Managing uncertainty - a qualitative study of surgeons' decision-making for one-stage and two-stage revision surgery for prosthetic hip joint infection.

PubMed

Moore, Andrew J; Blom, Ashley W; Whitehouse, Michael R; Gooberman-Hill, Rachael

2017-04-12

Approximately 88,000 primary hip replacements are performed in England and Wales each year. Around 1% go on to develop deep prosthetic joint infection. Between one-stage and two-stage revision arthroplasty best treatment options remain unclear. Our aims were to characterise consultant orthopaedic surgeons' decisions about performing either one-stage or two-stage revision surgery for patients with deep prosthetic infection (PJI) after hip arthroplasty, and to identify whether a randomised trial comparing one-stage with two-stage revision would be feasible. Semi-structured interviews were conducted with 12 consultant surgeons who perform revision surgery for PJI after hip arthroplasty at 5 high-volume National Health Service (NHS) orthopaedic departments in England and Wales. Surgeons were interviewed before the development of a multicentre randomised controlled trial. Data were analysed using a thematic approach. There is no single standardised surgical intervention for the treatment of PJI. Surgeons balance multiple factors when choosing a surgical strategy which include multiple patient-related factors, their own knowledge and expertise, available infrastructure and the infecting organism. Surgeons questioned whether it was appropriate that the two-stage revision remained the best treatment, and some surgeons' willingness to consider more one-stage revisions had increased over recent years and were influenced by growing evidence showing equivalence between surgical techniques, and local observations of successful one-stage revisions. Custom-made articulating spacers was a practice that enabled uncertainty to be managed in the absence of definitive evidence about the superiority of one surgical technique over the other. Surgeons highlighted the need for research evidence to inform practice and thought that a randomised trial to compare treatments was needed. Most surgeons thought that patients who they treated would be eligible for trial participation in instances where there was uncertainty about the best treatment option. Surgeons highlighted the need for evidence to support their choice of revision. Some surgeons' willingness to consider one-stage revision for infection had increased over time, largely influenced by evidence of successful one-stage revisions. Custom-made articulating spacers also enabled surgeons to manage uncertainty about the superiority of surgical techniques. Surgeons thought that a prospective randomised controlled trial comparing one-stage with two-stage joint replacement is needed and that randomisation would be feasible.

Two-stage revision of septic knee prosthesis with articulating knee spacers yields better infection eradication rate than one-stage or two-stage revision with static spacers.

PubMed

Romanò, C L; Gala, L; Logoluso, N; Romanò, D; Drago, L

2012-12-01

The best method for treating chronic periprosthetic knee infection remains controversial. Randomized, comparative studies on treatment modalities are lacking. This systematic review of the literature compares the infection eradication rate after two-stage versus one-stage revision and static versus articulating spacers in two-stage procedures. We reviewed full-text papers and those with an abstract in English published from 1966 through 2011 that reported the success rate of infection eradication after one-stage or two-stage revision with two different types of spacers. In all, 6 original articles reporting the results after one-stage knee exchange arthoplasty (n = 204) and 38 papers reporting on two-stage revision (n = 1,421) were reviewed. The average success rate in the eradication of infection was 89.8% after a two-stage revision and 81.9% after a one-stage procedure at a mean follow-up of 44.7 and 40.7 months, respectively. The average infection eradication rate after a two-stage procedure was slightly, although significantly, higher when an articulating spacer rather than a static spacer was used (91.2 versus 87%). The methodological limitations of this study and the heterogeneous material in the studies reviewed notwithstanding, this systematic review shows that, on average, a two-stage procedure is associated with a higher rate of eradication of infection than one-stage revision for septic knee prosthesis and that articulating spacers are associated with a lower recurrence of infection than static spacers at a comparable mean duration of follow-up. IV.

Changes in Antibiotic Susceptibility of Staphylococcus aureus Between the Stages of 2-Stage Revision Arthroplasty.

PubMed

George, Jaiben; Newman, Jared M; Klika, Alison K; Miller, Evan M; Tan, Timothy L; Parvizi, Javad; Higuera, Carlos A

2018-06-01

Staphylococcus aureus is the predominant cause of periprosthetic joint infection (PJI) and can persist at the time of planned second stage of 2-stage revision arthroplasty, despite antibiotic cement spacer insertion and parenteral antibiotic therapy. Given the rapid emergence of antibiotic resistance, it is important to determine whether the antibiotic susceptibility of microorganisms changes between the stages of a 2-stage revision. A total of 1614 2-stage revision hip/knee arthroplasties performed for PJI at 2 academic institutions from 2000 to 2015 were identified. S aureus (methicillin susceptible and/or resistant) was isolated by culture in 402 (24.9%) cases during the first stage (resection arthroplasty). S aureus persisted and was cultured in 30 cases (knees = 18, hips = 12) during the second stage. Minimum inhibitory concentrations (MICs), demographics, antibiotic therapy, and surgical history were collected. The MICs at the time of the first-stage and second-stage surgeries were compared. Nine (30%) revisions had an increase in vancomycin MIC. Six had an increase from ≤0.5 to 1 μg/mL, 2 had an increase from ≤0.5 to 2 μg/mL, and 1 had an increase from 1 to 2 μg/mL. All of the 9 revisions with an increase in vancomycin MIC had vancomycin in spacer. Increases in the MICs were observed for vancomycin, the antibiotic widely used in cement spacers, in about one-third of the revisions. Despite the small sample size, the data from this preliminary study raise concern about the potential for emergence of resistant organisms between the stages of a 2-stage revision. Copyright © 2018 Elsevier Inc. All rights reserved.

Prognostic significance of interventricular septal thickness in patients with AL amyloidosis.

PubMed

Cho, Hyunsoo; Kim, Soo-Jeong; Shim, Chi Young; Hong, Geu-Ru; Ha, Jong-Won; Kim, Yu Ri; Yang, Woo Ick; Chung, Haerim; Jang, Ji Eun; Cheong, June-Won; Min, Yoo Hong; Kim, Jin Seok

2017-09-01

The major prognostic determinant of immunoglobulin light chain (AL) amyloidosis is cardiac involvement. However, the role of interventricular septal thickness (IVST), which reflects the extent of cardiac involvement, remains unclear. Therefore, we analyzed 77 patients with newly diagnosed AL amyloidosis and evaluated the prognostic role of IVST. Fifty patients (64.9%) had cardiac involvement and 17 patients (22.1%) showed IVST >15mm. Among all patients, the revised Mayo Clinic Stage III-IV and IVST >15mm were independently associated with inferior overall survival (OS) in a multivariable analysis. IVST >15mm was also adversely prognostic for OS in a subgroup of advanced-stage (revised Mayo Clinic stage III-IV) patients in a multivariable analysis (P<0.001). Furthermore, advanced-stage patients with IVST >15mm did not show survival benefit from treatment with bortezomib-based regimens and/or autologous stem-cell transplantation (ASCT). Our study demonstrated that IVST >15mm is adversely prognostic independent of the revised Mayo Clinic staging system in patients with AL amyloidosis. In addition, the degree of IVST might be used as a useful prognostic indicator that can guide the management of patients with AL amyloidosis especially at an advanced stage. Copyright © 2017 Elsevier Ltd. All rights reserved.

One-stage or two-stage revision surgery for prosthetic hip joint infection--the INFORM trial: a study protocol for a randomised controlled trial.

PubMed

Strange, Simon; Whitehouse, Michael R; Beswick, Andrew D; Board, Tim; Burston, Amanda; Burston, Ben; Carroll, Fran E; Dieppe, Paul; Garfield, Kirsty; Gooberman-Hill, Rachael; Jones, Stephen; Kunutsor, Setor; Lane, Athene; Lenguerrand, Erik; MacGowan, Alasdair; Moore, Andrew; Noble, Sian; Simon, Joanne; Stockley, Ian; Taylor, Adrian H; Toms, Andrew; Webb, Jason; Whittaker, John-Paul; Wilson, Matthew; Wylde, Vikki; Blom, Ashley W

2016-02-17

Periprosthetic joint infection (PJI) affects approximately 1% of patients following total hip replacement (THR) and often results in severe physical and emotional suffering. Current surgical treatment options are debridement, antibiotics and implant retention; revision THR; excision of the joint and amputation. Revision surgery can be done as either a one-stage or two-stage operation. Both types of surgery are well-established practice in the NHS and result in similar rates of re-infection, but little is known about the impact of these treatments from the patient's perspective. The main aim of this randomised controlled trial is to determine whether there is a difference in patient-reported outcome measures 18 months after randomisation for one-stage or two-stage revision surgery. INFORM (INFection ORthopaedic Management) is an open, two-arm, multi-centre, randomised, superiority trial. We aim to randomise 148 patients with eligible PJI of the hip from approximately seven secondary care NHS orthopaedic units from across England and Wales. Patients will be randomised via a web-based system to receive either a one-stage revision or a two-stage revision THR. Blinding is not possible due to the nature of the intervention. All patients will be followed up for 18 months. The primary outcome is the WOMAC Index, which assesses hip pain, function and stiffness, collected by questionnaire at 18 months. Secondary outcomes include the following: cost-effectiveness, complications, re-infection rates, objective hip function assessment and quality of life. A nested qualitative study will explore patients' and surgeons' experiences, including their views about trial participation and randomisation. INFORM is the first ever randomised trial to compare two widely accepted surgical interventions for the treatment of PJI: one-stage and two-stage revision THR. The results of the trial will benefit patients in the future as the main focus is on patient-reported outcomes: pain, function and wellbeing in the long term. Patients state that these outcomes are more important than those that are clinically derived (such as re-infection) and have been commonly used in previous non-randomised studies. Results from the INFORM trial will also benefit clinicians and NHS managers by enabling the comparison of these key interventions in terms of patients' complication rates, health and social resource use and their overall cost-effectiveness. Current controlled trials ISRCTN10956306 (registered on 29 January 2015); UKCRN ID 18159.

One- and two-stage surgical revision of peri-prosthetic joint infection of the hip: a pooled individual participant data analysis of 44 cohort studies.

PubMed

Kunutsor, Setor K; Whitehouse, Michael R; Blom, Ashley W; Board, Tim; Kay, Peter; Wroblewski, B Mike; Zeller, Valérie; Chen, Szu-Yuan; Hsieh, Pang-Hsin; Masri, Bassam A; Herman, Amir; Jenny, Jean-Yves; Schwarzkopf, Ran; Whittaker, John-Paul; Burston, Ben; Huang, Ronald; Restrepo, Camilo; Parvizi, Javad; Rudelli, Sergio; Honda, Emerson; Uip, David E; Bori, Guillem; Muñoz-Mahamud, Ernesto; Darley, Elizabeth; Ribera, Alba; Cañas, Elena; Cabo, Javier; Cordero-Ampuero, José; Redó, Maria Luisa Sorlí; Strange, Simon; Lenguerrand, Erik; Gooberman-Hill, Rachael; Webb, Jason; MacGowan, Alasdair; Dieppe, Paul; Wilson, Matthew; Beswick, Andrew D

2018-04-05

One-stage and two-stage revision strategies are the two main options for treating established chronic peri-prosthetic joint infection (PJI) of the hip; however, there is uncertainty regarding which is the best treatment option. We aimed to compare the risk of re-infection between the two revision strategies using pooled individual participant data (IPD). Observational cohort studies with PJI of the hip treated exclusively by one- or two-stage revision and reporting re-infection outcomes were retrieved by searching MEDLINE, EMBASE, Web of Science, The Cochrane Library, and the WHO International Clinical Trials Registry Platform; as well as email contact with investigators. We analysed IPD of 1856 participants with PJI of the hip from 44 cohorts across four continents. The primary outcome was re-infection (recurrence of infection by the same organism(s) and/or re-infection with a new organism(s)). Hazard ratios (HRs) for re-infection were calculated using Cox proportional frailty hazards models. After a median follow-up of 3.7 years, 222 re-infections were recorded. Re-infection rates per 1000 person-years of follow-up were 16.8 (95% CI 13.6-20.7) and 32.3 (95% CI 27.3-38.3) for one-stage and two-stage strategies respectively. The age- and sex-adjusted HR of re-infection for two-stage revision was 1.70 (0.58-5.00) when compared with one-stage revision. The association remained consistently absent after further adjustment for potential confounders. The HRs did not vary importantly in clinically relevant subgroups. Analysis of pooled individual patient data suggest that a one-stage revision strategy may be as effective as a two-stage revision strategy in treating PJI of the hip.

Is Single-stage Revision Safe Following Infected Total Knee Arthroplasty? A Critical Review.

PubMed

Vaishya, Raju; Agarwal, Amit Kumar; Rawat, Sudheer K; Singh, Harsh; Vijay, Vipul

2017-08-30

With the improvement in outcomes and modern prosthesis design, total knee arthroplasty (TKA) has now become a commonly performed surgery. It is postulated that a total of 2-5% of the primary and revision TKA becomes infected every year, requiring a revision procedure which to date is the conventional two-stage revision. The diagnosis and treatment of these periprosthetic infections is a major and challenging task, as it requires precise identification of the pathogen, meticulous debridement, and postoperative rehabilitation. To date, there have been very few studies in existing literature comparing the outcomes of single-stage versus two-stage procedure in infected TKA. The aim of the review was to provide the clinicians an insight into the outcome of the single-stage procedure compared to two-stage procedures and to suggest ways to improve the results further. In the following critical review, a total of 669 cases that underwent either a single or two-stage revision for infected TKA were studied. The postoperative functional scores were comparable in most studies during the early postoperative period. Our data supports the use of a single-stage revision surgery in infected TKA as an alternative to a conventional two-stage procedure. However, larger prospective and multicentric trials are required to validate our findings.

T4 category revision enhances the accuracy and significance of stage III breast cancer.

PubMed

Güth, Uwe; Singer, Gad; Langer, Igor; Schötzau, Andreas; Herberich, Linda; Holzgreve, Wolfgang; Wight, Edward

2006-06-15

Because of the considerable heterogeneity in breast carcinoma with noninflammatory skin involvement (T4b/Stage IIIB), a revision was proposed of the TNM staging system that would classify these tumors exclusively based on their tumor size and lymph node status. In the current study, the authors evaluated how implementation of this proposal will affect Stage III noninflammatory breast cancer. Two hundred seven patients who were classified with noninflammatory Stage III breast cancer were treated consecutively between 1990 and 1999 at the University Hospital Basel, Switzerland. To assess the extent of T4b/Stage IIIB tumors independent of the clinicopathologic feature of skin involvement, the reclassification was undertaken. Of 68 patients who had nonmetastatic T4b breast cancer, 37 patients (54.4%) had a tumor extent in accordance with Stage I/II and had improved disease-specific survival (DSS) compared with patients who had Stage III breast cancer (P = .008). Excluding those patients from Stage III led to a 17.9% reduction of the number of patients in this group (n = 170 patients). The 10-year DSS declined from 48.5% to 42.9%. Considerable numbers of patients who are classified with noninflammatory Stage IIIB breast cancer show only a limited disease extent. Through a revision of the T4 category, these low-risk patients were excluded from the highest nonmetastatic TNM stage, and overstaging could be avoided. This procedure decreased the degree of heterogeneity of the entire Stage III group and may result in a more precise assessment of this disease entity. Copyright 2006 American Cancer Society.

Re-Infection Outcomes following One- and Two-Stage Surgical Revision of Infected Hip Prosthesis: A Systematic Review and Meta-Analysis

PubMed Central

Kunutsor, Setor K.; Whitehouse, Michael R.; Blom, Ashley W.; Beswick, Andrew D.

2015-01-01

Background The two-stage revision strategy has been claimed as being the “gold standard” for treating prosthetic joint infection. The one-stage revision strategy remains an attractive alternative option; however, its effectiveness in comparison to the two-stage strategy remains uncertain. Objective To compare the effectiveness of one- and two-stage revision strategies in treating prosthetic hip infection, using re-infection as an outcome. Design Systematic review and meta-analysis. Data Sources MEDLINE, EMBASE, Web of Science, Cochrane Library, manual search of bibliographies to March 2015, and email contact with investigators. Study Selection Cohort studies (prospective or retrospective) conducted in generally unselected patients with prosthetic hip infection treated exclusively by one- or two-stage revision and with re-infection outcomes reported within two years of revision. No clinical trials were identified. Review Methods Data were extracted by two independent investigators and a consensus was reached with involvement of a third. Rates of re-infection from 38 one-stage studies (2,536 participants) and 60 two-stage studies (3,288 participants) were aggregated using random-effect models after arcsine transformation, and were grouped by study and population level characteristics. Results In one-stage studies, the rate (95% confidence intervals) of re-infection was 8.2% (6.0–10.8). The corresponding re-infection rate after two-stage revision was 7.9% (6.2–9.7). Re-infection rates remained generally similar when grouped by several study and population level characteristics. There was no strong evidence of publication bias among contributing studies. Conclusion Evidence from aggregate published data suggest similar re-infection rates after one- or two-stage revision among unselected patients. More detailed analyses under a broader range of circumstances and exploration of other sources of heterogeneity will require collaborative pooling of individual participant data. Systematic Review Registration PROSPERO 2015: CRD42015016559 PMID:26407003

Two-stage knee arthrodesis with a modular intramedullary nail due to septic failure of revision total knee arthroplasty with extensor mechanism deficiency.

PubMed

Friedrich, Max J; Schmolders, Jan; Wimmer, Matthias D; Strauss, Andreas C; Ploeger, Milena M; Wirtz, Dieter C; Gravius, Sascha; Randau, Thomas M

2017-10-01

Periprosthetic joint infection is a serious complication and reconstruction after failed revision total knee arthroplasty with significant bone loss and compromised soft-tissues can be challenging. Objective of this study was to assess clinical and functional results, implant survival and infection recurrence rates in patients treated with two-stage arthrodesis after failed revision TKA with extensor mechanism deficiencies due to PJI, and to identify the factors that affect outcomes after surgery. Thirty seven patients with PJI treated within a two-stage exchange and reimplantation of an arthrodesis nail between 2008 and 2014 were included. Systemic and local risk factors were graded preoperatively according to McPherson et al. All patients were treated according to a structured treatment algorithm. Clinical and functional evaluation was performed using the Oxford Knee Score and the Visual Analogue Scale. Thirty two of 37 patients (86.5%) were graded as free of infection. Five patients (13.5%) had recurrent infection after arthrodesis with the need of revision surgery. Mean leg-length discrepancy was 2.2cm. The mean VAS for pain was three, the mean Oxford Knee Score was 38±9. Total implant survival at a 74month follow-up was 74.3% (95% CI: 45.4 to 91.1%), as determined by Kaplan-Meier survival curves. Local McPherson Score, as well as number of revisions was found to be of significant influence to the survival rate. Septic failure of revision knee arthroplasty can be effectively treated with two-stage arthrodesis using a modular intramedullary nail, providing a stable and painless limb with satisfactory functional results and acceptable infection eradication rates. Copyright © 2017 Elsevier B.V. All rights reserved.

Two-stage revisions for culture-negative infected total knee arthroplasties: A five-year outcome in comparison with one-stage and two-stage revisions for culture-positive cases.

PubMed

Li, Heng; Ni, Ming; Li, Xiang; Zhang, Qingmeng; Li, Xin; Chen, Jiying

2017-03-01

Culture-negative periprosthetic joint infection (PJI) is very intractable when dealing with an infected total knee arthroplasty (TKA) patient. Two-stage revision has been proved to be a reliable solution for PJI patients. Whether it is still credible for culture-negative infected patients remains uncertain. Our group retrospectively reviewed all total knee revision patients from January 2003 to January 2014, 145 PJI patients were diagnosed as infection with the PJI diagnostic criteria and 129 patients were successfully followed. As different treating strategies were utilized, these patients were divided into culture-negative (18 cases, CN) group, culture-positive with one-stage revision group (CP1, 21 cases) and culture-positive with two-stage revision group (CP2, 87 cases) groups. The CN group and CP2 group underwent two-stage revision with antibiotic loaded cement spacers and intravenous antibiotics, CP1 group received one-stage revision. All the culture results and relevant medical records were thoroughly reviewed. The mean follow-up time was 59.5 ± 32.3 months (range 12-158 months). The culture-negative rate was 14.2%. The overall infection control rate was 92.12%. Infection recurrence was observed in two cases in CP1 group (9.09%), six cases in CP2 group (6.90%) and two cases in CN group (11.1%). The reinfection rate of culture-negative patients and culture-positive patients was 7.34% and 11.1% with no significant difference (p = 0.94). No statistically difference was observed between CP2 group and CN group (p = 0.90). No Spacer fracture or dislocation was observed. With combined or broad spectrum antibiotics, two-stage revision showed comparable outcome when treating culture-negative infected TKA patients at five-year follow-up. Copyright © 2016. Published by Elsevier B.V.

Survey Results from the Philippines: NPUAP Changes in Pressure Injury Terminology and Definitions.

PubMed

Ayello, Elizabeth A; Delmore, Barbara; Smart, Hiske; Sibbald, R Gary

2018-01-01

To determine the opinions of healthcare clinicians in the Philippines regarding the 2016 National Pressure Ulcer Advisory Panel (NPUAP) terminology changes and revised staging definitions. A survey methodology was used in Manila, Philippines. Convenience samples of healthcare clinicians of varying disciplines and employment settings were invited to participate in this research. A survey was administered at key intervals regarding the revised NPUAP terminology changes and revised staging definitions. The survey was administered before and after an interactive, basic 2-day wound course was conducted. Results revealed strong support for the 2016 NPUAP terminology change from pressure ulcer to pressure injury and the revised staging definitions. Since the NPUAP changed its terminology and revised the staging definitions, the wound care community has been responding to those changes. Because pressure injuries are a global health concern, the opinions of clinicians outside the United States are equally valuable. The healthcare clinicians in the Philippines surveyed appear to embrace the new terminology changes and revised staging definitions put forth by the NPUAP.

Deep prosthetic joint infection: a qualitative study of the impact on patients and their experiences of revision surgery

PubMed Central

Blom, Ashley W; Whitehouse, Michael R; Gooberman-Hill, Rachael

2015-01-01

Objectives Around 1% of patients who have a hip replacement have deep prosthetic joint infection (PJI) afterwards. PJI is often treated with antibiotics plus a single revision operation (1-stage revision), or antibiotics plus a 2-stage revision process involving more than 1 operation. This study aimed to characterise the impact and experience of PJI and treatment on patients, including comparison of 1-stage with 2-stage revision treatment. Design Qualitative semistructured interviews with patients who had undergone surgical revision treatment for PJI. Patients were interviewed between 2 weeks and 12 months postdischarge. Data were audio-recorded, transcribed, anonymised and analysed using a thematic approach, with 20% of transcripts double-coded. Setting Patients from 5 National Health Service (NHS) orthopaedic departments treating PJI in England and Wales were interviewed in their homes (n=18) or at hospital (n=1). Participants 19 patients participated (12 men, 7 women, age range 56–88 years, mean age 73.2 years). Results Participants reported receiving between 1 and 15 revision operations after their primary joint replacement. Analysis indicated that participants made sense of their experience through reference to 3 key phases: the period of symptom onset, the treatment period and protracted recovery after treatment. By conceptualising their experience in this way, and through themes that emerged in these periods, they conveyed the ordeal that PJI represented. Finally, in light of the challenges of PJI, they described the need for support in all of these phases. 2-stage revision had greater impact on participants’ mobility, and further burdens associated with additional complications. Conclusions Deep PJI impacted on all aspects of patients’ lives. 2-stage revision had greater impact than 1-stage revision on participants’ well-being because the time in between revision procedures meant long periods of immobility and related psychological distress. Participants expressed a need for more psychological and rehabilitative support during treatment and long-term recovery. PMID:26644124

Comparable outcome of culture-negative and culture-positive periprosthetic hip joint infection for patients undergoing two-stage revision.

PubMed

Wang, Jin; Wang, Qiaojie; Shen, Hao; Zhang, Xianlong

2018-03-01

Lack of peri-operative microbiological evidence is an unfavourable factor in one-stage revision. The objective of this study was to figure out whether being culture-negative was an unfavourable factor for periprosthetic hip joint infection (PHJI) in patients undergoing two-stage revision. Records of PHJI patients treated between October 2003 and December 2016 were reviewed at our institution. Information such as microbiological data, clinical outcomes, and other details of patients' clinical courses were recorded. A total of the 58 cases were reviewed. The median follow-up duration was 68.5 months. The infection control rate of PHJI was 93.1% after two-stage revision. Kaplan-Meier analysis showed no significant difference in infection control rates between culture-negative and culture-positive groups. Culture-positive sinus secretions were significantly associated with an increased rate of reinfection (P = 0.039). Two-stage revision had a high success rate for eradication of PHJI. Culture-negative PHJI had a comparable outcome with culture-positive PHJI.

Medicare Program; End-Stage Renal Disease Prospective Payment System, Payment for Renal Dialysis Services Furnished to Individuals With Acute Kidney Injury, and End-Stage Renal Disease Quality Incentive Program. Final rule.

PubMed

2017-11-01

This rule updates and makes revisions to the end-stage renal disease (ESRD) prospective payment system (PPS) for calendar year (CY) 2018. It also updates the payment rate for renal dialysis services furnished by an ESRD facility to individuals with acute kidney injury (AKI). This rule also sets forth requirements for the ESRD Quality Incentive Program (QIP), including for payment years (PYs) 2019 through 2021.

Development of the Gross Motor Function Classification System (1997)

ERIC Educational Resources Information Center

Morris, Christopher

2008-01-01

To address the need for a standardized system to classify the gross motor function of children with cerebral palsy, the authors developed a five-level classification system analogous to the staging and grading systems used in medicine. Nominal group process and Delphi survey consensus methods were used to examine content validity and revise the…

A systematic review of the evidence for single stage and two stage revision of infected knee replacement

PubMed Central

2013-01-01

Background Periprosthetic infection about the knee is a devastating complication that may affect between 1% and 5% of knee replacement. With over 79 000 knee replacements being implanted each year in the UK, periprosthetic infection (PJI) is set to become an important burden of disease and cost to the healthcare economy. One of the important controversies in treatment of PJI is whether a single stage revision operation is superior to a two-stage procedure. This study sought to systematically evaluate the published evidence to determine which technique had lowest reinfection rates. Methods A systematic review of the literature was undertaken using the MEDLINE and EMBASE databases with the aim to identify existing studies that present the outcomes of each surgical technique. Reinfection rate was the primary outcome measure. Studies of specific subsets of patients such as resistant organisms were excluded. Results 63 studies were identified that met the inclusion criteria. The majority of which (58) were reports of two-stage revision. Reinfection rated varied between 0% and 41% in two-stage studies, and 0% and 11% in single stage studies. No clinical trials were identified and the majority of studies were observational studies. Conclusions Evidence for both one-stage and two-stage revision is largely of low quality. The evidence basis for two-stage revision is significantly larger, and further work into direct comparison between the two techniques should be undertaken as a priority. PMID:23895421

Single-stage Acetabular Revision During Two-stage THA Revision for Infection is Effective in Selected Patients.

PubMed

Fink, Bernd; Schlumberger, Michael; Oremek, Damian

2017-08-01

The treatment of periprosthetic infections of hip arthroplasties typically involves use of either a single- or two-stage (with implantation of a temporary spacer) revision surgery. In patients with severe acetabular bone deficiencies, either already present or after component removal, spacers cannot be safely implanted. In such hips where it is impossible to use spacers and yet a two-stage revision of the prosthetic stem is recommended, we have combined a two-stage revision of the stem with a single revision of the cup. To our knowledge, this approach has not been reported before. (1) What proportion of patients treated with single-stage acetabular reconstruction as part of a two-stage revision for an infected THA remain free from infection at 2 or more years? (2) What are the Harris hip scores after the first stage and at 2 years or more after the definitive reimplantation? Between June 2009 and June 2014, we treated all patients undergoing surgical treatment for an infected THA using a single-stage acetabular revision as part of a two-stage THA exchange if the acetabular defect classification was Paprosky Types 2B, 2C, 3A, 3B, or pelvic discontinuity and a two-stage procedure was preferred for the femur. The procedure included removal of all components, joint débridement, definitive acetabular reconstruction (with a cage to bridge the defect, and a cemented socket), and a temporary cemented femoral component at the first stage; the second stage consisted of repeat joint and femoral débridement and exchange of the femoral component to a cementless device. During the period noted, 35 patients met those definitions and were treated with this approach. No patients were lost to followup before 2 years; mean followup was 42 months (range, 24-84 months). The clinical evaluation was performed with the Harris hip scores and resolution of infection was assessed by the absence of clinical signs of infection and a C-reactive protein level less than 10 mg/L. All patients were assessed before surgery, between stages, every 3 months during the first year after surgery, every 6 months during the second year postoperative, and at latest followup, and were retrospectively drawn from a longitudinally maintained institutional database. Thirty-four of 35 patients (97.2%; 95% CI, 85.4%-99.5%) appeared free of infection by criteria of Masri et al. and Zimmerli et al. at latest followup. The Harris hip score was 61 ± 13 points after the first operation and 82 ± 16 points 2 years after the second operation. This technique is a promising treatment option for periprosthetic infections of the hip in which substantial acetabular defects exclude implantation of a normal spacer and a two-stage revision of the femoral component is favored. Level IV, therapeutic study.

Comparison of the King's and MiToS staging systems for ALS.

PubMed

Fang, Ton; Al Khleifat, Ahmad; Stahl, Daniel R; Lazo La Torre, Claudia; Murphy, Caroline; Young, Carolyn; Shaw, Pamela J; Leigh, P Nigel; Al-Chalabi, Ammar

2017-05-01

To investigate and compare two ALS staging systems, King's clinical staging and Milano-Torino (MiToS) functional staging, using data from the LiCALS phase III clinical trial (EudraCT 2008-006891-31). Disease stage was derived retrospectively for each system from the ALS Functional Rating Scale-Revised subscores using standard methods. The two staging methods were then compared for timing of stages using box plots, correspondence using chi-square tests, agreement using a linearly weighted kappa coefficient and concordance using Spearman's rank correlation. For both systems, progressively higher stages occurred at progressively later proportions of the disease course, but the distribution differed between the two methods. King's stage 3 corresponded to MiToS stage 1 most frequently, with earlier King's stages 1 and 2 largely corresponding to MiToS stage 0 or 1. The Spearman correlation was 0.54. There was fair agreement between the two systems with kappa coefficient of 0.21. The distribution of timings shows that the two systems are complementary, with King's staging showing greatest resolution in early to mid-disease corresponding to clinical or disease burden, and MiToS staging having higher resolution for late disease, corresponding to functional involvement. We therefore propose using both staging systems when describing ALS.

Economic Analysis of 4221 Revisions Due to Periprosthetic Joint Infection in Poland.

PubMed

Babiak, Ireneusz; Pędzisz, Piotr; Janowicz, Jakub; Kulig, Mateusz; Małdyk, Paweł

2017-01-26

Periprosthetic joint infection (PJI) is one of the most severe complications of total hip (THA) and total knee (TKA) arthroplasty. The aim of the study is to determine the number and type of hip and knee prosthesis revisions in Poland performed due to infection and reimbursement of the cost of septic revisions and to compare the costs of septic and aseptic revisions in Poland and other countries. The data published for the period 2009-2013 by the National Health Fund (NHF) were analysed and the average cost of septic and aseptic revisions was calculated. In the years 2009-2013, a total of 260,030 hip and knee arthroplasties including 23,027 revisions (incl. 4,221 septic) were performed in Poland. In 2013, septic revisions accounted for 1.38% of all hip replacement procedures, 2.56% of all knee replacement procedures and 14.67% of all hip revisions and 30.23% of all knee revisions. In 2013, the difference between the average cost incurred by the hospital and the NHF refund for septic revision due to PJI was at least €238 and the cost-refund gap for the entire year was €219198. 1. The system of reporting periprostheticjoint infections currently in use in Poland does not adequately reflect the current classification of PJI and reimbursement for septic revision of joint prosthesis does not match the actual costs. 2. The Polish DRG system does not distinguish between early and late PJI and fails to acknowledge basic guidelines for infection treatment currently followed in Poland and worldwide. 3. According to the DRG system, patients requiring different treatment are placed in one category. 4. Until the year 2013, the less expensive treatment of early infections had been reimbursed on the same basis as the more costly two-stage revision procedures.

Design Package for Fuel Retrieval System Fuel Handling Tool Modification

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

TEDESCHI, D.J.

This design package documents design, fabrication, and testing of new stinger tool design. Future revisions will document further development of the stinger tool and incorporate various developmental stages, and final test results.

77 FR 36274 - Public Water System Supervision Program Revision for the State of Alabama

Federal Register 2010, 2011, 2012, 2013, 2014

2012-06-18

... Surface Water Treatment Rule, Long Term 2 Enhanced Surface Water Treatment Rule, and Stage 2 Disinfection/Disinfection Byproducts Rule. EPA has determined that Alabama's rules are no less stringent than the...

Responding to the Challenges of Active Citizenship through the Revised UK Early Years Foundation Stage Curriculum

ERIC Educational Resources Information Center

Baker, Fiona S.

2013-01-01

The revised UK Early Years Foundation Stage (EYFS) now places a stronger emphasis on personal, social and emotional development (PSED) as one of its three prime areas. PSED has three characteristics of learning: active learning, creating and thinking critically, and playing and exploring. These aspects of the revised EYFS closely align with the…

Comparison of the King’s and MiToS staging systems for ALS

PubMed Central

Fang, Ton; Al Khleifat, Ahmad; Stahl, Daniel R; Lazo La Torre, Claudia; Murphy, Caroline; Young, Carolyn; Shaw, Pamela J; Leigh, P Nigel; Al-Chalabi, Ammar

2017-01-01

Abstract Objective: To investigate and compare two ALS staging systems, King’s clinical staging and Milano-Torino (MiToS) functional staging, using data from the LiCALS phase III clinical trial (EudraCT 2008-006891-31). Methods: Disease stage was derived retrospectively for each system from the ALS Functional Rating Scale-Revised subscores using standard methods. The two staging methods were then compared for timing of stages using box plots, correspondence using chi-square tests, agreement using a linearly weighted kappa coefficient and concordance using Spearman’s rank correlation. Results: For both systems, progressively higher stages occurred at progressively later proportions of the disease course, but the distribution differed between the two methods. King’s stage 3 corresponded to MiToS stage 1 most frequently, with earlier King’s stages 1 and 2 largely corresponding to MiToS stage 0 or 1. The Spearman correlation was 0.54. There was fair agreement between the two systems with kappa coefficient of 0.21. Conclusion: The distribution of timings shows that the two systems are complementary, with King’s staging showing greatest resolution in early to mid-disease corresponding to clinical or disease burden, and MiToS staging having higher resolution for late disease, corresponding to functional involvement. We therefore propose using both staging systems when describing ALS. PMID:28054828

Modulation of TCRβ surface expression during TCR revision.

PubMed

Simmons, Kalynn B; Wubeshet, Maramawit; Ames, Kristina T; McMahan, Catherine J; Hale, J Scott; Fink, Pamela J

2012-01-01

TCR revision is a tolerance mechanism by which self-reactive TCRs expressed by mature CD4(+) peripheral T cells are replaced by receptors encoded by genes generated by post-thymic DNA rearrangement. The downmodulation of surface TCR expression initiates TCR revision, and serves as a likely trigger for the induction of the recombinase machinery. We show here in a Vβ5 transgenic mouse model system that downregulation of the self-reactive transgene-encoded TCR is not maintained by transgene loss or diminished transcription or translation. The downregulation of surface TCR expression likely occurs in two stages, only one of which requires tolerogen expression. Copyright © 2011 Elsevier Inc. All rights reserved.

Outcome following subluxation of mobile articulating spacers in two-stage revision total knee arthroplasty.

PubMed

Lanting, Brent A; Lau, Adrian; Teeter, Matthew G; Howard, James L

2017-03-01

Infection after total knee arthroplasty (TKA) is a severe complication. It is usually treated with two-stage revision and implantation of a cement spacer. Few studies describe the complications associated with a mobile articulating spacer. This study examined the subluxation of articulating antibiotic spacers in knees and correlated it with prospectively collected early outcome scores after implantation of a revision prosthesis. Staged revisions for 72 infected primary total knee arthroplasties between 2004 and 2012 were examined. The mean age of the patients was 70.2 ± 10.8 years, with 40 right and 32 left knees. Sagittal and coronal subluxation was measured using radiographs prior to second-stage revision and grouped to be within (Group 1) or outside (Group 2) one standard deviation from the mean. Medical Outcomes Study Short Form-12 (SF-12), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Knee Society Score (KSS) were obtained via patient-administered questionnaire. Statistical analysis was carried out to look at the correlation between subluxation and outcome. Significant improvements were observed between the interim outcome scores prior to implantation of a revision prosthesis and scores obtained after second-stage revision. Debonding occurred in 5.6%, and one dislocation was found. Mean coronal subluxation was 4.8 ± 5.5% of the tibia width, in the lateral direction. Coronal subluxation did not affect SF12, WOMAC or KSS outcome scores. Mean sagittal subluxation was 6.1 ± 16.4% posteriorly. However, sagittal subluxation had a significant influence on Knee Society Scores, with Group 2 having a lower mean Knee Society Function Score of 39.3 than Group 1 (60.2) (p = 0.045). Sagittal subluxation did not affect SF12 or WOMAC scores. Sagittal subluxation of the knee may influence the early to midterm outcome scores following a staged revision TKA for infection.

[Two-stage revision of infected total knee arthroplasty using antibiotic-impregnated articulating cement spacer].

PubMed

Cai, Pengde; Hu, Yihe; Xie, Lie; Wang, Long

2012-10-01

To investigate the effectiveness of two-stage revision of infected total knee arthroplasty (TKA) using an antibiotic-impregnated articulating cement spacer. The clinical data were analyzed from 23 patients (23 knees) undergoing two-stage revision for late infection after primary TKA between January 2007 and December 2009. There were 15 males and 8 females, aged from 43 to 75 years (mean, 65.2 years). Infection occurred at 13-52 months (mean, 17.3 months) after TKA. The time interval between infection and admission ranged from 15 days to 7 months (mean, 2.1 months). One-stage operation included surgical debridement and removal of all knee prosthesis and cement, then an antibiotic-impregnated articulating cement spacer was implanted. The re-implantation of prosthesis was performed after 8-10 weeks when infections were controlled. The American Hospital for Special Surgery (HSS) score and Knee Society Score (KSS) were used to compare the function of the knee between pre- and post-revision. The rate of infection control and complication were analyzed. All incisions healed primarily. Re-infection occurred in 2 cases after two-stage revision, and infection was controlled in the other 21 cases, with an infection control rate of 91.3%. The patients were followed up 2-5 years (mean, 3.6 years). The HSS score was increased from 60.6 +/- 9.8 at pre-revision to 82.3 +/- 7.4 at last follow-up, the KSS score was increased from 110.7 +/- 9.6 at pre-revision to 134.0 +/- 10.5 at last follow-up, all showing significant differences (P < 0.01). Radiographs showed that prosthesis had good position with no loosening, fracture, or periprosthetic radiolucent. Two-stage revision using an antibiotic-impregnated articulating cement spacer is an effective method to control infected TKA and to restore the function of affected knee.

Cross-cultural adaptation of the Window to Hope: a psychological intervention to reduce hopelessness among U.S. veterans with traumatic brain injury.

PubMed

Matarazzo, Bridget B; Hoffberg, Adam S; Clemans, Tracy A; Signoracci, Gina M; Simpson, Grahame K; Brenner, Lisa A

2014-01-01

To conduct a cross-cultural adaptation of Window to Hope (WtoH), a treatment to reduce hopelessness after traumatic brain injury (TBI), from the Australian civilian context to that of U.S. Veterans. Three-stage mixed-methods approach. Stage 1: Consensus conference with stakeholders to revise the manual. Stage 2: Pilot study of the revised manual with US Veterans to examine acceptability, feasibility and fidelity. Stage 3: Review of results with consensus conference attendees and further revisions. Stage 1: Conference attendees reached 100% consensus regarding changes made to the manual. Stage 2: Qualitative results yielded themes that suggest that participants benefitted from the intervention and that multiple factors contributed to successful implementation (Narrative Evaluation of Intervention Interview, User Feedback Survey-Modified, Post-Treatment Interviews). Therapists achieved 100% treatment fidelity. Quantitative results from the Client Satisfaction Questionnaire-8 suggest that the intervention was acceptable. Stage 3: The culturally adapted manual was finalized. RESULTS of this study suggest that the revised WtoH manual is acceptable and feasible. US therapists exhibited adherence to the protocol. The three-stage methodology was successfully employed to cross-culturally adapt an intervention that is well-suited for a Phase II randomized controlled trial among US military Veterans.

Comparative Analysis of Direct Hospital Care Costs between Aseptic and Two-Stage Septic Knee Revision

PubMed Central

Kasch, Richard; Merk, Sebastian; Assmann, Grit; Lahm, Andreas; Napp, Matthias; Merk, Harry; Flessa, Steffen

2017-01-01

Background The most common intermediate and long-term complications of total knee arthroplasty (TKA) include aseptic and septic failure of prosthetic joints. These complications cause suffering, and their management is expensive. In the future the number of revision TKA will increase, which involves a greater financial burden. Little concrete data about direct costs for aseptic and two-stage septic knee revisions with an in depth-analysis of septic explantation and implantation is available. Questions/Purposes A retrospective consecutive analysis of the major partial costs involved in revision TKA for aseptic and septic failure was undertaken to compare 1) demographic and clinical characteristics, and 2) variable direct costs (from a hospital department’s perspective) between patients who underwent single-stage aseptic and two-stage septic revision of TKA in a hospital providing maximum care. We separately analyze the explantation and implantation procedures in septic revision cases and identify the major cost drivers of knee revision operations. Methods A total of 106 consecutive patients (71 aseptic and 35 septic) was included. All direct costs of diagnosis, surgery, and treatment from the hospital department’s perspective were calculated as real purchase prices. Personnel involvement was calculated in units of minutes. Results Aseptic versus septic revisions differed significantly in terms of length of hospital stay (15.2 vs. 39.9 days), number of reported secondary diagnoses (6.3 vs. 9.8) and incision-suture time (108.3 min vs. 193.2 min). The management of septic revision TKA was significantly more expensive than that of aseptic failure ($12,223.79 vs. $6,749.43) (p <.001). On the level of the separate hospitalizations the mean direct costs of explantation stage ($4,540.46) were lower than aseptic revision TKA ($6,749.43) which were again lower than those of the septic implantation stage ($7,683.33). All mean costs of stays were not comparable as they differ significantly (p <.001). Major cost drivers were the cost of the implant and general staff. The septic implantation part was on average $3,142.87 more expensive than septic explantations (p <.001). Conclusions Our study for the first time provides a detailed analysis of the major direct case costs of aseptic and septic revision TKA from the hospital-department’s perspective which is the basis for long-term orientated decision making. In the future, our cost analysis has to be interpreted in relation to reimbursement estimates. This is important to check whether revision TKA lead to a financial loss for the operating department. PMID:28107366

Facilitating Metacognitive Processes of Academic Genre-Based Writing Using an Online Writing System

ERIC Educational Resources Information Center

Yeh, Hui-Chin

2015-01-01

Few studies have investigated how metacognitive processes foster the application of genre knowledge to students' academic writing. This is largely due to its internal and unobservable characteristics. To bridge this gap, an online writing system based on metacognition, involving the stages of planning, monitoring, evaluating, and revising, was…

78 FR 9047 - Public Water System Supervision Program Revision for the State of Texas

Federal Register 2010, 2011, 2012, 2013, 2014

2013-02-07

... Water System Supervision Program. Texas has adopted three EPA drinking water rules, namely the: (1) Long Term 2 Enhanced Surface Water Treatment Rule (LT2), (2) the Stage 2 Disinfectants and Disinfection... Drinking Water Section (MC-155), Building F, 12100 Park 35 Circle, Austin, TX 78753; and United States...

75 FR 69435 - Public Water System Supervision Program Revision for the State of North Dakota

Federal Register 2010, 2011, 2012, 2013, 2014

2010-11-12

... Water System Supervision (PWSS) Primacy Program by adopting federal regulations for the Groundwater Rule, Long Term 2 Enhanced Surface Water Treatment Rule and Stage 2 Disinfection By-Product Rule which.... DATES: Any member of the public may request a public hearing on this determination by December 13, 2010...

75 FR 69436 - Public Water System Supervision Program Revision for the State of South Dakota

Federal Register 2010, 2011, 2012, 2013, 2014

2010-11-12

... Water System Supervision (PWSS) Primacy Program by adopting federal regulations for the Long Term 2 Enhanced Surface Water Treatment Rule, Stage 2 Disinfection By-Product Rule, Groundwater Rule, and the Lead... public hearing on this determination by December 13, 2010. Please see SUPPLEMENTARY INFORMATION, Item C...

Evaluation of Revised International Staging System (R-ISS) for transplant-eligible multiple myeloma patients.

PubMed

González-Calle, Verónica; Slack, Abigail; Keane, Niamh; Luft, Susan; Pearce, Kathryn E; Ketterling, Rhett P; Jain, Tania; Chirackal, Sintosebastian; Reeder, Craig; Mikhael, Joseph; Noel, Pierre; Mayo, Angela; Adams, Roberta H; Ahmann, Gregory; Braggio, Esteban; Stewart, A Keith; Bergsagel, P Leif; Van Wier, Scott A; Fonseca, Rafael

2018-04-06

The International Myeloma Working Group has proposed the Revised International Staging System (R-ISS) for risk stratification of multiple myeloma (MM) patients. There are a limited number of studies that have validated this risk model in the autologous stem cell transplant (ASCT) setting. In this retrospective study, we evaluated the applicability and value for predicting survival of the R-ISS model in 134 MM patients treated with new agents and ASCT at the Mayo Clinic in Arizona and the University Hospital of Salamanca in Spain. The patients were reclassified at diagnosis according to the R-ISS: 44 patients (33%) had stage I, 75 (56%) had stage II, and 15 (11%) had stage III. After a median follow-up of 60 months, R-ISS assessed at diagnosis was an independent predictor for overall survival (OS) after ASCT, with median OS not reached, 111 and 37 months for R-ISS I, II and III, respectively (P < 0.001). We also found that patients belonging to R-ISS II and having high-risk chromosomal abnormalities (CA) had a significant shorter median OS than those with R-ISS II without CA: 70 vs. 111 months, respectively. Therefore, this study lends further support for the R-ISS as a reliable prognostic tool for estimating survival in transplant myeloma patients and suggests the importance of high-risk CA in the R-ISS II group.

Cervical apron flap reconstruction: a technique for second-stage revision.

PubMed

Spiro, R H; Chaglassian, T A

1979-08-01

A technique for second-stage revision of a cervical apron flap is described. Food particle retention and pocketing in hair-bearing recesses can be minimized by accurately trimming and contouring the flap to fit smoothly into the oral defect.

Staging of intrahepatic cholangiocarcinoma

PubMed Central

Ronnekleiv-Kelly, Sean M.

2017-01-01

Intrahepatic cholangiocarcinoma (ICC) comprises approximately 5−30% of primary liver tumors, however it has been increasing over the last several decades. Up to and including the 6th edition of the American Joint Committee on Cancer/Union for International Cancer Control (AJCC/UICC) edition staging system, ICC was staged the same as hepatocellular carcinoma. In the 7th edition AJCC/UICC manual, the staging system of ICC was revised such that a distinct classification was proposed. Pathologic features for prognosis included vascular invasion, tumor multiplicity, local extension, periductal infiltration and lymph nodal metastasis. Over the last decade, as the incidence of ICC has increased and surgery for this indication has become more common, more data has been published on the prognostic factors associated with long-term survival. PMID:28261593

Single-stage revision for fungal peri-prosthetic joint infection: a single-centre experience.

PubMed

Klatte, T O; Kendoff, D; Kamath, A F; Jonen, V; Rueger, J M; Frommelt, L; Gebauer, M; Gehrke, T

2014-04-01

Fungal peri-prosthetic infections of the knee and hip are rare but likely to result in devastating complications. In this study we evaluated the results of their management using a single-stage exchange technique. Between 2001 and 2011, 14 patients (ten hips, four knees) were treated for a peri-prosthetic fungal infection. One patient was excluded because revision surgery was not possible owing to a large acetabular defect. One patient developed a further infection two months post-operatively and was excluded from the analysis. Two patients died of unrelated causes. After a mean of seven years (3 to 11) a total of ten patients were available for follow-up. One patient, undergoing revision replacement of the hip, had a post-operative dislocation. Another patient, undergoing revision replacement of the knee, developed a wound infection and required revision 29 months post-operatively following a peri-prosthetic femoral fracture. The mean Harris hip score increased to 74 points (63 to 84; p < 0.02) in those undergoing revision replacement of the hip, and the mean Hospital for Special Surgery knee score increased to 75 points (70 to 80; p < 0.01) in those undergoing revision replacement of the knee. A single-stage revision following fungal peri-prosthetic infection is feasible, with an acceptable rate of a satisfactory outcome.

A2-3: Impact of Mild Chronic Kidney Disease Stage on Outcomes after Total Hip or Knee Arthroplasty

PubMed Central

Graham, Jove; Deegan, Brian; Bowen, Thomas; Richard, Raveesh; Perkins, Robert; Foltzer, Michael

2014-01-01

Background/Aims Dialysis and kidney transplantation adversely impact outcomes of total hip or knee arthroplasty (THA, TKA), but complication rates have not been reported for patients with less advanced stages of chronic kidney disease (CKD). Surgeons lack the data necessary to have informed discussions regarding anticipated outcomes of joint replacement for these patients. Methods We retrospectively reviewed electronic health records of 779 adults with stages 1, 2, and 3 CKD not requiring dialysis or transplantation who underwent THA or TKA from 2004–2011, to assess infection, revision, 90-day readmission and mortality rates. Patients with less than 12 months follow-up, open fracture, prior joint surgery, pregnancy, or acute kidney injury were excluded. Chi-square analysis and Cox survival analysis compared these outcomes between the stage 1–2 and stage 3 groups, stratified by joint replaced (THA vs TKA). All models adjusted for age, sex and BMI at surgery. Results No statistically different rates of revision or infection between Stage 3 vs. Stages 1–2 were seen, although there was a trend toward increased infections in Stage 3. THA patients with Stage 3 showed a significantly increased mortality rate compared to Stage 1–2 THA patients (HR 3.40, 95% CI = 1.25–9.23, P = 0.02). Conclusions CKD affects nearly 15% of the U.S. population many of whom undergo joint replacement. End stage kidney disease (patients post-transplant or on hemodialysis) has been consistently associated with increased rates of infection and revision in excess of our observed outcomes, but the overall rate of infection/revision in our study population was only slightly higher than reported rates in the general population (2–7% vs. 1–2%, respectively). CKD should not preclude joint replacement, but these data can help clinicians engage in meaningful informed discussions with patients with mild kidney disease regarding risks for infection, revision and death following joint replacement.

Assessment of the American Joint Commission on Cancer 8th Edition Staging System for Patients with Pancreatic Neuroendocrine Tumors: A Surveillance, Epidemiology, and End Results analysis.

PubMed

Li, Xiaogang; Gou, Shanmiao; Liu, Zhiqiang; Ye, Zeng; Wang, Chunyou

2018-03-01

Although several staging systems have been proposed for pancreatic neuroendocrine tumors (pNETs), the optimal staging system remains unclear. Here, we aimed to assess the application of the newly revised 8th edition American Joint Committee on Cancer (AJCC) staging system for exocrine pancreatic carcinoma (EPC) to pNETs, in comparison with that of other staging systems. We identified pNETs patients from the Surveillance, Epidemiology, and End Results (SEER) database (2004-2014). Overall survival was analyzed using Kaplan-Meier curves with the log-rank test. The predictive accuracy of each staging system was assessed by the concordance index (c-index). Cox proportional hazards regression was conducted to calculate the impact of different stages. In total, 2424 patients with pNETs, including 2350 who underwent resection, were identified using SEER data. Patients with different stages were evenly stratified based on the 8th edition AJCC staging system for EPC. Kaplan-Meier curves were well separated in all patients and patients with resection using the 8th edition AJCC staging system for EPC. Moreover, the hazard ratio increased with worsening disease stage. The c-index of the 8th edition AJCC staging system for EPC was similar to that of the other systems. For pNETs patients, the 8th edition AJCC staging system for EPC exhibits good prognostic discrimination among different stages in both all patients and those with resection. © 2018 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.

77 FR 40951 - Medicare Program; End-Stage Renal Disease Prospective Payment System, Quality Incentive Program...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-07-11

...This rule proposes to update and make revisions to the End- Stage Renal Disease (ESRD) prospective payment system (PPS) for calendar year (CY) 2013. This rule also proposes to set forth requirements for the ESRD quality incentive program (QIP), including for payment year (PY) 2015 and beyond. This proposed rule will implement changes to bad debt reimbursement for all Medicare providers, suppliers, and other entities eligible to receive bad debt. (See the Table of Contents for a listing of the specific issues addressed in this proposed rule.)

Two-Stage Revision for Infected Total Knee Arthroplasty: Based on Autoclaving the Recycled Femoral Component and Intraoperative Molding Using Antibiotic-Impregnated Cement on the Tibial Side.

PubMed

Lee, Byoung-Joo; Kyung, Hee-Soo; Yoon, Seong-Dae

2015-09-01

The purpose of this study was to determine the degree of infection control and postoperative function for new articulating metal-on-cement spacer. A retrospective study of 19 patients (20 cases), who underwent a two-stage revision arthroplasty using mobile cement prosthesis, were followed for a minimum of 2 years. This series consisted of 16 women and 3 men, having an overall mean age of 71 years. During the first stage of revision, the femoral implant and all the adherent cement was removed, after which it was autoclaved before replacement. The tibial component was removed and a doughy state, antibiotic-impregnated cement was inserted on the tibial side. To achieve joint congruency, intraoperative molding was performed by flexing and extending the knee joint. Each patient was evaluated clinically and radiologically. The clinical assessments included range of motion, and the patients were scored as per the Hospital for Special Surgery (HSS) and Knee Society (KS) criteria. The mean range of knee joint motion was 70° prior to the first stage operation and 72° prior to the second stage revision arthroplasty; following revision arthroplasty, it was 113° at the final follow-up. The mean HSS score and KS knee and function scores were 86, 82, and 54, respectively, at the final follow-up. The success rate in terms of infection eradication was 95% (19/20 knees). No patient experienced soft tissue contracture requiring a quadriceps snip. This novel technique provides excellent radiological and clinical outcomes. It offers a high surface area of antibiotic-impregnated cement, a good range of motion between first and second stage revision surgery for the treatment of chronic infection after total knee arthroplasty, and is of a reasonable cost.

Changes in the 7th edition of the AJCC TNM classification and recommendations for pathologic analysis of lacrimal gland tumors.

PubMed

Rootman, Jack; White, Valerie A

2009-08-01

In our recent work to update the American Joint Committee on Cancer's AJCC Cancer Staging Manual, we brought the staging system in line with that of salivary gland malignancies to better describe the range of these tumors. In addition, we have suggested that information be collected on biomarkers and clinical and histologic data points. This revised staging, along with careful histologic analysis and patient follow-up, may provide information that helps develop more targeted management for these lesions.

Investigation of Performance of Axial-Flow Compressor of XT-46 Turbine-Propeller Engine. II - Performance of Revised Compressor at Design Equivalent Speed. II; Performance of Revised Compressor at Design Equivalent Speed

NASA Technical Reports Server (NTRS)

Creagh, John W. R.

1950-01-01

The compressor from the XT-46 turbine-propeller engine was revised by removing the last two rows of stator blades and by eliminating the interstage leakage paths described in a previous report. With the revised compressor, the flow choking point shifted upstream into the last rotor-blade row but the maximum weight flow was not increased over that of the original compressor. The flow range of the revised compressor was reduced to about two-thirds that obtained with the original compressor. The later stages of the compressor did not produce the design static-pressure increase probably because of excessive boundary-layer build-up in this region. Measurements obtained in the ninth-stage stator showed that the performance up to this station was promising but that the last three stages of the compressor were limiting the useful operating range of the preceding stages. Some modifications in flow-passage geometry and blade settings are believed to be necessary, however, before any major improvements in over-all compressor performance can be obtained.

76 FR 70227 - Medicare Program; End-Stage Renal Disease Prospective Payment System and Quality Incentive...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-11-10

...This final rule updates and makes certain revisions to the End-Stage Renal Disease (ESRD) prospective payment system (PPS) for calendar year (CY) 2012. We are also finalizing the interim final rule with comment period published on April 6, 2011, regarding the transition budget-neutrality adjustment under the ESRD PPS,. This final rule also sets forth requirements for the ESRD quality incentive program (QIP) for payment years (PYs) 2013 and 2014. In addition, this final rule revises the ambulance fee schedule regulations to conform to statutory changes. This final rule also revises the definition of durable medical equipment (DME) by adding a 3-year minimum lifetime requirement (MLR) that must be met by an item or device in order to be considered durable for the purpose of classifying the item under the Medicare benefit category for DME. Finally, this final rule implements certain provisions of section 154 of the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) related to the durable medical equipment, prosthetics, orthotics and supplies (DMEPOS) Competitive Acquisition Program and responds to comments received on an interim final rule published January 16, 2009, that implemented these provisions of MIPPA effective April 18, 2009. (See the Table of Contents for a listing of the specific issues addressed in this final rule.)

A Teacher's Guide to Individualizing Reading.

ERIC Educational Resources Information Center

Utah System Approach to Individualized Learning Project.

The objective of this teaching guide is to provide a comprehensive system for individualizing reading instruction through planning, organization, management, and skillful teaching. The planning stage involves establishing goals, reality bases, work bases and flows, and review, evaluation, and revision. The organization of program content involves…

Obsessive compulsive and related disorders: comparing DSM-5 and ICD-11.

PubMed

Marras, Anna; Fineberg, Naomi; Pallanti, Stefano

2016-08-01

Obsessive-compulsive disorder (OCD) has been recognized as mainly characterized by compulsivity rather than anxiety and, therefore, was removed from the anxiety disorders chapter and given its own in both the American Psychiatric Association (APA) Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and the Beta Draft Version of the 11th revision of the World Health Organization (WHO) International Classification of Diseases (ICD-11). This revised clustering is based on increasing evidence of common affected neurocircuits between disorders, differently from previous classification systems based on interrater agreement. In this article, we focus on the classification of obsessive-compulsive and related disorders (OCRDs), examining the differences in approach adopted by these 2 nosological systems, with particular attention to the proposed changes in the forthcoming ICD-11. At this stage, notable differences in the ICD classification are emerging from the previous revision, apparently converging toward a reformulation of OCRDs that is closer to the DSM-5.

May one-stage exchange for Candida albicans peri-prosthetic infection be successful?

PubMed

Jenny, J-Y; Goukodadja, O; Boeri, C; Gaudias, J

2016-02-01

Fungal infection of a total joint arthroplasty has a low incidence but is generally considered as more difficult to cure than bacterial infection. As for bacterial infection, two-stage exchange is considered as the gold standard of treatment. We report two cases of one-stage total joint exchange for fungal peri-prosthetic infection with Candida albicans, where the responsible pathogens was only identified on intraoperative samples. This situation can be considered as a one-stage exchange for fungal peri-prosthetic infection without preoperative identification of the responsible organism, which is considered as having a poor prognosis. Both cases were free of infection after two years. One-stage revision has several potential advantages over two-stage revision, including shorter hospital stay and rehabilitation, no interim period with significant functional impairment, shorter antibiotic treatment, better functional outcome and probably lower costs. We suggest that one-stage revision for C. albicans peri-prosthetic infection may be successful even without preoperative fungal identification. Level IV-Historical cases. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

Two-Stage Cementless Revision Total Hip Arthroplasty for Infected Primary Hip Arthroplasties.

PubMed

Camurcu, Yalkin; Sofu, Hakan; Buyuk, Abdul Fettah; Gursu, Sarper; Kaygusuz, Mehmet Akif; Sahin, Vedat

2015-09-01

The main purpose of the present study was to analyze the clinical features, the most common infective agents, and the results of two-stage total hip revision using a teicoplanin-impregnated spacer. Between January 2005 and July 2011, 41 patients were included. At the clinical status analysis, physical examination was performed, Harris hip score was noted, isolated microorganisms were recorded, and the radiographic evaluation was performed. The mean Harris hip score was improved from 38.9 ± 9.6 points to 81.8 ± 5.8 points (P<0.05). Infection was eradicated in 39 hips. Radiographic evidence of stability was noted in 37 acetabular revision components, and all femoral stems. Two-stage revision of the infected primary hip arthroplasty is a time-consuming but a reliable procedure with high rates of success. Copyright © 2015 Elsevier Inc. All rights reserved.

77 FR 67340 - National Fire Codes: Request for Comments on NFPA's Codes and Standards

Federal Register 2010, 2011, 2012, 2013, 2014

2012-11-09

... the process. The Code Revision Process contains four basic steps that are followed for developing new documents as well as revising existing documents. Step 1: Public Input Stage, which results in the First Draft Report (formerly ROP); Step 2: Comment Stage, which results in the Second Draft Report (formerly...

Learners' Uses of Two Types of Written Feedback on a L2 Writing Revision Task

ERIC Educational Resources Information Center

Sachs, Rebecca; Polio, Charlene

2007-01-01

This study examines the effectiveness of written error corrections versus reformulations of second language learners' writing as two means of improving learners' grammatical accuracy on a three-stage composition-comparison-revision task. Concurrent verbal protocols were employed during the comparison stage in order to study the learners' reported…

Comprehensive evaluation of the revised international staging system in multiple myeloma patients treated with novel agents as a primary therapy.

PubMed

Cho, Hyungwoo; Yoon, Dok Hyun; Lee, Jung Bok; Kim, Sung-Yong; Moon, Joon Ho; Do, Young Rok; Lee, Jae Hoon; Park, Yong; Lee, Ho Sup; Eom, Hyeon Seok; Shin, Ho-Jin; Min, Chang-Ki; Kim, Jin Seok; Jo, Jae-Cheol; Kang, Hye Jin; Mun, Yeung-Chul; Lee, Won Sik; Lee, Je-Jung; Suh, Cheolwon; Kim, Kihyun

2017-12-01

The revised International Staging System (R-ISS) has recently been developed to improve the risk stratification of multiple myeloma (MM) patients over the ISS. We assessed the R-ISS in MM patients who were treated with novel agents as a primary therapy and evaluated its discriminative power and ability to reclassify patients from the ISS. A total of 514 newly diagnosed MM patients treated with novel agents including thalidomide, bortezomib, and lenalidomide as a primary therapy were included in this retrospective analysis. With a median follow-up duration of 42.3 months (range, 40.5-44.1), the median overall survival (OS) was 61.0 months. There was a significant difference in median OS (not reached, 60.9, and 50.1 months for stages 1, 2, and 3, respectively, P < 0.001) among the three stages of R-ISS. The C-statistic was significantly greater for R-ISS than for ISS (0.769 vs. 0.696, P < 0.001). The event NRI was -0.08 (95% confidence interval [CI], -0.18-0.01) and the non-event NRI was 0.05 (95% CI, -0.03-0.10), resulting in a total NRI of -0.03 (95% CI, -0.14-0.08, P = 0.602). The R-ISS performs well and has significantly better discriminative power than the ISS in MM patients treated with novel agents as a primary therapy. However, it does not better reclassify patients from the ISS, suggesting that there is still room to improve the staging system. Moreover, new statistical measures for assessing and quantifying the risk prediction of new prognostic models are necessary in future studies. © 2017 Wiley Periodicals, Inc.

