Growth of Cities and Loss of Streams: Land Cover Change Impacts on Stream Channel Loss in Central Oklahoma from 1874 to 2010

EPA Science Inventory

Central Oklahoma has undergone substantial land cover changes since the 1800’s. Accordingly, regional watersheds have been covered by impervious surfaces, peripheral agricultural areas have been subdivided or intensified, and large reservoirs have been constructed. Here, we...

Magnetic resonance angiography: current status and future directions

PubMed Central

2011-01-01

With recent improvement in hardware and software techniques, magnetic resonance angiography (MRA) has undergone significant changes in technique and approach. The advent of 3.0 T magnets has allowed reduction in exogenous contrast dose without compromising overall image quality. The use of novel intravascular contrast agents substantially increases the image windows and decreases contrast dose. Additionally, the lower risk and cost in non-contrast enhanced (NCE) MRA has sparked renewed interest in these methods. This article discusses the current state of both contrast-enhanced (CE) and NCE-MRA. New CE-MRA methods take advantage of dose reduction at 3.0 T, novel contrast agents, and parallel imaging methods. The risks of gadolinium-based contrast media, and the NCE-MRA methods of time-of-flight, steady-state free precession, and phase contrast are discussed. PMID:21388544

Key Indicators on Vocational Education and Training. Central and Eastern Europe. Report.

ERIC Educational Resources Information Center

Badescu, Mircea; Kennedy, Alison

The transition economies of Central and Eastern Europe have undergone substantial changes due, in part, to vocational education and training (VET). One of the most important objectives of the European Union (EU) enlargement process is to monitor key indicators of the educational systems and labor markets so that the different skills in demand and…

NADE Members Respond--Developmental Education Research Agenda: Survey of Field Professionals, Part I

ERIC Educational Resources Information Center

Saxon, D. Patrick; Martirosyan, Nara M.; Wentworth, Rebecca A.; Boylan, Hunter R.

2015-01-01

The field of developmental education has undergone substantial change in recent years. It seems there are two primary forces driving reform at this time. The first is policy makers who believe reform is necessary in order for developmental education to perform more effectively. The second are opportunists and for-profit companies using social,…

Invisible Ink: An Analysis of Meaning Contained in Gender, Race, Performance, and Power Discourses

ERIC Educational Resources Information Center

Griggs, Susan A.

2012-01-01

The number of females in senior level leadership positions in higher education is substantially fewer than males. Yet female students in these same institutions represent over half the population (National Center for Educational Statistics, 2010). The leadership gender gap is a phenomenon that has undergone numerous studies in search of reasons…

Long-term development of hypolimnetic oxygen depletion rates in the large Lake Constance.

PubMed

Rhodes, Justin; Hetzenauer, Harald; Frassl, Marieke A; Rothhaupt, Karl-Otto; Rinke, Karsten

2017-09-01

This study investigates over 30 years of dissolved oxygen dynamics in the deep interior of Lake Constance (max. depth: 250 m). This lake supplies approximately four million people with drinking water and has undergone strong re-oligotrophication over the past decades. We calculated depth-specific annual oxygen depletion rates (ODRs) during the period of stratification and found that 50% of the observed variability in ODR was already explained by a simple separation into a sediment- and volume-related oxygen consumption. Adding a linear factor for water depth further improved the model indicating that oxygen depletion increased substantially along the depth. Two other factors turned out to significantly influence ODR: total phosphorus as a proxy for the lake's trophic state and mean oxygen concentration in the respective depth layer. Our analysis points to the importance of nutrient reductions as effective management measures to improve and protect the oxygen status of such large and deep lakes.

Meeting the Challenges of Higher Education in India through Open Educational Resources: Policies, Practices, and Implications

ERIC Educational Resources Information Center

Thakran, Archana; Sharma, Ramesh C.

2016-01-01

Over the past two decades, the education sector in India has undergone a substantial transformation. Recent advances in technology have provided access to high quality educational resources and information on the Internet. This article examines the role of open educational resources (OER) in addressing the challenges of higher education in India,…

Social disparities in access to breast and cervical cancer screening by women living in Spain.

PubMed

Ricardo-Rodrigues, I; Jiménez-García, R; Hernández-Barrera, V; Carrasco-Garrido, P; Jiménez-Trujillo, I; López de Andrés, A

2015-07-01

To describe uptake of breast and cervical cancer screening by women living in Spain, analyse the possible associated social and health factors, and compare uptake rates with those obtained in previous surveys. Cross-sectional study using data from the 2011 Spanish national health survey. Uptake of breast cancer screening was analysed by asking women aged 40-69 years whether they had undergone mammography in the previous two years. Uptake of cervical cancer screening was analysed by asking women aged 25-65 years whether they had undergone cervical cytology in the previous three years. Independent variables included sociodemographic characteristics, and variables related to health status and lifestyle. Seventy-two percent of women had undergone mammography in the previous two years. Having private health insurance increased the probability of breast screening uptake four-fold [odds ratio (OR) 3.96, 95% confidence interval (CI) 2.71-5.79], and being an immigrant was a negative predictor for breast screening uptake. Seventy percent of women had undergone cervical cytology in the previous three years. Higher-educated women were more likely to have undergone cervical cancer screening (OR 2.59, 95% CI 1.97-3.40), and obese women and women living in rural areas were less likely to have undergone cervical cancer screening. There have been no relevant improvements in uptake rates of either breast or cervical cancer screening since 2006. Uptake of breast and cervical cancer screening could be improved in Spain, and uptake rates have stagnated over recent years. Social disparities have been detected with regard to access to these screening tests, indicating that it is necessary to continue researching and optimizing prevention programmes in order to improve uptake and reduce these disparities. Copyright © 2015 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

A tactual pilot aid for the approach-and-landing task: Inflight studies

NASA Technical Reports Server (NTRS)

Gilson, R. D.; Fenton, R. E.

1973-01-01

A pilot aid -- a kinesthetic-tactual compensatory display -- for assisting novice pilots in various inflight situations has undergone preliminary inflight testing. The efficacy of this display, as compared with two types of visual displays, was evaluated in both a highly structured approach-and-landing task and a less structured test involving tight turns about a point. In both situations, the displayed quantity was the deviation (alpha sub 0 - alpha) in angle at attack from a desired value alpha sub 0. In the former, the performance with the tactual display was comparable with that obtained using a visual display of (alpha sub 0 - alpha), while in the later, substantial improvements (reduced tracking error (55%), decreased maximum altitude variations (67%), and decreased speed variations (43%)), were obtained using the tactual display. It appears that such a display offers considerable potential for inflight use.

Recent advancements of wide-angle polarization analysis with 3He neutron spin filters

NASA Astrophysics Data System (ADS)

Chen, W. C.; Gentile, T. R.; Ye, Q.; Kirchhoff, A.; Watson, S. M.; Rodriguez-Rivera, J. A.; Qiu, Y.; Broholm, C.

2016-09-01

Wide-angle polarization analysis with polarized 3He based neutron spin filters (NSFs) has recently been employed on the Multi-Axis Crystal Spectrometer (MACS) at the National Institute of Standards and Technology Center for Neutron Research (NCNR). Over the past several years, the apparatus has undergone many upgrades to address the fundamental requirements for wide angle polarization analysis using spin exchange optical pumping based 3He NSFs. In this paper, we report substantial improvements in the on-beam-line performance of the apparatus and progress toward routine user capability. We discuss new standard samples used for 3He NSF characterization and the flipping ratio measurement on MACS. We further discuss the management of stray magnetic fields produced by operation of superconducting magnets on the MACS instrument, which can significantly reduce the 3He polarization relaxation time. Finally, we present the results of recent development of horseshoe-shaped wide angle cells.

Performance characterization of a low power hydrazine arcjet

NASA Technical Reports Server (NTRS)

Knowles, S. C.; Smith, W. W.; Curran, F. M.; Haag, T. W.

1987-01-01

Hydrazine arcjets, which offer substantial performance advantages over alternatives in geosynchronous satellite stationkeeping applications, have undergone startup, materials compatibility, lifetime, and power conditioning unit design issues. Devices in the 1000-3000 W output range have been characterized for several different electrode configurations. Constrictor length and diameter, electrode gap setting, and vortex strength have been parametrically studied in order to ascertain the influence of each on specific impulse and efficiency; specific impulse levels greater than 700 sec have been achieved.

Behavioral surveillance surveys of the male clients of female sex workers in Hong Kong: results of three population-based surveys.

PubMed

Lau, Joseph T F; Tsui, H Y

2003-08-01

Male clients of female sex workers (FSWs) are an important group vulnerable to HIV infection. The goal was to administer and assess behavioral surveillance surveys of male clients of FSWs in Hong Kong. Three population-based telephone surveys of males aged 18 to 60 were conducted from 1998 to 2001 (n=5159). Of all respondents, about 10.8% to 14% had patronized FSWs in the previous 6 months. Among male clients of FSWs, about 25% did not always use condoms, 4% to 6% had contracted a sexually transmitted disease, 16% had undergone HIV antibody testing, and 20% or more reported having four or more sex partners in the previous 6 months. There was no improvement in condom use over time. Cross-border (from Hong Kong to mainland China) commercial sex was common. The level of risk behaviors associated with male clients of FSWs remained substantial. The overall effectiveness and coverage of relevant prevention programs were questioned.

The significance and scope of evolutionary developmental biology: a vision for the 21st century.

PubMed

Moczek, Armin P; Sears, Karen E; Stollewerk, Angelika; Wittkopp, Patricia J; Diggle, Pamela; Dworkin, Ian; Ledon-Rettig, Cristina; Matus, David Q; Roth, Siegfried; Abouheif, Ehab; Brown, Federico D; Chiu, Chi-Hua; Cohen, C Sarah; Tomaso, Anthony W De; Gilbert, Scott F; Hall, Brian; Love, Alan C; Lyons, Deirdre C; Sanger, Thomas J; Smith, Joel; Specht, Chelsea; Vallejo-Marin, Mario; Extavour, Cassandra G

2015-01-01

Evolutionary developmental biology (evo-devo) has undergone dramatic transformations since its emergence as a distinct discipline. This paper aims to highlight the scope, power, and future promise of evo-devo to transform and unify diverse aspects of biology. We articulate key questions at the core of eleven biological disciplines-from Evolution, Development, Paleontology, and Neurobiology to Cellular and Molecular Biology, Quantitative Genetics, Human Diseases, Ecology, Agriculture and Science Education, and lastly, Evolutionary Developmental Biology itself-and discuss why evo-devo is uniquely situated to substantially improve our ability to find meaningful answers to these fundamental questions. We posit that the tools, concepts, and ways of thinking developed by evo-devo have profound potential to advance, integrate, and unify biological sciences as well as inform policy decisions and illuminate science education. We look to the next generation of evolutionary developmental biologists to help shape this process as we confront the scientific challenges of the 21st century. © 2015 Wiley Periodicals, Inc.

Age at menarche and the reproductive performance of Saudi women.

PubMed

Babay, Zainab A; Addar, Mohammed H; Shahid, Khalida; Meriki, Naema

2004-01-01

Saudi Arabia has undergone substantial development in the recent past with concomitant changes in living conditions, and economic and general health status that have affected the age at menarche in Saudi women. We evaluated the current age at menarche and reproductive events among Saudi women. Age, age at menarche, age at marriage, age of first pregnancy, number of children, and number of abortions were collected for Saudi women attending King Khalid University Hospital (KKUH) over a 3-month period in 2002. For 989 Saudi women, the mean age at menarche was 13.05 years. There was a decrease in the age of menarche over the past 20 years, an increase in the age of marriage, age of first pregnancy, and a decrease in the number of children and abortions. Compared with data from two decades, the age at menarche decreased significantly from 13.22 to 13.05 years. The decrease in the age of menarche among Saudi women indicates better socioeconomic status and improvements in health.

Theory and operation of the real-time data acquisition system for the NASA-LaRC differential absorption lidar (DIAL)

NASA Technical Reports Server (NTRS)

Butler, Carolyn; Spencer, Randall

1988-01-01

The improvement of computer hardware and software of the NASA Multipurpose Differential Absorption Lidar (DIAL) system is documented. The NASA DIAL system has undergone development and experimental deployment at NASA/Langley Res. Center for the remote measurement of atmospheric trace gas concentrations from ground and aircraft platforms. A viable DIAL system was developed capable of remotely measuring O3 and H2O concentrations from an aircraft platform. The DIAL Data Acquisition System (DAS) has undergone a number of improvements also. Due to the participation of the DIAL in the Global Tropospheric Experiment, modifications and improvements of the system were tested and used both in the lab and in air. Therefore, this is an operational manual for the DIAL DAS.

Ten Years of Cloud Optical and Microphysical Retrievals from MODIS

NASA Technical Reports Server (NTRS)

Platnick, Steven; King, Michael D.; Wind, Galina; Hubanks, Paul; Arnold, G. Thomas; Amarasinghe, Nandana

2010-01-01

The MODIS cloud optical properties algorithm (MOD06/MYD06 for Terra and Aqua MODIS, respectively) has undergone extensive improvements and enhancements since the launch of Terra. These changes have included: improvements in the cloud thermodynamic phase algorithm; substantial changes in the ice cloud light scattering look up tables (LUTs); a clear-sky restoral algorithm for flagging heavy aerosol and sunglint; greatly improved spectral surface albedo maps, including the spectral albedo of snow by ecosystem; inclusion of pixel-level uncertainty estimates for cloud optical thickness, effective radius, and water path derived for three error sources that includes the sensitivity of the retrievals to solar and viewing geometries. To improve overall retrieval quality, we have also implemented cloud edge removal and partly cloudy detection (using MOD35 cloud mask 250m tests), added a supplementary cloud optical thickness and effective radius algorithm over snow and sea ice surfaces and over the ocean, which enables comparison with the "standard" 2.1 11m effective radius retrieval, and added a multi-layer cloud detection algorithm. We will discuss the status of the MOD06 algorithm and show examples of pixellevel (Level-2) cloud retrievals for selected data granules, as well as gridded (Level-3) statistics, notably monthly means and histograms (lD and 2D, with the latter giving correlations between cloud optical thickness and effective radius, and other cloud product pairs).

SPEECH EVALUATION WITH AND WITHOUT PALATAL OBTURATOR IN PATIENTS SUBMITTED TO MAXILLECTOMY

PubMed Central

de Carvalho-Teles, Viviane; Pegoraro-Krook, Maria Inês; Lauris, José Roberto Pereira

2006-01-01

Most patients who have undergone resection of the maxillae due to benign or malignant tumors in the palatomaxillary region present with speech and swallowing disorders. Coupling of the oral and nasal cavities increases nasal resonance, resulting in hypernasality and unintelligible speech. Prosthodontic rehabilitation of maxillary resections with effective separation of the oral and nasal cavities can improve speech and esthetics, and assist the psychosocial adjustment of the patient as well. The objective of this study was to evaluate the efficacy of the palatal obturator prosthesis on speech intelligibility and resonance of 23 patients with age ranging from 18 to 83 years (Mean = 49.5 years), who had undergone inframedial-structural maxillectomy. The patients were requested to count from 1 to 20, to repeat 21 words and to spontaneously speak for 15 seconds, once with and again without the prosthesis, for tape recording purposes. The resonance and speech intelligibility were judged by 5 speech language pathologists from the tape recordings samples. The results have shown that the majority of patients (82.6%) significantly improved their speech intelligibility, and 16 patients (69.9%) exhibited a significant hypernasality reduction with the obturator in place. The results of this study indicated that maxillary obturator prosthesis was efficient to improve the speech intelligibility and resonance in patients who had undergone maxillectomy. PMID:19089242

The Planning and Scheduling of HST: Improvements and Enhancements since Launch

NASA Astrophysics Data System (ADS)

Taylor, D. K.; Chance, D. R.; Jordan, I. J. E.; Patterson, A. P.; Stanley, M.; Taylor, D. C.

2001-12-01

The planning and scheduling (P&S) systems used in operating the Hubble Space Telescope (HST) have undergone such substantial and pervasive re-engineering that today they dimly resemble those used when HST was launched. Processes (i.e., software, procedures, networking, etc.) which allow program implementation, the generation of a Long Range Plan (LRP), and the scheduling of science and mission activities have improved drastically in nearly 12 years, resulting in a consistently high observing efficiency, a stable LRP that principal investigators can use, exceptionally clean command loads uplinked to the spacecraft, and the capability of a very fast response time due to onboard anomalies or targets of opportunity. In this presentation we describe many of the systems which comprise the P&S ("front-end") system for HST, how and why they were improved, and what benefits have been realized by either the HST user community or the STScI staff. The systems include the Guide Star System, the Remote Proposal Submission System - 2 (RPS2), Artificial Intelligence (AI) planning tools such as Spike, and the science and mission scheduling software. We also describe how using modern software languages such as Python and better development practices allow STScI staff to do more with HST (e.g., to handle much more science data when ACS is installed) without increasing the cost to HST operations.

Incentives for methane mitigation and energy-efficiency improvements in the case of Ukraine's natural gas transmission system

NASA Astrophysics Data System (ADS)

Roshchanka, Volha; Evans, Meredydd

2014-06-01

Reducing methane losses is a concern for climate change policy and energy policy. The energy sector is the major source of anthropogenic methane emissions into the atmosphere in Ukraine. Reducing methane emissions and avoiding combustion can be very cost-effective, but various barriers prevent such energy-efficiency measures from taking place. To date, few examples of industry-wide improvements exist. One example of substantial investments into upgrading natural gas transmission system comes from Ukraine's natural gas transmission company, Ukrtransgaz. The company's investments into system upgrades, along with a 34% fall in throughput, resulted in reduction of Ukrtransgaz system's own consumption of natural gas by 68% in 2011 compared to the level in 2005. Evaluating reductions in methane emissions is challenging because of lack of accurate data and gaps in accounting methodologies. At the same time, Ukraine's transmission system has undergone improvements that, at the very least, have contained methane emissions, if not substantially reduced them. In this paper, we describe recent developments in Ukraine's natural gas transmission system and analyze the incentives that forced the sector to pay close attention to its methane losses. Ukraine is one of the most energy-intensive countries, among the largest natural gas consumers in the world, and a significant emitter of methane. The country is also dependent on imports of natural gas. A combination of several factors has created conditions for successful reductions in methane emissions and combustion. These factors include: an eightfold increase in the price of imported natural gas; comprehensive domestic environmental and energy policies, such as the Laws of Ukraine on Protecting the Natural Environment and on Air Protection; policies aimed at integration with European Union's energy market and accession to the Energy Community Treaty; and the country's participation in international cooperation on environment, such as through the Joint Implementation mechanism and the voluntary Global Methane Initiative. Learning about such case studies can help policymakers and sustainability professionals design better policies elsewhere.

Radiology on handheld devices: image display, manipulation, and PACS integration issues.

PubMed

Raman, Bhargav; Raman, Raghav; Raman, Lalithakala; Beaulieu, Christopher F

2004-01-01

Handheld personal digital assistants (PDAs) have undergone continuous and substantial improvements in hardware and graphics capabilities, making them a compelling platform for novel developments in teleradiology. The latest PDAs have processor speeds of up to 400 MHz and storage capacities of up to 80 Gbytes with memory expansion methods. A Digital Imaging and Communications in Medicine (DICOM)-compliant, vendor-independent handheld image access system was developed in which a PDA server acts as the gateway between a picture archiving and communication system (PACS) and PDAs. The system is compatible with most currently available PDA models. It is capable of both wired and wireless transfer of images and includes custom PDA software and World Wide Web interfaces that implement a variety of basic image manipulation functions. Implementation of this system, which is currently undergoing debugging and beta testing, required optimization of the user interface to efficiently display images on smaller PDA screens. The PDA server manages user work lists and implements compression and security features to accelerate transfer speeds, protect patient information, and regulate access. Although some limitations remain, PDA-based teleradiology has the potential to increase the efficiency of the radiologic work flow, increasing productivity and improving communication with referring physicians and patients. Copyright RSNA, 2004

Comments on the 2015 ESC Guidelines for the Management of Acute Coronary Syndromes in Patients Presenting Without Persistent ST-segment Elevation.

PubMed

Barrabes, J

2015-12-01

Patients who have undergone angioplasty with stenting can be reintegrated into normal life at an early stage, thanks to the absence of sequelae associated with the procedure itself. Consequently, these patients can be involved earlier in the second stage of cardiac rehabilitation. Although rehabilitation for coronary patients follows the general guidelines used for all patients, which were developed with the secondary prevention of coronary artery atherosclerosis in mind, the specific form of rehabilitation adopted for each individual with ischemic heart disease will depend on the patient's circumstances, including the revascularization technique used. Regular physical exercise (i.e. physical training), in itself, has substantial cardiovascular benefits for both primary and secondary cardiovascular prevention. In patients who have had a myocardial infarction, training decreases mortality, increases functional capacity and improves ventricular function and remodeling. It is also thought to boost the collateral circulation. In addition, training improves endothelial function and stimulates the circulation of stem cells. It has been shown that physical training after percutaneous revascularization decreases the number of cardiac events. Moreover, in patients with stable angina, it results in fewer events than percutaneous revascularization. Copyright © 2015 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.

Cognitive Abilities of Children With Neurological and Liver Forms of Wilson Disease.

PubMed

Favre, Emilie; Lion-François, Laurence; Canton, Marie; Vanlemmens, Claire; Bonneton, Marjorie; Bouillet, Lise; Brunet, Anne-Sophie; Lachaux, Alain

2017-03-01

Cognitive impairment in adult patients experiencing Wilson disease is now more clearly described, even in liver forms of the disease. Although this condition can appear during childhood, the cognitive abilities of children have not yet been reported in a substantial case series. This retrospective study included 21 children with Wilson disease who had undergone general cognitive assessment. The results argue in favor of a poor working memory capacity in the liver form of the disease, and more extensive cognitive impairments in its neurological form. Extensive neuropsychological investigations on all children experiencing Wilson disease are thus required.

Schools with Federal Improvement Grants Face Challenges in Replacing Principals and Teachers

ERIC Educational Resources Information Center

McMurrer, Jennifer

2012-01-01

Several hundred of the nation's lowest-performing schools have recently undergone major changes in leadership and teaching staff to comply with federal requirements for using school improvement grants (SIGs) financed by the American Recovery and Reinvestment Act of 2009 (ARRA). In particular, schools that receive stimulus-funded SIG awards must…

The effect of a nurse-led telephone-based care coordination program on the follow-up and control of cardiovascular risk factors in patients with coronary artery disease.

PubMed

Wong, Ningyan; Chua, Siang Jin Terrance; Gao, Fei; Sim, Sok Tiang Rosalind; Matchar, David; Wong, Sung Lung Aaron; Yeo, Khung Keong; Tan, Wei Chieh Jack; Chin, Chee Tang

2016-12-01

We sought to analyse the impact of a care coordination protocol on transiting patients with coronary artery disease who had undergone percutaneous coronary intervention (PCI) to primary care and its effect on cardiovascular risk factor control. A prospective observational study involving 492 patients who had undergone PCI either electively or after an acute coronary syndrome. A tertiary institution in Singapore. Patients who had undergone a PCI either electively or after an acute coronary syndrome. The SCORE (Standardized Care for Optimal Outcomes, Right-Siting and Rapid Re-evaluation) program was a nurse-led, telephone-based, care coordination protocol. Transition to primary care within 1 year of enrolment, the achievement of low-density lipoprotein (LDL) level of <2.6 mmol/l within 1 year and hospital admissions related to cardiovascular causes within 1 year were studied. Under the SCORE protocol, a significantly higher number of patients transited to primary care and achieved the LDL target within 1 year, as compared with non-SCORE patients. Discharge to primary care and achievement of target LDL continued to be higher among those under the SCORE protocol even after multivariate analysis. Rates of hospital admission due to cardiovascular causes were not significantly different. Care coordination improved the rate of transition of post-PCI patients to primary care and improved LDL control, with no difference in the rate of hospital admissions due to cardiovascular causes. These findings support the implementation of a standardized follow-up protocol in patients who have undergone PCI. © The Author 2016. Published by Oxford University Press in association with the International Society for Quality in Health Care. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

Snacks, sweetened beverages, added sugars, and schools.

PubMed

2015-03-01

Concern over childhood obesity has generated a decade-long reformation of school nutrition policies. Food is available in school in 3 venues: federally sponsored school meal programs; items sold in competition to school meals, such as a la carte, vending machines, and school stores; and foods available in myriad informal settings, including packed meals and snacks, bake sales, fundraisers, sports booster sales, in-class parties, or other school celebrations. High-energy, low-nutrient beverages, in particular, contribute substantial calories, but little nutrient content, to a student's diet. In 2004, the American Academy of Pediatrics recommended that sweetened drinks be replaced in school by water, white and flavored milks, or 100% fruit and vegetable beverages. Since then, school nutrition has undergone a significant transformation. Federal, state, and local regulations and policies, along with alternative products developed by industry, have helped decrease the availability of nutrient-poor foods and beverages in school. However, regular access to foods of high energy and low quality remains a school issue, much of it attributable to students, parents, and staff. Pediatricians, aligning with experts on child nutrition, are in a position to offer a perspective promoting nutrient-rich foods within calorie guidelines to improve those foods brought into or sold in schools. A positive emphasis on nutritional value, variety, appropriate portion, and encouragement for a steady improvement in quality will be a more effective approach for improving nutrition and health than simply advocating for the elimination of added sugars. Copyright © 2015 by the American Academy of Pediatrics.

The Incidence of Propionibacterium acnes in Open Shoulder Surgery: A Controlled Diagnostic Study.

PubMed

Mook, William R; Klement, Mitchell R; Green, Cynthia L; Hazen, Kevin C; Garrigues, Grant E

2015-06-17

Propionibacterium acnes has arisen as the most common microorganism identified at the time of revision shoulder arthroplasty. There is limited evidence to suggest how frequently false-positive cultures occur. The purpose of this prospective controlled study was to evaluate culture growth from specimens obtained during open shoulder surgery. Patients undergoing an open deltopectoral approach to the shoulder were prospectively enrolled. Patients with a history of shoulder surgery or any concern for active or previous shoulder infection were excluded. Three pericapsular soft-tissue samples were taken from the shoulder for bacterial culture and were incubated for fourteen days. A sterile sponge was also analyzed in parallel with the tissue cultures. In addition, similar cultures were obtained from patients who had undergone previous shoulder surgery. Overall, 20.5% of surgeries (twenty-four of 117) yielded at least one specimen removed for culture that was positive for bacterial growth, and 13.0% of sterile control specimens (seven of fifty-four) had positive culture growth (p = 0.234). P. acnes represented 83.0% of all positive cultures (thirty-nine of forty-seven) at a median incubation time of fourteen days. Among the subjects who had not undergone previous surgery, 17.1% (fourteen of eighty-two) had at least one positive P. acnes culture. Male sex was univariably associated with a greater likelihood of bacterial growth (p < 0.01), and patients who had not undergone previous surgery and had received two or more preoperative corticosteroid injections had a higher likelihood of bacterial growth (p = 0.047). The clinical importance of positive P. acnes cultures from specimens obtained from open shoulder surgery remains uncertain. Male sex and preoperative corticosteroid injections were associated with a higher likelihood of bacterial growth on culture and are risk factors that merit further investigation. Previously reported incidences of positive P. acnes culture results from specimens from primary and revision shoulder arthroplasty may be overestimated because of a substantial level of culture contamination. P. acnes is isolated via culture at a substantial rate from shoulders undergoing a deltopectoral approach. The clinical importance of culture growth by this low-virulence organism still remains uncertain. Further study is necessary to more specifically characterize culture growth by P. acnes as an infection, commensal presence, or contaminant. Copyright © 2015 by The Journal of Bone and Joint Surgery, Incorporated.

School Improvements in Abu Dhabi, United Arab Emirates: Asking the "Expert Witnesses"

ERIC Educational Resources Information Center

Dickson, Martina

2013-01-01

Government schools in Abu Dhabi, as part of wide-scale educational reforms undertaken in the whole of the United Arab Emirates, have undergone massive school improvement developments over the past seven years. Over the course of these years, the reality of student life for those in government schools has been widely altered. This research explores…

Revitalization of open apex teeth with apical periodontitis using a collagen-hydroxyapatite scaffold.

PubMed

Nevins, Alan J; Cymerman, Jerome J

2015-06-01

An enhanced revision of the revitalization endodontic technique for immature teeth with apical periodontitis has been described. It includes the addition of collagen-hydroxyapatite scaffold to the currently practiced revascularization technique. Four cases treated in series are presented in this report, 1 case involving 2 teeth. Periapical diagnoses of immature teeth included "asymptomatic apical periodontitis," "symptomatic apical periodontitis," and "acute apical abscess." Additionally, 1 fully developed tooth that had undergone root canal treatment that failed had a periapical diagnosis of acute apical abscess. An established revascularization protocol was used for all teeth. In addition to stimulating blood clots, all teeth were filled with collagen-hydroxyapatite scaffolds. Periapical radiolucencies healed in all teeth, and diffuse radiopacity developed within the coronal portions of canal spaces. Root development with root lengthening occurred in the immature nonvital maxillary premolar that had not undergone prior treatment. The technique of adding a collagen-hydroxyapatite scaffold to the existing revitalization protocol has been described in which substantial hard tissue repair has occurred. This may leave teeth more fully developed and less likely to fracture. Copyright © 2015 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

Basic MR relaxation mechanisms and contrast agent design.

PubMed

De León-Rodríguez, Luis M; Martins, André F; Pinho, Marco C; Rofsky, Neil M; Sherry, A Dean

2015-09-01

The diagnostic capabilities of magnetic resonance imaging (MRI) have undergone continuous and substantial evolution by virtue of hardware and software innovations and the development and implementation of exogenous contrast media. Thirty years since the first MRI contrast agent was approved for clinical use, a reliance on MR contrast media persists, largely to improve image quality with higher contrast resolution and to provide additional functional characterization of normal and abnormal tissues. Further development of MR contrast media is an important component in the quest for continued augmentation of diagnostic capabilities. In this review we detail the many important considerations when pursuing the design and use of MR contrast media. We offer a perspective on the importance of chemical stability, particularly kinetic stability, and how this influences one's thinking about the safety of metal-ligand-based contrast agents. We discuss the mechanisms involved in MR relaxation in the context of probe design strategies. A brief description of currently available contrast agents is accompanied by an in-depth discussion that highlights promising MRI contrast agents in the development of future clinical and research applications. Our intention is to give a diverse audience an improved understanding of the factors involved in developing new types of safe and highly efficient MR contrast agents and, at the same time, provide an appreciation of the insights into physiology and disease that newer types of responsive agents can provide. © 2015 Wiley Periodicals, Inc.

"Basic MR Relaxation Mechanisms & Contrast Agent Design"

PubMed Central

De León-Rodríguez, Luis M.; Martins, André F.; Pinho, Marco; Rofsky, Neil; Sherry, A. Dean

2015-01-01

The diagnostic capabilities of magnetic resonance imaging (MRI) have undergone continuous and substantial evolution by virtue of hardware and software innovations and the development and implementation of exogenous contrast media. Thirty years since the first MRI contrast agent was approved for clinical use, a reliance on MR contrast media persists largely to improve image quality with higher contrast resolution and to provide additional functional characterization of normal and abnormal tissues. Further development of MR contrast media is an important component in the quest for continued augmentation of diagnostic capabilities. In this review we will detail the many important considerations when pursuing the design and use of MR contrast media. We will offer a perspective on the importance of chemical stability, particularly kinetic stability, and how this influences one's thinking about the safety of metal-ligand based contrast agents. We will discuss the mechanisms involved in magnetic resonance relaxation in the context of probe design strategies. A brief description of currently available contrast agents will be accompanied by an in-depth discussion that highlights promising MRI contrast agents in development for future clinical and research applications. Our intention is to give a diverse audience an improved understanding of the factors involved in developing new types of safe and highly efficient MR contrast agents and, at the same time, provide an appreciation of the insights into physiology and disease that newer types of responsive agents can provide. PMID:25975847

Public trust in the Spanish health‐care system

PubMed Central

Jovell, Albert; Blendon, Robert J.; Navarro, Maria Dolors; Fleischfresser, Channtal; Benson, John M.; DesRoches, Catherine M.; Weldon, Kathleen J.

2007-01-01

Abstract Background  Fifteen years ago, public opinion surveys in Spain showed substantial dissatisfaction with the health‐care system. Since that time, health‐care in Spain has undergone significant changes, including a decentralization of the system, an increase in spending and a change in the way the system is financed. Objective  This study examines how Spanish citizens rate the performance of their health system today, both as compared with other sectors of society and as compared with earlier time periods. Methods  Data are drawn from nationally representative telephone surveys of the non‐institutionalized adult Spanish population (age 18 years and over). The study was carried out in two phases: October–November 2005 (n = 3010) and January 2006 (n = 2101). Results  The majority of the Spanish population thinks the health system needs to be changed. The problems cited relate mostly to long wait times to get health‐care. Nevertheless, over the last 15 years, the proportion of people who have very negative views about the health system has decreased by half. The majority believes that not enough money is spent on health‐care, but few people would support an increase in taxes to provide additional funding. The survey finds the National Health System’s institutions and health professionals to be more highly trusted than other institutions and professional groups in the country. Conclusions  Government policy‐makers in Spain face a dilemma: the public wants more health spending to decrease wait times, but there is substantial resistance to increasing taxes as a means to finance improvements in the system’s capacity. PMID:17986071

Liposuction for Submental Lymphedema Improves Appearance and Self-Perception in the Head and Neck Cancer Patient.

PubMed

Brake, Maria K; Jain, Lauren; Hart, Robert D; Trites, Jonathan R B; Rigby, Matthew; Taylor, S Mark

2014-08-01

Patients who have undergone treatment for head and neck cancer are at risk for neck lymphedema, which can severely affect quality of life. Liposuction has been used successfully for cancer patients who suffer from posttreatment limb lymphedema. The purpose of our study was to review the outcomes of head and neck cancer patients at our center who have undergone submental liposuction for posttreatment lymphedema. Prospective cohort study. Oncology center in tertiary hospital setting. Head and neck cancer patients who underwent submental liposuction for posttreatment lymphedema were included. Nine patients met the study criteria. Patients completed 2 surveys (Modified Blepharoplasty Outcome Evaluation and the validated Derriford Appearance Scale) pre- and postoperatively to assess satisfaction. Patients' pre- and postoperative photos were graded by independent observers to assess outcomes objectively. Our study demonstrated a statistically significant improvement in patients' self-perception of appearance and statistically significant objective scoring of appearance following submental liposuction. Submental liposuction improves the appearance and quality of life for head and neck cancer patients suffering from posttreatment lymphedema by way of improving their self-perception and self-confidence. © American Academy of Otolaryngology—Head and Neck Surgery Foundation 2014.

Carbon dioxide and water transport through plant aquaporins.

PubMed

Groszmann, Michael; Osborn, Hannah L; Evans, John R

2017-06-01

Aquaporins are channel proteins that function to increase the permeability of biological membranes. In plants, aquaporins are encoded by multigene families that have undergone substantial diversification in land plants. The plasma membrane intrinsic proteins (PIPs) subfamily of aquaporins is of particular interest given their potential to improve plant water relations and photosynthesis. Flowering plants have between 7 and 28 PIP genes. Their expression varies with tissue and cell type, through development and in response to a variety of factors, contributing to the dynamic and tissue specific control of permeability. There are a growing number of PIPs shown to act as water channels, but those altering membrane permeability to CO 2 are more limited. The structural basis for selective substrate specificities has not yet been resolved, although a few key amino acid positions have been identified. Several regions important for dimerization, gating and trafficking are also known. PIP aquaporins assemble as tetramers and their properties depend on the monomeric composition. PIPs control water flux into and out of veins and stomatal guard cells and also increase membrane permeability to CO 2 in mesophyll and stomatal guard cells. The latter increases the effectiveness of Rubisco and can potentially influence transpiration efficiency. © 2016 John Wiley & Sons Ltd.

Development and Utilization of a Patient-Oriented Outpatient Guidance System.

PubMed

Baek, Mira; Koo, Bo Kyung; Kim, Byoung Jae; Hong, Kyung-Ran; Kim, Jongdeuk; Yoo, Sooyoung; Hwang, Hee; Seo, Jeongwan; Kim, Donghyeok; Shin, Kichul

2016-07-01

To develop a tool which can easily access the hospital information system (HIS) to facilitate outpatient care and maximize patient satisfaction on his or her hospital visit. Our Center for Informatics developed an outpatient guidance system (OGS) after careful analysis of the list of daily tasks undergone by patients and related work processes. Bluetooth beacons were installed to assist patients, to inform them of points of interest, and to guide them along the proper routes to and within the hospital. The OGS conveniently provided patients' clinic schedules, routes to the hospital, and direct costs; all of this information was embedded in the HIS accessed from patients' personal mobile devices or kiosks. Patients were also able to identify their locations within the hospital, receiving proper directions to subsequent task. Since its launch in October 2014, the number of mobile accesses increased from 4,011 to 8,242 per month within a year. The substantial growth of interest in and use of our OGS in such a short period indicate that this system has been successfully incorporated into patients' daily activities. We believe that this system will continue to help improve health services and the well-being of those visiting the hospital.

Inferring 'weak spots' in phylogenetic trees: application to mosasauroid nomenclature.

PubMed

Madzia, Daniel; Cau, Andrea

2017-01-01

Mosasauroid squamates represented the apex predators within the Late Cretaceous marine and occasionally also freshwater ecosystems. Proper understanding of the origin of their ecological adaptations or paleobiogeographic dispersals requires adequate knowledge of their phylogeny. The studies assessing the position of mosasauroids on the squamate evolutionary tree and their origins have long given conflicting results. The phylogenetic relationships within Mosasauroidea, however, have experienced only little changes throughout the last decades. Considering the substantial improvements in the development of phylogenetic methodology that have undergone in recent years, resulting, among others, in numerous alterations in the phylogenetic hypotheses of other fossil amniotes, we test the robustness in our understanding of mosasauroid beginnings and their evolutionary history. We re-examined a data set that results from modifications assembled in the course of the last 20 years and performed multiple parsimony analyses and Bayesian tip-dating analysis. Following the inferred topologies and the 'weak spots' in the phylogeny of mosasauroids, we revise the nomenclature of the 'traditionally' recognized mosasauroid clades, to acknowledge the overall weakness among branches and the alternative topologies suggested previously, and discuss several factors that might have an impact on the differing phylogenetic hypotheses and their statistical support.

Inferring ‘weak spots’ in phylogenetic trees: application to mosasauroid nomenclature

PubMed Central

2017-01-01

Mosasauroid squamates represented the apex predators within the Late Cretaceous marine and occasionally also freshwater ecosystems. Proper understanding of the origin of their ecological adaptations or paleobiogeographic dispersals requires adequate knowledge of their phylogeny. The studies assessing the position of mosasauroids on the squamate evolutionary tree and their origins have long given conflicting results. The phylogenetic relationships within Mosasauroidea, however, have experienced only little changes throughout the last decades. Considering the substantial improvements in the development of phylogenetic methodology that have undergone in recent years, resulting, among others, in numerous alterations in the phylogenetic hypotheses of other fossil amniotes, we test the robustness in our understanding of mosasauroid beginnings and their evolutionary history. We re-examined a data set that results from modifications assembled in the course of the last 20 years and performed multiple parsimony analyses and Bayesian tip-dating analysis. Following the inferred topologies and the ‘weak spots’ in the phylogeny of mosasauroids, we revise the nomenclature of the ‘traditionally’ recognized mosasauroid clades, to acknowledge the overall weakness among branches and the alternative topologies suggested previously, and discuss several factors that might have an impact on the differing phylogenetic hypotheses and their statistical support. PMID:28929018

Educational Programs That Work. Volume IV.

ERIC Educational Resources Information Center

Far West Lab. for Educational Research and Development, San Francisco, CA.

This catalog is published as one of many mechanisms to stimulate and facilitate continuing communication among the federal, state, intermediate, and local agencies that share responsibility for educational program improvement through nationwide dissemination activities. All the projects cited have undergone close scrutiny by the Joint…

Long-term follow-up of disease-specific quality of life after bariatric surgery.

PubMed

Biron, Simon; Biertho, Laurent; Marceau, Simon; Lacasse, Yves

2018-05-01

Substantial improvements in health-related quality of life measured by generic questionnaires (most often the Short Form-36) have been noted over the long term in patients with morbid obesity who had undergone bariatric surgery. To obtain long-term follow-up data on disease-specific quality of life in patients who underwent bariatric surgery (biliopancreatic diversion with duodenal switch) in 2007 to 2008. Québec Heart and Lung Institute, Québec, Canada. This study is a follow-up of the validation study, the Laval Questionnaire, an obesity-specific measure of health-related quality of life developed to be used in clinical trials. Patients who contributed to the validation study in 2007 to 2008 were administered the Laval Questionnaire again at long-term follow-up. Of 112 patients who contributed to the validation study, 90 were available for this long-term follow-up study (retention rate: 80%). Median follow-up was 8.8 years. For all 6 domains of the Laval Questionnaire, the improvements in quality-of-life scores were much larger than our best estimate of the minimal clinically important difference. In others, we observed some decline in quality-of-life scores over time after initial changes that occurred 1 to 2 years after surgery, during the so-called "honeymoon period." Improvements in quality of life were clearly related to surgery. This study confirms that bariatric surgery using biliopancreatic diversion with duodenal switch improves disease-specific quality of life in the short and long term. It also demonstrates that the Laval Questionnaire is responsive to treatment-induced changes. Copyright © 2018 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

New Challenges for Data Managment in Genebanks

USDA-ARS?s Scientific Manuscript database

The use of genetic resources for crop improvement has undergone a fundamental shift. Continued progress will be dependent upon the natural variation contained within the world’s gene banks. Gene banks must manage their collections in ways that promote their utilization by increasing access to not ...

INVERSE QUANTITATIVE STRUCTURE ACTIVITY RELATIONSHIP ANALYSIS FOR IMPROVING PREDICTIONS OF CHEMICAL TOXICITY

EPA Science Inventory

The toxic outcomes associated with environmental contaminants are often not due to the chemical form that was originally introduced into the environment, but rather to the chemical having undergone a transformation prior to reaching the vulnerable species. More importantly, the c...

A patient with Alzheimer's disease complicated by elderly-onset Cushing's syndrome who had undergone surgical treatment for adrenocorticotropic hormone-independent macronodular adrenal hyperplasia.

PubMed

Haraguchi, Yoshinori; Mizoguchi, Yoshito; Noguchi, Tomoyuki; Arai, Takeo; Fukuyama, Junko; Kato, Takahiro A; Kawashima, Toshiro; Monji, Akira

2016-07-01

Cushing's syndrome (CS) is a rare disorder, especially in older people. Loss of brain volume and neurocognitive impairment of varying degrees has been demonstrated in patients with CS. However, there is a large difference between the median age of presentation of CS and that of Alzheimer's disease. We herein report a case of a patient with Alzheimer's disease complicated by elderly-onset CS who had undergone surgical treatment for adrenal hyperplasia. Surgical correction of hypercortisolism seems to have slowed the progression of brain volume loss and cognitive dysfunction and improved psychiatric symptoms such as visual hallucination, restlessness, and psychomotor excitement. These improvements have remarkably reduced the burden on the patient's caregivers. The present case suggests that subclinical CS may be present, particularly in rapidly progressive dementia, and that surgical treatment of CS for neuropsychiatric symptoms is useful. © 2015 The Authors. Psychogeriatrics © 2015 Japanese Psychogeriatric Society.

Maternal and child health in Brazil: progress and challenges.

PubMed

Victora, Cesar G; Aquino, Estela M L; do Carmo Leal, Maria; Monteiro, Carlos Augusto; Barros, Fernando C; Szwarcwald, Celia L

2011-05-28

In the past three decades, Brazil has undergone rapid changes in major social determinants of health and in the organisation of health services. In this report, we examine how these changes have affected indicators of maternal health, child health, and child nutrition. We use data from vital statistics, population censuses, demographic and health surveys, and published reports. In the past three decades, infant mortality rates have reduced substantially, decreasing by 5·5% a year in the 1980s and 1990s, and by 4·4% a year since 2000 to reach 20 deaths per 1000 livebirths in 2008. Neonatal deaths account for 68% of infant deaths. Stunting prevalence among children younger than 5 years decreased from 37% in 1974-75 to 7% in 2006-07. Regional differences in stunting and child mortality also decreased. Access to most maternal-health and child-health interventions increased sharply to almost universal coverage, and regional and socioeconomic inequalities in access to such interventions were notably reduced. The median duration of breastfeeding increased from 2·5 months in the 1970s to 14 months by 2006-07. Official statistics show stable maternal mortality ratios during the past 10 years, but modelled data indicate a yearly decrease of 4%, a trend which might not have been noticeable in official reports because of improvements in death registration and the increased number of investigations into deaths of women of reproductive age. The reasons behind Brazil's progress include: socioeconomic and demographic changes (economic growth, reduction in income disparities between the poorest and wealthiest populations, urbanisation, improved education of women, and decreased fertility rates), interventions outside the health sector (a conditional cash transfer programme and improvements in water and sanitation), vertical health programmes in the 1980s (promotion of breastfeeding, oral rehydration, and immunisations), creation of a tax-funded national health service in 1988 (coverage of which expanded to reach the poorest areas of the country through the Family Health Program in the mid-1990s); and implementation of many national and state-wide programmes to improve child health and child nutrition and, to a lesser extent, to promote women's health. Nevertheless, substantial challenges remain, including overmedicalisation of childbirth (nearly 50% of babies are delivered by caesarean section), maternal deaths caused by illegal abortions, and a high frequency of preterm deliveries. Copyright © 2011 Elsevier Ltd. All rights reserved.

Maxillofacial prosthodontic rehabilitation of a patient with oral complications during and after multimodality therapy for the management of oral squamous cell carcinoma.

PubMed

Acharya, Varun; Chambers, Mark S

2015-06-01

Multimodality cancer therapy involving surgical resection, chemotherapy, and radiation therapy is frequently employed in the management of head and neck cancer. Patients who have undergone such therapy face substantial challenges during and after treatment. Prosthodontic rehabilitation is essential during and after tumor ablation to restore function, esthetics, and minimize interruption in daily routine. This clinical report describes the challenges faced by a patient undergoing multimodality therapy for a squamous cell carcinoma of the maxillary sinus and the stages involved in prosthodontic rehabilitation. Copyright © 2015 Editorial Council for the Journal of Prosthetic Dentistry. Published by Elsevier Inc. All rights reserved.

Contemporary Methodology for Protein Structure Determination.

ERIC Educational Resources Information Center

Hunkapiller, Michael W.; And Others

1984-01-01

Describes the nature and capabilities of methods used to characterize protein and peptide structure, indicating that they have undergone changes which have improved the speed, reliability, and applicability of the process. Also indicates that high-performance liquid chromatography and gel electrophoresis have made purifying proteins and peptides a…

International variation in programmes for assessment of children's neurodevelopment in the community: Understanding disparate approaches to evaluation of motor, social, emotional, behavioural and cognitive function.

PubMed

Wilson, Philip; Wood, Rachael; Lykke, Kirsten; Hauskov Graungaard, Anette; Ertmann, Ruth Kirk; Andersen, Merethe Kirstine; Haavet, Ole Rikard; Lagerløv, Per; Abildsnes, Eirik; Dahli, Mina P; Mäkelä, Marjukka; Varinen, Aleksi; Hietanen, Merja

2018-05-01

Few areas of medicine demonstrate such international divergence as child development screening and surveillance. Many countries have nationally mandated surveillance policies, but the content of programmes and mechanisms for delivery vary enormously. The cost of programmes is substantial but no economic evaluations have been carried out. We have critically examined the history, underlying philosophy, content and delivery of programmes for child development assessment in five countries with comprehensive publicly funded health services (Denmark, Finland, Norway, Scotland and Sweden). The specific focus of this article is on motor, social, emotional, behavioural and global cognitive functioning including language. Variations in developmental surveillance programmes are substantially explained by historical factors and gradual evolution although Scotland has undergone radical changes in approach. No elements of universal developmental assessment programmes meet World Health Organization screening criteria, although some assessments are configured as screening activities. The roles of doctors and nurses vary greatly by country as do the timing, content and likely costs of programmes. Inter-professional communication presents challenges to all the studied health services. No programme has evidence for improved health outcomes or cost effectiveness. Developmental surveillance programmes vary greatly and their structure appears to be driven by historical factors as much as by evidence. Consensus should be reached about which surveillance activities constitute screening, and the predictive validity of these components needs to be established and judged against World Health Organization screening criteria. Costs and consequences of specific programmes should be assessed, and the issue of inter-professional communication about children at remediable developmental risk should be prioritised.

Strategic plan for geriatrics and extended care in the veterans health administration: background, plan, and progress to date.

PubMed

Shay, Kenneth; Hyduke, Barbara; Burris, James F

2013-04-01

The leaders of Geriatrics and Extended Care (GEC) in the Veterans Health Administration (VHA) undertook a strategic planning process that led to approval in 2009 of a multidisciplinary, evidence-guided strategic plan. This article reviews the four goals contained in that plan and describes VHA's progress in addressing them. The goals included transforming the healthcare system to a veteran-centric approach, achieving universal access to a panel of services, ensuring that the Veterans Affair's (VA) healthcare workforce was adequately prepared to manage the needs of the growing elderly veteran population, and integrating continuous improvement into all care enhancements. There has been substantial progress in addressing all four goals. All VHA health care has undergone an extensive transformation to patient-centered care, has enriched the services it can offer caregivers of dependent veterans, and has instituted models to better integrate VA and non-VA cares and services. A range of successful models of geriatric care described in the professional literature has been adapted to VA environments to gauge suitability for broader implementation. An executive-level task force developed a three-pronged approach for enhancing the VA's geriatric workforce. The VHA's performance measurement approaches increasingly include incentives to enhance the quality of management of vulnerable elderly adults in primary care. The GEC strategic plan was intended to serve as a road map for keeping VHA aligned with an ambitious but important long-term vision for GEC services. Although no discrete set of resources was appropriated for fulfillment of the plan's recommendations, this initial report reflects substantial progress in addressing most of its goals. © 2013, Copyright the Authors Journal compilation © 2013, The American Geriatrics Society.

A Missing Link? Contemporary Insights into Principal Preparation and Training in Russia

ERIC Educational Resources Information Center

Bysik, Nadezhda; Evstigneeva, Nadezhda; Isaeva, Natalia; Kukso, Katsiaryna; Harris, Alma; Jones, Michelle

2015-01-01

Over the last decade, the Russian education system has undergone significant transformation that has radically changed the expectations placed upon the school principals. This current reform process has placed far greater responsibilities and accountabilities upon principals to secure school effectiveness and improved student learning outcomes.…

School Improvement in London: A Global Perspective

ERIC Educational Resources Information Center

McAleavy, Tony; Elwick, Alex

2016-01-01

This report considers how successful London's schools have been over the past decade and identifies potentially transferable components of the success story. There is much to be learned from the transformation undergone in London that is relevant to policymakers and educationalists worldwide, working in both high-income and low-income countries.…

Identifying Priorities for Post-Secondary Education in Qatar. Research Brief

ERIC Educational Resources Information Center

Stasz, Cathleen; Eide, Eric R.; Martorell, Francisco; Salem, Hanine; Constant, Louay; Goldman, Charles A.; Moini, Joy S.; Nadareishvili, Vazha

2007-01-01

Although Qatar has improved its post-secondary educational opportunities, the country's efforts have not undergone a broad strategic review. This study analyzed the extent to which the current offerings can meet the country's future needs and identified priorities for developing further educational options. Researchers found that Qataris' current…

SUPPORT NEEDS AND ACCEPTABILITY OF PSYCHOLOGICAL CONSULTATION: ATTITUDES OF 108 WOMEN WHO HAD UNDERGONE OR WERE CONSIDERING PROPHYLACTIC MASTECTOMY

PubMed Central

Patenaude, Andrea F; Orozco, Sara; Li, Xiaochun; Kaelin, Carolyn M; Gadd, Michelle; Matory, Yvedt; Mayzel, Kathleen; Roche, Constance A; Smith, Barbara L; Farkas, Walden; Garber, Judy E

2014-01-01

Summary Prophylactic mastectomy (PM) offers 90% or greater reduction in risk of breast cancer to women at increased hereditary risk. Nonetheless, acceptance in North America has been low (0–36%). Most women report reduced cancer worry post-operatively, but up to 25–50% of women electing surgery also report psychological distress and/or difficulty adapting following PM. Psychological consultation to aid decision-making and improve post-surgical coping isn’t routinely offered. This retrospective, cross-sectional study explored, quantitatively and qualitatively, interest in and acceptability of psychological consultation for issues related to PM among 108 women who had undergone or were considering surgery. Of the 71 women who had undergone PM, more than half felt pre-surgical psychological consultation was advisable and nearly 2/3 felt post-surgical psychological consultation would be helpful. All 37 women (100%) currently considering PM believed psychological consultation would aid decision-making and preparation for surgery. Narratives from the interviews illustrate the nature and intensity of the need for psychological support and describe preferences for the role of the psychologist. Suggestions are offered for the integration of psychological services for women deciding about or adapting to PM. PMID:18636423

[Four-port pars plana vitrectomy for severe proliferative diabetic retinopathy].

PubMed

Wei, Wen-bin; Yang, Qiong; Mo, Jing; Zhou, Dan

2008-01-01

To investigate the 4-port pars plana vitrectomy in eyes with severe proliferative diabetic retinopathy (PDR). It was a case-control study. Twenty-eight eyes in 27 patients with extensive fibrovascular proliferation associated with PDR were retrospectively collected, who were undergone 4-port pars plana vitreous surgery with bimanual manipulation techniques, such as membrane dissections and enbloc membranectomy. The control group consisted of 30 eyes in 30 patients with PDR which were undergone 3-port pars plana vitrectomy by the same surgeon. Twenty-eight eyes were undergone membrane dissection and enbloc membranectomy smoothly during 4-port pars plana vitrectomy, 2 iatrogenic holes occurred in 1 eye. During the follow up 7 months to 4.5 years, the retina was fully attached in all eyes, visual acuity had improved except 1 eye which complicated with neovascular glaucoma. In the control group, membranes partially remained in 2 eyes, 4 iatrogenic holes appeared in 3 eyes, neovascular glaucoma occurred in 3 eyes, the retina was reattached during the follow-up time from 12 to 34 months. For severe proliferative diabetic retinopathy, the 4-port pars plana vitrectomy with bimanual manipulations of membrane peeling is safe and efficiency.

Impact of surgery on quality of life in Crohn´s disease patients: final results of Czech cohort.

PubMed

Kunovský, Lumír; Mitas, Ladislav; Marek, Filip; Dolina, Jiri; Poredska, Karolina; Kucerova, Lenka; Benesova, Klara; Kala, Zdeněk

2018-01-01

Crohns disease (CD) belongs to chronic diseases that highly affect the patient´s quality of life (QoL). The effect of the disease and impairment of QoL in CD patients is already known. The aim was to assess how surgical treatment influences the patients QoL and determine factors that can affect postoperative QoL. We compared the QoL before and after surgery in patients who had undergone a bowel resection at our department due to CD between 2010-2016. The patients filled in a standardized QLQ-CR29 questionnaire to assess QoL in the preoperative period and the postoperative period after a 2-month interval. The control groups were CD patients who had not undergone surgical treatment (bowel resection) and a healthy cohort. In the QoL evaluation, 132 patients with CD who had undergone surgery (bowel resection), 83 patients with CD without an operation and 104 healthy subjects were enrolled. 104 of the operated patients experienced a postoperative improvement of the overall QoL (78.8 %), 2 patients did not register any changes in QoL (1.5 %) and 26 patients (19.7 %) experienced a worsening of their postoperative QoL. The results were statistically significant (p < 0.001). We detected a significant improvement of the overall QoL after surgical resection in CD patients (measured 2 months after surgery). Gender was identified as the only statistically relevant factor with influence on postoperative QoL.Key words: bowel resection - Crohn´s disease - Czech cohort - inflammatory bowel disease - quality of life - surgical treatment.

Finite-frequency P-wave tomography of the Western Canada Sedimentary Basin: Implications for the lithospheric evolution in Western Laurentia

NASA Astrophysics Data System (ADS)

Chen, Yunfeng; Gu, Yu Jeffrey; Hung, Shu-Huei

2017-02-01

The lithosphere beneath the Western Canada Sedimentary Basin has potentially undergone Precambrian subduction and collisional orogenesis, resulting in a complex network of crustal domains. To improve the understanding of its evolutionary history, we combine data from the USArray and three regional networks to invert for P-wave velocities of the upper mantle using finite-frequency tomography. Our model reveals distinct, vertically continuous high (> 1%) velocity perturbations at depths above 200 km beneath the Precambrian Buffalo Head Terrane, Hearne craton and Medicine Hat Block, which sharply contrasts with those beneath the Canadian Rockies (<- 1%) at comparable depths. The P velocity increases from - 0.5% above 70 km depth to 1.5% at 330 km depth beneath southern Alberta, which provides compelling evidence for a deep, structurally complex Hearne craton. In comparison, the lithosphere is substantially thinner beneath the adjacent Buffalo Head Terrane (160 km) and Medicine Hat Block (200 km). These findings are consistent with earlier theories of tectonic assembly in this region, which featured distinct Archean and Proterozoic plate convergences between the Hearne craton and its neighboring domains. The highly variable, bimodally distributed craton thicknesses may also reflect different lithospheric destruction processes beneath the western margin of Laurentia.

What role do hurricanes play in sediment delivery to subsiding river deltas?

USGS Publications Warehouse

Smith, James E.; Bentley, Samuel J.; Snedden, Gregg; White, Crawford

2015-01-01

The Mississippi River Delta (MRD) has undergone tremendous land loss over the past century due to natural and anthropogenic influences, a fate shared by many river deltas globally. A globally unprecedented effort to restore and sustain the remaining subaerial portions of the delta is now underway, an endeavor that is expected to cost $50–100B over the next 50 yr. Success of this effort requires a thorough understanding of natural and anthropogenic controls on sediment supply and delta geomorphology. In the MRD, hurricanes have been paradoxically identified as both substantial agents of widespread land loss, and vertical marsh sediment accretion. We present the first multi-decadal chronostratigraphic assessment of sediment supply for a major coastal basin of the MRD that assesses both fluvial and hurricane-induced contributions to sediment accumulation in deltaic wetlands. Our findings indicate that over multidecadal timescales, hurricane-induced sediment delivery may be an important contributor for deltaic wetland vertical accretion, but the contribution from hurricanes to long-term sediment accumulation is substantially less than sediment delivery supplied by existing and planned river-sediment diversions at present-day river-sediment loads.

What Role do Hurricanes Play in Sediment Delivery to Subsiding River Deltas?

NASA Astrophysics Data System (ADS)

Smith, James E.; Bentley, Samuel J.; Snedden, Gregg A.; White, Crawford

2015-12-01

The Mississippi River Delta (MRD) has undergone tremendous land loss over the past century due to natural and anthropogenic influences, a fate shared by many river deltas globally. A globally unprecedented effort to restore and sustain the remaining subaerial portions of the delta is now underway, an endeavor that is expected to cost $50-100B over the next 50 yr. Success of this effort requires a thorough understanding of natural and anthropogenic controls on sediment supply and delta geomorphology. In the MRD, hurricanes have been paradoxically identified as both substantial agents of widespread land loss, and vertical marsh sediment accretion. We present the first multi-decadal chronostratigraphic assessment of sediment supply for a major coastal basin of the MRD that assesses both fluvial and hurricane-induced contributions to sediment accumulation in deltaic wetlands. Our findings indicate that over multidecadal timescales, hurricane-induced sediment delivery may be an important contributor for deltaic wetland vertical accretion, but the contribution from hurricanes to long-term sediment accumulation is substantially less than sediment delivery supplied by existing and planned river-sediment diversions at present-day river-sediment loads.

Two-source energy balance model to calculate row crop E.T. and ET:Advances at ARS, Bushland, TX 2010-2015

USDA-ARS?s Scientific Manuscript database

The two-source energy balance (TSEB) model has undergone several advances recently that improved its accuracy in calculating evaporation (E), transpiration (T), and evapotranspiration (ET) for row crops. These advances were tested using microlysimeter, sap flow, and large weighing lysimeter measurem...

History and Development of Instructional Technology and Media in Social Work Education

ERIC Educational Resources Information Center

Shorkey, Clayton T.; Uebel, Michael

2014-01-01

Since the mid-20th century, instructional technologies and educational media in social work education have undergone significant development with the goals of improving learning and performance and enhancing access. This growth has been marked by technical advances in hardware and by innovations in media, or so-called soft formats. Current…

Leadership for Effective Teacher Training Transfer in Kuwaiti Secondary Schools

ERIC Educational Resources Information Center

Winokur, Ilene K.; Sperandio, Jill

2017-01-01

This article reports on the findings of a study undertaken to examine the links between leadership practices of a transformational nature and the transfer of teacher training in the public high schools in Kuwait. The participants in the study were teachers who had undergone mandated professional development (PD) aimed at improving teaching…

Results of posterior cervical foraminotomy for treatment of cervical spondylitic radiculopathy.

PubMed

Grieve, J P; Kitchen, N D; Moore, A J; Marsh, H T

2000-02-01

We evaluated the results of posterior cervical foraminotomy for spondylitic radiculopathy using a questionnaire sent to all 77 patients who had undergone surgery between 1990 and 1995 at our institution. Sixty-two patients (40 male) returned their questionnaires, one of whom had undergone two procedures (dealt with as separate events). Sixty patients complained of pre-operative arm pain; of these 42 (70%) had complete or > 75% resolution of their pain, 14 (23%) had < 75% improvement in their pain and four (7%) had the same or worsened pain at the time of the questionnaire. Sixteen patients (27%) reported initial improvement in symptoms with subsequent deterioration. The mean patient satisfaction score using a linear analogue scale from 0 to 10 was 7.5. Main postoperative complaints were neck pain (22%), persisting motor deficit (6%) and persisting sensory deficit (9%). One patient suffered nerve root damage at surgery. For unilateral and, in some cases, multi-level degenerative disease causing cervical radiculopathy, posterior cervical foraminotomy is a useful technique with the advantage of avoiding fusion, immobilization and the long-term risk of instability.

(99m)Tc HYNIC-TOC imaging and 177Lu DOTA-octreotate treatment in non-iodine-concentrating dedifferentiated thyroid carcinoma metastases: an unusual alternative diagnosis.

PubMed

Basu, Sandip; Joshi, Amit

2014-07-01

The value of Tc HYNIC-TOC scintigraphy clarifying skeletal and hepatic-predominant metastatic disease in a 55-year-old woman (diagnosed earlier to have papillary carcinoma thyroid and had undergone total thyroidectomy and radioiodine ablation) is illustrated. The whole-body radioiodine scan and battery of serum tumor markers were normal. Multiple metastatic foci in the liver and skeleton were Tc HYNIC-TOC avid. Serum chromogranin A level was substantially elevated (1771.60 ng/mL). This represents an unusual alternative diagnosis signified by a highly positive scan in the setting of apparent non-iodine-concentrating metastatic disease in a patient of differentiated thyroid carcinoma.

The Cold War is Over. What Now?

DOE R&D Accomplishments Database

Hecker, S. S.

1995-04-01

As you might imagine, the end of the Cold War has elicited an intense reexamination of the roles and missions of institutions such as the Los Alamos National Laboratory. During the past few years, the entire defense establishment has undergone substantial consolidation, with a concomitant decrease in support for research and development, including in areas such as materials. The defense industry is down-sizing at a rapid pace. Even universities have experienced significant funding cutbacks from the defense community. I view this as a profound time in history, bringing changes encompassing much more than just the defense world. In fact, support for science and technology is being reexamined across the board more completely than at any other time since the end of World War II.

Development of an integrated ecosystem model to determine effectiveness of potential watershed management projects on improving Old Tampa Bay

Treesearch

Edward T. Sherwood; Holly Greening; Lizanne Garcia; Kris Kaufman; Tony Janicki; Ray Pribble; Brett Cunningham; Steve Peene; Jim Fitzpatrick; Kellie Dixon; Mike Wessel

2016-01-01

The Tampa Bay estuary has undergone a remarkable ecosystem recovery since the 1980s despite continued population growth within the region. However during this time, the Old Tampa Bay (OTB) segment has lagged behind the rest of the Bay’s recovery relative to improvements in overall water quality and seagrass coverage. In 2011, the Tampa Bay Estuary Program, in...

Use of intraurethral alprostadil in patients not responding to sildenafil citrate.

PubMed

Jaffe, Jamison S; Antell, Mara R; Greenstein, Marc; Ginsberg, Phillip C; Mydlo, Jack H; Harkaway, Richard C

2004-05-01

To determine whether intraurethral alprostadil would be an effective alternative for men with erectile dysfunction who did not respond adequately to sildenafil citrate but desired minimally invasive treatment. A total of 44 male patients aged 41 to 74 years with erectile dysfunction refractory to treatment with sildenafil citrate were enrolled in this study. Of the 44 patients, 10 had undergone prior radical retropubic prostatectomy. The patients were evaluated for subjective improvement in an office setting and completed the Sexual Health Inventory for Men questionnaire as an objective assessment of improved erectile ability. Success was defined as subjective improvement in erectile function, as well as an improved Sexual Health Inventory for Men score. Of the 44 men, 13 (29.5%) responded successfully to intraurethral alprostadil, with a follow-up ranging from 2 to 15 months. The remaining 31 men had no response (n = 28, 90%), refused escalating doses (n = 2, 7%), or were lost to follow-up (n = 1, 3%). In the subgroup of 10 men with prior radical retropubic prostatectomy, 5 (50%) reported success with intraurethral alprostadil (500 microg in 2 patients and 1000 microg in 3 patients). Although sildenafil citrate remains the most common initial therapy in men with erectile dysfunction, intraurethral alprostadil may be a reasonable treatment option for sildenafil nonresponders. This may be especially true in men having undergone prior radical retropubic prostatectomy.

Rocks of the Columbia Hills

USGS Publications Warehouse

Squyres, S. W.; Arvidson, R. E.; Blaney, D.L.; Clark, B. C.; Crumpler, L.; Farrand, W. H.; Gorevan, S.; Herkenhoff, K. E.; Hurowitz, J.; Kusack, A.; McSween, H.Y.; Ming, D. W.; Morris, R.V.; Ruff, S.W.; Wang, A.; Yen, A.

2006-01-01

The Mars Exploration Rover Spirit has identified five distinct rock types in the Columbia Hills of Gusev crater. Clovis Class rock is a poorly sorted clastic rock that has undergone substantial aqueous alteration. We interpret it to be aqueously altered ejecta deposits formed by impacts into basaltic materials. Wishstone Class rock is also a poorly sorted clastic rock that has a distinctive chemical composition that is high in Ti and P and low in Cr. Wishstone Class rock may be pyroclastic or impact in origin. Peace Class rock is a sedimentary material composed of ultramafic sand grains cemented by significant quantities of Mg- and Ca-sulfates. Peace Class rock may have formed when water briefly saturated the ultramafic sands and evaporated to allow precipitation of the sulfates. Watchtower Class rocks are similar chemically to Wishstone Class rocks and have undergone widely varying degrees of near-isochemical aqueous alteration. They may also be ejecta deposits, formed by impacts into Wishstone-rich materials and altered by small amounts of water. Backstay Class rocks are basalt/trachybasalt lavas that were emplaced in the Columbia Hills after the other rock classes were, either as impact ejecta or by localized volcanic activity. The geologic record preserved in the rocks of the Columbia Hills reveals a period very early in Martian history in which volcanic materials were widespread, impact was a dominant process, and water was commonly present. Copyright 2006 by the American Geophysical Union.

The Rocks of the Columbia Hills

NASA Technical Reports Server (NTRS)

Squyres, Steven W.; Arvidson, Raymond E.; Blaney, Diana L.; Clark, Benton C.; Crumpler, Larry; Farrand, William H.; Gorevan, Stephen; Herkenhoff, Kenneth; Hurowitz, Joel; Kusack, Alastair;

High spectral resolution lidar at the university of wisconsin-madison

NASA Astrophysics Data System (ADS)

Razenkov, Ilya I.; Eloranta, Edwin W.

2018-04-01

This paper describes the modifications done on the University of Wisconsin-Madison High Spectral Resolution Lidar (HSRL) that improved the instrument's performance. The University of Wisconsin HSRL lidars designed by our group at the Space Science and Engineering Center were deployed in numerous field campaigns in various locations around the world. Over the years the instruments have undergone multiple modifications that improved the performance and added new measurement capabilities such as atmospheric temperature profile and extinction cross-section measurements.

Cooling techniques for turbojet pre-heater channels

NASA Astrophysics Data System (ADS)

Desaulty, M.; Troullot, P.; Coutor, S.

1985-09-01

Increases in the performance of turbojets with pre-heating are dependent upon technological research in the area of protection of the wall in pre-heater channels. The procedures used to cool the thermal protection jackets have undergone important improvements which have optimized performance, reduced weight and improved cooling efficiency. This report presents a comparison of the thermal protection jackets for several SNECMA engines, as well as the principal stages of development for the jacket from the design stages through static engines tests.

The Efficacy and Risk of Intense Aerobic Circuit Training in Coronary Artery Disease Patients Following Bypass Surgery.

ERIC Educational Resources Information Center

LaFontaine, Tom; Bruckerhoff, Diane

1987-01-01

This study describes the influence of highly intense aerobic circuit training on the cardiorespiratory fitness of 31 coronary artery disease patients who had undergone bypass surgery. Results show improvement in heart rate and other measured responses and no abnormal responses related to cardiovascular or musculoskeletal complications. (Author/MT)

Energy-Dispersive X-Ray Fluorescence Spectrometry: A Long Overdue Addition to the Chemistry Curriculum

ERIC Educational Resources Information Center

Palmer, Peter T.

2011-01-01

Portable Energy-Dispersive X-Ray Fluorescence (XRF) analyzers have undergone significant improvements over the past decade. Salient advantages of XRF for elemental analysis include minimal sample preparation, multielement analysis capabilities, detection limits in the low parts per million (ppm) range, and analysis times on the order of 1 min.…

Effective Partnerships in School Reform: Lessons Learned from the Midwest Child-Parent Center Expansion

ERIC Educational Resources Information Center

Hayakawa, Momoko; Englund, Michelle M.; Candee, Allyson; Lease, Erin; Sullivan, Molly; Warner-Richter, Mallory; Reynolds, Arthur J.

