reasons, it is worth doing it again but after being sure that surgery is still possibly indicated. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

Optimisation of a sample preparation procedure for the screening of fungal infection and assessment of deoxynivalenol content in maize using mid-infrared attenuated total reflection spectroscopy.

PubMed

Kos, Gregor; Lohninger, Hans; Mizaikoff, Boris; Krska, Rudolf

2007-07-01

A sample preparation procedure for the determination of deoxynivalenol (DON) using attenuated total reflection mid-infrared spectroscopy is presented. Repeatable spectra were obtained from samples featuring a narrow particle size distribution. Samples were ground with a centrifugal mill and analysed with an analytical sieve shaker. Particle sizes of <100, 100-250, 250-500, 500-710 and 710-1000 microm were obtained. Repeatability, classification and quantification abilities for DON were compared with non-sieved samples. The 100-250 microm fraction showed the best repeatability. The relative standard deviation of spectral measurements improved from 20 to 4.4% and 100% of sieved samples were correctly classified compared with 79% of non-sieved samples. The DON level in analysed fractions was a good estimate of overall toxin content.

Percutaneous drainage without sclerotherapy for benign ovarian cysts.

PubMed

Zerem, Enver; Imamović, Goran; Omerović, Safet

2009-07-01

To evaluate percutaneous short-term catheter drainage in the management of benign ovarian cysts in patients at increased surgical risk. Thirty-eight patients with simple ovarian cysts were treated with drainage of fluid content by catheters until output stopped. All patients were poor candidates for surgery. All procedures were performed under ultrasonographic (US) control and local anesthesia. Cytologic examination was performed in all cases. The patients were followed up monthly with color Doppler US for 12 months. Outcome measure was the recurrence of a cyst. During the 12-month follow-up period, 10 of 38 cysts recurred. Seven of the 10 cysts required further intervention, and three were followed up without intervention. Four of the seven patients who required further intervention underwent repeat transabdominal aspiration and three declined repeat aspiration and subsequently underwent surgery. After repeated aspirations, two of four cysts disappeared, one necessitated follow-up only, and one necessitated surgical intervention. Cyst volume (P = .009) and diameter (P = .001) were significantly larger in the cysts that recurred. No evidence of malignancy was reported in the cytologic examination in any patient. No patients developed malignancy during follow-up. No major complications were observed. The hospital stay was 1 day for all patients. The median duration of drainage in the groups with resolved and recurrent cysts was 1 day (interquartile range, 1-1) and 2 days (interquartile range, 1-3), respectively (P = .04). In patients considered poor candidates for open surgery or laparoscopy, percutaneous treatment of ovarian cysts with short-term catheter drainage without sclerotherapy appears to be a safe and effective alternative, with low recurrence rates.

Long-term consequences of pain in human neonates.

PubMed

Grunau, Ruth E; Holsti, Liisa; Peters, Jeroen W B

2006-08-01

The low tactile threshold in preterm infants when they are in the neonatal intensive care unit (NICU), while their physiological systems are unstable and immature, potentially renders them more vulnerable to the effects of repeated invasive procedures. There is a small but growing literature on pain and tactile responsivity following procedural pain in the NICU, or early surgery. Long-term effects of repeated pain in the neonatal period on neurodevelopment await further research. However, there are multiple sources of stress in the NICU, which contribute to inducing high overall 'allostatic load', therefore determining specific effects of neonatal pain in human infants is challenging.

Development of extraction procedure for determination of mercury species using SPME-assisted dispersive derivative agent

NASA Astrophysics Data System (ADS)

Abdullah, Md Pauzi; Khalik, Wan Mohd Afiq Wan Mohd; Othman, Mohamed Rozali

2016-11-01

The extraction procedure for determination of low level mercury using solid phase microextraction was successfully carried out. Design of experimental works using factorial design and central composite design were applied to screen and predict the optimum condition for extraction step. In this study, variables namely concentration level (5 % m/v) and volume of derivatization solution (150 µL) has depicted as main effect for controlling the suitability of derivative reagent condition. Maximum of signal response (account as total peak areas for mercury species) was obtained when extraction procedure was set up at pH of water sample (5.8), extraction time (14 min), extraction temperature (43 °C) and stirring rate (450 rpm). Reducing time required to reach equilibrium is new improvement achieved in this study. Detection limit for each species (MeHg 26.17 ngL-1; EtHg 48.84 ngL-1 and IHg 14.11 ngL-1) was calculated lower than our previous work. Recovery, repeatability and reproducibility trial were recorded varied at acceptable range and relative standard deviation was calculated below than 10 %.

Investigation of the continuous flow of the sample solution on the performance of electromembrane extraction: Comparison with conventional procedure.

PubMed

Nojavan, Saeed; Sirani, Mahsa; Asadi, Sakine

2017-10-01

In this study, electromembrane extraction from a flowing sample solution, termed as continuous-flow electromembrane extraction, was developed and compared with conventional procedures for the determination of four basic drugs in real samples. Experimental parameters affecting the extraction efficiency were further studied and optimized. Under optimum conditions, linearity of continuous-flow procedure was within 8.0-500 ng/mL, while it was wider for conventional procedures (2.0-500 ng/mL). Moreover, repeatability (percentage relative standard deviation) was found to range between 5.6 and 10.4% (n = 3) for the continuous-flow procedure, with a better repeatability than that of conventional procedures (2.3-5.5% (n = 3)). Also, for the continuous-flow procedure, the estimated detection limit (signal-to-noise ratio = 3) was less than 2.4 ng/mL and extraction recoveries were within 8-10%, while the corresponding figures for conventional procedures were less than 0.6 ng/mL and 42-60%, respectively. Thus, the results showed that both continuous flow and conventional procedures were applicable for the extraction of model compounds. However, the conventional procedure was more convenient to use, and thus it was applied to determine sample drugs in real urine and wastewater samples. © 2017 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

Procedural Error and Task Interruption

DTIC Science & Technology

2016-09-30

red for research on errors and individual differences . Results indicate predictive validity for fluid intelligence and specifi c forms of work...TERMS procedural error, task interruption, individual differences , fluid intelligence, sleep deprivation 16. SECURITY CLASSIFICATION OF: 17...and individual differences . It generates rich data on several kinds of errors, including procedural errors in which steps are skipped or repeated

Medial subclavicular musculotendinous complex and insulation break: Rare cause of late pacemaker lead malfunction

PubMed Central

Bhattacharyya, Pranab Jyoti; Agrawal, Shweta; Barkataky, Jogesh Chandra; Bhattacharyya, Anjan Kumar

2015-01-01

Insulation break in a permanent pacemaker lead is a rare long-term complication. We describe an elderly male with a VVIR pacemaker, who presented with an episode of presyncope more than 3 years after the initial implantation procedure, attributed to insulation break possibly caused by lead entrapment in components of the medial subclavicular musculotendinous complex (MSMC) and repeated compressive damage over time during ipsilateral arm movement requiring lead replacement. The differential diagnosis of a clinical presentation when pacing stimuli are present with failure to capture and the role of the MSMC in causing lead damage late after implantation are discussed. PMID:26995445

Flash evaporator systems test

NASA Technical Reports Server (NTRS)

Dietz, J. B.

1976-01-01

A flash evaporator heat rejection system representative of that proposed for the space shuttle orbiter underwent extensive system testing at the NASA Johnson Space Center (JSC) to determine its operational suitability and to establish system performance/operational characteristics for use in the shuttle system. During the tests the evaporator system demonstrated its suitability to meet the shuttle requirements by: (1) efficient operation with 90 to 95% water evaporation efficiency, (2) control of outlet temperature to 40 + or - 2 F for partial heat load operation, (3) stability of control system for rapid changes in Freon inlet temperature, and (4) repeated dormant-to-active device operation without any startup procedures.

Poster - Thur Eve - 10: Long term stability of VMAT quality assurance parameters using an EPID.

PubMed

Pekar, J; Diamond, K R

2012-07-01

The rapidly growing use of volumetric modulated arc therapy (VMAT) treatments in radiation therapy calls for a quantitative, automated, and reliable quality assurance (QA) procedure that can be used routinely in the clinical setting. In this work, we present a series VMAT QA procedures used to assess dynamic multi-leaf collimator (MLC) positional accuracy, variable dose-rate accuracy, and MLC leaf speed accuracy. The QA procedures were performed using amorphous silicon electronic portal imaging devices (EPID) to determine the long term stability of the measured parameters on two Varian linear accelerators. The measurements were repeated weekly on both linear accelerators for a period of three months and the EPID images were analyzed using custom Matlab software. The results of the picket fence tests indicate that MLC leaf positions can be identified to within 0.11 mm and 0.15 mm for static gantry delivery and VMAT delivery respectively. In addition, the dose-rate, gantry speed and MLC leaf speed tests both show very good stability over the measurement period. The measurements thus far, suggest that a number of the dosimetry tests may be suitable for quarterly QA for Varian iX and Trilogy linacs. However, additional measurements are required to confirm the frequency with which each test is required for safe and reliable VMAT delivery at our centre. © 2012 American Association of Physicists in Medicine.

16 CFR 1616.32 - Method for establishment and use of alternate laundering procedures under section 5(c)(4)(ii) of...

Code of Federal Regulations, 2010 CFR

2010-01-01

... after Repeated Home Laundering,” Technical Manual of the American Association of Textile Chemists and... containing the same identity while in production. (b) Application procedure. (1) Applicants seeking approval...

16 CFR 1615.32 - Method for establishment and use of alternate laundering procedures under section 4(g)(4)(ii) of...

Code of Federal Regulations, 2010 CFR

2010-01-01

... after Repeated Home Laundering,” Technical Manual of the American Association of Textile Chemists and... containing the same identity while in production. (b) Application procedure. (1) Applicants seeking approval...

A clinical decision-making model for repeat surgical treatment of pectus Bar displacement: distance measurement after nuss procedure.

PubMed

Sa, Young Jo; Lee, Jongho; Jeong, Jin Yong; Choi, Moonhee; Park, Soo Seog; Sim, Sung Bo; Jo, Keon Hyon

2016-01-19

Bar displacement is one of the most common and serious complications after the Nuss procedure. However, measurements of and factors affecting bar displacement have not been reported. The objectives of this study were to develop a decision model to guide surgeons considering repeat treatment and to estimate optimal cut-off values to determine whether reoperation to correct bar displacement is warranted. From July 2011 to August 2013, ninety bars were inserted in 61 patients who underwent Nuss procedures for pectus excavatum. Group A did not need surgical intervention and Group B required reoperation for bar displacement. Bar position was measured as the distance from the posterior superior end of the sternal body to the upper border of the metal bar on lateral chest radiographs. The bar displacement index (BDI) was calculated using D0 - Dx / D0 x 100 (D0: bar position the day after surgery; Dx: minimal or maximal distance of bar position on the following postoperative days). The optimal cut-off values of BDI warranting reoperation were assessed on the basis of ROC curve analysis. Of the 61 patients, 32 had single bars inserted whereas 29 had parallel bars inserted. There was a significant difference in age (14.0 ± 7.5 vs. 23.3 ± 12.0, p = 0.0062), preoperative Haller index (HI) (4.0 ± 1.1 vs. 5.0 ± 1.0, p = 0.033), and postoperative HI (2.7 ± 0.4 vs. 3.2 ± 0.5 p = 0.006) between the two groups. The optimal cut-off value of BDI was 8.7. We developed a BDI model for surgeons considering performing reoperation after Nuss procedure. The optimal cut-off value of BDI was 8.7. This model may help surgeons to decide objectively whether corrective surgery should be performed. The main factors affecting the relationship between bar displacement and reoperation were age and preoperative HI.

Transanal haemorrhoidal dearterialisation with mucopexy versus stapler haemorrhoidopexy: a randomised trial with long-term follow-up

PubMed Central

Lucarelli, R; Caporossi, M; De Angelis, F; Di Filippo, A; Stipa, F; Spaziani, E

2013-01-01

Introduction The present study aimed to compare the long-term results of transanal haemorrhoidal dearterialisation (THD) with mucopexy and stapler haemorrhoidopexy (SH) in treatment of grade III and IV haemorrhoids. Methods One hundred and twenty-four patients with grade III and IV haemorrhoids were randomised to receive THD with mucopexy (n=63) or SH (n=61). A telephone interview with a structured questionnaire was performed at a median follow-up of 42 months. The primary outcome was the occurrence of recurrent prolapse. Patients, investigators and those assessing the outcomes were blinded to group assignment. Results Recurrence was present in 21 patients (16.9%). It occurred in 16 (25.4%) in the THD group and 5 (8.2%) in the SH group (p=0.021). A second surgical procedure was performed in eight patients (6.4%). Reoperation was open haemorrhoidectomy in seven cases and SH in one case. Five patients out of six in the THD group and both patients in the SH group requiring repeat surgery presented with grade IV haemorrhoids. No significant difference was found between the two groups with respect to symptom control. Patient satisfaction for the procedure was 73.0% after THD and 85.2% after SH (p=0.705). Postoperative pain, return to normal activities and complications were similar. Conclusions The recurrence rate after THD with mucopexy is significantly higher than after SH at long-term follow-up although results are similar with respect to symptom control and patient satisfaction. A definite risk of repeat surgery is present when both procedures are performed, especially for grade IV haemorrhoids. PMID:23676807

Notes From the Field: Secondary Task Precision for Cognitive Load Estimation During Virtual Reality Surgical Simulation Training.

PubMed

Rasmussen, Sebastian R; Konge, Lars; Mikkelsen, Peter T; Sørensen, Mads S; Andersen, Steven A W

2016-03-01

Cognitive load (CL) theory suggests that working memory can be overloaded in complex learning tasks such as surgical technical skills training, which can impair learning. Valid and feasible methods for estimating the CL in specific learning contexts are necessary before the efficacy of CL-lowering instructional interventions can be established. This study aims to explore secondary task precision for the estimation of CL in virtual reality (VR) surgical simulation and also investigate the effects of CL-modifying factors such as simulator-integrated tutoring and repeated practice. Twenty-four participants were randomized for visual assistance by a simulator-integrated tutor function during the first 5 of 12 repeated mastoidectomy procedures on a VR temporal bone simulator. Secondary task precision was found to be significantly lower during simulation compared with nonsimulation baseline, p < .001. Contrary to expectations, simulator-integrated tutoring and repeated practice did not have an impact on secondary task precision. This finding suggests that even though considerable changes in CL are reflected in secondary task precision, it lacks sensitivity. In contrast, secondary task reaction time could be more sensitive, but requires substantial postprocessing of data. Therefore, future studies on the effect of CL modifying interventions should weigh the pros and cons of the various secondary task measurements. © The Author(s) 2015.

Sleep-Effects on Implicit and Explicit Memory in Repeated Visual Search

PubMed Central

Assumpcao, Leonardo; Gais, Steffen

2013-01-01

In repeated visual search tasks, facilitation of reaction times (RTs) due to repetition of the spatial arrangement of items occurs independently of RT facilitation due to improvements in general task performance. Whereas the latter represents typical procedural learning, the former is a kind of implicit memory that depends on the medial temporal lobe (MTL) memory system and is impaired in patients with amnesia. A third type of memory that develops during visual search is the observers’ explicit knowledge of repeated displays. Here, we used a visual search task to investigate whether procedural memory, implicit contextual cueing, and explicit knowledge of repeated configurations, which all arise independently from the same set of stimuli, are influenced by sleep. Observers participated in two experimental sessions, separated by either a nap or a controlled rest period. In each of the two sessions, they performed a visual search task in combination with an explicit recognition task. We found that (1) across sessions, MTL-independent procedural learning was more pronounced for the nap than rest group. This confirms earlier findings, albeit from different motor and perceptual tasks, showing that procedural memory can benefit from sleep. (2) Likewise, the sleep group compared with the rest group showed enhanced context-dependent configural learning in the second session. This is a novel finding, indicating that the MTL-dependent, implicit memory underlying contextual cueing is also sleep-dependent. (3) By contrast, sleep and wake groups displayed equivalent improvements in explicit recognition memory in the second session. Overall, the current study shows that sleep affects MTL-dependent as well as MTL-independent memory, but it affects different, albeit simultaneously acquired, forms of MTL-dependent memory differentially. PMID:23936363

Modeling Repeatable Events Using Discrete-Time Data: Predicting Marital Dissolution

ERIC Educational Resources Information Center

Teachman, Jay

2011-01-01

I join two methodologies by illustrating the application of multilevel modeling principles to hazard-rate models with an emphasis on procedures for discrete-time data that contain repeatable events. I demonstrate this application using data taken from the 1995 National Survey of Family Growth (NSFG) to ascertain the relationship between multiple…

Counterbalancing and Other Uses of Repeated-Measures Latin-Square Designs: Analyses and Interpretations.

ERIC Educational Resources Information Center

Reese, Hayne W.

1997-01-01

Recommends that when repeated-measures Latin-square designs are used to counterbalance treatments across a procedural variable or to reduce the number of treatment combinations given to each participant, effects be analyzed statistically, and that in all uses, researchers consider alternative interpretations of the variance associated with the…

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

PubMed

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

2013-01-01

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

[Extemporaneous examination in lung pathology: the pathologist's view].

PubMed

Molinié, V; Duchatelle, V; Abbey-Tobby, A; Balaton, A

2012-06-01

Extemporaneous examination of a thoracopulmonary lesion has an unquestionable interest when pre-surgical diagnostic workup has not allowed determining its exact nature. This examination, the sole objective of which is to guide the surgical approach, is especially important in lung pathology, due to the limited non-surgical access to thoracic lesions and the morbidity and mortality of repeated surgery. Its yield as a decision-making procedure is of utmost importance in many clinical situations, and a close collaboration between thoracic surgeons and pathologists is required to ensure its quality, in a context of mutual confidence that requires time and experience. After a presentation of the indications and practical modalities of extemporaneous examination, we will underline its limitations and insist on difficult situations for the pathologist and inadequate indications. Copyright © 2012 SPLF. Published by Elsevier Masson SAS. All rights reserved.

Porcelain-metal bonding: part I. Effects of repeated baking process.

PubMed

Nagasawa, S; Yoshida, T; Mizoguchi, H; Ito, M; Oshida, Y

2001-01-01

A plurality of repeated porcelain-baking procedures are normally practiced in order to achieve the final adjustment metal-porcelain restorations. By increasing the number of baking cycles, the undesired internal strain would be built-up, causing the reduction of mechanical properties and deterioration of color characteristics. However the extensive studies on such deterioration have not been done. In this study, effects of numbers (up to 10 times) of repeated baking cycles on baking shrinkage, surface roughness, bend strength, color changes and internal microstructure were investigated when opaque, body and enamel was individually applied or when a triple-player comprising of these three porcelains was repeatedly applied. It was concluded that (1) the bend strengths increased by increasing baking cycles, (2) the average surface roughness decreased by increasing number of baking procedures, (3) changes in color characteristics was very small in the Vintage halo porcelain system, and (4) since the pores entrapped in the porcelain remained even by increasing baking cycles, it is recommended to remove the surface pores before forming the next layer when handling the high viscous opaque porcelain.

Development of an algorithm for monitoring pattern fidelity on photomasks for 0.2-μm technology and beyond based on light optical CD metrology tools

NASA Astrophysics Data System (ADS)

Schaetz, Thomas; Hay, Bernd; Walden, Lars; Ziegler, Wolfram

1999-04-01

With the ongoing shrinking of design rules, the complexity of photomasks does increase continuously. Features are getting smaller and denser, their characterization requires sophisticated procedures. Looking for the deviation from their target value and their linewidth variation is not sufficient any more. In addition, measurements of corner rounding and line end shortening are necessary to define the pattern fidelity on the mask. Otherwise printing results will not be satisfying. Contacts and small features are suffering mainly from imaging inaccuracies. The size of the contacts as an example may come out too small on the photomask and therefore reduces the process window in lithography. In order to meet customer requirements for pattern fidelity, a measurement algorithm and a measurement procedure needs to be introduced and specifications to be defined. In this paper different approaches are compared, allowing an automatic qualification of photomask by optical light microscopy based on a MueTec CD-metrology system, the newly developed MueTec 2030UV, provided with a 365 nm light source. The i-line illumination allows to resolve features down to 0.2 micrometers size with good repeatability.

Stomaplasty with pannicuectomy in an obese patient with stomal retraction: A case report.

PubMed

Ito, Eisaku; Kosaka, Masaaki; Kawaguchi, Chie; Yoshida, Masashi; Ohdaira, Hironori; Nakashima, Keigo; Suzuki, Norihiko; Imakita, Tomonori; Tsutsui, Nobuhiro; Kitajima, Masaki; Suzuki, Yutaka

2016-01-01

Stomal retraction is a common complication following stoma formation. A repeat surgical procedure for stomal revision is an invasive treatment that is often required as a result. An 81-year-old woman with obstructive rectal carcinoma and perforative peritonitis underwent an emergent anterior resection and colostomy (Hartmann's operation). After the operation, the patient changed the stoma pouch every day because of stomal retraction and leakage. Thirty-eight days after the operation, we performed a stomaplasty with pannicuectomy. Following this procedure, the patient changed the stoma pouch twice weekly. Stomal retraction is caused by the thick subcutaneous fat and abnormal skin folds in obese patients, as well as the excess tension that is the result of inadequate mobilization. Treatment of stomal retraction typically requires an intraperitoneal stoma revision. Our method of panniculectomy with skin excision but without stomal revision does not involve an incision around the stoma and there is no risk of fecal contamination. We report a case of an obese patient who underwent stomaplasty with pannicuectomy for stomal retraction. We believe that stomaplasty with pannicuectomy is a feasible option in obese patients with stomal retraction. Copyright © 2016. Published by Elsevier Ltd.

All-photonic quantum repeaters

PubMed Central

Azuma, Koji; Tamaki, Kiyoshi; Lo, Hoi-Kwong

2015-01-01

Quantum communication holds promise for unconditionally secure transmission of secret messages and faithful transfer of unknown quantum states. Photons appear to be the medium of choice for quantum communication. Owing to photon losses, robust quantum communication over long lossy channels requires quantum repeaters. It is widely believed that a necessary and highly demanding requirement for quantum repeaters is the existence of matter quantum memories. Here we show that such a requirement is, in fact, unnecessary by introducing the concept of all-photonic quantum repeaters based on flying qubits. In particular, we present a protocol based on photonic cluster-state machine guns and a loss-tolerant measurement equipped with local high-speed active feedforwards. We show that, with such all-photonic quantum repeaters, the communication efficiency scales polynomially with the channel distance. Our result paves a new route towards quantum repeaters with efficient single-photon sources rather than matter quantum memories. PMID:25873153

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.

Patient Experience, Pain, and Quality of Life after Lower Limb Angioplasty: A Multisite Prospective Cohort Study

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

Culverwell, A. D., E-mail: adamculverwell@doctors.net.uk; Tapping, C. R.; Ettles, D. F.

Purpose: To explore the experience of patients undergoing endovascular lower limb angioplasty and evaluate the improvements in quality of life and disease-related symptoms after the procedure. Methods: Patients completed a questionnaire before treatment and three questionnaires after the procedure (immediately after the procedure, and again 4 weeks and 3 months later). Anxiety, patient understanding, procedure-related pain, and disease-related pain were assessed by a visual analog score (VAS). Complications, analgesic requirements, and satisfaction were recorded. Changes to quality of life were assessed by the validated SF36 questionnaire. Results: A total of 88 patients (41%) responded. Overall, disease-related pain decreased over 3more » months after the procedure. Smokers had more pain both before and after the procedure (P < 0.05). Explanation was considered better if provided by radiologist (P < 0.05). Sixty-nine percent of patients found the procedures less painful (mean VAS 2.5) than they had anticipated (VAS 5.5). Fifty percent of patients experienced adverse effects related to their puncture site, but this was highest among patients who had undergone the procedure before and smokers. The greatest quality-of-life improvements were in emotional and general health. Higher levels of disease-related pain were associated with worse general, emotional, and physical health (P < 0.05). Conclusion: Lower limb angioplasty provides symptomatic and quality-of-life improvements. Implementation of simple measures could improve patient satisfaction-for example, treatment should be explained by the radiologist in advance. Routine prescription of analgesics with particular attention to smokers and those undergoing repeat interventions is suggested.« less

What Is the Risk of Anastomotic Leak After Repeat Intestinal Resection in Patients With Crohn's Disease?

PubMed

Johnston, W Forrest; Stafford, Caitlin; Francone, Todd D; Read, Thomas E; Marcello, Peter W; Roberts, Patricia L; Ricciardi, Rocco

2017-12-01

Approximately half of Crohn's patients require intestinal resection, and many need repeat resections. The purpose of this study was to evaluate the increased risk of clinical anastomotic leak in patients with a history of previous intestinal resection undergoing repeat resection with anastomosis for Crohn's disease. This was a retrospective analysis of prospectively collected departmental data with 100% capture. The study was conducted at the department of colorectal surgery in a tertiary care teaching hospital between July 2007 and March 2016. A cohort of consecutive patients with Crohn's disease who were treated with intestinal resection and anastomosis, excluding patients with proximal fecal diversion, were included. The cohort was divided into 2 groups, those with no previous resection compared with those with previous resection. Clinical anastomotic leak within 30 days of surgery was measured. Of the 206 patients who met criteria, 83 patients had previous intestinal resection (40%). The 2 groups were similar in terms of patient factors, immune-suppressing medication use, and procedural factors. Overall, 20 clinical anastomotic leaks were identified (10% leak rate). There were 6 leaks (5%) detected in patients with no previous intestinal resection and 14 leaks (17%) detected in patients with a history of previous intestinal resection (p < 0.005). The OR of anastomotic leak in patients with Crohn's disease with previous resection compared with no previous resection was 3.5 (95% CI, 1.3-9.4). Patients with 1 previous resection (n = 53) had a leak rate of 13%, whereas patients with ≥2 previous resections (n = 30) had a leak rate of 23%. The number of previous resections correlated with increasing risk for clinical anastomotic leak (correlation coefficient = 0.998). This was a retrospective study with limited data to perform a multivariate analysis. Repeat intestinal resection in patients with Crohn's disease is associated with an increased rate of anastomotic leakage when compared with initial resection despite similar patient, medication, and procedural factors. See Video Abstract at http://links.lww.com/DCR/A459.

Performance of single-use and multiuse diamond rotary cutting instruments with turbine and electric handpieces.

PubMed

Rotella, Mario; Ercoli, Carlo; Funkenbusch, Paul D; Russell, Scott; Feng, Changyong

2014-01-01

As single-use rotary cutting instruments and electric handpieces become more available, the performance of these instruments with electric as compared to turbine handpieces requires evaluation. In addition, if rotary cutting instruments marketed as single-use instruments are used for multiple patients, the effects on their performance of cleaning, sterilization, and repeated use are of interest to the clinician. The purpose of the study was to evaluate how the cleaning, autoclaving, and repeated use of single-use and multiuse rotary cutting instruments, with either a turbine or electric handpiece, affected their performance. The effects on cutting performance of 2 handpieces (turbine and electric), 2 cleaning and sterilization conditions (cleaned and autoclaved versus noncleaned and nonautoclaved), and 6 different diamond rotary cutting instruments (4 single-use and 2 multiuse) during simulated tooth preparations were evaluated by using a 24-treatment condition full-factorial experimental design. A computer-controlled dedicated testing apparatus was used to simulate the cutting procedures, and machinable glass ceramic blocks were used as the cutting substrate for tangential cuts. In addition, for each treatment condition, 8 consecutive cuts, for a total of 192 cuts, were measured to assess the durability of the rotary cutting instruments. A linear mixed model was used to study the effect of instrument type, handpiece, cleaning, and sterilization, as well as the status and number of cuts on the outcome variables. The Tukey honestly significant difference test was used for the post hoc pairwise comparisons (α=.05). Performance, as measured by the rate of advancement, decreased with the repeated use of rotary cutting instruments (P<.001), while cleaning and sterilization procedures improved the average performance of the 8 cuts (P=.002). The electric handpiece showed a greater load than the turbine (P<.001) and a lower rate/load metric, but no differences in the rate of advancement. Significant differences were also detected among the different rotary cutting instruments tested with the Two Striper, which showed the highest cumulative performance of all groups. The repeated use of both single-use and multiuse rotary cutting instruments decreased cutting performance. The use of a cleaning and sterilization procedure between cuts improved the average cutting performance. During a tangential cutting process, although the ease of advancement (rate/load) was greater for the turbine, the electric handpiece did not produce a statistically different cutting rate. Copyright © 2014 Editorial Council for the Journal of Prosthetic Dentistry. Published by Mosby, Inc. All rights reserved.

Direct PCR Offers a Fast and Reliable Alternative to Conventional DNA Isolation Methods for Gut Microbiomes.

PubMed

Videvall, Elin; Strandh, Maria; Engelbrecht, Anel; Cloete, Schalk; Cornwallis, Charlie K

2017-01-01

The gut microbiome of animals is emerging as an important factor influencing ecological and evolutionary processes. A major bottleneck in obtaining microbiome data from large numbers of samples is the time-consuming laboratory procedures required, specifically the isolation of DNA and generation of amplicon libraries. Recently, direct PCR kits have been developed that circumvent conventional DNA extraction steps, thereby streamlining the laboratory process by reducing preparation time and costs. However, the reliability and efficacy of direct PCR for measuring host microbiomes have not yet been investigated other than in humans with 454 sequencing. Here, we conduct a comprehensive evaluation of the microbial communities obtained with direct PCR and the widely used Mo Bio PowerSoil DNA extraction kit in five distinct gut sample types (ileum, cecum, colon, feces, and cloaca) from 20 juvenile ostriches, using 16S rRNA Illumina MiSeq sequencing. We found that direct PCR was highly comparable over a range of measures to the DNA extraction method in cecal, colon, and fecal samples. However, the two methods significantly differed in samples with comparably low bacterial biomass: cloacal and especially ileal samples. We also sequenced 100 replicate sample pairs to evaluate repeatability during both extraction and PCR stages and found that both methods were highly consistent for cecal, colon, and fecal samples ( r s > 0.7) but had low repeatability for cloacal ( r s = 0.39) and ileal ( r s = -0.24) samples. This study indicates that direct PCR provides a fast, cheap, and reliable alternative to conventional DNA extraction methods for retrieving 16S rRNA data, which can aid future gut microbiome studies. IMPORTANCE The microbial communities of animals can have large impacts on their hosts, and the number of studies using high-throughput sequencing to measure gut microbiomes is rapidly increasing. However, the library preparation procedure in microbiome research is both costly and time-consuming, especially for large numbers of samples. We investigated a cheaper and faster direct PCR method designed to bypass the DNA isolation steps during 16S rRNA library preparation and compared it with a standard DNA extraction method. We used both techniques on five different gut sample types collected from 20 juvenile ostriches and sequenced samples with Illumina MiSeq. The methods were highly comparable and highly repeatable in three sample types with high microbial biomass (cecum, colon, and feces), but larger differences and low repeatability were found in the microbiomes obtained from the ileum and cloaca. These results will help microbiome researchers assess library preparation procedures and plan their studies accordingly.

Telemetric implantable pressure sensor for short- and long-term monitoring of intracranial pressure.

PubMed

Frischholz, M; Sarmento, L; Wenzel, M; Aquilina, K; Edwards, R; Coakham, H B

2007-01-01

Patients with hydrocephalus, idiopathic intracranial hypertension and head injury frequently require monitoring of intracranial pressure (ICP) and may need repeated episodes of monitoring months or years apart. The gold standard for measurement of ICP remains the external ventricular catheter. This is a fluid-filled catheter transducer system that allows regular recalibration and correction of zero drift by its position relative to a fixed anatomical reference. It also allows drainage of cerebrospinal fluid (CSF), providing a means of lowering the ICP. Several catheter tip transducer systems are currently in clinical use, including using strain gauges or fiber-optical pressure sensing techniques. In these devices, zero drift and calibration cannot be checked in vivo. All the ICP monitoring devices in current clinical use require a physical connection between the brain and the external environment. This is a source of infection and limits the duration of monitoring. A number of telemetric monitoring devices, in which data is in some way transmitted transcutaneously, have been developed over the last twenty years, but significant technical problems have precluded their use in routine clinical practice. All current ICP monitors are temporary percutaneous implanted devices. Placement of these devices carries significant morbidity, particularly infection. Patients undergoing repeated monitoring require multiple surgical procedures. Apart from decreasing the risk of infection in patients with severe head injury, the clinical value of an accurate telemetric ICP monitoring system which maintains its reliability over a long period of implantation is high.

40 CFR 1065.12 - Approval of alternate procedures.

Code of Federal Regulations, 2010 CFR

2010-07-01

... engine meets all applicable emission standards according to specified procedures. (iii) Use statistical.... (e) We may give you specific directions regarding methods for statistical analysis, or we may approve... statistical tests. Perform the tests as follows: (1) Repeat measurements for all applicable duty cycles at...

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.

Short- and long-term effects of clinical audits on compliance with procedures in CT scanning.

PubMed

Oliveri, Antonio; Howarth, Nigel; Gevenois, Pierre Alain; Tack, Denis

2016-08-01

To test the hypothesis that quality clinical audits improve compliance with the procedures in computed tomography (CT) scanning. This retrospective study was conducted in two hospitals, based on 6950 examinations and four procedures, focusing on the acquisition length in lumbar spine CT, the default tube current applied in abdominal un-enhanced CT, the tube potential selection for portal phase abdominal CT and the use of a specific "paediatric brain CT" procedure. The first clinical audit reported compliance with these procedures. After presenting the results to the stakeholders, a second audit was conducted to measure the impact of this information on compliance and was repeated the next year. Comparisons of proportions were performed using the Chi-square Pearson test. Depending on the procedure, the compliance rate ranged from 27 to 88 % during the first audit. After presentation of the audit results to the stakeholders, the compliance rate ranged from 68 to 93 % and was significantly improved for all procedures (P ranging from <0.001 to 0.031) in both hospitals and remained unchanged during the third audit (P ranging from 0.114 to 0.999). Quality improvement through repeated compliance audits with CT procedures durably improves this compliance. • Compliance with CT procedures is operator-dependent and not perfect. • Compliance differs between procedures and hospitals, even within a unified department. • Compliance is improved through audits followed by communication to the stakeholders. • This improvement is sustainable over a one-year period.

Diagnostic Applications and Methods to Isolate Circulating Tumor Cells (CTCs) from Blood

NASA Astrophysics Data System (ADS)

Tang, Cha-Mei

2013-03-01

Each year a million new cancer cases are diagnosed in the United States. Ninety percent of the deaths will be the result of metastasis, not from the primary tumor. Tissue biopsy is a universally accepted tool for cancer diagnosis and determination of treatment. The procedure varies, but is invasive, costly, and can be fatal, and for these reasons is seldom repeated after initial diagnosis. Monitoring of treatment response and for possible relapse is usually done by CT or MRI scan, both of which are expensive and require the tumor to change size perceptibly. Further, cancer can mutate or develop resistance to therapeutics and require modification of the treatment regimen. The initial tissue biopsy often cannot reflect the disease as it progresses, requiring new biopsy samples to determine a change of treatment. All carcinomas, about 80% of all cancer, shed tumor cells into the circulation, most often at the later stages when treatment is more critical. These circulating tumor cells (CTCs) are the cause of metastasis, and can be isolated from patient blood to serve as ``liquid biopsy''. These CTCs contain a valuable trove of information that help both patient and clinician understand disease status. In addition to counting the number of CTCs (known to be a prognostic indicator of survival), CTCs can provide biomarker information such as protein expressions and gene mutations, amplifications, and translocations. This information can be used to determine treatment. During treatment, the number of intact and apoptotic CTCs can be measured on a repeated basis to measure the patient's response to treatment and disease progression. Following treatment, liquid biopsy can be repeated at regular intervals to watch for relapse. Methods to isolate CTCs can be grouped into three categories: i) immunocapture based on surface markers of CTCs, ii) size exclusion based on CTC size, typically larger than blood cells, and iii) negative selection utilizing red blood cell lysis, white blood cell depletion or FICOLL. Various implementations of the CTC isolation methods will be presented.

Vibration Testing Procedures for Bone Stiffness Assessment in Fractures Treated with External Fixation.

PubMed

Mattei, Lorenza; Longo, Antonia; Di Puccio, Francesca; Ciulli, Enrico; Marchetti, Stefano

2017-04-01

A bone healing assessment is crucial for the successful treatment of fractures, particularly in terms of the timing of support devices. However, in clinical practice, this assessment is only made qualitatively through bone manipulation and X-rays, and hence cannot be repeated as often as might be required. The present study reconsiders the quantitative method of frequency response analysis for healing assessments, and specifically for fractures treated with an external fixator. The novelty consists in the fact that bone excitation and response are achieved through fixator pins, thus overcoming the problem of transmission through soft-tissues and their damping effect. The main objective was to develop and validate a test procedure in order to characterize the treated bone. More than 80 tests were performed on a tibia phantom alone, a phantom with pins, and a phantom with a complete fixator. Different excitation techniques and input-output combinations were compared. The results demonstrated the effectiveness of a procedure based on impact tests using a micro-hammer. Pins and fixator were demonstrated to influence the frequency response of the phantom by increasing the number of resonant frequencies. This procedure will be applied in future studies to monitor healing both in in vitro and in vivo conditions.

Standardization of skin cleansing in vivo: part I. Development of an Automated Cleansing Device (ACiD).

PubMed

Sonsmann, F K; Strunk, M; Gediga, K; John, C; Schliemann, S; Seyfarth, F; Elsner, P; Diepgen, T L; Kutz, G; John, S M

2014-05-01

To date, there are no legally binding requirements concerning product testing in cosmetics. This leads to various manufacturer-specific test methods and absent transparent information on skin cleansing products. A standardized in vivo test procedure for assessment of cleansing efficacy and corresponding barrier impairment by the cleaning process is needed, especially in the occupational context where repeated hand washing procedures may be performed at short intervals. For the standardization of the cleansing procedure, an Automated Cleansing Device (ACiD) was designed and evaluated. Different smooth washing surfaces of the equipment for ACiD (incl. goat hair, felt, felt covered with nitrile caps) were evaluated regarding their skin compatibility. ACiD allows an automated, fully standardized skin washing procedure. Felt covered with nitrile as washing surface of the rotating washing units leads to a homogenous cleansing result and does not cause detectable skin irritation, neither clinically nor as assessed by skin bioengineering methods (transepidermal water loss, chromametry). Automated Cleansing Device may be useful for standardized evaluation of the cleansing effectiveness and parallel assessment of the corresponding irritancy potential of industrial skin cleansers. This will allow objectifying efficacy and safety of industrial skin cleansers, thus enabling market transparency and facilitating rational choice of products. © 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

The repeatability and reproducibility of the BioRID IIg in a repeatable laboratory seat based on a production car seat.

PubMed

Hynd, David; Depinet, Paul; Lorenz, Bernd

2013-01-01

The United Nations Economic Commission for Europe Informal Group on GTR No. 7 Phase 2 are working to define a build level for the BioRID II rear impact (whiplash) crash test dummy that ensures repeatable and reproducible performance in a test procedure that has been proposed for future legislation. This includes the specification of dummy hardware, as well as the development of comprehensive certification procedures for the dummy. This study evaluated whether the dummy build level and certification procedures deliver the desired level of repeatability and reproducibility. A custom-designed laboratory seat was made using the seat base, back, and head restraint from a production car seat to ensure a representative interface with the dummy. The seat back was reinforced for use in multiple tests and the recliner mechanism was replaced by an external spring-damper mechanism. A total of 65 tests were performed with 6 BioRID IIg dummies using the draft GTR No.7 sled pulse and seating procedure. All dummies were subject to the build, maintenance, and certification procedures defined by the Informal Group. The test condition was highly repeatable, with a very repeatable pulse, a well-controlled seat back response, and minimal observed degradation of seat foams. The results showed qualitatively reasonable repeatability and reproducibility for the upper torso and head accelerations, as well as for T1 Fx and upper neck Fx . However, reproducibility was not acceptable for T1 and upper neck Fz or for T1 and upper neck My . The Informal Group has not selected injury or seat assessment criteria for use with BioRID II, so it is not known whether these channels would be used in the regulation. However, the ramping-up behavior of the dummy showed poor reproducibility, which would be expected to affect the reproducibility of dummy measurements in general. Pelvis and spine characteristics were found to significantly influence the dummy measurements for which poor reproducibility was observed. It was also observed that the primary neck response in these tests was flexion, not extension. This correlates well with recent findings from Japan and the United States showing a correlation between neck flexion and injury in accident replication simulations and postmortem human subjects (PMHS) studies, respectively. The present certification tests may not adequately control front cervical spine bumper characteristics, which are important for neck flexion response. The certification sled test also does not include the pelvis and so cannot be used to control pelvis response and does not substantially load the lumbar bumpers and so does not control these parts of the dummy. The stiffness of all spine bumpers and of the pelvis flesh should be much more tightly controlled. It is recommended that a method for certifying the front cervical bumpers should be developed. Recommendations are also made for tighter tolerance on the input parameters for the existing certification tests.

Repeat Radiosurgery for Trigeminal Neuralgia.

PubMed

Helis, Corbin A; Lucas, John T; Bourland, J Daniel; Chan, Michael D; Tatter, Stephen B; Laxton, Adrian W

2015-11-01

Repeat Gamma Knife radiosurgery (GKRS) is an established option for patients whose pain has recurred after the initial procedure, with reported success rates varying from 68% to 95%. Predictive factors for response to the repeat GKRS are ill-defined. This cohort study aimed to report the outcomes and factors predictive of success for patients who have undergone repeated GKRS for trigeminal neuralgia at Wake Forest University Baptist Medical Center. Between 1999 and 2013, 152 patients underwent repeat GKRS at Wake Forest, 125 of whom were available for long-term follow-up. A retrospective chart review and telephone interviews were conducted to determine background medical history, dosimetric data, outcomes, and adverse effects of the procedure. Eighty-four percent of patients achieved at least Barrow Neurological Institute (BNI) IIIb pain relief, with 46% achieving BNI I. The 1-, 3-, and 5-year rates of BNI I pain relief were 63%, 50%, and 37%, respectively. The 1-, 3-, and 5-year rates of BNI IIIb or better pain relief were 74%, 59%, and 46%, respectively. One patient experienced bothersome numbness and 2 patients developed anesthesia dolorosa. The dominant predictive factors for pain relief were facial numbness after the first GKRS and a positive pain response to the first GKRS. Repeat GKRS is an effective method of treating recurrent trigeminal neuralgia. Patients who have facial numbness after the first treatment and a positive pain response to the first GKRS are significantly more likely to respond well to the second treatment.

Consequences of common data analysis inaccuracies in CNS trauma injury basic research.

PubMed

Burke, Darlene A; Whittemore, Scott R; Magnuson, David S K

2013-05-15

The development of successful treatments for humans after traumatic brain or spinal cord injuries (TBI and SCI, respectively) requires animal research. This effort can be hampered when promising experimental results cannot be replicated because of incorrect data analysis procedures. To identify and hopefully avoid these errors in future studies, the articles in seven journals with the highest number of basic science central nervous system TBI and SCI animal research studies published in 2010 (N=125 articles) were reviewed for their data analysis procedures. After identifying the most common statistical errors, the implications of those findings were demonstrated by reanalyzing previously published data from our laboratories using the identified inappropriate statistical procedures, then comparing the two sets of results. Overall, 70% of the articles contained at least one type of inappropriate statistical procedure. The highest percentage involved incorrect post hoc t-tests (56.4%), followed by inappropriate parametric statistics (analysis of variance and t-test; 37.6%). Repeated Measures analysis was inappropriately missing in 52.0% of all articles and, among those with behavioral assessments, 58% were analyzed incorrectly. Reanalysis of our published data using the most common inappropriate statistical procedures resulted in a 14.1% average increase in significant effects compared to the original results. Specifically, an increase of 15.5% occurred with Independent t-tests and 11.1% after incorrect post hoc t-tests. Utilizing proper statistical procedures can allow more-definitive conclusions, facilitate replicability of research results, and enable more accurate translation of those results to the clinic.

Identification of repeating earthquakes and spatio-temporal variations of fault zone properties around the Parkfield section of the San Andreas fault and the central Calaveras fault

NASA Astrophysics Data System (ADS)

Zhao, P.; Peng, Z.

2008-12-01

We systemically identify repeating earthquakes and investigate spatio-temporal variations of fault zone properties associated with the 2004 Mw6.0 Parkfield earthquake along the Parkfield section of the San Andreas fault, and the 1984 Mw6.2 Morgan Hill earthquake along the central Calaveras fault. The procedure for identifying repeating earthquakes is based on overlapping of the source regions and the waveform similarity, and is briefly described as follows. First, we estimate the source radius of each event based on a circular crack model and a normal stress drop of 3 MPa. Next, we compute inter-hypocentral distance for events listed in the relocated catalog of Thurber et al. (2006) around Parkfield, and Schaff et al. (2002) along the Calaveras fault. Then, we group all events into 'initial' clusters by requiring the separation distance between each event pair to be less than the source radius of larger event, and their magnitude difference to be less than 1. Next, we calculate the correlation coefficients between every event pair within each 'initial' cluster using a 3-s time window around the direct P waves for all available stations. The median value of the correlation coefficients is used as a measure of similarity between each event pair. We drop an event if the median similarity to the rest events in that cluster is less than 0.9. After identifying repeating clusters in both regions, our next step is to apply a sliding window waveform cross-correlation technique (Niu et al., 2003; Peng and Ben-Zion, 2006) to calculate the delay time and decorrelation index for each repeating cluster. By measuring temporal changes in waveforms of repeating clusters at different locations and depth, we hope to obtain a better constraint on spatio-temporal variations of fault zone properties and near-surface layers associated with the occurrence of major earthquakes.

The long-term outcomes of recurrent adhesive small bowel obstruction after colorectal cancer surgery favor surgical management.

PubMed

Yang, Kwan Mo; Yu, Chang Sik; Lee, Jong Lyul; Kim, Chan Wook; Yoon, Yong Sik; Park, In Ja; Lim, Seok-Byung; Kim, Jin Cheon

2017-10-01

An adhesive small bowel obstruction (ASBO) is generally caused by postoperative adhesions and is more frequently associated with colorectal surgeries than other procedures. We compared the outcomes of operative and conservative management of ASBO after primary colorectal cancer surgery.We retrospectively reviewed 5060 patients who underwent curative surgery for primary colorectal cancer; 388 of these patients (7.7%) were readmitted with a diagnosis of SBO. We analyzed the clinical course of these patients with reference to the cause of their surgery.Of the 388 SBO patients analyzed, 170 were diagnosed with ASBO. Their 3-, 5-, and 7-year recurrence-free survival rates were 86.1%, 72.8%, and 61.5%, respectively. The median follow-up period was 59.2 months. Repeated conservative management for ASBO without surgical management led to higher recurrence rates: 21.0% after the first admission, 41.7% after the second, 60.0% after the third, and 100% after the fourth (P = .006). Surgical management was needed for 19.2%, 22.2%, 50%, and 66.7% of patients admitted with ASBO on the first to fourth hospitalizations, respectively. Repeated hospitalization for obstruction led to a greater possibility of surgical management (P = .001). Of 27 patients with surgical management at the first admission, 6 (17.6%) were readmitted with a diagnosis of SBO, but there were no further episodes of SBO in the surgically managed patients.Patients who undergo operative management for ASBO have a reduced risk of recurrence requiring hospitalization, whereas those with repeated conservative management have an increased risk of recurrence and require operative management. Operative management should be considered for recurrent SBO.

Otoplasty by percutaneous anterior scoring. Another twist to the story: a long-term study of 114 patients.

PubMed

Bulstrode, N W; Huang, S; Martin, D L

2003-03-01

A large number of techniques have been described for the correction of prominent ears to improve the cosmetic outcome and reduce the complication rates. The procedure favoured by the senior author brings together a number of refinements, notably, percutaneous anterior scoring using a modified green needle, control over the degree of fold created and a simple but effective dressing. 114 consecutive patients underwent the correction of 214 ears, with a mean follow up of 3 years and 11 months (9 months to 9 years and 6 months). The senior author performed 100 of these procedures and supervised a senior trainee for the remainder. The mean patient age was 18 years 3 months (3 to 66 years). 57 males and 57 females. 56 general anaesthetic and 58 local anaesthetic. Post-operative complications were; haemorrhage, one ear (required a dressing change); infection, four ears (treated with antibiotics); hypertrophic scarring, two ears which settled (no keloid); recurrence one ear (repeated surgery); continued prominence six ears (two had repeated surgery). No prominent sutures, no anterior skin necrosis, no visible irregularity of the anterior surface of the cartilage and no haematoma occurred. We feel that the low complication rate is due to maximising the advantages and minimising the disadvantages of the different techniques and refinements. We recommend this technique for the routine correction of prominent ears due to a poorly formed antihelical fold or deep conchal bowl.

Sequential lineup laps and eyewitness accuracy.