One-stage Revision ACL reconstruction with hamstring autograft results in satisfactory outcome

PubMed Central

Kejriwal, Ritwik; Buelow, Jens

2017-01-01

Objectives: Revision anterior cruciate ligament (ACL) reconstruction is associated with poorer outcomes and higher rerupture rates when compared to primary ACL reconstruction. There is also a significant heterogeneity in surgical technique, number of stages, and graft options. We report a large single surgeon case series with hamstring autograft as a graft option. Methods: Observational series of revision ACL reconstructions performed by the senior author between 2005 and 2015 was carried out. Chart reviews and clinic follow-ups were performed with the following recorded – re-rupture rate, radiographic grading of osteoarthritis, KT-1000 arthrometer test, IKDC outcome scores and knee range of motion. All patients underwent single bundle four-strand hamstring autograft performed in one stage with use of new tunnels in majority of the cases. Results: 66 patients underwent hamstring autograft one-stage revision ACL reconstruction by Dr Jens Buelow. Chart review was carried out on all patients, and 26 (39%) were followed up in clinic and/or by phone with a mean follow up of 4.7 years. Outcomes included re-rupture rate of 4.5%, reoperation rate of 12%, mean visual analogue scale score of 7.6, mean side-to-side difference of 2.6 mm for KT-1000 arthrometer test, and mean IKDC score of 79. Of the 17 patients with radiographs, 40% had moderate osteoarthritis (grade 2 or 3) at follow-up. Conclusion: Revision ACL reconstruction can result in a satisfactory outcome when performed with a hamstring autograft in one stage.

Topical Tranexamic Acid Use in Knee Periprosthetic Joint Infection Is Safe and Effective.

PubMed

Waddell, Bradford S; Zahoor, Talal; Meyer, Mark; Ochsner, Lock; Chimento, George

2016-07-01

Tranexamic acid (TXA) has been shown to decrease hemoglobin loss and reduce the need for transfusions in primary hip and knee arthroplasty. Our study evaluated the safety and efficacy of topical TXA in revision TKA for periprosthetic joint infection (PJI). We performed a retrospective review of patients who underwent removal of hardware with antibiotic spacer placement (stage 1) and/or revision TKA (stage 2) for PJI at our institution between September 2007 and July 2013. During that time, 49 patients underwent stage-1 procedures (20 knees with TXA, 29 without TXA) and 47 patients underwent stage-2 revisions (28 with TXA, 19 without TXA). We evaluated hemoglobin loss, need for transfusion, reinfection rate, length of stay (LOS), complications, and mortality with and without the use of TXA in these patients. All data sets were analyzed with a two-sample t-test. Average follow-up was 3.15 years (range, 1-7 years). TXA use led to a significantly lower percentage drop in the postoperative lowest hemoglobin compared with the preoperative hemoglobin in stage-1 surgeries (19.8 vs. 30.05%, p = 0.0004) and stage-2 revisions (24.5 vs 32.01%, p = 0.01). In both groups, TXA use was associated with a significant reduction in transfusion rates (stage-1, 25 vs 51.7%, p = 0.04; stage-2, 25 vs. 52.6%, p = 0.05). There was a nonstatistical decreased LOS in both groups in which TXA was used (stage 1, 5.15 vs. 6.72 days, p = 0.055; stage 2, 5.21 vs. 6.84 days, p = 0.09). There was no difference in the reinfection rate (4 vs. 4, p = 0.56) or mortality rate between groups (0 vs. 2 non-TXA group). A single upper extremity deep vein thrombosis occurred in a stage-1 patient who received TXA, and no pulmonary embolism occurred. We show that topical TXA is safe and effective for use in both stages of revision TKA for PJI. Previous studies have shown TXA to aggravate a staphylococcal infection in mice; however, topical TXA doesn't appear to negatively effect on the treatment of PJI in our patients and did not increase the reinfection, complication, or mortality rate. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

A modified TNM staging system for non-metastatic colorectal cancer based on nomogram analysis of SEER database.

PubMed

Kong, Xiangxing; Li, Jun; Cai, Yibo; Tian, Yu; Chi, Shengqiang; Tong, Danyang; Hu, Yeting; Yang, Qi; Li, Jingsong; Poston, Graeme; Yuan, Ying; Ding, Kefeng

2018-01-08

To revise the American Joint Committee on Cancer TNM staging system for colorectal cancer (CRC) based on a nomogram analysis of Surveillance, Epidemiology, and End Results (SEER) database, and to prove the rationality of enhancing T stage's weighting in our previously proposed T-plus staging system. Total 115,377 non-metastatic CRC patients from SEER were randomly grouped as training and testing set by ratio 1:1. The Nomo-staging system was established via three nomograms based on 1-year, 2-year and 3-year disease specific survival (DSS) Logistic regression analysis of the training set. The predictive value of Nomo-staging system for the testing set was evaluated by concordance index (c-index), likelihood ratio (L.R.) and Akaike information criteria (AIC) for 1-year, 2-year, 3-year overall survival (OS) and DSS. Kaplan-Meier survival curve was used to valuate discrimination and gradient monotonicity. And an external validation was performed on database from the Second Affiliated Hospital of Zhejiang University (SAHZU). Patients with T1-2 N1 and T1N2a were classified into stage II while T4 N0 patients were classified into stage III in Nomo-staging system. Kaplan-Meier survival curves of OS and DSS in testing set showed Nomo-staging system performed better in discrimination and gradient monotonicity, and the external validation in SAHZU database also showed distinctly better discrimination. The Nomo-staging system showed higher value in L.R. and c-index, and lower value in AIC when predicting OS and DSS in testing set. The Nomo-staging system showed better performance in prognosis prediction and the weight of lymph nodes status in prognosis prediction should be cautiously reconsidered.

Abridged republication of FIGO's staging classification for cancer of the ovary, fallopian tube, and peritoneum.

PubMed

Prat, Jaime

2015-10-01

Ovarian, fallopian tube, and peritoneal cancers have a similar clinical presentation and are treated similarly, and current evidence supports staging all 3 cancers in a single system. The primary site (i.e. ovary, fallopian tube, or peritoneum) should be designated where possible. The histologic type should be recorded. Intraoperative rupture ("surgical spill") is IC1; capsule ruptured before surgery or tumor on ovarian or fallopian tube surface is IC2; and positive peritoneal cytology with or without rupture is IC3. The new staging includes a revision of stage III patients; assignment to stage IIIA1 is based on spread to the retroperitoneal lymph nodes without intraperitoneal dissemination. Extension of tumor from omentum to spleen or liver (stage IIIC) should be differentiated from isolated parenchymal metastases (stage IVB). © 2015 American Cancer Society.

Colorectal cancer and the 7th revision of the TNM staging system: review of changes and suggestions for uniform pathologic reporting.

PubMed

Obrocea, F L; Sajin, Maria; Marinescu, Elena Cristina; Stoica, D

2011-01-01

Colorectal cancer (CRC) is a neoplastic disease with a continuously growing incidence in Romania and throughout the world. Although the surgery remains the first line treatment for most of the cases, newly discovered targeted molecular therapies - effective for some patients, but with various side effects and significant financial burden for the national health systems - requires not only stratification of patients in prognostic groups but also evaluation of some non-anatomic factors with major impact on the prognosis and therapeutic strategy. The AJCC/UICC TNM staging system, in his 7th revision, effective for cases diagnosed on or after January 1, 2010, responds to these needs. On the other hand, the role of the pathologist is increasing in terms of workload and amount of information to be included in the pathology report in order to deliver a personalized diagnosis. There are concerns worldwide regarding relevance, validity and completeness of pathologic reporting of CRC in the absence of a uniform reporting format. Therefore, suggestions for a standardized pathology report of CRC are made, based on TNM 7 and recent, up-to-date conclusive published data.

Custom-made hinged spacers in revision knee surgery for patients with infection, bone loss and instability.

PubMed

Macmull, S; Bartlett, W; Miles, J; Blunn, G W; Pollock, R C; Carrington, R W J; Skinner, J A; Cannon, S R; Briggs, T W R

2010-12-01

Polymethyl methacrylate spacers are commonly used during staged revision knee arthroplasty for infection. In cases with extensive bone loss and ligament instability, such spacers may not preserve limb length, joint stability and motion. We report a retrospective case series of 19 consecutive patients using a custom-made cobalt chrome hinged spacer with antibiotic-loaded cement. The "SMILES spacer" was used at first-stage revision knee arthroplasty for chronic infection associated with a significant bone loss due to failed revision total knee replacement in 11 patients (58%), tumour endoprosthesis in four patients (21%), primary knee replacement in two patients (11%) and infected metalwork following fracture or osteotomy in a further two patients (11%). Mean follow-up was 38 months (range 24-70). In 12 (63%) patients, infection was eradicated, three patients (16%) had persistent infection and four (21%) developed further infection after initially successful second-stage surgery. Above knee amputation for persistent infection was performed in two patients. In this particularly difficult to treat population, the SMILES spacer two-stage technique has demonstrated encouraging results and presents an attractive alternative to arthrodesis or amputation. Copyright © 2009 Elsevier B.V. All rights reserved.

Distinct clinical outcomes of two CIMP-positive colorectal cancer subtypes based on a revised CIMP classification system.

PubMed

Bae, Jeong Mo; Kim, Jung Ho; Kwak, Yoonjin; Lee, Dae-Won; Cha, Yongjun; Wen, Xianyu; Lee, Tae Hun; Cho, Nam-Yun; Jeong, Seung-Yong; Park, Kyu Joo; Han, Sae Won; Lee, Hye Seung; Kim, Tae-You; Kang, Gyeong Hoon

2017-04-11

Colorectal cancer (CRC) is a heterogeneous disease in terms of molecular carcinogenic pathways. Based on recent findings regarding the multiple serrated neoplasia pathway, we revised an eight-marker panel for a new CIMP classification system. 1370 patients who received surgical resection for CRCs were classified into three CIMP subtypes (CIMP-N: 0-4 methylated markers, CIMP-P1: 5-6 methylated markers and CIMP-P2: 7-8 methylated markers). Our findings were validated in a separate set of high-risk stage II or stage III CRCs receiving adjuvant fluoropyrimidine plus oxaliplatin (n=950). A total of 1287/62/21 CRCs cases were classified as CIMP-N/CIMP-P1/CIMP-P2, respectively. CIMP-N showed male predominance, distal location, lower T, N category and devoid of BRAF mutation, microsatellite instability (MSI) and MLH1 methylation. CIMP-P1 showed female predominance, proximal location, advanced TNM stage, mild decrease of CK20 and CDX2 expression, mild increase of CK7 expression, BRAF mutation, MSI and MLH1 methylation. CIMP-P2 showed older age, female predominance, proximal location, advanced T category, markedly reduced CK20 and CDX2 expression, rare KRAS mutation, high frequency of CK7 expression, BRAF mutation, MSI and MLH1 methylation. CIMP-N showed better 5-year cancer-specific survival (CSS; HR=0.47; 95% CI: 0.28-0.78) in discovery set and better 5-year relapse-free survival (RFS; HR=0.50; 95% CI: 0.29-0.88) in validation set compared with CIMP-P1. CIMP-P2 showed marginally better 5-year CSS (HR=0.28, 95% CI: 0.07-1.22) in discovery set and marginally better 5-year RFS (HR=0.21, 95% CI: 0.05-0.92) in validation set compared with CIMP-P1. CIMP subtypes classified using our revised system showed different clinical outcomes, demonstrating the heterogeneity of multiple serrated precursors of CIMP-positive CRCs.

[Revision of the TNM Stage Grouping in the Forthcoming Eighth Edition of the TNM Classification for Lung Cancer].

PubMed

Ye, Bo; Zhao, Heng

2016-06-20

The currently adopted staging system for lung cancer is the seventh edition of the TNM staging edited by Union for International Cancer Control (UICC) in January, 2009. In recent years, with the advances of techniques in lung cancer diagnosis and the treatment trends towards precision treatment modalities such as individualized therapy and molecular targeted therapy, the survival and prognosis of lung cancer has been significantly improved. The old staging standard is difficult to satisfy the currentrapidly developing clinical needs. Therefore, the International Lung Cancer Research Society (International Association for the Study of Lung Cancer, IASLC) updated the stage of lung cancer in 2015, and the forthcoming eighth edition of the TNM Classification for Lung Cancer, which will be formally adopted in Jan. 2017, has been published in Journal of Thoracic Oncology. The new staging system has adopted 35 databases from 16 countries, including 94,708 cases treated between 1999 and 2010. The advantages of the new staging lies in its higher prognosis prediction and clinical guidance value.

Fabricated torque shaft

DOEpatents

Mashey, Thomas Charles

2002-01-01

A fabricated torque shaft is provided that features a bolt-together design to allow vane schedule revisions with minimal hardware cost. The bolt-together design further facilitates on-site vane schedule revisions with parts that are comparatively small. The fabricated torque shaft also accommodates stage schedules that are different one from another in non-linear inter-relationships as well as non-linear schedules for a particular stage of vanes.

Economic analysis of two-stage septic revision after total hip arthroplasty: What are the relevant costs for the hospital's orthopedic department?

PubMed

Kasch, R; Assmann, G; Merk, S; Barz, T; Melloh, M; Hofer, A; Merk, H; Flessa, S

2016-03-01

The number of septic total hip arthroplasty (THA) revisions is increasing continuously, placing a growing financial burden on hospitals. Orthopedic departments performing septic THA revisions have no basis for decision making regarding resource allocation as the costs of this procedure for the departments are unknown. It is widely assumed that septic THA procedures can only be performed at a loss for the department. Therefore, the purpose of this study was to investigate whether this assumption is true by performing a detailed analysis of the costs and revenues for two-stage septic THA revision. Patients who underwent revision THA for septic loosening in two sessions from January 2009 through March 2012 were included in this retrospective, consecutive cost study from the orthopedic department's point of view. We analyzed variable and case-fixed costs for septic revision THA with special regard to implantation and explantation stay. By using marginal costing approach we neglected hospital-fixed costs. Outcome measures include reimbursement and daily contribution margins. The average direct costs (reimbursement) incurred for septic two-stage revision THA was €10,828 (€24,201). The difference in cost and contribution margins per day was significant (p < .001 and p = 0.019) for ex- and implantation (€4147 vs. €6680 and €429 vs. €306) while length of stay and reimbursement were comparable. This is the first detailed analysis of the hospital department's cost for septic revision THA performed in two sessions. Disregarding hospital-fixed costs the included variable and case fixed-costs were covered by revenues. This study provides cost data, which will be guidance for health care decision makers.

[Expectation for JSPN's contribution following revision of General Principles for Suicide Prevention Policy].

PubMed

Takeshima, Tadashi

2014-01-01

Japan's national suicide prevention efforts following the 1998 surge in the number of suicide deaths can be divided into three stages: the first stage administrated mainly by the health ministry (1998-2005), the second and transitional stage when it was upgraded to a full governmental issue (2005-2006), and the third and present stage following the promulgation of the Basic Act for Suicide Prevention in 2006. In June 2007, the General Principles for Suicide Prevention Policy (GPSP), a guideline on how the national government should act to promote suicide prevention, was announced, urging local governments to tackle the problem of suicide. The GPSP was set to be revised after around five years from its publication, and, thus, a revised GPSP was published in August of 2012. Based on the five years of challenges, the revised GPSP states that suicide prevention strategies should move on to more practical and community-oriented ones. The National Center of Neurology and Psychiatry (NCNP), through its Center for Suicide Prevention, played a coordinating role in putting forward a proposal for the revision, working with 29 academic societies including the Japanese Society of Psychiatry and Neurology (JSPN). In February 2013, by further developing the relationships with academic societies, etc., which were forged in the above-mentioned process, NCNP set up the Preparatory Committee for the Evidence-based Suicide Prevention Consortium in order to contribute to suicide prevention strategies from an academic perspective. Meanwhile, in the World Health Organization's 66th World Health Assembly held in May 2013, the Comprehensive Mental Health Action Plan 2013-2020 was approved. Its core principle is "no health without mental health", and it has the following four objectives: (1) to strengthen effective leadership and governance for mental health; (2) to provide comprehensive, integrated, and responsive mental health and social care services in community-based settings; (3) to implement strategies for promotion and prevention in mental health; and (4) to strengthen information systems, evidence, and research for mental health. In these, objective (3) includes a numerical target for the future global suicide rate. The WHO also plans to publish its first World Suicide Report on the World Suicide Prevention Day in September 2014. Today, suicide prevention forms an important part of mental health. The evolution of suicide prevention from mental health perspectives and its integration into society require comprehensive efforts.

School Desegregation in Hong Kong: Non-Chinese Linguistic Minority Students' Challenges to Learning Chinese in Mainstream Schools

ERIC Educational Resources Information Center

Shum, Mark; Gao, Fang; Ki, Wing Wah

2016-01-01

The enactment of the revised School Places Allocation Systems at the compulsory stage in 2004 had the aim of desegregating Hong Kong's non-Chinese linguistic minority (NCLM) students by including them into ethnic Chinese-dominated mainstream primary and secondary schools. Because of the presumed cause-consequence relationship between…

Asymmetrical booster ascent guidance and control system design study. Volume 2: SSFS math models - Ascent. [space shuttle development

NASA Technical Reports Server (NTRS)

Williams, F. E.; Lemon, R. S.

1974-01-01

The engineering equations and mathematical models developed for use in the space shuttle functional simulator (SSFS) are presented, and include extensive revisions and additions to earlier documentation. Definitions of coordinate systems used by the SSFS models and coordinate tranformations are given, along with documentation of the flexible body mathematical models. The models were incorporated in the SSFS and are in the checkout stage.

78 FR 65962 - Revision of the Land Management Plan for the Flathead National Forest

Federal Register 2010, 2011, 2012, 2013, 2014

2013-11-04

... over time. Under the 2012 Planning Rule, the assessment of ecological, social, and economic trends and... environmental impact statement and revised Forest Plan for public review and comment, and the preparation of the final environmental impact statement and revised Forest Plan. The third stage of the process is...

Clinical staging: its importance in therapeutic decisions and clinical trials.

PubMed

Denis, L J

1992-02-01

International collaboration has resulted in a revised and unified 1987 formulation for the TNM classification in solid tumors. The simplification and eliminations of most variables caused difficulties for the clinical use of the system in some tumors such as bladder cancer. The approval of the proposed adaptation covering the tumor mass, subdividing the T4 category and adapting the stage grouping, resolves these difficulties. Published reports demonstrate support for the TNM system as a clinical base for treatment decisions and prognosis. The TNMG stage and grade are important basic prognostic factors, but other prognostic factors, especially biologic tumor activity, are under clinical investigation. The TNM classification is the initial evaluation after histologic confirmation of cancer to guide treatment and prognosis. The quality of the evaluation is enhanced by precise communication on the employed methodology.

Revised International Staging System for Multiple Myeloma: A Report From International Myeloma Working Group

PubMed Central

Palumbo, Antonio; Avet-Loiseau, Hervé; Oliva, Stefania; Lokhorst, Henk M.; Goldschmidt, Hartmut; Rosinol, Laura; Richardson, Paul; Caltagirone, Simona; Lahuerta, Juan José; Facon, Thierry; Bringhen, Sara; Gay, Francesca; Attal, Michel; Passera, Roberto; Spencer, Andrew; Offidani, Massimo; Kumar, Shaji; Musto, Pellegrino; Lonial, Sagar; Petrucci, Maria T.; Orlowski, Robert Z.; Zamagni, Elena; Morgan, Gareth; Dimopoulos, Meletios A.; Durie, Brian G.M.; Anderson, Kenneth C.; Sonneveld, Pieter; San Miguel, Jésus; Cavo, Michele; Rajkumar, S. Vincent; Moreau, Philippe

2015-01-01

Purpose The clinical outcome of multiple myeloma (MM) is heterogeneous. A simple and reliable tool is needed to stratify patients with MM. We combined the International Staging System (ISS) with chromosomal abnormalities (CA) detected by interphase fluorescent in situ hybridization after CD138 plasma cell purification and serum lactate dehydrogenase (LDH) to evaluate their prognostic value in newly diagnosed MM (NDMM). Patients and Methods Clinical and laboratory data from 4,445 patients with NDMM enrolled onto 11 international trials were pooled together. The K-adaptive partitioning algorithm was used to define the most appropriate subgroups with homogeneous survival. Results ISS, CA, and LDH data were simultaneously available in 3,060 of 4,445 patients. We defined the following three groups: revised ISS (R-ISS) I (n = 871), including ISS stage I (serum β2-microglobulin level < 3.5 mg/L and serum albumin level ≥ 3.5 g/dL), no high-risk CA [del(17p) and/or t(4;14) and/or t(14;16)], and normal LDH level (less than the upper limit of normal range); R-ISS III (n = 295), including ISS stage III (serum β2-microglobulin level > 5.5 mg/L) and high-risk CA or high LDH level; and R-ISS II (n = 1,894), including all the other possible combinations. At a median follow-up of 46 months, the 5-year OS rate was 82% in the R-ISS I, 62% in the R-ISS II, and 40% in the R-ISS III groups; the 5-year PFS rates were 55%, 36%, and 24%, respectively. Conclusion The R-ISS is a simple and powerful prognostic staging system, and we recommend its use in future clinical studies to stratify patients with NDMM effectively with respect to the relative risk to their survival. PMID:26240224

Survival outcomes and prognostic factors in mycosis fungoides/Sézary syndrome: validation of the revised International Society for Cutaneous Lymphomas/European Organisation for Research and Treatment of Cancer staging proposal.

PubMed

Agar, Nita Sally; Wedgeworth, Emma; Crichton, Siobhan; Mitchell, Tracey J; Cox, Michael; Ferreira, Silvia; Robson, Alistair; Calonje, Eduardo; Stefanato, Catherine M; Wain, Elizabeth Mary; Wilkins, Bridget; Fields, Paul A; Dean, Alan; Webb, Katherine; Scarisbrick, Julia; Morris, Stephen; Whittaker, Sean J

2010-11-01

We have analyzed the outcome of mycosis fungoides (MF) and Sézary syndrome (SS) patients using the recent International Society for Cutaneous Lymphomas (ISCL)/European Organisation for Research and Treatment of Cancer (EORTC) revised staging proposal. Overall survival (OS), disease-specific survival (DSS), and risk of disease progression (RDP) were calculated for a cohort of 1,502 patients using univariate and multivariate models. The mean age at diagnosis was 54 years, and 71% of patients presented with early-stage disease. Disease progression occurred in 34%, and 26% of patients died due to MF/SS. A significant difference in survival and progression was noted for patients with early-stage disease having patches alone (T1a/T2a) compared with those having patches and plaques (T1b/T2b). Univariate analysis established that (1) advanced skin and overall clinical stage, increased age, male sex, increased lactate dehydrogenase (LDH), and large-cell transformation were associated with reduced survival and increased RDP; (2) hypopigmented MF, MF with lymphomatoid papulosis, and poikilodermatous MF were associated with improved survival and reduced RDP; and (3) folliculotropic MF was associated with an increased RDP. Multivariate analysis established that (1) advanced skin (T) stage, the presence in peripheral blood of the tumor clone without Sézary cells (B0b), increased LDH, and folliculotropic MF were independent predictors of poor survival and increased RDP; (2) large-cell transformation and tumor distribution were independent predictors of increased RDP only; and (3) N, M, and B stages; age; male sex; and poikilodermatous MF were only significant for survival. This study has validated the recently proposed ISCL/EORTC staging system and identified new prognostic factors.

Laparoscopic sleeve gastrectomy as revisional surgery for adjustable gastric band erosion.

PubMed

Park, Yeon Ho; Kim, Seong Min

2014-09-01

Laparoscopic sleeve gastrectomy (LSG) has been increasingly adopted as a revisional surgery for failed gastric banding. However, little information is available regarding the outcome of revisional LSG for band erosion. A retrospective database analysis was performed to study LSG as revisional surgery for band erosion. For staged revision, we waited a minimum of 3 months after band removal, and for single-stage revision, the band was removed by gastrotomy, and sleeve gastrectomy was performed at the same time. Main outcome measures were success rates of therapeutic strategies, morbidity, and mortality rates, length of stay, and body mass index (BMI) (percentage excess weight loss [%EWL]) before and after revision. From March 2011 to February 2013, 9 female patients underwent revisional LSG. Average age was 34.7 years. Six patients underwent a staged procedure, and the other 3 underwent a single-stage revision. Among the 6 staged patients, eroded bands had been removed by laparoscopy in 4 and by endoscopy in 2 without complications. Their LSGs were performed at a median of 4.4 months after band removal. Another 2 patients underwent single-stage revision. In the last patient, band erosion was incidentally found during a revisional LSG for insufficient weight loss. No mortality occurred. There were one stenosis and two proximal leaks. Two patients with leak underwent total gastrectomy and fistulojejunostomy. After a mean follow-up of 19.1 months, all 9 patients exhibited weight loss. The mean (±standard deviation [SD]) pre- and post-LSG BMIs were 34.0±4.4 and 25.6±2.1 kg/m(2), respectively, and their mean (±SD) %EWL from prebanding was 86.8±10.1%. Revisional LSG resulted in a further median %EWL of 28.0% (range, 7.9%-68.9%) versus weight at time of band removal. Revisional LSG after band erosion was found to be feasible and effective. However, it is prone to severe complication. In selected cases of band erosion, LSG can be performed at the time of band removal in a single stage.

77 FR 12581 - Public Water System Supervision Program Revision for the State of Montana

Federal Register 2010, 2011, 2012, 2013, 2014

2012-03-01

... accordance with the provisions of section 1413 of the Safe Drinking Water Act (SDWA), 42 U.S.C. 300g-2, and... Water Treatment Rule, Stage 2 Disinfectants and Disinfection Byproducts Rule and Ground Water Rule that correspond to the National Primary Drinking Water Regulations (NPDWR) in 40 CFR part 141 and 142. The EPA has...

Medicare program; End-Stage Renal Disease prospective payment system, quality incentive program, and Durable Medical Equipment, Prosthetics, Orthotics, and Supplies. Final rule.

PubMed

2014-11-06

This final rule will update and make revisions to the End-Stage Renal Disease (ESRD) prospective payment system (PPS) for calendar year (CY) 2015. This rule also finalizes requirements for the ESRD quality incentive program (QIP), including for payment years (PYs) 2017 and 2018. This rule will also make a technical correction to remove outdated terms and definitions. In addition, this final rule sets forth the methodology for adjusting Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) fee schedule payment amounts using information from the Medicare DMEPOS Competitive Bidding Program (CBP); makes alternative payment rules for certain DME under the Medicare DMEPOS CBP; clarifies the statutory Medicare hearing aid coverage exclusion and specifies devices not subject to the hearing aid exclusion; will not update the definition of minimal self-adjustment; clarifies the Change of Ownership (CHOW) and provides for an exception to the current requirements; revises the appeal provisions for termination of a CBP contract, including the beneficiary notification requirement under the Medicare DMEPOS CBP, and makes a technical change to the regulation related to the conditions for awarding contracts for furnishing infusion drugs under the Medicare DMEPOS CBP.

TREATMENT OF INFECTION AFTER TOTAL KNEE ARTHROPLASTY.

PubMed

Cury, Ricardo de Paula Leite; Cinagawa, Eduardo Hitoshi Tsuge; Camargo, Osmar Pedro Arbix; Honda, Emerson Kiyoshi; Klautau, Giselle Burlamaqui; Salles, Mauro José Costa

2015-01-01

To identify and compare the rate of success of therapeutic modalities applied in surgeries for the treatment of infections associated with total knee arthroplasty (TKA), and to evaluate the functional outcome and pain in different therapeutic modalities by means of quality of life scores. We evaluated all patients who developed periprosthetic infection after TKA for primary or secondary osteoarthritis, in the period from January 1(st), 2008 to December 31(st), 2010. In the study period, 29 patients with TKA had infection, and 12 of these underwent debridement and retention of the prosthesis (D+R), seven received two-stage and six one-stage exchange arthroplasties, and four patients were treated with suppressive antibiotic therapy because they could not undergo another surgical procedure. The D+R, one-stage revision and two-stage revision success rates were 75%, 83.3%, and 100%, respectively. The best results of quality of life (QoL) and function occur in patients undergoing D+R. In contrast, the worst QoL and functional results were obtained in patients treated with two-stage revision arthroplasty. Level of Evidence II, Prognostic Studies - Investigating the Effect of a Patient Characteristic on the Outcome of Disease.

One-Stage versus Two-Stage Repair of Asymmetric Bilateral Cleft Lip: A 20-Year Retrospective Study of Clinical Outcome.

PubMed

Chung, Kyung Hoon; Lo, Lun-Jou

2018-05-01

Both one- and two-stage approaches have been widely used for patients with asymmetric bilateral cleft lip. There are insufficient long-term outcome data for comparison of these two methods. The purpose of this retrospective study was to compare the clinical outcome over the past 20 years. The senior author's (L.J.L.) database was searched for patients with asymmetric bilateral cleft lip from 1995 to 2015. Qualified patients were divided into two groups: one-stage and two-stage. The postoperative photographs of patients were evaluated subjectively by surgical professionals and laypersons. Ratios of the nasolabial region were calculated for objective analysis. Finally, the revision procedures in the nasolabial area were reviewed. Statistical analyses were performed. A total of 95 consecutive patients were qualified for evaluation. Average follow-up was 13.1 years. A two-stage method was used in 35 percent of the patients, and a one-stage approach was used in 65 percent. All underwent primary nasal reconstruction. Among the satisfaction rating scores, the one-stage repair was rated significantly higher than two-stage reconstruction (p = 0.0001). Long-term outcomes of the two-stage patients and the unrepaired mini-microform deformities were unsatisfactory according to both professional and nonprofessional evaluators. The revision rate was higher in patients with a greater-side complete cleft lip and palate as compared with those without palatal involvement. The results suggested that one-stage repair provided better results with regard to achieving a more symmetric and smooth lip and nose after primary reconstruction. The revision rate was slightly higher in the two-stage patient group. Therapeutic, III.

Outcomes of Patients With Revised Stage I Clear Cell Sarcoma of Kidney Treated in National Wilms Tumor Studies 1-5

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

Kalapurakal, John A., E-mail: j-kalapurakal@northwestern.edu; Perlman, Elizabeth J.; Seibel, Nita L.

Purpose: To report the clinical outcomes of children with revised stage I clear cell sarcoma of the kidney (CCSK) using the National Wilms Tumor Study Group (NWTS)-5 staging criteria after multimodality treatment on NWTS 1-5 protocols. Methods and Materials: All CCSK patients enrolled in the National Wilms Tumor Study Group protocols had their pathology slides reviewed, and only those determined to have revised stage I tumors according to the NWTS-5 staging criteria were included in the present analysis. All patients were treated with multimodality therapy according to the NWTS 1-5 protocols. Results: A total of 53 children were identified asmore » having stage I CCSK. All patients underwent primary surgery with radical nephrectomy. The chemotherapy regimens used were as follows: regimen A, C, F, or EE in 4 children (8%); regimen DD or DD4A in 33 children (62%); regimen J in 4 children (8%); and regimen I in 12 children (22%). Forty-six patients (87%) received flank radiation therapy (RT). Seven children (13%) did not receive flank RT. The median delay between surgery and the initiation of RT was 9 days (range, 3-61). The median RT dose was 10.8 Gy (range, 10-36). The flank RT doses were as follows: 10.5 or 10.8 Gy in 25 patients (47%), 11-19.9 Gy in 2 patients (4%), 20-29.9 Gy in 9 patients (17%), and 30-40 Gy in 10 patients (19%). The median follow-up for the entire group was 17 years (range, 2-36). The relapse-free and cancer-specific survival rate was 100% at the last follow-up examination. Conclusions: The present results have demonstrated that children with revised stage I CCSK using the NWTS-5 staging criteria have excellent survival rates despite the use of varying RT doses and chemotherapy regimens in the NWTS 1-5 protocols.« less

Comparison of the current AJCC-TNM numeric-based with a new anatomical location-based lymph node staging system for gastric cancer: A western experience.

PubMed

Galizia, Gennaro; Lieto, Eva; Auricchio, Annamaria; Cardella, Francesca; Mabilia, Andrea; Diana, Anna; Castellano, Paolo; De Vita, Ferdinando; Orditura, Michele

2017-01-01

In gastric cancer, the current AJCC numeric-based lymph node staging does not provide information on the anatomical extent of the disease and lymphadenectomy. A new anatomical location-based node staging, proposed by Choi, has shown better prognostic performance, thus soliciting Western world validation. Data from 284 gastric cancers undergoing radical surgery at the Second University of Naples from 2000 to 2014 were reviewed. The lymph nodes were reclassified into three groups (lesser and greater curvature, and extraperigastric nodes); presence of any metastatic lymph node in a given group was considered positive, prompting a new N and TNM stage classification. Receiver-operating-characteristic (ROC) curves for censored survival data and bootstrap methods were used to compare the capability of the two models to predict tumor recurrence. More than one third of node positive patients were reclassified into different N and TNM stages by the new system. Compared to the current staging system, the new classification significantly correlated with tumor recurrence rates and displayed improved indices of prognostic performance, such as the Bayesian information criterion and the Harrell C-index. Higher values at survival ROC analysis demonstrated a significantly better stratification of patients by the new system, mostly in the early phase of the follow-up, with a worse prognosis in more advanced new N stages, despite the same current N stage. This study suggests that the anatomical location-based classification of lymph node metastasis may be an important tool for gastric cancer prognosis and should be considered for future revision of the TNM staging system.

Development and validation of a surgical-pathologic staging and scoring system for cervical cancer.

PubMed

Li, Shuang; Li, Xiong; Zhang, Yuan; Zhou, Hang; Tang, Fangxu; Jia, Yao; Hu, Ting; Sun, Haiying; Yang, Ru; Chen, Yile; Cheng, Xiaodong; Lv, Weiguo; Wu, Li; Zhou, Jin; Wang, Shaoshuai; Huang, Kecheng; Wang, Lin; Yao, Yuan; Yang, Qifeng; Yang, Xingsheng; Zhang, Qinghua; Han, Xiaobing; Lin, Zhongqiu; Xing, Hui; Qu, Pengpeng; Cai, Hongbing; Song, Xiaojie; Tian, Xiaoyu; Shen, Jian; Xi, Ling; Li, Kezhen; Deng, Dongrui; Wang, Hui; Wang, Changyu; Wu, Mingfu; Zhu, Tao; Chen, Gang; Gao, Qinglei; Wang, Shixuan; Hu, Junbo; Kong, Beihua; Xie, Xing; Ma, Ding

2016-04-12

Most cervical cancer patients worldwide receive surgical treatments, and yet the current International Federation of Gynecology and Obstetrics (FIGO) staging system do not consider surgical-pathologic data. We propose a more comprehensive and prognostically valuable surgical-pathologic staging and scoring system (SPSs). Records from 4,220 eligible cervical cancer cases (Cohort 1) were screened for surgical-pathologic risk factors. We constructed a surgical-pathologic staging and SPSs, which was subsequently validated in a prospective study of 1,104 cervical cancer patients (Cohort 2). In Cohort 1, seven independent risk factors were associated with patient outcome: lymph node metastasis (LNM), parametrial involvement, histological type, grade, tumor size, stromal invasion, and lymph-vascular space invasion (LVSI). The FIGO staging system was revised and expanded into a surgical-pathologic staging system by including additional criteria of LNM, stromal invasion, and LVSI. LNM was subdivided into three categories based on number and location of metastases. Inclusion of all seven prognostic risk factors improves practical applicability. Patients were stratified into three SPSs risk categories: zero-, low-, and high-score with scores of 0, 1 to 3, and ≥4 (P=1.08E-45; P=6.15E-55). In Cohort 2, 5-year overall survival (OS) and disease-free survival (DFS) outcomes decreased with increased SPSs scores (P=9.04E-15; P=3.23E-16), validating the approach. Surgical-pathologic staging and SPSs show greater homogeneity and discriminatory utility than FIGO staging. Surgical-pathologic staging and SPSs improve characterization of tumor severity and disease invasion, which may more accurately predict outcome and guide postoperative therapy.

Evaluation of the Revised International Staging System in an independent cohort of unselected patients with multiple myeloma

PubMed Central

Kastritis, Efstathios; Terpos, Evangelos; Roussou, Maria; Gavriatopoulou, Maria; Migkou, Magdalini; Eleutherakis-Papaiakovou, Evangelos; Fotiou, Despoina; Ziogas, Dimitrios; Panagiotidis, Ioannis; Kafantari, Eftychia; Giannouli, Stavroula; Zomas, Athanasios; Konstantopoulos, Konstantinos; Dimopoulos, Meletios A.

2017-01-01

The Revised International Staging System (R-ISS) was recently introduced in order to improve risk stratification over that provided by the widely used standard International Staging System. In addition to the parameters of the standard system, the R-ISS incorporates the presence of chromosomal abnormalities detected by interphase fluorescence in situ hybridization [t(4;14), t(14;16) and del17p] and elevated serum lactate dehydrogenase. The R-ISS was formulated on the basis of a large dataset of selected patients who had participated in clinical trials and has not been validated in an independent cohort of unselected patients. Thus, we evaluated the R-ISS in 475 consecutive, unselected patients, treated in a single center. Our patients were older and more often had severe renal dysfunction than those in the original publication on the R-ISS. As regards distribution by group, 18% had R-ISS-1, 64.5% R-ISS-2 and 18% R-ISS-3. According to R-ISS group, the 5-year survival rate was 77%, 53% and 19% for R-ISS-1, -2 and -3, respectively (P<0.001). The R-ISS could identify three groups with distinct outcomes among patients treated with or without autologous stem cell transplantation, among those treated with either bortezomib-based or immunomodulatory drug-based primary therapy and in patients ≤65, 66–75 or >75 years. However, in patients with severe renal dysfunction the distinction between groups was less clear. In conclusion, our data in consecutive, unselected patients, with differences in the characteristics and treatment approaches compared to the original International Myeloma Working Group cohort, verified that R-ISS is a robust tool for risk stratification of newly diagnosed patients with symptomatic myeloma. PMID:27789676

One Stage Conversion of an Infected Fused Knee to Total Knee Replacement - A Surgical Challenge

PubMed Central

Ravikumar, Mukartihal; Kendoff, Daniel; Citak, Mustafa; Luck, Stefan; Gehrke, Thorsten; Zahar, Akos

2013-01-01

Background and Purpose: Two-stage revision arthroplasty is a common technique for the treatment of infected total knee replacement. Few reports have addressed the conversion of a fused knee into a total knee replacement. However, there is no case reported of converting an infected fused knee into a hinge knee using a one-stage procedure. Methods: We report on a 51-year old male patient with an infected fused knee after multiple surgeries. Results and Interpretation: A one-stage conversion of septic fused knee into total knee arthroplasty by a rotational hinge prosthesis was performed. The case highlights that with profound preoperative assessment, meticulous surgical technique, combined antibiotic treatment and the right implant, one-stage revision in a surgical challenge may have a role as a treatment option with good functional outcome. PMID:23526706

Evaluation of the proposed International Association for the Study of Lung Cancer (IASLC)/International Thymic Malignancies Interest Group (ITMIG) staging revisions in thymic well-differentiated neuroendocrine carcinoma patients.

PubMed

Zhao, Yang; Shi, Jianxin; Fan, Limin; Yang, Jun; Hu, Dingzhong; Zhao, Heng

2016-02-01

In 2014, the International Association for the Study of Lung Cancer (IASLC)/International Thymic Malignancies Interest Group (ITMIG) launched a worldwide Tumor Node Metastasis (TNM) staging proposal for the next edition of thymic tumours. The objective of the current study was to evaluate the proposed new staging system specific to the thymic well-differentiated neuroendocrine carcinoma (TWDNC). From November 2003 to July 2014, 61 consecutive patients were enrolled in this study with pathologically confirmed TWDNC in Shanghai Chest Hospital. Clinical and pathological data were retrospectively reviewed. Survival analysis was performed using the Kaplan-Meier and log-rank tests. Validity evaluation was addressed by Cox proportional hazards regression model, after adjusting for potential confounders and visually assessing the distinction of curves generated based on the staging system of Masaoka-Koga and the proposed TNM ones. Thymic carcinoids made up 4% of total thymic tumours in our institution. The 5-year overall survival (OS) rate and the disease-free survival (DFS) rate were 72 and 41%, respectively. Neither Masaoka-Koga staging system nor the proposed TNM system showed ordered appropriateness visually in survival curves and the prognostic demarcation between stages was poor on both OS and DFS. The IASLC/ITMIG suggested that the TNM and Masaoka-Koga staging systems fail to predict the clinical course of TWDNC patients. Collaborative effort is needed in the future staging validation as ITMIG recommended. © The Author 2015. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

Distinct clinical outcomes of two CIMP-positive colorectal cancer subtypes based on a revised CIMP classification system

PubMed Central

Bae, Jeong Mo; Kim, Jung Ho; Kwak, Yoonjin; Lee, Dae-Won; Cha, Yongjun; Wen, Xianyu; Lee, Tae Hun; Cho, Nam-Yun; Jeong, Seung-Yong; Park, Kyu Joo; Han, Sae Won; Lee, Hye Seung; Kim, Tae-You; Kang, Gyeong Hoon

2017-01-01

Background: Colorectal cancer (CRC) is a heterogeneous disease in terms of molecular carcinogenic pathways. Based on recent findings regarding the multiple serrated neoplasia pathway, we revised an eight-marker panel for a new CIMP classification system. Methods: 1370 patients who received surgical resection for CRCs were classified into three CIMP subtypes (CIMP-N: 0–4 methylated markers, CIMP-P1: 5–6 methylated markers and CIMP-P2: 7–8 methylated markers). Our findings were validated in a separate set of high-risk stage II or stage III CRCs receiving adjuvant fluoropyrimidine plus oxaliplatin (n=950). Results: A total of 1287/62/21 CRCs cases were classified as CIMP-N/CIMP-P1/CIMP-P2, respectively. CIMP-N showed male predominance, distal location, lower T, N category and devoid of BRAF mutation, microsatellite instability (MSI) and MLH1 methylation. CIMP-P1 showed female predominance, proximal location, advanced TNM stage, mild decrease of CK20 and CDX2 expression, mild increase of CK7 expression, BRAF mutation, MSI and MLH1 methylation. CIMP-P2 showed older age, female predominance, proximal location, advanced T category, markedly reduced CK20 and CDX2 expression, rare KRAS mutation, high frequency of CK7 expression, BRAF mutation, MSI and MLH1 methylation. CIMP-N showed better 5-year cancer-specific survival (CSS; HR=0.47; 95% CI: 0.28–0.78) in discovery set and better 5-year relapse-free survival (RFS; HR=0.50; 95% CI: 0.29–0.88) in validation set compared with CIMP-P1. CIMP-P2 showed marginally better 5-year CSS (HR=0.28, 95% CI: 0.07–1.22) in discovery set and marginally better 5-year RFS (HR=0.21, 95% CI: 0.05–0.92) in validation set compared with CIMP-P1. Conclusions: CIMP subtypes classified using our revised system showed different clinical outcomes, demonstrating the heterogeneity of multiple serrated precursors of CIMP-positive CRCs. PMID:28278514

Preoperative ultrasound staging of the axilla make's peroperative examination of the sentinel node redundant in breast cancer: saving tissue, time and money.

PubMed

Van Berckelaer, Christophe; Huizing, Manon; Van Goethem, Mireille; Vervaecke, Andrew; Papadimitriou, Konstantinos; Verslegers, Inge; Trinh, Bich X; Van Dam, Peter; Altintas, Sevilay; Van den Wyngaert, Tim; Huyghe, Ivan; Siozopoulou, Vasiliki; Tjalma, Wiebren A A

2016-11-01

To evaluate the role of preoperative axillary staging with ultrasound (US) and fine needle aspiration cytology (FNAC). Can we avoid intraoperative sentinel lymph node (SLN) examination, with an acceptable revision rate by preoperative staging? This study is based on the retrospective data of 336 patients that underwent US evaluation of the axilla as part of their staging. A FNAC biopsy was performed when abnormal lymph nodes were visualized. Patients with normal appearing nodes on US or a benign diagnostic biopsy had removal of the SLNs without intraoperative pathological examination. We calculated the sensitivity, specificity and accuracy of US/FNAC in predicting the necessity of an axillary lymphadenectomy. Subsequently we looked at the total cost and the operating time of 3 models. Model A is our study protocol. Model B is a theoretical protocol based on the findings of the Z0011 trial with only clinical preoperative staging and in Model C preoperative staging and intraoperative pathological examination were both theoretically done. sentinel node, staging, ultrasound, preoperative axillary staging, FNAC, axilla RESULTS: The sensitivity, specificity and accuracy are respectively 0.75 (0.66-0.82), 1.00 (0.99-1.00) and 0.92 (0.88-0.94). Only 26 out of 317 (8.2%) patients that successfully underwent staging needed a revision. The total cost of Model A was 1.58% cheaper than Model C and resulted in a decrease in operation time by 9,46%. The benefits compared with Model B were much smaller. Preoperative US/FNAC staging of the axillary lymph nodes can avoid intraoperative examination of the sentinel node with an acceptable revision rate. It saves tissue, reduces operating time and decreases healthcare costs in general. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

What is the evidence base to guide surgical treatment of infected hip prostheses? systematic review of longitudinal studies in unselected patients

PubMed Central

2012-01-01

Background Prosthetic joint infection is an uncommon but serious complication of hip replacement. There are two main surgical treatment options, with the choice largely based on the preference of the surgeon. Evidence is required regarding the comparative effectiveness of one-stage and two-stage revision to prevent reinfection after prosthetic joint infection. Methods We conducted a systematic review to identify randomised controlled trials, systematic reviews and longitudinal studies in unselected patients with infection treated exclusively by one- or two-stage methods or by any method. The Embase, MEDLINE and Cochrane databases were searched up to March 2011. Reference lists were checked, and citations of key articles were identified by using the ISI Web of Science portal. Classification of studies and data extraction were performed independently by two reviewers. The outcome measure studied was reinfection within 2 years. Data were combined to produce pooled random-effects estimates using the Freeman-Tukey arc-sine transformation. Results We identified 62 relevant studies comprising 4,197 patients. Regardless of treatment, the overall rate of reinfection after any treatment was 10.1% (95% CI = 8.2 to 12.0). In 11 studies comprising 1,225 patients with infected hip prostheses who underwent exclusively one-stage revision, the rate of reinfection was 8.6% (95% CI = 4.5 to 13.9). After two-stage revision exclusively in 28 studies comprising 1,188 patients, the rate of reinfection was 10.2% (95% CI = 7.7 to 12.9). Conclusion Evidence of the relative effectiveness of one- and two-stage revision in preventing reinfection of hip prostheses is largely based on interpretation of longitudinal studies. There is no suggestion in the published studies that one- or two stage methods have different reinfection outcomes. Randomised trials are needed to establish optimum management strategies. PMID:22340795

Patients with Staged Bilateral Total Joint Arthroplasty in Registries: Immortal Time Bias and Methodological Options.

PubMed

van der Pas, Stéphanie L; Nelissen, Rob G H H; Fiocco, Marta

2017-08-02

In arthroplasty data, patients with staged bilateral total joint arthroplasty (TJA) pose a problem in statistical analysis. Subgroup analysis, in which patients with unilateral and bilateral TJA are studied separately, is sometimes considered an appropriate solution to the problem; we aim to show that this is not true because of immortal time bias. We reviewed patients who underwent staged (at any time) bilateral TJA. The logical fallacy leading to immortal time bias is explained through a simple artificial data example. The cumulative incidences of revision and death are computed by subgroup analysis and by landmark analysis based on hip replacement data from the Dutch Arthroplasty Register and on simulated data sets. For patients who underwent unilateral TJA, subgroup analysis can lead to an overestimate of the cumulative incidence of death and an underestimate of the cumulative incidence of revision. The reverse conclusion holds for patients who underwent staged bilateral TJA. Analysis of these patients can lead to an underestimate of the cumulative incidence of death and an overestimate of the cumulative incidence of revision. Immortal time bias can be prevented by using landmark analysis. When examining arthroplasty registry data, patients who underwent staged bilateral TJA should be analyzed with caution. An appropriate statistical method to address the research question should be selected.

Comparison of the current AJCC-TNM numeric-based with a new anatomical location-based lymph node staging system for gastric cancer: A western experience

PubMed Central

Auricchio, Annamaria; Cardella, Francesca; Mabilia, Andrea; Diana, Anna; Castellano, Paolo; De Vita, Ferdinando; Orditura, Michele

2017-01-01

Background In gastric cancer, the current AJCC numeric-based lymph node staging does not provide information on the anatomical extent of the disease and lymphadenectomy. A new anatomical location-based node staging, proposed by Choi, has shown better prognostic performance, thus soliciting Western world validation. Study design Data from 284 gastric cancers undergoing radical surgery at the Second University of Naples from 2000 to 2014 were reviewed. The lymph nodes were reclassified into three groups (lesser and greater curvature, and extraperigastric nodes); presence of any metastatic lymph node in a given group was considered positive, prompting a new N and TNM stage classification. Receiver-operating-characteristic (ROC) curves for censored survival data and bootstrap methods were used to compare the capability of the two models to predict tumor recurrence. Results More than one third of node positive patients were reclassified into different N and TNM stages by the new system. Compared to the current staging system, the new classification significantly correlated with tumor recurrence rates and displayed improved indices of prognostic performance, such as the Bayesian information criterion and the Harrell C-index. Higher values at survival ROC analysis demonstrated a significantly better stratification of patients by the new system, mostly in the early phase of the follow-up, with a worse prognosis in more advanced new N stages, despite the same current N stage. Conclusions This study suggests that the anatomical location-based classification of lymph node metastasis may be an important tool for gastric cancer prognosis and should be considered for future revision of the TNM staging system. PMID:28380037

Development and validation of a surgical-pathologic staging and scoring system for cervical cancer

PubMed Central

Zhou, Hang; Tang, Fangxu; Jia, Yao; Hu, Ting; Sun, Haiying; Yang, Ru; Chen, Yile; Cheng, Xiaodong; Lv, Weiguo; Wu, Li; Zhou, Jin; Wang, Shaoshuai; Huang, Kecheng; Wang, Lin; Yao, Yuan; Yang, Qifeng; Yang, Xingsheng; Zhang, Qinghua; Han, Xiaobing; Lin, Zhongqiu; Xing, Hui; Qu, Pengpeng; Cai, Hongbing; Song, Xiaojie; Tian, Xiaoyu; Shen, Jian; Xi, Ling; Li, Kezhen; Deng, Dongrui; Wang, Hui; Wang, Changyu; Wu, Mingfu; Zhu, Tao; Chen, Gang; Gao, Qinglei; Wang, Shixuan; Hu, Junbo; Kong, Beihua; Xie, Xing; Ma, Ding

2016-01-01

Background Most cervical cancer patients worldwide receive surgical treatments, and yet the current International Federation of Gynecology and Obstetrics (FIGO) staging system do not consider surgical-pathologic data. We propose a more comprehensive and prognostically valuable surgical-pathologic staging and scoring system (SPSs). Methods Records from 4,220 eligible cervical cancer cases (Cohort 1) were screened for surgical-pathologic risk factors. We constructed a surgical-pathologic staging and SPSs, which was subsequently validated in a prospective study of 1,104 cervical cancer patients (Cohort 2). Results In Cohort 1, seven independent risk factors were associated with patient outcome: lymph node metastasis (LNM), parametrial involvement, histological type, grade, tumor size, stromal invasion, and lymph-vascular space invasion (LVSI). The FIGO staging system was revised and expanded into a surgical-pathologic staging system by including additional criteria of LNM, stromal invasion, and LVSI. LNM was subdivided into three categories based on number and location of metastases. Inclusion of all seven prognostic risk factors improves practical applicability. Patients were stratified into three SPSs risk categories: zero-, low-, and high-score with scores of 0, 1 to 3, and ≥4 (P=1.08E-45; P=6.15E-55). In Cohort 2, 5-year overall survival (OS) and disease-free survival (DFS) outcomes decreased with increased SPSs scores (P=9.04E-15; P=3.23E-16), validating the approach. Surgical-pathologic staging and SPSs show greater homogeneity and discriminatory utility than FIGO staging. Conclusions Surgical-pathologic staging and SPSs improve characterization of tumor severity and disease invasion, which may more accurately predict outcome and guide postoperative therapy. PMID:27014971

Impact of centralized diagnostic review on quality of initial staging in Hodgkin lymphoma: experience of the German Hodgkin Study Group.

PubMed

Bröckelmann, Paul J; Goergen, Helen; Fuchs, Michael; Kriz, Jan; Semrau, Robert; Baues, Christian; Kobe, Carsten; Behringer, Karolin; Eichenauer, Dennis A; von Tresckow, Bastian; Klimm, Beate; Halbsguth, Teresa; Wongso, Diana; Plütschow, Annette; Haverkamp, Heinz; Dietlein, Markus; Eich, Hans T; Stein, Harald; Diehl, Volker; Borchmann, Peter; Engert, Andreas

2015-11-01

Accurate clinical staging is crucial for adequate risk-adapted treatment in Hodgkin lymphoma (HL) to prevent patients from under- or over-treatment. Within the latest German Hodgkin Study Group trial generation, diagnostic findings such as histopathology, computerized tomography imaging and clinical risk factors were re-evaluated by expert panels. Here, we retrospectively analysed 5965 patients and identified 399 in who major discordant findings changed their first-line treatment allocation. Histopathology review did not confirm the initial diagnosis of HL in 87 patients. Treatment allocation was revised in 312 of the remaining 5878 patients: 176 were assigned to a higher and 128 to a lower risk group, respectively; the correct treatment group remained unclear in 8 patients. Cases of revised treatment allocation accounted for 9·8%, 6·0%, 0·8%, and 14·8% of patients initially assigned to the HD13, HD14, HD15 trials and stage IA lymphocyte-predominant HL project, respectively. Most revisions were due to wrong application of clinical stage (20·5% of 312 patients with revised treatment group), histological subtype (9·0%) or the risk factors ≥3 involved areas (46·8%) or large mediastinal mass (9·3%). In conclusion, centralized review by experienced experts changed risk-adapted first-line treatment in a relevant proportion of HL patients. Quality control measures clearly improve the accuracy of treatment and should be implemented in clinical practice. © 2015 John Wiley & Sons Ltd.

Single-Anesthetic Versus Staged Bilateral Total Hip Arthroplasty: A Matched Cohort Study.

PubMed

Houdek, Matthew T; Wyles, Cody C; Watts, Chad D; Wagner, Eric R; Sierra, Rafael J; Trousdale, Robert T; Taunton, Michael J

2017-01-04

There is debate regarding the role of single-anesthetic versus staged bilateral total hip arthroplasty (THA) for patients with end-stage bilateral osteoarthritis. Studies have shown that single-anesthetic bilateral THA is associated with systemic complications, but there are limited data comparing patient outcomes in a matched setting of bilateral THA. We identified 94 patients (188 hips) who underwent single-anesthetic bilateral THA. Fifty-seven percent of the patients were male. Patients had a mean age of 52.2 years and body mass index of 27.1 kg/m. They were matched 1:1 on the basis of sex, age (±1 year), and year of surgery (±3 years) to a cohort of patients undergoing staged bilateral THA. In the staged group, there was <1 year between procedures (range, 5 days to 10 months). Mean follow-up was 4 years for each group. Patients in the single-anesthetic group experienced shorter total operating room time and length of stay. There was no difference (hazard ratio [HR] = 0.73, p = 0.50) in the overall revision-free survival in patients undergoing single-anesthetic or staged bilateral THA. The risks of reoperation (HR = 0.69, p = 0.40), complications (HR = 0.83, p = 0.48), and mortality (HR = 0.47, p = 0.10) were similar. Single-anesthetic bilateral THA reduced the total cost of care (by 27%, p = 0.0001). In this matched cohort analysis, single-anesthetic bilateral THA was not associated with an increased risk of revision, reoperation, or postoperative complications, while decreasing cost. In our experience, single-anesthetic bilateral THA is a safe procedure that, for certain patients, offers an excellent means to deal with bilateral hip osteoarthritis. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Complications and troubleshooting of sacral neuromodulation therapy.

PubMed

Hijaz, Adonis; Vasavada, Sandip

2005-02-01

As evident from the authors' series, the complications of sacral neuromodulation have changed with the introduction of the tined lead and the placement of the generator over the back. In the earlier series, most complications were related to pain at the generator site, which was rare in the authors' series. The posterior location of the generator seems to be better tolerated than the anterior location, which could explain the rare need for revisions for pain at the generator site. Lead migration was observed in 8.4% of the original sacral neuromodulation study group series. This was seen rarely in the authors' series in either stage-one or stage-two revisions. As part of the routine work-up of patients who present with decreased function after a successful period response in stage two, the authors obtain a lateral radiograph of the sacrum; the authors have made the diagnosis of lead migration rarely (1/130; 0.6%). Spinelli and colleagues reported on the use of the tined lead in 15 patients, and observed no lead migration during either the screening period (average 38.8 days) or during follow-up of IPG implantation cases (average 11 months). The total infection rate in the whole series was 18/180 (10%), which was slightly higher than that reported by the sacral neuromodulation study group (6.1%). Revision rates for stage one and stage two were 12.2% and 20%, respectively. The revision rate in the original study group was 33.3%. Thus, with advancing technology, new problems may arise, but the implanting physician should be aware of the ways to evaluate and manage these complications and appropriately troubleshoot patients with suboptimal responses.

Bone density and functional results after femoral revision with a cementless press-fit stem.

PubMed

Canovas, F; Roche, O; Girard, J; Bonnomet, F; Goldschild, M; Le Béguec, P

2015-05-01

The influence of radiographic bone density changes in the area surrounding a total hip arthroplasty (THA) revision with a cementless press-fit stem is unknown, notably in terms of functional results. We have therefore conducted a study aiming to (1) propose a radiographic method to assess bone density, (2) measure the functional effects of reduced bone density, and (3) determine the factors contributing to these modifications. A reduction in radiographic bone density has a negative influence on the functional result after revision using a cementless press-fit stem. We retrospectively assessed 150 THA revisions at a mean follow-up of 6.3 ± 3.2 years (range, 2-15 years). The clinical assessment was based on the Harris Hip Score. Bone density modifications were measured radiographically and the method was evaluated. The change in bone density was classified into two groups: (1) bone density not reduced or < 2 Gruen zones (118 cases [79%]); (2) bone density reduced ≥ 2 zones (32 cases [21%]). The variables showing a potential influence were the Cortical Index (CI), the type of primary stability with the press-fit system, and the femoral implant length. Inter- and intraobserver reliability of radiographic bone density measurement was evaluated as moderate or good (Kappa, 0.58; 0.60 and 0.67, respectively). For the Harris Hip Score at follow-up, there was a borderline statistical relation between stages 1 and 2: for the 118 stage 1 patients, this score was 83.62 ± 11.54 (range, 27-99) versus 78.34 ± 15.98 (range, 62-91) for stage 2 patients (P = 0.09). A CI ≤ 0.44 showed mediocre bone quality contributing to decreased bone density (P < 0.02). On the other hand, there was no statistically significant relation with the type of primary fixation (P = 0.34) or the length of the implant (P = 0.23). A cementless revision femoral stem can induce a reduction in bone density with possible functional effects. The negative role played by bone scarcity on the functional score is confirmed, and even though the difference is not statistically significant, we suggest using a short stem when this is possible. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

Can Good Infection Control Be Obtained in One-stage Exchange of the Infected TKA to a Rotating Hinge Design? 10-year Results.

PubMed

Zahar, Akos; Kendoff, Daniel O; Klatte, Till O; Gehrke, Thorsten A

2016-01-01

Prosthetic joint infection (PJI) occurs in 1% to 2% of total knee arthroplasties (TKAs). Although two-stage exchange is the preferred management method of patients with chronic PJI in TKA in North America, one-stage exchange is an alternative treatment method, but long-term studies of this approach have not been conducted. We reviewed our minimum 9-year results of 70 patients who underwent one-stage exchange arthroplasty with a rotating hinge design to determine: (1) What was the proportion of patients free of infection? (2) What was the patient rate of survival free of any reoperation? (3) What were the clinical outcomes as measured by Hospital for Special Surgery scores? (4) What proportion of patients developed radiographic evidence of loosening? All one-stage revision TKAs for infection between January 1 and December 31, 2002, with a minimum 9-year followup (mean, 10 years; range, 9-11 years), in which patients had been seen within the last 1 year, were included in this retrospective review. During that period, 11 patients with infected TKAs were treated with other approaches (including two-stage approaches in eight); the general indication for one-stage revision was the diagnosis of PJI with a known causative organism. Exclusion criteria were culture-negative preoperative aspiration, known allergy to local antibiotics or bone cement, or cases in which radical débridement was impossible as a result of the involvement of important anatomical structures. Eighty-one patients with PJI were seen during this period; 70 underwent one-stage exchange using our strict protocol and were reimplanted with a rotating hinge TKA. Eleven patients (15.7%) were lost to followup. Hospital for Special Surgery scores were recorded and all radiographs were evaluated for prosthetic loosening. Failure was defined as revision surgery for infection or any other cause. Our 10-year infection-free survival was 93% (mean, 4.1; 95% confidence interval [CI], 89%-96%; p < 0.007); and the patient 10-year survival rate free of revision for other causes was 91% (mean, 5.2; 95% CI, 86%-95%; p < 0.002). Mean Hospital for Special Surgery knee score at last followup was 69.6 (± 22.5 SD; range, 22-100) and the mean improvement in Hospital for Special Surgery knee score from preoperative to most recent followup was 35 (± 24.2 SD; range, 13-99). Evidence of radiographic loosening was seen in 11 patients at last followup, whereby in six patients, there was need for revision surgery. Our study results showed an overall infection control rate of 93% and good clinical results using our one-stage approach, which combines aggressive débridement of the collateral ligaments and posterior capsule with a rotating hinge implant. These results are comparable with two-stage techniques at a followup of 10 years; further research into one-stage exchange techniques for PJI in TKA appears warranted. Level IV, therapeutic study.

78 FR 72155 - Medicare Program; End-Stage Renal Disease Prospective Payment System, Quality Incentive Program...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-12-02

...This rule updates and makes revisions to the End-Stage Renal Disease (ESRD) prospective payment system (PPS) for calendar year (CY) 2014. This rule also sets forth requirements for the ESRD quality incentive program (QIP), including for payment year (PY) 2016 and beyond. In addition, this rule clarifies the grandfathering provision related to the 3-year minimum lifetime requirement (MLR) for Durable Medical Equipment (DME), and provides clarification of the definition of routinely purchased DME. This rule also implements budget-neutral fee schedules for splints and casts, and intraocular lenses (IOLs) inserted in a physician's office. Finally, this rule makes a few technical amendments and corrections to existing regulations related to payment for durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) items and services.

Two-stage revision for the culture-negative infected total hip arthroplasty : A comparative study.

PubMed

Ibrahim, M S; Twaij, H; Haddad, F S

2018-01-01

Periprosthetic joint infection (PJI) remains a challenging complication following total hip arthroplasty (THA). It is associated with high levels of morbidity, mortality and expense. Guidelines and protocols exist for the management of culture-positive patients. Managing culture-negative patients with a PJI poses a greater challenge to surgeons and the wider multidisciplinary team as clear guidance is lacking. We aimed to compare the outcomes of treatment for 50 consecutive culture-negative and 50 consecutive culture-positive patients who underwent two-stage revision THA for chronic infection with a minimum follow-up of five years. There was no significant difference in the outcomes between the two groups of patients, with a similar rate of re-infection of 6%, five years post-operatively. Culture-negative PJIs were associated with older age, smoking, referral from elsewhere and pre-operative antibiotic treatment. The samples in the culture-negative patients were negative before the first stage (aspiration), during the first-stage (implant removal) and second-stage procedures (re-implantation). Adherence to strict protocols for selecting and treating culture-negative patients with a PJI using the same two-stage revision approach that we employ for complex culture-positive PJIs is important in order to achieve control of the infection in this difficult group of patients. Cite this article: Bone Joint J 2018;(1 Supple A)100-B:3-8. ©2018 The British Editorial Society of Bone and Joint Surgery.