2015-01-01

The Midwest Expansion of the Child-Parent Center Education Program (MCPC) is a pre-K to 3rd grade intervention program aimed at improving economically disadvantaged children's school success by enhancing continuity in instruction and increasing parental involvement. Opened in Chicago in the 1960s, this school reform model has undergone significant…

Molecular evaluation of aphid-resistant black raspberry germplasm for improved durability in black and red raspberry

USDA-ARS?s Scientific Manuscript database

Over the last century, the black raspberry (Rubus occidentalis) industry in the U.S. has undergone a slow contraction because of a lack of adapted and disease resistant cultivars. The Pacific Northwest is the major black raspberry production region in North America, with the value of $9.6 million pr...

Master Curriculum Guide in Economics. A Framework for Teaching the Basic Concepts. Second Edition.

ERIC Educational Resources Information Center

Saunders, Phillip; And Others

Intended for curriculum developers, this revised Framework presents a set of basic concepts for teaching K-12 economics. The revision reflects the change and development which the field of economics has undergone and includes improvements suggested by users of the first edition. The purpose of teaching economics is to impart a general…

Have VET Reforms Resulted in Improvements in Quality? Illustrations from the Alcohol and Other Drugs Sector

ERIC Educational Resources Information Center

Roche, Ann; Kostadinov, Victoria; White, Michael

2014-01-01

Australian vocational education and training (VET) has undergone major reforms since the 1990s, including the introduction of competency based training (CBT) and the "streamlining" of qualifications. This paper examines the impact of these reforms, using the alcohol and other drugs sector as a case illustration. A survey of alcohol and…

Research Assessments and Rankings: Accounting for Accountability in "Higher Education Ltd"

ERIC Educational Resources Information Center

Singh, Geeta

2008-01-01

Over the past two decades, higher education in advanced capitalist societies has undergone a process of radical "reform". A key element of this reform has been the introduction of a number of accounting-based techniques in the pursuit of improved accountability and transparency. While the "old" accounting was to do with stewardship, the "new"…

Rural Education and Urbanization: Experiences and Struggles in China since the Late 1970s

ERIC Educational Resources Information Center

Xu, Shuqin; Law, Wing-Wah

2015-01-01

China has adopted an unbalanced policy for economic development to improve its domestic economy and international competitiveness for more than three decades. During this process, rural education has undergone a series of reforms. With reference to compulsory education, this article argues that rural education in China is a pragmatic instrument…

Diagnostic accuracy of optical coherence tomography in actinic keratosis and basal cell carcinoma.

PubMed

Olsen, J; Themstrup, L; De Carvalho, N; Mogensen, M; Pellacani, G; Jemec, G B E

2016-12-01

Early diagnosis of non-melanoma skin cancer (NMSC) is potentially possible using optical coherence tomography (OCT) which provides non-invasive, real-time images of skin with micrometre resolution and an imaging depth of up to 2mm. OCT technology for skin imaging has undergone significant developments, improving image quality substantially. The diagnostic accuracy of any method is influenced by continuous technological development making it necessary to regularly re-evaluate methods. The objective of this study is to estimate the diagnostic accuracy of OCT in basal cell carcinomas (BCC) and actinic keratosis (AK) as well as differentiating these lesions from normal skin. A study set consisting of 142 OCT images meeting selection criterea for image quality and diagnosis of AK, BCC and normal skin was presented uniformly to two groups of blinded observers: 5 dermatologists experienced in OCT-image interpretation and 5 dermatologists with no experience in OCT. During the presentation of the study set the observers filled out a standardized questionnaire regarding the OCT diagnosis. Images were captured using a commercially available OCT machine (Vivosight ® , Michelson Diagnostics, UK). Skilled OCT observers were able to diagnose BCC lesions with a sensitivity of 86% to 95% and a specificity of 81% to 98%. Skilled observers with at least one year of OCT-experience showed an overall higher diagnostic accuracy compared to inexperienced observers. The study shows an improved diagnostic accuracy of OCT in differentiating AK and BCC from healthy skin using state-of-the-art technology compared to earlier OCT technology, especially concerning BCC diagnosis. Copyright © 2016 Elsevier B.V. All rights reserved.

Reoperation after failed resective epilepsy surgery in children.

PubMed

Muthaffar, Osama; Puka, Klajdi; Rubinger, Luc; Go, Cristina; Snead, O Carter; Rutka, James T; Widjaja, Elysa

2017-08-01

OBJECTIVE Although epilepsy surgery is an effective treatment option, at least 20%-40% of patients can continue to experience uncontrolled seizures resulting from incomplete resection of the lesion, epileptogenic zone, or secondary epileptogenesis. Reoperation could eliminate or improve seizures. Authors of this study evaluated outcomes following reoperation in a pediatric population. METHODS A retrospective single-center analysis of all patients who had undergone resective epilepsy surgery in the period from 2001 to 2013 was performed. After excluding children who had repeat hemispherotomy, there were 24 children who had undergone a second surgery and 2 children who had undergone a third surgery. All patients underwent MRI and video electroencephalography (VEEG) and 21 underwent magnetoencephalography (MEG) prior to reoperation. RESULTS The mean age at the first and second surgery was 7.66 (SD 4.11) and 10.67 (SD 4.02) years, respectively. The time between operations ranged from 0.03 to 9 years. At reoperation, 8 patients underwent extended cortical resection; 8, lobectomy; 5, lesionectomy; and 3, functional hemispherotomy. One year after reoperation, 58% of the children were completely seizure free (International League Against Epilepsy [ILAE] Class 1) and 75% had a reduction in seizures (ILAE Classes 1-4). Patients with MEG clustered dipoles were more likely to be seizure free than to have persistent seizures (71% vs 40%, p = 0.08). CONCLUSIONS Reoperation in children with recurrent seizures after the first epilepsy surgery could result in favorable seizure outcomes. Those with residual lesion after the first surgery should undergo complete resection of the lesion to improve seizure outcome. In addition to MRI and VEEG, MEG should be considered as part of the reevaluation prior to reoperation.

Shuttle waste management system design improvements and flight evaluation

NASA Technical Reports Server (NTRS)

Winkler, H. Eugene; Goodman, Jerry R.; Murray, Robert W.; Mcintosh, Mathew E.

1986-01-01

The Space Shuttle waste management system has undergone a variety of design changes to improve performance and man-machine interface. These design improvements have resulted in more reliable operation and hygienic usage. Design enhancements include individual urinals, increased urine collection airflows, increased solids storage capacity, easier access to personal hygiene items, and additional wet trash stowage. The development and flight evaluation of these improvements are described herein. The Space Shuttle Orbiter has proved to be an invaluable test bed for development and in-flight evaluation of life support and habitability concepts which involve transport or separation of solids, liquids, and gases in a zero-g environment.

Socioeconomic barriers to informed decisionmaking regarding maternal serum screening for down syndrome: results of the French National Perinatal Survey of 1998.

PubMed

Khoshnood, Babak; Blondel, Béatrice; de Vigan, Catherine; Bréart, Gérard

2004-03-01

We sought to evaluate socioeconomic disparities in serum screening for Down syndrome and assess whether such disparities are more likely to reflect limits in access or information or, rather, informed decisionmaking. A nationally representative sample of 12 869 French women completed interviews after giving birth. We found substantial disparities in the likelihood of (1) women not being offered screening, (2) screening not being offered as a result of late prenatal care, and (3) women not knowing whether or not they had undergone screening. Except in the case of nationality, there was essentially no evidence of differences in refusal of testing. Rather than representing informed decisionmaking, socioeconomic disparities in screening for Down syndrome are mostly due to limits in access or to information.

Two years at Meridiani Planum: Results from the opportunity rover

USGS Publications Warehouse

Squyres, S. W.; Knoll, A.H.; Arvidson, R. E.; Clark, B. C.; Grotzinger, J.P.; Jolliff, B.L.; McLennan, S.M.; Tosca, N.; Bell, J.F.; Calvin, W.M.; Farrand, W. H.; Glotch, T.D.; Golombek, M.P.; Herkenhoff, K. E.; Johnson, J. R.; Klingelhofer, G.; McSween, H.Y.; Yen, A. S.

2006-01-01

The Mars Exploration Rover Opportunity has spent more than 2 years exploring Meridiani Planum, traveling ???8 kilometers and detecting features that reveal ancient environmental conditions. These include well-developed festoon (trough) cross-lamination formed in flowing liquid water, strata with smaller and more abundant hematite-rich concretions than those seen previously, possible relict "hopper crystals" that might reflect the formation of halite, thick weathering rinds on rock surfaces, resistant fracture fills, and networks of polygonal fractures likely caused by dehydration of sulfate salts. Chemical variations with depth show that the siliciclastic fraction of outcrop rock has undergone substantial chemical alteration from a precursor basaltic composition. Observations from microscopic to orbital scales indicate that ancient Meridiani once had abundant acidic groundwater, arid and oxidizing surface conditions, and occasional liquid flow on the surface.

Integrated But Not Whole? Applying an Ontological Account of Human Organismal Unity to the Brain Death Debate.

PubMed

Moschella, Melissa

2016-10-01

As is clear in the 2008 report of the President's Council on Bioethics, the brain death debate is plagued by ambiguity in the use of such key terms as 'integration' and 'wholeness'. Addressing this problem, I offer a plausible ontological account of organismal unity drawing on the work of Hoffman and Rosenkrantz, and then apply that account to the case of brain death, concluding that a brain dead body lacks the unity proper to a human organism, and has therefore undergone a substantial change. I also show how my view can explain hard cases better than one in which biological integration (as understood by Alan Shewmon and the President's Council) is taken to imply ontological wholeness or unity. © 2016 John Wiley & Sons Ltd.

Detection of total knee prostheses at airport security checkpoints.

PubMed

Naziri, Qais; Johnson, Aaron J; Hooper, Hasan A; Sana, Said H; Mont, Michael A

2012-06-01

Airport security screening measures have changed substantially during the past decade, but few reports have examined how this affects patients who have undergone knee arthroplasties. The purpose of this study was to characterize the efficacy of airport metal detection of total knee prostheses, the delays faced, any inconvenience this may have caused, and the role of implant identification cards. Ninety-seven total knee arthroplasty recipients reported passing through an airport metal detector, with 70 triggering the alarm a mean of 3 times (range, 1-36). The presence of a single-knee prosthesis triggered airport security alarms more than 83% of the time and increased patient inconvenience. Patients should be informed about this chance and be prepared to present documentation of their prosthesis. Copyright © 2012 Elsevier Inc. All rights reserved.

Improvement of posture stability by vibratory stimulation following anterior cruciate ligament reconstruction.

PubMed

Brunetti, O; Filippi, G M; Lorenzini, M; Liti, A; Panichi, R; Roscini, M; Pettorossi, V E; Cerulli, G

2006-11-01

Surgical reconstruction of the anterior cruciate ligament (ACL) may reduce, but it does not always eliminate, knee and body instability because of a persisting proprioceptive deficit. In order to enhance body stability, a new protocol of treatment has been proposed consisting of mechanical vibration (100 Hz frequency and < 20 microm amplitude) of the quadriceps muscle in the leg that has undergone ACL reconstruction. In our trials, stimulation was performed when the quadriceps muscle was kept isometrically contracted. Treatment was started one month after surgery. Vibration was applied for short periods over three consecutive days. Nine months after treatment, postural stability was re-evaluated with the subjects standing on one leg with open and with closed eyes. The postural stability of the subjects having undergone vibration treatment, standing on the operated leg was significantly improved one day after treatment when evaluated as mean of speed and elliptic area of the center of pressure. The improvement persisted and increased during the following weeks. Peak torques of the operated leg extensor muscles also increased and reached values close to that of the leg, which had not been operated. Conversely, the balance of the untreated subjects standing on the operated leg did not improve and the restoration of the extensor muscle peak torque was poor. It is concluded that short lasting proprioceptive activation by vibration may lead to a faster and more complete equilibrium recovery probably by permanently changing the network controlling knee posture.

Posterior fossa reconstruction using titanium plate for the treatment of cerebellar ptosis after decompression for Chiari malformation.

PubMed

Udani, Vikram; Holly, Langston T; Chow, Daniel; Batzdorf, Ulrich

2014-01-01

We describe our use of a perforated titanium plate to perform a partial posterior fossa cranioplasty in the treatment of cerebellar ptosis and dural ectasia after posterior fossa decompression (PFD). Twelve patients who had undergone PFD underwent posterior fossa reconstruction using a titanium plate. Symptoms were related to either descent of the cerebellum into the decompression or to dural ectasia into the craniectomy defect. Twelve patients who had undergone large suboccipital craniectomies and who presented with persistent headaches and some with neurological symptoms related to syringomyelia, underwent reoperation with placement of a small titanium plate. Ten of 12 patients showed symptomatic improvement after reoperation. Placement of a titanium plate appears to be an effective method of treatment of cerebellar ptosis and dural ectasia after PFD for Chiari malformation. Copyright © 2014 Elsevier Inc. All rights reserved.

[Home chemotherapy].

PubMed

Ichihara, Toshiaki

2010-12-01

We report the case of a male gastric cancer patient who had undergone outpatient chemotherapy with TAXOTAL+TS-1 for adrenal and lung metastases.The disease was in progress.Next, we performed home chemotherapy with TAXOL.However, this chemotherapy also was not effective either.Therefore, the patient was started on Campto with the premedication including NaseaOD, GasterD and Decadron.The 17-course was performed in the period of 12 months.However, his condition did not improve.He experienced delirium and was hospitalized and the chemotherapy was discontinued.Later, his disease was advanced further and he died.Because of our close relationship with the general hospital, this patient had undergone home chemotherapy as long as 13 months, so that if a seamless cooperation was insured, chemotherapy could have been more safely and effectively performed at the patient's home.This study suggests that home chemotherapy is an important treatment modality.

Angiogenesis in Glaucoma Filtration Surgery and Neovascular Glaucoma-A Review

PubMed Central

Kim, Megan; Lee, Chelsea; Payne, Rachael; Yue, Beatrice Y.J.T.; Chang, Jin-Hong; Ying, Hongyu

2015-01-01

Angiogenesis may pose a clinical challenge in glaucoma, for example during the wound healing phase after glaucoma filtration surgery and in a severe form of secondary glaucoma called neovascular glaucoma (NVG). Up regulation of vascular endothelial growth factor (VEGF), a key mediator of angiogenesis, occurs in eyes that have undergone glaucoma filtration surgery, as well as those with NVG. This has led to studies investigating the ability of anti-VEGF therapy to improve outcomes, and we examine their findings with respect to the safety and efficacy of anti-VEGF agents, mainly bevacizumab and ranibizumab, in eyes that have undergone glaucoma filtration surgery or have NVG. Combining conventional therapies—such as anti-metabolites after filtration surgery and panretinal photocoagulation in NVG—and anti-VEGF drugs may achieve a synergetic effect, although further studies are required to evaluate the long-term efficacy of combination treatments. PMID:25980779

Speech recognition: how good is good enough?

PubMed

Krohn, Richard

2002-03-01

Since its infancy in the early 1990s, the technology of speech recognition has undergone a rapid evolution. Not only has the reliability of the programming improved dramatically, the return on investment has become increasingly compelling. The author describes some of the latest health care applications of speech-recognition technology, and how the next advances will be made in this area.

The Exploration of Student-Centred Approaches for the Improvement of Learning Programming in Higher Education

ERIC Educational Resources Information Center

Hawi, Nazir

2010-01-01

The author has undergone a major shift in the way of teaching his undergraduate computer programming courses. In the classroom, the teacher's computer is connected to a splitter and a video projector that display the computer's screen to the entire class. Using this technology, the programming language itself is used live in class to help the…

The USDA Feed the Future Initiative for genetic improvement of African goats: an update on genomic resources and genetic characterization of indigenous breeds

USDA-ARS?s Scientific Manuscript database

Food production systems in Africa depend heavily on the use of locally adapted animals such as goats which are critical to small-scale farmers as they are easier to acquire, maintain, and act as scavengers in sparse pasture and marginal crop regions. Indigenous goat ecotypes have undergone generatio...

Leadership for Instructional Improvement: An Examination of How Principals Share Leadership

ERIC Educational Resources Information Center

Garceau, Mark

2012-01-01

Beginning in the latter part of the 20th century, and especially since the advent of No Child Left Behind, the roles and responsibilities of the elementary school principal have undergone significant expansion. While the primary function of the principal at one time may have been to serve as the manager of the physical plant of the school and as…

The Role of Search in University Productivity: Inside, outside, and Interdisciplinary Dimensions. NEBR Working Paper No. 15489

ERIC Educational Resources Information Center

Adams, James D.; Clemmons, J. Roger

2009-01-01

Due to improving information technology, the growing complexity of research problems, and policies designed to foster interdisciplinary research, the practice of science in the United States has undergone significant structural change. Using a sample of 110 top U.S. universities observed during the late 20th century we find that knowledge flows,…

The history of Martian volatiles

NASA Astrophysics Data System (ADS)

Jakosky, Bruce M.; Jones, John H.

The behavior of water and other volatiles on Mars is key to understanding the evolution of the climate. The early climate played a fundamental role in producing the observed surface morphology and possibly in enabling the existence of an early biosphere. Geochemical and isotopic data can be used to infer the history of volatiles. On the basis of the isotopic data from the atmosphere and from components of the surface (as measured in meteorites that come from Mars), there appear to be at least two reservoirs of volatiles, one that has undergone exchange with the atmosphere and has been isotopically fractionated, and a second that is unfractionated and may represent juvenile gases. The fractionation of the atmospheric component has occurred primarily through the escape of gas to space. In addition, the atmospheric gases have mixed substantially with crustal reservoirs of volatiles. Such exchange may have occurred in aqueous or hydrothermal environments. The history of escape to space, as driven by the properties of the Sun through time, is consistent with the surface geomorphology. Together, they suggest an early environment that was substantially different from the present one and the evolution through time to a colder, dryer climate.

The Pfam protein families database: towards a more sustainable future.

PubMed

Finn, Robert D; Coggill, Penelope; Eberhardt, Ruth Y; Eddy, Sean R; Mistry, Jaina; Mitchell, Alex L; Potter, Simon C; Punta, Marco; Qureshi, Matloob; Sangrador-Vegas, Amaia; Salazar, Gustavo A; Tate, John; Bateman, Alex

2016-01-04

In the last two years the Pfam database (http://pfam.xfam.org) has undergone a substantial reorganisation to reduce the effort involved in making a release, thereby permitting more frequent releases. Arguably the most significant of these changes is that Pfam is now primarily based on the UniProtKB reference proteomes, with the counts of matched sequences and species reported on the website restricted to this smaller set. Building families on reference proteomes sequences brings greater stability, which decreases the amount of manual curation required to maintain them. It also reduces the number of sequences displayed on the website, whilst still providing access to many important model organisms. Matches to the full UniProtKB database are, however, still available and Pfam annotations for individual UniProtKB sequences can still be retrieved. Some Pfam entries (1.6%) which have no matches to reference proteomes remain; we are working with UniProt to see if sequences from them can be incorporated into reference proteomes. Pfam-B, the automatically-generated supplement to Pfam, has been removed. The current release (Pfam 29.0) includes 16 295 entries and 559 clans. The facility to view the relationship between families within a clan has been improved by the introduction of a new tool. © The Author(s) 2015. Published by Oxford University Press on behalf of Nucleic Acids Research.

An overview of mineral dust modeling over East Asia

NASA Astrophysics Data System (ADS)

Chen, Siyu; Huang, Jianping; Qian, Yun; Zhao, Chun; Kang, Litai; Yang, Ben; Wang, Yong; Liu, Yuzhi; Yuan, Tiangang; Wang, Tianhe; Ma, Xiaojun; Zhang, Guolong

2017-08-01

East Asian dust (EAD) exerts considerable impacts on the energy balance and climate/climate change of the earth system through its influence on solar and terrestrial radiation, cloud properties, and precipitation efficiency. Providing an accurate description of the life cycle and climate effects of EAD is therefore critical to better understanding of climate change and socioeconomic development in East Asia and even worldwide. Dust modeling has undergone substantial development since the late 1990s, associated with improved understanding of the role of EAD in the earth system. Here, we review the achievements and progress made in recent decades in terms of dust modeling research, including dust emissions, long-range transport, radiative forcing (RF), and climate effects of dust particles over East Asia. Numerous efforts in dust/EAD modeling have been directed towards furnishing more sophisticated physical and chemical processes into the models on higher spatial resolutions. Meanwhile, more systematic observations and more advanced retrieval methods for instruments that address EAD related science issues have made it possible to evaluate model results and quantify the role of EAD in the earth system, and to further reduce the uncertainties in EAD simulations. Though much progress has been made, large discrepancies and knowledge gaps still exist among EAD simulations. The deficiencies and limitations that pertain to the performance of the EAD simulations referred to in the present study are also discussed.

Dynamic evolution at pericentromeres.

PubMed

Hall, Anne E; Kettler, Gregory C; Preuss, Daphne

2006-03-01

Pericentromeres are exceptional genomic regions: in animals they contain extensive segmental duplications implicated in gene creation, and in plants they sustain rearrangements and insertions uncommon in euchromatin. To examine the mechanisms and patterns of plant pericentromere evolution, we compared pericentromere sequence from four Brassicaceae species separated by <15 million years (Myr). This flowering plant family is ideal for studying relationships between genome reorganization and pericentromere evolution-its members have undergone recent polyploidization and hybridization, with close relatives changing in genome size and chromosome number. Through sequence and hybridization analyses, we examined regions from Arabidopsis arenosa, Capsella rubella, and Olimarabidopsis pumila that are homologous to Arabidopsis thaliana pericentromeres (peri-CENs) III and V, and used FISH to demonstrate they have been maintained near centromere satellite arrays in each species. Sequence analysis revealed a set of highly conserved genes, yet we discovered substantial differences in intergenic length and species-specific changes in sequence content and gene density. We discovered that A. thaliana has undergone recent, significant expansions within its pericentromeres, in some cases measuring hundreds of kilobases; these findings are in marked contrast to euchromatic segments in these species that exhibit only minor length changes. While plant pericentromeres do contain some duplications, we did not find evidence of extensive segmental duplications, as has been documented in primates. Our data support a model in which plant pericentromeres may experience selective pressures distinct from euchromatin, tolerating rapid, dynamic changes in structure and sequence content, including large insertions of mobile elements, 5S rDNA arrays and pseudogenes.

Oncogene-induced senescence results in marked metabolic and bioenergetic alterations

PubMed Central

Quijano, Celia; Cao, Liu; Fergusson, Maria M; Romero, Hector; Liu, Jie; Gutkind, Sarah; Rovira, Ilsa I; Mohney, Robert P; Karoly, Edward D

2012-01-01

Oncogene-induced senescence (OIS) is characterized by permanent growth arrest and the acquisition of a secretory, pro-inflammatory state. Increasingly, OIS is viewed as an important barrier to tumorgenesis. Surprisingly, relatively little is known about the metabolic changes that accompany and therefore may contribute to OIS. Here, we have performed a metabolomic and bioenergetic analysis of Ras-induced senescence. Profiling approximately 300 different intracellular metabolites reveals that cells that have undergone OIS develop a unique metabolic signature that differs markedly from cells undergoing replicative senescence. A number of lipid metabolites appear uniquely increased in OIS cells, including a marked increase in the level of certain intracellular long chain fatty acids. Functional studies reveal that this alteration in the metabolome reflects substantial changes in overall lipid metabolism. In particular, Ras-induced senescent cells manifest a decline in lipid synthesis and a significant increase in fatty acid oxidation. Increased fatty acid oxidation results in an unexpectedly high rate of basal oxygen consumption in cells that have undergone OIS. Pharmacological or genetic inhibition of carnitine palmitoyltransferase 1, the rate-limiting step in mitochondrial fatty acid oxidation, restores a presenescent metabolic rate and, surprisingly, selectively inhibits the secretory, pro-inflammatory state that accompanies OIS. Thus, Ras-induced senescent cells demonstrate profound alterations in their metabolic and bioenergetic profiles, particularly with regards to the levels, synthesis and oxidation of free fatty acids. Furthermore, the inflammatory phenotype that accompanies OIS appears to be related to these underlying changes in cellular metabolism. PMID:22421146

Changing Health Behaviors to Improve Health Outcomes after Angioplasty: A Randomized Trial of Net Present Value versus Future Value Risk Communication

ERIC Educational Resources Information Center

Charlson, M. E.; Peterson, J. C.; Boutin-Foster, C.; Briggs, W. M.; Ogedegbe, G. G.; McCulloch, C. E.; Hollenberg, J.; Wong, C.; Allegrante, J. P.

2008-01-01

Patients who have undergone angioplasty experience difficulty modifying at-risk behaviors for subsequent cardiac events. The purpose of this study was to test whether an innovative approach to framing of risk, based on "net present value" economic theory, would be more effective in behavioral intervention than the standard "future value approach"…

Professional Development during a Period of Change: A Small-Scale Case Study Exploring the Effect of Context on Practice in a South African Rural School

ERIC Educational Resources Information Center

Bryan, Chris

2011-01-01

Education in post-apartheid South Africa has undergone considerable change in recent years and is seen as providing the key to reform and social transformation. However, despite many government policies designed to improve the quality of teaching and learning, education continues to present challenges, particularly within the area of professional…

Chemical passivation as a method of improving the electrochemical corrosion resistance of Co-Cr-based dental alloy.

PubMed

Rylska, Dorota; Sokołowski, Grzegorz; Sokołowski, Jerzy; Łukomska-Szymańska, Monika

2017-01-01

The purpose of the study was to evaluate corrosion resistance of Wirobond C® alloy after chemical passivation treatment. The alloy surface undergone chemical passivation treatment in four different media. Corrosion studies were carried out by means of electrochemical methods in saline solution. Corrosion effects were determined using SEM. The greatest increase in the alloy polarization resistance was observed for passive layer produced in Na2SO4 solution with graphite. The same layer caused the highest increase in corrosion current. Generally speaking, the alloy passivation in Na2SO4 solution with graphite caused a substantial improvement of the corrosion resistance. The sample after passivation in Na2SO4 solution without graphite, contrary to others, lost its protective properties along with successive anodic polarization cycles. The alloy passivation in Na3PO4 solution with graphite was the only one that caused a decrease in the alloy corrosion properties. The SEM studies of all samples after chemical passivation revealed no pit corrosion - in contrast to the sample without any modification. Every successive polarization cycle in anodic direction of pure Wirobond C® alloy enhances corrosion resistance shifting corrosion potential in the positive direction and decreasing corrosion current value. The chemical passivation in solutions with low pH values decreases susceptibility to electrochemical corrosion of Co-Cr dental alloy. The best protection against corrosion was obtained after chemical passivation of Wirobond C® in Na2SO4 solution with graphite. Passivation with Na2SO4 in solution of high pH does not cause an increase in corrosion resistance of WIROBOND C. Passivation process increases alloy resistance to pit corrosion.

Efficacy of Antiarrhythmic Drugs Short-Term Use After Catheter Ablation for Atrial Fibrillation (EAST-AF) trial.

PubMed

Kaitani, Kazuaki; Inoue, Koichi; Kobori, Atsushi; Nakazawa, Yuko; Ozawa, Tomoya; Kurotobi, Toshiya; Morishima, Itsuro; Miura, Fumiharu; Watanabe, Tetsuya; Masuda, Masaharu; Naito, Masaki; Fujimoto, Hajime; Nishida, Taku; Furukawa, Yoshio; Shirayama, Takeshi; Tanaka, Mariko; Okajima, Katsunori; Yao, Takenori; Egami, Yasuyuki; Satomi, Kazuhiro; Noda, Takashi; Miyamoto, Koji; Haruna, Tetsuya; Kawaji, Tetsuma; Yoshizawa, Takashi; Toyota, Toshiaki; Yahata, Mitsuhiko; Nakai, Kentaro; Sugiyama, Hiroaki; Higashi, Yukei; Ito, Makoto; Horie, Minoru; Kusano, Kengo F; Shimizu, Wataru; Kamakura, Shiro; Morimoto, Takeshi; Kimura, Takeshi; Shizuta, Satoshi

2016-02-14

Substantial portion of early arrhythmia recurrence after catheter ablation for atrial fibrillation (AF) is considered to be due to irritability in left atrium (LA) from the ablation procedure. We sought to evaluate whether 90-day use of antiarrhythmic drug (AAD) following AF ablation could reduce the incidence of early arrhythmia recurrence and thereby promote reverse remodelling of LA, leading to improved long-term clinical outcomes. A total of 2038 patients who had undergone radiofrequency catheter ablation for paroxysmal, persistent, or long-lasting AF were randomly assigned to either 90-day use of Vaughan Williams class I or III AAD (1016 patients) or control (1022 patients) group. The primary endpoint was recurrent atrial tachyarrhythmias lasting for >30 s or those requiring repeat ablation, hospital admission, or usage of class I or III AAD at 1 year, following the treatment period of 90 days post ablation. Patients assigned to AAD were associated with significantly higher event-free rate from recurrent atrial tachyarrhythmias when compared with the control group during the treatment period of 90 days [59.0 and 52.1%, respectively; adjusted hazard ratio (HR) 0.84; 95% confidence interval (CI) 0.73-0.96; P = 0.01]. However, there was no significant difference in the 1-year event-free rates from the primary endpoint between the groups (69.5 and 67.8%, respectively; adjusted HR 0.93; 95% CI 0.79-1.09; P = 0.38). Short-term use of AAD for 90 days following AF ablation reduced the incidence of recurrent atrial tachyarrhythmias during the treatment period, but it did not lead to improved clinical outcomes at the later phase. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2015. For permissions please email: journals.permissions@oup.com.

Enhancing assertiveness in district nurse specialist practice.

PubMed

Green, Julie

2016-08-02

District nurse (DN) care delivery has undergone substantial change in recent years due to changing demographics and service delivery demands that have called for a move of care delivery from secondary to primary care. The title District Nurse is recorded with the Nursing and Midwifery Council (NMC) on completion of the Specialist Practice Qualification in District Nursing (SPQ DN), which purports to be a 'transformational' course that prepares future caseload holders to manage their team and prioritise care delivery effectively. This article explores the need for assertiveness skills in this role in response to Australian research, and outlines the pedagogic interventions implemented during the SPQ DN course to enhance this skill. Assertiveness scores were monitored for the duration of the course and demonstrated a significant increase-a topic that is now the subject of a future, funded study.

Disciplines, models, and computers: the path to computational quantum chemistry.

PubMed

Lenhard, Johannes

2014-12-01

Many disciplines and scientific fields have undergone a computational turn in the past several decades. This paper analyzes this sort of turn by investigating the case of computational quantum chemistry. The main claim is that the transformation from quantum to computational quantum chemistry involved changes in three dimensions. First, on the side of instrumentation, small computers and a networked infrastructure took over the lead from centralized mainframe architecture. Second, a new conception of computational modeling became feasible and assumed a crucial role. And third, the field of computa- tional quantum chemistry became organized in a market-like fashion and this market is much bigger than the number of quantum theory experts. These claims will be substantiated by an investigation of the so-called density functional theory (DFT), the arguably pivotal theory in the turn to computational quantum chemistry around 1990.

Optimizing fusion PIC code performance at scale on Cori Phase 2

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

Koskela, T. S.; Deslippe, J.

In this paper we present the results of optimizing the performance of the gyrokinetic full-f fusion PIC code XGC1 on the Cori Phase Two Knights Landing system. The code has undergone substantial development to enable the use of vector instructions in its most expensive kernels within the NERSC Exascale Science Applications Program. We study the single-node performance of the code on an absolute scale using the roofline methodology to guide optimization efforts. We have obtained 2x speedups in single node performance due to enabling vectorization and performing memory layout optimizations. On multiple nodes, the code is shown to scale wellmore » up to 4000 nodes, near half the size of the machine. We discuss some communication bottlenecks that were identified and resolved during the work.« less

Effects of gastric pacing on gastric emptying and plasma motilin

PubMed Central

Yang, Min; Fang, Dian-Chun; Li, Qian-Wei; Sun, Nian-Xu; Long, Qing-Lin; Sui, Jian-Feng; Gan, Lu

2004-01-01

AIM: To investigate the effects of gastric pacing on gastric emptying and plasma motilin level in a canine model of gastric motility disorders and the correlation between gastric emptying and plasma motilin level. METHODS: Ten healthy Mongrel dogs were divided into: experimental group of six dogs and control group of four dogs. A model of gastric motility disorders was established in the experimental group undergone truncal vagotomy combined with injection of glucagon. Gastric half-emptying time (GEt1/2) was monitored with single photon emission computerized tomography (SPECT), and the half-solid test meal was labeled with an isotope 99mTc sulfur colloid. Plasma motilin concentration was measured with radioimmunoassay (RIA) kit. Surface gastric pacing at 1.1-1.2 times the intrinsic slow-wave frequency and a superimposed series of high frequency pulses (10-30 Hz) was performed for 45 min daily for a month in conscious dogs. RESULTS: After surgery, GEt1/2 in dogs undergone truncal vagotomy was increased significantly from 56.35 ± 2.99 min to 79.42 ± 1.91 min (P < 0.001), but surface gastric pacing markedly accelerated gastric emptying and significantly decreased GEt1/2 to 64.94 ± 1.75 min (P < 0.001) in animals undergone vagotomy. There was a significant increase of plasma level of motilin at the phase of IMCIII (interdigestive myoelectrical complex, IMCIII) in the dogs undergone bilateral truncal vagotomy (baseline vs vagotomy, 184.29 ± 9.81 pg/ml vs 242.09 ± 17.22 pg/ml; P < 0.01). But plasma motilin concentration (212.55 ± 11.20 pg/ml; P < 0.02) was decreased significantly after a long-term treatment with gastric pacing. Before gastric pacing, GEt1/2 and plasma motilin concentration of the dogs undergone vagotomy showed a positive correlation (r = 0.867, P < 0.01), but after a long-term gastric pacing, GEt1/2 and motilin level showed a negative correlation (r = -0.733, P < 0.04). CONCLUSION: Surface gastric pacing with optimal pacing parameters can improve gastric emptying parameters and significantly accelerate gastric emptying and can resume or alter motor function in a canine model of motility disorders. Gastric emptying is correlated well with plasma motilin level before and after pacing, which suggests that motilin can modulate the mechanism of gastric pacing by altering gastric motility. PMID:14760770

Comparison between open and laparoscopic repair of perforated peptic ulcer disease.

PubMed

Bhogal, Ricky H; Athwal, Ruvinder; Durkin, Damien; Deakin, Mark; Cheruvu, Chandra N V

2008-11-01

The place of laparoscopic repair of perforated peptic ulcer followed by peritoneal toilet has been established, although it is not routinely practiced. This prospective study compared laparoscopic and open repair of perforated peptic ulcer disease. We evaluated whether the early results from laparoscopic repair resulted in improved patient outcome compared with conventional open repair. All patients who underwent repair of perforated peptic ulcer disease during a 12-month period in our unit were included in the study. The primary end points that were evaluated were total operative time, nasogastric tube utilisation, intravenous fluid requirement, total time of urinary catheter and abdominal drainage usage, time taken to return to normal diet, intravenous/intramuscular opiate use, time to full mobilization, and total in-patient hospital stay. Thirty-three patients underwent surgical repair of perforated peptic ulcer disease (19 laparoscopic repairs and 14 open repairs; mean age, 54.2 (range, 32-82) years). There was no increase in total operative time in patients who had undergone laparoscopic repair (mean: 61 minutes laparoscopic versus 57 minutes open). There was significantly less requirement for intravenous/intramuscular opiate analgesia in patients who had undergone laparoscopic repair (mean time to oral analgesia: 1.2 days laparoscopic versus 3.8 days open). In addition there was a significant decrease in the time that the nasogastric tube (mean: 2.1 days laparoscopic versus 3.1 days open), urinary catheter (mean: 2.3 days laparoscopic versus 3.7 days open) and abdominal drain (mean: 2.2 days laparoscopic versus 3.8 days open) were required during the postoperative period. Patients who had undergone laparoscopic repair required less intravenous fluids (mean: 1.4 days laparoscopic versus 3.1 days open) and returned to normal diet (mean: 2.3 days laparoscopic versus 4.8 days open) and full mobilization significantly earlier than those who had undergone open repair (mean: 2.3 days laparoscopic versus 3.3 days open). In addition, patients who had undergone laparoscopic repair required a shorter in-patient hospital stay (mean: 3.1 days laparoscopic versus 4.3 days open). Laparoscopic repair is a viable and safe surgical option for patients with perforated peptic ulcer disease and should be considered for all patients, providing that the necessary expertise is available.

Photodynamic therapy in thoracic oncology: a single institution experience

NASA Astrophysics Data System (ADS)

Luketich, James D.; Fernando, Hiran C.; Christie, Neil A.; Litle, Virginia R.; Ferson, Peter F.; Buenaventura, Percival O.

2001-04-01

We have performed 800 photodynamic therapy (PDT) treatments in over 300 patients at the University of Pittsburgh since 1996. Over 150 patients have undergone PDT for palliation of dysphagia for esophageal cancer. Of the first 77 dysphagia improved in 90.8% with a mean dysphagia-free interval of 80 days. An expandable metal stent was required for extrinsic compression in 19 patients. We have treated 14 high-risk patients with early esophageal cancer or Barrett's high-grade dysplasia for curative intent. At a median follow-up of 12.8 months eight remain free of cancer. Over 100 patients have undergone PDT for lung cancer. Sixty-two patients received 77 courses for palliation. Thirty-five patients were treated for non-massive hemoptysis with resolution in 90%. Forty-four patients were treated for dyspnea with improvement in 59%. A subset of seven high-risk patients with early lung cancer were treated with curative intent. A complete response was seen in 7/10 lesions at a mean follow-up of 30 months. PDT offers good palliation for both advanced esophageal and lung cancer. The role of PDT for curative intent needs further investigation in protocol settings. In our preliminary experience we have treated a small number of non-surgical, high-risk patients with a reasonable success rate.

[A project to provide instruction in the nursing of elderly patients with total hip replacement (T.H.R.)].

PubMed

Ting, Chao-Fong; Chou, Hsiu-Ling; Chen, Ming-Mie

2006-02-01

This project was aimed at improving the nursing of patients who have undergone total hip replacements. Investigation showed the following problems with existing nursing instruction in this area: lack of standard instruction, outdated educational materials, a 33.75% rate of completion of instruction lack of familiarity with instruction materials, and an average satisfaction score of 2.56 among nurses who have undergone instruction; The reading for patient's satisfaction with the guidance of nurses was 2.04. After site investigation, status analysis and reference check, we proposed the following program. (1) Establish standards and monitor tools for instruction for nursing total hip replacement patients, including "Caring standard", "Guidance for nursing instruction", "Nursing instruction sheet", "Notes at nursing instruction", "Satisfaction scoring system for nursing instruction"; (2) Carry out a training course to enhance nursing staff's knowledge about caring for patients with total hip replacement. After program had been implemented, a completion rate of 88.56% was achieved, and the satisfaction scores among nursing staff and patients were 4.3 and 4.36 respectively. This result shows that when we undertake reform at various different levels--including systemic structure, processing and monitoring--this can radically improve the quality of nursing instruction.

Results of isolated lateral retinacular reconstruction for iatrogenic medial patellar instability.

PubMed

Sanchis-Alfonso, Vicente; Montesinos-Berry, Erik; Monllau, Joan Carles; Merchant, Alan C

2015-03-01

The aim of this study was to assess the outcomes of an isolated lateral retinaculum reconstruction for iatrogenic medial patellar instability (IMPI) in patients with continued pain after failed lateral retinacular release (LRR), including associated psychometric analysis. Pain was assessed using the visual analog scale (VAS) and disability was determined with the Lysholm scale. Psychological variables such as anxiety, depression, catastrophizing, and fear-of-movement beliefs were studied by using self-administered psychometric questionnaires. All 17 patients (13 women and 4 men) in this retrospective study had undergone LRR previously for anterior knee pain or lateral patellar instability. Four patients had undergone LRR plus proximal (Insall) realignment, and one had undergone LRR plus a medial tibial tubercle transfer. After their procedures, all had disabling symptoms. All patients underwent reconstructive surgery for IMPI. At a minimum follow-up of 2 years (range, 2 to 8 years), the mean preoperative VAS score was 7.6 (range, 5 to 9) and improved to 1.9 (range, 0 to 8) at the time of final follow-up (P < .001). The mean preoperative Lysholm score was 36.4 (range, 20 to 55), and the knee was described as bad (<65 points) in all cases. Postoperatively, it improved to 86.1 (range, 70 to 94) at final follow-up (P < .001). Before surgery, 4 patients (24%) had the clinical criteria for depression, 10 (59%) had anxiety, 7 (41%) had "catastrophizing" ideas concerning pain, and all (100%) had kinesiophobia (fear of movement). After surgery, none of the patients had depression or anxiety, none had catastrophizing ideation, and only 53% had kinesiophobia. Reconstruction of the deep transverse layer of the lateral retinaculum (LR) using a central strip of the iliotibial band for IMPI in patients with continued pain after failed LRR can successfully treat these severely disabled patients. Level IV, therapeutic case series. Copyright © 2015 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

Colonoscopic surveillance improves survival after colorectal cancer diagnosis in inflammatory bowel disease.

PubMed

Lutgens, M W M D; Oldenburg, B; Siersema, P D; van Bodegraven, A A; Dijkstra, G; Hommes, D W; de Jong, D J; Stokkers, P C F; van der Woude, C J; Vleggaar, F P

2009-11-17

Colonoscopic surveillance provides the best practical means for preventing colorectal cancer (CRC) in inflammatory bowel disease (IBD) patients. Strong evidence for improved survival from surveillance programmes is sparse. The aim of this study was to compare tumour stage and survival of IBD patients with CRC who were a part of a surveillance programme with those who were not. A nationwide pathology database (PALGA (pathologisch anatomisch landelijk geautomatiseerd archief)) was consulted to identify IBD patients with CRC treated in all eight university hospitals in The Netherlands over a period of 15 years. Patients were assigned to the surveillance group when they had undergone one or more surveillance colonoscopies before a diagnosis of CRC. Patients who had not undergone surveillance served as controls. Tumour stage and survival were compared between the two groups. A total of 149 patients with IBD-associated CRC were identified. Twenty-three had had colonoscopic surveillance before CRC was discovered. The 5-year CRC-related survival rate of patients in the surveillance group was 100% compared with 74% in the non-surveillance group (P=0.042). In the surveillance group, only one patient died as a consequence of CRC compared with 29 patients in the control group (P=0.047). In addition, more early tumour stages were found in the surveillance group (P=0.004). These results provide evidence for improved survival from colonoscopic surveillance in IBD patients by detecting CRC at a more favourable tumour stage.

Correlates of having never been HIV tested among entrants to substance abuse treatment clinics: empiric findings from real-world New England settings.

PubMed

Chadwick, Jeanne J; Andrade, Leonardo F; Altice, Frederick L; Petry, Nancy M

2014-01-01

Routine testing is the cornerstone to identifying HIV, but not all substance abuse treatment patients have been tested. This study is a real-world evaluation of predictors of having never been HIV tested among patients initiating substance abuse treatment. Participants (N = 614) from six New England clinics were asked whether they had ever been HIV tested. Eighty-five patients (13.8%) reported having never been tested and were compared to those who had undergone testing. Clinic, male gender (adjusted odds ratio (AOR) = 1.91, 95% confidence interval (CI) = 1.07-3.41), and having fewer employment (AOR = 0.31; 95% CI = 0.11-0.88) and medical problems (AOR = 0.40, 95% CI = 0.17-0.99) were independently correlated with having never been HIV tested. Thus, there is still considerable room for improved testing strategies as a clinically significant minority of substance abuse patients have never undergone HIV testing when they initiate treatment.

[Combining herbs with medication--risks vs. chances].

PubMed

Amir, Nir

2013-07-01

Traditional herbal medicine is driven by the use of plants or parts of plants, which have undergone minimal processing in order to treat disease and improve health. The article: "Traditional Immunosuppression--Lei Gong Teng in Modern Medicine", published in this issue of "Harefuah", raises the importance of integrating herbal medicine within the existing medical system. However, there are various limitations on integrating herbology in official frameworks, such as bureaucratic and legislative restrictions concerning the safety and efficacy of the herbs. This allows the marketing of many plants without a prescription requirement or professional advice. Another limitation relates to therapists, some of whom have not undergone proper training and may recommend the improper use of plants, resulting in a problematic combination with drugs in some cases. Regulation is necessary in order to better serve both the public and doctors. Regulation will define who is allowed to work with herbs and this will create a secure integration of herbs into the formal medical world.

Achilles Tendon Open Surgical Treatment With Platelet-Rich Fibrin Matrix Augmentation: Biomechanical Evaluation.

PubMed

Alviti, Federica; Gurzì, Michele; Santilli, Valter; Paoloni, Marco; Padua, Roberto; Bernetti, Andrea; Bernardi, Marco; Mangone, Massimiliano

The relationship between surgical technique and ankle biomechanical properties after surgery for acute rupture of the Achilles tendon (ATR) has not yet been fully investigated. Platelet-rich fibrin (PRF) matrices seem to play a central role in the complex processes of tendon healing. Our aim was to analyze the biomechanical characteristics, stiffness, and mechanical work of the ankle during walking in patients who had undergone surgery after ATR with and without PRF augmentation. We performed a retrospective review of all consecutive patients who had been treated with surgical repair after ATR. Of the 20 male subjects enrolled, 9 (45%) had undergone conventional open repair of the Achilles tendon using the Krackow technique (no-PRF) and 11 (55%) had undergone surgery with PRF augmentation. An additional 8 healthy subjects were included as a control group. A gait analysis evaluation was performed at 6 months after surgery. The percentage of the stance time of the operated leg, double-support time of the healthy leg, and net work of the ankle during the gait cycle showed statistically significant differences between the no-PRF and the healthy group (p < .005). No differences were found between the PRF and healthy groups. Treatment with suture and PRF augmentation could result in significant functional improvements in term of efficiency of motion. Copyright © 2017 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

Comprehensive visualization of paresthesia in breast cancer survivors.

PubMed

Jud, Sebastian M; Hatko, Reinhard; Maihöfner, Christian; Bani, Mayada R; Schrauder, Michael G; Lux, Michael P; Beckmann, Matthias W; Bani, Gassan; Eder, Irina; Fasching, Peter A; Loehberg, Christian R; Rauh, Claudia; Hein, Alexander

2014-07-01

As breast cancer survivors are benefiting increasingly from advanced forms of therapy, the side effects of locoregional treatment in the adjuvant setting are becoming more and more important. This article presents a new method of assessing the spatial distribution of paresthesia in breast cancer survivors after different locoregional treatments. A structured questionnaire assessing paresthesia, with body pictograms for marking paresthesia areas, was completed by 343 breast cancer survivors. The image information was digitized, generating gray-scale summation images with numbers from 0, indicating black (100 % of the patients had paresthesia), to 255, indicating white (none had paresthesia). The resulting map visualization showed the locations of paresthesia on body pictograms. The group included patients who had undergone breast-conserving surgery (BCS) and mastectomy, and also patients who had received percutaneous and interstitial radiation. A total of 56.5 % of the patients stated that they had paresthesia. The paresthesia areas were distributed within the range suggested by clinical experience. Most patients stated that they had paresthesia in the upper outer quadrant and axilla. Patients who had undergone mastectomy or percutaneous radiotherapy appeared to have more paresthesia on some areas of the body surface. Patients who had undergone mastectomy indicated larger areas of paresthesia than those with BCS-4,066 pixels (px) vs. 2,275 px. Radiotherapy did not appear to influence the spatial distribution of paresthesia. Paresthesia is a common symptom after breast cancer treatment. This paper describes a new method of assessing this side effect to improve and individualize treatment for it in the future.

Forest extent and deforestation in tropical Africa since 1900.

PubMed

Aleman, Julie C; Jarzyna, Marta A; Staver, A Carla

2018-01-01

Accurate estimates of historical forest extent and associated deforestation rates are crucial for quantifying tropical carbon cycles and formulating conservation policy. In Africa, data-driven estimates of historical closed-canopy forest extent and deforestation at the continental scale are lacking, and existing modelled estimates diverge substantially. Here, we synthesize available palaeo-proxies and historical maps to reconstruct forest extent in tropical Africa around 1900, when European colonization accelerated markedly, and compare these historical estimates with modern forest extent to estimate deforestation. We find that forests were less extensive in 1900 than bioclimatic models predict. Resultantly, across tropical Africa, ~ 21.7% of forests have been deforested, yielding substantially slower deforestation than previous estimates (35-55%). However, deforestation was heterogeneous: West and East African forests have undergone almost complete decline (~ 83.3 and 93.0%, respectively), while Central African forests have expanded at the expense of savannahs (~ 1.4% net forest expansion, with ~ 135,270 km 2 of savannahs encroached). These results suggest that climate alone does not determine savannah and forest distributions and that many savannahs hitherto considered to be degraded forests are instead relatively old. These data-driven reconstructions of historical biome distributions will inform tropical carbon cycle estimates, carbon mitigation initiatives and conservation planning in both forest and savannah systems.

Evaluation of the major histocompatibility complex (Mhc) in cranes: applications to conservation efforts

USGS Publications Warehouse

Jarvi, S.I.; Miller, M.M.; Goto, R.M.; Gee, G.F.; Briles, W.E.

2001-01-01

Although there have been heated discussions concerning the relative importance of using Mhc diversity as a basis for selecting breeders in conservation projects, most parties agree that the genetic variability residual in an endangered species should be maintained through genetic management, if at all possible. Substantial evidence exists (particularly in birds) documenting the influences of specific Mhc haplotypes on disease outcome and also that those individuals which are heterozygous for Mhc alleles appear to have an advantage for survival over those that are homozygous. Thus, conservation of genetic variability of the Mhc is likely important for the preservation of fitness, especially in small breeding populations. More than half of the world's crane species are listed as endangered. Members of all 15 known species are represented among breeding animals for captive propagation at the International Crane Foundation (Wisconsin) and the USGS Patuxent Wildlife Research Center (Maryland). Collaborative multi-organization efforts and the availability of extensive pedigree records have allowed the study of Mhc variability in several species of cranes. We have found, for example, that Mhc diversity in the captive Florida sandhill crane (Grus canadensis pratensis) population appears high, whereas in the captive whooping crane (Grus americana), which has undergone a severe 'genetic bottleneck,? both the number of alleles and the levels of heterozygosity appear to be substantially reduced.

The role of HIV integration in viral persistence: no more whistling past the proviral graveyard

PubMed Central

Maldarelli, Frank

2016-01-01

A substantial research effort has been directed to identifying strategies to eradicate or control HIV infection without a requirement for combination antiretroviral therapy (cART). A number of obstacles prevent HIV eradication, including low-level viral persistence during cART, long-term persistence of HIV-infected cells, and latent infection of resting CD4+ T cells. Mechanisms of persistence remain uncertain, but integration of the provirus into the host genome represents a central event in replication and pathogenesis of all retroviruses, including HIV. Analysis of HIV proviruses in CD4+ lymphocytes from individuals after prolonged cART revealed that a substantial proportion of the infected cells that persist have undergone clonal expansion and frequently have proviruses integrated in genes associated with regulation of cell growth. These data suggest that integration may influence persistence and clonal expansion of HIV-infected cells after cART is introduced, and these processes may represent key mechanisms for HIV persistence. Determining the diversity of host genes with integrants in HIV-infected cells that persist for prolonged periods may yield useful information regarding pathways by which infected cells persist for prolonged periods. Moreover, many integrants are defective, and new studies are required to characterize the role of clonal expansion in the persistence of replication-competent HIV. PMID:26829624

Progressive genome-wide introgression in agricultural Campylobacter coli

PubMed Central

Sheppard, Samuel K; Didelot, Xavier; Jolley, Keith A; Darling, Aaron E; Pascoe, Ben; Meric, Guillaume; Kelly, David J; Cody, Alison; Colles, Frances M; Strachan, Norval J C; Ogden, Iain D; Forbes, Ken; French, Nigel P; Carter, Philip; Miller, William G; McCarthy, Noel D; Owen, Robert; Litrup, Eva; Egholm, Michael; Affourtit, Jason P; Bentley, Stephen D; Parkhill, Julian; Maiden, Martin C J; Falush, Daniel

2013-01-01

Hybridization between distantly related organisms can facilitate rapid adaptation to novel environments, but is potentially constrained by epistatic fitness interactions among cell components. The zoonotic pathogens Campylobacter coli and C. jejuni differ from each other by around 15% at the nucleotide level, corresponding to an average of nearly 40 amino acids per protein-coding gene. Using whole genome sequencing, we show that a single C. coli lineage, which has successfully colonized an agricultural niche, has been progressively accumulating C. jejuni DNA. Members of this lineage belong to two groups, the ST-828 and ST-1150 clonal complexes. The ST-1150 complex is less frequently isolated and has undergone a substantially greater amount of introgression leading to replacement of up to 23% of the C. coli core genome as well as import of novel DNA. By contrast, the more commonly isolated ST-828 complex bacteria have 10–11% introgressed DNA, and C. jejuni and nonagricultural C. coli lineages each have <2%. Thus, the C. coli that colonize agriculture, and consequently cause most human disease, have hybrid origin, but this cross-species exchange has so far not had a substantial impact on the gene pools of either C. jejuni or nonagricultural C. coli. These findings also indicate remarkable interchangeability of basic cellular machinery after a prolonged period of independent evolution. PMID:23279096

Secular Black Hole Growth and Feedback in Merger-Free Galaxies

NASA Astrophysics Data System (ADS)

Simmons, Brooke

2016-10-01

We will measure the merger-free galaxy-black hole mass relation for the first time, using a unique, newly-discovered sample of luminous active galactic nuclei (AGN) hosted in galaxies that have not grown via mergers. Our preliminary study has shown that supermassive black holes (SMBHs) in bulgeless galaxies - i.e., galaxies that have never undergone a significant merger - can have substantial growth: bulges are not required for the formation and growth of SMBHs. The proposed targets are broad-line AGN with black hole masses spanning a wide mass range (1e6 to >1e9 M_Sun) and hosted in strongly disk dominated galaxies (>80% light from a disk). This sample is an ideal laboratory for understanding merger-free black hole growth and its feedback on the host galaxy. HST imaging will allow us to disentangle bright nuclear emission from host galaxy, measure bulge type and strength, and identify bulgeless galaxies that have evolved under purely secular conditions. In addition, we will determine whether merger-free galaxies lie on the same SMBH-galaxy relation as galaxies with substantial past mergers, or whether merger-free growth results in a separate relation. The answer to this question has profound consequences for the role of baryon dynamics in driving black hole-galaxy co-evolution.

Ancient DNA reveals substantial genetic diversity in the California Condor (Gymnogyps californianus) prior to a population bottleneck

USGS Publications Warehouse

D'Elia, Jesse; Haig, Susan M.; Mullins, Thomas D.; Miller, Mark P.

2016-01-01

Critically endangered species that have undergone severe population bottlenecks often have little remaining genetic variation, making it difficult to reconstruct population histories to apply in reintroduction and recovery strategies. By using ancient DNA techniques, it is possible to combine genetic evidence from the historical population with contemporary samples to provide a more complete picture of a species' genetic variation across its historical range and through time. Applying this approach, we examined changes in the mitochondrial DNA (mtDNA) control region (526 base pairs) of the endangered California Condor (Gymnogyps californianus). Results showed a >80% reduction in unique haplotypes over the past 2 centuries. We found no spatial sorting of haplotypes in the historical population; the periphery of the range contained haplotypes that were common throughout the historical range. Direct examination of mtDNA from California Condor museum specimens provided a new window into historical population connectivity and genetic diversity showing: (1) a substantial loss of haplotypes, which is consistent with the hypothesis that condors were relatively abundant in the nineteenth century, but declined rapidly as a result of human-caused mortality; and (2) no evidence of historical population segregation, meaning that the available genetic data offer no cause to avoid releasing condors in unoccupied portions of their historical range.

CHARACTERISTICS OF MULTIPLE AND CONCURRENT PARTNERSHIPS AMONG WOMEN AT HIGH RISK FOR HIV INFECTION

PubMed Central

Adimora, Adaora A.; Hughes, James P.; Wang, Jing; Haley, Danielle F.; Golin, Carol E.; Magnus, Manya; Rompalo, Anne; Justman, Jessica; del Rio, Carlos; El-Sadr, Wafaa; Mannheimer, Sharon; Soto-Torres, Lydia; Hodder, Sally L.

2014-01-01

Objectives We examined parameters of sexual partnerships, including respondents’ participation in concurrency, belief that their partner had concurrent partnerships (partners’ concurrency), and partnership intervals, among the 2,099 women in HIV Prevention Trials Network 064, a study of women at high risk for HIV infection, in ten US communities. Methods We analyzed baseline survey responses about partnership dates to determine prevalence of participants’ and partners’ concurrency, intervals between partnerships, knowledge of whether recent partner(s) had undergone HIV testing, and intercourse frequency during the preceding 6 months. Results Prevalence of participants’ and partners’ concurrency was 40% and 36% respectively; 24% of respondents had both concurrent partnerships and non-monogamous partners. Among women with >1 partner and no concurrent partnerships themselves, the median gap between partners was one month. Multiple episodes of unprotected vaginal intercourse with >2 of their most recent partners was reported by 60% of women who had both concurrent partnerships and non-monogamous partners, 50% with only concurrent partners and no partners’ concurrency, and 33% with only partners’ concurrency versus 14% of women with neither type of concurrency (p<.0001). Women who had any involvement with concurrency were also more likely than women with no concurrency involvement to report lack of awareness of whether recent partners had undergone HIV testing (participants’ concurrency 41%, partners’ concurrency 40%, both participants’ and partners’ concurrency 48%, neither 17%; p<.0001). Conclusions These network patterns and short gaps between partnerships may create substantial opportunities for HIV transmission in this sample of women at high risk for HIV infection. PMID:24056163

Evolution of infectious hematopoietic necrosis virus (IHNV), a fish rhabdovirus, in Europe over 20 years: implications for control.

PubMed

Enzmann, Peter-Joachim; Castric, Jeannette; Bovo, Giuseppe; Thiery, Richard; Fichtner, Dieter; Schütze, Heike; Wahli, Thomas

2010-02-24

The fish pathogenic rhabdovirus infectious hematopoietic necrosis virus (IHNV) causes substantial losses in European aquaculture. IHNV was first detected in Europe in 1987 and has since undergone considerable spread. Phylogenetic analyses of the full G-gene sequences of 73 isolates obtained from 4 countries in Europe (France, n = 18; Italy, 9; Switzerland, 4; Germany, 42) enable determination of the evolution of the virus in Europe since the first detection, and identification of characteristic changes within the G-genes of European strains. Further, the database allows us to analyse the pathways of distribution in Europe over time. The results suggest that in most of the recent cases, spread of IHNV was related to trade of infected fish. The data further demonstrate that knowledge of the sequence is required to determine the source of infections in farms.

Lost Dollars Threaten Research in Public Academic Health Centers.

PubMed

Bourne, Henry R; Vermillion, Eric B

2017-03-01

The decrease of federal and state support threatens long-term sustainability of research in publicly supported academic health centers. In weathering these financial threats, research at the University of California, San Francisco (UCSF), has undergone 3 substantial changes: institutional salary support goes preferentially to senior faculty, whereas the young increasingly depend on grants; private and government support for research grows apace in clinical departments but declines in basic science departments; and research is judged more on its quantity (numbers of investigators and federal and private dollars) than on its goals, achievements, or scientific quality. We propose specific measures to alleviate these problems. Other large public academic health centers probably confront similar issues, but-except for UCSF-such centers have not been subjected to detailed public analysis.-Bourne, H. R., Vermillion, E. B. Lost dollars threaten research in public academic health centers. © FASEB.

Host genetics of HIV acquisition and viral control.

PubMed

Shea, Patrick R; Shianna, Kevin V; Carrington, Mary; Goldstein, David B

2013-01-01

Since the discovery of HIV as the cause of AIDS, numerous insights have been gained from studies of its natural history and epidemiology. It has become clear that there are substantial interindividual differences in the risk of HIV acquisition and course of disease. Meanwhile, the field of human genetics has undergone a series of rapid transitions that have fundamentally altered the approach to studying HIV host genetics. We aim to describe the field as it has transitioned from the era of candidate-gene studies and the era of genome-wide association studies (GWAS) to its current state in the infancy of comprehensive sequencing. In some ways the field has come full circle, having evolved from being driven almost exclusively by our knowledge of immunology, to a bias-free GWAS approach, to a point where our ability to catalogue human variation far outstrips our ability to biologically interpret it.

Age and origin of gneisses south of Ameralik, between Kangimut-Sangmissoq and Qasigianguit

NASA Technical Reports Server (NTRS)

Jones, N. W.; Moorbath, S.; Taylor, P. N.

1986-01-01

Gneisses which crop out along the southern coast of Ameralik between Kangimut-sangmissoq and Qasigianguit (K-s-Q) are the subject of long-standing controversy concerning their relationship to the early Archean Amitsoq gneisses of the Godthaab district. On the basis of field observations, it was argued that gneisses at Kangimut-sangmissoq and Qasigianguit are correlatives of the early Archean Amitsoq gneisses. The data were reexamined and it is concluded that the K-s-Q gneisses represent an addition of substantially juvenile mantle-derived material to the Archean craton of West Greenland during the late Archean times. Some of the parent magmas have undergone interaction with older crust, as indicated by Pb isotope evidence for contamination with Amitsoq-derived Pb. However, the positive epsilon Nd(I) value for the K-s-Q gneisses firmly rules out any significant material contribution from the Amitsoq gneisses to the K-s-Q gneisses.

The China National Tobacco Corporation: From domestic to global dragon?

PubMed

Fang, Jennifer; Lee, Kelley; Sejpal, Nidhi

2017-03-01

The China National Tobacco Corporation (CNTC), which produces one-third of the world's cigarettes, is the largest tobacco company in the world. Over the past 60 years, the CNTC has been focused on supplying a huge domestic market. As the market has become increasingly saturated, and potential foreign competition looms, the company has turned to expansion abroad. This paper examines the ambitions and prospects of the CNTC to 'go global'. Using Chinese and English language sources, this paper describes the globalisation ambitions of the CNTC, and its global business strategy focused on internal restructuring, brand development and expansion of overseas operations in selected markets. The paper concludes that the company has undergone substantial change over the past two decades and is consequently poised to become a new global player in the tobacco industry. This article is part of the special issue 'The Emergence of Asian Tobacco Companies: Implications for Global Health Governance'.

Safety and Clinical Usage of Newcastle Disease Virus in Cancer Therapy

PubMed Central

Lam, Han Yuen; Yeap, Swee Keong; Rasoli, Mehdi; Omar, Abdul Rahman; Yusoff, Khatijah; Suraini, Abd Aziz; Banu Alitheen, Noorjahan

2011-01-01

Newcastle disease virus (NDV) is an avian virus that causes deadly infection to over 250 species of birds, including domestic and wild-type, thus resulting in substantial losses to the poultry industry worldwide. Many reports have demonstrated the oncolytic effect of NDV towards human tumor cells. The interesting aspect of NDV is its ability to selectively replicate in cancer cells. Some of the studies have undergone human clinical trials, and favorable results were obtained. Therefore, NDV strains can be the potential therapeutic agent in cancer therapy. However, investigation on the therapeutic perspectives of NDV, especially human immunological effects, is still ongoing. This paper provides an overview of the current studies on the cytotoxic and anticancer effect of NDV via direct oncolysis effects or immune stimulation. Safety of NDV strains applied for cancer immunotherapy is also discussed in this paper. PMID:22131816

Effective management of low back pain: it’s time to accept the evidence

PubMed Central

Manga, Pran; Angus, Douglas E; Swan, William R

1993-01-01

Low back pain is a ubiquitous and economically costly problem. Unfortunately, the clinical management of low back pain is not yet well understood. Chiropractic management of back pain, long the black sheep of back care, has undergone a transition and is now a more respected and understood alternative to conservative medical care, itself under increased scrutiny due to unsatisfactory outcomes and unacceptable iatrogenic side effects. The substantial amount of clinical and related research on the effectiveness of manipulation for low back pain is summarized here from a larger study, divided into randomized control trials, case-control trials, meta-analyses and descriptive studies. The chiropractic management of low back pain is found to be a more effective way of dealing with this medical, social and economic problem. It is suggested that greater utilization of chiropractors be encouraged such that the “right people are doing the right things at the right time”.

The Simplexa™ Group A Strep Direct Assay: a sample-to-answer molecular assay for the diagnosis of group A streptococcal pharyngitis.

PubMed

Tabb, Michelle M; Batterman, Hollis J

2016-01-01

The Simplexa™ Group A Strep Direct assay is intended for use on the Integrated Cycler for detection of Group A Streptococcus (GAS) directly from throat swabs that have not undergone nucleic acid extraction. A prospective study of 1352 samples in 4 geographically diverse sites showed an overall prevalence of GAS of 15.4%. The assay demonstrated 97.4% sensitivity and 95.2% specificity versus culture. The positive predictive value compared to culture was 72.7%. However, 46 out of 57 discrepant samples were Group A Strep positive when tested using a bi-directional sequencing method illustrating the increased sensitivity of the assay compared to culture for detection of GAS. Rapid and accurate diagnosis of GAS allows for timely treatment to decrease complications of this prevalent organism that continues to cause substantial morbidity and mortality worldwide.

Synopsis of Phyllosticta in China

PubMed Central

Zhang, Ke; Shivas, Roger G.; Cai, Lei

2015-01-01

The generic concept of Phyllosticta has undergone substantial changes since its establishment in 1818. The existence of conidia with a mucilaginous sheath and an apical appendage is synapomorphic for Phyllosticta species, which has been shown in recent molecular phylogenetic studies. Thus a natural classification of Phyllosticta species should emphasize above morphological characters. Many names in Phyllosticta, both published in the scientific literatures and in publically accessible databases, need updating. In China, more than 200 species names in Phyllosticta have been recorded, of which, 158 species names are reviewed here based on their morphological descriptions and molecular data. Only 20 species of Phyllosticta are accepted from China. Other records of Phyllosticta refer to Phoma (89 records), Asteromella (14 records), Boeremia (9 records), Phomopsis (7 records) and Microsphaeropsis (1 record), with 19 names of uncertain generic classification. This work demonstrates an urgent need for the re-assessment of records of Phyllosticta worldwide. PMID:26000199

Whole-genome resequencing reveals signatures of selection and timing of duck domestication.

PubMed

Zhang, Zebin; Jia, Yaxiong; Almeida, Pedro; Mank, Judith E; van Tuinen, Marcel; Wang, Qiong; Jiang, Zhihua; Chen, Yu; Zhan, Kai; Hou, Shuisheng; Zhou, Zhengkui; Li, Huifang; Yang, Fangxi; He, Yong; Ning, Zhonghua; Yang, Ning; Qu, Lujiang

2018-04-01

The genetic basis of animal domestication remains poorly understood, and systems with substantial phenotypic differences between wild and domestic populations are useful for elucidating the genetic basis of adaptation to new environments as well as the genetic basis of rapid phenotypic change. Here, we sequenced the whole genome of 78 individual ducks, from two wild and seven domesticated populations, with an average sequencing depth of 6.42X per individual. Our population and demographic analyses indicate a complex history of domestication, with early selection for separate meat and egg lineages. Genomic comparison of wild to domesticated populations suggests that genes that affect brain and neuronal development have undergone strong positive selection during domestication. Our FST analysis also indicates that the duck white plumage is the result of selection at the melanogenesis-associated transcription factor locus. Our results advance the understanding of animal domestication and selection for complex phenotypic traits.

Observed Characteristics and Origins of Meltwaters Exported from Jakobshavn and Ilulissat Icefjord, Greenland

NASA Astrophysics Data System (ADS)

Beaird, N.; Straneo, F.; Jenkins, W. J.

2017-12-01

Jakobshavn Isbrae has undergone rapid retreat in recent decades and is now among the largest sources of anomalous ice discharge from Greenland's shrinking ice sheet. The characteristics, distribution, and pathways of meltwater sourced from Jakobshavn can have important impacts on ecosystems and regional, perhaps global, ocean circulation. Here we report on novel geochemical (noble gas) observations that enable a quantitative description of the meltwaters exiting Ilulissat Icefjord into Disko Bay, including the partition into Submarine Meltwater sources and Subglacial Discharge sources. We identify a coastally-trapped plume outside of the fjord mouth consistent with a coastal current flowing north. The plume extends to 100 m depth, and 10 km offshore. Temperature and salinity profiles inside the fjord suggest a deep-reaching buoyancy-forced overturning feeding this outflow. Relatively high Submarine Meltwater concentration (2.5%) imply a substantial contribution of iceberg meltwater to the fjord. Subglacial Discharge concentrations in the plume reach 6%.

Tethered cord release: a long-term study in 114 patients.

PubMed

Bowman, Robin M; Mohan, Avinash; Ito, Joy; Seibly, Jason M; McLone, David G

2009-03-01

All children born with a myelomeningocele at the authors' institution undergo aggressive treatment to maintain or improve functional outcome. Consequently, when any neurological, orthopedic, and/or urological changes are noted, a search for the cause is initiated. The most common cause of decline in a child born with a myelomeningocele is shunt malfunction. The second most common cause is tethering of the distal spinal cord at the site of the original back closure. In this report, the authors review the indicators of symptomatic spinal cord tethering and discuss the surgical interventions and outcomes in the children with myelomeningocele who underwent treatment at Children's Memorial Hospital from 1975 to 2008. Among the 502 children who underwent original closure at Children's Memorial Hospital, a symptomatic tethered spinal cord developed in 114 (23%). Eighty-one patients (71%) have undergone 1 untethering procedure, and 33 patients (29%) have undergone multiple untetherings, for a total of 163 total surgeries. The indicators of symptomatic spinal cord tethering include scoliosis, decline in lower-extremity (LE) motor strength, LE contractures, LE spasticity, gait change, urinary changes, and pain. Pain has shown the best response to surgical untethering, with 100% of children experiencing postoperative improvement. The results of long-term follow-up (average 12 years, range 1 month-23.3 years) in this cohort demonstrated scoliosis progression after surgical untethering in 52% of patients, with 28% requiring spinal fusion. On the 3-month postoperative manual muscle test, 70% of patients showed improved LE muscle strength compared to preoperatively. Gait was also similarly improved after untethering as evaluated by an orthopedic surgeon. Spasticity improved in two-thirds of the cohort, and as expected, LE contractures were stable (78%) postoperatively, as assessed by orthopedic and rehabilitation medicine specialists. Urologically, 64% of patients showed improvements on postoperative bladder evaluation. Although this is a clinical outcome study with no control group, the authors' experience has been that tethered cord release is beneficial in maintaining neurological, urological, and orthopedic functioning in children born with a myelomeningocele.

High resolution microendoscopy for classification of colorectal polyps.