PubMed

Steblay, Nancy K; Dietrich, Hannah L; Ryan, Shannon L; Raczynski, Jeanette L; James, Kali A

2011-08-01

Police practice of double-blind sequential lineups prompts a question about the efficacy of repeated viewings (laps) of the sequential lineup. Two laboratory experiments confirmed the presence of a sequential lap effect: an increase in witness lineup picks from first to second lap, when the culprit was a stranger. The second lap produced more errors than correct identifications. In Experiment 2, lineup diagnosticity was significantly higher for sequential lineup procedures that employed a single versus double laps. Witnesses who elected to view a second lap made significantly more errors than witnesses who chose to stop after one lap or those who were required to view two laps. Witnesses with prior exposure to the culprit did not exhibit a sequential lap effect.

25 CFR 11.1114 - Termination.

Code of Federal Regulations, 2010 CFR

2010-04-01

... functions; (iii) The parent(s) has subjected the minor to willful and repeated acts of sexual abuse; (iv... Minor-in-Need-of-Care Procedure § 11.1114 Termination. (a) Parental rights to a child may be terminated by the children's court according to the procedures in this section. (b) Proceedings to terminate...

16 CFR 1209.8 - Procedure for calibration of radiation instrumentation.

Code of Federal Regulations, 2012 CFR

2012-01-01

... SAFETY ACT REGULATIONS INTERIM SAFETY STANDARD FOR CELLULOSE INSULATION The Standard § 1209.8 Procedure... radiation pyrometer. Repeat for each temperature. (b) Total heat flux meter. The total flux meter shall be... meter. This latter calibration shall make use of the radiant panel tester as the heat source...

16 CFR 1209.8 - Procedure for calibration of radiation instrumentation.

Code of Federal Regulations, 2014 CFR

2014-01-01

... SAFETY ACT REGULATIONS INTERIM SAFETY STANDARD FOR CELLULOSE INSULATION The Standard § 1209.8 Procedure... radiation pyrometer. Repeat for each temperature. (b) Total heat flux meter. The total flux meter shall be... meter. This latter calibration shall make use of the radiant panel tester as the heat source...

16 CFR 1209.8 - Procedure for calibration of radiation instrumentation.

Code of Federal Regulations, 2011 CFR

2011-01-01

... SAFETY ACT REGULATIONS INTERIM SAFETY STANDARD FOR CELLULOSE INSULATION The Standard § 1209.8 Procedure... radiation pyrometer. Repeat for each temperature. (b) Total heat flux meter. The total flux meter shall be... meter. This latter calibration shall make use of the radiant panel tester as the heat source...

16 CFR 1209.8 - Procedure for calibration of radiation instrumentation.

Code of Federal Regulations, 2010 CFR

2010-01-01

... SAFETY ACT REGULATIONS INTERIM SAFETY STANDARD FOR CELLULOSE INSULATION The Standard § 1209.8 Procedure... radiation pyrometer. Repeat for each temperature. (b) Total heat flux meter. The total flux meter shall be... meter. This latter calibration shall make use of the radiant panel tester as the heat source...

The 9-MilCA method as a rapid, partly automated protocol for simultaneously recording milk coagulation, curd firming, syneresis, cheese yield, and curd nutrients recovery or whey loss.

PubMed

Cipolat-Gotet, C; Cecchinato, A; Stocco, G; Bittante, G

2016-02-01

The aim of this study was to propose and test a new laboratory cheesemaking procedure [9-mL milk cheesemaking assessment (9-MilCA)], which records 15 traits related to milk coagulation, curd firming, syneresis, cheese yield, and curd nutrients recovery or whey loss. This procedure involves instruments found in many laboratories (i.e., heaters and lacto-dynamographs), with an easy modification of the sample rack for the insertion of 10-mL glass tubes. Four trials were carried out to test the 9-MilCA procedure. The first trial compared 8 coagulation and curd firming traits obtained using regular or modified sample racks to process milk samples from 60 cows belonging to 5 breeds and 3 farms (480 tests). The obtained patterns exhibited significant but irrelevant between-procedure differences, with better repeatability seen for 9-MilCA. The second trial tested the reproducibility and repeatability of the 7 cheesemaking traits obtained using the 9-MilCA procedure on individual samples from 60 cows tested in duplicate in 2 instruments (232 tests). The method yielded very repeatable outcomes for all 7 tested cheese yield and nutrient recovery traits (repeatability >98%), with the exception of the fresh cheese yield (84%), which was affected by the lower repeatability (67%) of the water retained in the curd. In the third trial (96 tests), we found that using centrifugation in place of curd cooking and draining (as adopted in several published studies) reduced the efficiency of whey separation, overestimated all traits, and worsened the repeatability. The fourth trial compared 9-MilCA with a more complex model cheese-manufacturing process that mimics industry practices, using 1,500-mL milk samples (72 cows, 216 tests). The average results obtained from 9-MilCA were similar to those obtained from the model cheeses, with between-method correlations ranging from 78 to 99%, except for the water retained in the curd (r=54%). Our results indicate that new 9-MilCA method is a powerful research tool that allows the rapid, inexpensive, and partly automated analysis processing 40 samples per day with 2 replicates each, using 1 lacto-dynamograph, 2 heaters, and 3 modified sample racks, and yields a complete picture of the cheesemaking process (e.g., milk gelation, curd firming, syneresis, and whey expulsion) as well as the cheese yield and the efficiency of energy or nutrients retention in the cheese or loss in the whey. Copyright © 2016 American Dairy Science Association. Published by Elsevier Inc. All rights reserved.

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

PubMed

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

2010-01-01

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

A rapid, one step molecular identification of Trichoderma citrinoviride and Trichoderma reesei.

PubMed

Saroj, Dina B; Dengeti, Shrinivas N; Aher, Supriya; Gupta, Anil K

2015-06-01

Trichoderma species are widely used as production hosts for industrial enzymes. Identification of Trichoderma species requires a complex molecular biology based identification involving amplification and sequencing of multiple genes. Industrial laboratories are required to run identification tests repeatedly in cell banking procedures and also to prove absence of production host in the product. Such demands can be fulfilled by a brief method which enables confirmation of strain identity. This communication describes one step identification method for two common Trichoderma species; T. citrinoviride and T. reesei, based on identification of polymorphic region in the nucleotide sequence of translation elongation factor 1 alpha. A unique forward primer and common reverse primer resulted in 153 and 139 bp amplicon for T. citrinoviride and T. reesei, respectively. Simplification was further introduced by using mycelium as template for PCR amplification. Method described in this communication allows rapid, one step identification of two Trichoderma species.

Failure mode analysis in adrenal vein sampling: a single-center experience.

PubMed

Trerotola, Scott O; Asmar, Melissa; Yan, Yan; Fraker, Douglas L; Cohen, Debbie L

2014-10-01

To analyze failure modes in a high-volume adrenal vein sampling (AVS) practice in an effort to identify preventable causes of nondiagnostic sampling. A retrospective database was constructed containing 343 AVS procedures performed over a 10-year period. Each nondiagnostic AVS procedure was reviewed for failure mode and correlated with results of any repeat AVS. Data collected included selectivity index, lateralization index, adrenalectomy outcomes if performed, and details of AVS procedure. All AVS procedures were performed after cosyntropin stimulation, using sequential technique. AVS was nondiagnostic in 12 of 343 (3.5%) primary procedures and 2 secondary procedures. Failure was right-sided in 8 (57%) procedures, left-sided in 4 (29%) procedures, bilateral in 1 procedure, and neither in 1 procedure (laboratory error). Failure modes included diluted sample from correctly identified vein (n = 7 [50%]; 3 right and 4 left), vessel misidentified as adrenal vein (n = 3 [21%]; all right), failure to locate an adrenal vein (n = 2 [14%]; both right), cosyntropin stimulation failure (n = 1 [7%]; diagnostic by nonstimulated criteria), and laboratory error (n = 1 [7%]; specimen loss). A second AVS procedure was diagnostic in three of five cases (60%), and a third AVS procedure was diagnostic in one of one case (100%). Among the eight patients in whom AVS ultimately was not diagnostic, four underwent adrenalectomy based on diluted AVS samples, and one underwent adrenalectomy based on imaging; all five experienced improvement in aldosteronism. A substantial percentage of AVS failures occur on the left, all related to dilution. Even when technically nondiagnostic per strict criteria, some "failed" AVS procedures may be sufficient to guide therapy. Repeat AVS has a good yield. Copyright © 2014 SIR. Published by Elsevier Inc. All rights reserved.

Procedural Learning and Associative Memory Mechanisms Contribute to Contextual Cueing: Evidence from fMRI and Eye-Tracking

ERIC Educational Resources Information Center

Manelis, Anna; Reder, Lynne M.

2012-01-01

Using a combination of eye tracking and fMRI in a contextual cueing task, we explored the mechanisms underlying the facilitation of visual search for repeated spatial configurations. When configurations of distractors were repeated, greater activation in the right hippocampus corresponded to greater reductions in the number of saccades to locate…

The effect of technical replicate (repeats) on Nix Pro Color Sensor™ measurement precision for meat: A case-study on aged beef colour stability.

PubMed

Holman, Benjamin W B; Collins, Damian; Kilgannon, Ashleigh K; Hopkins, David L

2018-01-01

The Nix Pro Colour Sensor™ (NIX) can be potentially used to measure meat colour, but procedural guidelines that assure measurement reproducibility and repeatability (precision) must first be established. Technical replicate number (r) will minimise response variation, measureable as standard error of predicted mean (SEM), and contribute to improved precision. Consequently, we aimed to explore the effects of r on NIX precision when measuring aged beef colour (colorimetrics; L*, a*, b*, hue and chroma values). Each colorimetric SEM declined with increasing r to indicate improved precision and followed a diminishing rate of improvement that allowed us to recommend r=7 for meat colour studies using the NIX. This definition was based on practical limitations and a* variability, as additional r would be required if other colorimetrics or advanced levels of precision are necessary. Beef ageing and display period, holding temperature, loin and sampled portion were also found to contribute to colorimetric variation, but were incorporated within our definition of r. Crown Copyright © 2017. Published by Elsevier Ltd. All rights reserved.

Standardization, evaluation and early-phase method validation of an analytical scheme for batch-consistency N-glycosylation analysis of recombinant produced glycoproteins.

PubMed

Zietze, Stefan; Müller, Rainer H; Brecht, René

2008-03-01

In order to set up a batch-to-batch-consistency analytical scheme for N-glycosylation analysis, several sample preparation steps including enzyme digestions and fluorophore labelling and two HPLC-methods were established. The whole method scheme was standardized, evaluated and validated according to the requirements on analytical testing in early clinical drug development by usage of a recombinant produced reference glycoprotein (RGP). The standardization of the methods was performed by clearly defined standard operation procedures. During evaluation of the methods, the major interest was in the loss determination of oligosaccharides within the analytical scheme. Validation of the methods was performed with respect to specificity, linearity, repeatability, LOD and LOQ. Due to the fact that reference N-glycan standards were not available, a statistical approach was chosen to derive accuracy from the linearity data. After finishing the validation procedure, defined limits for method variability could be calculated and differences observed in consistency analysis could be separated into significant and incidental ones.

Organized Atrial Tachycardias after Atrial Fibrillation Ablation

PubMed Central

Castrejón-Castrejón, Sergio; Ortega, Marta; Pérez-Silva, Armando; Doiny, David; Estrada, Alejandro; Filgueiras, David; López-Sendón, José L.; Merino, José L.

2011-01-01

The efficacy of catheter-based ablation techniques to treat atrial fibrillation is limited not only by recurrences of this arrhythmia but also, and not less importantly, by new-onset organized atrial tachycardias. The incidence of such tachycardias depends on the type and duration of the baseline atrial fibrillation and specially on the ablation technique which was used during the index procedure. It has been repeatedly reported that the more extensive the left atrial surface ablated, the higher the incidence of organized atrial tachycardias. The exact origin of the pathologic substrate of these trachycardias is not fully understood and may result from the interaction between preexistent regions with abnormal electrical properties and the new ones resultant from radiofrequency delivery. From a clinical point of view these atrial tachycardias tend to remit after a variable time but in some cases are responsible for significant symptoms. A precise knowledge of the most frequent types of these arrhythmias, of their mechanisms and components is necessary for a thorough electrophysiologic characterization if a new ablation procedure is required. PMID:21941669

Validation of a reversed phase high performance thin layer chromatographic-densitometric method for secoisolariciresinol diglucoside determination in flaxseed.

PubMed

Coran, Silvia A; Bartolucci, Gianluca; Bambagiotti-Alberti, Massimo

2008-10-17

The validation of a HPTLC-densitometric method for the determination of secoisolariciresinol diglucoside (SDG) in flaxseed was performed improving the reproducibility of a previously reported HPTLC densitometric procedure by the use of fully wettable reversed phase plates (silica gel 60 RP18W F(254S), 10cmx10cm) with MeOH:HCOOH 0.1% (40:60, v/v) mobile phase. The analysis required only the alkaline hydrolysis in aqueous medium of undefatted samples and densitometry at 282nm of HPTLC runs. The method was validated following the protocol proposed by the Société Francaise des Sciences et Techniques Pharmaceutiques (SFSTP) giving rise to a dependable and high throughput procedure well suited to routine application. SDG was quantified in the range of 321-1071ng with RSD of repeatability and intermediate precision not exceeding 3.61% and accuracy inside the acceptance limits. Flaxseed of five cultivars of different origin was elected as test-bed.

FROM2D to 3d Supervised Segmentation and Classification for Cultural Heritage Applications

NASA Astrophysics Data System (ADS)

Grilli, E.; Dininno, D.; Petrucci, G.; Remondino, F.

2018-05-01

The digital management of architectural heritage information is still a complex problem, as a heritage object requires an integrated representation of various types of information in order to develop appropriate restoration or conservation strategies. Currently, there is extensive research focused on automatic procedures of segmentation and classification of 3D point clouds or meshes, which can accelerate the study of a monument and integrate it with heterogeneous information and attributes, useful to characterize and describe the surveyed object. The aim of this study is to propose an optimal, repeatable and reliable procedure to manage various types of 3D surveying data and associate them with heterogeneous information and attributes to characterize and describe the surveyed object. In particular, this paper presents an approach for classifying 3D heritage models, starting from the segmentation of their textures based on supervised machine learning methods. Experimental results run on three different case studies demonstrate that the proposed approach is effective and with many further potentials.

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

Systemic errors in quantitative polymerase chain reaction titration of self-complementary adeno-associated viral vectors and improved alternative methods.

PubMed

Fagone, Paolo; Wright, J Fraser; Nathwani, Amit C; Nienhuis, Arthur W; Davidoff, Andrew M; Gray, John T

2012-02-01

Self-complementary AAV (scAAV) vector genomes contain a covalently closed hairpin derived from a mutated inverted terminal repeat that connects the two monomer single-stranded genomes into a head-to-head or tail-to-tail dimer. We found that during quantitative PCR (qPCR) this structure inhibits the amplification of proximal amplicons and causes the systemic underreporting of copy number by as much as 10-fold. We show that cleavage of scAAV vector genomes with restriction endonuclease to liberate amplicons from the covalently closed terminal hairpin restores quantitative amplification, and we implement this procedure in a simple, modified qPCR titration method for scAAV vectors. In addition, we developed and present an AAV genome titration procedure based on gel electrophoresis that requires minimal sample processing and has low interassay variability, and as such is well suited for the rigorous quality control demands of clinical vector production facilities.

HIRES the high-resolution spectrograph for the E-ELT: dynamics and control of the repositioning mechanism for the E-ELT HIRES polarimeter

NASA Astrophysics Data System (ADS)

Di Varano, I.; Strassmeier, K. G.; Woche, M.

2016-08-01

A full Stokes dual channel polarimeter for the E-ELT HIRES spectrograph has been envisioned for the intermediate focus f/4.4, operating within a spectral range of 0.4-1.6 μ. It will feed the EELT- HIRES instrument located on the Nasmyth platform via two pairs of dedicated fibers: one fibre pair optimized for the BVRI, the other one optimized for the JH band or any other feasible combination. The instrument must be retractable within a workspace in fulfillment with the ESO requirements on the allocated volume and the dynamic response of the AO tower. For such purpose a swinging arm has been designed with a rotation provided by 5 revolute joints and a jackscrew. Moreover repeatability in repositioning has to be guaranteed by a parallel manipulator, performing an alignment procedure mainly along 5 axes. Dynamics and control criteria with a feed forward chain to compensate for vibration forces and feedback chain for tracking procedure are hereafter presented.

Endovascular Treatment of Epistaxis: Indications, Management, and Outcome

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

Strach, Katharina; Schroeck, Andreas; Wilhelm, Kai

2011-12-15

Objective: Epistaxis is a common clinical problem, and the majority of bleedings can be managed conservatively. However, due to extensive and sometimes life-threatening bleeding, further treatment, such as superselective embolization, may be required. We report our experience with endovascular treatment of life-threatening epistaxis. Methods: All patients presenting with excessive epistaxis, which received endovascular treatment at a German tertiary care facility between January 2001 and December 2009, were retrospectively identified. Demographic data, etiology, origin and clinical relevance of bleeding, interventional approach, therapy-associated complications, and outcome were assessed. Results: A total of 48 patients required 53 embolizations. Depending on the etiology ofmore » bleeding, patients were assigned to three groups: 1) idiopathic epistaxis (31/48), 2) traumatic or iatrogenic epistaxis (12/48), and 3) hereditary hemorrhagic telangiectasia (HHT) (5/48). Eleven of 48 patients required blood transfusions, and 9 of these 11 patients (82%) were termed clinically unstable. The sphenopalatine artery was embolized unilaterally in 10 of 53 (18.9%) and bilaterally in 41 of 53 (77.4%) procedures. During the same procedure, additional vessels were embolized in three patients (3/53; 5.7%). In 2 of 53(3.8%) cases, the internal carotid artery (ICA) was occluded. Long-term success rates of embolization were 29 of 31 (93.5%) for group 1 and 11 of 12 (91.7%) for group 2 patients. Embolization of patients with HHT offered at least a temporary relief in three of five (60%) cases. Two major complications (necrosis of nasal tip and transient hemiparesis) occurred after embolization. Conclusions: Endovascular treatment proves to be effective for prolonged and life-threatening epistaxis. It is easily repeatable if the first procedure is not successful and offers a good risk-benefit profile.« less

Precision and repeatability of the Optotrak 3020 motion measurement system.

PubMed

States, R A; Pappas, E

2006-01-01

Several motion analysis systems are used by researchers to quantify human motion and to perform accurate surgical procedures. The Optotrak 3020 is one of these systems and despite its widespread use there is not any published information on its precision and repeatability. We used a repeated measures design study to evaluate the precision and repeatability of the Optotrak 3020 by measuring distance and angle in three sessions, four distances and three conditions (motion, static vertical, and static tilted). Precision and repeatability were found to be excellent for both angle and distance although they decreased with increasing distance from the sensors and with tilt from the plane of the sensors. Motion did not have a significant effect on the precision of the measurements. In conclusion, the measurement error of the Optotrak is minimal. Further studies are needed to evaluate its precision and repeatability under human motion conditions.

The challenge of valve-in-valve procedures in degenerated Mitroflow bioprostheses and the advantage of using the JenaValve transcatheter heart valve.

PubMed

Conradi, Lenard; Kloth, Benjamin; Seiffert, Moritz; Schirmer, Johannes; Koschyk, Dietmar; Blankenberg, Stefan; Reichenspurner, Hermann; Diemert, Patrick; Treede, Hendrik

2014-12-01

Recently, the feasibility of valve-in-valve procedures using current first-generation transcatheter heart valves (THV) in cases of structural valve degeneration has been reported as an alternative to conventional open repeat valve replacement. By design, certain biological valve xenografts carry a high risk of coronary ostia occlusion due to lateral displacement of leaflets after valve-in-valve procedures. In the present report we aimed to prove feasibility and safety of transapical valve-in-valve implantation of the JenaValve THV in two cases of degenerated Mitroflow bioprostheses. We herein report two cases of successful transapical valve-in-valve procedures using a JenaValve THV implanted in Sorin Mitroflow bioprostheses for structural valve degeneration. Both patients were alive and in good clinical condition at 30 days from the procedure. However, increased transvalvular gradients were noted in both cases. Transcatheter valve-in-valve implantation of a JenaValve THV is a valid alternative for patients with degenerated Mitroflow bioprostheses of sufficient size and in the presence of short distances to the coronary ostia who are too ill for conventional repeat open heart surgery. Increased pressure gradients have to be expected and weighed against the disadvantages of other treatment options when planning such a procedure.

Modelling catheter-vein biomechanical interactions during an intravenous procedure.

PubMed

Weiss, Dar; Gefen, Amit; Einav, Shmuel

2016-02-01

A reliable intravenous (IV) access into the upper extremity veins requires the insertion of a temporary short peripheral catheter (SPC). This so common procedure is, however, associated with a risk of developing short peripheral catheter thrombophlebitis (SPCT) which causes distress and potentially prolongs patient hospitalization. We have developed and studied a biomechanical SPC-vein computational model during an IV procedure, and explored the biomechanical effects of repeated IV episodes on onset and reoccurrences of SPCT. The model was used to determine the effects of different insertion techniques as well as inter-patient biological variability on the catheter-vein wall contact pressures and wall deformations. We found that the maximal pressure exerted upon the vein wall was inhomogeneously distributed, and that the bending region was exposed to significantly greater pressures and deformations. The maximal exerted contact pressure on the inner vein's wall was 2938 Pa. The maximal extent of the SPC penetration into the vein wall reached 3.6 μm, which corresponds to approximately 100% of the average height of the inner layer, suggesting local squashing of endothelial cells at the contact site. The modelling describes a potential biomechanical damage pathway that can explain the reoccurrence of SPCT.

The Patient Burden of Bladder Outlet Obstruction after Prostate Cancer Treatment.

PubMed

Liberman, Daniel; Jarosek, Stephanie; Virnig, Beth A; Chu, Haitao; Elliott, Sean P

2016-05-01

Bladder outlet obstruction after prostate cancer therapy imposes a significant burden on health and quality of life in men. Our objective was to describe the burden of bladder outlet obstruction after prostate cancer therapy by detailing the type of procedures performed and how often those procedures were repeated in men with recurrent bladder outlet obstruction. Using SEER (Surveillance, Epidemiology and End Results)-Medicare linked data from 1992 to 2007 with followup through 2009 we identified 12,676 men who underwent at least 1 bladder outlet obstruction procedure after prostate cancer therapy, including external beam radiotherapy in 3,994, brachytherapy in 1,485, brachytherapy plus external beam radiotherapy in 1,847, radical prostatectomy in 4,736, radical prostatectomy plus external beam radiotherapy in 369 and cryotherapy in 245. Histogram, incidence rates and Cox proportional hazards models with repeat events analysis were done to describe the burden of repeat bladder outlet obstruction treatments stratified by prostate cancer therapy type. We describe the type of bladder outlet obstruction surgery grouped by level of invasiveness. At a median followup of 8.8 years 44.6% of men underwent 2 or more bladder outlet obstruction procedures. Compared to men who underwent radical prostatectomy those treated with brachytherapy and brachytherapy plus external beam radiotherapy were at increased adjusted risk for repeat bladder outlet obstruction treatment (HR 1.2 and 1.32, respectively, each p <0.05). After stricture incision the men treated with radical prostatectomy or radical prostatectomy plus external beam radiotherapy were most likely to undergo dilation at a rate of 34.7% to 35.0%. Stricture resection/ablation was more common after brachytherapy, external beam radiotherapy or brachytherapy plus external beam radiotherapy at a rate of 28.9% to 41.2%. Almost half of the men with bladder outlet obstruction after prostate cancer therapy undergo more than 1 procedure. Furthermore men with bladder outlet obstruction after radiotherapy undergo more invasive endoscopic therapies and are at higher risk for multiple treatments than men with bladder outlet obstruction after radical prostatectomy. Copyright © 2016 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

TVT-Secur mini-sling for stress urinary incontinence: a review of outcomes at 12 months.

PubMed

Walsh, Colin A

2011-09-01

• Synthetic mid-urethral slings (MUSs) are considered the first choice surgical procedure for stress urinary incontinence. Recent publications have raised concerns about the efficacy of third generation single-incision mini-slings. The present paper is a systematic review of studies reporting 12-month outcomes after the TVT-Secur (TVT-S) procedure. • Pubmed/Medline online databases, abstracts from recent International Continence Society and International Urogynecological Association annual scientific meetings and the Clinicaltrials.gov and Controlled-trials.com online trial registries were searched for English-language articles containing the terms 'TVT-Secur', 'TVT Secur' or 'mini-sling'. The primary outcomes were objective and subjective cure rates at 12 months. Secondary outcomes included peri-operative (vaginal perforation, urinary retention, urinary tract infection [UTI]) and postoperative (mesh exposure, de novo overactive bladder (OAB), dyspareunia and return to theatre) complication rates. • Among 1178 women undergoing the TVT-S procedure, from 10 studies, both objective and subjective cure rate at 12 months was 76%, with objective cure significantly higher in women undergoing the 'U-type' approach. Vaginal perforation was a complication in 1.5% of cases, with a 2.4% incidence of mesh exposure in the first year. The incidence of de novo OAB symptoms was 10%. Rates of urinary retention (2.3%), UTI (4.4%), dyspareunia (1%) and return to theatre for complications (0.8%) were low. In the first year after a TVT-S procedure 5% of women required repeat continence surgery. • Longer-term studies and randomized comparisons with more established MUSs are required before TVT-S should be routinely used in the surgical treatment of stress urinary incontinence. © 2011 THE AUTHOR. BJU INTERNATIONAL © 2011 BJU INTERNATIONAL.

Effect of a quality program with adverse events identification on airway management during overtube-assisted enteroscopy.

PubMed

Lara, Luis F; Ukleja, Andrew; Pimentel, Ronnie; Charles, Roger J

2014-11-01

Adverse events associated with overtube-assisted enteroscopy are similar to those with routine endoscopy. Our endoscopy quality program identified a number of respiratory adverse events resulting in emergency resuscitation efforts. The aim is to report all adverse events identified by quality monitoring and outcomes of adverse events associated with overtube-assisted enteroscopy. A retrospective study used data prospectively obtained from consecutive patients undergoing overtube-assisted enteroscopy between December 2008 and July 2012. Patient characteristics, medical history, procedure indication, and procedure outcomes, including diagnosis, endoscopic therapy, and complications, were obtained. In 432 overtube-assisted enteroscopies, 15 adverse events (most frequently hypoxemia, 9 /15, 60 %) occurred in 14 patients (3.2 % of total cohort; 12 were outpatients) mostly during antegrade enteroscopy. Four patients required endotracheal intubation and 4 /12 outpatients required intensive care. The procedure was aborted in 13 /14 patients, and only 1 of 10 patients scheduled for repeat antegrade enteroscopy returned. There was no mortality. Based on the frequency of adverse events, and in consultation with anesthesia providers, from August 2012 all antegrade overtube-assisted enteroscopies at our institution were done with general anesthesia. From then till September 2013, 145 antegrade and 52 retrograde overtube-assisted enteroscopies have been done, with no adverse events. Monitoring of endoscopy practice identified adverse events associated with overtube-assisted enteroscopy. The peer-review prompted a change in practice: all patients undergoing antegrade overtube-assisted enteroscopy at our institution now have endotracheal intubation which has dramatically decreased the rate of respiratory adverse events. The impact of endoscopic quality measurements on practices, procedures, and outcomes will be of further interest. © Georg Thieme Verlag KG Stuttgart · New York.

Rectal forceps biopsy procedure in cystic fibrosis: technical aspects and patients perspective for clinical trials feasibility

PubMed Central

2013-01-01

Background Measurements of CFTR function in rectal biopsies ex vivo have been used for diagnosis and prognosis of Cystic Fibrosis (CF) disease. Here, we aimed to evaluate this procedure regarding: i) viability of the rectal specimens obtained by biopsy forceps for ex vivo bioelectrical and biochemical laboratory analyses; and ii) overall assessment (comfort, invasiveness, pain, sedation requirement, etc.) of the rectal forceps biopsy procedure from the patients perspective to assess its feasibility as an outcome measure in clinical trials. Methods We compared three bowel preparation solutions (NaCl 0.9%, glycerol 12%, mannitol), and two biopsy forceps (standard and jumbo) in 580 rectal specimens from 132 individuals (CF and non-CF). Assessment of the overall rectal biopsy procedure (obtained by biopsy forceps) by patients was carried out by telephone surveys to 75 individuals who underwent the sigmoidoscopy procedure. Results Integrity and friability of the tissue specimens correlate with their transepithelial resistance (r = −0.438 and −0.305, respectively) and are influenced by the bowel preparation solution and biopsy forceps used, being NaCl and jumbo forceps the most compatible methods with the electrophysiological analysis. The great majority of the individuals (76%) did not report major discomfort due to the short procedure time (max 15 min) and considered it relatively painless (79%). Importantly, most (88%) accept repeating it at least for one more time and 53% for more than 4 times. Conclusions Obtaining rectal biopsies with a flexible endoscope and jumbo forceps after bowel preparation with NaCl solution is a safe procedure that can be adopted for both adults and children of any age, yielding viable specimens for CFTR bioelectrical/biochemical analyses. The procedure is well tolerated by patients, demonstrating its feasibility as an outcome measure in clinical trials. PMID:23688510

Rectal forceps biopsy procedure in cystic fibrosis: technical aspects and patients perspective for clinical trials feasibility.

PubMed

Servidoni, Maria F; Sousa, Marisa; Vinagre, Adriana M; Cardoso, Silvia R; Ribeiro, Maria A; Meirelles, Luciana R; de Carvalho, Rita B; Kunzelmann, Karl; Ribeiro, Antônio F; Ribeiro, José D; Amaral, Margarida D

2013-05-20

Measurements of CFTR function in rectal biopsies ex vivo have been used for diagnosis and prognosis of Cystic Fibrosis (CF) disease. Here, we aimed to evaluate this procedure regarding: i) viability of the rectal specimens obtained by biopsy forceps for ex vivo bioelectrical and biochemical laboratory analyses; and ii) overall assessment (comfort, invasiveness, pain, sedation requirement, etc.) of the rectal forceps biopsy procedure from the patients perspective to assess its feasibility as an outcome measure in clinical trials. We compared three bowel preparation solutions (NaCl 0.9%, glycerol 12%, mannitol), and two biopsy forceps (standard and jumbo) in 580 rectal specimens from 132 individuals (CF and non-CF). Assessment of the overall rectal biopsy procedure (obtained by biopsy forceps) by patients was carried out by telephone surveys to 75 individuals who underwent the sigmoidoscopy procedure. Integrity and friability of the tissue specimens correlate with their transepithelial resistance (r = -0.438 and -0.305, respectively) and are influenced by the bowel preparation solution and biopsy forceps used, being NaCl and jumbo forceps the most compatible methods with the electrophysiological analysis. The great majority of the individuals (76%) did not report major discomfort due to the short procedure time (max 15 min) and considered it relatively painless (79%). Importantly, most (88%) accept repeating it at least for one more time and 53% for more than 4 times. Obtaining rectal biopsies with a flexible endoscope and jumbo forceps after bowel preparation with NaCl solution is a safe procedure that can be adopted for both adults and children of any age, yielding viable specimens for CFTR bioelectrical/biochemical analyses. The procedure is well tolerated by patients, demonstrating its feasibility as an outcome measure in clinical trials.

The efficacy and safety of combined pulsed and conventional radiofrequency treatment of refractory cases of idiopathic trigeminal neuralgia: a retrospective study.

PubMed

Ali Eissa, Ali A; Reyad, Raafat M; Saleh, Emad G; El-Saman, Amr

2015-10-01

We conducted a retrospective study to evaluate the efficacy and duration of pain relief for idiopathic trigeminal neuralgia (TN) patients after continuous radiofrequency (CRF) combined with pulsed radiofrequency (PRF) treatment of the Gasserian ganglion (GG). Twenty-one patients were treated with pulsed RF for 6 min repeated after rotating the needle tip by 180°, at a pulse width of 10 ms and at 45 °C. This was followed by conventional RF at 60 °C for 60 s, repeated after needle rotation by 180°, then finally at 65 °C for 60 s also repeated after needle rotation by 180°. Patients were assessed for pain intensity and consumption of analgesics at baseline and 7 days, 1 month, 6 months, and 12 months after the procedure. The patients' global impression of change (PGIC) scale was also assessed 7 days, 1 month, 6 months, and 12 months after the procedure. The incidence of facial dysthesia was evaluated 7 days after the procedure. Excellent pain relief was achieved for 15 of 21 patients (71.4 %) after 1 week, 1 month, and 6 months. and for 14 of 21 patients (66.7 %) after 12 months. Consumption of analgesics was significantly reduced for more than 6 months, and for fifteen patients the PGIC scale result was very much improved 12 months after the procedure compared with baseline. Eighteen of the 21 patients (85.7 %) experienced facial dysthesia 1 week after the procedure. Excellent pain relief and reduced consumption of analgesics for more than 6 months were observed in patients who received PRF combined with CRF to the GG for treatment of idiopathic TN.

Dopamine D4 receptor (DRD4) gene polymorphism in the first psychotic episode.

PubMed

Rinetti, G; Camarena, B; Cruz, C; Apiquián, R; Fresán, A; Páez, F; Nicolini, H

2001-01-01

Dopamine D4 receptor (DRD4) has shown some interesting properties at genetic and possibly functional levels. It has been suggested that some molecular variants of the DRD4 gene (e.g., four and seven alleles) could be implicated in the pathogenesis of psychotic disorders. Additionally, the VNTR polymorphism could be implicated in part of the response to treatment with neuroleptics. This study tested the possible association between the 48-bp tandem repeats in exon 3 of the DRD4 gene and patients experiencing their first psychotic episode. Patients with a first psychotic episode (FPE, n = 37) were diagnosed and compared with a matched control group (n = 37). The FPE group was subdivided into two categories: those with nonaffective and those with affective psychoses. The variable number of tandem repeats (VNTR) region of the DRD4 gene was amplified by PCR procedures. Chi-square statistics and appropriate corrections and adjustments were used for data analysis. A significantly lower frequency of the four repeat (4-R) carriers in the FPE group was observed. This association was sustained mainly by the affective psychotic group (chi2 = 9.99 df = 2, p = 0.0073). Although these results require testing with stringent methods, it is suggested that the DRD4-4R allele may confer some protection against psychosis, mainly of the affective subtype.

Comparison of three methods to assess individual skeletal maturity.

PubMed

Pasciuti, Enzo; Franchi, Lorenzo; Baccetti, Tiziano; Milani, Silvano; Farronato, Giampietro

2013-09-01

The knowledge of facial growth and development is fundamental to determine the optimal timing for different treatment procedures in the growing patient. To analyze the reproducibility of three methods in assessing individual skeletal maturity, and to evaluate any degree of concordance among them. In all, 100 growing subjects were enrolled to test three methods: the hand-wrist, cervical vertebral maturation (CVM), and medial phalanges of the third finger method (MP3). Four operators determined the skeletal maturity of the subjects to evaluate the reproducibility of each method. After 30 days the operators repeated the analysis to assess the repeatability of each method. Finally, one operator examined all subjects' radiographs to detect any concordance among the three methods. The weighted kappa values for inter-operator variability were 0.94, 0.91, and 0.90, for the WRI, CVM, and MP3 methods, respectively. The weighted kappa values for intra-operator variability were 0.92, 0.91, and 0.92, for the WRI, CVM, and MP3 methods, respectively. The three methods revealed a high degree of repeatability and reproducibility. Complete agreement among the three methods was observed in 70% of the analyzed samples. The CVM method has the advantage of not necessitating an additional radiograph. The MP3 method is a simple and practical alternative as it requires only a standard dental x-ray device.

Brokering as a framework for hydrological model repeatability

NASA Astrophysics Data System (ADS)

Fuka, Daniel; Collick, Amy; MacAlister, Charlotte; Braeckel, Aaron; Wright, Dawn; Jodha Khalsa, Siri; Boldrini, Enrico; Easton, Zachary

2015-04-01

Data brokering aims to provide those in the the sciences with quick and repeatable access to data that represents physical, biological, and chemical characteristics; specifically to accelerate scientific discovery. Environmental models are useful tools to understand the behavior of hydrological systems. Unfortunately, parameterization of these hydrological models requires many different data, from different sources, and from different disciplines (e.g., atmospheric, geoscience, ecology). In basin scale hydrological modeling, the traditional procedure for model initialization starts with obtaining elevation models, land-use characterizations, soils maps, and weather data. It is often the researcher's past experience with these datasets that determines which datasets will be used in a study, and often newer, or more suitable data products will exist. An added complexity is that various science communities have differing data formats, storage protocols, and manipulation methods, which makes use by a non native user exceedingly difficult and time consuming. We demonstrate data brokering as a means to address several of these challenges. We present two test case scenarios in which researchers attempt to reproduce hydrological model results using 1) general internet based data gathering techniques, and 2) a scientific data brokering interface. We show that data brokering can increase the efficiency with which data are obtained, models are initialized, and results are analyzed. As an added benefit, it appears brokering can significantly increase the repeatability of a given study.

Cloning, expression, purification, and characterisation of the HEAT-repeat domain of TOR from the thermophilic eukaryote Chaetomium thermophilum.

PubMed

Robinson, Graham C; Vegunta, Yogesh; Gabus, Caroline; Gaubitz, Christl; Thore, Stéphane

2017-05-01

The Target of Rapamycin Complex is a central controller of cell growth and differentiation in eukaryotes. Its global architecture has been described by cryoelectron microscopy, and regions of its central TOR protein have been described by X-ray crystallography. However, the N-terminal region of this protein, which consists of a series of HEAT repeats, remains uncharacterised at high resolution, most likely due to the absence of a suitable purification procedure. Here, we present a robust method for the preparation of the HEAT-repeat domain, utilizing the thermophilic fungus Chaetomium thermophilum as a source organism. We describe construct design and stable expression in insect cells. An efficient two-step purification procedure is presented, and the purified product is characterised by SEC and MALDI-TOF MS. The methods described pave the way for a complete high-resolution characterisation of this elusive region of the TOR protein. Copyright © 2017 Elsevier Inc. All rights reserved.

The invasive management of angina: issues for consumers and commissioners.

PubMed Central

Gunnell, D; Harvey, I; Smith, L

1995-01-01

OBJECTIVE--To review, from the purchaser's perspective, the current state of knowledge of techniques for investigation and treating coronary artery disease. The study was based on evidence from past and continuing randomised controlled trials (RCTs). CRITERIA FOR INCLUSION OF REPORTS--Articles listed on Medline (1990-3) with the keywords coronary disease, angina, and unstable angina (combined with surgery, economics, therapy, or drug therapy) and percutaneous transluminal coronary angioplasty (PTCA) and coronary artery bypass grafting (CABG) were included. Articles published before 1990 were obtained from two comprehensive literature reviews published by the Rand organisation in 1991 and from the papers obtained using the Medline search. A hand search of relevant journals published between July 1993 and June 1994 was also undertaken. Results from more recently published RCTs are included. RESULTS--CABG provides improved angina relief compared with drug treatment and may prolong life in patients with more severe illness. PTCA is also better than drug treatment, but less so than CABG, and its cost advantages over CABG decrease with time. Repeat intervention for return of symptoms is more frequently required after PTCA, but increasing numbers of patients are also undergoing second and third repeat CABG for graft occlusion in the years after the original operation. Newer PTCA techniques are not, as yet, fully evaluated. One technique, atherectomy, has been shown to be no more effective, and more expensive, than conventional balloon angioplasty. In the short term intracoronary stents reduce the problems associated with vessel occlusion after PTCA and therefore reduce the need for further intervention. PTCA should not be performed without ready access to cardiothoracic support. There is an increasing trend towards the development of coronary catheterisation units at peripheral sites. This may lead to increasing, inappropriate use of this investigation in suboptimal circumstances. CONCLUSIONS--Ischaemic heart disease is an important cause of morbidity and mortality and invasive management techniques are developing rapidly; some service expansion is occurring without trial evidence. More research is required to determine the optimum balance of PTCA, CABG, and angiography and population requirements for these procedures. In the meantime, in the absence of firm long term evidence of the superior cost effectiveness of PTCA compared with CABG, the rapid expansion of this procedure should be limited. Patients should be fully informed of the benefits and disadvantages of CABG and PTCA, where either procedure is indicated, to enable them to make fully informed choices. PMID:7650455

Repeatability precision of the falling number procedure under standard and modified methodologies

USDA-ARS?s Scientific Manuscript database

The falling number (FN) procedure is used worldwide to assess the integrity of the starch stored within wheat seed. As an indirect measurement of the activity level of alpha-amylase, FN relies on a dedicated viscometer that measures the amount of time needed for a metal stirring rod of precise geome...

The Case for Use of Simple Difference Scores to Test the Significance of Differences in Mean Rates of Change in Controlled Repeated Measurements Designs

ERIC Educational Resources Information Center

Overall, John E.; Tonidandel, Scott

2010-01-01

A previous Monte Carlo study examined the relative powers of several simple and more complex procedures for testing the significance of difference in mean rates of change in a controlled, longitudinal, treatment evaluation study. Results revealed that the relative powers depended on the correlation structure of the simulated repeated measurements.…

Bronchoscopic lung biopsy using noninvasive ventilatory support: case series and review of literature of NIV-assisted bronchoscopy.

PubMed

Agarwal, Ritesh; Khan, Ajmal; Aggarwal, Ashutosh N; Gupta, Dheeraj

2012-11-01

Fiberoptic bronchoscopy and lung biopsy are important diagnostic tools in patients with diffuse pulmonary infiltrates. However, these patients often have hypoxemic respiratory failure that makes this procedure hazardous. Noninvasive ventilation (NIV) has been shown to improve oxygenation in hypoxemic patients. To report the efficacy and safety of an innovative technique of NIV-assisted bronchoscopic lung biopsy in a small case-series of hypoxemic subjects with diffuse parenchymal infiltrates; also to systematically review the literature on NIV-assisted bronchoscopy. Subjects with bilateral diffuse parenchymal infiltrates and P(aO(2))/F(IO(2)) < 200 mm Hg underwent bronchoscopic lung biopsy under NIV support. NIV was initiated 10 min before the procedure and continued for 30 min after the procedure. The primary outcomes were performance of successful procedure and episodes of decline in S(pO(2)) < 90%. Secondary end points were the change in the respiratory and hemodynamic parameters during the procedure and occurrence of complications such as pneumothorax, hemorrhage, and endotracheal intubation. Six subjects, with a mean ± SD age of 44.5 ± 11.6 years, were included in the study. The median (interquartile range [IQR]) P(aO(2))/F(IO(2)) prior to lung biopsy was 164.5 mm Hg (146.3-176.3 mm Hg), and the median (IQR) inspiratory and expiratory positive airway pressures were 14 cm H(2)O (12-15 cm H(2)O) and 5 cm H(2)O. Fiberoptic bronchoscopy was well tolerated and all subjects maintained S(pO(2)) > 92% during the procedure. One subject required endotracheal intubation due to hemoptysis. A definite diagnosis was obtained in 5 of the 6 subjects. A repeat procedure was performed in one subject, which again yielded no diagnosis. No other periprocedural complications were encountered. NIV-assisted bronchoscopic lung biopsy is a novel method for obtaining diagnosis in hypoxemic patients with diffuse lung infiltrates. However, this approach should be reserved for centers with extensive experience in NIV. More studies are required to define the utility of this approach.

Intraoperative endovascular ultrasonography

NASA Astrophysics Data System (ADS)

Eton, Darwin; Ahn, Samuel S.; Baker, J. D.; Pensabene, Joseph; Yeatman, Lawrence S.; Moore, Wesley S.

1991-05-01

The early experience using intra-operative endovascular ultrasonography (EU) is reported in eight patients undergoing lower extremity revasularization. In four patients, intra-operative EU successfully characterized inflow stenoses that were inadequately imaged with pre- operative arteriography. Two patients were found to have hemodynamically significant inflow stenoses, and were treated with intra-operative balloon angioplasty followed by repeat EU. The other two patients were found to have non-hemodynamically significant inflow stenoses requiring no treatment. Additional outflow procedures were required in all four patients. In the remaining four patients, EU was used to evaluate the completeness of TEC rotary atherectomy, of Hall oscillatory endarterectomy, of thrombectomy of the superficial femoral and popliteal arteries, and of valve lysis during in situ saphenous vein grafting, respectively. In the latter case, the valve leaflets were not clearly seen. In the other cases, EU assisted the surgeon. Angioscopy and angiography were available for comparison. In one case, angioscopy failed because of inability to clear the field while inspecting retrograde the limb of an aorto-bi-femoral graft. EU however was possible. No complications of EU occurred. EU is a safe procedure indicated when characterization of a lesion is needed prior to an intervention or when evaluation of the intervention's success is desired. We did not find it useful in valve lysis for in-site grafting.

Gamma knife radiosurgery for typical trigeminal neuralgia: An institutional review of 108 patients

PubMed Central

Elaimy, Ameer L.; Lamm, Andrew F.; Demakas, John J.; Mackay, Alexander R.; Lamoreaux, Wayne T.; Fairbanks, Robert K.; Pfeffer, Robert D.; Cooke, Barton S.; Peressini, Benjamin J.; Lee, Christopher M.

2013-01-01

Background: In this study, we present the previously unreported pain relief outcomes of 108 patients treated at Gamma Knife of Spokane for typical trigeminal neuralgia (TN) between 2002 and 2011. Methods: Pain relief outcomes were measured using the Barrow Neurological Institute (BNI) pain intensity scale. In addition, the effects gender, age at treatment, pain laterality, previous surgical treatment, repeat Gamma Knife radiosurgery (GKRS), and maximum radiosurgery dose have on patient pain relief outcomes were retrospectively analyzed. Statistical analysis was performed using Andersen 95% confidence intervals, approximate confidence intervals for log hazard ratios, and multivariate Cox proportional hazard models. Results: All 108 patients included in this study were grouped into BNI class IV or V prior to GKRS. The median clinical follow-up time was determined to be 15 months. Following the first GKRS procedure, 71% of patients were grouped into BNI class I-IIIb (I = 31%; II = 3%; IIIa = 19%; IIIb = 18%) and the median duration of pain relief for those patients was determined to be 11.8 months. New facial numbness was reported in 19% of patients and new facial paresthesias were reported in 7% of patients after the first GKRS procedure. A total of 19 repeat procedures were performed on the 108 patients included in this study. Following the second GKRS procedure, 73% of patients were grouped into BNI class I-IIIb (I = 44%; II = 6%; IIIa = 17%, IIIb = 6%) and the median duration of pain relief for those patients was determined to be 4.9 months. For repeat procedures, new facial numbness was reported in 22% of patients and new facial paresthesias were reported in 6% of patients. Conclusions: GKRS is a safe and effective management approach for patients diagnosed with typical TN. However, further studies and supporting research is needed on the effects previous surgical treatment, number of radiosurgery procedures, and maximum radiosurgery dose have on GKRS clinical outcomes. PMID:23956935

Beef donor cows with high number of retrieved COC produce more in vitro embryos compared with cows with low number of COC after repeated ovum pick-up sessions.

PubMed

Monteiro, F M; Batista, E O S; Vieira, L M; Bayeux, B M; Accorsi, M; Campanholi, S P; Dias, E A R; Souza, A H; Baruselli, P S

2017-03-01

The aim of the present study was to evaluate whether repeated ovum pick-up (OPU) procedures may affect the efficiency of OPU programs for in vitro embryo production (IVEP) in Bos indicus (Nelore) donors. In addition, the repeatability (r) efficiency of IVEP was also assessed. Data available were from 432 OPU-IVEP sessions that were performed at random stages of the estrous cycle in 36 cycling, nonlactating Nelore donors. Semen from three Nelore bulls was used for the IVF. Donors were submitted to 12 consecutive OPU procedures, with an interval of approximately 30 days between sessions. Data were analyzed as repeated measures using the GLIMMIX procedure of SAS 9.3. Cows yielding ≥15 COCs were defined as "high" COCs and cows with less than 15 COCs were defined as "low" COCs donors. The number of COCs retrieved decreased over time in donors classified with high COCs and remained fairly steady in cows with low COCs at the beginning of the program (P session*COC retrieved groups  = 0.02). Moreover, the number of COCs retrieved (P < 0.0001), and number of blastocysts produced per OPU (P = 0.001) was greater for the high COCs donors compared with the low COCs category, and these results were consistent across OPU sessions. Interestingly, there was no effect of COCs category on the rate of blastocyst development (P = 0.83). In addition, number of blastocysts produced were not affected by repeated OPU (P = 0.37) and interactions between time and COC category (P = 0.72). Similarly, blastocyst rate was not affected by repeated OPU (P = 0.21) and interactions between time and COC category (P = 0.58). Despite of COC category of the donor cows, repeatability was high for the number of COCs retrieved (r = 0.81), number of blastocysts produced per OPU (r = 0.79), and blastocyst rate (0.69). In conclusion, overall numbers of COCs decreased over time in donors classified as having high COCs. However, cumulative amounts of produced blastocysts were greater in donors with high COCs. More importantly, high repeatability was observed in terms of IVEP efficiency. Therefore, IVEP programs can be significantly improved with more aggressive selection toward donors with greater numbers of COCs. Copyright © 2016 Elsevier Inc. All rights reserved.