One-stage revision of infected hip arthroplasty: outcome of 39 consecutive hips.

PubMed

Ilchmann, Thomas; Zimmerli, Werner; Ochsner, Peter Emil; Kessler, Bernhard; Zwicky, Lukas; Graber, Peter; Clauss, Martin

2016-05-01

There are various options for treating periprosthetic joint infection (PJI). Two-stage exchange has traditionally been the gold standard. However, if the appropriate surgical intervention is chosen according to a rational algorithm, the outcome is similar when using all types of interventions. In an observational cohort study, the outcome of patients with PJI after hip replacement treated with one-stage revision was analysed. All patients fulfilling all criteria for one-stage exchange according to the Infectious Diseases Society of America (IDSA) guidelines and six without preoperative identification of a microorganism were included. Implant removal, debridement and cemented or uncemented reimplantations were performed in a single intervention. If a cemented device was implanted, commercially available gentamicin cement was used in all cases. Antibiotic treatment was administered intravenously for at least 2 weeks, followed by oral therapy for a total duration of 3 months. Patients had standardised clinical and radiological follow-up visits. Between 1996 and 2011, 38 patients (39 hips) were treated with a one-stage procedure and followed for at least 2 years. Coagulase-negative staphylococci were the most frequent pathogens, and polymicrobial infection was observed in five cases. In 25 hips, an uncemented revision stem was implanted, and 37 hips received an acetabular reinforcement ring. The mean follow-up was 6.6 (2.0-15.1) years. No patient had persistent, recurrent or new infection. There were four stem revisions for aseptic loosening. The mean Harris Hip Score was 81 points (26-99) at the final follow-up. Excellent cure rate and function seen in our study suggest that one-stage exchange is a safe procedure, even without local antibiotic treatment, provided that the patient has no sinus tract or severe soft tissue damage, no major bone grafting is required and the microorganism is susceptible to orally administered agents with high bioavailability.

Revised surveillance case definition for HIV infection--United States, 2014.

PubMed

2014-04-11

Following extensive consultation and peer review, CDC and the Council of State and Territorial Epidemiologists have revised and combined the surveillance case definitions for human immunodeficiency virus (HIV) infection into a single case definition for persons of all ages (i.e., adults and adolescents aged ≥13 years and children aged <13 years). The revisions were made to address multiple issues, the most important of which was the need to adapt to recent changes in diagnostic criteria. Laboratory criteria for defining a confirmed case now accommodate new multitest algorithms, including criteria for differentiating between HIV-1 and HIV-2 infection and for recognizing early HIV infection. A confirmed case can be classified in one of five HIV infection stages (0, 1, 2, 3, or unknown); early infection, recognized by a negative HIV test within 6 months of HIV diagnosis, is classified as stage 0, and acquired immunodeficiency syndrome (AIDS) is classified as stage 3. Criteria for stage 3 have been simplified by eliminating the need to differentiate between definitive and presumptive diagnoses of opportunistic illnesses. Clinical (nonlaboratory) criteria for defining a case for surveillance purposes have been made more practical by eliminating the requirement for information about laboratory tests. The surveillance case definition is intended primarily for monitoring the HIV infection burden and planning for prevention and care on a population level, not as a basis for clinical decisions for individual patients. CDC and the Council of State and Territorial Epidemiologists recommend that all states and territories conduct case surveillance of HIV infection using this revised surveillance case definition.

The 7th lung cancer TNM classification and staging system: Review of the changes and implications.

PubMed

Mirsadraee, Saeed; Oswal, Dilip; Alizadeh, Yalda; Caulo, Andrea; van Beek, Edwin

2012-04-28

Lung cancer is the most common cause of death from cancer in males, accounting for more than 1.4 million deaths in 2008. It is a growing concern in China, Asia and Africa as well. Accurate staging of the disease is an important part of the management as it provides estimation of patient's prognosis and identifies treatment sterategies. It also helps to build a database for future staging projects. A major revision of lung cancer staging has been announced with effect from January 2010. The new classification is based on a larger surgical and non-surgical cohort of patients, and thus more accurate in terms of outcome prediction compared to the previous classification. There are several original papers regarding this new classification which give comprehensive description of the methodology, the changes in the staging and the statistical analysis. This overview is a simplified description of the changes in the new classification and their potential impact on patients' treatment and prognosis.

Self-Assessing Abilities of Freshman Writers.

ERIC Educational Resources Information Center

Telleen, Jane A.

In view of research findings that unskilled writers are rule-based rather than context-based in revision of their written work, a study was conducted of the stage between writing a rough draft and the teacher conference to determine how inexperienced writers would articulate their performance and evaluate their strategies for revision. An…

The optimum intermediate pressure of two-stages vapor compression refrigeration cycle for Air-Conditioning unit

NASA Astrophysics Data System (ADS)

Ambarita, H.; Sihombing, H. V.

2018-03-01

Vapor compression cycle is mainly employed as a refrigeration cycle in the Air-Conditioning (AC) unit. In order to save energy, the Coefficient of Performance (COP) of the need to be improved. One of the potential solutions is to modify the system into multi-stages vapor compression cycle. The suitable intermediate pressure between the high and low pressures is one of the design issues. The present work deals with the investigation of an optimum intermediate pressure of two-stages vapor compression refrigeration cycle. Typical vapor compression cycle that is used in AC unit is taken into consideration. The used refrigerants are R134a. The governing equations have been developed for the systems. An inhouse program has been developed to solve the problem. COP, mass flow rate of the refrigerant and compressor power as a function of intermediate pressure are plotted. It was shown that there exists an optimum intermediate pressure for maximum COP. For refrigerant R134a, the proposed correlations need to be revised.

Developing a Manualized Occupational Therapy Diabetes Management Intervention: Resilient, Empowered, Active Living With Diabetes.

PubMed

Pyatak, Elizabeth A; Carandang, Kristine; Davis, Shain

2015-07-01

This article reports on the development of a manualized occupational therapy intervention for diabetes management. An initial theoretical framework and core content areas for a Stage I intervention manual were developed based on an in-depth needs assessment and review of existing literature. After evaluation by a panel of experts and completion of a feasibility study, the intervention was revised into a Stage 2 manual in preparation for a randomized study evaluating the intervention's efficacy. In developing the initial manual, we delineated core theoretical principles to allow for flexible application and tailoring of the intervention's content areas. Expert panel feedback and feasibility study results led to changes to the intervention structure and content as we developed the Stage 2 manual. Through describing this process, we illustrate the dynamic evolution of intervention manuals, which undergo revisions due to both theoretical and practical considerations at each stage of the research-to-clinical practice pipeline.

California Cenozoic Biostratigraphy -- Paleogene: Chapter 4 in Petroleum systems and geologic assessment of oil and gas in the San Joaquin Basin Province, California

USGS Publications Warehouse

McDougall, Kristin

2008-01-01

The time transgressive nature of the California benthic foraminiferal stages is in most cases the result of poor taxonomy, use of local species ranges, and a lack of understanding about the type sections. Correcting these problems allows the stages to be consistently applied and enhances their ability to identify coeval strata. Each stage is identified by the first and last appearances of selected cosmopolitan benthic foraminiferal species and of reliable local species. Although further study is needed, the stages correlate with the international time scale. The revised age interpretation of the stages suggests that the Cheneyian Stage is coeval with planktic zone P1 through P3, the Ynezian Stage is coeval with planktic zone P4, the Bulitian Stage is missing in most section but when present is coeval with zones P5 and P6a, the Penutian Stage is coeval with planktic zones P6b through early P9 (no younger than the overlap between P9 and CP11), the Ulatisian Stage is coeval with P9 (younger than CP11) through P11, the Narizian Stage is coeval with zones P12 through P15, and the Refugian Stage is coeval with zones P16 and P17.

[Comparison of the Masaoka-Koga Classification with the New TNM Staging of the IASLC/ITMIG for Thymoma and Thymic Carcinoma].

PubMed

Ried, Michael; Eicher, Maria-Magdalena; Neu, Reiner; Kraus, Dietmar; Inderhees, Sebastian; Marx, Alexander; Hofmann, Hans-Stefan

2018-05-18

The Masaoka-Koga classification describes the extent and spread of thymic epithelial malignancies. The objective of this study was to evaluate the Masaoka-Koga and the new TNM-staging system regarding differences in stage distributions, clinical implementation and therapeutic consequences. Retrospective analysis of all patients who underwent surgery between January 2005 and December 2015 for thymoma/thymic carcinoma in two centres for thoracic surgery. The final tumour stages were determined on the basis of preoperative imaging, surgical reports and histological findings. A total of 118 patients (male 51%) with a mean age of 56 ± 14.8 years were included. Indications for surgery were primary mediastinal tumour (n = 97), pleura dissemination (n = 15) or mediastinal recurrence (n = 7). Radical tumour resection was performed in 92% of patients (n = 109) within one operation, whereas 8% of patients (n = 9) underwent two operations. Surgical revision was necessary in 12 patients (10.1%) and in-hospital mortality was 1.7% (n = 2). Early Masaoka-Koga stages I (n = 34) and II (n = 16) shifted to the new UICC stage I (T1: n = 58). Locally advanced stages (Masaoka-Koga stage III n = 22 vs. UICC stage IIIA + IIIB n = 20) and metastasised stages (Masaoka-Koga stage IV n = 36 vs. UICC stage IV n = 39) remained very similar. The new TNM staging system gave rise to changes, especially in early stages (downstaging), but these had no therapeutic implications. Although advanced stages were very similar, the new TNM staging provides more clinically relevant differentiation. Georg Thieme Verlag KG Stuttgart · New York.

Description of the rates, trends and surgical burden associated with revision for prosthetic joint infection following primary and revision knee replacements in England and Wales: an analysis of the National Joint Registry for England, Wales, Northern Ireland and the Isle of Man.

PubMed

Lenguerrand, Erik; Whitehouse, Michael R; Beswick, Andrew D; Toms, Andrew D; Porter, Martyn L; Blom, Ashley W

2017-07-10

To describe the prevalence rates of revision surgery for the treatment of prosthetic joint infection (PJI) for patients undergoing knee replacement, their time trends, the cumulative incidence function of revision for PJI and estimate the burden of PJI at health service level. We analysed revision knee replacements performed due to a diagnosis of PJI and the linked index procedures recorded in the National Joint Registry from 2003 to 2014 for England and Wales. The cohort analysed consisted of 679 010 index primary knee replacements, 33 920 index revision knee replacements and 8247 revision total knee replacements performed due to a diagnosis of PJI. The prevalence rates, their time trends investigated by time from index surgery to revision for PJI, cumulative incidence functions and the burden of PJI (total procedures) were calculated. Overall linear trends were investigated with log-linear regression. The incidence of revision total knee replacement due to PJI at 2 years was 3.2/1000 following primary and 14.4/1000 following revision knee replacement, respectively. The prevalence of revision due to PJI in the 3 months following primary knee replacement has risen by 2.5-fold (95% CI 1.2 to 5.3) from 2005 to 2013 and 7.5-fold (95% CI 1.0 to 56.1) following revision knee replacement. Over 1000 procedures per year are performed as a consequence of knee PJI, an increase of 2.8 from 2005 to 2013. Overall, 75% of revisions were two-stage with an increase in use of single-stage from 7.9% in 2005 to 18.8% in 2014. Although the risk of revision due to PJI following knee replacement is low, it is rising, and coupled with the established and further predicted increased incidence of both primary and revision knee replacements, this represents an increasing and substantial treatment burden for orthopaedic service delivery in England and Wales. This has implications for future service design and the funding of individual and specialist centres. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Description of the rates, trends and surgical burden associated with revision for prosthetic joint infection following primary and revision knee replacements in England and Wales: an analysis of the National Joint Registry for England, Wales, Northern Ireland and the Isle of Man

PubMed Central

Lenguerrand, Erik; Whitehouse, Michael R; Beswick, Andrew D; Toms, Andrew D; Porter, Martyn L; Blom, Ashley W

2017-01-01

Objectives To describe the prevalence rates of revision surgery for the treatment of prosthetic joint infection (PJI) for patients undergoing knee replacement, their time trends, the cumulative incidence function of revision for PJI and estimate the burden of PJI at health service level. Design We analysed revision knee replacements performed due to a diagnosis of PJI and the linked index procedures recorded in the National Joint Registry from 2003 to 2014 for England and Wales. The cohort analysed consisted of 679 010 index primary knee replacements, 33 920 index revision knee replacements and 8247 revision total knee replacements performed due to a diagnosis of PJI. The prevalence rates, their time trends investigated by time from index surgery to revision for PJI, cumulative incidence functions and the burden of PJI (total procedures) were calculated. Overall linear trends were investigated with log-linear regression. Results The incidence of revision total knee replacement due to PJI at 2 years was 3.2/1000 following primary and 14.4/1000 following revision knee replacement, respectively. The prevalence of revision due to PJI in the 3 months following primary knee replacement has risen by 2.5-fold (95% CI 1.2 to 5.3) from 2005 to 2013 and 7.5-fold (95% CI 1.0 to 56.1) following revision knee replacement. Over 1000 procedures per year are performed as a consequence of knee PJI, an increase of 2.8 from 2005 to 2013. Overall, 75% of revisions were two-stage with an increase in use of single-stage from 7.9% in 2005 to 18.8% in 2014. Conclusions Although the risk of revision due to PJI following knee replacement is low, it is rising, and coupled with the established and further predicted increased incidence of both primary and revision knee replacements, this represents an increasing and substantial treatment burden for orthopaedic service delivery in England and Wales. This has implications for future service design and the funding of individual and specialist centres. PMID:28698316

Medicare program; end-stage renal disease prospective payment system, quality incentive program, and durable medical equipment, prosthetics, orthotics, and supplies.

PubMed

2013-12-02

This rule updates and makes revisions to the End-Stage Renal Disease (ESRD) prospective payment system (PPS) for calendar year (CY) 2014. This rule also sets forth requirements for the ESRD quality incentive program (QIP), including for payment year (PY) 2016 and beyond. In addition, this rule clarifies the grandfathering provision related to the 3-year minimum lifetime requirement (MLR) for Durable Medical Equipment (DME), and provides clarification of the definition of routinely purchased DME. This rule also implements budget-neutral fee schedules for splints and casts, and intraocular lenses (IOLs) inserted in a physician's office. Finally, this rule makes a few technical amendments and corrections to existing regulations related to payment for durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) items and services.

78 FR 40835 - Medicare Program; End-Stage Renal Disease Prospective Payment System, Quality Incentive Program...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-07-08

...This rule proposes to update and make revisions to the End- Stage Renal Disease (ESRD) prospective payment system (PPS) for calendar year (CY) 2014. This rule also proposes to set forth requirements for the ESRD quality incentive program (QIP), including for payment year (PY) 2016 and beyond. In addition, this rule proposes to clarify the grandfathering provision related to the 3-year minimum lifetime requirement (MLR) for Durable Medical Equipment (DME). In addition, it provides clarification of the definition of routinely purchased DME. This rule also proposes the implementation of budget- neutral fee schedules for splints and casts, and intraocular lenses (IOLs) inserted in a physician's office. Finally, this rule would make a few technical amendments and corrections to existing regulations related to payment for DMEPOS items and services.

Programmer's reference manual for the VAX-Gerber link software package. Revision 1. 0

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

Isobe, G.W.

1985-10-01

This guide provides the information necessary to edit, modify, and run the VAX-Gerber software link. Since the project is in the testing stage and still being modified, this guide discussess the final desired stage along with the current stage. The current stage is to set up as to allow the programmer to easily modify and update codes as necessary.

The usefulness of the revised classification for chronic kidney disease by the KDIGO for determining the frequency of diabetic micro- and macroangiopathies in Japanese patients with type 2 diabetes mellitus.

PubMed

Ito, Hiroyuki; Oshikiri, Koshiro; Mifune, Mizuo; Abe, Mariko; Antoku, Shinichi; Takeuchi, Yuichiro; Togane, Michiko; Yukawa, Chizuko

2012-01-01

A new classification of chronic kidney disease (CKD) was proposed by the Kidney Disease: Improving Global Outcomes (KDIGO) in 2011. The major point of revision of this classification was the introduction of a two-dimensional staging of the CKD according to the level of albuminuria in addition to the GFR level. Furthermore, the previous CKD stage 3 was subdivided into two stages (G3a and G3b). We examined the prevalence of diabetic micro- and macroangiopathies in patients with type 2 diabetes mellitus based on the new classification. A cross-sectional study was performed in 2018 patients with type 2 diabetes mellitus. All of the diabetic micro- and macroangiopathies significantly more common in the later stages of both the GFR and albuminuria. The proportion of subjects with diabetic retinopathy, neuropathy, cerebrovascular disease and coronary heart disease was significantly higher in the G3b group than in the G3a group. The brachial-ankle pulse wave velocity, which is one of the surrogate markers for atherosclerosis, was also significantly greater in the G3b group compared to the G3a group. The subdivision of the G3 stage in the revised classification proposed by the KDIGO is useful to evaluate the risk for diabetic vascular complications. Copyright © 2012 Elsevier Inc. All rights reserved.

Semantics of Inheritance and Attributions in the Description System Omega. Revision.

DTIC Science & Technology

1982-01-01

criticized either for being too general or too inflexible. General deductive procedures for predicate logic easily go out of control. There have been a...6 and 7. Section 8 is concerned with a discussion of attributions: the language is extended by introducing syntactic notations for four different...for valid formulas of the theory. The models prorided earlier are usefulL in this stage for providing a guideline and a criterion for suitability of

Genetic burden associated with varying degrees of disease severity in endometriosis

PubMed Central

Sapkota, Yadav; Attia, John; Gordon, Scott D.; Henders, Anjali K.; Holliday, Elizabeth G.; Rahmioglu, Nilufer; MacGregor, Stuart; Martin, Nicholas G.; McEvoy, Mark; Morris, Andrew P.; Scott, Rodney J.; Zondervan, Krina T.; Montgomery, Grant W.; Nyholt, Dale R.

2015-01-01

Endometriosis is primarily characterized by the presence of tissue resembling endometrium outside the uterine cavity and is usually diagnosed by laparoscopy. The most commonly used classification of disease, the revised American Fertility Society (rAFS) system to grade endometriosis into different stages based on disease severity (I to IV), has been questioned as it does not correlate well with underlying symptoms, posing issues in diagnosis and choice of treatment. Using two independent European genome-wide association (GWA) datasets and top-level classification of the endometriosis cases based on rAFS [minimal or mild (Stage A) and moderate-to-severe (Stage B) disease], we previously showed that Stage B endometriosis has greater contribution of common genetic variation to its aetiology than Stage A disease. Herein, we extend our previous analysis to four endometriosis stages [minimal (Stage I), mild (Stage II), moderate (Stage III) and severe (Stage IV) disease] based on the rAFS classification system and compared the genetic burden across stages. Our results indicate that genetic burden increases from minimal to severe endometriosis. For the minimal disease, genetic factors may contribute to a lesser extent than other disease categories. Mild and moderate endometriosis appeared genetically similar, making it difficult to tease them apart. Consistent with our previous reports, moderate and severe endometriosis showed greater genetic burden than minimal or mild disease. Overall, our results provide new insights into the genetic architecture of endometriosis and further investigation in larger samples may help to understand better the aetiology of varying degrees of endometriosis, enabling improved diagnostic and treatment modalities. PMID:25882541

Unsatisfactory Outcome of Arthrodesis Performed After Septic Failure of Revision Total Knee Arthroplasty

PubMed Central

Röhner, Eric; Windisch, Christoph; Nuetzmann, Katy; Rau, Max; Arnhold, Michael; Matziolis, Georg

2015-01-01

Background: Periprosthetic infection is one of the most dreaded orthopaedic complications. Current treatment procedures include one-stage or two-stage revision total knee arthroplasty. If the periprosthetic infection is no longer controllable after several revision total knee arthroplasties, many surgeons regard knee arthrodesis as a promising option. The aim of our study was to ascertain whether intramedullary nailing results in the suppression or eradication of an infection and to identify risk factors for persistent infection. Methods: All patients who had undergone intramedullary nailing following septic failure of revision total knee arthroplasty between 1997 and 2013 were included in the study. Pathogens, risk factors predisposing to persistent infection, and the rate of persistent infections were recorded. In addition, a visual analog scale (VAS) and Knee injury Osteoarthritis Outcome Score (KOOS), Knee Society Score (KSS), Lysholm, Short Form-36 (SF-36), and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) questionnaires were completed to assess clinical outcomes and quality of life. Results: Twenty-six patients were included in the study. Thirteen (50%) had a persistent infection requiring additional revision surgery. Nineteen patients (73%) reported persistent pain (VAS score of >3). All scores showed marked impairment of quality of life. Conclusions: Intramedullary nailing following septic failure of revision total knee arthroplasty must be regarded with skepticism, and we cannot recommend it. Repeat revision total knee arthroplasty or amputation should be considered as an alternative in such difficult cases. Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence. PMID:25695981

Ten questions on prosthetic shoulder infection

PubMed Central

Pinder, Elizabeth M; Ong, Joshua CY; Bale, R Stephen

2016-01-01

Prosthetic shoulder infection can cause significant morbidity secondary to pain and stiffness. Symptoms may be present for years before diagnosis because clinical signs are often absent and inflammatory markers may be normal. An emerging common culprit, Propionibacterium acnes, is hard to culture and so prolonged incubation is necessary. A negative culture result does not always exclude infection and new synovial fluid biochemical markers such as α defensin are less sensitive than for lower limb arthroplasty. A structured approach is necessary when assessing patients for prosthetic shoulder joint infection. This includes history, examination, serum inflammatory markers, plain radiology and aspiration and/or biopsy. A classification for the likelihood of prosthetic shoulder infection has been described based on culture, pre-operative and intra-operative findings. Treatment options include antibiotic suppression, debridement with component retention, one-stage revision, two-stage revision and excision arthroplasty. Revision arthroplasty is associated with the best outcomes. PMID:27583013

Ten questions on prosthetic shoulder infection.

PubMed

Pinder, Elizabeth M; Ong, Joshua Cy; Bale, R Stephen; Trail, Ian A

2016-07-01

Prosthetic shoulder infection can cause significant morbidity secondary to pain and stiffness. Symptoms may be present for years before diagnosis because clinical signs are often absent and inflammatory markers may be normal. An emerging common culprit, Propionibacterium acnes, is hard to culture and so prolonged incubation is necessary. A negative culture result does not always exclude infection and new synovial fluid biochemical markers such as α defensin are less sensitive than for lower limb arthroplasty. A structured approach is necessary when assessing patients for prosthetic shoulder joint infection. This includes history, examination, serum inflammatory markers, plain radiology and aspiration and/or biopsy. A classification for the likelihood of prosthetic shoulder infection has been described based on culture, pre-operative and intra-operative findings. Treatment options include antibiotic suppression, debridement with component retention, one-stage revision, two-stage revision and excision arthroplasty. Revision arthroplasty is associated with the best outcomes.

Exploring the Role of Reformulations and a Model Text in EFL Students' Writing Performance

ERIC Educational Resources Information Center

Yang, Luxin; Zhang, Ling

2010-01-01

This study examined the effectiveness of reformulation and model text in a three-stage writing task (composing-comparison-revising) in an EFL writing class in a Beijing university. The study documented 10 university students' writing performance from the composing (Stage 1) and comparing (Stage 2, where students compare their own text to a…

Rationale for one stage exchange of infected hip replacement using uncemented implants and antibiotic impregnated bone graft.

PubMed

Winkler, Heinz

2009-09-04

Infection of a total hip replacement (THR) is considered a devastating complication, necessitating its complete removal and thorough debridement of the site. It is undoubted that one stage exchange, if successful, would provide the best benefit both for the patient and the society. Still the fear of re-infection dominates the surgeons decisions and in the majority of cases directs them to multiple stage protocols. However, there is no scientifically based argument for that practice. Successful eradication of infection with two stage procedures is reported to average 80% to 98%. On the other hand a literature review of Jackson and Schmalzried (CORR 2000) summarizing the results of 1,299 infected hip replacements treated with direct exchange (almost exclusively using antibiotic loaded cement), reports of 1,077 (83%) having been successful. The comparable results suggest, that the major factor for a successful outcome with traditional approaches may be found in the quality of surgical debridement and dead space management. Failures in all protocols seem to be caused by small fragments of bacterial colonies remaining after debridement, whereas neither systemic antibiotics nor antibiotic loaded bone cement (PMMA) have been able to improve the situation significantly. Reasons for failure may be found in the limited sensitivity of traditional bacterial culturing and reduced antibiotic susceptibility of involved pathogens, especially considering biofilm formation. Whenever a new prosthesis is implanted into a previously infected site the surgeon must be aware of increased risk of failure, both in single or two stage revisions. Eventual removal therefore should be easy with low risk of additional damage to the bony substance. On the other hand it should also have potential of a good long term result in case of success. Cemented revisions generally show inferior long term results compared to uncemented techniques; the addition of antibiotics to cement reduces its biomechanical properties. Efficient cementing techniques will result in tight bonding with the underlying bone, making eventual removal time consuming and possibly associated with further damage to the osseous structures. All these issues are likely to make uncemented revisions more desirable. Allograft bone may be impregnated with high loads of antibiotics using special incubation techniques. The storage capacities and pharmacological kinetics of the resulting antibiotic bone compound (ABC) are more advantageous than the ones of antibiotic loaded cement. ABC provides local concentrations exceeding those of cement by more than a 100fold and efficient release is prolonged for several weeks. The same time they are likely to restore bone stock, which usually is compromised after removal of an infected endoprosthesis. ABC may be combined with uncemented implants for improved long term results and easy removal in case of a failure. Specifications of appropriate designs are outlined. Based on these considerations new protocols for one stage exchange of infected TJR have been established. Bone voids surrounding the implants may be filled with antibiotic impregnated bone graft; uncemented implants may be fixed in original bone. Recent studies indicate an overall success rate of more than 90% without any adverse side effects. Incorporation of allografts appears as after grafting with unimpregnated bone grafts. Antibiotic loaded bone graft seems to provide sufficient local antibiosis for protection against colonisation of uncemented implants, the eluted amounts of antibiotics are likely to eliminate biofilm remnants, dead space management is more complete and defects may be reconstructed efficiently. Uncemented implants provide improved long term results in case of success and facilitated re-revision in case of failure. One stage revision using ABC together with uncemented implants such should be at least comparably save as multiple stage procedures, taking advantage of the obvious benefits for patients and economy.

Risk factors contributing to a poor prognosis of papillary thyroid carcinoma: validity of UICC/AJCC TNM classification and stage grouping.

PubMed

Ito, Yasuhiro; Miyauchi, Akira; Jikuzono, Tomoo; Higashiyama, Takuya; Takamura, Yuuki; Miya, Akihiro; Kobayashi, Kaoru; Matsuzuka, Fumio; Ichihara, Kiyoshi; Kuma, Kanji

2007-04-01

In 2002, the UICC/AJCC TNM classification for papillary thyroid carcinoma was revised. In this study, we examined the validity of this classification system by investigating the predictors of disease-free survival (DFS) and cause-specific survival (CSS) in patients. We examined various clinicopathological features, including the component of the TNM classification, for 1,740 patients who underwent initial and curative surgery for papillary carcinoma between 1987 and 1995. Clinical and pathological T4a, clinical N1b in the TNM classification, and patient age were recognized as independent predictors of not only DFS, but also CSS of patients. Tumor size, male gender, and central node metastasis independently affected DFS only. There were 1,005 pathological N1b patients, but pathological N1b did not independently affect either DFS or CSS. Regarding the stage grouping, clinical stage IVA including clinical N1b more clearly affected DFS and CSS than pathological stage IVA including pathological N1b. Clinical stage grouping was more useful than pathological stage grouping for predicting the prognosis of papillary carcinoma patients possibly because pathological stage overestimates the biological characteristics of many pathological N1b tumors.

Articulating spacers used in two-stage revision of infected hip and knee prostheses abrade with time.

PubMed

Fink, Bernd; Rechtenbach, Annett; Büchner, Hubert; Vogt, Sebastian; Hahn, Michael

2011-04-01

Articulating spacers used in two-stage revision surgery of infected prostheses have the potential to abrade and subsequently induce third-body wear of the new prosthesis. We asked whether particulate material abraded from spacers could be detected in the synovial membrane 6 weeks after implantation when the spacers were removed for the second stage of the revision. Sixteen hip spacers (cemented prosthesis stem articulating with a cement cup) and four knee spacers (customized mobile cement spacers) were explanted 6 weeks after implantation and the synovial membranes were removed at the same time. The membranes were examined by xray fluorescence spectroscopy, xray diffraction for the presence of abraded particles originating from the spacer material, and analyzed in a semiquantitative manner by inductively coupled plasma mass spectrometry. Histologic analyses also were performed. We found zirconium dioxide in substantial amounts in all samples, and in the specimens of the hip synovial lining, we detected particles that originated from the metal heads of the spacers. Histologically, zirconium oxide particles were seen in the synovial membrane of every spacer and bone cement particles in one knee and two hip spacers. The observations suggest cement spacers do abrade within 6 weeks. Given the presence of abrasion debris, we recommend total synovectomy and extensive lavage during the second-stage reimplantation surgery to minimize the number of abraded particles and any retained bacteria.

Validation of the tool assessment of clinical education (AssCE): A study using Delphi method and clinical experts.

PubMed

Löfmark, Anna; Mårtensson, Gunilla

2017-03-01

The aim of the present study was to establish the validity of the tool Assessment of Clinical Education (AssCE). The tool is widely used in Sweden and some Nordic countries for assessing nursing students' performance in clinical education. It is important that the tools in use be subjected to regular audit and critical reviews. The validation process, performed in two stages, was concluded with a high level of congruence. In the first stage, Delphi technique was used to elaborate the AssCE tool using a group of 35 clinical nurse lecturers. After three rounds, we reached consensus. In the second stage, a group of 46 clinical nurse lecturers representing 12 universities in Sweden and Norway audited the revised version of the AssCE in relation to learning outcomes from the last clinical course at their respective institutions. Validation of the revised AssCE was established with high congruence between the factors in the AssCE and examined learning outcomes. The revised AssCE tool seems to meet its objective to be a validated assessment tool for use in clinical nursing education. Copyright © 2016 Elsevier Ltd. All rights reserved.

Impact of chronic kidney disease stage on lower-extremity arthroplasty.

PubMed

Deegan, Brian F; Richard, Raveesh D; Bowen, Thomas R; Perkins, Robert M; Graham, Jove H; Foltzer, Michael A

2014-07-01

End-stage renal disease and dialysis is commonly associated with poor outcomes after joint replacement surgery. The goal of this study was to evaluate postoperative complications in patients with less advanced chronic kidney disease undergoing total hip arthroplasty (THA) or total knee arthroplasty (TKA). Patients who underwent THA or TKA between 2004 and 2011 with stage 1, 2, or 3 chronic kidney disease were retrospectively reviewed via an electronic medical record. The authors compared 377 patients who had stage 1 to 2 chronic kidney disease with 402 patients who had stage 3 chronic kidney disease. No significant differences in 90-day readmission or revision rates were found between the stage 1 to 2 and stage 3 patient groups. For patients with stage 3 chronic kidney disease, the overall mortality rate was greater than that in patients with stage 1 to 2 chronic kidney disease. However, when adjusted for comorbid disease, no significant increases were seen in joint infection, readmission, or early revision between patients with stage 1 to 2 chronic kidney disease vs patients with stage 3 chronic kidney disease. The overall incidence of infection was high (3.5%) but far less than reported for patients with end-stage renal disease, dialysis, and kidney transplant. In conclusion, patients with stage 1, 2, or 3 chronic kidney disease may have a higher than expected rate of prosthetic joint infection (3.5%) after total joint arthroplasty. Patients with stage 3 chronic kidney disease are at higher risk for postoperative mortality compared with those with lesser stages of kidney disease. Copyright 2014, SLACK Incorporated.

Prognostic value of the 8th edition of the tumor-node-metastasis classification for patients with papillary thyroid carcinoma: a single-institution study at a high-volume center in Japan.

PubMed

Ito, Yasuhiro; Miyauchi, Akira; Hirokawa, Mitsuyoshi; Yamamoto, Masatoshi; Oda, Hitomi; Masuoka, Hiroo; Sasai, Hisanori; Fukushima, Mitsuhiro; Higashiyama, Takuya; Kihara, Minoru; Miya, Akihiro

2018-04-20

The tumor-node-metastasis (TNM) staging system is most commonly adopted to evaluate the prognosis of patients with thyroid carcinoma. The 8 th edition of the TNM staging system, an extensively revised version of the 7 th edition, was recently released. We aimed to investigate whether and how well the 8 th edition reflects the cause-specific survival (CSS) of patients with papillary thyroid carcinoma by analyzing the cases in 5,892 patients who underwent initial surgery at Kuma Hospital between 1987 and 2005. The median postoperative follow-up duration was 178 months (range: 6-357 months). One patient with T4b disease was excluded from the analysis. Overall, 116 (2.0%) patients died of thyroid carcinoma. The proportion of variance explained (PVE) for CSS in the 7 th and 8 th editions was 10.69 and 10.97, respectively. Using the 7 th edition, CSS of patients with stage IVA and stage III disease was similar (p = 0.32). In contrast, using the 8 th edition, CSS was poorer in stage II than in stage I (p < 0.001), in stage III than in stage II (p < 0.001), and in stage IVB than in stage III (p < 0.001). Similar results were observed for disease-free survival. Although we could not establish any objective evidence that the 8 th edition is superior to the 7 th edition, the 8 th edition is simpler and more convenient, as it includes fewer stages and addresses the issue of the 7 th edition where stage IVA and III patients had similar prognoses.

Implementation of the RS232 communication trainer using computers and the ATMEGA microcontroller for interface engineering Courses

NASA Astrophysics Data System (ADS)

Amelia, Afritha; Julham; Viyata Sundawa, Bakti; Pardede, Morlan; Sutrisno, Wiwinta; Rusdi, Muhammad

2017-09-01

RS232 of serial communication is the communication system in the computer and microcontroller. This communication was studied in Department of Electrical Engineering and Department of Computer Engineering and Informatics Department at Politeknik Negeri Medan. Recently, an application of simulation was installed on the computer which used for teaching and learning process. The drawback of this system is not useful for communication method between learner and trainer. Therefore, this study was created method of 10 stage to which divided into 7 stages and 3 major phases. It can be namely the analysis of potential problems and data collection, trainer design, and empirical testing and revision. After that, the trainer and module were tested in order to get feedback from the learner. The result showed that 70.10% of feedback which wide reasonable from the learner of questionnaire.

Analysis of fatigue reliability for high temperature and high pressure multi-stage decompression control valve

NASA Astrophysics Data System (ADS)

Yu, Long; Xu, Juanjuan; Zhang, Lifang; Xu, Xiaogang

2018-03-01

Based on stress-strength interference theory to establish the reliability mathematical model for high temperature and high pressure multi-stage decompression control valve (HMDCV), and introduced to the temperature correction coefficient for revising material fatigue limit at high temperature. Reliability of key dangerous components and fatigue sensitivity curve of each component are calculated and analyzed by the means, which are analyzed the fatigue life of control valve and combined with reliability theory of control valve model. The impact proportion of each component on the control valve system fatigue failure was obtained. The results is shown that temperature correction factor makes the theoretical calculations of reliability more accurate, prediction life expectancy of main pressure parts accords with the technical requirements, and valve body and the sleeve have obvious influence on control system reliability, the stress concentration in key part of control valve can be reduced in the design process by improving structure.

Developing a Manualized Occupational Therapy Diabetes Management Intervention: Resilient, Empowered, Active Living With Diabetes

PubMed Central

Pyatak, Elizabeth A.; Carandang, Kristine; Davis, Shain

2016-01-01

This article reports on the development of a manualized occupational therapy intervention for diabetes management. An initial theoretical framework and core content areas for a Stage 1 intervention manual were developed based on an in-depth needs assessment and review of existing literature. After evaluation by a panel of experts and completion of a feasibility study, the intervention was revised into a Stage 2 manual in preparation for a randomized study evaluating the intervention’s efficacy. In developing the initial manual, we delineated core theoretical principles to allow for flexible application and tailoring of the intervention’s content areas. Expert panel feedback and feasibility study results led to changes to the intervention structure and content as we developed the Stage 2 manual. Through describing this process, we illustrate the dynamic evolution of intervention manuals, which undergo revisions due to both theoretical and practical considerations at each stage of the research-to-clinical practice pipeline. PMID:26594741

The AGN Luminosity Fraction in Galaxy Mergers

NASA Astrophysics Data System (ADS)

Dietrich, Jeremy; Weiner, Aaron; Ashby, Matthew; Martinez-Galarza, Juan Rafael; Smith, Howard Alan

2017-01-01

Galaxy mergers are key events in galaxy evolution, generally triggering massive starbursts and AGNs. However, in these chaotic systems, it is not yet known what fraction each of these two mechanisms contributes to the total luminosity. Here we measure and model spectral energy distributions (SEDs) using the Code for Investigating Galaxy Emission (CIGALE) in up to 33 broad bands from the UV to the far-IR for 23 IR-luminous galaxies to estimate the fraction of the bolometric IR luminosity that can be attributed to the AGN. The galaxies are split nearly evenly into two subsamples: late-stage mergers, found in the IRAS Revised Bright Galaxy Sample or Faint Source Catalog, and early-stage mergers found in the Spitzer Interacting Galaxy Sample. We find that the AGN contribution to the total IR luminosity varies greatly from system to system, from 0% up to ~90%, but is substantially greater in the later-stage and brighter mergers. This is consistent with what is known about galaxy evolution and the triggering of AGNs.The SAO REU program is funded in part by the National Science Foundation REU and Department of Defense ASSURE programs under NSF Grant no. 1262851, and by the Smithsonian Institution.

WikiBuild: a new online collaboration process for multistakeholder tool development and consensus building.

PubMed

Gupta, Samir; Wan, Flora T; Newton, David; Bhattacharyya, Onil K; Chignell, Mark H; Straus, Sharon E

2011-12-08

Production of media such as patient education tools requires methods that can integrate multiple stakeholder perspectives. Existing consensus techniques are poorly suited to design of visual media, can be expensive and logistically demanding, and are subject to caveats arising from group dynamics such as participant hierarchies. Our objective was to develop a method that enables multistakeholder tool building while averting these difficulties. We developed a wiki-inspired method and tested this through the collaborative design of an asthma action plan (AAP). In the development stage, we developed the Web-based tool by (1) establishing AAP content and format options, (2) building a Web-based application capable of representing each content and format permutation, (3) testing this tool among stakeholders, and (4) revising this tool based on stakeholder feedback. In the wiki stage, groups of participants used the revised tool in three separate 1-week "wiki" periods during which each group collaboratively authored an AAP by making multiple online selections. In the development stage, we recruited 16 participants (9/16 male) (4 pulmonologists, 4 primary care physicians, 3 certified asthma educators, and 5 patients) for system testing. The mean System Usability Scale (SUS) score for the tool used in testing was 72.2 (SD 10.2). In the wiki stage, we recruited 41 participants (15/41 male) (9 pulmonologists, 6 primary care physicians, 5 certified asthma educators, and 21 patients) from diverse locations. The mean SUS score for the revised tool was 75.9 (SD 19.6). Users made 872, 466, and 599 successful changes to the AAP in weeks 1, 2, and 3, respectively. The site was used actively for a mean of 32.0 hours per week, of which 3.1 hours per week (9.7%) constituted synchronous multiuser use (2-4 users at the same time). Participants averaged 23 (SD 33) minutes of login time and made 7.7 (SD 15) changes to the AAP per day. Among participants, 28/35 (80%) were satisfied with the final AAP, and only 3/34 (9%) perceived interstakeholder group hierarchies. Use of a wiki-inspired method allowed for effective collaborative design of content and format aspects of an AAP while minimizing logistical requirements, maximizing geographical representation, and mitigating hierarchical group dynamics. Our method faced unique software and hardware challenges, and raises certain questions regarding its effect on group functioning. Potential uses of our method are broad, and further studies are required.

WikiBuild: A New Online Collaboration Process For Multistakeholder Tool Development and Consensus Building

PubMed Central

Wan, Flora T; Newton, David; Bhattacharyya, Onil K; Chignell, Mark H; Straus, Sharon E

2011-01-01

Background Production of media such as patient education tools requires methods that can integrate multiple stakeholder perspectives. Existing consensus techniques are poorly suited to design of visual media, can be expensive and logistically demanding, and are subject to caveats arising from group dynamics such as participant hierarchies. Objective Our objective was to develop a method that enables multistakeholder tool building while averting these difficulties. Methods We developed a wiki-inspired method and tested this through the collaborative design of an asthma action plan (AAP). In the development stage, we developed the Web-based tool by (1) establishing AAP content and format options, (2) building a Web-based application capable of representing each content and format permutation, (3) testing this tool among stakeholders, and (4) revising this tool based on stakeholder feedback. In the wiki stage, groups of participants used the revised tool in three separate 1-week “wiki” periods during which each group collaboratively authored an AAP by making multiple online selections. Results In the development stage, we recruited 16 participants (9/16 male) (4 pulmonologists, 4 primary care physicians, 3 certified asthma educators, and 5 patients) for system testing. The mean System Usability Scale (SUS) score for the tool used in testing was 72.2 (SD 10.2). In the wiki stage, we recruited 41 participants (15/41 male) (9 pulmonologists, 6 primary care physicians, 5 certified asthma educators, and 21 patients) from diverse locations. The mean SUS score for the revised tool was 75.9 (SD 19.6). Users made 872, 466, and 599 successful changes to the AAP in weeks 1, 2, and 3, respectively. The site was used actively for a mean of 32.0 hours per week, of which 3.1 hours per week (9.7%) constituted synchronous multiuser use (2–4 users at the same time). Participants averaged 23 (SD 33) minutes of login time and made 7.7 (SD 15) changes to the AAP per day. Among participants, 28/35 (80%) were satisfied with the final AAP, and only 3/34 (9%) perceived interstakeholder group hierarchies. Conclusion Use of a wiki-inspired method allowed for effective collaborative design of content and format aspects of an AAP while minimizing logistical requirements, maximizing geographical representation, and mitigating hierarchical group dynamics. Our method faced unique software and hardware challenges, and raises certain questions regarding its effect on group functioning. Potential uses of our method are broad, and further studies are required. PMID:22155694

INVESTIGATION OF RESPONSE DIFFERENCES BETWEEN ...

EPA Pesticide Factsheets

Total organic carbon (TOC) and dissolved organic carbon (DOC) have long been used to estimate the amount of natural organic matter (NOM) found in raw and finished drinking water. In recent years, computer automation and improved instrumental analysis technologies have created a variety of TOC instrument systems. However, the amount of organic carbon (OC) measured in a sample has been found to depend upon the way a specific TOC instrument treats the sample and the way the OC is calculated and reported. Specifically, relative instrument response differences for TOC/DOC, ranging between 15 to 62%, were documented when five different source waters were each analyzed by five different TOC instrument systems operated according to the manufacturer's specifications. Problems and possible solutions for minimizing these differences are discussed. Establish optimum performance criteria for current TOC technologies for application to Stage 2 D/DBP Rule.Develop a TOC and SUVA (incorporating DOC and UV254) method to be published in the Stage 2 D/DBP Rule that will meet requirements as stated in the Stage 1 D/DBP Rule (Revise Method 415.3,

Toward the Turkish National Registry System: A Prevalence Study of Total Knee Arthroplasty in Turkey.

PubMed

Ceyhan, Erman; Gursoy, Safa; Akkaya, Mustafa; Ugurlu, Mahmut; Koksal, Ismet; Bozkurt, Murat

2016-09-01

The aim of this pilot study was to analyze the data obtained from a retrospective examination of the records of the existing reimbursement system and through the identification of gaps in the data to create a foundation for a reliable, descriptive national registry system for our country. The Social Security Institution Medical Messenger (MEDULA) records were scanned for the years 2010-2014, and the numbers of total knee arthroplasty applied for a diagnosis of gonarthrosis and the numbers of revision knee arthroplasty were recorded for the country in general. The patients were classified according to age, gender, and bilateral or unilateral surgery. The institution where the surgery was applied, the geographic region and the province were also recorded. A total of 283,400 primary and 9900 revision knee arthroplasty operations were applied in Turkey between 2010 and 2014. Numbers were recorded for each year, and there was found to be an increase between years. For primary knee arthroplasty, the female:male ratio was 67 of 33, and surgery was applied most often between the ages of 60-69 years. Both types of surgery were determined to have been applied most often in second-stage state hospitals. Geographically, both types of surgery were applied most in the Marmara region, with the highest frequency of primary knee arthroplasty in Istanbul and the highest frequency of revision surgery in Ankara. The data obtained from this study will contribute to the creation of the basis for a National Registry System and thereby define more scientific treatment approaches. Copyright © 2016 Elsevier Inc. All rights reserved.

Sacral neurostimulation for urinary retention: 10-year experience from one UK centre.

PubMed

Datta, Soumendra N; Chaliha, Charlotte; Singh, Anubha; Gonzales, Gwen; Mishra, Vibhash C; Kavia, Rajesh B C; Kitchen, Neil; Fowler, Clare J; Elneil, Sohier

2008-01-01

To report our 10-year experience of sacral neurostimulation (SNS) for women in urinary retention, comparing the original one-stage with the newer two-stage technique, as SNS therapy is a well-established treatment for urinary retention secondary to urethral sphincter overactivity (Fowler's syndrome). Between 1996 and 2006, 60 patients with urinary retention had a SNS device inserted; their case records were reviewed and data on efficacy, follow-up, need for continued clean intermittent self-catheterization (CISC), complications and operative revision rate were assessed. Overall, 43 of 60 (72%) women were voiding spontaneously, with a mean postvoid residual volume of 100 mL; 30 (50%) no longer needed to use CISC. During a total of 2878 months of SNS experience, adverse event episodes included lead migration in 20, 'box-site' pain in 19, leg pain/numbness in 18 and loss of response/failure in 18 patients; 53% of the women required a surgical revision related to their implanted stimulator. The efficacy of the two-stage was similar to that of the one-stage procedure (73% vs 70%). Women with a normal urethral sphincter electromyogram had worse outcomes than women with an abnormal test (43% vs 76%). Although the efficacy was no different in those taking analgesia/antidepressant medication, this group of women had a higher surgical revision rate. Failure and complications for the one-stage procedure were not restricted to the early follow-up period. The mean battery life of the implant was 7.31 years. SNS has sustained long-term efficacy but the procedure has a significant complication rate. At present, the two-stage technique has comparable efficacy to the one-stage technique but a longer-term follow-up is required. The National Institute of Clinical Excellence recommended the use of SNS in women with urinary incontinence who fail to respond adequately to anticholinergic therapy, but patients choosing this treatment should be made aware of the high complication rate associated with the procedure.

Revised Criteria for Mild Cognitive Impairment May Compromise the Diagnosis of Alzheimer Disease Dementia

PubMed Central

Morris, John C.

2012-01-01

Objective To evaluate the potential impact of revised criteria for mild cognitive impairment (MCI), developed by a Workgroup sponsored by the National Institute on Aging and the Alzheimer’s Association, on the diagnosis of very mild and mild Alzheimer disease (AD) dementia. Design Retrospective review of ratings of functional impairment across diagnostic categories. Participants: The functional ratings of individuals (N = 17,535) with normal cognition, MCI, or AD dementia who were evaluated at Alzheimer’s Disease Centers and submitted to the National Alzheimer’s Coordinating Center were assessed in accordance with the definition of “functional independence” allowed by the revised criteria. Methods Pairwise demographic differences between the 3 diagnostic groups were tested using t-tests for continuous variables and chi-square for categorical variables. Results Almost all (99.8%) of individuals currently diagnosed with very mild AD dementia and the large majority (92.7%) of those diagnosed with mild AD dementia could be reclassified as MCI with the revised criteria, based on their level of impairment in the Clinical Dementia Rating domains for performance of instrumental activities of daily living in the community and at home. Large percentages of these AD dementia individuals also meet the revised “functional independence” criterion for MCI as measured by the Functional Assessment Questionnaire. Conclusions The categorical distinction between MCI and milder stages of Alzheimer dementia has been compromised by the revised criteria. The resulting diagnostic overlap supports the premise that “MCI due to AD” represents the earliest symptomatic stage of AD. PMID:22312163

Revised criteria for mild cognitive impairment may compromise the diagnosis of Alzheimer disease dementia.

PubMed

Morris, John C

2012-06-01

To evaluate the potential impact of revised criteria for mild cognitive impairment (MCI), developed by a work group sponsored by the National Institute on Aging and the Alzheimer's Association, on the diagnosis of very mild and mild Alzheimer disease (AD)dementia. Retrospective review of ratings of functional impairment across diagnostic categories. Alzheimer's Disease Centers and the National Alzheimer's Coordinating Center. Individuals (N=17 535) with normal cognition,MCI, or AD dementia. The functional ratings of individuals with normal cognition, MCI, or AD dementia who were evaluated at Alzheimer's Disease Centers and submitted to the National Alzheimer's Coordinating Center were assessed in accordance with the definition of "functional independence" allowed by the revised criteria. Pairwise demographic differences between the 3 diagnostic groups were tested using t tests for continuous variables and 2 for categorical variables. Almost all (99.8%) individuals currently diagnosed with very mild AD dementia and the large majority(92.7%) of those diagnosed with mild AD dementia could be reclassified as having MCI with the revised criteria,based on their level of impairment in the Clinical Dementia Rating domains for performance of instrumental activities of daily living in the community and at home.Large percentages of these individuals with AD dementia also meet the revised "functional independence" criterion for MCI as measured by the Functional Assessment Questionnaire. The categorical distinction between MCI and milder stages of AD dementia has been compromised by the revised criteria. The resulting diagnostic overlap supports the premise that "MCI due to AD" represents the earliest symptomatic stage of AD.

Revision Anterior Cruciate Ligament Reconstruction

PubMed Central

Wilde, Jeffrey; Bedi, Asheesh; Altchek, David W.

2014-01-01

Context: Reconstruction of the anterior cruciate ligament (ACL) is one of the most common surgical procedures, with more than 200,000 ACL tears occurring annually. Although primary ACL reconstruction is a successful operation, success rates still range from 75% to 97%. Consequently, several thousand revision ACL reconstructions are performed annually and are unfortunately associated with inferior clinical outcomes when compared with primary reconstructions. Evidence Acquisition: Data were obtained from peer-reviewed literature through a search of the PubMed database (1988-2013) as well as from textbook chapters and surgical technique papers. Study Design: Clinical review. Level of Evidence: Level 4. Results: The clinical outcomes after revision ACL reconstruction are largely based on level IV case series. Much of the existing literature is heterogenous with regard to patient populations, primary and revision surgical techniques, concomitant ligamentous injuries, and additional procedures performed at the time of the revision, which limits generalizability. Nevertheless, there is a general consensus that the outcomes for revision ACL reconstruction are inferior to primary reconstruction. Conclusion: Excellent results can be achieved with regard to graft stability, return to play, and functional knee instability but are generally inferior to primary ACL reconstruction. A staged approach with autograft reconstruction is recommended in any circumstance in which a single-stage approach results in suboptimal graft selection, tunnel position, graft fixation, or biological milieu for tendon-bone healing. Strength-of-Recommendation Taxonomy (SORT): Good results may still be achieved with regard to graft stability, return to play, and functional knee instability, but results are generally inferior to primary ACL reconstruction: Level B. PMID:25364483

Revision of FMM-Yukawa: An adaptive fast multipole method for screened Coulomb interactions

NASA Astrophysics Data System (ADS)

Zhang, Bo; Huang, Jingfang; Pitsianis, Nikos P.; Sun, Xiaobai

2010-12-01

FMM-YUKAWA is a mathematical software package primarily for rapid evaluation of the screened Coulomb interactions of N particles in three dimensional space. Since its release, we have revised and re-organized the data structure, software architecture, and user interface, for the purpose of enabling more flexible, broader and easier use of the package. The package and its documentation are available at http://www.fastmultipole.org/, along with a few other closely related mathematical software packages. New version program summaryProgram title: FMM-Yukawa Catalogue identifier: AEEQ_v2_0 Program summary URL:http://cpc.cs.qub.ac.uk/summaries/AEEQ_v2_0.html Program obtainable from: CPC Program Library, Queen's University, Belfast, N. Ireland Licensing provisions: GNU GPL 2.0 No. of lines in distributed program, including test data, etc.: 78 704 No. of bytes in distributed program, including test data, etc.: 854 265 Distribution format: tar.gz Programming language: FORTRAN 77, FORTRAN 90, and C. Requires gcc and gfortran version 4.4.3 or later Computer: All Operating system: Any Classification: 4.8, 4.12 Catalogue identifier of previous version: AEEQ_v1_0 Journal reference of previous version: Comput. Phys. Comm. 180 (2009) 2331 Does the new version supersede the previous version?: Yes Nature of problem: To evaluate the screened Coulomb potential and force field of N charged particles, and to evaluate a convolution type integral where the Green's function is the fundamental solution of the modified Helmholtz equation. Solution method: The new version of fast multipole method (FMM) that diagonalizes the multipole-to-local translation operator is applied with the tree structure adaptive to sample particle locations. Reasons for new version: To handle much larger particle ensembles, to enable the iterative use of the subroutines in a solver, and to remove potential contention in assignments for parallelization. Summary of revisions: The software package FMM-Yukawa has been revised and re-organized in data structure, software architecture, programming methods, and user interface. The revision enables more flexible use of the package and economic use of memory resources. It consists of five stages. The initial stage (stage 1) determines, based on the accuracy requirement and FMM theory, the length of multipole expansions and the number of quadrature points for diagonalization, and loads the quadrature nodes and weights that are computed off line. Stage 2 constructs the oct-tree and interaction lists, with adaptation to the sparsity or density of particles and employing a dynamic memory allocation scheme at every tree level. Stage 3 executes the core FMM subroutine for numerical calculation of the particle interactions. The subroutine can now be used iteratively as in a solver, while the particle locations remain the same. Stage 4 releases the memory allocated in Stage 2 for the adaptive tree and interaction lists. The user can modify the iterative routine easily. When the particle locations are changed such as in a molecular dynamics simulation, stage 2 to 4 can also be used together repeatedly. The final stage releases the memory space used for the quadrature and other remaining FMM parameters. Programs at the stage level and at the user interface are re-written in the C programming language, while most of the translation and interaction operations remain in FORTRAN. As a result of the change in data structures and memory allocation, the revised package can accommodate much larger particle ensembles while maintaining the same accuracy-efficiency performance. The new version is also developed as an important precursor to its parallel counterpart on multi-core or many core processors in a shared memory programming environment. Particularly, in order to ensure mutual exclusion in concurrent updates without incurring extra latency, we have replaced all the assignment statements at a source box that put its data to multiple target boxes with assignments at every target box that gather data from source boxes. This amounts to replacing the column version of matrix-vector multiplication with the row version. The matrix here, however, is in compressive representation. Sufficient care is taken in the revision not to alter the algorithmic complexity or numerical behavior, as concurrent writing potentially takes place in the upward calculation of the multipole expansion coefficients, interactions at every level of the FMM tree, and downward calculation of the local expansion coefficients. The software modules and their compositions are also organized according to the stages they are used. Demonstration files and makefiles for merging the user routines and the library routines are provided. Restrictions: Accuracy requirement is described in terms of three or six digits. Higher multiples of three digits will be allowed in a later version. Finer decimation in digits for accuracy specification may or may not be necessary. Unusual features: Ready and friendly for customized use and instrumental in expression of concurrency and dependency for efficient parallelization. Running time: The running time depends linearly on the number N of particles, and varies with the distribution characteristics of the particle distribution. It also depends on the accuracy requirement, a higher accuracy requirement takes relatively longer time. The code outperforms the direct summation method when N⩾750.

Patella Tendon Injuries Secondary to Cement Spacers Used at First-Stage Revision of Infected Total Knee Replacement

PubMed Central

Wilson, Katherine; Kothwal, Rahul; Khan, Wasim S.; Williams, Rhodri; Morgan-Jones, Rhidian

2015-01-01

We describe a series of three patients who sustained patella tendon injuries in infected total knee arthroplasties following the use of a static cement spacer at first-stage knee revision. The patella tendon injuries resulted in significant compromise to wound healing and knee stability requiring multiple surgeries. The mid-term function was poor with an Oxford score at 24 months ranging from 12 to 20. Based on our experience, we advise caution in the use of static cement spacer blocks. If they are to be used, we recommend that they should be keyed in the bone to prevent patella tendon injuries. PMID:25905106

Automated revision of CLIPS rule-bases

NASA Technical Reports Server (NTRS)

Murphy, Patrick M.; Pazzani, Michael J.

1994-01-01

This paper describes CLIPS-R, a theory revision system for the revision of CLIPS rule-bases. CLIPS-R may be used for a variety of knowledge-base revision tasks, such as refining a prototype system, adapting an existing system to slightly different operating conditions, or improving an operational system that makes occasional errors. We present a description of how CLIPS-R revises rule-bases, and an evaluation of the system on three rule-bases.

Getting the Books Off the Shelves. Making the Most of Your Congregation's Library. Second Revised Edition. CSLA Guide No. 12.

ERIC Educational Resources Information Center

Smith, Ruth S.

This second revised edition of a guide to promoting and attracting users to a church library retains most of the material of the previous edition, adds new material, and updates the references. Guidelines are presented in six chapters: (1) "Promoting Library Use" (stages of promotion, ways of attracting the attention and interest of prospective…

Framework and components for effective discharge planning system: a delphi methodology

PubMed Central

2012-01-01

Background To reduce avoidable hospital readmissions, effective discharge planning and appropriate post discharge support care are key requirements. This study is a 3-staged process to develop, pretest and pilot a framework for an effective discharge planning system in Hong Kong. This paper reports on the methodology of Delphi approach and findings of the second stage on pre-testing the framework developed so as to validate and attest to its applicability and practicability in which consensus was sought on the key components of discharge planning. Methods Delphi methodology was adopted to engage a group of experienced healthcare professionals to rate and discuss the framework and components of an effective discharge planning. The framework was consisted 36 statements under 5 major themes: initial screening, discharge planning process, coordination of discharge, implementation of discharge, and post discharge follow-up. Each statement was rated independently based on 3 aspects including clarity, validity and applicability on a 5-point Likert-scale. Statement with 75% or above of participants scoring 4–5 on all 3 aspects would be included in the discharge planning framework. For those statements not reaching 75% of consensus in any one of the aspect, it would be revised or discarded following the group discussion, and be re-rated in another round. Results A total of 24 participants participated in the consensus-building process. In round one rating, consensus was achieved in 25 out of 36 statements. Among those 11 statements not reaching consensus, the major concern was related to the “applicability” of the statements. The participants expressed a lack of manpower, skills and time in particular during weekends and long holidays in carrying out assessment and care plans within 24 h after admission. There were also timeliness and availability issue in providing transportation and necessary equipment to the patients. To make the statements more applicable, the wordings of some of the statements were revised to provide greater flexibility. Due to the lack of a statement in clarifying the role of the members of the healthcare professional team, one additional statement on the role and responsibility of the multidisciplinary team members was added. The first theme on “initial screening” was further revised to “initial screening and assessment” to better reflect the first stage of discharge planning process. After two rounds of rating process, all the 36 statements and the newly added statement reached consensus Conclusions A structured, systematic and coordinated system of hospital discharge system is required to facilitate the discharge process to ensure a smooth patient transition from the hospital to the community and improve patient health outcome in both clinical and social aspect. The findings of this paper provide a reference framework helping policymakers and hospital managers to facilitate the development of a coherent and systematized discharge planning process. Adopting a Delphi approach also demonstrates the values of the method as a pre-test (before the clinical run) of the components and requirements of a discharge planning system taking into account of the local context and system constraints, which would lead to improvements to its applicability and practicability. To confirm the applicability and practicability of this consensus framework for discharge planning system, the third stage of process of development of the discharge planning framework is to apply and pilot the framework in a hospital setting to evaluate its feasibility, applicability and impact in hospital including satisfaction from both the perspectives of staff and patients. PMID:23151173

41 CFR 105-64.601 - Procedures for establishing system of records.

Code of Federal Regulations, 2010 CFR

2010-07-01

... Services Administration 64-GSA PRIVACY ACT RULES 64.6-Establishing or Revising Systems of Records in GSA... proposed new or revised system of records: (a) Before establishing a new or revising an existing system of... provide to the GSA Privacy Act Officer a proposal describing and justifying the new system or revision. (b...

Failure of the first step of two-stage revision due to polymicrobial prosthetic joint infection of the hip.

PubMed

Bozhkova, Svetlana; Tikhilov, Rashid; Labutin, Dmitry; Denisov, Alexey; Shubnyakov, Igor; Razorenov, Vadim; Artyukh, Vasilii; Rukina, Anna

2016-12-01

The unsuccessful treatment of prosthetic joint infection (PJI) with two-stage revision leads to infection recurrence. The objectives of the study were to assess the clinical and demographic characteristics of patients with polymicrobial PJI, and to evaluate the role of the microbial profile involved in PJI in the risk of infection recurrence after the first step of two-stage revision surgery. A retrospective analysis of 189 cases of culture-positive PJI following total hip replacement over a 5-year period was performed. The demographic characteristics of patients, clinical symptoms, microbiology cultures of intraoperative biopsies, laboratory values of C-reactive protein (CRP), white blood cell count and erythrocyte sedimentation rate were analyzed. Patients were divided into two groups-135 with monomicrobial and 54 with polymicrobial infection. Of all patients, 68.9 % in the monomicrobial and 83.3 % in the polymicrobial group had a body mass index >25 kg/m 2 (p = 0.05). The median CRP values were 5.7 mg/L (IQR 4.0-10.0 mg/L) in the monomicrobial compared to 8.8 mg/L (IQR 5.0-27 mg/L) in the polymicrobial group (p = 0.01). The percentage of successful outcomes was 27.8 % in patients with microbial associations (p < 0.0001). Gram-negative pathogens caused polymicrobial PJI in 61.5 % of cases with infection recurrence (OR 4.4; 95 % CI 1.18-16.37; p = 0.03). Overweight and obese patients or those with elevated CRP had a greater risk of polymicrobial PJI. They were predisposed to recurrence of infection after the first step of two-stage revision. An unsuccessful outcome was more likely in cases with polymicrobial infection compared to those with monomicrobial infection. In addition, the presence of multidrug-resistant strains of Gram-negative bacteria substantially increased the risk of PJI treatment being unsuccessful. Level III, therapeutic study.

75 FR 73169 - Medicare Program; Payment Policies Under the Physician Fee Schedule and Other Revisions to Part B...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-11-29

...This final rule with comment period addresses changes to the physician fee schedule and other Medicare Part B payment policies to ensure that our payment systems are updated to reflect changes in medical practice and the relative value of services. It finalizes the calendar year (CY) 2010 interim relative value units (RVUs) and issues interim RVUs for new and revised procedure codes for CY 2011. It also addresses, implements, or discusses certain provisions of both the Affordable Care Act (ACA) and the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA). In addition, this final rule with comment period discusses payments under the Ambulance Fee Schedule (AFS), the Ambulatory Surgical Center (ASC) payment system, and the Clinical Laboratory Fee Schedule (CLFS), payments to end-stage renal disease (ESRD) facilities, and payments for Part B drugs. Finally, this final rule with comment period also includes a discussion regarding the Chiropractic Services Demonstration program, the Competitive Bidding Program for durable medical equipment, prosthetics, orthotics, and supplies (CBP DMEPOS), and provider and supplier enrollment issues associated with air ambulances.