PubMed

Chang, S S; Shukla, R; Polydorides, A D; Vila, P M; Lee, M; Han, H; Kedia, P; Lewis, J; Gonzalez, S; Kim, M K; Harpaz, N; Godbold, J; Richards-Kortum, R; Anandasabapathy, S

2013-07-01

It can be difficult to distinguish adenomas from benign polyps during routine colonoscopy. High resolution microendoscopy (HRME) is a novel method for imaging colorectal mucosa with subcellular detail. HRME criteria for the classification of colorectal neoplasia have not been previously described. Study goals were to develop criteria to characterize HRME images of colorectal mucosa (normal, hyperplastic polyps, adenomas, cancer) and to determine the accuracy and interobserver variability for the discrimination of neoplastic from non-neoplastic polyps when these criteria were applied by novice and expert microendoscopists. Two expert pathologists created consensus HRME image criteria using images from 68 patients with polyps who had undergone colonoscopy plus HRME. Using these criteria, HRME expert and novice microendoscopists were shown a set of training images and then tested to determine accuracy and interobserver variability. Expert microendoscopists identified neoplasia with sensitivity, specificity, and accuracy of 67 % (95 % confidence interval [CI] 58 % - 75 %), 97 % (94 % - 100 %), and 87 %, respectively. Nonexperts achieved sensitivity, specificity, and accuracy of 73 % (66 % - 80 %), 91 % (80 % - 100 %), and 85 %, respectively. Overall, neoplasia were identified with sensitivity 70 % (65 % - 76 %), specificity 94 % (87 % - 100 %), and accuracy 85 %. Kappa values were: experts 0.86; nonexperts 0.72; and overall 0.78. Using the new criteria, observers achieved high specificity and substantial interobserver agreement for distinguishing benign polyps from neoplasia. Increased expertise in HRME imaging improves accuracy. This low-cost microendoscopic platform may be an alternative to confocal microendoscopy in lower-resource or community-based settings.

Mercury measurements in the ocean - GEOTRACES intercalibration exercises

NASA Astrophysics Data System (ADS)

Heimbürger, L. E.

2015-12-01

Mercury is amongst the least concentrated trace metals in the ocean. We need to be able to measure, understand and interpret variability in mercury concentrations in seawater, which is often as low as some 10 percent. We organized international intcalibration exercises for total mercury and total methylmercury determination in seawater collected during the 2013 Dutch GEOTRACES MedBlack cruise (GA04- Black Sea), the 2014 French GEOTRACES GEOVIDE (GA01- North Atlantic Ocean) and the 2015 German GEOTRACES TranArc II cruise ( GN04 - Arctic Ocean). The exercises were intended to primarily evaluate the analytical performance of each participating laboratory. Therefore each laboratory received a single sample bottle of similar size, that has undergone the same cleaning procedure prior to sampling, and each sample was preserved in the same manner. The 2013 exercise was intended as a broader screening with a maximum number (25) of participating laboratories. Results indicated substantial disagreement between the participating laboratories, for both total mercury and methylmercury determinations. For the 2014 exercise we could only invite 10 laboratories of the 2013 exercise. Intercomparability of the second exercise was considerably better, but needs to be further improved in the years to come. The 2015 will be organized this summer. We will present the results of both intercalibration exercises in detail, attempt to explain causes for disagreements, and share our ideas about future developments to achieve traceable mercury measurements in the oceans. We will also make use of this occasion to plan the 2016 GEOTRACES intercalibration cruise.

The Impact of Deep Brain Stimulation on the Quality of Life and Swallowing in Individuals with Parkinson's Disease

PubMed Central

Olchik, Maira Rozenfel; Ghisi, Marciéle; Ayres, Annelise; Schuh, Arthur Francisco Shumacher; Oppitz, Paulo Petry; Rieder, Carlos Roberto de Mello

2018-01-01

Introduction  Deep brain stimulation (DBS) is an established treatment for Parkinson's disease (PD). However, there is little evidence regarding the effect of DBS on dysphagia. Objective  To assess the swallowing and quality of life of individuals with PD before and after DBS surgery. Methods  Our sample consisted of people who had undergone DBS surgery in a referral hospital in the state of Rio Grande do Sul, Brazil. The inclusion criteria were a diagnosis of PD and having undergone DBS surgery. A cognitive screening, through a questionnaire about depression and quality of life, was conducted. Evaluations of each patient's swallowing were performed before and after surgery. The assessment consisted of anamnesis, clinical assessment, the Functional Oral Intake Scale, clinical evaluation of swallowing, and the Hoehn and Yahr scale. Results  The sample included 10 individuals, all male, with a mean age of 57.3 years (±4.7), a mean disease duration of 13.0 years (±2.4), and mean level education of 8.1 years (±4.0). In the clinical evaluation of the swallowing, a significant improvement after DBS was not observed. However, little changes in the signs and symptoms of dysphagia that had a positive impact on the quality of life were observed. Furthermore, there was no relation between the patients' motor subtype and swallowing pre- and post-DBS. Conclusion  There was an improvement in the quality of life of the patients after DBS. However, the improvement in the clinical signs and symptoms of dysphagia did not cause an overall improvement in the swallowing function. PMID:29619099

A survey of the satisfaction of patients who have undergone implant surgery with and without employing a computer-guided implant surgical template

PubMed Central

Youk, Shin-Young; Lee, Jee-Ho; Heo, Seong-Joo; Roh, Hyun-Ki; Park, Eun-Jin; Shin, Im Hee

2014-01-01

PURPOSE This study aims to investigate the degree of subjective pain and the satisfaction of patients who have undergone an implant treatment using a computer-guided template. MATERIALS AND METHODS A survey was conducted for 135 patients who have undergone implant surgery with and without the use of the computer-guided template during the period of 2012 and 2013 in university hospitals, dental hospitals and dental clinics that practiced implant surgery using the computer-guided template. Likert scale and VAS score were used in the survey questions, and the independent t-test and One-Way ANOVA were performed (α=.05). RESULTS The route that the subjects were introduced to the computer-guided implant surgery using a surgical template was mostly advices by dentists, and the most common reason for which they chose to undergo such surgery was that it was accurate and safe. Most of them gave an answer that they were willing to recommend it to others. The patients who have undergone the computer-guided implant surgery felt less pain during the operation and showed higher satisfaction than those who have undergone conventional implant surgery. Among the patients who have undergone computer-guided implant surgery, those who also had prior experience of surgery without a computer-guided template expressed higher satisfaction with the former (P<.05). CONCLUSION In this study, it could be seen that the patients who have undergone computer-guided implant surgery employing a surgical template felt less pain and had higher satisfaction than those with the conventional one, and the dentist's description could provide the confidence about the safety of surgery. PMID:25352962

Short-term outcome of retrograde tibiotalocalcaneal arthrodesis with a curved intramedullary nail.

PubMed

Mückley, Thomas; Klos, Kajetan; Drechsel, Thomas; Beimel, Claudia; Gras, Florian; Hofmann, Gunther O

2011-01-01

The aim of this study was to investigate the potential clinical benefit of tibiotalocalcaneal arthrodesis (TTCA) with an intramedullary nail with a valgus curve, two compression options, and angle-stable locking. Patients who had undergone TTCA at two tertiary hospitals were eligible. Patients who had undergone TTCA before the beginning of the study were evaluated retrospectively, then all following patients were examined prospectively. There were 59 TTCAs; 55 patients were available for analysis. Twenty-eight were evaluated retrospectively, 27 prospectively. Main Outcome Measures were an SF-36, Mazur-, and AOFAS ankle-hindfoot rating scores and radiographic examination. Bony union was obtained in 53 patients. Fifty-one patients were satisfied with the outcome. Fifty-one patients had marked subjective improvement in mobility. The mean AOFAS score of the 55 patients at the latest followup was 66.8 (range, 38 to 86). The mean Mazzur score was 68.0 (range, 30 to 83). In the prospective group, the scores were significantly improved: AOFAS score by an average of 39.6 points (p<0.001); Mazur score by an average of 43 points (p<0.001); SF-36 physical component summary score (p<0.001) and mental component summary score also improved (p<0.048). Radiology showed good hindfoot alignment. The complication rate was 25%. Compared with the literature, the data obtained in this study show a good outcome and a high rate of bony union, with comparable complication rates. Patient satisfaction was good. However, the patients still had limitations. The clinical benefit of the nail used was confirmed.

Penile Improvement Protocol in Postoperative Management of Patients Undergoing Metoidioplasty.

PubMed

Cohanzad, Shahryar

2016-12-01

To introduce a postoperative protocol to optimize the final size of the penis in patients undergoing metoidioplasty. Fourteen patients with the mean age of 29.3 years (8-40 ± 11.7), ten female transsexuals (46 xx karyotype) and four with 5-alpha-reductase deficiency syndrome (5ARDS) who had undergone extensive metoidioplasty entered a penile improvement protocol (PIP) between 2007 and 2015 at a specialized clinic in a general hospital in Tehran, Iran. Subjects were thoroughly instructed, rehearsed on the protocol and closely followed for 24 weeks. Written informed consent was obtained from all participants. We adapted a popular device, the so-called penile traction device, to accommodate the size of the neo-penis. All patients achieved an increase in their penile length with a mean of 28.42 mm (21-47 ± 6.86). Two subjects developed penile bruises and edema during the protocol implementation. No significant procedural complications were detected in the remaining 12 participants. PIP can be an effective step in increasing the size of the neo-penis in patients who have undergone metoidioplasty. We suggest this procedure to be seriously considered in postoperative management of well-informed and motivated patients to improve the final penile length and function in this population. Larger studies are needed to further validate this protocol. This journal requires that the 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 .

Innovations in Balloon Catheter Technology in Rhinology.

PubMed

D'Anza, Brian; Sindwani, Raj; Woodard, Troy D

2017-06-01

Since being introduced more than 10 years ago, balloon catheter technology (BCT) has undergone several generations of innovations. From construction to utilization, there has been a myriad of advancements in balloon technology. The ergonomics of the balloon dilation systems have improved with a focus on limiting the extra assembly. "Hybrid" BCT procedures have shown promise in mucosal preservation, including treating isolated complex frontal disease. Multiple randomized clinical trials report improved long-term outcomes in stand-alone BCT, including in-office use. The ever-expanding technological innovations ensure BCT will be a key component in the armamentarium of the modern sinus surgeon. Copyright © 2017 Elsevier Inc. All rights reserved.

Urban sprawl leaves its PAH signature

USGS Publications Warehouse

Van Metre, P.C.; Mahler, B.J.; Furlong, E.T.

2000-01-01

The increasing vehicle traffic associated with urban sprawl in the United States is frequently linked to degradation of air quality, but its effect on aquatic sediment is less well-recognized. This study evaluates trends in PAHs, a group of contaminants with multiple urban sources, in sediment cores from 10 reservoirs and lakes in six U.S. metropolitan areas. The watersheds chosen represent a range in degree and age of urbanization. Concentrations of PAHs in all 10 reservoirs and lakes increased during the past 20-40 years. PAH contamination of the most recently deposited sediment at all sites exceeded sediment-quality guidelines established by Environment Canada, in some cases by several orders of magnitude. These results add a new chapter to the story told by previous coring studies that reported decreasing concentrations of PAHs after reaching highs in the 1950s. Concurrent with the increase in concentrations is a change in the assemblage of PAHs that indicates the increasing trends are driven by combustion sources. The increase in PAH concentrations tracks closely with increases in automobile use, even in watersheds that have not undergone substantial changes in urban land-use levels since the 1970s.The increasing vehicle traffic associated with urban sprawl in the United States is frequently linked to degradation of air quality, but its effect on aquatic sediment is less well-recognized. This study evaluates trends in PAHs, a group of contaminants with multiple urban sources, in sediment cores from 10 reservoirs and lakes in six U.S. metropolitan areas. The watersheds chosen represent a range in degree and age of urbanization. Concentrations of PAHs in all 10 reservoirs and lakes increased during the past 20-40 years. PAH contamination of the most recently deposited sediment at all sites exceeded sediment-quality guidelines established by Environment Canada, in some cases by several orders of magnitude. These results add a new chapter to the story told by previous coring studies that reported decreasing concentrations of PAHs after reaching highs in the 1950s. Concurrent with the increase in concentrations is a change in the assemblage of PAHs that indicates the increasing trends are driven by combustion sources. The increase in PAH concentrations tracks closely with increases in automobile use, even in watersheds that have not undergone substantial changes in urban land-use levels since the 1970s.

Quality plan for a product line.

PubMed

Lanza, M L; Binus, G K; McMillan, F J

1997-12-01

Continuous Quality improvement (CQI) has undergone radical change as health care facilities merge, expand, and modify their existing services. CQI has shifted from a centralized position in health care organizations, to unit based, to product lines. This paper describes one product line's endeavors to develop a Quality Plan to direct CQI activities. One particular strength of our innovation is that the Quality Plan was developed with attention to the important balance of interdisciplinary cooperation and maintenance of appropriate discipline boundaries.

Contact lens rehabilitation following repaired corneal perforations

PubMed Central

Titiyal, Jeewan S; Sinha, Rajesh; Sharma, Namrata; Sreenivas, V; Vajpayee, Rasik B

2006-01-01

Background Visual outcome following repair of post-traumatic corneal perforation may not be optimal due to presence of irregular keratometric astigmatism. We performed a study to evaluate and compare rigid gas permeable contact lens and spectacles in visual rehabilitation following perforating corneal injuries. Method Eyes that had undergone repair for corneal perforating injuries with or without lens aspiration were fitted rigid gas permeable contact lenses. The fitting pattern and the improvement in visual acuity by contact lens over spectacle correction were noted. Results Forty eyes of 40 patients that had undergone surgical repair of posttraumatic corneal perforations were fitted rigid gas permeable contact lenses for visual rehabilitation. Twenty-four eyes (60%) required aphakic contact lenses. The best corrected visual acuity (BCVA) of ≥ 6/18 in the snellen's acuity chart was seen in 10 (25%) eyes with spectacle correction and 37 (92.5%) eyes with the use of contact lens (p < 0.001). The best-corrected visual acuity with spectacles was 0.20 ± 0.13 while the same with contact lens was 0.58 ± 0.26. All the patients showed an improvement of ≥ 2 lines over spectacles in the snellen's acuity chart with contact lens. Conclusion Rigid gas permeable contact lenses are better means of rehabilitation in eyes that have an irregular cornea due to scars caused by perforating corneal injuries. PMID:16536877

Complications after type one thyroplasty: is day-case surgery feasible?

PubMed

Bray, D; Young, J P; Harries, M L

2008-07-01

Isshiki type one medialisation thyroplasty is an accepted treatment for a unilateral immobile vocal fold. It can also be performed simultaneously as a bilateral procedure in patients with severe bowing of the vocal folds (e.g. presbyphonia). The objectives of this study were to assess the incidence and timing of post-operative complications, and to evaluate whether patients undergoing this operation could, in future, be treated as day cases. A retrospective analysis was undertaken of 57 consecutive patients who had undergone a type one thyroplasty (52 unilateral and five bilateral) at a tertiary referral centre between April 2003 and April 2006. Post-operative improvement in the voice (measured subjectively, perceptually and quantitatively) was considered to constitute a successful outcome. Any complications were documented. Fifty-seven patients who had undergone laryngeal framework surgery were recruited from the study database. All of these patients had undergone either unilateral or bilateral type one medialisation thyroplasty but no arytenoid surgery. Thirty-seven were male (65 per cent) and 20 female (35 per cent), and there was left-sided predominance (74 per cent). All patients were discharged the morning following afternoon surgery (i.e. within 24 hours). Complications occurred in four patients (7 per cent). One patient, who was taking warfarin, developed a post-operative haematoma which resolved with conservative treatment. Two patients (both of whom had undergone revision thyroplasty) developed a wound infection three days post-operatively, which resolved with antibiotics. One patient returned with hoarseness five months post-operatively, after an initially successful result. This patient had previously received radiotherapy for early glottic carcinoma, and the Silastic implant was eroding through the mucosa. This was subsequently removed under general anaesthesia. No patients developed complications leading to airway compromise. The only complications in this series were in patients taking anticoagulation medication, undergoing revision surgery, or in whom the laryngeal tissue was atrophic or absent. Careful patient selection to exclude any of the above should reduce the risk of complications. The authors would therefore advocate type one thyroplasty for unilateral or bilateral vocal fold paralysis as a suitable procedure for day-case surgery within our department.

24 CFR 968.105 - Definitions.

Code of Federal Regulations, 2011 CFR

2011-04-01

... purpose of funding physical and management improvements. Modernization program. A PHA's program for... substantially the same kind does qualify, but reconstruction, substantial improvement in the quality or kind of... resident participation in each of the required program components. PHMAP. The Public Housing Management...

Social facilitation maintenance treatment for adults with obesity: study protocol for a randomised-controlled feasibility study (SFM study).

PubMed

Hilbert, Anja

2016-08-31

The long-term success of non-surgical weight loss treatment in adults with obesity is limited by substantial relapse, and only a few evidence-based weight loss maintenance treatments exist. This clinical trial investigates the feasibility and efficacy of a social facilitation maintenance programme for weight loss maintenance, tailored to meet the needs of obese adults who have undergone a lifestyle weight loss intervention. In a single-centre, open feasibility trial, 72 adults currently or previously obese or overweight who have undergone a lifestyle weight loss intervention are centrally randomised to 4 months of social facilitation maintenance treatment or treatment as a usual control condition. In 16 outpatient group sessions, the social facilitation maintenance treatment, based on a socioecological model and on evidence supporting social facilitation as a key process in maintaining weight loss, focuses on promoting interpersonal relationships to build up a healthy lifestyle for long-term weight loss maintenance. Primary outcome is the amount of weight regain at 6-month follow-up, compared with pre-treatment weight, derived from measured body weight. Secondary outcomes address feasibility, including recruitment, attrition, assessment non-completion, compliance and patients' programme evaluation; and in comparison with pre-weight loss maintenance, social and interpersonal functioning, eating behaviour and physical activity, psychological and physical symptoms, body composition and risk of comorbidity, and quality of life at post-treatment and follow-up assessments. The study was approved by the Ethical Committee at the University of Leipzig (165-13-15072013). The study results will be disseminated through peer-reviewed publications. DRKS00005182. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Control System Upgrade for a Mass Property Measurement Facility

NASA Technical Reports Server (NTRS)

Chambers, William; Hinkle, R. Kenneth (Technical Monitor)

2002-01-01

The Mass Property Measurement Facility (MPMF) at the Goddard Space Flight Center has undergone modifications to ensure the safety of Flight Payloads and the measurement facility. The MPMF has been technically updated to improve reliability and increase the accuracy of the measurements. Modifications include the replacement of outdated electronics with a computer based software control system, the addition of a secondary gas supply in case of a catastrophic failure to the gas supply and a motor controlled emergency stopping feature instead of a hard stop.

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

PubMed

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

2016-04-01

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

Laparoscopic inguinal hernioplasty after robot-assisted laparoscopic radical prostatectomy.

PubMed

Sakon, M; Sekino, Y; Okada, M; Seki, H; Munakata, Y

2017-10-01

To evaluate the efficacy and safety of laparoscopic transabdominal preperitoneal (TAPP) inguinal hernia repair in patients who have undergone robot-assisted laparoscopic radical prostatectomy (RALP). From July 2014 to December 2016, TAPP inguinal hernia repair was conducted in 40 consecutive patients who had previously undergone RALP. Their data were retrospectively analyzed as an uncontrolled case series. The mean operation time in patients who had previously undergone RALP was 99.5 ± 38.0 min. The intraoperative blood loss volume was small, and the duration of hospitalization was 2.0 ± 0.5 days. No intraoperative complications or major postoperative complications occurred. During the average 11.2-month follow-up period, no patients who had previously undergone prostatectomy developed recurrence. Laparoscopic TAPP inguinal hernia repair after RALP was safe and effective. TAPP inguinal hernia repair may be a valuable alternative to open hernioplasty.

Office-based treatment of glottal dysplasia and papillomatosis with the 585-nm pulsed dye laser and local anesthesia.

PubMed

Zeitels, Steven M; Franco, Ramon A; Dailey, Seth H; Burns, James A; Hillman, Robert E; Anderson, R Rox

2004-04-01

Treatment of glottal papillomatosis and dysplasia was mirror-guided and performed in surgeons' offices in the 19th century. It migrated to the operating room in the 20th century to accommodate direct laryngoscopic surgery, which required assistants to administer anesthesia and procedural support. Presently, the primary treatment goals, which are disease regression and voice restoration or maintenance, are tempered by the morbidity of general anesthesia and potential treatment-induced vocal deterioration. In fact, general anesthesia has been appropriately considered to be an acceptable source of morbidity for the promise of a precise procedure, which usually ensures airway safety and an optimal vocal outcome. However, patients with recurrent glottal papillomatosis and keratosis with dysplasia are typically monitored with various degrees of watchful waiting until there is a subjective judgment (on the part of the patient and surgeon) that the disease is more of a liability than is the procedure to treat it. Innovations in the 585-nm pulsed dye laser delivery system have allowed for its use in the clinic with local anesthesia through the working channel of a flexible fiberoptic laryngoscope. A prospective assessment was done on 51 patients in 82 cases of recurrent glottal papillomatosis (30) and dysplasia (52). All individuals had previously undergone microlaryngoscopic management with histopathologic evaluation. Five procedures could not be completed because of impaired exposure (2) or discomfort (3). Of those patients who could be treated, there was at least a 50% disease involution in 68 of 77 cases (88%) and 25% to 50% disease regression in the remaining 9 (12%). Patient self-assessment of the voice revealed that 34 of 77 were improved, 39 were unchanged, 4 were slightly worse, and none were substantially worse. These data confirm that diseased mucosa can be normalized without resection or substantial loss of vocal function. The putative mechanisms, which vary according to the fluence (energy) delivered by the laser, are photoangiolysis of sublesional microcirculation. denaturing of epithelial basement membrane linking proteins, and cellular destruction. Furthermore, this relatively safe, effective technique allowed for treatment of many patients (in a clinic setting) in whom classic surgery-related morbidity would have often delayed intervention.

Earthdata Search Client: Usability Review Process, Results, and Implemented Changes, Using Earthdata Search Client as a Case Study

NASA Technical Reports Server (NTRS)

Siarto, Jeff; Reese, Mark; Shum, Dana; Baynes, Katie

2016-01-01

User experience and visual design are greatly improved when usability testing is performed on a periodic basis. Design decisions should be tested by real users so that application owners can understand the effectiveness of each decision and identify areas for improvement. It is important that applications be tested not just once, but as a part of a continuing process that looks to build upon previous tests. NASA's Earthdata Search Client has undergone a usability study to ensure its users' needs are being met and that users understand how to use the tool efficiently and effectively. This poster will highlight the process followed for usability study, the results of the study, and what has been implemented in light of the results to improve the application's interface.

Structure and evolution of cereal genomes.

PubMed

Paterson, Andrew H; Bowers, John E; Peterson, Daniel G; Estill, James C; Chapman, Brad A

2003-12-01

The cereal species, of central importance to our diet, began to diverge 50-70 million years ago. For the past few thousand years, these species have undergone largely parallel selection regimes associated with domestication and improvement. The rice genome sequence provides a platform for organizing information about diverse cereals, and together with genetic maps and sequence samples from other cereals is yielding new insights into both the shared and the independent dimensions of cereal evolution. New data and population-based approaches are identifying genes that have been involved in cereal improvement. Reduced-representation sequencing promises to accelerate gene discovery in many large-genome cereals, and to better link the under-explored genomes of 'orphan' cereals with state-of-the-art knowledge.

The ISOLDE facility

NASA Astrophysics Data System (ADS)

Catherall, R.; Andreazza, W.; Breitenfeldt, M.; Dorsival, A.; Focker, G. J.; Gharsa, T. P.; J, Giles T.; Grenard, J.-L.; Locci, F.; Martins, P.; Marzari, S.; Schipper, J.; Shornikov, A.; Stora, T.

2017-09-01

The ISOLDE facility has undergone numerous changes over the last 17 years driven by both the physics and technical community with a common goal to improve on beam variety, beam quality and safety. Improvements have been made in civil engineering and operational equipment while continuing developments aim to ensure operations following a potential increase in primary beam intensity and energy. This paper outlines the principal technical changes incurred at ISOLDE by building on a similar publication of the facility upgrades by Kugler (2000 Hyperfine Interact. 129 23-42). It also provides an insight into future perspectives through a brief summary issues addressed in the HIE-ISOLDE design study Catherall et al (2013 Nucl. Instrum. Methods Phys. Res. B 317 204-207).

Lower Eyelid Retraction Surgery Without Internal Spacer Graft.

PubMed

Taban, Mehryar Ray

2017-02-01

Internal eyelid spacer graft is routinely placed during lower eyelid retraction surgery, which may be unnecessary. To evaluate the efficacy of lower eyelid retraction surgery without internal graft in select cases. Retrospective analysis of patients undergoing reconstructive lower eyelid retraction surgery without internal graft, by one surgeon from 2013 to 2015. Surgical technique included transconjunctival lower eyelid retractor lysis, canthoplasty, and temporary tarsorrhaphy, with or without subperiosteal midface-sub oribularis oculi fat (SOOF) lifting and scar lysis. Eyelids with true lower eyelid middle-lamella shortage were excluded. Analysis included 17 surgeries (11 patients). Eight of 11 patients had undergone at least one previous lower eyelid surgery with resultant lower eyelid retraction and sclera show. Preoperative and postoperative photographs at longest follow-up visit were analyzed with standardized measurements. Patient satisfaction was recorded using questionnaire. Etiologies of lower eyelid retraction included prior lower blepharoplasty, thyroid eye disease, and chronic facial palsy. All 11 patients (17 procedures) demonstrated improvement of lower eyelid position. The mean improvement of marginal reflex distance was 2.2 mm (range, 1.6-2.8 mm). There was one case of mild overcorrection. The average follow-up was 7 months (range, 6 months-2 years). Midface lift was performed for 14 of 17 eyelids. This study demonstrates improvement of lower lid position after lower eyelid retraction surgery without internal eyelid spacer graft in select patients. Most patients in our study had undergone previous lower eyelid blepharoplasty and required midface-SOOF lifting. The author proposes that "routine" placement of lower eyelid internal spacer/graft may not be necessary during lower eyelid retraction surgery. © 2016 The American Society for Aesthetic Plastic Surgery, Inc. Reprints and permission: journals.permissions@oup.com.

Ankle joint distraction arthroplasty for severe ankle arthritis.

PubMed

Xu, Yang; Zhu, Yuan; Xu, Xiang-Yang

2017-02-28

Ankle distraction arthroplasty is one option for the treatment of severe ankle arthritis in young patients. The outcomes and factors predicting success in distraction arthroplasty are poorly understood. From January 2011 to May 2015, 16 patients who had undergone ankle distraction arthroplasty for ankle arthritis were operated, including six males and ten females. All patients were available for analysis. The main outcome measurements included joint space on weight bearing radiographs, AOFAS-AH scores (American Orthopaedic Foot & Ankle Society ankle-hindfoot score), VAS scores and SF-36 scores. All 16 patients were followed for a mean follow-up of 40.9 ± 14.7 months (range, 17-67 months). Fourteen of the 16 patients still had their native ankle joints. One patient had undergone ankle arthrodesis 1 year after the operation and one patient had converted to spontaneous ankle fusion at the 3 years follow-up postoperative. The VAS score improved from 5.9 ± 0.8 to 3.7 ± 2.2 (p = 0.0028). The mean AOFAS-AH score improved from 41.9 ± 7.2 preoperatively to 68.1 ± 20.0 postoperatively (p = 0.001). The mean SF-36 score improved from 43.1 ± 7.6 preoperatively to 62.7 ± 18.8 postoperatively (p = 0.002). A weight-bearing ankle space larger than 3 mm at 1 year following distraction is a positive predictive factor. In this study, the treatment of ankle motion distraction for end stage ankle arthritis showed benefit in 9/16 (56.25%) patients at 41 months. It is a promising method for young patients with severe ankle arthritis.

Right inferior frontal gyrus activation is associated with memory improvement in patients with left frontal low-grade glioma resection.

PubMed

Miotto, Eliane C; Balardin, Joana B; Vieira, Gilson; Sato, Joao R; Martin, Maria da Graça M; Scaff, Milberto; Teixeira, Manoel J; Junior, Edson Amaro

2014-01-01

Patients with low-grade glioma (LGG) have been studied as a model of functional brain reorganization due to their slow-growing nature. However, there is no information regarding which brain areas are involved during verbal memory encoding after extensive left frontal LGG resection. In addition, it remains unknown whether these patients can improve their memory performance after instructions to apply efficient strategies. The neural correlates of verbal memory encoding were investigated in patients who had undergone extensive left frontal lobe (LFL) LGG resections and healthy controls using fMRI both before and after directed instructions were given for semantic organizational strategies. Participants were scanned during the encoding of word lists under three different conditions before and after a brief period of practice. The conditions included semantically unrelated (UR), related-non-structured (RNS), and related-structured words (RS), allowing for different levels of semantic organization. All participants improved on memory recall and semantic strategy application after the instructions for the RNS condition. Healthy subjects showed increased activation in the left inferior frontal gyrus (IFG) and middle frontal gyrus (MFG) during encoding for the RNS condition after the instructions. Patients with LFL excisions demonstrated increased activation in the right IFG for the RNS condition after instructions were given for the semantic strategies. Despite extensive damage in relevant areas that support verbal memory encoding and semantic strategy applications, patients that had undergone resections for LFL tumor could recruit the right-sided contralateral homologous areas after instructions were given and semantic strategies were practiced. These results provide insights into changes in brain activation areas typically implicated in verbal memory encoding and semantic processing.

A virtual reality endoscopic simulator augments general surgery resident cancer education as measured by performance improvement.

PubMed

White, Ian; Buchberg, Brian; Tsikitis, V Liana; Herzig, Daniel O; Vetto, John T; Lu, Kim C

2014-06-01

Colorectal cancer is the second most common cause of death in the USA. The need for screening colonoscopies, and thus adequately trained endoscopists, particularly in rural areas, is on the rise. Recent increases in required endoscopic cases for surgical resident graduation by the Surgery Residency Review Committee (RRC) further emphasize the need for more effective endoscopic training during residency to determine if a virtual reality colonoscopy simulator enhances surgical resident endoscopic education by detecting improvement in colonoscopy skills before and after 6 weeks of formal clinical endoscopic training. We conducted a retrospective review of prospectively collected surgery resident data on an endoscopy simulator. Residents performed four different clinical scenarios on the endoscopic simulator before and after a 6-week endoscopic training course. Data were collected over a 5-year period from 94 different residents performing a total of 795 colonoscopic simulation scenarios. Main outcome measures included time to cecal intubation, "red out" time, and severity of simulated patient discomfort (mild, moderate, severe, extreme) during colonoscopy scenarios. Average time to intubation of the cecum was 6.8 min for those residents who had not undergone endoscopic training versus 4.4 min for those who had undergone endoscopic training (p < 0.001). Residents who could be compared against themselves (pre vs. post-training), cecal intubation times decreased from 7.1 to 4.3 min (p < 0.001). Post-endoscopy rotation residents caused less severe discomfort during simulated colonoscopy than pre-endoscopy rotation residents (4 vs. 10%; p = 0.004). Virtual reality endoscopic simulation is an effective tool for both augmenting surgical resident endoscopy cancer education and measuring improvement in resident performance after formal clinical endoscopic training.

The effects of thoracic surgery operations on quality of life: a multicenter study.

PubMed

Öz, Gürhan; Solak, Okan; Metin, Muzaffer; Esme, Hıdır; Sayar, Adnan

2015-10-01

Some treatment modalities may cause losses in patients' life comfort because of the treatment process. Our aim is to determine the effects of thoracic surgery operations on patients' quality of life. This is a multicenter and prospective study. A hundred patients, who had undergone posterolateral thoracotomy (PLT) and/or lateral thoracotomy (LT), were included in the study. A quality of life questionnaire (SF-36) was used to determine the changes in life comfort. SF-36 was performed before the operation, on the first month, third month, sixth month and twelfth month after the operation. Seventy-two percent (n = 72) of the patients were male. PLT was performed in 66% (n = 66) of the patients, and LT was performed in 34% (n = 34) of the patients. The types of resections in patients were pneumonectomy in four patients, lobectomy in 59 patients and wedge resection in 11 patients. No resection was performed in 26 patients. Thoracotomy caused deteriorations in physical function (PF), physical role (RP), bodily pain (BP), health, vitality and social function scores. The deteriorations observed in the third month improved in the sixth and twelfth months. The PF, RP, BP and MH scores of the patients with lung resection were much more worsened compared with the patients who did not undergo lung resection. Thoracic surgery operations caused substantial dissatisfaction in life comfort especially in the third month postoperatively. The worsening in physical function, physical role, pain and mental health is much more in patients with resection compared with the patients who did not undergo resection. © 2014 John Wiley & Sons Ltd.

Physical therapy after prophylactic mastectomy with breast reconstruction: a prospective randomized study.

PubMed

Unukovych, Dmytro; Johansson, Hemming; Johansson, Elizabeth; Arver, Brita; Liljegren, Annelie; Brandberg, Yvonne

2014-08-01

The rate of prophylactic mastectomies (PM) is increasing. Patients generally report high levels of health related quality of life and satisfaction after the procedure, whereas body image perception and sexuality may be negatively affected. The aim of the study was to evaluate the interest in physical therapy as a means of improving body image and sexuality in women after PM. Patients undergoing PM at Karolinska University Hospital between 2006 and 2010 were eligible. The following patient-reported outcome measures were used at study baseline and 2 years postoperatively: the body image scale (BIS), the sexual activity questionnaire (SAQ), the short-form health survey (SF-36), the hospital anxiety and depression scale (HAD), and a study specific "pain/motion/sensation scale". Out of 125 patients invited to participate in this prospective randomized study, 43 (34%) consented and were randomized into the intervention (n = 24, 56%) or control (n = 19, 44%) groups. There were no statistically significant between-group differences found with respect to BIS, SAQ, SF-36, HAD, and "pain/motion/sensation". Two years postoperatively, more than half of the patients in both groups reported problems like feeling less attractive, less sexually attractive, their body feeling less whole, and being dissatisfied with their body. A majority marked a decreased sensation in breast area. The interest in a physiotherapy intervention was limited among women who had undergone PM. The intervention did not show any substantial effects. A large proportion of patients reported specific body image related and pain/motion/sensation problems postoperatively. Copyright © 2014 Elsevier Ltd. All rights reserved.

Variation in rates of breast cancer surgery: A national analysis based on French Hospital Episode Statistics.

PubMed

Rococo, E; Mazouni, C; Or, Z; Mobillion, V; Koon Sun Pat, M; Bonastre, J

2016-01-01

Minimum volume thresholds were introduced in France in 2008 to improve the quality of cancer care. We investigated whether/how the quality of treatment decisions in breast cancer surgery had evolved before and after this policy was implemented. We used Hospital Episode Statistics for all women having undergone breast conserving surgery (BCS) or mastectomy in France in 2005 and 2012. Three surgical procedures considered as better treatment options were analyzed: BCS, immediate breast reconstruction (IBR) and sentinel lymph node biopsy (SLNB). We studied the mean rates and variation according to the hospital profile and volume. Between 2005 and 2012, the volume of breast cancer surgery increased by 11% whereas one third of the hospitals no longer performed this type of surgery. In 2012, the mean rate of BCS was 74% and similar in all hospitals whatever the volume. Conversely, IBR and SLNB rates were much higher in cancer centers (CC) and regional teaching hospitals (RTH) [IBR: 19% and 14% versus 8% on average; SLNB: 61% and 47% versus 39% on average]; the greater the hospital volume, the higher the IBR and SLNB rates (p < 0.0001). Overall, whatever the surgical procedure considered, inter-hospital variation in rates declined substantially in CC and RTH. We identified considerable variation in IBR and SLNB rates between French hospitals. Although more complex and less standardized than BCS, most clinical guidelines recommended these procedures. This apparent heterogeneity suggests unequal access to high-quality procedures for women with breast cancer. Copyright © 2015 Elsevier Ltd. All rights reserved.

TOTAL KNEE REPLACEMENT IN PATIENTS WITH BELOW-KNEE AMPUTATION

PubMed Central

Karam, Matthew D; Willey, Michael; Shurr, Donald G

2010-01-01

Total knee replacement (TKR) is reserved for patients with severe and disabling arthritis that is non-responsive to conservative measures. Based on existing data, total knee replacement is a safe and cost-effective treatment for alleviating pain and improving physical function in patients who do not respond to conservative therapy. Despite the large variation in health status of patients and types of prosthesis implanted, total knee replacement has proven to be a relatively low risk and successful operation. Each year in the United States surgeons perform approximately 300,000 TKR.1 Likewise, lower extremity amputation is commonly performed in the United States with an annual incidence of 110,000 per year.2 Nearly 70% of all lower extremity amputations are performed as the result of chronic vascular disease, followed by trauma (22%), congenital etiology and tumor (4% each).3 Approximately 50% of all lower extremity amputations are performed secondary to complications from Diabetes Mellitus. Norvell et al. demonstrated that patients who have previously undergone transtibial amputation and ambulate with a prosthesis are more likely to develop degenerative joint disease in the con-tralateral extremity than the ipsilateral extremity.4 Further, radiographic changes consistent with osteoporosis have been demonstrated in up to 88% of limbs that have undergone transtibial amputation.8 To our knowledge, there have been only three reported cases of total knee replacement in patients with ipsilateral transtibial amputation.5,7 The purpose of the present study is to review the existing data on total knee replacement in patients who have undergone transtibial amputation. Further we present a patient with a transtibial amputation who underwent contralateral total knee replacement. PMID:21045987

Adherence to synthetic disease-modifying Antirheumatic Drugs in Rheumatoid Arthritis: Results of the OBSERVAR Study.

PubMed

Juan Mas, Antonio; Castañeda, Santos; Cantero Santamaría, José I; Baquero, José L; Del Toro Santos, Francisco J

2017-12-27

Treatment compliance with disease-modifying antirheumatic drugs (DMARD) is essential to achieve the therapeutic goals in rheumatoid arthritis (RA). However, despite the need for good compliance, there is evidence that patients with RA frequently fail to use DMARD for the control of RA. Thus, the main objective of the OBSERVAR study is to evaluate the reasons for the lack of therapeutic adherence to synthetic DMARD in these patients. A Delphi process involving 18 randomly selected Spanish rheumatologists determined the level of agreement with 66 causes of noncompliance selected from the literature in relation to synthetic DMARD in RA. The reasons for noncompliance were consistent in 75.7%, although 3 reasons (4.5%) were highly consistent: 1) not knowing what to do in the case of an adverse event with DMARD; 2) not having undergone adherence screening by health personnel for early detection of "noncompliant patients"; and 3) not having undergone interventions or strategies that improve adherence. In order to improve adherence to RA treatment with synthetic DMARD, the patient should be adequately informed of each new treatment introduced, the patient's compliance profile should be incorporated into the clinical routine and the patient's motivation for therapeutic compliance be reinforced through the methods available to us. Copyright © 2017 Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología. All rights reserved.

Effectiveness of interceptive treatment of class III malocclusions with skeletal anchorage: A systematic review and meta-analysis.

PubMed

Rodríguez de Guzmán-Barrera, Jorge; Sáez Martínez, Carla; Boronat-Catalá, Montserrat; Montiel-Company, Jose María; Paredes-Gallardo, Vanessa; Gandía-Franco, José Luís; Almerich-Silla, José Manuel; Bellot-Arcís, Carlos

2017-01-01

Recently, new strategies for treating class III malocclusions have appeared. Skeletal anchorage appears to reduce the dentoalveolar effects while maximising the orthopaedic effect in growing patients. The purpose of this systematic review and meta-analysis is to examine the effectiveness of bone anchorage devices for interceptive treatment of skeletal class III malocclusions. Searches were made in the Pubmed, Embase, Scopus and Cochrane databases, as well as in a grey literature database, and were complemented by hand-searching. The criteria for eligibility were: patients who had undergone orthodontic treatment with skeletal anchorage (miniplates and miniscrews). Patients with syndromes or craniofacial deformities or who had undergone maxillofacial surgery were excluded. The following variables were recorded for each article: author, year of publication, type of study, sample size, dropouts, demographic variables, treatment carried out, radiographic study (2D or 3D), follow-up time, and quality of the articles on the Newcastle-Ottawa Scale. The means and confidence intervals of the following variables were employed: Wits, overjet, ANB, SNA and SNB. Initially, 239 articles were identified. After removing the duplicates and applying the selection criteria, 9 were included in the qualitative synthesis and 7 in the quantitative synthesis (meta-analysis). It may be concluded that skeletal anchorage is an effective treatment for improving skeletal Class III malocclusion, but when compared with other traditional treatments such as disjunction and face mask, there is no clear evidence that skeletal anchorage improves the results.

Effectiveness of interceptive treatment of class III malocclusions with skeletal anchorage: A systematic review and meta-analysis

PubMed Central

Rodríguez de Guzmán-Barrera, Jorge; Sáez Martínez, Carla; Boronat-Catalá, Montserrat; Montiel-Company, Jose María; Paredes-Gallardo, Vanessa; Gandía-Franco, José Luís; Almerich-Silla, José Manuel; Bellot-Arcís, Carlos

2017-01-01

Recently, new strategies for treating class III malocclusions have appeared. Skeletal anchorage appears to reduce the dentoalveolar effects while maximising the orthopaedic effect in growing patients. The purpose of this systematic review and meta-analysis is to examine the effectiveness of bone anchorage devices for interceptive treatment of skeletal class III malocclusions. Searches were made in the Pubmed, Embase, Scopus and Cochrane databases, as well as in a grey literature database, and were complemented by hand-searching. The criteria for eligibility were: patients who had undergone orthodontic treatment with skeletal anchorage (miniplates and miniscrews). Patients with syndromes or craniofacial deformities or who had undergone maxillofacial surgery were excluded. The following variables were recorded for each article: author, year of publication, type of study, sample size, dropouts, demographic variables, treatment carried out, radiographic study (2D or 3D), follow-up time, and quality of the articles on the Newcastle-Ottawa Scale. The means and confidence intervals of the following variables were employed: Wits, overjet, ANB, SNA and SNB. Initially, 239 articles were identified. After removing the duplicates and applying the selection criteria, 9 were included in the qualitative synthesis and 7 in the quantitative synthesis (meta-analysis). It may be concluded that skeletal anchorage is an effective treatment for improving skeletal Class III malocclusion, but when compared with other traditional treatments such as disjunction and face mask, there is no clear evidence that skeletal anchorage improves the results. PMID:28328995

Endolymphatic Sac Decompression With Intra-Sac Dexamethasone Injection in Menière's Disease.

PubMed

Bojrab, Dennis I; LaRouere, Michael J; Bojrab, Dennis I; Babu, Seilesh C; Sargent, Eric W; Chan, Eleanor Y; Hong, Robert S

2018-06-01

Endolymphatic sac decompression surgery (ELSD) may be used to treat patients who have Menière's 's disease refractory to medical therapy. In this study, we investigated whether or not the injection of steroid into the endolymphatic sac at the time of ELSD provides additional benefit to patient outcomes. Randomized prospective single-blinded placebo-controlled study. Tertiary center. Patients with Menière's disease with poorly controlled vertigo despite medical therapy and serviceable hearing that were offered ELSD. Patients randomized into two groups, with control group (n = 17) undergone ELSD without steroid injection and experimental group undergone ELSD with steroid injection (n = 18) MAIN OUTCOME MEASURE(S):: Audiogram, dizziness handicap inventory, tinnitus handicap inventory, frequency of vertigo spells, functional level scale, and quality of life were obtained at multiple intervals from preoperatively to 24 months postoperatively. ELSD resulted in a statistically significant improvement in vertigo control whether or not steroid was injected into the endolymphatic sac at the time of surgery. However, no additional benefit was observed with the addition of intra-sac steroid injection. No statistical difference in pure-tone average, tinnitus handicap inventory, dizziness handicap inventory, or quality of life was observed between the steroid and nonsteroid surgical groups up to 24 months postoperatively. ELSD is an effective treatment for Menière's disease refractory to medical therapy; however, the addition of intra-sac steroid injection at the time of surgery does not seem to result in a further improvement in patient outcomes.

Evaluation of swallowing ability using swallowing sounds in maxillectomy patients.

PubMed

Kamiyanagi, A; Sumita, Y; Ino, S; Chikai, M; Nakane, A; Tohara, H; Minakuchi, S; Seki, Y; Endo, H; Taniguchi, H

2018-02-01

Maxillectomy for oral tumours often results in debilitating oral hypofunction, which markedly decreases quality of life. Dysphagia, in particular, is one of the most serious problems following maxillectomy. This study used swallowing sounds as a simple evaluation method to evaluate swallowing ability in maxillectomy patients with and without their obturator prosthesis placed. Twenty-seven maxillectomy patients (15 men, 12 women; mean age 66.0 ± 12.1 years) and 30 healthy controls (14 men, 16 women; mean age 44.9 ± 21.3 years) were recruited for this study. Participants were asked to swallow 4 mL of water, and swallowing sounds were recorded using a throat microphone. Duration of the acoustic signal and duration of peak intensity (DPI) were measured. Duration of peak intensity was significantly longer in maxillectomy patients without their obturator than with it (P < .05) and was significantly longer in maxillectomy patients without their obturator than in healthy controls (P < .025 after Bonferroni correction). With the obturator placed, DPI was significantly longer in maxillectomy patients who had undergone soft palate resection than in those who had not (P < .05). These results suggest swallowing ability in maxillectomy patients could be improved by wearing an obturator prosthesis, particularly during the oral stage. However, it is difficult to improve the oral stage of swallowing in patients who have undergone soft palate resection even with obturator placement. © 2017 John Wiley & Sons Ltd.

Assessment of the psychometric properties of the Short-Form Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12) following surgical placement of Prolift+M: a transvaginal partially absorbable mesh system for the treatment of pelvic organ prolapse.

PubMed

Roy, Sanjoy; Mohandas, Anita; Coyne, Karin; Gelhorn, Heather; Gauld, Judi; Sikirica, Vanja; Milani, Alfredo L

2012-04-01

Impairment of sexual function is a significant problem among women suffering from pelvic organ prolapse (POP). Because anatomical measures of POP do not always correspond with patients' subjective reports of their condition, patient-reported outcome measures may provide additional valuable information regarding the experiences of women who have undergone surgery. The Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12) is a validated, widely used condition-specific questionnaire focused on sexual function among patients with POP or urinary incontinence. This study aims to report sexual function outcomes as measured by PISQ-12 and to evaluate the psychometric characteristics of the questionnaire following surgical mesh implant for the treatment of POP. The PISQ-12 was used to measure sexual function, while a set of other measures, namely, Pelvic Organ Prolapse Quantification, Patient Global Impression of Change, Pelvic Floor Distress Inventory, Pelvic Floor Impact Questionnaire, and Surgical Satisfaction Questionnaire, was used for validation. Data for the study were collected from a prospective multicenter, single-arm study of surgical POP repair via the transvaginal placement of a partially absorbable mesh system. For baseline, month 3, and month 12 following POP surgery, several psychometric properties of the PISQ-12 were evaluated, including internal consistency (Cronbach's alpha), concurrent validity, discriminant validity, and responsiveness. As measured by the PISQ-12 questionnaire, statistically significant improvements were observed in the composite summary score as well as all three subscale scores at 1 year. The PISQ-12 generally demonstrated good psychometric properties including internal consistency reliability, validity, and responsiveness. The PISQ-12 items had good distributional properties at baseline, with substantial ceiling effects at follow-up visits reflecting improvements experienced by the patients. The PISQ-12 is a valid measure of sexual function in studies involving patients with POP. © 2012 International Society for Sexual Medicine.

Health insurance in Croatia: dynamics and politics of balancing revenues and expenditures.

PubMed

Voncina, Luka; Kehler, Jenni; Evetovits, Tamas; Bagat, Mario

2010-04-01

Since 2002, the Croatian social health insurance system has undergone substantial reforms, initiated for the most part with the aim of addressing the perpetual financial deficits of the state health insurance fund. While the reforms focussed heavily on increasing the inflow of private funds into the health care system, underlying inefficiencies contributing significantly to poor financial performance have been largely ignored. Furthermore, contrary to demographic trends and developments in social health insurance schemes in other countries, funding health care became even more dependent on its main collection mechanism-payroll tax-and consequently on the employment ratio and wage level. Little effort has been made to diversify the revenue base or to increase the efficiency of revenue collection. Like other countries, Croatia is facing difficulties in adjusting its 'Bismarck' system to its changing demographic and socioeconomic context. Instead of targetting a comprehensive effort at improving revenue collection and limitating unnecessary expenditure and system inefficiencies, simplified approaches to balance the budget have been implemented at a high price to users and with limited effect. As a result, the Croatian health insurance system now offers a lower level of financial protection, while still facing the problem of spending more than can be collected through the current mix of revenue collection mechanisms. The authors suggest that, in order to meet the sustainability requirement of the health financing system, measures affecting both revenue and expenditure should be considered and implemented. On the revenue collection side, the Croatian government must make further efforts to improve collection from the informally employed to broaden the base of contributing members; equally important is the diversification of revenue sources by increasing transfers from general taxation revenues. On the expenditure side, exploring inefficiencies of the delivery system can be delayed no longer, and the introduction of effective cost-control mechanisms and financial discipline would seem to be unavoidable.

Revision Ligament Reconstruction Tendon Interposition for Trapeziometacarpal Arthritis: A Case-Control Investigation

PubMed Central

Sadhu, Anita; Calfee, Ryan P.; Guthrie, Andre; Wall, Lindley B.

2016-01-01

Purpose To test the null hypothesis that there is no difference in patient-reported and objective outcomes of revision ligament reconstruction and tendon interposition (LRTI) compared to primary LRTI. Methods This case-control investigation enrolled 10 patients who had undergone revision LRTI at a tertiary care center. All patients had previously undergone primary trapeziectomy with LRTI. Patients with a minimum of two years of follow-up were eligible. All patients completed an in-office study evaluation. Controls (treated only with primary LRTI) were matched from our practice to reach a 1:2 case to control ratio. Outcome measures included Michigan Hand Questionnaire (primary outcome), Quick Disability of the Arm, Hand, and Shoulder (QuickDASH) Questionnaire, VAS for pain and improvement, and physical examination. Statistical analyses were conducted to compare the patient groups. Results Revision LRTI patients reported significantly worse outcomes on all measured standardized questionnaires compared with primary patients. The Michigan Hand Questionnaire indicated worse overall outcomes (54 versus 79) as well as worse pain, appearance, and ability to complete activities of daily living. Revision LRTI patients also reported more impairment (QuickDASH 47 versus 23), greater pain (VAS pain 6.3 versus 1), and less improvement after surgery (VAS improvement 2.7 versus 7.9). There was also a significantly higher rate of patient-reported depression in the revision LRTI group (50% versus 10% of primary LRTI patients). We did not find a significant difference in objective outcomes of pinch strength, grip strength, and thumb palmar abduction between the two groups. Conclusion Following revision LRTI patient-reported outcomes indicate worse perceived function and greater pain than expected following primary LRTI despite similar motion and strength. Revision surgery can be offered in the setting of persistent or recurrent symptoms, but patients should be counseled that improvement of symptoms is unpredictable. PMID:27751779

Brazilian mosquito (Diptera: Culicidae) fauna: I. Anopheles species from Porto Velho, Rondônia state, western Amazon, Brazil.

PubMed

Morais, Sirlei Antunes; Urbinatti, Paulo Roberto; Sallum, Maria Anice Mureb; Kuniy, Adriana Akemi; Moresco, Gilberto Gilmar; Fernandes, Aristides; Nagaki, Sandra Sayuri; Natal, Delsio

2012-12-01

This study contributes to knowledge of Anopheles species, including vectors of Plasmodium from the western Brazilian Amazon in Porto Velho, Rondônia State. The sampling area has undergone substantial environmental changes as a consequence of agricultural and hydroelectric projects, which have caused intensive deforestation and favored habitats for some mosquito species. The purpose of this study was to diagnose the occurrence of anopheline species from collections in three locations along an electric-power transmission line. Each locality was sampled three times from 2010 to 2011. The principal adult mosquitoes captured in Shannon trap were Anopheles darlingi, An. triannulatus, An. nuneztovari l.s., An.gilesi and An. costai. In addition, larvae were collected in ground breeding sites for Anopheles braziliensis, An. triannulatus, An. darlingi, An. deaneorum, An. marajoara, An. peryassui, An. nuneztovari l.s. and An. oswaldoi-konderi. Anopheles darlingi was the most common mosquito in the region. We discuss Culicidae systematics, fauna distribution, and aspects of malaria in altered habitats of the western Amazon.

Contraceptive practice in China: 1970-2004.

PubMed

Wang, Cuntong

2015-03-01

Using large-scale data from the national conventional statistics and nationally representative sample surveys, the current study aims to assess the level, mode, and determinants of modern contraceptive use from 1970 to 2004 among married couples aged 20 to 49 years in China. A relatively stable Chinese mode of contraception has been established and maintained since the 1980s, characterized by prominent, long-acting contraceptive use and the highest overall prevalence in the world during the past 3 decades. In recent years, the composition of contraceptive use has changed, characterized by the increasing use of the intrauterine device and short-acting methods and a drastic decrease in male and female sterilization. However, the dominance of the long-acting methods has not undergone substantial change. The results from a multinomial logit model employed in this study indicate that family planning policy and socioeconomic and demographic factors jointly influence contraceptive choice. In particular, contraceptive choice is closely associated with the strength of family planning policy in China. © 2011 APJPH.

The high-quality draft genome of peach (Prunus persica) identifies unique patterns of genetic diversity, domestication and genome evolution.

PubMed

Verde, Ignazio; Abbott, Albert G; Scalabrin, Simone; Jung, Sook; Shu, Shengqiang; Marroni, Fabio; Zhebentyayeva, Tatyana; Dettori, Maria Teresa; Grimwood, Jane; Cattonaro, Federica; Zuccolo, Andrea; Rossini, Laura; Jenkins, Jerry; Vendramin, Elisa; Meisel, Lee A; Decroocq, Veronique; Sosinski, Bryon; Prochnik, Simon; Mitros, Therese; Policriti, Alberto; Cipriani, Guido; Dondini, Luca; Ficklin, Stephen; Goodstein, David M; Xuan, Pengfei; Del Fabbro, Cristian; Aramini, Valeria; Copetti, Dario; Gonzalez, Susana; Horner, David S; Falchi, Rachele; Lucas, Susan; Mica, Erica; Maldonado, Jonathan; Lazzari, Barbara; Bielenberg, Douglas; Pirona, Raul; Miculan, Mara; Barakat, Abdelali; Testolin, Raffaele; Stella, Alessandra; Tartarini, Stefano; Tonutti, Pietro; Arús, Pere; Orellana, Ariel; Wells, Christina; Main, Dorrie; Vizzotto, Giannina; Silva, Herman; Salamini, Francesco; Schmutz, Jeremy; Morgante, Michele; Rokhsar, Daniel S

2013-05-01

Rosaceae is the most important fruit-producing clade, and its key commercially relevant genera (Fragaria, Rosa, Rubus and Prunus) show broadly diverse growth habits, fruit types and compact diploid genomes. Peach, a diploid Prunus species, is one of the best genetically characterized deciduous trees. Here we describe the high-quality genome sequence of peach obtained from a completely homozygous genotype. We obtained a complete chromosome-scale assembly using Sanger whole-genome shotgun methods. We predicted 27,852 protein-coding genes, as well as noncoding RNAs. We investigated the path of peach domestication through whole-genome resequencing of 14 Prunus accessions. The analyses suggest major genetic bottlenecks that have substantially shaped peach genome diversity. Furthermore, comparative analyses showed that peach has not undergone recent whole-genome duplication, and even though the ancestral triplicated blocks in peach are fragmentary compared to those in grape, all seven paleosets of paralogs from the putative paleoancestor are detectable.

Detection and attribution of flood change across the United States

NASA Astrophysics Data System (ADS)

Archfield, Stacey

2017-04-01

In the United States, there have a been an increasing number of studies quantifying trends in the annual maximum flood; yet, few studies examine trends in floods that may occur more than once in a given year and even fewer assess trends in floods on rivers that have undergone substantial changes due to urbanization, land-cover change, and agricultural drainage practices. Previous research has shown that, for streamgages having minimal direct human intervention, trends in the peak magnitude, frequency, duration and volume of frequent floods (floods occurring at an average of two events per year relative to a base period) across the United States show large changes; however, few trends are found to be statistically significant. This study extends previous research to provide a comprehensive assessment of flood change across the United States that includes streamgages having experienced confounding alterations to streamflow (urbanization, storage, and land-cover changes) that provides a comprehensive assessment of flood change. Attribution of these changes is also explored.

Demographics of the Canadian dairy industry from 1991 to 2011.

PubMed

Jelinski, Murray D; LeBlanc, Stephen; Kennedy, Richard

2015-07-01

A retrospective study of the demographics of the Canadian dairy industry was conducted using data derived from Statistics Canada's Census of Agriculture from 1991 to 2011. This longitudinal study shows that Canada's dairy industry has undergone considerable consolidation. From 1991 to 2011, the number of dairy producers and dairy farms decreased by 48.9% and 61.9%, respectively. Furthermore, this trend in consolidation is likely to continue; nearly half (45.8%) of all dairy producers in Canada were ≥ 50 y of age in 2011. Not only will most of these producers be retired by 2021, but younger producers will also exit the industry for other reasons. These findings mirror what is occurring in Canada's cow-calf industry, underscoring that supply-managed sectors experience demographic consolidation similar to non-supply managed sectors. These substantial changes will have ramifications for the veterinary profession. There will be fewer but larger farms, and the services and knowledge demanded of veterinarians will change accordingly, which has implications for food animal veterinary education.

Demographics of the Canadian dairy industry from 1991 to 2011

PubMed Central

Jelinski, Murray D.; LeBlanc, Stephen; Kennedy, Richard

2015-01-01

A retrospective study of the demographics of the Canadian dairy industry was conducted using data derived from Statistics Canada’s Census of Agriculture from 1991 to 2011. This longitudinal study shows that Canada’s dairy industry has undergone considerable consolidation. From 1991 to 2011, the number of dairy producers and dairy farms decreased by 48.9% and 61.9%, respectively. Furthermore, this trend in consolidation is likely to continue; nearly half (45.8%) of all dairy producers in Canada were ≥ 50 y of age in 2011. Not only will most of these producers be retired by 2021, but younger producers will also exit the industry for other reasons. These findings mirror what is occurring in Canada’s cow-calf industry, underscoring that supply-managed sectors experience demographic consolidation similar to non-supply managed sectors. These substantial changes will have ramifications for the veterinary profession. There will be fewer but larger farms, and the services and knowledge demanded of veterinarians will change accordingly, which has implications for food animal veterinary education. PMID:26130831

Surgical treatment of atrioventricular canal defect.

PubMed

Hardesty, R L; Zuberbuhler, J R; Bahnson, H T

1975-11-01

Fifty-nine patients with congenital anomalies of the atrioventricular canal underwent operation and all survivors were followed up. In 42 patients with partial atrioventricular canal defects, ten had preoperative congestive heart failure. Three, or 7.1%, died of endomyocardial fibroelastosis, high pulmonary vascular resistance, and severe mitral regurgitation. A fourth patient later died of Wolff-Parkinson-White syndrome and fibrilation. Reoperations in five patients were all successful. No patients had persistent atrioventricular blocks, and all patients are asymptomatic. Two of these subjects continue to receive digoxin therapy, and one of them is believed to have substantial mitral insufficiency. Of the 17 patients who had complete atrioventricular canal defects, 13 had a divided common anterior leaflet attached to the septum by chordae tendineae, and four had undivided and unattached anterior leaflets. Two had previously undergone pulmonary banding, and nine were treated for congestive heart failure. Six died after operation. There were no reoperations. No patient presently has required a pacemaker. Two subjects have persistent cardiomegaly.

Alkaline earth lead and tin compounds Ae2Pb, Ae2Sn, Ae = Ca, Sr, Ba, as thermoelectric materials

PubMed Central

Parker, David; Singh, David J

2013-01-01

We present a detailed theoretical study of three alkaline earth compounds Ca2Pb, Sr2Pb and Ba2Pb, which have undergone little previous study, calculating electronic band structures and Boltzmann transport and bulk moduli using density functional theory. We also study the corresponding tin compounds Ca2Sn, Sr2Sn and Ba2Sn. We find that these are all narrow band gap semiconductors with an electronic structure favorable for thermoelectric performance, with substantial thermopowers for the lead compounds at temperature ranges from 300 to 800 K. For the lead compounds, we further find very low calculated bulk moduli—roughly half of the values for the lead chalcogenides, suggestive of soft phonons and hence low lattice thermal conductivity. All these facts indicate that these materials merit experimental investigation as potential high performance thermoelectrics. We find good potential for thermoelectric performance in the environmentally friendly stannide materials, particularly at high temperature. PMID:27877610

Long-term neuropsychological, neuroanatomical, and life outcome in hippocampal amnesia

PubMed Central

Warren, David E.; Duff, Melissa C.; Magnotta, Vincent; Capizzano, Aristides A; Cassell, Martin D.; Tranel, Daniel

2012-01-01

Focal bilateral hippocampal damage typically causes severe and selective amnesia for new declarative information (facts and events), a cognitive deficit that greatly impacts the ability to live a normal, fully-independent life. We describe the case of 1846, a 48-year-old woman with profound hippocampal amnesia following status epilepticus and an associated anoxic episode at age 30. 1846 has undergone extensive neuropsychological testing on many occasions over the 18 years since her injury, and we present data indicating that her memory impairment has remained severe and stable during that time. New, high-resolution structural MRI studies of 1846's brain reveal substantial bilateral hippocampal atrophy resembling that of other well-known amnesic patients. In spite of severe amnesia, 1846 lives a full and mostly independent adult life, facilitated by an extensive social support network of family and friends. Her case provides an example of a rare and unlikely positive outcome in the face of severe memory problems. PMID:22401298

The China National Tobacco Corporation: From domestic to global dragon?

PubMed Central

Fang, Jennifer; Lee, Kelley; Sejpal, Nidhi

2017-01-01

ABSTRACT The China National Tobacco Corporation (CNTC), which produces one-third of the world’s cigarettes, is the largest tobacco company in the world. Over the past 60 years, the CNTC has been focused on supplying a huge domestic market. As the market has become increasingly saturated, and potential foreign competition looms, the company has turned to expansion abroad. This paper examines the ambitions and prospects of the CNTC to ‘go global’. Using Chinese and English language sources, this paper describes the globalisation ambitions of the CNTC, and its global business strategy focused on internal restructuring, brand development and expansion of overseas operations in selected markets. The paper concludes that the company has undergone substantial change over the past two decades and is consequently poised to become a new global player in the tobacco industry. This article is part of the special issue ‘The Emergence of Asian Tobacco Companies: Implications for Global Health Governance’. PMID:27737622

Slab-plume interaction beneath the Pacific Northwest

NASA Astrophysics Data System (ADS)

Obrebski, Mathias; Allen, Richard M.; Xue, Mei; Hung, Shu-Huei

2010-07-01

The Pacific Northwest has undergone complex plate reorganization and intense tectono-volcanic activity to the east during the Cenozoic (last 65 Ma). Here we show new high-resolution tomographic images obtained using shear and compressional data from the ongoing USArray deployment that demonstrate first that there is a continuous, whole-mantle plume beneath the Yellowstone Snake River Plain (YSRP) and second, that the subducting Juan de Fuca (JdF) slab is fragmented and even absent beneath Oregon. The analysis of the geometry of our tomographic models suggests that the arrival and emplacement of the large Yellowstone plume had a substantial impact on the nearby Cascadia subduction zone, promoting the tearing and weakening of the JdF slab. This interpretation also explains several intriguing geophysical properties of the Cascadia trench that contrast with most other subduction zones, such as the absence of deep seismicity and the trench-normal fast direction of mantle anisotropy. The DNA velocity models are available for download and slicing at http://dna.berkeley.edu.

Review of pharmacological therapies in fibromyalgia syndrome

PubMed Central

2014-01-01

This review addresses the current status of drug therapy for the management of fibromyalgia syndrome (FMS) and is based on interdisciplinary FMS management guidelines, meta-analyses of drug trial data, and observational studies. In the absence of a single gold-standard medication, patients are treated with a variety of drugs from different categories, often with limited evidence. Drug therapy is not mandatory for the management of FMS. Pregabalin, duloxetine, milnacipran, and amitriptyline are the current first-line prescribed agents but have had a mostly modest effect. With only a minority of patients expected to experience substantial benefit, most will discontinue therapy because of either a lack of efficacy or tolerability problems. Many drug treatments have undergone limited study and have had negative results. It is unlikely that these failed pilot trials will undergo future study. However, medications, though imperfect, will continue to be a component of treatment strategy for these patients. Both the potential for medication therapy to relieve symptoms and the potential to cause harm should be carefully considered in their administration. PMID:24433463

From compassionate ageism to intergenerational conflict?

PubMed

Binstock, Robert H

2010-10-01

During the 50 years in which The Gerontologist has been publishing, the politics of aging in the United States has undergone distinct changes. The political behavior of older individuals has remained largely the same even though different birth cohorts have succeeded each other in populating the ranks of older people. But the politics of policies on aging-the organized interest and advocacy groups active in this arena, the tenor of public discourse about older people as beneficiaries of policies on aging, the national political agendas regarding public old-age benefits, and the broader U.S. political economy-have changed substantially over these five decades. Now, in the contexts of the aging of the baby boom and concerns about reducing large federal fiscal deficits (annual and cumulative), the politics of U.S. policies on aging may change considerably from those of yesterday and today. Is there a possibility of future intergenerational political conflict over taxes and expenditures for the major old-age benefit programs? If so, what might prevent or mitigate it?

Targeted Therapies in Non-Small Cell Lung Cancer—Beyond EGFR and ALK

PubMed Central

Rothschild, Sacha I.

2015-01-01

Systemic therapy for non-small cell lung cancer (NSCLC) has undergone a dramatic paradigm shift over the past decade. Advances in our understanding of the underlying biology of NSCLC have revealed distinct molecular subtypes. A substantial proportion of NSCLC depends on oncogenic molecular aberrations (so-called “driver mutations”) for their malignant phenotype. Personalized therapy encompasses the strategy of matching these subtypes with effective targeted therapies. EGFR mutations and ALK translocation are the most effectively targeted oncogenes in NSCLC. EGFR mutations and ALK gene rearrangements are successfully being targeted with specific tyrosine kinase inhibitors. The number of molecular subgroups of NSCLC continues to grow. The scope of this review is to discuss recent data on novel molecular targets as ROS1, BRAF, KRAS, HER2, c-MET, RET, PIK3CA, FGFR1 and DDR2. Thereby the review will focus on therapeutic strategies targeting these aberrations. Moreover, the emerging challenge of acquired resistance to initially effective therapies will be discussed. PMID:26018876

Targeted Therapies in Non-Small Cell Lung Cancer-Beyond EGFR and ALK.

PubMed

Rothschild, Sacha I

2015-05-26

Systemic therapy for non-small cell lung cancer (NSCLC) has undergone a dramatic paradigm shift over the past decade. Advances in our understanding of the underlying biology of NSCLC have revealed distinct molecular subtypes. A substantial proportion of NSCLC depends on oncogenic molecular aberrations (so-called "driver mutations") for their malignant phenotype. Personalized therapy encompasses the strategy of matching these subtypes with effective targeted therapies. EGFR mutations and ALK translocation are the most effectively targeted oncogenes in NSCLC. EGFR mutations and ALK gene rearrangements are successfully being targeted with specific tyrosine kinase inhibitors. The number of molecular subgroups of NSCLC continues to grow. The scope of this review is to discuss recent data on novel molecular targets as ROS1, BRAF, KRAS, HER2, c-MET, RET, PIK3CA, FGFR1 and DDR2. Thereby the review will focus on therapeutic strategies targeting these aberrations. Moreover, the emerging challenge of acquired resistance to initially effective therapies will be discussed.

EBL effect on the observation of multi-TeV flaring of 2009 from Markarian 501

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

Sahu, Sarira; Yáñez, Marco Vladimir Lemus; Miranda, Luis Salvador

Markarian 501 is a high-peaked BL Lacertae object and has undergone many major outbursts since its discovery in 1996. As a part of the multiwavelength campaign, in the year 2009 this blazar was observed for 4.5 months from March 9 to August 1 and during the period April 17 to May 5 it was observed by both space and ground based observatories covering the entire electromagnetic spectrum. A very strong high energy γ-ray flare was observed on May 1 by Whipple telescope in the energy range 317 GeV to 5 TeV and the flux was about 10 times higher thanmore » the average baseline flux. Previously during 1997 Markarian 501 had undergone another long outburst, which was observed by HEGRA telescopes and the energy spectrum was well beyond 10 TeV. The photohadronic model complemented by the extragalactic background radiation (EBL) correction fits well with the flares data observed by both Whipple and HEGRA. Our model predicts a steeper slope of the energy spectrum beyond 10 TeV, which is compatible with the improved analysis of the HEGRA data.« less

EBL effect on the observation of multi-TeV flaring of 2009 from Markarian 501

DOE PAGES

Sahu, Sarira; Yáñez, Marco Vladimir Lemus; Miranda, Luis Salvador; ...

2017-01-10

Markarian 501 is a high-peaked BL Lacertae object and has undergone many major outbursts since its discovery in 1996. As a part of the multiwavelength campaign, in the year 2009 this blazar was observed for 4.5 months from March 9 to August 1 and during the period April 17 to May 5 it was observed by both space and ground based observatories covering the entire electromagnetic spectrum. A very strong high energy γ-ray flare was observed on May 1 by Whipple telescope in the energy range 317 GeV to 5 TeV and the flux was about 10 times higher thanmore » the average baseline flux. Previously during 1997 Markarian 501 had undergone another long outburst, which was observed by HEGRA telescopes and the energy spectrum was well beyond 10 TeV. The photohadronic model complemented by the extragalactic background radiation (EBL) correction fits well with the flares data observed by both Whipple and HEGRA. Our model predicts a steeper slope of the energy spectrum beyond 10 TeV, which is compatible with the improved analysis of the HEGRA data.« less

Alteration of Occlusal Plane in Orthognathic Surgery: Clinical Features to Help Treatment Planning on Class III Patients

PubMed Central

Costa, Tony Eduardo; Barbosa, Saulo de Matos; Pereira, Rodrigo Alvitos; Chaves Netto, Henrique Duque de Miranda

2018-01-01

Dentofacial deformities (DFD) presenting mainly as Class III malocclusions that require orthognathic surgery as a part of definitive treatment. Class III patients can have obvious signs such as increasing the chin projection and chin throat length, nasolabial folds, reverse overjet, and lack of upper lip support. However, Class III patients can present different facial patterns depending on the angulation of occlusal plane (OP), and only bite correction does not always lead to the improvement of the facial esthetic. We described two Class III patients with different clinical features and inclination of OP and had undergone different treatment planning based on 6 clinical features: (I) facial type; (II) upper incisor display at rest; (III) dental and gingival display on smile; (IV) soft tissue support; (V) chin projection; and (VI) lower lip projection. These patients were submitted to orthognathic surgery with different treatment plannings: a clockwise rotation and counterclockwise rotation of OP according to their facial features. The clinical features and OP inclination helped to define treatment planning by clockwise and counterclockwise rotations of the maxillomandibular complex, and two patients undergone to bimaxillary orthognathic surgery showed harmonic outcomes and stables after 2 years of follow-up. PMID:29854480

Predictors of skin cancer screening practice and attitudes in primary care.