Outcomes from the Delphi process of the Thoracic Robotic Curriculum Development Committee.

PubMed

Veronesi, Giulia; Dorn, Patrick; Dunning, Joel; Cardillo, Giuseppe; Schmid, Ralph A; Collins, Justin; Baste, Jean-Marc; Limmer, Stefan; Shahin, Ghada M M; Egberts, Jan-Hendrik; Pardolesi, Alessandro; Meacci, Elisa; Stamenkovic, Sasha; Casali, Gianluca; Rueckert, Jens C; Taurchini, Mauro; Santelmo, Nicola; Melfi, Franca; Toker, Alper

2018-06-01

As the adoption of robotic procedures becomes more widespread, additional risk related to the learning curve can be expected. This article reports the results of a Delphi process to define procedures to optimize robotic training of thoracic surgeons and to promote safe performance of established robotic interventions as, for example, lung cancer and thymoma surgery. In June 2016, a working panel was spontaneously created by members of the European Society of Thoracic Surgeons (ESTS) and European Association for Cardio-Thoracic Surgery (EACTS) with a specialist interest in robotic thoracic surgery and/or surgical training. An e-consensus-finding exercise using the Delphi methodology was applied requiring 80% agreement to reach consensus on each question. Repeated iterations of anonymous voting continued over 3 rounds. Agreement was reached on many points: a standardized robotic training curriculum for robotic thoracic surgery should be divided into clearly defined sections as a staged learning pathway; the basic robotic curriculum should include a baseline evaluation, an e-learning module, a simulation-based training (including virtual reality simulation, Dry lab and Wet lab) and a robotic theatre (bedside) observation. Advanced robotic training should include e-learning on index procedures (right upper lobe) with video demonstration, access to video library of robotic procedures, simulation training, modular console training to index procedure, transition to full-procedure training with a proctor and final evaluation of the submitted video to certified independent examiners. Agreement was reached on a large number of questions to optimize and standardize training and education of thoracic surgeons in robotic activity. The production of the content of the learning material is ongoing.

Hair decontamination procedure prior to multi-class pesticide analysis.

PubMed

Duca, Radu-Corneliu; Hardy, Emilie; Salquèbre, Guillaume; Appenzeller, Brice M R

2014-06-01

Although increasing interest is being observed in hair analysis for the biomonitoring of human exposure to pesticides, some limitations still have to be addressed for optimum use of this matrix in that specific context. One main possible issue concerns the need to differentiate chemicals biologically incorporated into hair from those externally deposited on hair surface from contaminated air or dust. The present study focuses on the development of a washing procedure for the decontamination of hair before analysis of pesticides from different chemical classes. For this purpose, three different procedures of artificial contamination (with silica, cellulose, and aqueous solution) were used to simulate pesticides deposition on hair surface. Several washing solvents (four organic: acetone, dichloromethane, methanol, acetonitrile; and four aqueous: water, phosphate buffer, shampoo, sodium dodecylsulfate) were evaluated for their capacity to remove artificially deposited pesticides from hair surface. The most effective washing solvents were sodium dodecylsulfate and methanol for aqueous and organic solvents, respectively. Moreover, after a first washing with sodium dodecylsulfate or methanol, the majority of externally deposited pesticides was removed and a steady-state was reached since significantly lower amounts were removed by additional second and third washings. Finally, the effectiveness of a decontamination procedure comprising washing with sodium dodecylsulfate and methanol was successively demonstrated. In parallel, it was determined that the final procedure did not affect the chemicals biologically incorporated, as hair strands naturally containing pesticides were used. Such a procedure appears to remove in one-shot the fraction of chemicals located on hair surface and does not require repeated washing steps. Copyright © 2014 John Wiley & Sons, Ltd.

Evaluation of sampling, cookery, and shear force protocols for objective evaluation of lamb longissimus tenderness.

PubMed

Shackelford, S D; Wheeler, T L; Koohmaraie, M

2004-03-01

Experiments were conducted to compare the effects of two cookery methods, two shear force procedures, and sampling location within non-callipyge and callipyge lamb LM on the magnitude, variance, and repeatability of LM shear force data. In Exp. 1, 15 non-callipyge and 15 callipyge carcasses were sampled, and Warner-Bratzler shear force (WBSF) was determined for both sides of each carcass at three locations along the length (anterior to posterior) of the LM, whereas slice shear force (SSF) was determined for both sides of each carcass at only one location. For approximately half the carcasses within each genotype, LM chops were cooked for a constant amount of time using a belt grill, and chops of the remaining carcasses were cooked to a constant endpoint temperature using open-hearth electric broilers. Regardless of cooking method and sampling location, repeatability estimates were at least 0.8 for LM WBSF and SSF. For WBSF, repeatability estimates were slightly higher at the anterior location (0.93 to 0.98) than the posterior location (0.88 to 0.90). The difference in repeatability between locations was probably a function of a greater level of variation in shear force at the anterior location. For callipyge LM, WBSF was higher (P < 0.001) at the anterior location than at the middle or posterior locations. For non-callipyge LM, WBSF was lower (P < 0.001) at the anterior location than at the middle or posterior locations. Consequently, the difference in WBSF between callipyge and non-callipyge LM was largest at the anterior location. Experiment 2 was conducted to obtain an estimate of the repeatability of SSF for lamb LM chops cooked with the belt grill using a larger number of animals (n = 87). In Exp. 2, LM chops were obtained from matching locations of both sides of 44 non-callipyge and 43 callipyge carcasses. Chops were cooked with a belt grill and SSF was measured, and repeatability was estimated to be 0.95. Repeatable estimates of lamb LM tenderness can be achieved either by cooking to a constant endpoint temperature with electric broilers or cooking for a constant amount of time with a belt grill. Likewise, repeatable estimates of lamb LM tenderness can be achieved with WBSF or SSF. However, use of belt grill cookery and the SSF technique could decrease time requirements which would decrease research costs.

Human mismatch repair protein hMutLα is required to repair short slipped-DNAs of trinucleotide repeats.

PubMed

Panigrahi, Gagan B; Slean, Meghan M; Simard, Jodie P; Pearson, Christopher E

2012-12-07

Mismatch repair (MMR) is required for proper maintenance of the genome by protecting against mutations. The mismatch repair system has also been implicated as a driver of certain mutations, including disease-associated trinucleotide repeat instability. We recently revealed a requirement of hMutSβ in the repair of short slip-outs containing a single CTG repeat unit (1). The involvement of other MMR proteins in short trinucleotide repeat slip-out repair is unknown. Here we show that hMutLα is required for the highly efficient in vitro repair of single CTG repeat slip-outs, to the same degree as hMutSβ. HEK293T cell extracts, deficient in hMLH1, are unable to process single-repeat slip-outs, but are functional when complemented with hMutLα. The MMR-deficient hMLH1 mutant, T117M, which has a point mutation proximal to the ATP-binding domain, is defective in slip-out repair, further supporting a requirement for hMLH1 in the processing of short slip-outs and possibly the involvement of hMHL1 ATPase activity. Extracts of hPMS2-deficient HEC-1-A cells, which express hMLH1, hMLH3, and hPMS1, are only functional when complemented with hMutLα, indicating that neither hMutLβ nor hMutLγ is sufficient to repair short slip-outs. The resolution of clustered short slip-outs, which are poorly repaired, was partially dependent upon a functional hMutLα. The joint involvement of hMutSβ and hMutLα suggests that repeat instability may be the result of aberrant outcomes of repair attempts.

Enhanced capture rate for haze defects in production wafer inspection

NASA Astrophysics Data System (ADS)

Auerbach, Ditza; Shulman, Adi; Rozentsvige, Moshe

2010-03-01

Photomask degradation via haze defect formation is an increasing troublesome yield problem in the semiconductor fab. Wafer inspection is often utilized to detect haze defects due to the fact that it can be a bi-product of process control wafer inspection; furthermore, the detection of the haze on the wafer is effectively enhanced due to the multitude of distinct fields being scanned. In this paper, we demonstrate a novel application for enhancing the wafer inspection tool's sensitivity to haze defects even further. In particular, we present results of bright field wafer inspection using the on several photo layers suffering from haze defects. One way in which the enhanced sensitivity can be achieved in inspection tools is by using a double scan of the wafer: one regular scan with the normal recipe and another high sensitivity scan from which only the repeater defects are extracted (the non-repeater defects consist largely of noise which is difficult to filter). Our solution essentially combines the double scan into a single high sensitivity scan whose processing is carried out along two parallel routes (see Fig. 1). Along one route, potential defects follow the standard recipe thresholds to produce a defect map at the nominal sensitivity. Along the alternate route, potential defects are used to extract only field repeater defects which are identified using an optimal repeater algorithm that eliminates "false repeaters". At the end of the scan, the two defect maps are merged into one with optical scan images available for all the merged defects. It is important to note, that there is no throughput hit; in addition, the repeater sensitivity is increased relative to a double scan, due to a novel runtime algorithm implementation whose memory requirements are minimized, thus enabling to search a much larger number of potential defects for repeaters. We evaluated the new application on photo wafers which consisted of both random and haze defects. The evaluation procedure involved scanning with three different recipe types: Standard Inspection: Nominal recipe with a low false alarm rate was used to scan the wafer and repeaters were extracted from the final defect map. Haze Monitoring Application: Recipe sensitivity was enhanced and run on a single field column from which on repeating defects were extracted. Enhanced Repeater Extractor: Defect processing included the two parallel routes: a nominal recipe for the random defects and the new high sensitive repeater extractor algorithm. The results showed that the new application (recipe #3) had the highest capture rate on haze defects and detected new repeater defects not found in the first two recipes. In addition, the recipe was much simpler to setup since repeaters are filtered separately from random defects. We expect that in the future, with the advent of mask-less lithography and EUV lithography, the monitoring of field and die repeating defects on the wafer will become a necessity for process control in the semiconductor fab.

A Retrospective Analysis of Apheresis Donor Deferral and Adverse Reactions at a Tertiary Care Centre in India.

PubMed

Arora, Disha; Garg, Ketan; Kaushik, Ankit; Sharma, Richa; Rawat, D S; Mandal, A K

2016-11-01

With increasing demand of platelet component each day, blood bank plays a pivotal role in ensuring supply of safe blood as and when required. Plateletpheresis procedure is a relatively simple, safe and important adjunct to blood bank inventory. However, recruitment of healthy blood donors is a challenge that the health industry is facing today. To determine the reasons and rates of apheresis donor deferral along with investigation of adverse reactions encountered during the procedure. Records of single donor apheresis were retrospectively analysed from 1 st January 2010 to 31 st December 2014. The study was carried out at Blood Bank, Safdarjung Hospital, New Delhi, India. The donor details that were studied included - age, sex, type of donation (voluntary/replacement/ repeat), reason for donor deferral and type of adverse reaction, if encountered during the procedure. Among the 478 donors screened for plateletpheresis procedure during a study period of 5 years, 134 (28.03%) were deferred. Temporary deferrals accounted for majority (93.28%) of the deferrals. Low platelet count (50.75%) was the main reason of donor deferral followed by low haemoglobin (20.89%). Amongst the 344 selected donors, 15 (4.36%) had some type of adverse reaction associated with the procedure. We suggest that the selection criteria for plateletpheresis donors should be revised to deal with shortage of apheresis donors. The criteria regarding minimum pre-procedure platelet count (above1.5 lac/μl) and haemoglobin (above 12.5 g/dl) need to be lowered so as to suit the Indian scenario. The lower adverse reaction rates, 14/344 (4.06%) associated with this procedure encourages safety of donors and is important in recruitment of new donors.

The Testing Effect for Learning Principles and Procedures from Texts

ERIC Educational Resources Information Center

Dirkx, Kim J. H.; Kester, Liesbeth; Kirschner, Paul A.

2014-01-01

The authors explored whether a testing effect occurs not only for retention of facts but also for application of principles and procedures. For that purpose, 38 high school students either repeatedly studied a text on probability calculations or studied the text, took a test on the content, restudied the text, and finally took the test a second…

Opportunistic screening of hospital staff using primary colonoscopy: participation, discomfort and willingness to repeat the procedure.

PubMed

Khalid-de Bakker, C A; Jonkers, D M; Hameeteman, W; de Ridder, R J; Masclee, A A; Stockbrügger, R W

2011-01-01

Participation in and tolerability of primary colonoscopy screening are presumed to be relatively low. The present study aimed to test its feasibility in a well-informed population of hospital staff using an intensive information campaign, and to identify factors associated with screening colonoscopy rated as uncomfortable. Data were collected using standardized forms. Out of 1,090 invited employees (50-65 years), 447 (41.0%) participated. Bowel preparation and colonoscopy were rated as 'somewhat to very uncomfortable' by 79.5 and 21.9%, respectively. 96.3% of participants were willing to repeat colonoscopy in the future. Participants rating colonoscopy as uncomfortable were more likely unwilling to repeat the procedure (OR 8.026, CI 2.667-24.154). Multivariate analysis (age- and gender-adjusted) showed an association of colonoscopy rated as uncomfortable with: abdominal pain during colonoscopy (OR 3.185, CI 1.642-6.178), other pain (OR 2.428, CI 1.335-4.416), flatulence (OR 2.175, CI 1.219-3.881), embarrassment (OR 2.843, CI 1.350-5.989), abdominal pain after colonoscopy (OR 1.976, CI 1.041-3.751), and a prolonged procedure time (OR 1.000, CI 1.000-1.001). Acceptance of primary colonoscopy screening for colorectal neoplasia was high, although participants with symptoms during and after colonoscopy were more likely to rate colonoscopy as uncomfortable. This type of opportunistic screening procedure is suitable for the introduction of screening programs and may be useful in areas that have no access to population-based screening. Copyright © 2011 S. Karger AG, Basel.

How to perform posterior wall isolation in catheter ablation for atrial fibrillation.

PubMed

Sugumar, Hariharan; Thomas, Stuart P; Prabhu, Sandeep; Voskoboinik, Aleksandr; Kistler, Peter M

2018-02-01

Catheter ablation has become standard of care in patients with symptomatic atrial fibrillation (AF). Although there have been significant advances in our understanding and technology, a substantial proportion of patients have ongoing AF requiring repeat procedures. Pulmonary vein isolation (PVI) is the cornerstone of AF ablation; however, it is less effective in patients with persistent as opposed to paroxysmal atrial fibrillation. Left atrial posterior wall isolation (PWI) is commonly performed as an adjunct to PVI in patients with persistent AF with nonrandomized studies showing improved outcomes. Anatomical considerations and detailed outline of the various approaches and techniques to performing PWI are detailed, and advantages and pitfalls to assist the clinical electrophysiologist successfully and safely complete PWI are described. © 2017 Wiley Periodicals, Inc.

Reverse Transcription Quantitative Polymerase Chain Reaction for Detection of and Differentiation Between RNA and DNA of HIV-1-Based Lentiviral Vectors.

PubMed

Pavlovic, Melanie; Koehler, Nina; Anton, Martina; Dinkelmeier, Anna; Haase, Maren; Stellberger, Thorsten; Busch, Ulrich; Baiker, Armin E

2017-08-01

The purpose of the described method is the detection of and differentiation between RNA and DNA of human immunodeficiency virus (HIV)-derived lentiviral vectors (LV) in cell culture supernatants and swab samples. For the analytical surveillance of genetic engineering, operations methods for the detection of the HIV-1-based LV generations are required. Furthermore, for research issues, it is important to prove the absence of LV particles for downgrading experimental settings in terms of the biosafety level. Here, a quantitative polymerase chain reaction method targeting the long terminal repeat U5 subunit and the start sequence of the packaging signal ψ is described. Numerous controls are included in order to monitor the technical procedure.

[The significance of dermatologic management in computer-assisted occupational dermatology consultation].

PubMed

Rakoski, J; Borelli, S

1989-01-15

At our occupational outpatient clinic, 230 patients were treated for about 15 months. With the help of a standardized questionary, we registered all the data regarding the relevant substances the patients contacted during their work as well as their various jobs since they left school. The patients were repeatedly seen and trained in procedures of skin care and skin protection. If required, we took steps to find new jobs for them within their employing company; this was done in cooperation with the trade cooperative association according to the dermatological insurance consultanship. If these proceedings did not work out, the patient had to change his profession altogether. All data were computerized. As an example for this computer-based documentation we present the data of barbers.

Preparation of submicrometer monodispersed magnetic silica particles using a novel water in oil microemulsion: properties and application for enzyme immobilization.

PubMed

Tuttolomondo, Maria Victoria; Villanueva, Maria Emilia; Alvarez, Gisela Solange; Desimone, Martín Federico; Díaz, Luis Eduardo

2013-10-01

The synthesis of monodispersed magnetic silica nanoparticles (MSN) is described using a water-in-oil reverse microemulsion system that does not require the use of co-surfactants. Sodium silicate, Tween 20 as a neutral surfactant and 1-butanol as the organic phase were used. There are several advantages of the proposed method including a saturation magnetization value of 10 emu/g for the particles obtained, uniformity of size and that they are easily functionalized to bind urease covalently. Moreover, the intra-day, inter-day and long-term stability results confirm that the procedure was successful and the enzyme-linked MSNs were stable over repeated uses and storage retaining more than 75% activity after 4 months.

Development of Standardized Material Testing Protocols for Prosthetic Liners

PubMed Central

Cagle, John C.; Reinhall, Per G.; Hafner, Brian J.; Sanders, Joan E.

2017-01-01

A set of protocols was created to characterize prosthetic liners across six clinically relevant material properties. Properties included compressive elasticity, shear elasticity, tensile elasticity, volumetric elasticity, coefficient of friction (CoF), and thermal conductivity. Eighteen prosthetic liners representing the diverse range of commercial products were evaluated to create test procedures that maximized repeatability, minimized error, and provided clinically meaningful results. Shear and tensile elasticity test designs were augmented with finite element analysis (FEA) to optimize specimen geometries. Results showed that because of the wide range of available liner products, the compressive elasticity and tensile elasticity tests required two test maxima; samples were tested until they met either a strain-based or a stress-based maximum, whichever was reached first. The shear and tensile elasticity tests required that no cyclic conditioning be conducted because of limited endurance of the mounting adhesive with some liner materials. The coefficient of friction test was based on dynamic coefficient of friction, as it proved to be a more reliable measurement than static coefficient of friction. The volumetric elasticity test required that air be released beneath samples in the test chamber before testing. The thermal conductivity test best reflected the clinical environment when thermal grease was omitted and when liner samples were placed under pressure consistent with load bearing conditions. The developed procedures provide a standardized approach for evaluating liner products in the prosthetics industry. Test results can be used to improve clinical selection of liners for individual patients and guide development of new liner products. PMID:28233885

[Strictureplasty in the surgical treatment of complicated Crohn's disease].

PubMed

Sampietro, G M; Sartani, A; Danelli, P; Ghizzoni, M; Sposito, C; Maconi, G; Parente, E; Taschieri, A M

2003-01-01

Crohns disease is a panintestinal chronic inflammatory condition. Its remitting-relapsing behaviour may require in the single patient repeated surgeries, with the aim of resolving the complications of the disease. The awereness that surgery cannot resolve the disease has led, in the last years, to the development of new "conservative surgical techniques", which preserve as much of the intestinal tissue as possible. These techniques are minimal resection and strictureplasty (SP). Aim of the study was to perform a prospective analysis of the long-term outcome of SP in a consecutive series of patients undergoing surgery for complicated Crohns Disease at the Division of general surgery, L. Sacco University Hospital, Milano, Italia. During the period of October 1992 to June 2002, 286 patients underwent surgical procedures for jejunoileal Crohns disease. 116 of them underwent SP resulting in a total of 217 procedures, of which: 111 Heineke-Mikulicz SP (51.2%), 36 ileoileal side-to-side SP (16.6%), 40 ileoceacal SP (18.4%) and the remaining 30 ileocolic SP (13.8%), as previously described by A.M. Taschieri. Fiftyone of the patients (23.5%) had concomitantly a minimal bowel resection. Postoperative mortality was nil, while in 3 cases (2.59%) repeated surgery was necessary due to postsurgical complications. Time-to-event estimates were performed using the Kaplan-Meier function. mortality, morbidity, and long-term results in this population of patients who underwent SP are encouraging and in line with reports in the international literature. It is suggested that SP together with minimal bowel resections, may be considered as first line surgical therapy in patients with Crohns Disease.

[The accuracy of palpation from orientation points for the navigated implantation of knee prostheses].

PubMed

Fuiko, R; Kotten, B; Zettl, R; Ritschl, P

2004-03-01

Cinematic and pointing procedures are used for non-image based navigated implantation during total knee replacement. Pointing procedures require an exact knowledge of the landmarks. In this anatomical study, landmarks are defined and repeatedly referenced. Precision and reproducibility are evaluated by means of an inter- and an intra-observer study. The axes of the femur and tibia are calculated using the landmarks. The specific landmarks of 30 femurs and 27 tibias were palpated by three surgeons and digitised by means of a photogrammetric system, as used intra-operatively. The recorded data were statistically evaluated. The specific landmarks can be referenced with great precision. The vectors that influence the implant position show a mean femoral deviation of 0.9 mm and a mean tibial deviation of 1.0 mm. The repeating accuracy of every observer was 1.5 mm femoral and 1.0 mm tibial. The calculated long axes at the femur and tibia thus reach a precision of 0.1 degrees (min.-max.: 0-0.9 degrees) at the femur and 0.2 degrees (.0-1.1 degrees) at the tibia. The short axes at the distal femur and proximal tibia exhibit an average deviation of from 0.7 degrees to 1.9 degrees (0-11.3 degrees). Long axes (mechanical axes) can be determined exactly but the precision of the short axes (rotational axes) is unsatisfactory, although palpation of landmarks was accurate. Therefore, palpation of more than one rotational axis at the femur and tibia is mandatory and should be visualized on the monitor during surgery.

Primary Realignment for Pelvic Fracture Urethral Injury Is Associated With Prolonged Time to Urethroplasty and Increased Stenosis Complexity.

PubMed

Horiguchi, Akio; Shinchi, Masayuki; Masunaga, Ayako; Okubo, Kazuki; Kawamura, Kazuki; Ojima, Kenichiro; Ito, Keiichi; Asano, Tomohiko; Azuma, Ryuichi

2017-10-01

To compare the clinical courses of patients with pelvic fracture urethral injury (PFUI) according to initial management strategy. We reviewed the clinical courses of 63 patients with PFUI who were initially treated elsewhere and underwent delayed anastomotic urethroplasty by a single surgeon between 2008 and 2015. Patients were grouped according to their initial treatment: by suprapubic tube placement alone (49 patients, SPT group) or primary realignment (14 patients, PR group). Time to urethroplasty was defined as the period between injury and delayed urethroplasty. Clinical data regarding the status of urethral stenosis, urethroplasty procedure, and treatment outcome were analyzed. The mean time to urethroplasty in the PR group was about 3 times than that in the SPT group (133 months vs 47 months, P = .035). Fifty percent of the PR group (7 of 14) had a history of repeated urethrotomy or dilation before referral, a percentage significantly higher than that of the SPT group (20.4%, 10 of 49, P = .027). The percentage of patients having a false passage and iatrogenic scar was significantly higher in the PR group (42.9% vs 16.3%, P = .035), but there was no significant between-group difference in urethral stenosis length, operative time, operative blood loss, or the percentage of patients requiring inferior pubectomy or urethral rerouting. PR does not facilitate delayed urethroplasty, and patients who undergo PR are at high risk of having a more complicated stenosis and longer time to urethroplasty, presumably because of repeated transurethral procedures. Copyright © 2017 Elsevier Inc. All rights reserved.

Sensitivity of a juvenile subject-specific musculoskeletal model of the ankle joint to the variability of operator-dependent input

PubMed Central

Hannah, Iain; Montefiori, Erica; Modenese, Luca; Prinold, Joe; Viceconti, Marco; Mazzà, Claudia

2017-01-01

Subject-specific musculoskeletal modelling is especially useful in the study of juvenile and pathological subjects. However, such methodologies typically require a human operator to identify key landmarks from medical imaging data and are thus affected by unavoidable variability in the parameters defined and subsequent model predictions. The aim of this study was to thus quantify the inter- and intra-operator repeatability of a subject-specific modelling methodology developed for the analysis of subjects with juvenile idiopathic arthritis. Three operators each created subject-specific musculoskeletal foot and ankle models via palpation of bony landmarks, adjustment of geometrical muscle points and definition of joint coordinate systems. These models were then fused to a generic Arnold lower limb model for each of three modelled patients. The repeatability of each modelling operation was found to be comparable to those previously reported for the modelling of healthy, adult subjects. However, the inter-operator repeatability of muscle point definition was significantly greater than intra-operator repeatability (p < 0.05) and predicted ankle joint contact forces ranged by up to 24% and 10% of the peak force for the inter- and intra-operator analyses, respectively. Similarly, the maximum inter- and intra-operator variations in muscle force output were 64% and 23% of peak force, respectively. Our results suggest that subject-specific modelling is operator dependent at the foot and ankle, with the definition of muscle geometry the most significant source of output uncertainty. The development of automated procedures to prevent the misplacement of crucial muscle points should therefore be considered a particular priority for those developing subject-specific models. PMID:28427313

Enhanced anatomical calibration in human movement analysis.

PubMed

Donati, Marco; Camomilla, Valentina; Vannozzi, Giuseppe; Cappozzo, Aurelio

2007-07-01

The representation of human movement requires knowledge of both movement and morphology of bony segments. The determination of subject-specific morphology data and their registration with movement data is accomplished through an anatomical calibration procedure (calibrated anatomical systems technique: CAST). This paper describes a novel approach to this calibration (UP-CAST) which, as compared with normally used techniques, achieves better repeatability, a shorter application time, and can be effectively performed by non-skilled examiners. Instead of the manual location of prominent bony anatomical landmarks, the description of which is affected by subjective interpretation, a large number of unlabelled points is acquired over prominent parts of the subject's bone, using a wand fitted with markers. A digital model of a template-bone is then submitted to isomorphic deformation and re-orientation to optimally match the above-mentioned points. The locations of anatomical landmarks are automatically made available. The UP-CAST was validated considering the femur as a paradigmatic case. Intra- and inter-examiner repeatability of the identification of anatomical landmarks was assessed both in vivo, using average weight subjects, and on bare bones. Accuracy of the identification was assessed using the anatomical landmark locations manually located on bare bones as reference. The repeatability of this method was markedly higher than that reported in the literature and obtained using the conventional palpation (ranges: 0.9-7.6 mm and 13.4-17.9, respectively). Accuracy resulted, on average, in a maximal error of 11 mm. Results suggest that the principal source of variability resides in the discrepancy between subject's and template bone morphology and not in the inter-examiner differences. The UP-CAST anatomical calibration could be considered a promising alternative to conventional calibration contributing to a more repeatable 3D human movement analysis.

Sensitivity of a juvenile subject-specific musculoskeletal model of the ankle joint to the variability of operator-dependent input.

PubMed

Hannah, Iain; Montefiori, Erica; Modenese, Luca; Prinold, Joe; Viceconti, Marco; Mazzà, Claudia

2017-05-01

Subject-specific musculoskeletal modelling is especially useful in the study of juvenile and pathological subjects. However, such methodologies typically require a human operator to identify key landmarks from medical imaging data and are thus affected by unavoidable variability in the parameters defined and subsequent model predictions. The aim of this study was to thus quantify the inter- and intra-operator repeatability of a subject-specific modelling methodology developed for the analysis of subjects with juvenile idiopathic arthritis. Three operators each created subject-specific musculoskeletal foot and ankle models via palpation of bony landmarks, adjustment of geometrical muscle points and definition of joint coordinate systems. These models were then fused to a generic Arnold lower limb model for each of three modelled patients. The repeatability of each modelling operation was found to be comparable to those previously reported for the modelling of healthy, adult subjects. However, the inter-operator repeatability of muscle point definition was significantly greater than intra-operator repeatability ( p < 0.05) and predicted ankle joint contact forces ranged by up to 24% and 10% of the peak force for the inter- and intra-operator analyses, respectively. Similarly, the maximum inter- and intra-operator variations in muscle force output were 64% and 23% of peak force, respectively. Our results suggest that subject-specific modelling is operator dependent at the foot and ankle, with the definition of muscle geometry the most significant source of output uncertainty. The development of automated procedures to prevent the misplacement of crucial muscle points should therefore be considered a particular priority for those developing subject-specific models.

Neurocognitive Effects of Transcranial Direct Current Stimulation in Arithmetic Learning and Performance: A Simultaneous tDCS-fMRI Study.

PubMed

Hauser, Tobias U; Rütsche, Bruno; Wurmitzer, Karoline; Brem, Silvia; Ruff, Christian C; Grabner, Roland H

A small but increasing number of studies suggest that non-invasive brain stimulation by means of transcranial direct current stimulation (tDCS) can modulate arithmetic processes that are essential for higher-order mathematical skills and that are impaired in dyscalculic individuals. However, little is known about the neural mechanisms underlying such stimulation effects, and whether they are specific to cognitive processes involved in different arithmetic tasks. We addressed these questions by applying tDCS during simultaneous functional magnetic resonance imaging (fMRI) while participants were solving two types of complex subtraction problems: repeated problems, relying on arithmetic fact learning and problem-solving by fact retrieval, and novel problems, requiring calculation procedures. Twenty participants receiving left parietal anodal plus right frontal cathodal stimulation were compared with 20 participants in a sham condition. We found a strong cognitive and neural dissociation between repeated and novel problems. Repeated problems were solved more accurately and elicited increased activity in the bilateral angular gyri and medial plus lateral prefrontal cortices. Solving novel problems, in contrast, was accompanied by stronger activation in the bilateral intraparietal sulci and the dorsomedial prefrontal cortex. Most importantly, tDCS decreased the activation of the right inferior frontal cortex while solving novel (compared to repeated) problems, suggesting that the cathodal stimulation rendered this region unable to respond to the task-specific cognitive demand. The present study revealed that tDCS during arithmetic problem-solving can modulate the neural activity in proximity to the electrodes specifically when the current demands lead to an engagement of this area. Copyright © 2016 Elsevier Inc. All rights reserved.

Reconfigurable multiport EPON repeater

NASA Astrophysics Data System (ADS)

Oishi, Masayuki; Inohara, Ryo; Agata, Akira; Horiuchi, Yukio

2009-11-01

An extended reach EPON repeater is one of the solutions to effectively expand FTTH service areas. In this paper, we propose a reconfigurable multi-port EPON repeater for effective accommodation of multiple ODNs with a single OLT line card. The proposed repeater, which has multi-ports in both OLT and ODN sides, consists of TRs, BTRs with the CDR function and a reconfigurable electrical matrix switch, can accommodate multiple ODNs to a single OLT line card by controlling the connection of the matrix switch. Although conventional EPON repeaters require full OLT line cards to accommodate subscribers from the initial installation stage, the proposed repeater can dramatically reduce the number of required line cards especially when the number of subscribers is less than a half of the maximum registerable users per OLT. Numerical calculation results show that the extended reach EPON system with the proposed EPON repeater can save 17.5% of the initial installation cost compared with a conventional repeater, and can be less expensive than conventional systems up to the maximum subscribers especially when the percentage of ODNs in lightly-populated areas is higher.

Improving the AOAC use-dilution method by establishing a minimum log density value for test microbes on inoculated carriers.

PubMed

Tomasino, Stephen F; Pines, Rebecca M; Hamilton, Martin A

2009-01-01

The AOAC Use-Dilution methods, 955.14 (Salmonella enterica), 955.15 (Staphylococcus aureus), and 964.02 (Pseudomonas aeruginosa), are used to measure the efficacy of disinfectants on hard inanimate surfaces. The methods do not provide procedures to assess log density of the test microbe on inoculated penicylinders (carrier counts). Without a method to measure and monitor carrier counts, the associated efficacy data may not be reliable and repeatable. This report provides a standardized procedure to address this method deficiency. Based on carrier count data collected by four laboratories over an 8 year period, a minimum log density value is proposed to qualify the test results. Carrier count data were collected concurrently with 242 Use-Dilution tests. The tests were conducted on products bearing claims against P. aeruginosa and S. aureus with and without an organic soil load (OSL) added to the inoculum (as specified on the product label claim). Six carriers were assayed per test for a total of 1452 carriers. All 242 mean log densities were at least 6.0 (geometric mean of 1.0 x 10(6) CFU/carrier). The mean log densities did not exceed 7.5 (geometric mean of 3.2 x 10(7) CFU/carrier). For all microbes and OSL treatments, the mean log density (+/- SEM) was 6.7 (+/- 0.07) per carrier (a geometric mean of 5.39 x 10(6) CFU/carrier). The mean log density for six carriers per test showed good repeatability (0.29) and reproducibility (0.32). A minimum mean log density of 6.0 is proposed as a validity requirement for S. aureus and P. aeruginosa. The minimum level provides for the potential inherent variability that may be experienced by a wide range of laboratories and the slight effect due to the addition of an OSL. A follow-up report is planned to present data to support the carrier count procedure and carrier counts for S. enterica.

[Exercise stress test and dobutamine stress echocardiography for the prognostic stratification after uncomplicated acute myocardial infarction].

PubMed

Vitiello, Nicola; Cirillo, Raffaele; Granato, Luigi; Coppola, Vincenzo; di Palma, Francesco

2007-05-01

Exercise stress test and dobutamine stress echocardiography are usually performed early after an uncomplicated acute myocardial infarction in the prognostic stratification of patients to define the optimal diagnostic and therapeutic procedure. The aim of this study was to evaluate if the association of an imaging test could increase exercise test capability to identify patients with residual ischemia and patients at high risk of events in the follow-up. Four hundred and forty-two consecutive patients underwent exercise stress testing and dobutamine stress echocardiography before discharge and subsequently coronary angiography within 30 days. In case of submaximal negative result at the exercise test, this was repeated 20 days after discharge. The follow-up lasted 26.8 +/- 9 months. The endpoints were death, reinfarction, and unstable angina requiring hospitalization or revascularization intervention. Both tests and their association showed a higher sensitivity in males; in females dobutamine stress echocardiography had a higher specificity. In females, the addition of dobutamine stress echocardiography increased either the negative or the positive prognostic values of exercise stress test by 31% and 5.6%, respectively. In males, the negative prognostic value increased by 15.5%, whereas the positive prognostic value decreased by 12%. A low exercise capability (<6 METs) showed an event predictive value independent of test results and any other variables. The event-free survival curves correlated with exercise capability differed shortly after the first months both in males and females. These results suggest different stratification procedures with regard to gender: in males, the exercise stress test might be sufficient at discharge, to be repeated 20 days later, if submaximal negative. In females, it seems to be useful to associate an imaging test at discharge. In any case, the exercise stress test remains the main step in the stratification procedure also for its capability to identify patients who are at high risk of events in the follow-up.

Mission design for NISAR repeat-pass Interferometric SAR

NASA Astrophysics Data System (ADS)

Alvarez-Salazar, Oscar; Hatch, Sara; Rocca, Jennifer; Rosen, Paul; Shaffer, Scott; Shen, Yuhsyen; Sweetser, Theodore; Xaypraseuth, Peter

2014-10-01

The proposed spaceborne NASA-ISRO SAR (NISAR) mission would use the repeat-pass interferometric Synthetic Aperture Radar (InSAR) technique to measure the changing shape of Earth's surface at the centimeter scale in support of investigations in solid Earth and cryospheric sciences. Repeat-pass InSAR relies on multiple SAR observations acquired from nearly identical positions of the spacecraft as seen from the ground. Consequently, there are tight constraints on the repeatability of the orbit, and given the narrow field of view of the radar antenna beam, on the repeatability of the beam pointing. The quality and accuracy of the InSAR data depend on highly precise control of both orbital position and observatory pointing throughout the science observation life of the mission. This paper describes preliminary NISAR requirements and rationale for orbit repeatability and attitude control in order to meet science requirements. A preliminary error budget allocation and an implementation approach to meet these allocations are also discussed.

Long-term clinical outcomes with the retropubic tension-free vaginal tape (TVT) procedure compared to Burch colposuspension for correcting stress urinary incontinence (SUI).

PubMed

Holdø, Bjørn; Verelst, Margareta; Svenningsen, Rune; Milsom, Ian; Skjeldestad, Finn Egil

2017-11-01

The retropubic tension-free vaginal tape (TVT) procedure replaced Burch colposuspension as the primary surgical method for stress urinary incontinence (SUI) and mixed urinary incontinence (MUI) in women in our department in 1998. In this study we compared the short-term and long-term clinical outcomes of these surgical procedures. Using a case series design, we compared the last 5 years of the Burch procedure (n = 127, 1994-1999) with the first 5 years of the retropubic TVT procedure (n = 180, 1998-2002). Information from the medical records was transferred to a case report form comprising data on perioperative and long-term complications as well as recurrence of UI, defined as bothersome UI or UI in need of repeat surgery. Other endpoints were rates of perioperative and late complications and the rates of prolapse surgery after primary surgery. The data were analyzed with the chi-squared and t tests and survival analysis using SPSS. The cumulative recurrence rate of SUI in women with preoperative SUI was significantly higher after the Burch procedure, but no difference was observed in women with MUI. There were no significant differences in rates of perioperative and late complications. At 12 years there was a significant increase in rates of repeat surgery for incontinence and prolapse in women after the Burch procedure. The long-term efficacy of TVT surgery was superior to that of Burch colposuspension in women with SUI. In addition, the rate of late prolapse surgery was significantly higher after the Burch procedure.

Colorimetry and SERS dual-mode detection of telomerase activity: combining rapid screening with high sensitivity

NASA Astrophysics Data System (ADS)

Zong, Shenfei; Wang, Zhuyuan; Chen, Hui; Hu, Guohua; Liu, Min; Chen, Peng; Cui, Yiping

2014-01-01

As an important biomarker and therapeutic target, telomerase has attracted considerable attention concerning its detection and monitoring. Here, we present a colorimetry and surface enhanced Raman scattering (SERS) dual-mode telomerase activity detection method, which has several distinctive advantages. First, colorimetric functionality allows rapid preliminary discrimination of telomerase activity by the naked eye. Second, the employment of SERS technique results in greatly improved detection sensitivity. Third, the combination of colorimetry and SERS into one detection system can ensure highly efficacious and sensitive screening of numerous samples. Besides, the avoidance of polymerase chain reaction (PCR) procedures further guarantees fine reliability and simplicity. Generally, the presented method is realized by an ``elongate and capture'' procedure. To be specific, gold nanoparticles modified with Raman molecules and telomeric repeat complementary oligonucleotide are employed as the colorimetric-SERS bifunctional reporting nanotag, while magnetic nanoparticles functionalized with telomerase substrate oligonucleotide are used as the capturing substrate. Telomerase can synthesize and elongate telomeric repeats onto the capturing substrate. The elongated telomeric repeats subsequently facilitate capturing of the reporting nanotag via hybridization between telomeric repeat and its complementary strand. The captured nanotags can cause a significant difference in the color and SERS intensity of the magnetically separated sediments. Thus both the color and SERS can be used as indicators of the telomerase activity. With fast screening ability and outstanding sensitivity, we anticipate that this method would greatly promote practical application of telomerase-based early-stage cancer diagnosis.As an important biomarker and therapeutic target, telomerase has attracted considerable attention concerning its detection and monitoring. Here, we present a colorimetry and surface enhanced Raman scattering (SERS) dual-mode telomerase activity detection method, which has several distinctive advantages. First, colorimetric functionality allows rapid preliminary discrimination of telomerase activity by the naked eye. Second, the employment of SERS technique results in greatly improved detection sensitivity. Third, the combination of colorimetry and SERS into one detection system can ensure highly efficacious and sensitive screening of numerous samples. Besides, the avoidance of polymerase chain reaction (PCR) procedures further guarantees fine reliability and simplicity. Generally, the presented method is realized by an ``elongate and capture'' procedure. To be specific, gold nanoparticles modified with Raman molecules and telomeric repeat complementary oligonucleotide are employed as the colorimetric-SERS bifunctional reporting nanotag, while magnetic nanoparticles functionalized with telomerase substrate oligonucleotide are used as the capturing substrate. Telomerase can synthesize and elongate telomeric repeats onto the capturing substrate. The elongated telomeric repeats subsequently facilitate capturing of the reporting nanotag via hybridization between telomeric repeat and its complementary strand. The captured nanotags can cause a significant difference in the color and SERS intensity of the magnetically separated sediments. Thus both the color and SERS can be used as indicators of the telomerase activity. With fast screening ability and outstanding sensitivity, we anticipate that this method would greatly promote practical application of telomerase-based early-stage cancer diagnosis. Electronic supplementary information (ESI) available: TEM images of individual MB@Au NPs, results of dynamic light scattering analysis and extinction spectrum obtained using colorimetry detection. See DOI: 10.1039/c3nr04942f

Ureteral wall thickness at the impacted ureteral stone site: a critical predictor for success rates after SWL.

PubMed

Sarica, Kemal; Kafkasli, Alper; Yazici, Özgür; Çetinel, Ali Cihangir; Demirkol, Mehmet Kutlu; Tuncer, Murat; Şahin, Cahit; Eryildirim, Bilal

2015-02-01

The aim of the study was to determine the possible predictive value of certain patient- and stone-related factors on the stone-free rates and auxiliary procedures after extracorporeal shock wave lithotripsy in patients with impacted proximal ureteral calculi. A total of 111 patients (86 male, 25 females M/F: 3.44/1) with impacted proximal ureteral stones treated with shock wave lithotripsy were evaluated. Cases were retrieved from a departmental shock wave lithotripsy database. Variables analyzed included BMI of the case, diameter of proximal ureter and renal pelvis, stone size and Hounsfield unit, ureteral wall thickness at the impacted stone site. Stone-free status on follow-up imaging at 3 months was considered a successful outcome. All patients had a single impacted proximal ureteral stone. While the mean age of the cases was 46 ± 13 years (range 26-79 years), mean stone size was 8.95 mm (5.3-15.1 mm). Following shock wave lithotripsy although 87 patients (78.4%) were completely stone-free at 3-month follow-up visit, 24 (21.6%) cases had residual fragments requiring further repeat procedures. Prediction of the final outcome of SWL in patients with impacted proximal ureteral stones is a challenging issue and our data did clearly indicate a highly significant relationship between ureteral wall thickness and the success rates of shock wave lithotripsy particularly in cases requiring additional procedures. Of all the evaluated stone- and patient-related factors, only ureteral wall thickness at the impacted stone site independently predicted shock wave lithotripsy success.

Repeated Infections in Children

MedlinePlus

... Kids and Teens Pregnancy and Childbirth Women Men Seniors Your Health Resources Healthcare Management End-of-Life Issues Insurance & Bills Self Care Working With Your Doctor Drugs, Procedures & Devices Over-the- ...

Photo point monitoring handbook—Part A: Field procedures; Part B: Concepts and analysis.

Treesearch

Frederick C. Hall

2002-01-01

This handbook describes quick, effective methods for documenting change in vegetation and soil through repeat photography. It is published in two parts: field procedures in part A and concepts and office analysis in part B. Topics may be effects of logging, change in wildlife habitat, livestock grazing impacts, or stream channel reaction to land management. Land...

Why McNemar's Procedure Needs to Be Included in the Business Statistics Curriculum

ERIC Educational Resources Information Center

Berenson, Mark L.; Koppel, Nicole B.

2005-01-01

In business research situations it is often of interest to examine the differences in the responses in repeated measurements of the same subjects or from among matched or paired subjects. A simple and useful procedure for comparing differences between proportions in two related samples was devised by McNemar (1947) nearly 60 years ago. Although…

Plasma-activated water: a new and effective alternative for duodenoscope reprocessing.

PubMed

Bălan, Gheorghe G; Roşca, Irina; Ursu, Elena-Laura; Doroftei, Florica; Bostănaru, Andra-Cristina; Hnatiuc, Eugen; Năstasă, Valentin; Şandru, Vasile; Ştefănescu, Gabriela; Trifan, Anca; Mareş, Mihai

2018-01-01

Duodenoscopes have been widely used for both diagnostic and therapeutic endoscopic retrograde cholangiopancreatography procedures. Numerous outbreaks of duodenoscope-associated infections involving multidrug-resistant bacteria have recently been reported. Plasma activated water (PAW) has been widely considered an effective agent for surface decontamination and is increasingly used for disinfection of medical equipment. The aim of this study was to evaluate whether the duodenoscopes currently on market are suited for the repeated use of PAW and to test the efficacy of PAW for their disinfection. In order to evaluate the disinfection efficacy and the required time of contact, the duodenoscope samples were contaminated by immersing them in fasted-state simulated intestinal fluid containing Escherichia coli , Klebsiella pneumoniae , Acinetobacter baumannii , and Pseudomonas aeruginosa , prior to PAW exposure. In order to test the duodenoscope polymer compatibility with PAW, a challenge test was conducted by immersing the samples in PAW for 30 minutes daily for 45 consecutive days. Significant reductions in bacterial populations were achieved after 30 minutes of PAW treatment, indicating a high-level disinfection. Atomic force microscopy and scanning electron microscopy were used to demonstrate that repeated PAW treatment of duodenoscope coating polymer samples did not result in significant differences in morphological surface between the treated and untreated samples. Energy-dispersive X-ray spectroscopy analysis also showed no significant differences between the elemental composition of the duodenoscope coating polymer samples before and after repeated PAW treatment. Considering these preliminary results, PAW could be considered as a new alternative for duodenoscope reprocessing.

[Code of civil procedure for medical workers -the essential principles of proceedings and expediting of trials-].

PubMed

Kageyama, Kyoko; Jimba, Koichi; Hashimoto, Satoru

2013-04-01

Code of civil procedure is started when a plaintiff appeals to the law. Conversely, if a suit is not appealed, it is not started. We explain the essential principles of the code of civil procedure, and present systems associated with expediting trials (a brief, preliminary oral arguments, preparatory proceedings, inquiry to opponent, organized proceedings, technical adviser system, etc.). Amendment of law is repeated for the purpose of aiming suitably expediting trials. We should utilize the present code of civil procedure suitably, and expect the quick conclusion of trials.

Laser, radiofrequency, and ethanol ablation for the management of thyroid nodules.

PubMed

Papini, Enrico; Gugliemi, Rinaldo; Pacella, Claudio Maurizio

2016-10-01

The majority of benign thyroid nodules are nearly asymptomatic, remain stable in size, and do not require treatment. However, a minority of patients with growing nodules may complain of local symptoms or have cosmetic concerns, and thus seek surgical consultation. The timely use of ultrasound-guided minimally invasive procedures can change the natural history of benign enlarging thyroid nodules. The procedures produce persistent shrinkage of thyroid nodules and are associated with improvement of local symptoms. Among the various procedures, percutaneous ethanol injection represents the first-line treatment for relapsing thyroid cysts. In solid nonfunctioning nodules, laser and radiofrequency ablation produces a more than 50% reduction in nodular volume that remains persistent over several years. For hyperfunctioning nodules, thermal ablation techniques are not appropriate unless radioactive iodine is contraindicated or not accessible. MITs are best suited for the management of medium or large-sized nodules that are sonographically well visualized. Conversely, large nodules or nodular goiters that extend into the chest are difficult to treat. MITs are performed in outpatient clinics, are less expensive, and have a lower risk of complications, compared to surgery, and usually do not induce thyroid dysfunction. However, malignancy should be ruled out with a dedicated ultrasound neck assessment and repeat fine needle aspiration of the lesion before treatment.

A Novel Methylation PCR that Offers Standardized Determination of FMR1 Methylation and CGG Repeat Length without Southern Blot Analysis

PubMed Central

Grasso, Marina; Boon, Elles M.J.; Filipovic-Sadic, Stela; van Bunderen, Patrick A.; Gennaro, Elena; Cao, Ru; Latham, Gary J.; Hadd, Andrew G.; Coviello, Domenico A.

2015-01-01

Fragile X syndrome and associated disorders are characterized by the number of CGG repeats and methylation status of the FMR1 gene for which Southern blot (SB) historically has been required for analysis. This study describes a simple PCR-only workflow (mPCR) to replace SB analysis, that incorporates novel procedural controls, treatment of the DNA in separate control and methylation-sensitive restriction endonuclease reactions, amplification with labeled primers, and two-color amplicon sizing by capillary electrophoresis. mPCR was evaluated in two independent laboratories with 76 residual clinical samples that represented typical and challenging fragile X alleles in both males and females. mPCR enabled superior size resolution and analytical sensitivity for size and methylation mosaicism compared to SB. Full mutation mosaicism was detected down to 1% in a background of 99% normal allele with 50- to 100-fold less DNA than required for SB. A low level of full mutation mosaicism in one sample was detected using mPCR but not observed using SB. Overall, the sensitivity for detection of full mutation alleles was 100% (95% CI: 89%–100%) with an accuracy of 99% (95% CI: 93%–100%). mPCR analysis of DNA from individuals with Klinefelter and Turner syndromes, and DNA from sperm and blood, were consistent with SB. As such, mPCR enables accurate, sensitive, and standardized methods of FMR1 analysis that can harmonize results across different laboratories. PMID:24177047

Repeated Miscarriage

MedlinePlus

... blood and is the body’s main source of fuel. In Vitro Fertilization: A procedure in which an ... that can be done during in vitro fertilization. Tests are performed on the fertilized egg before it ...