Financial implications of choice of dialysis type of the revised Medicare payment system: an economic analysis.

PubMed

Hornberger, John; Hirth, Richard A

2012-08-01

In 2011, the Medicare Improvements for Patients and Providers Act replaced the case-mix-adjusted composite payment system for Medicare outpatient dialysis facilities with a bundled end-stage renal disease prospective payment system (PPS). We assessed the economic implications for modality choice of the revised Medicare payment system. Microeconomic analyses. Patients eligible for dialysis in the United States. The perspective of this analysis is that of a financial administrator of a representative dialysis center in the United States. Data were obtained from the Medicare Payment Advisory Commission, the US Renal Data System, the DOPPS (Dialysis Outcomes and Practice Patterns Study) Practice Monitor, the US Bureau of Labor Statistics, and Medicare fee schedules. Recently implemented end-stage renal disease PPS versus the prior case-mix composite payment system. Medicare payment per month, center fixed and variable costs per month, net difference in revenue and variable costs (direct contribution), and net difference in revenue and total costs (operating margin). The direct contribution and operating margin for in-center hemodialysis and peritoneal dialysis are expected to be positive under the new bundled PPS. For Medicare fiscal intermediaries/administrators, paid treatments for home hemodialysis vary from 3.2 to more than 4.8 per week. The direct contribution and operating margin are expected to be negative for home hemodialysis if the number of paid treatments is similar between in-center and home hemodialysis; they are almost identical when the number of paid treatments increases for home hemodialysis by approximately 1 per week. Experience across centers and intermediaries/administrators may vary. Sensitivity analyses were conducted to assess the robustness of findings and determine which variables most influenced results. The new bundled PPS created a financial incentive for increased use of peritoneal dialysis. Use of home hemodialysis may be influenced by number of paid treatments per week. Copyright © 2012 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

The Psychobiological Theory of Temperament and Character: Comment on Farmer and Goldberg (2008)

ERIC Educational Resources Information Center

Cloninger, C. Robert

2008-01-01

The revised Temperament and Character Inventory (TCI-R) is the third stage of development of a widely used multiscale personality inventory that began with the Tridimensional Personality Questionnaire (TPQ) and then the Temperament and Character Inventory (TCI). The author describes the third stage of the psychobiological theory of temperament and…

Writing a Book from Your Dissertation: Seven Stages

ERIC Educational Resources Information Center

Pane, Debra M.

2016-01-01

The purpose of this Writer's Forum is to share seven stages for writing a book from your dissertation: relinquishing control of your dissertation; selecting and working with your publisher; defining and writing for your audience; revising and drafting your dissertation into a book; securing and using feedback; including front matter, back matter,…

Buccal mucosal urethroplasty for balanitis xerotica obliterans related urethral strictures: the outcome of 1 and 2-stage techniques.

PubMed

Dubey, Deepak; Sehgal, Anand; Srivastava, Aneesh; Mandhani, Anil; Kapoor, Rakesh; Kumar, Anant

2005-02-01

Balanitis xerotica obliterans (BXO) related strictures are complex and generally managed by 2-staged urethroplasty. We present our results with 1-stage dorsal onlay and 2-stage buccal mucosal urethroplasty for such strictures. Between January 2000 and April 2004, 39 patients underwent buccal mucosal urethroplasty for BXO related anterior urethral strictures. The 25 patients with a salvageable urethral plate (group 1) were treated with 1-stage dorsal onlay urethroplasty using a cosmetic incision. The 14 patients with a severely scarred urethral plate, focally dense segments or active infection (group 2) underwent 2-stage urethroplasty. Outcomes in terms of cosmetic appearance, stricture recurrence and complications in the 2 groups were assessed. At a mean followup of 32.5 months (range 3 to 52) 3 patients (12%) in group 1 had recurrent stricture, of which 2 and 1 were treated with optical urethrotomy and urethral dilation, respectively. All patients had a normal slit-like meatus and none had chordee or erectile dysfunction. Four group 2 patients (28.6%) required stomal revision and 2 had glans cleft narrowing after stage 1 urethroplasty. Following stage 2, 3 patients had recurrent stricture, of whom 2 were treated with optical urethrotomy and 1 underwent repeat urethroplasty. In BXO related strictures with a viable urethral plate 1-stage dorsal onlay buccal mucosal urethroplasty provides excellent intermediate term results. The cosmetic incision described provides a normal, wide caliber, slit-like glans. Two-stage procedures provide satisfactory outcomes but they are associated with a higher revision rate.

Propionibacterium Acnes Infection of a Metacarpophalangeal Joint Arthroplasty.

PubMed

Bacle, Guillaume; Sikora, Sheena K; Ek, Eugene T H

2017-05-01

Neglected and underestimated in the past, Propionibacterium acnes is currently the most prevalent organism associated with deep prosthetic infections around the shoulder. Surprisingly, it has never been reported as a cause of infection in the hand. Here we report a case of a late presentation of a P. acnes infection in a metacarpophalangeal joint replacement, resulting in chronic low-grade pain with movement. The patient underwent a 2-stage revision, with initial removal of the prosthesis. Positive cultures for P. acnes required 15 days of extended incubation. The patient subsequently had 6 weeks of oral antibiotics followed by a second-stage revision with a Silastic implant. Copyright © 2017 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

Medicare Program; End-Stage Renal Disease Prospective Payment System, Coverage and Payment for Renal Dialysis Services Furnished to Individuals With Acute Kidney Injury, End-Stage Renal Disease Quality Incentive Program, Durable Medical Equipment, Prosthetics, Orthotics and Supplies Competitive Bidding Program Bid Surety Bonds, State Licensure and Appeals Process for Breach of Contract Actions, Durable Medical Equipment, Prosthetics, Orthotics and Supplies Competitive Bidding Program and Fee Schedule Adjustments, Access to Care Issues for Durable Medical Equipment; and the Comprehensive End-Stage Renal Disease Care Model. Final rule.

PubMed

2016-11-04

This rule updates and makes revisions to the End-Stage Renal Disease (ESRD) Prospective Payment System (PPS) for calendar year 2017. It also finalizes policies for coverage and payment for renal dialysis services furnished by an ESRD facility to individuals with acute kidney injury. This rule also sets forth requirements for the ESRD Quality Incentive Program, including the inclusion of new quality measures beginning with payment year (PY) 2020 and provides updates to programmatic policies for the PY 2018 and PY 2019 ESRD QIP. This rule also implements statutory requirements for bid surety bonds and state licensure for the Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program (CBP). This rule also expands suppliers' appeal rights in the event of a breach of contract action taken by CMS, by revising the appeals regulation to extend the appeals process to all types of actions taken by CMS for a supplier's breach of contract, rather than limit an appeal for the termination of a competitive bidding contract. The rule also finalizes changes to the methodologies for adjusting fee schedule amounts for DMEPOS using information from CBPs and for submitting bids and establishing single payment amounts under the CBPs for certain groupings of similar items with different features to address price inversions. Final changes also are made to the method for establishing bid limits for items under the DMEPOS CBPs. In addition, this rule summarizes comments on the impacts of coordinating Medicare and Medicaid Durable Medical Equipment for dually eligible beneficiaries. Finally, this rule also summarizes comments received in response to a request for information related to the Comprehensive ESRD Care Model and future payment models affecting renal care.

Monitoring the performance of the next Climate Forecast System version 3, throughout its development stage at EMC/NCEP

NASA Astrophysics Data System (ADS)

Peña, M.; Saha, S.; Wu, X.; Wang, J.; Tripp, P.; Moorthi, S.; Bhattacharjee, P.

2016-12-01

The next version of the operational Climate Forecast System (version 3, CFSv3) will be a fully coupled six-components system with diverse applications to earth system modeling, including weather and climate predictions. This system will couple the earth's atmosphere, land, ocean, sea-ice, waves and aerosols for both data assimilation and modeling. It will also use the NOAA Environmental Modeling System (NEMS) software super structure to couple these components. The CFSv3 is part of the next Unified Global Coupled System (UGCS), which will unify the global prediction systems that are now operational at NCEP. The UGCS is being developed through the efforts of dedicated research and engineering teams and through coordination across many CPO/MAPP and NGGPS groups. During this development phase, the UGCS is being tested for seasonal purposes and undergoes frequent revisions. Each new revision is evaluated to quickly discover, isolate and solve problems that negatively impact its performance. In the UGCS-seasonal model, components (e.g., ocean, sea-ice, atmosphere, etc.) are coupled through a NEMS-based "mediator". In this numerical infrastructure, model diagnostics and forecast validation are carried out, both component by component, and as a whole. The next stage, model optimization, will require enhanced performance diagnostics tools to help prioritize areas of numerical improvements. After the technical development of the UGCS-seasonal is completed, it will become the first realization of the CFSv3. All future development of this system will be carried out by the climate team at NCEP, in scientific collaboration with the groups that developed the individual components, as well as the climate community. A unique challenge to evaluate this unified weather-climate system is the large number of variables, which evolve over a wide range of temporal and spatial scales. A small set of performance measures and scorecard displays are been created, and collaboration and software contributions from research and operational centers are being incorporated. A status of the CFSv3/UGCS-seasonal development and examples of its performance and measuring tools will be presented.

The development of a change model of "exits" during cognitive analytic therapy for the treatment of depression.

PubMed

Sandhu, Sundeep Kaur; Kellett, Stephen; Hardy, Gillian

2017-11-01

"Exits" in cognitive analytic therapy (CAT) are methods that change unhelpful patterns or roles during the final "revision" phase of the therapy. How exits are conceived and achieved is currently poorly understood. This study focussed on the revision stage to explore and define how change is accomplished in CAT. Qualitative content analysis studied transcripts of sessions 6 and 7 of a protocol delivered 8-session CAT treatment for depression. Eight participants met the study inclusion criteria, and therefore, 16 sessions were analysed. The exit model developed contained 3 distinct (but interacting) phases: (a) developing an observing self via therapist input or client self-reflection, (b) breaking out of old patterns by creating new roles and procedures, and (c) utilisation of a range of methods to support and maintain change. Levels of interrater reliability for the exit categories that formed the model were good. The revision stage of CAT emerged as a complex and dynamic process involving 3 interacting stages. Further research is recommended to understand how exits relate to durability of change and whether change processes differ according to presenting problem. Exit work in cognitive analytic therapy is a dynamic process that requires progression through stages of insight, active change, and consolidation. Development of an "observing self" is an important foundation stone for change, and cognitive analytic therapists need to work within the client's zone of proximal development. A number of aspects appear important in facilitating change, such as attending to the process and feelings generated by change talk. Copyright © 2017 John Wiley & Sons, Ltd.

78 FR 21547 - Approval and Promulgation of Air Quality Implementation Plans; Oregon: Eugene-Springfield PM10

Federal Register 2010, 2011, 2012, 2013, 2014

2013-04-11

... revision as a direct final rule without prior proposal because EPA views this as a noncontroversial SIP... daily multi-stage advisory issued each winter from November through the end of February. The daily advisory, which is based upon forecast meteorology and air quality, provides a color-coded stage based on...

Holistic Understanding in Geography Education (HUGE)--An Alternative Approach to Curriculum Development and Learning at Key Stage 3

ERIC Educational Resources Information Center

Renshaw, Simon; Wood, Phil

2011-01-01

This article reports the results of a small-scale curriculum development project focusing on two of the seven "key concepts" identified in the revised Key Stage 3 (KS3) National Curriculum programme of study for geography, introduced into schools in 2007. The study used "interdependence" and "physical processes" as…

Using prognostic models in CLL to personalize approach to clinical care: Are we there yet?

PubMed

Mina, Alain; Sandoval Sus, Jose; Sleiman, Elsa; Pinilla-Ibarz, Javier; Awan, Farrukh T; Kharfan-Dabaja, Mohamed A

2018-03-01

Four decades ago, two staging systems were developed to help stratify CLL into different prognostic categories. These systems, the Rai and the Binet staging, depended entirely on abnormal exam findings and evidence of anemia and thrombocytopenia. Better understanding of biologic, genetic, and molecular characteristics of CLL have contributed to better appreciating its clinical heterogeneity. New prognostic models, the GCLLSG prognostic index and the CLL-IPI, emerged. They incorporate biologic and genetic information related to CLL and are capable of predicting survival outcomes and cases anticipated to need therapy earlier in the disease course. Accordingly, these newer models are helping develop better informed surveillance strategies and ultimately tailor treatment intensity according to presence (or lack thereof) of certain prognostic markers. This represents a step towards personalizing care of CLL patients. We anticipate that as more prognostic factors continue to be identified, the GCLLSG prognostic index and CLL-IPI models will undergo further revisions. Copyright © 2017 Elsevier Ltd. All rights reserved.

The role of stages in designing English syllabus development for the students of electrical engineering study program

NASA Astrophysics Data System (ADS)

Imron, Aly

2017-09-01

Developing syllabus is badly needed to anticipate the quick progress of the educational era and revision of the existing one when it is considered not to meet a demand of clearness, efficiency, and pedagogic view. Polytechnic education product goes professional worker`s candidate in the workplace. Therefore, the subject given is designed as proper as possible which is closely and in line with the job place. The research problem is stated with: what is the suitable English syllabus for the technical student by using communicative approach. The method used consists of some stages, namely: 1. Doing the needs survey; 2. Deciding the purpose of the course; 3. Choosing the syllabus type; 4. Writing the proto syllabus; 5. Writing syllabus product for the technical students; 6. Expect validation and revising; and 7. Implementation of class procedure and revising the final product. The research uses the questionnaire and interview for collecting the data. The result shows that the syllabus developed are appropriate based on the input from students, teachers, subject specialist, and reviewer.

Validation of the Omron M3 Intellisense (HEM-7051-E) upper arm blood pressure monitor, for self-measurement, according to the European Society of Hypertension International Protocol revision 2010 in a stage 3-5 chronic kidney disease population.

PubMed

Akpolat, Tekin; Erdem, Emre; Aydogdu, Türkan

2012-01-01

Encouragement of home blood pressure (BP) monitoring has a great potential to improve hypertension control rates. The purpose of this study was to test validation of the Omron M3 Intellisense (HEM-7051-E) upper arm BP measuring monitor for self-measurement according to the European Society of Hypertension International Protocol revision 2010 (ESH-IP2) in stage 3-5 chronic kidney disease (CKD) patients. 66 patients having CKD stage 3-5 were included in the study. Nine consecutive measurements were made according to the ESH-IP2 protocol. The Omron M3 Intellisense device fulfills the validation criteria of the ESH-IP2 for stage 3-5 CKD patients. Although arterial stiffness can affect accurate BP measurement, there are limited data regarding the use of automated oscillometric devices in CKD. To our knowledge, this is the first study investigating validation of an oscillometric device in stage 3-5 predialysis CKD patients. This study validates the Omron M3 Intellisense upper arm device for stage 3-5 CKD patients. New validation studies investigating other oscillometric sphygmomanometers for CKD patients and involvement of nephrologists in these studies have great potential to increase patient care in CKD. Copyright © 2011 S. Karger AG, Basel.

Revising the IDEA Student Ratings of Instruction System 2002-2011 Data. IDEA Technical Report No. 18

ERIC Educational Resources Information Center

Benton, Stephen L.; Li, Dan; Brown, Ron; Guo, Meixi; Sullivan, Patricia

2015-01-01

This report describes the processes undertaken to revise the IDEA Student Ratings of Instruction (SRI) system. The previous revision occurred in 1999, as described in IDEA Technical Report No. 11, "Revising the IDEA System for Obtaining Student Ratings of Instructors and Courses" (Hoyt, Chen, Pallett, & Gross, 1999). The procedures…

Pasteurella multocida non-native joint infection after a dog lick: A case report describing a complicated two-stage revision and a comprehensive review of the literature

PubMed Central

Philip W, Lam; Page, Andrea V

2015-01-01

Prosthetic joint infections (PJIs) are commonly caused by pathogens such as Staphylococcus aureus and coagulase-negative staphylococci; however, other microbial etiologies and specific risk factors are increasingly recognized. Pasteurella multocida is a Gram-negative coccobacillus that is part of the normal oral flora in many animals, and is particularly common in dogs and cats. PJIs caused by P multocida have been reported only rarely in the literature and typically occur in the context of an animal bite or scratch. The present article describes a P multocida joint infection that occurred after a dog lick and complicated a two-stage revision arthroplasty. A comprehensive review of the literature regarding P multocida PJIs follows. PMID:26361490

Revising the Evolutionary Stage of HD 163899: The Effects of Convective Overshooting and Rotation

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

Ostrowski, Jakub; Daszyńska-Daszkiewicz, Jadwiga; Cugier, Henryk, E-mail: ostrowski@astro.uni.wroc.pl

We revise the evolutionary status of the B-type supergiant HD 163899 based on the new determinations of the mass–luminosity ratio, effective temperature, and rotational velocity, as well as on the interpretation of the oscillation spectrum of the star. The observed value of the nitrogen-to-carbon abundance fixes the value of the rotation rate of the star. Now, more massive models are strongly preferred than those previously considered, and it is very likely that the star is still in the main-sequence stage. The rotationally induced mixing manifests as the nitrogen overabundance in the atmosphere, which agrees with our analysis of the HARPSmore » spectra. Thus, HD 163899 probably belongs to a group of evolved nitrogen-rich main-sequence stars.« less

Historical evolution of anatomical terminology from ancient to modern.

PubMed

Sakai, Tatsuo

2007-06-01

The historical development of anatomical terminology from the ancient to the modern can be divided into five stages. The initial stage is represented by the oldest extant anatomical treatises by Galen of Pergamon in the Roman Empire. The anatomical descriptions by Galen utilized only a limited number of anatomical terms, which were essentially colloquial words in the Greek of this period. In the second stage, Vesalius in the early 16th century described the anatomical structures in his Fabrica with the help of detailed magnificent illustrations. He coined substantially no anatomical terms, but devised a system that distinguished anatomical structures with ordinal numbers. The third stage of development in the late 16th century was marked by innovation of a large number of specific anatomical terms especially for the muscles, vessels and nerves. The main figures at this stage were Sylvius in Paris and Bauhin in Basel. In the fourth stage between Bauhin and the international anatomical terminology, many anatomical textbooks were written mainly in Latin in the 17th century, and in modern languages in the 18th and 19th centuries. Anatomical terms for the same structure were differently expressed by different authors. The last stage began at the end of the 19th century, when the first international anatomical terminology in Latin was published as Nomina anatomica. The anatomical terminology was revised repeatedly until the current Terminologia anatomica both in Latin and English.

Fort Hood Solar Total Energy Project. Volume II. Preliminary design. Part 1. System criteria and design description. Final report

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

None,

1979-01-01

This volume documents the preliminary design developed for the Solar Total Energy System to be installed at Fort Hood, Texas. Current system, subsystem, and component designs are described and additional studies which support selection among significant design alternatives are presented. Overall system requirements which form the system design basis are presented. These include program objectives; performance and output load requirements; industrial, statutory, and regulatory standards; and site interface requirements. Material in this section will continue to be issued separately in the Systems Requirements Document and maintained current through revision throughout future phases of the project. Overall system design and detailedmore » subsystem design descriptions are provided. Consideration of operation and maintenance is reflected in discussion of each subsystem design as well as in an integrated overall discussion. Included are the solar collector subsystem; the thermal storage subsystem, the power conversion sybsystem (including electrical generation and distribution); the heating/cooling and domestic hot water subsystems; overall instrumentation and control; and the STES building and physical plant. The design of several subsystems has progressed beyond the preliminary stage; descriptions for such subsystems are therefore provided in more detail than others to provide complete documentation of the work performed. In some cases, preliminary design parameters require specific verificaton in the definitive design phase and are identified in the text. Subsystem descriptions will continue to be issued and revised separately to maintain accuracy during future phases of the project. (WHK)« less

Revision rates after knee replacement. Cumulative results from worldwide clinical studies versus joint registers.

PubMed

Pabinger, C; Berghold, A; Boehler, N; Labek, G

2013-02-01

To assess revision rates after knee arthroplasty by comparing the cumulative results from worldwide clinical studies and arthroplasty registers. We hypothesised that the revision rate of all clinical studies of a given implant and register data would not differ significantly. A systematic review of clinical studies in indexed peer-reviewed journals was performed followed by internal and external validation. Parameters for measurement of revision were applied (Revision for any reason, Revisions per 100 observed component years). Register data served as control group. Thirty-six knee arthroplasty systems were identified to meet the inclusion criteria: 21 total knee arthroplasty (TKA) systems, 14 unicondylar knee arthroplasty (UKA) systems, one patello-femoral implant system. For 13 systems (36%), no published study was available that contained revision data. For 17 implants (47%), publications were available dealing with radiographic, surgical or technical details, but power was too weak to compare revision rates at a significant level. Six implant systems (17%) had a significant number of revisions published and were finally analysed. In general, developers report better results than independent users. Studies from developers represent an overproportional share of all observed component years. Register data report overall 10-year revision rates of TKA of 6.2% (range: 4.9-7.8%), rates for UKA are 16.5% (range: 9.7-19.6%). Revision rates of all clinical studies of a given implant do not differ significantly from register data. However, significant differences were found between the revision rates published by developers and register data. Therefore the different data need to be interpreted in the context of the source of the information. Copyright © 2012 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.

Coaxing and Persuading: Making Rigorous History Teaching a Departmental Reality

ERIC Educational Resources Information Center

Arscott, Rachel; Hinks, Tom

2016-01-01

Faced with the introduction of a two-year key stage and a new whole-school assessment policy, Rachel Arscott and Tom Hinks decided to make a virtue out of necessity and reconsider their whole approach to planning, teaching and assessment at Key Stage 3. In this article they give an account of the process of reflection and revision they undertook…

A novel hybrid forecasting model for PM₁₀ and SO₂ daily concentrations.

PubMed

Wang, Ping; Liu, Yong; Qin, Zuodong; Zhang, Guisheng

2015-02-01

Air-quality forecasting in urban areas is difficult because of the uncertainties in describing both the emission and meteorological fields. The use of incomplete information in the training phase restricts practical air-quality forecasting. In this paper, we propose a hybrid artificial neural network and a hybrid support vector machine, which effectively enhance the forecasting accuracy of an artificial neural network (ANN) and support vector machine (SVM) by revising the error term of the traditional methods. The hybrid methodology can be described in two stages. First, we applied the ANN or SVM forecasting system with historical data and exogenous parameters, such as meteorological variables. Then, the forecasting target was revised by the Taylor expansion forecasting model using the residual information of the error term in the previous stage. The innovation involved in this approach is that it sufficiently and validly utilizes the useful residual information on an incomplete input variable condition. The proposed method was evaluated by experiments using a 2-year dataset of daily PM₁₀ (particles with a diameter of 10 μm or less) concentrations and SO₂ (sulfur dioxide) concentrations from four air pollution monitoring stations located in Taiyuan, China. The theoretical analysis and experimental results demonstrated that the forecasting accuracy of the proposed model is very promising. Copyright © 2014 Elsevier B.V. All rights reserved.

[S3 Guideline. Part 3: Non-Traumatic Avascular Necrosis in Adults - Surgical Treatment of Atraumatic Avascular Femoral Head Necrosis in Adults].

PubMed

Maus, U; Roth, A; Tingart, M; Rader, C; Jäger, M; Nöth, U; Reppenhagen, S; Heiss, C; Beckmann, J

2015-10-01

The present article describes the guidelines for the surgical treatment of atraumatic avascular necrosis (aFKN). These include joint preserving and joint replacement procedures. As part of the targeted literature, 43 publications were included and evaluated to assess the surgical treatment. According to the GRADE and SIGN criteria level of evidence (LoE), grade of recommendation (EC) and expert consensus (EK) were listed for each statement and question. The analysed studies have shown that up to ARCO stage III, joint-preserving surgery can be performed. A particular joint-preserving surgery currently cannot be recommended as preferred method. The selection of the method depends on the extent of necrosis. Core decompression performed in stage ARCO I (reversible early stage) or stage ARCO II (irreversible early stage) with medial or central necrosis with an area of less than 30 % of the femoral head shows better results than conservative therapy. In ARCO stage III with infraction of the femoral head, the core decompression can be used for a short-term pain relief. For ARCO stage IIIC or stage IV core decompression should not be performed. In these cases, the indication for implantation of a total hip replacement should be checked. Additional therapeutic procedures (e.g., osteotomies) and innovative treatment options (advanced core decompression, autologous bone marrow, bone grafting, etc.) can be discussed in the individual case. In elective hip replacement complications and revision rates have been clearly declining for decades. In the case of an underlying aFKN, however, previous joint-preserving surgery (osteotomies and grafts in particular) can complicate the implantation of a THA significantly. However, the implant life seems to be dependent on the aetiology. Higher revision rates for avascular necrosis are particularly expected in sickle cell disease, Gaucher disease, or kidney transplantation patients. Furthermore, the relatively young age of the patient with avascular necrosis should be seen as the main risk factor for higher revision rate. The results after resurfacing (today with known restricted indications) and cemented as well as cementless THA in aFKN are comparable for the appropriate indication to those in coxarthrosis or other diagnoses. Regardless of the underlying disease endoprosthetic treatment in aFKN leads to good results. Both cemented and cementless fixation techniques can be recommended. Georg Thieme Verlag KG Stuttgart · New York.

78 FR 48667 - Revised Company Registration System

Federal Register 2010, 2011, 2012, 2013, 2014

2013-08-09

...; and RM12-3-000] Revised Company Registration System AGENCY: Federal Energy Regulatory Commission... System. The Commission issued a previous notice in the Federal Register, 78 FR 44559 (July 24, 2013... Registration system.\\1\\ On July 17, 2013, the Commission issued a notice stating that the revised Company...

Space Station: The next iteration

NASA Astrophysics Data System (ADS)

Foley, Theresa M.

1995-01-01

NASA's international space station is nearing the completion stage of its troublesome 10-year design phase. With a revised design and new management team, NASA is tasked to deliver the station on time at a budget acceptable to both Congress and the White House. For the next three years, NASA is using tried-and-tested Russian hardware as the technical centerpiece of the station. The new station configuration consists of eight pressurized modules in which the crew can live and work; a long metal truss to connect the pieces; a robot arm for exterior jobs; a solar power system; and propelling the facility in space.

75 FR 49813 - List of Approved Spent Fuel Storage Casks: MAGNASTOR System, Revision 1, Confirmation of...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-08-16

... Storage Casks: MAGNASTOR System, Revision 1, Confirmation of Effective Date AGENCY: Nuclear Regulatory... spent fuel storage regulations at 10 CFR 72.214 to revise the MAGNASTOR System listing to include...

[Parameters modification and evaluation of two evapotranspiration models based on Penman-Monteith model for summer maize].

PubMed

Wang, Juan; Wang, Jian Lin; Liu, Jia Bin; Jiang, Wen; Zhao, Chang Xing

2017-06-18

The dynamic variations of evapotranspiration (ET) and weather data during summer maize growing season in 2013-2015 were monitored with eddy covariance system, and the applicability of two operational models (FAO-PM model and KP-PM model) based on the Penman-Monteith model were analyzed. Firstly, the key parameters in the two models were calibrated with the measured data in 2013 and 2014; secondly, the daily ET in 2015 calculated by the FAO-PM model and KP-PM model was compared to the observed ET, respectively. Finally, the coefficients in the KP-PM model were further revised with the coefficients calculated according to the different growth stages, and the performance of the revised KP-PM model was also evaluated. These statistical parameters indicated that the calculated daily ET for 2015 by the FAO-PM model was closer to the observed ET than that by the KP-PM model. The daily ET calculated from the revised KP-PM model for daily ET was more accurate than that from the FAO-PM model. It was also found that the key parameters in the two models were correlated with weather conditions, so the calibration was necessary before using the models to predict the ET. The above results could provide some guidelines on predicting ET with the two models.

Clinical staging and operative reporting for multi-institutional trials in head and neck squamous cell carcinoma.

PubMed

Weymuller, E A

1997-12-01

A Strategic Planning Conference (jointly supported by NCI and NIDCD) was convened to consider potential improvements in surgical patient data for multi-institutional trials. The thesis underlying this project is that inadequacies in staging, pretreatment patient stratification, and the details of surgical resection may have obscured the detection of treatment effect. The goals of this project were multiple: (1) to consider the utility of new clinical stratification variables, (2) to increase the precision of tumor staging, and (3) to improve operative reporting for multi-institutional trials in head and neck cancer. The conference attendees came to a number of important conclusions: (1) TNM status is inadequate for describing head and neck cancer in a multi-institutional trial setting. A detailed anatomic reporting scheme is proposed; (2) comorbidity measures should be included as patient descriptors, especially those that meet the criteria "definitely important and easy to obtain"; (3) surgical reporting in multi-institutional trials should use a format that is compatible with computer analysis and use the same items as the revised (anatomic) staging system; (4) the surgeon should be personally responsible for data coding and should interact directly with the pathologist in marking the surgical specimen; (5) pathologic reporting should use an anatomic template identical to the staging and operative reporting formats.

Impact of the 2009 AJCC staging guidelines for melanoma on the number of mitotic figures reported by dermatopathologists at one institution.

PubMed

Larson, Allison R; Rothschild, Brian; Walls, Andrew C; Granter, Scott R; Qureshi, Abrar A; Murphy, George F; Laga, Alvaro C

2015-08-01

In 2009 the revised seventh staging system for melanoma recommended the use of mitotic count to separate stage T1a from T1b. However, careful scrutiny of cases may lead to an inadvertent selection effect, with consequent increased reporting of mitotic counts. We investigated whether there is a significant increase in mitotic counts reported since 2009 for melanomas with a Breslow thickness of 1.0 mm or less. We conducted a retrospective, case-controlled study examining invasive melanoma cases at a large academic center. Mitotic counts were compared between pathology reports before 2009 (n = 61) and after 2009 (n = 125), with a subset of slides re-examined in a blinded fashion. Before the 2009 staging guidelines, 51% of cases had one or more mitosis reported compared to 38% after 2009 (p = 0.113). Blinded re-counting did not yield a significant difference when compared with the original pathology reports in either group. There was not a significant difference in the number of mitoses reported after the implementation of the new guidelines. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Lack of relevant information for tumor staging in pathology reports of primary cutaneous melanoma.

PubMed

Busam, K J

2001-05-01

For the T classification of primary cutaneous melanoma, the current American Joint Committee on Cancer staging (AJCC) system relies on tumor thickness and level of invasion. A new T classification has been proposed based on thickness and ulceration. The slides and reports of 135 departmental pathology consultations of patients referred to a major cancer center with a diagnosis of primary cutaneous invasive malignant melanoma were examined. Whether the outside pathology reports contained information on tumor thickness, level of invasion, and ulceration was recorded. Dermatopathologists had issued 76.3% of the reports and general surgical pathologists, 24.3%. Information provided was as follows: tumor thickness, 97.8%; Clark level, 71.9%; and presence or absence of ulceration, 28.1%. Of the 97 melanomas with no comment on ulceration, 17 were indeed ulcerated. Thus, the lack of a comment on ulceration cannot be equated with the absence of ulceration. The present study documents that many pathology reports on melanomas lack sufficient information for AJCC staging. Therefore, review of outside pathology material is necessary not only to confirm or revise the tumor diagnosis but also to provide clinicians with histologic parameters required for AJCC staging.

Incidence of revision after primary implantation of the Agility™ total ankle replacement system: a systematic review.

PubMed

Roukis, Thomas S

2012-01-01

Revision of failed total ankle replacement remains a challenge with limited information available to guide treatment options. I undertook a systematic review of electronic databases and other relevant sources to identify material relating to the incidence of revision after primary implantation of the Agility™ Total Ankle Replacement System. In an effort to procure the highest quality studies available, studies were eligible for inclusion only if they involved patients undergoing primary Agility™ Total Ankle Replacement; had evaluated patients at a mean follow-up of 12 months or longer; included details of the revision performed; and included revision etiologies of aseptic loosening, ballooning osteolysis, cystic changes, malalignment, or instability. A total of 14 studies involving 2312 ankles, with a weighted mean follow-up of 22.8 months, were included. Of the 2312 ankles, 224 (9.7%) underwent revision, of which 182 (81.3%) underwent implant component replacement, 34 (15.2%) underwent arthrodesis, and 8 (3.6%) underwent below-knee amputation. No significant effect from the surgeon's learning curve on the incidence of revision or the type of revision surgery performed was identified. However, excluding the inventor increased the incidence of revision twofold, from 6.6% to 12.2%, and skewed the type of revision away from arthrodesis and toward implant component replacement or below-knee amputation. Regardless, the incidence of revision after primary implantation of the Agility™ Total Ankle Replacement System was less than historically reported and amenable to implant component revision more than 80% of the time. However, methodologically sound cohort studies are needed that include the outcomes after revision surgery, specifically focusing on what implant component replacement techniques are effective in enhancing survivorship of these revised implants and the role of custom-stemmed talar and tibial components have in revision of the Agility™ Total Ankle Replacement System. A direct comparison of the incidence of revision between the various contemporary total ankle replacement systems in common use is also warranted. Copyright © 2012 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

75 FR 34107 - Submission for OMB Review; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2010-06-16

... Sciences Type of Review: Revision. Title: NAEP 2011 Wave II (Writing and Math Multi-Stage Computer- based, KASA Math and PR, NIES, NAEP-TIMSS Alignment) Frequency: Affected Public: Individuals or household...

History of the Voluntary Intermodal Sealift Agreement

DTIC Science & Technology

2002-06-01

reflect executed Voluntary Enrollment Contracts (VEC) for VISA Stages I, II, and III to include basic activation procedures; DOD annual minimums for...provisions; and on-the-shelf basic agreements (such as VISA Intermodal Contingency Contracts (VICC) for Stages I, II, and III). The anticipated...insufficient Program incentives are revised annually, but the basic tenets remain in place. Activation, capacity required to commit and carrier risk clauses

77 FR 24585 - List of Approved Spent Fuel Storage Casks: HI-STORM 100, Revision 8

Federal Register 2010, 2011, 2012, 2013, 2014

2012-04-25

... Storage Casks: HI-STORM 100, Revision 8 AGENCY: Nuclear Regulatory Commission. ACTION: Direct final rule... revising the Holtec International HI-STORM 100 System listing within the ``List of Approved Spent Fuel...) 72.214, by revising the Holtec International HI-STORM 100 System listing within the ``List of...

78 FR 20108 - Privacy Act of 1974; Notice of Revised System of Records

Federal Register 2010, 2011, 2012, 2013, 2014

2013-04-03

...; Notice of Revised System of Records AGENCY: General Services Administration. ACTION: Notice of a revised Privacy Act system of records. SUMMARY: GSA reviewed its Privacy Act systems to ensure that they are relevant, necessary, accurate, up-to-date, and covered by the appropriate legal or regulatory authority...

Performance comparison of earth and space storable bipropellant systems in interplanetary missions

NASA Technical Reports Server (NTRS)

Meissinger, H. F.

1978-01-01

The paper evaluates and compares the performance of earth-storable and space-storable liquid bipropellant propulsion systems in high-energy planetary mission applications, including specifically Saturn and Mercury orbiters, as well as asteroid and comet rendezvous missions. The discussion covers a brief review of the status of space-storable propulsion technology, along with an illustrative propulsion module design for a three-axis stabilized outer planet and cometary mission spacecraft of the Mariner class. The results take revised Shuttle/Upper Stage performance projections into account. It is shown that in some of the missions the performance improvement achievable in the ballistic transfer mode with space-storable spacecraft propulsion can provide a possible alternative to the use of solar-electric propulsion.

Nebula-based Primordial Atmospheres of Planets Around Solar-Like Stars Revised

NASA Astrophysics Data System (ADS)

Scherf, Manuel; Lammer, H.; Leitzinger, M.; Odert, P.; Güdel, M.; Hanslmeier, A.

2012-05-01

At the beginning of a planetary system, in the stage of the stellar nebula and the growing-phase of the planets, planetesimals and Earth-like proto-planets accumulate a remarkable amount of gas, mainly consisting of hydrogen and helium. The mass of such a primordial atmosphere was first estimated for the proto-Earth by Hayashi et al. (1979), with up to 1026 g accumulated within 106 years. Furthermore it is commonly expected that these primordial atmospheres will be completely dissipated due to irradiation of the stellar EUV-flux during the first 108 years. Recent observations of young solar-like stars indicate that the efficiency and effect of the EUV-flux after the nebula disappeared, was highly overestimated by previous studies. We show that parts of these dense hydrogen/helium-gas envelopes may sustain this early active stage of a young star. Implications on the habitability are also discussed.

The Singapore Myeloma Study Group Consensus Guidelines for the management of patients with multiple myeloma

PubMed Central

de Mel, Sanjay; Chen, Yunxin; Gopalakrishnan, Sathish Kumar; Ooi, Melissa; Teo, Constance; Tan, Daryl; Teo, Min Li Claire; Tso, Allison CY; Lee, Lian King; Nagarajan, Chandramouli; Goh, Yeow Tee; Chng, Wee Joo

2017-01-01

Multiple myeloma (MM) is an incurable plasma cell neoplasm with an incidence of 100 patients per year in Singapore. Major advances have been made in the diagnosis, risk stratification and treatment of MM in the recent past. The reclassification of a subset of patients with smouldering MM, based on high-risk biomarkers, and the development of the revised international staging system are among the key new developments in diagnosis and staging. The use of novel agent-based treatment has resulted in significant improvements in the survival and quality of life of many patients with MM. Determining the optimal use of proteasome inhibitors, immunomodulators and, more recently, monoclonal antibodies is an area of ongoing investigation. In this guideline, we aim to provide an overview of the management of MM, incorporating the latest developments in diagnosis and treatment. PMID:27609508

The Singapore Myeloma Study Group Consensus Guidelines for the management of patients with multiple myeloma.

PubMed

de Mel, Sanjay; Chen, Yunxin; Gopalakrishnan, Sathish Kumar; Ooi, Melissa; Teo, Constance; Tan, Daryl; Teo, Min Li Claire; Tso, Allison Cy; Lee, Lian King; Nagarajan, Chandramouli; Goh, Yeow Tee; Chng, Wee Joo

2017-02-01

Multiple myeloma (MM) is an incurable plasma cell neoplasm with an incidence of 100 patients per year in Singapore. Major advances have been made in the diagnosis, risk stratification and treatment of MM in the recent past. The reclassification of a subset of patients with smouldering MM, based on high-risk biomarkers, and the development of the revised international staging system are among the key new developments in diagnosis and staging. The use of novel agent-based treatment has resulted in significant improvements in the survival and quality of life of many patients with MM. Determining the optimal use of proteasome inhibitors, immunomodulators and, more recently, monoclonal antibodies is an area of ongoing investigation. In this guideline, we aim to provide an overview of the management of MM, incorporating the latest developments in diagnosis and treatment. Copyright: © Singapore Medical Association.

The Regional Advisory Councils: what is their potential to incorporate stakeholder knowledge into fisheries governance?

PubMed

Linke, Sebastian; Dreyer, Marion; Sellke, Piet

2011-03-01

The protection of the Baltic Sea ecosystem is exacerbated by the social, environmental and economic complexities of governing European fisheries. Increased stakeholder participation and knowledge integration are suggested to improve the EU's Common Fisheries Policy (CFP), suffering from legitimacy, credibility and compliance problems. As a result, the CFP was revised in 2002 to involve fisheries representatives, NGOs and other stakeholders through so called Regional Advisory Councils (RACs) in the policy process. We address the RAC's task to incorporate stakeholder knowledge into the EU's fisheries governance system in empirical and theoretical perspectives. Drawing on a four-stage governance concept we subsequently suggest that a basic problem is a mismatch between participation purpose (knowledge inclusion) and the governance stage at which RACs are formally positioned (evaluation of management proposals). We conclude that, if the aim is to broaden the knowledge base of fisheries management, stakeholders need to be included earlier in the governance process.

The management of failed ankle replacement.

PubMed

Kotnis, R; Pasapula, C; Anwar, F; Cooke, P H; Sharp, R J

2006-08-01

Advances in the design of the components for total ankle replacement have led to a resurgence of interest in this procedure. Between January 1999 and December 2004, 16 patients with a failed total ankle replacement were referred to our unit. In the presence of infection, a two-stage salvage procedure was planned. The first involved the removal of the components and the insertion of a cement spacer. Definitive treatment options included hindfoot fusion with a circular frame or amputation. When there was no infection, a one-stage salvage procedure was planned. Options included hindfoot fusion with an intramedullary nail or revision total ankle replacement. When there was suspicion of infection, a percutaneous biopsy was performed. The patients were followed up for a minimum of 12 months. Of the 16 patients, 14 had aseptic loosening, five of whom underwent a revision total ankle replacement and nine a hindfoot fusion. Of the two with infection, one underwent fusion and the other a below-knee amputation. There were no cases of wound breakdown, nonunion or malunion. Management of the failed total ankle replacement should be performed by experienced surgeons and ideally in units where multidisciplinary support is available. Currently, a hindfoot fusion appears to be preferable to a revision total ankle replacement.

Scar modification. Techniques for revision and camouflage.

PubMed

Horswell, B B

1998-09-01

The surgery and management of scars is a protracted and staged process that includes preparation of the skin through hygienic measures, scar softening (if indicated) with steroids, massage and pressure dressings, skilled execution of the surgical plan, and thorough postoperative wound care. This process generally covers a 1-year period for the various stages mentioned. Many general host and local skin factors will directly affect the final revision result. The two most important indirect factors that the surgeon must endeavor to control are optimal patient preparation and cutaneous health, and patient compliance with, and an ability to carry out, those wound care measures that the surgeon prescribes. Keloid and burn contracture scars represent two entities that are complicated and challenging to treat owing to their abnormal morphophysiologic features. Management of these scars is prolonged, and the patient must understand that the ultimate result will usually be a compromise. New grafting techniques, such as cultured autodermal grafts, offer improved initial management of burn wounds that may subsequently optimize scar revision in these patients. Keloids, and to a lesser extent hypertrophic scars, require steroid injections, pressure treatment, careful surgery, and protracted wound support and pressure treatment (exceeding 6 months) after surgery.

The dynamics of narrative writing in primary grade children: writing process factors predict story quality.

PubMed

von Koss Torkildsen, Janne; Morken, Frøydis; Helland, Wenche A; Helland, Turid

In this study of third grade school children, we investigated the association between writing process measures recorded with key stroke logging and the final written product. Moreover, we examined the cognitive predictors of writing process and product measures. Analyses of key strokes showed that while most children spontaneously made local online revisions while writing, few revised previously written text. Children with good reading and spelling abilities made more online revisions than their peers. Two process factors, transcription fluency and online revision activity, contributed to explaining variance in narrative macrostructural quality and story length. As for cognitive predictors, spelling was the only factor that gave a unique contribution to explaining variance in writing process factors. Better spelling was associated with more revisions and faster transcription. The results show that developing writers' ability to make online revisions in creative writing tasks is related to both the quality of the final written product and to individual literacy skills. More generally, the findings indicate that investigations of the dynamics of the writing process may provide insights into the factors that contribute to creative writing during early stages of literacy.

76 FR 20910 - Proposed Approval of Air Quality Implementation Plans; Indiana; Stage I Vapor Recovery Rule

Federal Register 2010, 2011, 2012, 2013, 2014

2011-04-14

... gasoline dispensing facilities more stringent by applying them statewide, making the rule applicable to... Emissions Standards for Hazardous Air Pollutants for gasoline dispensing facilities. The revisions also...

Predictors of surgical revision after in situ decompression of the ulnar nerve.

PubMed

Krogue, Justin D; Aleem, Alexander W; Osei, Daniel A; Goldfarb, Charles A; Calfee, Ryan P

2015-04-01

This study was performed to identify factors associated with the need for revision surgery after in situ decompression of the ulnar nerve for cubital tunnel syndrome. This case-control investigation examined all patients treated at one institution with open in situ decompression for cubital tunnel syndrome between 2006 and 2011. The case patients were 44 failed decompressions that required revision, and the controls were 79 randomly selected patients treated with a single operation. Demographic data and disease-specific data were extracted from the medical records. The rate of revision surgery after in situ decompression was determined from our 5-year experience. A multivariate logistic regression model was used based on univariate testing to determine predictors of revision cubital tunnel surgery. Revision surgery was required in 19% (44 of 231) of all in situ decompressions performed during the study period. Predictors of revision surgery included a history of elbow fracture or dislocation (odds ratio [OR], 7.1) and McGowan stage I disease (OR, 3.2). Concurrent surgery with in situ decompression was protective against revision surgery (OR, 0.19). The rate of revision cubital tunnel surgery after in situ nerve decompression should be weighed against the benefits of a less invasive procedure compared with transposition. When considering in situ ulnar nerve decompression, prior elbow fracture as well as patients requesting surgery for mild clinically graded disease should be viewed as risk factors for revision surgery. Patient factors often considered relevant to surgical outcomes, including age, sex, body mass index, tobacco use, and diabetes status, were not associated with a greater likelihood of revision cubital tunnel surgery. Copyright © 2015 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Characterization of Free Phenytoin Concentrations in End-Stage Renal Disease Using the Winter-Tozer Equation.

PubMed

Soriano, Vincent V; Tesoro, Eljim P; Kane, Sean P

2017-08-01

The Winter-Tozer (WT) equation has been shown to reliably predict free phenytoin levels in healthy patients. In patients with end-stage renal disease (ESRD), phenytoin-albumin binding is altered and, thus, affects interpretation of total serum levels. Although an ESRD WT equation was historically proposed for this population, there is a lack of data evaluating its accuracy. The objective of this study was to determine the accuracy of the ESRD WT equation in predicting free serum phenytoin concentration in patients with ESRD on hemodialysis (HD). A retrospective analysis of adult patients with ESRD on HD and concurrent free and total phenytoin concentrations was conducted. Each patient's true free phenytoin concentration was compared with a calculated value using the ESRD WT equation and a revised version of the ESRD WT equation. A total of 21 patients were included for analysis. The ESRD WT equation produced a percentage error of 75% and a root mean square error of 1.76 µg/mL. Additionally, 67% of the samples had an error >50% when using the ESRD WT equation. A revised equation was found to have high predictive accuracy, with only 5% of the samples demonstrating >50% error. The ESRD WT equation was not accurate in predicting free phenytoin concentration in patients with ESRD on HD. A revised ESRD WT equation was found to be significantly more accurate. Given the small study sample, further studies are required to fully evaluate the clinical utility of the revised ESRD WT equation.

76 FR 16263 - Revision to Electric Reliability Organization Definition of Bulk Electric System

Federal Register 2010, 2011, 2012, 2013, 2014

2011-03-23

...'s Reliability Standards Development Process, to revise its definition of the term ``bulk electric... definition of ``bulk electric system'' through the NERC Standards Development Process to address the... undertake the process of revising the bulk electric system definition to address the Commission's concerns...

77 FR 35676 - Public Water System Supervision Program Revision for the State of Texas

Federal Register 2010, 2011, 2012, 2013, 2014

2012-06-14

... ENVIRONMENTAL PROTECTION AGENCY [FRL-9687-5] Public Water System Supervision Program Revision for... Water System Supervision Program. Texas has adopted the Lead and Copper Rule (LCR) Short-Term Revisions...:30 p.m., Monday through Friday, at the following offices: Texas Commission on Environmental Quality...

Dynamic patterning by the Drosophila pair-rule network reconciles long-germ and short-germ segmentation

PubMed Central

2017-01-01

Drosophila segmentation is a well-established paradigm for developmental pattern formation. However, the later stages of segment patterning, regulated by the “pair-rule” genes, are still not well understood at the system level. Building on established genetic interactions, I construct a logical model of the Drosophila pair-rule system that takes into account the demonstrated stage-specific architecture of the pair-rule gene network. Simulation of this model can accurately recapitulate the observed spatiotemporal expression of the pair-rule genes, but only when the system is provided with dynamic “gap” inputs. This result suggests that dynamic shifts of pair-rule stripes are essential for segment patterning in the trunk and provides a functional role for observed posterior-to-anterior gap domain shifts that occur during cellularisation. The model also suggests revised patterning mechanisms for the parasegment boundaries and explains the aetiology of the even-skipped null mutant phenotype. Strikingly, a slightly modified version of the model is able to pattern segments in either simultaneous or sequential modes, depending only on initial conditions. This suggests that fundamentally similar mechanisms may underlie segmentation in short-germ and long-germ arthropods. PMID:28953896

Problem Solving Model for Science Learning

NASA Astrophysics Data System (ADS)

Alberida, H.; Lufri; Festiyed; Barlian, E.

2018-04-01

This research aims to develop problem solving model for science learning in junior high school. The learning model was developed using the ADDIE model. An analysis phase includes curriculum analysis, analysis of students of SMP Kota Padang, analysis of SMP science teachers, learning analysis, as well as the literature review. The design phase includes product planning a science-learning problem-solving model, which consists of syntax, reaction principle, social system, support system, instructional impact and support. Implementation of problem-solving model in science learning to improve students' science process skills. The development stage consists of three steps: a) designing a prototype, b) performing a formative evaluation and c) a prototype revision. Implementation stage is done through a limited trial. A limited trial was conducted on 24 and 26 August 2015 in Class VII 2 SMPN 12 Padang. The evaluation phase was conducted in the form of experiments at SMPN 1 Padang, SMPN 12 Padang and SMP National Padang. Based on the development research done, the syntax model problem solving for science learning at junior high school consists of the introduction, observation, initial problems, data collection, data organization, data analysis/generalization, and communicating.

77 FR 53967 - Medicare and Medicaid Programs; Electronic Health Record Incentive Program-Stage 2

Federal Register 2010, 2011, 2012, 2013, 2014

2012-09-04

...This final rule specifies the Stage 2 criteria that eligible professionals (EPs), eligible hospitals, and critical access hospitals (CAHs) must meet in order to qualify for Medicare and/or Medicaid electronic health record (EHR) incentive payments. In addition, it specifies payment adjustments under Medicare for covered professional services and hospital services provided by EPs, eligible hospitals, and CAHs failing to demonstrate meaningful use of certified EHR technology (CEHRT) and other program participation requirements. This final rule revises certain Stage 1 criteria, as finalized in the July 28, 2010 final rule, as well as criteria that apply regardless of Stage.

Brain maps 4.0—Structure of the rat brain: An open access atlas with global nervous system nomenclature ontology and flatmaps

PubMed Central

2018-01-01

Abstract The fourth edition (following editions in 1992, 1998, 2004) of Brain maps: structure of the rat brain is presented here as an open access internet resource for the neuroscience community. One new feature is a set of 10 hierarchical nomenclature tables that define and describe all parts of the rat nervous system within the framework of a strictly topographic system devised previously for the human nervous system. These tables constitute a global ontology for knowledge management systems dealing with neural circuitry. A second new feature is an aligned atlas of bilateral flatmaps illustrating rat nervous system development from the neural plate stage to the adult stage, where most gray matter regions, white matter tracts, ganglia, and nerves listed in the nomenclature tables are illustrated schematically. These flatmaps are convenient for future development of online applications analogous to “Google Maps” for systems neuroscience. The third new feature is a completely revised Atlas of the rat brain in spatially aligned transverse sections that can serve as a framework for 3‐D modeling. Atlas parcellation is little changed from the preceding edition, but the nomenclature for rat is now aligned with an emerging panmammalian neuroanatomical nomenclature. All figures are presented in Adobe Illustrator vector graphics format that can be manipulated, modified, and resized as desired, and freely used with a Creative Commons license. PMID:29277900

77 FR 64336 - Public Water System Supervision Program Revision for the State of Florida

Federal Register 2010, 2011, 2012, 2013, 2014

2012-10-19

... System Supervision Program by adopting the Lead and Copper Rule Short Term Revisions. EPA has determined... implement and enforce the Lead and Copper Rule Short Term Revisions. EPA reviewed the application using the...

Public Water System Supervision Program Revision for the State of Nevada

EPA Pesticide Factsheets

Nevada revised its approved Public Water System Supervision Program under the federal Safe Drinking Water Act. EPA has determined that these revisions by the State of Nevada are no less stringent than the corresponding Federal regulations.

76 FR 2277 - List of Approved Spent Fuel Storage Casks: NUHOMS® HD System Revision 1

Federal Register 2010, 2011, 2012, 2013, 2014

2011-01-13

... Fuel Storage Casks: NUHOMS[supreg] HD System Revision 1 AGENCY: Nuclear Regulatory Commission. ACTION... amend its spent fuel storage cask regulations by revising the Transnuclear, Inc. (TN) NUHOMS[supreg] HD System listing within the ``List of Approved Spent Fuel Storage Casks'' to include Amendment No. 1 to...

Discontinuing Medications: A Novel Approach for Revising the Prescribing Stage of the Medication-Use Process

PubMed Central

Bain, Kevin T.; Holmes, Holly M.; Beers, Mark H.; Maio, Vittorio; Handler, Steven M.; Pauker, Stephen G.

2009-01-01

Thousands of Americans are injured or die each year from adverse drug reactions, many of which are preventable. The burden of harm conveyed by the use of medications is a significant public health problem and, therefore, improving the medication-use process is a priority. Recent and ongoing efforts to improve the medication-use process focus primarily on improving medication prescribing, and not much emphasis has been put on improving medication discontinuation. A formalized approach for rationally discontinuing medications is a necessary antecedent to improving medication safety and improving the nation’s quality of care. This paper proposes a conceptual framework for revising the prescribing stage of the medication-use process to include discontinuing medications. This framework has substantial practice and research implications, especially for the clinical care of older persons, who are particularly susceptible to the adverse effects of medications. PMID:18771457

REVIEWS OF TOPICAL PROBLEMS: Sky surveys and deep fields of ground-based and space telescopes

NASA Astrophysics Data System (ADS)

Reshetnikov, Vladimir P.

2005-11-01

Selected results obtained in major observational sky surveys (DSS, 2MASS, 2dF, SDSS) and deep field observations (HDF, GOODS, UHDF, etc.) are reviewed. Modern surveys provide information on the characteristics and space distribution of millions of galaxies. Deep fields allow one to study galaxies at the stage of formation and to trace their evolution over billions of years. The wealth of observational data is altering the face of modern astronomy: the formulation of problems and their solutions are changing and all the previous knowledge, from planetary studies in the solar system to the most distant galaxies and quasars, is being revised.

How IPCC Science-Policy Interactions Shape Its Policymaker Summaries

NASA Astrophysics Data System (ADS)

Mach, K. J.; Freeman, P. T.; Mastrandrea, M.; Field, C. B.

2016-12-01

Government approval is a defining feature of the Intergovernmental Panel on Climate Change (IPCC) assessment process. In plenary sessions with scientist authors, IPCC member governments discuss and agree each sentence of every report's summary for policymakers (SPM). This consensus-based approval builds joint ownership of scientific knowledge by both scientists and governments. The approval process and its resulting SPM revisions have received extensive attention in published anecdotes and perspectives, but without comprehensive evaluation to date. We present the results of an in-depth analysis of IPCC SPM revisions, providing an evidence basis for understanding a complex science-policy interaction. Revisions resulting from governmental review and approval expand SPMs. SPM text lengthens by 17 to 53% in recent assessment summaries. Political sensitivities and associated failures of consensus have led to prominent exceptions resulting in SPM contractions. Contrasting recent assertions, we find IPCC SPMs to be as readable as other professionally edited assessment summaries, for multiple measures of reading ease. Across metrics, some SPMs, but not all, become more readable through the revision process. We additionally examine each revision in an SPM for which we have deep familiarity. Most of the SPM's revisions occur prior to the in-person government-approval session, and they emphasize different purposes compared to revisions made during the approval session. Revisions prior to the in-person session largely pertain to clarity, scientific rigor, and explanation, whereas the subsequent in-person government-approval revisions place more emphasis on policy relevance, comprehensiveness of examples, and nuances of expert judgment. The value added in the IPCC government-approval process emerges through multiple stages of revision and approval, as scientists and governments together navigate a complex science-policy interaction.

Application of the new GOLD COPD staging system to a US primary care cohort, with comparison to physician and patient impressions of severity.

PubMed

Mapel, Douglas W; Dalal, Anand A; Johnson, Phaedra T; Becker, Laura K; Hunter, Alyssa Goolsby

2015-01-01

In 2011, the traditional Global Initiative for Chronic Obstructive Lung Disease (GOLD) COPD spirometry-based severity classification system was revised to also include exacerbation history and COPD Assessment Test (CAT) and modified Medical Research Council Dyspnea Scale (mMRC) scores. This study examined how COPD patients treated in primary care are reclassified by the new GOLD system compared to the traditional system, and each system's level of agreement with patient's or physician's severity assessments. In this US multicenter cross-sectional study, COPD patients were recruited by 83 primary care practitioners (PCPs) to complete spirometry testing and a survey. Patients were classified by the traditional spirometry-based system (stages 1-4) and under the new system (grades A, B, C, D) using spirometry, exacerbation history, mMRC, and/or CAT results. Concordance between physician and patient-reported severity, spirometry stage, and ABCD grade based on either mMRC or CAT scores was examined. Data from 445 patients with spirometry-confirmed COPD were used. As compared to the traditional system, the GOLD mMRC system reclassifies 47% of patients, and GOLD CAT system reclassifies 41%, but the distributions are very different. The GOLD mMRC system resulted in relatively equal distributions by ABCD grade (33%, 22%, 19%, 26%, respectively), but the GOLD CAT system put most into either B or D groups (9%, 45%, 4%, and 42%). The addition of exacerbation history reclassified only 19 additional patients. Agreement between PCPs' severity rating or their patients' self-assessment and the new ABCD grade was very poor (κ=0.17 or less). As compared to the traditional system, the GOLD 2011 multidimensional system reclassified nearly half of patients, but how they were reclassified varied greatly by whether the mMRC or CAT questionnaire was chosen. Either way, the new system had little correlation with the PCPs or their patients' impressions about the COPD severity.

Clinical characteristics, microbiology, and outcomes of prosthetic joint infection in Taiwan.

PubMed

Tsai, Jen-Chih; Sheng, Wang-Huei; Lo, Wan-Yu; Jiang, Ching-Chuan; Chang, Shan-Chwen

2015-04-01

Prosthetic joint infection (PJI) after total knee or hip replacement is a devastating complication associated with substantial morbidity and economic cost. The incidence of prosthetic joint infection is increasing as the use of mechanical joint replacement increases. The treatment approach to prosthetic joint infection is based on different clinical situations such as a patient's comorbidities, epidemic microbiology data, and surgical procedures. The aim of our study was to understand clinical characteristics of prosthetic joint infection, the microbiology of the prosthetic joint infection, and the outcomes of different treatment strategies during 2006-2011. We retrospectively collected cases of prosthetic joint infection in the National Taiwan University Hospital between January 1, 2006 and December 31, 2011. The patients' characteristics, microbiology, outcomes, and factors associated with treatment success were recorded. One hundred and forty-four patients were identified as having PJI. Of these, 92 patients were entered into per-protocol analysis. Staphylococcus aureus was the most common causative organism (29.9%), followed by coagulase-negative Staphylococci (16.7%), and Enterococci (9.7%). The overall treatment success rate was 50%. Patients who received a two-stage revision had a better outcome, compared to patients who underwent other types of surgeries (70% vs. 32.7%, respectively; p < 0.001). In multivariate analysis, the two-stage revision was significantly associated with treatment success (odds ratio = 3.923, 95% confidence interval = 1.53-10.04). Our study demonstrates that Staphylococcus aureus was the most common causative organisms in PJI. Performing two-stage revisions was significantly associated with a better outcome. Copyright © 2013. Published by Elsevier B.V.

Vancomycin-Loaded Polymethylmethacrylate Spacers Fail to Eradicate Periprosthetic Joint Infection in a Clinically Representative Mouse Model.

PubMed

Carli, Alberto V; Bhimani, Samrath; Yang, Xu; de Mesy Bentley, Karen L; Ross, F Patrick; Bostrom, Mathias P G

2018-06-06

Periprosthetic joint infection (PJI) remains a devastating complication following total joint arthroplasty. Current animal models of PJI do not effectively recreate the clinical condition and thus provide limited help in understanding why treatments fail. We developed a mouse model of the first-stage surgery of a 2-stage revision for PJI involving a 3-dimensionally printed Ti-6Al-4V implant and a mouse-sized cement spacer that elutes vancomycin. Vancomycin was mixed with polymethylmethacrylate (PMMA) cement and inserted into custom-made mouse-sized spacer molds. Twenty C57BL/6 mice received a proximal tibial implant and an intra-articular injection of 3 × 10 colony-forming units of Staphylococcus aureus Xen36. At 2 weeks, 9 mice underwent irrigation and debridement of the leg with revision of the implant to an articulating vancomycin-loaded PMMA spacer. Postoperatively, mice underwent radiography and serum inflammatory-marker measurements. Following euthanasia of the mice at 6 weeks, bone and soft tissues were homogenized to quantify bacteria within periprosthetic tissues. Implants and articulating spacers were either sonicated to quantify adherent bacteria or examined under scanning electron microscopy (SEM) to characterize the biofilm. Vancomycin-loaded PMMA spacers eluted vancomycin for ≤144 hours and retained antimicrobial activity. Control mice had elevated levels of inflammatory markers, radiographic evidence of septic loosening of the implant, and osseous destruction. Mice treated with a vancomycin-loaded PMMA spacer had significantly lower levels of inflammatory markers (p < 0.01), preserved tibial bone, and no intra-articular purulence. Retrieved vancomycin-loaded spacers exhibited significantly lower bacterial counts compared with implants (p < 0.001). However, bacterial counts in periprosthetic tissue did not significantly differ between the groups. SEM identified S. aureus encased within biofilm on control implants, while vancomycin-loaded spacers contained no bacteria. This animal model is a clinically representative model of PJI treatment. The results suggest that the antimicrobial effects of PMMA spacers are tightly confined to the articular space and must be utilized in conjunction with thorough tissue debridement and systemic antibiotics. These data provide what we believe to be the first insight into the effect of antibiotic-loaded cement spacers in a clinically relevant animal model and justify the adjunctive use of intravenous antibiotics when performing a 2-stage revision for PJI.

75 FR 27463 - List of Approved Spent Fuel Storage Casks: NUHOMS® HD System Revision 1; Correction

Federal Register 2010, 2011, 2012, 2013, 2014

2010-05-17

... Fuel Storage Casks: NUHOMS[supreg] HD System Revision 1; Correction AGENCY: Nuclear Regulatory... fuel storage casks to add revision 1 to the NUHOMS HD spent fuel storage cask system. This action is... Federal Register on May 7, 2010 (75 FR 25120), that proposes to amend the regulations that govern storage...