PubMed

Rodriguez, Georgette L; Ma, Fangchao; Federman, Daniel G; Rouhani, Panta; Chimento, Stacy; Multach, Mark; Kirsner, Robert S

2007-11-01

Physician visits provide invaluable opportunities to screen patients for skin cancer, yielding earlier detection and improved survival. We sought to assess frequency of skin cancer screening by full body skin examinations (FBSE) by primary care physicians, patient attitudes toward FBSE, and risk factors for cutaneous malignancy. Questionnaires were distributed to patients at primary care and dermatology clinics. A total of 426 participants were surveyed. Overall, 20% of patients reported having undergone regular FBSE by their primary care physician. Sex, race, personal skin cancer history, and Fitzpatrick skin type were predictive of whether a FBSE was performed by a patient's primary care physician. Men were more likely to report having undergone a FBSE (22% vs 19%; P < .01); women were more likely to report feeling embarrassed by a FBSE (15% vs 4%; P < .01). This study was conducted at a single site academic center. Although low rates of skin cancer screening are reported by patients, those at higher risk are being screened more frequently. Sex disparity exists, and as both male and female patients have a strong preference to undergo FBSE, unmet opportunities for skin cancer prevention should be maximized.

Immediate breast reconstruction after mastectomy--why do women choose this option?

PubMed

Shameem, Haque; Yip, Cheng Har; Fong, E

2008-01-01

Mastectomy is an essential but disfiguring operation in cancer treatment. The negative impact on body image can however be prevented by immediate reconstruction. The aim of this study was to determine the reasons why patients choose to have or not to have immediate breast reconstruction. This is a cross sectional descriptive study of breast cancer patients post-mastectomy who had and had not undergone immediate breast reconstruction. The patients were asked a series of questions to ascertain the reasons why they chose or did not choose immediate breast reconstruction. 136 patients in total were interviewed of which 23 had undergone immediate breast reconstruction. 36.8% of the patients had been offered reconstruction. In the non-reconstructed group, the main reason for not having reconstruction were fear of additional surgery. In the group that had reconstruction done, the main reason was to feel whole again. Low on the list were reasons such as trying to improve marital or sexual relations. Only a third of patients undergoing mastectomy were offered immediate reconstruction. In public hospitals in developing countries, limited operating time and availability of plastic surgery services are major barriers to more women being offered the option.

Medical education in Japan: a challenge to the healthcare system.

PubMed

Suzuki, Yasuyuki; Gibbs, Trevor; Fujisaki, Kazuhiko

2008-01-01

In response to a change in health and societal need, the system of medical education in Japan has undergone major reform within the last two decades. Although the general health status of Japanese citizens ranks amongst the highest in the world, a rapidly increasingly elderly population, a social insurance system in crisis and a decrease in the number of practicing physicians is severely affecting this enviable position. To compensate, the Government has reversed its previous decision to reduce the number of doctors. Concomitantly, public opinion is changing to that of support and sympathy for the practicing physician. In order to produce a new breed of future doctors, Japanese medical education has undergone major reform: problem-based learning and clinical skills development has been instituted in most medical schools, more rigid assessment methods, ensuring competency and fitness to practice have been introduced, and there has been an increase in purposeful clinical attachments with a hands-on approach rather than a traditional observation model. A new postgraduate residency programme, introduced in 2004, hopes to improve general competency levels, while medical schools throughout the country are paying attention to modern medical education and faculty development.

Enhancement of mechanical properties of 123 superconductors

DOEpatents

Balachandran, Uthamalingam

1995-01-01

A composition and method of preparing YBa.sub.2 Cu.sub.3 O.sub.7-x superconductor. Addition of tin oxide containing compounds to YBCO superconductors results in substantial improvement of fracture toughness and other mechanical properties without affect on T.sub.c. About 5-20% additions give rise to substantially improved mechanical properties.

78 FR 25501 - Self-Regulatory Organizations; The NASDAQ Stock Market LLC; Notice of Designation of a Longer...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-05-01

... SECURITIES AND EXCHANGE COMMISSION [Release No. 34-69450; File No. SR-NASDAQ-2013-031] Self... Member Organization To Attest That ``Substantially All'' Orders Submitted to the Retail Price Improvement... ``substantially all,'' rather than all, orders submitted to the Retail Price Improvement Program qualify as...

[Why and how to modify standard cystectomy].

PubMed

Gotsadze, D T; Chakvetadze, V T; Danelia, E V

2008-01-01

To improve quality of life in postcystectomy patients, we made 150 radical cystectomies with recovery of urethral voiding. Cystectomy was performed by a modified technique in 87 of 135 operated men: transprostatic cystvesiculectomy (n = 11), transprostatic cystectomy (n = 53), supraprostatic cystectomy (n = 23). Indication for this modification was the absence of extravesicular growth of the primary tumor and prostatic cancer. Monitoring of radicalism was carried out by intraoperative urgent histological investigation of the resection line. 74 patients have undergone retrograde cystectomy. Postoperative lethality was 2.3%. 9 month and longer follow up results were studied.

NOAA Education: Adventures in Strategic Planning, External Review, and Evaluation

NASA Astrophysics Data System (ADS)

Michalopoulos, C.

2010-12-01

Since late 2007, the National Oceanic and Atmospheric Administration has undertaken the development of a 20-year Education Strategic Plan, has undergone an external review by the National Research Council of the National Academies, and has drafted a guiding document on an agency-wide approach for monitoring and evaluation of its education activities and programs. This presentation will review all these processes with special emphasis on lessons learned and on the implications of each one on NOAA’s ability to improve and better coordinate its educational portfolio.

An overview of the antiretroviral market.

PubMed

Camponeschi, Geannan; Fast, Jessica; Gauval, Marianne; Guerra, Katherine; Moore, Meredith; Ravinutala, Siddharth; Ripin, David; Shepel, Vadim

2013-11-01

An understanding of the current state of the antiretroviral marketplace is an important context in which to consider drug optimization work. The antiretroviral marketplace has undergone a remarkable evolution over the past 11 years, expanding from serving less than 300 000 patients in low and middle-income countries in 2002 to almost 10 million patients today. In addition to dramatic growth, a steady and rapid improvement in the drugs and drug regimens used to treat patients has characterized a rapidly changing market. The antiretroviral marketplace has been characterized by rapid growth and a succession of improving drugs and regimens over the past 11 years. The dynamic and innovative marketplace provides a strong platform from which to introduce new, optimized drugs and regimens to better serve patients' health needs.

24 CFR 881.201 - Definitions.

Code of Federal Regulations, 2014 CFR

2014-04-01

... from gutting and extensive reconstruction to the cure of substantial accumulation of deferred maintenance. Cosmetic improvements alone do not qualify as substantial rehabilitation under this definition...

24 CFR 881.201 - Definitions.

Code of Federal Regulations, 2011 CFR

2011-04-01

... from gutting and extensive reconstruction to the cure of substantial accumulation of deferred maintenance. Cosmetic improvements alone do not qualify as substantial rehabilitation under this definition...

24 CFR 881.201 - Definitions.

Code of Federal Regulations, 2012 CFR

2012-04-01

... from gutting and extensive reconstruction to the cure of substantial accumulation of deferred maintenance. Cosmetic improvements alone do not qualify as substantial rehabilitation under this definition...

24 CFR 881.201 - Definitions.

Code of Federal Regulations, 2013 CFR

2013-04-01

... from gutting and extensive reconstruction to the cure of substantial accumulation of deferred maintenance. Cosmetic improvements alone do not qualify as substantial rehabilitation under this definition...

Interim Design Report for the International Design Study for a Neutrino Factory

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

Choubey, S.; Gandhi, R.; Goswami, S.

2011-10-01

The starting point for the International Design Study for the Neutrino Factory (the IDS-NF) was the output of the earlier International Scoping Study for a future Neutrino Factory and super-beam facility (the ISS). The accelerator facility described in section 2 incorporates the improvements that have been derived from the substantial amount of work carried out within the Accelerator Working Group. Highlights of these improvements include: (1) Initial concepts for the implementation of the proton driver at each of the three example sites, CERN, FNAL, and RAL; (2) Detailed studies of the energy deposition in the target area; (3) A reductionmore » in the length of the muon beam phase-rotation and bunching systems; (4) Detailed analyses of the impact of the risk that stray magnetic field in the accelerating cavities in the ionization cooling channel will reduce the maximum operating gradient. Several alternative ionization-cooling lattices have been developed as fallback options to mitigate this technical risk; (5) Studies of particle loss in the muon front-end and the development of strategies to mitigate the deleterious effects of such losses; (6) The development of more complete designs for the muon linac and re-circulating linacs; (7) The development of a design for the muon FFAG that incorporates insertions for injection and extraction; and (8) Detailed studies of diagnostics in the decay ring. Other sub-systems have undergone a more 'incremental' evolution; an indication that the design of the Neutrino Factory has achieved a degree of maturity. The design of the neutrino detectors described in section 3 has been optimized and the Detector Working Group has made substantial improvements to the simulation and analysis of the Magnetized Iron Neutrino Detector (MIND) resulting in an improvement in the overall neutrino-detection efficiency and a reduction in the neutrino-energy threshold. In addition, initial consideration of the engineering of the MIND has generated a design that is feasible and a finite element analysis of the toroidal magnetic field to produce a realistic field map has been carried out. Section 3 also contains, for the first time, a specification for the near-detector systems and a demonstration that the neutrino flux can be determined with a precision of 1% through measurements of inverse muon decay at the near detector. The performance of the facility, the work of the Physics and Performance Evaluation Group, is described in section 1. The effect of the improved MIND performance is to deliver a discovery reach for CP-invariance violation in the lepton sector, the determination of the mass hierarchy, and of {theta}{sub 13} that extends down to values of sin{sup 2} 2{theta}{sub 13} {approx} 5 x 10{sup -5} and is robust against systematic uncertainties. In addition, the improved neutrino-energy threshold has allowed an indicative analysis of the kind of re-optimization of the facility that could be carried out should {theta}{sub 13} be found close to the current upper bound. The results presented in section 1 demonstrate that the discovery reach as well as the precision with which the oscillation parameters can be measured at the baseline Neutrino Factory is superior to that of other proposed facilities for all possible values of sin{sup 2} 2{theta}{sub 13}.« less

Rechargeable or Nonrechargeable Deep Brain Stimulation in Dystonia: A Cost Analysis.

PubMed

Perez, Jerome; Gonzalez, Victoria; Cif, Laura; Cyprien, Fabienne; Chan-Seng, Emilie; Coubes, Philippe

2017-04-01

Deep brain stimulation of the internal Globus Pallidus (GPi DBS) delivered by an implantable neurostimulator (INS) is an established, effective, and safe treatment option for patients with medically refractory primary dystonia. Compared to other DBS targets, the battery life of the INS is substantially shorter due to the higher energy demands required to penetrate the GPi resulting in faster battery depletion and more frequent hospitalizations for INS replacement. We, therefore, performed a cost analysis to compare a rechargeable DBS system, Activa®RC, with nonrechargeable systems, from the perspective of the French public health insurer. To estimate the cost of INS replacement in the nonrechargeable cohort, and costs potentially avoided in the hypothetical Activa ® RC cohort, the medical records of patients who had undergone GPi DBS with a nonrechargeable INS between 1996 and 2010 at a center in France were accessed. Replacement rates were estimated for up to nine years. With Activa ® RC, a total of 315 hospitalizations for replacement procedures would have been avoided over nine years compared with a nonrechargeable INS, resulting in a discounted mean direct medical cost per patient over nine years of €50,119 with a nonrechargeable INS and €33,306 with Activa ® RC, a reduction of 34%. The adoption of a rechargeable instead of a nonrechargeable INS for eligible patients with dystonia may provide substantial savings to the public health insurer in France. © 2017 International Neuromodulation Society.

Ethnic and gender specific life expectancies of the Singapore population, 1965 to 2009 – converging, or diverging?

PubMed Central

2013-01-01

Background The increase in life expectancy and the persistence of expectancy gaps between different social groups in the 20th century are well-described in Western developed countries, but less well documented in the newly industrialised countries of Asia. Singapore, a multiethnic island-state, has undergone a demographic and epidemiologic transition concomitant with economic development. We evaluate secular trends and differences in life expectancy by ethnicity and gender in Singapore, from independence to the present. Methods Period abridged life tables were constructed to derive the life expectancy of the Singapore population from 1965 to 2009 using data from the Department of Statistics and the Registry of Births and Deaths, Singapore. Results All 3 of Singapore’s main ethnic groups, and both genders, experienced an increase in life expectancy at birth and at 65 years from 1965 to 2009, though at substantially different rates. Although there has been a convergence in life expectancy between Indians and Chinese, the (substantial) gap between Malays and the other two ethnic groups has remained. Females continued to have a higher life expectancy at birth and at 65 years than males throughout this period, with no evidence of convergence. Conclusions Ethnic and gender differences in life expectancy persist in Singapore despite its rapid economic development. Targeted chronic disease prevention measures and health promotion activities focusing on people of Malay ethnicity and the male community may be needed to remedy this inequality. PMID:24160733

Draft Genome of the Scarab Beetle Oryctes borbonicus on La Réunion Island

PubMed Central

Meyer, Jan M.; Markov, Gabriel V.; Baskaran, Praveen; Herrmann, Matthias; Sommer, Ralf J.; Rödelsperger, Christian

2016-01-01

Beetles represent the largest insect order and they display extreme morphological, ecological and behavioral diversity, which makes them ideal models for evolutionary studies. Here, we present the draft genome of the scarab beetle Oryctes borbonicus, which has a more basal phylogenetic position than the two previously sequenced pest species Tribolium castaneum and Dendroctonus ponderosae providing the potential for sequence polarization. Oryctes borbonicus is endemic to La Réunion, an island located in the Indian Ocean, and is the host of the nematode Pristionchus pacificus, a well-established model organism for integrative evolutionary biology. At 518 Mb, the O. borbonicus genome is substantially larger and encodes more genes than T. castaneum and D. ponderosae. We found that only 25% of the predicted genes of O. borbonicus are conserved as single copy genes across the nine investigated insect genomes, suggesting substantial gene turnover within insects. Even within beetles, up to 21% of genes are restricted to only one species, whereas most other genes have undergone lineage-specific duplications and losses. We illustrate lineage-specific duplications using detailed phylogenetic analysis of two gene families. This study serves as a reference point for insect/coleopteran genomics, although its original motivation was to find evidence for potential horizontal gene transfer (HGT) between O. borbonicus and P. pacificus. The latter was previously shown to be the recipient of multiple horizontally transferred genes including some genes from insect donors. However, our study failed to provide any clear evidence for additional HGTs between the two species. PMID:27289092

Get Active Orlando: changing the built environment to increase physical activity.

PubMed

McCreedy, Malisa; Leslie, Jill G

2009-12-01

Active Living by Design's Get Active Orlando partnership (GAO) focused on downtown Orlando's Community Redevelopment Area, including the Parramore Heritage District, home to many low-income and ethnically diverse residents, including many seniors. The area had undergone substantial development, and GAO aimed to incorporate active living considerations into the city's changing landscape. Get Active Orlando conducted a baseline survey of all streets, sidewalks, and bicycle lanes in the project area and identified a sequence of plans and policies in which to incorporate changes identified in the assessment. To create more immediate opportunities for active living, the partnership initiated a senior walking program, a bicycle refurbishment and giveaway program, and community bicycle-riding events, and led a social-marketing campaign that emphasized simple lifestyle changes. Get Active Orlando influenced adoption of public policies supporting active living in Orlando, including the Downtown Transportation Plan, Streetscape Guidelines, Design Standards Review Checklist, and growth management policies. Establishment of the Mayor's Advisory Council on Active Living is testament to the heightened significance of active living in Orlando. Initial assessment data served as a strong platform for policy change. Creating connections across disciplines including land-use planning, transportation, public health, and economic development allowed GAO to secure substantial policy change to influence design of the built environment. Engaging community members, including youth, as leaders was an important factor in program success. The physical environment in Orlando's Community Redevelopment Area is beginning to change as a reflection of a new policy framework designed to support active living.

Ecological and evolutionary influences on body size and shape in the Galápagos marine iguana (Amblyrhynchus cristatus).

PubMed

Chiari, Ylenia; Glaberman, Scott; Tarroso, Pedro; Caccone, Adalgisa; Claude, Julien

2016-07-01

Oceanic islands are often inhabited by endemic species that have undergone substantial morphological evolutionary change due to processes of multiple colonizations from various source populations, dispersal, and local adaptation. Galápagos marine iguanas are an example of an island endemic exhibiting high morphological diversity, including substantial body size variation among populations and sexes, but the causes and magnitude of this variation are not well understood. We obtained morphological measurements from marine iguanas throughout their distribution range. These data were combined with genetic and local environmental data from each population to investigate the effects of evolutionary history and environmental conditions on body size and shape variation and sexual dimorphism. Our results indicate that body size and shape are highly variable among populations. Sea surface temperature and island perimeter, but not evolutionary history as depicted by phylogeographic patterns in this species, explain variation in body size among populations. Conversely, evolutionary history, but not environmental parameters or island size, was found to influence variation in body shape among populations. Finally, in all populations except one, we found strong sexual dimorphism in body size and shape in which males are larger, with higher heads than females, while females have longer heads than males. Differences among populations suggest that plasticity and/or genetic adaptation may shape body size and shape variation in marine iguanas. This study will help target future investigations to address the contribution of plasticity versus genetic adaptation on size and shape variation in marine iguanas.

36 CFR 51.55 - What must a concessioner do after substantial completion of the capital improvement?

Code of Federal Regulations, 2010 CFR

2010-07-01

... together with, if requested by the Director, a written certification from a certified public accountant... 36 Parks, Forests, and Public Property 1 2010-07-01 2010-07-01 false What must a concessioner do after substantial completion of the capital improvement? 51.55 Section 51.55 Parks, Forests, and Public...

Enhancement of mechanical properties of 123 superconductors

DOEpatents

Balachandran, U.

1995-04-25

A composition and method are disclosed of preparing YBa{sub 2}Cu{sub 3}O{sub 7{minus}x} superconductor. Addition of tin oxide containing compounds to YBCO superconductors results in substantial improvement of fracture toughness and other mechanical properties without affect on T{sub c}. About 5-20% additions give rise to substantially improved mechanical properties.

Flexible multiply towpreg and method of production therefor

NASA Technical Reports Server (NTRS)

Muzzy, John D. (Inventor); Varughese, Babu (Inventor)

1992-01-01

This invention relates to an improved flexible towpreg and a method of production therefor. The improved flexible towpreg comprises a plurality of towpreg plies which comprise reinforcing filaments and matrix forming material; the reinforcing filaments being substantially wetout by the matrix forming material such that the towpreg plies are substantially void-free composite articles, and the towpreg plies having an average thickness less than about 100 microns. The method of production for the improved flexible towpreg comprises the steps of spreading the reinforcing filaments to expose individually substantially all of the reinforcing filaments; coating the reinforcing filaments with the matrix forming material in a manner causing interfacial adhesion of the matrix forming material to the reinforcing filaments; forming the towpreg plies by heating the matrix forming material contacting the reinforcing filaments until the matrix forming material liquefies and coats the reinforcing filaments; and cooling the towpreg plies in a manner such that substantial cohesion between neighboring towpreg plies is prevented until the matrix forming material solidifies.

Flexible multiply towpreg

NASA Technical Reports Server (NTRS)

Muzzy, John D. (Inventor); Varughese, Babu (Inventor)

1992-01-01

This invention relates to an improved flexible towpreg and a method of production therefor. The improved flexible towpreg comprises a plurality of towpreg plies which comprise reinforcing filaments and matrix forming material; the reinforcing filaments being substantially wetout by the matrix forming material such that the towpreg plies are substantially void-free composite articles, and the towpreg plies having an average thickness less than about 100 microns. The method of production for the improved flexible towpreg comprises the steps of spreading the reinforcing filaments to expose individually substantially all of the reinforcing filaments; coating the reinforcing filaments with the matrix forming material in a manner causing interfacial adhesion of the matrix forming material to the reinforcing filaments; forming the towpreg plies by heating the matrix forming material contacting the reinforcing filaments until the matrix forming material liquifies and coats the reinforcing filaments; and cooling the towpreg plies in a manner such that substantial cohesion between neighboring towpreg plies is prevented until the matrix forming material solidifies.

Estimating the prevalence of female genital mutilation in Portugal.

PubMed

Teixeira, A L; Lisboa, M

2016-10-01

Due to globalized migratory processes, female genital mutilation/cutting (FGM/C) has spread to other countries, including countries in Europe, where, with a few exceptions, it remains a concealed problem. To the authors' knowledge, this is the first national extensive study to estimate the prevalence of FGM/C in Portugal. Prevalence estimation. Using extrapolation of country-of-origin prevalence data and the 2011 Census data, this study estimated: the prevalence of FGM/C in Portugal among women of reproductive age (15-49 years) and among all women aged ≥15 years; and the number of girls aged <15 years living in Portugal who have undergone or will probably undergo FGM/C. It is estimated that 6576 women aged ≥15 years living in Portugal have undergone FGM/C, with cases distributed unevenly throughout the national territory. In addition, it is estimated that 1830 girls aged <15 years living in Portugal have undergone or are likely to undergo FGM/C. This study estimated that more than 6000 women living in Portugal have undergone FGM/C, and many girls remain at risk. These two groups need different types of interventions. Awareness of the number and geographical dispersion of cases of FGM/C will enable more informed and targeted definition of public health policies for protection of females who have undergone or are at risk of undergoing FGM/C. Copyright © 2016 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

Laparoscopic bilateral salpingo-oophorectomy in breast cancer patients after transverse rectus abdominus myocutaneous flap reconstructive surgery.

PubMed

Awtrey, Christopher S; Abu-Rustum, Nadeem R; Disa, Joseph J; Ivy, Joseph J; Kauff, Noah D; Hummer, Amanda J; Barakat, Richard R

2005-12-01

The aim of this study was to describe the feasibility and outcome of laparoscopic risk-reducing salpingo-oophorectomy (RRSO) in patients with a history of breast cancer who previously had undergone a transverse rectus abdominus myocutaneous (TRAM) flap reconstruction. We performed a retrospective review of patients with a history of breast cancer who had undergone laparoscopic RRSO between February 1995 and April 2002. Patients who had undergone TRAM flap reconstructive surgery were compared with patients who had undergone laparoscopic RRSO without prior reconstructive surgery. We identified 102 patients with a history of breast cancer who were candidates for a laparoscopic RRSO during the study period. One hundred one of these patients underwent the procedure, including 10 patients with a history of TRAM flap breast reconstructive surgery. One patient did not undergo the procedure because she was noted to be hypotensive prior to the procedure from her bowel preparation. There were no differences between the groups with or without prior history of TRAM flap reconstruction with respect to body mass index, prior abdominal surgery, menopausal status, or preoperative ultrasound characteristics. Operatively, there was no difference between the groups with respect to estimated blood loss, hospital stay, and intraoperative and postoperative complication rates. The only noted difference between the two groups was the estimated operating time (TRAM group, 91 min; non-TRAM group, 70 min [P<0.01]). Laparoscopic RRSO is safe and feasible in patients who have undergone a prior TRAM flap reconstruction.

Public cardiopulmonary resuscitation training rates and awareness of hands-only cardiopulmonary resuscitation: a cross-sectional survey of Victorians.

PubMed

Bray, Janet E; Smith, Karen; Case, Rosalind; Cartledge, Susie; Straney, Lahn; Finn, Judith

2017-04-01

To provide contemporary Australian data on the public's training in cardiopulmonary resuscitation (CPR) and awareness of hands-only CPR. A cross-sectional telephone survey in April 2016 of adult residents of the Australian state of Victoria was conducted. Primary outcomes were rates of CPR training and awareness of hands-only CPR. Of the 404 adults surveyed (mean age 55 ± 17 years, 59% female, 73% metropolitan residents), 274 (68%) had undergone CPR training. Only 50% (n = 201) had heard of hands-only CPR, with most citing first-aid courses (41%) and media (36%) as sources of information. Of those who had undergone training, the majority had received training more than 5 years previously (52%) and only 28% had received training or refreshed training in the past 12 months. Most received training in a formal first-aid class (43%), and received training as a requirement for work (67%). The most common reasons for not having training were: they had never thought about it (59%), did not have time (25%) and did not know where to learn (15%). Compared to standard CPR, a greater proportion of respondents were willing to provide hands-only CPR for strangers (67% vs 86%, P < 0.001). From an Australian perspective, there is still room for improvement in CPR training rates and awareness of hands-only CPR. Further promotion of hands-only CPR and self-instruction (e.g. DVD kits or online) may see further improvements in CPR training and bystander CPR rates. © 2017 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

Theory and operation of the real-time data acquisition system for the NASA-LaRC differential absorption lidar (DIAL)

NASA Technical Reports Server (NTRS)

Butler, C.

1986-01-01

The improvement of computer hardware and software of the NASA Multipurpose Differential Absorption Lidar (DIAL) system is documented. The NASA DIAL system is undergoing development and experimental deployment at NASA Langley Research Center for the remote measurement of atmospheric trace gas concentrations from ground and aircraft platforms. A viable DIAL system was developed capable of remotely measuring O3 and H2O concentrations from an aircraft platform. Test flights of the DIAL system were successfully performed onboard the NASA Goddard Flight Center Electra aircraft from 1980 to 1985. The DIAL Data Acquisition System has undergone a number of improvements over the past few years. These improvements have now been field tested. The theory behind a real time computer system as it applies to the needs of the DIAL system is discussed. This report is designed to be used as an operational manual for the DIAL DAS.

[Bladder-conserving treatment for bladder cancer: potential of and developments in radiotherapy].

PubMed

Hulshof, Maarten C C M; Pieters, Bradley R; Koning, Caro C E

2013-01-01

The standard treatment for muscle-invasive bladder cancer is surgical removal of the bladder and construction of a neobladder. Recently, important improvements have been made in the potential for bladder-conserving treatment using radiotherapy. External beam radiotherapy has undergone technological improvements, as a result of which it is possible to radiate the tumour more precisely while decreasing radiation to healthy tissue. Radiochemotherapy improves local recurrence-free and overall survival compared with radiotherapy alone. The results of this combined treatment are comparable with those of surgery. Additionally, Dutch radiotherapy departments have collected data in a national database of 1040 selected patients with confined bladder cancer. These patients were treated with external beam radiation, limited surgery and brachytherapy. The 5-year local recurrence-free survival was 75%. Bladder conserving treatment options for muscle-invasive bladder cancer should be discussed during the multidisciplinary meeting.

Current trends in cardiac rehabilitation

PubMed Central

Dafoe, W; Huston, P

1997-01-01

Cardiac rehabilitation can reduce mortality and morbidity for patients with many types of cardiac disease cost-effectively, yet is generally underutilized. Rehabilitation is helpful not only for patients who have had a myocardial infarction but also for those with stable angina or congestive heart failure or those who have undergone myocardial revascularization procedures, a heart transplant or heart valve surgery. The beneficial effects of rehabilitation include a reduction in the rate of death from cardiovascular disease, improved exercise tolerance, fewer cardiac symptoms, improved lipid levels, decreased cigarette smoking, improvement in psychosocial well-being and increased likelihood of return to work. Rehabilitation involves a multidisciplinary team that focuses on education, individually tailored exercise, risk-factor modification and the optimization of functional status and mental health. Current research trends in this area include the evaluation of new secondary-prevention modalities and alternative program options, such as home-based rehabilitation. PMID:9054823

Effect of canard position and wing leading-edge flap deflection on wing buffet at transonic speeds

NASA Technical Reports Server (NTRS)

Gloss, B. B.; Henderson, W. P.; Huffman, J. K.

1974-01-01

A generalized wind-tunnel model, with canard and wing planform typical of highly maneuverable aircraft, was tested. The addition of a canard above the wing chord plane, for the configuration with leading-edge flaps undeflected, produced substantially higher total configuration lift coefficients before buffet onset than the configuration with the canard off and leading-edge flaps undeflected. The wing buffet intensity was substantially lower for the canard-wing configuration than the wing-alone configuration. The low-canard configuration generally displayed the poorest buffet characteristics. Deflecting the wing leading-edge flaps substantially improved the wing buffet characteristics for canard-off configurations. The addition of the high canard did not appear to substantially improve the wing buffet characteristics of the wing with leading-edge flaps deflected.

Hubble Space Telescope: Faint object spectrograph instrument handbook. Version 1.1

NASA Technical Reports Server (NTRS)

Ford, Holland C. (Editor)

1990-01-01

The Faint Object Spectrograph (FOS) has undergone substantial rework since the 1985 FOS Instrument Handbook was published, and we are now more knowledgeable regarding the spacecraft and instrument operations requirements and constraints. The formal system for observation specification has also evolved considerably, as the GTO programs were defined in detail. This supplement to the FOS Instrument Handbook addresses the important aspects of these changes, to facilitate proper selection and specification of FOS observing programs. Since the Handbook was published, the FOS red detector has been replaced twice, first with the best available spare in 1985 (which proved to have a poor, and steadily degrading red response), and later with a newly developed Digicon, which exhibits a high, stable efficiency and a dark-count rate less than half that of its predecessors. Also, the FOS optical train was realigned in 1987-88 to eliminate considerable beam-vignetting losses, and the collimators were both removed and recoated for greater reflectivity. Following the optics and detector rework, the FOS was carefully recalibrated (although only ambient measurements were possible, so the far-UV characteristics could not be re-evaluated directly). The resulting efficiency curves, including improved estimates of the telescope throughput, are shown. A number of changes in the observing-mode specifications and addition of several optional parameters resulted as the Proposal Instructions were honed during the last year. Target-brightness limitations, which have only recently been formulated carefully, are described. Although these restrictions are very conservative, it is imperative that the detector safety be guarded closely, especially during the initial stages of flight operations. Restrictions on the use of the internal calibration lamps and aperture-illumination sources (TA LEDs), also resulting from detector safety considerations, are outlined. Finally, many changes have been made to the instructions for target acquisition specification.

Simulated ward round: reducing costs, not outcomes.

PubMed

Ford, Helen; Cleland, Jennifer; Thomas, Ian

2017-02-01

Distractions and interruptions on the ward pose substantial patient safety risks, but medical students receive little training on their management. Although there is some evidence that medical students can be taught how to manage distractions and interruptions in a simulated ward environment, the only model to date is based on individual feedback, which is resource-expensive, mitigating curricular integration. Our aim was to assess the educational utility of a cost-efficient approach to a patient safety-focused simulated ward round. Twenty-three of 55 final-year medical students took part in a cost-reduced simulated ward round. Costs were minimised by providing group rather than individualised feedback, thereby shortening the duration of each simulation and reducing the number of interruptions. The utility of the simulation was assessed via student evaluation and performance on a patient safety station of an objective structured clinical examination (OSCE). The direct costs of the simulation were more than 50 per cent lower per student compared with the original study, mostly as a result of a reduction in the time that faculty members took to give feedback. Students managed distractions better and received higher scores in the OSCE station than those who had not undergone the ward round. Group feedback was evaluated positively by most participants: 94 per cent of those who provided feedback agreed or strongly agreed that the simulation would make them a safer doctor and would improve their handling of distractions. Our aim was to assess the educational utility of a cost-efficient approach to a patient safety-focused simulated ward round DISCUSSION: The costs of a simulated ward round can be significantly reduced whilst maintaining educational utility. These findings should encourage medical schools to integrate ward simulation into curricula. © 2016 John Wiley & Sons Ltd.

Effect of automated tube voltage selection, integrated circuit detector and advanced iterative reconstruction on radiation dose and image quality of 3rd generation dual-source aortic CT angiography: An intra-individual comparison.

PubMed

Mangold, Stefanie; De Cecco, Carlo N; Wichmann, Julian L; Canstein, Christian; Varga-Szemes, Akos; Caruso, Damiano; Fuller, Stephen R; Bamberg, Fabian; Nikolaou, Konstantin; Schoepf, U Joseph

2016-05-01

To compare, on an intra-individual basis, the effect of automated tube voltage selection (ATVS), integrated circuit detector and advanced iterative reconstruction on radiation dose and image quality of aortic CTA studies using 2nd and 3rd generation dual-source CT (DSCT). We retrospectively evaluated 32 patients who had undergone CTA of the entire aorta with both 2nd generation DSCT at 120kV using filtered back projection (FBP) (protocol 1) and 3rd generation DSCT using ATVS, an integrated circuit detector and advanced iterative reconstruction (protocol 2). Contrast-to-noise ratio (CNR) was calculated. Image quality was subjectively evaluated using a five-point scale. Radiation dose parameters were recorded. All studies were considered of diagnostic image quality. CNR was significantly higher with protocol 2 (15.0±5.2 vs 11.0±4.2; p<.0001). Subjective image quality analysis revealed no significant differences for evaluation of attenuation (p=0.08501) but image noise was rated significantly lower with protocol 2 (p=0.0005). Mean tube voltage and effective dose were 94.7±14.1kV and 6.7±3.9mSv with protocol 2; 120±0kV and 11.5±5.2mSv with protocol 1 (p<0.0001, respectively). Aortic CTA performed with 3rd generation DSCT, ATVS, integrated circuit detector, and advanced iterative reconstruction allow a substantial reduction of radiation exposure while improving image quality in comparison to 120kV imaging with FBP. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Testing for Human Immunodeficiency Virus Among Cancer Survivors Under Age 65 in the United States

PubMed Central

Thompson, Trevor D.; Tai, Eric; Zhao, Guixiang; Oster, Alexandra M.

2014-01-01

Introduction Knowing the human immunodeficiency virus (HIV) serostatus of patients at the time of cancer diagnosis or cancer recurrence is prerequisite to coordinating HIV and cancer treatments and improving treatment outcomes. However, there are no published data about HIV testing among cancer survivors in the United States. We sought to provide estimates of the proportion of cancer survivors tested for HIV and to characterize factors associated with having had HIV testing. Methods We used data from the 2009 Behavioral Risk Factor Surveillance System to calculate the proportion of cancer survivors under age 65 who had undergone HIV testing, by demographic and health-related factors and by state. Adjusted proportion estimates were calculated by multivariable logistic regression. Results Only 41% of cancer survivors in the United States under the age of 65 reported ever having had an HIV test. The highest proportion of survivors tested was among patients aged 25 to 34 years (72.2%), non-Hispanic blacks (59.5%), and cervical cancer survivors (51.2%). The proportion tested was highest in the District of Columbia (68.3%) and lowest in Nebraska (24.1%). Multivariable analysis showed that factors associated with HIV testing included being non-Hispanic black or Hispanic, being younger, having higher education, not being married or living with a partner, not being disabled, and having medical cost concerns. Having an AIDS-related cancer was associated with HIV testing only among females. Conclusion The proportions of HIV testing varied substantially by demographic and health-related factors and by state. Our study points to the need for public health interventions to promote HIV testing among cancer survivors. PMID:25393748

Reliability of a visual scoring system with fluorescent tracers to assess dermal pesticide exposure.

PubMed

Aragon, Aurora; Blanco, Luis; Lopez, Lylliam; Liden, Carola; Nise, Gun; Wesseling, Catharina

2004-10-01

We modified Fenske's semi-quantitative 'visual scoring system' of fluorescent tracer deposited on the skin of pesticide applicators and evaluated its reproducibility in the Nicaraguan setting. The body surface of 33 farmers, divided into 31 segments, was videotaped in the field after spraying with a pesticide solution containing a fluorescent tracer. A portable UV lamp was used for illumination in a foldaway dark room. The videos of five farmers were randomly selected. The scoring was based on a matrix with extension of fluorescent patterns (scale 0-5) on the ordinate and intensity (scale 0-5) on the abscissa, with the product of these two ranks as the final score for each body segment (0-25). Five medical students rated and evaluated the quality of 155 video images having undergone 4 h of training. Cronbach alpha coefficients and two-way random effects intraclass correlation coefficients (ICC) with absolute agreement were computed to assess inter-rater reliability. Consistency was high (Cronbach alpha = 0.96), but the scores differed substantially between raters. The overall ICC was satisfactory [0.75; 95% confidence interval (CI) = 0.62-0.83], but it was lower for intensity (0.54; 95% CI = 0.40-0.66) and higher for extension (0.80; 95% CI = 0.71-0.86). ICCs were lowest for images with low scores and evaluated as low quality, and highest for images with high scores and high quality. Inter-rater reliability coefficients indicate repeatability of the scoring system. However, field conditions for recording fluorescence should be improved to achieve higher quality images, and training should emphasize a better mechanism for the reading of body areas with low contamination.

Rapid advance and retreat over centennial/millennial timescales at Kangiata Nunaata Sermia, SW Greenland - implications for modelling, and behaviour of tidewater glaciers

NASA Astrophysics Data System (ADS)

Lea, J.; Mair, D. W.; Rea, B. R.; Schofield, J.; Kamenos, N.; Pearce, D.; Schoenrock, K. M.

2017-12-01

While the Greenland Ice Sheet has undergone significant retreat over the last 80 years, our understanding of the ice sheet's response to climate forcing over centennial to millennial timescales is poorly constrained. Knowledge of marine glacier outlets over these timescales would provide crucial information regarding longer term ice sheet dynamics, beyond instrumental and historical records. It is notably difficult to constrain such histories for these glaciers due to: (i) a highly dynamic ice front environment in combination with the Little Ice Age advance(s) destroying much of the preceding evidence for glacier change; (ii) often poor landform/sediment preservation due to steep sided fjords; (iii) the areas with greatest preservation potential, the fjords bottoms, being submarine and often ice choked, and therefore non-trivial to survey, and sample. The tidewater glacier Kangiata Nunaata Sermia (KNS), SW Greenland provides an exception to this. Here we present a record of >22km of terminus advance and retreat spanning the last 1000 years using a combination of geomorphological, sedimentological and archaeological evidence. This timescale includes periods of substantial warming and cooling of air temperatures that appear to correspond to periods of advance and retreat. Results also suggest that the average advance rates in the early part of the millennium (110 m a-1) are of a similar magnitude to contemporary retreat rates observed around Greenland. The results generated here provide an ideal opportunity to validate the performance of numerical models (notably those that include calving) over centennial timescales. Evaluating model performance against the past behaviour of KNS could therefore lead to significant improvements in the confidence of ice sheet change projections up to 2100 and beyond.

Long-Term Follow-Up Study of Temporary Tricuspid Valve Detachment as Approach to VSD Repair without Consequent Tricuspid Dysfunction.

PubMed

Lucchese, Gianluca; Rossetti, Lucia; Faggian, Giuseppe; Luciani, Giovanni B

2016-10-01

Temporary tricuspid valve detachment improves the operative view of certain congenital ventricular septal defects (VSDs), but its long-term effects on tricuspid valve function are still debated. From 2002 through 2012, we performed a prospective study of 68 children (mean age, 1.28 ± 1.01 yr) who underwent transatrial closure of VSDs following temporary tricuspid valve detachment. Sixty patients had conoventricular and 8 had mid-muscular VSDs. All were in sinus rhythm. Seventeen patients had systemic pulmonary artery pressures. Preoperative echocardiograms showed trivial-to-mild tricuspid regurgitation in 62 patients and tricuspid dysplasia with severe regurgitation in 6 patients. Patients were clinically and echocardiographically monitored at 30 postoperative days, 3 months, 6 months, every 6 months thereafter for the first 2 years, and then once a year. No in-hospital or late death was observed at the median follow-up evaluation of 5.9 years. Mean intensive care unit and hospital stays were 1.6 ± 1.1 and 7.3 ± 2.7 days, respectively. Residual small VSDs occurred in 3 patients, and temporary atrioventricular block in one. After VSD repair, 62 patients (91%) had trivial or mild tricuspid regurgitation, and 6 moderate. Five of these last had severe tricuspid regurgitation preoperatively and had undergone additional tricuspid valve repair during the procedure. The grade of residual tricuspid regurgitation remained stable postoperatively, and no tricuspid stenosis was documented. All patients were in New York Heart Association class I at follow-up. Temporary tricuspid valve detachment is a simple and useful method for a complete visualization of certain VSDs without incurring substantial tricuspid dysfunction.

Long-Term Follow-Up Study of Temporary Tricuspid Valve Detachment as Approach to VSD Repair without Consequent Tricuspid Dysfunction

PubMed Central

Rossetti, Lucia; Faggian, Giuseppe; Luciani, Giovanni B.

2016-01-01

Temporary tricuspid valve detachment improves the operative view of certain congenital ventricular septal defects (VSDs), but its long-term effects on tricuspid valve function are still debated. From 2002 through 2012, we performed a prospective study of 68 children (mean age, 1.28 ± 1.01 yr) who underwent transatrial closure of VSDs following temporary tricuspid valve detachment. Sixty patients had conoventricular and 8 had mid-muscular VSDs. All were in sinus rhythm. Seventeen patients had systemic pulmonary artery pressures. Preoperative echocardiograms showed trivial-to-mild tricuspid regurgitation in 62 patients and tricuspid dysplasia with severe regurgitation in 6 patients. Patients were clinically and echocardiographically monitored at 30 postoperative days, 3 months, 6 months, every 6 months thereafter for the first 2 years, and then once a year. No in-hospital or late death was observed at the median follow-up evaluation of 5.9 years. Mean intensive care unit and hospital stays were 1.6 ± 1.1 and 7.3 ± 2.7 days, respectively. Residual small VSDs occurred in 3 patients, and temporary atrioventricular block in one. After VSD repair, 62 patients (91%) had trivial or mild tricuspid regurgitation, and 6 moderate. Five of these last had severe tricuspid regurgitation preoperatively and had undergone additional tricuspid valve repair during the procedure. The grade of residual tricuspid regurgitation remained stable postoperatively, and no tricuspid stenosis was documented. All patients were in New York Heart Association class I at follow-up. Temporary tricuspid valve detachment is a simple and useful method for a complete visualization of certain VSDs without incurring substantial tricuspid dysfunction. PMID:27777518

[Identification of circulatory diseases and their risk during medical examination of an adult population: methodological aspects].

PubMed

Kalinina, A M; Ipatov, P V; Kaminskaya, A K; Kushunina, D V

2015-01-01

To study the efficiency of a methodology for the active detection of coronary heart disease (CHD) and cerebrovascular diseases (CVD) during medical examination and to determine the need and possible ways of its improvement. The medical examinations of 19.4 million people (94.6% of all the citizens who had undergone medical examinations in all the regions of Russia in 2013) were analyzed and the methodological aspects of identification of the circulatory diseases (CDs) that were induced by coronary and cerebral vessel atherosclerosis and had common risk factors, primarily CHD and CVD, were assessed. The medical examinations revealed 2,915,445 cases of CDs and their suspicions, during which its clinical diagnosis was established in 57.2%. The suspected disease requiring that its diagnosis should be further specified; off-medical examinations revealed hypertension in more than 770,000 cases, CHD in 232,000, and CVD in 146,000. The proportion of stable angina pectoris of all angina cases was much higher at a young age (25.6%) than at middle (15.6%) and elderly (11.3%) ages. Brachiocephalic artery stenoses were detected in almost 13,000 cases. According to the official health statistics, within the years preceding the introduction of large-scale medical examinations, there was a slight rise in new CD cases among the adult population of Russia, which was more significant in 2013 (according to the preliminary data) than in 2012. The methodology for the active detection of CDs through a two-step medical examination, which is used during a follow-up, makes it possible to substantially increase detection rates for CDs. There has been shown to be a need for the better quality and completeness of diagnostic examination in real practice.

The Immediacy of Arctic Change: New 2016-17 Extremes

NASA Astrophysics Data System (ADS)

Overland, J. E.; Kattsov, V.; Olsen, M. S.; Walsh, J. E.

2017-12-01

Additional recent observations add increased certainty to cryospheric Arctic changes, and trends are very likely to continue past mid-century. Observed and projected Arctic changes are large compared with those at mid-latitude, driven by greenhouse gas (GHG) increase and Arctic feedbacks. Sea ice has undergone a regime shift from mostly multi-year to first-year sea ice, and summer sea ice is likely to be esentially gone within the next few decades. Spring snow cover is decreasing, and Arctic greening is increasing, although somewhat variable. There are potential emerging impacts of Arctic change on mid-latitude weather and sea level rise. Model assessments under different future GHG concentration scenarios show that stabilizing global temperatures near 2° C compliant with Paris agreement could slow, but not halt further major changes in the Arctic before mid- 21st century; foreseeable Arctic temperature changes are 4-5° C for fall/winter by 2040-2050. Substantial and immediate mitigation reductions in GHG emissions (at least at the level of the RCP 4.5 emission scenario) should reduce the risk of further change for most cryospheric components after mid-century, and reduce the likelyhood of potential runaway loss of ice sheets and glaciers and their impact on sea level rise. Extreme winter 2016 Arctic temperatures and a large winter 2017 sea ice deficit demonstrate contemporary climate states outside the envelope of previous experience. While there is confidence in the sign of Arctic changes, recent observations increase uncertainty in projecting the rate for future real world scenarios. Do events return to mean conditions, represent irreversible changes, or contribute to accelerating trends beyond those provided by climate models? Such questions highlight the need for improved quantitative prediction of the cryosphere and its global impacts, crucial for adaptation actions and risk management at local to global scales.

The Impact of COPD on Management and Outcomes of Patients Hospitalized With Acute Myocardial Infarction

PubMed Central

Bannuru, Raveendhara R.; Lessard, Darleen; Gore, Joel M.; Lindenauer, Peter K.; Goldberg, Robert J.

2012-01-01

Background: There are limited data describing contemporary trends in the management and outcomes of patients with COPD who develop acute myocardial infarction (AMI). Methods: The study population consisted of patients hospitalized with AMI at all greater Worcester, Massachusetts, medical centers between 1997 and 2007. Results: Of the 6,290 patients hospitalized with AMI, 17% had a history of COPD. Patients with COPD were less likely to be treated with β-blockers or lipid-lowering therapy or to have undergone interventional procedures during their index hospitalization than patients without COPD. Patients with COPD were at higher risk for dying during hospitalization (13.5% vs 10.1%) and at 30 days after discharge (18.7% vs 13.2%), and their outcomes did not improve during the decade-long period under study. After multivariable adjustment, the adverse effects of COPD remained on both in-hospital (OR, 1.25; 95% CI, 0.99-1.50) and 30-day all-cause mortality (OR, 1.31; 95% CI, 1.10-1.58). The use of evidence-based therapies for all patients with AMI increased between 1997 and 2007, with a particularly marked increase for patients with COPD. Conclusions: Our results suggest that the gap in medical care between patients with and without COPD hospitalized with AMI narrowed substantially between 1997 and 2007. Patients with COPD, however, remain less aggressively treated and are at increased risk for hospital adverse outcomes than patients without COPD in the setting of AMI. Careful consideration is necessary to ensure that these high-risk complex patients are not denied the benefits of effective cardiac therapies. PMID:22207679

Very Low-mass Stars and Brown Dwarfs in Upper Scorpius Using Gaia DR1: Mass Function, Disks, and Kinematics

NASA Astrophysics Data System (ADS)

Cook, Neil J.; Scholz, Aleks; Jayawardhana, Ray

2017-12-01

Our understanding of the brown dwarf population in star-forming regions is dependent on knowing distances and proper motions and therefore will be improved through the Gaia space mission. In this paper, we select new samples of very low-mass objects (VLMOs) in Upper Scorpius using UKIDSS colors and optimized proper motions calculated using Gaia DR1. The scatter in proper motions from VLMOs in Upper Scorpius is now (for the first time) dominated by the kinematic spread of the region itself, not by the positional uncertainties. With age and mass estimates updated using Gaia parallaxes for early-type stars in the same region, we determine masses for all VLMOs. Our final most complete sample includes 453 VLMOs of which ˜125 are expected to be brown dwarfs. The cleanest sample is comprised of 131 VLMOs, with ˜105 brown dwarfs. We also compile a joint sample from the literature that includes 415 VLMOs, out of which 152 are likely brown dwarfs. The disk fraction among low-mass brown dwarfs (M< 0.05 {M}⊙ ) is substantially higher than in more massive objects, indicating that disks around low-mass brown dwarfs survive longer than in low-mass stars overall. The mass function for 0.01< M< 0.1 {M}⊙ is consistent with the Kroupa Initial Mass Function. We investigate the possibility that some “proper motion outliers” have undergone a dynamical ejection early in their evolution. Our analysis shows that the color-magnitude cuts used when selecting samples introduce strong bias into the population statistics due to varying levels of contamination and completeness.

Effect of processing on nutrients and fatty acid composition of garden cress (Lepidium sativum) seeds.

PubMed

Jain, Tanu; Grover, Kiran; Kaur, Gurpreet

2016-12-15

Garden cress seeds were undergone for different processing methods and analyzed for its nutritional composition. Effect of processing on nutrient retention was evaluated to attain the best processed form of seeds with maximum amount of nutrients. Soaking improved protein and ash by 2.10 and 2.48 percent respectively. Boiling improved fat and fibre by 1.66 and 8.32 percent respectively. Maximum retention of iron and zinc was found with roasting. It also improved calcium by 3.18 percent. Percent ionizable iron and bioavailability was found maximum with boiling (13.59 and 6.88% respectively). In vitro starch and protein digestibility were found maximum on boiling (57.98 and 32.39% respectively) with a decrease of 9.65 and 14.13 percent in phytin phosphorus and oxalate respectively. Amino acids and fatty acids were decreased with heat treatment and maximum retention was found with soaking. Overall improvement in nutrient composition and maximum nutrient retention was found with boiling method. Copyright © 2016 Elsevier Ltd. All rights reserved.

Assessment of Interradiologist Agreement Regarding Mammographic Breast Density Classification Using the Fifth Edition of the BI-RADS Atlas.

PubMed

Ekpo, Ernest U; Ujong, Ujong Peter; Mello-Thoms, Claudia; McEntee, Mark F

2016-05-01

The objective of the present study was to assess interradiologist agreement regarding mammographic breast density assessment performed using the rating scale outlined in the fifth edition of the BI-RADS atlas of the American College of Radiology. Breast density assessments of 1000 cases were conducted by five radiologists from the same institution who together had recently undergone retraining in mammographic breast density classification based on the fifth edition of BI-RADS. The readers assigned breast density grades (A-D) on the basis of the BI-RADS classification scheme. Repeat assessment of 100 cases was performed by all readers 1 month after the initial assessment. A weighted kappa was used to calculate intrareader and interreader agreement. Intrareader agreement ranged from a kappa value of 0.86 (95% CI, 0.77-0.93) to 0.89 (95% CI, 0.81-0.95) on a four-category scale (categories A-D) and from 0.89 (95% CI, 0.86-0.92) to 0.94 (95% CI, 0.89-0.97) on a two-category scale (category A-B vs category C-D). Interreader agreement ranged from substantial (κ = 0.76; 95% CI, 0.73-0.78) to almost perfect (κ = 0.87; 95% CI, 0.86-0.89) on a four-category scale, and the overall weighted kappa value was substantial (0.79; 95% CI, 0.78-0.83). Interreader agreement on a two-category scale ranged from a kappa value of 0.85 (95% CI, 0.83-0.86) to 0.91 (95% CI, 0.90-0.92), and the overall weighted kappa was 0.88 (95% CI, 0.87-0.89). Overall, with regard to mammographic breast density classification, radiologists had substantial interreader agreement when a four-category scale was used and almost perfect interreader agreement when a dichotomous scale was used.

Core Community Specifications for Electron Microprobe Operating Systems: Software, Quality Control, and Data Management Issues

NASA Technical Reports Server (NTRS)

Fournelle, John; Carpenter, Paul

2006-01-01

Modem electron microprobe systems have become increasingly sophisticated. These systems utilize either UNIX or PC computer systems for measurement, automation, and data reduction. These systems have undergone major improvements in processing, storage, display, and communications, due to increased capabilities of hardware and software. Instrument specifications are typically utilized at the time of purchase and concentrate on hardware performance. The microanalysis community includes analysts, researchers, software developers, and manufacturers, who could benefit from exchange of ideas and the ultimate development of core community specifications (CCS) for hardware and software components of microprobe instrumentation and operating systems.

Advanced fighter technology integration (AFTI)/F-16 Automated Maneuvering Attack System final flight test results

NASA Technical Reports Server (NTRS)

Dowden, Donald J.; Bessette, Denis E.

1987-01-01

The AFTI F-16 Automated Maneuvering Attack System has undergone developmental and demonstration flight testing over a total of 347.3 flying hours in 237 sorties. The emphasis of this phase of the flight test program was on the development of automated guidance and control systems for air-to-air and air-to-ground weapons delivery, using a digital flight control system, dual avionics multiplex buses, an advanced FLIR sensor with laser ranger, integrated flight/fire-control software, advanced cockpit display and controls, and modified core Multinational Stage Improvement Program avionics.

More Learning in Less Time: Optimizing the Resident Educational Experience with Limited Clinical and Educational Work Hours.

PubMed

Sedney, Cara L; Spirou, Eleni; Voelker, Joseph L; Rosen, Charles L

2017-11-01

Resident education in the United States and elsewhere has undergone significant changes in recent years owing to work hour restrictions, requiring didactics to fit within a limited schedule, while being increasingly effective at accomplishing educational goals. A single small program experience in improving the didactic experience of residents is described. Focused mentorship, curricula for intangibles, asynchronous education, and independent curricula all are useful tools in resident education. Residents can be exposed to both clinical material and specialty-specific mores using focused and intentional educational techniques. Copyright © 2017 Elsevier Inc. All rights reserved.

The relationship between addictions and bariatric surgery for nurses in recovery.

PubMed

Fogger, Susanne A; McGuinness, Teena M

2012-01-01

Determinants of morbid obesity are complex and numerous, yet understanding the neurobiological underpinnings improves our knowledge of this serious issue. Emerging science supports a comparison of disordered eating with other addictive substances. The study used a sub-analysis of a cross-sectional study of nurses in a state-monitoring program. A study of 173 participants in a state-monitoring program for impaired nurses revealed that 14% (n= 25) had undergone bariatric surgery. Of these, 17 developed an addiction after surgery. Evidence suggests that some individuals may require additional treatment, similar to those with pharmacological addictions. © 2011 Wiley Periodicals, Inc.

GYC: A program to compute the turbulent boundary layer on a rotating cone

NASA Technical Reports Server (NTRS)

Sullivan, R. D.

1976-01-01

A computer program, GYC, which is capable of computing the properties of a compressible turbulent boundary layer on a rotating axisymmetric cone-cylinder body, according to the principles of invariant modeling was studied. The program is extended to include the calculation of the turbulence scale by a differential equation. GYC is in operation on the CDC-7600 computer and has undergone several corrections and improvements as a result of the experience gained. The theoretical basis for the program and the method of implementation, as well as information on its operation are given.

A retrospective analysis of 34 potentially missed cases of female genital mutilation in the emergency department.

PubMed

Fawcett, Richard John; Kernohan, George

2017-09-12

To discover if healthcare professionals working within an ED are able to make a diagnosis of female genital mutilation (FGM) in those patients who have previously undergone the procedure and report it as per UK law. A retrospective analysis of patients' notes who were assigned an FGM code during the period of May 2015 to August 2016. Single-centre, large UK major trauma centre offering a tertiary FGM clinic. Any woman coded during the study period as having undergone FGM. Number of FGM cases identified by the ED. Mean age, presenting complaint, discharge diagnosis, genitourinary exam and defibulation status. 34 patients were identified as having undergone FGM, 19 had previously attended ED and none had their FGM identified during their ED attendance. The age range of those identified was 23 to 40 years. None had undergone defibulation. This study demonstrates that the identification of FGM victims by an ED is very poor, and more work needs to be done to increase awareness of the subject by front-line staff. © 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.

Nanoscale heterogeneity as remnant hexagonal-type local structures in shocked Cu-Pb and Zr

NASA Astrophysics Data System (ADS)

Tayal, Akhil; Conradson, Steven D.; Batuk, Olga N.; Fensin, Saryu; Cerreta, Ellen; Gray, George T.; Saxena, Avadh

2017-09-01

Extended X-ray absorption fine structure spectroscopy was used to determine the local structure in: (1) Zr that had undergone quasistatic elongation; (2) Zr that had undergone plastic deformation by shock at pressures above and below the ω-phase transformation; and (3) shocked Cu that contained a few percent of insoluble Pb. Below the transition pressure, Zr samples showed only general disorder as increases in the widths of the Zr-Zr pair distributions. Above this pressure, Zr that was a mixture of the original hcp and the high pressure ω-phase when measured by diffraction showed two sets of peaks in its distribution corresponding to these two phases. Some of the ones from the ω-phase were at distances substantially different from those calculated from the diffraction pattern, although they are still consistent with small domains exhibiting stacking faults associated with hexagonal-type structural components exhibiting variability in the [0001] basal plane spacing. A similar result, new pairs at just over 3 and 4 Å consistent with hexagonal-type stacking faults in addition to the original fcc structure, is found in shocked Cu despite the absence of a second diffraction pattern and peak pressures being far below those expected to induce an fcc to hcp transition. This result, therefore, demonstrates that the correlation between high strain rates and reduced stacking fault energy continues down to the length scale of atom pairs. These findings are significant as: (1) a microscopic description of the behavior of systems far from equilibrium; (2) a demonstration of the importance of strain rate at short length scales; and (3) a bridge between the abruptness of macroscopic pressure-induced phase transitions and the continuity of martensitic ones over their fluctuation region in terms of the inverse relationship between the length scale of the martensitic texture, manifested here as ordered lattice distortions and the lower pressure at which such texture first appears relative to the bulk transition pressure.

Meaningful improvement in gait speed in hip fracture recovery.

PubMed

Alley, Dawn E; Hicks, Gregory E; Shardell, Michelle; Hawkes, William; Miller, Ram; Craik, Rebecca L; Mangione, Kathleen K; Orwig, Denise; Hochberg, Marc; Resnick, Barbara; Magaziner, Jay

2011-09-01

To estimate meaningful improvements in gait speed observed during recovery from hip fracture and to evaluate the sensitivity and specificity of gait speed changes in detecting change in self-reported mobility. Secondary longitudinal data analysis from two randomized controlled trials Twelve hospitals in the Baltimore, Maryland, area. Two hundred seventeen women admitted with hip fracture. Usual gait speed and self-reported mobility (ability to walk 1 block and climb 1 flight of stairs) measured 2 and 12 months after fracture. Effect size-based estimates of meaningful differences were 0.03 for small differences and 0.09 for substantial differences. Depending on the anchor (stairs vs walking) and method (mean difference vs regression), anchor-based estimates ranged from 0.10 to 0.17 m/s for small meaningful improvements and 0.17 to 0.26 m/s for substantial meaningful improvement. Optimal gait speed cutpoints yielded low sensitivity (0.39-0.62) and specificity (0.57-0.76) for improvements in self-reported mobility. Results from this sample of women recovering from hip fracture provide only limited support for the 0.10-m/s cut point for substantial meaningful change previously identified in community-dwelling older adults experiencing declines in walking abilities. Anchor-based estimates and cut points derived from receiver operating characteristic curve analysis suggest that greater improvements in gait speed may be required for substantial perceived mobility improvement in female hip fracture patients. Furthermore, gait speed change performed poorly in discriminating change in self-reported mobility. Estimates of meaningful change in gait speed may differ based on the direction of change (improvement vs decline) or between patient populations. © 2011, Copyright the Authors. Journal compilation © 2011, The American Geriatrics Society.

Meaningful Improvement in Gait Speed in Hip Fracture Recovery

PubMed Central

Alley, Dawn E.; Hicks, Gregory E.; Shardell, Michelle; Hawkes, William; Miller, Ram; Craik, Rebecca L.; Mangione, Kathleen K.; Orwig, Denise; Hochberg, Marc; Resnick, Barbara; Magaziner, Jay

2011-01-01

OBJECTIVES To estimate meaningful improvements in gait speed observed during recovery from hip fracture and to evaluate the sensitivity and specificity of gait speed changes in detecting change in self-reported mobility. DESIGN Secondary longitudinal data analysis from two randomized controlled trials SETTING Twelve hospitals in the Baltimore, Maryland, area. PARTICIPANTS Two hundred seventeen women admitted with hip fracture. MEASUREMENTS Usual gait speed and self-reported mobility (ability to walk 1 block and climb 1 flight of stairs) measured 2 and 12 months after fracture. RESULTS Effect size–based estimates of meaningful differences were 0.03 for small differences and 0.09 for substantial differences. Depending on the anchor (stairs vs walking) and method (mean difference vs regression), anchor-based estimates ranged from 0.10 to 0.17 m/s for small meaningful improvements and 0.17 to 0.26 m/s for substantial meaningful improvement. Optimal gait speed cut-points yielded low sensitivity (0.39–0.62) and specificity (0.57–0.76) for improvements in self-reported mobility. CONCLUSION Results from this sample of women recovering from hip fracture provide only limited support for the 0.10-m/s cut point for substantial meaningful change previously identified in community-dwelling older adults experiencing declines in walking abilities. Anchor-based estimates and cut points derived from receiver operating characteristic curve analysis suggest that greater improvements in gait speed may be required for substantial perceived mobility improvement in female hip fracture patients. Furthermore, gait speed change performed poorly in discriminating change in self-reported mobility. Estimates of meaningful change in gait speed may differ based on the direction of change (improvement vs decline) or between patient populations. PMID:21883109

The mechanism of diabetes control after gastrointestinal bypass surgery reveals a role of the proximal small intestine in the pathophysiology of type 2 diabetes.

PubMed

Rubino, Francesco; Forgione, Antonello; Cummings, David E; Vix, Michel; Gnuli, Donatella; Mingrone, Geltrude; Castagneto, Marco; Marescaux, Jacques

2006-11-01

Most patients who undergo Roux-en-Y gastric bypass (RYGB) experience rapid resolution of type 2 diabetes. Prior studies indicate that this results from more than gastric restriction and weight loss, implicating the rearranged intestine as a primary mediator. It is unclear, however, if diabetes improves because of enhanced delivery of nutrients to the distal intestine and increased secretion of hindgut signals that improve glucose homeostasis, or because of altered signals from the excluded segment of proximal intestine. We sought to distinguish between these two mechanisms. Goto-Kakizaki (GK) type 2 diabetic rats underwent duodenal-jejunal bypass (DJB), a stomach-preserving RYGB that excludes the proximal intestine, or a gastrojejunostomy (GJ), which creates a shortcut for ingested nutrients without bypassing any intestine. Controls were pair-fed (PF) sham-operated and untreated GK rats. Rats that had undergone GJ were then reoperated to exclude the proximal intestine; and conversely, duodenal passage was restored in rats that had undergone DJB. Oral glucose tolerance (OGTT), food intake, body weight, and intestinal nutrient absorption were measured. There were no differences in food intake, body weight, or nutrient absorption among surgical groups. DJB-treated rats had markedly better oral glucose tolerance compared with all control groups as shown by lower peak and area-under-the-curve glucose values (P < 0.001 for both). GJ did not affect glucose homeostasis, but exclusion of duodenal nutrient passage in reoperated GJ rats significantly improved glucose tolerance. Conversely, restoration of duodenal passage in DJB rats reestablished impaired glucose tolerance. This study shows that bypassing a short segment of proximal intestine directly ameliorates type 2 diabetes, independently of effects on food intake, body weight, malabsorption, or nutrient delivery to the hindgut. These findings suggest that a proximal intestinal bypass could be considered for diabetes treatment and that potentially undiscovered factors from the proximal bowel might contribute to the pathophysiology of type 2 diabetes.

Effect of Whole Pelvic Radiotherapy for Patients With Locally Advanced Prostate Cancer Treated With Radiotherapy and Long-Term Androgen Deprivation Therapy

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

Mantini, Giovanna; Tagliaferri, Luca, E-mail: luca.tagliaferri@rm.unicatt.it; Mattiucci, Gian Carlo

2011-12-01

Purpose: To evaluate the effect of whole pelvic radiotherapy (WPRT) in prostate cancer patients treated with RT and long-term (>1 year) androgen deprivation therapy (ADT). Methods and materials: Prostate cancer patients with high-risk features (Stage T3-T4 and/or Gleason score {>=}7 and/or prostate-specific antigen level {>=}20 ng/mL) who had undergone RT and long-term ADT were included in the present analysis. Patients with bowel inflammatory disease, colon diverticula, and colon diverticulitis were excluded from WPRT and treated with prostate-only radiotherapy (PORT). Patients were grouped according to nodal risk involvement as assessed by the Roach formula using different cutoff levels (15%, 20%, 25%,more » and 30%). Biochemical disease-free survival (bDFS) was analyzed in each group according to the RT type (WPRT or PORT). Results: A total of 358 patients treated between 1994 and 2007 were included in the analysis (46.9% with WPRT and 53.1% with PORT). The median duration of ADT was 24 months (range, 12-38). With a median follow-up of 52 months (range, 20-150), the overall 4-year bDFS rate was 90.5%. The 4-year bDFS rate was similar between the patients who had undergone WPRT or PORT (90.4% vs. 90.5%; p = NS). However, in the group of patients with the greatest nodal risk (>30%), a significant bDFS improvement was recorded for the patients who had undergone WPRT (p = .03). No differences were seen in acute toxicity among the patients treated with WPRT or PORT. The late gastrointestinal toxicity was similar in patients treated with PORT or WPRT (p = NS). Conclusions: Our analysis has supported the use of WPRT in association with long-term ADT for patients with high-risk nodal involvement (>30%), although a definitive recommendation should be confirmed by a randomized trial.« less

Physical function and pain after surgical or conservative management of multiple rib fractures - a follow-up study.

PubMed

Fagevik Olsén, Monika; Slobo, Margareta; Klarin, Lena; Caragounis, Eva-Corina; Pazooki, David; Granhed, Hans

2016-10-28

There is scarce knowledge of physical function and pain due to multiple rib fractures following trauma. The purpose of this follow-up was to assess respiratory and physical function, pain, range of movement and kinesiophobia in patients with multiple rib fractures who had undergone stabilizing surgery and compare with conservatively managed patients. A consecutive series of 31 patients with multiple rib fractures who had undergone stabilizing surgery were assessed >1 year after the trauma concerning respiratory and physical function, pain, range of movement in the shoulders and thorax, shoulder function and kinesiophobia. For comparison, 30 patients who were treated conservatively were evaluated with the same outcome measures. The results concerning pain, lung function, shoulder function and level of physical activity were similar in the two groups. The patients who had undergone surgery had a significantly larger range of motion in the thorax (p < 0.01) and less deterioration in two items in Disability Rating Index (sitting and standing bent over a sink) (p < 0.05). It is questionable whether the control group is representative since the majority of patients were invited but refused to participate in the follow-up. In addition, this study is too small to make a definitive conclusion if surgery is better than conservative treatment. But we see some indications, such as a tendency for decreased pain, better thoracic range of motion and physical function which would indicate that surgery is preferable. If operation technique could improve in the future with a less invasive approach, it would presumably decrease post-operative pain and the benefit of surgery would be greater than the morbidity of surgery. Patients undergoing surgery have a similar long-term recovery to those who are treated conservatively except for a better range of motion in the thorax and fewer limitations in physical function. Surgery seems to be beneficial for some patients, the question remains which patients. FoU i Sverige (R&D in Sweden), No 106121.

No more broken hearts: weight loss after bariatric surgery returns patients' postoperative risk to baseline following coronary surgery.

PubMed

Baimas-George, Maria; Hennings, Dietric L; Al-Qurayshi, Zaid; Emad Kandil; DuCoin, Christopher

2017-06-01

The obesity epidemic is associated with a rise in coronary surgeries because obesity is a risk factor for coronary artery disease. Bariatric surgery is linked to improvement in cardiovascular co-morbidities and left ventricular function. No studies have investigated survival advantage in postoperative bariatric patients after coronary surgery. To determine if there is a benefit after coronary surgery in patients who have previously undergone bariatric surgery. National Inpatient Sample. We performed a retrospective, cross-sectional analysis of the National Inpatient Sample database from 2003 to 2010. We selected bariatric surgical patients who later underwent coronary surgery (n = 257). A comparison of postoperative complications and mortality after coronary surgery were compared with controls (n = 1442) using χ 2 tests, linear regression analysis, and multivariate logistical regression models. A subset population was identified as having undergone coronary surgery (n = 1699); of this population, 257 patients had previously undergone bariatric surgery. They were compared with 1442 controls. The majority was male (67.2%), white (82.6%), and treated in an urban environment (96.8%). Patients with bariatric surgery assumed the risk of postoperative complications after coronary surgery that was associated with their new body mass index (BMI) (BMI<25 kg/m 2 : odds ratio (OR) 1.01, 95% CI .76-1.34, P = .94; BMI 25 to<35 kg/m 2 : OR .20, 95% CI .02- 2 .16, P = .19; BMI≥35 kg/m 2 : OR>999.9, 95% CI .18 to>999.9, P = .07). Length of stay was significantly longer in postbariatric patients (BMI<25, OR 1.62, 95% CI 1.14-2.30, P = .007). Postoperative bariatric patients have a return to baseline risk of morbidity and mortality after coronary surgery. Copyright © 2017 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

Associations Among Quadriceps Strength and Rate of Torque Development 6 Weeks Post Anterior Cruciate Ligament Reconstruction and Future Hop and Vertical Jump Performance: A Prospective Cohort Study.

PubMed

Pua, Yong-Hao; Mentiplay, Benjamin F; Clark, Ross A; Ho, Jia-Ying

2017-11-01

Study Design Prospective cohort. Background Quadriceps strength is associated with hop distance and jump height in persons who have undergone anterior cruciate ligament (ACL) reconstruction. However, it is unknown whether the ability to rapidly generate quadriceps torque in the early phase of recovery is associated with future hopping and jumping performance in this population. Objective To evaluate the prospective associations among quadriceps strength and rate of torque development (RTD) and single-leg hop for distance, vertical jump height, vertical ground reaction force (vGRF), and vertical force loading rate during a landing task in persons who have undergone ACL reconstruction. Methods Seventy patients with unilateral ACL reconstruction participated. At 6 weeks post ACL reconstruction, isometric quadriceps strength and RTD were measured using a dynamometer. At 6 months following ACL reconstruction, patients performed the single-leg hop for distance test. Patients also performed the single-leg vertical jump test on a force plate that measured maximum jump height, vGRF, and average loading rate during landing. Results Both quadriceps strength and RTD at 6 weeks post ACL reconstruction were associated with all hopping and jumping measures at 6 months post ACL reconstruction (P≤.04). Single-leg hop distance was associated more closely with quadriceps strength than with quadriceps RTD (P = .05), and vertical jump height and vGRF measures were associated more closely with quadriceps RTD than with quadriceps strength (P = .05 and P<.01, respectively). Both quadriceps measures were associated with loading rate. Conclusion Quadriceps strength and RTD are complementary but distinct predictors of future hopping and jumping performance in persons who have undergone ACL reconstruction. These findings may contribute to improved rehabilitation of patients who are at risk for poor jumping/hopping performance and abnormal knee loading. J Orthop Sports Phys Ther 2017;47(11):845-852. Epub 13 Oct 2017. doi:10.2519/jospt.2017.7133.