Evaluation of a noninvasive expandable prosthesis in musculoskeletal oncology patients for the upper and lower limb.

PubMed

Beebe, Kathleen; Benevenia, Joseph; Kaushal, Neil; Uglialoro, Anthony; Patel, Neeraj; Patterson, Francis

2010-06-09

The noninvasive expandable prosthesis is used for limb-salvage surgery following tumor resection in skeletally immature patients. The purpose of this retrospective study is to report our experience with the Repiphysis (Wright Medical Technology, Inc; Arlington, Tennessee) noninvasive expandable prosthesis for both the lower extremity and compassionate use in the upper extremity in 12 patients between 2003 and 2008. Twelve prostheses were implanted in 12 patients with an average follow-up of 38 months (range, 12-78 months). Nine patients underwent a total of 38 expansion procedures. Mean total expansion was 4.5 cm (range, 0.8-9.9 cm). No complications of lengthening occurred. Seven nononcologic complications were noted. One infection was reported in 12 patients. The mean MSTS score after rehabilitation was 24.5 (range, 13-30). The Repiphysis noninvasive prosthesis provides acceptable functional outcomes for both upper and lower extremity implantation and appears to have an advantage as compared to conventional expandable prosthetics, which require open procedures that can potentially increase the risk of infection from repeated hardware exposure. Copyright 2010, SLACK Incorporated.

Rectal surgery for endometriosis--should we be aggressive?

PubMed

Varol, Nesrin; Maher, Peter; Healey, Martin; Woods, Rod; Wood, Carl; Hill, David; Lolatgis, Nick; Tsaltas, Jim

2003-05-01

To assess the outcome of aggressive but conservative laparoscopic surgery in the treatment of severe endometriosis involving the rectum. Retrospective study (Canadian Task Force classification III). Endosurgery unit of a tertiary referral center. One hundred sixty-nine women. Laparoscopy or laparotomy. The procedure was completed successfully laparoscopically in 145 (86%) and by laparotomy in 24 women (14%). The rate of preoperative symptoms was higher in 25 women who underwent bowel resection compared with those who had other bowel surgery. In addition to bowel surgery, excision of uterosacral ligaments, adhesiolysis, excision of endometrioma, and oophorectomy were the four most commonly performed procedures. At 35-month follow-up 61 patients (36%) required further surgery for pain. The average time between primary and repeat surgery was 16 months. This second operation was performed by laparoscopy in over three-fourths of the women. Overall recurrent endometriosis was found in 26 patients (15%). Overall morbidity associated with all surgery was 12.4%. Surgery for endometriosis of the cul-de-sac and bowel involves some of the most difficult dissections encountered, but it can be accomplished successfully with the low postoperative morbidity typical of laparoscopy.

Selective immediate responders to amoxicillin and clavulanic acid tolerate penicillin derivative administration after confirming the diagnosis.

PubMed

Blanca-Lopez, N; Perez-Alzate, D; Ruano, F; Garcimartin, M; de la Torre, V; Mayorga, C; Somoza, M L; Perkins, J; Blanca, M; Canto, M G; Torres, M J

2015-08-01

An increasing number of patients show immediate selective hypersensitivity reactions to clavulanic acid (CLV) and amoxicillin (AX), probably due to their increased prescription. The maintenance of this response should be established. To assess that the immediate hypersensitivity selective response to AX or to CLV is maintained after repeated administration of penicillin G (PG)/penicillin V (PV) and AX. Patients with proven immediate hypersensitivity to AX (Group A) or CLV (Group B) were included. Diagnosis was performed using skin tests with major and minor determinants of PG (PPL/MDM), AX and CLV and by drug provocation test (DPT) if required. Selectivity was established by confirming tolerance to PG/PV (Group A) and to PG/PV and AX (Group B). The maintenance of the selective response was verified by repeating DPT, 15 days after the initial investigation, with the same procedure. Of 51 patients, 78% belonged to Group A and 22% to Group B. Most had anaphylaxis. In Group A, 72% were skin test positive; 28% required DPT. In Group B, 63% were skin test positive; 37% required DPT. Only two AX-selective cases developed positive responses after re-provocation with PG/PV. No cases selective for CLV developed a positive response to PG, PV or AX. The selective response to AX appears consistent, and a response to penicillin determinants only develops in a minority of cases. For the case of CLV, the selective response appears not to be modified by exposure to penicillin determinants, meaning that patients with CLV allergy can take penicillin derivatives safely. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Randomized controlled trial of stereotactic 11-G vacuum-assisted core biopsy for the diagnosis and management of mammographic microcalcification

PubMed Central

Maxwell, Anthony J; Morris, Julie; Lim, Yit Y; Harake, MD Janick; Whiteside, Sigrid

2016-01-01

Objective: To compare the accuracy of 11-G vacuum-assisted biopsy (VAB) with 14-G core needle biopsy (CNB) to diagnose mammographic microcalcification (MM) and effect on surgical outcomes. Methods: Following ethical approval, VAB and CNB (control) were compared in a randomized prospective study for first-line diagnosis of MM and subsequent surgical outcomes in two breast-screening units. Participants gave written informed consent. Exclusions included comorbidity precluding surgery, prior ipsilateral breast cancer and lesions >40 mm requiring mastectomy as first surgical procedure. The final pathological diagnosis was compared with the initial biopsy result. Quality-of-life (QOL) questionnaires were administered at baseline, 2, 6 and 12 months. 110 participants were required to show a 25% improvement in diagnosis with VAB compared with CNB (90% power). Results: Eligibility was assessed for 787 cases; 129 females recalled from the National Health Service breast screening programme were randomized. Diagnostic accuracy of VAB was 86% and that of CNB was 84%. Using VAB, 2/14 (14.3%) cases upgraded from ductal carcinoma in situ to invasion at surgery and 3/19 (15.8%) using CNB. Following VAB 7/16 (44%) cases required repeat surgery vs 7/24 (29%) after CNB. Both groups recorded significant worsening of functional QOL measures and increased breast pain at follow-up. Conclusion: VAB and CNB were equally accurate at diagnosing MM, and no significant differences in surgical outcomes were observed. Advances in knowledge: The first randomized controlled study of VAB for diagnosis of microcalcification using digital mammography showed no difference in diagnostic accuracy of VAB and CNB, or in the proportion of participants needing repeat non-operative biopsy or second therapeutic operation to treat malignancy. PMID:26654214

Studying tumor growth in Drosophila using the tissue allograft method.

PubMed

Rossi, Fabrizio; Gonzalez, Cayetano

2015-10-01

This protocol describes a method to allograft Drosophila larval tissue into adult fly hosts that can be used to assay the tumorigenic potential of mutant tissues. The tissue of interest is dissected, loaded into a fine glass needle and implanted into a host. Upon implantation, nontransformed tissues do not overgrow beyond their normal size, but malignant tumors grow without limit, are invasive and kill the host. By using this method, Drosophila malignant tumors can be transplanted repeatedly, for years, and therefore they can be aged beyond the short life span of flies. Because several hosts can be implanted using different pieces from a single tumor, the method also allows the tumor mass to be increased to facilitate further studies that may require large amounts of tissue (i.e., genomics, proteomics and so on). This method also provides an operational definition of hyperplastic, benign and malignant growth. The injection procedure itself requires only ∼1 d. Tumor development can then be monitored until the death of the implanted hosts.

Automation process for morphometric analysis of volumetric CT data from pulmonary vasculature in rats.

PubMed

Shingrani, Rahul; Krenz, Gary; Molthen, Robert

2010-01-01

With advances in medical imaging scanners, it has become commonplace to generate large multidimensional datasets. These datasets require tools for a rapid, thorough analysis. To address this need, we have developed an automated algorithm for morphometric analysis incorporating A Visualization Workshop computational and image processing libraries for three-dimensional segmentation, vascular tree generation and structural hierarchical ordering with a two-stage numeric optimization procedure for estimating vessel diameters. We combine this new technique with our mathematical models of pulmonary vascular morphology to quantify structural and functional attributes of lung arterial trees. Our physiological studies require repeated measurements of vascular structure to determine differences in vessel biomechanical properties between animal models of pulmonary disease. Automation provides many advantages including significantly improved speed and minimized operator interaction and biasing. The results are validated by comparison with previously published rat pulmonary arterial micro-CT data analysis techniques, in which vessels were manually mapped and measured using intense operator intervention. Published by Elsevier Ireland Ltd.

Safety of low dose heparin in elective coronary angioplasty.

PubMed Central

Koch, K. T.; Piek, J. J.; de Winter, R. J.; David, G. K.; Mulder, K.; Tijssen, J. G.; Lie, K. I.

1997-01-01

OBJECTIVES: To evaluate the safety of a low dose of heparin in consecutive stable patients undergoing elective percutaneous transluminal coronary angioplasty (PTCA). DESIGN: Open prospective study in a single centre. PATIENTS: 1375 consecutive patients had elective PTCA (1952 lesions: type A 11%, B1 34%, B2 36%, and C 19%). There were no angiographic exclusion criteria. INTERVENTIONS: A bolus of 5000 IU heparin was used as the standard anticoagulation regimen during PTCA. The sheaths were removed immediately after successful completion of the procedure. Prolongation of heparin treatment was left to the operator's discretion. MAIN OUTCOME MEASURES: Procedural success was defined as < 50% residual stenosis without death from any cause, acute myocardial infarction, urgent coronary bypass surgery, or repeat angioplasty within 48 hours for acute recurrent ischaemia; the need for prolonged heparinisation; and the occurrence of puncture site complications. RESULTS: Procedural success without clinical events was achieved in 90% of patients. Mortality was 0.3%; coronary bypass surgery was performed in 1.7% of the procedures. The rate of myocardial infarction was 3.3%; repeat angioplasty within 48 hours was carried out in 0.7% of patients. A total of 89.1% of the patients were treated according to the protocol. Prolonged treatment with heparin was considered necessary in 123 patients (8.9%). Repeat angioplasty for abrupt closure was performed in two patients shortly after sheath removal and in two during prolonged heparinisation. Puncture site complications occurred in 2.1% of patients (low dose heparin 1.9% and prolonged heparinisation 4.9%). CONCLUSION: Elective PTCA can be safely performed using a low dose of heparin, with a negligible risk for subacute closure. Low dose heparin may reduce the incidence of puncture site complications, shorten hospitalisation, and enable out-patient angioplasty. PMID:9227294

Pig islet xenotransplantation acceptance in a Latin-American diabetic population.

PubMed

Abalovich, Adrián; Wechsler, Carlos; Lara, Silvia; Bervottini, Miguel

2010-01-01

Progress in porcine islet xenotransplantation has been accompanied by studies on acceptance of this new procedure by patients, health professionals or the general public. Such studies have not been done in the Latin-American population. We conducted a questionnaire in 108 diabetes patients (insulin-dependent, n = 53; insulin-independent, n = 55) in a public hospital in Argentina. The questions addressed the general perception of the xenotransplant procedure and specific items related to the outcome (achieving insulin independence, improvement in metabolic control, delay in emergence of diabetic complications, need for repeat procedures, potential of transfer of infectious viruses, association with psychological problems, and anticipated success in relation to achieving a cure). Eighty-six (79%) of the patients accepted islet xenotransplantation; this incidence was not different for insulin-dependent or insulin-independent patients, patients with or without complications, or patients with good or poor metabolic control. Also, over 75% of patients accepted the procedure if this is only associated with a reduction in insulin requirement, if the procedure just delays but not prevents the onset of complications, or if the procedure needs to be performed every 6 months. Fifty-seven percent of patients indicated acceptance even if the potential transmission of a virus infection cannot be completely ruled out: this outcome was not affected by the outbreak of the H1N1 flu epidemic during the conduct of this study. Forty percent of patients indicated that living with porcine cells in their body could give psychological problems. We conclude that this population of Latin-American diabetic patients shows a high acceptance rate of a porcine islet xenotransplantation product. (c) 2010 John Wiley & Sons A/S.

Audit of 117 otoplasties for prominent ear by one surgeon using a cartilage-cutting procedure.

PubMed

Brian, Tess; Cheng, Paul T; Loo, Stanley S

2018-02-07

The plethora of surgical procedures for prominent ear correction reflects lack of satisfaction with outcomes achieved. This paper describes a cartilage-cutting otoplasty procedure and reports an audit of its outcomes. Discharge coding was used to retrospectively identify patients who had undergone the otoplasty of interest at Middlemore Hospital, Auckland, during the 5 years from March 2010 to the end of February 2015. Hospital records were accessed. Demographic, procedure and patient satisfaction data were recorded and analysed (PASW/SPSS Statistics 18.0). Chi-square test and t-test were used to assess associations, with significance accepted at two-sided P < 0.05. Sixty-four patients underwent the specified otoplasty (54.7% females: mean age 9.5 years (standard deviation, SD: 4.2; range: 4-20)), of whom 93.8% had bilateral procedures with mean surgical time of 61 min (SD: 14; range: 34-94). This was significantly shorter (P < 0.001) than for bilateral surgeries by all other techniques and surgeons in the review period. None of the 117 procedures of interest subsequently had suture extrusion or revision surgery. Mean time from surgery to satisfaction determination was 993 days (SD: 521; range: 111-1850) for 43 (67.2%) patients. 23.3% believed that there had been aesthetically insignificant partial recurrence of prominence, typically of one ear only. This was insufficient for all but one patient to consider repeat otoplasty. Surgery outcome was rated 'very satisfactory' and 'satisfactory' by 90.7% and 9.3% of patients/parents, respectively. All would recommend the surgery to others. With infrequent complications and recurrence requiring revision, and without long-term reliance on sutures, the otoplasty reported is time-efficient, safe and generates high patient satisfaction. © 2018 Royal Australasian College of Surgeons.

Improving the cleaning procedure to make kitchen floors less slippery.

PubMed

Quirion, F; Poirier, P; Lehane, P

2008-12-01

This investigation shows that, in most cases, the floor cleaning procedure of typical restaurants could be improved, resulting in a better cleaning efficiency and a better floor friction. This simple approach could help reduce slips and falls in the workplace. Food safety officers visited ten European style restaurants in the London Borough of Bromley (UK) to identify their floor cleaning procedure in terms of the cleaning method, the concentration and type of floor cleaner and the temperature of the wash water. For all 10 restaurants visited, the cleaning method was damp mopping. Degreasers were used in three sites while neutral floor cleaners were used in seven sites. Typically, the degreasers were over diluted and the neutrals were overdosed. The wash water temperature ranged from 10 to 72 degrees C. The on-site cleaning procedures were repeated in the laboratory for the removal of olive oil from new and sealed quarry tiles, fouled and worn quarry tiles and new porcelain tiles. It is found that in 24 out of 30 cases, cleaning efficiency can be improved by simple changes in the floor cleaning procedure and that these changes result in a significant improvement of the floor friction. The nature of the improved floor cleaning procedure depends on the flooring type. New and properly sealed flooring tiles can be cleaned using damp mopping with a degreaser diluted as recommended by the manufacturer in warm or hot water (24 to 50 degrees C). But as the tiles become worn and fouled, a more aggressive floor cleaning is required such as two-step mopping with a degreaser diluted as recommended by the manufacturer in warm water (24 degrees C).

Laparoscopic-assisted percutaneous endoscopic gastrostomy: insertion of a skin-level device using a tear-away sheath

PubMed Central

Livingston, Michael H.; Pepe, Daniel; Jones, Sarah; Bütter, Andreana; Merritt, Neil H.

2015-01-01

Background This study describes our experience with the placement of a skin-level gastrostomy device (MIC-KEY) in a single procedure. Methods We identified infants, children and young adults who underwent laparoscopic-assisted percutaneous endoscopic gastrostomy (LAPEG) tube insertion between October 2009 and June 2013. The steps of this procedure include upper endoscopy, single-port laparoscopy, gastropexy via percutaneous T-fasteners and placement of a skin-level gastrostomy device (MIC-KEY) using a “push” technique with a tear-away sheath. Results We included 92 patients in our study. Mean age was 3.7 years (range 3 wk–5 yr), and mean weight was 11.2 (range 2.8–54) kg. Median procedural time was 20 (range 12–76) minutes. Total median duration for the most recent 25 procedures was lower than that of the first 25 (62 v. 79 min, p = 0.004). There were no intraoperative complications or conversions to open surgery. Postoperative complications were observed in 6 (6.5%) patients. Three retained T-fasteners were assessed endoscopically (n = 1) or removed via local excision (n = 2). Two patients experienced early dislodged feeding tubes that were replaced via interventional radiology (n = 1) or repeat LAPEG (n = 1). There was also 1 intra-abdominal fluid collection that was drained percutaneously but ultimately required a laparotomy and washout. There were no major complications in the most recent 50 procedures. Conclusion Our results suggest that LAPEG is a safe, minimally invasive procedure for infants, children and young adults. This approach allows for immediate use of a skin-level gastrostomy device without the need for postoperative tube exchanges. PMID:26204365

Community College Nursing Students' Experience of Repeating a Course after Academic Failure

ERIC Educational Resources Information Center

Lewis, Lisa Scandale

2016-01-01

This narrative inquiry study looked at community college nursing student repeaters, those who have failed a required nursing course and then gone on to repeat the course. Nursing student repeaters are a population at especially high risk for attrition, and about whom little is known. The community college setting is an important site of nursing…

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.

Development of synthetic simulators for endoscope-assisted repair of metopic and sagittal craniosynostosis.

PubMed

Eastwood, Kyle W; Bodani, Vivek P; Haji, Faizal A; Looi, Thomas; Naguib, Hani E; Drake, James M

2018-06-01

OBJECTIVE Endoscope-assisted repair of craniosynostosis is a safe and efficacious alternative to open techniques. However, this procedure is challenging to learn, and there is significant variation in both its execution and outcomes. Surgical simulators may allow trainees to learn and practice this procedure prior to operating on an actual patient. The purpose of this study was to develop a realistic, relatively inexpensive simulator for endoscope-assisted repair of metopic and sagittal craniosynostosis and to evaluate the models' fidelity and teaching content. METHODS Two separate, 3D-printed, plastic powder-based replica skulls exhibiting metopic (age 1 month) and sagittal (age 2 months) craniosynostosis were developed. These models were made into consumable skull "cartridges" that insert into a reusable base resembling an infant's head. Each cartridge consists of a multilayer scalp (skin, subcutaneous fat, galea, and periosteum); cranial bones with accurate landmarks; and the dura mater. Data related to model construction, use, and cost were collected. Eleven novice surgeons (residents), 9 experienced surgeons (fellows), and 5 expert surgeons (attendings) performed a simulated metopic and sagittal craniosynostosis repair using a neuroendoscope, high-speed drill, rongeurs, lighted retractors, and suction/irrigation. All participants completed a 13-item questionnaire (using 5-point Likert scales) to rate the realism and utility of the models for teaching endoscope-assisted strip suturectomy. RESULTS The simulators are compact, robust, and relatively inexpensive. They can be rapidly reset for repeated use and contain a minimal amount of consumable material while providing a realistic simulation experience. More than 80% of participants agreed or strongly agreed that the models' anatomical features, including surface anatomy, subgaleal and subperiosteal tissue planes, anterior fontanelle, and epidural spaces, were realistic and contained appropriate detail. More than 90% of participants indicated that handling the endoscope and the instruments was realistic, and also that the steps required to perform the procedure were representative of the steps required in real life. CONCLUSIONS Both the metopic and sagittal craniosynostosis simulators were developed using low-cost methods and were successfully designed to be reusable. The simulators were found to realistically represent the surgical procedure and can be used to develop the technical skills required for performing an endoscope-assisted craniosynostosis repair.

Determination of the purity of valine by isocratic liquid chromatography coupled with charged aerosol detection (CAD).

PubMed

Lodi, A; Angus, M; Nap, C J; Skellern, G; Nicolas, A

2015-01-01

A liquid chromatography coupled with charged aerosol detection (LC-CAD) procedure; capable of separating and quantifying the most common impurities of valine at levels as low as 0.05 per cent (m/m), has been developed. The procedure is simple (isocratic), rapid, linear, sensitive and repeatable. It employs a widely available and inexpensive stationary phase (C18).

Trial of repeated analgesia with Kangaroo Mother Care (TRAKC Trial).

PubMed

Campbell-Yeo, Marsha; Johnston, Celeste; Benoit, Britney; Latimer, Margot; Vincer, Michael; Walker, Claire-Dominique; Streiner, David; Inglis, Darlene; Caddell, Kim

2013-11-09

Skin-to-skin contact (SSC) between mother and infant, commonly referred to as Kangaroo Mother Care (KMC), is recommended as an intervention for procedural pain. Evidence demonstrates its consistent efficacy in reducing pain for a single painful procedure. The purpose of this study is to examine the sustained efficacy of KMC, provided during all routine painful procedures for the duration of Neonatal Intensive Care Unit (NICU) hospitalization, in diminishing behavioral pain response in preterm neonates. The efficacy of KMC alone will be compared to standard care of 24% oral sucrose, as well as the combination of KMC and 24% oral sucrose. Infants admitted to the NICU who are less than 36 6/7 weeks gestational age (according to early ultrasound), that are stable enough to be held in KMC, will be considered eligible (N = 258). Using a single-blinded randomized parallel group design, participants will be assigned to one of three possible interventions: 1) KMC, 2) combined KMC and sucrose, and 3) sucrose alone, when they undergo any routine painful procedure (heel lance, venipuncture, intravenous, oro/nasogastric insertion). The primary outcome is infant's pain intensity, which will be assessed using the Premature Infant Pain Profile (PIPP). The secondary outcome will be maturity of neurobehavioral functioning, as measured by the Neurobehavioral Assessment of the Preterm Infant (NAPI). Gestational age, cumulative exposure to KMC provided during non-pain contexts, and maternal cortisol levels will be considered in the analysis. Clinical feasibility will be accounted for from nurse and maternal questionnaires. This will be the first study to examine the repeated use of KMC for managing procedural pain in preterm neonates. It is also the first to compare KMC to sucrose, or the interventions in combination, across time. Based on the theoretical framework of the brain opioid theory of attachment, it is expected that KMC will be a preferred standard of care. However, current pain management guidelines are based on minimal data on repeated use of either intervention. Therefore, regardless of the outcomes of this study, results will have important implications for guidelines and practices related to management of procedural pain in preterm infants. ClinicalTrials.gov Identifier: NCT01561547.

Application of the Booth-Kautzmann method for the determination of N-2 packing leakage

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

Burkhart, D.M.; Milton, J.W.; Fawcett, S.T.

1995-06-01

To accurately determine turbine cycle heat rate, leakage past the N-2 steam seal packing must be determined on turbines with both HP and IP turbines contained within a common high pressure casing. N-2 packing leakage can be determined by the Booth-Kautzmann Method with instrumentation commonly used to determine the HP and IP turbine efficiency. The only additional requirements are changes to the main steam and/or hot reheat steam conditions. This paper discusses the actual test results using the Booth-Kautzmann test procedure on three natural gas fired units. The test results demonstrate the added advantage of having at least three N-2more » test runs, stability requirements for repeatable test runs and test procedures used to determine leakage results. Discussion of the sensitivity of the assumed N-2 enthalpy are also addressed. Utilizing Martins Formula with a series of N-2 Leakage test runs is shown to be a leakage prediction tool and a packing clearance approximation tool. It is concluded that the Booth-Kautzmann Method for determination of N-2 packing leakage should be utilized whenever HP and Ip turbine efficiency is determined. The two or three additional hours invested in the test runs is well worth the information gained on the performance of the N-2 packing.« less

Virtual reality simulators: current status in acquisition and assessment of surgical skills.

PubMed

Cosman, Peter H; Cregan, Patrick C; Martin, Christopher J; Cartmill, John A

2002-01-01

Medical technology is currently evolving so rapidly that its impact cannot be analysed. Robotics and telesurgery loom on the horizon, and the technology used to drive these advances has serendipitous side-effects for the education and training arena. The graphical and haptic interfaces used to provide remote feedback to the operator--by passing control to a computer--may be used to generate simulations of the operative environment that are useful for training candidates in surgical procedures. One additional advantage is that the metrics calculated inherently in the controlling software in order to run the simulation may be used to provide performance feedback to individual trainees and mentors. New interfaces will be required to undergo evaluation of the simulation fidelity before being deemed acceptable. The potential benefits fall into one of two general categories: those benefits related to skill acquisition, and those related to skill assessment. The educational value of the simulation will require assessment, and comparison to currently available methods of training in any given procedure. It is also necessary to determine--by repeated trials--whether a given simulation actually measures the performance parameters it purports to measure. This trains the spotlight on what constitutes good surgical skill, and how it is to be objectively measured. Early results suggest that virtual reality simulators have an important role to play in this aspect of surgical training.

Ultrasound control of magnet growing rod distraction in early onset scoliosis.

PubMed

Pérez Cervera, T; Lirola Criado, J F; Farrington Rueda, D M

2016-01-01

The growing rod technique is currently one of the most common procedures used in the management of early onset scoliosis. However, in order to preserve spine growth and control the deformity it requires frequent surgeries to distract the rods. Magnetically driven growing rods have recently been introduced with same treatment goal, but without the inconvenience of repeated surgical distractions. One of the limitations of this technical advance is an increase in radiation exposure due to the increase in distraction frequency compared to conventional growing rods. An improvement of the original technique is presented, proposing a solution to the inconvenience of multiple radiation exposure using ultrasound technology to control the distraction process of magnetically driven growing rods. Copyright © 2014 SECOT. Publicado por Elsevier España, S.L.U. All rights reserved.

Efficient generation of sum-of-products representations of high-dimensional potential energy surfaces based on multimode expansions

NASA Astrophysics Data System (ADS)

Ziegler, Benjamin; Rauhut, Guntram

2016-03-01

The transformation of multi-dimensional potential energy surfaces (PESs) from a grid-based multimode representation to an analytical one is a standard procedure in quantum chemical programs. Within the framework of linear least squares fitting, a simple and highly efficient algorithm is presented, which relies on a direct product representation of the PES and a repeated use of Kronecker products. It shows the same scalings in computational cost and memory requirements as the potfit approach. In comparison to customary linear least squares fitting algorithms, this corresponds to a speed-up and memory saving by several orders of magnitude. Different fitting bases are tested, namely, polynomials, B-splines, and distributed Gaussians. Benchmark calculations are provided for the PESs of a set of small molecules.

Efficient generation of sum-of-products representations of high-dimensional potential energy surfaces based on multimode expansions.

PubMed

Ziegler, Benjamin; Rauhut, Guntram

2016-03-21

The transformation of multi-dimensional potential energy surfaces (PESs) from a grid-based multimode representation to an analytical one is a standard procedure in quantum chemical programs. Within the framework of linear least squares fitting, a simple and highly efficient algorithm is presented, which relies on a direct product representation of the PES and a repeated use of Kronecker products. It shows the same scalings in computational cost and memory requirements as the potfit approach. In comparison to customary linear least squares fitting algorithms, this corresponds to a speed-up and memory saving by several orders of magnitude. Different fitting bases are tested, namely, polynomials, B-splines, and distributed Gaussians. Benchmark calculations are provided for the PESs of a set of small molecules.

Endoscopic electrosurgical papillotomy and manometry in biliary tract disease.

PubMed

Geenen, J E; Hogan, W J; Shaffer, R D; Stewart, E T; Dodds, W J; Arndorfer, R C

1977-05-09

Endoscopic papillotomy was performed in 13 patients after cholecystectomy for retained or recurrent common bile duct calculi (11 patients) and a clinical picture suggesting papillary stenosis (two patients). Following endoscopic papillotomy, ten of the 11 patients spontaneously passed common bile duct (CBD) stones verified on repeated endoscopic retrograde cholangiopancreatography (ERCP) study. One patient failed to pass a large CBD calculus; one patient experienced cholangitis three months after in inadequate papillotomy and required operative intervention. Endoscopic papillotomy substantially decreased the pressure gradient existing between the CBD and the duodenum in all five patients studied with ERCP manometry. Endoscopic papillotomy is a relatively safe and effective procedure for postcholecystectomy patients with retained or recurrent CBD stones. The majority of CBD stones will pass spontaneously if the papillotomy is adequate.

Extending double modulation: combinatorial rules for identifying the modulations necessary for determining elasticities in metabolic pathways.

PubMed

Giersch, C; Cornish-Bowden, A

1996-10-07

The double modulation method for determining the elasticities of pathway enzymes, originally devised by Kacser & Burns (Biochem. Soc. Trans. 7, 1149-1160, 1979), is extended to pathways of complex topological structure, including branching and feedback loops. An explicit system of linear equations for the unknown elasticities is derived. The constraints imposed on this linear system imply that modulations of more than one enzyme are not necessarily independent. Simple combinatorial rules are described for identifying without using any algebra the set of independent modulations that allow the determination of the elasticities of any enzyme. By repeated application, the minimum numbers of modulations required to determine the elasticities of all enzymes of a given pathway can be determined. The procedure is illustrated with numerous examples.

Parameter regimes for a single sequential quantum repeater

NASA Astrophysics Data System (ADS)

Rozpędek, F.; Goodenough, K.; Ribeiro, J.; Kalb, N.; Caprara Vivoli, V.; Reiserer, A.; Hanson, R.; Wehner, S.; Elkouss, D.

2018-07-01

Quantum key distribution allows for the generation of a secret key between distant parties connected by a quantum channel such as optical fibre or free space. Unfortunately, the rate of generation of a secret key by direct transmission is fundamentally limited by the distance. This limit can be overcome by the implementation of so-called quantum repeaters. Here, we assess the performance of a specific but very natural setup called a single sequential repeater for quantum key distribution. We offer a fine-grained assessment of the repeater by introducing a series of benchmarks. The benchmarks, which should be surpassed to claim a working repeater, are based on finite-energy considerations, thermal noise and the losses in the setup. In order to boost the performance of the studied repeaters we introduce two methods. The first one corresponds to the concept of a cut-off, which reduces the effect of decoherence during the storage of a quantum state by introducing a maximum storage time. Secondly, we supplement the standard classical post-processing with an advantage distillation procedure. Using these methods, we find realistic parameters for which it is possible to achieve rates greater than each of the benchmarks, guiding the way towards implementing quantum repeaters.

Vortex-assisted emulsification semimicroextraction for the analytical control of restricted ingredients in cosmetic products: determination of bronopol by liquid chromatography.

PubMed

Miralles, Pablo; Bellver, Raquel; Chisvert, Alberto; Salvador, Amparo

2016-03-01

Vortex-assisted emulsification semimicroextraction is proposed as a one-step solution-extraction procedure for sample preparation in cosmetic products. The procedure allows rapid preparation based on dispersion of the sample in a mixture of 1 mL of n-hexane and 0.5 mL of ethanol, followed by the addition of 0.5 mL of water and centrifugation to obtain two separated phases. This procedure provides good sample clean-up with minimum dilution and is very useful for the determination of ingredients with restricted concentrations, such as bronopol. The procedure was applied to the determination of bronopol by liquid chromatography with UV detection. The best chromatographic separation was obtained by using a C18 column set at 40 °C and performing a stepwise elution with a mixture of ethanol/aqueous 1 % acetic acid solution as mobile phase pumped at 0.5 mL min(-1). The detection wavelength was set at 250 nm and the total run time required was 12 min. The method was successfully applied to 18 commercial cosmetic samples including creams, shampoos, and bath gels. Good recoveries and repeatability were obtained, with a limit of detection of 0.9 μg mL(-1), which makes the method suitable for the analytical control of cosmetic products. Moreover, it could be considered environmentally friendly, because water, ethanol, and only a low volume of n-hexane are used as solvents.

Long-Term Outcome and Complications Following Prophylactic Laparoscopic-Assisted Gastropexy in Dogs.

PubMed

Loy Son, Natasha K; Singh, Ameet; Amsellem, Pierre; Kilkenny, Jessica; Brisson, Brigitte A; Oblak, Michelle L; Ogilvie, Adam T

2016-11-01

To characterize the short- and long-term outcome (>12 months), complications, and owner satisfaction following prophylactic laparoscopic-assisted gastropexy (LAG) in dogs. Retrospective study. Client-owned dogs (n = 49). Dogs that underwent prophylactic LAG at 2 veterinary academic hospitals were studied. Surgical time, anesthesia time, concurrent intra- and extra-abdominal procedures, and intraoperative and postoperative complications were recorded following review of medical records. Veterinarian and/or owner follow-up was obtained to determine outcome and satisfaction with LAG. Five of 49 dogs (10%) experienced complications related to abdominal access during LAG. Four percent (2/49) of dogs experienced an intraoperative complication. Follow-up information was available for 89% of dogs (44/49). Four dogs died of causes unrelated to LAG or gastric dilatation volvulus (GDV) in the follow-up period. Two dogs experienced major postoperative complications requiring additional veterinary intervention. Thirty percent (13 dogs) experienced a minor postoperative self-limiting wound-related complication. Median follow-up time was 698 days (range, 411-1825). No dogs experienced GDV. One hundred percent of dog owners were satisfied with LAG, would repeat the procedure in a future pet, and would recommend the procedure to a friend or family member. LAG was an effective procedure for prevention of GDV and was associated with high client satisfaction in this cohort of dogs. A moderate rate of postoperative wound complications occurred that were minor and self-limiting in nature. © Copyright 2016 by The American College of Veterinary Surgeons.

A procedure for landslide susceptibility zonation by the conditional analysis method1

NASA Astrophysics Data System (ADS)

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

2002-12-01

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

A procedure for quantitation of total oxidized uranium for bioremediation studies

USGS Publications Warehouse

Elias, Dwayne A.; Senko, John M.; Krumholz, Lee R.

2003-01-01

A procedure was developed for the quantitation of complexed U(VI) during studies on U(VI) bioremediation. These studies typically involve conversion of soluble or complexed U(VI) (oxidized) to U(IV) (the reduced form which is much less soluble). Since U(VI) freely exchanges between material adsorbed to the solid phase and the dissolved phase, uranium bioremediation experiments require a mass balance of U in both its soluble and adsorbed forms as well as in the reduced sediment bound phase. We set out to optimize a procedure for extraction and quantitation of sediment bound U(VI). Various extractant volumes to sediment ratios were tested and it was found that between 1:1 to 8:1 ratios (v/w) there was a steady increase in U(VI) recovered, but no change with further increases in v/w ratio.Various strengths of NaHCO3, Na-EDTA, and Na-citrate were used to evaluate complexed U(VI) recovery, while the efficiency of a single versus repeated extraction steps was compared with synthesized uranyl-phosphate and uranyl-hydroxide. Total recovery with 1 M NaHCO3 was 95.7% and 97.9% from uranyl-phosphate and uranyl-hydroxide, respectively, compared to 80.7% and 89.9% using 450 mM NaHCO3. Performing the procedure once yielded an efficiency of 81.1% and 92.3% for uranyl-phosphate and uranyl-hydroxide, respectively, as compared to three times. All other extractants yielded 7.9–82.0% in both experiments.

Repeatability of intravital capillaroscopic measurement of capillary density.

PubMed

Lamah, M; Chaudhry, H; Mortimer, P S; Dormandy, J A

1996-01-01

The reliability of intravital capillaroscopy for determining capillary density (CD) of skin has been questioned because it depends upon the variability of the measuring process and subjective interpretation of data as well as the intrinsic heterogeneity of capillary spacing. The aim of this study was to assess the repeatability of a standardised method for measuring CD of the skin of the dorsum of foot. In each of 30 subjects (10 controls and 20 patients with peripheral vascular disease), the foot was systematically mapped by examining 20 sites on the dorsum of foot and 2 sites on each toe, using white light (native) videomicroscopy at 40 x magnification. Off-line analysis of videoprints was then undertaken to determine CD at each site, by counting capillaries within areas of acceptable photographic quality only, having first defined the criteria for counting capillaries. The mean values were then calculated and taken to represent the CD of the foot or toes. Repeatability of the measuring equipment was first assessed by noting the presence or absence of each corresponding capillary in 2 prints, taken at intervals of hours or days (in 10 subjects) or months (in 2 patients), of an identical area of skin which was marked by a microtattoo on the first occasion. On average, 95% of corresponding capillaries were identified in both prints (from controls and patients), thus implying little intrinsic temporal variation of capillary anatomy as well as excellent repeatability of the measuring equipment. Repeatability of data analysis was assessed by the same observer reading the same 20 prints in a blinded manner on three separate occasions (intraobserver repeatability), and 2 observers reading the same 24 prints (interobserver repeatability). The mean coefficient of intraobserver variation of CD estimate was 5.6% and the interobserver correlation coefficient was 0.94. Finally, overall repeatability of the method was assessed by repeating the procedure on a subsequent occasion (mean time interval of 5 days) in 10 subjects. The rate of agreement in mean CD between the two procedures [defined as 100- (difference between the two measurements/mean of the two measurements) x 100]% ranged from 86.4 to 97.1% (mean 93.5%). Thus using the above methodological technique, native capillaroscopy can be reliably used to determine CD of the dorsum of foot in comparing patient subgroups, as well as in longitudinal studies.

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...

Assessing resident performance and training of colonoscopy in a general surgery training program.

PubMed

Hope, William W; Hooks, W Borden; Kilbourne, S Nicole; Adams, Ashley; Kotwall, Cyrus A; Clancy, Thomas V

2013-05-01

Recently, the adequacy of endoscopy training in general surgery residency programs has been questioned. Efforts to improve resident endoscopic training and to judge competency are ongoing but not well studied. We assessed resident performance using two assessment tools in colonoscopy in a general surgery residency program. Prospectively collected data were reviewed from consecutive colonoscopies by a single surgeon: September 2008 to June 2011. Colonoscopies performed without residents were excluded. Data included patient demographics, procedural data, and outcomes. Following the colonoscopy, residents were graded by the attending surgeon using up two different assessment tools. Descriptive statistics were calculated and outcomes were compared. Colonoscopies were performed by residents in 100 patients. Average age was 52 (range, 22-79) years. Females made up 66 % of patients, and 63 % were Caucasian. Postgraduate level (PG-Y) 3 level residents performed 72 % of colonoscopies. The average resident participation was 73 % of the procedure. Biopsies were performed in 35 %; adenomatous polyps were found in 17 % and invasive cancer in 1 %. Bowel preparation was deemed good in 76 % of patients. Colonoscopy was completed in 90 % of patients. Reasons for incomplete exam were technical (7 patients), inability to pass a stricture (2 patients), and poor prep (1 patient). For completed full colonoscopies, the average time to reach the cecum was 22 min, and withdrawal time was 13 min. Resident assessments were made in 89 of the colonoscopies using 2 separate assessment tools. There were no mortalities; the morbidity rate was 3 %. Morbidities included a perforation related to a biopsy requiring surgery and partial colectomy, a postpolypectomy bleed requiring repeat colonoscopy with clipping of the bleeding vessel, and a patient with transient bradycardia requiring atropine during the procedure. Using objective assessment tools, overall resident skill and knowledge in performing colonoscopy appears to improve based on increasing PG-Y level, although this was not evident with all categories measured. Methods to assess competency continue to evolve and should be the focus of future research.

40 CFR 1065.320 - Fuel-flow calibration.

Code of Federal Regulations, 2012 CFR

2012-07-01

... manufacturer's instructions and use good engineering judgment to repeat the calibration. (b) You may also develop a procedure based on a chemical balance of carbon or oxygen in engine exhaust. (c) You may remove...

40 CFR 1065.320 - Fuel-flow calibration.

Code of Federal Regulations, 2011 CFR

2011-07-01

... manufacturer's instructions and use good engineering judgment to repeat the calibration. (b) You may also develop a procedure based on a chemical balance of carbon or oxygen in engine exhaust. (c) You may remove...

40 CFR 1065.320 - Fuel-flow calibration.

Code of Federal Regulations, 2010 CFR

2010-07-01

... manufacturer's instructions and use good engineering judgment to repeat the calibration. (b) You may also develop a procedure based on a chemical balance of carbon or oxygen in engine exhaust. (c) You may remove...

40 CFR 1065.320 - Fuel-flow calibration.

Code of Federal Regulations, 2013 CFR

2013-07-01

... manufacturer's instructions and use good engineering judgment to repeat the calibration. (b) You may also develop a procedure based on a chemical balance of carbon or oxygen in engine exhaust. (c) You may remove...

40 CFR 1065.320 - Fuel-flow calibration.

Code of Federal Regulations, 2014 CFR

2014-07-01

... manufacturer's instructions and use good engineering judgment to repeat the calibration. (b) You may also develop a procedure based on a chemical balance of carbon or oxygen in engine exhaust. (c) You may remove...

Feasibility of monomodal analgesia with IV alfentanil during burn dressing changes at bedside (in spontaneously breathing non-intubated patients).

PubMed

Fontaine, Mathieu; Latarjet, Jacques; Payre, Jacqueline; Poupelin, Jean-Charles; Ravat, François

2017-03-01

The severe pain related to repeated burn dressing changes at bedside is often difficult to manage. However these dressings can be performed at bedside on spontaneously breathing non-intubated patients using powerful intravenous opioids with a quick onset and a short duration of action such as alfentanil. The purpose of this study is to demonstrate the efficacy and safety of the protocol which is used in our burn unit for pain control during burn dressing changes. Cohort study began after favorable opinion from local ethic committee has been collected. Patient's informed consent was collected. No fasting was required. Vital signs for patients were continuously monitored (non-invasive blood pressure, ECG monitoring, cutaneous oxygen saturation, respiratory rate) all over the process. Boluses of 500 (±250) mcg IV alfentanil were administered. A continuous infusion was added in case of insufficient analgesia. Adverse reactions were collected and pain intensity was measured throughout the dressing using a ten step verbal rating scale (VRS) ranging from 0 (no pain) to 10 (worst pain conceivable). 100 dressings (35 patients) were analyzed. Median age was 45 years and median burned area 10%. We observed 3 blood pressure drops, 5 oxygen desaturations (treated with stimulation without the necessity of ventilatory support) and one episode of nausea. Most of the patients (87%) were totally conscious during the dressing and 13% were awakened by verbal stimulation. Median total dose of alfentanil used was 2000μg for a median duration of 35min. Pain scores during the procedure were low or moderate (VRS mean=2.0 and maximal VRS=5). Median satisfaction collected 2h after the dressing was 10 on a ten step scale. Pain control with intravenous alfentanil alone is efficient and appears safe for most burn bedside repeated dressings in hospitalized patients. It achieves satisfactory analgesia during and after the procedure. It is now our standard analgesic method to provide repeated bedside dressings changes for burned patients. Copyright © 2016 Elsevier Ltd and ISBI. All rights reserved.

Nonword repetition in lexical decision: support for two opposing processes.

PubMed

Wagenmakers, Eric-Jan; Zeelenberg, René; Steyvers, Mark; Shiffrin, Richard; Raaijmakers, Jeroen

2004-10-01

We tested and confirmed the hypothesis that the prior presentation of nonwords in lexical decision is the net result of two opposing processes: (1) a relatively fast inhibitory process based on global familiarity; and (2) a relatively slow facilitatory process based on the retrieval of specific episodic information. In three studies, we manipulated speed-stress to influence the balance between the two processes. Experiment 1 showed item-specific improvement for repeated nonwords in a standard "respond-when-ready" lexical decision task. Experiment 2 used a 400-ms deadline procedure and showed performance for nonwords to be unaffected by up to four prior presentations. In Experiment 3 we used a signal-to-respond procedure with variable time intervals and found negative repetition priming for repeated nonwords. These results can be accounted for by dual-process models of lexical decision.

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

PubMed

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

2014-07-01

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

A multicenter international registry of redo per-oral endoscopic myotomy (POEM) after failed POEM.

PubMed

Tyberg, Amy; Seewald, Stefan; Sharaiha, Reem Z; Martinez, Guadalupe; Desai, Amit P; Kumta, Nikhil A; Lambroza, Arnon; Sethi, Amrita; Reavis, Kevin M; DeRoche, Ketisha; Gaidhane, Monica; Talbot, Michael; Saxena, Payal; Zamarripa, Felipe; Barret, Maximilien; Eleftheriadis, Nicholas; Balassone, Valerio; Inoue, Haruhiro; Kahaleh, Michel

2017-06-01

Per-oral endoscopic myotomy (POEM) has become an accepted treatment for patients with achalasia. Despite its excellent efficacy rate of greater than 80%, a small percentage of patients remain symptomatic after the procedure. Limited data exist as to the best management for recurrence of symptoms after POEM. We present the first international, multicenter experience on the efficacy and safety of a repeat POEM in the management of achalasia. Patients who underwent a redo POEM from 15 centers in 9 countries were included in a dedicated registry. Technical success was defined as successful completion of a second myotomy. Clinical success was defined as an Eckardt score of less than or equal to 3 after the second myotomy. Adverse events including anesthesia-related, operative, and postoperative adverse events were recorded. Forty-six patients were included in the study. The average age was 49.3 ± 16.78 years. Twenty (45%) patients were male. The mean pre-redo-POEM Eckardt score was 4.3 ± 2.48. Technical success was achieved in 46 (100%) patients. Clinical success was achieved in 41 patients (85%). The average post-POEM Eckardt score was 1.64 ± 1.67, with a significant difference of 2.58 (P < .00001). Eight patients (17%) had adverse events consisting of procedural bleeding, all managed endoscopically. There were no deaths. No POEMs were aborted or required surgical conversion or assistance. For patients with persistent symptoms after POEM, repeat POEM appears to be an efficacious and safe technique. Further randomized trials comparing redo POEM versus Heller should be considered. (Clinical trial registration number: NCT02162589.). Copyright © 2017 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.

Accuracy of an infrared marker-based patient positioning system (ExacTrac®) for stereotactic body radiotherapy in localizing the planned isocenter using fiducial markers

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

Montes-Rodríguez, María de los Ángeles, E-mail: angy24538@yahoo.com; Mitsoura, Eleni; Hernández-Bojórquez, Mariana

2014-11-07

Stereotactic Body Radiation Therapy (SBRT) requires a controlled immobilization and position monitoring of patient and target. The purpose of this work is to analyze the performance of the imaging system ExacTrac® (ETX) using infrared and fiducial markers. Materials and methods: In order to assure the accuracy of isocenter localization, a Quality Assurance procedure was applied using an infrared marker-based positioning system. Scans were acquired of an inhouse-agar gel and solid water phantom with infrared spheres. In the inner part of the phantom, three reference markers were delineated as reference and one pellet was place internally; which was assigned as themore » isocenter. The iPlan® RT Dose treatment planning system. Images were exported to the ETX console. Images were acquired with the ETX to check the correctness of the isocenter placement. Adjustments were made in 6D the reference markers were used to fuse the images. Couch shifts were registered. The procedure was repeated for verification purposes. Results: The data recorded of the verifications in translational and rotational movements showed averaged 3D spatial uncertainties of 0.31 ± 0.42 mm respectively 0.82° ± 0.46° in the phantom and the first correction of these uncertainties were of 1.51 ± 1.14 mm respectively and 1.37° ± 0.61°. Conclusions: This study shows a high accuracy and repeatability in positioning the selected isocenter. The ETX-system for verifying the treatment isocenter position has the ability to monitor the tracing position of interest, making it possible to be used for SBRT positioning within uncertainty ≤1mm.« less

Endoscopic Balloon Dilatation of Benign Esophageal Stricture—A Nonhazardous Procedure?

PubMed Central

Borgström, Anders; Fork, Frans-Thomas; Lövdahl, Eje

1994-01-01

Balloon dilatation of benign esophageal strictures has been widely used since its introduction. We have performed 224 dilatation procedures in 52 patients. Dilatation was done as an outpatient procedure. Strictures were due to reflux esophagitis in 25 patients, anastomatic stenosis in 6, achalasia in 5, complications of sclerotherapy in 5, corrosive lesions in 3, and long-standing nasogastric intubation in 2. The cause was unknown in 6 cases. The intention was to dilate all strictures up to 20 mm. Three major complications occurred, and one of these patients died. The risk of perforation seems to be higher after repeated procedures than during the first one. PMID:18493348

Cumulative Incidence of a Subsequent Surgery After Stress Urinary Incontinence and Pelvic Organ Prolapse Procedure.