Application of the new GOLD COPD staging system to a US primary care cohort, with comparison to physician and patient impressions of severity

PubMed Central

Mapel, Douglas W; Dalal, Anand A; Johnson, Phaedra T; Becker, Laura K; Hunter, Alyssa Goolsby

2015-01-01

Background In 2011, the traditional Global Initiative for Chronic Obstructive Lung Disease (GOLD) COPD spirometry-based severity classification system was revised to also include exacerbation history and COPD Assessment Test (CAT) and modified Medical Research Council Dyspnea Scale (mMRC) scores. This study examined how COPD patients treated in primary care are reclassified by the new GOLD system compared to the traditional system, and each system’s level of agreement with patient’s or physician’s severity assessments. Methods In this US multicenter cross-sectional study, COPD patients were recruited by 83 primary care practitioners (PCPs) to complete spirometry testing and a survey. Patients were classified by the traditional spirometry-based system (stages 1–4) and under the new system (grades A, B, C, D) using spirometry, exacerbation history, mMRC, and/or CAT results. Concordance between physician and patient-reported severity, spirometry stage, and ABCD grade based on either mMRC or CAT scores was examined. Results Data from 445 patients with spirometry-confirmed COPD were used. As compared to the traditional system, the GOLD mMRC system reclassifies 47% of patients, and GOLD CAT system reclassifies 41%, but the distributions are very different. The GOLD mMRC system resulted in relatively equal distributions by ABCD grade (33%, 22%, 19%, 26%, respectively), but the GOLD CAT system put most into either B or D groups (9%, 45%, 4%, and 42%). The addition of exacerbation history reclassified only 19 additional patients. Agreement between PCPs’ severity rating or their patients’ self-assessment and the new ABCD grade was very poor (κ=0.17 or less). Conclusion As compared to the traditional system, the GOLD 2011 multidimensional system reclassified nearly half of patients, but how they were reclassified varied greatly by whether the mMRC or CAT questionnaire was chosen. Either way, the new system had little correlation with the PCPs or their patients’ impressions about the COPD severity. PMID:26251587

Adjuvant chemoradiotherapy instead of revision radical resection after local excision for high-risk early rectal cancer.

PubMed

Jeong, Jae-Uk; Nam, Taek-Keun; Kim, Hyeong-Rok; Shim, Hyun-Jeong; Kim, Yong-Hyub; Yoon, Mee Sun; Song, Ju-Young; Ahn, Sung-Ja; Chung, Woong-Ki

2016-09-05

After local excision of early rectal cancer, revision radical resection is recommended for patients with high-risk pathologic stage T1 (pT1) or pT2 cancer, but the revision procedure has high morbidity rates. We evaluated the efficacy of adjuvant concurrent chemoradiotherapy (CCRT) for reducing recurrence after local excision in these patients. Eighty-three patients with high-risk pT1 or pT2 rectal cancer underwent postoperative adjuvant CCRT after local excision. We defined high-risk features as pT1 having tumor size ≤3 cm, and/or resection margin (RM) ≤3 mm, and/or lymphovascular invasion (LVI), and/or non-full thickness excision such as endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD), or unknown records regarding those features, or pT2 cancer. Radiotherapy was administered with a median dose of 50.4 Gy in 1.8 Gy fraction size over 5-7 weeks. Concurrent 5-fluorouracil and leucovorin were administered for 4 days in the first and fifth weeks of radiotherapy. The median interval between local excision and radiotherapy was 34 (range, 11-104) days. Fifteen patients (18.1 %) had stage pT2 tumors, 22 (26.5 %) had RM of ≥3 mm, and 21 (25.3 %) had tumors of ≥3 cm in size. Thirteen patients (15.7 %) had LVI. Transanal excision was performed in 58 patients (69.9 %) and 25 patients (30.1 %) underwent EMR or ESD. The median follow-up was 61 months. The 5-year overall survival (OS), locoregional relapse-free survival (LRFS), and disease-free survival (DFS) rates for all patients were 94.9, 91.0, and 89.8 %, respectively. Multivariate analysis did not identify any significant factors for OS or LRFS, but the only significant factor affecting DFS was the pT stage (p = 0.027). In patients with high-risk pT1 rectal cancer, adjuvant CCRT after local excision could be an effective alternative treatment instead of revision radical resection. However, patients with pT2 stage showed inferior DFS compared to pT1.

78 FR 15755 - Proposed Revision to Design of Structures, Components, Equipment and Systems; Correction

Federal Register 2010, 2011, 2012, 2013, 2014

2013-03-12

... NUCLEAR REGULATORY COMMISSION [NRC-2013-0041] Proposed Revision to Design of Structures, Components, Equipment and Systems; Correction AGENCY: Nuclear Regulatory Commission. ACTION: Standard review... for comments of the proposed revision in Chapter 3, ``Design of Structures, Components, Equipment, and...

Measure in the ESRD QIP for PY 2020. Final rule.

PubMed

2017-08-04

This final rule updates the payment rates used under the prospective payment system (PPS) for skilled nursing facilities (SNFs) for fiscal year (FY) 2018. It also revises and rebases the market basket index by updating the base year from 2010 to 2014, and by adding a new cost category for Installation, Maintenance, and Repair Services. The rule also finalizes revisions to the SNF Quality Reporting Program (QRP), including measure and standardized resident assessment data policies and policies related to public display. In addition, it finalizes policies for the Skilled Nursing Facility Value-Based Purchasing Program that will affect Medicare payment to SNFs beginning in FY 2019. The final rule also clarifies the regulatory requirements for team composition for surveys conducted for investigating a complaint and aligns regulatory provisions for investigation of complaints with the statutory requirements. The final rule also finalizes the performance period for the National Healthcare Safety Network (NHSN) Healthcare Personnel (HCP) Influenza Vaccination Reporting Measure included in the End-Stage Renal Disease (ESRD) Quality Incentive Program (QIP) for Payment Year 2020.

Emerging role of multimodality treatment in gall bladder cancer: Outcomes following 510 consecutive resections in a tertiary referral center.

PubMed

Patkar, Shraddha; Ostwal, Vikas; Ramaswamy, Anant; Engineer, Reena; Chopra, Supriya; Shetty, Nitin; Dusane, Rohit; Shrikhande, Shailesh V; Goel, Mahesh

2018-03-01

Gall bladder cancer (GBC) is a disease with high incidence in India. We analyzed the outcomes of patients with suspected GBC who underwent surgical exploration. Analysis of a prospectively maintained database of patients undergoing surgical exploration for clinic-radiologically suspected GBC from January 2010 to August 2015. Outcomes as well as factors influencing survival were analyzed. Five hundred and ten patients underwent surgery for suspected GBC. Of these 400 had histologically proven malignancy. Eighty patients were deemed inoperable. Radical cholecystectomy was performed in 153 patients, revision surgery for incidental GBC in 160 and port site excision in seven patients. A total of 112 received peri-operative chemotherapy or chemoradiation. Majority were stage III (36%, n = 144) and stage II (31.8% n = 127). At a median follow up of 28.4 months, the median overall survival (OS) was not yet reached. Median disease free survival (DFS) was 33.4 months. Lymph node involvement, stage of the disease and resection status were the main factors influencing outcomes (P = 0.0001). Surgery alone is curative only for early GBC (Stage I). Combination of surgery and peri-operative systemic therapy results in favorable outcomes even in stage II/III disease. Potentially, multimodality treatment may add meaningful survival for this disease with inherently aggressive tumor biology. © 2017 Wiley Periodicals, Inc.

Head and Neck cancers-major changes in the American Joint Committee on cancer eighth edition cancer staging manual.

PubMed

Lydiatt, William M; Patel, Snehal G; O'Sullivan, Brian; Brandwein, Margaret S; Ridge, John A; Migliacci, Jocelyn C; Loomis, Ashley M; Shah, Jatin P

2017-03-01

Answer questions and earn CME/CNE The recently released eighth edition of the American Joint Committee on Cancer (AJCC) Staging Manual, Head and Neck Section, introduces significant modifications from the prior seventh edition. This article details several of the most significant modifications, and the rationale for the revisions, to alert the reader to evolution of the field. The most significant update creates a separate staging algorithm for high-risk human papillomavirus-associated cancer of the oropharynx, distinguishing it from oropharyngeal cancer with other causes. Other modifications include: the reorganizing of skin cancer (other than melanoma and Merkel cell carcinoma) from a general chapter for the entire body to a head and neck-specific cutaneous malignancies chapter; division of cancer of the pharynx into 3 separate chapters; changes to the tumor (T) categories for oral cavity, skin, and nasopharynx; and the addition of extranodal cancer extension to lymph node category (N) in all but the viral-related cancers and mucosal melanoma. The Head and Neck Task Force worked with colleagues around the world to derive a staging system that reflects ongoing changes in head and neck oncology; it remains user friendly and consistent with the traditional tumor, lymph node, metastasis (TNM) staging paradigm. CA Cancer J Clin 2017;67:122-137. © 2017 American Cancer Society. © 2017 American Cancer Society.

Gynecomastia Management: An Evolution and Refinement in Technique at UT Southwestern Medical Center

PubMed Central

Bailey, Steven H.; Guenther, Dax; Constantine, Fadi

2016-01-01

Summary: Gynecomastia is a benign proliferation of male breast glandular tissue. Gynecomastia can affect men at any stage of life. Traditional treatment options involved excisional surgeries with periareolar or T-shaped scars, which can leave more visible scars on the chest. The technique presented represents a technique used by the senior author, which relies on ultrasonic liposuction and pull-through technique to remove breast tissue. A retrospective chart review was performed, including all patients who were treated, from 2000 to 2013 by the senior author, for gynecomastia. A deidentified database was created to record patient characteristics, including age, height, weight, ptosis, stage of gynecomastia, and gynecomastia classification. Surgical approaches, complications, and revisions were also recorded. Our experience includes 75 patients with all grades of gynecomastia from 2000 to 2013. These cases span the evolution of our technique to include direct pull-through excision with ultrasound-assisted liposuction. The distribution of the grades I, II, III, and IV ptosis was 30.6%, 36 %, 22.6%, and 10.6% respectively. There were no complications in this series. Only one patient with grade III ptosis required revision surgery. This technique provides a safe and aesthetically pleasing way to treat gynecomastia with a low need for revision. PMID:27482482

75 FR 6622 - The U.S. Department of Agriculture (USDA) Proposes to Revise Three of Its Privacy Act Systems of...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-02-10

... DEPARTMENT OF AGRICULTURE Office of the Secretary The U.S. Department of Agriculture (USDA) Proposes to Revise Three of Its Privacy Act Systems of Records AGENCY: Office of the Secretary, USDA. ACTION: The U.S. Department of Agriculture (USDA) proposes to revise three of its Privacy Act systems of...

Is it time to incorporate 'depth of infiltration' in the T staging of oral tongue and floor of mouth cancer?

PubMed

Piazza, Cesare; Montalto, Nausica; Paderno, Alberto; Taglietti, Valentina; Nicolai, Piero

2014-04-01

To summarize recent acquisitions in three-dimensional tongue and floor of mouth anatomy that can help in better evaluation of the pathways of cancer progression within these oral subsites, thus giving some hints for refining of the current TNM staging system. The Visual Human Project is an initiative aimed at establishing a three-dimensional dataset of anatomy of two cadavers made available free to the scientific community. Visual human data have been analyzed by specific software thus improving our three-dimensional understanding of the tongue myostructure. It is already known that there is limited prognostic utility in using the two-dimensional surface diameter alone as criterion for T1-T3 definition. Recently, also the T4a categorization for the infiltration of 'deep' or extrinsic tongue muscles has been criticized. This is largely because the descriptor 'deep' does not take into account the fact that considerable portions of these muscles lie in a very superficial plane. Different prognosticators have been proposed for inclusion into the TNM staging system of oral cancer but 'depth of tumor infiltration' seems to be the most robust, universally recognized, and reproducible in the preoperative, intraoperative, and postoperative settings. Oral tongue and floor of mouth cancer needs to be classified according to a revised TNM staging system in which 'depth of infiltration' should be taken into account. An 'ideal cut off' for distinguishing 'low' (T1-T2) from 'high-risk' (T3-T4) categories has been proposed based on the literature review, but needs retrospective as well as large prospective trials before its validation.

Biology and external morphology of the immature stages of the butterfly Callicore pygas eucale , with comments on the taxonomy of the genus Callicore (Nymphalidae: Biblidinae)

PubMed Central

Dias, Fernando Maia Silva; Casagrande, Mirna Martins; Mielke, Olaf Hermann Hendrik

2014-01-01

Abstract The biology and the external morphology of the immature stages of Callicore pygas eucale (Fruhstorfer, 1916) (Lepidoptera: Nymphalidae: Biblidinae) are described. Immatures were collected on Allophylus edulis (Radlkofer) (Sapindales: Sapindaceae) in Curitiba, Paraná, Brazil, and reared in the laboratory. Morphological descriptions and illustrations are given based on observations through electronic, stereoscopic, and optic microscopes, the latter two attached to a camera lucida. Results are compared and discussed with the immature stages of other species of the subtribe Callicorina. Immature stages data provide further evidence that Callicore is paraphyletic and that generic limits within the Callicorina need revision. PMID:25368047

Real Audiences and Contexts for LD Writers.

ERIC Educational Resources Information Center

Stires, Susan

1983-01-01

The process/conference model of writing instruction is described for intermediate-level learning disabled students. Students proceed through several stages of writing (rehearsal, drafting, revising, editing, and rewriting) during which they have conferences with the teacher and eventually publish their writing. (CL)

Explanatory Coherence and Belief Revision in Naive Physics

DTIC Science & Technology

1988-07-01

continental drift (Thagard & Nowak, 1988), and debates about why the dinosaurs became extinct . Application of ECHO to the belief revisions in Pat and Hal...rewono of nocuamy Idid 4onoly by bodck number) Students of reasoning have long tried to understand how people revise systems of beliefs. We maintain...Princeton University Students of reasoning have long tried to understand how people revise systems of beliefs (see Wertheimer, 1945, for example). We will

Revised Conceptual Framework of Parent-to-Parent Support for Parents of Children Who Are Deaf or Hard of Hearing: A Modified Delphi Study.

PubMed

Henderson, Rebecca J; Johnson, Andrew M; Moodie, Sheila T

2016-06-01

A scoping review of the literature was conducted, resulting in the development of a conceptual framework of parent-to-parent support for parents with children who are Deaf or hard of hearing. This is the 2nd stage of a dual-stage scoping review. This study sought stakeholder opinion and feedback with an aim to achieve consensus on the constructs, components, and design of the initial conceptual framework. A modified electronic Delphi study was completed with 21 handpicked experts from 7 countries who have experience in provision, research, or experience in the area of parent-to-parent support. Participants completed an online questionnaire using an 11-point Likert scale (strongly disagree to strongly agree) and open-ended questions to answer various questions related to the descriptor terms, definitions, constructs, components, and overall design of the framework. Participant responses led to the revision of the original conceptual framework. The findings from this dual-stage scoping review and electronic Delphi study provide a conceptual framework that defines the vital contribution of parents in Early Hearing Detection and Intervention programs that will be a useful addition to these programs.

76 FR 35923 - Notice of Opportunity for Public Comment on the Proposed Model Safety Evaluation for Plant...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-06-20

... Traveler TSTF-510, Revision 2, ``Revision to Steam Generator Program Inspection Frequencies and Tube Sample...-510, Revision 2, ``Revision to Steam Generator Program Inspection Frequencies and Tube Sample Selection.'' TSTF-510, Revision 2, is available in the Agencywide Documents Access and Management System...

Shuttle mission simulator. Volume 2: Requirement report, volume 2, revision C

NASA Technical Reports Server (NTRS)

Burke, J. F.

1973-01-01

The requirements for space shuttle simulation which are discussed include: general requirements, program management, system engineering, design and development, crew stations, on-board computers, and systems integration. For Vol. 1, revision A see N73-22203, for Vol 2, revision A see N73-22204.

75 FR 81205 - Privacy Act: Revision of Privacy Act Systems of Records

Federal Register 2010, 2011, 2012, 2013, 2014

2010-12-27

... DEPARTMENT OF AGRICULTURE Office of the Secretary Privacy Act: Revision of Privacy Act Systems of.... SUMMARY: Notice is hereby given that the United States Department of Agriculture (USDA) proposes to revise... from participating in SNAP. Dated: December 14, 2010. Thomas J. Vilsack, Secretary of Agriculture...

12 CFR 216.8 - Revised privacy notices.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 12 Banks and Banking 2 2014-01-01 2014-01-01 false Revised privacy notices. 216.8 Section 216.8 Banks and Banking FEDERAL RESERVE SYSTEM BOARD OF GOVERNORS OF THE FEDERAL RESERVE SYSTEM PRIVACY OF CONSUMER FINANCIAL INFORMATION (REGULATION P) Privacy and Opt Out Notices § 216.8 Revised privacy notices...

12 CFR 216.8 - Revised privacy notices.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 12 Banks and Banking 2 2011-01-01 2011-01-01 false Revised privacy notices. 216.8 Section 216.8 Banks and Banking FEDERAL RESERVE SYSTEM BOARD OF GOVERNORS OF THE FEDERAL RESERVE SYSTEM PRIVACY OF CONSUMER FINANCIAL INFORMATION (REGULATION P) Privacy and Opt Out Notices § 216.8 Revised privacy notices...

12 CFR 216.8 - Revised privacy notices.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 12 Banks and Banking 2 2012-01-01 2012-01-01 false Revised privacy notices. 216.8 Section 216.8 Banks and Banking FEDERAL RESERVE SYSTEM BOARD OF GOVERNORS OF THE FEDERAL RESERVE SYSTEM PRIVACY OF CONSUMER FINANCIAL INFORMATION (REGULATION P) Privacy and Opt Out Notices § 216.8 Revised privacy notices...

12 CFR 216.8 - Revised privacy notices.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 12 Banks and Banking 2 2013-01-01 2013-01-01 false Revised privacy notices. 216.8 Section 216.8 Banks and Banking FEDERAL RESERVE SYSTEM BOARD OF GOVERNORS OF THE FEDERAL RESERVE SYSTEM PRIVACY OF CONSUMER FINANCIAL INFORMATION (REGULATION P) Privacy and Opt Out Notices § 216.8 Revised privacy notices...

12 CFR 216.8 - Revised privacy notices.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 12 Banks and Banking 2 2010-01-01 2010-01-01 false Revised privacy notices. 216.8 Section 216.8 Banks and Banking FEDERAL RESERVE SYSTEM BOARD OF GOVERNORS OF THE FEDERAL RESERVE SYSTEM PRIVACY OF CONSUMER FINANCIAL INFORMATION (REGULATION P) Privacy and Opt Out Notices § 216.8 Revised privacy notices...

Fractional dynamics of globally slow transcription and its impact on deterministic genetic oscillation.

PubMed

Wei, Kun; Gao, Shilong; Zhong, Suchuan; Ma, Hong

2012-01-01

In dynamical systems theory, a system which can be described by differential equations is called a continuous dynamical system. In studies on genetic oscillation, most deterministic models at early stage are usually built on ordinary differential equations (ODE). Therefore, gene transcription which is a vital part in genetic oscillation is presupposed to be a continuous dynamical system by default. However, recent studies argued that discontinuous transcription might be more common than continuous transcription. In this paper, by appending the inserted silent interval lying between two neighboring transcriptional events to the end of the preceding event, we established that the running time for an intact transcriptional event increases and gene transcription thus shows slow dynamics. By globally replacing the original time increment for each state increment by a larger one, we introduced fractional differential equations (FDE) to describe such globally slow transcription. The impact of fractionization on genetic oscillation was then studied in two early stage models--the Goodwin oscillator and the Rössler oscillator. By constructing a "dual memory" oscillator--the fractional delay Goodwin oscillator, we suggested that four general requirements for generating genetic oscillation should be revised to be negative feedback, sufficient nonlinearity, sufficient memory and proper balancing of timescale. The numerical study of the fractional Rössler oscillator implied that the globally slow transcription tends to lower the chance of a coupled or more complex nonlinear genetic oscillatory system behaving chaotically.

User's guide for a revised computer program to analyze the LRC 16 foot transonic dynamics tunnel active cable mount system. [computer techniques - aircraft models

NASA Technical Reports Server (NTRS)

Chin, J.; Barbero, P.

1975-01-01

The revision of an existing digital program to analyze the stability of models mounted on a two-cable mount system used in a transonic dynamics wind tunnel is presented. The program revisions and analysis of an active feedback control system to be used for controlling the free-flying models are treated.

The Earth Science Education Unit's Professional Development Workshop on "The Carbon Question--Cycling, Releasing, Capturing" for Teachers of Key Stages 3 and 4

ERIC Educational Resources Information Center

King, Chris

2014-01-01

The revised National Curriculum for Science for key stages 3 and 4 (ages 11-16) in England provides the opportunity to develop a new coherent approach to teaching about the carbon cycle, the use of carbon as a fuel and the resulting issues. The Earth Science Education Unit (ESEU) intends to develop a new workshop to support the teaching of this…

The Chinese version of monitoring and evaluation system strengthening tool for human immunodeficiency virus (HIV) capacity building: Development and evaluation.

PubMed

Zhao, Ran; Chen, Ren; Zhang, Bing; Ma, Ying; Qin, Xia; Hu, Zhi

2015-08-01

Monitoring and evaluation (M&E) for human immunodeficiency virus (HIV) capacity building has become a significant step for HIV prevention and control. The M&E system strengthening tool published by the United Nations Joint Programme on HIV/AIDS (UNAIDS) was intended to be the most authoritative assessment tool internationally. Facing the fact that the M&E system in China did not function at an optimum level, we considered taking the international standards for reference. By linguistic validating and different stages' discussions and revisions, we came up with the Chinese version of the capacity diagnosis tool with at least 12 components and tested its validity and reliability. The tool turned out to have a sufficiently linguistic validation and proved to be a scientific and feasible instrument which was suitable for China's national conditions.

Government Projects and Teaching the Technical Proposal.

ERIC Educational Resources Information Center

Butler, Douglas R.

1987-01-01

Describes a technical proposal writing assignment modeled after the conditions in industry. Provides a paradigm of government project proposals and then outlines the stages of the assignment that allow student to rework and revise, thereby discouraging students from writing formulaic and superficial proposals. (SRT)

76 FR 69734 - Public Water System Supervision Program Revision for the State of New Mexico

Federal Register 2010, 2011, 2012, 2013, 2014

2011-11-09

... Water System Supervision Program. New Mexico has adopted the Lead and Copper Rule Short Term Revisions... water. EPA has determined that this rule revision submitted by New Mexico is no less stringent than the... the following offices: New Mexico Environment Department, Drinking Water Bureau, 525 Camino De Los...

78 FR 7659 - Revised Medical Criteria for Evaluating Congenital Disorders That Affect Multiple Body Systems

Federal Register 2010, 2011, 2012, 2013, 2014

2013-02-04

... SOCIAL SECURITY ADMINISTRATION 20 CFR Part 404 [Docket No. SSA-2009-0039] RIN 0960-AH04 Revised Medical Criteria for Evaluating Congenital Disorders That Affect Multiple Body Systems AGENCY: Social... in adults and children under titles II and XVI of the Social Security Act (Act). The revisions...

75 FR 14097 - Revision to Electric Reliability Organization Definition of Bulk Electric System

Federal Register 2010, 2011, 2012, 2013, 2014

2010-03-24

... Commission 18 CFR Part 40 [Docket No. RM09-18-000; 130 FERC ] 61,204] Revision to Electric Reliability... Reliability Organization (ERO) to revise its definition of the term ``bulk electric system'' to include all... compliance with mandatory Reliability Standards. The Commission believes that a 100 kV threshold for...

Brain maps 4.0-Structure of the rat brain: An open access atlas with global nervous system nomenclature ontology and flatmaps.

PubMed

Swanson, Larry W

2018-04-15

The fourth edition (following editions in 1992, 1998, 2004) of Brain maps: structure of the rat brain is presented here as an open access internet resource for the neuroscience community. One new feature is a set of 10 hierarchical nomenclature tables that define and describe all parts of the rat nervous system within the framework of a strictly topographic system devised previously for the human nervous system. These tables constitute a global ontology for knowledge management systems dealing with neural circuitry. A second new feature is an aligned atlas of bilateral flatmaps illustrating rat nervous system development from the neural plate stage to the adult stage, where most gray matter regions, white matter tracts, ganglia, and nerves listed in the nomenclature tables are illustrated schematically. These flatmaps are convenient for future development of online applications analogous to "Google Maps" for systems neuroscience. The third new feature is a completely revised Atlas of the rat brain in spatially aligned transverse sections that can serve as a framework for 3-D modeling. Atlas parcellation is little changed from the preceding edition, but the nomenclature for rat is now aligned with an emerging panmammalian neuroanatomical nomenclature. All figures are presented in Adobe Illustrator vector graphics format that can be manipulated, modified, and resized as desired, and freely used with a Creative Commons license. © 2018 The Authors The Journal of Comparative Neurology Published by Wiley Periodicals, Inc.

The seventh tumour-node-metastasis staging system for lung cancer: Sequel or prequel?

PubMed

van Meerbeeck, Jan P; Janssens, Annelies

2013-09-01

Anatomical cancer extent is an important predictor of prognosis and determines treatment choices. In non-small-cell lung cancer (NSCLC) the tumour-node-metastasis (TNM) classification developed by Pierre Denoix replaced in 1968 the Veterans Administration Lung cancer Group (VALG) classification, which was still in use for small-cell lung cancer (SCLC). Clifton Mountain suggested several improvements based on a database of mostly surgically treated United States (US) patients from a limited number of centres. This database was pivotal for a uniform reporting of lung cancer extent by the American Joint Committee of Cancer (AJCC) and the International Union against Cancer (IUCC), but it suffered increasingly from obsolete diagnostic and staging procedures and did not reflect new treatment modalities. Moreover, its findings were not externally validated in large Japanese and European databases, resulting in persisting controversies which could not be solved with the available database. The use of different mediastinal lymph-node maps in Japan, the (US) and Europe facilitated neither the exchange nor the comparison of treatment results. Peter Goldstraw, a United Kingdom (UK) thoracic surgeon, started the process of updating the sixth version in 1996 and brought it to a good end 10 years later. His goals were to improve the TNM system in lung cancer by addressing the ongoing controversies, to validate the modifications and additional descriptors, to validate the TNM for use in staging SCLC and carcinoid tumours, to propose a new uniform lymph-node map and to investigate the prognostic value of non-anatomical factors. A staging committee was formed within the International Association for the Study of Lung Cancer (IASLC) - which supervised the collection of the retrospective data from >100,000 patients with lung cancer - treated throughout the world between 1990 and 2000, analyse them with the help of solid statistics and validate externally with the Surveillance, Epidemiology and End Results (SEER) database. The ten modifications and the mediastinal lymph-node map - which were proposed in 2007 and adopted by the AJCC and IUCC in their respective seventh revision of the TNM system - were implemented as of 2010 and were rapidly adopted by the thoracic oncology community and cancer registries. As expected, not all controversies could be fully addressed, and the need for a prospective data set containing more granular information was felt early on. This data set of 25,000 consecutive incident cases will form the base for the eighth revision in 2017 and is currently being collected. Other threats are the role of stage migration and the increasing number of biological factors interfering with disease extent for prognostication. The latter issue will be addressed by the creation of a prognostic index, including several prognostic factors, of which stage will be one. For the time being, the seventh TNM classification is considered the gold standard for the description of disease extent, initial treatment allocation and the reporting of treatment results. The uniform use of the TNM descriptors and the lymph-node map by all involved in lung cancer care is to be considered a process indicator of quality.

Sex determination and disorders of sex development according to the revised nomenclature and classification in 46,XX individuals.

PubMed

Kousta, Eleni; Papathanasiou, Asteroula; Skordis, Nicos

2010-01-01

There have been considerable advances concerning understanding of the early and later stages of ovarian development; a number of genes have been implicated and their mutations have been associated with developmental abnormalities. The most important genes controlling the initial phase of gonadal development, identical in females and males, are Wilms' tumor suppressor 1 (WT1) and steroidogenic factor 1 (SF1). Four genes are likely to be involved in the subsequent stages of ovarian development (WNT4, DAX1, FOXL2 and RSPO1), but none is yet proven to be the ovarian determining factor. Changes in nomenclature and classification were recently proposed in order to incorporate genetic advances and substitute gender-based diagnostic labels in terminology. The term "disorders of sex development" (DSD) is proposed to substitute the previous term "intersex disorders". Three main categories have been used to describe DSD in the 46,XX individual: 1) disorders of gonadal (ovarian) development: ovotesticular DSD, previously named true hermaphroditism, testicular DSD, previously named XX males, and gonadal dysgenesis; 2) disorders related to androgen excess (congenital adrenal hyperplasia, aromatase deficiency and P450 oxidoreductase deficiency); and 3) other rare disorders. In this mini-review, recent advances concerning development of the genital system in 46,XX individuals and related abnormalities are discussed. Basic embryology of the ovary and molecular pathways determining ovarian development are reviewed, focusing on mutations disrupting normal ovarian development. Disorders of sex development according to the revised nomenclature and classification in 46,XX individuals are summarized, including genetic progress in the field.

Evidence-based clinical practice guidelines for chronic pancreatitis 2015.

PubMed

Ito, Tetsuhide; Ishiguro, Hiroshi; Ohara, Hirotaka; Kamisawa, Terumi; Sakagami, Junichi; Sata, Naohiro; Takeyama, Yoshifumi; Hirota, Morihisa; Miyakawa, Hiroyuki; Igarashi, Hisato; Lee, Lingaku; Fujiyama, Takashi; Hijioka, Masayuki; Ueda, Keijiro; Tachibana, Yuichi; Sogame, Yoshio; Yasuda, Hiroaki; Kato, Ryusuke; Kataoka, Keisho; Shiratori, Keiko; Sugiyama, Masanori; Okazaki, Kazuichi; Kawa, Shigeyuki; Tando, Yusuke; Kinoshita, Yoshikazu; Watanabe, Mamoru; Shimosegawa, Tooru

2016-02-01

Chronic pancreatitis is considered to be an irreversible progressive chronic inflammatory disease. The etiology and pathology of chronic pancreatitis are complex; therefore, it is important to correctly understand the stage and pathology and provide appropriate treatment accordingly. The newly revised Clinical Practice Guidelines of Chronic Pancreatitis 2015 consist of four chapters, i.e., diagnosis, staging, treatment, and prognosis, and includes a total of 65 clinical questions. These guidelines have aimed at providing certain directions and clinically practical contents for the management of chronic pancreatitis, preferentially adopting clinically useful articles. These revised guidelines also refer to early chronic pancreatitis based on the Criteria for the Diagnosis of Chronic Pancreatitis 2009. They include such items as health insurance coverage of high-titer lipase preparations and extracorporeal shock wave lithotripsy, new antidiabetic drugs, and the definition of and treatment approach to pancreatic pseudocyst. The accuracy of these guidelines has been improved by examining and adopting new evidence obtained after the publication of the first edition.

The Development of Statistics Textbook Supported with ICT and Portfolio-Based Assessment

NASA Astrophysics Data System (ADS)

Hendikawati, Putriaji; Yuni Arini, Florentina

2016-02-01

This research was development research that aimed to develop and produce a Statistics textbook model that supported with information and communication technology (ICT) and Portfolio-Based Assessment. This book was designed for students of mathematics at the college to improve students’ ability in mathematical connection and communication. There were three stages in this research i.e. define, design, and develop. The textbooks consisted of 10 chapters which each chapter contains introduction, core materials and include examples and exercises. The textbook developed phase begins with the early stages of designed the book (draft 1) which then validated by experts. Revision of draft 1 produced draft 2 which then limited test for readability test book. Furthermore, revision of draft 2 produced textbook draft 3 which simulated on a small sample to produce a valid model textbook. The data were analysed with descriptive statistics. The analysis showed that the Statistics textbook model that supported with ICT and Portfolio-Based Assessment valid and fill up the criteria of practicality.

Effect of contrast on the perception of direction of a moving pattern

NASA Technical Reports Server (NTRS)

Stone, L. S.; Watson, A. B.; Mulligan, J. B.

1989-01-01

A series of experiments examining the effect of contrast on the perception of moving plaids was performed to test the hypothesis that the human visual system determines the direction of a moving plaid in a two-staged process: decomposition into component motion followed by application of the intersection-of-contraints rule. Although there is recent evidence that the first tenet of the hypothesis is correct, i.e., that plaid motion is initially decomposed into the motion of the individual grating components, the nature of the second-stage combination rule has not yet been established. It was found that when the gratings within the plaid are of different contrast the preceived direction is not predicted by the intersection-of-constraints rule. There is a strong (up to 20 deg) bias in the direction of the higher-constrast grating. A revised model, which incorporates a contrast-dependent weighting of perceived grating speed as observed for one-dimensional patterns, can quantitatively predict most of the results. The results are then discussed in the context of various models of human visual motion processing and of physiological responses of neurons in the primate visual system.

A Corpus-Based System of Error Detection and Revision Suggestion for Spanish Learners in Taiwan: A Case Study

ERIC Educational Resources Information Center

Lu, Hui-Chuan; Chu, Yu-Hsin; Chang, Cheng-Yu

2013-01-01

Compared with English learners, Spanish learners have fewer resources for automatic error detection and revision and following the current integrative Computer Assisted Language Learning (CALL), we combined corpus-based approach and CALL to create the System of Error Detection and Revision Suggestion (SEDRS) for learning Spanish. Through…

[Digital learning object for diagnostic reasoning in nursing applied to the integumentary system].

PubMed

da Costa, Cecília Passos Vaz; Luz, Maria Helena Barros Araújo

2015-12-01

To describe the creation of a digital learning object for diagnostic reasoning in nursing applied to the integumentary system at a public university of Piaui. A methodological study applied to technological production based on the pedagogical framework of problem-based learning. The methodology for creating the learning object observed the stages of analysis, design, development, implementation and evaluation recommended for contextualized instructional design. The revised taxonomy of Bloom was used to list the educational goals. The four modules of the developed learning object were inserted into the educational platform Moodle. The theoretical assumptions allowed the design of an important online resource that promotes effective learning in the scope of nursing education. This study should add value to nursing teaching practices through the use of digital learning objects for teaching diagnostic reasoning applied to skin and skin appendages.

Bottom-up priority setting revised. A second evaluation of an institutional intervention in a Swedish health care organisation.

PubMed

Waldau, Susanne

2015-09-01

Transparent priority setting in health care based on specific ethical principles is requested by the Swedish Parliament since 1997. Implementation has been limited. In this case, transparent priority setting was performed for a second time round and engaged an entire health care organisation. Objectives were to refine a bottom-up priority setting process, reach a political decision on service limits to make reallocation towards higher prioritised services possible, and raise systems knowledge. An action research approach was chosen. The national model for priority setting was used with addition of dimensions costs, volumes, gender distribution and feasibility. The intervention included a three step process and specific procedures for each step which were created, revised and evaluated regarding factual and functional aspects. Evaluations methods included analyses of documents, recordings and surveys. Vertical and horizontal priority setting occurred and resources were reallocated. Participants' attitudes remained positive, however less so than in the first priority setting round. Identifying low-priority services was perceived difficult, causing resentment and strategic behaviour. The horizontal stage served to raise quality of the knowledge base, level out differences in ranking of services and raise systems knowledge. Existing health care management systems do not meet institutional requirements for transparent priority setting. Introducing transparent priority setting constitutes a complex institutional reform, which needs to be driven by management/administration. Strong managerial commitment is required. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Modification of the education system for organ procurement coordinators in Japan after the revision of the Japanese Organ Transplantation Act.

PubMed

Konaka, S; Kato, O; Ashikari, J; Fukushima, N

2012-05-01

From October 1997 to July 2010, only 86 brain-dead (BD) organ donations were obtained and no organs were retrieved from children under 15 years of age because of the strict Japan Organ Transplantation Act. The Act was revised on July 17, 2010, allowing organs to be donated after BD with family consent. To manage the increased donations after the revision, the Japan Organ Transplant Network (JOT) employed 10 organ procurement coordinators (OPCs) and modified its education systems. We retrospectively reviewed the modified education programs to evaluate whether they were effective and whether the processes of organ donation were promptly performed after the revision of the Act. The modifications of education program were: changing OPC to guideline manuals to correspond to the revised Transplant Act; OPCs were taught the new organ procurement system; and a special education program was provided for the 10 newcomers for 2 months. After 12 months of the revision, 58 BD organ donations were accomplished, whereas they had averaged 6.6 in a year before the revision. Two pediatric BD organ donations were accomplished without problem. One priority organ donation to a relative was performed uneventfully. After applying the modified education program, skilled JOT OPCs and leader JOT OPCs increased. To manage increased organ donations after the revision of the Act, the educational system was modified and 58 brain dead organ donations were performed safely. Copyright © 2012 Elsevier Inc. All rights reserved.

Revision surgery of metal-on-metal hip arthroplasties for adverse reactions to metal debris.

PubMed

Matharu, Gulraj S; Eskelinen, Antti; Judge, Andrew; Pandit, Hemant G; Murray, David W

2018-06-01

Background and purpose - The initial outcomes following metal-on-metal hip arthroplasty (MoMHA) revision surgery performed for adverse reactions to metal debris (ARMD) were poor. Furthermore, robust thresholds for performing ARMD revision are lacking. This article is the second of 2. The first article considered the various investigative modalities used during MoMHA patient surveillance (Matharu et al. 2018a ). The present article aims to provide a clinical update regarding ARMD revision surgery in MoMHA patients (hip resurfacing and large-diameter MoM total hip arthroplasty), with specific focus on the threshold for performing ARMD revision, the surgical strategy, and the outcomes following revision. Results and interpretation - The outcomes following ARMD revision surgery appear to have improved with time for several reasons, among them the introduction of regular patient surveillance and lowering of the threshold for performing revision. Furthermore, registry data suggest that outcomes following ARMD revision are influenced by modifiable factors (type of revision procedure and bearing surface implanted), meaning surgeons could potentially reduce failure rates. However, additional large multi-center studies are needed to develop robust thresholds for performing ARMD revision surgery, which will guide surgeons' treatment of MoMHA patients. The long-term systemic effects of metal ion exposure in patients with these implants must also be investigated, which will help establish whether there are any systemic reasons to recommend revision of MoMHAs.

78 FR 47537 - Airworthiness Directives; Airbus Airplanes

Federal Register 2010, 2011, 2012, 2013, 2014

2013-08-06

... 47172-530 shall [also] be included in the next Airworthiness Limitation Section (ALS) Part 4 revision... Limitations Section (ALS) Part 4--Ageing Systems Maintenance, Revision 03, dated September 9, 2011; instead of Revision 02, dated December 16, 2009. Delta stated that Revision 03 of that ALS specifies the 1,000 flight...

Thirteen-year outcomes in the Anatomique Benoist Girard II hip prosthesis.

PubMed

Catanach, Michael J M; Sorial, Rami M; Eslick, Guy D

2015-04-01

The Stryker Anatomique Benoist Girard (ABG) hip implant system was a commonly used cementless prosthesis in the early 2000s, which fell from favour after several studies emerged implicating the prosthesis in high rates of revision. This retrospective, single-surgeon clinical study examines the fracture rate, revision rate and reasons for revision in 500 consecutive ABG II primary total conventional hip replacements. Follow-up was conducted by audit of patient notes, patient mailout survey, patient phone contact and audit of the Australian National Joint Replacement Registry (NJRR) database to find instances of fracture and revision. End points were periprosthetic fracture and revision for any reason. Follow-up was 1.2-13.8 years with a mean of 6.58 years. Of the 500 hips, 17 (3.4%) had undergone a revision. Of these, 13 were due to periprosthetic fracture. Four further fractures occurred that were not revised. Eight of these periprosthetic fractures occurred within 1 year post-operatively. There were four revisions for recurrent dislocations. Kaplan-Meier survival curve demonstrates a 93.7% survivorship at 6.58 years for revision for any reason. Multivariate analysis showed the only statistically significant factor for increased risk of revision was smaller stem size. Our results were consistent with the literature in that the ABG II system has good medium-term results but is prone to periprosthetic fractures, especially in the early post-operative period. When used as a primary total hip arthroplasty, the ABG II system has an 8-year revision rate of 5.6% compared with the 4.9% of all primary total hip arthroplasties. © 2014 Royal Australasian College of Surgeons.

Revision of failed shoulder hemiarthroplasty to reverse total arthroplasty: analysis of 157 revision implants.

PubMed

Merolla, Giovanni; Wagner, Eric; Sperling, John W; Paladini, Paolo; Fabbri, Elisabetta; Porcellini, Giuseppe

2018-01-01

There remains a paucity of studies examining the conversion of failed hemiarthroplasty (HA) to reverse total shoulder arthroplasty (RTSA). Therefore, the purpose of this study was to examine a large series of revision HA to RTSA. A population of 157 patients who underwent conversion of a failed HA to a revision RTSA from 2006 through 2014 were included. The mean follow-up was 49 months (range, 24-121 months). The indications for revision surgery included instability with rotator cuff insufficiency (n = 127) and glenoid wear (n = 30); instability and glenoid wear were associated in 38 cases. Eight patients with infection underwent 2-stage reimplantation. Patients experienced significant improvements in their preoperative to postoperative pain and shoulder range of motion (P < .0001), with median American Shoulder and Elbow Surgeons and Simple Shoulder Test scores of 60 and 6 points, respectively. There were 11 (7%) repeated revision surgeries, secondary to glenoid component loosening (n = 3), instability (n = 3), humeral component disassembly (n = 2), humeral stem loosening (n = 1), and infection (n = 2). Implant survivorship was 95.5% at 2 years and 93.3% at 5 years. There were 4 reoperations including axillary nerve neurolysis (n = 2), heterotopic ossification removal (n = 1), and hardware removal for rupture of the metal cerclage for an acromial fracture (n = 1). At final follow-up, there were 5 "at-risk" glenoid components. Patients experience satisfactory pain relief and recovery of reasonable shoulder function after revision RTSA from a failed HA. There was a relatively low revision rate, with glenoid loosening and instability being the most common causes. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Development, implementation, and evaluation of an energy and power unit of instruction for junior high school industrial arts/technology education programs

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

Litowitz, L.S.

The unit of instruction was developed and refined in three stages. In the first stage, potential objectives for the unit of instruction were identified from appropriate literature. The objectives were mailed to a group primarily consisting of IA/TE state supervisors for critiquing. Upon receiving responses from the critique group, a revised list of objectives was created. From this revised list a content framework was developed. The content framework was then submitted for critiquing to a second group primarily consisting of energy and power curriculum developers. The responses from the second critique group were summarized, and a refined content framework wasmore » produced. A series of twelve hand-on learning activities for junior high school students were then developed to fulfill the unit objectives and concepts identified in the content framework. These activities were critiqued by a final group of experts representing in-service junior high school IA/TE teachers. Revisions to the unit of instruction were made based on feedback from the final critique group. The unit of instruction was then implemented in a junior high school setting as a final means of obtaining formative evaluation. Results of the formative evaluation indicated that the students who participated in the field test had met many of the unit objectives. Recommendations as to the use of the unit of instruction were made.« less

Acute Infection in Total Knee Arthroplasty: Diagnosis and Treatment

PubMed Central

Martínez-Pastor, Juan Carlos; Maculé-Beneyto, Francisco; Suso-Vergara, Santiago

2013-01-01

Infection is one of the most serious complications after total knee arthroplasty (TKA). The current incidence of prosthetic knee infection is 1-3%, depending on the series. For treatment and control to be more cost effective, multidisciplinary groups made up of professionals from different specialities who can work together to eradicate these kinds of infections need to be assembled. About the microbiology, Staphylococcus aureus and coagulase-negative staphylococcus were among the most frequent microorganisms involved (74%). Anamnesis and clinical examination are of primary importance in order to determine whether the problem may point to a possible acute septic complication. The first diagnosis may then be supported by increased CRP and ESR levels. The surgical treatment for a chronic prosthetic knee infection has been perfectly defined and standardized, and consists in a two-stage implant revision process. In contrast, the treatment for acute prosthetic knee infection is currently under debate. Considering the different surgical techniques that already exist, surgical debridement with conservation of the prosthesis and polythene revision appears to be an attractive option for both surgeon and patient, as it is less aggressive than the two-stage revision process and has lower initial costs. The different results obtained from this technique, along with prognosis factors and conclusions to keep in mind when it is indicated for an acute prosthetic infection, whether post-operative or haematogenous, will be analysed by the authors. PMID:23919094

The United States Revised Uniform Anatomical Gift Act (2006): new challenges to balancing patient rights and physician responsibilities.

PubMed

Verheijde, Joseph L; Rady, Mohamed Y; McGregor, Joan L

2007-09-12

Advance health care directives and informed consent remain the cornerstones of patients' right to self-determination regarding medical care and preferences at the end-of-life. However, the effectiveness and clinical applicability of advance health care directives to decision-making on the use of life support systems at the end-of-life is questionable. The Uniform Anatomical Gift Act (UAGA) has been revised in 2006 to permit the use of life support systems at or near death for the purpose of maximizing procurement opportunities of organs medically suitable for transplantation. Some states have enacted the Revised UAGA (2006) and a few of those have included amendments while attempting to preserve the uniformity of the revised Act. Other states have introduced the Revised UAGA (2006) for legislation and remaining states are likely to follow soon. The Revised UAGA (2006) poses challenges to the Patient Self Determination Act (PSDA) embodied in advance health care directives and individual expression about the use of life support systems at the end-of-life. The challenges are predicated on the UAGA revising the default choice to presumption of donation intent and the use of life support systems to ensure medical suitability of organs for transplantation. The default choice trumps the expressed intent in an individual's advance health care directive to withhold and/or withdraw life support systems at the end-of-life. The Revised UAGA (2006) overrides advance directives on utilitarian grounds, which is a serious ethical challenge to society. The subtle progression of the Revised UAGA (2006) towards the presumption about how to dispose of one's organs at death can pave the way for an affirmative "duty to donate". There are at least two steps required to resolve these challenges. First, physicians and hospitals must fulfill their responsibilities to educate patients on the new legislations and document their preferences about the use of life support systems for organ donation at the end-of-life. Second, a broad based societal discussion must be initiated to decide if the Revised UAGA (2006) infringes on the PSDA and the individual's right of autonomy. The discussion should also address other ethical concerns raised by the Revised UAGA (2006), including the moral stance on 1) the interpretation of the refusal of life support systems as not applicable to organ donation and 2) the disregarding of the diversity of cultural beliefs about end-of-life in a pluralistic society.

Resting no more: re-defining telogen, the maintenance stage of the hair growth cycle

PubMed Central

Geyfman, Mikhail; Plikus, Maksim V.; Treffeisen, Elsa; Andersen, Bogi; Paus, Ralf

2014-01-01

The hair follicle (HF) represents a prototypic ectodermal–mesodermal interaction system in which central questions of modern biology can be studied. A unique feature of these stem-cell-rich mini-organs is that they undergo life-long, cyclic transformations between stages of active regeneration (anagen), apoptotic involution (catagen), and relative proliferative quiescence (telogen). Due to the low proliferation rate and small size of the HF during telogen, this stage was conventionally thought of as a stage of dormancy. However, multiple lines of newly emerging evidence show that HFs during telogen are anything but dormant. Here, we emphasize that telogen is a highly energy-efficient default state of the mammalian coat, whose function centres around maintenance of the hair fibre and prompt responses to its loss. While actively retaining hair fibres with minimal energy expenditure, telogen HFs can launch a new regeneration cycle in response to a variety of stimuli originating in their autonomous micro-environment (including its stem cell niche) as well as in their external tissue macro-environment. Regenerative responses of telogen HFs change as a function of time and can be divided into two sub-stages: early ‘refractory’ and late ‘competent’ telogen. These changing activities are reflected in hundreds of dynamically regulated genes in telogen skin, possibly aimed at establishing a fast response-signalling environment to trauma and other disturbances of skin homeostasis. Furthermore, telogen is an interpreter of circadian output in the timing of anagen initiation and the key stage during which the subsequent organ regeneration (anagen) is actively prepared by suppressing molecular brakes on hair growth while activating pro-regenerative signals. Thus, telogen may serve as an excellent model system for dissecting signalling and cellular interactions that precede the active ‘regenerative mode’ of tissue remodeling. This revised understanding of telogen biology also points to intriguing new therapeutic avenues in the management of common human hair growth disorders. PMID:25410793

Resting no more: re-defining telogen, the maintenance stage of the hair growth cycle.

PubMed

Geyfman, Mikhail; Plikus, Maksim V; Treffeisen, Elsa; Andersen, Bogi; Paus, Ralf

2015-11-01

The hair follicle (HF) represents a prototypic ectodermal-mesodermal interaction system in which central questions of modern biology can be studied. A unique feature of these stem-cell-rich mini-organs is that they undergo life-long, cyclic transformations between stages of active regeneration (anagen), apoptotic involution (catagen), and relative proliferative quiescence (telogen). Due to the low proliferation rate and small size of the HF during telogen, this stage was conventionally thought of as a stage of dormancy. However, multiple lines of newly emerging evidence show that HFs during telogen are anything but dormant. Here, we emphasize that telogen is a highly energy-efficient default state of the mammalian coat, whose function centres around maintenance of the hair fibre and prompt responses to its loss. While actively retaining hair fibres with minimal energy expenditure, telogen HFs can launch a new regeneration cycle in response to a variety of stimuli originating in their autonomous micro-environment (including its stem cell niche) as well as in their external tissue macro-environment. Regenerative responses of telogen HFs change as a function of time and can be divided into two sub-stages: early 'refractory' and late 'competent' telogen. These changing activities are reflected in hundreds of dynamically regulated genes in telogen skin, possibly aimed at establishing a fast response-signalling environment to trauma and other disturbances of skin homeostasis. Furthermore, telogen is an interpreter of circadian output in the timing of anagen initiation and the key stage during which the subsequent organ regeneration (anagen) is actively prepared by suppressing molecular brakes on hair growth while activating pro-regenerative signals. Thus, telogen may serve as an excellent model system for dissecting signalling and cellular interactions that precede the active 'regenerative mode' of tissue remodeling. This revised understanding of telogen biology also points to intriguing new therapeutic avenues in the management of common human hair growth disorders. © 2014 Cambridge Philosophical Society.

Program Objectives for Science. Revised.

ERIC Educational Resources Information Center

Bednarczyk, Angela; And Others

The guide lists program objectives for science instruction of hearing impaired students at Kendall Demonstration Elementary School. The curriculum, it is explained, is based on theories of J. Piaget. Objectives are stated in terms of process skills within four Piagetian stages of development: pre-operational, transition to concrete, concrete, and…

Repetition and Metaphor in the Early Stages of Composing.

ERIC Educational Resources Information Center

Peterson, Linda

1985-01-01

Describes some of the strategies of repetition and metaphor used by Black American novelist Richard Wright, as a model that students can adopt in their own writing, both for generating ideas and for revising them. Appendixes include various drafts of an interview statement by Wright. (HTH)

The Odd Fish Story

ERIC Educational Resources Information Center

Essley, Roger

2005-01-01

Essley was a "different learner," and now he works in schools showing teachers how visual/verbal tools can help all students, including their "different learners," succeed. One valuable tool is storyboarding, a process by which students build a story through visual stages--drafts, conferences, revisions--before writing even begins. Essley shares…

18 CFR 380.3 - Environmental information to be supplied by an applicant.

Code of Federal Regulations, 2010 CFR

2010-04-01

... stages of the proposed action to ensure that all potential environmental impacts are identified. (The... 18 Conservation of Power and Water Resources 1 2010-04-01 2010-04-01 false Environmental... FEDERAL ENERGY REGULATORY COMMISSION, DEPARTMENT OF ENERGY REVISED GENERAL RULES REGULATIONS IMPLEMENTING...

77 FR 69898 - Privacy Act of 1974; Privacy Act System of Records

Federal Register 2010, 2011, 2012, 2013, 2014

2012-11-21

... System of Records AGENCY: National Aeronautics and Space Administration (NASA). ACTION: Notice of proposed revisions to an existing Privacy Act system of records. SUMMARY: Pursuant to the provisions of the... notice of its intention to revise a previously noticed system of records Earth Observing System Data and...

76 FR 7845 - Public Water System Supervision Program Revision for the State of Utah

Federal Register 2010, 2011, 2012, 2013, 2014

2011-02-11

... ENVIRONMENTAL PROTECTION AGENCY [FRL-9263-9] Public Water System Supervision Program Revision for... accordance with the provisions of section 1413 of the Safe Drinking Water Act (SDWA), 42 U.S.C. 300g-2, and 40 CFR 142.13, public notice is hereby given that the State of Utah has revised its Public Water...

IDC System Specification Document.

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

Clifford, David J.

2014-12-01

This document contains the system specifications derived to satisfy the system requirements found in the IDC System Requirements Document for the IDC Reengineering Phase 2 project. Revisions Version Date Author/Team Revision Description Authorized by V1.0 12/2014 IDC Reengineering Project Team Initial delivery M. Harris

42 CFR 414.502 - Definitions.

Code of Federal Regulations, 2010 CFR

2010-10-01

... laboratory test for which a new or substantially revised Healthcare Common Procedure Coding System Code is assigned on or after January 1, 2005. Substantially Revised Healthcare Common Procedure Coding System Code...

42 CFR 414.502 - Definitions.

Code of Federal Regulations, 2011 CFR

2011-10-01

... laboratory test for which a new or substantially revised Healthcare Common Procedure Coding System Code is assigned on or after January 1, 2005. Substantially Revised Healthcare Common Procedure Coding System Code...

A revised inoceramid biozonation for the Upper Cretaceous based on high-resolution carbon isotope stratigraphy in northwestern Hokkaido, Japan

NASA Astrophysics Data System (ADS)

Hayakawa, Tatsuya; Hirano, Hiromichi

2013-06-01

Hayakawa, T., Hirano, H. 2013. A revised inoceramid biozonation for the Upper Cretaceous based on high-resolution carbon isotope stratigraphy in northwestern Hokkaido, Japan. Acta Geologica Polonica, 63 (2), 239-263. Warszawa. Biostratigraphic correlations of inoceramid bivalves between the North Pacific and Euramerican provinces have been difficult because the inoceramid biostratigraphy of the Japanese strata has been based on endemic species of the northwest Pacific. In this study, carbon stable isotope fluctuations of terrestrial organic matter are assembled for the Upper Cretaceous Yezo Group in the Haboro and Obira areas, Hokkaido, Japan, in order to revise the chronology of the inoceramid biozonation in Japan. The carbon isotope curves are correlated with those of marine carbonates in English and German sections with the aid of age-diagnostic taxa. According to the correlations of the carbon isotope curves, 11 isotope events are recognised in the sections studied. As a result of these correlations, the chronology of the inoceramid biozones of the Northwest Pacific has been considerably revised. The revised inoceramid biozones suggest that the timing of the origination and extinction of the inoceramids in the North Pacific biotic province is different from the stage/substage boundaries defined by inoceramids, as used in Europe and North America.

Describing Peripancreatic Collections According to the Revised Atlanta Classification of Acute Pancreatitis: An International Interobserver Agreement Study.

PubMed

Bouwense, Stefan A; van Brunschot, Sandra; van Santvoort, Hjalmar C; Besselink, Marc G; Bollen, Thomas L; Bakker, Olaf J; Banks, Peter A; Boermeester, Marja A; Cappendijk, Vincent C; Carter, Ross; Charnley, Richard; van Eijck, Casper H; Freeny, Patrick C; Hermans, John J; Hough, David M; Johnson, Colin D; Laméris, Johan S; Lerch, Markus M; Mayerle, Julia; Mortele, Koenraad J; Sarr, Michael G; Stedman, Brian; Vege, Santhi Swaroop; Werner, Jens; Dijkgraaf, Marcel G; Gooszen, Hein G; Horvath, Karen D

2017-08-01

Severe acute pancreatitis is associated with peripancreatic morphologic changes as seen on imaging. Uniform communication regarding these morphologic findings is crucial for accurate diagnosis and treatment. For the original 1992 Atlanta classification, interobserver agreement is poor. We hypothesized that for the revised Atlanta classification, interobserver agreement will be better. An international, interobserver agreement study was performed among expert and nonexpert radiologists (n = 14), surgeons (n = 15), and gastroenterologists (n = 8). Representative computed tomographies of all stages of acute pancreatitis were selected from 55 patients and were assessed according to the revised Atlanta classification. The interobserver agreement was calculated among all reviewers and subgroups, that is, expert and nonexpert reviewers; interobserver agreement was defined as poor (≤0.20), fair (0.21-0.40), moderate (0.41-0.60), good (0.61-0.80), or very good (0.81-1.00). Interobserver agreement among all reviewers was good (0.75 [standard deviation, 0.21]) for describing the type of acute pancreatitis and good (0.62 [standard deviation, 0.19]) for the type of peripancreatic collection. Expert radiologists showed the best and nonexpert clinicians the lowest interobserver agreement. Interobserver agreement was good for the revised Atlanta classification, supporting the importance for widespread adaption of this revised classification for clinical and research communications.

48 CFR 252.247-7002 - Revision of prices.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 48 Federal Acquisition Regulations System 3 2010-10-01 2010-10-01 false Revision of prices. 252... Provisions And Clauses 252.247-7002 Revision of prices. As prescribed in 247.270-4(c), use the following clause: Revision of Prices (DEC 1991) (a) Definition. Wage adjustment, as used in this clause, means a...

48 CFR 1.502 - Unsolicited proposed revisions.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 48 Federal Acquisition Regulations System 1 2010-10-01 2010-10-01 false Unsolicited proposed revisions. 1.502 Section 1.502 Federal Acquisition Regulations System FEDERAL ACQUISITION REGULATION GENERAL FEDERAL ACQUISITION REGULATIONS SYSTEM Agency and Public Participation 1.502 Unsolicited proposed...

Shock metamorphism of ordinary chondrites

NASA Technical Reports Server (NTRS)

Stoeffler, Dieter; Keil, Klaus; Scott, Edward R. D.

1991-01-01

This study proposes a revised petrographic classification of progressive stages of shock metamorphism of 26 ordinary chondrites. Six stages of shock (S1 to S6) are defined on the basis of shock effects in olivine and plagioclase as recognized by thin section microscopy, and the characteristic shock effects of each shock stage are described. It is concluded that shock effects and the sequence of progressively increasing degrees of shock metamorphosis are very similar in H, L, and LL groups. Differences in the frequency distribution of shock stages are relatively minor. It is suggested that the collisional histories of the H, L, and LL parent bodies were similar. Petrologic type-3 chondrites are deficient in stages S4 and S6 and, with increasing petrologic type, the frequency of stages S4 to S6 increases. It is suggested that the more porous and volatile-rich Type-3 chondrites are subject to melting at a lower shock pressure than the nonporous chondrites of higher petrologic type. Stage S3 is the most abundant in nearly all petrologic types.

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

Rudeen, David Keith; Weber, Paula D.; Lord, David L.

The U.S. Strategic Petroleum Reserve implemented the first stage of a leach plan in 2011-2012 to expand storage volume in the existing Bryan Mound 113 cavern from a starting volume of 7.4 million barrels (MMB) to its design volume of 11.2 MMB. The first stage was terminated several months earlier than expected in August, 2012, as the upper section of the leach zone expanded outward more quickly than design. The oil-brine interface was then re-positioned with the intent to resume leaching in the second stage configuration. This report evaluates the as-built configuration of the cavern at the end of themore » first stage, and recommends changes to the second stage plan in order to accommodate for the variance between the first stage plan and the as-built cavern. SANSMIC leach code simulations are presented and compared with sonar surveys in order to aid in the analysis and offer projections of likely outcomes from the revised plan for the second stage leach.« less

76 FR 20850 - Approval and Promulgation of Air Quality Implementation Plans; Indiana; Stage I Vapor Recovery Rule

Federal Register 2010, 2011, 2012, 2013, 2014

2011-04-14

... gasoline dispensing facilities more stringent by applying them statewide, making the rule applicable to... Emissions Standards for Hazardous Air Pollutants (NESHAPs) for gasoline dispensing facilities. The revisions... January 10, 2008, EPA issued new, more stringent National Regulations for Gasoline Dispensing Facilities...

76 FR 5157 - Public Water Supply Supervision Program; Program Revision for the State of Alaska

Federal Register 2010, 2011, 2012, 2013, 2014

2011-01-28

... ENVIRONMENTAL PROTECTION AGENCY [FRL-9259-6] Public Water Supply Supervision Program; Program... Water Supply Supervision Primacy Program. Alaska has adopted regulations analogous to EPA's Stage 2 Disinfectants and Disinfection Byproducts Rule; Long Term 2 Enhanced Surface Water Treatment Rule; and Lead and...

78 FR 42945 - Public Water Supply Supervision Program; Program Revision for the State of Oregon

Federal Register 2010, 2011, 2012, 2013, 2014

2013-07-18

... ENVIRONMENTAL PROTECTION AGENCY [FRL-9834-9] Public Water Supply Supervision Program; Program... Water Supply Supervision Primacy Program. Oregon has adopted regulations analogous to EPA's Stage 2 Disinfectants and Disinfection Byproducts Rule; Long Term 2 Enhanced Surface Water Treatment Rule; Ground Water...

Educational Evaluation: Key Characteristics. ACER Research Series No. 102.

ERIC Educational Resources Information Center

Maling-Keepes, Jillian

A set of 13 key characteristics is presented as a framework for educational evaluation studies: (1) program's stage of development when evaluator is appointed; (2) program's openness to revision; (3) program uniformity from site to site; (4) specificity of program objectives; (5) evaluator's independence; (6) evaluator's orientation to value…

National and State Writing Tests: The Writing Process Betrayed

ERIC Educational Resources Information Center

Schuster, Edgar H.

2004-01-01

State academic standards broadly support the writing process, including the planning (prewriting), drafting, revising, editing, and publishing (sharing) stages. There is also widespread recognition that a valuable part of the process is conferencing, either between teacher and student, student and student (often referred to as peer feedback), or…

Inquiry-Oriented Learning Material to Increased General Physics Competence Achievement

ERIC Educational Resources Information Center

Sinuraya, Jurubahasa

2016-01-01

This study aims to produce inquiry-oriented general physics learning material to improve student learning outcome. Development steps of learning materials were adapted from the design model of Dick and Carey. Stages of development consists of three phases: planning, development, and formative evaluation and revision. Implementation of formative…

Revisiting and Revising the Apprenticeship of Observation

ERIC Educational Resources Information Center

Smagorinsky, Peter; Barnes, Meghan E.

2014-01-01

In this article, the authors present (Lortie's, D. C. (1975) construct of the apprenticeship of observation--what people learn about teaching from having been students in school--as fundamentally conservative. Students, see teachers "front stage and center like an audience viewing a play," thus learning about teaching in a manner that is…

Undergraduate Physical Education Programs: Issues and Approaches.

ERIC Educational Resources Information Center

Lawson, Hal A., Ed.

Papers presented at the National Professional Preparation Conference in Physical Education were revised and expanded for publication in this monograph. In part I, two papers, "Professional Preparation Conferences: One More Time" (W. G. Anderson) and "Current Context and Future Curriculum" (M. J. Ellis), set the stage for a presentation of…

Workload Management Strategies for Online Educators

ERIC Educational Resources Information Center

Crews, Tena B.; Wilkinson, Kelly; Hemby, K. Virginia; McCannon, Melinda; Wiedmaier, Cheryl

2008-01-01

With increased use of online education, both students and instructors are adapting to the online environment. Online educators must adjust to the change in responsibilities required to teach online, as it is quite intensive during the designing, teaching, and revising stages. The purpose of this study is to examine and update workload management…

Communication: Learning to Write for the Reader.

ERIC Educational Resources Information Center

Todd, Mavis M.

1980-01-01

A new approach to teaching students to write effective business letters is presented. It uses class members as resources, writers, and readers for the assignment. Four stages are described: the interview, discussion of models and format, revision, and the reply. Results of the exercise and suggestions for continued application are included. (CT)

Prosthetic Joint Infections and Cost Analysis?