Post-Mortem Magnetic Resonance Imaging Appearances of Feticide in Perinatal Deaths.

PubMed

Shelmerdine, Susan C; Hickson, Melissa; Sebire, Neil J; Arthurs, Owen J

2018-06-06

The aim of this study was to characterise the imaging features seen in fetuses having undergone feticide by intracardiac potassium chloride injection compared to those of non-terminated fetuses at post-mortem magnetic resonance imaging (PMMRI). A case-control study was performed comparing PMMRI findings between two groups of patients - those having undergone feticide were matched to a control group of miscarried/stillborn fetuses. The groups were matched according to gestational age, weight, and time since death. Two independent readers reviewed the PMMRI for thoracic, abdominal, and musculoskeletal imaging features. The Fishers exact test was conducted for differences between the patient groups. Twenty-six cases of feticide (mean gestation 25 weeks [20-36]) and 75 non-terminated fetuses (mean gestation 26.7 weeks [19-36]) were compared. There was a higher proportion of feticide cases demonstrating pneumothorax (23.1 vs. 1.3%, p = 0.001), haemothorax (42.3 vs. 4%, p = 0.001), pneumopericardium (30.8 vs. 5.3%, p = 0.002), and haemopericardium (34.6 vs. 0%, p = 0.0001). Intracardiac gas and intra-abdominal findings were higher in the feticide group, but the differences were not statistically significant. Characteristic PMMRI features of feticide can help improve reporter confidence in differentiating iatrogenic from physiological/pathological processes. © 2018 S. Karger AG, Basel.

Seismic evidence for widespread western-US deep-crustal deformation caused by extension

USGS Publications Warehouse

Moschetti, M.P.; Ritzwoller, M.H.; Lin, F.; Yang, Y.

2010-01-01

Laboratory experiments have established that many of the materials comprising the Earth are strongly anisotropic in terms of seismic-wave speeds. Observations of azimuthal and radial anisotropy in the upper mantle are attributed to the lattice-preferred orientation of olivine caused by the shear strains associated with deformation, and provide some of the most direct evidence for deformation and flow within the Earths interior. Although observations of crustal radial anisotropy would improve our understanding of crustal deformation and flow patterns resulting from tectonic processes, large-scale observations have been limited to regions of particularly thick crust. Here we show that observations from ambient noise tomography in the western United States reveal strong deep (middle to lower)-crustal radial anisotropy that is confined mainly to the geological provinces that have undergone significant extension during the Cenozoic Era (since 65 Myr ago). The coincidence of crustal radial anisotropy with the extensional provinces of the western United States suggests that the radial anisotropy results from the lattice-preferred orientation of anisotropic crustal minerals caused by extensional deformation. These observations also provide support for the hypothesis that the deep crust within these regions has undergone widespread and relatively uniform strain in response to crustal thinning and extension. ?? 2010 Macmillan Publishers Limited. All rights reserved.

Metabolic Profiling of IDH Mutation and Malignant Progression in Infiltrating Glioma

NASA Astrophysics Data System (ADS)

Jalbert, Llewellyn E.; Elkhaled, Adam; Phillips, Joanna J.; Neill, Evan; Williams, Aurelia; Crane, Jason C.; Olson, Marram P.; Molinaro, Annette M.; Berger, Mitchel S.; Kurhanewicz, John; Ronen, Sabrina M.; Chang, Susan M.; Nelson, Sarah J.

2017-03-01

Infiltrating low grade gliomas (LGGs) are heterogeneous in their behavior and the strategies used for clinical management are highly variable. A key factor in clinical decision-making is that patients with mutations in the isocitrate dehydrogenase 1 and 2 (IDH1/2) oncogenes are more likely to have a favorable outcome and be sensitive to treatment. Because of their relatively long overall median survival, more aggressive treatments are typically reserved for patients that have undergone malignant progression (MP) to an anaplastic glioma or secondary glioblastoma (GBM). In the current study, ex vivo metabolic profiles of image-guided tissue samples obtained from patients with newly diagnosed and recurrent LGG were investigated using proton high-resolution magic angle spinning spectroscopy (1H HR-MAS). Distinct spectral profiles were observed for lesions with IDH-mutated genotypes, between astrocytoma and oligodendroglioma histologies, as well as for tumors that had undergone MP. Levels of 2-hydroxyglutarate (2HG) were correlated with increased mitotic activity, axonal disruption, vascular neoplasia, and with several brain metabolites including the choline species, glutamate, glutathione, and GABA. The information obtained in this study may be used to develop strategies for in vivo characterization of infiltrative glioma, in order to improve disease stratification and to assist in monitoring response to therapy.

Women's experiences of having an early medical abortion at home.

PubMed

Hedqvist, Maria; Brolin, Lina; Tydén, Tanja; Larsson, Margareta

2016-10-01

The aim of this study was to assess women's experiences of having an early medical abortion at home and to investigate their perceptions of the information provided before the abortion. The study also aimed to investigate possible differences between groups of women. The study is cross-sectional with a descriptive and comparative design. Semi-structured telephone interviews were conducted with 119 women who had undergone a medical abortion at home. Almost half of the women (43%, n = 51) experienced the bleeding as more than expected and one-fourth (26%, n = 31) bled for more than four weeks. One-third (34%, n = 41) stated a lack of information, especially about the bleeding and pain. The experience of pain differed between groups. Women who had undergone an earlier abortion and women who had previously given birth experienced the abortion as being less painful than that experienced by first-time gravidae (p < 0.05). The finding that women experience information about the pain and bleeding to be insufficient suggests that information in those areas can be improved. The result that women without previous experience of abortion or childbirth stated the pain as being worse than other groups investigated suggests that special attention should be paid to those women. Copyright © 2016 Elsevier B.V. All rights reserved.

[Lumbar canal stenosis in achondroplasia. Prevention and correction of lumbosacral lordosis].

PubMed

Gómez Prat, A; García Ollé, L; Ginebreda Martí, I; Gairí Tahull, J; Vilarrubias Guillamet, J

2001-02-01

To determine through the measurement of different angles the correction of lumbar hyperlordosis after bilateral femoral lengthening using the Icatme technique and to assess the absence of neurological symptomatology secondary to stenosis of the lumbar canal after femoral lengthening. Thirty-four patients with achondroplasia were studied. Mean age was 22.3 years. The patients underwent femoral lengthening using the Icatme technique. X rays of the lateral rachis taken before and after lengthening were used to measure a series of angles. The lumbar lordosis angle, Sez's angle and the L5S1 angle decreased while the lumbosacral angle, Jungham's angle and the sacrum angle increased, leading to correction of lumbar hyperlordosis, verticalization of the sacrum and improvement in thoracolumbar and lumbosacral inflection. Values were similar to the standard for individuals without achondroplasia. Femoral lengthening using the Icatme technique in achondroplastics modifies the statics of the lumbar spine, making them similar to those of nonachondroplastics. The procedure corrects lumbar hyperlordosis and prevents the appearance of neurological symptomatology due to stenosis of the lumbar canal. The incidence of neurological complications due to stenosis of the lumbar canal in achondroplastics who have undergone femoral lengthening is low compared with that of achondroplastics of the same age and sex who have not undergone this procedure.

Resurfacing of Facial Acne Scars With a New Variable-Pulsed Er:YAG Laser in Fitzpatrick Skin Types IV and V

PubMed Central

Chathra, Namitha; Mysore, Venkataram

2018-01-01

Introduction: The Er:YAG laser, considered to be less effective than CO2 laser in its traditional form, in its new modulated version has variable pulse technology that is claimed to be superior to the earlier versions of the laser. Aim: The aim of the study was to check efficacy and safety of the new variable square pulse (VSP) Er:YAG laser in the management of acne scar in patients with Fitzpatrick skin types IV and V. Materials and Methods: This retrospective study consisted of 80 patients (Fitzpatrick skin types IV and V) with atrophic and hypertrophic facial acne scars. Records of the patients who had undergone four treatment sessions with VSP technology equipped with Er:YAG laser were extracted. Each patient had undergone a minimum of four sessions. Fractional mode at medium laser pulse (SP) and long pulse (LP) was employed for the depressed center of the scars to stimulate neocollagenogenesis. Short laser pulse (MSP) in nonfractionated mode was used for ablating the raised scar border and hypertrophic scars. Goodman and Baron global scarring grading system was used for qualitative and quantitative assessments. Patient’s satisfaction to the treatment and observer’s assessment of improvement (based on photographs) was graded as poor (<25% improvement), fair (25–50% improvement), good (51–75% improvement), and excellent (>75% improvement). Results: At the end of the four sessions, the number of patients in grade IV postacne scarring reduced from 16 to 2 and that in grade III from 47 to 29. The mean score significantly dropped from 36.94 to 27.5. Subjective assessment revealed that 78 of 80 patients had noticed more than 25% improvement, with 50 of them showing more than 50% improvement at the end of four sessions. Eight patients perceived an excellent response and 42 reported a good response. This is notably higher than the observer’s grading, which showed an excellent response in only 2 patients and a good response in 35. Adverse effects were limited to prolonged erythema (two patients), prolonged crusting (one patient), and postinflammatory hyperpigmentation (one patient). Conclusion: Ninety-seven percent of the subjects in our study perceived at least a fair improvement. We also saw a significant change in the objective score with a fall of the mean quantitative score from 36.94 to 27.15. This underscores the new variable-pulsed Er:YAG laser’s effectiveness in the treatment of acne scars. It also has the added advantage of lesser adverse events and faster healing. PMID:29731588

Resurfacing of Facial Acne Scars With a New Variable-Pulsed Er:YAG Laser in Fitzpatrick Skin Types IV and V.

PubMed

Chathra, Namitha; Mysore, Venkataram

2018-01-01

The Er:YAG laser, considered to be less effective than CO 2 laser in its traditional form, in its new modulated version has variable pulse technology that is claimed to be superior to the earlier versions of the laser. The aim of the study was to check efficacy and safety of the new variable square pulse (VSP) Er:YAG laser in the management of acne scar in patients with Fitzpatrick skin types IV and V. This retrospective study consisted of 80 patients (Fitzpatrick skin types IV and V) with atrophic and hypertrophic facial acne scars. Records of the patients who had undergone four treatment sessions with VSP technology equipped with Er:YAG laser were extracted. Each patient had undergone a minimum of four sessions. Fractional mode at medium laser pulse (SP) and long pulse (LP) was employed for the depressed center of the scars to stimulate neocollagenogenesis. Short laser pulse (MSP) in nonfractionated mode was used for ablating the raised scar border and hypertrophic scars. Goodman and Baron global scarring grading system was used for qualitative and quantitative assessments. Patient's satisfaction to the treatment and observer's assessment of improvement (based on photographs) was graded as poor (<25% improvement), fair (25-50% improvement), good (51-75% improvement), and excellent (>75% improvement). At the end of the four sessions, the number of patients in grade IV postacne scarring reduced from 16 to 2 and that in grade III from 47 to 29. The mean score significantly dropped from 36.94 to 27.5. Subjective assessment revealed that 78 of 80 patients had noticed more than 25% improvement, with 50 of them showing more than 50% improvement at the end of four sessions. Eight patients perceived an excellent response and 42 reported a good response. This is notably higher than the observer's grading, which showed an excellent response in only 2 patients and a good response in 35. Adverse effects were limited to prolonged erythema (two patients), prolonged crusting (one patient), and postinflammatory hyperpigmentation (one patient). Ninety-seven percent of the subjects in our study perceived at least a fair improvement. We also saw a significant change in the objective score with a fall of the mean quantitative score from 36.94 to 27.15. This underscores the new variable-pulsed Er:YAG laser's effectiveness in the treatment of acne scars. It also has the added advantage of lesser adverse events and faster healing.

Evolution of speech-specific cognitive adaptations.

PubMed

de Boer, Bart

2015-01-01

This paper argues that an evolutionary perspective is natural when investigating cognitive adaptations related to language. This is because there appears to be correspondence between traits that linguists consider interesting and traits that have undergone selective pressure related to language. The paper briefly reviews theoretical results that shed light on what kind of adaptations we can expect to have evolved and then reviews concrete work related to the evolution of adaptations for combinatorial speech. It turns out that there is as yet no strong direct evidence for cognitive traits that have undergone selection related to speech, but there is indirect evidence that indicates selection. However, the traits that may have undergone selection are expected to be continuously variable ones, rather than the discrete ones that linguists have focused on traditionally.

[Thyroid status peculiarities of elderly patients 5 years after operation depending on the volume of surgical intervention].

PubMed

Aristarhov, V G; Danilov, N V; Aristarkhov, R V; Puzin, D A; Birykov, C V

2016-01-01

Long-term results of treatment of 180 patients operated 5 years ago for benign thyroid nodular pathology have been analyzed in the present paper, the results being analyzed depending on the volume of surgical intervention. The rate of postoperative hypothyrodism is lower in patients who had undergone limited thyroid resection, recurrent cases are more frequent, but they are not clinically significant and seldom require reoperation. It should also be noted that those patients have fewer cardiac complaints as the dose of hormone replacement therapy preparations is small. Elder patients who had undergone functionally significant thyroidectomy and need to take great doses of Thyroxin (107-150 mcg/day) have cardiac complaints more often (43 %) comparing to those who had undergone limited resections (35 %).

Primary care needs of patients who have undergone gender reassignment.

PubMed

Sobralske, Mary

2005-04-01

The purpose of this article is to inform nurse practitioners (NPs) about the primary care needs of patients who have undergone gender reassignment, either by hormone therapy alone or in conjunction with surgery. Data sources used were mainly from a review of the literature about gender identity disorder and gender reassignment. Information was also gathered from several leading surgeons on gender reassignment surgical procedures and subsequent clinical considerations. There is very little written on the primary care clinical ramifications of transsexual patients and how clinicians can adapt their approaches to healthcare delivery to accommodate their special situations. Implications for practice include how an NP can adapt clinical practice approaches to provide for patients who have undergone gender reassignment. Changes that occur in the transsexual process may warrant noncustomary primary healthcare screening and examination.

The HI HOPES data set of deaf children under the age of 6 in South Africa: maternal suspicion, age of identification and newborn hearing screening.

PubMed

Störbeck, Claudine; Young, Alys

2016-03-22

Identification of deafness before 3 months of age substantially improves the socio-linguistic and cognitive development of deaf children. Existing studies demonstrating the feasibility of newborn hearing screening in South Africa have used small samples unrepresentative of general population characteristics. This study establishes the characteristics of the largest data set of deaf infants and their families in South Africa on which there is baseline and longitudinal data (n = 532); explores its representativeness in terms of socio-demographic features and reports on access to and quality of newborn hearing screening within the sample. It examines specifically the relationship between age of maternal suspicion of childhood deafness and age of identification of deafness by cohort characteristics. Secondary analysis, using descriptive and inferential statistics, of a pre-existing longitudinal data set (n = 532) of deaf infants under 6 years of age, and their families, collected as routine monitoring of the HI HOPES (HH) early intervention programme. The HH cohort is representative in terms of racial profile and private/public health care use but displays slightly higher level of maternal education and slightly lower socio-economic status than national comparators. 102 out of 532 infants had undergone newborn hearing screening, resulting in 29 true positives, 15 of whom would have met the criteria for targeted screening. Later onset deafness does not account for the 73 false negatives. The median age of maternal suspicion (n = 247) of infant deafness was 18 months; the median age of identification of 28 months. Age of identification was unrelated to private/public health care status. The median delay between age of suspicion and age of identification was significantly longer in the public sector (7 m; IQR 0-15 m) compared to the private sector (2 m; IQR 0-8.5 m) (p = 0.035). Age of suspicion was unrelated to level of maternal education. Earlier age of suspicion did not predict earlier identification. Targeted screening as timely response to maternal suspicion offers a viable means to reduce substantially the age of identification of deafness in South Africa until implementation of newborn hearing screening on a population-wide basis can be justified.

Penile Prosthesis Surgery: Current Recommendations From the International Consultation on Sexual Medicine.

PubMed

Levine, Laurence A; Becher, Edgardo; Bella, Anthony; Brant, William; Kohler, Tobias; Martinez-Salamanca, Juan Ignacio; Trost, Landon; Morey, Allen

2016-04-01

Penile prosthesis implantation has emerged as a definitive treatment to restore sexual function to the motivated man with erectile dysfunction. Substantial improvements in the design of inflatable devices have been made since they first became available more than four decades ago. To review the history of the penile prosthesis, the indications, preoperative evaluation, and patient and partner satisfaction. The current approaches to addressing intra- and postoperative complications, provide an understanding of prosthesis infection, and placement of these devices will be reviewed. A committee of worldwide experts in this field was assembled during the 2015 International Consultation on Sexual Medicine (ICSM) and performed a systematic review of the peer-reviewed published medical literature pertaining to penile prosthesis. Particular attention was given to higher level trials when available. Recommendations are based upon the Oxford Criteria. Unfortunately there is limited level 1 and 2 evidence, and where expert opinion was utilized, the decision was unanimous within the committee with a goal of presenting a clinically relevant guideline pertaining to penile prostheses. Penile prosthesis has undergone an evolution over the past 40 years resulting in a more effective and reliable treatment for advanced erectile dysfunction not responding to less invasive methods including oral treatment with PDE5 inhibitors, vacuum erection device, and intracorporal injection therapy. It should be considered an appropriate treatment option for the man who wishes to restore erectile function and who understands the potential risk of mechanical failure and infection, both of which are less common now as a result of improvements made in device design as well as surgical protocols adhered to in the operating room. Patients must be clearly informed of the risks associated with penile prosthesis including mechanical failure, infection, shortening of the penis, change in sensation and configuration of the penis, as well as injury to local structures. Intraoperative complications are unusual but do occur and can usually be addressed intraoperatively to allow placement of the device at the time of initial surgery. Postoperative complications may also be addressed when they occur but may require more advanced reconstructive surgical techniques. Men with Peyronie's disease, corporal fibrosis due to infection, trauma, prior prosthesis explantation, priapism, and men who have undergone construction of a neophallus may require additional advanced maneuvers to obtain optimum results with a penile prosthesis. Penile prosthesis remains as an important, viable, and effective treatment for male erectile dysfunction that does not respond to other less invasive approaches or when these approaches are contraindicated or not acceptable to the patient. These devices provide the patient with the ability to engage in penetrative sexual activity without interfering with urination, ejaculation, sensation, or orgasm. Although mechanical failure can occur, the current devices are more reliable as a result of design modifications. Infection remains the most dreaded complication but since the introduction of antibiotic and hydrophilic coatings, infection is less common. Overall, patient and partner satisfaction appear to be reasonably high when a penile prosthesis is used to restore erectile function. Copyright © 2016 International Society for Sexual Medicine. Published by Elsevier Inc. All rights reserved.

Tradeoffs between income, air pollution and life expectancy: Brief report on the US experience, 1980-2000.

PubMed

Pope, C Arden; Ezzati, Majid; Dockery, Douglas W

2015-10-01

During the period of 1980-2000, the US obtained substantial reductions in air pollution and improvements in life expectancy (LE). Multiple factors contributed to improved health. This report explores and illustrates trade-offs between income, air pollution, and LE. Both improved air quality and income growth contributed to LE gains - without evidence of substantial negative tradeoffs between air pollution and income. Cleaner air may be considered an "economic good" with contributions to health, wellbeing, and human capital. Copyright © 2015 Elsevier Inc. All rights reserved.

Cavitation-resistant inducer

DOEpatents

Dunn, Charlton; Subbaraman, Maria R.

1989-01-01

An improvement in an inducer for a pump wherein the inducer includes a hub, a plurality of radially extending substantially helical blades and a wall member extending about and encompassing an outer periphery of the blades. The improvement comprises forming adjacent pairs of blades and the hub to provide a substantially rectangular cross-sectional flow area which cross-sectional flow area decreases from the inlet end of the inducer to a discharge end of the inducer, resulting in increased inducer efficiency improved suction performance, reduced susceptibility to cavitation, reduced susceptibility to hub separation and reduced fabrication costs.

Adjuvant radiation therapy for pancreatic cancer: a review of the old and the new.

PubMed

Boyle, John; Czito, Brian; Willett, Christopher; Palta, Manisha

2015-08-01

Surgery represents the only potential curative treatment option for patients diagnosed with pancreatic adenocarcinoma. Despite aggressive surgical management for patients deemed to be resectable, rates of local recurrence and/or distant metastases remain high, resulting in poor long-term outcomes. In an effort to reduce recurrence rates and improve survival for patients having undergone resection, adjuvant therapies (ATs) including chemotherapy and chemoradiation therapy (CRT) have been explored. While adjuvant chemotherapy has been shown to consistently improve outcomes, the data regarding adjuvant radiation therapy (RT) is mixed. Although the ability of radiation to improve local control has been demonstrated, it has not always led to improved survival outcomes for patients. Early trials are flawed in their utilization of sub-optimal radiation techniques, limiting their generalizability. Recent and ongoing trials incorporate more optimized RT approaches and seek to clarify its role in treatment strategies. At the same time novel radiation techniques such as intensity modulated RT (IMRT) and stereotactic body RT (SBRT) are under active investigation. It is hoped that these efforts will lead to improved disease-related outcomes while reducing toxicity rates.

Adjuvant radiation therapy for pancreatic cancer: a review of the old and the new

PubMed Central

Boyle, John; Czito, Brian; Willett, Christopher

2015-01-01

Surgery represents the only potential curative treatment option for patients diagnosed with pancreatic adenocarcinoma. Despite aggressive surgical management for patients deemed to be resectable, rates of local recurrence and/or distant metastases remain high, resulting in poor long-term outcomes. In an effort to reduce recurrence rates and improve survival for patients having undergone resection, adjuvant therapies (ATs) including chemotherapy and chemoradiation therapy (CRT) have been explored. While adjuvant chemotherapy has been shown to consistently improve outcomes, the data regarding adjuvant radiation therapy (RT) is mixed. Although the ability of radiation to improve local control has been demonstrated, it has not always led to improved survival outcomes for patients. Early trials are flawed in their utilization of sub-optimal radiation techniques, limiting their generalizability. Recent and ongoing trials incorporate more optimized RT approaches and seek to clarify its role in treatment strategies. At the same time novel radiation techniques such as intensity modulated RT (IMRT) and stereotactic body RT (SBRT) are under active investigation. It is hoped that these efforts will lead to improved disease-related outcomes while reducing toxicity rates. PMID:26261730

Current Trends in the Management of Abdominal Aortic Aneurysms

PubMed Central

Harris, K.A.; Ameli, F. Michael; Louis, E.L. St.

1987-01-01

The treatment of abdominal aortic aneurysm has undergone dramatic changes over the last three decades. More sophisticated diagnostic techniques have allowed early elective repair to be carried out. Improvement has resulted in both morbidity and mortality rates. Investigations such as ultrasound, computerized tomographic scanning and arteriography allow easy confirmation of the diagnosis of aortic aneurysms and permit a better assessment of the extent prior to surgical intervention. Improvement in the pre-operative management, particularly in relation to cardiac, renal, and pulmonary disease, has led to greatly improved results. The most important change in surgical technique has been repair of the aneurysm rather than resection. Combined with better post-operative intensive care units, this development has contributed to the improved morbidity and mortality rates. Although the complication rate of elective repair is low, the major cause of death remains myocardial infarction. As a result of all these improvements, indication for repair of abdominal aortic aneurysms has been extended to patients over the age of 80. Following surgical repair, most patients can be expected to return to normal lifestyles and lifespans. ImagesFigure 2Figure 3Figure 4 PMID:21263973

Long term changes in forest cover and land use of Similipal Biosphere Reserve of India using satellite remote sensing data

NASA Astrophysics Data System (ADS)

Saranya, K. R. L.; Reddy, C. Sudhakar

2016-04-01

The spatial changes in forest cover of Similipal biosphere reserve, Odisha, India over eight decades (1930-2012) has been quantified by using multi-temporal data from different sources. Over the period, the forest cover reduced by 970.8 km2 (23.6% of the total forest), and most significantly during the period, 1930-1975. Human-induced activities like conversion of forest land for agriculture, construction of dams and mining activities have been identified as major drivers of deforestation. Spatial analysis indicates that 399 grids (1 grid = 1 × 1 km) have undergone large-scale changes in forest cover (>75 ha) during 1930-1975, while only 3 grids have shown >75 ha loss during 1975-1990. Annual net rate of deforestation was 0.58 during 1930-1975, which has been reduced substantially during 1975-1990 (0.04). Annual gross rate of deforestation in 2006-2012 is indeed low (0.01) as compared to the national and global average. This study highlights the impact and effectiveness of conservation practices in minimizing the rate of deforestation and protecting the Similipal Biosphere Reserve.

In Support of a National Treatment Evaluation Study.

PubMed

Brown, Barry S; Flynn, Patrick M

2015-01-01

Argument is made for the importance of conducting a national treatment evaluation to permit understanding of the nature and effectiveness of typical treatment programming. Only through such study can we hope to learn areas of success and failure of normative programming relative to population characteristics and treatment strategies, and the extent to which research-based initiatives have been adopted by the field. That information is central to efforts to draw up a research agenda appropriate to the needs of clients and the staffs responsible for their treatment, and to clarify and respond to gaps in the application of potentially useful treatment components. In spite of such need, our understanding of typical treatment programming and of its effectiveness is based on data collected from a treatment cohort of 20 years ago, although patterns of drug use, characteristics of clients, and the treatment components available have all undergone substantial change. The responsibility taken to provide such information to the field, once seen as a central task of research, needs to be reasserted to strengthen and support our treatment efforts.

Kinetics of Materials at Extreme Conditions: Understanding the Time Dependent Approach to Equilibrium at MaRIE

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

Kraus, R. G.; Mcnabb, D.; Kumar, M.

The National Nuclear Security Agency has recently recognized that a long-term need exists to establish a stronger scientific basis for the assessment and qualification of materials and manufacturing processes for the nuclear stockpile and other national security applications. These materials may have undergone substantial changes with age, or may represent new materials that are being introduced because of difficulties associated with reusing or recreating materials used in original stockpile components. Also, with advancements in manufacturing methods, the NNSA anticipates opportunities for an enhanced range of control over fabricated components, an enhanced pace of materials development, and enhanced functionality. The developmentmore » of qualification standards for these new materials will require the ability to understand and control material characteristics that affect both mechanical and dynamic performance. A unique aspect for NNSA is that the performance requirements for materials are often set by system hydrodynamics, and these materials must perform in extreme environments and loading conditions. Thus, the scientific motivation is to understand “Matter-Radiation Interactions in Extremes (MaRIE).”« less

Management algorithms for cervical cancer screening and precancer treatment for resource-limited settings.

PubMed

Basu, Partha; Meheus, Filip; Chami, Youssef; Hariprasad, Roopa; Zhao, Fanghui; Sankaranarayanan, Rengaswamy

2017-07-01

Management algorithms for screen-positive women in cervical cancer prevention programs have undergone substantial changes in recent years. The WHO strongly recommends human papillomavirus (HPV) testing for primary screening, if affordable, or if not, then visual inspection with acetic acid (VIA), and promotes treatment directly following screening through the screen-and-treat approach (one or two clinic visits). While VIA-positive women can be offered immediate ablative treatment based on certain eligibility criteria, HPV-positive women need to undergo subsequent VIA to determine their eligibility. Simpler ablative methods of treatment such as cryotherapy and thermal coagulation have been demonstrated to be effective and to have excellent safety profiles, and these have become integral parts of new management algorithms. The challenges faced by low-resource countries are many and include, from the management perspective, identifying an affordable point-of-care HPV detection test, minimizing over-treatment, and installing an effective information system to ensure high compliance to treatment and follow-up. © 2017 The Authors. International Journal of Gynecology & Obstetrics published by John Wiley & Sons Ltd on behalf of International Federation of Gynecology and Obstetrics.

Brain Modules, Personality Layers, Planes of Being, Spiral Structures, and the Equally Implausible Distinction between TCI-R "Temperament" and "Character" Scales: A Reply to Cloninger.

PubMed

Farmer, Richard F; Goldberg, Lewis R

2008-09-01

In this reply we address comments by Cloninger (this issue) related to our report (Farmer & Goldberg, this issue) on the psychometric properties of the revised Temperament and Character Inventory (TCI-R) and a short inventory derivative, the TCI-140. Even though Cloninger's psychobiological model has undergone substantial theoretical modifications, the relevance of these changes for the evaluation and use of the TCI-R remains unclear. Aspects of TCI-R assessment also appear to be theoretically and empirically incongruent with Cloninger's assertion that TCI-R personality domains are non-linear and dynamic in nature. Several other core assumptions from the psychobiological model, including this most recent iteration, are non-falsifiable, inconsistently supported, or have no apparent empirical basis. Although researchers using the TCI and TCI-R have frequently accepted the temperament/character distinction and associated theoretical ramifications, for example, we find little overall support for the differentiation of TCI-R domains into these two basic categories. The implications of these observations for TCI-R assessment are briefly discussed.

Gene therapy for PIDs: progress, pitfalls and prospects.

PubMed

Mukherjee, Sayandip; Thrasher, Adrian J

2013-08-10

Substantial progress has been made in the past decade in treating several primary immunodeficiency disorders (PIDs) with gene therapy. Current approaches are based on ex-vivo transfer of therapeutic transgene via viral vectors to patient-derived autologous hematopoietic stem cells (HSCs) followed by transplantation back to the patient with or without conditioning. The overall outcome from all the clinical trials targeting different PIDs has been extremely encouraging but not without caveats. Malignant outcomes from insertional mutagenesis have featured prominently in the adverse events associated with these trials and have warranted intense pre-clinical investigation into defining the tendencies of different viral vectors for genomic integration. Coupled with issues pertaining to transgene expression, the therapeutic landscape has undergone a paradigm shift in determining safety, stability and efficacy of gene therapy approaches. In this review, we aim to summarize the progress made in the gene therapy trials targeting ADA-SCID, SCID-X1, CGD and WAS, review the pitfalls, and outline the recent advancements which are expected to further enhance favourable risk benefit ratios for gene therapeutic approaches in the future. Copyright © 2013 Elsevier B.V. All rights reserved.

Combined Vocal Exercises for Rehabilitation After Supracricoid Laryngectomy: Evaluation of Different Execution Times.

PubMed

Silveira, Hevely Saray Lima; Simões-Zenari, Marcia; Kulcsar, Marco Aurélio; Cernea, Claudio Roberto; Nemr, Kátia

2017-10-27

The supracricoid partial laryngectomy allows the preservation of laryngeal functions with good local cancer control. To assess laryngeal configuration and voice analysis data following the performance of a combination of two vocal exercises: the prolonged /b/vocal exercise combined with the vowel /e/ using chest and arm pushing with different durations among individuals who have undergone supracricoid laryngectomy. Eleven patients undergoing partial laryngectomy supracricoid with cricohyoidoepiglottopexy (CHEP) were evaluated using voice recording. Four judges performed separately a perceptive-vocal analysis of hearing voices, with random samples. For the analysis of intrajudge reliability, repetitions of 70% of the voices were done. Intraclass correlation coefficient was used to analyze the reliability of the judges. For an analysis of each judge to the comparison between zero time (time point 0), after the first series of exercises (time point 1), after the second series (time point 2), after the third series (time point 3), after the fourth series (time point 4), and after the fifth and final series (time point 5), the Friedman test was used with a significance level of 5%. The data relative to the configuration of the larynx were subjected to a descriptive analysis. In the evaluation, were considered the judge results 1 which have greater reliability. There was an improvement in the general level of vocal, roughness, and breathiness deviations from time point 4 [T4]. The prolonged /b/vocal exercise, combined with the vowel /e/ using chest- and arm-pushing exercises, was associated with an improvement in the overall grade of vocal deviation, roughness, and breathiness starting at minute 4 among patients who had undergone supracricoid laryngectomy with CHEP reconstruction. Copyright © 2017 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

Subtalar Coalitions: Does the Morphology of the Subtalar Joint Involvement Influence Outcomes After Coalition Excision?

PubMed

Mahan, Susan T; Prete, Victoria I; Spencer, Samantha A; Kasser, James R; Bixby, Sarah D

Posteromedial subtalar (PMST) coalitions are a recently described anatomic subtype of tarsal coalitions. We compared with clinical patient-based outcomes of patients with PMST and standard middle facet (MF) coalitions who had undergone surgical excision of their coalition. The included patients had undergone surgical excision of a subtalar tarsal coalition, preoperative computed tomography (CT), and patient-based outcomes measures after surgery (including the American Orthopaedic Foot and Ankle Society [AOFAS] scale and University of California, Los Angeles [UCLA], activity score). Blinded analysis of the preoperative CT scan findings determined the presence of a standard MF versus a PMST coalition. The perioperative factors and postoperative outcomes between the MF and PMST coalitions were compared. A total of 51 feet (36 patients) were included. The mean follow-up duration was 2.6 years after surgery. Of the 51 feet, 15 (29.4%) had a PMST coalition and 36 (70.6%) had an MF coalition. No difference was found in the UCLA activity score; however, the mean AOFAS scale score was higher for patients with PMST (95.7) than for those with MF (86.5; p = .018). Of the patients with a PMST, none had foot pain limiting their activities at the final clinical follow-up visit. However, in the group with an MF subtalar coalition, 10 (27.8%) had ongoing foot pain limiting activity at the final follow-up visit (p = .024). Compared with MF subtalar tarsal coalitions, patients with PMST coalitions showed significantly improved clinical outcomes after excision. Preoperative identification of the facet morphology can improve patient counseling and expectations after surgery. Copyright © 2017 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

A randomised, double-blinded clinical study on the efficacy of multimedia presentation using an iPad for patient education of postoperative hip surgery patients in a public hospital in Singapore.

PubMed

Dallimore, Rachel-Kim; Asinas-Tan, Marxengel Leonin; Chan, Daryl; Hussain, Suharti; Willett, Catherine; Zainuldin, Rahizan

2017-09-01

This study compared patient satisfaction and recall of physiotherapy patient education among patients who had undergone hip surgery, with information presented via an iPad versus a standard paper booklet. Patients who had undergone hip surgery joined and completed this single-centre study, which utilised a randomised parallel group design. They were randomly allocated to either Group A (received information on hip surgery physiotherapy via an iPad) or Group B (received the same information via a paper booklet). The participants were blinded to the intervention received by the other group and the testers were blinded to the intervention received by the participants. The interventions were carried out during the patients' first four postoperative physiotherapy sessions. The outcome measures were recorded using pre-validated questionnaires. A total of 42 participants (mean age 70 ± 12 years) were recruited. After the intervention, patients in both groups had improved recall of the information presented during patient education. However, the patients in Group A had a significantly better recall score than those in Group B (4.0 points higher, p < 0.001). The level of patient satisfaction was also significantly higher in Group A than in Group B (8.5 points higher, p < 0.001). While the use of an iPad and a paper booklet both had positive outcomes for patient recall and satisfaction, the use of an iPad was found to be more effective at improving patient satisfaction and recall of physiotherapy patient education in the present study. Copyright: © Singapore Medical Association

Laser in-situ keratomileusis for refractive error following radial keratotomy

PubMed Central

Sinha, Rajesh; Sharma, Namrata; Ahuja, Rakesh; Kumar, Chandrashekhar; Vajpayee, Rasik B

2011-01-01

Aim: To evaluate the safety and efficacy of laser in-situ keratomileusis (LASIK) in eyes with residual/induced refractive error following radial keratotomy (RK). Design: Retrospective study. Materials and Methods: A retrospective analysis of data of 18 eyes of 10 patients, who had undergone LASIK for refractive error following RK, was performed. All the patients had undergone RK in both eyes at least one year before LASIK. Parameters like uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA), contrast sensitivity, glare acuity and corneal parameters were evaluated both preoperatively and postoperatively. Statistical Software: STATA-9.0. Results: The mean UCVA before LASIK was 0.16±0.16 which improved to 0.64 ± 0.22 (P < 0.001) after one year following LASIK. Fourteen eyes (out of 18) had UCVA of ≥ 20/30 on Snellen's acuity chart at one year following LASIK. The mean BCVA before LASIK was 0.75 ± 0.18. This improved to 0.87 ± 0.16 at one year following LASIK. The mean spherical refractive error at the time of LASIK and at one year after the procedure was –5.37 ± 4.83 diopters (D) and –0.22 ± 1.45D, respectively. Only three eyes had a residual spherical refractive error of ≥ 1.0D at one year follow-up. In two eyes, we noted opening up of the RK incisions. No eye developed epithelial in-growth till 1 year after LASIK. Conclusion: LASIK is effective in treating refractive error following RK. However, it carries the risk of flap-related complications like opening up of the previously placed RK incisions and splitting of the corneal flap. PMID:21666312

Patients' perceptions of physical activity before and after joint replacement: a systematic review with meta-ethnographic analysis.

PubMed

Smith, Toby O; Latham, Sarah; Maskrey, Vivienne; Blyth, Annie

2015-09-01

It has been perceived that people following total hip arthroplasty (THA) or total knee arthroplasty (TKA) have the capability, with reduced pain, to increase their levels of physical activity. To determine the attitudes and perceptions of people awaiting or having undergone THA or TKA to physical activity post-arthroplasty and to identify potential facilitators or barriers to engage in active living and physical activity pursuits. Systematic review of published and unpublished databases was undertaken from their inception to November 2014. Studies exploring the attitudes and perceptions of people awaiting or having undergone THA or TKA to physical activity post-arthroplasty were included. Data were analysed through a meta-ethnography approach. From 528 citations, 13 papers were eligible, sampling 282 people post-THA or TKA. The literature was judged moderate to high quality. Following THA and TKA, people either wished to return to their pre-pathology level of physical activity or simply be able to engage in less physically demanding activities that are meaningful to them and their lifestyles. Barriers to engaging in higher levels of physical activity were largely related to limited information, which culminated in fear surrounding 'doing the right thing' both for individual's recovery and the longevity of the joint replacement. While many people post-THA or TKA wish to return to pre-pathological physical activity status, there is limited interest in actually undertaking greater levels of physical activity post-arthroplasty either for pleasure or health gains. Improvement in education and awareness of this may be key drivers to improve habitualisation of physical activity post-arthroplasty. CRD42014014995. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

New birthweight charts according to parity and type of delivery for the Spanish population.

PubMed

Terán, José Manuel; Varea, Carlos; Bernis, Cristina; Bogin, Barry; González-González, Antonio

Birthweight by gestational age charts enable fetal growth to be evaluated in a specific population. Given that maternal profile and obstetric practice have undergone a remarkable change over the past few decades in Spain, this paper presents new Spanish reference percentile charts stratified by gender, parity and type of delivery. They have been prepared with data from the 2010-2014 period of the Spanish Birth Statistics Bulletin. Reference charts have been prepared using the LMS method, corresponding to 1,428,769 single, live births born to Spanish mothers. Percentile values and mean birth weight are compared among newborns according to gender, parity and type of delivery. Newborns to primiparous mothers show significantly lower birthweight than those born to multiparous mothers (p<0.036). Caesarean section was associated with a substantially lower birthweight in preterm births (p<0.048), and with a substantially higher birthweight for full-term deliveries (p<0.030). Prevalence of small for gestational age is significantly higher in newborns born by Caesarean section, both in primiparous (p<0.08) and multiparous mothers (p<0.027) and, conversely, the prevalence of large for gestational age among full-term births is again greater both in primiparous (p<0.035) and in multiparous mothers (p<0.007). Results support the consideration of establishing parity and type of delivery-specific birthweight references. These new charts enable a better evaluation of the impact of the demographic, reproductive and obstetric trends currently in Spain on fetal growth. Copyright © 2016 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.

The Effect of Medicaid Expansion on Delivery of Finger and Thumb Replantation Care to Medicaid Beneficiaries and the Uninsured.

PubMed

Giladi, Aviram M; Aliu, Oluseyi; Chung, Kevin C

2015-11-01

Despite advances in replantation, over 80 percent of finger and thumb amputation injuries in the United States result in revision amputation. Although numerous factors contribute to this, disparities in access and delivery of replantation care play a substantial role. With ongoing Medicaid expansion under the Affordable Care Act, it is prudent to understand whether expansion of coverage changes use of replantation care. The authors used the 2001 Medicaid expansion in New York State to evaluate changes in replantation for Medicaid beneficiaries and the uninsured. Data for patients having undergone replantation between 1998 and 2006 were obtained from the New York State Inpatient Database. The authors used an interrupted time series to evaluate the effect of Medicaid expansion on the probability that Medicaid beneficiaries or uninsured patients underwent replantation. Census data were used for population-adjusted case volume analysis. After expansion, the likelihood of Medicaid as the primary payer for replantation increased 0.0059 percent per quarter, reaching a 1.7 percent increase 5 years after expansion. With population-based analysis, this indicates that Medicaid covered 12 additional replantation cases in New York State annually. After expansion, 11 fewer of the replantation cases in New York State each year were provided to patients without health care coverage. Medicaid expansion resulted in a modest but significant increase in replantation for Medicaid beneficiaries. In addition, fewer patients that underwent replantation remained uninsured. Considering the substantial cost and effort burden of replantation, these findings support the benefits of Medicaid expansion on delivery and payer coverage of replantation.

Body composition measured by dual-energy X-ray absorptiometry in patients who have undergone small-intestinal resection.

PubMed

Haderslev, Kent Valentin; Jeppesen, Paller Bekker; Sorensen, Henrik Ancher; Mortensen, Per Brobech; Staun, Michael

2003-07-01

Patients who have undergone resection of the small intestine have lower body weight than do healthy persons. It remains unclear whether it is the body fat mass or the lean tissue mass that is reduced. We compared body-composition values in patients who had undergone small-intestinal resection with reference values obtained in healthy volunteers, and we studied the relation between body-composition estimates and the net intestinal absorption of energy. In a cross-sectional study, we included 20 men and 24 women who had undergone small-intestinal resection and had malabsorption of energy > 2000 kJ/d. Diagnoses were Crohn disease (n = 37) and other conditions (n = 7). Body composition was estimated by dual-energy X-ray absorptiometry, and data were compared with those from a reference group of 173 healthy volunteers. Energy absorption was measured during 48-h balance studies by using bomb calorimetry, and individual values were expressed relative to the basal metabolic rate. Body weight and body mass index in patients were significantly (P < 0.05) lower than the reference values. Fat mass was 6.4 kg (30%) lower (95% CI: -8.8, -3.9 kg), but lean tissue mass was only slightly and insignificantly lower (1.5 kg, or 3.3%; 95% CI: -3.7, 0.60 kg). Weight, body mass index, and body-composition estimates by dual-energy X-ray absorptiometry did not correlate significantly with the net energy absorption relative to the basal metabolic rate, expressed as a percentage. Patients who had undergone small-intestinal resection had significantly lower body weights and body mass indexes than did healthy persons, and they had significant changes in body composition, mainly decreased body fat mass.

Effects of a minor surgery on health related quality of life in children from different perspectives

PubMed

Brazo-Sayavera, Javier; Parejo-Cabezas, Inés M; Gusi, Narcís; Olivares, Pedro R

2018-01-01

To compare the health related quality of life (HRQoL) perceptions in parents and physician regarding the patient undergoing ambulatory surgery, and to analyse the evolution of HRQoL before and after the ambulatory surgery. 36 patients underwent ambulatory surgical interventions taken part in this study. The questionnaires EQ-5D-Y were administered to the patients and questionnaires EQ-5D-Y proxy to parents and physicians. Variable TTO was used. Statistical differences were found at baseline between answers of patients and physicians (p < 0.05). However, after surgery, answers of patients and proxies were similar. Paediatric patients undergone to a minor surgery improve HRQoL after the operation and this improvement goes on a month after the surgery. Copyright: © 2018 SecretarÍa de Salud

Rumination as a Marker of Psychological Improvement in Transsexual Women Postoperative

PubMed Central

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

2016-01-01

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

The role of a lack of social integration in never having undergone breast cancer screening: results from a population-based, representative survey in the Paris metropolitan area in 2010.

PubMed

Rondet, Claire; Soler, Marion; Ringa, Virginie; Parizot, Isabelle; Chauvin, Pierre

2013-10-01

This study aims to investigate the association between social contact and social support and women's breast cancer screening (BCS) practices, taking their socioeconomic status (SES) into account. The SIRS survey was conducted in 2010 in the Paris metropolitan area among a representative sample of 3000 French-speaking adults. For the 784 women aged 50years or older with no history of breast cancer, multivariate logistic regressions and bootstrap methods were used to analyze the factors associated with never having undergone BCS. 6.5% of these women had never undergone BCS. In multivariate analysis, being older, having a low education level, having poor-quality health insurance, and having one or less than one social contact per 3-day period were significantly associated with never having undergone BCS during their lifetime, but the level of social support was not. The strength of the association with a low frequency of social contact tended to increase with age. This study analyzed the role of social contact in social inequalities in BCS practices in the Paris metropolitan area. Like SES, social integration and social isolation should be taken into consideration by public health professionals and practitioners when planning BCS programs and incentives. © 2013.

Cavitation-resistant inducer

DOEpatents

Dunn, C.; Subbaraman, M.R.

1989-06-13

An improvement in an inducer for a pump is disclosed wherein the inducer includes a hub, a plurality of radially extending substantially helical blades and a wall member extending about and encompassing an outer periphery of the blades. The improvement comprises forming adjacent pairs of blades and the hub to provide a substantially rectangular cross-sectional flow area which cross-sectional flow area decreases from the inlet end of the inducer to a discharge end of the inducer, resulting in increased inducer efficiency improved suction performance, reduced susceptibility to cavitation, reduced susceptibility to hub separation and reduced fabrication costs. 11 figs.

Action of a 904-nm diode laser in orthopedics and traumatology: a clinical study on 447 cases

NASA Astrophysics Data System (ADS)

Tam, Giuseppe

2001-10-01

Objective: The evidence in medical literature is that a beneficial analgesic effect can only be obtained by employing laser radiation of relatively low power density and wavelengths which are able to penetrate tissue. For this reason the semiconductor, or laser diode (GaAs, 904 nm), is the most appropriate choice in pain-reduction therapy. Summary Background Data: Low power laser (or LLL) acts on the Prostaglandins synthesis, increases the endorphins synthesis in the Rolando gelatinous substance and in the dorsal horn of the spinal cord. The L-Arginine, which is the classic substrate of nitric oxide, carries on vasodilatory and anti- inflammatory action. Methods: Treatment was carried out on 447 cases and 435 patients (250 women and 185 men) between 20th May 1987 and 31st December 1999. The patients, whose age ranged from 25 to 70, were suffering from rheumatic, degenerative and traumatic pathologies as well as cutaneous ulcers. The majority of patients had been seen by orthopaedists and rheumatologists and had undergone x-ray, ultrasound scan, etc. All patients had previously received drug-based treatment and/or physiotherapy, with poor results. Two thirds were experiencing acute symptomatic pain, while the others presented a chronic pathology with recurrent crises. We used a pulsed IR diode laser, GaAs emitting at 904 nm. Frequency of treatment: 1 application per day for 5 consecutive days, followed by a 2-day interval. The percentage reduction in symptoms or improvement in functional status were determined on the basis of objective analysis as it happens in the Legal and Insurance Medicine field. Results: Very good results were achieved especially with cases of symptomatic osteoarthritis of the cervical vertebrae, with sport-related injuries, epicondylitis, osteoarthritis of the knee, periarthritis and with cutaneous ulcers. The beneficial action of the LLLT in the latter pathology is linked to the increase in collagen and to fibroblast proliferation. The total relief of the pain was achieved in 80% of acute and 65% of chronic cases. Conclusions: Treatment with 904 nm IR diode laser has substantially reduced the symptoms as well as improved the quality of life of the patient, thus postponing the need for surgery.

Enzyme replacement therapy improves joint motion and outcome of the 12-min walk test in a mucopolysaccharidosis type VI patient previously treated with bone marrow transplantation.

PubMed

Sohn, Young Bae; Park, Sung Won; Kim, Se-Hwa; Cho, Sung-Yoon; Ji, Sun-Tae; Kwon, Eun Kyung; Han, Sun Ju; Oh, Se Jung; Park, Yong Jae; Ko, Ah-Ra; Paik, Kyung-Hoon; Lee, Jeehun; Lee, Dong Hwan; Jin, Dong-Kyu

2012-05-01

Mucopolysaccharidosis type VI (MPS VI; Maroteaux-Lamy syndrome, OMIM #253200) is a rare disorder involving multiple organs and manifested particularly by severe skeletal abnormalities. Bone marrow transplantation (BMT) improves cardiopulmonary function and facial features, but has limited success in ameliorating skeletal abnormalities and short stature. Here, we report the outcome of enzyme replacement therapy (ERT) with recombinant human arylsulfatase-B (ASB, Naglazyme, BioMarin, Novato, CA) in an MPS VI patient who received BMT 10 years prior to ERT induction. Administration of weekly Naglazyme for 18 months was effective in improving range of motion in several joints [shoulders (improvement of flexion (Right/Left): 40°/55°; improvement of extension 30°/40°; improvement of abduction 10°/10°), elbows (improvement of flexion 25°/25°; improvement of extension 10°/15°), hips (improvement of flexion 25°/10°), and knees (improvement of flexion 45°/40°; improvement of extension 50°/60°)]. Improvement in the outcome of the 12-min walk test (70% increase) and 3-min stair-climbing test (29% increase) was also noted after ERT. Because ERT improved clinical features in an MPS VI patient who had undergone prior BMT, the role of ERT post successful BMT in MPS VI needs further investigation. Copyright © 2012 Wiley Periodicals, Inc.

Influence of gut microbiota and intestinal barrier on enterogenic infection after liver transplantation.

PubMed

Mu, Jingzhou; Chen, Qiuyu; Zhu, Liang; Wu, Yunhong; Liu, Suping; Zhao, Yufei; Ma, Tonghui

2018-04-27

Liver transplantation is currently a standard therapy for patients with end-stage liver diseases and hepatocellular carcinoma. Given that liver transplantation has undergone a thriving development in these decades, the survival rates after liver transplantation have markedly improved as a result of the critical advancement in surgical techniques, immunosuppressive therapies, and postoperative care. However, infection remains a fatal complication after liver transplantation surgery. In particular, enterogenic infection represents a major complication in liver transplant recipients. This article gives an overview of infection cases after liver transplantation and focuses on the discussion of enterogenic infection in terms of its pathophysiology, risk factor, outcome, and treatment.

Application of improved technology to a preprototype vapor compression distillation /VCD/ water recovery subsystem

NASA Technical Reports Server (NTRS)

Johnson, K. L.; Reysa, R. P.; Fricks, D. H.

1981-01-01

Vapor compression distillation (VCD) is considered the most efficient water recovery process for spacecraft application. This paper reports on a preprototype VCD which has undergone the most extensive operational and component development testing of any VCD subsystem to date. The component development effort was primarily aimed at eliminating corrosion and the need for lubrication, upgrading electronics, and substituting nonmetallics in key rotating components. The VCD evolution is documented by test results on specific design and/or materials changes. Innovations worthy of further investigation and additional testing are summarized for future VCD subsystem development reference. Conclusions on experience gained are presented.

[Stress management for office workers].

PubMed

Hayashi, Takeshi

2002-09-01

The environment which surrounds office workers has undergone a big transformation with the collapse of lifetime employment, the shift from the long employment principle to meritocracy, the results principle, the introduction of flexible work hours, outsourcing and dispatch work. Today's office worker stressor include 1. VDT work, 2. meritocracy, 3. management by objective, 4. excessive load on the middle and advanced age generations, 5. the collapse of the lifetime employment system and 6. non-employee changes. (1) VDT work management, (2) the use of Information technology, (3) Improvement of office environments, (4) Management of long overtime work and (5) Support of superiors and colleagues are thought as stress management.

Recent Science and Engineering Results with the Laser Guidestar Adaptive Optics System at Lick Observatory

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

Gavel, D T; Gates, E; Max, C

2002-10-17

The Lick Observatory laser guide star adaptive optics system has undergone continual improvement and testing as it is being integrated as a facility science instrument on the Shane 3 meter telescope. Both Natural Guide Star (NGS) and Laser Guide Star (LGS) modes are now used in science observing programs. We report on system performance results as derived from data taken on both science and engineering nights and also describe the newly developed on-line techniques for seeing and system performance characterization. We also describe the future enhancements to the Lick system that will enable additional science goals such as long-exposure spectroscopy.

Implant-supported and magnet-retained oral-nasal combination prosthesis in a patient with a total rhinectomy and partial maxillectomy due to cancer: A clinical report.

PubMed

Won, Alexander M; Montgomery, Patti; Aponte-Wesson, Ruth; Chambers, Mark

2017-02-01

This clinical report describes the fabrication of an implant-supported and magnet-retained combination oral-nasal prosthesis for a patient with a midline midfacial defect. The patient had undergone a total rhinectomy and partial maxillectomy as part of his cancer treatment. The nasal prosthesis was retained on the face by a magnet attached to the implant-supported maxillary denture, resulting in improved appearance and the recovery of speech, mastication, and swallowing functions. Copyright © 2016 Editorial Council for the Journal of Prosthetic Dentistry. Published by Elsevier Inc. All rights reserved.

Substantially oxygen-free contact tube

NASA Technical Reports Server (NTRS)

Pike, James F. (Inventor)

1993-01-01

A device for arc welding is provided in which a continuously-fed electrode wire is in electrical contact with a contact tube. The contact tube is improved by using a substantially oxygen-free conductive alloy in order to reduce the amount of electrical erosion.

Substantially Oxygen-Free Contact Tube

NASA Technical Reports Server (NTRS)

Pike, James F. (Inventor)

1991-01-01

A device for arc welding is provided in which a continuously-fed electrode wire is in electrical contact with a contact tube. The contact tube is improved by using a substantially oxygen-free conductive alloy in order to reduce the amount of electrical erosion.

Magnetic Resonance-Guided Focused Ultrasound Neurosurgery for Essential Tremor: A Health Technology Assessment

PubMed Central

Schaink, Alexis; Li, Chunmei; Gajic-Veljanoski, Olga; Wells, David; Higgins, Caroline

2018-01-01

Background The standard treatment option for medication-refractory essential tremor is invasive neurosurgery. A new, noninvasive alternative is magnetic resonance-guided focused ultrasound (MRgFUS) neurosurgery. We aimed to determine the effectiveness, safety, and cost-effectiveness of MRgFUS neurosurgery for the treatment of moderate to severe, medication-refractory essential tremor in Ontario. We also spoke with people with essential tremor to gain an understanding of their experiences and thoughts regarding treatment options, including MRgFUS neurosurgery. Methods We performed a systematic review of the clinical literature published up to April 11, 2017, that examined MRgFUS neurosurgery alone or compared with other interventions for the treatment of moderate to severe, medication-refractory essential tremor. We assessed the risk of bias of each study and the quality of the body of evidence according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) Working Group criteria. We performed a systematic review of the economic literature and created Markov cohort models to assess the cost-effectiveness of MRgFUS neurosurgery compared with other treatment options, including no surgery. We also estimated the budget impact of publicly funding MRgFUS neurosurgery in Ontario for the next 5 years. To contextualize the potential value of MRgFUS neurosurgery as a treatment option for essential tremor, we spoke with people with essential tremor and their families. Results Nine studies met our inclusion criteria for the clinical evidence review. In noncomparative studies, MRgFUS neurosurgery was found to significantly improve tremor severity and quality of life and to significantly reduce functional disability (GRADE: very low). It was also found to be significantly more effective than a sham procedure (GRADE: high). We found no significant difference in improvements in tremor severity, functional disability, or quality of life between MRgFUS neurosurgery and deep brain stimulation (GRADE: very low). We found no significant difference in improvement in tremor severity compared with radiofrequency thalamotomy (GRADE: low). MRgFUS neurosurgery has a favourable safety profile. We estimated that MRgFUS neurosurgery has a mean cost of $23,507 and a mean quality-adjusted survival of 3.69 quality-adjusted life-years (QALYs). We also estimated that the mean costs and QALYs of radiofrequency thalamotomy and deep brain stimulation are $14,978 and 3.61 QALYs, and $57,535 and 3.94 QALYs, respectively. For people ineligible for invasive neurosurgery, we estimated the incremental cost-effectiveness ratio (ICER) of MRgFUS neurosurgery compared with no surgery as $43,075 per QALY gained. In people eligible for invasive neurosurgery, the ICER of MRgFUS neurosurgery compared with radiofrequency thalamotomy is $109,795 per QALY gained; when deep brain stimulation is compared with MRgFUS neurosurgery, the ICER is $134,259 per QALY gained. Of note however, radiofrequency thalamotomy is performed very infrequently in Ontario. We also estimated that the budget impact of publicly funding MRgFUS neurosurgery in Ontario at the current case load (i.e., 48 cases/year) would be about $1 million per year for the next 5 years. People with essential tremor who had undergone MRgFUS neurosurgery reported positive experiences with the procedure. The tremor reduction they experienced improved their ability to perform activities of daily living and improved their quality of life. Conclusions MRgFUS neurosurgery is an effective and generally safe treatment option for moderate to severe, medication-refractory essential tremor. It provides a treatment option for people ineligible for invasive neurosurgery and offers a noninvasive option for all people considering neurosurgery. For people ineligible for invasive neurosurgery, MRgFUS neurosurgery is cost-effective compared with no surgery. In people eligible for invasive neurosurgery, MRgFUS neurosurgery may be one of several reasonable options. Publicly funding MRgFUS neurosurgery for the treatment of moderate to severe, medication-refractory essential tremor in Ontario at the current case load would have a net budget impact of about $1 million per year for the next 5 years. People with essential tremor who had undergone MRgFUS neurosurgery reported positive experiences. They liked that it was a noninvasive procedure and reported a substantial reduction in tremor that resulted in an improvement in their quality of life. PMID:29805721

Do code of conduct audits improve chemical safety in garment factories? Lessons on corporate social responsibility in the supply chain from Fair Wear Foundation.

PubMed

Lindholm, Henrik; Egels-Zandén, Niklas; Rudén, Christina

2016-10-01

In managing chemical risks to the environment and human health in supply chains, voluntary corporate social responsibility (CSR) measures, such as auditing code of conduct compliance, play an important role. To examine how well suppliers' chemical health and safety performance complies with buyers' CSR policies and whether audited factories improve their performance. CSR audits (n = 288) of garment factories conducted by Fair Wear Foundation (FWF), an independent non-profit organization, were analyzed using descriptive statistics and statistical modeling. Forty-three per cent of factories did not comply with the FWF code of conduct, i.e. received remarks on chemical safety. Only among factories audited 10 or more times was there a significant increase in the number of factories receiving no remarks. Compliance with chemical safety requirements in garment supply chains is low and auditing is statistically correlated with improvements only at factories that have undergone numerous audits.

Epigenetics as an emerging tool for improvement of fungal strains used in biotechnology.

PubMed

Aghcheh, Razieh Karimi; Kubicek, Christian P

2015-08-01

Filamentous fungi are today a major source of industrial biotechnology for the production of primary and secondary metabolites, as well as enzymes and recombinant proteins. All of them have undergone extensive improvement strain programs, initially by classical mutagenesis and later on by genetic manipulation. Thereby, strategies to overcome rate-limiting or yield-reducing reactions included manipulating the expression of individual genes, their regulatory genes, and also their function. Yet, research of the last decade clearly showed that cells can also undergo heritable changes in gene expression that do not involve changes in the underlying DNA sequences (=epigenetics). This involves three levels of regulation: (i) DNA methylation, (ii) chromatin remodeling by histone modification, and (iii) RNA interference. The demonstration of the occurrence of these processes in fungal model organisms such as Aspergillus nidulans and Neurospora crassa has stimulated its recent investigation as a tool for strain improvement in industrially used fungi. This review describes the progress that has thereby been obtained.

Do code of conduct audits improve chemical safety in garment factories? Lessons on corporate social responsibility in the supply chain from Fair Wear Foundation

PubMed Central

2016-01-01

Background In managing chemical risks to the environment and human health in supply chains, voluntary corporate social responsibility (CSR) measures, such as auditing code of conduct compliance, play an important role. Objectives To examine how well suppliers’ chemical health and safety performance complies with buyers’ CSR policies and whether audited factories improve their performance. Methods CSR audits (n = 288) of garment factories conducted by Fair Wear Foundation (FWF), an independent non-profit organization, were analyzed using descriptive statistics and statistical modeling. Results Forty-three per cent of factories did not comply with the FWF code of conduct, i.e. received remarks on chemical safety. Only among factories audited 10 or more times was there a significant increase in the number of factories receiving no remarks. Conclusions Compliance with chemical safety requirements in garment supply chains is low and auditing is statistically correlated with improvements only at factories that have undergone numerous audits. PMID:27611103

Recent Upgrades at the Fermilab Test Beam Facility

NASA Astrophysics Data System (ADS)

Rominsky, Mandy

2016-03-01

The Fermilab Test Beam Facility is a world class facility for testing and characterizing particle detectors. The facility has been in operation since 2005 and has undergone significant upgrades in the last two years. A second beam line with cryogenic support has been added and the facility has adopted the MIDAS data acquisition system. The facility also recently added a cosmic telescope test stand and improved tracking capabilities. With two operational beam lines, the facility can deliver a variety of particle types and momenta ranging from 120 GeV protons in the primary beam line down to 200 MeV particles in the tertiary beam line. In addition, recent work has focused on analyzing the beam structure to provide users with information on the data they are collecting. With these improvements, the Fermilab Test Beam facility is capable of supporting High Energy physics applications as well as industry users. The upgrades will be discussed along with plans for future improvements.

Surgical Management of Stones: New Technology

PubMed Central

Matlaga, Brian R.; Lingeman, James E.

2011-01-01

In recent years, the surgical treatment of kidney stone disease has undergone tremendous advances, many of which were possible only as a result of improvements in surgical technology. Rigid intracorporeal lithotrites, the mainstay of percutaneous nephrolithotomy, are now available as combination ultrasonic and ballistic devices. These combination devices have been reported to clear a stone burden with much greater efficiency than devices that operate by either ultrasonic or ballistic energy alone. The laser is the most commonly used flexible lithotrite; advances in laser lithotripsy have led to improvements in the currently utilized Holmium laser platform, as well as the development of novel laser platforms such as Thulium and Erbium devices. Our understanding of shock wave lithotripsy (SWL)has been improved over recent years as a consequence of basic science investigations. It is now recognized that there are certain maneuvers with SWL that the treating physician can do that will increase the likelihood of a successful outcome while minimizing the likelihood of adverse treatment-related events. PMID:19095207

Demonstration/Validation of Low Volatile Organic Compound (VOC) Chemical Agent Resistant Coating (CARC)

DTIC Science & Technology

2003-11-25

alkyd resin enamel was 14 Figure 1 -- Test Panels Before Application of WD CARC at MCB Figure 2 -- Test Panels with WD CARC Applied at MCB...WD) Chemical Agent Resistant Coating (CARC) patented (#5,691,410) by the Army Research Laboratory (ARL) has undergone technology Demonstration...Resistant Coating (CARC) patented (#5,691,410) by the Army Research Laboratory (ARL) has undergone technology Demonstration/Validation (Dem/Val) testing

Trends in the phenotypic hip status of selected breeds of dog as measured by the New Zealand Veterinary Association Hip Dysplasia scheme (1990-2008).

PubMed

Worth, A J; Bridges, J P; Jones, G

2011-03-01

To determine whether there has been improvement in the phenotypic hip dysplasia status in four susceptible dog breeds as measured by the New Zealand Veterinary Association (NZVA) Canine Hip Dysplasia (CHD) scheme. A retrospective analysis of the NZVA CHD database was performed using records of all German Shepherd dogs, Labrador Retrievers, Golden Retrievers and Rottweilers that had undergone evaluation for hip dysplasia between 1990 and 2008. The effect of date of birth on the total hip score was analysed using linear regression, including the covariates of age and gender. When a significant effect of date of birth on total score was noted, ordinal logistic regression was performed to determine the probability of different grades of the Norberg angle and subluxation scores by year of birth; these categories being most indicative of laxity of the coxofemoral joint. Given the known heritability of hip phenotype, determined using radiological measurements, the hypothesis was that if sufficient selection pressure has been applied there would have been a trend towards a lower total score over time. For Labrador Retrievers (n=1,451), Golden Retrievers (n=896) and Rottweilers (n=313), there was no effect of date of birth on total score over the period of the study (p>0.1). For German Shepherd dogs (n=1,087), there was a significant trend to a lower total score over time (p=0.0003). However the actual size of the effect was small. Ordinal logistic regression on the Norberg angle and subluxation scores for German Shepherd dogs demonstrated a significant lowering of grade in both of these measures of hip laxity. This study failed to show significant improvement in the phenotypic hip status of three out of the four most populous large-dog breeds in the NZVA CHD database. Even in the German Shepherd dog, the trend towards a lower total score did not represent a substantial change. Lack of evidence of phenotypic improvement may be due to insufficient selection pressure over the course of the study, selective usage of the scheme (and thus a biased sample), or deficiencies within the NZVA CHD scoring method itself. Greater improvement might be possible if use of the scheme (or an equivalent) is made a compulsory requirement for registration of pedigree breeding stock, if greater selection pressure is applied and/or if pedigree data are included to enable estimations of breeding value.

Choosing a Surgeon: An Exploratory Study of Factors Influencing Selection of a Gender Affirmation Surgeon.

PubMed

Ettner, Randi; Ettner, Frederic; White, Tonya

2016-01-01

Purpose: Selecting a healthcare provider is often a complicated process. Many factors appear to govern the decision as to how to select the provider in the patient-provider relationship. While the possibility of changing primary care physicians or specialists exists, decisions regarding surgeons are immutable once surgery has been performed. This study is an attempt to assess the importance attached to various factors involved in selecting a surgeon to perform gender affirmation surgery (GAS). It was hypothesized that owing to the intimate nature of the surgery, the expense typically involved, the emotional meaning attached to the surgery, and other variables, decisions regarding choice of surgeon for this procedure would involve factors other than those that inform more typical healthcare provider selection or surgeon selection for other plastic/reconstructive procedures. Methods: Questionnaires were distributed to individuals who had undergone GAS and individuals who had undergone elective plastic surgery to assess decision-making. Results: The results generally confirm previous findings regarding how patients select providers. Conclusion: Choosing a surgeon to perform gender-affirming surgery is a challenging process, but patients are quite rational in their decision-making. Unlike prior studies, we did not find a preference for gender-concordant surgeons, even though the surgery involves the genital area. Providing strategies and resources for surgical selection can improve patient satisfaction.

Evaluation of secondary surgery to enlarge the peeling of the internal limiting membrane following the failed surgery of idiopathic macular holes.

PubMed

Che, Xin; He, Fanglin; Lu, Linna; Zhu, Dongqing; Xu, Xiaofang; Song, Xin; Fan, Xianqun; Wang, Zhiliang

2014-03-01

The aim of the present study was to evaluate the clinical results of pars plana vitrectomy (PPV) combined with the surgical enlargement of internal limiting membrane (ILM) peeling in patients who had previously undergone failed idiopathic macular hole (IMH) surgery. In the study, 134 eyes from 130 IMH patients who had received PPV combined with ILM peeling surgery (2 disk diameters) were analyzed. Within this cohort, 14 eyes had IMHs that were not closed, of which 13 eyes underwent a second surgery involving enlargement of the ILM peeling. The extent of the ILM peeling was increased to the vascular arcades of the posterior fundus in the secondary surgery. Of the 13 eyes that underwent secondary surgery, five were in stage III and nine were in stage IV. The second surgery successfully achieved IMH closure in 61.5% (8/13) of the eyes. The IMH was completely closed following surgery and the logMAR vision increased from 0.98 to 0.84 (P=0.013) in the 8 successfully treated cases. The surgical enlargement of ILM peeling closed the IMHs and improved vision in the majority of patients. In addition, the procedures were safe. Therefore, the results of the present study indicate that enlargement of ILM peeling may be an effective therapy for patients who have previously undergone the failed surgical correction of an IMH.

Increasing the Cryogenic Toughness of Steels

NASA Technical Reports Server (NTRS)

Rush, H. F.

1986-01-01

Grain-refining heat treatments increase toughness without substantial strength loss. Five alloys selected for study, all at or near technological limit. Results showed clearly grain sizes of these alloys refined by such heat treatments and grain refinement results in large improvement in toughness without substantial loss in strength. Best improvements seen in HP-9-4-20 Steel, at low-strength end of technological limit, and in Maraging 200, at high-strength end. These alloys, in grain refined condition, considered for model applications in high-Reynolds-number cryogenic wind tunnels.

26 CFR 1.1237-1 - Real property subdivided for sale.

Code of Federal Regulations, 2013 CFR

2013-04-01

... improvements. Other changes in the market price of the lot, not arising from improvements made by the taxpayer... roads, including gravel roads where required by the climate, are not substantial improvements. (5...

26 CFR 1.1237-1 - Real property subdivided for sale.

Code of Federal Regulations, 2014 CFR

2014-04-01

... improvements. Other changes in the market price of the lot, not arising from improvements made by the taxpayer... roads, including gravel roads where required by the climate, are not substantial improvements. (5...

26 CFR 1.1237-1 - Real property subdivided for sale.

Code of Federal Regulations, 2011 CFR

2011-04-01

... improvements. Other changes in the market price of the lot, not arising from improvements made by the taxpayer... roads, including gravel roads where required by the climate, are not substantial improvements. (5...

26 CFR 1.1237-1 - Real property subdivided for sale.

Code of Federal Regulations, 2012 CFR

2012-04-01

... improvements. Other changes in the market price of the lot, not arising from improvements made by the taxpayer... roads, including gravel roads where required by the climate, are not substantial improvements. (5...

26 CFR 1.1237-1 - Real property subdivided for sale.

Code of Federal Regulations, 2010 CFR

2010-04-01

... improvements. Other changes in the market price of the lot, not arising from improvements made by the taxpayer... roads, including gravel roads where required by the climate, are not substantial improvements. (5...