PubMed

Wu, Jennifer M; Dieter, Alexis A; Pate, Virginia; Jonsson Funk, Michele

2017-06-01

To assess the 5-year risk and timing of repeat stress urinary incontinence (SUI) and pelvic organ prolapse (POP) procedures. We conducted a retrospective cohort study using a nationwide database, the 2007-2014 MarketScan Commercial Claims and Encounters and Medicare Supplemental Databases (Truven Health Analytics), which contain deidentified health care claims data from approximately 150 employer-based insurance plans across the United States. We included women aged 18-84 years and used Current Procedural Terminology codes to identify surgeries for SUI and POP. We identified index procedures for SUI or POP after at least 3 years of continuous enrollment without a prior procedure. We defined three groups of women based on the index procedure: 1) SUI surgery only; 2) POP surgery only; and 3) Both SUI+POP surgery. We assessed the occurrence of a subsequent SUI or POP procedure over time for women younger than 65 years and 65 years or older with a median follow-up time of 2 years (interquartile range 1-4). We identified a total of 138,003 index procedures: SUI only n=48,196, POP only n=49,120, and both SUI+POP n=40,687. The overall cumulative incidence of a subsequent SUI or POP surgery within 5 years after any index procedure was 7.8% (95% confidence interval [CI] 7.6-8.1) for women younger than 65 years and 9.9% (95% CI 9.4-10.4) for women 65 years or older. The cumulative incidence was lower if the initial surgery was SUI only and higher if an initial POP procedure was performed, whether POP only or SUI+POP. The 5-year risk of undergoing a repeat SUI or POP surgery was less than 10% with higher risks for women 65 years or older and for those who underwent an initial POP surgery.

Rare case-series of electrocautery burn following off-pump coronary artery bypass grafting

PubMed Central

Sabzi, Feridoun; Niazi, Mojtaba; Ahmadi, Alireza

2014-01-01

Abstract: With an increasing number of off-pump coronary artery surgery procedures in high-risk patients with coagulopathy, including renal failure, hepatic failure and anticoagulant drug-using patients, the frequency of related complications such as repeated exploration for bleeding is also increasing. The associated co-morbidity and repeated use of electrocautery in postoperative bleeding leaves patients susceptible to electrocautery ulcers. In this case series, rare cases of cautery burn with unique causative mechanisms are described. PMID:23669602

Management of Pleural Space After Lung Resection by Cryoneuroablation of Phrenic Nerve: A Randomized Study.

PubMed

Pan, Xiao-Jie; Ou, De-Bin; Lin, Xing; Ye, Ming-Fang

2017-06-01

Residual air space problems after pulmonary lobectomy are an important concern in thoracic surgical practice, and various procedures have been applied to manage them. This study describes a novel technique using controllable paralysis of the diaphragm by localized freezing of the phrenic nerve, and assesses the effectiveness of this procedure to reduce air space after pulmonary lobectomy. In this prospective randomized study, 207 patients who underwent lobectomy or bilobectomy and systematic mediastinal node dissection in our department between January 2009 and November 2013 were randomly allocated to a cryoneuroablation group or a conventional group. Patients in the cryoneuroablation group (n = 104) received phrenic nerve cryoneuroablation after lung procedures, and patients in the conventional group (n = 103) did not receive cryoneuroablation after the procedure. Data regarding preoperative clinical and surgical characteristics in both groups were collected. Both groups were compared with regard to postoperative parameters such as total amount of pleural drainage, duration of chest tube placement, length of hospital stay, requirement for repeat chest drain insertion, prolonged air leak, and residual space. Perioperative lung function was also compared in both groups. Recovery of diaphragmatic movement in the cryoneuroablation group was checked by fluoroscopy on the 15th, 30th, and 60th day after surgery. There was no statistically significant difference in patient characteristics between the 2 groups; nor was there a difference in terms of hospital stay, new drain requirement, and incidence of empyema. In comparison with the conventional group, the cryoneuroablation group had less total drainage (1024 ± 562 vs 1520 ± 631 mL, P < .05), fewer cases of residual space (9 vs 2, P < .05), fewer cases of prolonged air leak (9 vs 1, P < .01), and shorter duration of drainage (3.2 ± 0.2 vs 4.3 + 0.3 days, P < .01). Diaphragmatic paralyses caused by cryoneuroablation reversed within 30 to 60 days. Cryoneuroablation of the phrenic nerve offers a reasonable option for prevention of residual air space following major pulmonary resection.

40 CFR 59.405 - Container labeling requirements.

Code of Federal Regulations, 2012 CFR

2012-07-01

...) Repeated (frequent) heavy abrasion, including mechanical wear and repeated (frequent) scrubbing with industrial solvents, cleansers, or scouring agents; or (v) Exterior exposure of metal structures and...

The cost-effectiveness of CT-guided sacroiliac joint injections: a measure of QALY gained.

PubMed

Bydon, Mohamad; Macki, Mohamed; De la Garza-Ramos, Rafael; Youssef, Mina; Gokaslan, Ziya L; Meleka, Sherif; Bydon, Ali

2014-10-01

The purpose of this study is to estimate the total cost and the quality of life years (QALY) gained for computer tomography (CT)-guided sacroiliac joint (SIJ) injections. The cost per QALY gained for the procedure is the primary end-point of this study. In our 1-year prospective institutional study, we gathered 30 patients undergoing CT-guided SIJ injections for degenerative changes at the SIJ space. Patient-reported outcomes included both the US population-based EQ-5D (EuroQol) index score and the EQ-visual analog scale (VAS). The EQ-5D is based on mobility, self-care, usual activities, pain/discomfort, and anxiety depression. Utility expenditures were based on hospital charges at our institution. All 30 patients had one pre-injection physician visit followed by 43 initial injections (13 bilateral). Each patient underwent one CT scan, and three patients required additional plain films. In the 1 year following the injections, 26 physician visits were documented. Five patients required repeat CT-guided injections. Total 1-year cost for all 30 patients was $34 874·00. Mean decrease in EQ-VAS was 0·60 (P  =  0·187). The mean 1-year gain of 0·58 EQ-5D QALY reached statistical significance (P < 0·001). The cost per QALY gained by CT-guided sacroiliac injections was $2004·29. In one of the first cost analyses of CT-guided sacroiliac injections, we found that the procedure improves pain and activities of daily living. The cost per QALY gained by CT-guided sacroiliac injections falls well below the threshold cost of 1 QALY, suggesting that the procedure is strongly cost-effective.

Medialization thyroplasty versus injection laryngoplasty: a cost minimization analysis.

PubMed

Tam, Samantha; Sun, Hongmei; Sarma, Sisira; Siu, Jennifer; Fung, Kevin; Sowerby, Leigh

2017-02-20

Medialization thyroplasty and injection laryngoplasty are widely accepted treatment options for unilateral vocal fold paralysis. Although both procedures result in similar clinical outcomes, little is known about the corresponding medical care costs. Medialization thyroplasty requires expensive operating room resources while injection laryngoplasty utilizes outpatient resources but may require repeated procedures. The purpose of this study, therefore, is to quantify the cost differences in adult patients with unilateral vocal fold paralysis undergoing medialization thyroplasty versus injection laryngoplasty. Cost minimization analysis conducted using a decision tree model. A decision tree model was constructed to capture clinical scenarios for medialization thyroplasty and injection laryngoplasty. Probabilities for various events were obtained from a retrospective cohort from the London Health Sciences Centre, Canada. Costs were derived from the published literature and the London Health Science Centre. All costs were reported in 2014 Canadian dollars. Time horizon was 5 years. The study was conducted from an academic hospital perspective in Canada. Various sensitivity analyses were conducted to assess differences in procedure-specific costs and probabilities of key events. Sixty-three patients underwent medialization thyroplasty and 41 underwent injection laryngoplasty. Cost of medialization thyroplasty was C$2499.10 per patient whereas those treated with injection laryngoplasty cost C$943.19. Results showed that cost savings with IL were C$1555.91. Deterministic and probabilistic sensitivity analyses suggested cost savings ranged from C$596 to C$3626. Treatment with injection laryngoplasty results in cost savings of C$1555.91 per patient. Our extensive sensitivity analyses suggest that switching from medialization thyroplasty to injection laryngoplasty will lead to a minimum cost savings of C$596 per patient. Considering the significant cost savings and similar effectiveness, injection laryngoplasty should be strongly considered as a preferred treatment option for patients diagnosed with unilateral vocal fold paralysis.

Comparison of three different dressings for partial thickness burns in children: study protocol for a randomised controlled trial.

PubMed

Gee Kee, Emma; Kimble, Roy M; Cuttle, Leila; Stockton, Kellie

2013-11-25

In the paediatric population, pain and distress associated with burn injuries during wound care procedures remain a constant challenge. Although silver dressings are the gold standard for burn care in Australasia, very few high-level trials have been conducted that compare silver dressings to determine which will provide the best level of care clinically. Therefore, for paediatric patients in particular, identifying silver dressings that are associated with lower levels of pain and rapid wound re-epithelialisation is imperative. This study will determine whether there is a difference in time to re-epithelialisation and pain and distress experienced during wound care procedures among Acticoat™, Acticoat™ combined with Mepitel™ and Mepilex Ag™ dressings for acute, paediatric partial thickness burns. Children aged 0 to 15 years with an acute partial thickness (superficial partial to deep partial thickness inclusive) burn injury and a burn total body surface area of ≤ 10% will be eligible for the trial. Patients will be randomised to one of the three dressing groups: (1) Acticoat™ or (2) Acticoat™ combined with Mepitel™ or (3) Mepilex Ag™. A minimum of 28 participants will be recruited for each treatment group. Primary measures of pain, distress and healing will be repeated at each dressing change until complete wound re-epithelialisation occurs or skin grafting is required. Additional data collected will include infection status at each dressing change, physical function, scar outcome and scar management requirements, cost effectiveness of each dressing and staff perspectives of the dressings. The results of this study will determine the effects of three commonly used silver and silicone burn dressing combinations on the rate of wound re-epithelialisation and pain experienced during dressing procedures in acute, paediatric partial thickness burn injuries. Australian New Zealand Clinical Trials Registry ACTRN12613000105741.

Computer-Aided Design Of Turbine Blades And Vanes

NASA Technical Reports Server (NTRS)

Hsu, Wayne Q.

1988-01-01

Quasi-three-dimensional method for determining aerothermodynamic configuration of turbine uses computer-interactive analysis and design and computer-interactive graphics. Design procedure executed rapidly so designer easily repeats it to arrive at best performance, size, structural integrity, and engine life. Sequence of events in aerothermodynamic analysis and design starts with engine-balance equations and ends with boundary-layer analysis and viscous-flow calculations. Analysis-and-design procedure interactive and iterative throughout.

Effective local anesthesia for onabotulinumtoxin A injections to treat hyperhidrosis associated with traumatic amputation.

PubMed

Shi, Lucy L; Sargen, Michael R; Chen, Suephy C; Arbiser, Jack L; Pollack, Brian P

2016-06-15

Botulinum toxin type A (BTX-A) injections are an effective treatment for controlling hyperhidrosis at sites of amputation. Hyperesthesia associated with amputated limbs is a major barrier to performing this procedure under local anesthesia. To present a novel method for improving local anesthesia with BTX-A injections. Methods & A 29-year-old military veteran with a below-the-knee amputation of his right leg was suffering from amputation site hyperhidrosis, which was impeding his ability to comfortably wear a prosthesis. Prior to presenting to our clinic, the patient received one treatment of BTX-A injections to his amputation stump while under general anesthesia for surgical repair of trauma-related injuries. In our dermatology clinic, we repeated the procedure using topical lidocaine-prilocaine (30 gm total) for local anesthesia. This provided effective relief of hyperhidrosis for 6 months, but the procedure was very painful (9/10 intensity). We repeated the same procedure 6 months later, using ice in addition to topical lidocaine-prilocaine (30 gm) for local anesthesia; this resulted in reduced pain (3/10 intensity) for the patient. We suggest using ice in combination with a topical anesthetic as an effective method for pain control that avoids general anesthesia in treating amputation-associated hyperhidrosis.

A method for improving the accuracy of stereotaxic procedures in monkeys using implanted fiducial markers in CT scans that also serve as anchor points in a stereotaxic frame.

PubMed

Risher, D W; Zhang, X; Kostarczyk, E; Gokin, A P; Honda, C N; Giesler, G J

1997-04-25

We developed a relatively inexpensive method for stereotaxic placement of electrodes or needles in the brains of monkeys. Steel balls were affixed to the skulls of monkeys. These balls served as fiducial markers and were also used as points at which the monkey's skull was held in a modified stereotaxic apparatus. Computed tomography (CT) was used to establish the location of an injection target with respect to the fiducial markers. A computer program related the CT coordinates to stereotaxic coordinates. These were used to direct an electrode marker toward a target in the hypothalamus. With the marker left in place, the monkey was removed from the stereotaxic frame and a second CT scan was performed. Corrections for errors in marker placement were made and retrograde tracers were injected. This procedure was found to be more accurate and reliable than conventional stereotaxic procedures. The accuracy and repeatability of the technique were also established using a phantom model of a monkey's skull. Two important advantages of this method are that animals can be repeatedly placed into the stereotaxic frame in precisely the same position and that there are many opportunities during the procedure to check for and correct errors.

PH Tester Gauge Repeatability and Reproducibility Study for WO3 Nanostructure Hydrothermal Growth Process

NASA Astrophysics Data System (ADS)

Abd Rashid, Amirul; Hayati Saad, Nor; Bien Chia Sheng, Daniel; Yee, Lee Wai

2014-06-01

PH value is one of the important variables for tungsten trioxide (WO3) nanostructure hydrothermal synthesis process. The morphology of the synthesized nanostructure can be properly controlled by measuring and controlling the pH value of the solution used in this facile synthesis route. Therefore, it is very crucial to ensure the gauge used for pH measurement is reliable in order to achieve the expected result. In this study, gauge repeatability and reproducibility (GR&R) method was used to assess the repeatability and reproducibility of the pH tester. Based on ANOVA method, the design of experimental metrics as well as the result of the experiment was analyzed using Minitab software. It was found that the initial GR&R value for the tester was at 17.55 % which considered as acceptable. To further improve the GR&R level, a new pH measuring procedure was introduced. With the new procedure, the GR&R value was able to be reduced to 2.05%, which means the tester is statistically very ideal to measure the pH of the solution prepared for WO3 hydrothermal synthesis process.

Analyzing Web pages visual scanpaths: between and within tasks variability.

PubMed

Drusch, Gautier; Bastien, J M Christian

2012-01-01

In this paper, we propose a new method for comparing scanpaths in a bottom-up approach, and a test of the scanpath theory. To do so, we conducted a laboratory experiment in which 113 participants were invited to accomplish a set of tasks on two different websites. For each site, they had to perform two tasks that had to be repeated ounce. The data were analyzed using a procedure similar to the one used by Duchowski et al. [8]. The first step was to automatically identify, then label, AOIs with the mean-shift clustering procedure [19]. Then, scanpaths were compared two by two with a modified version of the string-edit method, which take into account the order of AOIs visualizations [2]. Our results show that scanpaths variability between tasks but within participants seems to be lower than the variability within task for a given participant. In other words participants seem to be more coherent when they perform different tasks, than when they repeat the same tasks. In addition, participants view more of the same AOI when they perform a different task on the same Web page than when they repeated the same task. These results are quite different from what predicts the scanpath theory.

Neurocognitive assessment in patients with a minor traumatic brain injury and an abnormal initial CT scan: Can cognitive evaluation assist in identifying patients who require surveillance CT brain imaging?

PubMed

Clements, Thomas W; Dunham, Michael; Kirkpatrick, Andrew; Rajakumar, Ruphus; Gratton, Carolyn; Lall, Rohan; McBeth, Paul; Ball, Chad G

2018-05-01

Evidence for repeat computed tomography (CT) in minor traumatic brain injury (mTBI) patients with intracranial pathology is scarce. The aim of this study was to investigate the utility of clinical cognitive assessment (COG) in defining the need for repeat imaging. COG performance was compared with findings on subsequent CT, and need for neurosurgery in mTBI patients (GCS 13-15 and positive CT findings). Of 152 patients, 65.8% received a COG (53.0% passed). Patients with passed COG underwent fewer repeat CT (43.4% vs. 78.7%; p = .001) and had shorter LOS (8.7 vs. 19.5; p < .05). Only 1 patient required neurosurgery after a passed COG. The negative predictive value of a normal COG was 90.6% (95%CI = 81.8%-95.4%). mTBI patients with an abnormal index CT who pass COG are less likely to undergo repeat CT head, and rarely require neurosurgery. The COG warrants further investigation to determine its role in omitting repeat head CT. Copyright © 2018 Elsevier Inc. All rights reserved.

40 CFR 1066.20 - Units of measure and overview of calculations.

Code of Federal Regulations, 2014 CFR

2014-07-01

... POLLUTION CONTROLS VEHICLE-TESTING PROCEDURES Applicability and General Provisions § 1066.20 Units of..., repeatability, linearity, or noise specification. See 40 CFR 1065.1001 for the definition of tolerance. In this...

Rational design of alpha-helical tandem repeat proteins with closed architectures

PubMed Central

Doyle, Lindsey; Hallinan, Jazmine; Bolduc, Jill; Parmeggiani, Fabio; Baker, David; Stoddard, Barry L.; Bradley, Philip

2015-01-01

Tandem repeat proteins, which are formed by repetition of modular units of protein sequence and structure, play important biological roles as macromolecular binding and scaffolding domains, enzymes, and building blocks for the assembly of fibrous materials1,2. The modular nature of repeat proteins enables the rapid construction and diversification of extended binding surfaces by duplication and recombination of simple building blocks3,4. The overall architecture of tandem repeat protein structures – which is dictated by the internal geometry and local packing of the repeat building blocks – is highly diverse, ranging from extended, super-helical folds that bind peptide, DNA, and RNA partners5–9, to closed and compact conformations with internal cavities suitable for small molecule binding and catalysis10. Here we report the development and validation of computational methods for de novo design of tandem repeat protein architectures driven purely by geometric criteria defining the inter-repeat geometry, without reference to the sequences and structures of existing repeat protein families. We have applied these methods to design a series of closed alpha-solenoid11 repeat structures (alpha-toroids) in which the inter-repeat packing geometry is constrained so as to juxtapose the N- and C-termini; several of these designed structures have been validated by X-ray crystallography. Unlike previous approaches to tandem repeat protein engineering12–20, our design procedure does not rely on template sequence or structural information taken from natural repeat proteins and hence can produce structures unlike those seen in nature. As an example, we have successfully designed and validated closed alpha-solenoid repeats with a left-handed helical architecture that – to our knowledge – is not yet present in the protein structure database21. PMID:26675735

Effect of live music therapy for patients undergoing magnetic resonance imaging.

PubMed

Walworth, Darcy D

2010-01-01

The purpose of the current study was to identify the effects of live music therapy interventions compared with preferred recorded music for patients undergoing MRI scans. To date, there has not been a published study involving the use of live music therapy during MRI scans. The current study investigated the differences between teenage through adult patients receiving live music therapy intervention during outpatient MRI scans versus the standard protocol of care listening to recorded music (N = 88). Subjects ranged in age from 15 to 93 years old. Results indicated subjects who received the live music therapy protocol reported significantly better perception of the MRI procedure (p < 0.05). Additionally, subjects receiving the live music therapy protocol had fewer scans repeated due to movement. Of the repeated images, 26% occurred in the live music group and 73% occurred in the recorded music group. Subjects receiving live music therapy also requested less breaks from the scan. Two percent of the live music subjects requested a break and 17.6% of the control patients requested breaks. When comparing the same type of scan between groups, subjects receiving the live music protocol required less time to complete the scans. For lumbar scans without contrast (N = 14, n = 7, n = 7), live music subjects spent an average of 4.63 less min per scan for a total of 32 less min for 7 subjects. For brain scans (N = 8, n = 4, n = 4), live music subjects spent an average of 5.8 less min per scan for a total of 23 less min for 4 subjects. Results of the current study supports the use of live music therapy intervention for teenage and adult patients undergoing MRI scans to reduce patient anxiety and improve patient perception of the scan experience. Additionally, live music therapy has the potential to shorten the length of time required for patients to complete MRI scans due to decreased patient movements and fewer breaks requested during the scans. The cost savings impact of reduced procedure time can positively impact the facility productivity by allowing more scans to be scheduled daily.

Cost Savings Associated with the Adoption of a Cloud Computing Data Transfer System for Trauma Patients.

PubMed

Feeney, James M; Montgomery, Stephanie C; Wolf, Laura; Jayaraman, Vijay; Twohig, Michael

2016-09-01

Among transferred trauma patients, challenges with the transfer of radiographic studies include problems loading or viewing the studies at the receiving hospitals, and problems manipulating, reconstructing, or evalu- ating the transferred images. Cloud-based image transfer systems may address some ofthese problems. We reviewed the charts of patients trans- ferred during one year surrounding the adoption of a cloud computing data transfer system. We compared the rates of repeat imaging before (precloud) and af- ter (postcloud) the adoption of the cloud-based data transfer system. During the precloud period, 28 out of 100 patients required 90 repeat studies. With the cloud computing transfer system in place, three out of 134 patients required seven repeat films. There was a statistically significant decrease in the proportion of patients requiring repeat films (28% to 2.2%, P < .0001). Based on an annualized volume of 200 trauma patient transfers, the cost savings estimated using three methods of cost analysis, is between $30,272 and $192,453.

Effects of repeated administration of chemotherapeutic agents tamoxifen, methotrexate, and 5-fluorouracil on the acquisition and retention of a learned response in mice

PubMed Central

Foley, John J.; Clark-Vetri, Rachel; Raffa, Robert B.

2011-01-01

Rationale A number of cancer chemotherapeutic agents have been associated with a loss of memory in breast cancer patients although little is known of the causality of this effect. Objectives To assess the potential cognitive effects of repeated exposure to chemotherapeutic agents, we administered the selective estrogen receptor modulator tamoxifen or the antimetabolite chemotherapy, methotrexate, and 5-fluorouracil, alone and in combination to mice and tested them in a learning and memory assay. Methods Swiss-Webster male mice were injected with saline, 32 mg/kg tamoxifen, 3.2 or 32 mg/kg methotrexate, 75 mg/kg 5-fluorouracil, 3.2 or 32 mg/kg methotrexate in combination with 75 mg/kg 5-fluorouracil once per week for 3 weeks. On days 23 and 24, mice were tested for acquisition and retention of a nose-poke response in a learning procedure called autoshaping. In addition, the acute effects of tamoxifen were assessed in additional mice in a similar procedure. Results The chemotherapeutic agents alone and in combination reduced body weight relative to saline treatment over the course of 4 weeks. Repeated treatment with tamoxifen produced both acquisition and retention effects relative to the saline-treated group although acute tamoxifen was without effect except at a behaviorally toxic dose. Repeated treatment with methotrexate in combination with 5-fluorouracil produced effects on retention, but the magnitude of these changes depended on the methotrexate dose. Conclusions These data demonstrate that repeated administration of tamoxifen or certain combination of methotrexate and 5-fluorouracil may produce deficits in the acquisition or retention of learned responses which suggest potential strategies for prevention or remediation might be considered in vulnerable patient populations. PMID:21537942

Improved variance estimation of classification performance via reduction of bias caused by small sample size.

PubMed

Wickenberg-Bolin, Ulrika; Göransson, Hanna; Fryknäs, Mårten; Gustafsson, Mats G; Isaksson, Anders

2006-03-13

Supervised learning for classification of cancer employs a set of design examples to learn how to discriminate between tumors. In practice it is crucial to confirm that the classifier is robust with good generalization performance to new examples, or at least that it performs better than random guessing. A suggested alternative is to obtain a confidence interval of the error rate using repeated design and test sets selected from available examples. However, it is known that even in the ideal situation of repeated designs and tests with completely novel samples in each cycle, a small test set size leads to a large bias in the estimate of the true variance between design sets. Therefore different methods for small sample performance estimation such as a recently proposed procedure called Repeated Random Sampling (RSS) is also expected to result in heavily biased estimates, which in turn translates into biased confidence intervals. Here we explore such biases and develop a refined algorithm called Repeated Independent Design and Test (RIDT). Our simulations reveal that repeated designs and tests based on resampling in a fixed bag of samples yield a biased variance estimate. We also demonstrate that it is possible to obtain an improved variance estimate by means of a procedure that explicitly models how this bias depends on the number of samples used for testing. For the special case of repeated designs and tests using new samples for each design and test, we present an exact analytical expression for how the expected value of the bias decreases with the size of the test set. We show that via modeling and subsequent reduction of the small sample bias, it is possible to obtain an improved estimate of the variance of classifier performance between design sets. However, the uncertainty of the variance estimate is large in the simulations performed indicating that the method in its present form cannot be directly applied to small data sets.

Improving power to detect changes in blood miRNA expression by accounting for sources of variability in experimental designs.

PubMed

Daniels, Sarah I; Sillé, Fenna C M; Goldbaum, Audrey; Yee, Brenda; Key, Ellen F; Zhang, Luoping; Smith, Martyn T; Thomas, Reuben

2014-12-01

Blood miRNAs are a new promising area of disease research, but variability in miRNA measurements may limit detection of true-positive findings. Here, we measured sources of miRNA variability and determine whether repeated measures can improve power to detect fold-change differences between comparison groups. Blood from healthy volunteers (N = 12) was collected at three time points. The miRNAs were extracted by a method predetermined to give the highest miRNA yield. Nine different miRNAs were quantified using different qPCR assays and analyzed using mixed models to identify sources of variability. A larger number of miRNAs from a publicly available blood miRNA microarray dataset with repeated measures were used for a bootstrapping procedure to investigate effects of repeated measures on power to detect fold changes in miRNA expression for a theoretical case-control study. Technical variability in qPCR replicates was identified as a significant source of variability (P < 0.05) for all nine miRNAs tested. Variability was larger in the TaqMan qPCR assays (SD = 0.15-0.61) versus the qScript qPCR assays (SD = 0.08-0.14). Inter- and intraindividual and extraction variability also contributed significantly for two miRNAs. The bootstrapping procedure demonstrated that repeated measures (20%-50% of N) increased detection of a 2-fold change for approximately 10% to 45% more miRNAs. Statistical power to detect small fold changes in blood miRNAs can be improved by accounting for sources of variability using repeated measures and choosing appropriate methods to minimize variability in miRNA quantification. This study demonstrates the importance of including repeated measures in experimental designs for blood miRNA research. See all the articles in this CEBP Focus section, "Biomarkers, Biospecimens, and New Technologies in Molecular Epidemiology." ©2014 American Association for Cancer Research.

Measurements of Repeated Tightening and Loosening Torque of Seven Different Implant/Abutment Connection Designs and Their Modifications: An In Vitro Study.

PubMed

Butkevica, Alena; Nathanson, Dan; Pober, Richard; Strating, Herman

2018-02-01

Repeated tightening and loosening of the abutment screw may alter its mechanical and physical properties affecting the optimal torque and ultimate reliability of an implant/abutment connection. The purpose of this study was to evaluate the effect of repeated tightening and loosening of implant/abutment screws on the loosening torque of implant/abutment connections of commercially available implant systems. Seven different implant/abutment connections and their modifications were tested. The screws of each system were tightened according to the manufacturer's specifications. After 20 minutes the screws were loosened. This procedure was repeated ten times, and the differences between the 1st and 10th cycle were expressed as a percentage change RTq(%) and correlated with initial torque, the number of threads, the length of shank, and thread surface area employing Spearman's analysis. All systems showed significant differences in residual torque (RTq) value (p < 0.05) between the 1st and 10th cycle except groups 6 and 11 (p > 0.05). All connections but group 3 (p = 1.000) showed a significant change from the initial torque (ITq) to the RTq values. The first successive RTq values increased in two connection groups 1 and 2. The remaining connections showed reduced RTq values ranging from -1.2 % (group 5) to -23.5% (group 6). The RTq values declined gradually with every repeated tightening in groups 1, 2, 3, 8, 9, 11, 12. In group 2, after the tenth tightening the RTq was still above the ITq value. Only length of shank demonstrated a correlation with the RTq(%) change over the successive tightening loosening cycles (p < 0.05). Repeated tightening and loosening of implant/abutment screws caused varying torque level changes among the different systems. These observations can probably be attributed to connection design. Limiting the number of tightening/loosening cycles in clinical and laboratory procedures is advisable for most of the implant systems tested. © 2016 by the American College of Prosthodontists.

Comparison of Right and Left Upper Limb Arterial Variants in Patients Undergoing Bilateral Transradial Procedures.

PubMed

Burzotta, Francesco; Brancati, Marta Francesca; Porto, Italo; Saffioti, Silvia; Aurigemma, Cristina; Niccoli, Giampaolo; Leone, Antonio Maria; Coluccia, Valentina; Crea, Filippo; Trani, Carlo

2015-12-01

Transradial approach (TRA), when compared with transfemoral, improves the safety of percutaneous coronary procedures. Arterial axis variants are known to hinder the performance of transradial approach percutaneous coronary procedures. Data on the occurrence of arterial axis variants in the right and left arm arterial axes of individual patients are lacking. From a single-center prospective registry, we selected all patients in whom bilateral upper limb arterial anatomy was assessed based on the performance of left and right radial catheterization obtained during the same or during repeat coronary diagnostic or interventional procedure(s). The occurrence of upper right and left limb arterial axis variants was classified according to the previously described operative ABC classification. A total of 610 patients were identified. An ABC upper limb arterial axis variant was detected in 156 (25.6%) patients. Variants were right-sided only in 65 (11.0%), left-sided only in 40 (6.6%), and bilateral in 46 (7.5%) patients. Thus, arterial axis variants were significantly more common in the right side (P=0.02). Bilateral arterial variants were significantly associated with age, female sex, and valvulopathy. Both A (radial/brachial) and B (axillary/subclavian/innominate) variants exhibited concordance across the 2 sides (odds ratio, 7.2; 95% confidence interval, 4.1-12.7 and 8.0; 95% confidence interval, 2.1-30.9, respectively). The occurrence of an anatomic variant potentially hindering transradial approach coronary diagnostic or interventional procedures is bilateral in <8% of cases and is more common in the right arm. Such information may guide, during the clinical practice, the access selection in the case of repeat procedures or need for additional accesses. © 2015 American Heart Association, Inc.

[Does repeated endometrial destruction procedure decrease abnormal uterine bleeding, and does it reduce the number of hysterectomies in this indication?].

PubMed

Levy-Zauberman, Y; Fernandez, H; Pourcelot, A-G; Legendre, G

2014-01-01

Hysteroscopic endometrial resection or destruction in the indication of abnormal uterine bleeding or post-menopausal bleeding represents an alternative to hysterectomy, as it carries a lower morbidity rate. In case of failure of such procedure though, hysterectomy will most often be proposed as a second line of treatment. The place of the repetition of an endometrial destruction procedure has not yet been evaluated. The aim of our study is to evaluate the efficiency and the satisfaction after two consecutive techniques of endometrial destruction in case of abnormal uterine bleeding or post-menopausal bleeding. Nineteen patients presenting with recurring abnormal uterine bleeding after one procedure of endometrial destruction, underwent in our department, between 2004 and 2011, a second conservative endometrial procedure. No complication occurred during the repeated procedure. Sixteen of the nineteen patients (84.2 %) included answered a questionnaire. The mean delay since the second procedure was 27 months [25; 29]. Eight patients (i.e. 50 %) later underwent a hysterectomy, with 5 of them (31.25 % of all 16 patients) being directly attributed to treatment failure. Patients said to be satisfied with the management of their condition in 68.75 % of cases, and 93.75 % of them would recommend it to a friend. Our results suggest that a second conservative management in case of recurrence of AUB is effective. Hysterectomy could be avoided in 50 % of cases. A second conservative treatment could be an interesting option for patients with medical contra-indication for heavier surgery, as well as for patients willing to keep their uterus. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

The effects of the Cox maze procedure on atrial function

PubMed Central

Voeller, Rochus K.; Zierer, Andreas; Lall, Shelly C.; Sakamoto, Shun–ichiro; Chang, Nai–Lun; Schuessler, Richard B.; Moon, Marc R.; Damiano, Ralph J.

2010-01-01

Objective The effects of the Cox maze procedure on atrial function remain poorly defined. The purpose of this study was to investigate the effects of a modified Cox maze procedure on left and right atrial function in a porcine model. Methods After cardiac magnetic resonance imaging, 6 pigs underwent pericardiotomy (sham group), and 6 pigs underwent a modified Cox maze procedure (maze group) with bipolar radiofrequency ablation. The maze group had preablation and immediate postablation left and right atrial pressure–volume relations measured with conductance catheters. All pigs survived for 30 days. Magnetic resonance imaging was then repeated for both groups, and conductance catheter measurements were repeated for the right atrium in the maze group. Results Both groups had significantly higher left atrial volumes postoperatively. Magnetic resonance imaging–derived reservoir and booster pump functional parameters were reduced postoperatively for both groups, but there was no difference in these parameters between the groups. The maze group had significantly higher reduction in the medial and lateral left atrial wall contraction postoperatively. There was no change in immediate left atrial elastance or in the early and 30-day right atrial elastance after the Cox maze procedure. Although the initial left atrial stiffness increased after ablation, right atrial diastolic stiffness did not change initially or at 30 days. Conclusions Performing a pericardiotomy alone had a significant effect on atrial function that can be quantified by means of magnetic resonance imaging. The effects of the Cox maze procedure on left atrial function could only be detected by analyzing segmental wall motion. Understanding the precise physiologic effects of the Cox maze procedure on atrial function will help in developing less-damaging lesion sets for the surgical treatment of atrial fibrillation. PMID:19026812

Technical Note: Unified imaging and robotic couch quality assurance.

PubMed

Cook, Molly C; Roper, Justin; Elder, Eric S; Schreibmann, Eduard

2016-09-01

To introduce a simplified quality assurance (QA) procedure that integrates tests for the linac's imaging components and the robotic couch. Current QA procedures for evaluating the alignment of the imaging system and linac require careful positioning of a phantom at isocenter before image acquisition and analysis. A complementary procedure for the robotic couch requires an initial displacement of the phantom and then evaluates the accuracy of repositioning the phantom at isocenter. We propose a two-in-one procedure that introduces a custom software module and incorporates both checks into one motion for increased efficiency. The phantom was manually set with random translational and rotational shifts, imaged with the in-room imaging system, and then registered to the isocenter using a custom software module. The software measured positioning accuracy by comparing the location of the repositioned phantom with a CAD model of the phantom at isocenter, which is physically verified using the MV port graticule. Repeatability of the custom software was tested by an assessment of internal marker location extraction on a series of scans taken over differing kV and CBCT acquisition parameters. The proposed method was able to correctly position the phantom at isocenter within acceptable 1 mm and 1° SRS tolerances, verified by both physical inspection and the custom software. Residual errors for mechanical accuracy were 0.26 mm vertically, 0.21 mm longitudinally, 0.55 mm laterally, 0.21° in pitch, 0.1° in roll, and 0.67° in yaw. The software module was shown to be robust across various scan acquisition parameters, detecting markers within 0.15 mm translationally in kV acquisitions and within 0.5 mm translationally and 0.3° rotationally across CBCT acquisitions with significant variations in voxel size. Agreement with vendor registration methods was well within 0.5 mm; differences were not statistically significant. As compared to the current two-step approach, the proposed QA procedure streamlines the workflow, accounts for rotational errors in imaging alignment, and simulates a broad range of variations in setup errors seen in clinical practice.

Treatment of male urethral strictures - possible reasons for the use of repeated dilatation or internal urethrotomy rather than urethroplasty.

PubMed

Heyns, C F; van der Merwe, J; Basson, J; van der Merwe, A

2012-07-16

To investigate the possible reasons for repeated urethral dilatation or optical internal urethrotomy rather than urethroplasty in the treatment of male urethral strictures. Men referred to the stricture clinic of our institution during the period April 2007 - March 2008 were reviewed and the operative urological procedures performed in the same period were analysed. Statistical analysis was performed using Student's t-test and Fisher's exact test (p<0.05 statistically significant). The mean age of the 125 men was 49.9 years (range 12.8 - 93.4 years). Previous stricture treatment had been given 1 - 2, 3 - 4 and 5 - 6 times in 52%, 32% and 12% of patients, respectively (4% had not undergone treatment). In these groups, previous treatment was dilatation in 70%, 76% and 72%, urethrotomy in 26%, 15% and 28%, and urethroplasty in 4%, 9% and 0, respectively. The group with 5 - 6 compared with 1 - 2 previous treatments was significantly older (mean age 60.2 v. 46.6 years) and had a significantly greater proportion with underlying co-morbidities (80% v. 52%). The group that had undergone urethroplasty compared with 5 - 6 repeated dilatations or urethrotomies was significantly younger (mean age 48.2 v. 60.2 years) with a lower prevalence of co-morbidities (47% v. 80%). During the study period urethroplasty was performed in 16 (2%) of 821 inpatients, whereas 55 men were seen who had undergone ≥3 previous procedures, indicating that urethroplasty was performed in less than one-third of cases in which it would have been the optimal treatment. Owing to limited theatre time, procedures indicated for malignancy, urolithiasis, renal failure and congenital anomalies were performed more often than urethroplasty. Factors that possibly influenced the decision to perform repeated urethrotomy or dilatation instead of urethroplasty were limited theatre time, increased patient age and the presence of underlying co-morbidities.

Consensus and controversies in best practices for molecular genetic testing of spinocerebellar ataxias

PubMed Central

Sequeiros, Jorge; Seneca, Sara; Martindale, Joanne

2010-01-01

Many laboratories worldwide are offering molecular genetic testing for spinocerebellar ataxias (SCAs). This is essential for differential diagnosis and adequate genetic counselling. The European Molecular Genetics Quality Network (EMQN) started an SCA external quality assessment scheme in 2004. There was a clear need for updated laboratory guidelines. EMQN and EuroGentest organized a Best Practice (BP) meeting to discuss current practices and achieve consensus. A pre-meeting survey showed that 36 laboratories (20 countries) conducted nearly 18 000 SCA tests the year before, and identified issues to discuss. Draft guidelines were produced immediately after the meeting and discussed online for several months. The final version was endorsed by EMQN, and harmonized with guidelines from other oligonucleotide repeat disorders. We present the procedures taken to organize the survey, BP meeting, as well as drafting and approval of BP guidelines. We emphasize the most important recommendations on (1) pre-test requirements, (2) appropriate methodologies and (3) interpretation and reporting, and focus on the discussion of controversial issues not included in the final document. In addition, after an extensive review of scientific literature, and responding to recommendations made, we now produce information that we hope will facilitate the activities of diagnostic laboratories and foster quality SCA testing. For the main loci, this includes (1) a list of repeat sequences, as originally published; (2) primers in use; and (3) an evidence-based description of the normal and pathogenic repeat-size ranges, including those of reduced penetrance and those in which there is still some uncertainty. This information will be maintained and updated in http://www.scabase.eu. PMID:20179748

Systematic review and meta-analysis of colon cleansing preparations in patients with inflammatory bowel disease

PubMed Central

Restellini, Sophie; Kherad, Omar; Bessissow, Talat; Ménard, Charles; Martel, Myriam; Taheri Tanjani, Maryam; Lakatos, Peter L; Barkun, Alan N

2017-01-01

AIM To performed a systematic review and meta-analysis to determine any possible differences in terms of effectiveness, safety and tolerability between existing colon-cleansing products in patients with inflammatory bowel disease. METHODS Systematic searches were performed (January 1980-September 2016) using MEDLINE, EMBASE, Scopus, CENTRAL and ISI Web of knowledge for randomized trials assessing preparations with or without adjuvants, given in split and non-split dosing, and in high (> 3 L) or low-volume (2 L or less) regimens. Bowel cleansing quality was the primary outcome. Secondary outcomes included patient willingness-to-repeat the procedure and side effects/complications. RESULTS Out of 439 citations, 4 trials fulfilled our inclusion criteria (n = 449 patients). One trial assessed the impact of adding simethicone to polyethylene glycol (PEG) 4 L with no effect on bowel cleansing quality, but a better tolerance. Another trial compared senna to castor oil, again without any differences in term of bowel cleansing. Two trials compared the efficacy of PEG high-volume vs PEG low-volume associated to an adjuvant in split-dose regimens: PEG low-dose efficacy was not different to PEG high-dose; OR = 0.84 (0.37-1.92). A higher proportion of patients were willing to repeat low-volume preparations vs high-volume; OR = 5.11 (1.31-20.0). CONCLUSION In inflammatory bowel disease population, PEG low-volume regimen seems not inferior to PEG high-volume to clean the colon, and yields improved willingness-to-repeat. Further additional research is urgently required to compare contemporary products in this population. PMID:28932092

Systematic review and meta-analysis of colon cleansing preparations in patients with inflammatory bowel disease.

PubMed

Restellini, Sophie; Kherad, Omar; Bessissow, Talat; Ménard, Charles; Martel, Myriam; Taheri Tanjani, Maryam; Lakatos, Peter L; Barkun, Alan N

2017-08-28

To performed a systematic review and meta-analysis to determine any possible differences in terms of effectiveness, safety and tolerability between existing colon-cleansing products in patients with inflammatory bowel disease. Systematic searches were performed (January 1980-September 2016) using MEDLINE, EMBASE, Scopus, CENTRAL and ISI Web of knowledge for randomized trials assessing preparations with or without adjuvants, given in split and non-split dosing, and in high (> 3 L) or low-volume (2 L or less) regimens. Bowel cleansing quality was the primary outcome. Secondary outcomes included patient willingness-to-repeat the procedure and side effects/complications. Out of 439 citations, 4 trials fulfilled our inclusion criteria ( n = 449 patients). One trial assessed the impact of adding simethicone to polyethylene glycol (PEG) 4 L with no effect on bowel cleansing quality, but a better tolerance. Another trial compared senna to castor oil, again without any differences in term of bowel cleansing. Two trials compared the efficacy of PEG high-volume vs PEG low-volume associated to an adjuvant in split-dose regimens: PEG low-dose efficacy was not different to PEG high-dose; OR = 0.84 (0.37-1.92). A higher proportion of patients were willing to repeat low-volume preparations vs high-volume; OR = 5.11 (1.31-20.0). In inflammatory bowel disease population, PEG low-volume regimen seems not inferior to PEG high-volume to clean the colon, and yields improved willingness-to-repeat. Further additional research is urgently required to compare contemporary products in this population.

Outcomes of repeat revascularization in diabetic patients with prior coronary surgery.

PubMed

Cole, Jason H; Jones, Ellis L; Craver, Joseph M; Guyton, Robert A; Morris, Douglas C; Douglas, John S; Ghazzal, Ziyad; Weintraub, William S

2002-12-04

This study evaluated both short- and long-term outcomes of diabetic patients who underwent repeat coronary artery bypass graft surgery (CABG) or percutaneous coronary intervention (PCI) after initial CABG. Although diabetic patients who have multivessel coronary disease and require initial revascularization may benefit from CABG as compared with PCI, the uncertainty concerning the choice of revascularization may be greater for diabetic patients who have had previous CABG. Data were obtained over 15 years for diabetic patients undergoing PCI procedures or repeat CABG after previous coronary surgery. Baseline characteristics were compared between groups, and in-hospital, 5-year, and 10-year mortality rates were calculated. Multivariate correlates of in-hospital and long-term mortality were determined. Both PCI (n = 1,123) and CABG (n = 598) patients were similar in age, gender, years of diabetes, and insulin dependence, but they varied in presence of hypertension, prior myocardial infarction, angina severity, heart failure, ejection fraction, and left main disease. In-hospital mortality was greater for CABG, but differences in long-term mortality were not significant (10 year mortality, 68% PCI vs. 74% CABG, p = 0.14). Multivariate correlates of long-term mortality were older age, hypertension, low ejection fraction, and an interaction between heart failure and choice of PCI. The PCI itself did not correlate with mortality. The increased initial risk of redo CABG in diabetic patients and the comparable high long-term mortality regardless of type of intervention suggest that, except for patients with severe heart failure, PCI be strongly considered in all patients for whom there is a percutaneous alternative.

Colorimetry and SERS dual-mode detection of telomerase activity: combining rapid screening with high sensitivity.

PubMed

Zong, Shenfei; Wang, Zhuyuan; Chen, Hui; Hu, Guohua; Liu, Min; Chen, Peng; Cui, Yiping

2014-01-01

As an important biomarker and therapeutic target, telomerase has attracted considerable attention concerning its detection and monitoring. Here, we present a colorimetry and surface enhanced Raman scattering (SERS) dual-mode telomerase activity detection method, which has several distinctive advantages. First, colorimetric functionality allows rapid preliminary discrimination of telomerase activity by the naked eye. Second, the employment of SERS technique results in greatly improved detection sensitivity. Third, the combination of colorimetry and SERS into one detection system can ensure highly efficacious and sensitive screening of numerous samples. Besides, the avoidance of polymerase chain reaction (PCR) procedures further guarantees fine reliability and simplicity. Generally, the presented method is realized by an "elongate and capture" procedure. To be specific, gold nanoparticles modified with Raman molecules and telomeric repeat complementary oligonucleotide are employed as the colorimetric-SERS bifunctional reporting nanotag, while magnetic nanoparticles functionalized with telomerase substrate oligonucleotide are used as the capturing substrate. Telomerase can synthesize and elongate telomeric repeats onto the capturing substrate. The elongated telomeric repeats subsequently facilitate capturing of the reporting nanotag via hybridization between telomeric repeat and its complementary strand. The captured nanotags can cause a significant difference in the color and SERS intensity of the magnetically separated sediments. Thus both the color and SERS can be used as indicators of the telomerase activity. With fast screening ability and outstanding sensitivity, we anticipate that this method would greatly promote practical application of telomerase-based early-stage cancer diagnosis.

The Peculiar Landscape of Repetitive Sequences in the Olive (Olea europaea L.) Genome

PubMed Central

Barghini, Elena; Natali, Lucia; Cossu, Rosa Maria; Giordani, Tommaso; Pindo, Massimo; Cattonaro, Federica; Scalabrin, Simone; Velasco, Riccardo; Morgante, Michele; Cavallini, Andrea

2014-01-01

Analyzing genome structure in different species allows to gain an insight into the evolution of plant genome size. Olive (Olea europaea L.) has a medium-sized haploid genome of 1.4 Gb, whose structure is largely uncharacterized, despite the growing importance of this tree as oil crop. Next-generation sequencing technologies and different computational procedures have been used to study the composition of the olive genome and its repetitive fraction. A total of 2.03 and 2.3 genome equivalents of Illumina and 454 reads from genomic DNA, respectively, were assembled following different procedures, which produced more than 200,000 differently redundant contigs, with mean length higher than 1,000 nt. Mapping Illumina reads onto the assembled sequences was used to estimate their redundancy. The genome data set was subdivided into highly and medium redundant and nonredundant contigs. By combining identification and mapping of repeated sequences, it was established that tandem repeats represent a very large portion of the olive genome (∼31% of the whole genome), consisting of six main families of different length, two of which were first discovered in these experiments. The other large redundant class in the olive genome is represented by transposable elements (especially long terminal repeat-retrotransposons). On the whole, the results of our analyses show the peculiar landscape of the olive genome, related to the massive amplification of tandem repeats, more than that reported for any other sequenced plant genome. PMID:24671744

The peculiar landscape of repetitive sequences in the olive (Olea europaea L.) genome.

PubMed

Barghini, Elena; Natali, Lucia; Cossu, Rosa Maria; Giordani, Tommaso; Pindo, Massimo; Cattonaro, Federica; Scalabrin, Simone; Velasco, Riccardo; Morgante, Michele; Cavallini, Andrea

2014-04-01

Analyzing genome structure in different species allows to gain an insight into the evolution of plant genome size. Olive (Olea europaea L.) has a medium-sized haploid genome of 1.4 Gb, whose structure is largely uncharacterized, despite the growing importance of this tree as oil crop. Next-generation sequencing technologies and different computational procedures have been used to study the composition of the olive genome and its repetitive fraction. A total of 2.03 and 2.3 genome equivalents of Illumina and 454 reads from genomic DNA, respectively, were assembled following different procedures, which produced more than 200,000 differently redundant contigs, with mean length higher than 1,000 nt. Mapping Illumina reads onto the assembled sequences was used to estimate their redundancy. The genome data set was subdivided into highly and medium redundant and nonredundant contigs. By combining identification and mapping of repeated sequences, it was established that tandem repeats represent a very large portion of the olive genome (∼31% of the whole genome), consisting of six main families of different length, two of which were first discovered in these experiments. The other large redundant class in the olive genome is represented by transposable elements (especially long terminal repeat-retrotransposons). On the whole, the results of our analyses show the peculiar landscape of the olive genome, related to the massive amplification of tandem repeats, more than that reported for any other sequenced plant genome.

Assessment of safety and efficacy of an indigenous self-expandable fully covered esophageal metal stent for palliation of esophageal cancer.