PubMed

Haddad, F S; Ngu, A; Negus, J J

2017-01-01

Prosthetic joint infection is a devastating complication of arthroplasty surgery that can lead to debilitating morbidity for the patient and significant expense for the healthcare system. With the continual rise of arthroplasty cases worldwide every year, the revision load for infection is becoming a greater financial burden on healthcare budgets. Prevention of infection has to be the key to reducing this burden. For treatment, it is critical for us to collect quality data that can guide future management strategies to minimise healthcare costs and morbidity / mortality for patients. There has been a management shift in many countries to a less expensive 1-stage strategy and in selective cases to the use of debridement, antibiotics and implant retention. These appear very attractive options on many levels, not least cost. However, with a consensus on the definition of joint infection only clarified in 2011, there is still the need for high quality cost analysis data to be collected on how the use of these different methods could impact the healthcare expenditure of countries around the world. With a projected spend on revision for infection at US$1.62 billion in the US alone, this data is vital and urgently needed.

77 FR 26071 - Revisions to the Unregulated Contaminant Monitoring Regulation (UCMR 3) for Public Water Systems

Federal Register 2010, 2011, 2012, 2013, 2014

2012-05-02

... 142 Revisions to the Unregulated Contaminant Monitoring Regulation (UCMR 3) for Public Water Systems... (UCMR 3) for Public Water Systems AGENCY: Environmental Protection Agency (EPA). ACTION: Final rule... action are public water systems (PWSs). All large community and non-transient non-community water systems...

78 FR 41810 - Proposed Revisions to Light Load Handling System and Operations

Federal Register 2010, 2011, 2012, 2013, 2014

2013-07-11

... NUCLEAR REGULATORY COMMISSION [NRC-2013-0148] Proposed Revisions to Light Load Handling System and... soliciting public comment on Section 9.1.4, ``Light Load Handling System and Operations'' of NUREG-0800... Federal Regulations (10 CFR) with respect to the light load handling system and related refueling...

77 FR 44238 - Public Water System Supervision Program Revision for the State of Alabama

Federal Register 2010, 2011, 2012, 2013, 2014

2012-07-27

... ENVIRONMENTAL PROTECTION AGENCY [EPA-R04-OW-2012-0449; FRL-9705-1] Public Water System Supervision... Public Water System Supervision Program. Alabama has adopted the following rule: Public Notification Rule.... Therefore, EPA is tentatively approving this revision to the State of Alabama's Public Water System...

77 FR 60107 - National Estuarine Research Reserve System

Federal Register 2010, 2011, 2012, 2013, 2014

2012-10-02

... DEPARTMENT OF COMMERCE National Oceanic and Atmospheric Administration National Estuarine Research... Research Reserve Management Plan Revisions. SUMMARY: Notice is hereby given that the Estuarine Reserves..., Alaska National Estuarine Research Reserve Management Plan Revisions. The revised management plans...

Revised Total Coliform Rule Assessments and Corrective Actions

EPA Pesticide Factsheets

EPA has developed the Revised Total Coliform Rule Assessment and Corrective Actions Guidance Manual for public water systems (e.g., owners and operators) to assist in complying with the requirements of the Revised Total Coliform Rule.

76 FR 77025 - Office of New Reactors; Notice of Availability of the Final Staff Guidance Section 1.0, Revision...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-12-09

... the Final Staff Guidance Section 1.0, Revision 2 on Introduction and Interfaces AGENCY: Nuclear... Plants: LWR Edition,'' Section 1.0, Revision 2 on ``Introduction and Interfaces'' (Agencywide Documents Access and Management System (ADAMS) Accession No. ML112730393). The NRC staff issues revisions to SRP...

77 FR 9515 - List of Approved Spent Fuel Storage Casks: HI-STORM 100, Revision 8

Federal Register 2010, 2011, 2012, 2013, 2014

2012-02-17

... Storage Casks: HI-STORM 100, Revision 8 AGENCY: Nuclear Regulatory Commission. ACTION: Direct final rule... regulations by revising the Holtec International HI-STORM 100 dry cask storage system listing within the... and safety will be adequately protected. This direct final rule revises the HI-STORM 100 listing in 10...

Cultural and Linguistic Adaptation of a Healthy Diet Text Message Intervention for Hispanic Adults

PubMed Central

Cameron, Linda D.; Durazo, Arturo; Ramirez, A. Susana; Corona, Roberto; Ultreras, Mayra; Piva, Sonia

2017-01-01

Hispanics represent a critical target for culturally-adapted diet interventions. In this formative research, we translated HealthyYouTXT, an mHealth program developed by the U.S. National Cancer Institute, into HealthyYouTXT en Español, a linguistically and culturally appropriate version for Spanish speakers. We report a three-stage, mixed-methods process through which we culturally adapted the text messages, evaluated their acceptability, and revised the program based on the findings. In Stage 1, we conducted initial translations and adaptations of the text libraries using an iterative, principle-guided process. In Stage 2, we used mixed methods including focus groups and surveys with 109 Hispanic adults to evaluate the acceptability and cultural appropriateness of the program. Further, we used survey data to evaluate whether Self-Determination Theory factors (used to develop HealthyYouTXT) of autonomous motivation, controlled motivation, and amotivation and Hispanic cultural beliefs about familism, fatalism, and destiny predict program interest and its perceived efficacy. Mixed-methods analyses revealed substantial interest in HealthyYouTXT, with most participants expressing substantial interest in using it and viewing it as highly efficacious. Both cultural beliefs (i.e., beliefs in destiny and, for men, high familism) and SDT motivations (i.e., autonomy) predicted HealthyYouTXT evaluations, suggesting utility in emphasizing them in messages. Higher destiny beliefs predicted lower interest and perceived efficacy, suggesting they could impede program use. In Stage 3, we implemented the mixed-methods findings to generate a revised HealthyYouTXT en Español. The emergent linguistic principles and multi-stage, multi-methods process can be applied beneficially in health communication adaptations. PMID:28248628

Effects of the Original Versus Revised Bloom's Taxonomy on Lesson Planning Skills: A Turkish Study Among Pre-Service Teachers

NASA Astrophysics Data System (ADS)

Bümen, Nilay T.

2007-07-01

The original taxonomy of educational objectives, developed by Benjamin S.␣Bloom and his associates in the 1950s, was revised several decades later by a group of educationists and cognitive psychologists, who developed a revised taxonomy (RT). This article describes a Turkish study carried out among a group of pre-service teachers in order to compare the influence of the two systems on lesson planning skills. The results confirmed other studies that have indicated a number of advantages of the revised system over the earlier one.

Documentation for 2015 Revisions and Confidentiality Determinations for Petroleum and Natural Gas Systems

EPA Pesticide Factsheets

Regulatory text and supporting information regarding 2015 revisions and confidentiality determinations for petroleum and natural gas system reporters (Subpart W) under EPA’s Greenhouse Gas Reporting Program (GHGRP).

Inter and intra-system size variability of reverse shoulder arthroplasty polyethylene inserts

PubMed Central

Teeter, Matthew G.; Dawson, Matthew T.; Athwal, George S.

2016-01-01

Background: As the incidence of reverse shoulder arthroplasty (RSA) increases, so will the revision burden. At times, the revision surgeon may be faced with a well-fixed component on one side of the joint and revision implants from a different manufacturer. The ability to use glenoid and humeral implants from different manufacturers could simplify the revision procedure. This study hypothesized that across a range of RSA systems, some implants would demonstrate high size compatibility and others would demonstrate low compatibility. Materials and Methods: Six polyethylene inserts each from eight reverse total shoulder arthroplasty systems were examined (48 total inserts). All inserts were scanned using a laboratory micro-computed tomography scanner at 50 μm isotropic voxel spacing, and their surface geometries were reconstructed. The different implant geometries were co-registered, and the three-dimensional (3D) variability between the articular surfaces of the different implant systems was measured. Intrasystem manufacturing variability was also determined by measuring the 3D variability of inserts from the same system. Results: The intersystem polyethylene articular surface deviations between same-size systems were not significantly different (P = 0.61) and were a mean maximum of 60 ± 16 μm (range: 30-80 μm). Intrasystem manufacturing variability was equivalent between all but two models, averaging 49 ± 17 μm (range: 23-99 μm). Discussion: Differences in articular geometry between same-size inserts from different systems were on the same scale as intrasystem manufacturing variability, suggesting that different implant systems of the same nominal diameter could potentially be used interchangeably in revision or extenuating circumstances. Conclusion: The results of this study suggest that surgeons can theoretically interchange same-sized implant components from the different RSA systems tested when conducting revisions. PMID:26980984

Stagewise cognitive development: an application of catastrophe theory.

PubMed

van der Maas, H L; Molenaar, P C

1992-07-01

In this article an overview is given of traditional methodological approaches to stagewise cognitive developmental research. These approaches are evaluated and integrated on the basis of catastrophe theory. In particular, catastrophe theory specifies a set of common criteria for testing the discontinuity hypothesis proposed by Piaget. Separate criteria correspond to distinct methods used in cognitive developmental research. Such criteria are, for instance, the detection of spurts in development, bimodality of test scores, and increased variability of responses during transitional periods. When a genuine stage transition is present, these criteria are expected to be satisfied. A revised catastrophe model accommodating these criteria is proposed for the stage transition in cognitive development from the preoperational to the concrete operational stage.

Cancer of the Esophagus and Esophagogastric Junction: An Eighth Edition Staging Primer

PubMed Central

Rice, Thomas W.; Ishwaran, Hemant; Ferguson, Mark K.; Blackstone, Eugene H.; Goldstraw, Peter

2017-01-01

This primer for eighth edition staging of esophageal and esophagogastric epithelial cancers presents separate classifications for the clinical (cTNM), pathologic (pTNM), and postneoadjuvant pathologic (ypTNM) stage groups, which are no longer shared. For pTNM, pT1 has been subcategorized as pT1a and pT1b for the subgrouping pStage I adenocarcinoma and squamous cell carcinoma. A new, simplified esophagus-specific regional lymph node map has been introduced. Undifferentiated histologic grade (G4) has been eliminated; additional analysis is required to expose histopathologic cell type. Location has been removed as a category for pT2N0M0 squamous cell cancer. The definition of the esophagogastric junction has been revised. ypTNM stage groups are identical for both histopathologic cell types, unlike those for cTNM and pTNM. PMID:27810391

Draft Reformulation. Phase I. General Design Memorandum and Draft Environmental Impact Statement: Geneva-on-the-Lake, Ohio Small Boat Harbor. Revision.

DTIC Science & Technology

1981-04-01

east of Arcola Creek. The Interim Report gave a favorable recommendation for the harbor project and the results were published in House Document No. 91...Draft Reformulation Phase I GDM Re]port (Draft Stage 3 Report) The purpi se of this )rf t Stag. 3 Report Is to present the results of the Stage 3...Iirements for a small-boat harbor at Geneva State Park. Results of the bathymetric survey and sediment sampling program are presented in Appendix A. (3

Client Perceptions of Occupational Health and Safety Management System Assistance Provided by OSHA On-Site Consultation: Results of a Survey of Colorado Small Business Consultation Clients.

PubMed

Autenrieth, Daniel A; Brazile, William J; Gilkey, David P; Reynolds, Stephen J; June, Cathy; Sandfort, Del

2015-01-01

The Occupational Safety and Health Administration (OSHA) On-Site Consultation Service provides assistance establishing occupational health and safety management systems (OHSMS) to small businesses. The Safety and Health Program Assessment Worksheet (Revised OSHA Form 33) is the instrument used by consultants to assess an organization's OHSMS and provide feedback on how to improve a system. A survey was developed to determine the usefulness of the Revised OSHA Form 33 from the perspective of Colorado OSHA consultation clients. One hundred and seven clients who had received consultation services within a six-year period responded to the survey. The vast majority of respondents indicated that the Revised OSHA Form 33 accurately reflected their OHSMS and that information provided on the Revised OSHA Form 33 was helpful for improving their systems. Specific outcomes reported by the respondents included increased safety awareness, reduced injuries, and improved morale. The results indicate that the OHSMS assistance provided by OSHA consultation is beneficial for clients and that the Revised OSHA Form 33 can be an effective tool for assessing and communicating OHSMS results to business management. Detailed comments and suggestions provided on the Revised OSHA Form 33 are helpful for clients to improve their OHSMS.

78 FR 19541 - Proposed Revision to Design of Structures, Components, Equipment and Systems

Federal Register 2010, 2011, 2012, 2013, 2014

2013-04-01

... NUCLEAR REGULATORY COMMISSION [NRC-2013-0041] Proposed Revision to Design of Structures, Components, Equipment and Systems AGENCY: Nuclear Regulatory Commission. ACTION: Standard review plan-draft..., ``Design of Structures, Components, Equipment, and Systems;'' and the request for comment on NUREG-0800...

Review of image defined risk factors in localized neuroblastoma patients: Results of the GPOH NB97 trial.

PubMed

Simon, Thorsten; Hero, Barbara; Benz-Bohm, Gabriele; von Schweinitz, Dietrich; Berthold, Frank

2008-05-01

Recently, an international expert group proposed revision of the International Neuroblastoma Staging System (INSS). Localized disease can be classified as L1 without and as L2 with image defined risk factors (IDRF published in JCO 2005; 23:8483-8489). Our aim was to evaluate IDRF for the prediction of resectability, complications, and outcome. Records of 520 localized neuroblastoma patients of the NB97 trial were reviewed. Patients were retrospectively classified as having IDRF or not. A total of 366 evaluable patients were then analyzed for extent and complications of surgery and the prognostic value of IDRF. Any IDRF was present in 26/160 of stage 1, 49/113 of stage 2, and 64/93 of stage 3 patients. Complete primary resection was achieved in 156/227 patients without IDRF and 43/139 patients with IDRF (P < 0.001). The frequency of complications was higher if any IDRF was present: 37/139 versus 33/227 (P = 0.006). Lack of IDRF was associated with better event free survival (3-year-EFS 86 +/- 2% vs. 75 +/- 4%, P = 0.010), whereas overall survival was similar (3-year-OS 98 +/- 1% vs. 96 +/- 2%, P = 0.462). EFS clearly depended on INSS stage (3-year-EFS 93 +/- 2% in stage 1, 78 +/- 4% in stage 2, and 69 +/- 5% in stage 3, P < 0.001). OS was not different (3-year-OS 98 +/- 1% vs. 99 +/- 1% vs. 94 +/- 2%, P = 0.056). Multivariate analysis demonstrated an impact of INSS stage on EFS only. IDRF were not shown to be significant for predicting EFS or OS. IDRF were useful in predicting risk and completeness of operation. IDRF failed as independent risk predictors in localized neuroblastoma. INSS more precisely identified patients with poor prognosis. (c) 2008 Wiley-Liss, Inc.

Cerebrospinal fluid inflammatory markers in patients with multiple sclerosis: a pilot study.

PubMed

Matejčíková, Z; Mareš, J; Přikrylová Vranová, H; Klosová, J; Sládková, V; Doláková, J; Zapletalová, J; Kaňovský, P

2015-02-01

Multiple sclerosis (MS) is an inflammatory demyelinating disease of the central nervous system. Autoimmune inflammation is common in the early stages of MS. This stage is followed by the neurodegenerative process. The result of these changes is axon and myelin breakdown. Although MS is according to McDonald's revised diagnostic criteria primarily a clinical diagnosis, paraclinical investigation methods are an important part in the diagnosis of MS. In common practice, magnetic resonance imaging of the brain and spinal cord, examination of cerebrospinal fluid (CSF) and examination of visual evoked potentials are used. There are an increasing number of studies dealing with biomarkers in CSF and their role in the diagnosis and treatment of MS. We hypothesized that the levels of some markers could be changed in MS in comparison with controls. We studied five inflammatory markers [interleukin-6 (IL-6), interleukin-8, interleukin-10 (IL-10), beta-2-microglobulin, orosomucoid]. CSF and serum levels of inflammatory markers were assessed in 38 patients with newly diagnosed MS meeting McDonald's revised diagnostic criteria and in 28 subjects as a control group (CG). Levels of beta-2-microglobulin and interleukin-8 in CSF were found to be significantly higher in MS patients in comparison to CG (p < 0.001 resp. p = 0.007). No differences in other CSF markers (IL-6, IL-10 and orosomucoid) and serum levels of all markers between both groups were found. The levels of two studied inflammatory markers were found to be increased at the time of first clinical symptoms of MS. Research on the role of inflammatory and neurodegenerative markers in MS should continue.

Clinical motivation and the surgical safety checklist.

PubMed

Yu, X; Huang, Y; Guo, Q; Wang, Y; Ma, H; Zhao, Y

2017-03-01

Although the surgical safety checklist (SSC) has been adopted worldwide, its efficacy can be diminished by poor clinical motivation. Systematic methods for improving implementation are lacking. A multicentre prospective study was conducted in 2015 in four academic/teaching hospitals to investigate changes during revision of the SSC for content, staffing and workflow. All modifications were based on feedback from medical staff. Questionnaires were used to monitor dynamic changes in surgeons', nurses' and anaesthetists' perceptions. Complete information was obtained from 30 654 operations in which the newly developed SSC system was used. Implementation quality was evaluated in 1852 operations before, and 1822 after the changes. The revised SSC content was simplified from 34 to 22 items. Anaesthetists achieved widespread recommendation as SSC coordinators. Completion rates of all stages reached over 80·0 per cent at all sites (compared with 10·2-59·5 per cent at the sign-out stage in the baseline survey). There was a significant change in doctors who participated (for example, surgeon: from 24·6 to 64·5 per cent at one site). The rates of hasty (15·1-33·7 per cent) or casual (0·4-4·4 per cent) checking decreased to less than 6·0 per cent overall. Perceptions about the SSC were studied from 2211 forms. They improved, with a converging trend among the three different professions, to a uniform 80·0 per cent agreeing on the need for its regular use. Medical staff members are both the users and owners of the SSC. High-quality SSC implementation can be achieved by clinically motivated adaptation. © 2017 BJS Society Ltd Published by John Wiley & Sons Ltd.

Revisions of the Learning Mastery Systems for the Harper and Row Grades One and Two and the Macmillan Bank Street Grade One Reading Series.

ERIC Educational Resources Information Center

Maeder, Jacqueline; And Others

The revisions on the Learning Mastery Systems (LMSs) for the Harper & Row grade-one and grade-two and the Macmillan Bank Street grade-one reading programs are outlined in this document. A rationale for the revisions is presented. An LMS is a set of materials and procedures prepared by the southwest Regional Laboratory (SWRL) as an…

PCMO L01-Setting Specifications for Biological Investigational Medicinal Products.

PubMed

Krause, Stephan O

2015-01-01

This paper provides overall guidance and best practices for the setting of specifications for clinical biological drug substances and drug products within the framework of ICH guidelines on pharmaceutical development [Q8(R2) and Q11], quality risk management (Q9), and quality systems (Q10). A review is provided of the current regulatory expectations for the specification setting process as part of a control strategy during product development, pointing to existing challenges for the investigational new drug/investigational medicinal product dossier (IND/IMPD) sponsor. A case study illustrates how the investigational medicinal product specification revision process can be managed within a flexible quality system, and how specifications can be set and justified for early and late development stages. This paper provides an overview for the setting of product specifications for investigational medicinal products used in clinical trials. A case study illustrates how product specifications of investigational medicinal products can be justified and managed within a modern product quality system. © PDA, Inc. 2015.

Guidelines for the revision of practice data sets.

PubMed

Culpepper, L

1980-09-01

As residencies and practices mature, a frequent undertaking is the revision of initial data sets and information systems. This report presents an expanded data set which has been developed in the Family Medicine Residency Program at the University of Rochester and suggests guidelines for the selection of data items and revision of existing information systems. In the selection of data items it is important to carefully identify planned use and definition of terms, as well as to carefully consider the complexity of the items and the realistic ability of personnel to maintain and update both individual items and the entire set of data. The implementation of a revised data system requires careful planning and frequent involvement of staff to insure accurate collection of information and proper managment of workload. The implementation phase should not be considered complete until an ongoing system for reviewing and maintaining data is established.

78 FR 40891 - Revisions to the Export Administration Regulations: Military Vehicles; Vessels of War...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-07-08

..., among other things, reducing incentives for foreign manufacturers to design out and avoid U.S.-origin... designed'' for military applications, then it is identified in one of the new ``600 series'' ECCNs created..., that have reached a stage in manufacture where they are clearly identifiable by material composition...

Year 6 Planning Exemplification 3. National Literacy Strategy.

ERIC Educational Resources Information Center

Department for Education and Skills, London (England).

Third in a series of booklets designed to assist Year 6 teachers with planning instruction to meet objectives of the National Literacy Strategy, this booklet contains Summer Term planning exemplification for three "revision" units (Narrative, Poetry and Non-fiction) prior to the Key Stage 2 tests and one unit after the tests (Extended…

Determining Factors for Cyberbullying Prevention Programmes

ERIC Educational Resources Information Center

Manzuoli, Cristina Hennig; Medina, Liliana Cuesta

2017-01-01

This study reports on the first stages of a larger project to develop an ICT-supported cyberbullying prevention programme that fosters development of children's communication skills for the safe use of social media. To establish baseline data on the incidence and growth of cyberbullying in Bogotá, Colombia, we applied a Revised School Violence…

78 FR 7681 - Energy Conservation Program for Consumer Products: Test Procedures for Residential Furnaces and...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-02-04

.... Description of AFUE Inflation Issues Associated with Omitting Cool-Down and Heat-Up Testing for Two-Stage and... to revise a provision concerning the insulation of the flue collector box in order to ensure the... furnaces and boilers that employ the optional procedure to skip [[Page 7683

75 FR 74073 - Endangered and Threatened Wildlife and Plants; Draft Revised Recovery Plan for the Northern...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-11-30

... population program HexSim. Though still at preliminary draft stage, population response simulations from this portion of the modeling process are available for public review by request from our office. These simulations do not estimate what will occur in the future, but provide comparative information on potential...

The Testing of a Desegregation Planning Model in Black and White Neighborhoods in Milwaukee, Wisconsin.

ERIC Educational Resources Information Center

Ollie, Bert W., Jr.

A study was conducted to test a desegregation impact planning model in predominantly black and predominantly white neighborhoods in Milwaukee, Wisconsin. The model tested has seven planning stages, pre-planning through the implementation and revision cycle. The model features feedback loops which permit desegregation planners to get community…

77 FR 39156 - Airworthiness Directives; Rolls-Royce Deutschland Ltd & Co KG (RRD) Turbofan Engines

Federal Register 2010, 2011, 2012, 2013, 2014

2012-07-02

... Administration (FAA), DOT. ACTION: Final rule; rescission. SUMMARY: We are rescinding an airworthiness directive... resulted from the need to reduce the published life limits of high-pressure (HP) turbine stage 1 discs... are rescinding the existing AD because RRD has revised the approved published life limits of these...

Massachusetts Adult Basic Education Curriculum Framework for Mathematics and Numeracy

ERIC Educational Resources Information Center

Massachusetts Department of Education, 2005

2005-01-01

Over the past number of years, several initiatives have set the stage for writing the Massachusetts ABE (Adult Basic Education) Curriculum Frameworks for Mathematics and Numeracy. This current version of the "Massachusetts ABE Mathematics Curriculum Frameworks" is a second revision of that first framework, but it is heavily influenced by…

Iranian EFL Students' Writing Strategies for Error Correction: An MI Approach

ERIC Educational Resources Information Center

Ansari, Dariush Nejad; Varnosfadrani, Azizollah Dabaghi

2010-01-01

This study tries to shed some light on the Iranian EFL students' writing strategies at the revision stage of the process of writing in relation to students' interpersonal or intrapersonal intelligences. A total of 73 students majoring in English participated in this investigation. The results indicated that there was a significant relationship…

Department of Defense / General Services Administration / National...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-12-20

... ADMINISTRATION (FAR) Final Rule Stage 492. FAR CASE 2006-005, HUBZONE PROGRAM REVISIONS Legal Authority: 40 USC 121(c); 10 USC ch 137; 42 USC 2473(c) Abstract: The Civilian Agency Acquisition Council and the... REPORTING PROCEDURES Legal Authority: 40 USC 121(c); 10 USC ch 137; 42 USC 2473(c) Abstract: The Civilian...

The Battle of Bunker Hill: Now We Are at War. Revised. Teaching with Historic Places.

ERIC Educational Resources Information Center

Brue, Sandy

This lesson describes and discusses the Battle of Bunker Hill (Massachusetts), which took place during the Revolutionary War. The lesson plan contains eight sections: (1) "About this Lesson"; (2) "Getting Started: Inquiry Question"; (3) "Setting the Stage: Historical Context"; (4) "Locating the Site: Maps"…

Re-Visioning Teacher Education in Pennsylvania.

ERIC Educational Resources Information Center

Hawley, Willis D.; Evertson, Carolyn M.

This paper deals with the need to redefine and comprehensively restructure teacher education programs, emphasizing what teachers can best learn, in what contexts, and at what stages of their cognitive and social development as professionals. The report is organized into 5 parts: Part 1 concentrates on what schools should do that they are not…

An Ethnographic Approach to Syllabus Design: A Case Study of the Indian Institute of Science, Bangalore.

ERIC Educational Resources Information Center

Ramani, Esther; And Others

1988-01-01

Argues for an ethnographic reorientation to needs analysis and syllabus design in English for specific purposes in advanced postgraduate centers of science and technology. The seven-stage framework (specify learners, analyze needs, specify enabling objectives, select materials, identify teaching/learning activities, evaluate, and revise) used to…

The Epidemiology of Revision Anterior Cruciate Ligament Reconstruction in Adults from Ontario, Canada

PubMed Central

Leroux, Timothy; Wasserstein, David; Dwyer, Tim; Ogilvie-Harris, Darrell; Marks, Paul H.; Bach, Bernard R.; Townley, John; Mahomed, Nizar; Chahal, Jaskarndip

2015-01-01

Objectives: The morbidity associated with revision anterior cruciate ligament reconstruction (ACLR) is largely unknown. The objective of this study was to determine the rate of and risk factors for re-revision, re-operation, and re-admission following revision ACLR in the general population. Methods: All patients who underwent first revision ACLR in Ontario, Canada from January 2004 to December 2010 were identified and followed to December 2012. Exclusions included age (<16 years), previous osteotomy, or multi-ligament knee reconstruction. The main outcome was re-revision ACLR. Secondary outcomes included re-operation [irrigation and debridement (I&D), meniscectomy, manipulation under anesthesia (MUA), contralateral ACLR, and total knee arthroplasty (TKA)], and re-admission within 90 days of surgery. Survival to re-revision was determined using the Kaplan-Meier (KM) approach. A Cox proportional hazards model or logistic regression were used to determine the influence of patient factors (age, sex, neighborhood income quintile, and comorbidity), surgical factors (graft choice, concurrent meniscal procedure, and fixation method), and provider factors (surgeon volume, surgeon years in practice, and hospital status) on outcomes. A post-hoc analysis was performed to determine the influence of the aforementioned factors on overall post-operative infection risk, including both operative and non-operative cases. Results: Overall, 827 patients were included (median age: 30 years; 58.8% males). Single stage revisions comprised 92.9% of cases, and a meniscal procedure (repair or debridement) was performed in 45.3% of cases. The re-revision rate at a mean follow-up of 4.8±2.2 years was 4.4%, and the five-year survival rate was 95.4% (Figure 1). The rates of I&D, meniscectomy, contralateral ACLR, and re-admission were 0.8%, 3.1%, 3.4%, and 4.1%, respectively. MUA and TKA were rare. Young age significantly increased contralateral ACLR risk (risk decreased by 5.1% with each year of age above 16 years, p=0.02), but not re-revision ACLR risk. Low surgeon annual volume of revision ACLR [<4 revisions/year: odds ratio (OR) 1.2, p=0.02)] and male sex (OR 13.3, p=0.01) significantly increased overall infection risk, while male sex also influenced I&D risk. No other factors significantly influenced re-revision, re-operation, or re-admission risk. Conclusion: Re-revision, re-operation, and re-admission rates following revision ACLR are low. The risk of I&D, overall infection, and contralateral ACLR were influenced by male sex, low surgeon volume, and young age, respectively. This is the first study of this magnitude to determine rates of and risk factors for morbidity following revision ACLR, providing clinicians with reference data from the general population.

76 FR 66950 - Privacy Act; Notice of Revision of System of Records, the Single Family Housing Enterprise Data...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-10-28

... Management System (SAMS) 6. F17--Computerized Home Underwriting Mortgage System (CHUMS) 7. F42D--Single... Federal Reserve Board (FRB) 14. F71A--Generic Debt Management System (GDEBT) 15. A15--Geocoding Service... Revision of System of Records, the Single Family Housing Enterprise Data Warehouse AGENCY: Office of the...

Validation of the Japanese disease severity classification and the GAP model in Japanese patients with idiopathic pulmonary fibrosis.

PubMed

Kondoh, Shun; Chiba, Hirofumi; Nishikiori, Hirotaka; Umeda, Yasuaki; Kuronuma, Koji; Otsuka, Mitsuo; Yamada, Gen; Ohnishi, Hirofumi; Mori, Mitsuru; Kondoh, Yasuhiro; Taniguchi, Hiroyuki; Homma, Sakae; Takahashi, Hiroki

2016-09-01

The clinical course of idiopathic pulmonary fibrosis (IPF) shows great inter-individual differences. It is important to standardize the severity classification to accurately evaluate each patient׳s prognosis. In Japan, an original severity classification (the Japanese disease severity classification, JSC) is used. In the United States, the new multidimensional index and staging system (the GAP model) has been proposed. The objective of this study was to evaluate the model performance for the prediction of mortality risk of the JSC and GAP models using a large cohort of Japanese patients with IPF. This is a retrospective cohort study including 326 patients with IPF in the Hokkaido prefecture from 2003 to 2007. We obtained the survival curves of each stage of the GAP and JSC models to perform a comparison. In the GAP model, the prognostic value for mortality risk of Japanese patients was also evaluated. In the JSC, patient prognoses were roughly divided into two groups, mild cases (Stages I and II) and severe cases (Stages III and IV). In the GAP model, there was no significant difference in survival between Stages II and III, and the mortality rates in the patients classified into the GAP Stages I and II were underestimated. It is difficult to predict accurate prognosis of IPF using the JSC and the GAP models. A re-examination of the variables from the two models is required, as well as an evaluation of the prognostic value to revise the severity classification for Japanese patients with IPF. Copyright © 2016 The Japanese Respiratory Society. Published by Elsevier B.V. All rights reserved.

78 FR 41285 - Airworthiness Directives; Pilatus Aircraft Ltd. Airplanes

Federal Register 2010, 2011, 2012, 2013, 2014

2013-07-10

... manual). The limitations were revised to include an emergency fuel control system adjustment test. We are... a 300 Flight Hour (FH) hour inspection on the Emergency Fuel Control System (FCS). For the reason...., maintenance manual). The limitations were revised to include an emergency fuel control system adjustment test...

76 FR 61293 - Extension of Public Comment Period: Mandatory Reporting of Greenhouse Gases: Technical Revisions...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-10-04

... Electronics Manufacturing and the Petroleum and Natural Gas Systems Categories of the Greenhouse Gas Reporting...: Technical Revisions to the Electronics Manufacturing and the Petroleum and Natural Gas Systems Categories of... to the Electronics Manufacturing and the Petroleum and Natural Gas Systems Categories of the...

75 FR 9895 - Public Water System Supervision Program Revision for the State of Oklahoma

Federal Register 2010, 2011, 2012, 2013, 2014

2010-03-04

... through Friday, at the following offices: Oklahoma Department of Environmental Quality, Water Quality... ENVIRONMENTAL PROTECTION AGENCY [FRL-9121-9] Public Water System Supervision Program Revision for... Public Water System Supervision Program adopting new regulations for the Lead and Copper Rule (LCR) Short...

77 FR 58421 - Model Safety Evaluation for Plant-Specific Adoption of Technical Specifications Task Force...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-09-20

... Ventilation System Surveillance Requirements To Operate for 10 Hours per Month,'' Using the Consolidated Line... currently require operating the ventilation system for at least 10 continuous hours with the heaters... Technical Specifications (TSs) Task Force (TSTF) Traveler TSTF-522, Revision 0, ``Revise Ventilation System...

77 FR 16869 - Proposed Models for Plant-Specific Adoption of Technical Specifications Task Force Traveler TSTF...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-03-22

... Ventilation System Surveillance Requirements to Operate for 10 hours per Month.'' DATES: Comment period....1, which currently require operating the heaters in the respective systems for at least 10... Adoption of Technical Specifications Task Force Traveler TSTF-522, Revision 0, ``Revise Ventilation System...

Gender, renal function, and outcomes on the liver transplant waiting list: assessment of revised MELD including estimated glomerular filtration rate.

PubMed

Myers, Robert P; Shaheen, Abdel Aziz M; Aspinall, Alexander I; Quinn, Robert R; Burak, Kelly W

2011-03-01

The Model for End-Stage Liver Disease (MELD) allocation system for liver transplantation (LT) may present a disadvantage for women by including serum creatinine, which is typically lower in females. Our objectives were to investigate gender disparities in outcomes among LT candidates and to assess a revised MELD, including estimated glomerular filtration rate (eGFR), for predicting waiting list mortality. Adults registered for LT between 2002 and 2007 were identified using the UNOS database. We compared components of MELD, MDRD-derived eGFR, and the 3-month probability of LT and death between genders. Discrimination of MELD, MELDNa, and revised models including eGFR for mortality were compared using c-statistics. A total of 40,393 patients (36% female) met the inclusion criteria; 9% died and 24% underwent LT within 3 months of listing. Compared with men, women had lower median serum creatinine (0.9 vs. 1.0 mg/dl), eGFR (72 vs. 83 ml/min/1.73 m(2)), and mean MELD (16.5 vs. 17.2; all p <0.0005), but within most MELD strata, had higher bilirubin and INR. After adjusting for relevant covariates including creatinine and body weight, women were less likely than men to receive a LT (hazard ratio [HR] 0.85; 95% CI 0.79-0.87) and had greater 3-month mortality (HR 1.13; 95% CI 1.05-1.21). Revision of MELD and MELDNa to include eGFR did not improve discrimination for 3-month mortality (c-statistics: MELD 0.896, MELD-eGFR 0.894, MELDNa 0.911, MELDNa-eGFR 0.905). Women are disadvantaged under MELD potentially due to its inclusion of creatinine. However, since including eGFR in MELD does not improve mortality prediction, alternative refinements are necessary. Copyright © 2010 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.

Crestal fault geometries reveal late halokinesis and collapse of the Samson Dome, Northern Norway: Implications for petroleum systems in the Barents Sea

NASA Astrophysics Data System (ADS)

Mattos, Nathalia H.; Alves, Tiago M.; Omosanya, Kamaldeen O.

2016-10-01

This paper uses 2D and high-quality 3D seismic reflection data to assess the geometry and kinematics of the Samson Dome, offshore Norway, revising the implications of the new data to hydrocarbon exploration in the Barents Sea. The study area was divided into three (3) zones in terms of fault geometries and predominant strikes. Displacement-length (D-x) and Throw-depth (T-z) plots showed faults to consist of several segments that were later dip-linked. Interpreted faults were categorised into three families, with Type A comprising crestal faults, Type B representing large E-W faults, and Type C consisting of polygonal faults. The Samson Dome was formed in three major stages: a) a first stage recording buckling of the post-salt overburden and generation of radial faults; b) a second stage involving dissolution and collapse of the dome, causing subsidence of the overburden and linkage of initially isolated fault segments; and c) a final stage in which large fault segments were developed. Late Cretaceous faults strike predominantly to the NW, whereas NE-trending faults comprise Triassic structures that were reactivated in a later stage. Our work provides scarce evidence for the escape of hydrocarbons in the Samson Dome. In addition, fault analyses based on present-day stress distributions indicate a tendency for 'locking' of faults at depth, with the largest leakage factors occurring close to the surface. The Samson Dome is an analogue to salt structures in the Barents Sea where oil and gas exploration has occurred with varied degrees of success.

Prostate intensity-modulated radiotherapy planning in seven mouse clicks: Development of a class solution for cancer.

PubMed

Wood, Maree; Fonseca, Amara; Sampson, David; Kovendy, Andrew; Westhuyzen, Justin; Shakespeare, Thomas; Turnbull, Kirsty

2016-01-01

The aim of the retrospective study was to develop a planning class solution for prostate intensity-modulated radiotherapy (IMRT) that achieved target and organs-at-risk (OAR) doses within acceptable departmental protocol criteria using the Monaco treatment planning system (Elekta-CMS Software, MO, USA). Advances in radiation therapy technology have led to a re-evaluation of work practices. Class solutions have the potential to produce highly conformal plans in a time-efficient manner. Using data from intermediate and high risk prostate cancer patients, a stepwise quality improvement model was employed. Stage 1 involved the development of a broadly based treatment template developed across 10 patients. Stage 2 involved template refinement and clinical audit ( n  = 20); Stage 3, template review ( n  = 50) and Stage 4 an assessment of a revised template against the actual treatment plan involving 72 patients. The computer algorithm that comprised the Stage 4 template met clinical treatment criteria for 82% of patients. Minor template changes were required for a further 13% of patients. Major changes were required in 4%; one patient could not be assessed. The average calculation time was 13 min and involved seven mouse clicks by the planner. Thus, the new template met treatment criteria or required only minor changes in 95% of prostate patients; this is an encouraging result suggesting improvements in planning efficiency and consistency. It is feasible to develop a class solution for prostate IMRT using a stepwise quality improvement model which delivers clinically acceptable plans in the great majority of prostate cases.

Revision Knee Arthroplasty in Patients with Inherited Bleeding Disorders: A Single-Center Experience

PubMed Central

Kotela, Andrzej; Wilk-Frańczuk, Magdalena; Żbikowski, Piotr; Łęgosz, Paweł; Ambroziak, Paweł; Kotela, Ireneusz

2017-01-01

Background The results of total knee arthroplasty (TKA) in patients with inherited bleeding disorders (IBDs) are poorer when compared with those in the general population, with a notably higher risk of complications and higher revision rates. Thus, revision procedures are becoming a growing concern in this group of patients. The aim of this study was to evaluate the results of revision TKA in patients with IBD. Material/Methods A retrospective cohort study with longitudinal assessment of hemophilia patients scheduled for revision TKA between January 2010 and September 2015 was performed. The clinical status of the patients was assessed based on the Knee Society Score, and the Numeric Rating Scale was used to assess knee pain severity and patient satisfaction with the surgery. Radiological examination, post-operative complications, and reinterventions were recorded and analyzed. Results Very good results were obtained in all patients treated for aseptic loosening of the implant. However, inferior results were found in cases with infection. All patients operated on for aseptic loosening required only single-stage TKA, whereas patients with infection underwent multiple interventions. Complications were observed only in cases with infection. Conclusions Our study clearly outlined the differences in results based on failure mode, with far inferior results obtained in cases with infection. Given the lack of data in this area as well as the high specificity of this population, further high-quality studies are needed. PMID:28068306

MARIKA - A model revision system using qualitative analysis of simulations. [of human orientation system

NASA Technical Reports Server (NTRS)

Groleau, Nicolas; Frainier, Richard; Colombano, Silvano; Hazelton, Lyman; Szolovits, Peter

1993-01-01

This paper describes portions of a novel system called MARIKA (Model Analysis and Revision of Implicit Key Assumptions) to automatically revise a model of the normal human orientation system. The revision is based on analysis of discrepancies between experimental results and computer simulations. The discrepancies are calculated from qualitative analysis of quantitative simulations. The experimental and simulated time series are first discretized in time segments. Each segment is then approximated by linear combinations of simple shapes. The domain theory and knowledge are represented as a constraint network. Incompatibilities detected during constraint propagation within the network yield both parameter and structural model alterations. Interestingly, MARIKA diagnosed a data set from the Massachusetts Eye and Ear Infirmary Vestibular Laboratory as abnormal though the data was tagged as normal. Published results from other laboratories confirmed the finding. These encouraging results could lead to a useful clinical vestibular tool and to a scientific discovery system for space vestibular adaptation.

Revised Total Coliform Rule Implementation in Wyoming and on Tribal Lands in EPA Region 8

EPA Pesticide Factsheets

The Revised Total Coliform Rule (RTCR) aims to increase public health protection through the reduction of potential pathways for fecal contamination in the distribution system of a public water system (PWS).

Children's human figure drawings do not measure intellectual ability.

PubMed

Willcock, Emma; Imuta, Kana; Hayne, Harlene

2011-11-01

Children typically follow a well-defined series of stages as they learn to draw, but the rate at which they progress through these stages varies from child to child. Some experts have argued that these individual differences in drawing development reflect individual differences in intelligence. Here we assessed the validity of a drawing test that is commonly used to assess children's intellectual abilities. In a single study, 125 5- and 6-year-olds completed the Draw-A-Person: A Quantitative Scoring System (DAP:QSS) and the Wechsler Preschool and Primary Scale of Intelligence-Revised (WPPSI-R) or the Wechsler Abbreviated Scale of Intelligence (WASI). Although there was a statistically significant correlation between scores on the DAP:QSS and scores on the Wechsler tests, when the scores of individual children were examined, the DAP:QSS yielded a high number of false positives and false negatives for low intellectual functioning. We conclude that the DAP:QSS is not a valid measure of intellectual ability and should not be used as a screening tool. Copyright © 2011 Elsevier Inc. All rights reserved.

The economic impact of revision otologic surgery.

PubMed

Nadimi, Sahar; Leonetti, John P; Pontikis, George

2016-03-01

Revision otologic surgery places a significant economic burden on patients and the healthcare system. We conducted a retrospective chart analysis to estimate the economic impact of revision canal-wall-down (CWD) mastoidectomy. We reviewed the medical records of all 189 adults who had undergone CWD mastoidectomy performed by the senior author between June 2006 and August 2011 at Loyola University Medical Center in Maywood, Ill. Institutional charges and collections for all patients were extrapolated to estimate the overall healthcare cost of revision surgery in Illinois and at the national level. Of the 189 CWD mastoidectomies, 89 were primary and 100 were revision procedures. The total charge for the revision cases was $2,783,700, and the net reimbursement (collections) was $846,289 (30.4%). Using Illinois Hospital Association data, we estimated that reimbursement for 387 revision CWD mastoidectomies that had been performed in fiscal year 2011 was nearly $3.3 million. By extrapolating our data to the national level, we estimated that 9,214 patients underwent revision CWD mastoidectomy in the United States during 2011, which cost the national healthcare system roughly $76 million, not including lost wages and productivity. Known causes of failed CWD mastoidectomies that often result in revision surgery include an inadequate meatoplasty, a facial ridge that is too high, residual diseased air cells, and recurrent cholesteatoma. A better understanding of these factors can reduce the need for revision surgery, which could have a positive impact on the economic strain related to this procedure at the local, state, and national levels.

Development and validation of the Australian version of the Birth Satisfaction Scale-Revised (BSS-R).

PubMed

Jefford, Elaine; Hollins Martin, Caroline J; Martin, Colin R

2018-02-01

The 10-item Birth Satisfaction Scale-Revised (BSS-R) has recently been endorsed by international expert consensus for global use as the birth satisfaction outcome measure of choice. English-language versions of the tool include validated UK and US versions; however, the instrument has not, to date, been contextualised and validated in an Australian English-language version. The current investigation sought to develop and validate an English-language version of the tool for use within the Australian context. A two-stage study. Following review and modification by expert panel, the Australian BSS-R (A-BSS-R) was (Stage 1) evaluated for factor structure, internal consistency, known-groups discriminant validity and divergent validity. Stage 2 directly compared the A-BSS-R data set with the original UK data set to determine the invariance characteristics of the new instrument. Participants were a purposive sample of Australian postnatal women (n = 198). The A-BSS-R offered a good fit to data consistent with the BSS-R tridimensional measurement model and was found to be conceptually and measurement equivalent to the UK version. The A-BSS-R demonstrated excellent known-groups discriminant validity, generally good divergent validity and overall good internal consistency. The A-BSS-R represents a robust and valid measure of the birth satisfaction concept suitable for use within Australia and appropriate for application to International comparative studies.

A Revised Total Coliform Rule Guide for Small Public Water Systems

EPA Pesticide Factsheets

This document aims to assist small water systems serving 1,000 persons with fewer in complying with the requirements of the Revised Total Coliform Rule (RTCR). It is divided into four parts, Parts A, B, C and D.

Phylogenetic-based nomenclatural proposals for Ophiocordycipitaceae (Hypocreales) with new combinations in Tolypocladium.

PubMed

Quandt, C Alisha; Kepler, Ryan M; Gams, Walter; Araújo, João P M; Ban, Sayaka; Evans, Harry C; Hughes, David; Humber, Richard; Hywel-Jones, Nigel; Li, Zengzhi; Luangsa-Ard, J Jennifer; Rehner, Stephen A; Sanjuan, Tatiana; Sato, Hiroki; Shrestha, Bhushan; Sung, Gi-Ho; Yao, Yi-Jian; Zare, Rasoul; Spatafora, Joseph W

2014-06-01

Ophiocordycipitaceae is a diverse family comprising ecologically, economically, medicinally, and culturally important fungi. The family was recognized due to the polyphyly of the genus Cordyceps and the broad diversity of the mostly arthropod-pathogenic lineages of Hypocreales. The other two cordyceps-like families, Cordycipitaceae and Clavicipitaceae, will be revised taxonomically elsewhere. Historically, many species were placed in Cordyceps, but other genera have been described in this family as well, including several based on anamorphic features. Currently there are 24 generic names in use across both asexual and sexual life stages for species of Ophiocordycipitaceae. To reflect changes in Art. 59 in the International Code of Nomenclature for algae, fungi, and plants (ICN), we propose to protect and to suppress names within Ophiocordycipitaceae, and to present taxonomic revisions in the genus Tolypocladium, based on rigorous and extensively sampled molecular phylogenetic analyses. When approaching this task, we considered the principles of priority, monophyly, minimizing taxonomic revisions, and the practical utility of these fungi within the wider biological research community.

Redescription of Clinostomum phalacrocoracis metacercariae (Digenea: Clinostomidae) in cichlids from Lake Kinneret, Israel

PubMed Central

Caffara, Monica; Davidovich, Nadav; Falk, Rama; Smirnov, Margarita; Ofek, Tamir; Cummings, David; Gustinelli, Andrea; Fioravanti, Maria L.

2014-01-01

Clinostomidae are digeneans characterized by a complex taxonomic history, continuously under revision based on both morphological and molecular analysis. Among the 14 species considered valid so far Clinostomum phalacrocoracis has been well described only at the adult stage, whereas the morphology of the metacercarial stage has been reported only once. During a parasitological survey carried out on 262 wild cichlids sampled from Lake Kinneret (Israel) metacercariae referable to C. phalacrocoracis were found in 18 fingerlings. In this study, we report this clinostomid species for the first time in wild fish from Israel describing the metacercarial stage of Clinostomum phalacrocoracis, coupling its morphological description with molecular analysis carried out on ITS rDNA and COI mtDNA sequences. PMID:24986336

The Alcohol Services Reporting System (ASRS) Revision Study.

ERIC Educational Resources Information Center

Borkman, Thomasina

This document reports a revision study of the California Alcohol Services Reporting System (ASRS), a system which consists of a structure of definitions and categories of services, a budget form of planned alcohol services, instructions for the county plan, and the report of expenditures. The study problem is that the ASRS structure of…

78 FR 41436 - Proposed Revision to Treatment of Non-Safety Systems for Passive Advanced Light Water Reactors

Federal Register 2010, 2011, 2012, 2013, 2014

2013-07-10

... Safety Analysis Reports for Nuclear Power Plants: LWR Edition,'' on a proposed new section to its... revised position on the treatment of the high winds external hazard for certain RTNSS structures, systems... winds external hazard for certain RTNSS structures, systems and components (SSCs). This position differs...

76 FR 37300 - Mandatory Reporting of Greenhouse Gases: Petroleum and Natural Gas Systems: Revisions to Best...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-06-27

... natural gas. 211112 Natural gas liquid extraction facilities. Table 1 of this preamble is not intended to... Mandatory Reporting of Greenhouse Gases: Petroleum and Natural Gas Systems: Revisions to Best Available... regulations for Petroleum and Natural Gas Systems of the Greenhouse Gas Reporting Rule. Specifically, EPA is...

77 FR 18809 - Notice of Tentative Approval and Opportunity for Public Comment and Public Hearing for Public...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-03-28

... Public Comment and Public Hearing for Public Water System Supervision Program Revision for Virginia... revising its approved Public Water System Supervision Program. The Commonwealth has adopted the drinking... by reducing public water system consumers' risk of microbial illness from drinking water. EPA has...

IDC System Specification Document Version 1.1.

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

Harris, James M.; Lober, Randall R.

2015-02-01

This document contains the system specifications derived to satisfy the system requirements found in the IDC System Requirements Document for the IDC Reengineering Phase 2 project. Revisions Version Date Author/Team Revision Description Authorized by V1.0 12/2014 IDC Reengineering Project Team Initial delivery M. Harris V1.1 2/2015 IDC Reengineering Project Team Iteration I2 Review Comments M. Harris

Modification of the explant system for the removal of well fixed hip resurfacing sockets.

PubMed

Rawal, Jaikirty S; Soler, J Agustin; Rhee, Jae S; Dobson, Michael H; Konan, Sujith; Haddad, Fares S

2010-10-01

A major concern during revision hip arthroplasty is acetabular bone loss during the extraction of well-fixed acetabular components. Despite the good early survivorship of resurfacing prostheses, revision surgery may be necessary. We recommend the use of the Explant acetabular extraction system (Zimmer, Warsaw, Ind) with a trial liner to preserve acetabular bone stock. We present 2 cases of revised resurfacings using this technique, demonstrating minimal interference to the remaining acetabular bone. Copyright © 2010 Elsevier Inc. All rights reserved.

77 FR 58616 - Pipeline Safety: Information Collection Activities, Revision to Gas Transmission and Gathering...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-09-21

... DEPARTMENT OF TRANSPORTATION Pipeline and Hazardous Materials Safety Administration [Docket No. PHMSA-2012-0024] Pipeline Safety: Information Collection Activities, Revision to Gas Transmission and Gathering Pipeline Systems Annual Report, Gas Transmission and Gathering Pipeline Systems Incident Report...

48 CFR 30.202-3 - Amendments and revisions.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 48 Federal Acquisition Regulations System 1 2011-10-01 2011-10-01 false Amendments and revisions. 30.202-3 Section 30.202-3 Federal Acquisition Regulations System FEDERAL ACQUISITION REGULATION GENERAL CONTRACTING REQUIREMENTS COST ACCOUNTING STANDARDS ADMINISTRATION CAS Program Requirements 30.202...

Developing a point-of-care electronic medical record system for TB/HIV co-infected patients: experiences from Lighthouse Trust, Lilongwe, Malawi.

PubMed

Tweya, Hannock; Feldacker, Caryl; Gadabu, Oliver Jintha; Ng'ambi, Wingston; Mumba, Soyapi L; Phiri, Dave; Kamvazina, Luke; Mwakilama, Shawo; Kanyerere, Henry; Keiser, Olivia; Mwafilaso, Johnbosco; Kamba, Chancy; Egger, Matthias; Jahn, Andreas; Simwaka, Bertha; Phiri, Sam

2016-03-05

Implementation of user-friendly, real-time, electronic medical records for patient management may lead to improved adherence to clinical guidelines and improved quality of patient care. We detail the systematic, iterative process that implementation partners, Lighthouse clinic and Baobab Health Trust, employed to develop and implement a point-of-care electronic medical records system in an integrated, public clinic in Malawi that serves HIV-infected and tuberculosis (TB) patients. Baobab Health Trust, the system developers, conducted a series of technical and clinical meetings with Lighthouse and Ministry of Health to determine specifications. Multiple pre-testing sessions assessed patient flow, question clarity, information sequencing, and verified compliance to national guidelines. Final components of the TB/HIV electronic medical records system include: patient demographics; anthropometric measurements; laboratory samples and results; HIV testing; WHO clinical staging; TB diagnosis; family planning; clinical review; and drug dispensing. Our experience suggests that an electronic medical records system can improve patient management, enhance integration of TB/HIV services, and improve provider decision-making. However, despite sufficient funding and motivation, several challenges delayed system launch including: expansion of system components to include of HIV testing and counseling services; changes in the national antiretroviral treatment guidelines that required system revision; and low confidence to use the system among new healthcare workers. To ensure a more robust and agile system that met all stakeholder and user needs, our electronic medical records launch was delayed more than a year. Open communication with stakeholders, careful consideration of ongoing provider input, and a well-functioning, backup, paper-based TB registry helped ensure successful implementation and sustainability of the system. Additional, on-site, technical support provided reassurance and swift problem-solving during the extended launch period. Even when system users are closely involved in the design and development of an electronic medical record system, it is critical to allow sufficient time for software development, solicitation of detailed feedback from both users and stakeholders, and iterative system revisions to successfully transition from paper to point-of-care electronic medical records. For those in low-resource settings, electronic medical records for integrated care is a possible and positive innovation.

5 CFR 532.415 - Application of new or revised wage schedules.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 5 Administrative Personnel 1 2010-01-01 2010-01-01 false Application of new or revised wage schedules. 532.415 Section 532.415 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS PREVAILING RATE SYSTEMS Pay Administration § 532.415 Application of new or revised wage schedules...

7 CFR 1726.303 - Promulgation of new or revised contract forms.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 7 Agriculture 11 2010-01-01 2010-01-01 false Promulgation of new or revised contract forms. 1726... UTILITIES SERVICE, DEPARTMENT OF AGRICULTURE ELECTRIC SYSTEM CONSTRUCTION POLICIES AND PROCEDURES RUS Standard Forms § 1726.303 Promulgation of new or revised contract forms. RUS may, from time to time...

Evaluator's Guide for Microcomputer-Based Instructional Packages. Developed by MicroSIFT, a Project of the Computer Technology Program. Sixth Revision.

ERIC Educational Resources Information Center

Northwest Regional Educational Lab., Portland, OR.

This guide developed by MicroSIFT, a clearinghouse for microcomputer-based educational software and courseware, provides background information and forms to aid teachers and other educators in evaluating available microcomputer courseware. The evaluation process comprises six stages: (1) sifting, which screens out those programs that are not…

Relaxation for Children. (Revised and Expanded Edition.)

ERIC Educational Resources Information Center

Rickard, Jenny

Intended as a guide to reduce negative stress in children, this book suggests relaxation and meditation techniques to help children cope with stressful events. Part 1 provides an introduction to the format of the book. Part 2 contains summaries of the 10 sessions that make up the program. Each session has six sequential stages in which students…

76 FR 61062 - Approval and Promulgation of Implementation Plans; Arizona; Update to Stage II Gasoline Vapor...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-10-03

... ARS provisions listed in table 1 with the exception of ARS 41- 2121, paragraph (5), which defines the... paragraph (4) of ARS section 41-2121) in connection with our approval of the carbon monoxide redesignation... ADWM (codified in the Arizona Administrative Code). Arizona Revised Statutes (ARS) section 41-2132...

Measuring Moral Thinking from a Neo-Kohlbergian Perspective

ERIC Educational Resources Information Center

Thoma, Stephen J.

2014-01-01

The neo-Kohlbergian model revises and extends Lawrence Kohlberg's model of moral reasoning development to better reflect advances in research and theory. In moving from Kohlberg's global stage model to a multi-process description of moral functioning, these modifications are most evident in the ways in which moral thinking is described,…

Formation of N3(-) during interaction of NO with reduced ceria.

PubMed

Mihaylov, Mihail Y; Ivanova, Elena Z; Aleksandrov, Hristiyan A; St Petkov, Petko; Vayssilov, Georgi N; Hadjiivanov, Konstantin I

2015-04-04

We show that the first stages of interaction between NO and reduced ceria comprise the formation of azides, N3(-), with simultaneous oxidation of Ce(3+) to Ce(4+). This finding imposes revision on some current views of catalytic NO conversion and may contribute to design of new deNOx materials and processes.

Improving Students' Expertise and Attitudes during the Postwriting Stage of the Writing Process through Collaborative Revision.

ERIC Educational Resources Information Center

Wells, Mary C.

A practicum addressed the problem of students' lack of fluency in standard English despite the traditional paradigm for formal grammar instruction and the emphasis on process writing in most English classrooms. Nineteen (English 2) high school students participated in peer editing groups in a collaborative learning environment. The solution…

Slow Dangerous Curve: Scoliosis and Posture Screening Handbook. Revised Edition.

ERIC Educational Resources Information Center

Tenney, Horace K., III; And Others

The yearly screening process to detect scoliosis (curvature of the spine) and poor posture in girls 10 to 14 and boys 13 to 14 is discussed. The purpose of the program is to detect deformities in their earliest stages to prevent progression. Photographs are interspersed with text on suggestions for planning the screening program, clothing, setting…

Practical Ideas for Teaching Writing as a Process at the High School and College Levels. 1997 Revised Edition.

ERIC Educational Resources Information Center

Olson, Carol Booth, Comp.

The concept of writing as process has revolutionized the way many view composition, and this book is organized by the stages of that process. Each section begins with a well-known author presenting specific techniques, followed by commentaries which include testimonials, applications of writing techniques, and descriptions of strategy…

SEABEE Combat Handbook. Revision

DTIC Science & Technology

1989-02-01

early stages of any biological disease, the general symptoms are fever , malaise, and * Warning, reporting, detection, and inflammation, identification...be thoroughly scrubbed . Contaminated clothing i ilgclwraeee cus fyusolu scontract a disease from biological warfare in spite must be washed in hot...protective masks, skin decontamination caused by thermal radiation and injuries caused kits, and atropine. 19-16 Chapter 19-CHEMICAL, BIOLOGICAL , AND

Implementation of the evidence review on best practice for confirming the correct placement of nasogastric tube in patients in an acute care hospital.

PubMed

Tho, Poh Chi; Mordiffi, Siti; Ang, Emily; Chen, Helen

2011-03-01

Nasogastric (NG) tube is a device passed through the gastrointestinal tract of patients for the purpose of feeding, gastric decompression and medication administration. However, a small risk involved in the process is that the tube may be misplaced into the trachea during insertion or may get displaced at a later stage, leading to disastrous results. Recent adverse incidences arising out of the misplacement of NG tube raised concerns among the nursing and medical community and the Patient Safety Officer of the hospital. The Evidence Based Nursing Unit, in collaboration with some of the key nursing leaders in nursing administration, was tasked to explore and institute the current best practice in confirming the correct placement of NG tube. The aim of this project was to institute the best practice to confirm the correct placement of NG tube in patients in an acute care hospital setting. The project comprised of a few stages. The first stage involved reviewing the existing recommendations and guidelines on the methods for checking correct NG tube placement. The second stage involved incorporation of the change of practice into the clinical setting. The final stage was to monitor and evaluate the impact of the new practice on the patients, nurses and other healthcare professionals. Evidence search from guidelines and journals supported the test that used pH indicator instead of the litmus test. There is no evidence that supports the method of auscultation and bubbling to confirm correct NG tube placement in the absence of aspirate. Radiology remains the 'gold standard' for checking correct NG tube placement. The revised method of NG tube placement and workflow was incorporated in the revised Standard Operating Procedures. A total of 17 roadshows were conducted to create awareness regarding the new method amongst the nurses, and the implementation of the revised method and workflow was commenced on 3 November 2008. The initial audit conducted 1 month after the practice change was implemented reported 26 (50%) observations of NG tube feeding in 26 audit wards. The key areas of practice change in feeding when tube placement was confirmed (84.6%) and proper testing of aspirate (76.9%) showed good compliance. The implementation of the change in the practice of confirming the correct placement of the NG tube in patients requires good coordination and a multidisciplinary team approach. © 2011 The Authors. International Journal of Evidence-Based Healthcare © 2011 The Joanna Briggs Institute.

Early experience with dual mobility acetabular systems featuring highly cross-linked polyethylene liners for primary hip arthroplasty in patients under fifty five years of age: an international multi-centre preliminary study.

PubMed

Epinette, Jean-Alain; Harwin, Steven F; Rowan, Fiachra E; Tracol, Philippe; Mont, Michael A; Chughtai, Morad; Westrich, Geoffrey H

2017-03-01

To evaluate early performance of contemporary dual mobility acetabular systems with second generation annealed highly cross-linked polyethylene for primary hip arthroplasty of patients under 55 years of age. A prospective observational five years study across five centers in Europe and the USA of 321 patients with a mean age of 48.1 years was performed. Patients were assessed for causes of revision, hip instability, intra-prosthetic dissociation, Harris hip score and radiological signs of osteolysis. There were no dislocations and no intra-prosthetic dissociations. Kaplan Meier analysis demonstrated 97.51% survivorship for all cause revision and 99.68% survivorship for acetabular component revision at five years. Mean Harris hip score was 93.6. Two acetabular shells were revised for neck-rim implant impingement without dislocation and ten femoral stems were revised for causes unrelated to dual mobility implants. Contemporary highly cross-linked polyethylene dual mobility systems demonstrate excellent early clinical, radiological, and survivorship results in a cohort of patients that demand high performance from their implants. It is envisaged that DM and second generation annealed HXLPE may reduce THA instability and wear, the two most common causes of THA revision in hip arthroplasty.

Steps through the revision process of reproductive health sections of ICD-11.

PubMed

Chou, Doris; Tunçalp, Özge; Hotamisligil, Selen; Norman, Jane; Say, Lale; Volkmer, Björn; Pattinson, Bob; Rooney, Cleo; Serour, Gamal; de Mouzon, Jacques; Gardosi, Jason; Thueroff, Joachim; Mark, Morgan; D'Hooghe, Thomas

2012-01-01

In 2007, the WHO initiated an organizational structure for the 11th revision of the International Classification of Diseases (ICD). Effective deployment of ICD-derived tools facilitates the use and collection of health information in a variety of resource settings, promoting quantitatively informed decisions. They also facilitate comparison of disease incidence and outcomes between different countries and different health care systems around the world. The Department of Reproductive Health and Research (RHR) coordinates the revision of chapters 14 (diseases of the genitourinary system), 15 (pregnancy, childbirth, and puerperium), and 16 (conditions originating in the perinatal period). RHR convened a technical advisory group (TAG), the Genito-Urinary Reproductive Medicine (GURM) TAG, for the ICD revision. The TAG's work reflects the collective understanding of sexual and reproductive health and is now available for review within the ICD-11 revision process. Copyright © 2012 S. Karger AG, Basel.