75 FR 27504 - Substantial Product Hazard List: Hand-Held Hair Dryers

Federal Register 2010, 2011, 2012, 2013, 2014

2010-05-17

...The Consumer Product Safety Improvement Act of 2008 (``CPSIA''), authorizes the United States Consumer Product Safety Commission (``Commission'') to specify, by rule, for any consumer product or class of consumer products, characteristics whose existence or absence shall be deemed a substantial product hazard under certain circumstances. In this document, the Commission is proposing a rule to determine that any hand-held hair dryer without integral immersion protection presents a substantial product hazard.

Adjustment to Work: A Follow Up of Mildly Intellectually Handicapped Adolescents Who Have Undergone Training in a Work Preparation Centre. [The Granville Project].

ERIC Educational Resources Information Center

Ward, James; And Others

The paper reports on a followup study of the work adjustment of 43 mildly retarded adolescents who had undergone training in social and work skills at the Granville Work Preparation Centre in Australia. Among the findings were that 40% of the Ss had a history of full open employment, with no unemployment at all, since leaving the Center; that 21%…

Risk of acute myocardial infarction in upper tract urothelial carcinoma patients receiving radical nephroureterectomy: a population-based cohort study

PubMed Central

Lin, Shih-Yi; Lin, Cheng-Li; Chang, Chao-Hsiang; Wu, His-Chin; Wang, I-Kuan; Chou, Che-Yi; Liang, Ji-An

2017-01-01

Background The outcomes of upper tract urothelial carcinoma (UTUC) receiving radical nephroureterectomy were usually limited to small sample size, case-control studies, and often focused on cancer progression. Risk of acute myocardial infarction (AMI) in these patients was never investigated. Results The overall incidences of AMI were 3.39, 1.44, and 1.70 per 10,000 person-years in the radical nephroureterectomy, nonnephroureterectomy, and non-UTUC cohorts, respectively. Multivariable Cox proportional hazard regression analysis revealed a significantly higher AMI risk in the radical nephroureterectomy cohort [adjusted HR (aHR) = 1.83, 95% confidence interval (CI) = 1.08–3.11], compared with non-UTUC cohorts. The risk of mortality were the highest in patients with UTUC who had undergone radical nephroureterectomy [adjusted HR (aHR) = 5.37, 95% confidence interval (CI) = 4.80–6.02]. Materials and Methods From the Taiwan National Health Insurance claims data, 1,359 patients with UTUC who had undergone radical nephroureterectomy and 3,154 patients with UTUC who had undergone nephron sparing surgery and were newly diagnosed between 2000 and 2010 were identified. For each patient, 4 individuals without UTUC were randomly selected and frequency matched by age, sex, and diagnosis year. Conclusions Patients with UTUC who have undergone radical nephroureterectomy are at a higher risk of developing AMI, compared with those receiving nephron sparing surgery. PMID:29108329

30 CFR 700.5 - Definitions.

Code of Federal Regulations, 2014 CFR

2014-07-01

... substantial physical harm to persons, property, or the environment and to which persons or improvements on... substantially the quality of the environment, prevent or damage the beneficial use of land or water resources.... Reclamation activity means the reclamation, abatement, control, or prevention of adverse effects of past...

30 CFR 700.5 - Definitions.

Code of Federal Regulations, 2012 CFR

2012-07-01

... substantial physical harm to persons, property, or the environment and to which persons or improvements on... substantially the quality of the environment, prevent or damage the beneficial use of land or water resources.... Reclamation activity means the reclamation, abatement, control, or prevention of adverse effects of past...

Past successes and future challenges: Improving the urban environment

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

Gade, M.

1994-12-31

The author discusses issues related to the Chicago urban environment from her perspective in the Illinois Environmental Protection Agency. Understanding of the ozone air pollution problem in the Chicago area has undergone significant changes in the past three years, and there is still more to be understood about the complex factors which contribute to ozone pollution over urban areas such as Chicago. Ability to address these problems to present clean air standards is not in hand at present. The author asserts that information, and the ability of governmental agencies to ingest and respond to that information in a timely mannermore » is a key to improvement of the environment in urban areas in reasonable time spans. In addition cost and price information on environmental control and protection needs to be more clearly presented to the people so they can understand the difficult choices which must be made in addressing these environmental problems.« less

Drug-Coated Balloon Angioplasty: A Novel Treatment for Pulmonary Artery In-Stent Stenosis in a Patient with Williams Syndrome.

PubMed

Cohen, Jennifer L; Glickstein, Julie S; Crystal, Matthew A

2017-12-01

A 20-month-old boy with Williams syndrome had undergone multiple surgical and catheter-based interventions for resistant peripheral pulmonary arterial stenoses with eventual bilateral stent placement and conventional balloon angioplasty. He persistently developed suprasystemic right ventricular (RV) pressure. Angioplasty with a drug-coated balloon (DCB) was performed for in-stent restenosis and to remodel his distal pulmonary vessels bilaterally. This resulted in immediate improvement in the in-stent stenosis and resultant decrease in RV pressure. Follow-up catheterization two months later continued to show long-lasting improvement in the in-stent stenosis. We hypothesize that the anti-proliferative effects of DCBs may be of benefit in the arteriopathy associated with Williams syndrome. We report this as a novel use of a DCB in the pulmonary arterial circulation in a patient with Williams syndrome.

Positron Emission Tomography: state of the art and future developments

NASA Astrophysics Data System (ADS)

Pizzichemi, M.

2016-08-01

Positron emission tomography (PET) plays a fundamental role in medical imaging, with a wide range of applications covering, among the others, oncology, neurology and cardiology. PET has undergone a steady technological evolution since its introduction in mid 20th century, from the development of 3D PET in the late 1980s, to the invention of PET/CT in the 1990s and more recently with the introduction of PET/MR scanners. The current research topics aiming to develop the next generation of PET scanners are summarized in this paper, focusing on the efforts to increase the sensitivity of the detectors, as long as improving their timing, spatial and energy resolutions, with the final goal of reducing the amount of radioactive dose received by the patients and the duration of the exams while improving at the same time the detectability of lesions.

Late diagnosis of multiple myeloma: a case report

NASA Astrophysics Data System (ADS)

Syahreza, A.; Gatot, D.; Mardia, A. I.

2018-03-01

Multiple myeloma is a challenging hematologic case to handle. Sometimes the disease is diagnosed too late for the patient and doctor. Therefore, careful approaches are needed to manage the patient. A 66-year-old mansuffersfrom low back pain since one year before he came to the hospital. He was diagnosed multiple compression fractures by orthopedic and had undergone two surgeries in one year. Punched out lesions werein skull radiology and lumbar compression in lumbar MRI. After further investigation, plasmacytoma and M protein in urine electrophoresis were founded. Significant improvement found after bortezomib and dexamethasone were given.Diagnosis and management of multiple myeloma is a challenge for a doctor. Systematically approach is needed for a patient with a recurrent fracture. Even a novel therapies are not widely available in our country.We reported a late diagnosis of multiple myeloma and had a significant improvement after bortezomib and dexamethasone therapy.

Improving Situational Awareness for First Responders via Mobile Computing

NASA Technical Reports Server (NTRS)

Betts, Bradley J.; Mah, Robert W.; Papasin, Richard; Del Mundo, Rommel; McIntosh, Dawn M.; Jorgensen, Charles

2005-01-01

This project looks to improve first responder situational awareness using tools and techniques of mobile computing. The prototype system combines wireless communication, real-time location determination, digital imaging, and three-dimensional graphics. Responder locations are tracked in an outdoor environment via GPS and uploaded to a central server via GPRS or an 802.11 network. Responders can also wirelessly share digital images and text reports, both with other responders and with the incident commander. A pre-built three dimensional graphics model of a particular emergency scene is used to visualize responder and report locations. Responders have a choice of information end points, ranging from programmable cellular phones to tablet computers. The system also employs location-aware computing to make responders aware of particular hazards as they approach them. The prototype was developed in conjunction with the NASA Ames Disaster Assistance and Rescue Team and has undergone field testing during responder exercise at NASA Ames.

Improving Situational Awareness for First Responders via Mobile Computing

NASA Technical Reports Server (NTRS)

Betts, Bradley J.; Mah, Robert W.; Papasin, Richard; Del Mundo, Rommel; McIntosh, Dawn M.; Jorgensen, Charles

2006-01-01

This project looks to improve first responder incident command, and an appropriately managed flow of situational awareness using mobile computing techniques. The prototype system combines wireless communication, real-time location determination, digital imaging, and three-dimensional graphics. Responder locations are tracked in an outdoor environment via GPS and uploaded to a central server via GPRS or an 802. II network. Responders can also wireless share digital images and text reports, both with other responders and with the incident commander. A pre-built three dimensional graphics model of the emergency scene is used to visualize responder and report locations. Responders have a choice of information end points, ranging from programmable cellular phones to tablet computers. The system also employs location-aware computing to make responders aware of particular hazards as they approach them. The prototype was developed in conjunction with the NASA Ames Disaster Assistance and Rescue Team and has undergone field testing during responder exercises at NASA Ames.

Water, Sanitation and Hygiene Situation in Kenya's Urban Slums.

PubMed

Kamau, Njoroge; Njiru, Haron

2018-01-01

Kenya has undergone rapid urbanization as people migrate to the cities in search of economic opportunities. This has given rise to informal settlements characterized by overcrowding, poor infrastructure, and inadequate social amenities. A cross-sectional study on water, sanitation, and hygiene (WASH) status was carried out in Mathare, an informal settlement in Nairobi. A random sample of 380 households was used. The average household size was five people, and 26% of the household heads had completed secondary or higher level of education. The main source of income (70%) was self-employment with 41% of the households living on less than 1.5 USD per day. The WASH situation in the urban slums is below the minimum standard recommended by the World Health Organization (WHO). There is need to improve the situation by improving and installing basic infrastructure including water, sanitation, and solid waste collection.

Nanostructured electrocatalysts with tunable activity and selectivity

NASA Astrophysics Data System (ADS)

Mistry, Hemma; Varela, Ana Sofia; Kühl, Stefanie; Strasser, Peter; Cuenya, Beatriz Roldan

2016-04-01

The field of electrocatalysis has undergone tremendous advancement in the past few decades, in part owing to improvements in catalyst design at the nanoscale. These developments have been crucial for the realization of and improvement in alternative energy technologies based on electrochemical reactions such as fuel cells. Through the development of novel synthesis methods, characterization techniques and theoretical methods, rationally designed nanoscale electrocatalysts with tunable activity and selectivity have been achieved. This Review explores how nanostructures can be used to control electrochemical reactivity, focusing on three model reactions: O2 electroreduction, CO2 electroreduction and ethanol electrooxidation. The mechanisms behind nanoscale control of reactivity are discussed, such as the presence of low-coordinated sites or facets, strain, ligand effects and bifunctional effects in multimetallic materials. In particular, studies of how particle size, shape and composition in nanostructures can be used to tune reactivity are highlighted.

Effects of Using Personal Genotype Data on Student Learning and Attitudes in a Pharmacogenomics Course

PubMed Central

McDonough, Caitrin W.; Elsey, Amanda R.; Burkley, Benjamin; Cavallari, Larisa H.; Johnson, Julie A.

2016-01-01

Objective. To evaluate the impact of personal genotyping and a novel educational approach on student attitudes, knowledge, and beliefs regarding pharmacogenomics and genomic medicine. Methods. Two online elective courses (pharmacogenomics and genomic medicine) were offered to student pharmacists at the University of Florida using a flipped-classroom, patient-centered teaching approach. In the pharmacogenomics course, students could be genotyped and apply results to patient cases. Results. Thirty-four and 19 student pharmacists completed the pharmacogenomics and genomic medicine courses, respectively, and 100% of eligible students (n=34) underwent genotyping. Student knowledge improved after the courses. Seventy-four percent (n=25) of students reported better understanding of pharmacogenomics based on having undergone genotyping. Conclusions. Completion of a novel pharmacogenomics elective course sequence that incorporated personal genotyping and genomic medicine was associated with increased student pharmacist knowledge and improved clinical confidence with pharmacogenomics. PMID:27756930

Near Field Enhanced Photocurrent Generation in P-type Dye-Sensitized Solar Cells

PubMed Central

Xu, Xiaobao; Cui, Jin; Han, Junbo; Zhang, Junpei; Zhang, Yibo; Luan, Lin; Alemu, Getachew; Wang, Zhong; Shen, Yan; Xiong, Dehua; Chen, Wei; Wei, Zhanhua; Yang, Shihe; Hu, Bin; Cheng, Yibing; Wang, Mingkui

2014-01-01

Over the past few decades, the field of p-type dye-sensitized solar cell (p-DSSC) devices has undergone tremendous advances, in which Cu-based delafossite nanocrystal is of prime interest. This paper presents an augment of about 87% improvement in photocurrent observed in a particular configuration of organic dye P1 sensitized CuCrO2 delafossite nanocrystal electrode coupled with organic redox shuttle, 1-methy-1H- tetrazole-5-thiolate and its disulfide dimer when Au nanoparticles (NPs, with diameter of about 20 nm) is added into the photocathode, achieving a power convert efficiency of 0.31% (measured under standard AM 1.5 G test conditions). Detailed investigation shows that the local electrical-magnetic field effect, induced by Au NPs among the mesoporous CuCrO2 film, can improve the charge injection efficiency at dye/semiconductor interface, which is responsible for the bulk of the gain in photocurrent. PMID:24492539

Cardiac Embryology and Molecular Mechanisms of Congenital Heart Disease: A Primer for Anesthesiologists.

PubMed

Kloesel, Benjamin; DiNardo, James A; Body, Simon C

2016-09-01

Congenital heart disease is diagnosed in 0.4% to 5% of live births and presents unique challenges to the pediatric anesthesiologist. Furthermore, advances in surgical management have led to improved survival of those patients, and many adult anesthesiologists now frequently take care of adolescents and adults who have previously undergone surgery to correct or palliate congenital heart lesions. Knowledge of abnormal heart development on the molecular and genetic level extends and improves the anesthesiologist's understanding of congenital heart disease. In this article, we aim to review current knowledge pertaining to genetic alterations and their cellular effects that are involved in the formation of congenital heart defects. Given that congenital heart disease can currently only occasionally be traced to a single genetic mutation, we highlight some of the difficulties that researchers face when trying to identify specific steps in the pathogenetic development of heart lesions.

Reactivity of sulfide-containing silane toward boehmite and in situ modified rubber/boehmite composites by the silane

NASA Astrophysics Data System (ADS)

Lin, Tengfei; Zhu, Lixin; Chen, Weiwei; Wu, Siwu; Guo, Baochun; Jia, Demin

2013-09-01

The silanization reaction between boehmite (BM) nanoplatelets and bis-[3-(triethoxysilyl)-propyl]-tetrasulfide (TESPT) was characterized in detail. Via such modification process, the grafted sulfide moieties on the BM endow reactivity toward rubber and substantially improved hydrophobicity for BM. Accordingly, TESPT was employed as in situ modifier for the nitrile rubber (NBR)/BM compounds to improve the mechanical properties of the reinforced vulcanizates. The effects of BM content and in situ modification on the mechanical properties, curing characteristics and morphology were investigated. BM was found to be effective in improving the mechanical performance of NBR vulcanizates. The NBR/BM composites could be further strengthened by the incorporation of TESPT. The interfacial adhesion of NBR/BM composites was obviously improved by the addition of TESPT. The substantially improved mechanical performance was correlated to the interfacial reaction and the improved dispersion of BM in rubber matrix.

Vehicular impact absorption system

NASA Technical Reports Server (NTRS)

Knoell, A. C.; Wilson, A. H. (Inventor)

1978-01-01

An improved vehicular impact absorption system characterized by a plurality of aligned crash cushions of substantially cubic configuration is described. Each consists of a plurality of voided aluminum beverage cans arranged in substantial parallelism within a plurality of superimposed tiers and a covering envelope formed of metal hardware cloth. A plurality of cables is extended through the cushions in substantial parallelism with an axis of alignment for the cushions adapted to be anchored at each of the opposite end thereof.

Cyclophosphamide-induced hemorrhagic cystitis in rats that underwent colocystoplasty: experimental study.

PubMed

Rodó, J; Farré, X; Martín, E

2001-02-01

Cyclophosphamide and its derivatives induce hemorrhagic cystitis. A substantial number of patients receive bladder augmentation or replacements using bowel. If patients who have undergone colocystoplasty need treatment with cyclophosphamide before or after the operation, does hemorrhagic cystitis develop? We evaluated the histological changes produced in the colon wall and bladder related to cyclophosphamide and its derivatives in rats that underwent colocystoplasty. Sprague-Dawley rats of each sex were grouped according to whether they received a single 200 mg./kg. dose of cyclophosphamide, underwent colocystoplasty, underwent each technique or served as controls. The technique of colocystoplasty was the same in all groups. Results were analyzed according to previously reported criteria, by the gross appearance of the bladder and colon segment used for colocystoplasty, and by histological changes. Two weeks after surgery colocystoplasty had not resulted in secondary changes in the implanted colon segment or original bladder, while there were only nonspecific changes of an inflammatory type in the anastomotic area. After cyclophosphamide administration the animals lost considerable weight and in the bladder area we observed hemorrhagic cystitis that was greater in males than in females, and greater in isolated bladder than when the bladder was sutured to the colon segment. In the colon there was no inflammation or hemorrhage damage of the hemorrhagic cystitis type in the bladder. A total of 12 days after colocystoplasty there were no secondary histological changes except in the anastomotic area. A single 200 mg./kg. dose of cyclophosphamide caused substantial weight loss and hemorrhagic cystitis. Cystitis was quantitatively greater in males than in females and greater in isolated bladder than in bladder anastomosed to the colon. Administering a single dose of cyclophosphamide did not result in lesions in the colon segment used for colocystoplasty analogous to those of the bladder, such as hemorrhagic cystitis.

Visual Pigments, Ocular Filters and the Evolution of Snake Vision.

PubMed

Simões, Bruno F; Sampaio, Filipa L; Douglas, Ronald H; Kodandaramaiah, Ullasa; Casewell, Nicholas R; Harrison, Robert A; Hart, Nathan S; Partridge, Julian C; Hunt, David M; Gower, David J

2016-10-01

Much of what is known about the molecular evolution of vertebrate vision comes from studies of mammals, birds and fish. Reptiles (especially snakes) have barely been sampled in previous studies despite their exceptional diversity of retinal photoreceptor complements. Here, we analyze opsin gene sequences and ocular media transmission for up to 69 species to investigate snake visual evolution. Most snakes express three visual opsin genes (rh1, sws1, and lws). These opsin genes (especially rh1 and sws1) have undergone much evolutionary change, including modifications of amino acid residues at sites of known importance for spectral tuning, with several tuning site combinations unknown elsewhere among vertebrates. These changes are particularly common among dipsadine and colubrine "higher" snakes. All three opsin genes are inferred to be under purifying selection, though dN/dS varies with respect to some lineages, ecologies, and retinal anatomy. Positive selection was inferred at multiple sites in all three opsins, these being concentrated in transmembrane domains and thus likely to have a substantial effect on spectral tuning and other aspects of opsin function. Snake lenses vary substantially in their spectral transmission. Snakes active at night and some of those active by day have very transmissive lenses, whereas some primarily diurnal species cut out shorter wavelengths (including UVA). In terms of retinal anatomy, lens transmission, visual pigment spectral tuning and opsin gene evolution the visual system of snakes is exceptionally diverse compared with all other extant tetrapod orders. © The Author 2016. Published by Oxford University Press on behalf of the Society for Molecular Biology and Evolution. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Melting mountains of Appalachia: exceptionally high weathering rates in mined watersheds

NASA Astrophysics Data System (ADS)

Ross, M. R.; Nippgen, F.; Hassett, B.; McGlynn, B. L.; Bernhardt, E. S.

2016-12-01

Mountaintop mining operations excavate ridges as deep as 200 m and bury adjacent valleys and streams beneath fractured bedrock and coal residues. Post-mining, landscapes have lower slopes, greatly increased water storage potential, and an abundance of acid-generating pyrite, which is intentionally mixed with neutralizing calcareous bedrock. Together these design features of mountaintop mined lands create ideal conditions for long water residence times and rapid weathering rates, leading to widely documented and substantial increases in streamwater ion concentrations. To date, these concentration changes have not been linked to rates of watershed scale element flux. In a paired catchment study, we documented a 4,000% increase in the export of total dissolved solids from a mined watershed, and estimate that pyrite and carbonate weathering in reclaimed mines can export 9,000 kg ha-1 y-1 of dissolved rock to receiving streams. Such high rates of element flux after a disturbance are not only much higher than other watershed disturbances, but are among the highest rates of weathering ever reported globally. Sulfuric acid weathering of carbonate rock drives these patterns of chemical erosion. This strong acid weathering changes Appalachian geology from a slight net geologic CO2 sink-sequestering 800-1,500 kg CO2 km-2 yr-1 through carbonic acid weathering of carbonates-to a substantial net geologic source of CO2, releasing 170,000 kg CO2 km-2 yr-1. Over the more than 4,000 km2 area of Central Appalachia that has undergone mountaintop mining, this rapid weathering represents 4 million tons of dissolved rock being delivered to the streams of West Virginia, potentially releasing 680,000 tons of CO2 in the process.

Variation among cleft centres in the use of secondary surgery for children with cleft palate: a retrospective cohort study

PubMed Central

Sitzman, Thomas J; Hossain, Monir; Carle, Adam C; Heaton, Pamela C; Britto, Maria T

2017-01-01

Objectives To test whether cleft centres vary in their use of secondary cleft palate surgery, also known as revision palate surgery, and if so to identify modifiable hospital factors and surgeon factors that are associated with use of secondary surgery. Design Retrospective cohort study. Setting Forty-three paediatric hospitals across the USA. Patients Children with cleft lip and palate who underwent primary cleft palate repair from 1999 to 2013. Main outcome measures Time from primary cleft palate repair to secondary palate surgery. Results We identified 4939 children who underwent primary cleft palate repair. At 10 years after primary palate repair, 44% of children had undergone secondary palate surgery. Significant variation existed among hospitals (p<0.001); the proportion of children undergoing secondary surgery by 10 years ranged from 9% to 77% across hospitals. After adjusting for patient demographics, primary palate repair before 9 months of age was associated with an increased hazard of secondary palate surgery (initial HR 6.74, 95% CI 5.30 to 8.73). Postoperative antibiotics, surgeon procedure volume and hospital procedure volume were not associated with time to secondary surgery (p>0.05). Of the outcome variation attributable to hospitals and surgeons, between-hospital differences accounted for 59% (p<0.001), while between-surgeon differences accounted for 41% (p<0.001). Conclusions Substantial variation in the hazard of secondary palate surgery exists depending on a child’s age at primary palate repair and the hospital and surgeon performing their repair. Performing primary palate repair before 9 months of age substantially increases the hazard of secondary surgery. Further research is needed to identify other factors contributing to variation in palate surgery outcomes among hospitals and surgeons. PMID:29479567

KENNEDY SPACE CENTER, FLA. - In the Orbiter Processing Facility, KSC employee Gene Peavler works in the wheel area on the orbiter Discovery. The vehicle has undergone Orbiter Major Modifications in the past year. Discovery is scheduled to fly on mission STS-121 to the International Space Station.

NASA Image and Video Library

2003-12-09

KENNEDY SPACE CENTER, FLA. - In the Orbiter Processing Facility, KSC employee Gene Peavler works in the wheel area on the orbiter Discovery. The vehicle has undergone Orbiter Major Modifications in the past year. Discovery is scheduled to fly on mission STS-121 to the International Space Station.

Pancreaticoduodenectomy after esophageal and gastric surgery preserving right gastroepiploic vessels.

PubMed

Ikeda, Mami; Hasegawa, Kiyoshi; Akamatsu, Nobuhisa; Minagawa, Masami; Imamura, Hiroshi; Sugawara, Yasuhiko; Kokudo, Norihiro; Makuuchi, Masatoshi

2006-02-01

Secondary pancreaticoduodenectomy was performed in 2 patients, 1 who had undergone proximal gastrectomy for a gastric carcinoma and 1 who had undergone subtotal esophagectomy with stomach tube reconstruction for an inferior thoracic esophageal carcinoma. To prevent ischemia and congestion of the remnant stomach, the inflow and outflow pathways to the stomach, such as the right gastroepiploic artery and vein, were preserved. In this article, we describe the preservation procedures and discuss the problems of the secondary abdominal surgical procedure.

Effect of early correction of nasal septal deformity in unilateral cleft lip and palate on inferior turbinate hypertrophy and nasal patency.

PubMed

Pinto, Valentina; Piccin, Ottavio; Burgio, Luca; Summo, Valeria; Antoniazzi, Elisa; Morselli, Paolo G

2018-05-01

A relatively neglected aspect of cleft lip nasal deformity is the effect of septal deviation and inferior turbinate hypertrophy (ITH) on the functional airway. In particular, ITH in the noncleft side can be especially problematic, because it reduces the healthy nasal area, creating bilateral nasal obstruction that might affect the growth of the maxillofacial skeleton. Although these anatomic and functional changes are documented, few recommendations have been developed regarding the proper approach to ITH. The aim of the present study was to asses the ITH severity and determine the degree of nasal airway patency in patients who have undergone primary correction of the nasal septum during lip repair compared to patients operated on without primary septal correction. The study population included two groups. One group consisted of twenty unilateral cleft lip palate UCLP patients who have previously undergone primary rhinoseptoplasty as part of their treatment plan. The control group consisted of twenty UCLP patients operated on without rhinoseptal correction. The Nasal Obstructive Symptom Evaluation (NOSE) scale and nasal endoscopy were used to assess nasal obstruction. The overall untreated group reported severe symptoms across all NOSE scale dimensions more frequently than children who have undergone primary rhinoseptoplasty. The difference was statistically significant for each dimensions (p < 0.05). The mean NOSE score for group A and group B was 21.4 ± 9.4 and 70.8 ± 17.2 respectively (p < 0.0001). In group A turbinate size decreased significantly (p < 0.05) compared to pre-operative data. Comparing the two groups a statistically significant difference in turbinate size was observed (p < 0.0001). The results of the present study confirm that there is a significant degree of ITH and nasal airway dysfunction in patients with UCLP. Early septal repositioning during primary cleft lip repair results in a statistically significant reduction in IT size and improvement of nasal patency. Copyright © 2018 Elsevier B.V. All rights reserved.

Use of lean and six sigma methodology to improve operating room efficiency in a high-volume tertiary-care academic medical center.

PubMed

Cima, Robert R; Brown, Michael J; Hebl, James R; Moore, Robin; Rogers, James C; Kollengode, Anantha; Amstutz, Gwendolyn J; Weisbrod, Cheryl A; Narr, Bradly J; Deschamps, Claude

2011-07-01

Operating rooms (ORs) are resource-intense and costly hospital units. Maximizing OR efficiency is essential to maintaining an economically viable institution. OR efficiency projects often focus on a limited number of ORs or cases. Efforts across an entire OR suite have not been reported. Lean and Six Sigma methodologies were developed in the manufacturing industry to increase efficiency by eliminating non-value-added steps. We applied Lean and Six Sigma methodologies across an entire surgical suite to improve efficiency. A multidisciplinary surgical process improvement team constructed a value stream map of the entire surgical process from the decision for surgery to discharge. Each process step was analyzed in 3 domains, ie, personnel, information processed, and time. Multidisciplinary teams addressed 5 work streams to increase value at each step: minimizing volume variation; streamlining the preoperative process; reducing nonoperative time; eliminating redundant information; and promoting employee engagement. Process improvements were implemented sequentially in surgical specialties. Key performance metrics were collected before and after implementation. Across 3 surgical specialties, process redesign resulted in substantial improvements in on-time starts and reduction in number of cases past 5 pm. Substantial gains were achieved in nonoperative time, staff overtime, and ORs saved. These changes resulted in substantial increases in margin/OR/day. Use of Lean and Six Sigma methodologies increased OR efficiency and financial performance across an entire operating suite. Process mapping, leadership support, staff engagement, and sharing performance metrics are keys to enhancing OR efficiency. The performance gains were substantial, sustainable, positive financially, and transferrable to other specialties. Copyright © 2011 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

Multimodal exercise training in multiple sclerosis: A randomized controlled trial in persons with substantial mobility disability.

PubMed

Sandroff, Brian M; Bollaert, Rachel E; Pilutti, Lara A; Peterson, Melissa L; Baynard, Tracy; Fernhall, Bo; McAuley, Edward; Motl, Robert W

2017-10-01

Mobility disability is a common, debilitating feature of multiple sclerosis (MS). Exercise training has been identified as an approach to improve MS-related mobility disability. However, exercise randomized controlled trials (RCTs) on mobility in MS have generally not selectively targeted those with the onset of irreversible mobility disability. The current multi-site RCT compared the efficacy of 6-months of supervised, multimodal exercise training with an active control condition for improving mobility, gait, physical fitness, and cognitive outcomes in persons with substantial MS-related mobility disability. 83 participants with substantial MS-related mobility disability underwent initial mobility, gait, fitness, and cognitive processing speed assessments and were randomly assigned to 6-months of supervised multimodal (progressive aerobic, resistance, and balance) exercise training (intervention condition) or stretching-and-toning activities (control condition). Participants completed the same outcome assessments halfway through and immediately following the 6-month study period. There were statistically significant improvements in six-minute walk performance (F(2158)=3.12, p=0.05, η p 2 =0.04), peak power output (F(2150)=8.16, p<0.01, η p 2 =0.10), and Paced Auditory Serial Addition Test performance (F(2162)=4.67, p=0.01, η p 2 =0.05), but not gait outcomes, for those who underwent the intervention compared with those who underwent the control condition. This RCT provides novel, preliminary evidence that multimodal exercise training may improve endurance walking performance and cognitive processing speed, perhaps based on improvements in cardiorespiratory capacity, in persons with MS with substantial mobility disability. This is critical for informing the development of multi-site exercise rehabilitation programs in larger samples of persons with MS-related mobility disability. Copyright © 2017 Elsevier Inc. All rights reserved.

Highly porous ceramic oxide aerogels having improved flexibility

NASA Technical Reports Server (NTRS)

Guo, Haiquan (Inventor); Meador, Mary Ann B. (Inventor); Nguyen, Baochau N. (Inventor)

2012-01-01

Ceramic oxide aerogels having improved flexibility are disclosed. Preferred embodiments exhibit high modulus and other strength properties despite their improved flexibility. The gels may be polymer cross-linked via organic polymer chains to further improve strength properties, without substantially detracting from the improved flexibility. Methods of making such aerogels are also disclosed.

Enhancement of perfluoropolyether boundary lubrication performance: I. Preliminary results

NASA Technical Reports Server (NTRS)

Jones, W. R., Jr.; Ajayi, O. O.; Goodell, A. J.; Wedeven, L. D.; Devine, E.; Premore, R. E.

1995-01-01

A ball bearing simulator operating under starved conditions was used to evaluate the boundary lubrication performance of a perfluoropolyether (PFPE) Krytox 143 AB. Several approaches to enhance boundary lubrication were studied. These included: (1) soluble boundary additives, (2) bearing surface modifications, (3) 'run-in' surface films, and (4) ceramic bearing components. In addition, results were compared with two non-perfluorinated liquid lubricant formulations. Based on these preliminary tests, the following tentative conclusions can be made: (1) substantial improvements in boundary lubrication performance were observed with a beta-diketone boundary additive and a tricresyl phosphate (TCP) liquid surface pretreatment; (2) the use of rough Si3N4 balls (Ra = 40 micro-in) also provided substantial improvement but with concomitant abrasive wear; (3) marginal improvements were seen with two boundary additives (a phosphine and a phosphatriazine) and a neat (100%) fluid (a carboxylic acid terminated PFPE); and surface pretreatments with a synthetic hydrocarbon, a PTFE coating, and TiC coated 440C and smooth Si3N4 balls (R(sub a) less than 1 micro-in); and (4) two non-PFPE lubricant formulations (a PAO and a synthetic hydrocarbon) yielded substantial improvements.

Bioprosthetic Mesh in Abdominal Wall Reconstruction

PubMed Central

Baumann, Donald P.; Butler, Charles E.

2012-01-01

Mesh materials have undergone a considerable evolution over the last several decades. There has been enhancement of biomechanical properties, improvement in manufacturing processes, and development of antiadhesive laminate synthetic meshes. The evolution of bioprosthetic mesh materials has markedly changed our indications and methods for complex abdominal wall reconstruction. The authors review the optimal properties of bioprosthetic mesh materials, their evolution over time, and their indications for use. The techniques to optimize outcomes are described using bioprosthetic mesh for complex abdominal wall reconstruction. Bioprosthetic mesh materials clearly have certain advantages over other implantable mesh materials in select indications. Appropriate patient selection and surgical technique are critical to the successful use of bioprosthetic materials for abdominal wall repair. PMID:23372454

Intraoperative Computed Tomography for Cervicomedullary Decompression of Foramen Magnum Stenosis in Achondroplasia: Two Case Reports

PubMed Central

Arishima, Hidetaka; Tsunetoshi, Kenzo; Kodera, Toshiaki; Kitai, Ryuhei; Takeuchi, Hiroaki; Kikuta, Ken-ichiro

2013-01-01

The authors report two cases of cervicomedullary decompression of foramen magnum (FM) stenosis in children with achondroplasia using intraoperative computed tomography (iCT). A 14-month-old girl with myelopathy and retarded motor development, and a 10-year-old girl who had already undergone incomplete FM decompression was presented with myelopathy. Both patients underwent decompressive sub-occipitalcraniectomy and C1 laminectomy without duraplasty using iCT. It clearly showed the extent of FM decompression during surgery, which finally enabled sufficient decompression. After the operation, their myelopathy improved. We think that iCT can provide useful information and guidance for sufficient decompression for FM stenosis in children with achondroplasia. PMID:24140778

Intraoperative computed tomography for cervicomedullary decompression of foramen magnum stenosis in achondroplasia: two case reports.

PubMed

Arishima, Hidetaka; Tsunetoshi, Kenzo; Kodera, Toshiaki; Kitai, Ryuhei; Takeuchi, Hiroaki; Kikuta, Ken-Ichiro

2013-01-01

The authors report two cases of cervicomedullary decompression of foramen magnum (FM) stenosis in children with achondroplasia using intraoperative computed tomography (iCT). A 14-month-old girl with myelopathy and retarded motor development, and a 10-year-old girl who had already undergone incomplete FM decompression was presented with myelopathy. Both patients underwent decompressive sub-occipitalcraniectomy and C1 laminectomy without duraplasty using iCT. It clearly showed the extent of FM decompression during surgery, which finally enabled sufficient decompression. After the operation, their myelopathy improved. We think that iCT can provide useful information and guidance for sufficient decompression for FM stenosis in children with achondroplasia.

Novel biomarkers for cardiovascular risk assessment: current status and future directions.

PubMed

MacNamara, James; Eapen, Danny J; Quyyumi, Arshed; Sperling, Laurence

2015-09-01

Cardiovascular disease (CVD) is the leading cause of mortality in the modern world. Traditional risk algorithms may miss up to 20% of CVD events. Therefore, there is a need for new cardiac biomarkers. Many fields of research are dedicated to improving cardiac risk prediction, including genomics, transcriptomics and proteomics. To date, even the most promising biomarkers have only demonstrated modest associations and predictive ability. Few have undergone randomized control trials. A number of biomarkers are targets to new therapies aimed to reduce cardiovascular risk. Currently, some of the most promising risk prediction has been demonstrated with panels of multiple biomarkers. This article reviews the current state and future of proteomic biomarkers and aggregate biomarker panels.

Stewart Treves Syndrome.

PubMed

Pereira, Elisangela Samartin Pegas; Moraes, Elisa Trino de; Siqueira, Daniela Melo; Santos, Marcel Alex Soares dos

2015-01-01

Stewart-Treves Syndrome is characterized by the presence of lymphangiosarcoma on limb extremities. Rare, it occurs in 0.5% of patients who have undergone radical mastectomy with axillary node dissection. The main cause is chronic lymphedema with endothelial and lymphatic differentiation, with no direct relationship to breast cancer. Seven years after a radical right-side mastectomy with lymph node dissection and adjuvant therapy, the patient developed a lesion on her right arm. The dermatological examination revealed an erythematous nodule with bleeding surface on chronic right forearm lymphedema. After the biopsy, a lymphangiosarcoma on chronic lymphedema was diagnosed. Infrequent, this syndrome is relevant because of its associated mortality. Early diagnosis is important to improve survival and reduce complications.

Topographic mapping

USGS Publications Warehouse

,

2008-01-01

The U.S. Geological Survey (USGS) produced its first topographic map in 1879, the same year it was established. Today, more than 100 years and millions of map copies later, topographic mapping is still a central activity for the USGS. The topographic map remains an indispensable tool for government, science, industry, and leisure. Much has changed since early topographers traveled the unsettled West and carefully plotted the first USGS maps by hand. Advances in survey techniques, instrumentation, and design and printing technologies, as well as the use of aerial photography and satellite data, have dramatically improved mapping coverage, accuracy, and efficiency. Yet cartography, the art and science of mapping, may never before have undergone change more profound than today.

Release of peptide YY (PYY) after resection of small bowel, colon, or pancreas in man.

PubMed

Adrian, T E; Savage, A P; Fuessl, H S; Wolfe, K; Besterman, H S; Bloom, S R

1987-06-01

To investigate the possible role of peptide YY (PYY) in the adaptive changes that accompany enterectomy, plasma levels of this peptide were measured during breakfast in patients with resected small or large intestines and in controls. In 18 patients who had undergone partial ileal resection, basal PYY concentrations were greatly elevated when compared with controls (51.4 +/- 8.7 pmol/L versus 10.3 +/- 1.0; p less than 0.001) and the postprandial response was similarly increased. In contrast, PYY concentrations were low in 16 patients who had undergone colonic resection and ileostomy (fasting 7.1 +/- 0.7 pmol/L, p less than 0.01). In eight patients who had undergone pancreatectomies, basal and postprandial PYY levels were moderately increased (23.4 +/- 3.5 pmol/L; fasting p less than 0.001). PYY does not appear to have a role in the adaptive trophic response after small intestinal resection, but it may contribute to reduction of gastric secretion and gastrointestinal transit in these patients.

Complementary and alternative medicine for childhood asthma: an overview of evidence and patents.

PubMed

Hon, Kam-Lun E; Fung, Ching Ki; Leung, Alexander K C; Leung, Theresa Ngan-Ho; Ng, Daniel K K

2015-01-01

Asthma is a prevalent childhood atopic disease associated with significant impairment of quality of life. Management relies on avoidance of triggers such as food and aeroallergens, the use of inhaled bronchodilators/corticosteroids and anti-allergic or immune-modulating therapies. Inhaled corticosteroids (ICSs) and bronchodilators have been the mainstay of treatment. In China as well as throughout Asia, myths and misconceptions on western medicine and corticosteroids are prevalent and result in non-adherence of treatment. A wide variety of complementary and alternative medicines (CAM) are available. Some of these have undergone extensive clinical trials and have been documented to have some therapeutic effects on asthma. Nevertheless, the majority of these treatment modalities is not efficacious and may even be detrimental. This article overviews the evidence for the clinical efficacy of all major CAM modalities. Despite CAM modalities are extensively used by the patients with asthma, very few CAM patents are available. This article also discusses recent patents pertinent to asthma. Only a few patents on herbal medicine for asthma have been evaluated but therapeutic efficacy is not substantially documented. Parents seeking CAM for asthma must consult qualified registered practitioners before using it.

Declining physical activity and the socio-cultural context of the geography of industrial restructuring: a novel conceptual framework.

PubMed

Rind, Esther; Jones, Andy

2014-05-01

At the population level, the prevalence of physical activity has declined considerably in many developed countries in recent decades. There is some evidence that areas exhibiting the lowest activity levels are those which have undergone a particularly strong transition away from employment in physically demanding occupations. We propose that processes of deindustrialization may be causally linked to unexplained geographical disparities in levels of physical activity. While the sociocultural correlates of physical activity have been well studied, and prior conceptual frameworks have been developed to explain more general patterns of activity, none have explicitly attempted to identify the components of industrial change that may impact physical activity. In this work we review the current literature on sociocultural correlates of health behaviors before using a case study centered on the United Kingdom to present a novel framework that links industrial change to declining levels of physical activity. We developed a comprehensive model linking sociocultural correlates of physical activity to processes associated with industrial restructuring and discuss implication for policy and practice. A better understanding of sociocultural processes may help to ameliorate adverse health consequences of employment decline in communities that have experienced substantial losses of manual employment.

The cooperative economy of food: Implications for human life history and physiology.

PubMed

Kramer, Karen L

2018-04-06

The human diet has undergone substantial modifications since the emergence of modern humans and varies considerably in today's traditional societies. Despite these changes and cross-cultural differences, the human diet can be characterized by several common elements. These include diverse, high quality foods, technological complexity to acquire and process food, and the establishment of home bases for storage, processing and consumption. Together these aspects of the human diet challenge any one individual to independently meet all of his or her daily caloric needs. Humans solve this challenge through food sharing, labor exchange and the division of labor. The cooperative nature of the human diet is associated with many downstream effects on our life history and physiology. This paper overviews the constellation of traits that likely led to a cooperative economy of food, and draws on ethnographic examples to illustrate its effects on human life history and physiology. Two detailed examples using body composition, time allocation and food acquisition data show how cooperation among Savanna Pumé hunter-gatherers affects activity levels, sexual dimorphism in body fat, maturational pace and age at first birth. Copyright © 2018. Published by Elsevier Inc.

Parallel evolution of passive and active defence in land snails.

PubMed

Morii, Yuta; Prozorova, Larisa; Chiba, Satoshi

2016-11-11

Predator-prey interactions are major processes promoting phenotypic evolution. However, it remains unclear how predation causes morphological and behavioural diversity in prey species and how it might lead to speciation. Here, we show that substantial divergence in the phenotypic traits of prey species has occurred among closely related land snails as a result of adaptation to predator attacks. This caused the divergence of defensive strategies into two alternatives: passive defence and active defence. Phenotypic traits of the subarctic Karaftohelix land snail have undergone radiation in northeast Asia, and distinctive morphotypes generally coexist in the same regions. In these land snails, we documented two alternative defence behaviours against predation by malacophagous beetles. Furthermore, the behaviours are potentially associated with differences in shell morphology. In addition, molecular phylogenetic analyses indicated that these alternative strategies against predation arose independently on the islands and on the continent suggesting that anti-predator adaptation is a major cause of phenotypic diversity in these snails. Finally, we suggest the potential speciation of Karaftohelix snails as a result of the divergence of defensive strategies into passive and active behaviours and the possibility of species radiation due to anti-predatory adaptations.

Comparing inequalities in women's and men's health: Britain in the 1990s.

PubMed

Arber, S

1997-03-01

Data on over 20,000 women and men aged 20-59 are analysed from the British General Household Survey for 1991 and 1992, showing the importance of separately analysing educational qualifications, occupational class and employment status for both women and men. Own occupational class and employment status are the key structural factors associated with limiting long-standing illness, but educational qualifications are particularly good predictors of women's self-assessed health. Class inequalities in health are less pronounced among women who are not in paid work. Women's limiting long-standing illness relates solely to their own labour market characteristics, whereas self-assessed health relates to wider aspects of women's everyday lives, including their household material conditions, and for married women, their partner's occupational class and employment status. Men's unemployment has adverse consequences for the health of their wives, which occurs through the mechanism of the family living in disadvantaged material circumstances. Women's labour market position and role in the family have undergone substantial changes since the 1970s. Approaches to measuring inequalities in women's health need to reflect changes in women's employment participation and changes in marital status and living arrangements.

Downregulation of 26S proteasome catalytic activity promotes epithelial-mesenchymal transition

PubMed Central

van Baarsel, Eric D.; Metz, Patrick J.; Fisch, Kathleen; Widjaja, Christella E.; Kim, Stephanie H.; Lopez, Justine; Chang, Aaron N.; Geurink, Paul P.; Florea, Bogdan I.; Overkleeft, Hermen S.; Ovaa, Huib; Bui, Jack D.; Yang, Jing; Chang, John T.

2016-01-01

The epithelial-mesenchymal transition (EMT) endows carcinoma cells with phenotypic plasticity that can facilitate the formation of cancer stem cells (CSCs) and contribute to the metastatic cascade. While there is substantial support for the role of EMT in driving cancer cell dissemination, less is known about the intracellular molecular mechanisms that govern formation of CSCs via EMT. Here we show that β2 and β5 proteasome subunit activity is downregulated during EMT in immortalized human mammary epithelial cells. Moreover, selective proteasome inhibition enabled mammary epithelial cells to acquire certain morphologic and functional characteristics reminiscent of cancer stem cells, including CD44 expression, self-renewal, and tumor formation. Transcriptomic analyses suggested that proteasome-inhibited cells share gene expression signatures with cells that have undergone EMT, in part, through modulation of the TGF-β signaling pathway. These findings suggest that selective downregulation of proteasome activity in mammary epithelial cells can initiate the EMT program and acquisition of a cancer stem cell-like phenotype. As proteasome inhibitors become increasingly used in cancer treatment, our findings highlight a potential risk of these therapeutic strategies and suggest a possible mechanism by which carcinoma cells may escape from proteasome inhibitor-based therapy. PMID:26930717

Greenland meltwater storage in firn limited by near-surface ice formation

NASA Astrophysics Data System (ADS)

Machguth, Horst; Macferrin, Mike; van As, Dirk; Box, Jason E.; Charalampidis, Charalampos; Colgan, William; Fausto, Robert S.; Meijer, Harro A. J.; Mosley-Thompson, Ellen; van de Wal, Roderik S. W.

2016-04-01

Approximately half of Greenland’s current annual mass loss is attributed to runoff from surface melt. At higher elevations, however, melt does not necessarily equal runoff, because meltwater can refreeze in the porous near-surface snow and firn. Two recent studies suggest that all or most of Greenland’s firn pore space is available for meltwater storage, making the firn an important buffer against contribution to sea level rise for decades to come. Here, we employ in situ observations and historical legacy data to demonstrate that surface runoff begins to dominate over meltwater storage well before firn pore space has been completely filled. Our observations frame the recent exceptional melt summers in 2010 and 2012 (refs ,), revealing significant changes in firn structure at different elevations caused by successive intensive melt events. In the upper regions (more than ~1,900 m above sea level), firn has undergone substantial densification, while at lower elevations, where melt is most abundant, porous firn has lost most of its capability to retain meltwater. Here, the formation of near-surface ice layers renders deep pore space difficult to access, forcing meltwater to enter an efficient surface discharge system and intensifying ice sheet mass loss earlier than previously suggested.

Effects of linear and nonlinear speech rate changes on speech intelligibility in stationary and fluctuating maskers

PubMed Central

Cooke, Martin; Aubanel, Vincent

2017-01-01

Algorithmic modifications to the durational structure of speech designed to avoid intervals of intense masking lead to increases in intelligibility, but the basis for such gains is not clear. The current study addressed the possibility that the reduced information load produced by speech rate slowing might explain some or all of the benefits of durational modifications. The study also investigated the influence of masker stationarity on the effectiveness of durational changes. Listeners identified keywords in sentences that had undergone linear and nonlinear speech rate changes resulting in overall temporal lengthening in the presence of stationary and fluctuating maskers. Relative to unmodified speech, a slower speech rate produced no intelligibility gains for the stationary masker, suggesting that a reduction in information rate does not underlie intelligibility benefits of durationally modified speech. However, both linear and nonlinear modifications led to substantial intelligibility increases in fluctuating noise. One possibility is that overall increases in speech duration provide no new phonetic information in stationary masking conditions, but that temporal fluctuations in the background increase the likelihood of glimpsing additional salient speech cues. Alternatively, listeners may have benefitted from an increase in the difference in speech rates between the target and background. PMID:28618803

Surprising migration and population size dynamics in ancient Iberian brown bears (Ursus arctos)

PubMed Central

Valdiosera, Cristina E.; García-Garitagoitia, José Luis; Garcia, Nuria; Doadrio, Ignacio; Thomas, Mark G.; Hänni, Catherine; Arsuaga, Juan-Luis; Barnes, Ian; Hofreiter, Michael; Orlando, Ludovic; Götherström, Anders

2008-01-01

The endangered brown bear populations (Ursus arctos) in Iberia have been suggested to be the last fragments of the brown bear population that served as recolonization stock for large parts of Europe during the Pleistocene. Conservation efforts are intense, and results are closely monitored. However, the efforts are based on the assumption that the Iberian bears are a unique unit that has evolved locally for an extended period. We have sequenced mitochondrial DNA (mtDNA) from ancient Iberian bear remains and analyzed them as a serial dataset, monitoring changes in diversity and occurrence of European haplogroups over time. Using these data, we show that the Iberian bear population has experienced a dynamic, recent evolutionary history. Not only has the population undergone mitochondrial gene flow from other European brown bears, but the effective population size also has fluctuated substantially. We conclude that the Iberian bear population has been a fluid evolutionary unit, developed by gene flow from other populations and population bottlenecks, far from being in genetic equilibrium or isolated from other brown bear populations. Thus, the current situation is highly unusual and the population may in fact be isolated for the first time in its history. PMID:18347332

Surprising migration and population size dynamics in ancient Iberian brown bears (Ursus arctos).

PubMed

Valdiosera, Cristina E; García-Garitagoitia, José Luis; Garcia, Nuria; Doadrio, Ignacio; Thomas, Mark G; Hänni, Catherine; Arsuaga, Juan-Luis; Barnes, Ian; Hofreiter, Michael; Orlando, Ludovic; Götherström, Anders

2008-04-01

The endangered brown bear populations (Ursus arctos) in Iberia have been suggested to be the last fragments of the brown bear population that served as recolonization stock for large parts of Europe during the Pleistocene. Conservation efforts are intense, and results are closely monitored. However, the efforts are based on the assumption that the Iberian bears are a unique unit that has evolved locally for an extended period. We have sequenced mitochondrial DNA (mtDNA) from ancient Iberian bear remains and analyzed them as a serial dataset, monitoring changes in diversity and occurrence of European haplogroups over time. Using these data, we show that the Iberian bear population has experienced a dynamic, recent evolutionary history. Not only has the population undergone mitochondrial gene flow from other European brown bears, but the effective population size also has fluctuated substantially. We conclude that the Iberian bear population has been a fluid evolutionary unit, developed by gene flow from other populations and population bottlenecks, far from being in genetic equilibrium or isolated from other brown bear populations. Thus, the current situation is highly unusual and the population may in fact be isolated for the first time in its history.

Gaia reveals a metal-rich in-situ component of the local stellar halo

NASA Astrophysics Data System (ADS)

Bonaca, Ana; Conroy, Charlie; Wetzel, Andrew; Hopkins, Philip; Keres, Dusan

2018-01-01

We use the first Gaia data release, combined with RAVE and APOGEE spectroscopic surveys, to investigate the origin of halo stars within ~3 kpc from the Sun. We identify halo stars kinematically, as moving with a relative speed of at least 220 km/s with respect to the local standard of rest. These stars are in general more metal-poor than the disk, but surprisingly, half of our halo sample is comprised of stars with [Fe/H]>-1. The orbital directions of these metal-rich halo stars are preferentially aligned with the disk rotation, in sharp contrast with the isotropic orbital distribution of the more metal-poor halo stars. We find similar properties in the Latte cosmological zoom-in simulation of a Milky Way-like galaxy from the FIRE project. In Latte, metal-rich halo stars formed primarily inside of the solar circle, while lower-metallicity halo stars preferentially formed at larger distances (extending beyond the virial radius). This suggests that metal-rich halo stars in the Solar neighborhood in fact formed in situ within the Galactic disk rather than having been accreted from satellite systems. These stars, currently on halo-like orbits, therefore have likely undergone substantial radial migration/heating.

Gaia Reveals a Metal-rich, in situ Component of the Local Stellar Halo

NASA Astrophysics Data System (ADS)

Bonaca, Ana; Conroy, Charlie; Wetzel, Andrew; Hopkins, Philip F.; Kereš, Dušan

2017-08-01

We use the first Gaia data release, combined with the RAVE and APOGEE spectroscopic surveys, to investigate the origin of halo stars within ≲ 3 kpc from the Sun. We identify halo stars kinematically as moving at a relative speed of at least 220 km s-1 with respect to the local standard of rest. These stars are generally less metal-rich than the disk, but surprisingly, half of our halo sample is comprised of stars with [{Fe}/{{H}}]> -1. The orbital directions of these metal-rich halo stars are preferentially aligned with the disk rotation, in sharp contrast with the intrinsically isotropic orbital distribution of the metal-poor halo stars. We find similar properties in the Latte cosmological zoom-in simulation of a Milky Way-like galaxy from the FIRE project. In Latte, metal-rich halo stars formed primarily inside of the solar circle, whereas lower-metallicity halo stars preferentially formed at larger distances (extending beyond the virial radius). This suggests that metal-rich halo stars in the solar neighborhood actually formed in situ within the Galactic disk, rather than having been accreted from satellite systems. These stars, currently on halo-like orbits, therefore have likely undergone substantial radial migration/heating.

Structural failure and drowning of Johnston Atoll, central Pacific Basin

NASA Astrophysics Data System (ADS)

Keating, Barbara H.

Emery (1956) and Ashmore (1973) described the geology of Johnston Atoll (Northern Line Islands chain) and pointed out the anomalous structure of the atoll. These studies led Ashmore )1973) to suggest that the atoll itself is tilted. Johnston Atoll appears to be an example of a seamount that is undergoing a transition from an atoll to a drowned seamount (guyot). Submersible studies of the shallow carbonate bank demonstrate that the carbonate bank displays important karstic features. Recent side-scan sonar studies of the southern flank of this seamount provide evidence that the southern flank of the seamount has undergone substantial mass-wasting. We hypothesize that the mass-wasting of the seamount has loaded the seafloor surrounding Johnston Island unevenly. The southeast Johnston Basin lies 700 m shallower than the southwest Johnston Basin. The loading of the southeast Johnston Basin has resulted in differential subsidence of the sea floor surrounding the seamount which has resulted in the tilting of the seamount (0.016°) and is responsible for the drowning of much of the reef. It is suggested that local structural failure, preferential erosion and drainage, and differential subsidence of seamounts can cause drowning of reefs which may lead to the formation of guyots.

Neurochemical abnormalities in brains of renal failure patients treated by repeated hemodialysis.

PubMed

Perry, T L; Yong, V W; Kish, S J; Ito, M; Foulks, J G; Godolphin, W J; Sweeney, V P

1985-10-01

We examined autopsied brain from 10 patients with end-stage renal failure who had undergone repeated hemodialysis. Eight had classic symptoms, and two had suggestive symptoms of dialysis encephalopathy. Findings were compared with those in autopsied brain from control adults who had never been hemodialyzed. Mean gamma-aminobutyric acid (GABA) contents were significantly reduced in frontal and occipital cortex, cerebellar cortex, dentate nucleus, caudate nucleus, and medial-dorsal thalamus of the hemodialyzed patients, the reduction being greater than 40% in cerebral cortex and thalamus. Choline acetyltransferase activity was reduced by 25-35% in three cortical regions in the hemodialyzed patients. These two abnormalities were observed in the brain of each hemodialyzed patient, regardless of whether or not the patient died with unequivocal dialysis encephalopathy. Pyridoxal phosphate contents were substantially reduced in brains of the hemodialyzed patients, but metabolites of noradrenaline, 3,4-dihydroxyphenylethylamine (dopamine), and 5-hydroxytryptamine (serotonin) were present in normal amounts. Aluminum levels were abnormally high in frontal cortical gray matter in the hemodialyzed patients. Although this study does not clarify the role played by aluminum toxicity in the pathogenesis of dialysis encephalopathy, the abnormalities we found suggest the need for further neurochemical investigations in this disorder.

A theoretical and empirical review of the death-thought accessibility concept in terror management research.

PubMed

Hayes, Joseph; Schimel, Jeff; Arndt, Jamie; Faucher, Erik H

2010-09-01

Terror management theory (TMT) highlights the motivational impact of thoughts of death in various aspects of everyday life. Since its inception in 1986, research on TMT has undergone a slight but significant shift from an almost exclusive focus on the manipulation of thoughts of death to a marked increase in studies that measure the accessibility of death-related cognition. Indeed, the number of death-thought accessibility (DTA) studies in the published literature has grown substantially in recent years. In light of this increasing reliance on the DTA concept, the present article is meant to provide a comprehensive theoretical and empirical review of the literature employing this concept. After discussing the roots of DTA, the authors outline the theoretical refinements to TMT that have accompanied significant research findings associated with the DTA concept. Four distinct categories (mortality salience, death association, anxiety-buffer threat, and dispositional) are derived to organize the reviewed DTA studies, and the theoretical implications of each category are discussed. Finally, a number of lingering empirical and theoretical issues in the DTA literature are discussed with the aim of stimulating and focusing future research on DTA specifically and TMT in general.

Stratigraphic and Earth System approaches to defining the Anthropocene

NASA Astrophysics Data System (ADS)

Steffen, Will; Leinfelder, Reinhold; Zalasiewicz, Jan; Waters, Colin N.; Williams, Mark; Summerhayes, Colin; Barnosky, Anthony D.; Cearreta, Alejandro; Crutzen, Paul; Edgeworth, Matt; Ellis, Erle C.; Fairchild, Ian J.; Galuszka, Agnieszka; Grinevald, Jacques; Haywood, Alan; Ivar do Sul, Juliana; Jeandel, Catherine; McNeill, J. R.; Odada, Eric; Oreskes, Naomi; Revkin, Andrew; Richter, Daniel deB.; Syvitski, James; Vidas, Davor; Wagreich, Michael; Wing, Scott L.; Wolfe, Alexander P.; Schellnhuber, H. J.

2016-08-01

Stratigraphy provides insights into the evolution and dynamics of the Earth System over its long history. With recent developments in Earth System science, changes in Earth System dynamics can now be observed directly and projected into the near future. An integration of the two approaches provides powerful insights into the nature and significance of contemporary changes to Earth. From both perspectives, the Earth has been pushed out of the Holocene Epoch by human activities, with the mid-20th century a strong candidate for the start date of the Anthropocene, the proposed new epoch in Earth history. Here we explore two contrasting scenarios for the future of the Anthropocene, recognizing that the Earth System has already undergone a substantial transition away from the Holocene state. A rapid shift of societies toward the UN Sustainable Development Goals could stabilize the Earth System in a state with more intense interglacial conditions than in the late Quaternary climate regime and with little further biospheric change. In contrast, a continuation of the present Anthropocene trajectory of growing human pressures will likely lead to biotic impoverishment and a much warmer climate with a significant loss of polar ice.

Horizontal Gene Acquisitions, Mobile Element Proliferation, and Genome Decay in the Host-Restricted Plant Pathogen Erwinia Tracheiphila

PubMed Central

Shapiro, Lori R.; Scully, Erin D.; Straub, Timothy J.; Park, Jihye; Stephenson, Andrew G.; Beattie, Gwyn A.; Gleason, Mark L.; Kolter, Roberto; Coelho, Miguel C.; De Moraes, Consuelo M.; Mescher, Mark C.; Zhaxybayeva, Olga

2016-01-01

Modern industrial agriculture depends on high-density cultivation of genetically similar crop plants, creating favorable conditions for the emergence of novel pathogens with increased fitness in managed compared with ecologically intact settings. Here, we present the genome sequence of six strains of the cucurbit bacterial wilt pathogen Erwinia tracheiphila (Enterobacteriaceae) isolated from infected squash plants in New York, Pennsylvania, Kentucky, and Michigan. These genomes exhibit a high proportion of recent horizontal gene acquisitions, invasion and remarkable amplification of mobile genetic elements, and pseudogenization of approximately 20% of the coding sequences. These genome attributes indicate that E. tracheiphila recently emerged as a host-restricted pathogen. Furthermore, chromosomal rearrangements associated with phage and transposable element proliferation contribute to substantial differences in gene content and genetic architecture between the six E. tracheiphila strains and other Erwinia species. Together, these data lead us to hypothesize that E. tracheiphila has undergone recent evolution through both genome decay (pseudogenization) and genome expansion (horizontal gene transfer and mobile element amplification). Despite evidence of dramatic genomic changes, the six strains are genetically monomorphic, suggesting a recent population bottleneck and emergence into E. tracheiphila’s current ecological niche. PMID:26992913

Trade-off between aerobic capacity and locomotor capability in an Antarctic pteropod

PubMed Central

Rosenthal, Joshua J. C.; Seibel, Brad A.; Dymowska, Agnieszka; Bezanilla, Francisco

2009-01-01

At −1.8 °C, the waters of Antarctica pose a formidable physiological barrier for most ectotherms. The few taxa that inhabit this zone have presumably made specific adjustments to their neuromuscular function and have enhanced their metabolic capacity. However, support for this assertion is equivocal and the details of specific compensations are largely unknown. This can generally be attributed to the fact that most Antarctic organisms are either too distantly related to their temperate relatives to permit direct comparisons (e.g., notothenioid fishes) or because they are not amenable to neuromuscular recording. Here, as a comparative model, we take advantage of 2 pelagic molluscs in the genus Clione to conduct a broadly integrative investigation on neuromuscular adaptation to the extreme cold. We find that for the Antarctic congener aerobic capacity is enhanced, but at a cost. To support a striking proliferation of mitochondria, the Antarctic species has shed a 2-gear swim system and the associated specialized neuromuscular components, resulting in greatly reduced scope for locomotor activity. These results suggest that polar animals have undergone substantial tissue-level reorganizations to accommodate their environment, which may reduce their capacity to acclimate to a changing climate. PMID:19325127

Theoretical modeling of time-dependent skin temperature and heat losses during whole-body cryotherapy: A pilot study.

PubMed

Polidori, G; Marreiro, A; Pron, H; Lestriez, P; Boyer, F C; Quinart, H; Tourbah, A; Taïar, R

2016-11-01

This article establishes the basics of a theoretical model for the constitutive law that describes the skin temperature and thermolysis heat losses undergone by a subject during a session of whole-body cryotherapy (WBC). This study focuses on the few minutes during which the human body is subjected to a thermal shock. The relationship between skin temperature and thermolysis heat losses during this period is still unknown and have not yet been studied in the context of the whole human body. The analytical approach here is based on the hypothesis that the skin thermal shock during a WBC session can be thermally modelled by the sum of both radiative and free convective heat transfer functions. The validation of this scientific approach and the derivation of temporal evolution thermal laws, both on skin temperature and dissipated thermal power during the thermal shock open many avenues of large scale studies with the aim of proposing individualized cryotherapy protocols as well as protocols intended for target populations. Furthermore, this study shows quantitatively the substantial imbalance between human metabolism and thermolysis during WBC, the explanation of which remains an open question. Copyright © 2016 Elsevier Ltd. All rights reserved.

The Origin and Early Radiation of Archosauriforms: Integrating the Skeletal and Footprint Record.

PubMed

Bernardi, Massimo; Klein, Hendrik; Petti, Fabio Massimo; Ezcurra, Martín D

2015-01-01

We present a holistic approach to the study of early archosauriform evolution by integrating body and track records. The ichnological record supports a Late Permian-Early Triassic radiation of archosauriforms not well documented by skeletal material, and new footprints from the Upper Permian of the southern Alps (Italy) provide evidence for a diversity not yet sampled by body fossils. The integrative study of body fossil and footprint data supports the hypothesis that archosauriforms had already undergone substantial taxonomic diversification by the Late Permian and that by the Early Triassic archosauromorphs attained a broad geographical distribution over most parts of Pangea. Analysis of body size, as deduced from track size, suggests that archosauriform average body size did not change significantly from the Late Permian to the Early Triassic. A survey of facies yielding both skeletal and track record indicate an ecological preference for inland fluvial (lacustrine) environments for early archosauromorphs. Finally, although more data is needed, Late Permian chirotheriid imprints suggest a shift from sprawling to erect posture in archosauriforms before the end-Permian mass extinction event. We highlight the importance of approaching palaeobiological questions by using all available sources of data, specifically through integrating the body and track fossil record.

The Origin and Early Radiation of Archosauriforms: Integrating the Skeletal and Footprint Record

PubMed Central

Bernardi, Massimo; Klein, Hendrik; Petti, Fabio Massimo; Ezcurra, Martín D.

2015-01-01

We present a holistic approach to the study of early archosauriform evolution by integrating body and track records. The ichnological record supports a Late Permian–Early Triassic radiation of archosauriforms not well documented by skeletal material, and new footprints from the Upper Permian of the southern Alps (Italy) provide evidence for a diversity not yet sampled by body fossils. The integrative study of body fossil and footprint data supports the hypothesis that archosauriforms had already undergone substantial taxonomic diversification by the Late Permian and that by the Early Triassic archosauromorphs attained a broad geographical distribution over most parts of Pangea. Analysis of body size, as deduced from track size, suggests that archosauriform average body size did not change significantly from the Late Permian to the Early Triassic. A survey of facies yielding both skeletal and track record indicate an ecological preference for inland fluvial (lacustrine) environments for early archosauromorphs. Finally, although more data is needed, Late Permian chirotheriid imprints suggest a shift from sprawling to erect posture in archosauriforms before the end-Permian mass extinction event. We highlight the importance of approaching palaeobiological questions by using all available sources of data, specifically through integrating the body and track fossil record. PMID:26083612

Regional variability in sea ice melt in a changing Arctic

PubMed Central

Perovich, Donald K.; Richter-Menge, Jacqueline A.

2015-01-01

In recent years, the Arctic sea ice cover has undergone a precipitous decline in summer extent. The sea ice mass balance integrates heat and provides insight on atmospheric and oceanic forcing. The amount of surface melt and bottom melt that occurs during the summer melt season was measured at 41 sites over the time period 1957 to 2014. There are large regional and temporal variations in both surface and bottom melting. Combined surface and bottom melt ranged from 16 to 294 cm, with a mean of 101 cm. The mean ice equivalent surface melt was 48 cm and the mean bottom melt was 53 cm. On average, surface melting decreases moving northward from the Beaufort Sea towards the North Pole; however interannual differences in atmospheric forcing can overwhelm the influence of latitude. Substantial increases in bottom melting are a major contributor to ice losses in the Beaufort Sea, due to decreases in ice concentration. In the central Arctic, surface and bottom melting demonstrate interannual variability, but show no strong temporal trends from 2000 to 2014. This suggests that under current conditions, summer melting in the central Arctic is not large enough to completely remove the sea ice cover. PMID:26032323

Relaxed genetic control of cortical organization in human brains compared with chimpanzees

PubMed Central

Gómez-Robles, Aida; Hopkins, William D.; Schapiro, Steven J.; Sherwood, Chet C.

2015-01-01

The study of hominin brain evolution has focused largely on the neocortical expansion and reorganization undergone by humans as inferred from the endocranial fossil record. Comparisons of modern human brains with those of chimpanzees provide an additional line of evidence to define key neural traits that have emerged in human evolution and that underlie our unique behavioral specializations. In an attempt to identify fundamental developmental differences, we have estimated the genetic bases of brain size and cortical organization in chimpanzees and humans by studying phenotypic similarities between individuals with known kinship relationships. We show that, although heritability for brain size and cortical organization is high in chimpanzees, cerebral cortical anatomy is substantially less genetically heritable than brain size in humans, indicating greater plasticity and increased environmental influence on neurodevelopment in our species. This relaxed genetic control on cortical organization is especially marked in association areas and likely is related to underlying microstructural changes in neural circuitry. A major result of increased plasticity is that the development of neural circuits that underlie behavior is shaped by the environmental, social, and cultural context more intensively in humans than in other primate species, thus providing an anatomical basis for behavioral and cognitive evolution. PMID:26627234

North Atlantic Oscillation Drives Regional Greenland Glacier Volume During the 20th Century

NASA Astrophysics Data System (ADS)

Bjork, A. A.; Aagaard, S.; Hallander, A. M.; Khan, S. A.; Box, J. E.; Kjeldsen, K. K.; Larsen, N. K.; Korsgaard, N. J.; Cappelen, J.; Colgan, W. T.; Machguth, H.; Andresen, C. S.; Kjaer, K. H.

2016-12-01

While most areas of the Greenland ice sheet have undergone rapid mass loss since c. 1990, the central eastern section of the ice sheet has advanced and gained mass. This contrasting regional trend has been attributed to positive surface mass balance (SMB) in the absence of significant dynamic mass loss. To constrain the atypical behavior in this region, we mapped glacier length fluctuations of nearly 200 peripheral glaciers and ice caps (PGICs) over a 103-year period, and compare the results with c. 150 new glacier length records from central west Greenland. We demonstrate that the regional response in ice volume is closely correlated to changes in precipitation, governed by circulation patterns associated with the North Atlantic Oscillation (NAO) and secondarily influenced by temperature forcing in certain periods. More broadly, we find that the NAO contributes to contrasting precipitation variability in East and West Greenland, where it appears to be responsible for at least 10% and more than 25%, respectively, of the variability in ice sheet accumulation rate. This east-west asymmetry, which influences both LGICs and the ice sheet, illustrates how substantial uncertainty in NAO projections directly contributes to uncertainty in mass balance projections.

Generalized worry disorder: a review of DSM-IV generalized anxiety disorder and options for DSM-V.

PubMed

Andrews, Gavin; Hobbs, Megan J; Borkovec, Thomas D; Beesdo, Katja; Craske, Michelle G; Heimberg, Richard G; Rapee, Ronald M; Ruscio, Ayelet Meron; Stanley, Melinda A

2010-02-01

Generalized anxiety disorder (GAD) has undergone a series of substantial classificatory changes since its first inclusion in DSM-III. The majority of these revisions have been in response to its poor inter-rater reliability and concerns that it may lack diagnostic validity. This article provides options for the revision of the DSM-IV GAD criteria for DSM-V. First, searches were conducted to identify the evidence that previous DSM Work Groups relied upon when revising the DSM-III-R GAD and the overanxious disorder classifications. Second, the literature pertaining to the DSM-IV criteria for GAD was examined. The review presents a number of options to be considered for DSM-V. One option is for GAD to be re-labeled in DSM-V as generalized worry disorder. This would reflect its hallmark feature. Proposed revisions would result in a disorder that is characterized by excessive anxiety and worry generalized to a number of events or activities for 3 months or more. Worry acts as a cognitive coping strategy that manifests in avoidant behaviors. The reliability and validity of the proposed changes could be investigated in DSM-V validity tests and field trials.

Demographics and macroeconomic effects in aesthetic surgery in the UK.