PubMed

Padhan, R K; Nongthombam, S K; Venuthurimilli, A; Dhingra, R; Sahni, P; Garg, P K

2016-01-01

Patients with unresectable esophageal cancer require palliation for dysphagia. Placement of a self-expandable metal stent (SEMS) is the procedure of choice for palliation of dysphagia. To evaluate the safety and efficacy of an indigenous fully-covered SEMS in patients with esophageal cancer. Eligible patients with unresectable esophageal cancer requiring palliation for dysphagia were included in the study. An indigenous fully covered SEMS of appropriate length was placed under endoscopic and fluoroscopic guidance. Outcome measures assessed were adverse events and improvement in dysphagia. Twenty one patients (mean age 57.71±13.14 years; 17 males) were included. After stenting, dysphagia score decreased from 3.2+0.4 to 0.35+0.74 at 4 weeks. Adverse events included retrosternal pain, respiratory distress and aspiration pneumonia in 12, 2 and 1 patients respectively. Five patients required repeat stenting due to stent migration in 4 (following radiotherapy in 3) and tumour ingrowth in 1. There was primary stent malfunction in one patient. The median survival of patients was 140 (76-199) days, which was higher in those who received radiotherapy. The stent was reasonably safe and effective to relieve dysphagia due to unresectable esophageal cancer.

A study of the complications of small bore 'Seldinger' intercostal chest drains.

PubMed

Davies, Helen E; Merchant, Shairoz; McGown, Anne

2008-06-01

Use of small bore chest drains (<14F), inserted via the Seldinger technique, has increased globally over the last few years. They are now used as first line interventions in most acute medical situations when thoracostomy is required. Limited data are available on the associated complications. In this study, the frequency of complications associated with 12F chest drains, inserted using the Seldinger technique, was quantified. A retrospective case note audit was performed of consecutive patients requiring pleural drainage over a 12-month period. One hundred consecutive small bore Seldinger (12F) chest drain insertions were evaluated. Few serious complications occurred. However, 21% of the chest drains were displaced ('fell out') and 9% of the drains became blocked. This contributed to high morbidity rates, with 13% of patients requiring repeat pleural procedures. The frequency of drain blockage in pleural effusion was reduced by administration of regular normal saline drain flushes (odds ratio for blockage in flushed drains compared with non-flushed drains 0.04, 95% CI: 0.01-0.37, P < 0.001). Regular chest drain flushes are advocated in order to reduce rates of drain blockage, and further studies are needed to determine optimal fixation strategies that may reduce associated patient morbidity.

Investigation of electroforming techniques. [fabrication of regeneratively cooled thrust chambers

NASA Technical Reports Server (NTRS)

Malone, G. A.

1975-01-01

Copper and nickel electroforming was examined for the purpose of establishing the necessary processes and procedures for repeatable, successful fabrication of the outer structures of regeneratively cooled thrust chambers. The selection of electrolytes for copper and nickel deposition is described. The development studies performed to refine and complete the processes necessary for successful chamber shell fabrication and the testing employed to verify the applicability of the processes and procedures to small scale hardware are described. Specifications were developed to afford a guideline for the electroforming of high quality outer shells on regeneratively cooled thrust chamber liners. Test results indicated repeatable mechanical properties could be produced in copper deposits from the copper sulfate electrolyte with periodic current reversal and in nickel deposits from the sulfamate solution. Use of inert, removable channel fillers and the conductivizing of such is described. Techniques (verified by test) which produce high integrity bonds to copper and copper alloy liners are discussed.

DNA motifs determining the accuracy of repeat duplication during CRISPR adaptation in Haloarcula hispanica

PubMed Central

Wang, Rui; Li, Ming; Gong, Luyao; Hu, Songnian; Xiang, Hua

2016-01-01

Clustered Regularly Interspaced Short Palindromic Repeats (CRISPRs) acquire new spacers to generate adaptive immunity in prokaryotes. During spacer integration, the leader-preceded repeat is always accurately duplicated, leading to speculations of a repeat-length ruler. Here in Haloarcula hispanica, we demonstrate that the accurate duplication of its 30-bp repeat requires two conserved mid-repeat motifs, AACCC and GTGGG. The AACCC motif was essential and needed to be ∼10 bp downstream from the leader-repeat junction site, where duplication consistently started. Interestingly, repeat duplication terminated sequence-independently and usually with a specific distance from the GTGGG motif, which seemingly served as an anchor site for a molecular ruler. Accordingly, altering the spacing between the two motifs led to an aberrant duplication size (29, 31, 32 or 33 bp). We propose the adaptation complex may recognize these mid-repeat elements to enable measuring the repeat DNA for spacer integration. PMID:27085805

Five-year outcomes of staged percutaneous coronary intervention in the SYNTAX study.

PubMed

Watkins, Stuart; Oldroyd, Keith G; Preda, Istvan; Holmes, David R; Colombo, Antonio; Morice, Marie-Claude; Leadley, Katrin; Dawkins, Keith D; Mohr, Friedrich W; Serruys, Patrick W; Feldman, Ted E

2015-04-01

The SYNTAX study compared PCI with TAXUS Express stents to CABG for the treatment of de novo 3-vessel and/or left main coronary disease. This study aimed to determine patient characteristics and five-year outcomes after a staged PCI strategy compared to single-session PCI. In the SYNTAX trial, staged procedures were discouraged but were allowed within 72 hours or, if renal insufficiency or contrast-induced nephropathy occurred, within 14 days (mean 9.8±18.1 days post initial procedure). A total of 125 (14%) patients underwent staged PCI. These patients had greater disease severity and/or required a more complex procedure. MACCE was significantly increased in staged patients (48.1% vs. 35.5%, p=0.004), as was the composite of death/stroke/MI (32.2% vs. 19%, p=0.0007). Individually, cardiac death and stroke occurred more frequently in the staged PCI group (p=0.03). Repeat revascularisation was significantly higher in staged patients (32.8% vs 24.8%, p=0.035), as was stent thrombosis (10.9% vs. 4.7%, p=0.005). There is a higher incidence of MACCE in patients undergoing staged compared to single-session PCI for 3-vessel and/or left main disease over the first five years of follow-up. However, these patients had more comorbidities and more diffuse disease.

Modified Terminal Restriction Fragment Analysis for Quantifying Telomere Length Using In-gel Hybridization.

PubMed

Jenkins, Frank J; Kerr, Charles M; Fouquerel, Elise; Bovbjerg, Dana H; Opresko, Patricia L

2017-07-10

There are several different techniques for measuring telomere length, each with their own advantages and disadvantages. The traditional approach, Telomere Restriction Fragment (TRF) analysis, utilizes a DNA hybridization technique whereby genomic DNA samples are digested with restriction enzymes, leaving behind telomere DNA repeats and some sub-telomeric DNA. These are separated by agarose gel electrophoresis, transferred to a filter membrane and hybridized to oligonucleotide probes tagged with either chemiluminescence or radioactivity to visualize telomere restriction fragments. This approach, while requiring a larger quantity of DNA than other techniques such as PCR, can measure the telomere length distribution of a population of cells and allows measurement expressed in absolute kilobases. This manuscript demonstrates a modified DNA hybridization procedure for determining telomere length. Genomic DNA is first digested with restriction enzymes (that do not cut telomeres) and separated by agarose gel electrophoresis. The gel is then dried and the DNA is denatured and hybridized in situ to a radiolabeled oligonucleotide probe. This in situ hybridization avoids loss of telomere DNA and improves signal intensity. Following hybridization, the gels are imaged utilizing phosphor screens and the telomere length is quantified using a graphing program. This procedure was developed by the laboratories of Drs. Woodring Wright and Jerry Shay at the University of Texas Southwestern 1 , 2 . Here, we present a detailed description of this procedure, with some modifications.

Utilization of Neurophysiological Protocols to Characterize Soldier Response to Irritant Gases. Phase 1.

DTIC Science & Technology

1990-02-15

electrical activity mapping procedures. It is necessary to employ approximately 20 electrodes to conduct full- scale brain mapping procedures, using a...animal groups, likewise, showed no observable differences in the animal’s exploratory behavior, nuzzle response, lid-corneal and ear reflexes, pain ...SPECIFICATIONS FOR THE ENVIRONICS SERIES 100 GAS STANDARDS GENERATOR Accuracy of Flow 0.15 % of Full Scale Linearity 0.15 % of Full Scale Repeatability 0.10

Mesh quality control for multiply-refined tetrahedral grids

NASA Technical Reports Server (NTRS)

Biswas, Rupak; Strawn, Roger

1994-01-01

A new algorithm for controlling the quality of multiply-refined tetrahedral meshes is presented in this paper. The basic dynamic mesh adaption procedure allows localized grid refinement and coarsening to efficiently capture aerodynamic flow features in computational fluid dynamics problems; however, repeated application of the procedure may significantly deteriorate the quality of the mesh. Results presented show the effectiveness of this mesh quality algorithm and its potential in the area of helicopter aerodynamics and acoustics.

De novo identification of highly diverged protein repeats by probabilistic consistency.

PubMed

Biegert, A; Söding, J

2008-03-15

An estimated 25% of all eukaryotic proteins contain repeats, which underlines the importance of duplication for evolving new protein functions. Internal repeats often correspond to structural or functional units in proteins. Methods capable of identifying diverged repeated segments or domains at the sequence level can therefore assist in predicting domain structures, inferring hypotheses about function and mechanism, and investigating the evolution of proteins from smaller fragments. We present HHrepID, a method for the de novo identification of repeats in protein sequences. It is able to detect the sequence signature of structural repeats in many proteins that have not yet been known to possess internal sequence symmetry, such as outer membrane beta-barrels. HHrepID uses HMM-HMM comparison to exploit evolutionary information in the form of multiple sequence alignments of homologs. In contrast to a previous method, the new method (1) generates a multiple alignment of repeats; (2) utilizes the transitive nature of homology through a novel merging procedure with fully probabilistic treatment of alignments; (3) improves alignment quality through an algorithm that maximizes the expected accuracy; (4) is able to identify different kinds of repeats within complex architectures by a probabilistic domain boundary detection method and (5) improves sensitivity through a new approach to assess statistical significance. Server: http://toolkit.tuebingen.mpg.de/hhrepid; Executables: ftp://ftp.tuebingen.mpg.de/pub/protevo/HHrepID

Emergency department revisits for patients with kidney stones in California.

PubMed

Scales, Charles D; Lin, Li; Saigal, Christopher S; Bennett, Carol J; Ponce, Ninez A; Mangione, Carol M; Litwin, Mark S

2015-04-01

Kidney stones affect nearly one in 11 persons in the United States, and among those experiencing symptoms, emergency care is common. In this population, little is known about the incidence of and factors associated with repeat emergency department (ED) visits. The objective was to identify associations between potentially mutable factors and the risk of an ED revisit for patients with kidney stones in a large, all-payer cohort. This was a retrospective cohort study of all patients in California initially treated and released from EDs for kidney stones between February 2008 and November 2009. A multivariable regression model was created to identify associations between patient-level characteristics, area health care resources, processes of care, and the risk of repeat ED visits. The primary outcome was a second ED visit within 30 days of the initial discharge from emergent care. Among 128,564 patients discharged from emergent care, 13,684 (11%) had at least one additional emergent visit for treatment of their kidney stone. In these patients, nearly one in three required hospitalization or an urgent temporizing procedure at the second visit. On multivariable analysis, the risk of an ED revisit was associated with insurance status (e.g., Medicaid vs. private insurance; odds ratio [OR] = 1.52, 95% confidence interval [CI] = 1.43 to 1.61; p < 0.001). Greater access to urologic care was associated with lower odds of an ED revisit (highest quartile OR = 0.88, 95% CI = 0.80 to 0.97; p < 0.01 vs. lowest quartile). In exploratory models, performance of a complete blood count was associated with a decreased odds of revisit (OR = 0.86, 95% CI = 0.75 to 0.97; p = 0.02). Repeat high-acuity care affects one in nine patients discharged from initial emergent evaluations for kidney stones. Access to urologic care and processes of care are associated with lower risk of repeat emergent encounters. Efforts are indicated to identify preventable causes of ED revisits for kidney stone patients and design interventions to reduce the risk of high-cost, high-acuity, repeat care. © 2015 by the Society for Academic Emergency Medicine.

Automatic welding of stainless steel tubing

NASA Technical Reports Server (NTRS)

Clautice, W. E.

1978-01-01

The use of automatic welding for making girth welds in stainless steel tubing was investigated as well as the reduction in fabrication costs resulting from the elimination of radiographic inspection. Test methodology, materials, and techniques are discussed, and data sheets for individual tests are included. Process variables studied include welding amperes, revolutions per minute, and shielding gas flow. Strip chart recordings, as a definitive method of insuring weld quality, are studied. Test results, determined by both radiographic and visual inspection, are presented and indicate that once optimum welding procedures for specific sizes of tubing are established, and the welding machine operations are certified, then the automatic tube welding process produces good quality welds repeatedly, with a high degree of reliability. Revised specifications for welding tubing using the automatic process and weld visual inspection requirements at the Kennedy Space Center are enumerated.

Cell module and fuel conditioner

NASA Technical Reports Server (NTRS)

Hoover, D. Q., Jr.

1980-01-01

Stack tests indicate that the discrepancies between calculated and measured temperature profiles are due to reactant cross-over and a lower than expected thermal conductivity of cells. Preliminary results indicate that acceptable contact resistance between cooling plane halves can be achieved without the use of paper. The preliminary design of the enclosure, definition of required labor and equipment for manufacturing repeating components, and the assembly procedures for the benchwork design were developed. Fabrication of components for a second 5-cell stack of the MK-2 design and a second 23-cell stack of the MK-1 design was started. The definition of water and fuel for the reforming subsystem was developed along with a preliminary definition of the control system for the subsystem. The construction and shakedown of the differential catalytic reactor was completed and testing of the first catalyst initiated.

Local ablation therapy with contrast-enhanced ultrasonography for hepatocellular carcinoma: a practical review

PubMed Central

Kim, Tae Kyoung; Khalili, Korosh; Jang, Hyun-Jung

2015-01-01

A successful program for local ablation therapy for hepatocellular carcinoma (HCC) requires extensive imaging support for diagnosis and localization of HCC, imaging guidance for the ablation procedures, and post-treatment monitoring. Contrast-enhanced ultrasonography (CEUS) has several advantages over computed tomography/magnetic resonance imaging (CT/MRI), including real-time imaging capability, sensitive detection of arterial-phase hypervascularity and washout, no renal excretion, no ionizing radiation, repeatability, excellent patient compliance, and relatively low cost. CEUS is useful for image guidance for isoechoic lesions. While contrast-enhanced CT/MRI is the standard method for the diagnosis of HCC and post-ablation monitoring, CEUS is useful when CT/MRI findings are indeterminate or CT/MRI is contraindicated. This article provides a practical review of the role of CEUS in imaging algorithms for pre- and post-ablation therapy for HCC. PMID:26169081

Stress measurement in thin films by geometrical optics

NASA Technical Reports Server (NTRS)

Rossnagel, S. M.; Gilstrap, P.; Rujkorakarn, R.

1982-01-01

A variation of Newton's rings experiment is proposed for measuring film stress. The procedure described, the geometrical optics method, is used to measure radii of curvature for a series of film depositions with Ta, Al, and Mo films. The method has a sensitivity of 1 x 10 to the 9th dyn/sq cm, corresponding to the practical radius limit of about 50 m, and a repeatability usually within five percent. For the purposes of comparison, radii are also measured by Newton's rings method and the Talysurf method; all results are found to be in general agreement. Measurement times are also compared: the geometrical optics method requires only 1/2-1 minute. It is concluded that the geometrical optics method provides an inexpensive, fast, and a reasonably correct technique with which to measure stresses in film.

Narrative in Exergames: Thoughts on Procedure, Mechanism, and Others

PubMed Central

2015-01-01

Abstract Narratives are stories with a beginning, middle, and end that provide information about the characters and plot. Exergames are videogames that require players to move or exercise. Narratives and exergames have seldom been examined together. Based on my review of the literature, there are five potential opportunities narratives could bring to exergames: Enhanced engagement with characters and with the plot, increased motivation, repeated play sessions, and better behavioral consequence. However, the rewards offered by these possibilities may be offset by the challenges they pose. These challenges include the difficulty in fully integrating narratives into the gameplay, the players' limited information processing capacity, difficulty in measurement, the lack of full understanding of the player–character identification process, and the narrative saturation effects. Innovative research is needed to bridge the two potentially important domains. PMID:26181676

Modelling Framework and Assistive Device for Peripheral Intravenous Injections

NASA Astrophysics Data System (ADS)

Kam, Kin F.; Robinson, Martin P.; Gilbert, Mathew A.; Pelah, Adar

2016-02-01

Intravenous access for blood sampling or drug administration that requires peripheral venepuncture is perhaps the most common invasive procedure practiced in hospitals, clinics and general practice surgeries.We describe an idealised mathematical framework for modelling the dynamics of the peripheral venepuncture process. Basic assumptions of the model are confirmed through motion analysis of needle trajectories during venepuncture, taken from video recordings of a skilled practitioner injecting into a practice kit. The framework is also applied to the design and construction of a proposed device for accurate needle guidance during venepuncture administration, assessed as consistent and repeatable in application and does not lead to over puncture. The study provides insights into the ubiquitous peripheral venepuncture process and may contribute to applications in training and in the design of new devices, including for use in robotic automation.

Validity of /sup 99m/Tc dimercaptosuccinic acid renal uptake for an assessment for individual kidney function

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

Kawamura, J.; Hosakawa, S.; Yoshida, O.

/sup 99m/Tc dimercaptosuccinic acid is a new renal scanning agent that provides a good quality of renal image as a result of preferential cortical accumulation and also makes feasible a quantitative assessment of separate kidney function, correlating well with renal plasma flow obtained from a /sup 131/I hippuran renogram of each kidney. By measuring the dimercaptosuccinic acid uptake, the cortical functioning nephrons can be determined independent of the activity from the urinary outflow tract. Such evaluations may replace the conventional split renal function study in which traumatic procedures, such as cystoscopy and ureteral catheterizations, are required. /sup 99m/Tc dimercaptosuccinic acidmore » scintigraphy causes less discomfort to the patient and can be performed repeatedly and routinely even in children and debilitated geriatric patients.« less

Suppression of Systematic Errors of Electronic Distance Meters for Measurement of Short Distances

PubMed Central

Braun, Jaroslav; Štroner, Martin; Urban, Rudolf; Dvořáček, Filip

2015-01-01

In modern industrial geodesy, high demands are placed on the final accuracy, with expectations currently falling below 1 mm. The measurement methodology and surveying instruments used have to be adjusted to meet these stringent requirements, especially the total stations as the most often used instruments. A standard deviation of the measured distance is the accuracy parameter, commonly between 1 and 2 mm. This parameter is often discussed in conjunction with the determination of the real accuracy of measurements at very short distances (5–50 m) because it is generally known that this accuracy cannot be increased by simply repeating the measurement because a considerable part of the error is systematic. This article describes the detailed testing of electronic distance meters to determine the absolute size of their systematic errors, their stability over time, their repeatability and the real accuracy of their distance measurement. Twenty instruments (total stations) have been tested, and more than 60,000 distances in total were measured to determine the accuracy and precision parameters of the distance meters. Based on the experiments’ results, calibration procedures were designed, including a special correction function for each instrument, whose usage reduces the standard deviation of the measurement of distance by at least 50%. PMID:26258777

Failed biliary cannulation: Clinical and technical outcomes after tertiary referral endoscopic retrograde cholangiopancreatography

PubMed Central

Swan, Michael P; Bourke, Michael J; Williams, Stephen J; Alexander, Sina; Moss, Alan; Hope, Rick; Ruppin, David

2011-01-01

AIM: Prospective evaluation of repeat endoscopic retrograde cholangiopancreatography (ERCP) for failed Schutz grade 1 biliary cannulation in a high-volume center. METHODS: Prospective intention-to-treat analysis of patients referred for biliary cannulation following recent unsuccessful ERCP. RESULTS: Fifty-one patients (35 female; mean age: 62.5 years; age range: 40-87 years) with previous failed biliary cannulation were referred for repeat ERCP. The indication for ERCP was primarily choledocholithiasis (45%) or pancreatic malignancy (18%). Successful biliary cannulation was 100%. The precut needle knife sphincterotomy (NKS) rate was 27.4%. Complications occurred in 3.9% (post-ERCP pancreatitis). An identifiable reason for initial unsuccessful biliary cannulation was present in 55% of cases. Compared to a cohort of 940 naïve papilla patients (female 61%; mean age: 59.9 years; age range: 18-94 years) who required sphincterotomy over the same time period, there was no statistical difference in the cannulation success rate (100% vs 98%) or post-ERCP pancreatitis (3.1% vs 3.9%). Precut NKS use was more frequent (27.4% vs 12.7%) (P = 0.017). CONCLUSION: Referral to a high-volume center following unsuccessful ERCP is associated with high technical success, with a favorable complication rate, compared to routine ERCP procedures. PMID:22174549

Minimum number of measurements for evaluating soursop (Annona muricata L.) yield.

PubMed

Sánchez, C F B; Teodoro, P E; Londoño, S; Silva, L A; Peixoto, L A; Bhering, L L

2017-05-31

Repeatability studies on fruit species are of great importance to identify the minimum number of measurements necessary to accurately select superior genotypes. This study aimed to identify the most efficient method to estimate the repeatability coefficient (r) and predict the minimum number of measurements needed for a more accurate evaluation of soursop (Annona muricata L.) genotypes based on fruit yield. Sixteen measurements of fruit yield from 71 soursop genotypes were carried out between 2000 and 2016. In order to estimate r with the best accuracy, four procedures were used: analysis of variance, principal component analysis based on the correlation matrix, principal component analysis based on the phenotypic variance and covariance matrix, and structural analysis based on the correlation matrix. The minimum number of measurements needed to predict the actual value of individuals was estimated. Principal component analysis using the phenotypic variance and covariance matrix provided the most accurate estimates of both r and the number of measurements required for accurate evaluation of fruit yield in soursop. Our results indicate that selection of soursop genotypes with high fruit yield can be performed based on the third and fourth measurements in the early years and/or based on the eighth and ninth measurements at more advanced stages.

Suppression of Systematic Errors of Electronic Distance Meters for Measurement of Short Distances.

PubMed

Braun, Jaroslav; Štroner, Martin; Urban, Rudolf; Dvoček, Filip

2015-08-06

In modern industrial geodesy, high demands are placed on the final accuracy, with expectations currently falling below 1 mm. The measurement methodology and surveying instruments used have to be adjusted to meet these stringent requirements, especially the total stations as the most often used instruments. A standard deviation of the measured distance is the accuracy parameter, commonly between 1 and 2 mm. This parameter is often discussed in conjunction with the determination of the real accuracy of measurements at very short distances (5-50 m) because it is generally known that this accuracy cannot be increased by simply repeating the measurement because a considerable part of the error is systematic. This article describes the detailed testing of electronic distance meters to determine the absolute size of their systematic errors, their stability over time, their repeatability and the real accuracy of their distance measurement. Twenty instruments (total stations) have been tested, and more than 60,000 distances in total were measured to determine the accuracy and precision parameters of the distance meters. Based on the experiments' results, calibration procedures were designed, including a special correction function for each instrument, whose usage reduces the standard deviation of the measurement of distance by at least 50%.

[Error prevention through management of complications in urology: standard operating procedures from commercial aviation as a model].

PubMed

Kranz, J; Sommer, K-J; Steffens, J

2014-05-01

Patient safety and risk/complication management rank among the current megatrends in modern medicine, which has undoubtedly become more complex. In time-critical, error-prone and difficult situations, which often occur repeatedly in everyday clinical practice, guidelines are inappropriate for acting rapidly and intelligently. With the establishment and consistent use of standard operating procedures like in commercial aviation, a possible strategic approach is available. These medical aids to decision-making - quick reference cards - are short, optimized instructions that enable a standardized procedure in case of medical claims.

Crosstalk in concurrent repeated games impedes direct reciprocity and requires stronger levels of forgiveness.

PubMed

Reiter, Johannes G; Hilbe, Christian; Rand, David G; Chatterjee, Krishnendu; Nowak, Martin A

2018-02-07

Direct reciprocity is a mechanism for cooperation among humans. Many of our daily interactions are repeated. We interact repeatedly with our family, friends, colleagues, members of the local and even global community. In the theory of repeated games, it is a tacit assumption that the various games that a person plays simultaneously have no effect on each other. Here we introduce a general framework that allows us to analyze "crosstalk" between a player's concurrent games. In the presence of crosstalk, the action a person experiences in one game can alter the person's decision in another. We find that crosstalk impedes the maintenance of cooperation and requires stronger levels of forgiveness. The magnitude of the effect depends on the population structure. In more densely connected social groups, crosstalk has a stronger effect. A harsh retaliator, such as Tit-for-Tat, is unable to counteract crosstalk. The crosstalk framework provides a unified interpretation of direct and upstream reciprocity in the context of repeated games.

Characteristics and clinical outcomes of repeat endovascular therapy after infrapopliteal balloon angioplasty in patients with critical limb ischemia.

PubMed

Kobayashi, Norihiro; Hirano, Keisuke; Yamawaki, Masahiro; Araki, Motoharu; Sakai, Tsuyoshi; Sakamoto, Yasunari; Mori, Shinsuke; Tsutsumi, Masakazu; Honda, Yohsuke; Tokuda, Takahiro; Makino, Kenji; Shirai, Shigemitsu; Ito, Yoshiaki

2018-02-15

We clarified characteristics and clinical outcomes of critical limb ischemia (CLI) patients who underwent repeat endovascular therapy (EVT) for infrapopliteal lesions. High restenosis rate after infrapopliteal EVT remains a major concern. Patients with CLI who underwent EVT between April 2007 and February 2014, were divided into the following three groups according to how often EVT was repeated: Group A, no repeat of EVT; Group B, EVT repeated once/twice; and Group C, EVT repeated ≥3 times. Wound healing rates at 1 year were 93.9% in Group A, 77.1% in Group B, and 27.3% in Group C (P < 0.001). Limb salvage rates at 3 years were 93.0, 88.5, and 57.1%, respectively (P = 0.001). Amputation-free survival rates at 3 years were 60.8, 51.2, and 29.2%, respectively (P = 0.019). Multivariate analysis revealed that hemodialysis (OR 3.413, 95% CI 1.263-9.225, P = 0.016), low ejection fraction (OR 7.758, 1.049-57.360, P = 0.045), and clinical stage assessed by SVS WIfI (OR 2.440, 1.417-4.203, P = 0.001) were independent predictors of repeat EVT. The rate of requirement for repeat EVT significantly increased as clinical stage became more severe (repeat EVT rate: 0% in CS 1, 28.6% in CS 2, 34.0% in CS 3, and 45.7% in CS 4, P < 0.001). The clinical outcomes of CLI patients requiring repeat EVT three or more times were poor. The SVS WIfI clinical stage may be useful to predict the necessity of repeat EVT. © 2017 Wiley Periodicals, Inc.

Adapting Gel Wax into an Ultrasound-Guided Pericardiocentesis Model at Low Cost

PubMed Central

Daly, Robert; Planas, Jason H.; Edens, Mary Ann

2017-01-01

Cardiac tamponade is a life-threatening emergency for which pericardiocentesis may be required. Real-time bedside ultrasound has obviated the need for routine blind procedures in cardiac arrest, and the number of pericardiocenteses being performed has declined. Despite this fact, pericardiocentesis remains an essential skill in emergency medicine. While commercially available training models exist, cost, durability, and lack of anatomical landmarks limit their usefulness. We sought to create a pericardiocentesis model that is realistic, simple to build, reusable, and cost efficient. We constructed the model using a red dye-filled ping pong ball (simulating the right ventricle) and a 250cc normal saline bag (simulating the effusion) encased in an artificial rib cage and held in place by gel wax. The inner saline bag was connected to a 1L saline bag outside of the main assembly to act as a fluid reservoir for repeat uses. The entire construction process takes approximately 16–20 hours, most of which is attributed to cooling of the gel wax. Actual construction time is approximately four hours at a cost of less than $200. The model was introduced to emergency medicine residents and medical students during a procedure simulation lab and compared to a model previously described by dell’Orto.1 The learners performed ultrasound-guided pericardiocentesis using both models. Learners who completed a survey comparing realism of the two models felt our model was more realistic than the previously described model. On a scale of 1–9, with 9 being very realistic, the previous model was rated a 4.5. Our model was rated a 7.8. There was also a marked improvement in the perceived recognition of the pericardium, the heart, and the pericardial sac. Additionally, 100% of the students were successful at performing the procedure using our model. In simulation, our model provided both palpable and ultrasound landmarks and held up to several months of repeated use. It was less expensive than commercial models ($200 vs up to $16,500) while being more realistic in simulation than other described “do-it-yourself models.” This model can be easily replicated to teach the necessary skill of pericardiocentesis. PMID:28116020

Evaluation and improvement of micro-surfacing mix design method and modelling of asphalt emulsion mastic in terms of filler-emulsion interaction

NASA Astrophysics Data System (ADS)

Robati, Masoud

This Doctorate program focuses on the evaluation and improving the rutting resistance of micro-surfacing mixtures. There are many research problems related to the rutting resistance of micro-surfacing mixtures that still require further research to be solved. The main objective of this Ph.D. program is to experimentally and analytically study and improve rutting resistance of micro-surfacing mixtures. During this Ph.D. program major aspects related to the rutting resistance of micro-surfacing mixtures are investigated and presented as follow: 1) evaluation of a modification of current micro-surfacing mix design procedures: On the basis of this effort, a new mix design procedure is proposed for type III micro-surfacing mixtures as rut-fill materials on the road surface. Unlike the current mix design guidelines and specification, the new mix design is capable of selecting the optimum mix proportions for micro-surfacing mixtures; 2) evaluation of test methods and selection of aggregate grading for type III application of micro-surfacing: Within the term of this study, a new specification for selection of aggregate grading for type III application of micro-surfacing is proposed; 3) evaluation of repeatability and reproducibility of micro-surfacing mixture design tests: In this study, limits for repeatability and reproducibility of micro-surfacing mix design tests are presented; 4) a new conceptual model for filler stiffening effect on asphalt mastic of micro-surfacing: A new model is proposed, which is able to establish limits for minimum and maximum filler concentrations in the micro-surfacing mixture base on only the filler important physical and chemical properties; 5) incorporation of reclaimed asphalt pavement and post-fabrication asphalt shingles in micro-surfacing mixture: The effectiveness of newly developed mix design procedure for micro-surfacing mixtures is further validated using recycled materials. The results present the limits for the use of RAP and RAS amount in micro-surfacing mixtures; 6) new colored micro-surfacing formulations with improved durability and performance: The significant improvement of around 45% in rutting resistance of colored and conventional micro-surfacing mixtures is achieved through employing low penetration grade bitumen polymer modified asphalt emulsion stabilized using nanoparticles.

Repeatability of testing procedures for resilient modulus and fatigue.

DOT National Transportation Integrated Search

1989-04-01

Extensive use of diametral resilient modulus and fatigue testing is made by the Oregon State Highway Division to evaluate asphaltic concrete materials. Test results on similar materials (e.g., adjacent field cores), however, often indicate a poor lev...

Culvert rating guide : August 2009.

DOT National Transportation Integrated Search

2009-08-01

The purpose of this Culvert Rating Guide is to present a clear, repeatable and valid procedure for Texas : Department of Transportation (TxDOT) engineers and their consultants to use for load rating culverts in the TxDOT : roadway system. : The Ameri...

A 48 SNP set for grapevine cultivar identification

PubMed Central

2011-01-01

Background Rapid and consistent genotyping is an important requirement for cultivar identification in many crop species. Among them grapevine cultivars have been the subject of multiple studies given the large number of synonyms and homonyms generated during many centuries of vegetative multiplication and exchange. Simple sequence repeat (SSR) markers have been preferred until now because of their high level of polymorphism, their codominant nature and their high profile repeatability. However, the rapid application of partial or complete genome sequencing approaches is identifying thousands of single nucleotide polymorphisms (SNP) that can be very useful for such purposes. Although SNP markers are bi-allelic, and therefore not as polymorphic as microsatellites, the high number of loci that can be multiplexed and the possibilities of automation as well as their highly repeatable results under any analytical procedure make them the future markers of choice for any type of genetic identification. Results We analyzed over 300 SNP in the genome of grapevine using a re-sequencing strategy in a selection of 11 genotypes. Among the identified polymorphisms, we selected 48 SNP spread across all grapevine chromosomes with allele frequencies balanced enough as to provide sufficient information content for genetic identification in grapevine allowing for good genotyping success rate. Marker stability was tested in repeated analyses of a selected group of cultivars obtained worldwide to demonstrate their usefulness in genetic identification. Conclusions We have selected a set of 48 stable SNP markers with a high discrimination power and a uniform genome distribution (2-3 markers/chromosome), which is proposed as a standard set for grapevine (Vitis vinifera L.) genotyping. Any previous problems derived from microsatellite allele confusion between labs or the need to run reference cultivars to identify allele sizes disappear using this type of marker. Furthermore, because SNP markers are bi-allelic, allele identification and genotype naming are extremely simple and genotypes obtained with different equipments and by different laboratories are always fully comparable. PMID:22060012

75 FR 1563 - Airworthiness Directives; BAE Systems (Operations) Limited Model BAe 146-100A, -200A, and -300A...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-01-12

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Distinct Single but Not Necessarily Repeated Tetanization Is Required to Induce Hippocampal Late-LTP in the Rat CA1

ERIC Educational Resources Information Center

Sajikumar, Sreedharan; Navakkode, Sheeja; Frey, Julietta U.

2008-01-01

The protein synthesis-dependent form of hippocampal long-term potentiation (late-LTP) is thought to underlie memory. Its induction requires a distinct stimulation strength, and the common opinion is that only repeated tetani result in late-LTP whereas as single tetanus only reveals a transient early-LTP. Properties of LTP induction were compared…

Towards single embryo transfer? Modelling clinical outcomes of potential treatment choices using multiple data sources: predictive models and patient perspectives.

PubMed

Roberts, Sa; McGowan, L; Hirst, Wm; Brison, Dr; Vail, A; Lieberman, Ba

2010-07-01

In vitro fertilisation (IVF) treatments involve an egg retrieval process, fertilisation and culture of the resultant embryos in the laboratory, and the transfer of embryos back to the mother over one or more transfer cycles. The first transfer is usually of fresh embryos and the remainder may be cryopreserved for future frozen cycles. Most commonly in UK practice two embryos are transferred (double embryo transfer, DET). IVF techniques have led to an increase in the number of multiple births, carrying an increased risk of maternal and infant morbidity. The UK Human Fertilisation and Embryology Authority (HFEA) has adopted a multiple birth minimisation strategy. One way of achieving this would be by increased use of single embryo transfer (SET). To collate cohort data from treatment centres and the HFEA; to develop predictive models for live birth and twinning probabilities from fresh and frozen embryo transfers and predict outcomes from treatment scenarios; to understand patients' perspectives and use the modelling results to investigate the acceptability of twin reduction policies. A multidisciplinary approach was adopted, combining statistical modelling with qualitative exploration of patients' perspectives: interviews were conducted with 27 couples at various stages of IVF treatment at both UK NHS and private clinics; datasets were collated of over 90,000 patients from the HFEA registry and nearly 9000 patients from five clinics, both over the period 2000-5; models were developed to determine live birth and twin outcomes and predict the outcomes of policies for selecting patients for SET or DET in the fresh cycle following egg retrieval and fertilisation, and the predictions were used in simulations of treatments; two focus groups were convened, one NHS and one web based on a patient organisation's website, to present the results of the statistical analyses and explore potential treatment policies. The statistical analysis revealed no characteristics that specifically predicted multiple birth outcomes beyond those that predicted treatment success. In the fresh transfer following egg retrieval, SET would lead to a reduction of approximately one-third in the live birth probability compared with DET, a result consistent with the limited data from clinical trials. From the population or clinic perspective, selection of patients based on prognostic indicators might mitigate about half of the loss in live births associated with SET in the initial fresh transfer while achieving a twin rate of 10% or less. Data-based simulations suggested that, if all good-quality embryos are replaced over multiple frozen embryo transfers, repeated SET has the potential to produce more live birth events than repeated DET. However, this would depend on optimising cryopreservation procedures. Universal SET could both reduce the number of twin births and lead to more couples having a child, but at an average cost of one more embryo transfer procedure per egg retrieval. The interview and focus group data suggest that, despite the potential to maintain overall success rates, patients would prefer DET: the potential for twins was seen as positive, while additional transfer procedures can be emotionally, physically and financially draining. For any one transfer, SET has about a one-third loss of success rate relative to DET. This can be only partially mitigated by patient and treatment cycle selection, which may be criticised as unfair as all patients receiving SET will have a lower chance of success than they would with DET. However, considering complete cycles (fresh plus frozen transfers), it is possible for repeat SET to produce more live births than repeat DET. Such a strategy would require support from funders and acceptance by patients of both cryopreservation and the burden of additional transfer cycles. Future work should include development of improved clinical and regulatory database systems, surveys to quantify the extent of patients' beliefs and experiences and develop approaches to meet their information needs, and, ideally, randomised controlled trials comparing policies of repeated SET with repeated DET.

Trial of Repeated Analgesia with Kangaroo Mother Care (TRAKC Trial)

PubMed Central

2013-01-01

Background Skin-to-skin contact (SSC) between mother and infant, commonly referred to as Kangaroo Mother Care (KMC), is recommended as an intervention for procedural pain. Evidence demonstrates its consistent efficacy in reducing pain for a single painful procedure. The purpose of this study is to examine the sustained efficacy of KMC, provided during all routine painful procedures for the duration of Neonatal Intensive Care Unit (NICU) hospitalization, in diminishing behavioral pain response in preterm neonates. The efficacy of KMC alone will be compared to standard care of 24% oral sucrose, as well as the combination of KMC and 24% oral sucrose. Methods/design Infants admitted to the NICU who are less than 36 6/7 weeks gestational age (according to early ultrasound), that are stable enough to be held in KMC, will be considered eligible (N = 258). Using a single-blinded randomized parallel group design, participants will be assigned to one of three possible interventions: 1) KMC, 2) combined KMC and sucrose, and 3) sucrose alone, when they undergo any routine painful procedure (heel lance, venipuncture, intravenous, oro/nasogastric insertion). The primary outcome is infant’s pain intensity, which will be assessed using the Premature Infant Pain Profile (PIPP). The secondary outcome will be maturity of neurobehavioral functioning, as measured by the Neurobehavioral Assessment of the Preterm Infant (NAPI). Gestational age, cumulative exposure to KMC provided during non-pain contexts, and maternal cortisol levels will be considered in the analysis. Clinical feasibility will be accounted for from nurse and maternal questionnaires. Discussion This will be the first study to examine the repeated use of KMC for managing procedural pain in preterm neonates. It is also the first to compare KMC to sucrose, or the interventions in combination, across time. Based on the theoretical framework of the brain opioid theory of attachment, it is expected that KMC will be a preferred standard of care. However, current pain management guidelines are based on minimal data on repeated use of either intervention. Therefore, regardless of the outcomes of this study, results will have important implications for guidelines and practices related to management of procedural pain in preterm infants. Trial registration ClinicalTrials.gov Identifier: NCT01561547. PMID:24284002

Sample sizes needed for specified margins of relative error in the estimates of the repeatability and reproducibility standard deviations.

PubMed

McClure, Foster D; Lee, Jung K

2005-01-01

Sample size formulas are developed to estimate the repeatability and reproducibility standard deviations (Sr and S(R)) such that the actual error in (Sr and S(R)) relative to their respective true values, sigmar and sigmaR, are at predefined levels. The statistical consequences associated with AOAC INTERNATIONAL required sample size to validate an analytical method are discussed. In addition, formulas to estimate the uncertainties of (Sr and S(R)) were derived and are provided as supporting documentation. Formula for the Number of Replicates Required for a Specified Margin of Relative Error in the Estimate of the Repeatability Standard Deviation.

Tests of an alternate mobile transporter and extravehicular activity assembly procedure for the Space Station Freedom truss

NASA Technical Reports Server (NTRS)

Heard, Walter L., Jr.; Watson, Judith J.; Lake, Mark S.; Bush, Harold G.; Jensen, J. Kermit; Wallsom, Richard E.; Phelps, James E.

1992-01-01

Results are presented from a ground test program of an alternate mobile transporter (MT) concept and extravehicular activity (EVA) assembly procedure for the Space Station Freedom (SSF) truss keel. A three-bay orthogonal tetrahedral truss beam consisting of 44 2-in-diameter struts and 16 nodes was assembled repeatedly in neutral buoyancy by pairs of pressure-suited test subjects working from astronaut positioning devices (APD's) on the MT. The truss bays were cubic with edges 15 ft long. All the truss joint hardware was found to be EVA compatible. The average unit assembly time for a single pair of experienced test subjects was 27.6 sec/strut, which is about half the time derived from other SSF truss assembly tests. A concept for integration of utility trays during truss assembly is introduced and demonstrated in the assembly tests. The concept, which requires minimal EVA handling of the trays, is shown to have little impact on overall assembly time. The results of these tests indicate that by using an MT equipped with APD's, rapid EVA assembly of a space station-size truss structure can be expected.

Delayed Slater determinant update algorithms for high efficiency quantum Monte Carlo

DOE PAGES

McDaniel, Tyler; D’Azevedo, Ed F.; Li, Ying Wai; ...

2017-11-07

Within ab initio Quantum Monte Carlo simulations, the leading numerical cost for large systems is the computation of the values of the Slater determinants in the trial wavefunction. Each Monte Carlo step requires finding the determinant of a dense matrix. This is most commonly iteratively evaluated using a rank-1 Sherman-Morrison updating scheme to avoid repeated explicit calculation of the inverse. The overall computational cost is therefore formally cubic in the number of electrons or matrix size. To improve the numerical efficiency of this procedure, we propose a novel multiple rank delayed update scheme. This strategy enables probability evaluation with applicationmore » of accepted moves to the matrices delayed until after a predetermined number of moves, K. The accepted events are then applied to the matrices en bloc with enhanced arithmetic intensity and computational efficiency via matrix-matrix operations instead of matrix-vector operations. Here this procedure does not change the underlying Monte Carlo sampling or its statistical efficiency. For calculations on large systems and algorithms such as diffusion Monte Carlo where the acceptance ratio is high, order of magnitude improvements in the update time can be obtained on both multi- core CPUs and GPUs.« less

Delayed Slater determinant update algorithms for high efficiency quantum Monte Carlo

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

McDaniel, Tyler; D’Azevedo, Ed F.; Li, Ying Wai

Within ab initio Quantum Monte Carlo simulations, the leading numerical cost for large systems is the computation of the values of the Slater determinants in the trial wavefunction. Each Monte Carlo step requires finding the determinant of a dense matrix. This is most commonly iteratively evaluated using a rank-1 Sherman-Morrison updating scheme to avoid repeated explicit calculation of the inverse. The overall computational cost is therefore formally cubic in the number of electrons or matrix size. To improve the numerical efficiency of this procedure, we propose a novel multiple rank delayed update scheme. This strategy enables probability evaluation with applicationmore » of accepted moves to the matrices delayed until after a predetermined number of moves, K. The accepted events are then applied to the matrices en bloc with enhanced arithmetic intensity and computational efficiency via matrix-matrix operations instead of matrix-vector operations. Here this procedure does not change the underlying Monte Carlo sampling or its statistical efficiency. For calculations on large systems and algorithms such as diffusion Monte Carlo where the acceptance ratio is high, order of magnitude improvements in the update time can be obtained on both multi- core CPUs and GPUs.« less

Delayed Slater determinant update algorithms for high efficiency quantum Monte Carlo.

PubMed

McDaniel, T; D'Azevedo, E F; Li, Y W; Wong, K; Kent, P R C

2017-11-07

Within ab initio Quantum Monte Carlo simulations, the leading numerical cost for large systems is the computation of the values of the Slater determinants in the trial wavefunction. Each Monte Carlo step requires finding the determinant of a dense matrix. This is most commonly iteratively evaluated using a rank-1 Sherman-Morrison updating scheme to avoid repeated explicit calculation of the inverse. The overall computational cost is, therefore, formally cubic in the number of electrons or matrix size. To improve the numerical efficiency of this procedure, we propose a novel multiple rank delayed update scheme. This strategy enables probability evaluation with an application of accepted moves to the matrices delayed until after a predetermined number of moves, K. The accepted events are then applied to the matrices en bloc with enhanced arithmetic intensity and computational efficiency via matrix-matrix operations instead of matrix-vector operations. This procedure does not change the underlying Monte Carlo sampling or its statistical efficiency. For calculations on large systems and algorithms such as diffusion Monte Carlo, where the acceptance ratio is high, order of magnitude improvements in the update time can be obtained on both multi-core central processing units and graphical processing units.

Delayed Slater determinant update algorithms for high efficiency quantum Monte Carlo

NASA Astrophysics Data System (ADS)

McDaniel, T.; D'Azevedo, E. F.; Li, Y. W.; Wong, K.; Kent, P. R. C.

2017-11-01

Within ab initio Quantum Monte Carlo simulations, the leading numerical cost for large systems is the computation of the values of the Slater determinants in the trial wavefunction. Each Monte Carlo step requires finding the determinant of a dense matrix. This is most commonly iteratively evaluated using a rank-1 Sherman-Morrison updating scheme to avoid repeated explicit calculation of the inverse. The overall computational cost is, therefore, formally cubic in the number of electrons or matrix size. To improve the numerical efficiency of this procedure, we propose a novel multiple rank delayed update scheme. This strategy enables probability evaluation with an application of accepted moves to the matrices delayed until after a predetermined number of moves, K. The accepted events are then applied to the matrices en bloc with enhanced arithmetic intensity and computational efficiency via matrix-matrix operations instead of matrix-vector operations. This procedure does not change the underlying Monte Carlo sampling or its statistical efficiency. For calculations on large systems and algorithms such as diffusion Monte Carlo, where the acceptance ratio is high, order of magnitude improvements in the update time can be obtained on both multi-core central processing units and graphical processing units.

Improving the geological interpretation of magnetic and gravity satellite anomalies

NASA Technical Reports Server (NTRS)

Hinze, William J.; Braile, Lawrence W.; Vonfrese, Ralph R. B.

1987-01-01

Quantitative analysis of the geologic component of observed satellite magnetic and gravity fields requires accurate isolation of the geologic component of the observations, theoretically sound and viable inversion techniques, and integration of collateral, constraining geologic and geophysical data. A number of significant contributions were made which make quantitative analysis more accurate. These include procedures for: screening and processing orbital data for lithospheric signals based on signal repeatability and wavelength analysis; producing accurate gridded anomaly values at constant elevations from the orbital data by three-dimensional least squares collocation; increasing the stability of equivalent point source inversion and criteria for the selection of the optimum damping parameter; enhancing inversion techniques through an iterative procedure based on the superposition theorem of potential fields; and modeling efficiently regional-scale lithospheric sources of satellite magnetic anomalies. In addition, these techniques were utilized to investigate regional anomaly sources of North and South America and India and to provide constraints to continental reconstruction. Since the inception of this research study, eleven papers were presented with associated published abstracts, three theses were completed, four papers were published or accepted for publication, and an additional manuscript was submitted for publication.

The preprocessed connectomes project repository of manually corrected skull-stripped T1-weighted anatomical MRI data.

PubMed

Puccio, Benjamin; Pooley, James P; Pellman, John S; Taverna, Elise C; Craddock, R Cameron

2016-10-25

Skull-stripping is the procedure of removing non-brain tissue from anatomical MRI data. This procedure can be useful for calculating brain volume and for improving the quality of other image processing steps. Developing new skull-stripping algorithms and evaluating their performance requires gold standard data from a variety of different scanners and acquisition methods. We complement existing repositories with manually corrected brain masks for 125 T1-weighted anatomical scans from the Nathan Kline Institute Enhanced Rockland Sample Neurofeedback Study. Skull-stripped images were obtained using a semi-automated procedure that involved skull-stripping the data using the brain extraction based on nonlocal segmentation technique (BEaST) software, and manually correcting the worst results. Corrected brain masks were added into the BEaST library and the procedure was repeated until acceptable brain masks were available for all images. In total, 85 of the skull-stripped images were hand-edited and 40 were deemed to not need editing. The results are brain masks for the 125 images along with a BEaST library for automatically skull-stripping other data. Skull-stripped anatomical images from the Neurofeedback sample are available for download from the Preprocessed Connectomes Project. The resulting brain masks can be used by researchers to improve preprocessing of the Neurofeedback data, as training and testing data for developing new skull-stripping algorithms, and for evaluating the impact on other aspects of MRI preprocessing. We have illustrated the utility of these data as a reference for comparing various automatic methods and evaluated the performance of the newly created library on independent data.

Dynamic damping of the aortic pressure trace during hyperemia: the impact on fractional flow reserve measurement.