Proposed Lymph Node Staging System Using the International Consensus Guidelines for Lymph Node Levels Is Predictive for Nasopharyngeal Carcinoma Patients From Endemic Areas Treated With Intensity Modulated Radiation Therapy

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

Li, Wen-Fei; Sun, Ying; Mao, Yan-Ping

2013-06-01

Purpose: To propose a lymph node (N) staging system for nasopharyngeal carcinoma (NPC) based on the International Consensus Guidelines for lymph node (LN) levels and MRI-determined nodal variables. Methods and Materials: The MRI scans and medical records of 749 NPC patients receiving intensity modulated radiation therapy with or without chemotherapy were retrospectively reviewed. The prognostic significance of nodal level, laterality, maximal axial diameter, extracapsular spread, necrosis, and Union for International Cancer Control/American Joint Committee on Cancer (UICC/AJCC) size criteria were analyzed. Results: Nodal level and laterality were the only independent prognostic factors for distant failure and disease failure in multivariatemore » analysis. Compared with unilateral levels Ib, II, III, and/or Va involvement (hazard ratio [HR] 1), retropharyngeal lymph node involvement alone had a similar prognostic value (HR 0.71; 95% confidence interval [CI] 0.43-1.17; P=.17), whereas bilateral levels Ib, II, III, and/or Va involvement (HR 1.65; 95% CI 1.06-2.58; P=.03) and levels IV, Vb, and/or supraclavicular fossa involvement (HR 3.47; 95% CI 1.92-6.29; P<.01) both significantly increased the HR for distant failure. Thus we propose that the N category criteria could be revised as follows: N0, no regional LN metastasis; N1, retropharyngeal lymph node involvement, and/or unilateral levels Ib, II, III, and/or Va involvement; N2, bilateral levels Ib, II, III, and/or Va involvement; N3, levels IV, Vb, and/or supraclavicular fossa involvement. Compared with the 7th edition of the UICC/AJCC criteria, the proposed N staging system provides a more satisfactory distinction between the HRs for regional failure, distant failure, and disease failure in each N category. Conclusions: The proposed N staging system defined by the International Consensus Guidelines and laterality is predictive and practical. However, because of no measurements of the maximal nodal diameter on MRI slices, the prognostic significance of LN size needs further evaluation.« less

FIELD TEST OF THE PROPOSED REVISED HAZARD RANKING SYSTEM (HRS)

EPA Science Inventory

The Superfund Amendments and Reauthorization Act of 1986 (SARA) requires the U.S. Environmental Protection Agency (EPA) to revise the Hazard Ranking System (HRS) so that, to the maximum extent feasible, it accurately assesses the relative risks associated with actual or potent...

75 FR 27401 - List of Approved Spent Fuel Storage Casks: NUHOMS® HD System Revision 1; Correction

Federal Register 2010, 2011, 2012, 2013, 2014

2010-05-17

... Storage Casks: NUHOMS[reg] HD System Revision 1; Correction AGENCY: Nuclear Regulatory Commission. ACTION... HD spent fuel storage cask system. This action is necessary to correctly specify the effective date... on May 6, 2010 (75 FR 24786), that amends the regulations that govern storage of spent nuclear fuel...

75 FR 49368 - Airworthiness Directives; Rolls-Royce plc (RR) RB211-Trent 900 Series Turbofan Engines

Federal Register 2010, 2011, 2012, 2013, 2014

2010-08-13

...-Royce Trent 900 Series Propulsion Systems Alert Non- Modification Service Bulletin (NMSB) RB.211-72... Propulsion Systems Alert NMSB RB.211-72-AG329, Revision 1, dated January 13, 2010. The actions described in... Series Propulsion Systems Alert Non-Modification Service Bulletin (NMSB) RB.211-72-AG329, Revision 1...

Washington's Community and Technical Colleges' Student Achievement Initiative: Lessons Learned since the 2012 Revision and Considerations for New Allocation Model. Research Report 16-1

ERIC Educational Resources Information Center

Washington State Board for Community and Technical Colleges, 2016

2016-01-01

In January 2012, a system-wide task force came together for a nearly year-long process of revising the community and technical college system's performance-based funding (PBF) system, the Student Achievement Initiative. This review was consistent with national experts' recommendations for continuous evaluation of PBF systems to ensure overall…

The formation of novel social category conjunctions in working memory: A possible role for the episodic buffer?

PubMed

Hutter, Russell R C; Allen, Richard J; Wood, Chantelle

2016-01-01

Recent research (e.g., Hutter, Crisp, Humphreys, Waters, & Moffit; Siebler) has confirmed that combining novel social categories involves two stages (e.g., Hampton; Hastie, Schroeder, & Weber). Furthermore, it is also evident that following stage 1 (constituent additivity), the second stage in these models involves cognitively effortful complex reasoning. However, while current theory and research has addressed how category conjunctions are initially represented to some degree, it is not clear precisely where we first combine or bind existing social constituent categories. For example, how and where do we compose and temporarily store a coherent representation of an individual who shares membership of "female" and "blacksmith" categories? In this article, we consider how the revised multi-component model of working memory (Baddeley) can assist in resolving the representational limitations in the extant two-stage theoretical models. This is a new approach to understanding how novel conjunctions form new bound "composite" representations.

Design of capability measurement instruments pedagogic content knowledge (PCK) for prospective mathematics teachers

NASA Astrophysics Data System (ADS)

Aminah, N.; Wahyuni, I.

2018-05-01

The purpose of this study is to find out how the process of designing a tool of measurement Pedagogical Content Knowledge (PCK) capabilities, especially for prospective mathematics teachers are valid and practical. The design study of this measurement appliance uses modified Plomp development step, which consists of (1) initial assessment stage, (2) design stage at this stage, the researcher designs the measuring grille of PCK capability, (3) realization stage that is making measurement tool ability of PCK, (4) test phase, evaluation, and revision that is testing validation of measurement tools conducted by experts. Based on the results obtained that the design of PCK capability measurement tool is valid as indicated by the assessment of expert validator, and the design of PCK capability measurement tool, shown based on the assessment of teachers and lecturers as users of states strongly agree the design of PCK measurement tools can be used.

Protocol for Uniformly Measuring and Expressing the Performance of Energy Storage Systems

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

Conover, David R.; Crawford, Aladsair J.; Fuller, Jason C.

The Protocol for Uniformly Measuring and Expressing the Performance of Energy Storage Systems (PNNL-22010) was first issued in November 2012 as a first step toward providing a foundational basis for developing an initial standard for the uniform measurement and expression of energy storage system (ESS) performance. Based on experiences with the application and use of that document, and to include additional ESS applications and associated duty cycles, test procedures and performance metrics, a first revision of the November 2012 Protocol was issued in June 2014 (PNNL 22010 Rev. 1). As an update of the 2014 revision 1 to the Protocol,more » this document (the March 2016 revision 2 to the Protocol) is intended to supersede the June 2014 revision 1 to the Protocol and provide a more user-friendly yet more robust and comprehensive basis for measuring and expressing ESS performance.« less

Revision history aware repositories of computational models of biological systems.

PubMed

Miller, Andrew K; Yu, Tommy; Britten, Randall; Cooling, Mike T; Lawson, James; Cowan, Dougal; Garny, Alan; Halstead, Matt D B; Hunter, Peter J; Nickerson, David P; Nunns, Geo; Wimalaratne, Sarala M; Nielsen, Poul M F

2011-01-14

Building repositories of computational models of biological systems ensures that published models are available for both education and further research, and can provide a source of smaller, previously verified models to integrate into a larger model. One problem with earlier repositories has been the limitations in facilities to record the revision history of models. Often, these facilities are limited to a linear series of versions which were deposited in the repository. This is problematic for several reasons. Firstly, there are many instances in the history of biological systems modelling where an 'ancestral' model is modified by different groups to create many different models. With a linear series of versions, if the changes made to one model are merged into another model, the merge appears as a single item in the history. This hides useful revision history information, and also makes further merges much more difficult, as there is no record of which changes have or have not already been merged. In addition, a long series of individual changes made outside of the repository are also all merged into a single revision when they are put back into the repository, making it difficult to separate out individual changes. Furthermore, many earlier repositories only retain the revision history of individual files, rather than of a group of files. This is an important limitation to overcome, because some types of models, such as CellML 1.1 models, can be developed as a collection of modules, each in a separate file. The need for revision history is widely recognised for computer software, and a lot of work has gone into developing version control systems and distributed version control systems (DVCSs) for tracking the revision history. However, to date, there has been no published research on how DVCSs can be applied to repositories of computational models of biological systems. We have extended the Physiome Model Repository software to be fully revision history aware, by building it on top of Mercurial, an existing DVCS. We have demonstrated the utility of this approach, when used in conjunction with the model composition facilities in CellML, to build and understand more complex models. We have also demonstrated the ability of the repository software to present version history to casual users over the web, and to highlight specific versions which are likely to be useful to users. Providing facilities for maintaining and using revision history information is an important part of building a useful repository of computational models, as this information is useful both for understanding the source of and justification for parts of a model, and to facilitate automated processes such as merges. The availability of fully revision history aware repositories, and associated tools, will therefore be of significant benefit to the community.

Diffusion tensor imaging analysis of sequential spreading of disease in amyotrophic lateral sclerosis confirms patterns of TDP-43 pathology.

PubMed

Kassubek, Jan; Müller, Hans-Peter; Del Tredici, Kelly; Brettschneider, Johannes; Pinkhardt, Elmar H; Lulé, Dorothée; Böhm, Sarah; Braak, Heiko; Ludolph, Albert C

2014-06-01

Diffusion tensor imaging can identify amyotrophic lateral sclerosis-associated patterns of brain alterations at the group level. Recently, a neuropathological staging system for amyotrophic lateral sclerosis has shown that amyotrophic lateral sclerosis may disseminate in a sequential regional pattern during four disease stages. The objective of the present study was to apply a new methodological diffusion tensor imaging-based approach to automatically analyse in vivo the fibre tracts that are prone to be involved at each neuropathological stage of amyotrophic lateral sclerosis. Two data samples, consisting of 130 diffusion tensor imaging data sets acquired at 1.5 T from 78 patients with amyotrophic lateral sclerosis and 52 control subjects; and 55 diffusion-tensor imaging data sets at 3.0 T from 33 patients with amyotrophic lateral sclerosis and 22 control subjects, were analysed by a tract of interest-based fibre tracking approach to analyse five tracts that become involved during the course of amyotrophic lateral sclerosis: the corticospinal tract (stage 1); the corticorubral and the corticopontine tracts (stage 2); the corticostriatal pathway (stage 3); the proximal portion of the perforant path (stage 4); and two reference pathways. The statistical analyses of tracts of interest showed differences between patients with amyotrophic lateral sclerosis and control subjects for all tracts. The significance level of the comparisons at the group level was lower, the higher the disease stage with corresponding involved fibre tracts. Both the clinical phenotype as assessed by the amyotrophic lateral sclerosis functional rating scale-revised and disease duration correlated significantly with the resulting staging scheme. In summary, the tract of interest-based technique allowed for individual analysis of predefined tract structures, thus making it possible to image in vivo the disease stages in amyotrophic lateral sclerosis. This approach can be used not only for individual clinical work-up purposes, but enlarges the spectrum of potential non-invasive surrogate markers as a neuroimaging-based read-out for amyotrophic lateral sclerosis studies within a clinical context. © The Author (2014). Published by Oxford University Press on behalf of the Guarantors of Brain. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Evolving understanding and treatment of labour dystocia.

PubMed

Karaçam, Zekiye; Walsh, Denis; Bugg, George John

2014-11-01

The objective of the review is to critically review the diagnosis and management of dystocia in the first stage of labour. We conducted a narrative review of research since 1998. Eight studies were identified, four about the onset and duration of active phase of the first stage of labour, one on the diagnosis of dystocia, and three focused on the treatment of dystocia. The review demonstrates that current understandings of dystocia rest on outdated definitions of active first stage of labour, its progress and on treatments with an equivocal evidence base. These include the cervical dilatation threshold for active first stage, uncertainty over whether a reduced rate of dilatation and reduced strength of uterine contractions always represent pathology and the effectiveness of amniotomy/oxytocin for treating dystocia. Prospective studies should evaluate the impact of defining the active phase of the first stage of labour as commencing at 6 cm dilated and should test this definition in combination with Zhang's revised partogram. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Teaching undergraduates the process of peer review: learning by doing.

PubMed

Rangachari, P K

2010-09-01

An active approach allowed undergraduates in Health Sciences to learn the dynamics of peer review at first hand. A four-stage process was used. In stage 1, students formed self-selected groups to explore specific issues. In stage 2, each group posted their interim reports online on a specific date. Each student read all the other reports and prepared detailed critiques. In stage 3, each report was discussed at sessions where the lead discussant was selected at random. All students participated in the peer review process. The written critiques were collated and returned to each group, who were asked to resubmit their revised reports within 2 wk. In stage 4, final submissions accompanied by rebuttals were graded. Student responses to a questionnaire were highly positive. They recognized the individual steps in the standard peer review, appreciated the complexities involved, and got a first-hand experience of some of the inherent variabilities involved. The absence of formal presentations and the opportunity to read each other's reports permitted them to study issues in greater depth.

36 CFR 212.54 - Revision of designations.

Code of Federal Regulations, 2010 CFR

2010-07-01

... National Forest System lands pursuant to § 212.51 may be revised as needed to meet changing conditions... TRAVEL MANAGEMENT Designation of Roads, Trails, and Areas for Motor Vehicle Use § 212.54 Revision of... § 212.55, and shall be reflected on a motor vehicle use map pursuant to § 212.56. ...

75 FR 35510 - License Renewal Interim Staff Guidance Process, Revision 2 Notice of Availability

Federal Register 2010, 2011, 2012, 2013, 2014

2010-06-22

... Related Regulatory Functions.'' An electronic copy of the revised LR-ISG process is available in the NRC's Agencywide Documents Access and Management System (ADAMS) under Accession No. ML100920158. The revised LR-ISG... interim changes to certain NRC license renewal guidance documents. These guidance documents facilitate the...

76 FR 19510 - Notice of Availability (NOA) of the Models For Plant-Specific Adoption of Technical...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-04-07

...-Specific Adoption of Technical Specifications Task Force (TSTF) Traveler TSTF- 422, Revision 2, ``Change In... model safety evaluation (SE) for plant-specific adoption of TSTF Traveler TSTF-422, Revision 2, ``Change..., Revision 2, is available in the Agencywide Documents Access and Management System (ADAMS) under Accession...

75 FR 47184 - Airworthiness Directives; Empresa Brasileira de Aeronautica S.A. (EMBRAER) Model EMB-135ER...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-08-05

... is revising the Airworthiness Limitations Section (ALS) of the Instructions for Continued... is revising the Airworthiness Limitations Section (ALS) of the Instructions for Continued... 16, 2008, revise the ALS of the ICA to incorporate Section A2.5.2, Fuel System Limitation Items, of...

75 FR 61785 - Proposed Collection; Comment Request for Review of a Revised Information Collection: (OMB Control...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-10-06

... OFFICE OF PERSONNEL MANAGEMENT Proposed Collection; Comment Request for Review of a Revised... Management and Budget (OMB) a request for review of a revised information collection. This information...) System'' (OMB Control No. 3206-0201), and the Open Season Web site, Open Season Online, are used by...

Update on implementation of GHS in Korea and revision of Industrial Safety and Health Act in relation to GHS.

PubMed

Yu, Il Je; Kim, Dong Suk; Lim, Cheol Hong; Choi, Jung Yun; Lee, Je Bong; Chung, Ok-Sun; Kwon, Kyungok; Yum, Young Na; Kim, Jeongho; Kuk, Won-Kwen; Kim, Kyun

2007-12-01

To implement the globally harmonized system of classification and labelling of chemicals (GHS) in Korea, an inter-ministerial GHS committee, involving 8 ministries and an expert working group composed of 9 experts from relevant organizations and one private consultant, have made some progress towards implementation by 2008. As such, the first revision of the official Korean translated version of the GHS in accordance with the GHS purple book revision 1 in 2005, including annexes, started in August, 2006, was completed in December, 2006. The Ministry of Labor also finally revised the Industrial Safety and Health Act (ISHA) relating to the GHS and the detailed notification was announced on Dec 12, 2006 and became effective immediately. The revised ISHA will allow continued use of the existing hazard communication system until Jun 30, 2008. Other revisions of chemical-related regulations will follow soon to facilitate the implementation of the GHS by 2008. Besides, inter-ministerial collaborative efforts on harmonizing regulations and disseminating the GHS in Korea will continue to avoid any confusion or duplication and for the effective use of resources.

Formal methods in the design of Ada 1995

NASA Technical Reports Server (NTRS)

Guaspari, David

1995-01-01

Formal, mathematical methods are most useful when applied early in the design and implementation of a software system--that, at least, is the familiar refrain. I will report on a modest effort to apply formal methods at the earliest possible stage, namely, in the design of the Ada 95 programming language itself. This talk is an 'experience report' that provides brief case studies illustrating the kinds of problems we worked on, how we approached them, and the extent (if any) to which the results proved useful. It also derives some lessons and suggestions for those undertaking future projects of this kind. Ada 95 is the first revision of the standard for the Ada programming language. The revision began in 1988, when the Ada Joint Programming Office first asked the Ada Board to recommend a plan for revising the Ada standard. The first step in the revision was to solicit criticisms of Ada 83. A set of requirements for the new language standard, based on those criticisms, was published in 1990. A small design team, the Mapping Revision Team (MRT), became exclusively responsible for revising the language standard to satisfy those requirements. The MRT, from Intermetrics, is led by S. Tucker Taft. The work of the MRT was regularly subject to independent review and criticism by a committee of distinguished Reviewers and by several advisory teams--for example, the two User/Implementor teams, each consisting of an industrial user (attempting to make significant use of the new language on a realistic application) and a compiler vendor (undertaking, experimentally, to modify its current implementation in order to provide the necessary new features). One novel decision established the Language Precision Team (LPT), which investigated language proposals from a mathematical point of view. The LPT applied formal mathematical analysis to help improve the design of Ada 95 (e.g., by clarifying the language proposals) and to help promote its acceptance (e.g., by identifying a verifiable subset that would meet the needs of safety-critical applications). The first LPT project, which ran from the fall of 1990 unti the end of 1992, produced studies of several language issues: optimization, sharing and storage, tasking and protected records, overload resolution, the floating point model, distribution, program erros, and object-oriented programming. The second LPT project, in 1994, formally modeled the dynamic semantics of a large part of the (almost) final language definition, looking especially for interactions between language features.

Ultraviolet to Infrared SED (Spectral Energy Distribution) Analysis of Nearby Late-Stage Mergers

NASA Astrophysics Data System (ADS)

Weiner, Aaron S.; Smith, Howard A.; Ashby, Matthew; Martínez-Galarza, Juan Rafael; Ramos Padilla, Andres; Hung, Chao-Ling; Dietrich, Jeremy; Lanz, Lauranne; Hayward, Christopher; Rosenthal, Lee; Willner, Steven; Zezas, Andreas

2018-01-01

We present an analysis of the fundamental properties of nearby merging galaxies based on an in-depth analysis of their spectral energy distributions. The Late-Stage Interacting Galaxy Sample (LSIGS) cross-correlates the Revised IRAS-FSC Redshift Catalogue (Wang et al. 2014) with Galaxy Zoo (Lintott et al. 2008, 2011). LSIGS builds on and extends SIGS (Spitzer Interacting Galaxy Sample; Lanz et al. 2013, Brassington et al. 2015) in two ways. First it enlarges the sample considerably to 453 systems, increasing the statistical power of the analysis significantly. Second, it includes galaxies in the most advanced merger stage, during coalescence, filling a gap in the SIGS sample. We present full ultraviolet (UV) to far-infrared (FIR) aperture photometry for 50 galaxies in this sample, 40 of which are late-stage mergers, selecting based on availability of both UV and SPIRE observations. These have subsequently been fit and analyzed by CIGALE (Code Investigating Galaxy Emission; Burgarella 2005) in order to retrieve key physical properties of the galaxies including star-formation rate (SFR), AGN fraction, dust luminosity, bolometric luminosity, and stellar and gas mass. We use this same analysis on hydrodynamical simulations created with GADGET-3 and using SUNRISE for the radiative transfer. Using the observations in conjunction with the simulations, CIGALE fits the simulated values accurately for fAGN>0.3. Additionally galaxies in the midst of coalescence have significantly increased sSFR compared to both early and late-stage mergers, while finding that the gas mass and alpha significantly increase from early stage mergers to those in coalescence. Furthermore, we find a linear anti-correlation between alpha and both the log(60/100μm) flux, and, more interestingly, the compactness. Lastly we bring forth the idea of using the best fit age of the oldest stars and the folding time of the stellar population, τmain, in conjunction to predict the likelihood of a galaxy being in a late-stage merger or in the midst of coalescence.

Preoperative Anemia Is Associated With Failure of Open Debridement Polyethylene Exchange in Acute and Acute Hematogenous Prosthetic Joint Infection.

PubMed

Swenson, Richard D; Butterfield, James A; Irwin, Timothy J; Zurlo, John J; Davis, Charles M

2018-06-01

Acute and acute hematogenous prosthetic joint infections (PJIs) are often treated with open debridement and polyethylene exchange (ODPE) in an effort to save the prosthesis, decrease morbidity, and reduce costs. However, failure of ODPE may compromise a subsequent 2-stage treatment. The purpose of this study is to identify patient factors that impact the success of ODPE for acute and acute hematogenous PJIs. A retrospective review examined comorbidities, preoperative laboratory values, and patient history for patients with successful and failed ODPE treatment for acute perioperative or acute hematogenous periprosthetic hip or knee joint infections. Successful treatment was defined as retaining a well-fixed implant without the need for additional surgery for a minimum of 6-month follow-up with or without lifelong oral maintenance antibiotics. Fifty-three of 72 patients (73.6%) underwent successful ODPE. Of the 19 failures, 14 completed 2-stage revision with one subsequent known failure for recurrent infection. Patients with a Staphylococcus aureus infection were more likely to fail ODPE (48.3% vs 11.6%, P = .0012, odds ratio 7.1, 95% confidence interval 2.3-25.3). Patients with a preoperative hematocrit ≤32.1 were also more likely to fail ODPE (55% vs 16%, P = .0013, odds ratio 6.7, 95% confidence interval 2.2-22.4). When neither risk factor was present, 97.1% of PJIs were successfully treated with ODPE. S aureus infection and preoperative hematocrit ≤32.1 are independent risk factors for ODPE failure. ODPE is a safe alternative to 2-stage revision in patients without preoperative anemia and without S aureus infection. Two-thirds of patients with a failed ODPE were successfully treated with a 2-stage reimplantation. Copyright © 2018 Elsevier Inc. All rights reserved.

Knee arthrodesis with a press-fit modular intramedullary nail without bone-on-bone fusion after an infected revision TKA.

PubMed

Iacono, Francesco; Bruni, Danilo; Lo Presti, Mirco; Raspugli, Giovanni; Bondi, Alice; Sharma, Bharat; Marcacci, Maurilio

2012-10-01

Knee arthrodesis can be an effective treatment after an infected revision Total Knee Arthroplasty (TKA). The main hypothesis of this study is that a two-stage arthrodesis of the knee using a press-fit, modular intramedullary nail and antibiotic loaded cement, to fill the residual gap between the bone surfaces, prevents an excessive limb shortening, providing satisfactory clinical and functional results even without direct bone-on-bone fusion. The study included 22 patients who underwent knee arthrodesis between 2004 and 2009 because of recurrent infection following revision-TKA (R-TKA). Clinical and functional evaluations were performed using the Visual Analogue Scale (VAS) and the Lequesne Algofunctional Score. A postoperative clinical and radiographical evaluation of the residual limb-length discrepancy was conducted by three independent observers. VAS and LAS results showed a significant improvement with respect to the preoperative condition. The mean leg length discrepancy was less than 1cm. There were three recurrent infections that needed further surgical treatment. This study demonstrated that reinfection after Revision of total knee Arthroplasty can be effectively treated with arthrodesis using a modular intramedullary nail, along with an antibiotic loaded cement spacer and that satisfactory results can be obtained without direct bone-on-bone fusion. Published by Elsevier B.V.

Analysis of difficulties in mathematics problem solving based on revised Bloom’s Taxonomy viewed from high self-efficacy

NASA Astrophysics Data System (ADS)

Prismana, R. D. E.; Kusmayadi, T. A.; Pramudya, I.

2018-04-01

The ability of solving problem is a part of the mathematic curriculum that is very important. Problem solving prefers the process and strategy that is done by students in solving a problem rather than the result. This learning concept in accordance with the stages on the revised bloom’s taxonomy. The revised Bloom’s Taxonomy has two dimensions, namely the dimension of cognitive process and the dimension of knowledge. Dimension of knowledge has four categories, but this study only restricted on two knowledge, conceptual knowledge and procedural knowledge. Dimensions of cognitive processes are categorized into six kinds, namely remembering, understanding, applying, analyzing, evaluating, and creating. Implementation of learning more emphasis on the role of students. Students must have their own belief in completing tasks called self-efficacy. This research is a qualitative research. This research aims to know the site of the students’ difficulty based on revised Bloom’s Taxonomy viewed from high self-efficacy. The results of the study stated the students with high self efficacy have difficulties site. They are evaluating conceptual knowledge, evaluating procedural knowledge, creating conceptual knowledge, and creating procedural knowledge. It could be the consideration of teachers in the teaching, so as to reduce the difficulties of learning in students.

The Subunit Principle in Scar Face Revision.

PubMed

Elshahat, Ahmed; Lashin, Riham

2017-06-01

Facial scaring is considered one of the most difficult cosmetic problems for any plastic surgeon to solve. The condition is more difficult if the direction of the scar is not parallel to relaxed skin tension lines. Attempts to manage this difficult situation included revisions using geometric designs, Z plasties or W plasties to camouflage the straight line visible scaring. The use of long-lasting resorbable sutures was tried too. Recently, the use of botulinum toxin during revision improved the results. Fractional CO2 lasers, microfat grafts, and platelet-rich plasma were added to the armamentarium. The scar is least visible if placed in the junction between the facial subunits. The aim of this study is to investigate the use of the subunit principle to improve the results of scar revision. Four patients were included in this study. Tissue expansion of the intact part of the subunit allowed shifting the scar to the junction between the affected subunit and the adjacent one. Tissue expansion, delivery of the expanders, and advancement of the flaps were successful in all patients. The fact that this is a 2-stage procedure and sacrifices some of the intact skin from the affected facial subunit, makes this technique reserved to patients with ugly facial scars who are ambitious to improve their appearance.

Revised fire safety system cuts emergency response time.

PubMed

Keir, D C

1979-03-01

As Margaret R. Pardee Memorial Hospital, Hendersonville, NC. expanded, fire safety plans had to be reevaluated. With each new addition, fire safety responsibilities for hospital personnel multiplied and overlapped. Confusion resulted, and a revised, simplified, and coordinated fire safety system was devised. Seventeen false alarms within one year, caused by a faulty sprinkler system, gave hospital personnel ample opportunity to test the system and iron out unexpected problems.

75 FR 69434 - Public Water System Supervision Program Revision for the State of Montana

Federal Register 2010, 2011, 2012, 2013, 2014

2010-11-12

... ENVIRONMENTAL PROTECTION AGENCY [FRL-9225-4] Public Water System Supervision Program Revision for... approval action does not extend to public water systems in Indian country, as defined in 18 U.S.C. 1151... accordance with the provisions of section 1413 of the Safe Drinking Water Act (SDWA), 42 U.S.C. 300g-2, and...

Diagnosis and management of the infected total joint arthroplasty

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

Cuckler, J.M.; Star, A.M.; Alavi, A.

The preoperative diagnosis of the infected orthopedic implant is complicated by lack of a single precise test to forewarn patient and surgeon of the presence of microorganisms. Given the overall limitation of accuracy of preoperative diagnosis to approximately 80% when 111In scanning, preoperative aspiration, and ESR are considered, it would seem prudent to approach each revision surgery with the possibility in mind of subclinical sepsis as the cause for failure of the implant. The essentials of surgical technique including thorough debridement of the wound and removal of all existing foreign bodies, especially including PMMA bone cement, are critical to minimizingmore » the risk for occurrence or persistence of sepsis. Although the use of antibiotic impregnated bone cement may enhance the treatment of orthopedic sepsis, the data available to date lead to the conclusion that two-stage revision surgery in the face of known sepsis remains the cornerstone of surgical therapy for the infected implant, along with aggressive and rational antibiotic treatment. The surgeon is offered the following guidelines in the management of the septic total hip arthroplasty. 1. Preoperative evaluation including ESR, 111In WBC scan, and aspiration for culture and sensitivity (fluoroscopically guided for the hip) will produce on average approximately 80% accuracy. 2. Intraoperative cultures at the time of revision surgery should be obtained prior to administration of systemic antibiotics; three tissue specimens (hip capsule, femoral membrane, acetabular membrane) should be submitted for culture and sensitivity determination. 3. Careful debridement of the surgical site of granulation tissue and all foreign bodies (e.g., PMMA) should be performed within the limits of patient safety to maximize the likelihood of success. 37 refs.« less

Staged Reimplantation of a Total Hip Prosthesis After Co-infection with Candida tropicalis and Staphylococcus haemolyticus: A Case Report.

PubMed

Sebastian, Sujeesh; Malhotra, Rajesh; Pande, Ashish; Gautam, Deepak; Xess, Immaculata; Dhawan, Benu

2018-06-01

Fungal prosthetic joint infection is a rare complication in total joint arthroplasty. There are no established guidelines for management of these infections. We present a case of a 53-year-old male with a hip joint prosthesis co-infected with Candida tropicalis and Staphylococcus haemolyticus. A two-stage exchange arthroplasty was performed. The patient underwent implant removal, debridement, irrigation with saline solution and application of cement spacer impregnated with vancomycin followed by aggressive antimicrobial treatment in first stage. Complete eradication of infection was demonstrated by negative culture of sonicated cement spacer fluid and negative 16S rRNA and 18S rRNA gene PCR of sonicate fluid, synovial fluid and periprosthetic tissue samples. He underwent second-stage revision hip arthroplasty after 9 months of the first stage. At the latest follow-up, there was no evidence of recurrence of infection. This case illustrates the utility of sonication of biomaterials and molecular techniques for microbiological confirmation of absence of infection in staged surgeries which is required for a successful outcome.

Shaking Up the Debate: Ensuring the Ethical Use of DBS Intervention Criteria for Mid-Stage Parkinson's Patients.

PubMed

Eijkholt, Marleen; Cabrera, Laura Y; Ramirez-Zamora, Adolfo; Pilitsis, Julie G

2017-07-01

Deep brain stimulation (DBS) is a well-established treatment for the management of severe motor fluctuations in advanced Parkinson's disease (PD). Until recently, device regulation, medical, and insurance practices limited DBS to patients with advanced stages of PD. In February 2016 this changed, however, when the US Food and Drug Administration (FDA) granted formal approval for the use of brain stimulator in mid-stage PD patients. In this article, we examine whether DBS in mid-stage PD can be ethically justified beyond the FDA approval. We scrutinize the current risk-benefit profile, the costs-benefit profile, and the capacity for informed consent requirement, to ask if use of subthalamic nucleus (STN) in mid-stage DBS is ethically appropriate. We propose that mid-stage DBS decisions could be appropriate under a shared decision-making model, which embraces a broad quality of life perspective. Although it might be too premature to know how the FDA decision will affect medical and insurance practices, we conclude by arguing that revisions to persisting guidelines seems justified both on scientific and ethical grounds. © 2017 International Neuromodulation Society.

76 FR 19716 - Airworthiness Directives; BAE SYSTEMS (Operations) Limited Model 4101 Airplanes

Federal Register 2010, 2011, 2012, 2013, 2014

2011-04-08

... Jetstream J41 Aircraft Maintenance Manual (AMM), includes the following chapters: --05-10-10 ``Airworthiness... Jetstream Series 4100 Aircraft Maintenance Manual, Revision 33, dated February 15, 2010. The actions...: * * * BAE Systems (Operations) Ltd has issued Revision 33 of the AMM [airplane maintenance manual] to amend...

76 FR 82079 - AP1000 Design Certification Amendment

Federal Register 2010, 2011, 2012, 2013, 2014

2011-12-30

... reference Revision 15 of the design control document (DCD) (ADAMS Accession No. ML053460400), which... to DAC in the areas of piping design (Chapter 3), instrumentation and control (I&C) systems (Chapter... Systems Manual, as described in the AP1000 Design Control Document, Revision 17, meets the criteria of...

76 FR 71707 - Revising Underground Storage Tank Regulations-Revisions to Existing Requirements and New...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-11-18

... Equipment C. Addressing Deferrals 1. Emergency Power Generator UST Systems 2. Airport Hydrant Fuel.... Maintain Deferral for USTs Containing Radioactive Material and Emergency Generator UST Systems at Nuclear... (air, water, 481, 483-486, 48811. truck, transit, pipeline, and airport operations). Communications and...

78 FR 47015 - Software Requirement Specifications for Digital Computer Software Used in Safety Systems of...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-08-02

... NUCLEAR REGULATORY COMMISSION [NRC-2012-0195] Software Requirement Specifications for Digital Computer Software Used in Safety Systems of Nuclear Power Plants AGENCY: Nuclear Regulatory Commission... issuing a revised regulatory guide (RG), revision 1 of RG 1.172, ``Software Requirement Specifications for...

Redescription of Clinostomum phalacrocoracis metacercariae (Digenea: Clinostomidae) in cichlids from Lake Kinneret, Israel.

PubMed

Caffara, Monica; Davidovich, Nadav; Falk, Rama; Smirnov, Margarita; Ofek, Tamir; Cummings, David; Gustinelli, Andrea; Fioravanti, Maria L

2014-01-01

Clinostomidae are digeneans characterized by a complex taxonomic history, continuously under revision based on both morphological and molecular analysis. Among the 14 species considered valid so far Clinostomum phalacrocoracis has been well described only at the adult stage, whereas the morphology of the metacercarial stage has been reported only once. During a parasitological survey carried out on 262 wild cichlids sampled from Lake Kinneret (Israel) metacercariae referable to C. phalacrocoracis were found in 18 fingerlings. In this study, we report this clinostomid species for the first time in wild fish from Israel describing the metacercarial stage of Clinostomum phalacrocoracis, coupling its morphological description with molecular analysis carried out on ITS rDNA and COI mtDNA sequences. © M. Caffara et al., published by EDP Sciences, 2014.

Development and testing of study tools and methods to examine ethnic bias and clinical decision-making among medical students in New Zealand: The Bias and Decision-Making in Medicine (BDMM) study.

PubMed

Harris, Ricci; Cormack, Donna; Curtis, Elana; Jones, Rhys; Stanley, James; Lacey, Cameron

2016-07-11

Health provider racial/ethnic bias and its relationship to clinical decision-making is an emerging area of research focus in understanding and addressing ethnic health inequities. Examining potential racial/ethnic bias among medical students may provide important information to inform medical education and training. This paper describes the development, pretesting and piloting of study content, tools and processes for an online study of racial/ethnic bias (comparing Māori and New Zealand European) and clinical decision-making among final year medical students in New Zealand (NZ). The study was developed, pretested and piloted using a staged process (eight stages within five phases). Phase 1 included three stages: 1) scoping and conceptual framework development; 2) literature review and identification of potential measures and items; and, 3) development and adaptation of study content. Three main components were identified to assess different aspects of racial/ethnic bias: (1) implicit racial/ethnic bias using NZ-specific Implicit Association Tests (IATs); (2) explicit racial/ethnic bias using direct questions; and, (3) clinical decision-making, using chronic disease vignettes. Phase 2 (stage 4) comprised expert review and refinement. Formal pretesting (Phase 3) included construct testing using sorting and rating tasks (stage 5) and cognitive interviewing (stage 6). Phase 4 (stage 7) involved content revision and building of the web-based study, followed by pilot testing in Phase 5 (stage 8). Materials identified for potential inclusion performed well in construct testing among six participants. This assisted in the prioritisation and selection of measures that worked best in the New Zealand context and aligned with constructs of interest. Findings from the cognitive interviewing (nine participants) on the clarity, meaning, and acceptability of measures led to changes in the final wording of items and ordering of questions. Piloting (18 participants) confirmed the overall functionality of the web-based questionnaire, with a few minor revisions made to the final study. Robust processes are required in the development of study content to assess racial/ethnic bias in order to optimise the validity of specific measures, ensure acceptability and minimise potential problems. This paper has utility for other researchers in this area by informing potential development approaches and identifying possible measurement tools.

Development of a new Rasch-based scoring algorithm for the National Eye Institute Visual Functioning Questionnaire to improve its interpretability.

PubMed

Petrillo, Jennifer; Bressler, Neil M; Lamoureux, Ecosse; Ferreira, Alberto; Cano, Stefan

2017-08-14

The NEI VFQ-25 has undergone psychometric evaluation in patients with varying ocular conditions and the general population. However, important limitations which may affect the interpretation of clinical trial results have been previously identified, such as concerns with reliability and validity. The purpose of this study was to evaluate the National Eye Institute Visual Functioning Questionnaire (NEI VFQ-25) and make recommendations for a revised scoring structure, with a view to improving its psychometric performance and interpretability. Rasch Measurement Theory analyses were conducted in two stages using pooled baseline NEI VFQ-25 data for 2487 participants with retinal diseases enrolled in six clinical trials. In stage 1, we examined: scale-to-sample targeting; thresholds for item response options; item fit statistics; stability; local dependence; and reliability. In stage 2, a post-hoc revision of the scoring structure (VFQ-28R) was created and psychometrically re-evaluated. In stage 1, we found that the NEI VFQ-25 was mis-targeted to the sample, and had disordered response thresholds (15/25 items) and mis-fitting items (8/25 items). However, items appeared to be stable (differential item functioning for three items), have minimal item dependency (one pair of items) and good reliability (person-separation index, 0.93). In stage 2, the modified Rasch-scored NEI VFQ-28-R was assessed. It comprised two broad domains: Activity Limitation (19 items) and Socio-Emotional Functioning (nine items). The NEI VFQ-28-R demonstrated improved performance with fewer disordered response thresholds (no items), less item misfit (three items) and improved population targeting (reduced ceiling effect) compared with the NEI VFQ-25. Compared with the original version, the proposed NEI VFQ-28-R, with Rasch-based scoring and a two-domain structure, appears to offer improved psychometric performance and interpretability of the vision-related quality of life scale for the population analysed.

A positive bacterial culture during re-implantation is associated with a poor outcome in two-stage exchange arthroplasty for deep infection.

PubMed

Akgün, D; Müller, M; Perka, C; Winkler, T

2017-11-01

The aim of this study was to identify the incidence of positive cultures during the second stage of a two-stage revision arthroplasty and to analyse the association between positive cultures and an infection-free outcome. This single-centre retrospective review of prospectively collected data included patients with a periprosthetic joint infection (PJI) of either the hip or the knee between 2013 and 2015, who were treated using a standardised diagnostic and therapeutic algorithm with two-stage exchange. Failure of treatment was assessed according to a definition determined by a Delphi-based consensus. Logistic regression analysis was performed to assess the predictors of positive culture and risk factors for failure. The mean follow-up was 33 months (24 to 48). A total of 163 two-stage revision arthroplasties involving 84 total hip arthroplasties (THAs) and 79 total knee arthroplasties (TKAs) were reviewed. In 27 patients (16.6%), ≥ 1 positive culture was identified at re-implantation and eight (29.6%) of these subsequently failed compared with 20 (14.7%) patients who were culture-negative. The same initially infecting organism was isolated at re-implantation in nine of 27 patients (33.3%). The organism causing re-infection in none of the patients was the same as that isolated at re-implantation. The risk of the failure of treatment was significantly higher in patients with a positive culture (odds ratio (OR) 1.7; 95% confidence interval (CI) 1.0 to 3.0; p = 0.049) and in patients with a higher Charlson Comorbidity Index (OR 1.5; 95% CI 1.6 to 1.8; p = 0.001). Positive culture at re-implantation was independently associated with subsequent failure. Surgeons need to be aware of this association and should consider the medical optimisation of patients with severe comorbidities both before and during treatment. Cite this article: Bone Joint J 2017;99-B:1490-5. ©2017 The British Editorial Society of Bone & Joint Surgery.

78 FR 79340 - Approval and Promulgation of Air Quality Implementation Plans; Texas; Stage II Vapor Recovery...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-12-30

...-Port Arthur (BPA), Dallas-Fort Worth (DFW) and Houston- Galveston Brazoria (HGB) areas, and in El Paso... required are comprised of 16 counties: Beaumont-Port Arthur (BPA), including Hardin, Jefferson and Orange... equipment by August 31, 2018 in the BPA, DFW and HGB areas and El Paso County is whether these revisions...

Diagnosis and management of endocrine gland neoplasmas. Revision 1

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

Weller, R.E.

1994-03-01

Functional and nonfunctional neoplasms of the endocrine glands constitute some of the more challenging diagnostic and therapeutic problems in veterinary cancer medicine. This discussion will focus on the clinical signs and syndromes associated with neoplasms of the thyroid, adrenal, and parathyroid glands, and pancreas in companion animals and will concentrate on the mechanisms producing the clinical signs, diagnosis, staging, therapy and prognosis.

Getting the Books Off the Shelves. Making the Most of Your Congregation's Library. Revised Edition. CSLA Guide No. 12.

ERIC Educational Resources Information Center

Smith, Ruth S.

This guide provides guidelines for promoting and attracting users to a church library. The first of six chapters, "Promoting Library Use," discusses stages of promotion, methods of attracting the attention and interest of prospective users, and how to involve members of the congregation in library activities; the second chapter, "Publicizing the…

An Examination of Reflective Thinking, Learning Approaches, and Self-Efficacy Beliefs at the University of the South Pacific: A Path Analysis Approach

ERIC Educational Resources Information Center

Phan, Huy P.

2007-01-01

This study examined the causal and mediating relations between students' learning approaches, self-efficacy beliefs, stages of reflective thinking, and academic performance. Second-year undergraduate students (n = 241; 118 females, 123 males) in the South Pacific were administered the revised version of Biggs' Study Process Questionnaire, the…

Getting Uncle Sam To Enforce Your Civil Rights. Clearinghouse Publication 59. Revised.

ERIC Educational Resources Information Center

Brooks, Barbara J.

There are many Federal laws against discrimination, passed to protect people who are denied their rights because of race, color, religion, sex, national origin, age, or disability. This publication is a guide to the initial stages of filing a discrimination complaint. Although it does not cover all the steps after a complaint is filed, it helps…

Preventing Prostate Cancer Metastasis by Targeting Exosome Secretion

DTIC Science & Technology

2015-12-01

extensive and painful metastasis of the bone. We proposed compare the impact of exosomes derived from advanced stage prostate cancer on bone stromal cells...The revised report including additional figures, tables, and text, is attached below. 1. INTRODUCTION Bone metastasis is a painful and often lethal...UT) supplemented with 10% fetal bovine serum (Atlanta Biologicals, Lawrenceville, GA) plus penicillin/streptomycin (Gibco, Gaithersburg, MD

Financial Analysis of Treating Periprosthetic Joint Infections at a Tertiary Referral Center.

PubMed

Waddell, Bradford S; Briski, David C; Meyer, Mark S; Ochsner, John L; Chimento, George F

2016-05-01

Periprosthetic joint infection (PJI) is a significant challenge to the orthopedic surgeon, patient, hospital, and insurance provider. Our study compares the financial information of self-originating and referral 2-stage revision hip and knee surgeries at our tertiary referral center for hip or knee PJI over the last 4 years. We performed an in-house retrospective financial review of all patients who underwent 2-stage revision hip or knee arthroplasty for infection between January 2008 and August 2013, comparing self-originating and referral cases. We found an increasing number of referrals over the study period. There was an increased cost of treating hips over knees. All scenarios generated a positive net income; however, referral hip PJIs offered lower reimbursement and net income per case (although not statistically significant), whereas knee PJIs offered higher reimbursement and net income per case (although not statistically significant). With referral centers treating increased numbers of infected joints performed elsewhere, we show continued financial incentive in accepting referrals, although with less financial gain than when treating one's own hip PJI and an increased financial gain when treating referral knee PJIs. Copyright © 2016 Elsevier Inc. All rights reserved.

41 CFR 102-118.510 - Can my agency revise or alter a GSA Form 7931, Certificate of Settlement?

Code of Federal Regulations, 2010 CFR

2010-07-01

... Property Management Federal Property Management Regulations System (Continued) FEDERAL MANAGEMENT... 41 Public Contracts and Property Management 3 2010-07-01 2010-07-01 false Can my agency revise or... Information for All Claims § 102-118.510 Can my agency revise or alter a GSA Form 7931, Certificate of...

Inquiry, A Project of the Wisconsin Bar Foundation. Vols. 1 and 2, Revised.

ERIC Educational Resources Information Center

Scheurich, G. Michael, Ed.

This new, revised edition of the Inquiry instructional materials is designed for use in teaching high school students about the U. S. laws and legal systems. The revised outlines, designed for instructors who have had legal training, are less technical and more informal, include new concepts and many current relevant topics, and de-emphasize…

77 FR 60075 - Airworthiness Directives; Airbus Airplanes

Federal Register 2010, 2011, 2012, 2013, 2014

2012-10-02

... 47172-530 shall [also] be included in the next Airworthiness Limitation Section (ALS) Part 4 revision... A330 MRBR, Revision 12, dated July 1, 2010. Task 274400-00001-1-E of Airbus A330 ALS Part 4--Ageing Systems Maintenance, Revision 02, dated December 16, 2009. Task 274400-00001-1-E of Airbus A330 ALS Part 4...

76 FR 437 - Airworthiness Directives; Empresa Brasileira de Aeronautica S.A. (EMBRAER) Model EMB-135BJ Airplanes

Federal Register 2010, 2011, 2012, 2013, 2014

2011-01-05

... corrective action is revising the Airworthiness Limitations Section (ALS) of the Instructions for Continued... corrective action is revising the Airworthiness Limitations Section (ALS) of the Instructions for Continued... 16, 2008, revise the ALS of the ICA to incorporate Section A2.5.2, Fuel System Limitation Items, of...

Emergent issues in forest plan revision: a dialogue

Treesearch

Susan I. Stewart; Pamela J. Jakes; Paul Monson

1998-01-01

Working with National Forest planners can raise many questions for social scientists regarding their role in planning or plan revision. Social scientists from the North Central Forest Experiment Station and the National Forest System Eastern Region debate 3 questions that continue to surface in their work with Forest Service managers on plan revision: first, what is...

Lengthening Temporalis Myoplasty for Single-Stage Smile Reconstruction in Children with Facial Paralysis.

PubMed

Panossian, Andre

2016-04-01

Free muscle transfer for dynamic smile reanimation in facial paralysis is not always predictable with regard to cosmesis. Hospital stays range from 5 to 7 days. Prolonged operative times, longer hospital stays, and excessive cheek bulk are associated with free flap options. Lengthening temporalis myoplasty offers single-stage smile reanimation with theoretical advantages over free tissue transfer. From 2012 to 2014, 18 lengthening temporalis myoplasties were performed in 14 children for smile reconstruction. A retrospective chart review was completed for demographics, operative times, length of hospital stay, and perioperative complications. Fourteen consecutive patients with complete facial paralysis were included. Four patients underwent single-stage bilateral reconstruction, and 10 underwent unilateral procedures. Diagnoses included Möbius syndrome (n = 5), posterior cranial fossa tumors (n = 4), posttraumatic (n = 2), hemifacial microsomia (n = 1), and idiopathic (n = 2). Average patient age was 10.1 years. Average operative time was 410 minutes (499 minutes for bilateral lengthening temporalis myoplasty and 373 for unilateral lengthening temporalis myoplasty). Average length of stay was 3.3 days (4.75 days for bilateral lengthening temporalis myoplasty and 2.8 for unilateral lengthening temporalis myoplasty). Nine patients required minor revisions. Lengthening temporalis myoplasty is a safe alternative to free tissue transfer for dynamic smile reconstruction in children with facial paralysis. Limited donor-site morbidity, shorter operative times, and shorter hospital stays are some benefits over free flap options. However, revisions are required frequently secondary to tendon avulsions and adhesions. Therapeutic, IV.

The Addenbrooke's Cognitive Examination-Revised accurately detects cognitive decline in Huntington's disease.

PubMed

Begeti, Faye; Tan, Adrian Y K; Cummins, Gemma A; Collins, Lucy M; Guzman, Natalie Valle; Mason, Sarah L; Barker, Roger A

2013-11-01

Cognitive features, which begin before manifestation of the motor features, are an integral part of Huntington's disease and profoundly affect quality of life. A number of neuropsychological batteries have been used to assess this aspect of the condition, many of which are difficult to administer and time consuming, especially in advanced disease. We, therefore, investigated a simple and practical way to monitor cognition using the Addenbrooke's Cognitive Examination-Revised (ACE-R) in 126 manifest Huntington's disease patients, 28 premanifest gene carriers and 21 controls. Using this test, we demonstrated a selective decrease in phonemic, but not semantic, fluency in premanifest participants Cognitive decline in manifest Huntington's disease varied according to disease severity with extensive cognitive decline observed in early-stage Huntington's disease patients, indicating that this would be an optimal stage for interventions designed to halt cognitive decline, and lesser changes in the advanced cases. We next examined cognitive performance in patients prescribed antidopaminergic drugs as these drugs are known to decrease cognition when administered to healthy volunteers. We paradoxically found that these drugs may be beneficial, as early-stage Huntington's disease participants in receipt of them had improved attention and Mini-Mental State Examination scores. In conclusion, this is the first study to test the usefulness of the ACE-R in a Huntington's disease population and demonstrates that this is a brief, inexpensive and practical way to measure global cognitive performance in clinical practice with potential use in clinical trials.

Using Theories of Change to inform implementation of health systems research and innovation: experiences of Future Health Systems consortium partners in Bangladesh, India and Uganda.

PubMed

Paina, Ligia; Wilkinson, Annie; Tetui, Moses; Ekirapa-Kiracho, Elizabeth; Barman, Debjani; Ahmed, Tanvir; Mahmood, Shehrin Shaila; Bloom, Gerry; Knezovich, Jeff; George, Asha; Bennett, Sara

2017-12-28

The Theory of Change (ToC) is a management and evaluation tool supporting critical thinking in the design, implementation and evaluation of development programmes. We document the experience of Future Health Systems (FHS) Consortium research teams in Bangladesh, India and Uganda with using ToC. We seek to understand how and why ToCs were applied and to clarify how they facilitate the implementation of iterative intervention designs and stakeholder engagement in health systems research and strengthening. This paper combines literature on ToC, with a summary of reflections by FHS research members on the motivation, development, revision and use of the ToC, as well as on the benefits and challenges of the process. We describe three FHS teams' experiences along four potential uses of ToCs, namely planning, communication, learning and accountability. The three teams developed ToCs for planning and evaluation purposes as required for their initial plans for FHS in 2011 and revised them half-way through the project, based on assumptions informed by and adjusted through the teams' experiences during the previous 2 years of implementation. All teams found that the revised ToCs and their accompanying narratives recognised greater feedback among intervention components and among key stakeholders. The ToC development and revision fostered channels for both internal and external communication, among research team members and with key stakeholders, respectively. The process of revising the ToCs challenged the teams' initial assumptions based on new evidence and experience. In contrast, the ToCs were only minimally used for accountability purposes. The ToC development and revision process helped FHS research teams, and occasionally key local stakeholders, to reflect on and make their assumptions and mental models about their respective interventions explicit. Other projects using the ToC should allow time for revising and reflecting upon the ToCs, to recognise and document the adaptive nature of health systems, and to foster the time, space and flexibility that health systems strengthening programmes must have to learn from implementation and stakeholder engagement.

Further characterisation of the functional neuroanatomy associated with prosodic emotion decoding.

PubMed

Mitchell, Rachel L C

2013-06-01

Current models of prosodic emotion comprehension propose a three stage cognition mediated by temporal lobe auditory regions through to inferior and orbitofrontal regions. Cumulative evidence suggests that its mediation may be more flexible though, with a facility to respond in a graded manner based on the need for executive control. The location of this fine-tuning system is unclear, as is its similarity to the cognitive control system. In the current study, need for executive control was manipulated in a block-design functional MRI study by systematically altering the proportion of incongruent trials across time, i.e., trials for which participants identified prosodic emotions in the face of conflicting lexico-semantic emotion cues. Resultant Blood Oxygenation Level Dependent contrast data were analysed according to standard procedures using Statistical Parametric Mapping v8 (Ashburner et al., 2009). In the parametric analyses, superior (medial) frontal gyrus activity increased linearly with increased need for executive control. In the separate analyses of each level of incongruity, results suggested that the baseline prosodic emotion comprehension system was sufficient to deal with low proportions of incongruent trials, whereas a more widespread frontal lobe network was required for higher proportions. These results suggest an executive control system for prosodic emotion comprehension exists which has the capability to recruit superior (medial) frontal gyrus in a graded manner and other frontal regions once demand exceeds a certain threshold. The need to revise current models of prosodic emotion comprehension and add a fourth processing stage are discussed. Copyright © 2012 Elsevier Ltd. All rights reserved.

42 CFR 414.502 - Definitions.

Code of Federal Regulations, 2013 CFR

2013-10-01

... diagnostic laboratory test for which a new or substantially revised Healthcare Common Procedure Coding System Code is assigned on or after January 1, 2005. Substantially Revised Healthcare Common Procedure Coding...

42 CFR 414.502 - Definitions.

Code of Federal Regulations, 2012 CFR

2012-10-01

... diagnostic laboratory test for which a new or substantially revised Healthcare Common Procedure Coding System Code is assigned on or after January 1, 2005. Substantially Revised Healthcare Common Procedure Coding...

42 CFR 414.502 - Definitions.

Code of Federal Regulations, 2014 CFR

2014-10-01

... diagnostic laboratory test for which a new or substantially revised Healthcare Common Procedure Coding System Code is assigned on or after January 1, 2005. Substantially Revised Healthcare Common Procedure Coding...

Clinical staging of Fibrodysplasia Ossificans Progressiva (FOP).

PubMed

Pignolo, Robert J; Kaplan, Frederick S

2018-04-01

Fibrodyplasia ossificans progressiva (FOP) is an ultra-rare genetic condition of heterotopic ossification (HO) that results in progressive loss of joint function, ultimately rendering movement impossible. Death is most commonly the result of thoracic insufficiency syndrome, or complications related to recurrent respiratory infections. There are no current treatments for FOP, but early and emerging clinical trials offer hope for this devastating disease. With the recent reporting of a comprehensive global natural history study, scales to assess joint dysfunction, and a more accurate prediction of joint survival, it is now possible to construct a conceptual framework for the clinical staging of FOP. Based on assessment of FOP features in seven areas, it is possible to assign five clinical stages. FOP features include flare-up activity, body regions affected, thoracic insufficiency, other complications, activities of daily living (ADLs), ambulatory status, and the cumulative joint involvement scale (CAJIS) score. Assessments of these features assign an individual with FOP to early/mild, moderate, severe, profound, or late-stage disease. These criteria seek to be flexible enough to be used by clinicians without reliance on advanced imaging or specialized testing, as well as by investigators involved in research or clinical trial studies who would have these tools available. These staging measures for FOP assess the influence of HO and accelerated joint dysfunction (due to congenital abnormalities) on the ability to perform common functional activities, and thus a delay or lack of progression from one stage to the next represents the ultimate test of efficacy for drug trials. This framework will serve both as a prediction tool for FOP progression as well as a critical opportunity to substantiate therapeutic interventions. The staging system proposed here will permit an accurate assessment of severity to appropriately develop or revise clinical plans of care, define operational research criteria, and identify the effectiveness of interventions. Ultimately, this clinical staging will aid the field in moving toward earlier intervention at a stage where disease-modifying therapies may be most efficacious. Copyright © 2017 Elsevier Inc. All rights reserved.

Early radiological and functional outcomes for a cementless press-fit design modular femoral stem revision system.

PubMed

Hancock, Douglas S; Sharplin, Paul K; Larsen, Peter D; Phillips, Fredrick Ts

2018-05-01

To assess early radiological and functional outcomes of revision hip surgery with a cementless press-fit design femoral stem. A retrospective review of 48 consecutive revision total hip replacements using the RECLAIM revision hip system, between October 2012 and August 2015. Radiographic assessment was undertaken with serial anteroposterior (AP) X-rays of the pelvis. Risk factors for subsidence were evaluated. Prospective clinical follow up was performed on 21 patients to assess functional outcomes. Mean stem subsidence was 1.1 mm (95% confidence interval[CI]: 0.63-1.57). Median follow up of 12 months. An inverse relationship was observed between level of subsidence and femoral stem diameter r = -0.45, p = 0.001. Subsidence at the time of follow-up assessment was correlated with initial subsidence (correlation coefficient rho 0.69, p = 0.001). The mean Merle d'Aubigne score at the latest follow up was 14.2 (range 8-17). The mean OHS was 34.1 (range 15-48). Early radiological and functional outcomes for the RECLAIM revision system showed very low levels of subsidence and good functional outcomes. There was an association with smaller diameter femoral stems and greater levels of subsidence.

Comparing two anesthesia information management system user interfaces: a usability evaluation.

PubMed

Wanderer, Jonathan P; Rao, Anoop V; Rothwell, Sarah H; Ehrenfeld, Jesse M

2012-11-01

Anesthesia information management systems (AIMS) have been developed by multiple vendors and are deployed in thousands of operating rooms around the world, yet not much is known about measuring and improving AIMS usability. We developed a methodology for evaluating AIMS usability in a low-fidelity simulated clinical environment and used it to compare an existing user interface with a revised version. We hypothesized that the revised user interface would be more useable. In a low-fidelity simulated clinical environment, twenty anesthesia providers documented essential anesthetic information for the start of the case using both an existing and a revised user interface. Participants had not used the revised user interface previously and completed a brief training exercise prior to the study task. All participants completed a workload assessment and a satisfaction survey. All sessions were recorded. Multiple usability metrics were measured. The primary outcome was documentation accuracy. Secondary outcomes were perceived workload, number of documentation steps, number of user interactions, and documentation time. The interfaces were compared and design problems were identified by analyzing recorded sessions and survey results. Use of the revised user interface was shown to improve documentation accuracy from 85.1% to 92.4%, a difference of 7.3% (95% confidence interval [CI] for the difference 1.8 to 12.7). The revised user interface decreased the number of user interactions by 6.5 for intravenous documentation (95% CI 2.9 to 10.1) and by 16.1 for airway documentation (95% CI 11.1 to 21.1). The revised user interface required 3.8 fewer documentation steps (95% CI 2.3 to 5.4). Airway documentation time was reduced by 30.5 seconds with the revised workflow (95% CI 8.5 to 52.4). There were no significant time differences noted in intravenous documentation or in total task time. No difference in perceived workload was found between the user interfaces. Two user interface design problems were identified in the revised user interface. The usability of anesthesia information management systems can be evaluated using a low-fidelity simulated clinical environment. User testing of the revised user interface showed improvement in some usability metrics and highlighted areas for further revision. Vendors of AIMS and those who use them should consider adopting methods to evaluate and improve AIMS usability.

Comparing Cultural Differences in Two Quality Measures in Chinese Kindergartens: The Early Childhood Environment Rating Scale-Revised and the Kindergarten Quality Rating System

ERIC Educational Resources Information Center

Hu, Bi Ying

2015-01-01

This study examined the degrees of congruence between two early childhood evaluation systems on various quality concepts: the Early Childhood Environment Rating Scale-Revised (ECERS-R) and Zhejiang's Kindergarten Quality Rating System (KQRS). Analysis of variance and post hoc least significant difference tests were employed to show the extent to…

Economic Decision Model Suggests Total Shoulder Arthroplasty is Superior to Hemiarthroplasty in Young Patients with End-stage Shoulder Arthritis.

PubMed

Bhat, Suneel B; Lazarus, Mark; Getz, Charles; Williams, Gerald R; Namdari, Surena

2016-11-01

Young patients with severe glenohumeral arthritis pose a challenging management problem for shoulder surgeons. Two controversial treatment options are total shoulder arthroplasty (TSA) and hemiarthroplasty. This study aims to characterize costs, as expressed by reimbursements for episodes of acute care, and outcomes associated with each treatment. We asked: for patients 30 to 50 years old with severe end-stage glenohumeral arthritis refractory to conservative management, (1) are more years of patient-derived satisfactory outcome by the Neer criteria and quality-adjusted life-years (QALYs) achieved using a TSA or a hemiarthroplasty; (2) does a TSA or a hemiarthroplasty result in a greater number of revision procedures; and (3) does a TSA or a hemiarthroplasty result in greater associated costs to society? The incidence of glenohumeral arthritis among 30- to 50-year-old patients, outcomes, reoperation probabilities, and associated costs from TSA and hemiarthroplasty were derived from the literature. A Markov chain decision tree model was developed from these estimates with number of revisions, cost of management for patients to 70 years old as defined by reimbursement for acute-care episodes, years with "satisfactory" or "excellent" outcome by the modified Neer criteria, and QALYs gained as principle outcome measures. A Monte Carlo simulation was conducted with a cohort representing the at-risk population for shoulder arthritis between 30 and 50 years old in the United States. During the lifetime of a cohort of 5279 patients, hemiarthroplasty as the initial treatment resulted in 59,574 patient years of satisfactory or excellent results (11.29 per patient) and average QALYs gained of 6.55, whereas TSA as the initial treatment resulted in 85,969 patient years of satisfactory or excellent results (16.29 per patient) and average QALYs gained of 7.96. During the lifetime of a cohort of 5279 patients, a hemiarthroplasty as the initial treatment led to 2090 lifetime revisions (0.4 per patient), whereas a TSA as the initial treatment led to 1605 lifetime revisions (0.3 per patient). During the lifetime of a cohort of 5279 patients, a hemiarthroplasty as initial treatment resulted in USD 132,500,000 associated direct reimbursements (USD 25,000 per patient), whereas a TSA as initial treatment resulted in USD 125,500,000 associated direct reimbursements (USD 23,700 per patient). Treatment of end-stage glenohumeral arthritis refractory to conservative treatment in patients 30 to 50 years old in the United States with TSA, instead of hemiarthroplasty, would result in greater cost savings, avoid a substantial number of revision procedures, and result in greater years of satisfactory or excellent patient outcomes and greater QALYs gained. On a population level, TSA is the cost-effective treatment for glenohumeral arthritis in patients 30 to 50 years old. Level II, economic and decision analysis study.

The writing process: A powerful approach for the language-disabled student.

PubMed

Moulton, J R; Bader, M S

1985-01-01

Our understanding of the writing process can be a powerful tool for teaching language-disabled students the "how" of writing. Direct, explicit instruction in writing process helps these students learn to explore their ideas and to manage the multiple demands of writing. A case study of one student, Jeff, demonstrates how we structure the stages of writing: prewriting, planning, drafting, revising, and proofreading. When these stages are clearly defined and involve specific skills, language-disabled students can reach beyond their limitations and strengthen their expression. The case study of Jeff reveals the development of his sense of control and his regard for himself as a writer.

Discovery and Entropy in the Revision of Technical Reports.

ERIC Educational Resources Information Center

Marder, Daniel

A useful device in revising technical reports is the metaphor of entropy, which refers to the amount of disorder that is present in a system. Applied to communication theory, high entropy would correspond to increased amounts of unfamiliar or useless information in a text. Since entropy in rhetorical systems increases with the unfamiliarity of…

77 FR 23396 - Revisions to the Requirements for Authority To Manufacture and Distribute Postage Evidencing Systems

Federal Register 2010, 2011, 2012, 2013, 2014

2012-04-19

... POSTAL SERVICE 39 CFR Part 501 Revisions to the Requirements for Authority To Manufacture and Distribute Postage Evidencing Systems AGENCY: Postal Service TM . ACTION: Final rule. SUMMARY: This rule... causing denial-of-service attacks on Web sites. Cyber attacks may be carried out by third parties or...

Effectiveness of the Revised Ontario School Record System.

ERIC Educational Resources Information Center

Humphreys, Edward H.; Elwood, Bryan C.

Results of a study conducted for the Ministry of Education (Ontario) and designed to evaluate the effectiveness of the Ontario School Record System (OSR) as revised in 1973 are reported in this paper. In order to evaluate the OSR's effectiveness, the study team examined educators', parents and students' perceived needs for student information,…

New and Revised Emissions Factors for Flares and New Emissions Factors for Certain Refinery Process Units and Determination for No Changes to VOC Emissions Factors for Tanks and Wastewater Treatment Systems

EPA Pesticide Factsheets

New and Revised Emission Factors for Flares and New Emission Factors for Certain Refinery Process Units and Determination for No Changes to VOC Emission Factors for Tanks and Wastewater Treatment Systems

78 FR 47011 - Software Unit Testing for Digital Computer Software Used in Safety Systems of Nuclear Power Plants

Federal Register 2010, 2011, 2012, 2013, 2014

2013-08-02

... NUCLEAR REGULATORY COMMISSION [NRC-2012-0195] Software Unit Testing for Digital Computer Software... revised regulatory guide (RG), revision 1 of RG 1.171, ``Software Unit Testing for Digital Computer Software Used in Safety Systems of Nuclear Power Plants.'' This RG endorses American National Standards...