PubMed

Duncan, C O; Ho-Asjoe, M; Hittinger, R; Nishikawa, H; Waterhouse, N; Coghlan, B; Jones, B

2004-09-01

Media interest in aesthetic surgery is substantial and suggestions of demographic changes such as reductions in age or an increase in the number of male patients are common. In spite of this, there is no peer reviewed literature reporting demographics of a contemporary large patient cohort or of the effect of macroeconomic indicators on aesthetic surgery in the UK. In this study, computer records 13006 patients presenting between 1998 and the first quarter of 2003 at a significant aesthetic surgery centre were analysed for procedures undergone, patient age and sex. Male to female ratios for each procedure were calculated and a comparison was made between unit activity and macroeconomic indicators. The results showed that there has been no significant demographic change in the procedures studied with patient age and male to female ratio remaining constant throughout the period studied for each procedure. Comparison with macroeconomic indicators suggested increasing demand for aesthetic surgery in spite of a global recession. In conclusion, media reports of large scale demographic shifts in aesthetic surgery patients are exaggerated. The stability of unit activity in spite of falling national economic indicators suggested that some units in the UK might be relatively immune to economic vagaries. The implications for training are discussed.

A comparison of the chemistry of pseudotachylyte breccias in the Archean Levack Gneisses of the Sudbury structure, Ontario

NASA Technical Reports Server (NTRS)

Thompson, Lucy M.; Spray, John G.

1992-01-01

The Archean Levack Gneisses of the North Range host millimeter-thick veins and centimeter-thick lenses of pseudotachylyte, as well as substantially larger meter-wide, dykelike bodies of pseudotachylytic 'breccia'. The 'breccia' occurs up to several tens of kilometers away from the Sudbury Igneous Complex and is commonly sited within or near joints and other natural weaknesses such as bedding, dyke contacts, and lithological boundaries. The larger 'breccia' dykes comprise a generally dark matrix containing rounded to subrounded and occasionally angular rock fragments derived predominantly from Levack Gneiss. Selected samples of bulk Sudbury Breccia and Sudbury Breccia matrices were chemically analyzed and compared to existing data on the Levack Gneisses and Sudbury Breccia. The matrices are apparently enriched in Fe and, to a lesser extent, Mg, Ti, and Ca compared to the wallrocks and the majority of clasts. This enrichment can be partly explained by the preferential cataclasis and/or frictional melting of hydrous ferromagnesian wallrock minerals, but also appear to require contamination by more basic exotic lithologies. This suggests that certain components of pseudotachylitic Sudbury Breccia have undergone significant transport during their formation.

The Information Needs of Women Who Have Undergone Breast Cancer Surgery in the West of Turkey.

PubMed

Findik, Ummu Yildiz

2017-09-01

This descriptive study aimed to evaluate the information needs of breast cancer patients who have undergone surgery, and the level to which those information needs are met in the west of Turkey. It was conducted in 55 women who had undergone surgical intervention between March 2013 and March 2014 in a university hospital in the west of Turkey. A personal information form and the Patient Information Needs Scale were used to gather data. Descriptive statistics, the Chi-square test, and the Wilcoxon signed-rank test were used to analyze the data. It was found that the information need of the patients (3.9 +/- 0.6) was near the "very important" level, and that this need was "somewhat met" (2.4 +/- 0.9). When the information needs of the patients and the level to which those needs were fulfilled were compared, the level of fulfillment was statistically significantly lower (p < 0.001). Among the different subscales evaluated, information relating to medication was the most needed, and the information needs pertaining to this subscale were met to a greater degree (p < 0.05) than the remaining subscales. The results showed that the information needs, primarily the medication-related information needs, of the patients were high, but that the level of meeting these needs was low. It should be considered important for patients who have undergone breast cancer surgery to be kept informed and provided with information regarding their medication.

Incidence of ovarian cancer after hysterectomy: a nationwide controlled follow up.

PubMed

Loft, A; Lidegaard, O; Tabor, A

1997-11-01

To estimate the risk of developing ovarian cancer after abdominal (total or subtotal) hysterectomy on benign indication. Prospective historical cohort study with 12.5 years of follow up. Denmark, nationwide. All Danish women (aged 0 to 99 years) having undergone hysterectomy with conservation of at least one ovary for a benign indication from 1977 to 1981 (n = 22,135). Follow up was conducted from 1977 to 1991. The reference group included all Danish women who had not undergone hysterectomy, age-standardised according to the hysterectomy group (n = 2,554,872). Registry data derived from the Danish National Register of Patients (diagnoses and operation codes) and the Civil Registration System (information about general population, including time of death). Incidence rate of ovarian cancer, lifetime risk of ovarian cancer, relative risk of ovarian cancer. Seventy-one women developed ovarian cancer on average 7.0 years after hysterectomy and 10,659 women in the reference group had ovarian cancer diagnosed after on average 6.4 years. The incidence rate of ovarian cancer was 0.27 per 1000 person-years in the group that had undergone hysterectomy and 0.34 per 1000 person-years in the general population (age-standardised). The extrapolated lifetime risk of developing ovarian cancer was 2.1% after hysterectomy and 2.7% in the general population (RR 0.78; 95% CI 0.60-0.96). The risk of ovarian cancer is lower among women who have undergone hysterectomy compared with those who have not. The protection seems to decrease with time.

The Relationship Between Female Genital Cutting and Obstetric Fistulas

PubMed Central

Browning, Andrew; Allsworth, Jenifer E.; Wall, L. Lewis

2013-01-01

Objective To evaluate any association between female genital cutting and vesicovaginal fistula formation during obstructed labor. Methods A comparison was made between 255 fistula patients who had undergone Type I or Type II female genital cutting and 237 patients who had not undergone such cutting. Women were operated on at the Barhirdar Hamlin Fistula Centre in Ethiopia. Data points used in the analysis included age, parity, length of labor, labor outcome (stillbirth or not), type of fistula, site, size and scarring of fistula, outcomes of surgery (fistula closed, persistent incontinence with closed fistula, urinary retention with overflow, site, size, and scarring of any rectovaginal fistula and operation outcomes, as well as specific methods employed during the operation (utilization of a graft or not, application of a pubococcygeal or similar autologous sling, vaginoplasty, catheterization of ureters, and flap reconstruction of vagina). Primary outcomes were site of genitourinary fistula and persistent incontinence despite successful fistula closure. Results The only statistically significant differences between the two groups (p = 0.05) was a slightly greater need to place ureteral catheters at the time of surgery in women who had not undergone a genital cutting operation, and slightly higher use of a pubococcygeal sling at the time of fistula repair and a slightly longer length of labor (by 0.3 of a day) in women who had undergone genital cutting. Conclusion Type I and Type II female genital cutting are not independent causative factors in the development of obstetric fistulas from obstructed labor. PMID:20177289

Quantifying Reporting Timeliness to Improve Outbreak Control

PubMed Central

Swaan, Corien; van Steenbergen, Jim; Kretzschmar, Mirjam

2015-01-01

The extent to which reporting delays should be reduced to gain substantial improvement in outbreak control is unclear. We developed a model to quantitatively assess reporting timeliness. Using reporting speed data for 6 infectious diseases in the notification system in the Netherlands, we calculated the proportion of infections produced by index and secondary cases until the index case is reported. We assumed interventions that immediately stop transmission. Reporting delays render useful only those interventions that stop transmission from index and secondary cases. We found that current reporting delays are adequate for hepatitis A and B control. However, reporting delays should be reduced by a few days to improve measles and mumps control, by at least 10 days to improve shigellosis control, and by at least 5 weeks to substantially improve pertussis control. Our method provides quantitative insight into the required reporting delay reductions needed to achieve outbreak control and other transmission prevention goals. PMID:25625374

Surgical repair of humeral condylar fractures in New Zealand working farm dogs - long-term outcome and owner satisfaction.

PubMed

Nortje, J; Bruce, W J; Worth, A J

2015-03-01

To report the long-term outcome, return to work and owner satisfaction, for working farm dogs in New Zealand following surgical repair of humeral condylar fractures. A retrospective study of working dogs that had undergone surgical repair of one or more condylar fractures of the humerus was undertaken by searching the medical records of two referral veterinary clinics. The inclusion criteria were working dogs that had undergone open surgical reduction and internal fixation of a fracture of one or both humeral condyles. The ability of the dog to work after surgery, persistence of lameness and the owners' degree of satisfaction with the outcome were assessed from answers to a questionnaire. Sixteen dogs met the inclusion criteria and had owner questionnaires completed at a median follow-up interval of 54 (min 3, max 121) months. Fifteen were working farm dogs (13 Heading dogs, including Border Collies, and two New Zealand Huntaways) and one dog was a cross-breed used for pig hunting. Four dogs had two fractures on separate occasions, of which three underwent surgery on both elbows at a median interval of 19 months. Of the 20 humeral fractures, 10 were lateral condylar, one was a medial condylar fracture and nine were dicondylar fractures. Of the 16 repairs with follow-up data, seven (44%) dogs could perform all expected duties following surgical repair, whilst a further eight (50%) could perform most duties although some allowances had to be made for some limitation of their performance. Of the 15 owners responding, 13 (87%) were satisfied or very satisfied with the outcome of surgery and felt the surgery was worth the expense. Post-operative complications requiring a second surgery occurred in 7/20 (35%) dogs, and all six dogs that received appropriate surgical revision returned to work. In this small case series, surgical repair of humeral condylar fractures in working dogs had a good prognosis with 15/16 of treated dogs returning to full or substantial levels of work. These data provide veterinarians with relevant information regarding the outcome and prognosis of surgery for clients whose working dogs have fractured a humeral condyle.

AMATS FY 1997-2000 Transportation Improvement Program

DOT National Transportation Integrated Search

1996-06-26

Planning, design and construction of major transportation capital : investment projects, such as major highway relocations and transit service expansions, are costly and time-consuming. Even relatively minor improvements require substantial investmen...

Strategies to improve water productivity in a water-stressed future

USDA-ARS?s Scientific Manuscript database

In the fiscal years 2011 through 2014, ARS scientists and engineers made substantial progress in addressing research problems related to improving water productivity and creating new knowledge, products and outcomes to improve American agricultural production, efficiency of resource use, safety and ...

Strengthening of certain types of arch dams at broad sites

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

Kaganov, G. M.; Volkov, V. I.; Uchevatkin, A. A.

2012-01-15

The problem of strengthening defective and damaged arch dams is formulated, and methodical calculations are performed to substantiate a set of structural and production measures permitting substantial improvement in the stress-strain state and an increase in the safety factor of the structure. Feasibility of practical implementation of the results is foreseen.

Two-Year Outcomes from a Randomized Controlled Trial of Minimally Invasive Sacroiliac Joint Fusion vs. Non-Surgical Management for Sacroiliac Joint Dysfunction.

PubMed

Polly, David W; Swofford, John; Whang, Peter G; Frank, Clay J; Glaser, John A; Limoni, Robert P; Cher, Daniel J; Wine, Kathryn D; Sembrano, Jonathan N

2016-01-01

Sacroiliac joint (SIJ) dysfunction is an important and underappreciated cause of chronic low back pain. To prospectively and concurrently compare outcomes after surgical and non-surgical treatment for chronic SIJ dysfunction. One hundred and forty-eight subjects with SIJ dysfunction were randomly assigned to minimally invasive SIJ fusion with triangular titanium implants (SIJF, n = 102) or non-surgical management (NSM, n = 46). SIJ pain (measured with a 100-point visual analog scale, VAS), disability (measured with Oswestry Disability Index, ODI) and quality of life scores were collected at baseline and at scheduled visits to 24 months. Crossover from non-surgical to surgical care was allowed after the 6-month study visit was complete. Improvements in continuous measures were compared using repeated measures analysis of variance. The proportions of subjects with clinical improvement (SIJ pain improvement ≥20 points, ODI ≥15 points) and substantial clinical benefit (SIJ pain improvement ≥25 points or SIJ pain rating ≤35, ODI ≥18.8 points) were compared. In the SIJF group, mean SIJ pain improved rapidly and was sustained (mean improvement of 55.4 points) at month 24. The 6-month mean change in the NSM group (12.2 points) was substantially smaller than that in the SIJF group (by 38.3 points, p<.0001 for superiority). By month 24, 83.1% and 82.0% received either clinical improvement or substantial clinical benefit in VAS SIJ pain score. Similarly, 68.2% and 65.9% had received clinical improvement or substantial clinical benefit in ODI score at month 24. In the NSM group, these proportions were <10% with non-surgical treatment only. Parallel changes were seen for EQ-5D and SF-36, with larger changes in the surgery group at 6 months compared to NSM. The rate of adverse events related to SIJF was low and only 3 subjects assigned to SIJF underwent revision surgery within the 24-month follow-up period. In this Level 1 multicenter prospective randomized controlled trial, minimally invasive SIJF with triangular titanium implants provided larger improvements in pain, disability and quality of life compared to NSM. Improvements after SIJF persisted to 24 months. This study was approved by a local or central IRB before any subjects were enrolled. All patients provided study-specific informed consent prior to participation.

The ambulance services in northern Norway 2004–2008: improved competence, more tasks, better logistics and increased costs

PubMed Central

Elsbak, Trond M.

2010-01-01

Background The ambulance services in northern Norway have undergone significant development during recent years. Aims The objective of this study was to describe these changes in terms of tasks performed, distance driven, resources spent and level of competence in terms of education. Methods A retrospective analysis was performed. The ambulance fleet’s activity during the time period 2004–2008 was analysed. The subject was the ambulance fleet in northern Norway and its crew members. Tasks done, kilometres driven, resources spent per thousand inhabitants and level of competence were the main outcome measures. Results The major findings were almost doubled costs (92%), increasing number of tasks performed (13%) and a stable situation concerning kilometres driven. We also revealed improving competence in terms of education. A 20% absolute increase in crew members having a certificate of competence (fagbrev) was observed. Conclusions Significant economic resources have been invested in the fleet. Improved level of competence and an upgraded coordination system have improved logistics and hopefully treatment outcome. The latter should be further elucidated when the electronic patient record (EPR) system has been implemented. PMID:20606813

UKIRT fast guide system improvements

NASA Astrophysics Data System (ADS)

Balius, Al; Rees, Nicholas P.

1997-09-01

The United Kingdom Infra-Red Telescope (UKIRT) has recently undergone the first major upgrade program since its construction. One part of the upgrade program was an adaptive tip-tilt secondary mirror closed with a CCD system collectively called the fast guide system. The installation of the new secondary and associated systems was carried out in the first half of 1996. Initial testing of the fast guide system has shown great improvement in guide accuracy. The initial installation included a fixed integration time CCD. In the first part of 1997 an integration time controller based on computed guide star luminosity was implemented in the fast guide system. Also, a Kalman type estimator was installed in the image tracking loop based on a dynamic model and knowledge of the statistical properties of the guide star position error measurement as a function of computed guide star magnitude and CCD integration time. The new configuration was tested in terms of improved guide performance nd graceful degradation when tracking faint guide stars. This paper describes the modified fast guide system configuration and reports the results of performance tests.

Complications of Laparoscopy in Connection with Entry Techniques

PubMed Central

2017-01-01

Abstract The anatomy of the human being has not changed. However, technical developments in operating materials and methods call for improvements in surgical procedures as well as the management of complications. A fundamental distinction between any operating method and laparoscopy is that, in the latter, the initial entry is usually performed in blind fashion. Blind entry may result in vessel or organ damage, especially in patients who have undergone previous surgery. One of the difficulties associated with the entry is that the damage may not be identified immediately and then necessitate major abdominal repair. Furthermore, the improvement of surgical instruments and techniques enables the surgeon to perform even major operations by the laparoscopic approach. This is associated with renewed learning curves and a high rate of complications due to vascular, bowel, uterine, or bladder damage. The improvement of surgical techniques must be accompanied by advancements in the management of complications. The aim of this review is to address the risks of laparoscopy as well as their correct and professional management. (J GYNECOL SURG 33:81) PMID:28663686

Management of percids in Lake Erie, North America

USGS Publications Warehouse

Hatch, Richard W.; Nepszy, Stephen J.; Rawson, Michael R.; van Densen, W.L.T.; Steinmetz, B.; Hughes, R.H.

1990-01-01

Lake Erie's fish populations and their habitats have undergone very substantial changes since 1945. Of the four percid forms originally present, the blue pike (Stizostedion vitreum glaucum) is presumed extinct, and the sauger (S. canadense) was commercially extinct by the 1950's. The walleye (S. v. vitreum) has remained stable in eastern Lake Erie but the highly productive stock of the western basin collapsed in the 1960's. Closure of the walleye fishery from 1970 to 1973, necessitated by mercury contamination, provided an opportunity for the development of an international management plan for restoration of the stock. An inter-agency Scientific Protocol Committee evaluated walleye dynamics and recommended management by quota beginning in 1976. Although quotas have been exceeded several times, the walleye stock responded well to limited exploitation, steadily increased, and expanded its range. Landings of the yellow perch (Perca flavescens) increased during the 1950's, but a steady decline in abundance, beginning in the early 1970's led to the formation in 1980 of another international inter-agency task group to recommend a basis for quota management. The short-term management recommendation, reported and accepted in 1986, was to reduce fishing effort by 20% by 1990. Both management schemes evolved when the resource agencies of the five jurisdictions (New York, Pennsylvania, Ohio, Michigan, and Ontario), in the two nations surrounding Lake Erie, perceived a need for the increased and improved management of a shared resource. They sought an international forum in which to develop strategies, appointed inter-agency scientific task groups to develop a basis for management recommendations, and adopted a quota management scheme. Each jurisdiction is responsible for the enforcement and allocation of its portion of the quota between user groups. Reports of catch, effort, and biological observations on stock performance are submitted annually to a standing technical committee charged with updating quotas.

Outcomes following balloon mitral valvuloplasty in pregnant females with mitral stenosis and significant sub valve disease with severe decompensated heart failure.

PubMed

Ananthakrishna Pillai, Ajith; Ramasamy, Chandramohan; V, Saranya Gousy; Kottyath, Harichandrakumar

2018-03-11

Mitral stenosis may present with decompensated heart failure during pregnancy. Many patients do have advanced sub valve disease and present late with decompensated state. The outcomes of balloon mitral valvuloplasty (BMV) in such advanced sub valve disease with severe heart failure in pregnancy has not been specifically studied till now. A descriptive study looking at the immediate and long-term outcomes of pregnant patients with MS who presented with severe heart failure and sub valve disease who had undergone BMV. Ninety-six patients were studied. The mean gestational age was 23.4 ± 10.9 weeks .Mean SpO2 was 89% at admission,17% were in cardiogenic shock and 33.33 were on mechanical ventilation. The mean Wilkin's score was 9.71 ± 2.1 and sub valve score was 3.3 ± 0.12. BMV was successful in 77 (80.2%) patients and failed in 19. In 5.2% cases, acute severe MR occurred. There were 11 maternal deaths (six in failed and five in success group). A successful obstetric outcome was seen in 71 patients in success (92%) and 11/19 (57%) in failed (P < 0.001). The obstetric outcomes were better in success versus failure group. Anova post hoc analysis showed sustained gradient reductions at 1 and 5 year follow-up (P = 0.03) in success group. BMV offers substantial improvement in clinical outcomes among pregnant patients with MS and heart failure even with severe sub valve disease. The morality rate among failed was high at 31%. The obstetric outcomes were poor after a failed BMV. Outcomes following balloon mitral valvuloplasty in pregnant females with mitral stenosis and significant sub valve disease with severe decompensated heart failure. © 2018, Wiley Periodicals, Inc.

A survey of general dental practitioners in the North West of England concerning the dental care of patients following head and neck radiotherapy.

PubMed

Husein, Adam B; Butterworth, Chris J; Ranka, Meena S; Kwasnicki, Andrew; Rogers, Simon N

2011-04-01

The aim of this survey was to investigate the views of general dental practitioners (GDPs) on their perceived roles and the barriers regarding dental care of patients following head and neck radio-therapy. From a total of 1163 GDPs on the Mersey Postgraduate Dental Deanery mailing list, 369 were selected at random. Questionnaires were sent out in February 2010 followed by reminders a month later. A study-specific questionnaire was piloted prior to the survey. One hundred and ninety-eight of the potential 336 respondents returned valid questionnaires, a response rate of 59%. They did not respond to all questions. Of those who responded, 99/188 (53%) were either 'not at all' or 'little' happy about managing these patients and 118/183 (64%) and 100/173 (58%), respectively, perceived that complex management and the new General Dental Services (nGDS) contract introduced in 2006 were 'quite a bit' or 'very much' barriers to treatment. The majority of the respondents felt that they were 'quite a bit' or 'very much' happy to carry out routine fillings (177/195; 90%), periodontal treatment (166/195; 85%), removable dentures (161/195; 83%), crown and bridge work (123/192; 64%), and root canal therapy (114/195; 58%) but only 53/191 (28%) to perform dental extractions. Over half of the respondents felt that they had 'quite a bit' or a 'main role' in managing radiotherapy caries, xerostomia, detecting recurrence and offering smoking-cessation advice. The majority of the GDPs who responded had been involved in the management of patients who had undergone radio-therapy to the head and neck. A substantial number perceived barriers to care, such as the complexity of the treatment and the nGDS contract. These findings need further investigation. Continuing professional development would be helpful to improve GDPs' confidence in dealing with this group of patients.

Zoomed EPI-DWI of the pancreas using two-dimensional spatially-selective radiofrequency excitation pulses.

PubMed

Riffel, Philipp; Michaely, Henrik J; Morelli, John N; Pfeuffer, Josef; Attenberger, Ulrike I; Schoenberg, Stefan O; Haneder, Stefan

2014-01-01

Implementation of DWI in the abdomen is challenging due to artifacts, particularly those arising from differences in tissue susceptibility. Two-dimensional, spatially-selective radiofrequency (RF) excitation pulses for single-shot echo-planar imaging (EPI) combined with a reduction in the FOV in the phase-encoding direction (i.e. zooming) leads to a decreased number of k-space acquisition lines, significantly shortening the EPI echo train and potentially susceptibility artifacts. To assess the feasibility and image quality of a zoomed diffusion-weighted EPI (z-EPI) sequence in MR imaging of the pancreas. The approach is compared to conventional single-shot EPI (c-EPI). 23 patients who had undergone an MRI study of the abdomen were included in this retrospective study. Examinations were performed on a 3T whole-body MR system (Magnetom Skyra, Siemens) equipped with a two-channel fully dynamic parallel transmit array (TimTX TrueShape, Siemens). The acquired sequences consisted of a conventional EPI DWI of the abdomen and a zoomed EPI DWI of the pancreas. For z-EPI, the standard sinc excitation was replaced with a two-dimensional spatially-selective RF pulse using an echo-planar transmit trajectory. Images were evaluated with regard to image blur, respiratory motion artifacts, diagnostic confidence, delineation of the pancreas, and overall scan preference. Additionally ADC values of the pancreatic head, body, and tail were calculated and compared between sequences. The pancreas was better delineated in every case (23/23) with z-EPI versus c-EPI. In every case (23/23), both readers preferred z-EPI overall to c-EPI. With z-EPI there was statistically significantly less image blur (p<0.0001) and respiratory motion artifact compared to c-EPI (p<0.0001). Diagnostic confidence was statistically significantly better with z-EPI (p<0.0001). No statistically significant differences in calculated ADC values were observed between the two sequences. Zoomed diffusion-weighted EPI leads to substantial image quality improvements with reduction of susceptibility artifacts in pancreatic DWI.

Socioeconomic inequalities in health-related quality of life between men and women, 5 years after a coronary angiography.

PubMed

Tchicaya, Anastase; Lorentz, Nathalie

2016-12-03

The aim of this study is to measure gender differences in health-related quality of life (HRQOL) among men and women patients with cardiovascular diseases (CVD), and to assess the impact of socioeconomic factors on HRQOL between men and women, 5 years after a coronary angiography. The study included 1,289 out of 4,391 patients who had undergone an angiography in the National Institute for Cardiac Surgery and Interventional Cardiology, Luxembourg in 2008/2009. Four indicators of the WHOQOL-BREF questionnaire (Self-rated health, Quality of life, Physical health, and Psychological health) were used in this study as interest variables. To assess the socioeconomic inequalities in HRQOL between men and women, general linear models were constructed for every indicator, with educational level and living conditions as predictors, and demographic variables, cardiovascular risk factors, and cardiovascular events as covariates. Women were older than men (71.5 versus 68.1, p <0.0001) and less likely to be married. HRQOL was significantly different between men and women despite the fact they had the same socioeconomic status. The average score for overall health was 3.7/5 for men versus 3.5/5 for women; similarly, the life quality score was 3.8/5 for men versus 3.6/5 for women. Education level and living conditions were associated with lower HRQOL scores in men and women. The findings showed that women have lower HRQOL than men regarding self-rated health, quality of life, and the WHOQOL-BREF physical and psychological domains 5 years after a coronary angiography. Socioeconomic inequalities affect HRQOL, and their influence was similar in both men and women. Socioeconomic inequalities in HRQOL in women and men with CVD are strong 5 years after a coronary angiography. Taking into account differences in gender and socioeconomic status in intervention strategies to substantially reduce the differences observed between women and men could help improve the effectiveness of secondary prevention.

Postgraduate nurses' self-assessment of clinical competence and need for further training. A European cross-sectional survey.

PubMed

Wangensteen, Sigrid; Finnbakk, Elisabeth; Adolfsson, Annsofie; Kristjansdottir, Gudrun; Roodbol, Petrie; Ward, Helen; Fagerström, Lisbeth

2018-03-01

Nursing practice requires application of knowledge, skills and values in various combinations and has undergone substantial changes the last decades. An increased focus on inter-professional collaboration and possible new and more independent roles for nurses are described. A variety of programs have been developed in order to educate registered nurses (RN) to meet the changes and demands in health and nursing care throughout the world. The aims were to 1) describe nurses' self-assessment of clinical competence and need for further training, and 2) explore possible differences between nurses in specialist vs master's programs. A cross-sectional survey design was applied. 97 nurses in postgraduate programs from five countries responded (response rate 45%). A revised version of the Professional Nurse Self-Assessment Scale of clinical core competencies (PROFFNurseSASII) was used for data collection. Independent student t-test and regression analyses were carried out. The respondents rated their competence highest in taking full responsibility, cooperation with other health professionals and in acting ethically. Items where they considered themselves needing further training most were competence on medications, interaction and side effects and differential diagnoses. For all items, nurses in master's programs rated their competence higher than nurses in the specialist programs. Nurses in specialist programs rated their need for more training for all items higher than nurses in master's degree programs, and for 47 out of the 50 items these differences were statistically significant. Even though the nurses rated their competence high for important competence aspects such as taking responsibility and cooperation with other health professionals, it is worrying that their need for further training was highest for effects and interaction of various types of medications. Further studies are needed to conclude if and how master's education improves patient outcome. Copyright © 2017 Elsevier Ltd. All rights reserved.

Diastereocontrolled Electrophilic Fluorinations of 2-Deoxyribonolactone: Syntheses of All Corresponding 2-Deoxy-2-fluoro-lactones and 2’-Deoxy-2’-fluoro-NAD+s

PubMed Central

Cen, Yana; Sauve, Anthony A.

2009-01-01

Methods to construct 2’-deoxy-2’-fluoro-nucleosides have undergone limited improvement in the last twenty years in spite of substantially increased value of these compounds as pharmaceuticals and as tools for studying biological processes. We herein describe a consolidated approach to synthesize precursors to these commercially and scientifically valuable compounds via diastereocontrolled fluorination of the readily available precursor 2-deoxy-d-ribonolactone. With employment of appropriate sterically bulky silyl protecting groups at 3 and 5 positions, controlled electrophilic fluorination of the Li-ribonolactone enolate by N-fluorodibenezenesulfonamide yielded the corresponding 2-deoxy-2-fluoro-arabino-lactone in high isolated yield (72 %). The protected 2-deoxy-2, 2-difluoro-ribonolactone was obtained similarly in high yield from a second round of electrophilic fluorination (2 steps, 51% from protected ribonolactone starting material). Accomplishment of the difficult ribo-fluorination of the lactone was achieved by the directive effects of a diastereoselectively installed α-trimethylsilyl group. Electrophilic fluorination of a protected 2-deoxy-2-trimethylsilyl-arabino-lactone via enolate generation provided the protected 2-deoxy-2-fluoro-ribo-lactone as the exclusive fluorinated product. The reaction also yielded the starting material, the desilylated protected 2-deoxy-ribonolactone, which was recycled to provide a 38% chemical yield of the fluorinated product (versus initial protected ribonolactone) after consecutive silylation and fluorination cycles. Using our fluorinated sugar precursors we prepared the 2’-fluoro-arabino-, 2’-fluoro-ribo- and 2’,2’-difluoro-nicotinamide adenine dinucleotides (NAD+) of potential biological interest. These syntheses provide the most consolidated and efficient methods for production of sugar precursors of 2’-deoxy-2’-fluoronucleosides and have the advantage of utilizing an air-stable electrophilic fluorinating agent. The fluorinated NAD+s are anticipated to be useful for studying a variety of cellular metabolic and signaling processes. PMID:19958035

A Decade of Change: Training and Career Paths of Cardiothoracic Surgery Residents 2003 to 2014.

PubMed

Stephens, Elizabeth H; Odell, David; Stein, William; LaPar, Damien J; DeNino, Walter F; Aftab, Muhammad; Berfield, Kathleen; Eilers, Amanda L; Groth, Shawn; Lazar, John F; Robich, Michael P; Shah, Asad A; Smith, Danielle A; Stock, Cameron; Tchantchaleishvili, Vakhtang; Mery, Carlos M; Turek, Joseph W; Salazar, Jorge; Nguyen, Tom C

2015-10-01

During the past decade, cardiothoracic surgery (CTS) education has undergone tremendous change with the advent of new technologies and the implementation of integrated programs, to name a few. The goal of this study was to assess how residents' career paths, training, and perceptions changed during this period. The 2006 to 2014 surveys accompanying the Thoracic Surgery Residents Association/Thoracic Surgery Directors' Association in-training examination taken by CTS residents were analyzed, along with a 2003 survey of graduating CTS residents. Of 2,563 residents surveyed, 2,434 (95%) responded. During the decade, fewer residents were interested in mixed adult cardiac/thoracic practice (20% in 2014 vs 52% in 2003, p = 0.004), more planned on additional training (10% in 2003 vs 41% to 47% from 2011 to 2014), and the frequent use of simulation increased from 1% in 2009 to 24% in 2012 (p < 0.001). More residents recommended CTS to potential trainees (79% in 2014 vs 65% in 2010, p = 0.007). Job offers increased from a low of 12% in 2008 with three or more offers to 34% in 2014. Debt increased from 0% with more than $200,000 in 2003 to 40% in 2013 (p < 0.001). Compared with residents in traditional programs, more integrated residents in 2014 were interested in adult cardiac surgery (53% vs 31%) and congenital surgery (22% vs 7%), fewer were interested in general thoracic surgery (5% vs 31%, p < 0.001), and more planned on additional training (66% vs 36%, p < 0.001). With the evolution in CTS over the last decade, residents' training and career paths have changed substantially, with increased specialization and simulation accompanied by increased resident satisfaction and an improved job market. Copyright © 2015 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

Development and Feasibility of an Interactive Smartphone App for Early Assessment and Management of Symptoms Following Pancreaticoduodenectomy.

PubMed

Gustavell, Tina; Langius-Eklöf, Ann; Wengström, Yvonne; Segersvärd, Ralf; Sundberg, Kay

2018-03-27

Patients who have undergone pancreaticoduodenectomy because of pancreatic cancer experience distressing symptoms and unmet supportive care needs after discharge. To meet these needs, we have developed a mobile health app (Interaktor) for daily assessment of symptoms and access to self-care advice that includes a risk assessment model for alerts with real-time interactions with professionals. The study aim was to develop and test a version of the Interaktor app adapted for patients who have undergone pancreaticoduodenectomy. The app was developed and tested for feasibility in 6 patients during 4 weeks. One nurse monitored and responded to alerts. Logged data from the app were collected, and all participants were interviewed about their experiences. Adherence to reporting daily was 84%. Alerts were generated in 41% of the reports. The patients felt reassured and cared for and received support for symptom management. The app was easy to use, had relevant content, and had few technical problems, although suggestions for improvement were given. The daily reporting of symptoms and having access to a nurse in real time in the case of an alarming symptom seem to enhance symptom management and render a feeling of security in patients. Some modifications of the app are needed before use in a larger sample. Daily reporting of symptoms after pancreaticoduodenectomy enhances symptom management, self-care, and participation without being a burden to patients, indicating that mobile health can be used in clinical practice by patients with poor prognosis who experience severe symptoms.

Etiological involvement of Helicobacter pylori in "reflux" gastritis after gastrectomy.

PubMed

Nagahata, Y; Kawakita, N; Azumi, Y; Numata, N; Yano, M; Saitoh, Y

1996-10-01

"Reflux" gastritis after gastrectomy is associated with various symptoms that are often detrimental to the patients' quality of life. However, prevention of the reflux does not always bring relief from the symptoms of gastritis. Helicobacter pylori (H. pylori) is now considered one of the most important pathogenetic factors in gastritis. The association between H. pylori infection and reflux gastritis after gastrectomy was investigated in the present study. In total, 115 patients who had undergone gastrectomy were entered in this study. Five biopsy specimens from the gastric remnant were taken during upper GI endoscopy. One specimen was examined pathohistologically, and the remaining four were examined for H. pylori infection. The histological degree of gastritis was determined according to the score system of Rauws et al. Forty-six patients (40%) demonstrated H. pylori infection in their stomachs. The prevalence of the infection was significantly higher in patients with conventional gastrectomy than in those with subtotal gastrectomy. The prevalence of H. pylori infection was significantly lower in patients who had undergone gastrectomy more than 4 yr ago. The histological gastritis score in patients with H. pylori infection was significantly higher than in those without H. pylori infection. Furthermore, the eradication of H. pylori in patients with both serious gastritis symptoms and no bile reflux improved the symptoms and significantly decreased the histological gastritis score. The results suggest that H. pylori is a factor in the pathogenesis of reflux gastritis after gastrectomy.

Incretin response to a standard test meal in a rat model of sleeve gastrectomy with diet-induced obesity.

PubMed

Al-Sabah, Suleiman; Alasfar, Fahad; Al-Khaledi, Ghanim; Dinesh, Reshma; Al-Saleh, Mervat; Abul, Habib

2014-01-01

Currently, the most effective treatment for obesity is bariatric surgery. Gastroduodenal bypass surgery produces sustained weight loss and improves glycemic control and insulin sensitivity. Previous studies have shown that sleeve gastrectomy (SG) produces similar results and implicate changes in incretin hormone release in these effects. Male Sprague-Dawley rats were divided into four groups; lean control (lean), diet-induced obesity (DIO), DIO animals that had undergone SG (SG), and DIO animals that had undergone a sham operation (sham). After a 2-week recovery period, the incretin response to a standard test meal was measured. Blood sampling was performed in free-moving rats at various time points using chronic vascular access to the right jugular vein. There was a significant increase in the bodyweight of DIO animals fed a high-fat/high-sugar diet compared with the lean animals, which was reversed by SG. DIO caused an impairment of the GLP-1 response to a standard test meal, but not the GIP response. SG resulted in a dramatic increase in the GLP-1 response to a standard test meal but had no effect on the GIP response. A rapid rise in blood sugar was observed in the SG group following a standard test meal that was followed by reactive hypoglycemia. SG dramatically increases the GLP-1 response to a standard test meal but has no effect on GIP in a rat model of DIO.

Psoas tunnel perforation—an unreported complication of hip arthroscopy

PubMed Central

Degen, Ryan M.; O’Sullivan, Eilish; Sink, Ernest L.; Kelly, Bryan T.

2015-01-01

The utilization of hip arthroscopy is rapidly increasing due to improved arthroscopic techniques and training, better recognition of pathology responsible for non-arthritic hip pain and an increasing desire for minimally invasive procedures. With increasing rates of arthroscopy, associated complications are also being recognized. We present a series of six patients who experienced psoas tunnel perforation during anchor insertion from the distal anterolateral portal during labral repair. All patients underwent prior hip arthroscopy and labral repair and presented with persistent symptoms at least partly attributable to magnetic resonance imaging (MRI)-documented psoas tunnel perforation. Their clinical records, operative notes and intra-operative photographs were reviewed. All patients presented with persistent pain, both with an anterior impingement test and resisted hip flexion. MRI imaging demonstrated medial cortical perforation with anchors visualized in the psoas tunnel, adjacent to the iliopsoas muscle. Four patients have undergone revision hip arthroscopy, whereas two have undergone periacetabular osteotomies. All patients had prominent anchors in the psoas tunnel removed at the time of surgery, with varying degrees of concomitant pathology appropriately treated during the revision procedure. Care must be utilized during medial anchor placement to avoid psoas tunnel perforation. Although this complication alone was not the sole cause for revision in each case, it may have contributed to their poor outcome and should be avoided in future cases. This can be accomplished by using a smaller anchor, inserting the anchor from the mid-anterior portal and checking the drill hole with a nitinol wire prior to anchor insertion. PMID:27011849

Treatment of Chronic Plantar Fasciitis With Percutaneous Latticed Plantar Fasciotomy.

PubMed

Yanbin, Xu; Haikun, Chu; Xiaofeng, Ji; Wanshan, Yang; Shuangping, Liu

2015-01-01

Plantar fasciitis, the most common cause of pain in the inferior heel, accounts for 11% to 15% of all foot symptoms requiring professional care among adults. The present study reports the results of a minimally invasive surgical treatment of chronic plantar fasciitis. All patients with plantar fasciitis who had undergone percutaneous latticed plantar fasciotomy at 3 clinical sites from March 2008 to March 2009 were included in the present study. The follow-up evaluations for this treatment were conducted using the Mayo clinical scoring system. We investigated 17 patients with recalcitrant chronic plantar fasciitis who had undergone this treatment within a follow-up period of ≥13 months. All procedures were performed in the clinic with the patient under local anesthesia. No wound infections or blood vessel or nerve damage occurred. At a mean follow-up period of 16.0 ± 2.29 (range 13 to 21) months, significant improvement was seen in the preoperative mean Mayo score (from 12.06 ± 2.54 to 89.76 ± 4.28, p < .001) and no patient had developed symptom recurrence. Also, none of the patients had developed complex regional pain syndrome. All patients were able to return to regular shoe wear by 3 weeks postoperatively. The technique of plantar fasciitis with percutaneous latticed plantar fasciotomy could be a promising treatment option for patients with recalcitrant chronic plantar fasciitis. Copyright © 2015 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

Fitting the post-keratoplasty cornea with hydrogel lenses.

PubMed

Katsoulos, Costas; Nick, Vasileiou; Lefteris, Karageorgiadis; Theodore, Mousafeiropoulos

2009-02-01

We report two cases who have undergone penetrating keratoplasty (three eyes total), and who were fitted with hydrogel lenses. In the first case, a 28-year-old male presented with an interest in contact lens fitting. He had undergone corneal transplantation in both eyes, about 5 years ago. After topographies and trial fitting were performed, it was decided to be fitted with reverse geometry hydrogel lenses, due to the globular geometry of the cornea, the resultant instability of RGPs, and personal preference. In the second case, a 26-year-old female who had also penetrating keratoplasty was fitted with a hydrogel toric lens of high cylinder in the right eye. The final hydrogel lenses for the first subject incorporated a custom tricurve design, in which the second curve was steeper than the base curve and the third curve flatter than the second but still steeper than the first. Visual acuity was 6/7.5 RE and a mediocre 6/15 LE (OU 6/7.5). The second subject achieved 6/4.5 acuity RE with the high cylinder hydrogel toric lens. In corneas exhibiting extreme protrusion, such as keratoglobus and some cases after penetrating keratoplasty, curvatures are so extreme and the cornea so globular leading to specific fitting options: sclerals, small diameter RGPs and reverse geometry hydrogel lenses, in order to improve lens and optical stability. In selected cases such as the above, large diameter inverse geometry RGP may be fitted only if the eyelid shape and tension permits so. The first case demonstrates that the option of hydrogel lenses is viable when the patient has no interest in RGPs and in certain cases can improve vision to satisfactory levels. In other cases, graft toricity might be so high that the practitioner will need to employ hydrogel torics with large amounts of cylinder in order to correct vision. In such cases, the patient should be closely monitored in order to avoid complications from hypoxia.

Evaluation of a peer-reviewed career development and compensation program for physicians at an academic health science center.

PubMed

O'Brodovich, Hugh; Pleinys, Ramune; Laxer, Ronald; Tallett, Susan; Rosenblum, Norman; Sass-Kortsak, Christina

2003-01-01

The Department of Pediatrics at the Hospital for Sick Children, which is funded by an alternative payment plan, has implemented a novel career development and compensation program (CDCP). Job activity profiles were used to more clearly define job expectations, benchmarks guided career development, and peer review was used to assess performance. The objective of this study was to evaluate the departmental pediatricians' satisfaction with the CDCP. Pediatricians, all of whom had undergone CDCP annual reviews, could participate if they had undergone the in-depth triennial CDCP review. Each received a 5-point Likert scale-based questionnaire that asked how well the CDCP had conformed to the principles identified by the department during the development of the CDCP. Anonymous, confidential responses were collated and used to guide focus groups that discussed areas of greatest concern and attempted to identify solutions. Focus groups were led by external facilitators who were experienced in qualitative research. They audiotaped the sessions, transcribed the comments, and analyzed the data with the assistance of a qualitative analysis application. Sixty of the eligible 88 pediatricians participated, and 74% of their responses were that the CDCP had addressed the original principles "somewhat," "to a great extent," or "extremely well." The remainder indicated that some of the principles were either "not addressed" or "only to a small extent" by the CDCP. Results from the 11 focus groups (46 participants) indicated that the CDCP was an improvement over the previous method of career development and determination of the rate of remuneration. Most were also still in agreement with the purpose and design principles. Although they did not want the CDCP to undergo a major redesign, they identified areas that need improvement. Short-, medium-, and long-term action plans to address these areas are under way. Pediatricians at the health science center of the Hospital for Sick Children remain supportive of the CDCP.

Surgery versus physical therapy for a meniscal tear and osteoarthritis.

PubMed

Katz, Jeffrey N; Brophy, Robert H; Chaisson, Christine E; de Chaves, Leigh; Cole, Brian J; Dahm, Diane L; Donnell-Fink, Laurel A; Guermazi, Ali; Haas, Amanda K; Jones, Morgan H; Levy, Bruce A; Mandl, Lisa A; Martin, Scott D; Marx, Robert G; Miniaci, Anthony; Matava, Matthew J; Palmisano, Joseph; Reinke, Emily K; Richardson, Brian E; Rome, Benjamin N; Safran-Norton, Clare E; Skoniecki, Debra J; Solomon, Daniel H; Smith, Matthew V; Spindler, Kurt P; Stuart, Michael J; Wright, John; Wright, Rick W; Losina, Elena

2013-05-02

Whether arthroscopic partial meniscectomy for symptomatic patients with a meniscal tear and knee osteoarthritis results in better functional outcomes than nonoperative therapy is uncertain. We conducted a multicenter, randomized, controlled trial involving symptomatic patients 45 years of age or older with a meniscal tear and evidence of mild-to-moderate osteoarthritis on imaging. We randomly assigned 351 patients to surgery and postoperative physical therapy or to a standardized physical-therapy regimen (with the option to cross over to surgery at the discretion of the patient and surgeon). The patients were evaluated at 6 and 12 months. The primary outcome was the difference between the groups with respect to the change in the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) physical-function score (ranging from 0 to 100, with higher scores indicating more severe symptoms) 6 months after randomization. In the intention-to-treat analysis, the mean improvement in the WOMAC score after 6 months was 20.9 points (95% confidence interval [CI], 17.9 to 23.9) in the surgical group and 18.5 (95% CI, 15.6 to 21.5) in the physical-therapy group (mean difference, 2.4 points; 95% CI, -1.8 to 6.5). At 6 months, 51 active participants in the study who were assigned to physical therapy alone (30%) had undergone surgery, and 9 patients assigned to surgery (6%) had not undergone surgery. The results at 12 months were similar to those at 6 months. The frequency of adverse events did not differ significantly between the groups. In the intention-to-treat analysis, we did not find significant differences between the study groups in functional improvement 6 months after randomization; however, 30% of the patients who were assigned to physical therapy alone underwent surgery within 6 months. (Funded by the National Institute of Arthritis and Musculoskeletal and Skin Diseases; METEOR ClinicalTrials.gov number, NCT00597012.).

[Laser debulking surgery prior to radiotherapy for T1T2 carcinoma of the hypopharynx].

PubMed

Mori, K; Chijiwa, K; Umeno, H; Umeno, T; Sakamoto, K

2000-09-01

The local control rate for T1-T2 carcinomas of the hypopharynx is rather high whereas the overall survival rate is unsatisfactory, irrespective of treatment modalities. Radical radiotherapy has yielded a local control rate of 40-70% and an overall 5-year survival of 30-50%, while surgical treatment with or without postoperative radiotherapy has yielded a local control rate of 60-90% and an overall 5-year survival rate of 30-60%. Based on these reasons, for the patients with minor hypopharyngeal lesions, such as T1-T2 carcinomas, in the Kurume University Hospital radiotherapy has often been selected as a first choice instead of partial pharyngectomy. If the primary lesion is exophytic and has a large volume, laser debulking surgery has been employed prior to radiotherapy to improve the local control rate. The purpose of the present study is to describe the details of laser debulking surgery prior to radiotherapy (LDSR) for the treatment of T1-T2 carcinomas of the hypopharynx. In addition, the preliminary results for this treatment procedure will also be compared with the results of partial pharyngectomies preserving the larynx (PPPL) that were performed in the Kurume University Hospital. In this study 20 patients (T1: 4, T2: 16) who had undergone PPPL and 16 patients (T1: 4, T2: 12) who had undergone LDSR were included. For patients undergoing PPPL, the 5-year local control rate, 5-year larynx conservation rate and disease specific 5-year survival rate were 83.6%, 70.4%, and 75.0%, respectively, whereas for patients undergoing LDSR these were 87.1%, 93.8%, 87.5% respectively. Although the treatment outcomes by LDSR did not show a significant drastic improvement compared with those by PPPL, the quality of life of the patients undergoing LDSR was not aggravated. LDSR may thus be preferable to PPPL for selected cases of T1-T2 carcinomas of the hypopharynx.

Project ORDER: Organization for Responsibility, Dependability, Education and Reality. Evaluation Report 1974-75.

ERIC Educational Resources Information Center

North Forest Independent School District, Houston, TX.

Project ORDER is a pilot project tested in an urban middle school in Houston, Texas. The program was intended to improve the general school atmosphere; to improve students' attitudes toward the school, its program, faculty, and administration; to show significant improvement in pupil behavior; and to substantially improve teaching-learning…

An artifacts removal post-processing for epiphyseal region-of-interest (EROI) localization in automated bone age assessment (BAA)

PubMed Central

2011-01-01

Background Segmentation is the most crucial part in the computer-aided bone age assessment. A well-known type of segmentation performed in the system is adaptive segmentation. While providing better result than global thresholding method, the adaptive segmentation produces a lot of unwanted noise that could affect the latter process of epiphysis extraction. Methods A proposed method with anisotropic diffusion as pre-processing and a novel Bounded Area Elimination (BAE) post-processing algorithm to improve the algorithm of ossification site localization technique are designed with the intent of improving the adaptive segmentation result and the region-of interest (ROI) localization accuracy. Results The results are then evaluated by quantitative analysis and qualitative analysis using texture feature evaluation. The result indicates that the image homogeneity after anisotropic diffusion has improved averagely on each age group for 17.59%. Results of experiments showed that the smoothness has been improved averagely 35% after BAE algorithm and the improvement of ROI localization has improved for averagely 8.19%. The MSSIM has improved averagely 10.49% after performing the BAE algorithm on the adaptive segmented hand radiograph. Conclusions The result indicated that hand radiographs which have undergone anisotropic diffusion have greatly reduced the noise in the segmented image and the result as well indicated that the BAE algorithm proposed is capable of removing the artifacts generated in adaptive segmentation. PMID:21952080

Improving LHC searches for dark photons using lepton-jet substructure

NASA Astrophysics Data System (ADS)

Barello, G.; Chang, Spencer; Newby, Christopher A.; Ostdiek, Bryan

2017-03-01

Collider signals of dark photons are an exciting probe for new gauge forces and are characterized by events with boosted lepton jets. Existing techniques are efficient in searching for muonic lepton jets but due to substantial backgrounds have difficulty constraining lepton jets containing only electrons. This is unfortunate since upcoming intensity frontier experiments are sensitive to dark photon masses which only allow electron decays. Analyzing a recently proposed model of kinetic mixing, with new scalar particles decaying into dark photons, we find that existing techniques for electron jets can be substantially improved. We show that using lepton-jet-substructure variables, in association with a boosted decision tree, improves background rejection, significantly increasing the LHC's reach for dark photons in this region of parameter space.

Two-stage coal liquefaction process

DOEpatents

Skinner, Ronald W.; Tao, John C.; Znaimer, Samuel

1985-01-01

An improved SRC-I two-stage coal liquefaction process which improves the product slate is provided. Substantially all of the net yield of 650.degree.-850.degree. F. heavy distillate from the LC-Finer is combined with the SRC process solvent, substantially all of the net 400.degree.-650.degree. F. middle distillate from the SRC section is combined with the hydrocracker solvent in the LC-Finer, and the initial boiling point of the SRC process solvent is increased sufficiently high to produce a net yield of 650.degree.-850.degree. F. heavy distillate of zero for the two-stage liquefaction process.

Carbon or boron modified titanium silicide

DOEpatents

Thom, A.J.; Akinc, M.

1998-07-14

A titanium silicide material based on Ti{sub 5}Si{sub 3} intermetallic compound exhibits substantially improved oxidative stability at elevated temperatures. In particular, carbon is added to a Ti{sub 5}Si{sub 3} base material in an amount (e.g. about 0.3 to about 3.6 weight % C) effective to impart substantially improved oxidative stability at elevated temperatures, such as about 1000 C. Boron is added to a Ti{sub 5}Si{sub 3} base material in an amount (e.g. about 0.3 to about 3.3 weight % B) to this same end. 3 figs.

Carbon or boron modified titanium silicide

DOEpatents

Thom, A.J.; Akinc, M.

1997-12-02

A titanium silicide material based on Ti{sub 5}Si{sub 3} intermetallic compound exhibits substantially improved oxidative stability at elevated temperatures. In particular, carbon is added to a Ti{sub 5}Si{sub 3} base material in an amount (e.g. about 0.3 to about 3.6 weight % C) effective to impart substantially improved oxidative stability at elevated temperatures, such as about 1000 C. Boron is added to a Ti{sub 5}Si{sub 3} base material in an amount (e.g. about 0.3 to about 3.3 weight % B) to this same end. 3 figs.

Carbon or boron modified titanium silicide

DOEpatents

Thom, Andrew J.; Akinc, Mufit

1996-12-03

A titanium silicide material based on Ti.sub.5 Si.sub.3 intermetallic compound exhibits substantially improved oxidative stability at elevated temperatures. In particular, carbon is added to a Ti.sub.5 Si.sub.3 base material in an amount (e.g. about 0.3 to about 3.6 weight % C) effective to impart substantially improved oxidative stability at elevated temperatures, such as about 1000.degree. C. Boron is added to a Ti.sub.5 Si.sub.3 base material in an amount (e.g. about 0.3 to about 3.3 weight % B) to this same end.

Carbon or boron modified titanium silicide

DOEpatents

Thom, Andrew J.; Akinc, Mufit

1997-12-02

A titanium silicide material based on Ti.sub.5 Si.sub.3 intermetallic compound exhibits substantially improved oxidative stability at elevated temperatures. In particular, carbon is added to a Ti.sub.5 Si.sub.3 base material in an amount (e.g. about 0.3 to about 3.6 weight % C) effective to impart substantially improved oxidative stability at elevated temperatures, such as about 1000.degree. C. Boron is added to a Ti.sub.5 Si.sub.3 base material in an amount (e.g. about 0.3 to about 3.3 weight % B) to this same end.

Carbon or boron modified titanium silicide

DOEpatents

Thom, A.J.; Akinc, M.

1996-12-03

A titanium silicide material based on Ti{sub 5}Si{sub 3} intermetallic compound exhibits substantially improved oxidative stability at elevated temperatures. In particular, carbon is added to a Ti{sub 5}Si{sub 3} base material in an amount (e.g. about 0.3 to about 3.6 weight % C) effective to impart substantially improved oxidative stability at elevated temperatures, such as about 1000 C. Boron is added to a Ti{sub 5}Si{sub 3} base material in an amount (e.g. about 0.3 to about 3.3 weight % B) to this same end. 3 figs.

Carbon or boron modified titanium silicide

DOEpatents

Thom, Andrew J.; Akinc, Mufit

1998-07-14

A titanium silicide material based on Ti.sub.5 Si.sub.3 intermetallic compound exhibits substantially improved oxidative stability at elevated temperatures. In particular, carbon is added to a Ti.sub.5 Si.sub.3 base material in an amount (e.g. about 0.3 to about 3.6 weight % C) effective to impart substantially improved oxidative stability at elevated temperatures, such as about 1000.degree. C. Boron is added to a Ti.sub.5 Si.sub.3 base material in an amount (e.g. about 0.3 to about 3.3 weight % B) to this same end.

Efficacy and safety of fractional carbon dioxide laser for treatment of unwanted facial freckles in phototypes II-IV: a pilot study.

PubMed

El Zawahry, Bakr; Zaki, Naglaa; Hafez, Vanessa; Abdel Hay, Rania; Hay, Rania Abdel; Fahim, Aya

2014-11-01

Facial freckles are a cosmetic concern to Egyptians, particularly young females. Several therapeutic lines exist with variable response rates and limitations. Fractional carbon dioxide (FCO2) laser provides minimal ablation and therefore less down time and less side effects. The efficacy and safety of this laser technology have still not been studied in freckles. The aim of this study is to assess the efficacy and safety of FCO2 laser in the treatment of unwanted facial freckles in Egyptians. Twenty patients undergone a single session of FCO2 laser and then were followed up clinically a month later. Photographs were taken before treatment and at follow-up visit and were assessed by three blinded investigators. Percent of global improvement was measured on a 4-point grading scale. Patient's satisfaction and adverse events were recorded. Two patients (10 %) showed grade 1 improvement, while eight patients (40 %) showed grade 2 improvement. Nine patients (45 %) showed grade 3 improvement, and only one patient (5 %) showed grade 4 improvement. FCO2 laser resurfacing is effective and safe in treatment of facial freckles in skin phototypes II-IV. It can offer a more practical alternative to topical treatments, and a cheaper alternative to Q-switched lasers.

Special issue : safety advancements

DOT National Transportation Integrated Search

1999-04-24

This issue of 'Status Report' focuses on some of the most recent key safety technology improvements. The crash protection in passenger vehicles is improving substantially; advanced frontal airbags will soon be available in a number of models and side...

Age-adjusted Charlson comorbidity index score as predictor of survival of patients with digestive system cancer who have undergone surgical resection.

PubMed

Tian, Yaohua; Jian, Zhong; Xu, Beibei; Liu, Hui

2017-10-03

Comorbidities have considerable effects on survival outcomes. The primary objective of this retrospective study was to examine the association between age-adjusted Charlson comorbidity index (ACCI) score and postoperative in-hospital mortality in patients with digestive system cancer who have undergone surgical resection of their cancers. Using electronic hospitalization summary reports, we identified 315,464 patients who had undergone surgery for digestive system cancer in top-rank (Grade 3A) hospitals in China between 2013 and 2015. The Cox proportional hazard regression model was applied to evaluate the effect of ACCI score on postoperative mortality, with adjustments for sex, type of resection, anesthesia methods, and caseload of each healthcare institution. The postoperative in-hospital mortality rate in the study cohort was 1.2% (3,631/315,464). ACCI score had a positive graded association with the risk of postoperative in-hospital mortality for all cancer subtypes. The adjusted HRs for postoperative in-hospital mortality scores ≥ 6 for esophagus, stomach, colorectum, pancreas, and liver and gallbladder cancer were 2.05 (95% CI: 1.45-2.92), 2.00 (95% CI: 1.60-2.49), 2.54 (95% CI: 2.02-3.21), 2.58 (95% CI: 1.68-3.97), and 4.57 (95% CI: 3.37-6.20), respectively, compared to scores of 0-1. These findings suggested that a high ACCI score is an independent predictor of postoperative in-hospital mortality in Chinese patients with digestive system cancer who have undergone surgical resection.

Shoulder and neck morbidity in quality of life after surgery for head and neck cancer.

PubMed

van Wilgen, C P; Dijkstra, P U; van der Laan, B F A M; Plukker, J Th; Roodenburg, J L N

2004-10-01

Quality of life has become a major issue in determining the outcome of treatment in head and neck surgery with curative intent. The aim of our study was to determine which factors in the postoperative care, especially shoulder and neck morbidity, are related to quality of life and how these outcomes compared between patients who had undergone surgery and a control group. We analyzed physical symptoms, psychological symptoms, and social and functional well-being at least 1 year after surgery and evaluated the differences in quality of life between patients who had undergone head and neck surgery and a control group. Depression scores contributed significantly to all domains of quality of life. Reduced shoulder abduction, shoulder pain, and neck pain are related to several domains of quality of life. The patient group scored significantly worse for social functioning and limitations from physical problems but scored significantly better for bodily pain and health changes. Depression and shoulder and neck morbidity are important factors in quality of life for patients who have undergone surgery for head and neck cancer. (c) 2004 Wiley Periodicals, Inc.

[Relations between extraction of wisdom teeth and temporomandibular disorders: a case/control study].

PubMed

Duval, Florian; Leroux, Agathe; Bertaud, Valérie; Meary, Fleur; Le Padellec, Clément; Refuveille, Laura; Lemaire, Arnaud; Sorel, Olivier; Chauvel-Lebret, Dominique

2015-09-01

The aim of this study was to assess the impact of extraction of third molars on the occurrence of temporo-mandibular disorders (TMD). A review of the literature and a case-control study have been conducted. The case-control study compares the frequency of extraction of third molars between the sample with TMD (case) and the sample without TMD (control). The proportion of patients who had undergone extractions of wisdom teeth was higher in the case group than in the control group. The difference was statistically significant when patients had undergone extraction of all four wisdom teeth or when the extraction of four wisdom teeth underwent in one sitting or under general anesthesia. The study of patients in case sample shows that all signs of TMD were more common in patients who had undergone extractions in several sessions and under local anesthesia. The temporomandibular joint sounds are significantly more frequent with local anesthesia. In the case group, 85 to 92% of patients have parafunctions and 5 to 11% have malocclusion. This demonstrates the multifactorial etiology of temporomandibular disorders. © EDP Sciences, SFODF, 2015.

20 CFR 220.178 - Determining medical improvement and its relationship to the annuitant's ability to do work.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 20 Employees' Benefits 1 2010-04-01 2010-04-01 false Determining medical improvement and its... Disability Due to Substantial Gainful Activity or Medical Improvement § 220.178 Determining medical improvement and its relationship to the annuitant's ability to do work. (a) General. Paragraphs (a), (b), and...

Achievements and challenges in structural bioinformatics and computational biophysics.

PubMed

Samish, Ilan; Bourne, Philip E; Najmanovich, Rafael J

2015-01-01

The field of structural bioinformatics and computational biophysics has undergone a revolution in the last 10 years. Developments that are captured annually through the 3DSIG meeting, upon which this article reflects. An increase in the accessible data, computational resources and methodology has resulted in an increase in the size and resolution of studied systems and the complexity of the questions amenable to research. Concomitantly, the parameterization and efficiency of the methods have markedly improved along with their cross-validation with other computational and experimental results. The field exhibits an ever-increasing integration with biochemistry, biophysics and other disciplines. In this article, we discuss recent achievements along with current challenges within the field. © The Author 2014. Published by Oxford University Press.

Achievements and challenges in structural bioinformatics and computational biophysics

PubMed Central

Samish, Ilan; Bourne, Philip E.; Najmanovich, Rafael J.

2015-01-01

Motivation: The field of structural bioinformatics and computational biophysics has undergone a revolution in the last 10 years. Developments that are captured annually through the 3DSIG meeting, upon which this article reflects. Results: An increase in the accessible data, computational resources and methodology has resulted in an increase in the size and resolution of studied systems and the complexity of the questions amenable to research. Concomitantly, the parameterization and efficiency of the methods have markedly improved along with their cross-validation with other computational and experimental results. Conclusion: The field exhibits an ever-increasing integration with biochemistry, biophysics and other disciplines. In this article, we discuss recent achievements along with current challenges within the field. Contact: Rafael.Najmanovich@USherbrooke.ca PMID:25488929

A GIS-based Model for Natural Gas Data Conversion

NASA Astrophysics Data System (ADS)

Bitik, E.; Seker, D. Z.; Denli, H. H.

2014-12-01

In Turkey gas utility sector has undergone major changes in terms of increased competition between gas providers, efforts in improving services, and applying new technological solutions. This paper discusses the challenges met by gas companies to switch from long workflows of gas distribution, sales and maintenance into IT driven efficient management of complex information both spatially and non-spatially. The aim of this study is migration of all gas data and information into a GIS environment in order to manage and operate all infrastructure investments with a Utility Management System. All data conversion model for migration was designed and tested during the study. A flowchart is formed to transfer the old data layers to the new structure based on geodatabase.

Anatomy of an upgraded pulverized coal facility: Combustion modification through flue gas scrubbing

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

Watts, J.U.; Savichky, W.J.; O`Dea, D.T.

1997-12-31

Regeneration is a biological term for formation or creating anew. In the case of Milliken station, a species of steam generation (Tangentus coali) regeneration refers to refitting critical systems with the latest technological advances to reduce emissions while maintaining or improving performance. The plant has undergone a series of operations which provided anatomical changes as well as a face lift. Each of the two units were place in suspended animation (outage) to allow these changes to be made. The paper describes the project which includes retrofitting combustion systems, pulverizers, boiler liners, scrubbers, and control room. This retrofit is meant tomore » increase thermal efficiency while reducing the formation of nitrogen oxides.« less

PET with the HIDAC camera?

NASA Astrophysics Data System (ADS)

Townsend, D. W.

1988-06-01

In 1982 the first prototype high density avalanche chamber (HIDAC) positron camera became operational in the Division of Nuclear Medicine of Geneva University Hospital. The camera consisted of dual 20 cm × 20 cm HIDAC detectors mounted on a rotating gantry. In 1984, these detectors were replaced by 30 cm × 30 cm detectors with improved performance and reliability. Since then, the larger detectors have undergone clinical evaluation. This article discusses certain aspects of the evaluation program and the conclusions that can be drawn from the results. The potential of the HIDAC camera for quantitative positron emission tomography (PET) is critically examined, and its performance compared with a state-of-the-art, commercial ring camera. Guidelines for the design of a future HIDAC camera are suggested.

Building bridges, breaking barriers

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

Gonzalez, R.G.

1996-05-01

Communication is one of the most important factors in determining the success of any enterprise. It is certain to rise to the forefront for the international refining and petrochemical industries as companies seek continuous improvement in their operations. Most industry participants have recently undergone a wave of business process re-engineering, integrating new people with new practices in more areas than ever before. Companies have broken down the old functional organizations within the plant in favor of asset teams, placed renewed emphasis on optimizing profits across the entire downstream value chain and extended their global businesses to include joint venture partners.more » The goal is to empower people to make better decisions in a more timely manner to positively impact performance.« less

Low-dose mitomycin C, etoposide, and cisplatin for invasive vulvar Paget's disease.

PubMed

Watanabe, Yoh; Hoshiai, H; Ueda, H; Nakai, H; Obata, K; Noda, K

2002-01-01

We report the effect of low-dose mitomycin C, etoposide, and cisplatin (low-dose MEP) therapy for three patients with invasive vulvar Paget's disease (invasive VPD) who declined radical vulvectomy and skin grafting. One patient achieved a complete response, while the other two showed partial responses (PR) without grade 3 or 4 adverse effects. The two patients with PR were undergone partial vulvectomy and inguinal lymph node dissection. All patients have no sign of recurrence for 10 months after chemotherapy. Our present results suggest that low-dose MEP is an effective and safe chemotherapy for invasive VPD and low-dose MEP may significantly improve postoperative quality of life in patients with invasive VPD by avoiding extensive vulvar resection and skin grafting.

[Continent colostomy and colon irrigation].

PubMed

Kostov, D; Temelkov, T; Kiriazov, E; Ivanov, K; Ignatov, V; Kobakov, G

2000-01-01

The authors have studied a functional activity of a continent colostomy at 20 patients, undergone an abdomeno-perineal extirpation of rectum and carried out periodic colonirrigations, during a period of 6 months. A conus type, closed irrigating system has been used. The degree of an incontinency at patients has been compared before and after the beginning of the colonirrigations. The irrigating procedures have reduced spontaneous defications at patients during a week 28 times and have improved the quality of life significantly. The application of colostomy bags has been restricted in 8 (40%) patients. An intraluminal ultrasonographic investigation has been done at 12 (60%) patients at the end of 6 month irrigating period. No changes of the ultrasonographic image of the precolostomic segment of colon has been observed.

Fontan Operation: Indications, Short and Long Term Outcomes.

PubMed

Rao, P Syamasundar

2015-12-01

Fontan operation, since its original description, has undergone a number of modifications so that it is now a staged, total cavo-pulmonary connection with fenestration. Stage I is palliation, depending upon the pathophysiology of the defect complex in early life, Stage II is bidirectional Glenn at about the age of 6 mo and Stage III is transfer of inferior vena caval blood to the pulmonary circuit along with fenestration between 2 to 4 y. Any patient that has only one functioning ventricle is a candidate for Fontan surgery. The morbidity and mortality have remarkably improved since the institution of staged, total cavo-pulmonary connection with fenestration. Complications during follow up continue to occur, though diminished with the newer modifications, and should be promptly addressed.

[The management of 126 cases of posterior cracked crown of tooth and its effective observation].

PubMed

Chen, L L

2000-06-01

To detect the treatment and effect of posterior cracked tooth. 162 posterior cracked teeth of 158 cases, including enamel fissure and dentin fissure, all there cases undergone the synthetical treatment and follow up in different period, the longest observation period was 2.5 years. The healing and improved rate of 162 cracked teeth 90.74%. Among cases of failure, we have founded 6 cases of acute pulpitis (3.7%), 3 cases of alveodental abscess (1.85%), 2 cases of chronic apical periodontitis (1.24%), 4 cases of tooth fracture (2.4%). Cracked tooth was caused by multiple factors. Early diagnosis, synthetical treatment, and follow up in different period are 3 main factors in treatment.

Brain Neuromodulation Techniques: A Review.

PubMed

Lewis, Philip M; Thomson, Richard H; Rosenfeld, Jeffrey V; Fitzgerald, Paul B

2016-08-01

The modulation of brain function via the application of weak direct current was first observed directly in the early 19th century. In the past 3 decades, transcranial magnetic stimulation and deep brain stimulation have undergone clinical translation, offering alternatives to pharmacological treatment of neurological and neuropsychiatric disorders. Further development of novel neuromodulation techniques employing ultrasound, micro-scale magnetic fields and optogenetics is being propelled by a rapidly improving understanding of the clinical and experimental applications of artificially stimulating or depressing brain activity in human health and disease. With the current rapid growth in neuromodulation technologies and applications, it is timely to review the genesis of the field and the current state of the art in this area. © The Author(s) 2016.

Recent field experiments with commercial satellite imagery direct downlink.

PubMed

Gonzalez, Anthony R; Amber, Samuel H

US Pacific Command's strategy includes assistance to United States government relief agencies and nongovernment organizations during humanitarian aid and disaster relief operations in the Asia-Pacific region. Situational awareness during these operations is enhanced by broad interagency access to unclassified commercial satellite imagery. The Remote Ground Terminal-a mobile satellite downlink ground station-has undergone several technology demonstrations and participated in an overseas deployment exercise focused on a natural disaster scenario. This ground station has received new commercial imagery within 20 minutes, hastening a normally days-long process. The Army Geospatial Center continues to manage technology development and product improvement for the Remote Ground Terminal. Furthermore, this ground station is now on a technology transition path into the Distributed Common Ground System-Army program of record.

Satellite Servicing in Mission Design Studies at the NASA GSFC

NASA Technical Reports Server (NTRS)

Leete, Stephen J.

2003-01-01

Several NASA missions in various stages of development have undergone one-week studies in the National Aeronautics and Space Administration (NASA) Goddard Space Flight Center (GSFC) Integrated Mission Design Center (IMDC), mostly in preparation for proposals. The possible role of satellite servicing has been investigated for several of these missions, applying the lessons learned from Hubble Space Telescope (HST) servicing, taking into account the current state of the art, projecting into the future, and implementing NASA long-range plans, and is presented here. The general benefits and costs of injecting satellite servicing are detailed, including components such as mission timeline, mass, fuel, spacecraft design, risk abatement, life extension, and improved performance. The approach taken in addressing satellite servicing during IMDC studies is presented.

Development of a teaching tool for women with a gynecologic malignancy undergoing minimally invasive robotic-assisted surgery.

PubMed

Castiglia, Luisa Luciani; Drummond, Nancy; Purden, Margaret A

2011-08-01

Women undergoing minimally invasive robotic-assisted surgery for a gynecologic malignancy have many questions and concerns related to the cancer diagnosis and surgery. The provision of information enhances coping with such illness-related challenges. A lack of print materials for these patients prompted the creation of a written teaching tool to improve informational support. A booklet was developed using guidelines for the design of effective patient education materials, including an iterative process of collaboration with healthcare providers and women who had undergone robotic-assisted surgery, as well as attention to readability. The 52-page booklet covers the trajectory of the woman's experience and includes the physical, psychosocial, and sexual aspects of recovery.

Mouse Genome Informatics (MGI): Resources for Mining Mouse Genetic, Genomic, and Biological Data in Support of Primary and Translational Research.

PubMed

Eppig, Janan T; Smith, Cynthia L; Blake, Judith A; Ringwald, Martin; Kadin, James A; Richardson, Joel E; Bult, Carol J

2017-01-01

The Mouse Genome Informatics (MGI), resource ( www.informatics.jax.org ) has existed for over 25 years, and over this time its data content, informatics infrastructure, and user interfaces and tools have undergone dramatic changes (Eppig et al., Mamm Genome 26:272-284, 2015). Change has been driven by scientific methodological advances, rapid improvements in computational software, growth in computer hardware capacity, and the ongoing collaborative nature of the mouse genomics community in building resources and sharing data. Here we present an overview of the current data content of MGI, describe its general organization, and provide examples using simple and complex searches, and tools for mining and retrieving sets of data.

Evaluation of the Oregon DMV driver improvement program.

DOT National Transportation Integrated Search

2007-04-01

This report provides an evaluation of the Oregon Department of Transportation-Driver and Motor Vehicle : (DMV) Services Driver Improvement Program (DIP), which was substantially changed in 2002. Prior to 2002, : the DIP was organized around four prog...

Multilayer insulation blanket, fabricating apparatus and method

DOEpatents

Gonczy, John D.; Niemann, Ralph C.; Boroski, William N.