PubMed

Lockie, Tim; Rolandi, M Cristina; Piek, Jan J

2013-10-01

We report on two cases that illustrate an important caveat in the measurement of fractional flow reserve (FFR) in coronary arteries. To obtain accurate FFR measurements, two fundamental requirements must be fulfilled. One is to minimize microvascular resistance; the other is that there is no damping of the proximal aortic pressure trace. A problem with either of these requirements can be a source of serious error in the measurement of FFR. In each case we present here, despite a good aortic pressure trace at the start of the procedure, there is dynamic damping of the pressure trace during hyperemia, secondary to axial migration of the guiding catheter into the left main stem (LMS). In both cases, a normal aortic pressure trace (Pa) is present at baseline. After intracoronary adenosine injection, there was a fall in both mean Pa and distal coronary pressure (Pd) concomitant with damping of Pa, evidenced by loss of the dicrotic notch and ventricularization of the pressure trace. The resultant FFR value is underestimated. As hyperemia wears off, both pressure traces return to normal with good articulation of the dicrotic notch. When the procedure was repeated taking care to ensure that the guide did not move into the LMS during hyperemia, the Pa trace remained stable following intracoronary adenosine, while mean Pd decreased as before. In both cases, hemodynamically significant lesions were demonstrated that had been masked by the artifactual drop in Pa during the first attempt.

Long-term outcome of catheter ablation in atrial fibrillation patients with coexistent metabolic syndrome and obstructive sleep apnea: impact of repeat procedures versus lifestyle changes.

PubMed

Mohanty, Sanghamitra; Mohanty, Prasant; DI Biase, Luigi; Bai, Rong; Trivedi, Chintan; Santangeli, Pasquale; Santoro, Francesco; Hongo, Richard; Hao, Steven; Beheiry, Salwa; Burkhardt, David; Gallinghouse, Joseph G; Horton, Rodney; Sanchez, Javier E; Bailey, Shane; Hranitzky, Patrick M; Zagrodzky, Jason; Natale, Andrea

2014-09-01

Metabolic syndrome (MS) and obstructive sleep apnea (OSA) are well-known independent risk factors for atrial fibrillation (AF) recurrence. This study evaluated ablation outcome in AF patients with coexistent MS and OSA and influence of lifestyle modifications (LSM) on arrhythmia recurrence. We included 1,257 AF patients undergoing first catheter ablation (30% paroxysmal AF). Patients having MS + OSA were classified into Group 1 (n = 126; 64 ± 8 years; 76% male). Group 2 (n = 1,131; 62 ± 11 years; 72% male) included those with either MS (n = 431) or OSA (n = 112; no CPAP users) or neither of these comorbidities (n = 588). Patients experiencing recurrence after first procedure were divided into 2 subgroups; those having sporadic events (frequency < 2 months) remained on previously ineffective antiarrhythmic drugs (AAD) and aggressive LSM, while those with persistent arrhythmia (incessant or ≥2 months) underwent repeat ablation. After 34 ± 8 months of first procedure, 66 (52%) in Group 1 and 386 (34%) in Group 2 had recurrence (P < 0.001). Recurrence rate in only-MS, only-OSA, and without MS/OSA groups were 40%, 38%, and 29%, respectively. Patients with MS + OSA experienced substantially higher recurrence compared to those with lone MS or OSA (52% vs. 40% vs. 38%; P = 0.036). Of the 452 patients having recurrence, 250 underwent redo-ablation and 194 remained on AAD and LSM. At 20 ± 6 months, 76% of the redo group remained arrhythmia-free off AAD whereas 74% of the LSM group were free from recurrence (P = 0.71), 33% of which were off AAD. MS and OSA have additive negative effect on arrhythmia recurrence following single procedure. Repeat ablation or compliant LSM increase freedom from recurrent AF. © 2014 Wiley Periodicals, Inc.

Single-port videoscopic splanchnotomy for palliation of refractory chronic pancreatitis.

PubMed

Kuijpers, Michiel; Klinkenberg, Theo J; Bouma, Wobbe; Beese, Ulrich; DeJongste, Mike J; Mariani, Massimo A

2016-04-01

Interrupting the afferent signals that travel through the splanchnic nerves by multiportal thoracoscopic splanchnotomy can offer effective palliation in chronic pancreatitis. However, obtained results weaken after time, possibly necessitating repeat procedures. Given the palliative nature of this procedure, potential for iatrogenic damage should be kept at a minimum. So, in order to minimize invasiveness while optimizing repeatability, we sought to create an easily reproducible single-access port operative strategy. Four patients suffering from intractable pain due to chronic pancreatitis for >10 years (12.8 ± 5.9) underwent a single-port unilateral R5-R11 splanchnotomy. Postoperative recovery was uneventful. No operative complications were observed. All 4 patients experienced excellent pain relief with a significant improvement of Visual Analogue Scale pain scores (8.8 ± 1.0 preoperatively to 3.0 ± 1.2 postoperatively, P = 0.003). We report the first series of single-port video-assisted thoracoscopic surgical (VATS) splanchnotomy for palliation of intractable pain due to chronic pancreatitis. From this small study, single-port VATS splanchnotomy seems to be a safe and effective alternative to multiportal or open procedures. © The Author 2016. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

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

PubMed

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

2014-12-19

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

The impact and outcomes of establishing an integrated interdisciplinary surgical team to care for the diabetic foot.

PubMed

Armstrong, David G; Bharara, Manish; White, Matthew; Lepow, Brian; Bhatnagar, Sugam; Fisher, Timothy; Kimbriel, Heather R; Walters, Jodi; Goshima, Kaoru R; Hughes, John; Mills, Joseph L

2012-09-01

This study aimed to quantify the impact of an integrated diabetic foot surgical service on outcomes and changes in surgical volume and focus. We abstracted registry data from 48 consecutive months at a single institution, evaluating all patients with diabetic foot complications requiring surgery or vascular intervention, and compared outcomes in the 24 months before and after integrating podiatric surgery with vascular surgical limb-salvage service. The service performed 2923 operations; 790 (27.0%) were related to treatment of diabetic foot complications in 374 patients. Of these, 502 were classified as non-vascular diabetic foot surgery and 288 were vascular interventions. Urgent surgery was significantly reduced after team implementation (77.7% vs 48.5%, p < 0.0001; OR = 3.7, 95% CI: 2.4-5.5). The high/low amputation ratio decreased from 0.35 to 0.27 due to an increase in low-level (midfoot) amputations (8.2% vs 26.1%, p < 0.0001; OR = 4.0, 95% CI: 2.0-83.3). A 45.7% reduction in below-knee amputations was realized with a stable above-knee/below-knee amputation ratio (0.73-0.81). One-third of patients required vascular intervention. Vascular reconstructions increased 44.1% following institution of the team. Initial revascularization was endovascular in 70.6% of patients. Repeat endovascular intervention or conversion to open bypass was required in 37.1% of these patients, almost double the reintervention rate of those receiving open bypass first (18.9%). Interdisciplinary diabetic foot surgery teams may significantly impact surgery type, with greater focus on proactive and preventive, rather than reactive and ablative, procedures. Although endovascular limb-sparing procedures have become increasingly applicable, open bypass remains critical to success. Copyright © 2012 John Wiley & Sons, Ltd.

Mucosal complications of modified osteo-odonto keratoprosthesis in chronic Stevens-Johnson syndrome.

PubMed

Basu, Sayan; Pillai, Vinay Sukumara; Sangwan, Virender S

2013-11-01

To describe clinical outcomes of complications afflicting the autologous oral mucous membrane graft after modified osteo-odonto keratoprosthesis surgery in chronic Stevens-Johnson syndrome (SJS). Prospective case series. This study included 30 eyes of 30 patients with SJS-induced dry keratinized ocular surfaces; the patients underwent various stages of this procedure between August 2009 and February 2012. Mucosal complications were classified as either necrosis or overgrowth. Mucosal necrosis was managed according to a predesigned algorithm based on timing (pre- and postimplantation) and location (central or peripheral) of necrosis. Cases with mucosal overgrowth underwent mucosal debulking and trimming. Mucosal necrosis developed in 15 (50%) eyes and overgrowth in 4 (13.3%) eyes. Preimplantation necrosis (n = 7) was initially managed conservatively, but 2 eyes required free labial-mucous membrane grafting for persistent corneal exposure. Free labial-mucous membrane grafting was performed in all cases of postimplantation necrosis (n = 10), but 8 eyes required additional tarsal pedicle flaps (n = 6, for peripheral necrosis) or through-the-lid revisions (n = 2, for central necrosis). Debulking and trimming effectively managed all cases of mucosal overgrowth, but 3 eyes required repeat procedures. At 24.1 ± 6.5 months postimplantation, the keratoprosthesis was retained in all eyes, and the probability of maintaining 20/60 or better vision was similar in eyes with or without mucosal necrosis (86 ± 8.8% vs 80 ± 10.3%). Mucosal complications, especially necrosis, occurred commonly following modified osteo-odonto keratoprosthesis surgery in dry keratinized post-SJS eyes. The algorithm-based management approach described in this study was successful in treating these complications, retaining the prosthesis and preserving useful vision. Copyright © 2013 Elsevier Inc. All rights reserved.

The social buffering effect of playful handling on responses to repeated intraperitoneal injections in laboratory rats.

PubMed

Cloutier, Sylvie; Wahl, Kim; Baker, Chelsea; Newberry, Ruth C

2014-03-01

Handling small animals for veterinary and experimental procedures can negatively affect animal wellbeing. We hypothesized that playful handling (tickling) would decrease stress associated with repeated injections in adult laboratory rats, especially those with prior tickling experience. We compared responses of 4 groups of male Sprague-Dawley rats to intraperitoneal injection of saline daily for 10 d. Rats either tickled or not tickled as juveniles (2 min/d for 21 d) were exposed as adults to either a passive hand or tickling for 2 min immediately before and after injections. Rates of vocalization (22- and 50-kHz ultrasonic vocalizations (USV), indicative of negative and positive affective states, respectively, and audible calls indicative of pain and discomfort) were quantified before, during, and after injection. Tickling before and after injection, especially when combined with juvenile tickling experience (ending 40 to 50 d earlier), increased 50-kHz USV rates before and after injection, reduced audible call rate during injection, and decreased the duration of the injection procedure. The treatments did not affect indicators of physiologic stress (body weight change; fecal corticosteroid levels). We conclude that playful handling performed in association with a mildly aversive procedure serves as a useful refinement by inducing a positive affective state that mitigates the aversiveness of the procedure and makes rats easier to handle, especially when they have been accustomed to tickling as juveniles.

The Social Buffering Effect of Playful Handling on Responses to Repeated Intraperitoneal Injections in Laboratory Rats

PubMed Central

Cloutier, Sylvie; Wahl, Kim; Baker, Chelsea; Newberry, Ruth C

2014-01-01

Handling small animals for veterinary and experimental procedures can negatively affect animal wellbeing. We hypothesized that playful handling (tickling) would decrease stress associated with repeated injections in adult laboratory rats, especially those with prior tickling experience. We compared responses of 4 groups of male Sprague–Dawley rats to intraperitoneal injection of saline daily for 10 d. Rats either tickled or not tickled as juveniles (2 min/d for 21 d) were exposed as adults to either a passive hand or tickling for 2 min immediately before and after injections. Rates of vocalization (22- and 50-kHz ultrasonic vocalizations (USV), indicative of negative and positive affective states, respectively, and audible calls indicative of pain and discomfort) were quantified before, during, and after injection. Tickling before and after injection, especially when combined with juvenile tickling experience (ending 40 to 50 d earlier), increased 50-kHz USV rates before and after injection, reduced audible call rate during injection, and decreased the duration of the injection procedure. The treatments did not affect indicators of physiologic stress (body weight change; fecal corticosteroid levels). We conclude that playful handling performed in association with a mildly aversive procedure serves as a useful refinement by inducing a positive affective state that mitigates the aversiveness of the procedure and makes rats easier to handle, especially when they have been accustomed to tickling as juveniles. PMID:24602543

Cloning Should Be Simple: Escherichia coli DH5α-Mediated Assembly of Multiple DNA Fragments with Short End Homologies

PubMed Central

Richardson, Ruth E.; Suzuki, Yo

2015-01-01

Numerous DNA assembly technologies exist for generating plasmids for biological studies. Many procedures require complex in vitro or in vivo assembly reactions followed by plasmid propagation in recombination-impaired Escherichia coli strains such as DH5α, which are optimal for stable amplification of the DNA materials. Here we show that despite its utility as a cloning strain, DH5α retains sufficient recombinase activity to assemble up to six double-stranded DNA fragments ranging in size from 150 bp to at least 7 kb into plasmids in vivo. This process also requires surprisingly small amounts of DNA, potentially obviating the need for upstream assembly processes associated with most common applications of DNA assembly. We demonstrate the application of this process in cloning of various DNA fragments including synthetic genes, preparation of knockout constructs, and incorporation of guide RNA sequences in constructs for clustered regularly interspaced short palindromic repeats (CRISPR) genome editing. This consolidated process for assembly and amplification in a widely available strain of E. coli may enable productivity gain across disciplines involving recombinant DNA work. PMID:26348330

Applicability of UV laser-induced solid-state fluorescence spectroscopy for characterization of solid dosage forms.

PubMed

Woltmann, Eva; Meyer, Hans; Weigel, Diana; Pritzke, Heinz; Posch, Tjorben N; Kler, Pablo A; Schürmann, Klaus; Roscher, Jörg; Huhn, Carolin

2014-10-01

High production output of solid pharmaceutical formulations requires fast methods to ensure their quality. Likewise, fast analytical procedures are required in forensic sciences, for example at customs, to substantiate an initial suspicion. We here present the design and the optimization of an instrumental setup for rapid and non-invasive characterization of tablets by laser-induced fluorescence spectroscopy (with a UV-laser (λ ex = 266 nm) as excitation source) in reflection geometry. The setup was first validated with regard to repeatability, bleaching phenomena, and sensitivity. The effect on the spectra by the physical and chemical properties of the samples, e.g. their hardness, homogeneity, chemical composition, and granule grain size of the uncompressed material, using a series of tablets, manufactured in accordance with design of experiments, was investigated. Investigation of tablets with regard to homogeneity, especially, is extremely important in pharmaceutical production processes. We demonstrate that multiplicative scatter correction is an appropriate tool for data preprocessing of fluorescence spectra. Tablets with different physical and chemical characteristics can be discriminated well from their fluorescence spectra by subjecting the results to principal component analysis.

Endoscopic Injection of Low Dose Triamcinolone: a Simple, Minimally Invasive and Effective Therapy for Interstitial Cystitis with Hunner Lesions.

PubMed

Funaro, Michael G; King, Alexandra N; Stern, Joel N H; Moldwin, Robert M; Bahlani, Sonia

2018-05-18

To investigate the efficacy of low dose triamcinolone injection for effectiveness and durability in interstitial cystitis/bladder pain syndrome (IC/BPS) patients with Hunner Lesions (HL). Clinical data from patients with HL who underwent endoscopic submucosal injection of triamcinolone were reviewed: Demographics, pre/post operative pain and nocturia scores, and long-term clinical outcomes were assessed. Duration of response was estimated by time to repeat procedure. Kaplan-Meier estimator was used to evaluate time to repeat procedure. 36 patients who received injections of triamcinolone between 2011 and 2015 were included. Median age±SD of patients was 61.5±12.0 years 23; 28 (77.8%) of patients were female and 8 (22.2%) were male. 26 patients (72.2%) received only 1 set of injections, 8 (22.2%) received 2 sets of injections, and 2 (5.56%) received 3 or more sets of injections. Average time between injections in those receiving more than one set of injections was 344.9 days (median: 313.5, range: 77-714). Pre-procedural pain scores were 8.3±1.2 (mean±SD) on Likert pain scale (0-10), and mean post-procedural pain scores at approximately one month were 3.8±2.2 p<0.001. Mean pre-procedural nocturia bother scores were 7.5±2.0 and mean post-procedural nocturia bother scores were 5.1±2.5) p<0.001. Endoscopic submucosal injection of low dose triamcinolone in IC/BPS patients with HL is an effective and durable adjunct to existing treatment modalities. This approach is associated with low morbidity and can be performed on an outpatient basis. Copyright © 2018. Published by Elsevier Inc.

Auroral Data Analysis

DTIC Science & Technology

1979-01-31

LT) sector, distinct and repeatable electron lair - and disceearrlrgos epetvI.Tepro tde tudinal distributions \\%ere observed as a function of substorm...of surface a ,wcond time by using the same procedure, Next the)’ were optical albedo and east-%est nonuniformities in precipitation grouped together

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

DOT National Transportation Integrated Search

1977-01-01

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

Using GOMS models and hypertext to create representations of medical procedures for online display

NASA Technical Reports Server (NTRS)

Gugerty, Leo; Halgren, Shannon; Gosbee, John; Rudisill, Marianne

1991-01-01

This study investigated two methods to improve organization and presentation of computer-based medical procedures. A literature review suggested that the GOMS (goals, operators, methods, and selecton rules) model can assist in rigorous task analysis, which can then help generate initial design ideas for the human-computer interface. GOMS model are hierarchical in nature, so this study also investigated the effect of hierarchical, hypertext interfaces. We used a 2 x 2 between subjects design, including the following independent variables: procedure organization - GOMS model based vs. medical-textbook based; navigation type - hierarchical vs. linear (booklike). After naive subjects studies the online procedures, measures were taken of their memory for the content and the organization of the procedures. This design was repeated for two medical procedures. For one procedure, subjects who studied GOMS-based and hierarchical procedures remembered more about the procedures than other subjects. The results for the other procedure were less clear. However, data for both procedures showed a 'GOMSification effect'. That is, when asked to do a free recall of a procedure, subjects who had studies a textbook procedure often recalled key information in a location inconsistent with the procedure they actually studied, but consistent with the GOMS-based procedure.

Pancreatic Cancer Arising From the Remnant Pancreas: Is It a Local Recurrence or New Primary Lesion?

PubMed

Hashimoto, Daisuke; Chikamoto, Akira; Masuda, Toshiro; Nakagawa, Shigeki; Imai, Katsunori; Yamashita, Yo-Ichi; Reber, Howard A; Baba, Hideo

2017-10-01

Local recurrence of pancreatic cancer (PC) can occur in the pancreatic remnant. In addition, new primary PC can develop in the remnant. There are limited data available regarding this so-called remnant PC. The aim of this review was to describe the characteristics and therapeutic strategy regarding remnant PC. A literature search was performed using Medline published in English according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The incidence of remnant PC has been reported to be 3% to 5%. It is difficult to distinguish local recurrence from new primary PC. Genetic diagnosis such as Kirsten rat sarcoma viral oncogene homolog mutation may resolve this problem. For patients with remnant PC, repeated pancreatectomy can be performed. Residual total pancreatectomy is the most common procedure. Recent studies have described the safety of the operation because of recent surgical progress and perioperative care. The patients with remnant PC without distant metastasis have shown good long-term outcomes, especially those who underwent repeated pancreatectomy. Adjuvant chemotherapy may contribute to longer survival. In conclusion, this review found that both local recurrence and new primary PC can develop in the pancreatic remnant. Repeated pancreatectomy for the remnant PC is a feasible procedure and can prolong patient survival.

Critical Period of Memory Enhancement during Taste Avoidance Conditioning in Lymnaea stagnalis

PubMed Central

Sunada, Hiroshi; Lukowiak, Ken; Sakakibara, Manabu

2013-01-01

The present study investigated the optimal training procedure leading to long-lasting taste avoidance behavior in Lymnaea. A training procedure comprising 5 repeated pairings of a conditional stimulus (CS, sucrose), with an unconditional stimulus (US, a tactile stimulation to the animal’s head), over a 4-day period resulted in an enhanced memory formation than 10 CS-US repeated pairings over a 2-day period or 20 CS-US repeated pairings on a single day. Backward conditioning (US-CS) pairings did not result in conditioning. Thus, this taste avoidance conditioning was CS-US pairing specific. Food avoidance behavior was not observed following training, however, if snails were immediately subjected to a cold-block (4°C for 10 min). It was critical that the cold-block be applied within 10 min to block long-term memory (LTM) formation. Further, exposure to the cold-block 180 min after training also blocked both STM and LTM formation. The effects of the cold-block on subsequent learning and memory formation were also examined. We found no long lasting effects of the cold-block on subsequent memory formation. If protein kinase C was activated before the conditioning paradigm, snails could still acquire STM despite exposure to the cold-block. PMID:24098373

Analysis of dental care of children receiving comprehensive care under general anaesthesia at a teaching hospital in England.

PubMed

Tahmassebi, J F; Achol, L T; Fayle, S A

2014-10-01

This study aimed to analyse the characteristics of comprehensive dental care provided under general anaesthesia (CDGA) and to review the additional treatment required by children over the 6 years subsequent to CDGA. Information collected from hospital records for the 6-year period following the first CDGA included the types of dental treatment performed at CDGA, the return rates for follow-up appointments, further treatment required subsequent to CDGA and the types of dental treatment performed at repeat DGA. The study population consisted of 263 children, of whom 129 had a significant medical history, with mean age of 6.7 years. The results revealed that the waiting time for CDGA was significantly shorter in children who had a significant medical history, with 49% being admitted for CDGA within 3 months of pre-GA assessment, as compared to 29% of healthy children. 67% of children had follow-up care recorded, with a slightly higher proportion of children with significant medical history returning for follow-up [70% (90/129)] compared with 65% (87/134) of healthy children. Re-treatment rates were 34% (88/263), the majority of cases being treated under local analgesia (42/88). 34 of 263 children had repeat DGA (12.9%). Of these 71% (24/34) were children with significant medical history. The mean age at repeat DGA was 9 years. In 25 of 34 children (74%), repeat DGA was due to trauma, oral pathology, supernumerary removal, hypomineralized teeth or new caries of previously sound or un-erupted teeth at CDGA. The ratio of extraction over restoration (excluding fissure sealants) performed at repeat DGA was 2.8, compared with the ratio of 1.3 in the initial CDGA. There was a higher ratio of extraction over restorations at the repeat DGA. This suggests that the prescribed treatments at repeat DGA were more aggressive as compared to the initial CDGA in 1997. The majority of the treatment required at repeat DGA was to treat new disease.

Improving the satellite communication efficiency of the accumulative acknowledgement strategies

NASA Astrophysics Data System (ADS)

Duarte, Otto Carlos M. B.; de Lima, Heliomar Medeiros

The performances of two finite buffer error recovery strategies are analyzed. In both strategies the retransmission request decision between selective repeat and continuous retransmission is based on an imminent buffer overflow condition. These are accumulative acknowledgment schemes, but in the second strategy the selective-repeat control frame is uniquely an individual negative acknowledgment. The two strategies take advantage of the availability of a greater buffer capacity, making the most of the selective repeat, postponing the sending of a continuous retransmission request. Numerical results show a better performance very close to the ideal, but it does not integrally conform to the high-level data link control (HDLC) procedures. It is shown that these strategies are well suited for high-speed data transfer in the high-error-rate satellite environment.

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...

Limitations of dormant conduction as a predictor of atrial fibrillation recurrence and pulmonary vein reconnection after catheter ablation.

PubMed

Lin, Frank S; Ip, James E; Markowitz, Steven M; Liu, Christopher F; Thomas, George; Lerman, Bruce B; Cheung, Jim W

2015-05-01

Adenosine (ADO) can uncover dormant conduction following pulmonary vein (PV) isolation. We sought to identify the value of dormant conduction for predicting atrial fibrillation (AF) recurrence and chronic PV reconnection. One hundred fifty-two patients (80 male; age 60 ± 11 years) undergoing PV isolation for AF were studied. After PV isolation, sites of ADO-induced PV reconnection were recorded and targeted with additional ablation. In patients undergoing repeat ablation for recurrent AF, chronic PV reconnection was assessed. Forty-five (30%) patients had ADO-induced PV reconnection following PV isolation. Dormant conduction was successfully eliminated with additional ablation in 41 (91%) of these patients. After follow-up of 598 ± 270 days, 60 (39%) patients had recurrent AF. Dormant PV conduction was not a significant predictor of AF recurrence (hazard ratio 1.51; 95% confidence interval: 0.89-2.56; P = 0.12) although three of four (75%) patients with residual dormant conduction following initial ablation developed recurrent AF. Twenty-six patients with recurrent AF underwent repeat ablation with 52 of 99 (53%) PVs found to have chronic reconnection. Nine of 11 (82%) PVs with dormant conduction and 43 of 88 (49%) PVs without dormant conduction at initial procedure had chronic reconnection at repeat ablation. When additional ablation is performed to eliminate ADO-induced PV reconnection after PV isolation, dormant conduction is not a significant predictor of recurrent AF. Although PVs with dormant conduction at initial procedure may develop chronic reconnection, the majority of PVs that show conduction recovery at repeat ablation occur in nondormant PVs. © 2015 Wiley Periodicals, Inc.

Reliability of segmental accelerations measured using a new wireless gait analysis system.

PubMed

Kavanagh, Justin J; Morrison, Steven; James, Daniel A; Barrett, Rod

2006-01-01

The purpose of this study was to determine the inter- and intra-examiner reliability, and stride-to-stride reliability, of an accelerometer-based gait analysis system which measured 3D accelerations of the upper and lower body during self-selected slow, preferred and fast walking speeds. Eight subjects attended two testing sessions in which accelerometers were attached to the head, neck, lower trunk, and right shank. In the initial testing session, two different examiners attached the accelerometers and performed the same testing procedures. A single examiner repeated the procedure in a subsequent testing session. All data were collected using a new wireless gait analysis system, which features near real-time data transmission via a Bluetooth network. Reliability for each testing condition (4 locations, 3 directions, 3 speeds) was quantified using a waveform similarity statistic known as the coefficient of multiple determination (CMD). CMD's ranged from 0.60 to 0.98 across all test conditions and were not significantly different for inter-examiner (0.86), intra-examiner (0.87), and stride-to-stride reliability (0.86). The highest repeatability for the effect of location, direction and walking speed were for the shank segment (0.94), the vertical direction (0.91) and the fast walking speed (0.91), respectively. Overall, these results indicate that a high degree of waveform repeatability was obtained using a new gait system under test-retest conditions involving single and dual examiners. Furthermore, differences in acceleration waveform repeatability associated with the reapplication of accelerometers were small in relation to normal motor variability.

Upstream mononucleotide A-repeats play a cis-regulatory role in mammals through the DICER1 and Ago proteins.

PubMed

Aporntewan, Chatchawit; Pin-on, Piyapat; Chaiyaratana, Nachol; Pongpanich, Monnat; Boonyaratanakornkit, Viroj; Mutirangura, Apiwat

2013-10-01

A-repeats are the simplest form of tandem repeats and are found ubiquitously throughout genomes. These mononucleotide repeats have been widely believed to be non-functional 'junk' DNA. However, studies in yeasts suggest that A-repeats play crucial biological functions, and their role in humans remains largely unknown. Here, we showed a non-random pattern of distribution of sense A- and T-repeats within 20 kb around transcription start sites (TSSs) in the human genome. Different distributions of these repeats are observed upstream and downstream of TSSs. Sense A-repeats are enriched upstream, whereas sense T-repeats are enriched downstream of TSSs. This enrichment directly correlates with repeat size. Genes with different functions contain different lengths of repeats. In humans, tissue-specific genes are enriched for short repeats of <10 bp, whereas housekeeping genes are enriched for long repeats of ≥10 bp. We demonstrated that DICER1 and Argonaute proteins are required for the cis-regulatory role of A-repeats. Moreover, in the presence of a synthetic polymer that mimics an A-repeat, protein binding to A-repeats was blocked, resulting in a dramatic change in the expression of genes containing upstream A-repeats. Our findings suggest a length-dependent cis-regulatory function of A-repeats and that Argonaute proteins serve as trans-acting factors, binding to A-repeats.

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...

Computer-based Astronomy Labs for Non-science Majors

NASA Astrophysics Data System (ADS)

Smith, A. B. E.; Murray, S. D.; Ward, R. A.

1998-12-01

We describe and demonstrate two laboratory exercises, Kepler's Third Law and Stellar Structure, which are being developed for use in an astronomy laboratory class aimed at non-science majors. The labs run with Microsoft's Excel 98 (Macintosh) or Excel 97 (Windows). They can be run in a classroom setting or in an independent learning environment. The intent of the labs is twofold; first and foremost, students learn the subject matter through a series of informational frames. Next, students enhance their understanding by applying their knowledge in lab procedures, while also gaining familiarity with the use and power of a widely-used software package and scientific tool. No mathematical knowledge beyond basic algebra is required to complete the labs or to understand the computations in the spreadsheets, although the students are exposed to the concepts of numerical integration. The labs are contained in Excel workbook files. In the files are multiple spreadsheets, which contain either a frame with information on how to run the lab, material on the subject, or one or more procedures. Excel's VBA macro language is used to automate the labs. The macros are accessed through button interfaces positioned on the spreadsheets. This is done intentionally so that students can focus on learning the subject matter and the basic spreadsheet features without having to learn advanced Excel features all at once. Students open the file and progress through the informational frames to the procedures. After each procedure, student comments and data are automatically recorded in a preformatted Lab Report spreadsheet. Once all procedures have been completed, the student is prompted for a filename in which to save their Lab Report. The lab reports can then be printed or emailed to the instructor. The files will have full worksheet and workbook protection, and will have a "redo" feature at the end of the lab for students who want to repeat a procedure.

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

PubMed

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

2014-01-01

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

Effects of a docosahexaenoic acid-rich microalgae nutritional product on insulin sensitivity after prolonged dexamethasone treatment in healthy mature horses.

PubMed

Brennan, Kristen M; Graugnard, Daniel E; Spry, Malinda L; Brewster-Barnes, Tammy; Smith, Allison C; Schaeffer, Rachel E; Urschel, Kristine L

2015-10-01

To determine effects of a microalgae nutritional product on insulin sensitivity in horses. 8 healthy mature horses. PROCEDURES :Horses (n = 4/group) received a basal diet without (control diet) or with docosahexaenoic acid-rich microalgae meal (150 g/d) for 49 days (day 0 = first day of diet). On day 28, an isoglycemic hyperinsulinemic clamp procedure was performed. Horses then received dexamethasone (0.04 mg/kg/d) for 21 days. On day 49, the clamp procedure was repeated. After a 60-day washout, horses received the alternate diet, and procedures were repeated. Plasma fatty acid, glucose, and insulin concentrations and glucose and insulin dynamics during the clamp procedure were measured on days 28 and 49. Two estimates of insulin sensitivity (reciprocal of the square root of the insulin concentration and the modified insulin-to-glucose ratio for ponies) were calculated. Baseline glucose and insulin concentrations or measures of insulin sensitivity on day 28 did not differ between horses when fed the control diet or the basal diet plus microalgae meal. On day 49 (ie, after dexamethasone administration), the microalgae meal was associated with lower baseline insulin and glucose concentrations and an improved modified insulin-to-glucose ratio for ponies, compared with results for the control diet. Although the microalgae meal had no effect on clamp variables following dexamethasone treatment, it was associated with improved plasma glucose and insulin concentrations and insulin sensitivity estimates. A role for microalgae in the nutritional management of insulin-resistant horses warrants investigation.

Detection of antistripping additives with quick bottle test.

DOT National Transportation Integrated Search

1980-01-01

Several variations of the quick bottle test were evaluated to determine the procedure having the best repeatability. Naphtha was selected over kerosene and white gas as the solvent for use in the test, and room temperature was selected over 140F as...

New shield for gamma-ray spectrometry

NASA Technical Reports Server (NTRS)

Brar, S. S.; Gustafson, P. F.; Nelson, D. M.

1969-01-01

Gamma-ray shield that can be evacuated, refilled with a clean gas, and pressurized for exclusion of airborne radioactive contaminants effectively lowers background noise. Under working conditions, repeated evacuation and filling procedures have not adversely affected the sensitivity and resolution of the crystal detector.

Approaches for assessing temperament in calves post-weaning

USDA-ARS?s Scientific Manuscript database

Cattle undergo routine management, which may cause anxiety with potential to impact well-being and performance. Our objectives were to develop procedures to reliably evaluate calf behavior indicative of stress, and determine whether behaviors change under repeated handling. A factorial design of 2...

The stories of nursing student repeaters: A narrative inquiry study.

PubMed

Lewis, Lisa Scandale

2018-01-01

This narrative inquiry study examined community college nursing student repeaters, who failed a required nursing course and then went on to repeat the course. The purpose of this study was to learn about the experience of this group of students who are at high risk for attrition. While each participant had a unique story, common narratives emerged and were presented as storylines. Two storylines that are new to the literature were: Repeating is an Emotional Journey, and Ultimately Repeating was the Best Thing for Me. These findings suggest that there is a need for additional support for this population. Copyright © 2017 Elsevier Ltd. All rights reserved.

A Network Optimization Solution using SAS/OR Tools for the Department of the Army Branching Problem

DTIC Science & Technology

2010-02-18

OPTMODEL; NETFLOW ;Nodes;Arcs;ROTC; assignments;Basic Branches;Cadet Satisfaction; CLASSIFICATION: Unclassified This paper will demonstrate...implement a solution using the NETFLOW procedure and repeat that network solution using the OPTMODEL procedure. The OPTMODEL implementation will be...96.545599 M 1 AV AV IN EN FA AR 4 96.221521 M 1 IN IN MI EN MP AR 1 Figure 1, Supply: cadet data (5 of 2545) ordered by OMS PROC NETFLOW takes a

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

Faye, Sherry A.; Richards, Jason M.; Gallardo, Athena M.

Sequential extraction is a useful technique for assessing the potential to leach actinides from soils; however, current literature lacks uniformity in experimental details, making direct comparison of results impossible. This work continued development toward a standardized five-step sequential extraction protocol by analyzing extraction behaviors of 232Th, 238U, 239,240Pu and 241Am from lake and ocean sediment reference materials. Results produced a standardized procedure after creating more defined reaction conditions to improve method repeatability. A NaOH fusion procedure is recommended following sequential leaching for the complete dissolution of insoluble species.

Study of repeater technology for advanced multifunctional communications satellites

NASA Technical Reports Server (NTRS)

1972-01-01

Investigations are presented concerning design concepts and implementation approaches for the satellite communication repeater subsystems of advanced multifunctional satellites. In such systems the important concepts are the use of multiple antenna beams, repeater switching (routing), and efficient spectrum utilization through frequency reuse. An information base on these techniques was developed and tradeoff analyses were made of repeater design concepts, with the work design taken in a broad sense to include modulation beam coverage patterns. There were five major areas of study: requirements analysis and processing; study of interbeam interference in multibeam systems; characterization of multiple-beam switching repeaters; estimation of repeater weight and power for a number of alternatives; and tradeoff analyses based on these weight and power data.

The influence of repeated abutment changes on peri-implant tissue stability: 3-year post-loading results from a multicentre randomised controlled trial.

PubMed

Bressan, Eriberto; Grusovin, Maria Gabriella; D'Avenia, Ferdinando; Neumann, Konrad; Sbricoli, Luca; Luongo, Giuseppe; Esposito, Marco

To evaluate the influence of at least three abutment disconnections in conventional loaded implants against placement of a definitive abutment in immediately non-occlusal loaded implants on hard and soft tissue changes. A secondary aim was to evaluate whether the presence of less than 2 mm of keratinised mucosa is associated with increased peri-implant marginal bone loss and soft tissue recessions. Eighty patients requiring one single crown or one fixed partial prosthesis supported by a maximum of three implants were randomised, after implants were placed with more than 35 Ncm, according to a parallel group design to receive definitive abutments that were loaded immediately (definitive abutment or immediate loading group) or transmucosal abutments, which were delayed loaded after 3 months and removed at least three times: 1. At impression taking (3 months after implant placement); 2. When checking the zirconium core on titanium abutments at single crowns or the fitting the metal structure at prostheses supported by multiple implants; 3. At delivery of the definitive prostheses (repeated disconnection or conventional loading group). Patients were treated at four centres and each patient contributed to the study, with only one prosthesis followed for 3 years after initial loading. Outcome measures were: prosthesis failures, implant failures, complications, pink aesthetic score (PES), buccal recessions, patient satisfaction, peri-implant marginal bone level changes and height of the keratinised mucosa. Forty patients were randomly allocated to each group according to a parallel group design. Six patients from the definitive abutment group dropped out or died, and one left from the repeated disconnection group. One implant, from the repeated disconnection group, fractured (difference = 3%; CI 95%: -2%, 8%; P = 1). Four provisional crowns and one definitive single crown had to be remade because of poor fitting, and one definitive crown and one definitive prosthesis because of ceramic and implant fracture, respectively, in the repeated disconnection group vs one provisional prosthesis from the definitive abutment group due to frequent debondings (difference = 15%; CI 95%: 2%, 28%; P = 0.060). Five patients from the definitive abutment group and four patients from the repeated disconnection group were affected by complications (difference = 4%; CI 95%: -11%, 20%; P = 0.725). PES scores assessed at 3 years post-loading were 11.7 (standard deviation = 1.8) mm for the definitive abutment group and 11.3 (1.5) mm for the repeated abutment changes group (difference = 0.4; CI 95%: -0.4, 1.2; P = 0.315). However, there was a difference of 0.26 out of a maximum score of 2 in favour of the definitive abutment group for soft tissue contour only. Buccal recessions at 3 years post-loading amounted to -0.1 (0.8) mm for the definitive abutment group and -0.1 (1.2) mm for the repeated abutment changes group (it was actually a soft tissue gain; difference = 0.01 mm CI 95%: -0.48, 0.50; P = 0.965). All patients declared being very satisfied or satisfied with the function and aesthetics of the prostheses and said they would undergo the same procedure again, with the exception of one patient from the repeated disconnection group who was uncertain regarding function. Mean peri-implant marginal bone loss 3 years after loading was 0.07 (0.18) mm for the definitive abutment group and 0.50 (0.93) mm for the repeated abutment changes group (difference = 0.43 mm; CI 95%: 0.13, 0.74; P = 0.007). The height of keratinised mucosa at 3 years post-loading was 2.8 (1.3) mm for the definitive abutment group and 2.8 (1.6) mm for the repeated abutment changes group (difference = 0.03; CI 95%: -0.67, 0.73; P = .926). Up to 3 years after initial loading there were no statistically significant differences between the two procedures, with the exception of 0.4 mm more marginal bone loss at implants subjected to three abutment disconnections. There were no significantly increased marginal bone loss (difference = 0.1 mm, CI 95%: -0.3, 0.5, P = 0.590) or buccal recessions (difference = 0.1 mm, CI 95%: -0.4, 0.7, P = 0.674) at implants with less than 2 mm of keratinised mucosa at loading. Three-year post-loading data showed that repeated abutment disconnections significantly increased bone loss of 0.43 mm, but this difference may not be considered clinically relevant; therefore clinicians can use the procedure they find more convenient for each specific patient. Immediately non-occlusally loaded dental implants are a viable alternative to conventional loading and no increased bone loss or buccal recessions were noticed at implants with less than 2 mm of keratinised mucosa. Conflict of interest statement: This trial was partially funded by Dentsply Sirona Implants, the manufacturer of the implants and other products evaluated in this investigation. However, data belonged to the authors and by no means did the manufacturer interfere with the conduct of the trial or the publication of the results, with the exception of rejecting a proposal to change the protocol, after the trial was started, allowing the use of indexed abutments.

Context-specific control and the Stroop negative priming effect.

PubMed

Milliken, Bruce; Thomson, David R; Bleile, Karmen; MacLellan, Ellen; Giammarco, Maria

2012-01-01

The present study highlights the utility of context-specific learning for different probe types in accounting for the commonly observed dependence of negative priming on probe selection. Using a Stroop priming procedure, Experiments 1a and 1b offered a demonstration that Stroop priming effects can differ qualitatively for selection and no-selection probes when probe selection is manipulated between subjects, but not when it is manipulated randomly from trial to trial within subject (see also Moore, 1994). In Experiments 2 and 3, selection and no-selection probes served as two contexts that varied randomly from trial to trial, but for which proportion repeated was manipulated separately. A context-specific proportion repeated effect was observed in Experiment 2, characterized by modest quantitative shifts in the repetition effects as a function of the context-specific proportion repeated manipulation. However, with a longer intertrial interval in Experiment 3, a context-specific proportion repeated manipulation that focused on the no-selection probes changed the repetition effect qualitatively, from negative priming when the proportion repeated was .25 to positive priming when the proportion repeated was .75. The results are discussed with reference to the role of rapid, context-specific learning processes in the integration of prior experiences with current perception and action.

Association of the GGCX (CAA)16/17 repeat polymorphism with higher warfarin dose requirements in African Americans.

PubMed

Cavallari, Larisa H; Perera, Minoli; Wadelius, Mia; Deloukas, Panos; Taube, Gelson; Patel, Shitalben R; Aquino-Michaels, Keston; Viana, Marlos A G; Shapiro, Nancy L; Nutescu, Edith A

2012-02-01

Little is known about genetic contributors to higher than usual warfarin dose requirements, particularly for African Americans. This study tested the hypothesis that the γ-glutamyl carboxylase (GGCX) genotype contributes to warfarin dose requirements greater than 7.5 mg/day in an African American population. A total of 338 African Americans on a stable dose of warfarin were enrolled. The GGCX rs10654848 (CAA)n, rs12714145 (G>A), and rs699664 (p.R325Q); VKORC1 c.-1639G>A and rs61162043; and CYP2C9*2, *3, *5, *8, *11, and rs7089580 genotypes were tested for their association with dose requirements greater than 7.5 mg/day alone and in the context of other variables known to influence dose variability. The GGCX rs10654848 (CAA)16 or 17 repeat occurred at a frequency of 2.6% in African Americans and was overrepresented among patients requiring greater than 7.5 mg/day versus those who required lower doses (12 vs. 3%, P=0.003; odds ratio 4.0, 95% confidence interval, 1.5-10.5). The GGCX rs10654848 genotype remained associated with high dose requirements on regression analysis including age, body size, and VKORC1 genotype. On linear regression, the GGCX rs10654848 genotype explained 2% of the overall variability in warfarin dose in African Americans. An examination of the GGCX rs10654848 genotype in warfarin-treated Caucasians revealed a (CAA)16 repeat frequency of only 0.27% (P=0.008 compared with African Americans). These data support the GGCX rs10654848 genotype as a predictor of higher than usual warfarin doses in African Americans, who have a 10-fold higher frequency of the (CAA)16/17 repeat compared with Caucasians.

Resident-performed laser peripheral iridotomy in primary angle closure, primary angle closure suspects, and primary angle closure glaucoma.

PubMed

Kam, Jason P; Zepeda, Emily M; Ding, Leona; Wen, Joanne C

2017-01-01

To investigate the power use and complication frequency of resident-performed laser peripheral iridotomy (LPI). A retrospective analysis of 196 eyes from 103 patients who underwent neodymium: yttrium-aluminum-garnet laser iridotomy performed by resident physicians from January 1, 2010 through April 30, 2015 at a university-based county hospital was done. All patients were treated for primary angle closure, primary angle closure suspects, and primary angle closure glaucoma. Data were collected on pre- and post-laser intraocular pressure (IOP), ethnicity, laser parameters and complications. Mean power use and frequency of complications were evaluated. Complications included elevated post-laser IOP at 30-45 minutes (≥8 mmHg), hyphema, aborted procedures, and lasering non-iris structures. The number of repeated LPI procedures, was also recorded. Mean total power used for all residents was 78.2±68.7 mJ per eye. Power use by first-year trainees was significantly higher than second- and third-year trainees (103.5±75.5 mJ versus 73.7±73.8 mJ and 67.2±56.4 mJ, respectively, p =0.011). Complications included hyphema or microhyphema in 17.9% (35/196), IOP spikes in 5.1% (10/196), aborted procedures in 1.1% (3/196) and lasering non-iris structures in 0.5% (1/196). LPI was repeated in 22.4% of cases (44/196) with higher incidence of repeat LPI among non-Caucasian compared to the Caucasian subjects ( p =0.02). Complication rates did not differ with increased training ( p =0.16). Total power used for LPI decreased with increased resident training, while the complication rate did not differ significantly among resident classes. Complication rates were comparable to rates reported in the literature for attending-performed LPIs.

Parameters affecting the frequency of a fluid oscillator

NASA Astrophysics Data System (ADS)

Cheng, R. M. H.; Kwok, C. K.; Lee, R. S.

1983-06-01

A new type of liquid-operated low-frequency oscillator is introduced. The oscillator consists of a cone-shaped housing with a fluid inlet and two outlet discharging tubes. The fluid discharge is controlled by a ball which blocks one of the outlet tubes. A strong vacuum develops due to the inertial effect of the column of liquid moving downward in the blocked tube. When the initial energy and velocity of the liquid slug are reduced to zero, it starts to return toward the ball. Eventually the combined force of the pressure inside the housing and the momentum of the upcoming slug is large enough to displace the ball to the other outlet tube, and the same procedure is then repeated. The main part of the paper consists of an analysis of the time required for the forward and reverse motion of the slug and for the ball to move from one discharge hole to the other.

Breath analysis using external cavity diode lasers: a review

NASA Astrophysics Data System (ADS)

Bayrakli, Ismail

2017-04-01

Most techniques that are used for diagnosis and therapy of diseases are invasive. Reliable noninvasive methods are always needed for the comfort of patients. Owing to its noninvasiveness, ease of use, and easy repeatability, exhaled breath analysis is a very good candidate for this purpose. Breath analysis can be performed using different techniques, such as gas chromatography mass spectrometry (MS), proton transfer reaction-MS, and selected ion flow tube-MS. However, these devices are bulky and require complicated procedures for sample collection and preconcentration. Therefore, these are not practical for routine applications in hospitals. Laser-based techniques with small size, robustness, low cost, low response time, accuracy, precision, high sensitivity, selectivity, low detection limit, real-time, and point-of-care detection have a great potential for routine use in hospitals. In this review paper, the recent advances in the fields of external cavity lasers and breath analysis for detection of diseases are presented.

A rapid microwave-assisted synthesis of a sodium-cadmium metal-organic framework having improved performance as a CO2 adsorbent for CCS.

PubMed

Palomino Cabello, Carlos; Arean, Carlos Otero; Parra, José B; Ania, Conchi O; Rumori, P; Turnes Palomino, G

2015-06-07

We report on a facile and rapid microwave-assisted method for preparing a sodium-cadmium metal-organic framework (having coordinatively unsaturated sodium ions) that considerably shortens the conventional synthesis time from 5 days to 1 hour. The obtained (Na,Cd)-MOF showed an excellent volumetric CO2 adsorption capacity (5.2 mmol cm(-3) at 298 K and 1 bar) and better CO2 adsorption properties than those shown by the same metal-organic framework when synthesized following a more conventional procedure. Moreover, the newly prepared material was found to display high selectivity for adsorption of carbon dioxide over nitrogen, and good regenerability and stability during repeated CO2 adsorption-desorption cycles, which are the required properties for any adsorbent intended for carbon dioxide capture and sequestration (CSS) from the post-combustion flue gas of fossil fuelled power stations.

Probabilistic structural mechanics research for parallel processing computers

NASA Technical Reports Server (NTRS)

Sues, Robert H.; Chen, Heh-Chyun; Twisdale, Lawrence A.; Martin, William R.

1991-01-01

Aerospace structures and spacecraft are a complex assemblage of structural components that are subjected to a variety of complex, cyclic, and transient loading conditions. Significant modeling uncertainties are present in these structures, in addition to the inherent randomness of material properties and loads. To properly account for these uncertainties in evaluating and assessing the reliability of these components and structures, probabilistic structural mechanics (PSM) procedures must be used. Much research has focused on basic theory development and the development of approximate analytic solution methods in random vibrations and structural reliability. Practical application of PSM methods was hampered by their computationally intense nature. Solution of PSM problems requires repeated analyses of structures that are often large, and exhibit nonlinear and/or dynamic response behavior. These methods are all inherently parallel and ideally suited to implementation on parallel processing computers. New hardware architectures and innovative control software and solution methodologies are needed to make solution of large scale PSM problems practical.

Stratospheric Sampling and In Situ Atmospheric Chemical Element Analysis During Meteor Showers: A Resource Study

NASA Technical Reports Server (NTRS)

Noever, David A.

2000-01-01

Resources studies for asteroidal mining evaluation have depended historically on remote sensing analysis for chemical elements. During the November 1998 Leonids meteor shower, a stratospheric balloon and various low-density capture media were used to sample fragments from Comet Tempel-Tuttle debris during a peak Earth crossing. The analysis not only demonstrates how potential sampling strategies may improve the projections for metals or rare elements in astromining, but also benchmarks materials during low temperature (-60 F), high dessication environments as seen during atmospheric exposure. The results indicate high aluminum, magnesium and iron content for various sampled particles recovered, but generalization to the sporadic meteors expected from asteroidal sources will require future improvements in larger sampling volumes before a broad-use strategy for chemical analysis can be described. A repeat of the experimental procedure is planned for the November 1999 Leonids' shower, and various improvements for atmospheric sampling will be discussed.

Identification of volatiles by headspace gas chromatography with simultaneous flame ionization and mass spectrometric detection.