78 FR 64027 - Preoperational Testing of Emergency Core Cooling Systems for Pressurized-Water Reactors

Federal Register 2010, 2011, 2012, 2013, 2014

2013-10-25

...The U.S. Nuclear Regulatory Commission (NRC) is issuing a revision to regulatory guide (RG), 1.79, ``Preoperational Testing of Emergency Core Cooling Systems for Pressurized-Water Reactors.'' This RG is being revised to incorporate guidance for preoperational testing of new pressurized water reactor (PWR) designs.

Emerging Marriage: One Story of Learning Sciences and Instructional Systems as a Possible Revisioned Future

ERIC Educational Resources Information Center

Carr-Chellman, Alison A.

2016-01-01

This article explores the potentials for symbiotic partnering between traditional Instructional Systems and Learning Sciences disciplines. This confluence is explored through a narrative discussion of the changes happening at Penn State University over the past decade leading that program toward a name change, curricular revisions, new hiring…

76 FR 63296 - Notice of Tentative Approval and Opportunity for Public Comment and Public Hearing for Public...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-10-12

... Public Comment and Public Hearing for Public Water System Supervision Program Revision for Maryland... approved Public Water System Supervision Program. Maryland has adopted drinking water regulations for the Long Term 2 Enhanced Surface Water Treatment Rule (LT2), the Lead and Copper Rule Short Term Revisions...

Complications leading to surgical revision in implantable cardioverter defibrillator patients: comparison of patients with single-chamber, dual-chamber, and biventricular devices.

PubMed

Duray, Gabor Z; Schmitt, Joern; Cicek-Hartvig, Sule; Hohnloser, Stefan H; Israel, Carsten W

2009-03-01

Implantable cardioverter defibrillator (ICD) technology has become more complex, particularly with respect to biventricular resynchronization devices. The incidence of hardware-related complications in single (SC)-, dual (DC)-, and triple (BiV)-chamber devices requiring surgical revision has not been investigated systematically. We analysed data from consecutive ICD recipients implanted between January 2000 and December 2007 with respect to the need of surgical re-intervention for device- or lead-related complications. Generator exchanges due to normal battery depletion were not considered. From 816 patients (81% male, 69% ischaemic cardiomyopathy, 48% secondary prevention ICDs) followed for 31 +/- 24 months (2118 cumulative patient-years), 98 patients underwent 110 revisions (5.2% per patient-year). Complications included lead-related revision procedures in 81 cases and generator-related problems in 29 cases. The annual incidence of surgical revision due to complications was 11.8% in BiV compared with 4.9% in SC and 4.1% in DC patients (P = 0.002). This higher revision rate was mainly caused by lead-related complications. Implantation of a BiV system was an independent risk factor of the need for surgical revision (relative risk 2.37, 95% confidence interval 1.38-4.04). Even with long-lasting operator experience, complications requiring surgical revision remain a clinically important problem of ICD therapy. The incidence of complications is significantly higher in BiV resynchronization devices than in SC and DC systems.

Meanings of the sickening process for patients with systemic lupus erythematosus: a review of the literature.

PubMed

Alves, Vera Lucia Pereira; Carniel, Andreia Queiroz; Costallat, Lilian Tereza Lavras; Turato, Egberto Ribeiro

2015-01-01

Systemic lupus erythematosus is an autoimmune disease that causes many psychological repercussions that have been studied through qualitative research. These are considered relevant, since they reveal the amplitude experienced by patients. Given this importance, this study aims to map the qualitative production in this theme, derived from studies of experiences of adult patients of both genders and that had used as a tool a semi-structured interview and/or field observations, and had made use of a sampling by a saturation criterion to determine the number of participants in each study. The survey was conducted in Pubmed, Lilacs, Psycinfo e Cochrane databases, searching productions in English and Portuguese idioms published between January 2005 and June 2012. The 19 revised papers that have dealt with patients in the acute phase of the disease showed themes that were categorized into eight topics that contemplated the experienced process at various stages, from the onset of the disease, extending through the knowledge of the diagnosis and the understanding of the manifestations of the disease, drug treatment and general care, evolution and prognosis. The collected papers also point to the difficulty of understanding, of the patients, on what consists the remission phase, revealing also that this is a clinical stage underexplored by psychological studies. Copyright © 2014 Elsevier Editora Ltda. All rights reserved.

Has Metal-On-Metal Resurfacing Been a Cost-Effective Intervention for Health Care Providers?-A Registry Based Study.

PubMed

Pulikottil-Jacob, Ruth; Connock, Martin; Kandala, Ngianga-Bakwin; Mistry, Hema; Grove, Amy; Freeman, Karoline; Costa, Matthew; Sutcliffe, Paul; Clarke, Aileen

2016-01-01

Total hip replacement for end stage arthritis of the hip is currently the most common elective surgical procedure. In 2007 about 7.5% of UK implants were metal-on-metal joint resurfacing (MoM RS) procedures. Due to poor revision performance and concerns about metal debris, the use of RS had declined by 2012 to about a 1% share of UK hip procedures. This study estimated the lifetime cost-effectiveness of metal-on-metal resurfacing (RS) procedures versus commonly employed total hip replacement (THR) methods. We performed a cost-utility analysis using a well-established multi-state semi-Markov model from an NHS and personal and social services perspective. We used individual patient data (IPD) from the National Joint Registry (NJR) for England and Wales on RS and THR surgery for osteoarthritis recorded from April 2003 to December 2012. We used flexible parametric modelling of NJR RS data to guide identification of patient subgroups and RS devices which delivered revision rates within the NICE 5% revision rate benchmark at 10 years. RS procedures overall have an estimated revision rate of 13% at 10 years, compared to <4% for most THR devices. New NICE guidance now recommends a revision rate benchmark of <5% at 10 years. 60% of RS implants in men and 2% in women were predicted to be within the revision benchmark. RS devices satisfying the 5% benchmark were unlikely to be cost-effective compared to THR at a standard UK willingness to pay of £20,000 per quality-adjusted life-year. However, the probability of cost effectiveness was sensitive to small changes in the costs of devices or in quality of life or revision rate estimates. Our results imply that in most cases RS has not been a cost-effective resource and should probably not be adopted by decision makers concerned with the cost effectiveness of hip replacement, or by patients concerned about the likelihood of revision, regardless of patient age or gender.

Myospherulosis following sinus surgery: pathological curiosity or important clinical entity?

PubMed

Sindwani, Raj; Cohen, Jacob T; Pilch, Ben Z; Metson, Ralph B

2003-07-01

Myospherulosis is a foreign body reaction to lipid material used on nasal packing at the conclusion of sinus surgery. This reaction has been associated with postoperative adhesion formation. The purpose of the study was to determine whether the occurrence of myospherulosis has an adverse effect on clinical outcome following sinus surgery. Case-control study at an academic medical center. Thirty-two cases of myospherulosis were identified in 28 patients (4 with bilateral disease) who underwent sinus surgery between 1989 and 1999. Cases were staged according to histological and radiological grading systems. Clinical outcome was compared with a control group of 28 patients who had similar surgery during the same time period. Patients with myospherulosis were found to have a significantly higher likelihood of developing postoperative adhesions compared with control subjects (50% vs. 18%, respectively [P =.023]). Histological stage, based on the extent of lipid vacuoles and spherules (erythrocyte remnants) present in the surgical specimen, was found to correlate with disease severity based on preoperative sinus computed tomography staging (P =.009). Patients with myospherulosis tended to have a shorter interval between their last two surgeries than did control subjects (2.2 +/- 2.1 vs. 4.5 +/- 7.1 y, respectively [P =.086]). Patient age, sex, comorbid conditions, CT stage, and number of previous operations were not predictive for the occurrence of myospherulosis. Patients who develop myospherulosis from lipid-based packing material used during sinus surgery are more likely to form postoperative adhesions. These adhesions appear to be clinically relevant and may hasten the need for revision surgery.

Translational systems biology: introduction of an engineering approach to the pathophysiology of the burn patient.

PubMed

An, Gary; Faeder, James; Vodovotz, Yoram

2008-01-01

The pathophysiology of the burn patient manifests the full spectrum of the complexity of the inflammatory response. In the acute phase, inflammation may have negative effects via capillary leak, the propagation of inhalation injury, and development of multiple organ failure. Attempts to mediate these processes remain a central subject of burn care research. Conversely, inflammation is a necessary prologue and component in the later stage processes of wound healing. Despite the volume of information concerning the cellular and molecular processes involved in inflammation, there exists a significant gap between the knowledge of mechanistic pathophysiology and the development of effective clinical therapeutic regimens. Translational systems biology (TSB) is the application of dynamic mathematical modeling and certain engineering principles to biological systems to integrate mechanism with phenomenon and, importantly, to revise clinical practice. This study will review the existing applications of TSB in the areas of inflammation and wound healing, relate them to specific areas of interest to the burn community, and present an integrated framework that links TSB with traditional burn research.

Ant system: optimization by a colony of cooperating agents.

PubMed

Dorigo, M; Maniezzo, V; Colorni, A

1996-01-01

An analogy with the way ant colonies function has suggested the definition of a new computational paradigm, which we call ant system (AS). We propose it as a viable new approach to stochastic combinatorial optimization. The main characteristics of this model are positive feedback, distributed computation, and the use of a constructive greedy heuristic. Positive feedback accounts for rapid discovery of good solutions, distributed computation avoids premature convergence, and the greedy heuristic helps find acceptable solutions in the early stages of the search process. We apply the proposed methodology to the classical traveling salesman problem (TSP), and report simulation results. We also discuss parameter selection and the early setups of the model, and compare it with tabu search and simulated annealing using TSP. To demonstrate the robustness of the approach, we show how the ant system (AS) can be applied to other optimization problems like the asymmetric traveling salesman, the quadratic assignment and the job-shop scheduling. Finally we discuss the salient characteristics-global data structure revision, distributed communication and probabilistic transitions of the AS.

Automated knowledge-base refinement

NASA Technical Reports Server (NTRS)

Mooney, Raymond J.

1994-01-01

Over the last several years, we have developed several systems for automatically refining incomplete and incorrect knowledge bases. These systems are given an imperfect rule base and a set of training examples and minimally modify the knowledge base to make it consistent with the examples. One of our most recent systems, FORTE, revises first-order Horn-clause knowledge bases. This system can be viewed as automatically debugging Prolog programs based on examples of correct and incorrect I/O pairs. In fact, we have already used the system to debug simple Prolog programs written by students in a programming language course. FORTE has also been used to automatically induce and revise qualitative models of several continuous dynamic devices from qualitative behavior traces. For example, it has been used to induce and revise a qualitative model of a portion of the Reaction Control System (RCS) of the NASA Space Shuttle. By fitting a correct model of this portion of the RCS to simulated qualitative data from a faulty system, FORTE was also able to correctly diagnose simple faults in this system.

Measuring input prices for physicians: The revised Medicare Economic Index

PubMed Central

Freeland, Mark S.; Chulis, George S.; Arnett, Ross H.; Brown, Aaron P.

1991-01-01

Medicare payments for physician services under Part B were historically restrained by capping prevailing charges using the Medicare Economic Index (MEI). The MEI, an input price index for physician services that incorporates an adjustment for economywide labor productivity, has not undergone a major revision since 1975. The MEI is an important determinant of the annual volume performance standard that will be used to set aggregate increases in the revised system for paying physicians under Medicare beginning in 1992. The MEI will also be used in establishing the annual changes to the payment conversion factors under the new payment system. PMID:10170807

Comparing Ultraviolet Spectra Against Calculations: First Results

NASA Technical Reports Server (NTRS)

Peterson, Ruth C.

2003-01-01

The five-year goal of this effort is to calculate high fidelity mid-UV spectra for individual stars and stellar systems for a wide range of ages, abundances, and abundance ratios. In this first year, the emphasis was placed on revising the list of atomic line parameters used to calculate mid-UV spectra. First, new identifications of atomic lines and measurements of their transition probabilities were obtained for lines of the first and second ionization stages of iron-peak elements. Second, observed mid-UV and optical spectra for standard stars were re-analyzed and compared to new calculations, to refine the determination of transition probabilities and to estimate the identity of lines still missing from the laboratory lists. As evidenced by the figures, a dramatic improvement has resulted in the reproduction of the spectra of standard stars by the calculations.

Clinical outcome and long-term survival of 150 consecutive patients with pancreatic neuroendocrine tumors: A comprehensive analysis by the World Health Organization 2010 grading classification.

PubMed

Deng, Ben-Yuan; Liu, Fei; Yin, Si-Neng; Chen, An-Ping; Xu, Lin; Li, Bo

2018-06-01

The World Health Organization (WHO) has revised its grading system for pancreatic neuroendocrine tumors (PNETs) in 2010 into three main group, which has not been widely and comprehensively evaluated. We aimed to validate the clinical valve of this system associated with the clinical outcome and long-term survival when applied to PNETs, which were rare and heterogeneous. We retrospectively collected and analyzed the data of 150 consecutive patients with PNETs who underwent a resection. Sixty-four males and 86 females with PNETs were enrolled in our study. The clinical stage from I to IV by European Neuroendocrine Tumor Society were respectively defined in 53, 60, 19 and 18 patients. Seventy-two patients were pathologically diagnosed as neuroendocrine tumor G1 (NET G1), 48 as neuroendocrine tumor G2 (NET G2) and 30 as neuroendocrine carcinoma G3 (NEC G3). Patients with a radical resection obtained a notably higher overall survival (OS) than that of patients who underwent a palliative surgery (P=0.001). The 5-year OS of patients with NET G1 was significantly higher than that of patients with NET G2 (P=0.015) and NEC G3 (P<0.001); the comparison of OS for patients with NET G2 and NEC G3 was also statistically significant (P=0.005). In both univariate and multivariate analysis, clinical staging by ENETS (stage I and II vs. stage III and IV), resection (radical vs. palliative) and WHO 2010 grading classification (NET G1 and G2 vs. NEC G3) were validated to be independent predictors for the survivals of PNETs. The newly-updated WHO 2010 grading classification was prognostic for the OS of PNETs and could be widely adopted in clinical practice. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

Updates in the Management of Hepatocellular Carcinoma

PubMed Central

Frenette, Catherine

2011-01-01

Hepatocellular carcinoma (HCC) is a leading cause of cancer-related death, and its increasing incidence worldwide is a cause for concern. Fortunately, advances in diagnostic and therapeutic approaches have contributed to earlier detection and treatment. As cancer epidemiology studies continue to elucidate the natural history of liver diseases, greater understanding of HCC has led to improved risk stratification and earlier enrollment of high-risk patients in cancer screening and surveillance programs. Improved survival rates among HCC patients also reflect significant advances in available treatment options. Advances in surgical techniques are pushing the boundaries of resection for localized disease, and progress in the field of transplantation has led to refinements in listing criteria and improved post-transplantation outcomes. The evolving field of locoregional therapies—including percutaneous ablation and transarterial chemoembolization—continues to provide novel therapeutic options that can be used in place of, or in addition to, surgical approaches. Recent advances in systemic multikinase inhibitor therapies have also demonstrated significant benefits for advanced-stage disease, and these therapies also show promise as adjuvant treatments for earlier-stage disease. This article provides an update on the management of HCC, with a focus on revised guidelines for screening and an in-depth discussion of emerging novel therapies. PMID:21346848

The development and regulation of occupational exposure limits in Taiwan.

PubMed

Shih, Tung-Sheng; Wu, Kuen-Yuh; Chen, Hong-I; Chang, Cheng-Ping; Chang, Ho-Yuan; Huang, Yi-Shiao; Liou, Saou-Hsing

2006-11-01

The occupational exposure limits (OELs) in Taiwan was promulgated in 1974 and has been revised five times since then. Many of the OELs were adopted from the most recent ACGIH TLVs and US OSHA PELs. A total of 483 chemicals were listed in the current Taiwan OELs Standard. The procedures of OELs development in Taiwan include the IOSH organized a recommended exposure limits (RELs) Committee to select the target chemicals and to recommend the RELs through literature review based on the health effects in the first stage, then, the CLA put policy needs, economical and technical feasibility into consideration and set up the final OELs at the second stage. A standard operation manual of RELs Committee has been developed. Based on our experience, several issues including the participation of representatives from a comprehensive spectrum, communication/education and training/enforcement, continuous collection of the local exposure data and health hazard information, use of health risk assessment, consideration of economic, and technical feasibility, as well as the globalization and information and experience sharing are critical in developing the appropriate OELs. Three examples including benzene, crystalline silica, and 2-methoxy ethanol are given to demonstrate the operation of system.

The Differential Effect of Two Types of Direct Written Corrective Feedback on Noticing and Uptake: Reformulation vs. Error Correction

ERIC Educational Resources Information Center

Santos, Maria; Lopez-Serrano, Sonia; Manchon, Rosa M.

2010-01-01

Framed in a cognitively-oriented strand of research on corrective feedback (CF) in SLA, the controlled three-stage (composition/comparison-noticing/revision) study reported in this paper investigated the effects of two forms of direct CF (error correction and reformulation) on noticing and uptake, as evidenced in the written output produced by a…

Preliminary Feasibility Report Stage II, Lorain Small-Boat Harbor, Lorain, Ohio. Revision.

DTIC Science & Technology

1982-03-01

effects of each alternative plan. Activities consist of analyzing each measure to deter- mine potential sources , the incidence, and the magni- tude...using existing reports, available data sources , visual inspections, onsite interviews, and workshop discussions. Alternative small-boat harbor designs...were developed to a consistent level of detail. Prior reports were used as data sources for preliminary design of break- waters, including length

Raccoons of North and Middle America

USGS Publications Warehouse

Goldman, Edward A.; Jackson, Hartley H.T.

1950-01-01

Dr. E. W. Nelson became keenly interested in the raccoons, as shown by his work on those inhabiting the Florida Keys (1930a).' During the same time and in the following year new subspecies were described jointly by Nelson and the writer in preparation for a revision of the group; but other projects claimed attention and our collaboration could not be carried beyond this preliminary stage

Geneva-on-the-Lake Ohio. Small Boat Harbor. Stage 2 Document for Reformulation Phase I General Design Memorandum. Revision.

DTIC Science & Technology

1980-04-01

Seismic velocities of 3,000 to 6,700 feet per second indicate that the till is rippable , but in these areas where the velocities approach 6,700 feet per...marginally rippable to nonrippable using a D9H ripper. Bedrock excavation pro- bably will require drilling and blasting. A22. APPROACH CHANNELS Bedrock is

Social Facilitation During the Initial Stage of Motor Learning: A Re-examination of Martens' Audience Study. Revised.

ERIC Educational Resources Information Center

Landers, Daniel M.; And Others

1978-01-01

R. Martens' hypothesis that an audience acts as a stimulus to elicit arousal or drive in the performance of an individual, which in turn enhances the emission of the dominant habit, is reexamined. Where incorrect responses are dominant, learning of a novel task will be inhibited, or at least improvement will not be as rapid as for individuals…

Long-term follow-up after surgery in localized laryngeal amyloidosis.

PubMed

Hazenberg, Aldert J C; Hazenberg, Bouke P C; Dikkers, Frederik G

2016-09-01

To study effectiveness of surgery and watchful waiting in localized laryngeal amyloidosis, retrospective case series. This retrospective study comprises all consecutive patients with localized laryngeal amyloidosis surgically treated in a tertiary hospital between 1994 and February 2016. Recurrence rate, revision surgery, progression to systemic amyloidosis, and changes in voice were monitored yearly. Eighteen patients were included. Seven women and eleven men had a median age 50 years (range 21-77 years) and median follow-up 6.4 years (2.4-17 years). Amyloid was located in subglottis (5), glottis (8), false vocal folds (8) and other supraglottic areas (5), in more than one laryngeal region (13) and bilaterally (12). Cold steel excision was used at the glottis; CO2 laser excision, sometimes assisted by microdebrider, at other laryngeal areas. Eleven patients needed revision surgery, ten within the first 4 years after surgical treatment. One patient needed his first revision surgery after 11 years. Five patients needed a second revision within 6 years after initial diagnosis. Two patients needed a third revision. Indications for first revision surgery were progression (8) with dysphonia (7), dyspnea (2), dysphagia (1), exclusion of malignancy (1), and aphonia (1). No patient developed systemic amyloidosis during follow-up. Although local progression of amyloid necessitates revision surgery once or twice in the first 4-6 years, progression slows down thereafter. Late progression, however, remains possible.

Maximally efficient two-stage screening: Determining intellectual disability in Taiwanese military conscripts.

PubMed

Chien, Chia-Chang; Huang, Shu-Fen; Lung, For-Wey

2009-01-27

The purpose of this study was to apply a two-stage screening method for the large-scale intelligence screening of military conscripts. We collected 99 conscripted soldiers whose educational levels were senior high school level or lower to be the participants. Every participant was required to take the Wisconsin Card Sorting Test (WCST) and the Wechsler Adult Intelligence Scale-Revised (WAIS-R) assessments. Logistic regression analysis showed the conceptual level responses (CLR) index of the WCST was the most significant index for determining intellectual disability (ID; FIQ ≤ 84). We used the receiver operating characteristic curve to determine the optimum cut-off point of CLR. The optimum one cut-off point of CLR was 66; the two cut-off points were 49 and 66. Comparing the two-stage window screening with the two-stage positive screening, the area under the curve and the positive predictive value increased. Moreover, the cost of the two-stage window screening decreased by 59%. The two-stage window screening is more accurate and economical than the two-stage positive screening. Our results provide an example for the use of two-stage screening and the possibility of the WCST to replace WAIS-R in large-scale screenings for ID in the future.

Maximally efficient two-stage screening: Determining intellectual disability in Taiwanese military conscripts

PubMed Central

Chien, Chia-Chang; Huang, Shu-Fen; Lung, For-Wey

2009-01-01

Objective: The purpose of this study was to apply a two-stage screening method for the large-scale intelligence screening of military conscripts. Methods: We collected 99 conscripted soldiers whose educational levels were senior high school level or lower to be the participants. Every participant was required to take the Wisconsin Card Sorting Test (WCST) and the Wechsler Adult Intelligence Scale-Revised (WAIS-R) assessments. Results: Logistic regression analysis showed the conceptual level responses (CLR) index of the WCST was the most significant index for determining intellectual disability (ID; FIQ ≤ 84). We used the receiver operating characteristic curve to determine the optimum cut-off point of CLR. The optimum one cut-off point of CLR was 66; the two cut-off points were 49 and 66. Comparing the two-stage window screening with the two-stage positive screening, the area under the curve and the positive predictive value increased. Moreover, the cost of the two-stage window screening decreased by 59%. Conclusion: The two-stage window screening is more accurate and economical than the two-stage positive screening. Our results provide an example for the use of two-stage screening and the possibility of the WCST to replace WAIS-R in large-scale screenings for ID in the future. PMID:21197345

Local repair of stoma prolapse: Case report of an in vivo application of linear stapler devices.

PubMed

Monette, Margaret M; Harney, Rodney T; Morris, Melanie S; Chu, Daniel I

2016-11-01

One of the most common late complications following stoma construction is prolapse. Although the majority of prolapse can be managed conservatively, surgical revision is required with incarceration/strangulation and in certain cases laparotomy and/or stoma reversal are not appropriate. This report will inform surgeons on safe and effective approaches to revising prolapsed stomas using local techniques. A 58 year old female with an obstructing rectal cancer previously received a diverting transverse loop colostomy. On completion of neoadjuvant treatment, re-staging found new lung metastases. She was scheduled for further chemotherapy but incarcerated a prolapsed segment of her loop colostomy. As there was no plan to resect her primary rectal tumor at the time, a local revision was preferred. Linear staplers were applied to the prolapsed stoma in step-wise fashion to locally revise the incarcerated prolapse. Post-operative recovery was satisfactory with no complications or recurrence of prolapse. We detail in step-wise fashion a technique using linear stapler devices that can be used to locally revise prolapsed stoma segments and therefore avoid a laparotomy. The procedure is technically easy to perform with satisfactory post-operative outcomes. We additionally review all previous reports of local repairs and show the evolution of local prolapse repair to the currently reported technique. This report offers surgeons an alternative, efficient and effective option for addressing the complications of stoma prolapse. While future studies are needed to assess long-term outcomes, in the short-term, our report confirms the safety and effectiveness of this local technique.

Reductive Augmentation of the Breast.

PubMed

Chasan, Paul E

2018-06-01

Although breast reduction surgery plays an invaluable role in the correction of macromastia, it almost always results in a breast lacking in upper pole fullness and/or roundness. We present a technique of breast reduction combined with augmentation termed "reductive augmentation" to solve this problem. The technique is also extremely useful for correcting breast asymmetry, as well as revising significant pseudoptosis in the patient who has previously undergone breast augmentation with or without mastopexy. An evolution of techniques has been used to create a breast with more upper pole fullness and anterior projection in those patients desiring a more round, higher-profile appearance. Reductive augmentation is a one-stage procedure in which a breast augmentation is immediately followed by a modified superomedial pedicle breast reduction. Often, the excision of breast tissue is greater than would normally be performed with breast reduction alone. Thirty-five patients underwent reductive augmentation, of which 12 were primary surgeries and 23 were revisions. There was an average tissue removal of 255 and 227 g, respectively, per breast for the primary and revision groups. Six of the reductive augmentations were performed for gross asymmetry. Fourteen patients had a previous mastopexy, and 3 patients had a previous breast reduction. The average follow-up was 26 months. Reductive augmentation is an effective one-stage method for achieving a more round-appearing breast with upper pole fullness both in primary breast reduction candidates and in revisionary breast surgery. This technique can also be applied to those patients with significant asymmetry. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Temporary arthrodesis using fixator rods in two-stage revision of septic knee prothesis with severe bone and tissue defects.

PubMed

Röhner, Eric; Pfitzner, Tilman; Preininger, Bernd; Zippelius, Timo; Perka, Carsten

2016-01-01

The present study describes a new temporary arthrodesis procedure, which aims for septic knee prosthesis replacement, in particular for larger bone and soft tissue defects. Our technique offers high stability and full weight-bearing capacity of the knee joint. The study included 16 patients with major bone defects (AORI type IIb or greater) after receiving a radical debridement and a septic two-stage revision total knee arthroplasty. After removing the infected prosthesis and debridement, two AO fixator rods were positioned into the intramedullary space of the femur and tibia. Subsequently, both rods were joined tube-to-tube and adjusted in the center of the knee joint. Finally, the whole cavity of the knee joint was filled with PMMA. The number of previous surgeries, bacterial spectrum, risk factors for further infection and reinfection rates was recorded. Immediately after the temporary arthrodesis, radiographs of the knee with the enclosed spacers were taken in order to compare to previous radiographs and avoiding to miss possible spacer loosening. Nine of sixteen patients underwent more than two revision surgeries before receiving our new arthrodesis technique. No cases of spacer loosening were observed in all 16 patients; further, there were no peri-implant fractures, and four persistent infections were noted. Temporary arthrodesis using AO fixator rods offers a high stability without loosening. Its potential to replace conventional augmentation techniques should be taken into account, particularly in the case of larger bone and tissue defects. In clinical practice, the cemented spacer using AO fixator rods could be an alternative technique for temporary knee arthrodesis after septic debridement. Retrospective case series, Level IV.

Application of individually performed acrylic cement spacers containing 5% of antibiotic in two-stage revision of hip and knee prosthesis due to infection.

PubMed

Babiak, Ireneusz

2012-07-03

Deep infection of a joint endoprosthesis constitutes a threat to the stability of the implant and joint function. It requires a comprehensive and interdisciplinary approach, involving the joint revision and removal of the bacterial biofilm from all tissues, the endoprosthesis must be often removed and bone stock infection treated. The paper presents the author's experience with the use of acrylic cement spacers, custom-made during the surgery and containing low dose of an antibiotic supplemented with 5% of a selected, targeted antibiotic for the infection of hip and knee endoprostheses. 33 two-stage revisions of knee and hip joints with the use of a spacer were performed. They involved 24 knee joints and 9 hip joints. The infections were mostly caused by staphylococci MRSA (18) and MSSA (8), and in some cases Enterococci (4), Salmonella (1), Pseudomonas (1) and Acinetobacter (1). The infection was successfully treated in 31 out of 33 cases (93.93%), including 8 patients with the hip infection and 23 patients with the knee infection. The endoprosthesis was reimplanted in 30 cases: for 7 hips and 23 knees, in 3 remaining cases the endoprosthesis was not reimplanted. Mechanical complications due to the spacer occurred in 4 cases: 3 dislocations and 1 fracture (hip spacer). The patients with hip spacers were ambulatory with a partial weight bearing of the operated extremity and those with knee spacers were also ambulatory with a partial weight bearing, but the extremity was initially protected by an orthosis. The spacer enables to maintain a limb function, and making it by hand allows the addition of the specific bacteria targeted antibiotic thus increasing the likelihood of the effective antibacterial treatment.

Beyond cause to consequence: The road from possible to core self-revision

PubMed Central

Carroll, Patrick J.; Agler, Robert A.; Newhart, Daniel W.

2015-01-01

Two studies addressed the ultimate consequences and pathways running from repeated possible self-revisions to gradual revisions in core selves over time. As hypothesized, greater prior experiences of downward possible self-revision ultimately predicted greater subsequent declines in core self-integrity (e.g., greater self-doubt, lower self-esteem). However, also as hypothesized, this effect was mediated by the relative use of defensive vs. remedial attributions for past downward self-revision experiences. In closing, we unpack how the present work extends prior work by situating possible selves and motivated self-attributions as complementary systems that can slowly undermine as well as expand the integrity of core selves over time. PMID:26635509

Toxic Substances Registry System: Index of Material Safety Data Sheets. Revised

NASA Technical Reports Server (NTRS)

1998-01-01

The January 1998 revision of the Index of Materials Safety Data Sheets (MSDS) for the Kennedy Space Center (KSC) Toxic Substances Registry System (TSRS) is presented. The MSDS lists toxic substances by manufacturer, trade name, stock number, and distributor. The index provides information on hazards, use, and chemical composition of materials stored at KSC.

77 FR 39521 - Applications and Amendments to Facility Operating Licenses and Combined Licenses Involving...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-07-03

... Methodology for Boiling Water Reactors, June 2011. To support use of Topical Report ANP-10307PA, Revision 0... the NRC's E-Filing system does not support unlisted software, and the NRC Meta System Help Desk will... Water Reactors with AREVA Topical Report ANP- 10307PA, Revision 0, ``AREVA MCPR Safety Limit Methodology...

77 FR 39182 - Revisions to the Unregulated Contaminant Monitoring Regulation (UCMR 3) for Public Water Systems

Federal Register 2010, 2011, 2012, 2013, 2014

2012-07-02

... ENVIRONMENTAL PROTECTION AGENCY 40 CFR Parts 141 and 142 [Docket No. EPA-HQ-OW-2009-0090; FRL-9660-4] RIN 2040-AF10 Revisions to the Unregulated Contaminant Monitoring Regulation (UCMR 3) for Public Water Systems Correction In rule document 2012-9978 appearing on pages 26072-26101 in the issue of...

77 FR 43523 - Revisions to the Unregulated Contaminant Monitoring Regulation (UCMR 3) for Public Water Systems

Federal Register 2010, 2011, 2012, 2013, 2014

2012-07-25

... ENVIRONMENTAL PROTECTION AGENCY 40 CFR Parts 141 and 142 [Docket No. EPA-HQ-OW-2009-0090; FRL-9660-4] RIN 2040-AF10 Revisions to the Unregulated Contaminant Monitoring Regulation (UCMR 3) for Public Water Systems Correction In rule document 2012-9978 appearing on pages 26072-26101 in the issue of...

Revised Total Coliform Rule Lab Sampling Form

EPA Pesticide Factsheets

This form should be completed when a water system collects any required Revised Total Coliform Rule (RTCR) samples. It should also be used when collecting “Special” non-compliance samples for the RTCR.

Brady's Geothermal Field - March 2016 Vibroseis SEG-Y Files and UTM Locations

DOE Data Explorer

Kurt Feigl

2016-03-31

PoroTomo March 2016 (Task 6.4) Updated vibroseis source locations with UTM locations. Supersedes gdr.openei.org/submissions/824. Updated vibroseis source location data for Stages 1-4, PoroTomo March 2016. This revision includes source point locations in UTM format (meters) for all four Stages of active source acquisition. Vibroseis sweep data were collected on a Signature Recorder unit (mfr Seismic Source) mounted in the vibroseis cab during the March 2016 PoroTomo active seismic survey Stages 1 to 4. Each sweep generated a GPS timed SEG-Y file with 4 input channels and a 20 second record length. Ch1 = pilot sweep, Ch2 = accelerometer output from the vibe's mass, Ch3 = accel output from the baseplase, and Ch4 = weighted sum of the accelerometer outputs. SEG-Y files are available via the links below.

Revised Geometric Measure of Entanglement in Infinite Dimensional Multipartite Quantum Systems

NASA Astrophysics Data System (ADS)

Wang, Yinzhu; Wang, Danxia; Huang, Li

2018-05-01

In Cao and Wang (J. Phys.: Math. Theor. 40, 3507-3542, 2007), the revised geometric measure of entanglement (RGME) for states in finite dimensional bipartite quantum systems was proposed. Furthermore, in Cao and Wang (Commun. Theor. Phys. 51(4), 613-620, 2009), the authors obtained the revised geometry measure of entanglement for multipartite states including three-qubit GHZ state, W state, and the generalized Smolin state in the presence of noise and the two-mode squeezed thermal state, and defined the Gaussian geometric entanglement measure. In this paper, we generalize the RGME to infinite dimensional multipartite quantum systems, and prove that this measure satisfies some necessary properties as a well-defined entanglement measure, including monotonicity under local operations and classical communications.

Superfund record of decision amendment (EPA Region 3): Tyson Dump Superfund Site, Upper Merion Township, Montgomergy County, PA, July 20, 1996

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

NONE

1996-08-01

The Record of Decision Amendment (`ROD Amendment`) modifies the selected remedy described in the Revised Record of Decision for the Tyson`s Superfund Site (Site) issued by the U.S. Environmental Protection Agency (EPA) on March 31, 1988 (1988 Revised ROD - PB89-233894). In the 1988 Revised ROD, EPA selected a soil vapor extraction (SVE) remedy for lagoon area soils. The SVE system has removed approximately 200,000 pounds of volatile organic compounds (VOCs) from the lagoon area soils. Although several enhancements and modifications have been employed to improve performance, the SVE system will not achieve the cleanup standards specified in the 1988more » Revised ROD. The decision document presents the selected remedial action for the lagoon area soils at the Tyson`s Site.« less

Naval Sea Systems Command > Home > Warfare Centers > NSWC Corona

Science.gov Websites

Modernization Inactive Ships International Fleet Support Surface Ship Readiness and Sustainment SURFMEPP Surface ; Schemas MIL-DTL-24784C IM/IP DTD Suite IWS6 Common Schema NAVSEA Class 2 ETM DTD Changes from the ETM Class 2 Revision E History Early Revisions Early Revisions Rev E Changes Rev D Changes Rev C 1.2 Changes

The role of Brazilian National Health Information Systems in assessing the impact of Zika virus outbreak.

PubMed

Pavão, Ana Luiza Braz; Barcellos, Christovam; Pedroso, Marcel; Boccolini, Cristiano; Romero, Dália

2017-01-01

The Zika virus (ZIKV) epidemic has become a public health emergency following its association with severe neurological complications. We aim to discuss how the Brazilian National Health Information Systems can help to assess the impact of the ZIKV epidemic on health outcomes potentially related to ZIKV. Health outcomes potentially related to ZIKV infection were described based on a literature review of published studies on ZIKV infection outcomes and on recent protocols developed and published by the Brazilian Ministry of Health for different stages of the life cycle. These outcomes were correlated with the International Classification of Diseases 10th Revision (ICD-10) classification system, as this is the diagnostic classification registered in the Health Information System. A suggested list of 50 clinical manifestations, dispersed into 4 ICD chapters, and their information sources was created to help monitor the ZIKV epidemics and trends. Correlation of these selected ICD-10 codes and the HIS, as well as, a review of the potentialities and limitations of health information systems were performed. The potential of the Health Information System and its underutilization by stakeholders and researchers have been a barrier in diagnosing and reporting ZIKV infection and its complications. The ZIKV outbreak is still a challenge for health practice and the Brazilian Health Information System.

Revised geologic cross sections of parts of the Colorado, White River, and Death Valley regional groundwater flow systems, Nevada, Utah, and Arizona

USGS Publications Warehouse

Page, William R.; Scheirer, Daniel S.; Langenheim, V.E.; Berger, Mary A.

2006-01-01

This report presents revisions to parts of seven of the ten cross sections originally published in U.S. Geological Survey Open-File Report 2006-1040. The revisions were necessary to correct errors in some of the original cross sections, and to show new parts of several sections that were extended and (or) appended to the original section profiles. Revisions were made to cross sections C-C', D-D', E-E', F-F', G-G', I-I', and J-J', and the parts of the sections revised or extended are highlighted below the sections on plate 1 by red brackets and the word "revised," or "extended." Sections not listed above, as well as the interpretive text and figures, are generally unchanged from the original report. Cross section C-C' includes revisions in the east Mormon Mountains in the east part of the section; D-D' includes revisions in the Mormon Mesa area in the east part of the section; E-E' includes revisions in the Muddy Mountains in the east part of the section; F-F' includes revisions from the Muddy Mountains to the south Virgin Mountains in the east part of the section; and J-J' includes some revisions from the east Mormon Mountains to the Virgin Mountains. The east end of G-G' was extended about 16 km from the Black Mountains to the southern Virgin Mountains, and the northern end of I-I' was extended about 45 km from the Muddy Mountains to the Mormon Mountains, and revisions were made in the Muddy Mountains part of the original section. This report contains 10 interpretive cross sections and an integrated text describing the geology of parts of the Colorado, White River, and Death Valley regional groundwater flow systems in Nevada, Utah, and Arizona. The primary purpose of the report is to provide geologic framework data for input into a numerical groundwater model. Therefore, the stratigraphic and structural summaries are written in a hydrogeologic context. The oldest rocks (basement) are Early Proterozoic metamorphic and intrusive crystalline rocks that are considered confining units because of their low permeability. Late Proterozoic to Lower Cambrian clastic units overlie the crystalline rocks and are also considered confining units within the regional flow systems. Above the clastic units are Middle Cambrian to Lower Permian carbonate rocks that are the primary aquifers in the flow systems. The Middle Cambrian to Lower Permian carbonate rocks are overlain by a sequence of mainly clastic rocks of late Paleozoic to Mesozoic age that are mostly considered confining units, but they may be permeable where faulted. Tertiary volcanic and plutonic rocks are exposed in the northern and southern parts of the study area. In the Clover and Delamar Mountains, these rocks are highly deformed by north- and northwest-striking normal and strike-slip faults that are probably important conduits in transmitting groundwater from the basins in the northern Colorado and White River flow systems to basins in the southern part of the flow systems. The youngest rocks in the region are Tertiary to Quaternary basin-fill deposits. These rocks consist of middle to late Tertiary sediments consisting of limestone, conglomerate, sandstone, tuff, and gypsum, and younger Quaternary surficial units consisting of alluvium, colluvium, playa deposits, and eolian deposits. Basin-fill deposits are both aquifers and aquitards. The rocks in the study area were complexly deformed by episodes of Mesozoic compression and Cenozoic extensional tectonism. Some Cretaceous thrust faults and folds of the Sevier orogenic belt form duplex zones and define areas of maximum thickness for the Paleozoic carbonate rocks. Cenozoic faults are important because they are the primary structures that control groundwater flow in the regional flow systems.

A simple two-stage design for quantitative responses with application to a study in diabetic neuropathic pain.

PubMed

Whitehead, John; Valdés-Márquez, Elsa; Lissmats, Agneta

2009-01-01

Two-stage designs offer substantial advantages for early phase II studies. The interim analysis following the first stage allows the study to be stopped for futility, or more positively, it might lead to early progression to the trials needed for late phase II and phase III. If the study is to continue to its second stage, then there is an opportunity for a revision of the total sample size. Two-stage designs have been implemented widely in oncology studies in which there is a single treatment arm and patient responses are binary. In this paper the case of two-arm comparative studies in which responses are quantitative is considered. This setting is common in therapeutic areas other than oncology. It will be assumed that observations are normally distributed, but that there is some doubt concerning their standard deviation, motivating the need for sample size review. The work reported has been motivated by a study in diabetic neuropathic pain, and the development of the design for that trial is described in detail. Copyright 2008 John Wiley & Sons, Ltd.

Impact of ETO propellants on the aerothermodynamic analyses of propulsion components

NASA Technical Reports Server (NTRS)

Civinskas, K. C.; Boyle, R. J.; Mcconnaughey, H. V.

1988-01-01

The operating conditions and the propellant transport properties used in Earth-to-Orbit (ETO) applications affect the aerothermodynamic design of ETO turbomachinery in a number of ways. Some aerodynamic and heat transfer implications of the low molecular weight fluids and high Reynolds number operating conditions on future ETO turbomachinery are discussed. Using the current SSME high pressure fuel turbine as a baseline, the aerothermodynamic comparisons are made for two alternate fuel turbine geometries. The first is a revised first stage rotor blade designed to reduce peak heat transfer. This alternate design resulted in a 23 percent reduction in peak heat transfer. The second design concept was a single stage rotor to yield the same power output as the baseline two stage rotor. Since the rotor tip speed was held constant, the turbine work factor doubled. In this alternate design, the peak heat transfer remained the same as the baseline. While the efficiency of the single stage design was 3.1 points less than the baseline two stage turbine, the design was aerothermodynamically feasible, and may be structurally desirable.

[The Use of Jumbo Cups in Revision Total Hip Arthroplasty].

PubMed

von Roth, Philipp; Wassilew, Georgi I

2017-10-01

Extra-large uncemented jumbo cups are among the most common methods of acetabular revision. Jumbo cups do not contribute to bone stock restoration, and in the case of a subsequent revision, an even larger bone defect is to be expected. Thus, understanding long-term survival is essential. The present article discusses the literature relevant to this topic and addresses technical and implant-specific characteristics of jumbo cups. In summary, jumbo cups show an acceptable long-term survival rate, with aseptic loosening as the most common reason for revision and dislocation being the most common complication. Through the development of alternative revision systems, jumbo cups have lost their importance in today's practice. However, they can serve as a benchmark for studies of newer technologies in revision total hip arthroplasty. Georg Thieme Verlag KG Stuttgart · New York.

Reform in medical ethics curriculum: a step by step approach based on available resources

PubMed Central

Asghari, Fariba; Mirzazadeh, Azim; Samadi, Aniseh; Safa, Aliakbar Nejati; Jafarian, Ali; Farahani, Ali Vasheghani; Razavi, Seyed Hasan Emami

2011-01-01

In this project, we aimed to revise the medical ethics curriculum at the School of Medicine, Tehran University of Medical Sciences, in order to promote the level of students’ ethical awareness and enable them to make ethical decisions. Ideal and long term educational objectives were set to determine directions for future reforms and to provide a baseline for future evaluation of the project. However, based on limited available recourses, the first stage of the reform was planned and implemented with a 3 years scope. In revising the curriculum, which was done according to the Harden’s ten questions, we focused on moral attitude and ethical reasoning skill in addition to academic knowledge base by using methods such as case discussions, portfolio, and clinical ethics rounds. The revised curriculum was implemented during the first semester of the 2006–2007 academic year for the first time. The student feedback indicated that the new curriculum was successful in increasing the students’ awareness of ethical issues and enabled them to understand and accept their professional obligations. Revising the curriculum and its evaluation should be considered as an ongoing process. The present project was a successful experience that motivated faculty members to pursue the next steps of improving the curriculum on medical ethics and proved to be convincing for the authorities and policy makers to support it. PMID:23908750

Thin layer model for nonlinear evolution of the Rayleigh-Taylor instability

NASA Astrophysics Data System (ADS)

Zhao, K. G.; Wang, L. F.; Xue, C.; Ye, W. H.; Wu, J. F.; Ding, Y. K.; Zhang, W. Y.

2018-03-01

On the basis of the thin layer approximation [Ott, Phys. Rev. Lett. 29, 1429 (1972)], a revised thin layer model for incompressible Rayleigh-Taylor instability has been developed to describe the deformation and nonlinear evolution of the perturbed interface. The differential equations for motion are obtained by analyzing the forces (the gravity and pressure difference) of fluid elements (i.e., Newton's second law). The positions of the perturbed interface are obtained from the numerical solution of the motion equations. For the case of vacuum on both sides of the layer, the positions of the upper and lower interfaces obtained from the revised thin layer approximation agree with that from the weakly nonlinear (WN) model of a finite-thickness fluid layer [Wang et al., Phys. Plasmas 21, 122710 (2014)]. For the case considering the fluids on both sides of the layer, the bubble-spike amplitude from the revised thin layer model agrees with that from the WN model [Wang et al., Phys. Plasmas 17, 052305 (2010)] and the expanded Layzer's theory [Goncharov, Phys. Rev. Lett. 88, 134502 (2002)] in the early nonlinear growth regime. Note that the revised thin layer model can be applied to investigate the perturbation growth at arbitrary Atwood numbers. In addition, the large deformation (the large perturbed amplitude and the arbitrary perturbed distributions) in the initial stage can also be described by the present model.

An open and randomized study comparing the efficacy of standard danazol and modified triptorelin regimens for postoperative disease management of moderate to severe endometriosis.

PubMed

Wong, Alice Yuen Kwan; Tang, Lawrence

2004-06-01

To compare the efficacy of danazol and triptorelin (Decapeptyl CR, Ferring, Kiel, Germany) in the management of moderate and severe endometriosis in terms of symptom control and revised American Fertility Society (AFS) score reduction, and to evaluate the hormonal profile of patients treated with triptorelin every 6 weeks. Open and randomized trial. Kwong Wah Hospital, a large public hospital in an urban location (Hong Kong). Forty patients after their first conservative operation for endometriosis, with surgical confirmation of revised AFS stage III or IV endometriosis. Postoperative 6 months' therapy of danazol or triptorelin every 6 weeks, postmedical therapy second-look laparoscopy. Symptom control and patients' tolerance during medical therapy, posttherapy revised AFS score, hormonal profile during triptorelin therapy. Pain control was similar between danazol and triptorelin therapy. There was less breakthrough bleeding with triptorelin. More patients failed to complete the whole course of danazol because of its side effects. The revised AFS score at second-look laparoscopy did not show a significant difference between the two medications. Adequate pituitary suppression was observed with injection of triptorelin every 6 weeks. Lengthening of triptorelin administration intervals from 4 weeks to 6 weeks is effective in maintaining a hypoestrogenic state. Patients were more compliant with triptorelin than danazol. Thus, triptorelin injection every 6 weeks is more cost-effective than conventional regimens.

A dose-response study in animals to evaluate the anticoagulant effect of the stage 2 unfractionated heparin USP monograph change.

PubMed

Honchel, R; Carraway, J; Gopee, N; Callicott, R; Chen, J; Patton, R; Xu, Q; Zalkkar, J; Laniyonu, A; Krefting, I; Cato, M; Robie-Suh, K; Rieves, R

2011-08-01

The United States Pharmacopeia (USP) monograph for unfractionated heparin (UFH) was revised in October 2009. This revision was anticipated, based upon in vitro tests, to reduce UFH potency by approximately 10%. To study the potential in vivo consequences of the monograph change, we evaluated activated partial thromboplastin time (aPTT) and activated clotting time (ACT) responses in animals. Female mini-pigs and monkeys (n=8/species) were administered intravenously 60, 54, 48, or 42 U/kg and 50, 45, 40, or 35 U/kg "old" (pre-USP revision) UFH, respectively, in a Williams 4×4 crossover design. Blood samples for aPTT and ACT were collected at 15 min after dosing. The same study design was then repeated using "new" (post-USP revision) UFH. Mean "new" UFH aPTT and ACT values were generally lower than those for "old" UFH although individual animal responses varied considerably. The aPTT and ACT response was generally dose-proportional for both "old" and "new" UFH. These studies indicate that the USP monograph alteration for UFH may result in a modest reduction in the anticoagulant response across a population, but the variability in animal responses underscores the importance of individualization of clinical UFH dosing and the importance of anticoagulant test monitoring. Published by Elsevier Inc.

75 FR 53267 - National Primary Drinking Water Regulations: Revisions to the Total Coliform Rule; Extension of...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-08-31

.... The proposed revisions require systems that have an indication of coliform contamination in the... deaths due to potential fecal contamination and waterborne pathogen exposure. This proposal also...

How will military/civilian coordination work for reception of mass casualties from overseas?

PubMed

Mackenzie, Colin; Donohue, John; Wasylina, Philip; Cullum, Woodrow; Hu, Peter; Lam, David M

2009-01-01

In Maryland, there have been no military/civilian training exercises of the Medical Mutual Aid Agreement for >20 years. The aims of this paper are to describe the National Disaster Medical System (NDMS), to coordinate military and civilian medical mutual aid in response to arrival of overseas mass casualties, and to evaluate the mass-casualty reception and bed "surge" capacity of Maryland NDMS Hospitals. Three tabletop exercises and a functional exercise were performed using a simulated, overseas, military mass-casualty event. The first tabletop exercise was with military and civilian NMDS partners. The second tested the revised NDMS activation plan. The third exercised the Authorities of State Emergency Medical System and Walter Reed Army Medical Center Directors of Emergency Medicine over Maryland NDMS hospitals, and their Medical Mutual Aid Agreement. The functional exercise used Homeland Security Exercise Evaluation Program tools to evaluate reception, triage, staging, and transportation of 160 notional patients (including 20 live, moulaged "patients") and one canine. The first tabletop exercise identified deficiencies in operational protocols for military/civilian mass-casualty reception, triage, treatment, and problems with sharing a Unified Command. The second found improvements in the revised NDMS activation plan. The third informed expectations for NDMS hospitals. In the functional exercise, all notional patients were received, triaged, dispatched, and accounted in military and five civilian hospitals within two hours. The canine revealed deficiencies in companion/military animal reception, holding, treatment, and evacuation. Three working groups were suggested: (1) to ensure 100% compliance with triage tags, patient accountability, and return of equipment used in mass casualty events and exercises; (2) to investigate making information technology and imaging networks available for Emergency Operation Centers and Incident Command; and (3) to establish NDMS training, education, and evaluation to further integrate and support civil-military operations. The exercises facilitated military/state inter-agency cooperation, resulting in revisions to the Maryland Emergency Operations Plan across all key state emergency response agencies. The recommendations from these exercises likely apply to the vast majority of NDMS activities in the US.

SSME/side loads analysis for flight configuration, revision A. [structural analysis of space shuttle main engine under side load excitation

NASA Technical Reports Server (NTRS)

Holland, W.

1974-01-01

This document describes the dynamic loads analysis accomplished for the Space Shuttle Main Engine (SSME) considering the side load excitation associated with transient flow separation on the engine bell during ground ignition. The results contained herein pertain only to the flight configuration. A Monte Carlo procedure was employed to select the input variables describing the side load excitation and the loads were statistically combined. This revision includes an active thrust vector control system representation and updated orbiter thrust structure stiffness characteristics. No future revisions are planned but may be necessary as system definition and input parameters change.

75 FR 10299 - Revision to Navigation and Inspection Circular 11-93, Change 3 (NVIC 11-93 CH-3), Applicability...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-03-05

... Inspection Circular 11-93, Change 3 (NVIC 11-93 CH-3), Applicability of Tonnage Measurement Systems to U.S. Flag Vessels AGENCY: Coast Guard, DHS. ACTION: Notice of policy revision and request for comments... Systems to U.S. Flag Vessels to update the document and improve its usefulness. We are seeking public...

75 FR 57841 - List of Approved Spent Fuel Storage Casks: NAC-MPC System, Revision 6, Confirmation of Effective...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-09-23

... Spent Fuel Storage Casks: NAC-MPC System, Revision 6, Confirmation of Effective Date AGENCY: Nuclear... include Amendment Number 6 to Certificate of Compliance (CoC) Number 1025. DATES: Effective Date: The... regulations at 10 CFR 72.214 to include Amendment No. 6 to CoC No. 1025. Amendment No. 6 changes the...

Toxic Substances Registry System: Index of Material Safety Data Sheets. Revised

NASA Technical Reports Server (NTRS)

1997-01-01

The October 1997 revision of the Index of Material Safety Data Sheets (MSDS) for the Kennedy Space Center (KSC) Toxic Substances Registry System (TSRS) is presented. The MSDS lists toxic substances by manufacturer, trade name, stock number, and distributor. The index provides information on the hazards, use, and chemical composition of materials stored and used at KSC.

Preparing Information Systems Graduates for a Complex Society: Aligning IS Curricula with Liberal Education Learning Outcomes

ERIC Educational Resources Information Center

Pratt, Jean A.; Keys, Anthony; Wirkus, Tyrrell

2014-01-01

The purpose of this paper is to encourage Information Systems (IS) faculty to intentionally revise their curriculum to address (and assess) higher-order learning skills which are demanded by industry and society and are representative of a liberal arts based education. We substantiated the need for this proposed curriculum revision by first…

Intramedullary Arthrodesis of the Knee in the Treatment of Sepsis After TKR

PubMed Central

Bono, James V.; Figgie, Mark P.; Sculco, Thomas P.; Laskin, Richard S.; Windsor, Russell E.

2007-01-01

Infection is a devastating complication following total knee replacement (TKR). In the majority of cases, single- or two-stage revision has excellent results in eradicating infection and restoring function. Rarely, recurrent infection requires alternative treatments such as resection, amputation, or arthrodesis. A review of infections following TKR treated at two joint replacement centers identified 29 cases of resistant knee sepsis treated with a long intramedullary fusion nail. Clinical outcome and radiographs were reviewed at an average follow-up of 48 months (13–114). After the initial intramedullary arthrodesis union occurred in 24 of 29 patients (83%). The average time to fusion was 6 months (3–18 months). Failures included two cases of nail breakage, one of which subsequently achieved fusion following revision nailing, and three cases of recurrent infection requiring nail removal and permanent resection. At a minimum 2-year follow-up, 28% of the patients that achieved fusion complained of pain in the fused knee, 28% complained of ipsilateral hip pain, and two patients complained of contralateral knee pain. Four of the 25 fused patients (16%) remained nonambulatory after fusion, 17 required walking aids (68%) and only four ambulated unassisted. There was no association between age, number of previous procedures, the use of two-stage versus single stage technique, or infecting organism and failure of arthrodesis. Intramedullary arthrodesis is a viable treatment for refractory infection after TKR. Patients undergoing fusion should be informed of the potential for nonunion, recurrence of infection, pain in the ipsilateral extremity, and the long-term need for walking aids. PMID:18751775

Intramedullary arthrodesis of the knee in the treatment of sepsis after TKR.

PubMed

Talmo, Carl T; Bono, James V; Figgie, Mark P; Sculco, Thomas P; Laskin, Richard S; Windsor, Russell E

2007-02-01

Infection is a devastating complication following total knee replacement (TKR). In the majority of cases, single- or two-stage revision has excellent results in eradicating infection and restoring function. Rarely, recurrent infection requires alternative treatments such as resection, amputation, or arthrodesis. A review of infections following TKR treated at two joint replacement centers identified 29 cases of resistant knee sepsis treated with a long intramedullary fusion nail. Clinical outcome and radiographs were reviewed at an average follow-up of 48 months (13-114). After the initial intramedullary arthrodesis union occurred in 24 of 29 patients (83%). The average time to fusion was 6 months (3-18 months). Failures included two cases of nail breakage, one of which subsequently achieved fusion following revision nailing, and three cases of recurrent infection requiring nail removal and permanent resection. At a minimum 2-year follow-up, 28% of the patients that achieved fusion complained of pain in the fused knee, 28% complained of ipsilateral hip pain, and two patients complained of contralateral knee pain. Four of the 25 fused patients (16%) remained nonambulatory after fusion, 17 required walking aids (68%) and only four ambulated unassisted. There was no association between age, number of previous procedures, the use of two-stage versus single stage technique, or infecting organism and failure of arthrodesis. Intramedullary arthrodesis is a viable treatment for refractory infection after TKR. Patients undergoing fusion should be informed of the potential for nonunion, recurrence of infection, pain in the ipsilateral extremity, and the long-term need for walking aids.

Outcomes of Articulating Spacers With Autoclaved Femoral Components in Total Knee Arthroplasty Infection.

PubMed

Goltz, Daniel E; Sutter, E Grant; Bolognesi, Michael P; Wellman, Samuel S

2018-03-30

In 2-stage revision of total knee arthroplasty (TKA) infection, articulating antibiotic spacers show similar eradication rates and superior range of motion compared with static spacers. This study evaluated infection control and other outcomes in articulating spacers with an autoclaved index femoral component. We reviewed 59 patients who underwent 2-stage treatment of TKA infection using articulating antibiotic spacers with an autoclaved femoral component with at least 2-year follow-up (mean: 5.0 years) from spacer placement. Reinfection was defined as any subsequent infection; recurrence was defined as reinfection with the same organism, need for chronic antibiotics, or conversion directly to amputation/arthrodesis. Nine patients (15%) experienced a recurrence and 22 patients (37%) experienced a reinfection. Incidence of diabetes mellitus was significantly higher in patients who became reinfected. Other comorbidities, revision history, prior spacer, or presence of virulent organisms did not predict infection recurrence. Forty-seven spacers underwent reimplantation, 6 (13%) of these went on to above-knee amputation, 6 (13%) received another 2-stage procedure, and 3 (6%) underwent subsequent irrigation and debridement. Three patients (5%) proceeded directly from spacer to above-knee amputation (2) or arthrodesis (1). Nine spacers (15%) in 7 patients were retained indefinitely (mean: 3.4 years), with overall good motion and function. Accounting for methodology, articulating spacers with autoclaved femoral components provide similar infection control to previous reports. Most patients with reinfection grew different organisms compared with initial infection, suggesting that some subsequent infections may be host related. Some patients retained spacers definitively with overall good patient satisfaction. Copyright © 2018 Elsevier Inc. All rights reserved.

Program Operating Procedures for the Integrated Command ASW Prediction System (ICAPS). Volume 1, Revision A.

DTIC Science & Technology

1981-06-01

RETIIN. •4 C H’T SE’LE(T Till’E S()NAR S TO EI Sonai r’ types are specified INCI.’I)EI) IN TIllI. RAN( G ’ individually. Prompt repeats PR I(’ICTION...complete revision, Revision A. Symbols are not used in this revision to identify changes with respect to the pre- vious issue, due to the exten- g siveness...maintenance such as source editing, compiling, and debugging. In addition, it provides the user with a simple and uniform interface for transfcrrin g files of

Design criteria: data acquisition system for waste tank liquid level gauges and SX Tank Farm thermocouples

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

Martin, G.E.; Oliver, R.G.

1972-02-17

This design criteria revision (revision 2) will cancel revision 1 and will provide complete functional supervision of the liquid level gauges. A new.counter and an electronic supervisory circuit will be installed in each waste tank liquid level gauge. The electronic supervisory circuit will monitor (via the new counter and a signal from the gauge electronics) cycling of the gauge on a one minute time cycle. This supervisory circuit will fulfill the intent of revision 1 (monitor AC power to the gauge) and, in addition, will supervise all other aspects of the gauge including: the electronics, the drive motor, all sprocketsmore » and chain linkages, and the counter. If a gauge failure should occur, this circuit will remove the +12 volts excitation from the data acquisition system inferface board; and the computer will be programmed to recognize this condition as a gauge failure. (auth)« less

Staging Lung Cancer: Metastasis.

PubMed

Shroff, Girish S; Viswanathan, Chitra; Carter, Brett W; Benveniste, Marcelo F; Truong, Mylene T; Sabloff, Bradley S

2018-05-01

The updated eighth edition of the tumor, node, metastasis (TNM) classification for lung cancer includes revisions to T and M descriptors. In terms of the M descriptor, the classification of intrathoracic metastatic disease as M1a is unchanged from TNM-7. Extrathoracic metastatic disease, which was classified as M1b in TNM-7, is now subdivided into M1b (single metastasis, single organ) and M1c (multiple metastases in one or multiple organs) descriptors. In this article, the rationale for changes in the M descriptors, the utility of preoperative staging with PET/computed tomography, and the treatment options available for patients with oligometastatic disease are discussed. Copyright © 2018 Elsevier Inc. All rights reserved.

Retrieval with Clustering in a Case-Based Reasoning System for Radiotherapy Treatment Planning

NASA Astrophysics Data System (ADS)

Khussainova, Gulmira; Petrovic, Sanja; Jagannathan, Rupa

2015-05-01

Radiotherapy treatment planning aims to deliver a sufficient radiation dose to cancerous tumour cells while sparing healthy organs in the tumour surrounding area. This is a trial and error process highly dependent on the medical staff's experience and knowledge. Case-Based Reasoning (CBR) is an artificial intelligence tool that uses past experiences to solve new problems. A CBR system has been developed to facilitate radiotherapy treatment planning for brain cancer. Given a new patient case the existing CBR system retrieves a similar case from an archive of successfully treated patient cases with the suggested treatment plan. The next step requires adaptation of the retrieved treatment plan to meet the specific demands of the new case. The CBR system was tested by medical physicists for the new patient cases. It was discovered that some of the retrieved cases were not suitable and could not be adapted for the new cases. This motivated us to revise the retrieval mechanism of the existing CBR system by adding a clustering stage that clusters cases based on their tumour positions. A number of well-known clustering methods were investigated and employed in the retrieval mechanism. Results using real world brain cancer patient cases have shown that the success rate of the new CBR retrieval is higher than that of the original system.

Eliminating Fear of the Blank Page: A Thematic Approach, aka Squeezing the California Department of Education's 1992 ESL Model Standards for Adult Education Programs into One Tidy Package.

ERIC Educational Resources Information Center

DesRoches, Diane

An approach to teaching integrated language skills in adult English-as-a-Second-Language (ESL) instruction is described. The technique uses a combination of classroom drama and role-playing, writing about the event, revision, publication, and follow-up activities to develop speaking, listening, reading, and writing skills. Eight stages are defined…

Developing Teaching Materials Using Comic Media to Enhance Students’ Mathematical Communication

NASA Astrophysics Data System (ADS)

Yulian, V. N.

2018-04-01

Teaching materials are a set of materials that are arranged systematically written or not, to create an environment or atmosphere that allows students to learn. The purpose of this study is to provide an overview of how the development of teaching materials using comic media that enhance mathematical communication, as well as feasible and effective teaching materials developed. Research method used in this research is Research and Development. In the sense of research contains about how to develop teaching materials through several stages such as validation by experts, as well as revisions. Sources of data used in this study were students and teachers SMK Bandung Barat. The results showed that the teaching materials developed feasible and effective use for students of class X SMK Bandung Barat. Teaching materials received a proper assessment of the experts after going through several stages of revision, in addition to the effective teaching materials used by students seen from the liveliness and the value of classical completeness that reaches more 85% of students. Based on the result of the research, it can be concluded that the developed teaching material gets the proper judgment from the expert, and effectively used in the learning by the students of X-1 Pharmacy class with the classical completeness reach 86% and the student activity is 91,4%.