1992-01-01

An improved multilayer insulation blanket for insulating cryogenic structures operating at very low temperatures is disclosed. An apparatus and method for fabricating the improved blanket are also disclosed. In the improved blanket, each successive layer of insulating material is greater in length and width than the preceding layer so as to accommodate thermal contraction of the layers closest to the cryogenic structure. The fabricating apparatus has a rotatable cylindrical mandrel having an outer surface of fixed radius that is substantially arcuate, preferably convex, in cross-section. The method of fabricating the improved blanket comprises (a) winding a continuous sheet of thermally reflective material around the circumference of the mandrel to form multiple layers, (b) binding the layers along two lines substantially parallel to the edges of the circumference of the mandrel, (c) cutting the layers along a line parallel to the axle of the mandrel, and (d) removing the bound layers from the mandrel.

Method of fabricating a multilayer insulation blanket

DOEpatents

Gonczy, John D.; Niemann, Ralph C.; Boroski, William N.

1993-01-01

An improved multilayer insulation blanket for insulating cryogenic structures operating at very low temperatures is disclosed. An apparatus and method for fabricating the improved blanket are also disclosed. In the improved blanket, each successive layer of insulating material is greater in length and width than the preceding layer so as to accommodate thermal contraction of the layers closest to the cryogenic structure. The fabricating apparatus has a rotatable cylindrical mandrel having an outer surface of fixed radius that is substantially arcuate, preferably convex, in cross-section. The method of fabricating the improved blanket comprises (a) winding a continuous sheet of thermally reflective material around the circumference of the mandrel to form multiple layers, (b) binding the layers along two lines substantially parallel to the edges of the circumference of the mandrel, (c) cutting the layers along a line parallel to the axle of the mandrel, and (d) removing the bound layers from the mandrel.

Method of fabricating a multilayer insulation blanket

DOEpatents

Gonczy, J.D.; Niemann, R.C.; Boroski, W.N.

1993-07-06

An improved multilayer insulation blanket for insulating cryogenic structures operating at very low temperatures is disclosed. An apparatus and method for fabricating the improved blanket are also disclosed. In the improved blanket, each successive layer of insulating material is greater in length and width than the preceding layer so as to accommodate thermal contraction of the layers closest to the cryogenic structure. The fabricating apparatus has a rotatable cylindrical mandrel having an outer surface of fixed radius that is substantially arcuate, preferably convex, in cross-section. The method of fabricating the improved blanket comprises (a) winding a continuous sheet of thermally reflective material around the circumference of the mandrel to form multiple layers, (b) binding the layers along two lines substantially parallel to the edges of the circumference of the mandrel, (c) cutting the layers along a line parallel to the axle of the mandrel, and (d) removing the bound layers from the mandrel.

Multilayer insulation blanket, fabricating apparatus and method

DOEpatents

Gonczy, J.D.; Niemann, R.C.; Boroski, W.N.

1992-09-01

An improved multilayer insulation blanket for insulating cryogenic structures operating at very low temperatures is disclosed. An apparatus and method for fabricating the improved blanket are also disclosed. In the improved blanket, each successive layer of insulating material is greater in length and width than the preceding layer so as to accommodate thermal contraction of the layers closest to the cryogenic structure. The fabricating apparatus has a rotatable cylindrical mandrel having an outer surface of fixed radius that is substantially arcuate, preferably convex, in cross-section. The method of fabricating the improved blanket comprises (a) winding a continuous sheet of thermally reflective material around the circumference of the mandrel to form multiple layers, (b) binding the layers along two lines substantially parallel to the edges of the circumference of the mandrel, (c) cutting the layers along a line parallel to the axle of the mandrel, and (d) removing the bound layers from the mandrel. 7 figs.

Use of wild genotypes in breeding program increases strawberry fruit sensorial and nutritional quality.

PubMed

Diamanti, Jacopo; Mazzoni, Luca; Balducci, Francesca; Cappelletti, Roberto; Capocasa, Franco; Battino, Maurizio; Dobson, Gary; Stewart, Derek; Mezzetti, Bruno

2014-05-07

This study evaluated 20 advanced selections, derived from a strawberry interspecific backcross program, and their parents for fruit weight, commercial yield, acidity, sugar content, antioxidant capacity, and phenol and anthocyanin contents. Phytochemical profiling analysis was performed to determine the compositional characteristics of the improved selections in comparison with their parents and an important commercial variety ('Elsanta'). Advanced selections showed substantial improvement for agronomic and nutritional quality parameters. From the profiling analysis there was evidence for specific improvements in fruit phytochemical contents; new advanced selections had substantially increased fruit flavonol, anthocyanin, and ellagitannin contents compared to their parent cultivar 'Romina' and, for flavonols and ellagitannins, compared to a standard cultivar 'Elsanta'. Such results confirm that an appropriate breeding program that includes wild strawberry germplasm can produce new strawberry cultivars with a well-defined improvement in fruit nutritional and nutraceutical values.

Chest Reconstruction and Chest Dysphoria in Transmasculine Minors and Young Adults: Comparisons of Nonsurgical and Postsurgical Cohorts.

PubMed

Olson-Kennedy, Johanna; Warus, Jonathan; Okonta, Vivian; Belzer, Marvin; Clark, Leslie F

2018-05-01

Transmasculine youth, who are assigned female at birth but have a gender identity along the masculine spectrum, often report considerable distress after breast development (chest dysphoria). Professional guidelines lack clarity regarding referring minors (defined as people younger than 18 years) for chest surgery because there are no data documenting the effect of chest surgery on minors. To examine the amount of chest dysphoria in transmasculine youth who had had chest reconstruction surgery compared with those who had not undergone this surgery. Using a novel measure of chest dysphoria, this cohort study at a large, urban, hospital-affiliated ambulatory clinic specializing in transgender youth care collected survey data about testosterone use and chest distress among transmasculine youth and young adults. Additional information about regret and adverse effects was collected from those who had undergone surgery. Eligible youth were 13 to 25 years old, had been assigned female at birth, and had an identified gender as something other than female. Recruitment occurred during clinical visits and via telephone between June 2016 and December 2016. Surveys were collected from participants who had undergone chest surgery at the time of survey collection and an equal number of youth who had not undergone surgery. Outcomes were chest dysphoria composite score (range 0-51, with higher scores indicating greater distress) in all participants; desire for chest surgery in patients who had not had surgery; and regret about surgery and complications of surgery in patients who were postsurgical. Of 136 completed surveys, 68 (50.0%) were from postsurgical participants, and 68 (50.0%) were from nonsurgical participants. At the time of the survey, the mean (SD) age was 19 (2.5) years for postsurgical participants and 17 (2.5) years for nonsurgical participants. Chest dysphoria composite score mean (SD) was 29.6 (10.0) for participants who had not undergone chest reconstruction, which was significantly higher than mean (SD) scores in those who had undergone this procedure (3.3 [3.8]; P < .001). Among the nonsurgical cohort, 64 (94%) perceived chest surgery as very important, and chest dysphoria increased by 0.33 points each month that passed between a youth initiating testosterone therapy and undergoing surgery. Among the postsurgical cohort, the most common complication of surgery was loss of nipple sensation, whether temporary (59%) or permanent (41%). Serious complications were rare and included postoperative hematoma (10%) and complications of anesthesia (7%). Self-reported regret was near 0. Chest dysphoria was high among presurgical transmasculine youth, and surgical intervention positively affected both minors and young adults. Given these findings, professional guidelines and clinical practice should consider patients for chest surgery based on individual need rather than chronologic age.

Developing a neurosurgical simulation-based educational curriculum: an overview.

PubMed

Harrop, James; Lobel, Darlene A; Bendok, Bernard; Sharan, Ashwini; Rezai, Ali R

2013-10-01

The science of medicine has undergone rapid advancement and expansion as a result of significant technological innovations, and this has affected the training of neurosurgical residents. To develop a simulation-based neurosurgical educational curriculum to improve resident education. The Congress of Neurological Surgeons established a Simulation Committee to explore the use of this technology in maximizing neurosurgical education. Simulators were incorporated into an educational curriculum with both a didactic and a technical component. The simulators and didactic portions were validated with objective pretests and posttests. The Simulator Committee has continued to expand the use of simulators in neurosurgical education and has organized several practical courses. The simulator use continues to expand into vasculature, spinal, and cranial modules. Each module has independently shown improved training scores in both didactic and technical skills. The Congress of Neurological Surgeons has successfully incorporated simulation into an educational curriculum with both didactic and technical components. This appears to be a powerful educational tool, and its uses are being further expanded.

Evolution of medical education in the Department of Medicine of the Complutense University of Madrid in the last decade.

PubMed

Collado-Yurrita, L; Ciudad-Cabañas, M J; Cuadrado-Cenzual, M A

2018-03-11

This paper aims to show changes in Medical Education in the Department of Medicine at the Complutense University of Madrid in the last 10-15 years. Medical education in the Department of Medicine at the Complutense University of Madrid has undergone significant changes in the last 10-15 years. An attempt to summarize these shows that radical change in the teaching of medicine for both teachers and students has taken place in three areas: 1. Progressive development of Patient-centered medical education. 2. Development of a competency-based training concerned with the mastering of knowledge and skills and their evaluation through objective and structured clinical assessment tests. 3. Introducing simulation techniques and virtual reality in the teaching of clinical practice aimed at improving our students' training and enhancing patient safety. We believe that the changes applied have pleased students as well as teachers and even patients and are helping to improve the training of our students.

A report of three cases of jaundice with thyrotoxicosis.

PubMed

Akande, T O; Balogun, W O

2013-09-01

Jaundice and hepatic dysfunction have been reported in patients with thyrotoxicosis and could be due to different mechanisms. To describe three cases of jaundice occurring in patients with thyrotoxicosis and to illustrate the importance of early institution of thionamides when indicated. We present the clinical and laboratory features of three patients presenting within a year with thyrotoxicosis and jaundice and whose clinical conditions improved remarkably following treatment with thionamides. In addition, current literature on the subject is reviewed and summarised. The three patients presented with goitre and jaundice. None of the patients had received blood products, undergone scarification markings or experienced any previous episode of jaundice. Thyroid function tests in the three patients were consistent with a diagnosis of thyrotoxicosis. Liver function tests showed elevated bilirubin and transaminases. All patients improved remarkably following treatment with thionamides. It is important to rule out thyrotoxicosis in patients with jaundice of unknown cause and consider early use of thionamides for treatment of the thyrotoxicosis, if confirmed.

Improved CPAS Photogrammetric Capabilities for Engineering Development Unit (EDU) Testing

NASA Technical Reports Server (NTRS)

Ray, Eric S.; Bretz, David R.

2013-01-01

This paper focuses on two key improvements to the photogrammetric analysis capabilities of the Capsule Parachute Assembly System (CPAS) for the Orion vehicle. The Engineering Development Unit (EDU) system deploys Drogue and Pilot parachutes via mortar, where an important metric is the muzzle velocity. This can be estimated using a high speed camera pointed along the mortar trajectory. The distance to the camera is computed from the apparent size of features of known dimension. This method was validated with a ground test and compares favorably with simulations. The second major photogrammetric product is measuring the geometry of the Main parachute cluster during steady-state descent using onboard cameras. This is challenging as the current test vehicles are suspended by a single-point attachment unlike earlier stable platforms suspended under a confluence fitting. The mathematical modeling of fly-out angles and projected areas has undergone significant revision. As the test program continues, several lessons were learned about optimizing the camera usage, installation, and settings to obtain the highest quality imagery possible.

[Development and current situation of reconstruction methods following total sacrectomy].

PubMed

Huang, Siyi; Ji, Tao; Guo, Wei

2018-05-01

To review the development of the reconstruction methods following total sacrectomy, and to provide reference for finding a better reconstruction method following total sacrectomy. The case reports and biomechanical and finite element studies of reconstruction following total sacrectomy at home and abroad were searched. Development and current situation were summarized. After developing for nearly 30 years, great progress has been made in the reconstruction concept and fixation techniques. The fixation methods can be summarized as the following three strategies: spinopelvic fixation (SPF), posterior pelvic ring fixation (PPRF), and anterior spinal column fixation (ASCF). SPF has undergone technical progress from intrapelvic rod and hook constructs to pedicle and iliac screw-rod systems. PPRF and ASCF could improve the stability of the reconstruction system. Reconstruction following total sacrectomy remains a challenge. Reconstruction combining SPF, PPRF, and ASCF is the developmental direction to achieve mechanical stability. How to gain biological fixation to improve the long-term stability is an urgent problem to be solved.

Healthy casetas: A potential strategy to improve the food environment in low-income schools to reduce obesity in children in Guatemala City.

PubMed

Pehlke, Elisa L; Letona, Paola; Ramirez-Zea, Manuel; Gittelsohn, Joel

2016-01-01

Developing countries have undergone transitions driven by globalization and development, accelerating increases in prevalence of overweight and obesity among children. Schools have been identified as effective settings for interventions that target children's dietary behaviors. In Guatemala, public schools commonly have food kiosks (Casetas) that sell products to children. From July through October 2013, observations during recess, in-depth interviews with school principals (n = 4) and caseta vendors (n = 4), and focus groups with children (n = 48) were conducted. This article explores products available to children at casetas. Factors that affect what casetas offer include regulations and enforcement, vendor investment and earnings, vendor resources, product demand, pricing, and children's preferences. These factors influence the products that are available and children's tendency to purchase them. Potential strategies for improvement include healthy food preparation, price manipulation and promotions, raffles and games to encourage healthier choices, and policy to push toward development of healthier products.

The influence of a Vascular Surgery Hospitalist program on physician and patient satisfaction, resident education, and resource utilization.

PubMed

Cull, David L; Langan, Eugene M; Taylor, Spence M; Carsten, Christopher G; Tong, Angie; Johnson, Brent

2013-10-01

A number of surgery practice models have been developed to address general and trauma surgeon workforce shortages and on-call issues and to improve surgeon satisfaction. These include the creation of acute or urgent care surgery services and "surgical hospitalist" programs. To date, no practice models corresponding to those developed for general and trauma surgeons have been proposed to address these same issues among vascular surgeons or other surgical subspecialists. In 2003, our practice established a Vascular Surgery Hospitalist program. Since its inception nearly a decade ago, it has undergone several modifications. We reviewed hospital administrative databases and surveys of faculty, residents, and patients to evaluate the program's impact. Benefits of the Vascular Surgery Hospitalist program include improved surgeon satisfaction, resource utilization, timeliness of patient care, communication among referring physicians and ancillary staff, and resident teaching/supervision. Elements of this program may be applicable to a variety of surgical subspecialty settings. Copyright © 2013 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.

Rose garden promises of intelligent tutoring systems: Blossom or thorn

NASA Technical Reports Server (NTRS)

Shute, Valerie J.

1991-01-01

Intelligent tutoring systems (ITS) have been in existence for over a decade. However, few controlled evaluation studies have been conducted comparing the effectiveness of these systems to more traditional instruction methods. Two main promises of ITSs are examined: (1) Engender more effective and efficient learning in relation to traditional formats; and (2) Reduce the range of learning outcome measures where a majority of individuals are elevated to high performance levels. Bloom (1984) has referred to these as the two sigma problem; to achieve two standard deviation improvements with tutoring over traditional instruction methods. Four ITSs are discussed in relation to the two promises. These tutors have undergone systematic, controlled evaluations: (1) The LISP tutor (Anderson Farrell and Sauers, 1984); (2) Smithtown (Shute and Glaser, in press); (3) Sherlock (Lesgold, Lajoie, Bunzo and Eggan, 1990); and (4) The Pascal ITS (Bonar, Cunningham, Beatty and Well, 1988). Results show that these four tutors do accelerate learning with no degradation in final outcome. Suggestions for improvements to the design and evaluation of ITSs are discussed.

Implementation experiences of ISO/IEEE11073 standard applied to new use cases for e-health environments.

PubMed

Martinez, I; Escayola, J; Martinez-Espronceda, M; Serrano, L; Trigo, J D; Led, S; Garcia, J

2009-01-01

Recent advances in biomedical engineering and continuous technological innovations in last decade are promoting new challenges, especially in e-Health environments. In this context, the medical devices interoperability is one of the interest fields wherein these improvements require a standard-based design in order to achieve homogeneous solutions. Furthermore, the spreading of wearable devices, oriented to the paradigm of patient environment and supported by wireless technologies as Bluetooth or ZigBee, is bringing new medical use cases based on Ambient Assisted Living, home monitoring of elderly, heart failure, chronic, under palliative care or patients who have undergone surgery, urgencies and emergencies, or even fitness auto-control and health follow-up. In this paper, several implementation experiences based on ISO/IEEE11073 standard are detailed. These evolved e-Health services can improve the quality of the patient's care, increase the user's interaction, and assure these e-Health applications to be fully compatible with global telemedicine systems.

Single session treatment for bleeding hemorrhoids

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

Weinstein, S.J.; Rypins, E.B.; Houck, J.

1987-12-01

Fifty consecutive outpatients with bleeding internal hemorrhoids were prospectively treated with a single application of rubber band ligation or infrared coagulation. Complete follow-up observation was obtained in 48 patients (23 underwent rubber band ligation and 25 underwent infrared coagulation). At one month after treatment, 22 patients who underwent rubber band ligation and 16 who underwent infrared coagulation, were symptomatically improved (p less than 0.05). At six months, 15 patients who had undergone rubber band ligation and ten who had infrared coagulation treatment, remained improved (p less than 0.05). There was no statistical difference in the discomfort experienced by either groupmore » during or after the procedure as determined by a self-assessment scale. Two patients who underwent rubber band ligation experienced complications--a thrombosed external hemorrhoid developed in one patient and another had delayed rectal bleeding. Although associated with occasional complications after treatment, rubber band ligation is more effective than in infrared coagulation for single session treatment of bleeding internal hemorrhoids.« less

Four years of Landsat-7 on-orbit geometric calibration and performance

USGS Publications Warehouse

Lee, D.S.; Storey, James C.; Choate, M.J.; Hayes, R.W.

2004-01-01

Unlike its predecessors, Landsat-7 has undergone regular geometric and radiometric performance monitoring and calibration since launch in April 1999. This ongoing activity, which includes issuing quarterly updates to calibration parameters, has generated a wealth of geometric performance data over the four-year on-orbit period of operations. A suite of geometric characterization (measurement and evaluation procedures) and calibration (procedures to derive improved estimates of instrument parameters) methods are employed by the Landsat-7 Image Assessment System to maintain the geometric calibration and to track specific aspects of geometric performance. These include geodetic accuracy, band-to-band registration accuracy, and image-to-image registration accuracy. These characterization and calibration activities maintain image product geometric accuracy at a high level - by monitoring performance to determine when calibration is necessary, generating new calibration parameters, and verifying that new parameters achieve desired improvements in accuracy. Landsat-7 continues to meet and exceed all geometric accuracy requirements, although aging components have begun to affect performance.

International space Launch Services Today, ILS

NASA Astrophysics Data System (ADS)

Rymarcsuk, James A.; Haase, Ethan E.

2002-01-01

In the last five years the international space launch industry has undergone substantial change. New entrants and existing players in this market have introduced new and upgraded vehicles with greater lift capability than was available five years ago. In addition, some of these vehicles offer reduced risk from their predecessors thanks to design improvements and reductions in the number of failure points. The entry of these vehicles have generated greater supply, increased choice, and improved capabilities to the benefit of satellite operators and manufacturers. Some launch service providers have also enhanced the products and services they offer due to the increased competitiveness in the market. Although the number of commercial satellites launched per year has remained within a fairly narrow range in the last five years, expectations for the future that were once very optimistic have fallen dramatically. The significant number of commercial NGSO satellites launched in the late 1990s helped raise these expectations, but today, the predicted continued growth in launches due to NGSO and broadband systems has not materialized. Despite the decline in expectations from the late 1990s, however, the satellite market that the launch industry supports remains robust. Satellite operators maintain generally favorable financial positions, but the number of satellites required to provide services worldwide is growing slowly, with the number of new and replacement satellites launched per year remaining essentially flat. Satellite operators are undergoing consolidation that is rendering them stronger than ever, and putting them in a position to demand better service from their launch service providers. The increase in supply in the marketplace and the corresponding lack of growth in demand has led to a highly competitive marketplace for launch services internationally. ILS is well positioned with products and services to meet customer needs. Key customer buying factors include reliability and schedule assurance, in addition to price. The Atlas and Proton launch vehicles offered by ILS are based on long heritages, stretching across four decades of research, development, and operational experience. Compared to competing vehicles, Atlas and Proton present lower technical risk. ILS has also developed an innovative system for providing schedule assurance by using one vehicle to back up the other. This "mutual backup" service works because of the inherent similarities of the vehicles, and is unmatched by any other arrangement in the industry.

Roles of universal three-dimensional image analysis devices that assist surgical operations.

PubMed

Sakamoto, Tsuyoshi

2014-04-01

The circumstances surrounding medical image analysis have undergone rapid evolution. In such a situation, it can be said that "imaging" obtained through medical imaging modality and the "analysis" that we employ have become amalgamated. Recently, we feel the distance between "imaging" and "analysis" has become closer regarding the imaging analysis of any organ system, as if both terms mentioned above have become integrated. The history of medical image analysis started with the appearance of the computer. The invention of multi-planar reconstruction (MPR) used in the helical scan had a significant impact and became the basis for recent image analysis. Subsequently, curbed MPR (CPR) and other methods were developed, and the 3D diagnostic imaging and image analysis of the human body have started on a full scale. Volume rendering: the development of a new rendering algorithm and the significant improvement of memory and CPUs contributed to the development of "volume rendering," which allows 3D views with retained internal information. A new value was created by this development; computed tomography (CT) images that used to be for "diagnosis" before that time have become "applicable to treatment." In the past, before the development of volume rendering, a clinician had to mentally reconstruct an image reconfigured for diagnosis into a 3D image, but these developments have allowed the depiction of a 3D image on a monitor. Current technology: Currently, in Japan, the estimation of the liver volume and the perfusion area of the portal vein and hepatic vein are vigorously being adopted during preoperative planning for hepatectomy. Such a circumstance seems to be brought by the substantial improvement of said basic techniques and by upgrading the user interface, allowing doctors easy manipulation by themselves. The following describes the specific techniques. Future of post-processing technology: It is expected, in terms of the role of image analysis, for better or worse, that computer-aided diagnosis (CAD) will develop to a highly advanced level in every diagnostic field. Further, it is also expected in the treatment field that a technique coordinating various devices will be strongly required as a surgery navigator. Actually, surgery using an image navigator is being widely studied, and coordination with hardware, including robots, will also be developed. © 2014 Japanese Society of Hepato-Biliary-Pancreatic Surgery.

A survey of the reformulation of Australian child-oriented food products.

PubMed

Savio, Stephanie; Mehta, Kaye; Udell, Tuesday; Coveney, John

2013-09-11

Childhood obesity is one of the most pressing public health challenges of the 21st century. Reformulating commonly eaten food products is a key emerging strategy to improve the food supply and help address rising rates of obesity and chronic disease. This study aimed to monitor reformulation of Australian child-oriented food products (products marketed specifically to children) from 2009-2011. In 2009, all child-oriented food products in a large supermarket in metropolitan Adelaide were identified. These baseline products were followed up in 2011 to identify products still available for sale. Nutrient content data were collected from Nutrient Information Panels in 2009 and 2011. Absolute and percentage change in nutrient content were calculated for energy, total fat, saturated fat, sugars, sodium and fibre. Data were descriptively analysed to examine reformulation in individual products, in key nutrients, within product categories and across all products. Two methods were used to assess the extent of reformulation; the first involved assessing percentage change in single nutrients over time, while the second involved a set of nutrient criteria to assess changes in overall healthiness of products over time. Of 120 products, 40 remained unchanged in nutrient composition from 2009-2011 and 80 underwent change. The proportions of positively and negatively reformulated products were similar for most nutrients surveyed, with the exception of sodium. Eighteen products (15%) were simultaneously positively and negatively reformulated for different nutrients. Using percentage change in nutrient content to assess extent of reformulation, nearly half (n = 53) of all products were at least moderately reformulated and just over one third (n = 42) were substantially reformulated. The nutrient criteria method revealed 5 products (6%) that were positively reformulated and none that had undergone negative reformulation. Positive and negative reformulation was observed to a similar extent within the sample indicating little overall improvement in healthiness of the child-oriented food supply from 2009-2011. In the absence of agreed reformulation standards, the extent of reformulation was assessed against criteria developed specifically for this project. While arbitrary in nature, these criteria were based on reasonable assessment of the meaningfulness of reformulation and change in nutrient composition. As well as highlighting nutrient composition changes in a number of food products directed to children, this study emphasises the need to develop comprehensive, targeted and standardised reformulation benchmarks to assess the extent of reformulation occurring in the food supply.

Including a range of outcome targets offers a broader view of fibromyalgia treatment outcome: results from a retrospective review of multidisciplinary treatment.

PubMed

Marcus, Dawn A; Bernstein, Cheryl D; Haq, Adeel; Breuer, Paula

2014-06-01

Fibromyalgia is associated with substantial functional disability. Current drug and non-drug treatments result in statistically significant but numerically small improvements in typical numeric measures of pain severity and fibromyalgia impact. The aim of the present study was to evaluate additional measures of pain severity and functional outcome that might be affected by fibromyalgia treatment. This retrospective review evaluated outcomes from 274 adults with fibromyalgia who participated in a six-week, multidisciplinary treatment programme. Pain and function were evaluated on the first and final treatment visit. Pain was evaluated using an 11-point numerical scale to determine clinically meaningful pain reduction (decrease ≥ 2 points) and from a pain drawing. Function was evaluated by measuring active range of motion (ROM), walking distance and speed, upper extremity exercise repetitions, and self-reports of daily activities. Numerical rating scores for pain decreased by 10-13% (p < 0.01) and Fibromyalgia Impact Questionnaire (FIQ) scores decreased by 20% (p < 0.001). More substantial improvements were noted when using alternative measures. Clinically meaningful pain relief was achieved by 37% of patients, and the body area affected by pain decreased by 31%. ROM showed significant improvements in straight leg raise and cervical motion, without improvements in lumbar ROM. Daily walking distance increased fourfold and arm exercise repetitions doubled. Despite modest albeit statistically significant improvements in standard measures of pain severity and the FIQ, more substantial pain improvement was noted when utilizing alternative measures of pain and functional improvement. Alternative symptom assessment measures might be important outcome measures to include in drug and non-drug studies to better understand fibromyalgia treatment effectiveness. © 2013 John Wiley & Sons, Ltd.

Light, Strong Insulating Tiles

NASA Technical Reports Server (NTRS)

Cordia, E.; Schirle, J.

1987-01-01

Improved lightweight insulating silica/aluminum borosilicate/silicon carbide tiles combine increased tensile strength with low thermal conductivity. Changes in composition substantially improve heat-insulating properties of silica-based refractory tile. Silicon carbide particles act as high-emissivity radiation scatterers in tile material.

An Improved Framework for Confound Regression and Filtering for Control of Motion Artifact in the Preprocessing of Resting-State Functional Connectivity Data

PubMed Central

Satterthwaite, Theodore D.; Elliott, Mark A.; Gerraty, Raphael T.; Ruparel, Kosha; Loughead, James; Calkins, Monica E.; Eickhoff, Simon B.; Hakonarson, Hakon; Gur, Ruben C.; Gur, Raquel E.; Wolf, Daniel H.

2013-01-01

Several recent reports in large, independent samples have demonstrated the influence of motion artifact on resting-state functional connectivity MRI (rsfc-MRI). Standard rsfc-MRI preprocessing typically includes regression of confounding signals and band-pass filtering. However, substantial heterogeneity exists in how these techniques are implemented across studies, and no prior study has examined the effect of differing approaches for the control of motion-induced artifacts. To better understand how in-scanner head motion affects rsfc-MRI data, we describe the spatial, temporal, and spectral characteristics of motion artifacts in a sample of 348 adolescents. Analyses utilize a novel approach for describing head motion on a voxelwise basis. Next, we systematically evaluate the efficacy of a range of confound regression and filtering techniques for the control of motion-induced artifacts. Results reveal that the effectiveness of preprocessing procedures on the control of motion is heterogeneous, and that improved preprocessing provides a substantial benefit beyond typical procedures. These results demonstrate that the effect of motion on rsfc-MRI can be substantially attenuated through improved preprocessing procedures, but not completely removed. PMID:22926292

Economic and Nutritional Analyses Offer Substantial Synergies for Understanding Human Nutrition1

PubMed Central

Alderman, Harold; Behrman, Jere R.; Hoddinott, John

2007-01-01

There is growing recognition that interventions designed to improve human nutritional status have, in addition to their intrinsic value, instrumental value in terms of economic outcomes. In many cases, productivity gains alone provide sufficient economic returns to justify investments using benefit and cost criteria. The often-held belief that nutrition programs are welfare interventions that divert resources that could be better used in other ways to raise national incomes is incorrect. Many investments in nutrition are in fact very good economic investments. This recognition has developed out of work that integrates insights from nutrition and economics. Further exploration of this interface is the focus of this article, which seeks: 1) to outline recent contributions that integrate research results from both economics and nutrition, particularly in the context of poor countries; and 2) to describe some areas in which enhanced collaboration is likely to have substantial payoffs in terms of both improved knowledge and more informed policy choices. Collaborative cross-disciplinary research on the topics described here is likely to have substantial payoffs, not only in terms of our understanding of nutritional and economic issues, but also in the improved design of programs and policies that seek to benefit nutritional-related outcomes. PMID:17311936

Economic and nutritional analyses offer substantial synergies for understanding human nutrition.

PubMed

Alderman, Harold; Behrman, Jere R; Hoddinott, John

2007-03-01

There is growing recognition that interventions designed to improve human nutritional status have, in addition to their intrinsic value, instrumental value in terms of economic outcomes. In many cases, productivity gains alone provide sufficient economic returns to justify investments using benefit and cost criteria. The often-held belief that nutrition programs are welfare interventions that divert resources that could be better used in other ways to raise national incomes is incorrect. Many investments in nutrition are in fact very good economic investments. This recognition has developed out of work that integrates insights from nutrition and economics. Further exploration of this interface is the focus of this article, which seeks: 1) to outline recent contributions that integrate research results from both economics and nutrition, particularly in the context of poor countries; and 2) to describe some areas in which enhanced collaboration is likely to have substantial payoffs in terms of both improved knowledge and more informed policy choices. Collaborative cross-disciplinary research on the topics described here is likely to have substantial payoffs, not only in terms of our understanding of nutritional and economic issues, but also in the improved design of programs and policies that seek to benefit nutritional-related outcomes.

Two-Year Outcomes from a Randomized Controlled Trial of Minimally Invasive Sacroiliac Joint Fusion vs. Non-Surgical Management for Sacroiliac Joint Dysfunction

PubMed Central

Swofford, John; Whang, Peter G.; Frank, Clay J.; Glaser, John A.; Limoni, Robert P.; Cher, Daniel J.; Wine, Kathryn D.; Sembrano, Jonathan N.

2016-01-01

Background Sacroiliac joint (SIJ) dysfunction is an important and underappreciated cause of chronic low back pain. Objective To prospectively and concurrently compare outcomes after surgical and non-surgical treatment for chronic SIJ dysfunction. Methods One hundred and forty-eight subjects with SIJ dysfunction were randomly assigned to minimally invasive SIJ fusion with triangular titanium implants (SIJF, n = 102) or non-surgical management (NSM, n = 46). SIJ pain (measured with a 100-point visual analog scale, VAS), disability (measured with Oswestry Disability Index, ODI) and quality of life scores were collected at baseline and at scheduled visits to 24 months. Crossover from non-surgical to surgical care was allowed after the 6-month study visit was complete. Improvements in continuous measures were compared using repeated measures analysis of variance. The proportions of subjects with clinical improvement (SIJ pain improvement ≥20 points, ODI ≥15 points) and substantial clinical benefit (SIJ pain improvement ≥25 points or SIJ pain rating ≤35, ODI ≥18.8 points) were compared. Results In the SIJF group, mean SIJ pain improved rapidly and was sustained (mean improvement of 55.4 points) at month 24. The 6-month mean change in the NSM group (12.2 points) was substantially smaller than that in the SIJF group (by 38.3 points, p<.0001 for superiority). By month 24, 83.1% and 82.0% received either clinical improvement or substantial clinical benefit in VAS SIJ pain score. Similarly, 68.2% and 65.9% had received clinical improvement or substantial clinical benefit in ODI score at month 24. In the NSM group, these proportions were <10% with non-surgical treatment only. Parallel changes were seen for EQ-5D and SF-36, with larger changes in the surgery group at 6 months compared to NSM. The rate of adverse events related to SIJF was low and only 3 subjects assigned to SIJF underwent revision surgery within the 24-month follow-up period. Conclusions In this Level 1 multicenter prospective randomized controlled trial, minimally invasive SIJF with triangular titanium implants provided larger improvements in pain, disability and quality of life compared to NSM. Improvements after SIJF persisted to 24 months. This study was approved by a local or central IRB before any subjects were enrolled. All patients provided study-specific informed consent prior to participation. PMID:27652199

Photovoltaic cell with thin CS layer

DOEpatents

Jordan, John F.; Albright, Scot P.

1994-01-18

An improved photovoltaic panel and method of forming a photovoltaic panel are disclosed for producing a high efficiency CdS/CdTe photovoltaic cell. The photovoltaic panel of the present invention is initially formed with a substantially thick Cds layer, and the effective thickness of the CdS layer is substantially reduced during regrowth to both form larger diameter CdTe crystals and substantially reduce the effective thickness of the C This invention was made with Government support under Subcontract No. ZL-7-06031-3 awarded by the Department of Energy. The Government has certain rights in this invention.

The School Improvement Grant Rollout in America's Great City Schools: School Improvement Grants

ERIC Educational Resources Information Center

Lachlan-Hache, Jonathon; Naik, Manish; Casserly, Michael

2012-01-01

The School Improvement Grant (SIG) program, initially enacted as part of the "No Child Left Behind" amendments to the Elementary and Secondary Education Act, underwent a substantial transformation under the American Recovery and Reinvestment Act of 2009. Under the new program, states identified 2,172 persistently low-achieving schools…

Job-Embedded Professional Learning Essential to Improving Teaching and Learning in Early Education

ERIC Educational Resources Information Center

Pacchiano, Debra; Klein, Rebecca; Hawley, Marsha Shigeyo

2016-01-01

Improving classroom teaching improves children's learning outcomes. In pursuit of those goals, the early education field has made substantial investments aimed at increasing the quality of classroom environments and teacher-child interactions. Yet, in publicly funded programs across the country, the quality of instruction remains low and…

Shunting normal-pressure hydrocephalus: do the benefits outweigh the risks? A multicenter study and literature review.

PubMed

Vanneste, J; Augustijn, P; Dirven, C; Tan, W F; Goedhart, Z D

1992-01-01

We performed a multicenter retrospective study in 166 consecutive patients shunted for presumed normal-pressure hydrocephalus (NPH) in the four neurosurgical departments of Amsterdam. Overall improvement occurred in 36%, substantial improvement in 21%. In the subgroup of idiopathic NPH (N = 127), marked improvement was only 15%. The incidence of shunt-responsive NPH in our area was 2.2/million/year. The rate of severe and moderate shunt-related complications was 28%, leading to death or severe residual morbidity in 7%. The substantial benefit/serious harm ration in the whole group was only three (21%/7%), decreasing to 1.7 in idiopathic NPH. By excluding patients at high surgical risk, this ratio might have risen to 10 in the whole group and to six in idiopathic NPH. Our experience is much less favorable than that encountered in the literature, reporting overall improvement in 74% and marked improvement in 55% of the shunted patients. We conclude that NPH is probably a very rare and still overdiagnosed syndrome and that the overall morbidity rate for each patient demonstrating meaningful improvement is high.

Preoperative determinant of early postoperative renal function following radical cystectomy and intestinal urinary diversion.

PubMed

Gondo, Tatsuo; Ohno, Yoshio; Nakashima, Jun; Hashimoto, Takeshi; Nakagami, Yoshihiro; Tachibana, Masaaki

2017-02-01

To identify preoperative factors correlated with postoperative early renal function in patients who had undergone radical cystectomy (RC) and intestinal urinary diversion. We retrospectively identified 201 consecutive bladder cancer patients without distant metastasis who had undergone RC at our institution between 2003 and 2012. The estimated glomerular filtration rate (eGFR) was calculated using the modified Chronic Kidney Disease Epidemiology equation before RC and 3 months following RC. Univariate and stepwise multiple linear regression analyses were applied to estimate postoperative renal function and to identify significant preoperative predictors of postoperative renal function. Patients who had undergone intestinal urinary diversion and were available for the collection of follow-up data (n = 164) were eligible for the present study. Median preoperative and postoperative eGFRs were 69.7 (interquartile range [IQR] 56.3-78.0) and 70.7 (IQR 57.3-78.1), respectively. In univariate analyses, age, preoperative proteinuria, thickness of abdominal subcutaneous fat tissue (TSF), preoperative serum creatinine level, preoperative eGFR, and urinary diversion type were significantly associated with postoperative eGFR. In a stepwise multiple linear regression analysis, preoperative eGFR, age, and TSF were significant factors for predicting postoperative eGFR (p < 0.001, p = 0.02, and p = 0.046, respectively). The estimated postoperative eGFRs correlated well with the actual postoperative eGFRs (r = 0.65, p < 0.001). Preoperative eGFR, age, and TSF were independent preoperative factors for determining postoperative renal function in patients who had undergone RC and intestinal urinary diversion. These results may be used for patient counseling before surgery, including the planning of perioperative chemotherapy administration.

Sleep-disordered breathing in patients with myelomeningocele.

PubMed

Patel, Daxa M; Rocque, Brandon G; Hopson, Betsy; Arynchyna, Anastasia; Bishop, E Ralee'; Lozano, David; Blount, Jeffrey P

2015-07-01

OBJECT A paucity of literature examines sleep apnea in patients with myelomeningocele, Chiari malformation Type II (CM-II), and related hydrocephalus. Even less is known about the effect of hydrocephalus treatment or CM-II decompression on sleep hygiene. This study is an exploratory analysis of sleep-disordered breathing in patients with myelomeningocele and the effects of neurosurgical treatments, in particular CM-II decompression and hydrocephalus management, on sleep organization. METHODS The authors performed a retrospective review of all patients seen in their multidisciplinary spina bifida clinic (approximately 435 patients with myelomeningocele) to evaluate polysomnographs obtained between March 1999 and July 2013. They analyzed symptoms prompting evaluation, results, and recommended interventions by using descriptive statistics. They also conducted a subset analysis of 9 children who had undergone polysomnography both before and after neurosurgical intervention. RESULTS Fifty-two patients had polysomnographs available for review. Sleep apnea was diagnosed in 81% of these patients. The most common presenting symptom was "breathing difficulties" (18 cases [43%]). Mild sleep apnea was present in 26 cases (50%), moderate in 10 (19%), and severe in 6 (12%). Among the 42 patients with abnormal sleep architecture, 30 had predominantly obstructive apneas and 12 had predominantly central apneas. The most common pulmonology-recommended intervention was adjustment of peripheral oxygen supplementation (24 cases [57%]), followed by initiation of peripheral oxygen (10 cases [24%]). In a subset analysis of 9 patients who had sleep studies before and after neurosurgical intervention, there was a trend toward a decrease in the mean number of respiratory events (from 34.8 to 15.9, p = 0.098), obstructive events (from 14.7 to 13.9, p = 0.85), and central events (from 20.1 to 2.25, p = 0.15) and in the apnea-hypopnea index (from 5.05 to 2.03, p = 0.038, not significant when corrected for multiple measures). CONCLUSIONS A large proportion of patients with myelomeningocele who had undergone polysomnography showed evidence of disordered sleep on an initial study. Furthermore, 31% of patients had moderate or severe obstructive sleep apnea. Myelomeningocele patients with an abnormal sleep structure who had undergone nonoperative treatment with peripheral oxygen supplementation showed improvement in the apnea-hypopnea index. Results in this study suggested that polysomnography in patients with myelomeningocele may present an opportunity to detect and classify sleep apnea, identify low-risk interventions, and prevent future implications of sleep-disordered breathing.

36 CFR 223.137 - Causes for debarment.

Code of Federal Regulations, 2010 CFR

2010-07-01

..., fire prevention, and the disposal of slash; (2) Protection of soil, water, wildlife, range, cultural, and timber resources and protection of improvements when such failure causes significant environmental, resource, or improvements damage; (3) Removal of designated timber when such failure causes substantial...

Article having an improved platinum-aluminum-hafnium protective coating

NASA Technical Reports Server (NTRS)

Nagaraj, Bangalore Aswatha (Inventor); Williams, Jeffrey Lawrence (Inventor)

2005-01-01

An article protected by a protective coating has a substrate and a protective coating having an outer layer deposited upon the substrate surface and a diffusion zone formed by interdiffusion of the outer layer and the substrate. The protective coating includes platinum, aluminum, no more than about 2 weight percent hafnium, and substantially no silicon. The outer layer is substantially a single phase.

Exercise and chemotherapy-induced amenorrhea.

PubMed

Mathis, Katlynn M; Sturgeon, Kathleen M; Winkels, Renate M; Wiskemann, Joachim; Williams, Nancy I; Schmitz, Kathryn

2018-07-01

Chemotherapy-induced amenorrhea (CIA) is the temporary or permanent loss of menses experienced by premenopausal women undergoing chemotherapy treatment for cancer. Two possible mechanisms through which chemotherapy induces CIA have been identified: systemic endothelial dysfunction, resulting in decreased blood flow to the ovaries, and increased oxidative stress within the ovaries, both of which are proposed to lead to apoptosis of follicles. Endothelial dysfunction in ovarian arteries in women undergoing or who have undergone chemotherapy treatment is characterized by prothrombotic changes and thickening of the vascular wall. These changes result in occlusion of the blood vessels. Oxidative stress is increased and antioxidants decreased in the ovaries secondary to chemotherapy drugs, specifically cyclophosphamide. It is hypothesized that low to moderate intensity aerobic exercise during chemotherapy may prevent these changes and lessen the risk for developing CIA in premenopausal women. Low to moderate intensity aerobic exercise has been shown to improve endothelial function and blood flow in patients with cardiovascular disease-a disease state characterized by endothelial dysfunction and for which patients who have undergone chemotherapy are at increased risk. In mice, moderate intensity aerobic exercise has been shown to decrease the amount of oxidative stress within the ovaries, and in humans, chronic aerobic exercise has been shown to increase antioxidant production systemically. This hypothesis should be tested in both a mouse model, using sedentary and exercising mice treated with chemotherapy drugs that commonly result in CIA, as well as a human model to determine the effects of low to moderate intensity aerobic exercise on ovarian function in premenopausal women undergoing chemotherapy. Copyright © 2018 Elsevier Ltd. All rights reserved.

Cost-effectiveness of antibiotic prophylaxis for dental patients with prosthetic joints: Comparisons of antibiotic regimens for patients with total hip arthroplasty.

PubMed

Skaar, Daniel D; Park, Taehwan; Swiontkowski, Marc F; Kuntz, Karen M

2015-11-01

Clinician uncertainty concerning the need for antibiotic prophylaxis to prevent prosthetic joint infection (PJI) after undergoing dental procedures persists. Improved understanding of the potential clinical and economic risks and benefits of antibiotic prophylaxis will help inform the debate and facilitate the continuing evolution of clinical management guidelines for dental patients with prosthetic joints. The authors developed a Markov decision model to compare the lifetime cost-effectiveness of alternative antibiotic prophylaxis strategies for dental patients aged 65 years who had undergone total hip arthroplasty (THA). On the basis of the authors' interpretation of previous recommendations from the American Dental Association and American Academy of Orthopaedic Surgeons, they compared the following strategies: no prophylaxis, prophylaxis for the first 2 years after arthroplasty, and lifetime prophylaxis. A strategy of foregoing antibiotic prophylaxis before dental visits was cost-effective and resulted in lower lifetime accumulated costs ($11,909) and higher accumulated quality-adjusted life years (QALYs) (12.375) when compared with alternative prophylaxis strategies. The results of Markov decision modeling indicated that a no-antibiotic prophylaxis strategy was cost-effective for dental patients who had undergone THA. These results support the findings of case-control studies and the conclusions of an American Dental Association Council on Scientific Affairs report that questioned general recommendations for antibiotic prophylaxis before dental procedures. The results of cost-effectiveness decision modeling support the contention that routine antibiotic prophylaxis for dental patients with total joint arthroplasty should be reconsidered. Copyright © 2015 American Dental Association. Published by Elsevier Inc. All rights reserved.

[Interval hypoxic-hyperoxic training in the treatment of the metabolic syndrome].

PubMed

Glazachev, O S; Zvenigorodskaia, L A; Dudnik, E N; Iartseva, L A; Mishchenkova, T V; Platonenko, A V; Spirina, G K

2010-01-01

to investigate the possibility of a new method--interval hypo-hyperoxic training (IHHT)--in the correction of the individual components of metabolic syndrome. The study included 35 patients with metabolic syndrome (alimentary obesity 1-3rd stage [BMI over 30 kg/m2], violation of carbohydrate tolerance or diabetes mellitus type II, hypertension and dyslipidemia). All patients were random separated into three groups: control (11 pers., basic therapy), trial 1 (13 pers. who have undergone 12 procedures of the IHHT) and trial 2 (11 pers. who have undergone IHHT in parallel with systemic hyperthermia and vibrating massage hardware). Course duration was 21 days average. Prior to the course procedures IHHT and the 3-day 4 upon completion all patients were fully examined. This examination included history taking, assessment of diet, psychometric testing, counseling psychologist to determine the type of feeding behavior, anthropometric measurements; body impendansemetria, biochemical study of blood determining the level of total cholesterol, HDL, LDL, TG, fasting plasma glucose (GP), 6-minute walk test to assess physical performance. Was established that the use of hypo-hyperoxic exercise (alone or in combination with systemic hyperthermia and hardware vibratory) leads to a significant reduction in body weight. It mainly arise by reducing fat mass accompanied by a reduction of total cholesterol, LDL, GPN, optimization of blood pressure, increased hypoxic stability, physical endurance, improved mental status. At individual selection of the course structure, dosing of hypoxic effects, combined with other physiotherapy method has some promise in treatment and rehabilitation of patients with metabolic syndrome.

Balance, mobility and gaze stability deficits remain following surgical removal of vestibular schwannoma (acoustic neuroma): an observational study.

PubMed

Choy, Nancy Low; Johnson, Natalie; Treleaven, Julia; Jull, Gwendolen; Panizza, Benedict; Brown-Rothwell, David

2006-01-01

Are there residual deficits in balance, mobility, and gaze stability after surgical removal of vestibular schwannoma? Observational study. Twelve people with a mean age of 52 years who had undergone surgical removal of vestibular schwannoma at least three months previously and had not undergone vestibular rehabilitation. Twelve age- and gender-matched healthy people who acted as controls. Handicap due to dizziness, balance, mobility, and gaze stability was measured. Handicap due to dizziness was moderate for the clinical group. They swayed significantly more than the controls in comfortable stance: firm surface eyes open and visual conflict (p < 0.05); foam surface eyes closed (p < 0.05) and visual conflict (p < 0.05); and feet together: firm surface, eyes closed (p < 0.05), foam surface, eyes open (p < 0.05) and eyes closed (p < 0.01). They displayed a higher rate of failure for timed stance and gaze stability (p < 0.05) than the controls. Step Test (p < 0.01), Tandem Walk Test (p < 0.05) and Dynamic Gait Index (p < 0.01) scores were also significantly reduced compared with controls. There was a significant correlation between handicap due to dizziness and the inability to maintain balance in single limb and tandem stance (r = 0.68, p = 0.02) and the ability to maintain gaze stability during passive head movement (r = 0.78; p = 0.02). A prospective study is required to evaluate vestibular rehabilitation to ameliorate dizziness and to improve balance, mobility, and gaze stability for this clinical group.

Investigation of contact allergy to dental materials by patch testing.

PubMed

Rai, Reena; Dinakar, Devina; Kurian, Swetha S; Bindoo, Y A

2014-07-01

Dental products are widely used by patients and dental personnel alike and may cause problems for both. Dental materials could cause contact allergy with varying manifestations such as burning, pain, stomatitis, cheilitis, ulcers, lichenoid reactions localized to the oral mucosa in patients, and hand dermatitis in dental personnel. Patch testing with the dental series comprising commonly used materials can be used to detect contact allergies to dental materials. This study aimed to identify contact allergy among patients who have oral mucosal lesions after dental treatment and among dental personnel who came in contact with these materials. Twenty patients who had undergone dental procedures with symptoms of oral lichen planus, oral stomatitis, burning mouth, and recurrent aphthosis, were included in the study. Dental personnel with history of hand dermatitis were also included in the study. Patch testing was performed using Chemotechnique Dental Series and results interpreted as recommended by the International Contact Dermatitis Research Group (ICDRG). Out of 13 patients who had undergone dental treatment/with oral symptoms, six patients with stomatitis, lichenoid lesions, and oral ulcers showed positive patch tests to a variety of dental materials, seven patients with ulcers had negative patch tests, seven dental personnel with hand dermatitis showed multiple allergies to various dental materials, and most had multiple positivities. The patch test is a useful, simple, noninvasive method to detect contact allergies among patients and among dental personnel dealing with these products. Long term studies are necessary to establish the relevance of these positive patch tests by eliminating the allergic substances, identifying clinical improvement, and substituting with nonallergenic materials.

Psychosocial factors affecting the therapeutic decision-making and postoperative mood states in Japanese breast cancer patients who underwent various types of surgery: body image and sexuality.

PubMed

Adachi, Keiichiro; Ueno, Tokumi; Fujioka, Toshio; Fujitomi, Yutaka; Ueo, Hiroaki

2007-06-01

We conducted an empirical study to clarify how psychosocial factors (e.g. body image and sexuality) influence therapeutic decision-making and to identify the factors that affect post-operative mood states in Japanese women who underwent various types of surgery. One hundred and two patients who had undergone surgical treatment for breast cancer participated in this study. Twenty-five patients had undergone mastectomy, 67 breast conserving treatment and 11 skin-sparing mastectomy and immediate breast reconstruction. The participants were evaluated based on a battery of questionnaires including value estimates of decision-making factors, a shortened version of the Profile of Mood States and self-efficacy. The patients regarded the possibility of cure and recurrence of cancer as well as the physician's support as important, regardless of the treatments they had chosen. The patients that had immediate breast reconstruction placed significantly more importance on their body image and sexuality (i.e. physical appearance, attractiveness to partner and self-evaluation of femininity and sexuality) than the mastectomy patients. After surgery, the former group tended to have a more negative mood on the shortened version of the Profile of Mood States than the latter group. Degree of self-efficacy had a marked influence on the patients' mood after surgery. This study suggests the importance of discussing body image and sexuality that has tended to be disregarded in therapeutic decision-making situations in breast cancer patients in Japan. Self-efficacy is a crucial variable for improving mood after treatment.

Employment and professional outcomes in 803 patients undergoing bariatric surgery in a French reference center for obesity.

PubMed

Durand-Moreau, Q; Gautier, A; Bécouarn, G; Topart, P; Rodien, P; Sallé, A

2015-04-01

Very few studies have been performed on small populations about the links between employment and bariatric surgery. To determine if rates of employment are increased among patients who have undergone bariatric surgery, to assess their post-operative health consequences (post-prandial weakness, diarrhea), and patients' ability to maintain post-operative advice (ie, 30 minutes of daily physical activity, 6 small meals daily) compared to non-employed post-surgical patients. This cross-sectional study was performed in the Regional Reference Centre for Obesity, which is a partnership between the University Hospital and a clinic in Angers, France during 2012 using a self-administrated questionnaire completed by patients hospitalized for post-operative follow-ups after bariatric surgery. Issues investigated were their professional situation before and after the surgery, compliancy to post-operative advice, and any postoperative side effects. Employment rates were 64.4% before and 64.7% after the surgery (p=0.94). Of these, 30.6% maintained 30 minutes of daily physical activity vs. 41.0% of non-workers (p=0.02). 50.5% of employed patients and 57.3% of non-workers maintained 6 small meals a day after surgery (p=0.09). 8% of working patients reported post-prandial weaknesses and 8% reported diarrhea that caused problems at work. Employment rate remained stable after surgery. Having a job seemed to be an obstacle to managing 30 minutes of daily exercise, especially among women, but not maintaining 6 small meals a day. Therefore, working environment needs to be assessed to improve job quality and retention for patients who have undergone bariatric surgery.

ASSOCIATION BETWEEN COMPUTED TOMOGRAPHIC CHARACTERISTICS AND FRACTURES FOLLOWING STEREOTACTIC RADIOSURGERY IN DOGS WITH APPENDICULAR OSTEOSARCOMA.

PubMed

Kubicek, Lyndsay; Vanderhart, Daniel; Wirth, Kimberly; An, Qi; Chang, Myron; Farese, James; Bova, Francis; Sudhyadhom, Atchar; Kow, Kelvin; Bacon, Nicholas J; Milner, Rowan

2016-05-01

The objective of this observational, descriptive, retrospective study was to report CT characteristics associated with fractures following stereotactic radiosurgery in canine patients with appendicular osteosarcoma. Medical records (1999 and 2012) of dogs that had a diagnosis of appendicular osteosarcoma and undergone stereotactic radiosurgery were reviewed. Dogs were included in the study if they had undergone stereotactic radiosurgery for an aggressive bone lesion with follow-up information regarding fracture status, toxicity, and date and cause of death. Computed tomography details, staging, chemotherapy, toxicity, fracture status and survival data were recorded. Overall median survival time (MST) and fracture rates of treated dogs were calculated. CT characteristics were evaluated for association with time to fracture. Forty-six dogs met inclusion criteria. The median overall survival time was 9.7 months (95% CI: 6.9-14.3 months). The fracture-free rates at 3, 6, and 9 months were 73%, 44%, and 38% (95% CI: 60-86%, 29-60%, and 22-54%), respectively. The region of bone affected was significantly associated with time to fracture. The median time to fracture was 4.2 months in dogs with subchondral bone involvement and 16.3 months in dogs without subchondral bone involvement (P-value = 0.027, log-rank test). Acute and late skin effects were present in 58% and 16% of patients, respectively. Findings demonstrated a need for improved patient selection for this procedure, which can be aided by CT-based prognostic factors to predict the likelihood of fracture. © 2016 American College of Veterinary Radiology.

The value of auditing negative lower GI investigations preceding a final diagnosis of colorectal cancer.

PubMed

Somasekar, A; James, L; Stephenson, B M; Thompson, I W; Vellacott, K D; Allison, M C

2009-09-01

To review all preceding 'negative' large bowel investigations in patients with a final diagnosis of colorectal cancer, and to examine whether delayed diagnosis was associated with worse outcome. Details were gathered on all patients with a new diagnosis of colorectal adenocarcinoma presenting over 4.5 years. For each patient the hospital's clinical workstation and radiology and endoscopy databases were interrogated for all flexible sigmoidoscopies, colonoscopies and barium enemas during the 5 years prior to diagnosis. Among the 570 patients, 28 (5%) had undergone colonoscopy and/or flexible sigmoidoscopy that had not shown colorectal cancer during the 5 years preceding final diagnosis, and a further 28 (5%) had undergone 'negative' barium enemas. Polyp surveillance might have missed four lesions destined to become malignant. Correspondingly there were three patients undergoing IBD surveillance found to have CRC, having had a negative complete colonoscopy within the preceding 5 years. Among patients undergoing de novo colonoscopy for diagnosis the true miss rate was only one patient per year. At August 2007, 29 (58%) of those with delayed diagnosis were still alive, compared with 216 (42%) of those diagnosed during initial investigation (chi2 = 5.04, P < 0.05). Colonoscopic miss rates are in line with previous studies. The application of simple clinical ground rules will avoid most pitfalls. The methodology described herein may assist in auditing the quality assurance of lower gastrointestinal diagnostic services. Despite the delay, late diagnosis was found to be associated with improved survival and a lower likelihood of metastatic disease.

Fluctuating Behavior of the French Population in Cancer Screening: 5th Edition of the EDIFICE Survey.

PubMed

Viguier, Jérôme; Morère, Jean-François; Pivot, Xavier; Touboul, Chantal; Lhomel, Christine; Couraud, Sébastien; de La Motte Rouge, Thibault; Eisinger, François

2018-03-05

The EDIFICE surveys have assessed cancer screening behavior in the French population since 2005. The 2016 edition was conducted among a representative sample of 1501 individuals (age, 50-75 years). The current analysis focuses on breast, colorectal, prostate, lung, and cervical cancer screening. The rate of women (50 to 74 years) declaring having had at least one breast cancer screening test in their lifetime remained stable and high between 2005 and 2016. Compliance with recommended screening intervals improved between 2005 and 2011 from 75 to 83%, respectively, then decreased significantly to 75% in 2016 (P = 0.02). Uptake of at least one lifetime colorectal cancer screening test procedure declared (individuals aged 50-74 years) increase from 25% in 2005 to 59% in 2011, stabilized at 60% in 2014, then reached 64% in 2016. Opportunistic prostate cancer screening (men aged 50-75 years) rose between 2005 and 2008 from 36 to 49%, plateaued until 2014 then dropped to 42% in 2016. The proportion of women aged 50-65 declaring having undergone one cervical cancer screening test dropped significantly between 2014 and 2016 from 99 to 94% (P < 0.01). Lastly, 11% of our survey population in 2014 and 2016 (55-74 years) declared having already undergone lung cancer screening. Cancer screening behavior fluctuates in France, regardless of the context, i.e., organized programs or opportunistic screening. This observation highlights the need for constant analysis of population attitudes to optimize public awareness campaigns.

Therapeutic temperature modulation in severe or moderate traumatic brain injury: a propensity score analysis of data from the Nationwide Japan Neurotrauma Data Bank.

PubMed

Miyata, Kei; Ohnishi, Hirofumi; Maekawa, Kunihiko; Mikami, Takeshi; Akiyama, Yukinori; Iihoshi, Satoshi; Wanibuchi, Masahiko; Mikuni, Nobuhiro; Uemura, Shuji; Tanno, Katsutoshi; Narimatsu, Eichi; Asai, Yasufumi

2016-02-01

In patients with severe traumatic brain injury (TBI), a randomized controlled trial revealed that outcomes did not significantly improve after therapeutic hypothermia (TH) or normothermia (TN). However, avoiding pyrexia, which is often associated with intracranial disorders, might improve clinical outcomes. The objective of this study was to compare neurological outcomes among patients with moderate and severe TBI after therapeutic temperature modulation (TTM) in the absence of other interventions. Data from 1091 patients were obtained from the Japan Neurotrauma Data Bank Project 2009, a cohort observational study. Patients with cardiac arrest, those with a Glasgow Coma Scale score of 3 and dilated fixed pupils, and those whose cause of death was injury to another area of the body were excluded, leaving 687 patients aged 16 years or older in this study. The patients were divided into 2 groups: the TTM group underwent TN (213 patients) or TH (82 patients), and the control group (392 patients) did not receive TTM. The primary end point for this study was the rate of poor outcome at hospital discharge, and the secondary end point was in-hospital death. Out of the 208 total items in the database, 29 variables that could potentially affect outcome were matched using the propensity score (PS) method in order to reduce selection bias and balance the baseline characteristics. From each group, 141 patients were extracted using the PS-matching process. Among the patients in the TTM group, 29 had undergone TH and 112 had undergone TN. In a log-rank test using Kaplan-Meier survival curves, no significant differences in patient outcome or death were observed between the 2 groups (poor outcome, p = 0.83; death, p = 0.18). A Cox proportional-hazards regression analysis established the HR for poor outcome and mortality at 1.03 (95% CI 0.78-1.36, p = 0.83) and 1.34 (95% CI 0.87-2.07, p = 0.18), respectively. There was no clear improvement in neurological outcomes after TTM in patients with moderate or severe TBI. To elucidate the role of TTM in patients with these injuries, a prospective study is needed with long-term follow-up using specific target temperatures.

Repeat Endoscopic Ultrasound-Guided Fine-Needle Aspiration in Patients with Suspected Pancreatic Cancer: Diagnostic Yield and Associated Change in Access to Appropriate Care

PubMed Central

Stanger, Dylan; Shuster, Constantin; Telford, Jennifer; Lam, Eric

2016-01-01

Background. There is a high incidence of inconclusive cytopathology at initial EUS-FNA (endoscopic ultrasound-guided fine-needle aspiration) for suspected malignant pancreatic lesions. To obtain appropriate preoperative or palliative chemotherapy for pancreatic cancer, definitive cytopathology is often required. The utility of repeat EUS-FNA is not well established. Methods. A retrospective cohort study was conducted evaluating the yield of repeat EUS-FNA in determining a cytological diagnosis in patients who had undergone a prior EUS-FNA for diagnosis of suspected malignant pancreatic lesions with inconclusive cytopathology. The wait times to the second procedure and to decisions regarding therapy were calculated. Results. Overall, 45 repeat EUS-FNA procedures were performed over seven years for suspected malignant pancreatic lesions. Cytopathological class (I to IV) changed between first and second EUS-FNA in 32 patients (71%). Of 34 patients with an initially nonconclusive diagnosis, 20 had a conclusive diagnosis (59%) on repeat EUS-FNA. The cumulative yield after repeat EUS-FNA for definite pancreatic adenocarcinoma was 7 (16%). The median time interval between first and second EUS-FNA was 31 (7–175) days. Conclusions. A substantial number of patients had a definitive diagnosis of adenocarcinoma on repeat FNA and were, therefore, subsequently able to access appropriate care. PMID:27648440

Lateral plate evolution in the threespine stickleback: getting nowhere fast.

PubMed

Bell, M A

2001-01-01

Gasterosteus aculeatus is a small Holarctic fish with marine, anadromous, and freshwater populations. Marine and anadromous populations apparently have changed little in the past 10 million years and exhibit limited geographical variation. In contrast, freshwater isolates have been founded repeatedly by marine and anadromous populations, and post-glacial isolates have undergone extraordinary adaptive radiation. Stickleback traits that have diversified during post-glacial radiation, including the 'lateral plates' (LP), can evolve substantially within decades after colonization of fresh water or when the environment (particularly predation regime) changes. Although highly divergent freshwater isolates of G. aculeatus have existed for at least 10 million years, they have rarely experienced sustained evolutionary divergence leading to formation of widespread, phenotypically distinct species. The paradox of rapid LP evolution without sustained divergence has resulted from selective extinction of highly divergent populations, because they are specialized for conditions in small, isolated habitats that tend to dry up within limited periods. Biological species of G. aculeatus may also evolve within decades, and are also prone to extinction because they are endemic to and specialized for small, ephemeral habitats. The high rate of evolution observed in contemporary threespine stickleback populations may not be unique to this species complex and has important implications for use of post-glacial populations in comparative studies, speciation rate, and discrimination of sympatric and allopatric speciation.

Isolated pores dissected from human two-pore channel 2 are functional

PubMed Central

Penny, Christopher J.; Rahman, Taufiq; Sula, Altin; Miles, Andrew J.; Wallace, B. A.; Patel, Sandip

2016-01-01

Multi-domain voltage-gated ion channels appear to have evolved through sequential rounds of intragenic duplication from a primordial one-domain precursor. Whereas modularity within one-domain symmetrical channels is established, little is known about the roles of individual regions within more complex asymmetrical channels where the domains have undergone substantial divergence. Here we isolated and characterised both of the divergent pore regions from human TPC2, a two-domain channel that holds a key intermediate position in the evolution of voltage-gated ion channels. In HeLa cells, each pore localised to the ER and caused Ca2+ depletion, whereas an ER-targeted pore mutated at a residue that inactivates full-length TPC2 did not. Additionally, one of the pores expressed at high levels in E. coli. When purified, it formed a stable, folded tetramer. Liposomes reconstituted with the pore supported Ca2+ and Na+ uptake that was inhibited by known blockers of full-length channels. Computational modelling of the pore corroborated cationic permeability and drug interaction. Therefore, despite divergence, both pores are constitutively active in the absence of their partners and retain several properties of the wild-type pore. Such symmetrical ‘pore-only’ proteins derived from divergent channel domains may therefore provide tractable tools for probing the functional architecture of complex ion channels. PMID:27941820

Measurement of UO2 surface oxidation using grazing-incidence x-ray diffraction: Implications for nuclear forensics

NASA Astrophysics Data System (ADS)

Tracy, Cameron L.; Chen, Chien-Hung; Park, Sulgiye; Davisson, M. Lee; Ewing, Rodney C.

2018-04-01

Nuclear forensics involves determination of the origin and history of interdicted nuclear materials based on the detection of signatures associated with their production and trafficking. The surface oxidation undergone by UO2 when exposed to air is a potential signature of its atmospheric exposure during handling and transport. To assess the sensitivity of this oxidation to atmospheric parameters, surface sensitive grazing-incidence x-ray diffraction (GIXRD) measurements were performed on UO2 samples exposed to air of varying relative humidity (34%, 56%, and 95% RH) and temperature (room temperature, 50 °C, and 100 °C). Near-surface unit cell contraction was observed following exposure, indicating oxidation of the surface and accompanying reduction of the uranium cation ionic radii. The extent of unit cell contraction provides a measure of the extent of oxidation, allowing for comparison of the effects of various exposure conditions. No clear influence of relative humidity on the extent of oxidation was observed, with samples exhibiting similar degrees of unit cell contraction at all relative humidities investigated. In contrast, the thickness of the oxidized layers increased substantially with increasing temperature, such that differences on the order of 10 °C yielded readily observable crystallographic signatures of the exposure conditions.

Can the tardigrade Hypsibius dujardini survive in the absence of the geomagnetic field?

PubMed Central

Erdmann, Weronika; Idzikowski, Bogdan; Kowalski, Wojciech; Szymański, Bogdan; Kosicki, Jakub Z.; Kaczmarek, Łukasz

2017-01-01

Earth's geomagnetic field has undergone critical changes in the past. Studies on the influence of the magnetic field on Earth’s organisms are crucial for the understanding of evolution of life on Earth and astrobiological considerations. Numerous studies conducted both on plants and animals confirmed the significant influence of the geomagnetic field on the metabolism of living organisms. Water bears (Tardigrada), which are a mong the most resistant animals due to their cryptobiotic abilities, show significant resistance to a number of environmental stressors, but the influence of the geomagnetic field on their fitness has not been addressed before. In our studies, we used eutardigrade Hypsibius dujardini to analyse whether isolation from the geomagnetic field had an effect on mortality. We found that Hypsibius dujardini specimens demonstrated relatively high mortality during anhydrobiosis, also in control groups exposed to the normal geomagnetic field. Moreover, similar mortality was observed in anhydrobiotic specimens isolated from the geomagnetic field. However, a significant difference was noted between tardigrade survival and the moment of their isolation from the geomagnetic field. In particular, tardigrade mortality substantially increased in absence of a magnetic field during the process of entering anhydrobiosis and returning to active life. Our results suggest that these processes rely on complex metabolic processes that are critically influenced by the geomagnetic field. PMID:28886031

Experience with a mouse intranasal test for the predictive identification of respiratory sensitization potential of proteins.

PubMed

Blaikie, L; Basketter, D A

1999-08-01

The predictive identification of respiratory allergenic potential is an important primary step in the safety evaluation of (novel) proteins, such as the enzymes used in a range of consumer laundry products. In the past this has been achieved by assessing the relative ability of proteins to give rise to the formation of anaphylactic antibody in the guinea pig. Recently, an alternative model has been proposed which assesses the formation of specific IgG1 antibody in a mouse intranasal test (MINT), the assumption being that specific IgG1 antibody is a surrogate for anaphylactic antibody in the mouse. This procedure has undergone successful initial intralaboratory and interlaboratory assessment. In the present work, the MINT has been evaluated in a more thorough intralaboratory study using eight enzymes plus ovalbumin. While the data generated with a reference enzyme protein, Alcalase, showed good reproducibility, results with the remaining eight proteins led to estimates of their relative antigenic or sensitization potential several of which were at variance from those derived from the guinea pig/ human experience. In consequence, it is concluded that the MINT requires substantial further investigation before it can be adopted as a model for the assessment of the relative ability of proteins to behave as respiratory allergens.

Iatrogenic Preterm Premature Rupture of Membranes after Fetoscopic Laser Ablative Surgery.

PubMed

Maggio, Lindsay; Carr, Stephen R; Watson-Smith, Debra; O'Brien, Barbara M; Lopes, Vrishali; Muratore, Christopher S; Luks, Francois I

2015-01-01

To describe the incidence and risk factors for iatrogenic premature preterm rupture of membranes (iPPROM) after fetoscopic laser surgery for the twin-to-twin-transfusion syndrome. This is a retrospective review of all patients who have undergone fetoscopic laser surgery at a single fetal treatment center since 2000. We defined iPPROM as spontaneous rupture of membranes before the onset of labor prior to 34 weeks of gestation. The iPPROM cohort was compared to the cohort without iPPROM for several preoperative, operative, and delivery characteristics. Ninety-two consecutive patients were reviewed. The overall rate of iPPROM was 18.5% (n = 17). The rates of iPPROM within 1 and 4 weeks were 5.4 and 10.9%, respectively. The median interval from surgery to delivery was significantly shorter in the iPPROM group (21 vs. 62 days, p = 0.01). The mean gestational age at delivery (27.0 vs. 31.1 weeks, p = 0.02) was lower in the iPPROM group. No other characteristics studied differed significantly between the groups. The incidence of iPPROM was substantially lower than in recent multicenter reports; however, no risk factors of iPPROM could be identified. Whether this is related to variations in surgical or anesthetic management will require further investigation. © 2014 S. Karger AG, Basel.

Failing left ventricle to ascending aorta conduit-Hybrid implantation of a melody valve and NuMed covered stent.

PubMed

Gössl, Mario; Johnson, Jonathan N; Hagler, Donald J

2014-04-01

We present the case of a 36-year-old woman with increasing shortness of breath, a new 3/4 diastolic murmur, and a complex history of LV outflow tract obstruction. She has undergone multiple surgeries including the replacement of her old LV apex to ascending aorta conduit with a 20-mm Gore-Tex tube graft, addition of a 24-mm homograft sutured between the conduit and the LV apex, and insertion of a 21-mm Freestyle porcine valve conduit between the Gore-Tex tube graft and allograft at age 23. The current assessment showed a failing Freestyle conduit prosthesis leading to left heart decompensation. Due to substantial surgical risk, the patient underwent successful implantation of a Melody valve into the Gore-Tex tube and exclusion of the failing Freestyle bioprosthesis with a NuMed CP stent in a hybrid procedure. The case nicely illustrates the collaborative potential of cardiovascular surgeons and interventional cardiologists in the new arena of a hybrid operating room. Complex hybrid procedures like the current one, especially those including percutaneous placements of valves, offer therapeutic options for patients that are otherwise too high risk for conventional open heart surgery. Copyright © 2013 Wiley Periodicals, Inc.