PubMed

Tiscione, Nicholas B; Yeatman, Dustin Tate; Shan, Xiaoqin; Kahl, Joseph H

2013-10-01

Volatiles are frequently abused as inhalants. The methods used for identification are generally nonspecific if analyzed concurrently with ethanol or require an additional analytical procedure that employs mass spectrometry. A previously published technique utilizing a capillary flow technology splitter to simultaneously quantitate and confirm ethyl alcohol by flame ionization and mass spectrometric detection after headspace sampling and gas chromatographic separation was evaluated for the detection of inhalants. Methanol, isopropanol, acetone, acetaldehyde, toluene, methyl ethyl ketone, isoamyl alcohol, isobutyl alcohol, n-butyl alcohol, 1,1-difluoroethane, 1,1,1-trifluoroethane, 1,1,1,2-tetrafluoroethane (Norflurane, HFC-134a), chloroethane, trichlorofluoromethane (Freon®-11), dichlorodifluoromethane (Freon®-12), dichlorofluoromethane (Freon®-21), chlorodifluoromethane (Freon®-22) and 1,2-dichlorotetrafluoroethane (Freon®-114) were validated for qualitative identification by this method. The validation for qualitative identification included evaluation of matrix effects, sensitivity, carryover, specificity, repeatability and ruggedness/robustness.

Morel-Lavallée lesion: diagnosis and treatment with imaging techniques.

PubMed

Martel Villagrán, J; Díaz Candamio, M J; Bueno Horcajadas, A

We aim to review the characteristics of Morel-Lavallée lesions and to evaluate their treatment. We retrospectively reviewed 17 patients (11 men and 6 women; mean age, 56.1 years, range 25-81 years) diagnosed with Morel-Lavallée lesions in two different departments. All patients underwent ultrasonography, 5 underwent computed tomography, and 9 underwent magnetic resonance imaging. Percutaneous treatment with fine-needle aspiration and/or drainage with a 6F-8F catheter was performed in 13 patients. Two patients required percutaneous sclerosis with doxycycline. All patients responded adequately to percutaneous treatment, although it was necessary to repeat the procedure in 4 patients. Radiologists need to be familiar with this lesion that can be treated percutaneously in the ultrasonography suite when it is not associated with other entities. Copyright © 2018 SERAM. Publicado por Elsevier España, S.L.U. All rights reserved.

[Knee arthrodesis using a customized intramedullary nail: 14 cases].

PubMed

Volpi, R; Dehoux, E; Touchard, P; Mensa, C; Segal, P

2004-02-01

We report our experience with knee arthrodesis using a customized intramedullary nail implanted in 14 patients. Indications for knee arthrodesis were: recurrent prosthesis infection (n=11), post-traumatic septic arthritis (n=1), aseptic loosening of a hinge prosthesis (n=1), and nonunion (n=1). A two-stage procedure was used for the 12 patients with infected joints. Mean follow-up was 19 months. Weight bearing began during the first week after arthrodesis in 13 patients. First intention bone healing was achieved in 13 patients. Mean time to healing was three months. All patients rapidly recovered full independence. Complications were: one misinsertion of the tibial stem, one nonunion which fused after repeated grafting, and two recurrent infections (controlled chronic fistulae) which required skin flaps for cover. We have found that this customized nail is a useful method for achieving bone fusion in patients with difficult indications for arthrodesis, particularly recurrent prosthesis infection.

A Lagrangian meshfree method applied to linear and nonlinear elasticity.

PubMed

Walker, Wade A

2017-01-01

The repeated replacement method (RRM) is a Lagrangian meshfree method which we have previously applied to the Euler equations for compressible fluid flow. In this paper we present new enhancements to RRM, and we apply the enhanced method to both linear and nonlinear elasticity. We compare the results of ten test problems to those of analytic solvers, to demonstrate that RRM can successfully simulate these elastic systems without many of the requirements of traditional numerical methods such as numerical derivatives, equation system solvers, or Riemann solvers. We also show the relationship between error and computational effort for RRM on these systems, and compare RRM to other methods to highlight its strengths and weaknesses. And to further explain the two elastic equations used in the paper, we demonstrate the mathematical procedure used to create Riemann and Sedov-Taylor solvers for them, and detail the numerical techniques needed to embody those solvers in code.

Nonhybrid, finished microbial genome assemblies from long-read SMRT sequencing data.

PubMed

Chin, Chen-Shan; Alexander, David H; Marks, Patrick; Klammer, Aaron A; Drake, James; Heiner, Cheryl; Clum, Alicia; Copeland, Alex; Huddleston, John; Eichler, Evan E; Turner, Stephen W; Korlach, Jonas

2013-06-01

We present a hierarchical genome-assembly process (HGAP) for high-quality de novo microbial genome assemblies using only a single, long-insert shotgun DNA library in conjunction with Single Molecule, Real-Time (SMRT) DNA sequencing. Our method uses the longest reads as seeds to recruit all other reads for construction of highly accurate preassembled reads through a directed acyclic graph-based consensus procedure, which we follow with assembly using off-the-shelf long-read assemblers. In contrast to hybrid approaches, HGAP does not require highly accurate raw reads for error correction. We demonstrate efficient genome assembly for several microorganisms using as few as three SMRT Cell zero-mode waveguide arrays of sequencing and for BACs using just one SMRT Cell. Long repeat regions can be successfully resolved with this workflow. We also describe a consensus algorithm that incorporates SMRT sequencing primary quality values to produce de novo genome sequence exceeding 99.999% accuracy.

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.

A Lagrangian meshfree method applied to linear and nonlinear elasticity

PubMed Central

2017-01-01

The repeated replacement method (RRM) is a Lagrangian meshfree method which we have previously applied to the Euler equations for compressible fluid flow. In this paper we present new enhancements to RRM, and we apply the enhanced method to both linear and nonlinear elasticity. We compare the results of ten test problems to those of analytic solvers, to demonstrate that RRM can successfully simulate these elastic systems without many of the requirements of traditional numerical methods such as numerical derivatives, equation system solvers, or Riemann solvers. We also show the relationship between error and computational effort for RRM on these systems, and compare RRM to other methods to highlight its strengths and weaknesses. And to further explain the two elastic equations used in the paper, we demonstrate the mathematical procedure used to create Riemann and Sedov-Taylor solvers for them, and detail the numerical techniques needed to embody those solvers in code. PMID:29045443

The outcome of manipulation under general anesthesia for the management of frozen shoulder in patients with diabetes mellitus.

PubMed

Jenkins, Emily F; Thomas, William J C; Corcoran, John P; Kirubanandan, Ravisankar; Beynon, Celia R; Sayers, Adrian E; Woods, David A

2012-11-01

Frozen shoulder has a greater incidence, more severe course, and resistance to treatment in patients with diabetes mellitus compared with the general population. We hypothesized that diabetic patients with frozen shoulder undergoing treatment with manipulation under general anaesthesia (MUA) would have the same outcome as patients without diabetes. We retrospectively analyzed data collected during a 10-year period of referrals for frozen shoulder. In all cases, a standardized MUA protocol was followed once the diagnosis of frozen shoulder in the frozen phase was made; this included an early repeat MUA in individuals with recurrence. We compared outcomes for patients documented as having diabetes with a nondiabetic control group and assessed the effect of insulin dependence and frozen shoulder etiology within the diabetic group. Of a consecutive series of 315 frozen shoulders, 36 patients (39 shoulders) were included in the diabetic group, with 256 patients (274 shoulders) as controls. There was a significant improvement in range of movement and Oxford Shoulder Score (P all <.001), with no difference between diabetic and control groups at early or late follow-up (mean, 41 months). A repeat procedure was required in 36% of diabetic patients compared with 15% of control patients. Recurrence in the diabetic group was influenced by etiology (47% of primary vs 0% of secondary frozen shoulders) and insulin requirement (39% insulin-dependent vs. 31% non-insulin-dependent). We provide a strategy for the management of diabetic frozen shoulders using MUA and estimates of success and recurrence rates that may be useful when informing consent. Copyright © 2012 Journal of Shoulder and Elbow Surgery Board of Trustees. All rights reserved.

Surgical management of anterior chamber epithelial cysts.

PubMed

Haller, Julia A; Stark, Walter J; Azab, Amr; Thomsen, Robert W; Gottsch, John D

2003-03-01

To review management strategies for treatment of anterior chamber epithelial cysts. Retrospective review of consecutive interventional case series. Charts of patients treated for epithelial ingrowth over a 10-year period by a single surgeon were reviewed. Cases of anterior chamber epithelial cysts were identified and recorded, including details of ocular history, preoperative and postoperative acuity, intraocular pressure (IOP), and ocular examination, type of surgical intervention, and details of further procedures performed. Seven eyes with epithelial cysts were identified. Patient age ranged from 1.5 to 53 years at presentation. Four patients were children. In four eyes, cysts were secondary to trauma, one case was presumably congenital, one case developed after corneal perforation in an eye with Terrien's marginal degeneration, and one case developed after penetrating keratoplasty (PK). Three eyes were treated with vitrectomy, en bloc resection of the cyst and associated tissue, fluid-air exchange and cryotherapy. The last four eyes were treated with a new conservative strategy of cyst aspiration (three cases) or local excision (one keratin "pearl" cyst), and endolaser photocoagulation of the collapsed cyst wall/base. All epithelial tissue was successfully eradicated by clinical criteria; one case required repeat excision (follow-up, 9 to 78 months, mean 45). Two eyes required later surgery for elevated IOP, two for cataract extraction and one for repeat PK. Final visual acuity ranged from 20/20 to hand motions, depending on associated ocular damage. Best-corrected visual results were obtained in the more conservatively managed eyes. Anterior chamber epithelial cysts can be managed conservatively in selected cases with good results. This strategy may be particularly useful in children's eyes, where preservation of the lens, iris, and other structures may facilitate amblyopia management. Copyright 2003 by Elsevier Science Inc.

Patient satisfaction with the endoscopy experience and willingness to return in a central Canadian health region.

PubMed

Loftus, Russell; Nugent, Zoann; Graff, Lesley A; Schumacher, Frederick; Bernstein, Charles N; Singh, Harminder

2013-01-01

Patient experiences with endoscopy visits within a large central Canadian health region were evaluated to determine the relationship between the visit experience and the patients' willingness to return for future endoscopy, and to identify the factors associated with patients' willingness to return. A self-report survey was distributed to 1200 consecutive individuals undergoing an upper and⁄or lower gastrointestinal endoscopy at any one of the six hospital-based endoscopy facilities in the region. The Spearman correlation coefficient was used to assess the association between the patients' overall rating of the visits and willingness to return for repeat procedures under similar medical circumstances. Logistic regression analyses were performed to identify the factors associated with willingness to return for repeat endoscopy and overall satisfaction (rating) of the visit. A total of 529 (44%) individuals returned the questionnaire, with 45% rating the visit as excellent and 56% indicating they were extremely likely to return for repeat endoscopy. There was a low moderate correlation between overall rating of the visit and patients' willingness to return for repeat endoscopy (r=0.30). The factors independently associated with patient willingness to return for repeat endoscopy included perceived technical skills of the endoscopists (OR 2.7 [95% CI 1.3 to 5.5]), absence of pain during the procedure (OR 2.2 [95% CI 1.3 to 3.6]) and history of previous endoscopy (OR 2.4 [95% CI 1.4 to 4.1]). In contrast, the independent factors associated with the overall rating of the visit included information provided pre- and postprocedure, wait time before and on the day of the visit, and the physical environment. To facilitate patient return for needed endoscopy, it is important to assess patients' willingness to return because positive behavioural intent is not simply a function of satisfaction with the visit.

40 CFR 60.285a - Test methods and procedures.

Code of Federal Regulations, 2014 CFR

2014-07-01

... performance test. (b) The owner or operator must determine compliance with the filterable particulate matter... used to determine the filterable particulate matter concentration. The sampling time and sample volume... repeat performance tests for filterable particulate matter at intervals no longer than 5 years following...

Curiosity & Connections

ERIC Educational Resources Information Center

Lim, Kien H.

2014-01-01

Retaining mathematical knowledge is difficult for many students, especially for those who learn facts and procedures without understanding the meanings underlying the symbols and operations. Repeated practice may be necessary for developing skills but is unlikely to make conceptual ideas stick. An idea is more likely to stick if students are…

42 CFR 84.307 - Environmental treatments.

Code of Federal Regulations, 2013 CFR

2013-10-01

... environmental treatments simulating extreme storage temperatures, shock, and vibration. (b) The units will be...) The units will be subjected to vibration according to the following procedure: (1) The unit will be...; and (3) The vibration frequency regimen applied to each axis will be cyclical, repeating the sequence...

42 CFR 84.307 - Environmental treatments.

Code of Federal Regulations, 2012 CFR

2012-10-01

... environmental treatments simulating extreme storage temperatures, shock, and vibration. (b) The units will be...) The units will be subjected to vibration according to the following procedure: (1) The unit will be...; and (3) The vibration frequency regimen applied to each axis will be cyclical, repeating the sequence...

42 CFR 84.307 - Environmental treatments.

Code of Federal Regulations, 2014 CFR

2014-10-01

... environmental treatments simulating extreme storage temperatures, shock, and vibration. (b) The units will be...) The units will be subjected to vibration according to the following procedure: (1) The unit will be...; and (3) The vibration frequency regimen applied to each axis will be cyclical, repeating the sequence...

Continuous assimilation of simulated Geosat altimetric sea level into an eddy-resolving numerical ocean model. I - Sea level differences. II - Referenced sea level differences

NASA Technical Reports Server (NTRS)

White, Warren B.; Tai, Chang-Kou; Holland, William R.

1990-01-01

The optimal interpolation method of Lorenc (1981) was used to conduct continuous assimilation of altimetric sea level differences from the simulated Geosat exact repeat mission (ERM) into a three-layer quasi-geostrophic eddy-resolving numerical ocean box model that simulates the statistics of mesoscale eddy activity in the western North Pacific. Assimilation was conducted continuously as the Geosat tracks appeared in simulated real time/space, with each track repeating every 17 days, but occurring at different times and locations within the 17-day period, as would have occurred in a realistic nowcast situation. This interpolation method was also used to conduct the assimilation of referenced altimetric sea level differences into the same model, performing the referencing of altimetric sea sevel differences by using the simulated sea level. The results of this dynamical interpolation procedure are compared with those of a statistical (i.e., optimum) interpolation procedure.

Predictors of eyewitness identification decisions from video lineups in England: a field study.

PubMed

Horry, Ruth; Memon, Amina; Wright, Daniel B; Milne, Rebecca

2012-08-01

Eyewitness identification decisions from 1,039 real lineups in England were analysed. Identification procedures have undergone dramatic change in the United Kingdom over recent years. Video lineups are now standard procedure, in which each lineup member is seen sequentially. The whole lineup is seen twice before the witness can make a decision, and the witness can request additional viewings of the lineup. A key aim of this paper was to investigate the association between repeated viewing and eyewitness decisions. Repeated viewing was strongly associated with increased filler identification rates, suggesting that witnesses who requested additional viewings were more willing to guess. In addition, several other factors were associated with lineup outcomes, including the age difference between the suspect and the witness, the type of crime committed, and delay. Overall, the suspect identification rate was 39%, the filler identification rate was 26% and the lineup rejection rate was 35%. (PsycINFO Database Record (c) 2012 APA, all rights reserved).

Feasibility of Multiple Repeat Gamma Knife Radiosurgeries for Trigeminal Neuralgia: A Case Report and Review of the Literature

PubMed Central

Jones, Guy C.; Elaimy, Ameer L.; Demakas, John J.; Jiang, Hansi; Lamoreaux, Wayne T.; Fairbanks, Robert K.; Mackay, Alexander R.; Cooke, Barton S.; Lee, Christopher M.

2011-01-01

Treatment options for trigeminal neuralgia (TN) must be customized for the individual patient, and physicians must be aware of the medical, surgical, and radiation treatment modalities to prescribe optimal treatment courses for specific patients. The following case illustrates the potential for gamma knife radiosurgery (GKRS) to be repeated multiple times for the purpose of achieving facial pain control in cases of TN that have been refractory to other medical and surgical options, as well as prior GKRS. The patient described failed to achieve pain control with initial GKRS, as well as medical and surgical treatments, but experienced significant pain relief for a period of time with a second GKRS procedure and later underwent a third procedure. Only a small subset of patients have reportedly undergone more than two GKRS for TN; thus, further research and long-term clinical followup will be valuable in determining its usefulness in specific clinical situations. PMID:21904556

Counterconditioning reduces cue-induced craving and actual cue-elicited consumption.

PubMed

Van Gucht, Dinska; Baeyens, Frank; Vansteenwegen, Debora; Hermans, Dirk; Beckers, Tom

2010-10-01

Cue-induced craving is not easily reduced by an extinction or exposure procedure and may constitute an important route toward relapse in addictive behavior after treatment. In the present study, we investigated the effectiveness of counterconditioning as an alternative procedure to reduce cue-induced craving, in a nonclinical population. We found that a cue, initially paired with chocolate consumption, did not cease to elicit craving for chocolate after extinction (repeated presentation of the cue without chocolate consumption), but did so after counterconditioning (repeated pairing of the cue with consumption of a highly disliked liquid, Polysorbate 20). This effect persisted after 1 week. Counterconditioning moreover was more effective than extinction in disrupting reported expectancy to get to eat chocolate, and also appeared to be more effective in reducing actual cue-elicited chocolate consumption. These results suggest that counterconditioning may be more promising than cue exposure for the prevention of relapse in addictive behavior. (PsycINFO Database Record (c) 2010 APA, all rights reserved).

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

Denton, T; Howe, J; Spalding, A

Purpose: Occipital neuralgia is a condition wherein pain is transmitted by the occipital nerves. Non-invasive therapies generally alleviate symptoms; however, persistent or recurring pain may require invasive procedures. Repeated invasive procedures upon failure are considered higher risk and are often contraindicated due to compounding inherent risk. SRS has not been explored as a treatment option largely due to the extracranial nature of the target (as opposed to the similar, more established trigeminal neuralgia), but advances in linear-accelerator frameless-based SRS now present an opportunity to evaluate the novel potential of this modality for this application. Methods: Patient presented with severe occipitalmore » pain following decompression and fusion of the cervical vertebrae with prior intervention attempted via radiofrequency ablation yielding temporary pain cessation. A 0.6 mm slice spacing CT was obtained for treatment planning, and a cervical spine oriented 1.0 mm slice spacing CT myelogram was obtained for the purpose of defining the targeted C2 occipital dorsal root ganglion (to receive 80 Gy to the isocenter) and spinal cord. Results: The spinal cord was most proximally 12.0 mm from the isocenter receiving a maximum dose of 3.36 Gy, and doses to 0.35 and 1.2 cc of 1.84 Gy and 0.79 Gy, respectively. The brain maximum dose was 2.29 Gy. The treatment was successfully performed with a NovalisTX (Varian) equipped with ExacTrac stereoscopic x-ray image guidance (BrainLAB). Treatment time was 59 minutes for 18,323 MUs. Imaging was performed prior to each arc delivery resulting in twenty-one imaging sessions (twelve requiring positional corrections with the remaining verified within tolerance). The average deviation magnitude requiring a positional or rotational correction was 0.96±0.25 mm, 0.8±0.41° while the average deviation magnitude deemed within tolerance was 0.41±0.12 mm, 0.57±0.28°. Conclusion: Linear accelerator-based frameless radiosurgery provides an accurate, non-invasive alternative for treating occipital neuralgia where an invasive procedure is contraindicated.« less

45 CFR 308.2 - Required program compliance criteria.

Code of Federal Regulations, 2011 CFR

2011-10-01

... Motor Vehicles, and credit bureaus; (iii) Repeating location attempts quarterly and when new information... employment security agency, Department of motor vehicles, and credit bureaus; (ii) Repeating attempts to..., State employment security agency, unemployment data, Department of Motor Vehicles, and credit bureaus...

Omasal sampling technique for assessing fermentative digestion in the forestomach of dairy cows.

PubMed

Huhtanen, P; Brotz, P G; Satter, L D

1997-05-01

A procedure allowing digesta sampling from the omasum via a ruminal cannula without repeated entry into the omasum was developed. The sampling system consisted of a device inserted into the omasum via the ruminal cannula, a tube connecting the device to the ruminal cannula, and a single compressor/vacuum pump. Eight cows given ad libitum access to a total mixed diet were used in a crossover design to evaluate the effects of the sampling system on digestive activity, animal performance, and animal behavior. Results indicated that the omasal sampling system has minimal effect on normal digestive and productive functions of high-producing dairy cows. Dry matter intake was reduced (24.0 vs 21.8 kg/d; P < .02) and seemed related more to the sampling procedures than to the device in the omasum. Observations of animal behavior indicated that cows with the sampling device were similar to control cows, although rumination and total chewing times were reduced slightly. The composition of digesta samples was biased toward an over-abundance of the liquid phase, but using a double-marker system to calculate digesta flow resulted in fairly small coefficients of variation for measurements of ruminal digestion variables. This technique may prove useful for partitioning digestion between the fermentative portion of the forestomach and the lower gastrointestinal tract. The omasal sampling procedure requires less surgical intervention than the traditional methods using abomasal or duodenal cannulas as sampling sites to study forestomach digestion and avoids potentially confounding endogenous secretions of the abomasum.

Image-guided automatic triggering of a fractional CO2 laser in aesthetic procedures.

PubMed

Wilczyński, Sławomir; Koprowski, Robert; Wiernek, Barbara K; Błońska-Fajfrowska, Barbara

2016-09-01

Laser procedures in dermatology and aesthetic medicine are associated with the need for manual laser triggering. This leads to pulse overlapping and side effects. Automatic laser triggering based on image analysis can provide a secure fit to each successive doses of radiation. A fractional CO2 laser was used in the study. 500 images of the human skin of healthy subjects were acquired. Automatic triggering was initiated by an application together with a camera which tracks and analyses the skin in visible light. The tracking algorithm uses the methods of image analysis to overlap images. After locating the characteristic points in analysed adjacent areas, the correspondence of graphs is found. The point coordinates derived from the images are the vertices of graphs with respect to which isomorphism is sought. When the correspondence of graphs is found, it is possible to overlap the neighbouring parts of the image. The proposed method of laser triggering owing to the automatic image fitting method allows for 100% repeatability. To meet this requirement, there must be at least 13 graph vertices obtained from the image. For this number of vertices, the time of analysis of a single image is less than 0.5s. The proposed method, applied in practice, may help reduce the number of side effects during dermatological laser procedures resulting from laser pulse overlapping. In addition, it reduces treatment time and enables to propose new techniques of treatment through controlled, precise laser pulse overlapping. Copyright © 2016 Elsevier Ltd. All rights reserved.

A new method to precisely control the depth of percutaneous screws into the pedicle by counting the rotation number of the screw with low radiation exposure: technical note.

PubMed

Li, Xu; Zhang, Feng; Zhang, Wenzhi; Shang, Xifu; Han, Jintao; Liu, Pengfei

2017-03-01

Technique note. To report a new method for precisely controlling the depth of percutaneous pedicle screws (PPS)-without radiation exposure to surgeons and less fluoroscopy exposure to patients than with conventional methods. PPS is widely used in minimal invasive spine surgery; the advantages include reduced muscle damage, pain, and hospital stays. However, placement of PPS demands repeated checking with fluoroscopy. Thus, radiation exposure is considerable for both surgeons and patients. The PPS depth was determined by counting rotations of the screws. The distance between screw threads can be measured for particular screws; thus, full rotations of the PPS results in the screw advancing in the pedicle the distance between screw threads. To fully insert screws into the pedicle, the number of full rotations is equal to the number of threads in the PPS. We applied this technique in 58 patients with thoracolumbar fracture. The position and depth of the screws was checked during the operation with the C-arm and after operation by anteroposterior X-ray film or computed tomography. No additional procedures were required to correct the screws; we observed no neurological deficits or malpositioning of the screws. In the screw placement procedure, the radiation exposure for surgeons is zero, and the patient is well protected from extensive radiation exposure. This method of counting rotation of screws is a safe way to precisely determine the depth of PPS in the placement procedure. IV.

Application of FTA sample collection and DNA purification system on the determination of CTG trinucleotide repeat size by PCR-based Southern blotting.

PubMed

Hsiao, K M; Lin, H M; Pan, H; Li, T C; Chen, S S; Jou, S B; Chiu, Y L; Wu, M F; Lin, C C; Li, S Y

1999-01-01

Myotonic dystrophy (DM) is caused by a CTG trinucleotide expansion mutation at exon 15 of the myotonic dystrophy protein kinase gene. The clinical severity of this disease correlates with the length of the CTG trinucleotide repeats. Determination of the CTG repeat length has been primarily relied on by Southern blot analysis of restriction enzyme-digested genomic DNA. The development of PCR-based Southern blotting methodology provides a much more sensitive and simpler protocol for DM diagnosis. However, the quality of the template and the high (G+C) ratio of the amplified region hamper the use of PCR on the diagnosis of DM. A modified PCR protocol to amplify different lengths of CTG repeat region using various concentrations of 7deaza-dGTP has been reported (1). Here we describe a procedure including sample collection, DNA purification, and PCR analysis of CTG repeat length without using 7-deaza-dGTP. This protocol is very sensitive and convenient because only a small number of nucleate cells are needed for detection of CTG expansion. Therefore, it could be very useful in clinical and prenatal diagnosis as well as in prevalence study of DM.

Case study: videogame distraction reduces behavioral distress in a preschool-aged child undergoing repeated burn dressing changes: a single-subject design.

PubMed

Sil, Soumitri; Dahlquist, Lynnda M; Burns, Andrew J

2013-04-01

This single-subject design study evaluated the feasibility and efficacy of passive and interactive videogame distraction on behavioral distress for a preschool-aged child receiving repeated burn dressing changes. A 4-year-old girl underwent 3 baseline and 10 videogame distraction sessions (5 passive and 5 interactive) using a restricted alternating treatments design. Observed behavioral distress was coded, and parents and nurses rated the child's distress and cooperative behavior. Relative to baseline, behavioral distress decreased and cooperative behavior increased immediately after the onset of videogame distraction. Single Case Randomization Tests revealed significantly lower behavioral distress and greater cooperation during interactive videogame distraction relative to passive videogame distraction. Interactive videogame distraction appears to be a feasible and effective pain management strategy for a preschool-aged child undergoing repeated painful medical procedures.

Tuboimpedance: A New Test of Eustachian Tube Function.

PubMed

Smith, Matthew E; Zou, Charlie C; Blythe, Andrew J C; Tysome, James R

2017-04-01

Objective Eustachian tube (ET) dysfunction is most frequently caused by a failure of the ET to adequately open; however, there is currently no reliable method of assessing this. Tubomanometry has recently shown good interindividual repeatability as a measure of ET function by measuring middle ear pressure after the application of regulated nasopharyngeal pressures during swallowing. We present the first reports of a novel test: middle ear impedance measurements during standard nasopharyngeal pressure application (tuboimpedance). We assess repeatability in healthy ears and any advantages over tubomanometry. Study Design Exploratory cohort diagnosis study. Setting Tertiary referral center. Subjects Twenty screened, healthy ears (10 volunteers). Methods Tubomanometry and tuboimpedance tests were performed while individuals swallowed with applied nasopharyngeal pressures of 20, 30, 40, and 50 mbar. Eustachian tube opening detection rate and test repeatability (measured by intraclass correlation coefficient [ICC]) for immediate and delayed repeats at each pressure were compared. Results ET opening was detected more frequently using tuboimpedance, with a 100% detection rate using a nasopharyngeal pressure of 30 mbar or more, compared to 88% to 96% with tubomanometry. Detection of ET opening at 20 mbar was possible with tuboimpedance. Repeatability of both tests was mostly strong (ICC >0.7) for both immediate and delayed repeats. Repeatability for the tubomanometry R value was only fair to moderate. Conclusion Tuboimpedance may provide a repeatable measure of ET opening that is easier to perform due to lower nasopharyngeal pressures required and fewer issues with poor ear-probe sealing. Further assessment in patients with different forms of ET dysfunction is required.

Selective recognition of N4-methylcytosine in DNA by engineered transcription-activator-like effectors.

PubMed

Rathi, Preeti; Maurer, Sara; Summerer, Daniel

2018-06-05

The epigenetic DNA nucleobases 5-methylcytosine (5mC) and N 4-methylcytosine (4mC) coexist in bacterial genomes and have important functions in host defence and transcription regulation. To better understand the individual biological roles of both methylated nucleobases, analytical strategies for distinguishing unmodified cytosine (C) from 4mC and 5mC are required. Transcription-activator-like effectors (TALEs) are programmable DNA-binding repeat proteins, which can be re-engineered for the direct detection of epigenetic nucleobases in user-defined DNA sequences. We here report the natural, cytosine-binding TALE repeat to not strongly differentiate between 5mC and 4mC. To engineer repeats with selectivity in the context of C, 5mC and 4mC, we developed a homogeneous fluorescence assay and screened a library of size-reduced TALE repeats for binding to all three nucleobases. This provided insights into the requirements of size-reduced TALE repeats for 4mC binding and revealed a single mutant repeat as a selective binder of 4mC. Employment of a TALE with this repeat in affinity enrichment enabled the isolation of a user-defined DNA sequence containing a single 4mC but not C or 5mC from the background of a bacterial genome. Comparative enrichments with TALEs bearing this or the natural C-binding repeat provides an approach for the complete, programmable decoding of all cytosine nucleobases found in bacterial genomes.This article is part of a discussion meeting issue 'Frontiers in epigenetic chemical biology'. © 2018 The Author(s).

Beef longissimus slice shear force measurement among steak locations and institutions.

PubMed

Wheeler, T L; Shackelford, S D; Koohmaraie, M

2007-09-01

The objectives of this study were 1) to determine which longissimus thoracis et lumborum steaks were appropriate for slice shear force measurement and 2) to determine the among and within institution variation in LM slice shear force values of 6 institutions after they received expert training on the procedure and a standard kit of equipment. In experiment 1, longissimus thoracis et lumborum muscles were obtained from the left sides of 50 US Select carcasses. Thirteen longissimus thoracis and 12 longissimus lumborum steaks were cut 2.54 cm thick from each muscle. Slice shear force was measured on each steak. Mean slice shear force among steak locations (1 to 25) ranged from 19.7 to 27.3 kg. Repeatability of slice shear force (based on variance) among steak locations ranged from 0.71 to 0.96. In experiment 2, the longissimus thoracis et lumborum were obtained from the left sides of 154 US Select beef carcasses. Eight 2.54-cm-thick steaks were obtained from the caudal end of each frozen longissimus thoracis, and six 2.54-cm-thick steaks were obtained from the cranial end of each frozen longissimus lumborum. Seven pairs of consecutive steaks were assigned for measurement of slice shear force. Seven institutions were assigned to steak pairs within each carcass using a randomized complete block design, such that each institution was assigned to each steak pair 22 times. Repeatability estimates for slice shear force for the 7 institutions were 0.89, 0.83, 0.91, 0.90, 0.89, 0.76, and 0.89, respectively, for institutions 1 to 7. Mean slice shear force values were least (P <0.05) for institutions 3 (22.7 kg) and 7 (22.3 kg) and were greatest (P <0.05) for institutions 5 (27.3 kg) and 6 (27.6 kg). Institutions with greater mean slice shear force (institutions 5 and 6) used cooking methods that required more (P <0.05) time (32.0 and 36.9 min vs. 5.5 to 11.8 min) to reach the end point temperature (71 degrees C) and resulted in greater (P <0.05) cooking loss (both 26.6% vs. 14.4 to 24.1%). Differences among institutions in the repeatability of slice shear force were partially attributable to differences among institutions in the consistency of steak thawing and cooking procedures. These results emphasize the importance of sample location within the muscle and cooking method in the measurement of tenderness and indicate that with proper training and application of the protocol, slice shear force is a highly repeatable (R approximately 0.90) measure of beef LM tenderness.

Meta-analysis of the technical performance of an imaging procedure: guidelines and statistical methodology.

PubMed

Huang, Erich P; Wang, Xiao-Feng; Choudhury, Kingshuk Roy; McShane, Lisa M; Gönen, Mithat; Ye, Jingjing; Buckler, Andrew J; Kinahan, Paul E; Reeves, Anthony P; Jackson, Edward F; Guimaraes, Alexander R; Zahlmann, Gudrun

2015-02-01

Medical imaging serves many roles in patient care and the drug approval process, including assessing treatment response and guiding treatment decisions. These roles often involve a quantitative imaging biomarker, an objectively measured characteristic of the underlying anatomic structure or biochemical process derived from medical images. Before a quantitative imaging biomarker is accepted for use in such roles, the imaging procedure to acquire it must undergo evaluation of its technical performance, which entails assessment of performance metrics such as repeatability and reproducibility of the quantitative imaging biomarker. Ideally, this evaluation will involve quantitative summaries of results from multiple studies to overcome limitations due to the typically small sample sizes of technical performance studies and/or to include a broader range of clinical settings and patient populations. This paper is a review of meta-analysis procedures for such an evaluation, including identification of suitable studies, statistical methodology to evaluate and summarize the performance metrics, and complete and transparent reporting of the results. This review addresses challenges typical of meta-analyses of technical performance, particularly small study sizes, which often causes violations of assumptions underlying standard meta-analysis techniques. Alternative approaches to address these difficulties are also presented; simulation studies indicate that they outperform standard techniques when some studies are small. The meta-analysis procedures presented are also applied to actual [18F]-fluorodeoxyglucose positron emission tomography (FDG-PET) test-retest repeatability data for illustrative purposes. © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

Meta-analysis of the technical performance of an imaging procedure: Guidelines and statistical methodology

PubMed Central

Huang, Erich P; Wang, Xiao-Feng; Choudhury, Kingshuk Roy; McShane, Lisa M; Gönen, Mithat; Ye, Jingjing; Buckler, Andrew J; Kinahan, Paul E; Reeves, Anthony P; Jackson, Edward F; Guimaraes, Alexander R; Zahlmann, Gudrun

2017-01-01

Medical imaging serves many roles in patient care and the drug approval process, including assessing treatment response and guiding treatment decisions. These roles often involve a quantitative imaging biomarker, an objectively measured characteristic of the underlying anatomic structure or biochemical process derived from medical images. Before a quantitative imaging biomarker is accepted for use in such roles, the imaging procedure to acquire it must undergo evaluation of its technical performance, which entails assessment of performance metrics such as repeatability and reproducibility of the quantitative imaging biomarker. Ideally, this evaluation will involve quantitative summaries of results from multiple studies to overcome limitations due to the typically small sample sizes of technical performance studies and/or to include a broader range of clinical settings and patient populations. This paper is a review of meta-analysis procedures for such an evaluation, including identification of suitable studies, statistical methodology to evaluate and summarize the performance metrics, and complete and transparent reporting of the results. This review addresses challenges typical of meta-analyses of technical performance, particularly small study sizes, which often causes violations of assumptions underlying standard meta-analysis techniques. Alternative approaches to address these difficulties are also presented; simulation studies indicate that they outperform standard techniques when some studies are small. The meta-analysis procedures presented are also applied to actual [18F]-fluorodeoxyglucose positron emission tomography (FDG-PET) test–retest repeatability data for illustrative purposes. PMID:24872353

Safety and Efficacy of Cryoballoon Ablation for Paroxysmal Atrial Fibrillation in Japan　- Results From the Japanese Prospective Post-Market Surveillance Study.

PubMed

Okumura, Ken; Matsumoto, Kazuo; Kobayashi, Yoshinori; Nogami, Akihiko; Hokanson, Robert B; Kueffer, Fred

2016-07-25

Outcomes of cryoballoon ablation for paroxysmal atrial fibrillation (PAF) have been reported in the Western countries but not in Japan. The CRYO-Japan PMS study was a single-arm, observational, multicenter, prospective study of the 2nd-generation cryoballoon Arctic Front Advance(TM). We evaluated device- and procedure-related complications and clinical outcomes at 6 months. The 616 patients (male, 72%; mean age, 63±11 years) were enrolled from 33 Japanese hospitals. Of all patients, 610 had PAF, and procedural data were analyzed in 607. A subset of 328 patients was followed for 6 months for the primary efficacy analysis. AF recurrence outside the 3-month blanking period or repeat ablation was considered treatment failure. Pulmonary vein isolation was achieved in 606/607 patients (99.8%); 1 patient (0.3%) had a repeat ablation during the blanking period. Freedom from AF at 6 months was 88.4% (95% CI: 84.1-91.6%). Device- and/or procedure-related adverse events included phrenic nerve injury unresolved at hospital discharge in 9/616 patients (1.5%), which resolved within 6 months in 7, pericardial effusion in 5/616 (0.8%), and tamponade in 4/616 (0.6%). One non-device-related death from pneumonia was reported 6 days post-procedure. Cryoballoon ablation is safe and effective for Japanese PAF patients, with 88.4% AF freedom at 6 months post-ablation. (Circ J 2016; 80: 1744-1749).

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...

Development of an analytical procedure to study linear alkylbenzenesulphonate (LAS) degradation in sewage sludge-amended soils.

PubMed

Comellas, L; Portillo, J L; Vaquero, M T

1993-12-24

A procedure for determining linear alkylbenzenesulphonates (LASs) in sewage sludge and amended soils has been developed. Extraction by sample treatment with 0.5 M potassium hydroxide in methanol and reflux was compared with a previously described extraction procedure in Soxhlet with methanol and solid sodium hydroxide in the sample. Repeatability results were similar with savings in extraction time, solvents and evaporation time. A clean-up method involving a C18 cartridge has been developed. Analytes were quantified by a reversed-phase HPLC method with UV and fluorescence detectors. Recoveries obtained were higher than 84%. The standing procedure was applied to high doses of sewage sludge-amended soils (15%) with increasing quantities of added LASs. Degradation data for a 116-day period are presented.

Evaluation of the repeatability of a crude adult indirect Ostertagia ostertagi ELISA and methods of expressing test results.

PubMed

Sanchez, J; Dohoo, I R; Markham, F; Leslie, K; Conboy, G

2002-10-16

An indirect enzyme-linked immunosorbent assay (ELISA) for the detection of antibodies against Ostertagia ostertagi using a crude adult worm antigen was evaluated using serum and milk samples from adult cows, as well as from bulk tank milk. Within and between plate repeatabilities were determined. In addition, the effects of factors such as antigen batch, freezing, preserving of the samples and somatic cell counts (SCCs) of the samples were evaluated. Raw optical densities (ODs) and normalized values were compared using the concordance correlation coefficient (CCC), the coefficient of variation (CV), Bland-Altman plots (BA). Based on raw OD values, there was a high repeatability within a plate (CCC approximately 0.96 and CV<10%). Repeatability between plates was evaluated following normalization of OD values by four methods. Computing normalized values as (OD-Nt)/(Pst-Nt), gave the most repeatable results, with the CCC being approximately 0.95 and the CV approximately 11%. When the OD values were higher than 1.2 and 0.3 for the positive and the negative controls, respectively, none of the normalization methods evaluated provided highly repeatable results and it was necessary to repeat the test. Two batches of the crude antigen preparation were evaluated for repeatability, and no difference was found (CCC=0.96). The use of preservative (bronopol) did not affect test results, nor did freezing the samples for up to 8 months. A significant positive relationship between ELISA OD for milk samples and SCC score was found. Therefore, the use of composite milk samples, which have less variable SCC than samples taken from each quarter, would be more suitable when the udder health status is unknown. The analytical methods used to evaluate repeatability provided a practical way to select among normalization procedures.

Postparalysis Facial Synkinesis: Clinical Classification and Surgical Strategies

PubMed Central

Chang, Tommy Nai-Jen; Lu, Johnny Chuieng-Yi

2015-01-01

Background: Postparalysis facial synkinesis (PPFS) can occur after any cause of facial palsy. Current treatments are still inadequate. Surgical intervention, instead of Botox and rehabilitation only, for different degrees of PPFS was proposed. Methods: Seventy patients (43 females and 27 males) with PPFS were enrolled since 1986. They were divided into 4 patterns based on quality of smile and severity of synkinesis. Data collection for clinically various presentations was made: pattern I (n = 14) with good smile but synkinesis, pattern II (n = 17) with acceptable smile but dominant synkinesis, pattern III (n = 34) unacceptable smile and dominant synkinesis, and pattern IV (n = 5) poor smile and synkinesis. Surgical interventions were based on patterns of PPFS. Selective myectomy and some cosmetic procedures were performed for pattern I and II patients. Extensive myectomy and neurectomy of the involved muscles and nerves followed by functioning free-muscle transplantation for facial reanimation in 1- or 2-stage procedure were performed for pattern III and many pattern II patients. A classic 2-stage procedure for facial reanimation was performed for pattern IV patients. Results: Minor aesthetic procedures provided some help to pattern I patients but did not cure the problem. They all had short follow-up. Most patients in patterns II (14/17, 82%) and III (34/34, 100%) showed a significant improvement of eye and smile appearance and significant decrease in synkinetic movements following the aggressively major surgical intervention. Nearly, all of the patients treated by the authors did not need repeated botulinum toxin A injection nor require a profound rehabilitation program in the follow-up period. Conclusions: Treatment of PPFS remains a challenging problem. Major surgical reconstruction showed more promising and long-lasting results than botulinum toxin A and/or rehabilitation on pattern III and II patients. PMID:25878931

Intracardiac echo-facilitated 3D electroanatomical mapping of ventricular arrhythmias from the papillary muscles: assessing the 'fourth dimension' during ablation.

PubMed

Proietti, Riccardo; Rivera, Santiago; Dussault, Charles; Essebag, Vidal; Bernier, Martin L; Ayala-Paredes, Felix; Badra-Verdu, Mariano; Roux, Jean-François

2017-01-01

Ventricular arrhythmias (VA) originating from a papillary muscle (PM) have recently been described as a distinct clinical entity with peculiar features that make its treatment with catheter ablation challenging. Here, we report our experience using an intracardiac echo-facilitated 3D electroanatomical mapping approach in a case series of patients undergoing ablation for PM VA. Sixteen patients who underwent catheter ablation for ventricular tachycardia (VT) or symptomatic premature ventricular contractions originating from left ventricular PMs were included in the study. A total of 24 procedures (mean 1.5 per patient) were performed: 15 using a retrograde aortic approach and 9 using a transseptal approach. Integrated intracardiac ultrasound for 3D electroanatomical mapping was used in 15 of the 24 procedures. The posteromedial PM was the most frequent culprit for the clinical arrhythmia, and the body was the part of the PM most likely to be the successful site for ablation. The site of ablation was identified based on the best pace map matching the clinical arrhythmia and the site of earliest the activation. At a mean follow-up of 10.5 ± 7 months, only two patients had recurrent arrhythmias following a repeat ablation procedure. An echo-facilitated 3D electroanatomical mapping allows for real-time creation of precise geometries of cardiac chambers and endocavitary structures. This is useful during procedures such as catheter ablation of VAs originating from PMs, which require detailed representation of anatomical landmarks. Routine adoption of this technique should be considered to improve outcomes of PM VA ablation. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2016. For permissions please email: journals.permissions@oup.com.

Application of gas chromatography-tandem mass spectrometry for the determination of amphetamine-type stimulants in blood and urine.

PubMed

Woźniak, Mateusz Kacper; Wiergowski, Marek; Aszyk, Justyna; Kubica, Paweł; Namieśnik, Jacek; Biziuk, Marek

2018-01-30

Amphetamine, methamphetamine, phentermine, 3,4-methylenedioxyamphetamine (MDA), 3,4-methylenedioxymethamphetamine (MDMA), and 3,4-methylenedioxy-N-ethylamphetamine (MDEA) are the most popular amphetamine-type stimulants. The use of these substances is a serious societal problem worldwide. In this study, a method based on gas chromatography-tandem mass spectrometry (GC-MS/MS) with simple and rapid liquid-liquid extraction (LLE) and derivatization was developed and validated for the simultaneous determination of the six aforementioned amphetamine derivatives in blood and urine. The detection of all compounds was based on multiple reaction monitoring (MRM) transitions. The most important advantage of the method is the minimal sample volume (as low as 200μL) required for the extraction procedure. The validation parameters, i.e., the recovery (90.5-104%), inter-day accuracy (94.2-109.1%) and precision (0.5-5.8%), showed the repeatability and sensitivity of the method for both matrices and indicated that the proposed procedure fulfils internationally established acceptance criteria for bioanalytical methods The procedure was successfully applied to the analysis of real blood and urine samples examined in 22 forensic toxicological cases. To the best of our knowledge, this is the first work presenting the use of GC-MS/MS for the determination of amphetamine-type stimulants in blood and urine. In view of the low limits of detection (0.09-0.81ng/mL), limits of quantification (0.26-2.4ng/mL), and high selectivity, the procedure can be applied for drug monitoring in both fatal and non-fatal intoxication cases in routine toxicology analysis. Copyright © 2017 Elsevier B.V. All rights reserved.

When Should We Give Up Filtration Surgery: Indications, Techniques and Results of Cyclodestruction.

PubMed

Masis Solano, Marisse; Huang, Guofu; Lin, Shan C

2017-01-01

Cyclodestructive procedures are traditionally used in cases of glaucoma that are refractory to medical and surgical therapy. The goal of this chapter is to describe the indications, contraindications, techniques, and pitfalls of cyclodestructive procedures, including transscleral cyclophotocoagulation (TCP), micropulse TCP (MP-TCP), endoscopic cyclophotocoagulation (ECP), and ultrasound cilioplasty. A literature search for cyclodestructive techniques was performed, and relevant studies were included for evaluation and review. It is encouraging that TCP seems relatively efficacious even for patients who have been refractory to other treatments, depending on the energy setting, follow-up period, and definition of success. Repeated TCP is often required. TCP was more often used in eyes with limited visual potential caused by severe forms of glaucoma than in eyes with good visual potential. Serious complications were significant vision loss, inflammation, hypotony, and phthisis. ECP came later into clinical use for the treatment of refractory glaucoma. ECP is able to specifically target the ciliary epithelium under direct viewing as compared to TCP, which is an indirect cyclodestructive procedure. In the literature, it has been demonstrated that ECP has overall good success with relatively low complication rates when used for adult forms of glaucoma. A new technology using MP-TCP is a promising alternative to conventional cyclophotocoagulation. Early evidence shows that MP-TCP has clinical utility and a good safety profile. Ultrasound cilioplasty is a possible alternative to laser cyclodestruction that is already being commercialized and is currently under investigation. Both TCP and ECP are effective cyclodestructive procedures and alternatives for the treatment of glaucoma refractory to medical and surgical therapy, though potential for serious complications exists. TCP, ECP, and ultrasound cilioplasty are being used increasingly as the primary surgery for various kinds and stages of glaucoma. © 2017 S. Karger AG, Basel.

AUDIOVISUAL RESOURCES ON THE TEACHING PROCESS IN SURGICAL TECHNIQUE

PubMed Central

PUPULIM, Guilherme Luiz Lenzi; IORIS, Rafael Augusto; GAMA, Ricardo Ribeiro; RIBAS, Carmen Australia Paredes Marcondes; MALAFAIA, Osvaldo; GAMA, Mirnaluci

2015-01-01

Background: The development of didactic means to create opportunities to permit complete and repetitive viewing of surgical procedures is of great importance nowadays due to the increasing difficulty of doing in vivo training. Thus, audiovisual resources favor the maximization of living resources used in education, and minimize problems arising only with verbalism. Aim: To evaluate the use of digital video as a pedagogical strategy in surgical technique teaching in medical education. Methods: Cross-sectional study with 48 students of the third year of medicine, when studying in the surgical technique discipline. They were divided into two groups with 12 in pairs, both subject to the conventional method of teaching, and one of them also exposed to alternative method (video) showing the technical details. All students did phlebotomy in the experimental laboratory, with evaluation and assistance of the teacher/monitor while running. Finally, they answered a self-administered questionnaire related to teaching method when performing the operation. Results: Most of those who did not watch the video took longer time to execute the procedure, did more questions and needed more faculty assistance. The total exposed to video followed the chronology of implementation and approved the new method; 95.83% felt able to repeat the procedure by themselves, and 62.5% of those students that only had the conventional method reported having regular capacity of technique assimilation. In both groups mentioned having regular difficulty, but those who have not seen the video had more difficulty in performing the technique. Conclusion: The traditional method of teaching associated with the video favored the ability to understand and transmitted safety, particularly because it is activity that requires technical skill. The technique with video visualization motivated and arouse interest, facilitated the understanding and memorization of the steps for procedure implementation, benefiting the students performance. PMID:26734790

45 CFR 308.2 - Required program compliance criteria.

Code of Federal Regulations, 2010 CFR

2010-10-01

..., State employment security agency, employment data, Department of Motor Vehicles, and credit bureaus... vehicles, and credit bureaus; (ii) Repeating attempts to locate quarterly and when new information is..., Department of Motor Vehicles, and credit bureaus; (ii) Repeating location attempts quarterly and when new...